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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 /> plants etc. <br /> Dyes tNo <br /> If you answered"No,"please describe below: <br /> 6_,p ceit,„4, .41,4x4r..„ 747 4„r, jtark +- <br /> • Sand filter appears to be free from surface water runoff and down spouts F'Ves []No <br /> • .Evidence of ponding in/on sand filter media surface []Yes �No <br /> • Surface access to manifold and valves Yes ONo <br /> • Monitoring ports are present gives ONo <br /> •. Lateral lines flushed and equal distribution verified EYes ONo <br /> • The sand filter has a pump DYes No - <br /> (If"No",skip the rest of section 6) • <br /> • Pump vault appears to be watertight and in good condition DYes. .ON° ON/A <br /> • Pump is functional Dyes []No <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes. ONo <br /> • High water alarm in pump vault(audible and visual)is working DYes ON° <br /> • Pump electrical components are sealed and watertight Dyes 'ONo <br /> • Additional Comments: • <br /> - <br /> 7: Alternative Treatment Technology System <br /> The owner of an ATT 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 local Health Department <br /> or the DEQ to obtain a copy of the WPCF'permit. <br /> • The septic system has an Alternative Treatment Technology(ATT)[]Yes. l o <br /> (If"No,"skip the rest of section _ • <br /> • Please provide the product name,system ID number,and manufacturer name below: <br /> Product name <br /> System ID number <br /> Manufacturer name <br /> • <br /> • <br /> • :.Page 6:fly`$:. <br />