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Oregon.Department Of Environn ental Quality <br /> • Sand filter twit appears to be free from roads,vehicuiartraffic,structures.,Iivestock,deep-rooted <br /> plants'et . <br /> ❑Yes ONO <br /> if you answered"No,"please describe below: <br /> o Sand filter appears tote free from surface water runoff and down spouts [Yes [No <br /> e Evidence of'ponding in/on sand filter media surface [Yes No <br /> O Stu:face access to manifold and valves [Yes [NO <br /> O Monitoring ports are present. Li es [No <br /> e Lateral lines flushed and equ..l distribution verified ❑Yes [No <br /> 0 The sand filter has a pinup: Dyes [No <br /> Of"Nor,skip the rest ofsectioa 6) <br /> e Pump vault appears to be-watertight and in good condition [Yes ONO [NIA <br /> • Pump is functional [Yes [No <br /> • Pump control mechanism is.functional (floats;pressure transducer)[Yes [No <br /> O High water alactrt iii pump maul (audible and visual)is-working .[Yes [No <br /> • Pump electrical components are sealed and watertight [Yet [No <br /> ® Additi.onat Coifrrtents: <br /> 7. Alternative`treatment Technology System <br /> The Owner of an ATT systeni must.maintain an annu<it service contract With a certified <br /> Maintenance Provider:Maintenance records should be available from the system owner, or the <br /> contracted Maintenance Provider..Please attacli•cop es of the previous two years'of <br /> maintenance recorls'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 /> O The septic system has an Alternative Treatment Teehnoloo(ATT)Eyes ONG <br /> (If"No"skip the rest of section 7) <br /> o Please provide the product name, system ID number_:and manufacturer name below: <br /> Product name <br /> • <br /> System ID•nurribei <br /> Mantrfacturer.name <br /> Page 6 of S <br />