NCG550182_Regional Office Historical File Pre 2018 (6)

Inspection Date: 2// 15 Start T I , / f -f --• End Time: Z It / 10V --,%
_ ;' SIIVCLE FAiilIILY WASTEWATER SYSTEM CHECKLIST
1012812014
Permittee: c� o VA S C- 0
Permit: N c 6—
5'So / 8
2-
Address: �� g / V , -s��� - E-mail-
Phone: a 2 - '4 0 -5 Cell Phone:(336) r�13 - $ /It $
County:
The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and disposal system.
Doesn't
Did Not
Yes. No
Apply
Investigate
1. Is the current resident in the home the Permittee?
2. If not does the resident rent from the permittee?
0
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3. Change of Ownership form needed? (mail the form with the inspection letter)
4. Is there a inspection and maintenance agreement with a contractor?
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0
5. If yes to #4 who is the contractor?
SEPTIC TANK The septic tank and filters should be checked annually and pumped/cleaned as needed.
6. Is all wastewater from the home connected to the septic tank?
0
7. Does the permittee/resident know where the septic tank is located?
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8. Has the septic tank been pumped in the last 5 years'?�
y � z yes
9. If yes to #8 date, if known If proof, describe
10. Does the septic tank have an EFFLUENT FILTER or SANITARY T? (circle one)
11. If Yes to filter when was -the filter cleaned? By who?
SAND FILTER / TREATMENT PODS YES NO
If no proceed to the next section.
Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall
be removed manually.
s
12. Is system something other than a sand filter?
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13. If yes, what kind? (examples - Peat, Textile or brand name - Advantex, etc.)
14. Does the permittee know where the filter is?
0
15. If above ground does the filter require maintenance?
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If maintenace is required explain in the comment section.
DISINFECTION / UV YES NO
If no proceed to the next section.
The ultraviolet unit shall be checked weekly. The lamps and sleeves should be cleaned or replaced as needed to ensure proper disinfection.
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16. Is UV working?
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17. Has the UV Unit been serviced and bulbs cleaned?
0 0
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18. Who completes the weekly check for the UV?( Non -Disc rge)
DISINFECTION / TABLETS YES NO
If no proceed to the next section.
The tablet chlorinator unit shall be checked weekly to ensure continuous and proper operation.
19.'Does the permittee have the correct chlorine tablets?(If none, mark No)
'-='
22. Does the Permittee know the location of the chlorinator?
0
23. Were chlorine tablets observed in the chl rinvor? 4-, I
poke
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24. Are tablets contacting via P If possible them o determine. G�: h s
DECHLOR (Discharge only) YES Ll NO
If no proceed to the next section.
The dechlorinator unit shall be checked weekly to ensure continuous and proper operation.
25. Does the permittee know where the dechlor is?
0
26. Does the permittee have the correct dechlor tablets?
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27. Were dechlor tablets observed in the dechlorination chamber?

0
DRAFT Doesn't Did Not d
Yes No. Appiv Investiqate
Are tablets contacting water? If possible poke them to determine.
PUMP TANK YES NO
If no proceed to the next section. —2
All pump and alarm sytems shall be inspected monthly. (non -discharge)
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29. Is the pump working?
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Is the audible and visual high water alarm operational?
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31. Did the permittee know how to check the pump & high water alarm?
32. Last functional test?
DISCHARGE ONLY YES NO
If no proceed to the next section.
A visual review of the outfall location shall be executed twice each year (one at the time of sampling to ensure no visible solids or evidence of a malfunction.
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33. Does the permittee know where the outfall is?
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34. Were you able to locate the outfall?
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35. Is the end of the discharge pipe visible? If not, explain why.
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36. Is outlet discharging?
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37. Is right of way maintained around the discharge point?
38. Any Lab Results F �V fM,4 s J
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ET'
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available? —,9 Q Fs �y o o�+�
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39. Is there evidence of solic around the discharge point?
DRIP or SPRAY YES NO
If no proceed to the next section.
The irrigation sysetm shall be inspected monthly to ensure the system is free of leaks and equipment is operating as designed.
40. Is the system DRIP or IRRIGATION (circle one)? If irrigation number
of sprinkler heads.
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41. Are the buffers adequate?
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42. Is the site free of ponding and runoff?
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43. Does the application equipment appear to be working properly?
44. Is there a two wire fence?
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GENERAL
45. Are the treatment units locked and or secured?
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37. Has resident had any sewage problems? If yes explain in the comment section.
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37. Is the system compliant?
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38. Is the system failing? If yes, take pictures if possible.
39. If system is failing, any sign of children or animals contacting sewage?
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Comments: /1� 1t� /�/� , - C Photos Taken? YES
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70 Lakeside Loop, Hickory, NC 28601 to 1157 Players Ridge Rd, Hickory, NC 28601 - ... Page 1 of 1
Map data 02015 Google 1000 ft
https://www.google.comlmapsldirl70+Lakeside+Loop,+Hickory,+NC+28601 / 1157+Player... 4/27/2015

70 Lakeside Loop