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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 L } Measured i !Stamped on Tank i _j Other * Dosing tank material * Dosing tank appears to be watertight and in good condition r 'Yes [ i No * Dosing tank lid is intact 1-1 Yes (— I No * Electrical components are sealed and watertight r 1 Yes 1—1 No * Pump/siphon is functional 11 Yes H No * Type of Pump _wI Demand dose !Time dose j * Pump control mechanism is functional (floats,pressure transducer) L L. !Yes I. No * There is a high water alarm I Yes � ,No Iw�J * The high water alarm(audible and visual)is working L Yes __J No .__ Not Applicable * Type of screen * Screen is clean and free of debris I Yes r /No * Screen cleaned for this evaluation 1 �Yes i I No * Scum/sludge present in Dosing tank i Yes i, _I 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 x !Yes __ r No i 1 Unknown * Was the soil absorption system part of the evaluation? I x Yes riT I No i I 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 Lx,Equal Serial ( 113ressure I Equal via pressure * Absorption lines construction material: I X Gravel and pipe 1 I Chamber (-- I Tile % ;Polystyrene foam and pipe l I Other * Absorption distribution unit(s): r J dropbox �hydrosplitter i y —'!equal distribution box L x I Intact I w+Damaged 1 )N/A * Absorption distribution unit(s)are free of debris or solids I jYes [INo L IN/A Page 4 of 8