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A24 147N. C. Department of Environment and Natural Resources ��+ �� 7 Division of Environmental Health INSPECTION OI' ENGII\TEERED SUBSURTACE WASTEWATER SYSTEM ��« �� Health Department _ _ � Name of Establishment Permit/Project No. Owner/ Operator � ' Address Ye� 1� o i. ESTABLISHMENT: .� Type, size, and sewa�e flow in accordance with pemiit? ...................... ❑❑_ 2. COLLEC7'ION SYSTEM: No evidence of leaks into or out from sewer lines/manholes? ............... ❑�— Free of blockages/solids buildup in lines or manholes? ........................ �❑_ 3. TANKAGE (Grease 7"raps/Lift Stations/Septic/Dosing Tanks): Tank risers accessibie and surface water diverted? ................................ ❑ Tanks and access manholes swcturally sound, watertight? .................. ❑ Sanitary tee(s) in good working condition? ........................................... ❑ Tanks pumped, cleaned out as needed? ................................................. ❑_ 4. RAW SEWAGE LIFT STATION (if present): Required pumps present, operating, and cycling properly? ................... ❑ High-water alarm present and operating properly? ................................ ❑ Ploats/pipelvalves/disconnects in good working condition? ................. O Control panel enclosure!cornponents in good condition? ...................... 5. EFFLUENT DOSING SYSTEM: Effluent appears ciear, free of excess solids? ......................................... ❑ PUMP SYSTEMS: Required pumps present, operating, and cycling properly? ................... ❑ High-water alarm present and operating properly? ................................ � � Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosure/components in good condition? ...................... ❑ Elapsed time readings: SIPHON SYSTEMS: No evidence of overflow or siphon leakage? ......................................... Siphon(s) appear to be working/altemating properly? ........................... Belis and vents free of debris and in good condition? ........................... GROUND ABSORPTION FIELDS: No evidence of effluent surfacing/reaching surface waters? .................. Minirnal ponding in subsurface trenches? ............................................. Surface ��ater being effectively diverted away? ..................................... D'rversions/ditches/swales/tile drains properly maintained? .................. Line cover/veaetation adequate/maintained as needed? ........................ Protected from traffic, destructive uses? ................................................ Distribution devices in good condition, working properly? .................. Repair area properly reserved, maintained? ........................................... LOW-PRESSURE PIPE DRAIN FIELDS: Turnups/cleanouts/valves intact and accessible? ................................... No effluent standing in lower laterals? .................................................. Laterals free of excess solids, cleaned out as needed? ........................... Pressure head is properly adjusted? ....................................................... OVERALL CONDITION AND OPERATION OF SYSTEM: lmprovement �. REMARKS ❑ � �' °a ❑ ❑ ❑ ❑ ❑ , ❑ NJ LJ ❑ °a � � � SUMMARY OF IMPROVEMENTS NEEDED: DATE: SIGNED: DE1R 3;0? (Revfsed l98} OmSite W astewater Section (Revicw I'_/98) — over — Flow � _ �� Phone Repair �Vithin (Days) Health ,��ii�on .t�te- I 6 � -b � :�mca�raa aaid: . _ I�� 2�imt �` �-� I�� - . � rsasan��acac�#v �?�aith Det�artment . : .... . .._,-.. .: �--�n�irmm��ntai H�aalltl� S�ection i -�: �� ,� ✓� 2' �-f ' �rczi �T � � `� � � ��" � � �- � � � 1— _�3��..a:�T...�:.. � � � :�.5 • - �.}� - . �� . . .:;:. APFL'lCAT10N WR S�1lIC�3 . 1} Pmrcrlit reque�bed by: (OwRBr/�rospecttve ownel�: �� e r��C� e�n �� • HOQI@ Pf1011e: �!' I�- 9(� Fi- �I 3 0� Addf�55: �l 1.4 �- a l�C e E l�e t- . 8tJ6jRE98 �10I1@: l 9-�} 10 FS- �id O p � � Ch a op 1 I-�- � 1� �'UG 27 S/'� 2� Nama and addre�a •oi carnertt owner: �.� e�'� � C, o� n e r- S • • . . . a �� ; c-+, � \��.�rhaw; . G � z77•o� 3) Pro�eriy Descr3ption: Lct slze: '• ��a T eouist�: �/� n n,'n� 1ia � /,, // / ua ��rees/�l,`l1 0( � Direc�ons io the pro/��qj'�� (lndudirtQ`� road��\��(�,'��es and numbers): /.� a I n%l e!-%�/ i n 1_//. �l c I� IP-�l- '� n G tn �G 1� i D�n '� c d 1/ D Okk �;�fSu��,•s,'o�, . . : �/ant¢,f:o.,� 6ea�,.�y� a� �Y-o�/a�u fo �.�c►', 4) ProQos�d llse and Structu�+e Descri¢tlon: answer eact► of the foilawirtg questtons: 10 ��'S/ ,'s ��` � e�, f- � P�� ,. 9� , . . fo 3� 4 1iee��', �/�L4� r 6) • S�dc B t AAodular Q Single V1llde �. Doubie Wtde � se.�` o � a,'U G � c) Numi�er of 8edrooms:. � • � Number of occupar�ts ar peo�ie to 6e served: � . � �). ..EasemernC : Y�� Q Nc�es, �-of basement fndures: . . . : . . .. ... • . .. - .. _ � - . = - -- � � � : . . • � • car�iace. Dispc.�.ai: Yes� ?� Q--u- . _. .._ . _ .. . _ . . . . � . . . . _ _....._ -.. ._ . _ . � -- .- . ... . .. gj Dimensions of Progosed Strur,�ute: Width: � Depth: �� Water Su�ply TYPe;. Private� (new 0 or e�dsting I7j, Pubiic O, Community 4 Spring ❑ . •� Are acry wells on adjania9 P�PeKy? Yes`� No 11 If yes, loc�ttcn ��e-e e h � � o s:� c� i�. �,1_ �� S) Pieass lndlcata D�ired System T`ype: (systems can hs ranked 1n ortler of y�ur prefeiencs) . .• �Canventiotnl _dRodifled Converrtlonal �Altemativ�e. Innovative �ther (spediyj: CLcARLY STAWe ALL CORNEi4S ARID 11NE8 OF THE PROPE�t'ill. STAKE THE CaRlVEiiS OF ALI. PROPOSE� STRllCNRES. PLE4SE ATTACN BURVEY PLAT �R SRE P�.AN TO THIS APP�ICATION 1 hefeby make ap�lication to the Persor� Caurtly Heaith Depar#ment for a siie evaluation far the an-site sewrage dispasai system far the a6ove-descn'bed property. I agcee that the ca� of this appiicatian are true and ne�reserrt� the ma�arntun fia� to be piaced an the propert�/. I understand if the siie is afteced or the ir�tended use ct�aciges, the persiit st�ait b�ame invaitd. l under3tand that as a�piicam, 1 am respans�ie for ide�ifying and mar�ng property lines, camers and rnaicing th� siie �crossible for the persannei af the Persan Cawdy Heslth Departrnerrt to canduct thear avaivattans. l understand that I am respons�ble for notiiying the Heaith Dep e� i� preperty carrtains arry wetlands as desigrZated by the Army Carps of gin - � �` /q � % � Owner or Legal R2pr�sentative . Qa#e � pCH(], rev. 10l12l99 Materials Lot 51 Oak Pointe This summary of materials includes major components of the system, and is meant to assist the installer in preparing an estimate. It does not include consumable supplies (glue, etc) or exact numbers of fittings. It does not include any specified drainage ( curtain drain, stormwater diversion, etc.) septic tank 1200 gal effluent filter yes pump tank 120o gal qreaSe trap none pretreatment none um one panel simplex floats three zone valve none supplv line 65 ft *" manifolds 25 ft ** check valves one qate valves three threaded unions one trenches laterals fittin s Zoeller N98 Rhombus with panel 2" Sch. 40 3" Sch. 40 2" diameter 2" diameter 2" diameter 1121 W914H8AC mounted on float tree may include segments beiween valves and manifolds - see pipe detail 1 in PT 1 in PT 2 at field 1 in PT 640' 18" wide, 8-9" gravel 640' 1 1/4" Sch. 40 sleeved in 4" corrugated "holey" pipe 6 center-fed laterals, with turnups in vatve boxes couplings, tees, elbows, etc. as needed to connect components cleanouts, valve boxes, etc, as needed to provide access and protection to components ** length is approwmate February Associates, Inc. printed 3/27/02 Flow Chart Lot 51 Oak Pointe Permit # Bench Mark 7.9 =420.00 set at eip - see site pian line color rod read elev. elev. dif. head length hole size flowlhole spacing # holes t sUlast flow/iat inst. flow rate subfield 1 1 L white 6.6 421.30 0.00 3.00 45 5/32 0.50 4.50 9 4.50 4.49 0.100 1 R white 6.6 421.30 0.00 3.00 55 5/32 0.50 4.50 11 5.00 5.48 0.100 2L red 6.7 421.20 -0.10 3.10 45 5/32 0.51 5.00 8 5.00 4.05 0.090 2R red 6.7 421.20 -0.10 3.10 55 5/32 0.51 5.00 10 5.00 5.07 0.092 3L ur le 6.8 421.10 -0.20 3.20 55 5/32 0.51 7.00 8 3.00 4.12 0.075 3R ur le 6.8 421.10 -0.20 3.20 55 S/32 0.51 7.00 8 3.00 4.12 0.075 total feet = 310 gal/min 27.33 subfield 2 5L C=�.a 7.1 420.80 0.00 3.00 55 7.1 420.80 0.00 3.00 55 7.2 420.70 -0.10 3.10 55 7.2 420.70 -0.10 3.10 55 7.4 420.50 -0.30 3.30 55 7.4 420.50 -0.30 3.30 55 total feet = 330 Total Feet = 640 5/32 0.50 5/32 0.50 5/32 0.51 5/32 0.52 5/32 0.52 6.00 9 � 3.50 4.49 6.00 9 3.50 4.49 7.00 8 3.00 4.05 7.00 8 3.00 4.05 9.00 6 5.00 3.14 9.00 6 5.00 3.14 gai/min 23.3E Total gai/min = 50.69 0.074 0.074 February Associates, Inc. printed 3/27/02 Manifold(s) 3" Sch. 40 length 25 ft draining length 25 ft actul diameter 3.068 in volume 9_6 gal draining volume 9_6 gal Elevations top lateral 421.30 pump tank 423.00 pump off 418.00 ELEVATION HEAD DESIGN HEAD FRICTION LOSS FLUSH HEAD TOTAL DYNAMIC HEAD HYDRAULIC PROFILE LPP Calculations Lot 51 Oak Pointe SupalY linels) 2" SCh. 40 length 65 draining length 65 actual diameter 2.067 volume 11.31 draining volume 11.31 3.30 ft 3.00 ft 3.87 ft 2.00 ft 12.17 ft Friction loss manifold(s) supply line fittings 0.17 3.05 0.64 ft ft in gal gal ft ft ft Laterals 1 1/4" Sch. 40 length 640 ft draining length 640 ft actual diameter 1 1/4 in volume 49.92 gal dosing rate draining volume min. dosing vol. max. dosing vol. PT gal/inch DOSING VOLUME DRAWDOWN PUMP RUN TIME 50.69 20.9 270.5 520.1 25 375 15.00 7.40 �pm gal gal gal gai in min February Associates, Inc. printed 3/27/02 Qct 30 02 10:44a February RsSociate5 9195423482 Lot 51 Start-up Inspection Checkiisi Oak Pointe instaited by date inspected by OP date saecified installed pump Zoeller N98 panel Rhombus 112W914H8AC septic tartk 1200 gallon ID #: firters pump tank '12D0 gallon gaitons per inch assumed 25 gaUin ciesiqned dosing tate 50_69 gpm � 12.Q5 ft TDH dosing votume 375 gaUons drawdown 15" l.ateral heads 3.0 3.0 (left, right) 3.1 3.1 3.2 3.2 3.0 3.0 3.1 3.1 3.3 3.3 !AT 1 LAT 2 LAT 3 LAT 4 iAT 5 LAT 6 tD #: measured � p.2 Please list or sketch any deviations from plans. include thanges ia location oi tanks, vatves, supply iines, or other campoaents. Note utility lirte crossings, locations of sleeves 8� cfeanouts, and any othe�' features of +nterest. . ...�_.�..� �. . ..�. .. .. . . �� .i .. .�.« . .'_ � ./ �. .� -_I_ . . ..L .. _ prirrted 10l30/2002 -_- . .. . ."'. . .-._, �=� ::. . . .- . .. . ... ". _. .. _ , .,_ . .__ � �� S� � ��.� �� o� a� � __ � o �-� � �, � ' `' � � C�. � ��' � � ° (�J G`��'i��0' =��t-=� �=--lb� r , ,� �•� " 5 , �`' �.�.a-��m.��,.��.0 ��.Il��. D�o D�B�[loc� �- /b - a 3 o� Well Log Owner: ('�"' k�',� : -}'� �'o y n � .- �� Tax Map �i� P arcel # �� Location: Subdivision: _�� Y ,j� ; n-t � ��,'�ot # ;; ( Well Construction Distance From neazest Property Line (Minimum 10 feet) `� Distance from Septic System (Minimum 60 feet) Tota1 Depth: �`}a $ Yield: �_ GPM Static Water Level: �_ $ Water Bearing Zones: Depth 3� $�� v$ ft ft Casing: Depth: From �_ to � $. Diameter: �_ in Type: Galvanized Steel � Weight: 13 Thiclmess: �� Height above Ground: �� • Drive Shoe: ��es No Any problems encountered while setting casing? _yes �No If "yes" give reason: Grout: Neat: SandlCement � Concrete GraveUCement Annular Space Width inches Water in Annular Space Yes No Method of Grout: Pumped Pressure Poured � Depth to Ft. Materials Used: No. Bags Portland cement Weight of 1 Bag �/ 1/ Pounds If mixture (sand, gravel, cuttings) — Ratio Yto i ID plates: �es No 4 x 4 slab �Yes — No Drilling Log i�ncatinn ilrawino - ---------�..�b From 7Co Formation � 3 � � , �. , I hereby certify that the above informarion is correct and that this well was constructed in accordance with regulations set forth by the Person County Heal Department. � , Signature of Contractor �T ID# I)ate � —o3 --,�.�..� 1 � 1 7 ' PCHD rev O1/16/02 � ��,�� ,a ,s�.� �� —; .� c�� .�� .�.�. ��.�.�� 1'�A�� SE� 1�'�"I'1�CI�E1) I'I.A1�T F�12 WEI.�T. SI'�'E I.AYOU�' 'I'ax Map #: � 1'azcell # � 'I'ownship A�plicant � �P �� -'9/'l/'7 P �'v Subdivision: '�'�pe of �ater SBa��lv: �.es�uareaa�eaits- Secsion: Lat � � %.l.l /� - G�S i'�'��%� "� l �r ./ j�di�ridual Communitp Public °�`� I �l( %:S � ,i-u: l; �� Te e '��✓c l� �� '��f � Site Approved by ✓3 � �" " ( � -Q3 Grouting Approved bp i/ �N 4'I l��3 Well Log �: N�- I - 43 Well T � y � � � A.ir Vent Hose Bib Concrete Slab �'� • � �Ci. r 1 � `-` ��-�.3 �y , ;�va��s l�%�% �r ��%� � 2° x a 2� Well Approved ��.��• I�ate• Z' � �See Attaciied Site Sk�tch�` Wells must be 10 feet from property lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building founda.�ion. Other ,p �^,'d r / r2 /�� n. �` Se� �,' ��1 ✓P-�? a �► nt Y s�� /a! `� Gzuk�. 3-3c-o� s'S PC�-ID, rev. 09/07/01 � �C.rGT I SC ,i�}lY� �1V�7�LL 1'!Q� �rfl�iH�, r�'�` 1 ``3i'� i� � � .• . T� MaQ #�� Par�x! � �`'� � System Type (Tai�le Vaj - Owmer/Appiicarrt S�bdivisian AddresslLocation - SeclPhase � Lot # � pc�d rev. 31-t3ro1 � �� 1�� `_'' � � �Jl��`� �� ,�. ��.� ��.a�. r�� s7 - � � ��6� APD�icar� �� . Location: � . . . O��ration PeTi�riit � � • � System Type (ln Acxordance Witti Tabie Va): .-=�'`'� THIS � gYSTEAA HA5 BEEN MSTALLED 1N COMPtIANCE VYiTH APPLICABLE NORTH CAROL•INA GEi+IERAL.S'TATUTES, �RULES FOR� SEWAGE.TREATAiIENT ADID DISPOSAt, : . AND- ALL' COND1710NS ..OF T13E lel[PROVmIENT PERMIT AND. CONS"FE2UC'�ION •A[1T'HOR12A. N:";' . . .. . . `�.. _' . .. • . - . _ . ' - " x �`'� �. ' • . - � orized e � . . � . � . . .� - � . _ . . . . . . � �L�,�;�. . - . lnstaUed By. � � . Dafie•� . . . ,r��'g,� .� � (rt(pQ� f`2 "� � . : �.: : .. . �. .- : � _ .: -� . -- =: - .-y _- - � �,� lezK�... � _-� 0 ,�� . `I��' FEf3RUf�R� �SS��i��, ��. P.O. Box 5427 Cary, N.C. 27512 Ph: 919/467-5427 Fax: 919/467-5463 Low Pressure Pipe Desi9n Dabe: 3/19/02 County: Person �wner: C. Keith Connecs P•�-N� #� Pe�� ontac� Peter Bochenek (919) 968-4200 Property address: Deefieid Lane 30104 Baxter Drive �o�; 51 Cha I Hill NC 27517 Subdiv: Oak Pointe � of 9DR: 4 Dailv Flow: 480 gaUday LT.AR: 0.15 gaUday/sq.ft 5q, Ft: 3200 Late�afs: 640 linear ft Lat diameter: 1.25 �n, sleeved in 4' d�am. comig. p1Pe Trench depth: 15 inches on downt�ll side Depth of stone: $ �� Trench width: 18 ��h�s F�� P: no �° y� See site lan flow ch a�d detail sheets es Pum Tank: i 200 gais ga1 per inch: 25 Septic Tank: 1200 gats Filter. y P Supply Une�s): 65 tt Diameter: 2 in. sch 40pvc actual I.D. = 2.067 in 3 in. sch 40pvc actuai 1.0. = 3•�8 in Manifold(s): 25 ft Diameter: _ Etev. Head: 3.30 ft Design Head: 3.00 ft � �'� � Friction loss: 3.87 ft pncl. �tin9S) Flush Head: 2.00 ft 375 gallons Total Dynamic Dose volume: Head 12.17 ft PumptoDeliver: 50.69 gpm � 12.17 ft Drawdown: 15 inches Pump 8� Controts• Pum run time: 7_4 minutes pump� Zoeiler N 98 panel: Rhombus 1921W914H8AC, simplex control panei 1 ot��' ��"^�. 9.4 amos witli event counter, etapsed time meter� NEMA �OC bo�4 �e � circuit ather ui at that rneets or exceeds the cations ma be substituted. CorKact desi ner if uestions. The plar�s and specifications for th� On-site Seuvage Disposai & Treatment SYstem have been Prepared a�rdm9 to cide� in North Carolina's rules and reguMations 9wern�n9 On-site Sy�ems, to add6i "a�al countY standards (d appticable), and to generaily-exepted desi9� Prinaples. Febntary Associates� inc., makes no r�en�tion re9ardi�9 sa'Is conditions on tt►is property. Long-tertn acceptanc� rates, trench dimensions, and waste loads are d�ertnined by the countY Healtl� Departrnent (or o�r sal sc�nce Profe�iot�s)� and are induded as conditions of the permit issued by the H�Ith Departrnent. Febniary Associates� Inc., accepls no �sponsib�'dY fo� changes in thess pians 8� specifications, unfess we specifu�ify auttwr¢e such change.s in advance. If char�es in �eci� or bcatfo� of components are needed, pl�se fee{ free to contact us � for assistance in mal�n alterations behxe the in uPstion fs ir�stali�. Repair. LPP t� yo�s're biciciing on +this job, please make sure thafi you ha�s been given A�� tne pages. February Associates, Inc. printed 3/27/02 -�, i,>� � �a �� .� V V.� . . �. ..:.. . � � �� 7E�.�� ¢�.71 IE3L��.-�1la ' �� • UM Permit Valid for �Iive Y Type of Facility: '' � # of Occupants � # of Be� Proposed Wastewater System: _ Proposed Repair: L,�� i�r� � T��x IV1•�.� � Parcel ;= S'U iJ C�ii l,'1-�'I.0:1�1 �� w Fh,��•e=5ec-tio.r�!L�t ,_ � � Iffiprovement Permit ears _ No �apirahon 0 New �Addition Wates Supply��-� ed Daily Flow g.p.d. � � � � Type:� Type: 7'�c� _ � . Owner or Legal Representative S Authorized State Agent: r Date: Date' l0 -:.�� 02 The issuance of this pe�it by the Health Department in dnes aot •gua=antee the issnance of ot�er pemiits. It is the responsbility of the �PPli��P�P�' owner to in sure . t�at ail Person Coimty Planniag and. Zoniag. and Bn�ding Inspections reqn�em� are .met. This .: Imgrnvement Permit is. snbject to re�ocation � the site plan, plat or the intended:�e �changes. The Imprnvement Permit is not affff'ected �p a� change�m ownership of the property,. Tiris permit was issued in compliance..wi#h the�provisions of the North Carol'ma `.�ax� and Rules,}or Sewage Tnabneirt mid Disposal3bsr�ms' (15A NCAC� 1�A .1900). Neither�Person Co�tq nor the Environmental Health =.��Specialist warrants that the septic tank system will continne.to�fimction satisfactorl��ut the fatnre or that the water snpply w�11 remam potable. . � � . _ , � Anthorization to Const�aet: Wastewate� Syste�t� (�red for Bn�c�ing �ermit) . * See site plan and additional attachmenLr ('LQ ). � . ��sea w�� sy�: � ,� �� .� �•�`�� Type 1� w�� r�ow �.P.a. New ✓ Repair F.Apansion So� LTAYt: .% S. g.p.dJ ft 2 Type of Facility: � R� S;' � ,� �.r,, , /� ,Pcsi�/��.�� . Basement Yes _�/�To . � �astewater System Reqairements � Size: Septic Tank: �� ga1 Pump Tank: O�v g91 CneasB Tlap: �' $al Drainfield: Total Area: �� sq $ '�otal Leugth �� ft Ma�maim Trench Depth �_ m Trench Width /•.� ft Mmimnm Soil Cover: �_ m Mi.nimum Trench Separation: S ft Distnbntion: � Disinbution Box � Serial Distdbution - Pressnre Manifold ��PP � �p �S�i. �rr�� Pi"'a�S 6�-� }� r/�J �'�'- . ' Anthorized State Agent � , i�� . � Peffiit Egpiration Date• IO � 3C - D'Z Date: /0-30-02 The type of system pemiitted i�- �� Conventional -� Innovative ✓Alternative. I accspt the specifications of the peanit OwnerlLegal Representative: Date: � . � PCHD7/30/2Q02 N. C. DepaRment of Environment and Natural Resources �� 1� I�� Division of Environmental Health INSPECTION OT �NGII\TEERED SUBSURTAC� WASTEWATER SYSTEM Iiealth Department Name of Establishment Permit/Project No. 2, t C� � ��'��u�% �i� / /:z;r-� -- �.: � �� Location Type of Establishment Design Flow r; l. ESTABLISHMENT: Type, size, and sewage flow in accordance with permit? ...................... 2. COLLECTION SYSTEM: No evidence of leaks into or out from sewer lines/manholes? ............... Free of blockages/solids buildup in lines or manholes? ........................ 3. TANKAGE (Grease Traps/Lift Stations/Septic/Dosing Tanks): Tank risers accessibie and surface water diverted? ................................ Tanks and access manholes structurally sound, watertight? .................. Sanitary tee(s) in good working condition? ........................................... Tanks pumped, cleaned out as needed? ................................................. 4. R.AW SEWAGE LIF"T STATION (if present): Required pumps present, operating, and cycling properly? ................... High-water alarm present and operating properly? ................................ Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosure!cornponents in good condition? ...................... 5. EFFLUENT DOSING SYSTEM: Effluent appears clear, free of excess solids? ......................................... PUMP SYSTEMS: Required pumps present, operating, and cycling properly? ................... High-water alarm present and operating properly? ................................ Floats/pipe/valves/disconnects in good working condition? ................. Control panel enclosure/components in good condition? ...................... Elapsed time readings: SIPHON SYSTEMS: No evidence of overflow or siphon leakage? ......................................... Siphon(s) appear to be working/alternating properly? ........................... Bells and vents free of debris and in good condition? ........................... 6. GROUND ABSORPTION FIELDS: No evidence of effluent surfacing/reaching surface waters? .................. Minimal ponding in subsurface trenches? ............................................. Surface water being effectively diverted away? ..................................... Diversions/ditches/swales/tile drains properly maintained? .................. Line cover/vegetation adequate/maintained as needed? ........................ Protected from traffic, destructive uses? ................................................ Distribution devices in good condition, working properly? .................. Repair area property reserved, maintained? ........................................... LOW-PRESSURE PIPE DRAIN FIELDS: Tumups/cteanouts/valves intact and accessible? ................................... No effluent standing in lower laterals? .................................................. Laterals free of excess solids, cleaned out as needed? ........................... Pressure head is properly adjusted? ....................................................... J.T Address Ye� l�o �' ❑ r�°'a i� / �/ ❑ ❑ �' ❑ .❑ ; ❑ �� a� — �f❑ f � ❑ Q' ❑ � ❑ � ❑ ❑ L� �❑ a� ❑ �o a° [I}� ❑ �; ❑ �' ❑ s I �� ❑ l�1 ❑ OVERALL CONDITION AND OPERATION OF SYSTEM: �(/�rrc/� ,-v, 'f �� SUMMARY OF INIPROVENIENTS NEEDED: Improvement � DATE: �� ,��%�/� T� / DEN R 3702 (Revis¢d 3�98) OmSue Wascewarcr Section (Revizw 12'98) REMARKS F� ��s' Phone Phone Repair Within (Days) SIGNED: � � - t'.z.=-=' �___ _r-�-,. -- AGENT � Division of Environmental Health — over —