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• -. • :.• „ „ Oregon Department of Environmental Quality • Sand filter unit appears to be free from roads,vehicular traffic,structures,livestock,:deep-rooted plants etc.: Eiyos:No If you answered"No,"PleaseldeseribebelOw: ;:. . : • " ; ;; ,;; :;: ;;. ;,: , i! ;,• .• s •• • Sand filter.appears':to be free from surface water runoff and down spouts DYes ON° • Evidence of pOnding in/on sand filter media surface OYeS. EjNo • Surface access to manifold and valves", DYes;, ON° • • Monitoring ports are present DYes :,ONo 1 . • ,„ „, : :.; „ :„ • :. • Lateral •• •• • ; • L lines flushed and equal distribution verified DYes ONO •• The sand filter has a pump DYes ONo (If"No",Skip the rest of section • Pump vault appears to be watertight and in good condition DYes ONo ON/A.1 • Pump is functional DYes ONo • Pump control mechanism is functional(floats,pressure transducer)DYes ON.° • High water alarm in pump vault(audible and visual)is working DYes ONo., • Pump;electrical components are sealed and watertight DYes DNo . : ; • • Additional Coinments:,,, • •• • • •• •• •• :: ::: • • • ••• .• • 7 Alternatiye Treatment Technology System The owner of an ATT system.must maintain an,annual service contract: with a certified . . . • • Maintenance Provider.:Maintenance records should be available from the system owner,or the contracted Maintenance Provider Please attach copies of the previous two years of . . maintenance records to thiS:,evaluation form; • ; Note*Some AEI'systems may have a WPCF permit Please contact the local Health Department or the DEQ to obtain a Copy of the WPCFperrint • The Septie,system has an Alternative Treatment Technology!(ATT)DYes No • (If"No,"Skip the rest of section 7)• „ Please provide the product name,system ID number,and manufacturer name below; ;;• ;' ;;; Product name:: ;:; • ;- . : System ID number : ;. :.• . :• ; ; ; ;; ;; Manufacturer name ;! ;! : s : • • f":; .;; .!- !!! '; .• Page of 8. • . , !; : . . •