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II ii]! !::, and:filter;unif apPearf3:to be free from roads,vehicular traffic,structures,livestock,iEdeep-rooted ::.: •il. 11 Hi ;.:: plants:etc ::. ::. .: .1 •:. : :i :. •.: i; ;:. .. . . : .. . .... . . .. . .. ... ::::• • :11 •,:i 11 ::11; 4 ::1; Lly6i Elko 1i1 l'i !; ;.: :: r..ii 1 li :::.. : ;i1ii "; - •••; .;:: :;: .. ..: •• •:: • :: : • .-:. i, ..: ;; ..• 1i: ••• •'• . : •••• ' :. : : ii;E.: .. :• . . .. • If you:answered"No2"Please:describebelow: 11 • : i: .. ,:. .. .. .*: .: :: ::: !i: ::.. ::: i:: i:: ::. i: 1 .:i :: :1 1:. : :::::: . :.1 •::• :: •.:.•.• :•:: .•••.: . : :: . 1:: .: ::: ::i .: :•: :i: ::: i:: :• :: .:. : :: :: :: i:: : • :• :::•: 1. •E I'•: :: :: .. . - -.. : . . . :. . •: .• : :: .:: .• ••• ::: ::: •• . .. .: . ". •: . ii::i ' .: .: . ... .. .. . . ... . ... ... .. .. .. .. ...i •:i • : •i • 1:: " :•• ::: ••• •:: :• ::: :.. .: •. •:: -: •: • :• ::::. . .• . .. . ,.. . . . : • - • -:• .___ -. -,,•• •-• • : •:::• : .• :: •:::•: I. . •:: Sand;filteappearito be free from surface water runoff and down spouts DYes [JNo .:. ... . .. .. ... .. . ;:. • .:1 11 ::. Evidence of pOpdit!ig in/on sand filter media surface ['Yak, DNo ., . . ••: Surface accesslto Manifold and valves? E[Yes::[]No . . • - • • . • •. : ::: ::: :' :. : ::. --: ,:. .-• :.: ::: :. ' :: 1;:: • .. : . . . •. . • . •• Monitoring ports ate present; Dres DNo •. . ::•• :: ••• • • • ::: -:: r• i:.: iii Lateral lines flushed and equal distribution verified: Di es iiON0 • •• •.. . • •. . •:: :.- ii - i-i :; :: :: ji i.: , :: :'; - ;! ... :: 11:: : F. i . :• . ••: :.: i ::i :: `:: The sand;41tef:4aia pump ElYel3 ONo 1' .• 1: 111i • . :.: :,• • : : ::7 ':: •': ..: :: .1: • •: :: ::' . '! :: :: :::: : . •• •.. • •• •• • - -- • • • •• •.• • ' i.... ..! :. '::: • 4, (ff"No",skip the rest of section 6) :•.: : .. ii i i .: : : . . .. . • . . . ::1 Pump vault appears to be watertight and in good condition DIY es EINo ON/A : . , : • .:. • -: - . :: ::. :: .• •• .-: . . • - •1 Pump is ftinctionalOYes ONO • • . . .. . . : . . .. •• • . ••• ::•:: . • • • ••• •• •• • - • • •• • --- *: Pump;control mechanism is functional(floats,pressure transducer)Dies ON° • . : . ' ::: : ;: ;:ii :i: ;.: ;i: ;.; ;; •:: :: :: :i: •; • •: High water alarm in pump vault(audible and visual)is working Dyes ONo; i; • . • • ... . ... .. .. .. .. .. . ... . .. ... .. .. .. ... ... ... .. .. ... ... ... .. . . iif. Pump electrical components are sealed and watertight ElYea DNo . . • .-... .. .•. .. •.• .•. .. . • .: i; . -: . " ;1' - . .. .. : .. .. .:.• .:-. :".1 i!E il • Additional Comant8:1.:* : ! . • . . . . . .. . . .. .. .. .. ... ... ... ..... ... ... .. .. ... ... ... . , .. . . . •• •• ••• •• • • . .. .. . :.. .. .. ... . . . . ... .. .. . . :: :. 7:: :::*: .:: ;. ;: .. ;-- ;. - • :. :: • -. . .."• ::: :.:: :.: •:: .•. -. ::: :.: .: .. : .: •: .• i: i: H : .: ::- .•-: . .. .. ... ..... ... .. . .. ... ... . - i. : - . . : . • . . .. - - : . . .. . . - • • , ! :.• Ei:!. 7 Alternative Treatment Technology System . . : • • . • :: :, •:: :.i 1:1 The owner of" nAIT system must maintain an annual service contract with.a certified . • . Mainferisce Provider.Maintenarice records should be available from the system owner,or the ;.. contracted Maintenance Provider Please attach copies Of the previous two years of i:_iafirlientin ce records:to this evaluation form ••• i.• :,-i• .:. • .:: .. .. . . .. .. . ... .. .. .. . . . . . . . . .. . . .. .. .. ... .. . ... .. • •• •• • - • - •• • •• : 1:.,..• . . .. . • • •• ••• --- • • • - •".: 1: :1 - ::1 Note .Some ATI'systems may have a WPCF p:ermit.Please contact the local Health Department : :, •:. or the:DEO to obtain a•copy of the WPCF perniit. ;; '• !- ; : • 1! i •:: .1. ii: iii i; :: The septic system has an Alternative Treatment Technology(ATT)nYeS No • . . . . . . (If"No,"skip the rest of section 7) • Please provide the product name,system ID number,and manufacturer name below; .. .... . . . , ::. • ;:! ::i i: Product name:- : ": '• .. ; 11: .: ..1 : !I: : : • ; , . • : • • : ••: -,. :;: System ID number ••• .: .• *i. .! • :. ;F::: • . .. . . . : • : . . . . .. .. .. . . .. .. . . . ... . . • . I: i;:.: Manufacturer..namg :: : :: i I': i :i . . , . ..... . .. . .... . . .. , . . .. .. ..... . ... ... ... .. . .. ..... . . . . . : . . . . .. .... . .. ... . . . . . .. .. . • - .': ii • • • . . .. ... . • •, • •; ;•:• •• :: •:: :i: ::. :: .• :; . ..: •: • •• . :::-: .: -. • . . .. . . . . . •• .• :: -.:. --• ;; :•: ::: •:: : 1; ..! i:::Pabe 6.of 8 :1 .. : . .. . .. . .: • : •• •:::: . : .. • : -- • ••: :: .. •..• :: :• .:• .•• ::. :•: .•• :: •. - . : . •:::: " - - • .. . .. .. . . . . ... . .. .. ... .. .. :. .: • .. ... . -- -.- :: :::: :: :. ::: :: ::: - .. .: • :.: :, :. :: :: •:::: - . .. . . .. . . •: • :: 1:i: :• :: •• •:: ::: • •• :: •, ::: .: • •• - ::::: .. ... - -.. .. : . . . .. .-.• • • - . . . . ... . . .. . :