NCG550635_2024 Field Checklist_20240705

I )ate 6-125-/2o Z Li Arr:va! Time 9: to Alv1 EK:i Twie 4 ; S -0 •4M
NON DISCHARGE SINGLE FAMILY WASTEWATER SYSTEMS
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AddresS C011 _ 13alrd Stl _ -- Durho n E-mail-
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Ibo Pat n,itWe is raspoosrbla for the opari6or, and m aintenance 01 1he enrira wastewater tress neat .341u uosposal system
Doesn't Did Not
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Nil
Apply Investigate
1 I, rc'si+l—it in the home the Permittee?
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2 If not does the residan!. rent from the permittee?
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3. Change of Osan6rship farm needed? (,mail the foray v ith the insfaaction letter)
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4. Is there a inspe: tion ri-i I pi. 0iten:in-,u agreemv;nt v,il'r, a contra .tor?
5. If yes to 44 vlho,is.the contractor? _ _ ......
S'EPTIC Tl Trra si-pnc to 1, a-:: Viers sho.:,-i be ci;eckeJ a•i,uall, arid purnp�d :ie3r'er1 "i; nee:•?d
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6. Is all vraslerrater from the home connected to th4, septic tank?
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7. Does the perrnittee.'resrlent knov., where the septi:_ tank is located?
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S. Has the septic; tank been pumped in the last 5 years?
9. If yes to #8 date. if known__ _ , -__._ If proof, describe
10. Does the septic tank hire an EFFLUEN-1 FILTER or SANITARY T'? (circle one)
11. If Yes to filter when was the filter cleaned? By whom?
SAND FILTER I TREATMENT YES NO UK
If no proceed to the
next section.
Accessible sand fitter surfa.-es shal be raked and le.,eied every s„ months a•,d any vegeiat:.e gro.vlh s2-a
be removed manua'ly
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12 Is system something other than a sandrtlter?
13. If yes what kind? (examples - Peat Textile, Other or brand name - A-1 iantt�x,
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14. Does the permittee knovi where the sandflter is located?
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15. Does the sandfilter require maintenance?
I'n'awtenance sraq i'iLse•-,',a', c tqe y.i,n"e-.t se:i:r'
DISINFECTION I UV YES NO K
If no proceed
to the next section.
16. Is UV working?
17. Has the UV Unit been servieetl and bulbs cleaned'?
18. Who completes the ~< eekly check for the UV?( Non -Discharge)
DISINFECTION I TABLETS YES NO
If no proceed
to the next section-
Thetab'e'= '��na'�' �^:'s�s'i bec�c_b.3r;r.:r;!y t. e,rs:n, ca',t.nto..=..a:,,f rr_perope-3•.;
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19. Does the permittee have the correct chlorine tablets?(If none. mark No)
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20. Does the f ermittee knot, the lacalion of the chlorinator?
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lil/err,: :hiorine tablets obser-ved in the chlorinatoe?
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22. Are tablets contacting water? If possible poke them to determine.
DECHLOR (Discharge only) YES NO
If no proceed to the next section.
Tnz d}'nic,wa,er uw shai! be cne_.eC wee, r to e^su•e roni nue.;s a --,I pior?r
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23. Does the permittee kno:v +.There the rlechlor is?
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24, Does the permittee have the correct rlechlor tablets?
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2b Were rlechlor tabiels observed in the dechiorination chanlbur?
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20. Are tablets contacting water? If possible poke them to determine.
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