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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 0 Permit Records 0 Measured 0 Stamped on Tank 0 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 ❑Yes ❑No • Type of Pump ❑Demand 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 ❑Yes ❑No ❑Not Applicable • Type of screen • Screen is clean and free of debris❑Yes ❑No-Screen cleaned for this evaluation❑Yes ❑No • Scum/sludge present in Dosing tank ❑Yes ❑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®Yes ❑No ❑Unknown • Was the soil absorption system part of the evaluation?®Yes ❑No OSee 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 ❑Equal via pressure • Absorption lines construction material: ®Gravel and pipe ❑Chamber 0 Tile 0 Polystyrene foam and pipe ❑Other • Absorption distribution unit(s):®dropbox Ohydrosplitter❑equal distribution box ®Intact 0 Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids ZYes ❑No 0 N/A Page 4 of 8