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Oregon Department ofEnvironrnental QUalitY <br /> e Sand filter unit appears to,be free from roads,vehicular t attic,structures,livestock,deep.rooted <br /> plants e.tr. <br /> 1:1Yes ONG <br /> lfyou answered"No,"please describe below: <br /> ▪ Saud filter appears to be free from surface water runoff and down spouts DYes ON° <br /> • Evidence of ponding in/on sand tiller media surface OVes UNo <br /> • Surface access to manifold and valves DYes Eil\To <br /> Q Monitoring ports are.present. Etlies LING <br /> G Lateral lines fitished and equal distribution verified QYes <br /> W. The sand filter has a pump DYes ON° <br /> (If"NU',skip the rest of section 6) <br /> • Pump vault appears to be watertight and in good condition Ds UNo EN/A <br /> • Pump is functional DYes DNo <br /> a Pump control mechanism is finictiorial(floats,pressure trnsdueer)DYes ON° <br /> Q High water alarm in pump vault(audible and visual)is working DYes <br /> ONo <br /> ▪ Pump electrical components are sealed and watertight DYes []No <br /> G Additional Comments: <br /> 7. Alternative-Treatment Technology System <br /> The owner of an AT.T system mist maintain an annual service contract with a certified <br /> Maintenance Provider. Maintenance records,should be available from the system owner,or the <br /> Contacted Maintenance Provider.Please attach copies of the previous two years of <br /> 'maintenance records to this evaluation form. <br /> Now Some ATT systems may have a WPCF permit.Please contact die local Ffealth Department <br /> or the DEQ to obtain a copy of the WPCF pennit. <br /> The septic sysitin has au -A*Iternative Treatment Technology( rr)DYes D'No <br /> (if"No,"skip the rest of section 7) <br /> G Please provide the product name;system TB numbers and manufacturer name below: <br /> Product name <br /> System ID number <br /> Manufacturer name <br /> Page of 8 <br />