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MAINTENANCE REPORT FORM
my Name and Location of System Date of Inspection
Kyle Tucker 07 Apr 2022
FI►}lrjrrolAP7'1R'FARrII 1558 Sherwood Court Permit Number
Sherrills Ford, NC 28673 461902769848
Operators Responsible for Care (O.R.C.'s): System Classification
Jack Moore - Certified Operator #985357 Phone (704) 746-8132 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 Sherwood Shores to 13
Statesville, NC 28625 Mobile(704) 902-1122 County Phone
Cc4 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? ES] 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 I. 2 2
Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2
Line 3 2 2
INLET Scum: — 1 in. Sludge: — 8 in. Line 4 2 2
OUTLET Scum: — 0 in. Sludge: — 4 in. Line 5 2 2
Line 6 2 2
Approximate Percentage of Solids to Liquid Waste in Tank
18 %
DRAIN FIELD
No effluent surfacing? [5] Satisfactory
Surface water diverted? [S] Satisfactory
Line cover maintained properly? [5] Satisfactory
Protected from traffic? [5] Satisfactory COMMENTS
Distribution devices operating properly? [5] Satisfactory
Repair area reserved? [5] Satisfactory The pipe work in the pump tank is leaking and needs
repaired.
PUMP
Pump present and operating?
Design GPM 40
Actual GPM 40 r fl
Efficiency 100% . l�-- �-
High water alarm operating properly? [5] Satisfactory
Pipework in good condition? [U] Unsatisfactory
Control panel in good condition? ES) Satisfactory
Control floats operating properly? [S] Satisfactory
Straps/float tree in good condition? [S] Satisfactory
Effluent free and clear of solids? [S] Satisfactory Environmental Health
A -iiu - ,
MAINTENANCE REPORT FORM
s 11/ E
Name and Location of System Date of inspection
Kyle Tucker 17 Oct 2022
1558 Sherwood Court Permit Number
Frt!NprnRrt�t�P�rr*� / cAfvrr`E?S Sherrills Ford, NC 28673 461902769848
Operators Responsible for Care (O.R.C.'s): System Classification
Jack Moore - Certified Operator #985357 Phone (704) 746-8132 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 Sherwood Shores lot 13
Statesville, NC 28625 Mobile(704) 902-1122 County Phone
Iredell 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? [5] 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 1 2 2
Approximate Quantity of Solid Waste in Septic Tank Line 2 2 2
Line 3 2 2
INLET Scum: ^ 0 in. Sludge: ' 8 in. Line 4 2 2
OUTLET Scum: - 0 in. Sludge: - 6 in. Line 5 2 2
Line 6 2 2
Approximate Percentage of Solids to Liquid Waste in Tank
17 %
DRAIN FIELD
No effluent surfacing? [5] Satisfactory
Surface water diverted? [S] Satisfactory
Line cover maintained properly? [5) Satisfactory
Protected from traffic? [5] Satisfactory COMMENTS
Distribution devices operating properly? [5] Satisfactory
Repair area reserved? [S] Satisfactory
PUMP
Pump present and operating?
Design GPM 40 �r„_,
Actual GPM 40 RE I VED
Efficiency 100%
High water alarm operating properly? [S] Satisfactory
Pipework in good condition? [U] Unsatisfactory NO': n 2022
Control panel in good condition? [S] Satisfactory
Control floats operating properly? [5] Satisfactory
Straps/float tree in good condition? [s] Satisfactory En'✓ironn-ental Health
Effluent free and clear of solids? [S] Satisfactory