HomeMy WebLinkAboutAUTH-03-2015-059062.TIF SUBSURFACE WASTEWATER INSPECTION FORM 4l4// O(,02
System Manager: Date of Inspection Initial 6 month ✓ 12 month
TCW Wastewater Management, LLC 7- 7- Z Z Follow-up Service call _Other
5600 Lakeview Road,Charlotte,NC 28269 •),,,,i, D ra i n f i e l r)
Tele,704.776.4443 •C_a. alb ib 3 On-site Off-site
info@tcwwastewater.com Time: I Initials
N___ n JJ.-.... a ri,.,,,,,, Location of System/Drainfield (off-site)
Todd Knower
4467 Marion Dr. Acres
Terrell, NC 28682 / Lot# 20 Phase Subdivision Qhr+ei I c e3
Curnpnanw osmn -- -t!_��.,,,-.�•.. Non-Compliant Malfunctioning
Copies: 1✓ Homeowner �EH Builder Owner's Association Developer
=Satisfactory IN= r.krrriin • . , t f, ',1 , F. , . .. . Not acluir.abl'.,
Septic Tank: sl_e: . .' v gallons 1000=53"LL 1500=43"LL 2000=aa"LL
Tank risers agree )acc iib'lg_ ✓ P eunea r
t Riser Type t- -k'� Height Diameter (.V " Inlet End of Tank
No odors present .J� Scum Level Sludge Level
There are no Infiltration problems ✓ ► Surface Subsurface —" ___k_"
Surface water Is being diverted away Scumplus Sludge level U " (SST)
Tanks and accesses are structurally sound Fitter End of Tank SST "f liquid Depth "x 100= %
Inlet pipe at proper angle yes Can't obeerve eve' Slur9 a Leel Tan g: yes No
nlet lee Is In good condition WA _" `Q "v <30%=No >30%=Yes
Inlet Tee Is cleaned today N/A
Effluent Filter clogging pe centat(00.250,75,100) L J - N/A Type: Sample of total viper column
Effluent Filter was cleaned No Yes J,..„ N/A Three distinct zones: good medium murky_
Effluent Filter is In good condition .// N/A
Effluent Filter Canister Is in good condition X N/A
Effluent Filter Is snapped in place QIIA _ Bacteria: Added at inspect' Left with homeowner
Effluent Pipe at proper angle _2/ Pulp pks Pulp pits
oard
Wafer level Is at proper level to Yes Freeb Regular pks Regular pks
Effluent Dosing Station:size: IOOer gallons 1000=50"=20 GPI 00=52"=28 GPI 2000=59"=34 G Scum Level Sludge Level
Tank Riser Is_gt pr er riel ht 0 " plus I �—"
Riser Type I Ur--#1 Height " Dlametl 7"4 " Total Scum+Sludge "
No odors present
No Infiltration Issues: Surface Subsurface / Tank Needs Pumping: yes _,_ No (>4" yes)
Required pumps are present&operating properly ✓/, Amp.Draw
High water alarm is operating properly ✓ Can't Observe Filter Cleaned today No Yes N/A
Floats,pipes,valves, disconnects are In good condition Pump make and model _ Flitenls In good condition N/A
Pump Is Installed on block or raised platform(min.6 Inches) .1./ N/A Root Kilter Added 1LB_ 2LBS,Y
Pump float Is not resting on lop of pump t4z N/A
Control panel enclosure/components are In good condition Elapsed Time Readings:
TCW sticker Is placed on front door of Panel Pump la1-C -P___ =Liaaa. hue-
Duct Seal Is present In at conduit openings Usage `—
=Use Per Day hrs
Effluent appears clear and free of solids J Hrs x 60= minx GPM - GPD
Telemetry/Dialer Is working properly N/A v Average_(<275) Above average (>275) Very high(>350)
Pressure Bell settings: Off 4",On 10"-12",Tele 16", Alarm 22' Pump r/1-CC - PC = Useage
Grinder Lift Station: Authorized to Inspect Not Authorized to Inspect
Tank Riser is at proper height ► Buried 1 "
No odors present _______
No Infiltration issues: _._ u ace Subsurface
Required pumps are present&o y .
High water alarm is o properly Can't Observe
Floats,pipes, es, disconnects are In good condition
Pump float Is not resting en top of.pranp
Control panel enclosure/components Brett good condition
Grease Trap Section N/A size: gallons 1000=52"LL 1500=43"LL Scum Level
Tank diets are accessible . ► Boned I ___ Inlet Outlet
•
No odorsprkisent .
Mare are no Infiltration problems . ace • surface ds Puitlping: yet , No (>3"yes I
Surface water Is b away
Tank sses are structurally sound
e pipe at proper angle Sample of total water column
Inlet Lee Is In good condition Three distinct zones: goo -Sdwgpam► rer .
Inlet Tee Is cleaned today (ice.
1 '' ;� I .:�a r,� i
Effluent Filter clogging percentage % Filler type
Effluent Filler was cleaned No Yes
Effluent Filter Is in good condition �1
Effluent Filter Canister Is in good condition S E P 2 22
Effluent Filter Is snapped in place
Effluent Pipe at proper angle
Water level Is at proper level No_ Yes Freeboard
rewsea/vualluzu
Environmental Health
Ground Absorption Fields: /
No odors present
There Is no evidence of effluent eurfecir Drop boxes used in lieu of DMhlbutlon box No Yes
Vegetative cover Is maintained properly Distribution box(ea)Ingood cored!on
Field Protected from traffic/destructive r Distribution box(es)In proper adjustment
Surface water Is being diverted away
I Ines are not ponding or holding water ��le If pending to mewing,how much? .,/No low areas or settling occurring f// f//
Line cover(soli)Is adequate Repair area Is property reserved,maintainer_
Pressure Manifold Systen #of 1/2"taps = GPM (Formula' head-Taps X 6.71 GPM; @ 2 feel head-Taps X 5.48)
Manifold vault,valves,piping ere In good ilea Replacement needed: Lid I qty; Repair needed: Box. ___
No evidence of leakage,bl ischarge lines Deep cleaning needed Corrected Today
No evidence of effluent cking up into box
Pressure head Is properly adjusted Corrected Tode
Low Pressure Pipe System: /
Turn-ups/cleenouts/valves are intact and accessible ✓/ Corrected Tedr Need extensions? Yes / "
Laterals are free of excess solids ✓/ letting necessar CPDR= GPM; Efficiency= %
Laterals were flushed this inspection No Yes
Zone valves are operating properly Corrected Toth __ Need replacing? Yes ___/ qty
Pressure head Is properly adjusted / Corrected Tode
Turn-up buckets are dry Inside / Buckets needs replacing? Yes 1- qty
Valve box or buckets are dry Inside �/ Buckets needs replacing? Yes / qty
Pump Tank Size (Gallons) 1000 1500 2000 Design Pump Delivery Rate GPM Design Dose Gallons
1000 Gallon=50"=20 GPI 1500 Gallon=52"=28 GPI 2000 Gallon=58"=34 GPI
Level End Dose - Level Begin Dose =Difference Inches X GPI = Current Dose GeJio(y�@/
Level End(large#) 1 Z - e.Q2.Level Begin(small#) = ( 0 X 7v GPI = ZO6 + rj Min.Run Time = �"'}t}t v GPM(CPDR)
Current GPM(CPDR) + Design GPM(DPDR) = X 100 = %Efficiency
Valves Lines Design Observe Adjusted Valves Lines Design Observe Adjusted
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Recommendations to Owner:
I al 0 . a. e • • y, „di!" • I , I .
tilIPI►TIAVEir'111101►M1• ► , MIL:: . , tiO Afi.
Signature of"ORC"
Revisvu 5f24107
SUBSURFACE WASTEWATER INSPECTION FORM 4
I.( I' 0
5 Ittf)
System Manager: Date of inspedron T _ Initial 6 month 11211month
TCW Wastewater Management, LLC — -)C t-
g �. ) _Follow-up _Service call _Other
5600 Lakeview Road,Charlotte,NC 28269
Tele.704.776.4443 a 4,,' k On-site Off-site
info@tcwwastewater.corn Time j 1' /_ I- Initials l
i Location of System r Drainfield(off-site)
Todd Knower
4467 Marion Dr.
Terrell, NC 28682 (
Lot e;,�L Phase Subdmsion p br ,'e 61)c.
Compliance Status: . .<r Compli Non-Compliant Malfunctioning
Copies: Homeowner DEH Builder Owners Association Developer
r
Septic Tank: size: t000= 3"L ...-L ...- 1 •4r IL •4r LL
Tank risers ar ► errata__ r
Riser Type Haight ' Demeter a S,,. Inlet End of Tank
No odors ores 1 Scum},evel Sludge Level f
There are no Infiltration problems i-► Surface Subsurface 1 7
Surface water Is being diverted wives _�w >- — — Scum plus Sludge level / 0 " (SST)
Tanks and accesses are strua a unray sound `,- _ Mar Esie silts* SET f U"/liquid Depth "x 100=f °/y✓`
Inlet pipe al proper angle yes_ _ Cant observe A SCUTereirl S►r ttel Trek Meads Pum No
inlet tee Is in good condition _ WA_,..-_---4. _ <30% o >30%=Yes
Inlet Tee is cleaned today WA _..----
Effluent Filter clogging percenial leap is 75.1es) WA__ Type Sample of totajwerfer column
Effluent Filter was cleaned No Yes " WA Throe eine at series: good medium murk
Effluent Filter Is in good condition %�� --""
Effluent Filter Canister is in good oersilen - ' WA
Effluent Filler is snapped in place WA_ eecMrle Added at Left with ho eowner —
Effluent Pipe at proper angle ,' (y Pulp pks Pulp� {,�tLr�ks I)Water level Is at proper level to Yes , Freeboard p Regular pks Regular pks r(t-c-4
Effluent Dosing Station:size: I G c.)J gallons 1000. 0'=20 GPI 57=2e GPI 2000=59"=34 G Scum Lee jel Sludge Level
Tank Riser Is at per nheiglA r/" plus (9
Riser Type ! Tl � D.�— — ' ) (,
No odors present Total Scum+Sludge "
No infiltration issues Surface _ Subsurface Tank Needs Pumping: yes No / (>4" yes)
Required pumps are present&owning property ____ ,Arlo Drat„
High water alarm is operating properly ant Observe Fiber Cleaned today No Yes_ N/A
Floats,pipes,valves, disconnects we In good cprAhon urr)►ereks and maw _ Filer is in good condition N/A
Pump is Installed on block or raised platform Own a Inches) /IA Root Killer Added 1LB 2LBs
Pump float Is not resting on top of pump 1..--- WA Control panel enclosure/compansres are In good condition Z Deland Time Readings: --
TCW sticker is placed on front door as Panel Pump al C P =Usage his
Duct Seal Is present in all conduit openings , Usage _ /days =Use Per Day hrs
Effluent appears clear and free of solids _ Nis x 80- min x GPM = GPD
Telemetry/Dialer is working properly WA Average_(<275) Above average (>275) Ve high
Pressure eel settings: Off 4",On 11Y-12",Tole te", Alarm 22` Pump II-CC _ PC = Useage _
Grinder Lift Station: Authorized to Inspect Not Authorized to Inspect
Tank Riser Is at proper height ► Hurled
—No odors present
No Infiltration Issues: ► Surface Subsurface
Required pumps we present 4 operseel meshy -----
High water alarm is operating proper* __ Cant e Oseve
Floats,pipes,valves, disconnects we In good concision -_--
Pump float Is not resting on lop of pump
Control panel endears/components are In good carnAon
Grease Trap Section N/A size: colons 18 '5r LL I30-13•479LL Scum Level
Tank deers are accessible ► llkebd_ f Inlet _ Outlet
No odors present —
There are no InfiltrationuAau er
problems _-__- ► S -- suos5a. an Needs rsgp; .ye^s� Io r ( 3"ye-)
Surface water is being diverted away Lamm kw,wawa l
Tanks and accesses we structurally sound
Intel pipe at proper angle 5Mipie of total water column
Inlet tee is In good condition _, L — T e distinct Mae. good medium murky
Inlet Tee is cleaned today �, l �" �'TT — —"
Effluent Flier clogging pxpKaaga % Fisar fyve / M f; C ! GJ
Effluent Filter was cleaned No— Yes _____.
Effluent Filter Is In good condition
Effluent Filer Canister Is in good condition Environmental Health
& Effluent Flier is snapped in place
Effluent Pipe at properangle p — —
Water level is at proper
r level No YN Freeboard /
reviser'trcarcvcv
Ground Absorption Fields:
No odors present
There Is no evidence of effluent surfs* Drop bow roe In Om d/DarMsills„Now No_ Yes _
Vegetative cover Is maintained property DIOrrk,M Noyes)
on ooes)In good cordlike.c -- i
Field Protected from traffic/destructive i LMenb lion boe(es)In proper a+uel nr4 -.
Surface water Is being diverted away
Lines are not ponding or holding weft( _�IN h r g isa
P ry ooatp.how mice? _
_
No low areas or settling occurring
Line cover(soil)Is adequate -_ geom.wee r properly reserved ^enwker
Pressure Manifold Systen #of 1/2"taps_ =_._ '":PM (F Drrnula 03 teat head `ahs X 6 71 GPM; @ 2 feet head-Taps X 5.48)
Manifold vault,valves,piping are In good candMkrr Hapaoamanl Mead I Id _ valves / qty; Repair needed: Box
No evidence of leakage,blockage In discharge lines (rime commune needed Comad*rd Today
No evidence of effluent backing up into box
Pressure head Is properly adjusted Corroded Inds
Low Pressure Pipe System:
Turn-ups/cleanouta/valves are intact end ecceseble _ _/ c.orrseted Todd Need extensions? Yes / "
Laterals are free of excess solids � of rrw.rr CPOR• GPM; Efficiency= %
Laterals were flushed Oils Inspection No__ Yee ___;::„.-----
Zone
valves are operating proper,/ _ c.orrersed Toed Need raplacing) Yes—I qly
Pressure head is properly adjusted �_- ,--Cerrecled Tod,
Tum•up buckets are dry Inside / Buckets needs replacing? Yes^ /i qly
Valve box or buckets are dry inside Buckets needs replacing? Yes _/_ qty
Pump Tank Size (Gallons): 1000 1500 2000 ' Design Pump DsMwy Rate GPM Design Dose Gallons
1000 Gallon=50"=20 GPI 1500 Gallon=52"=26 GPI 2000 Gallon•5a •34 GPI
Level End Dose - Level Begin rose •Difference __- M,d+as x GPI • r,uranr Dose Gallons !.
Level End(large#) - Love{Begin lsrsM#) _ -_ x OPt • - + --Min Run Time = _ _—__ GPM(CPDR)
Current GPM(CPDR) + _Design GPM(DPDP) _ _ X 100 • 16 Efficiency _
1
Va7s Lines D�gn Oba4rys Adlue e1 valves Lines Deelyn Ofwerve Adjusted
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Recommendations to Owner:
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�Siynature of"'ORC"
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Revised e/24/07
Q,+k-0. _.o5—05 SO(c.a
SUBSURFACE WASTEWATER INSPECTION FORM
System Manager: Date of Ins• mon
-ction _Initial 6 th 12 month
' TCW Wastewater flfldIIagement, tie 6 ( >':a {—Follow-up Service call Other
. 5600 Lakeview Road,Charlotte,NC2S2S9 County Systuiii Type Drainfield
Tele,704,776.4443 GCz-. On-site Of site
info@tcwwastewater.corn Time: i GI ', I J I Initials 9)4',/,v,,\•1 7 ,,f."‘77 8' g
Na' Location of System/Drainfieid(off-site) il fit .'
Todd Knower
4467 Marion Dr. n n ,a,
Terrell, NC 28682
_ Lot* -Phase Subdivision
Compliance Status: .� Compliant Non-Compliant Maffunctionirigrr1Ctit?I Flout.11 •
Copies: Homeowner .DEH Builder Owner's Association Developer
-'=Satisfactory r/1=Marginal X=Unsatisfactory N=Not Evaluated NA=Not Applicable
Septic Tank: size: iiii gallons 1000=53"LL 1500=43"LL 2000=49'LL \ ; f il y nle_ = b a
Tank risers are accessible J P. donee i r`f; -roi/1. LU uivei-c 6 i
Riser Type s Height ° Diameter Inlet End of Tank
No odors present — Scum Level Sludge Levu'
There are no infiltration problems 1> Surface Subsurface_ i'
Surface water Is being diverted away _yL Scum plus Skrdg level ( ° (SST)
' Tanks and accesses are structurally sound. ,L Filter End of'Tank SST y "l liquid Depth Ci 3 'x 100= %
Inlet pipe at proper angle yes ✓ Can't observe Sawa Level Sludge Level Tank Needs Pumping: yea No_.G
inlet tee is in good condition NIA / 0%.--..No" 1� ,� <3 .No >.30%=Yes
inlet Tee Is cleaned today N/A f ( '
Effluent Filter clogging percerrtal(<10.25,50,75,tAo)i O % N/A Type:EO,he 1 Sample of total water column
Effluent Filter was cleaned No_ Yes ,/' WA Three distinct zones: good/ madiam murky
Effluent Filter Is In good condition J N/A ✓
Effluent Filter Canister Is In good condition ./ _ N/A .
Effluent Filter Is snapped in place — N/A Bacteria: Added at inspection Left with homeowner
Effluent Pipe at proper angle Pulp pits Pulp plcs
, Water level Is at proper level to_ Yes_/" Freeboard Regular pits Regular oil/ pits
'Effluent-Dosing Station:size: \e(,r') gallons 1D00=b0"=20 UPI 1500=52"=28 lii'1 2000=59"=34 G" Scum lLevel Sludge Lev2�I
Tank Riser Is al proper height ✓ C6 " plus
RiserType -1'1" Height Diameter " ' Total Scum+Sludge
No odors present ,
. No i nfiltration les,(Ps• Surface S,hsuriace --- -; .Tank Needs.Rumping: yes No / .(>4" yes)
Required pumps are present&operating properly % Amp.Draw
High water alarm is operating properly —/-- Can't Observe Filter Cleaned today No Yes NIA /
Floats,pipes,valves, disconnects are in good condition / Pump make and model Fitter Is In good condition N/A
Pump Is Installed on block or raised platform(min.6 Inches) N/A Root Killer Added 1LB 2LBS`
Pump float Is not resting on lop of pump L N/A
Control panel enclosure/components are In good condition Elapsed Time Readings:
TOW sticker is placed on front door of Panel / Pump 41-C -P =-Usage tins
Duct Seal is present In alt conduit openings . Usage /days =Use Per Day his
Effluent appears clear and free of solids n Hrs x B0= min.x GPM GPD
Telemetry/Dialer is working property N/A/ Average_(<275) Above average_,(>275) Very blgh___(>350)
Pressure Belt settings: Off 4",On 10"-12",Tale 16", Alarm 22° Pump#1-CO PC = Ussage
Grinder Lift Station: Authorized to Inspect Not Authorized to Inspect
Tank Riser Is at proper height ► Burled / "
No odors present
No Infiltration issues: ► Surface_ urface
Required Droops are present&operating pi upa ly
High water alarm Is operating properly Can't Observe
Floats,•plpes,craves,disconnects are to good Ilion —
Pump float Is not resting on top of pump
Coritrolpanel enclosure/components are in condition
Grease Trap Section N/A size: gallorl 1000= 2"L . 15 —43°LL Scum Level
Tank risers are accessible Buried ./ i Inlet Outlet "
No odors present _ I
There are no Infiltration problems ► ace - Tank.Needs Pumping: yes No (>3"yes)
Surface water is being diverted away —
Tanks and accesses are structurally sound
inlet pipe al proper angle Sample of-total water-column
Inlet tee Is In good condition i Three distinct zones: good medium murky
' Inlet Tee Is cleaned today
Effluent Fiier dogging percentage % Filter type
. ,Fffh lent Filter was cleaned No Yes,
Effluent Flier Is in good condition
Effluent Filer Canister Is In good condition
Effluent Fitter is snapped in place
Effluent Pipe at proper angle
Water level Is at proper level No Yes Freeboard
revises,$4 2tJLU
1
'Ground Absorptton Ftetds:
No odors present /
These le co evidence et diluent suds* / Drop boxes media.feu otDiabEinlonbox No_ Yes_
Vegetative cover Is maintained properly / Distribution box(es)In good condition
Field Protected from(ralflofdestructive ✓ Dish bu0orl box(es)In proper adjustmentSurfacenaterlabeingdivertedaway* ✓
lines are not ponding or holding water 7- h. If ponding Is oocurkrg,how much?
No low areas or settling metering
Line cover(soil)Is adequate Repair area Is property reserved,melntainec •
Pressure licanifokf Systen ff of fr2"•taps = G ormula: @ 3 feet head-Taps X 6.71 GPM; @ 2 feet head-Taps X 5.48)
} Merdfold vault,valves,piping are hr good won R cement needed: Lid_ Valves__f qty; Repair needed: Box
Nil evidence of leakage,blockage lndischarge-lines p gleaning needed_ Corrected Today
No evidence of efrhsent baGdng up into box
Pressure heed Is properly adjusted enacted TodE
Low Pressure Pipe System:
TUrn-upsibleanoublinivee are Intact end accessible Corrected Torii Need extensions? Yes .t. ,_
t were flushed this inspection No ,/ Yes Laterals we free of excess solidsletting necessar CPDR= GPM; Efficiency= %
LaZone valves are properly CorrectedCorrected rTodsods
Need replacing? Yes f_9ty
Pressure head is
Turn-up bucketsare'dri .,G_ Buckets needs replacing? Yest qty
Valve box or buckets are dry inside _,/___ Buckets needs replacing? Yes^t_qty
Pump Tank Size (Gallons): V 1000 .__,1500 : ;,2000 I Design Pump Delivery Rate GPM • Design Dose Gallons..
4000Galce 50"a 20 GPI t50GGalbn=sr=28 GPI 200EtGallon=59"=34 GPt
Level End Dose - . .. Level Begin Dose=Difference Inches X GPt =Current Dose Gallons
Lever Endgame#) - Level Begin(small#) = X GPI = + Mln.Run lime= GPM(CPDR)
Current GPM(CPDR) .. . + . . . ... Design GPM(DPDR) = X 100= %Etflciency
. Valves Lines Design: Observe. Adjusted I Valves Lines Design Observe Adjusted
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.Rec.ommendatiorts to Owner:
���) ' � r nr 1 C1cL 4�
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Signature Of"Of2C" ,< c.a.. '� / /i x
Revised 8/24r07
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