NCG550537_2024 Field Checklist_20240705

Date G/Z.X/ZZ)e ArrvalTime . 10,00 /ar"t E-.-.T pie d0, za ^fn
NON_ DISCHARGE SINGLE FAMILY WASTEWATER SYSTEMS
Ia2. _
Perni,ttee. Lu;z - Diaz. F'.rf , NCGSS00-7
Address 6 Y11- W6tr E-mail--
Phone ( ---3__- -- --------_--Cell Prone (41� )_G97 i793 C:ounly D(,rjkG/n
The Pal ill Is rasprnslble for the operali(in a.ld Ir.1I01enance el the enure Hlstewat:l r -A rent Iild u:sposaI system
Doesn't Did Not
Yes No AAi)ly Inveshuate
1 I. thy: Uffr;ml, residvr,t in llir, horse the Peirmitte;e!
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2 If not does the resident rent from the permittee?
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3. Ch Inge of 0%.,nership fora, needed? (mail 1:16e fora, v,,tn the insp,2r6--)rL letter}
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4.Is there a inspection and maintenance a.jre-?m,)ntvrlth a con,ra;bit,
5. If yes to 94 who.is the contractor`? —____
SEPTIC Tf The ieolir Ian', aria f"{ars should Le chetke:f a,nvall, ar,., owr:p_"] -ia3": i ee!?'j
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6 Is ali viiste,'P ater from the home connected to the septic tank?
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7. Does the permittee?resident knave where the septic tank is locot, <NP
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8. Has the septic: tank been pumped in the last 5 years?
9. If yes to #8 dale, if known !a/3ol21023 If proof, describe _Mt Forte"d
_InvaiCe
10 Does the septic tank hate a �or SANITARY T"? (circle one{
11, If Yes to filter when was the filter cleaned? _1 /3�/znz3 By whom?
/�� Fort on�
SAND FTLTER ! TREATMENT YES X NO Ll
If no proceed to the next section.
AecesrNe sand filly surfaces shall be rakes and eveled evey sr, mhnhs and a-,y g•a,vth s-,a,i
be re --loved manun iy
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12. Is system so^,ething other than a sandfilter?
13 If yes, what rind? (examples - Peal, Textile Other or brand name • Advant?x et.'
) - - .
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14. Doses the permittee knot:, where the sandflte( Is located?
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15. Does the s-indfriter require mainten_)nce?
1` max:,�rance i req a ed •.plan " ln.: - _ n, SO"
DISINFECTION ! UV YES NO Xl
If no proceed
to the next section
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16 13 UV working?
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17, Has the UV Unit been serviced and bulbs cleaned?
18 Who completes the weekly check for the UV?( Non -Discharge)
DISINFECTION ! TABLETS YES X NO
If no proceed
to the next section
The ,at le, znlorna'x ,,-.r. sha l be chr_ Ren v.=e;f, to ens.rre con'. n.rnu:; a 1, rrcpie opa a• .
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19 Does the permittee have the correct chlorine tablets?(If none, mark N-jr,
20- Do-s the Peirnittee knm,, (lie location of the chlorin3;or?
21. %iVer, chlorine tablets observed in the chlorinitor?
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22. Are tablets contacting water? If possible poke them to determine.
DECHLOR (Discharge only) YES [XI NO
If no proceed to the next
section.
The d"cf , i+,d',orun'sha!f Lecha.ke'l r,3s'.1-, t' en5.'c"_J".' ., a 1 Pr•=? 0 ='3' ;
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23 Does the permittee know %%here the de:-hlor is?
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24 Dues the permittee have the correct dechlor tablets?
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25. Wer_, dechlor tablets observe;{ in the dechlorination chamber?
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26. Are tablets contacting %rater? If possible poke them to determine.