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r Oregon Department of Environmental Quality J - • Dosing tank capacity 5e0 (gallons) • Tank volume determined by: Check all that apply,add comments below as needed i! Permit Records 0 Measured 0 Stamped on Tank D Other • Dosing tank materialhet iic_ • Dosing tank appears to be watertight and in good condition Wes ONo • Dosing tank lid is intact IglYes QNo • Electrical components are sealed and watertight Wes ONo • Pump/siphon is functional Pres ONo• - • Type of Pump )emand dose [Time dose • Pump control mechanism is functional(floats,pressure transducer) I:4 Yes ONo •. There is a high water alarm JYes ONo . • . The high water alarm(audible and visual)is working It::(Yes ['No [Not Applicable • Type of screen NAts • Screen is clean and free of debris❑Yes IgNo-Screen cleaned for this evaluation Wes DNo • Scum/sludge present in Dosing tank F..4 Yes.DNo . • Scum layer ii (inches) Sludge layer 3 (inches) • Additional Comments: 5. Soil absorption system The soil.absorption system is a set of trenches that receives effluent fromthe septic tank and filters the effluent before it enters the groundwater. • • The septic system has a soil absorption system%Yes ONo DUnknown • • .Was the soil absorption system part of the evaluation?Oyes pIo.['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 DEqual ['Serial ['Pressure DEqual via pressure •.. Absorption lines construction material: . 0 Gravel and pipe .D Chamber 0 The 0 Polystyrene foam and pipe ['Other • Absorption distribution unit(s):OdropboxOhydrosplitter Dequal distribution.box 0 Intact 0 Damaged 0 N/A . • Absorption distribution unit(s)are free of debris or solids Dyes DNo 0 N/A • Page4of8 .