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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 ikrPermit Records 0 Measured� 0 Stamped on Tank 0 Other • Dosing tank material t rte.,f-G. • Dosing tank appears to be watertight and in good condition Yes ❑No • Dosing tank lid is intact AYes ❑No • Electrical components are sealed and watertight ['Yes No -took IS Ifni SScle w� • Pump/siphon is functional pies ❑No • Type of Pump pDemand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer)figYes ❑No • There is a high water alarm['Yes NNo • The high water alarm(audible' and visual)is working Oyes ❑No 16Not Applicable • Type of screen ( `GSh lilt t f i/ u l t • Screen is clean and free of debris Oyes 031No-Screen cleaned for this evaluationJYes ['No • Scum/sludge present in Dosing tank Dyes ['No • Scum layer a (inches) Sludge layer - (inches) • AcicliIional Co"' ents: tk laerA 1p r04� e, h u-r"• In - ,�. b t+4. t S (cel .o nit 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 Wes ❑No ['Unknown • Was the soil absorption system part of the evaluation?['Yes riNo ['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 ['Equal ['Serial [Pressure ['Equal via pressure • Absorption lines construction material: ❑Gravel and pipe 0 Chamber D Tile ❑Polystyrene foam and pipe ['Other • Absorption distribution unit(s):❑dropbox❑hydrosplitter❑equal distribution box ❑Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids Oyes ❑No❑NIA Page 4 of 8