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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 /> j Yes 'No <br /> If you answered "No," please describe below: <br /> * Sand filter appears to be free from surface water runoff and down spouts I Yes L^I No <br /> * Evidence of ponding in/on sand filter media surface 'Yes l No <br /> * Surface access to manifold and valves ;Yes No <br /> * Monitoring ports are present _ ;Yes No <br /> * li <br /> nes l l'a es flushed and equal distribution verified Yes No <br /> * The sand filter has a pump j Yes I !No <br /> (If"No,"skip the rest of section 6) <br /> * Pump vault appears to be watertight and in good condition Yes ! No I I N/A <br /> * Pump is functional Yes 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 'Yes i 1 No <br /> * Pump electrical components are sealed and watertight Yes 11—;No <br /> * Additional Comments: <br /> 7. Alternative Treatment Technology System <br /> The owner of an AU 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) 'Yes Lx 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 />