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Oregon Department of Environmental Quality • .: •.:: : !i A • Sand..!filter:Unit appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted plants etc . ..„. . OYea Digo :„ „ : • : •:- .• • • •-• • :: ;; ;; • ; Ji you answered"No,"please describe below: • • • Sand:filter appears to be free from surface'water runoff and down spouts DYes ONo • •; Evidence of ponding int,on sand filter media surface DYes DNo • Surface access to Manifold and valves!; DYes ONo . . I • • Monitoring ports are present DYes ONo • Lateral lines flushed and equal distribution verified DYes ONo • ••• - -• ..- ;: • The sand filter has a pump DYes ONo (Jf"No",aldp the rest Of section 6) ;! .*i • Pump vault appears to be watertight and in good condition DYes DNo • Pump is functional DYes ONo • PUmii.control mechanism is functional(floats,pressure transducer)DYes ONo • High water alarm in pump vault(audible and visual)is working DYes DNo !.! . . . . . . ; . • Pumpelectrical components.ar. e sealed and watertight DYes [3No • Additional COMments:: : ;; .• • -. ... • • . • •• • • • . ,.; 7. Alternative Treatment.Technology System The owner of an ATT system must maintain an annual service contract with a certified • Maintenance•Provider.;MaintensTiee records should 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 toi:;Obtin a'copy Of the WPCF perrint. • The septic system bins an Alternative Treatment Technology(ATT)DYes RiNoi (If"No,"skip the rest of section7) :• „ • • • Please provide the product m1ne,aystemIP number,and mannfacturet name below Product namei System ID number • • • MannfactUrefnanie • • •• • • • • • • - ... :; •:. ;'; ;; Page 6of 8 . . . . • • •