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•• •• •-• ••• ••• •• ••• •• •-• •• • -- •• • • <br /> :: • <br /> !, Oregon Department of Environmental Quality <br /> !1 1! <br /> • Sand filter unit appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted <br /> !! •,, 1! 1,1; •!! <br /> plants etc!! !! !; • • <br /> . . . . . <br /> 11 11 11 1111 11 <br /> LYesDNo1 1 11 11 11 1 1 1 1 <br /> !! !! !! !!! If you answered"No,"please describe below: <br /> • <br /> . . . . - • <br /> . . . <br /> :.• • • ! • <br /> . . <br /> • • • • - <br /> !!! <br /> ; : ! .•• .•• <br /> • • <br /> . . . . . <br /> ,1 11 1i • Sandfilterappears1to be free from surface,water runoff and down spouts OYes ONo <br /> • Evidence of pending in/on sand filter!media surface 111YeS ON° : : • <br /> • Surface aceesa,to manifold and valveS!!! :Nes 1 DisIo ! . <br /> • • <br /> • • <br /> 11,. 11 11 1111 <br /> • Monitoring ports are present!1 DYes 110h10 <br /> • • <br /> 11 11 11 11 • ii,ateial lines flushed and equal distribution verified [fres DNo <br /> 11 11 ;1 1111 • The sand filter has a pump ElYes EINo11 11 1 1 1 11 • <br /> 11 11 111 i <br /> (If"No",skip the rest of section 6) !! 11 i i 1! <br /> „ „ „ •:: „ : : <br /> • Pump vault appears to be watertight and in good condition DYes ON° Ell\t/A1 <br /> 11 11 11 111; Pump is functionalitlYes ON0 1i <br /> 11 1! 11 111 i • Pump control mechanism is functional(floats,pressure transducer)['Yes ON° <br /> ,1 11 11 11; <br /> • High Water alarm in pump vault(audible and visual)is working [Nes ONO <br /> 1-1 11_ 11 1111. p electrical components are sealed and watertight DYes o <br /> . • <br /> . . • - <br /> 11 11 11 1111 • Additional Comments:11 <br /> ::• :: : , : : : : <br /> •• •••• • •• • ••• <br /> . • <br /> . . <br /> „ : •• :• 7' • •: : : <br /> 7 Alternative Treatment Technology System <br /> The owner of an ATT system must maintain an amnial service contract with a certified <br /> 11 11 11 111; 11 Maintenance Provider Maintenance records should he available from the system owner,or the <br /> i1 11 1111 11 <br /> contracted Maintenance Provider Please attach copies of the previous two years of <br /> maintenance records to this evaluation form, 11 !!!! <br /> 11 1! 11 1111 !!! <br /> Note*Some ATT systems may have iWPCF permit Please contact the local Health Department <br /> or the DEQ to obtain a copy of the WPCF permit !! <br /> 11 11 ii 111 • The septic system has an Alternative Treatment T chnologYi(ATT)ElYes K\To! <br /> ;1 11 11 1111 11 <br /> (If"No,"skip! the rest of section 7) 1!! 1! !! 11 !1 <br /> ••: •:: • :•• • ••: •• •• <br /> 40 Please provide the product name,system ID number,and manufacturer name below <br /> Product name! !! !! !!! !! !! !!!! <br /> !, !! • !! !!!! System ID number <br /> Manufacturer name <br /> 11H !1 !ii !1! !! !! !!! i 1J'aige 6 of 8. <br /> ::: • : : •• <br /> : •.: : : : <br /> . . . <br /> ••• • • <br />