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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 /> plain etc. <br /> If you answered"No,"please describe below: <br /> • Sand filter appears to be free from surface water runoff and down spouts E]Yes Cjk b <br /> • Evidence.of.ponding in/on sand filter media surface Dyes ONo <br /> • Surface access to manifold and valves [ Yes allo <br /> • Monitoring ports are present DYes QNo <br /> • Lateral lines flushed and equal distribution verified Eyes ON© <br /> • The sand filter has a pump Yes DNo <br /> (If"No",skip the rest of section 6) <br /> • Pump vault appears to be watertight and in good condition []Yes ❑Ne ®N/A <br /> • Pump is functional ElYes ONO <br /> • Pump control mechanism is functional(flow,pressure transducer)(JYes ONo <br /> • High water alarm in pump vault(audible and visual)is working ❑Yes ONe <br /> • Pump electrical components are sealed and watertight OYes 10 <br /> _ <br /> • Additional Comments:. <br /> 7 -.Alternative Treatment System <br /> The owner of anATT 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 focal.Health Department <br /> or the DEQ to obtain a copy of the NIIPCF permit. <br /> • The septic system has an Alternative Treatment Technology(AT I')OYes No <br /> Of"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 6of8 <br />