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