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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 DYes ONo • Dosing tank lid is intact [Wes ONo • Electrical components are sealed and watertight DYes ONo • Pump/siphon is functional 0Yes ONo • Type of Pump ODemand dose Dime dose • Pump control mechanism is functional(floats,pressure transducer)DYes ONo • There is a high water alarm DYes ['No • The high water alarm(audible and visual)is working DYes ONo ['Not Applicable • Type of screen • Screen is clean and free of debris Dyes ['No-Screen cleaned for this evaluation DYes [QNo • Scum/sludge present in Dosing tank ['Yes QNo • 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*tes ONo ['Unknown • Was the soil absorption system part of the evaluation?IglYes QNo ['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 lEqual ['Serial ['Pressure ['Equal via pressure • Absorption lines construction material: 54 Gravel and pipe ['Chamber Tile 0 Polystyrene foam and pipe 0Other Jrt }i4 al it At-5 are • Absorption distribution unit(s): Ddropbox['hydrosplitter( equal distribution bo)71k. 'w' lilt es, • IN- Intact 0 Damaged 0 N/A &"th 7 re` I d pi pc, • Absorption distribution unit(s)are free of debris or solids N Yes QNo 0 N/A Page 4 of 8