NCG550439_Compliance Evaluation Inspection_20200116

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
Barbara Carter
1210 Meadow View Drive
Tobaccoville, NC 27050
NORTH CAROLINA
Environmental Quality
January 16, 2020
SUBJECT: Compliance Evaluation Inspection
Certificate of Coverage #NCG550439 — General Permit 550000
Single -Family NPDES Wastewater Treatment System
1210 Meadow View Drive Tobaccovile, NC 27050
Stokes County
Dear Ms. Carter:
On January 15, 2020, staff of the North Carolina Division of Water Resources' Winston-Salem
Regional Office (DWR) performed a compliance inspection of the single-family NPDES
wastewater treatment system located at the subject property. This compliance inspection was
conducted by DWR staff person Mr. Justin Henderson. Ms. Barbara Carter and Mr. Jimmy Carter
were present during this inspection. While inspection of the wastewater treatment system mostly
reflects compliance with Permit No. NCG550439, the following items of concern require your
attention and action:
1) While chlorine tablets were present in the chlorinator at the time of this inspection, the
Division was unable to discern if they were the appropriate grade chlorine, since they were
not stored in the original packaging. Please be aware that wastewater grade (calcium
hypochlorite) chlorine tablets shall be utilized to ensure continuous and proper disinfection
in accordance with Permit Condition Part I. Section D. (1.) (a.). Chlorine tablets should be
stored in the original packaging to clearly demonstrate compliance with this permit
condition.
2) The permittee was unsure of the last time that the septic tank was pumped out, and there
were no records available for review. Permit Condition Part I. Section D. (3.) (b.) states:
Septic tanks shall be pumped out at least once every five years or when the solids level is
found to be more than 1/3 of the liquid depth in any compartment, whichever is greater.
Permit Condition Part II. Section D. (6.) states: Records related to the Permittee's sewage
sludge use and disposal activities shall be retained for a period of at least five years.
NORTH CAROLINAD_E Q��
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North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

3) Effluent monitoring as required by Permit Condition Part I. Section C. has never been
conducted. The effluent discharge pipe was submerged at this time of this inspection and
appeared to be at an elevation would continually result in submergence. Please be aware
that modification to the outfall pipe to allow for collection of effluent prior to dilution with
the stream may be necessary to allow for effluent monitoring in accordance with Permit
Condition I. C. Also, in accordance with Permit Condition Part I D. (5.) (b.) records of
effluent monitoring results shall be retained for a minimum period of three years.
Failure to abide by the conditions contained in your permit may subject the permittee to
enforcement action by DWR in accordance with North Carolina General Statute 143-215.6A to
143-215.6C and/or revocation of this permit. A follow-up inspection, to evaluate your responses
to these items of concern, is planned to be conducted within the next 180-days.
If you have any questions concerning this letter, you may contact Mr. Justin Henderson or me at
[phone].
Sincerely,
E145Docu Siiggned by:
w. l c%mAr
B49E225C94EA...
Lon Snider, Regional Supervisor
Water Quality Regional Operation Section
Division of Water Resources, NCDEQ-WSRO
enc.: Inspection Report
cc: Laserfiche Files (electronic copies)

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN I 2 15 I 3 I NCG550439 111 12 I 20/01/15 I17
18 I S J 19 L G] 201 I
211111 1 1 I I I I II I I I I I I I I I I I I 1 I I I I
I I I I I I II I I I I I f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA
---------------------- Reserved -------------------
671
70 I I 71 I I 72 I r I
u ty
73 I I 174 751 I I I I I I I80
I I i
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES oermit Number)
09:30AM 20/01/15
19/11/18
1210 Meadow View Drive
1210 Meadow View Dr
Exit Time/Date
Permit Expiration Date
Tobaccoville NC 27050
10:30AM 20/01/15
20/10/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Barbara K Carter, 1210 Meadow View Dr Tobaccoville NC 27050///
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Other
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
DocuSigned by:
Justin L Henderson L DWR/WSRO WQ/336-776-9701/
U.SI tIA,
D51F3525961`8113496...
1/15/2020
Signature of Management Q A R cusigned by: Agency/Office/Phone and Fax Numbers
Date
L-0ti T Snac,
1/16/2020
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
NCG550439 I11 121 20/01/15 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On January 15, 2020, staff of the North Carolina Division of Water Resources' Winston-Salem
Regional Office (DWR) performed a compliance inspection of the single-family NPDES wastewater
treatment system located at the subject property. This compliance inspection was conducted by DWR
staff person Mr. Justin Henderson. Ms. Barbara Carter and Mr. Jimmy Carter were present during this
inspection. While inspection of the wastewater treatment system mostly reflects compliance with
Permit No. NCG550439, the following items of concern require your attention and action:
1) While chlorine tablets were present in the chlorinator at the time of this inspection, the Division was
unable to discern if they were the appropriate grade chlorine, since they were not stored in the original
packaging. Please be aware that wastewater grade (calcium hypochlorite) chlorine tablets shall be
utilized to ensure continuous and proper disinfection in accordance with Permit Condition Part I.
Section D. (1.) (a.). Chlorine tablets should be stored in the original packaging to clearly demonstrate
compliance with this permit condition.
2) The permittee was unsure of the last time that the septic tank was pumped out, and there were no
records available for review. Permit Condition Part I. Section D. (3.) (b.) states: Septic tanks shall be
pumped out at least once every five years or when the solids level is found to be more than 1/3 of the
liquid depth in any compartment, whichever is greater. Permit Condition Part 11. Section D. (6.) states:
Records related to the Permittee's sewage sludge use and disposal activities shall be retained for a
period of at least five years.
3) Effluent monitoring as required by Permit Condition Part I. Section C. has never been conducted.
The effluent discharge pipe was submerged at this time of this inspection and appeared to be at an
elevation would continually result in submergence. Please be aware that modification to the outfall pipe
to allow for collection of effluent prior to dilution with the stream may be necessary to allow for effluent
monitoring in accordance with Permit Condition 1. C. Also, in accordance with Permit Condition Part I
D. (5.) (b.) records of effluent monitoring results shall be retained for a minimum period of three years.
Failure to abide by the conditions contained in your permit may subject the permittee to enforcement
action by DWR in accordance with North Carolina General Statute 143-215.6A to 143-215.6C and/or
revocation of this permit.
Page#

Permit: NCG550439
Inspection Date: 01/15/2020
Other
Comment:
Owner -Facility: 1210 Meadow View Drive
Inspection Type: Compliance Evaluation
Yes No NA NE
Page#