NCG550698_Field Inspection Form_20220228

NON_ DISCHARGE SINGLE FAMILY WASTEWATER SYSTEMS
14/2015
Permittee: Nancy St(Cfl Permit: NCL 5504( I
Address: G 1 8 R 055 •--) cxsa R E-mail-
h 6.51- tc ceD t?C• (P. con-)
Phone:( (I 1 ci ) `f 5 3 - q 7 6 CeII Phone:( ) -
County: C1'k+11-tarYt
The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and disposal system.
Yes
No
Doesn't Did Not
Apply Investigate
1. Is the current resident in the home the Permittee?
2. If not does the resident rent from the permittee?
3. Change of Ownership form needed? (mail the form with the inspection letter)
4. Is there a inspection and maintenance agreement with a contractor?
5. If yes to #4 who is the contractor? -�'
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SEPTIC T1 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?
7. Does the permittee/resident know where the septic tank is located?
8. Has the septic tank been pumped in the last 5 years?
9. If yes to #8 date, if known ! f - ZZ 1 If proof, describebeRex
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10. Does the septic tank have an EFFLUENT FILTER or SAf�ILTAJ7-Y—T? (circle one)
11. If Yes to filter when was the filter cleaned? By whom?
SAND FILTER / TREATMENT YES NO ❑
Accessible sand filter surfaces shall be raked and leveled every six months and any vegetative growth shall
12. Is system something other than a sandfilter?
13. If yes, what kind? (examples - Peat, Textile, Other or brand name - Advantex, etc.)
14. Does the permittee know where the sandfilter is located?
15. Does the sandfilter require maintenance?
If maintenance is required explain in the comment section
If no proceed
be removed manually
to the
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next section.
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DISINFECTION 1 UV YES n NO El 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.
16. Is UV working? ❑ ❑ ❑
17. Has the UV Unit been serviced and bulbs cleaned? ❑ ❑ ❑
18. Who completes the weekly check for the UV?( Non -Discharge)
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DISINFECTION 1 TABLETS YES f ( NO ❑
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)
20. Does the Permittee know the location of the chlorinator?
21. Were chlorine tablets observed in the chlorinator?
22. Are tablets contacting water? If possible poke them to determine.
If no proceed
to the next
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section.
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DECHLOR (Discharge only) YES ❑ NO kJ
The dechlorinator unit shall be checked weekly to ensure continuous and proper operation.
23. Does the permittee know where the dechlor is?
24. Does the permittee have the correct dechlor tablets?
25. Were dechlor tablets observed in the dechlorination chamber?
26. Are tablets contacting water? If possible poke them to determine.
If no proceed
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to the next
section.
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PUMP TANK YES NO
All pump and alarm sytems shall be inspected monthly. (non -discharge)
27. Is the pump working?
28. Are the audible and visual high water alarms operational?
29. Does the permittee know how to check the pump & high water alarm?
30. Last fur PUMP AUDIBLE & VISUAL
If no proceed to the next section.
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DISCHARGE ONLY YES 1 NO
A visual review of the outfall location shall be executed twice each year (one at the time of sampling to ensure no visible
31. Does the permittee know where the outfall is located?
32. Were you able to locate the outfall?
33. Is the end of the discharge pipe visible and accessible?
34. Is outlet discharging?
35. Is right of way maintained around the discharge point?
36. Any Lab Results available?
37. is there evidence of solids around the discharge point?
solids
operating
of
If no proceed to the next
or evidence of a malfunction
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section.
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If no proceed to the next
as designed
sprinkler heads.
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section.
DRIP or SPRAY YES II NO 1I
The irrigation system shall be inspected monthly to ensure the system is free of leaks and equipment is
38. Is the system DRIP or IRRIGATION (circle one)? If irrigation number
39. Are the buffers adequate?
40. Is the site free of ponding and runoff?
41. Does the application equipment appear to be working properly?
42. Is there a minimum two wire fence surrounding entire irrigation area?
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GENERAL
43. Are the treatment units locked and or secured?
44. Has resident had any sewage problems? If yes explain in the comment section.
45. Does the system match the permit description? If no explain in the comment section-
46. Is the system compliant?
47. Is the s If yes, take pictures if possible.
48. If system is failing, any sign of children or animals contacting sewage?
NOD Sent #: - - - NOV Sent #:
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ID
12
Comments: Photos Taken?
YES n
NO
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Lrr ( ChIbrine )nc 0
INSPECTOR: AI,/J 1-IG n 11 um SIGNATURE:
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