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• . _ Oregon Department of Environmental duality • • • • Sand filter unit appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted . plants etc. • DYes ONo . If you.answered"No,"please describe below: • • • • • • • • Sand filter appears to be free from surface water runoff and down spouts DYes ONO • Evidence of pending in/on sand filter media surface DYes ❑No • Surface access to manifold and valves Dyes ONo • • Monitoring ports are present DYes ❑No • • Lateral lines flushed and equal distribution verified DYes ❑No • The sand filter has a pump Dyes ONG • (If"No",skip the rest of section 6) • _ • Pump vault appears to be watertight and in good condition ['Yes ❑No ON/A • Pump is functional clYes ❑No . • Pump control mechanism is functional(floats,pressure transducer)DYes ❑No • . • High water alarm in pump vault(audible and visual)is working DYes ❑No . • Pump electrical components are sealed and watertight Oyes ❑No • Additional Comments: - • • • 7.. Alternative 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 ATT systems may have a.WPCF permit.Please contact the local Health Department or the DEQ to obtain a copy of the WPCF permit. • • The septic system has an Alternative Treatment Technology(ATT)Dyes cg8No (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 . • • • Page 6 of 8 •