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Oregon Department of Environmental Quality • Dosing tank capacity 500 (gallons) • Tank volume determined by: Check all that apply,add comments below as needed ❑Permit Records❑✓ Measured 0 Stamped on Tank 0 Other • Dosing tank material Concrete • Dosing tank appears to be watertight and in good condition ®Yes ❑No • Dosing tank lid is intact ®Yes DNo • Electrical components are sealed and watertight ©Yes ONO • Pump/siphon is functional EYes [No • Type of Pump 1Demand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer)®Yes ❑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 Plastic Screen • Screen is clean and free of debris EYes :No-Screen cleaned for this evaluation©Yes ❑No • Scum/sludge present in Dosing tank EYes No • Scum layer 0 (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 EYes ❑No DUnknown • Was the soil absorption system part of the evaluation?❑Yes ❑No :Dee 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): Not a part of this transaction • Absorption distribution ['Equal ❑Serial ['Pressure DEqual via pressure • Absorption lines construction material: ❑ Gravel and pipe ❑ Chamber 0 Tile ❑Polystyrene foam and pipe ['Other • Absorption distribution unit(s): Ddropbox Dhydrosplitter❑equal distribution box ❑ Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids ❑Yes ❑No❑N/A Page 4 of 8