NCG550673_2024 Field Checklist_20240705

Date r_ / 2S / 2.0 7- If Arrival Time 11; 4�+0 . A/ -I EA.t 1-..7,r I2: 00 P/P7
NON — DISCHARGE SINGLE FAMILY WASTEWATER SYSTEMS
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Pernwtee Mauie R-jert
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Andress 724— 1 Dc'n6M E-nail-_me�9�
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Prone (RIB 19y1 i$I a,. Cell Pnone ( _)_ _ - _
COUnty D(OrPM"
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T-! Per, rttce s respohsib): for tt,et oper,rt!on mnJ n,mritenance of me enure Nasiywit
.e, cr-lirinent and
&4posal system
Doesn't Did Not
Yes
No
Apply Investigate
rt-Skl�'lt' ,1 th�� hoftfe the Perm.tta,�i
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2 if not does lrie redden, rent from the pe(mittee?
3. Change of O-.rnersh!p form needed? (mail the form v.dh the inspect on letter)
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4. Is there a inspection ;)o f rigreement with a contractor?
5. If yes to 44 who is the
SEPTIC T/ Tha ,-�plic tan, a�-a I- tors sn.;,..i L-� .:re. kej a - gall, a.,,, ou--!pad ,ia3..d,j J
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6 Is all wastehater fron) the home connected to tne septa- tank?
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7. Does the permlttee'residenl knorr where the septic tank is located?
8. His the septic lank been pumped in the last 5 years?
9. If yes to 98 dale, if known _ If proof describe
10. Does the septic tank h-a.e an EFFLUENT FILTER or SANITARY T" (circle one)
11. If Yes to filter when was the filler cleaned? By whom?
_
SAND FILTER i TREATMENT YES t./—NL NO M
If no proceed to the next
section.
Accessible sand titer surfaces sha be rai.e9 a -id le je'ed eve, s % n onlh; and azy vegetative gfo,vth sha r
t'e removed manually
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12. Is system something other than a sandfilter?
13. If yes, what kind? (eAamples - Peat, Textile, Other or brand name - Advantex, etc)
14. Does the permittee know where the sandfilter is located?EJ
15. Dues the sandfilter require maintenance?
r maintinance is reziired e•.pla,n in the zzormvent sezwri
DISINFECTION / UV YES NO
If no proceed to the next
section.
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6. Is UV working?
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17. 1las the UV Unit been serviced and hulbs cleaned?
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18. Who completes the weekly check for the UV?( Non -Discharge)
DISINFECTION 1 TABLETS YES P9 NO .T
If no proceed to the next section.
Tha table: ih1,inri3:J: t n1: sha] J? checkeo V. ?aj 1-3 ens -,re CJn, noon! ai :
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19. Does the permittee have the correct chlorine tablets?(If none mark No)
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13
20. Does the Permittee kno % the location of the chlorinator?
4XI
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❑
❑
21. Were chlorine tablets observed in the chlorinator?
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22. Are tablets contacting water? If possible poke them to determine.
DECHLOR (Discharge only) YES — NO rK
If no proceed to the next section.
Tne dacht(}riiia,Or um; Sha!I t;e Ciie-nec vj3e'• Ij 13 e-is'tre com!ritious a":1 pro t3
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21. Does the permittee know where the dechlor is?
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24. Does the permittee have the correct dechlor tablets?
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2:i Were dechlor tablets observed in the dechlorinatcon chamber?
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2&. Are tablets contacting water? If possible poke thorn to determine