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Home My WebLink AboutAUTH-03-2013-036405.TIF A tm D3i1 voc MAINTENANCE REPORT FORM 95 ��^^^��'''r�_ + 1 � Name andLocation of System Date of Inspection 1 ."' Wayne Jacobus 06 Jun 2022 EnvironmentalServices9071 Azalea Rd Permit Number Sherrills Ford, NC 28673 PIN#461904823654 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (925) 321-9571 Type IV-A David Lynch - Certified Operator #996383 Phone Alternate Mailing Address J.C. Moore Phone (704) 873-2171 Subdivision 1227 Troutman Drive Fax (704) 873-9928 Statesville, NC 28625 Mobile(704) 902-1122 County Phone Catawba Phone SEPTIC TANK AND PUMP TANK LOW PRESSURE PIPE SYSTEM Risers accessible? [S] Satisfactory Turnups,cleanouts,valves Signs of infiltration? [s] Satisfactory located and protected? [5] Satisfactory Structurally sound? [S] Satisfactory Laterals free of excess solids? [S] Satisfactory Landscape position? [5] Satisfactory Laterals flushed? YES Septic tank filter cleaned? YES Pump tank filter cleaned? YES PRESSURE HEADS SOLIDS ACCUMULATION DESIGN HEAD ADJUSTED HEAD Line J. 2 2 Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2 Line 3 2 2 INLET Scum: — 1 in. Sludge: _ 9 in. Line 4 2 2 OUTLET Scum: — 0 in. Sludge: " 7 in. Line 5 2 2 Approximate Percentage of Solids to Liquid Waste in Tank 20 DRAIN FIELD No effluent surfacing? [S] Satisfactory Surface water diverted? [5] Satisfactory Line cover maintained properly? [S] Satisfactory Protected from traffic? [s] Satisfactory COMMENTS RECEIVED ,E�Distribution devices operating properly? [S] Satisfactory Repair area reserved? [SI Satisfactory PUMP JUL - 7 2022 Pump present and operating? Design GPM 37 Actual GPM 37 Environmental Health Efficiency 100% High water alarm operating properly? [5] Satisfactory Pipework in good condition? [S] Satisfactory Control panel in good condition? [s] Satisfactory Control floats operating properly? [s] Satisfactory Straps/float tree in good condition? [5] Satisfactory Effluent free and clear of solids? [S] Satisfactory I MAINTENANCE REPORT FORM Name and Location of System Date of Inspection Wa1 If i ‘1" Viir ' st Ilis— '''' yne Jacobus 02 Dec 2022 Frovrirrtrirrppra 9071 Azalea Rd Permit Number Sherrills Ford, NC 28673 PIN#461904823654 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (925) 321-9571 Type IV-A Phone David Lynch - Certified Operator #996383 Alternate Mailing Address J.C. Moore Phone (704) 873-2171 Subdivision 1227 Troutman Drive Fax (704) 873-9928 Statesville, NC 28625 Mobile(704) 902-1122 county Phone Catawba Phone SEPTIC TANK AND PUMP TANK LOW PRESSURE PIPE SYSTEM Risers accessible? [5] Satisfactory Turnups, cleanouts,valves Signs of infiltration? [5] Satisfactory located and protected? [S] Satisfactory Structurally sound? [S] Satisfactory Laterals free of excess solids? [5] Satisfactory Landscape position? [5] Satisfactory Laterals flushed? YES Septic tank filter cleaned? YES Pump tank filter cleaned? YES PRESSURE HEADS SOLIDS ACCUMULATION DESIGN HEAD ADJUSTED HEAD Line 1 2 2 Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2 Line 3 2 2 INLET Scum: - 1 in. Sludge: - 12 in. Line 4 2 2 OUTLET Scum: - 0 in. Sludge: - 10 in. Line S 2 2 Approximate Percentage of Solids to Liquid Waste in Tank "' 27 °% . . �—„ ""_ Ze \`L® DRAIN FIELD No effluent surfacing? [5] Satisfactory JAl j Surface water diverted? [5] Satisfactory Line cover maintained properly? [S] Satisfactory Protected from traffic? [S] Satisfactory COMMENTS Environmental Health Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory PUMP Pump present and operating? Design GPM 37 Actual GPM 37 Efficiency 100% High water alarm operating properly? [5] Satisfactory Pipework in good condition? [5] Satisfactory Control panel in good condition? [S] Satisfactory Control floats operating properly? [S] Satisfactory Straps/float tree in good condition? [5] Satisfactory Effluent free and clear of solids? [5] Satisfactory 41171+ 0 3/f y0c MAINTENANCE REPORT FORM i Name and Location of System Date of Inspection jiWayne Jacobus 01 Jun 2023 9071 Azalea Rd !� P A `"� P.S Permit Number Fn f e nm of I ' ..L - ` SPiC` Sherrills Ford, NC 28673 PIN#461904823654 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (925) 321-9571 Type IV-A Phone David Lynch - Certified Operator #996383 Alternate Mailing Address J.C. Moore Phone (704)873-2171 Subdivision 1227 Troutman Drive Fax (704) 873-9928 Statesville, NC 28625 Mobile(704)902-1122 County Phone Catawba Phone SEPTIC TANK AND PUMP TANK LOW PRESSURE PIPE SYSTEM Risers accessible? [S] Satisfactory Turnups,cleanouts,valves Signs of infiltration? [5] Satisfactory located and protected? [5] Satisfactory Structurally sound? [S] Satisfactory Laterals free of excess solids? [5] Satisfactory Landscape position? [S I Satisfactory Laterals flushed? YES Septic tank filter cleaned? YES Pump tank filter cleaned? YES PRESSURE HEADS SOLIDS ACCUMULATION DESIGN HEAD ADJUSTED HEAD Line 1 2 2 Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2 Line 3 2 2 INLET Scum: — 1 in. Sludge: — 5 in. Line 4 2 2 OUTLET Scum: — 0 in. Sludge: — 5 in. Line S 2 2 Approximate Percentage of Solids to Liquid Waste in Tank ~ 12 °% DRAIN FIELD No effluent surfacing? [S] Satisfactory Surface water diverted? [S] Satisfactory Line cover maintained properly? [S] Satisfactory Protected from traffic? [5] Satisfactory COMMENTS Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory PUMP Pump present and operating? ,�--it 'VE D Design GPM 37 Actual GPM 37 Efficiency 100% NI I 2 0 2023 High water alarm operating properly? [5] Satisfactory Pipework in good condition? [5] Satisfactory Control panel in good condition? [5] Satisfactory � Control floats operating properly? [5] Satisfactory Environmental Health Straps/float tree in good condition? [S] Satisfactory Effluent free and clear of solids? [S] Satisfactory I Gui-h-0 -013- O3(P (c5 MAINTENANCE REPORT FORM 4, rtl, Name and Location of System Date of Inspection r Wayne Jacobus 03 Jun 2025 9071 Azalea Rd Permit Number l�nve�l�l�etlat®I "�*. Services — Sherrills Ford, NC 28673 PIN#461904823654 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (925) 321-9571 Type IV-A Phone David Lynch - Certified Operator #996383 v p Alternate Mailing Address J.C. Moore Phone (704)873-2171 Subdivision 1227 Troutman Drive Fax (704)873-9928 Statesville,NC 28625 Mobile(704)902-1122 County Phone Catawba Phone SEPTIC TANK AND PUMP TANK LOW PRESSURE PIPE SYSTEM Risers accessible? [S] Satisfactory Turnups,cleanouts,valves Signs of infiltration? [S] Satisfactory located and protected? [S] Satisfactory Structurally sound? [S] Satisfactory Laterals free of excess solids? [S] Satisfactory Landscape position? [S] Satisfactory Laterals flushed? YES Septic tank filter cleaned? YES Pump tank filter cleaned? YES PRESSURE HEADS DESIGN HEAD ADJUSTED HEAD SOLIDS ACCUMULATION Line 1 2 2 Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2 Line 3 2 2 INLET Scum: ^' 1 in. Sludge: ^' 12 in. Line 4 2 2 OUTLET Scum: '" 0 in. Sludge: "' 10 in. Line 5 2 2 Approximate Percentage of Solids to Liquid Waste in Tank 27 % DRAIN FIELD No effluent surfacing? [S] Satisfactory Surface water diverted? [S] Satisfactory Line cover maintained properly? [S] Satisfactory COMMENTS Protected from traffic? [5] Satisfactory Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory PUMP RECEIVED Pump present and operating? Design GPM 37 Actual GPM 37 JUN 2 3 2025 Efficiency 100% High water alarm operating properly? [S] Satisfactory Pipework in good condition? [5] Satisfactory Control panel in good condition? [5] Satisfactory Environmental Health Control floats operating properly? [S] Satisfactory Straps/float tree in good condition? [S] Satisfactory Effluent free and clear of solids? [S] Satisfactory