The URL can be used to link to this page

Home My WebLink AboutAUTH-07-2014-052116.TIF MAINTENANCE REPORT FORM „p Name and Location of System Date of Inspection Michael Kazura 04 May 2022 Frivi►nnArftnP Snrtiii-^� 9637 Island Point Rd Permit Number "�► Sherrills Ford, NC 28673 PIN:462801457650 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828) 478-1455 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 Stutts Circle - Lot 16 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? [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 DESIGN HEAD ADJUSTED HEAD SOLIDS ACCUMULATION 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: - 12 in. Line 4 2 2 OUTLET Scum: - 0 in. Sludge: - 9 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? [5) Satisfactory Protected from traffic? [5] Satisfactory COMMENTS Distribution devices operating properly? [S] Satisfactory Repair area reserved? [5) Satisfactory PUMP Pump present and operating? Design GPM 30 Actual GPM 30 Efficiency 100% RECEIVED High water alarm operating properly? [S] Satisfactory Pipework in good condition? [S] Satisfactory Control panel in good condition? [S] Satisfactory Control floats operating properly? [5] Satisfactory Straps/float tree in good condition? [5] Satisfactory Effluent free and clear of solids? [5] Satisfactory FnvirnnmAntal HAcIth 411 i14 -f)S.)l/(a MAINTENANCE REPORT FORM l Name and Location of System Date of Inspection 441 j k• \ _ Michael Kazura 14 Nov 2022 9637 Island Point Rd Fn•• • r*rrProfr+� c.-,r%rir•..� Permit Number Sherrills Ford, NC 28673 PIN:462801457650 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828) 478-1455 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 Stutts Circle - Lot 16 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? [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: — 10 in. Line 4 2 2 OUTLET Scum: — 0 in. Sludge: ^' 9 in. Line 5 2 2 Approximate Percentage of Solids to Liquid Waste in Tank - 23 %DRAIN FIELD No effluent surfacing? [S] Satisfactory _ Surface water diverted? [S I Satisfactory Line cover maintained properly? [5] Satisfactory Protected from traffic? [5] Satisfactory COMMENTS Distribution devices operating properly? [5] Satisfactory Repair area reserved? [5] Satisfactory PUMP Pump present and operating? [! �^- Design GPM 30 1 iEC 5zIVED Actual GPM 30 Efficiency 100% High water alarm operating properly? [5] Satisfactory Pipework in good condition? [S] Satisfactory Control panel in good condition? [5] Satisfactory Control floats operating properly? [S] Satisfactory Environmental Health Straps/float tree in good condition? [5] Satisfactory Effluent free and clear of solids? [S] Satisfactory / o5 i11D MAINTENANCE REPORT FORM mo .i ... ... .,' ,T;it E . „,,.: Name and Location of Systemcue 4 4 0 Date of Inspection Michael Kazura 10 May 2023 F1'PMi�'RaIR!!�'�PATtAf SPI'�/!r`Pf� 9637 Island Point Rd Permit Number r Sherrills Ford, NC 28673 PIN: 462801457650 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828) 478-1455 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 Stutts Circle - Lot 16 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? [S] 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: - 12 in. Line 5 2 2 Approximate Percentage of Solids to Liquid Waste in Tank 27 % DRAIN FIELD No effluent surfacing? [5] Satisfactory Surface water diverted? [5] Satisfactory Line cover maintained properly? [S] Satisfactory Protected from traffic? [S] Satisfactory COMMENTS Distribution devices operating properly? [5] Satisfactory Repair area reserved? [5] Satisfactory PUMP Pump present and operating? ""` r-74'"N r.-7 i V Design GPM 30 ^ `•�� :, Actual GPM 30 Efficiency 100% , 'nHi h water alarm operating properly? [S] Satisfactory C3 Pipework in good condition? [5] Satisfactory Control panel in good condition? [S] Satisfactory Fc-),.;r.l.�-,t t.�.:r� Control floats operating properly? [5] Satisfactory f ntal Health Straps/float tree in good condition? [5] Satisfactory Effluent free and clear of solids? [5] Satisfactory J,ui on-- 141_d 1 di MAINTENANCE REPORT FORM 1s ( Name and Location of System Date of Inspection Michael Kazura 08 May 2024 )1E1 9637 Island Point Rd Envirrolrntl enta8 Services Permit Number Sherrills Ford, NC 28673 PIN:462801457650 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828)478-1455 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 Stuffs Circle-Lot 16 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? [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: 12 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 1 Line cover maintained properly? [S] Satisfactory Protected from traffic? [S] Satisfactory COMMENTS Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory PUMP Pump present and operating? Design GPM 30 Actual GPM 30 RECEIVED Efficiency 100% High water alarm operating properly? [S] Satisfactory Pipework in good condition? [5] Satisfactory S E P 5 2024 Control panel in good condition? [S] 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 r QU--% b�- Doicf - b5gif (c, MAINTENANCE REPORT FORM € Name and Location of System Date of Inspection f` `�`T'`� Michael Kazura 20 Nov 2024 4 if �- 9637 Island Point Rd Permit Number Environmental �. / Services Sherrills Ford, NC 28673 PIN:462801457650 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828) 478-1455 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 Stuffs Circle-Lot 16 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 SOLIDS ACCUMULATION Line 1 DESI 2 HEAD ADJUST2 HEAD 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: ^' 12 in. Line 5 2 2 Approximate Percentage of Solids to Liquid Waste in Tank 27 % DRAIN FIELD No effluent surfacing? [5] Satisfactory Surface water diverted? [S] Satisfactory Line cover maintained properly? [S] Satisfactory COMMENTS Protected from traffic? [S] Satisfactory Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory RECEIVED PUMP Pump present and operating? Design GPM 30 DEC - 2 2024 Actual GPM 30 Efficiency 100% High water alarm operating properly? [5] Satisfactory Pipework in good condition? [S] Satisfactory Environmental Health Control panel in good condition? [S] Satisfactory Control floats operating properly? [S] Satisfactory Straps/float tree in good condition? [S] Satisfactory Effluent free and clear of solids? [S] Satisfactory I GLIL.Ph-,0-1 o i Li - 05g I I 6 MAINTENANCE REPORT FORM ' ,< Name and Location of System Date of Inspection { s Michael Kazura 15 May 2025 c --Jii' 9637 Island Point Rd Permit Number Environme rnital - Services PIN:462801457650 Sherrllls Ford, NC 28673 Operators Responsible for Care (O.R.C.'s): System Classification Jack Moore - Certified Operator #985357 Phone (828) 478-1455 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 Stutts Circle-Lot 16 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: — 12 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? [S] Satisfactory Distribution devices operating properly? [S] Satisfactory Repair area reserved? [S] Satisfactory PUMP RECEIVED Pump present and operating? Design GPM 30 Actual GPM 30 J U N ? 3 2025 Efficiency 100% High water alarm operating properly? [S] Satisfactory Pipework in good condition? [S] Satisfactory Control panel in good condition? [S] 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