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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. Lx_., on Tank []Otherx_.� Permit Records �i Measured �_, • Dosing tank material CONCRETE * Dosing tank appears to be watertight and in good condition x 1 Yes * Dosing tank lid is intact L x]Yes I _�No * Electrical components are sealed and watertight r_'Yes x No • Pump/siphon is functional [ x l Yes [ _A No * Type of Pump x I Demand dose j 1 Time dose • Pump control mechanism is functional(floats,pressure transducer) L x_I Yes r 1 No * There is a high water alarm x_I Yes ! 1 No * The high water alarm(audible and visual)is working I x 1 Yes L. i No I 1 Not Applicable * Type of screen BASKET FILTER * Screen is clean and free of debris x j Yes In_j fo * Screen cleaned for this evaluation x Yes [Id No • Scum/sludge present in Dosing tank 1 I Yes I No * Scum layer 0 (inches) Sludge layer 1 (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 x_!Yes ` j No `_J Unknown * Was the soil absorption system part of the evaluation? 1 Yes ; x ;No ; I See note below If the soil absorption system was not evaluated,please explain below(for exampi unable to locate,client did not authorize this part of the evaluation): * Absorption distribution lEqual I- Serial Pressure ` Equal via pressure * Absorption lines construction material: Gravel and pipe Chamber ' 'Tile !Polystyrene foam and pipe ! ;Other * Absorption distribution unit(s): ,dropbox ,hydrosplitter _ equal distribution box Intact 1 Damaged '.N/A * Absorption distribution unit(s)are free of debris or solids Yes I No i N/A Page 4 of 8