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Oregon Department of Environmental Quality • Sand filter unit appears to be free from roads,vehicular traffic,structures, livestock,deep-rooted plants etc. ❑Yes ENo If you answered"No," please describe below: • Sand filter appears to be free from surface water runoff and down spouts EYes ❑No • Evidence of ponding in/on sand filter media surface ['Yes ❑No • Surface access to manifold and valves EYes ENo • Monitoring ports are present EYes ENo • Lateral lines flushed and equal distribution verified EYes ❑No • The sand filter has a pump EYes ENo (If"No",skip the rest of section 6) • Pump vault appears to be watertight and in good condition EYes :No ❑N/A • Pump is functional EYes ENo • Pump control mechanism is functional (floats, pressure transducer)[Yes ENo • High water alarm in pump vault(audible and visual) is working EYes [No • Pump electrical components are sealed and watertight EYes ❑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 ATT 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(ATT) ['Yes ENo (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