Form 1-1 Operational Checklist: System description (SD)

(This form is used for the initial system evaluation for the facility and the site. It should be kept on file, and a copy should accompany the service provider at each O&M service visit. Any changes to the system facility should be recorded on the form, along ith the date the change as noted.!

A. Client Contact Information

Name of owner: Phone: Cell: Site address/County: Mailin address/County !if different": #irections to site: System ref. #: T: R: Sec: E-mail: No.:

. System Doc!mentation A"aila#le !$f no documentation% fill out Section #."

#ate installed: $nstaller: Phone: E-mail: #esi ner: Phone: E-mail: Pre)ious ser)ice *ro)ider: Phone: E-mail: #esi n flow: Cell: &icense #: 'a(: &icense #: 'a(: &icense #: 'a(:

Cell:

Cell: +al *er day

C. Operational Checklists
Identify operational checklists for components included in system. "umber the components of the treatment train in order in the spaces provided after the titles. Form $.1 Site Assessment on 'ile. ,es No

%anks and ad"anced treatment component operational checklists (Chapters &' ( and )): Pum*: #emand-#osed system: Pum*: Timer-#osed system: /oldin tan0: Se*tic/trash/*rocessin !tan0": Pum* tan0!s": -ero.ic treatment unit: Constructed wetland: &a oon: #isinfection unit 1chlorine: #isinfection unit 1ultra)iolet li ht:

Media filter:

#isinfection unit 1o2one:

System ref. #: Final treatment and dispersal component operational checklists (Chapter *): +ra)ity #istri.ution: #ri* field: E)a*otrans*iration .ed: Mound system: 4ottomless sand filter: &ow-*ressure drainfield: S*ray field: 3utfalls: 4ottomless *eat filter:

D. +o System Doc!mentation A"aila#le

#omplete the remaining information if it is not available in the permit or as$built dra ings. Facility Details 5. Num.er of .edrooms: 6. S7uare foota e of facility: s7 ft 8. Num.er of current occu*ants: 9. #esi n flow: *d :. #esi n stren th: ;;;;;;;;;;; 43# !m /&" ;;;;;;;;;;;;TSS !m /&" ;;;;;;;;;;; '3+ !m /&" <. =ater su**ly: Pri)ate water su**ly >. Pu.lic water su**ly =ater source !if *ri)ate su**ly": +roundwater well: ft S*rin : Surface water !i.e. cree0% la0e% etc.": +ar.a e dis*osal *resent. -re any water softener or water treatment chemicals used. Softener .ac0wash drains to system: &ateral distance to water su**ly

ft ft ,es ,es ,es ,es ,es No No No No No

?. @.

Softener .ac0wash does not drain to system: 5A. /as facility .een remodeled since ori inal construction. System Details 1. Site a. &andsca*e *osition: .. #raina e: Surface/ ra)ity c. Monitorin well *resent. ,. -retreatment components - %anks a. /oldin tan0 5" Ca*acity: 6" Material: Concrete i" Manufacturer: 8" -ccess to surface. 9" &ocation !+$S": .. Se*tic tan0 /Trash tan0

Su.surface/ ra)ity

Su.surface/*um* ,es No

al 'i.er lass Plastic 3ther ,es No /

5" Ca*acity !total": i" Com*artmented. ii" Ca*acities for com*artmented system: 6" Material: Concrete 'i.er lass i" Manufacturer: 8" -ccess to surface. 9" &ocation !+$S": :" Effluent screen. i" Manufacturer: c.

al 5" Plastic 3ther System ref. #: ,es ,es Model: No / No ,es No al 6" al

'low e7uali2ation tan0 !sur e% etc." 5" Ca*acity: 6" Material: Concrete 'i.er lass Plastic 8" -ccess to surface. 9" &ocation !+$S": :" Pum* tan0: i" Manufacturer: <" Pum*: i" Manufacturer: >" Pum* o*eratin condition i" #ischar e Rate: ii" 3*eratin Pressure: ?" Control method i" Sensors: 'loats Pressure transducer ii" #escri*tion: @" Pum* dose settin s i" 're7uency ii" $nter)al iii" Colume 5A" Control *anel i" Manufacturer: 55" Electrical i" Se*arate circuits !*um*% alarm". ii" 4rea0er si2e: 56" -larm i" Manufacturer: ii" Sensors: 'loats Pressure transducer iii" #escri*tion: #osin *um* tan0 5" Ca*acity: 6" Material: Concrete 8" -ccess to surface. 9" &ocation !+$S": :" #osin tan0: i" Manufacturer: <" Pum*: i" Manufacturer: >" Pum* o*eratin condition i" #ischar e Rate: ii" /ead:

al/in ,es No / N.-. N.-. Model: /P: al/min ft Bltrasonic 3ther

;;;;;;;;; doses/day ;;;;;;;;; sec/dose ;;;;;;;;;; al/dose Model: ,es No

Bltrasonic

3ther

d.

al/in 'i.er lass Plastic ,es No / N.-. N.-. Model: /P: al/min ft

?" Control method i" Sensors: ii" #escri*tion: @" Pum* dose settin s i" 're7uency: ;;;;;;; doses/day

'loats

Pressure transducer

Bltrasonic

3ther

System ref. #: ii" $nter)al: iii" Colume: 5A" Panel for sensors i" Manufacturer: 55" Electrical i" Se*arate circuits !*um*% alarm". ii" 4rea0er si2e: 56" -larm i" Manufacturer: ii" Sensors: 'loats Pressure transducer iii" #escri*tion: .. -retreatment components / ad"anced a. -ero.ic treatment unit !-TB" 5" Treatment method: Sus*ended rowth -ttached rowth Com.ination attached/sus*ended rowth 3ther: 6" Ca*acity: 8" Material: Concrete 'i.er lass i" Manufacturer: ii" Product serial #: 9" -ccess to surface. :" &ocation !+$S": <" Effluent screen / Tertiary filter i" Manufacturer: >" -ir su**ly i" -ir su**ly method: -s*irator ii" Manufacturer: ?" Slud e return method: .. Sin le *ass filter 5" Media: Sand +lass i" Media de*th: ii" &iner material: 6" 'ilter si2e: i" #imensions: ii" -ccessi.ility: 4uried iii" Co)er material: i)" &id insulated. 8" #istri.ution method: Pressure i" Pi*e diameter: ;;;;;;;;; sec/dose ;;;;;;;;; al/dose Model: ,es No

Bltrasonic

3ther

Rotatin 4iolo ical Contactor Se7uencin 4atch Reactor *d Plastic Model #: ,es No / N.-.

Com*ressor

4lower Model #:

'ree -ir

'oam

Peat

3ther: in ft ( s7 ft ft

'ree -ccess

Co)ered ,es No in

+ra)ity

3rifice S*ray no22le 3ther: 3rifice orientation: iii" 'low control diameter: i)" Num.er of flow controls !orifices% no22les% etc.": )" S7uirt hei ht/3*eratin Pressure: )i" Clean outs/$ns*ection *orts: Num.er )ii" Clean out access to surface. 9" 'iltrate collection system:

ii" 'low control:

in in ,es ,es No No

System ref. #: c. Recirculatin 'ilter 5" Media: Sand

+ra)el

Polystyrene

4ottom -sh

'oam

Te(tile in s7 ft ft

6"

8"

9" :" d.

3ther: i" Media de*th: ii" &iner material: iii" Recirculation method: 'ilter si2e: i" #imensions: ii" -ccessi.ility: 4uried 'ree -ccess iii" Co)er material: i)" &id insulated. #istri.ution method i" Pi*e diameter: ii" 'low control: 3rifice S*ray no22le 3ther: 3rifice *osition: iii" 'low control diameter: i)" Num.er of flow controls !orifices% no22les% etc.": )" S7uirt hei ht/3*eratin head: )i" Clean outs/$ns*ection *orts: Num.er )ii" Clean out access to surface. 'iltrate collection system: 'orced aeration: i" #escri*tion:

ft (

,es

No in

in in ,es ,es No No N.-.

Tric0lin filter 5" Media: +ra)el 'oam Te(tile Plastic 3ther: i" Media de*th: ii" &iner material: 6" 'ilter si2e: i" #imensions: 8" #istri.ution method i" Pi*e diameter: ii" 'low control: 3rifice S*ray no22le 3ther: 3rifice *osition: iii" 'low control diameter: i)" Num.er of flow controls !orifices% no22les% etc.": )" S7uirt hei ht/3*eratin Pressure: )i" Clean outs/$ns*ection *orts: Num.er )ii" Clean out access to surface. 9" 'iltrate collection system: :" 'orced aeration: i" #escri*tion: Constructed wetland 5" 4ed media: None i" Num.er of cells: ii" Media de*th: iii" =ater de*th: i)" &iner material: )" 4order material: 6" Si2e:

in ft ( s7 ft ft in

in in ,es ,es No No N.-.

e.

+ra)el

3ther: in in s7 ft

i"

#imensions: System ref. #:

ft (

ft

ii" &en th to width ratio: 8" #istri.ution method i" Pi*e diameter: ii" 'low control: 3rifice S*ray no22le 3ther: 3rifice *osition: iii" 'low control diameter: i)" Num.er of flow controls !orifices% no22les% etc.": )" S7uirt hei ht/3*eratin Pressure: )i" Clean outs/$ns*ection *orts: Num.er )ii" Clean out access to surface. 9" Surface loadin rate: :" 'iltrate collection system: <" Monitorin location: >" Ce etation: i" #escri*tion: ?" =ater le)el control: i" #escri*tion: f. &a oon system 5" Ty*e: -ero.ic 'acultati)e i" =ater de*th: ii" &iner material: 6" &a oon si2e: i" #imensions: ii" &en th to width ratio: 8" $nlet to la oon i" Pi*e descri*tion: ii" Pi*e diameter: iii" Clean outs. 9" Surface loadin rate: :" Monitorin location: <" Ce etation: i" #escri*tion: >" =ater le)el control: i" #escri*tion:

: in

in ,es ,es in No No *d/s7 ft N.-. N.-.

Partial-mi(ed aerated

-naero.ic ft ft ( : s7 ft ft

,es

in No *d/s7 ft N.-. N.-.

. #isinfection unit 5" Chlorine 1 ta.let i" Manufacturer: 6" Chorine 1 li7uid i" Manufacturer: 8" Bltra)iolet li ht i" Manufacturer: 9" 32one i" Manufacturer: :" 3ther: <" #isinfection monitorin location: >" #echlorination i" Ty*e: ii" Manufacturer: ?" #echlorination monitorin location:

Model: Model: Model: Model:

Model:

System ref. #: $. Final treatment and dispersal a. +ra)ity distri.ution 5" Ty*e: Trench 4ed i" $f lined ET .ed% descri.e liner material: 6" #istri.ution method: +ra)ity-to- ra)ity 8" Confi uration: Parallel

ET .ed Pum*-to- ra)ity Serial Si*hon-to- ra)ity Se7uential Ste*down

9" #istri.ution a**roach: #istri.ution .o( Solid header *i*e #ro* .o( :" #istri.ution media i" Material: +ra)elless Multi-*i*e Cham.er =ashed roc0 .. Pressure 5" &ow-*ressure drainfield i" &e)el. ii" Num.er of 2ones: a" Switchin method: Polystyrene 3ther:

,es /ydraulic )al)es Se*arate *um*s

No

6"

8"

3ther: iii" #istri.ution method a" Pi*e diameter: ." 3rifice diameter: c" 3rifice orientation: d" Num.er of orifices: e" S7uirt hei ht/3*eratin head: f" Clean outs/$ns*ection *orts: Num.er " Clean out access to surface. i)" Num.er of trenches/.eds: )" #imensions of trenches/.eds: Pressure mound distri.ution i" #istri.ution method: Trench 4ed 3ther: a" Pi*e diameter: ." 3rifice diameter: c" Num.er of orifices: d" S7uirt hei ht/3*eratin head: e" Clean outs/$ns*ection *orts: Num.er f" Clean out access to surface. ii" Num.er of trenches/.eds: iii" #imensions of trenches/.eds: #ri* distri.ution i" #istri.ution field: Surface Su.surface ii" #ri* tu.in manufacturer: Model: iii" 'iltration: Screen #is0 Sand Manufacturer: Model: i)" 'ilter cleanin : -utomated Manual/Continuous flush )" Num.er of 2ones: a" $f multi*le% switchin de)ice: ." Done area!s": s7 ft s7 ft

in in in ,es ,es No No ft ( ft

in in in ,es ,es No No ft ( ft

s7 ft

)i" 'ield flushin : -utomated )ii" -ir release/Cacuum .rea0er: a" Manufacturer:

Continuous Model:

Manual N.-.

System ref. #: )iii" $ns*ection *orts. a" &ocations: 9" S*ray field i" Num.er of 2ones: a" $f multi*le% switchin de)ice: ii" #istri.ution heads *er 2one: a" Manufacturer: ." Pattern!s": iii" $n-line filtration: None Screen a" Manufacturer: i)" Total area of s*ray distri.ution fields: )" +au in #e)ice: :" Surface dischar e i" Permit num.er: ii" Permit re7uirements: iii" &ocation: i)" Monitorin location: ,es No

Model!s": #is0 Sand Model: s7 ft

System ref. #: 0. Sketch of system

Scale 5 in E ;;;;;;; ft