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i Oregon Department of Environmental Quality * Sand filter unit appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted plants,etc. ;Yes No If you answered"No," please describe below: * Sand filter appears to be free from surface water runoff and down spouts Yes No * Evidence of ponding in/on sand filter media surface Yes No * Surface access to manifold and valves jYes No * Monitoring ports are present E Yes No * Lateral lines flushed and equal distribution verified Yes q CNo * The sand filter has a pump (Yes No (If"No,"skip the rest of section 6)* Pump vault appears to be watertight and in good condition 7 Yes 7 No f r-- N/A * Pump is functional Yes No * Pump control mechanism is functional(floats,pressure transducer) Yes n No * High water alarm in pump vault(audible and visual)is working n Yes ri No * Pump electrical components are sealed and watertight ❑Yes U No * Additional Comments: 7. Alternative Treatment Technology System The owner of an ATT system must maintain an annual service contract with a certified Maintenance Provider. Maintenance records should be available from the system owner,or the contracted Maintenance Provider. Please attach copies of the previous two years of maintenance records to this evaluation form. Note*Some AU systems may have a WPCF permit. Please contact the local Health Department or the DEQ to obtain a copy of the WPCF permit. * The septic system has an Alternative Treatment Technology(AU) Yes x No (If"No,"skip the rest of section 7) * Please provide the product name,system ID number,and manufacturer name below: Product name System ID number Manufacturer name Page 6 of 8