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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 /> I_ Yes Ii No <br /> If you answered"No,"please describe below: <br /> * Sand filter appears to be free from surface water runoff and down spouts r .i Yes L.I No <br /> * Evidence of ponding in/on sand filter media surface __ _1 Yes 1____J No <br /> r- <br /> * Surface access to manifold and valves l ;Yes _ I No <br /> * Monitoring ports are present L j Yes L___a No <br /> • Lateral lines flushed and equal distribution verified I j Yes f. _JNo <br /> * The sand filter has a pump Yes j No <br /> (If"No,"skip the rest of section 6) <br /> * Pump vault appears to be watertight and in good condition i__lj Yes 117_.[No .111 N/A <br /> * Pump is functional Lj Yes I No <br /> * Pump control mechanism is functional (floats,pressure transducer) Yes I No <br /> High water alarm in pump vault(audible and visual)is working ^I Yes ; __J No <br /> * Pump electrical components are sealed and watertight J Yes i_f 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(An) [. ]Yes i x j 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 />