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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 DNo <br /> If you answered"No,"please describe below: <br /> • Sand filter appears to be free from surface water runoff and down spouts DYes ❑No <br /> • Evidence of ponding in/on sand filter media surface ['Yes DNo <br /> • Surface access to manifold and valves DYes DNo <br /> • Monitoring ports are present DYes DNo <br /> • Lateral lines flushed and equal distribution verified DYes DNo <br /> • The sand filter has a pump DYes ['No <br /> (If"No",skip the rest of section 6) <br /> • Pump vault appears to be watertight and in good condition DYes DNo EN/A <br /> • Pump is functional DYes DNo <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes DNo <br /> • High water alarm in pump vault(audible and visual)is working DYes DNo <br /> • Pump electrical components are sealed and watertight Dyes ❑No <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 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 ®No <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 /> Page 6 of 8 <br />