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• Oregon Department of Environmental Quality •. Dosing tank capacity (gallons) • Tank volume determined by:Check all that'apply,add comments below as needed ❑Permit Records❑Measured❑ Stamped on Tank❑Other • Dosing tank material • Dosing tank appears to be watertight and in good condition [Yes ['No • Dosing tank lid is intact ❑Yes No • Electrical components are sealed and watertight ['Yes ❑No • Pump/siphon is functional Eyes ENo • Type'of Pump ['Demand dose .['Time dose • Pump control mechanism is functional(floats,pressure transducer)Eyes ❑No • There is a high water alarm❑Yes ❑No • The high water alarm(audible and visual)is working Eyes ❑No ['Not Applicable •. Type of screen • Screen is:clean and free of debris Eyes ❑No-Screen cleaned for this evaluation Oyes ❑No • Scum/sludge present in Dosing tank Eyes [No • Scum layer (inches) Sludge layer (inches) • Additional Comments: 5. Soil absorption system The soil absorption system is a set of trenches that receives effluent from the septic tank and filters the effluent before it enters the groundwater. • The septic system has a soil absorption system v'/Yes [No ['Unknown • • Was the soil absorption system part of the evaluation?Eyes h No ❑See note below If the soil.absorption system was not evaluated,please explain below(for example unable to locate,client did not authorize this part of the evaluation): • Absorption distribution ['Equal ['Serial ['Pressure DEqual via pressure • Absorption lines construction material: ❑Gravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe ['Other • Absorption distribution unit(s):Edropbox❑hydrosplitter['equal distribution box ❑Intact ❑Damaged ❑N/A . • Absorption distribution unit(s)are free of debris or solids Eyes ❑No❑N/A Page4of8