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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. EYes ENo If you answered"No,"please describe below: • Sand filter appears to be free from surface water runoff and down spouts EYes No • Evidence of ponding in/on sand filter media surface EYes No • Surface access to manifold and valves EYes No • Monitoring ports are present EYes No • Lateral lines flushed and equal distribution verified EYes No • The sand filter has a pump EYes No (If"No",skip the rest of section 6) • Pump vault appears to be watertight and in good condition EYes ENo ❑N/A • Pump is functional EYes ENo • Pump control mechanism is functional(floats, pressure transducer) EYes ENo • High water alarm in pump vault(audible and visual)is working EYes ENo • Pump electrical components are sealed and watertight EYes ENo • 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) EYes ENo (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 ;2,. Page6of8