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• <br /> Oregon Department of Environmental Quality <br /> • Sand filter unit appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted <br /> plants etc. <br /> DYes ONo • <br /> If you answered"No,"please describe below: <br /> • Sand filter appears to be free from surface water runoff and down spouts DYes ONo <br /> • Evidence of ponding in/ sand filter media surface DYes ONo <br /> • Surface access to manifold and valves OYes ONo <br /> • Monitoring ports are present DYes DNo <br /> • Lateral lines flushed and equal distribution verified DYes ONo <br /> • The sand filter has a pump DYes ONo <br /> (If"No",skip the rest of section 6) <br /> • Pump vault appears to be watertight and in good condition OYes DNo ON/A <br /> • Pump is functional OYes DNo <br /> • . Pump control mechanism is functional(floats,pressure transducer)DYes ONo <br /> • High water alarm in pump.vault(audible and visual)is working Dyes DNo • <br /> • Pump electrical components are sealed and watertight .DYes DNo <br /> • Additional Comments: <br /> 7. Alternative Treatment Technology System <br /> The owner of an ATT system must maintain an annual service contract with a certified <br /> Maintenance Provider.Maintenance records should be available from the system owner,or the <br /> contracted Maintenance.Provider.Please attach copies of the a previous:two years of <br /> maintenance records to this evaluation form. <br /> Note*Some ATT systems may have a WPCF permit.Please contact the local Health Department <br /> or the DEQ to obtain a copy of the WPCF permit. <br /> • The septic system has an Alternative Treatment Technology(ATT)DYes ZNo <br /> (If"No,"skip the rest of section 7) <br /> • Please provide the product name, system ID number,and manufacturer name below: <br /> Product name <br /> System ID number <br /> Manufacturer name <br /> Page6of8 <br />