NCG590003_Regional Office Historical File Pre 2016

j ,
CDE04R
North Carolina Department of Environmental Quality
Pat McCrory
Governor
October 1, 2015
Winston Salem/Forsyth County Utilities Division
Attn: Ron Hargrove,. Utilities Director.
P.O. Box 2511 .
Winston Salem, NC 27101
Donald R. van der Vaart
Secretary
Subject: Compliance Evaluation Inspection
NPDES Permits: NCG500669, Swann (Northwest) Water Treatment Plant
Forsyth County
, Dear Mr. Hargrove:
1. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the
Division) conducted compliance evaluation inspections (CEI) at the subject facility on September 30,
2015. The assistance and cooperation of Bill Brewer and Harry Hull was greatly appreciated. Inspection
reports are attached for your records and the inspection findings are summarized below.
General
2. The facility is located at 2800 River Ridge Road, in Winston Salem, Forsyth County, North Carolina. The
facility is authorized to discharge wastewater from the treatment works through outfall 001 to an unnamed
tributary (UT) of Bashavia Creek, which is currently classified as Class C. waters in the Yadkin Pee -Dee
River basin. The wastewater treatment system consists of one equalization basin and two settling
lagoons with a sodium bisulfite dechlorination system. The waste stream consists of backwash water
from the water treatment system's filters and sludge from the water treatment system's sedimentation
basins.
Documentation & Monitoring Review
3. All required records were readily available, complete, and current. Discharge monitoring records for 2015
were reviewed and no discrepancies were noted.
Site Review
4. Filter backwash wastewater goes to the equalization basin, then to the lagoon(s), and is then discharged.
The sedimentation basin blowdowns (sludge) go directly to the lagoons for settling and are then
discharged. Wastewater is dechlorinated using sodium bisulfate before discharge. Decanted and dried
North Carolina Division of Water Resources, Winston-Salem Regional Office
Location: 460 West Hanes Mill Road, Suite #300, Winston-Salem, North Carolina 27105
Phone: [phone] FAX: [phone] Customer Service;1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

sludge from the lagoons is land applied on site as authorized by Permit WQ0031314. The effluent flow
meter was last calibrated on 9/16/2015. The site was very clean and no discrepancies or violations were
noted.
Please encourage your operators to continue their outstanding efforts in complying with all permit
conditions. Should you have any questions, please feel free to contact Mr. Boone or me at (336) 776-
9800.
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. BIMS Inspection Reports
cc: DWI — WSR�
Central Fi es
NPDES Unit
City of Winston Salem
Swann Water Treatment Plant
Attn: Bill Brewer and Harry Hull
2800 River Ridge Road
Pfafffown, NC 27040-8600

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 1 2 15 1 3 I NCG590003 I11 12 15/09/30 17 18 LCJ 19 L S j 201 I
211 I I I I I I I I I II 11 I I I I I I I I I I I I I I I I I I I I I II I I I 1 I f6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------------- —---- Reserved---------
67 70 I_ 71 I I 72 L_l L �, � 73 LLJ74 751 I I I I I I I80
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 permit Number)
09:OOAM 15/09/30
15/02/01
P.W. Swann WTP
River Ridge Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27103
10:OOAM 15/09/30
19/07/31
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
James F Crump,2801 Griffith Rd Winston Salem NC 271036417//336-765-0165/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of Harrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
1i
Ron Boone WSRO WQ//336=776-9690/
! J
r y
•` b
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

t*
NPDES yr/mo/day Inspection Type 1
31 NCG590003 I11 121 15/09/30 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page# 2

Permit: NCG590003 Owner -Facility: P.W. Swann WTP
Inspection Date: 09/30/2015 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
❑
❑
M
❑
# Are there any special conditions for the permit?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
M
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: None
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
0
❑
❑
❑
Is all required information readily available, complete and current?
M
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
0
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
0
❑
❑
❑
Is the chain -of -custody complete?
0
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
M
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
0
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
M
❑
on each shift?
Is the ORC visitation log available and current?
M
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
0
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
M
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
0
❑
Comment: None
Flow Measurement - Effluent Yes No NA NE
# Is flow meter used for reporting? M ❑ ❑ ❑
Is flow meter calibrated annually? 0 ❑ ❑ ❑
Page# 3

I
Permit: NCG590003
Inspection Date: 09/30/2015
Flow Measurement - Effluent
Owner - Facility: P-W- Swann WrP
Inspection Type: Compliance Evaluation
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: None
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: None
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ ■ ❑
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ■ ❑
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ ■ ❑
Page# 4

�®
I� CDEN
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Regional Operations
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
October 27, 2014
Winston Salem/Forsyth County Utilities Division
Attn: Ron Hargrove, Utilities Director
P.O. Box 2511 -
Winston Salem, NC 27101
Subject: Compliance Evaluation Inspections _
N P D E S Permits: CE....'�Q,8�6762;Swanrr(Nortfiwest) WaterTreatmenf Plant:`
N00086011, Neilson Water Treatment Plant
NC0079821, RA Thomas Water Treatment Plant
Forsyth County
Dear Mr. Hargrove:
1. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the
Division) conducted compliance evaluation inspections (CEI) at the subject facilities on October 23,_
2014. The assistance and cooperation of Bill Brewer and Kenneth Atkins was greatly appreciated.
Inspection reports are attached for your records and the inspection findings are summarized below.
N00086762, SWANN (NORTHWEST) WATER TREATMENT PLANT
General
2. The facility is located at 2800 River Ridge Road, in Winston Salem, Forsyth County, North Carolina.
The facility is authorized to discharge wastewater from the treatment works through outfall 001 to an
unnamed tributary (UT) of Bashavia Creek, which is currently classified as Class C waters in the
Yadkin Pee -Dee River basin. The wastewater treatment system consists of one equalization basin and
two settling lagoons with a sodium bisulfite dechlorination system. The waste stream consists of
backwash water from the water treatment system's filters and sludge from the water treatment system's
sedimentation basins.
Documentation & Monitoring Review
3. All required records were readily available, complete, and current.. Discharge monitoring records for
2013 and 2014 were reviewed and no discrepancies were noted.
North Carolina Division of Water Resources, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service;1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

Site Review
4. Filter backwash wastewater goes to the equalization basin, then to the lagoon(s), and is then
discharged. The sedimentation basin blowdowns (sludge) go directly to the lagoons for settling and are
then discharged. Wastewater is dechlorinated using sodium bisulfate before discharge. Decanted and
dried sludge from the lagoons is land applied on site as authorized by Permit WQ0031314. The effluent
flow meter was calibrated on 10/21/2014. The site was very clean and no discrepancies or violations
were noted.
NC0086011, NEILSON WATER TREATMENT PLANT
General
5. The facility is located at 5725 Frye Bridge Road, in Winston Salem, Forsyth County, North Carolina.
The facility is authorized to discharge wastewater from the treatment works through outfall 001 to an
unnamed tributary (UT). of Muddy Creek, this section of which is currently classified as Class C waters
in the Yadkin Pee -Dee River• basin. However, the wastewater treatment system does NOT discharge.
All wastewater is recycled through two wastewater treatment lagoons and one of the raw water
reservoirs. The wastewater is then treated through the potable water treatment system. The waste
stream consists of backwash water from the water treatment system's filters and sludge from the water
treatment system's sedimentation basins.
Documentation & Monitoring Review
6. All required records were readily available, complete, and current. There are no DMRs for review. The
plant currently has a waiver from submitting monthly DMRs because the plant recycles all wastewater_
and there is no discharge. The waiver is in effect until the plant begins discharging again.
Site Review
7. Filter backwash wastewater is pumped to the easternmost raw water reservoir. Sedimentation basin
blowdowns (sludge) go to one of three waste lagoons and decant from that sludge is then also pumped
to the easternmost raw water reservoir. All wastewater is recycled through this process and then'back
through the potable water treatment system. As stated above, there is currently no discharge from the
waste treatment system. Decanted and dried sludge from the waste lagoons is land disposed on the
"Cooper, Road Disposal Site", which is located a few miles from the water treatment plant.
The site was very clean and no discrepancies or violations were noted.
NC0079821, RA THOMAS WATER TREATMENT PLANT
General

8. All required records were readily available, complete, and current. Discharge, monitoring reports for
2013 and 2014 were reviewed and no discrepancies were noted.
Site Review
9. Filter backwash wastewater goes directly to the equalization basin, then to the clarifier. The treated
effluent from the clarifier goes to a flume where it is measured and discharged. The sludge from the
clarifier goes to the waste lagoons. Sedimentation basin blowdowns (sludge) go directly to the waste
lagoons. Decant from the waste lagoons goes to the equalization basin, then to the clarifier. The
effluent flow meter was calibrated on 9/23/2014.
10. Please encourage your operators to continue their outstanding efforts in complying with all permit
conditions. Should you have any questions, please feel free to contact Mr. Boone or me at (336) 771-
5000.
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. BIMS Inspection Reports
cc: SWP � WSRO-
Central Files
NPDES Unit
City of Winston Salem
Swann Water Treatment Plant
Attn: Bill Brewer
2800 River Ridge Road
Pfafftown, NC 27040-8600

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 FacType
1 IN ' 2 IF I 3 I NCO086762 I11 121 14/10/23 I17 18,1 c I 19 I c I 201
211 I I I I I I I I I 11 I I I I I I I l i i i i i i 1-1 I I I I I I I 11 I I 1 1 1 f6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----------Reserved-------
67 170 I I 71 itI I 72 I N I 731 I I 174 75I I I I I I I 1,80
LJ 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 permit Number)
08:00AM 14/10/23
12/03/01
P.W. Swann WTP
River Ridge Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27103
09:30AM 14/10/23
14/01/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Harry E Hull/ORC/336-945-1179/.
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Bill Brewer,2800 River Rdg Rd Pfafftown NC 270408435//336-945-1179/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
® Permit ® Flow Measurement ® Operations & Maintenance ® Records/Reports
® Self -Monitoring Program ® Sludge Handling Disposal ® Facility Site Review ® Effluent/Receiving Waters
® Laboratory
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
Ron Boone WSRO WQ//336-771-4967/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
7Z)
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NC0066762 I1 12114/10/23 17 18 I
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

Permit: NCO086162 Owner - Facility: P.W. Swann VVI-P
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
I
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
®
❑
application?
Is the facility as described in the permit?
X
❑
❑
❑
# Are there any special conditions for the permit?
❑
®
❑
❑
Is access to the plant site restricted to the general public?
®
❑
❑
❑
Is the inspector granted access to all areas for inspection?
M
❑
❑
❑
Comment: None
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
®
❑
❑
❑
Is all, required information readily available, complete and current?
11
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
®
❑
❑
❑
Are analytical results consistent with data reported on DM Rs?
3
❑
❑
❑
Is the chain -of -custody complete?
It
❑
❑
❑
Dates, times and location of sampling
®
-
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
®
-
Transported COCs
Are DMRs complete: do they include all permit parameters?
®
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ? _
❑
❑
®,
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 2417 with a certified operator
®.
❑
❑.
❑
on each shift?
Is the ORC visitation log available and current?
IN
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
®'
❑
❑
❑
Is the backup operator certified .at one grade less or greater than the facility classification?
®
❑
❑
❑
' Is a copy of the current NPDES permit available on site?
®
❑
❑
❑ -
Facility has copy of previous year's Annual Report on file for review?
❑
❑
S
❑
Comment: None
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ® ❑ ❑ ❑
Are all other parameters(excluding field parameters) performed by a certified lab? ® ❑ ❑ ❑
Page# 3

Permit: NCO086762 Owner -Facility: P.W. Swann WTP
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
Laboratory
Yes No NA NE
# Is the facility using a contract lab?
®
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
❑
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑
❑
®
❑
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
❑
❑
IN
❑
Comment: None
Effluent Sampling
Yes No NA NE
Is composite sampling flow proportional?
❑
❑
®
❑
Is sample collected below all treatment units?
®
❑
❑
❑
Is proper volume collected?
®
❑
❑
❑
Is the tubing clean? -
❑
❑
®
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
®
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
®
❑
❑
❑
representative)?
Comment: None
De -chlorination
Yes No NA NE
Type of system ?
Liquid
Is the feed ratio proportional to chlorine amount (1 to 1)?
❑
❑
❑
Is storage appropriate for cylinders?
❑
❑
®
❑
# Is de -chlorination substance stored away from chlorine containers?
®
❑
❑
❑
Are the tablets the proper size and type?
❑
❑
®
❑
Comment: None
Are tablet de -chlorinators operational? ❑ . ❑ ® ❑
Number of tubes in use?
Comment: System is liquid Sodium Bisulfite.
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
®
❑
❑
❑
Is flow meter calibrated annually?
®
❑
❑
❑
Is the flow meter operational?
®
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
®
❑
Page# 4

Permit: NCO086762 Owner - Facility: P.W. Swann WTP
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
Flow Measurement - Effluent Yes No NA NE
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? M ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? N ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ 99 ❑
Comment: None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? M ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable 9 ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Page# 5

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires B-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Cade NPDES yr/mo/day Inspection Type Inspector Fac Type
1 2 IF I 3 NCoossoll I11 12 14/10/23 17 18 I I 19 L S j 201 I
2111IIIIIIIIII1IIIIIIIIIIIIII11111111IIIIIII f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ----------=-Reserved-------
67
71 I I 72 L, � 731. I 174 75I III I 11 180
70 ILj it LJ
Section B: FacilityData
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:OOAM 14/10/23
09/09/01
Neilson WTP
5725 Frye Bridge Rd
Exit Time/Date
Permit Expiration Date
Clemmons NC 27012
11:OOAM 14/10/23
14/06/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Rodney Clark Darr/ORC/336-766-9885/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
-
Thomas David Johnson,PO Box 2511 Winston Salem NC 271079998//336-766-4272/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
IN Permit ® Flow Measurement IN Operations & Maintenance ,® Records/Reports
® Self -Monitoring Program Sludge Handling Disposal ® Facility Site Review ® Effluent/Receiving Waters
IN Laboratory
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
Ron Boone WSRO WQ//336-771-4967/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
P
.. e�L'p,— -'
EPA.Form 3560-Aev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCO086011 I11 12 14/10/23 17 18 ]
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

Permit: NCO086011 Owner -Facility: Neilson WTP
inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
®
❑
application?
Is the facility as described in the permit?
W
❑
❑
❑
# Are there any special conditions for the permit?
❑
®
❑
❑
Is access to the plant site restricted to the general public?
FA
❑
_❑
❑
Is the inspector granted access to all areas for inspection?
®
❑
❑
❑
Comment: None
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
®
❑
❑
❑
Is all required information readily available, complete and current? .
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
®
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
®
❑ .
Is the chain -of -custody complete?
❑
❑
®
❑
Dates, times and location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
IN
❑
(if the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified. operator
❑
❑
❑
11
on each shift?
Is the ORC visitation log available and current?
M
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?.
®
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
®
❑
❑
❑
Is a copy of the current NPDES permit available on site?
®
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
®
❑
Comment: Facility does not discharge. All wastewater is recycled.
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ❑ ❑ ® ❑
Are all other parameters(excluding field parameters) performed by a certified lab? ❑ ❑ ® ❑
Page# 3

Permit: NCO086011 Owner - Facility: Neilson wTP
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
LaboratoU
Yes No NA NE
# Is the facility using a contract lab?
❑
❑
®
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
®
❑
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑
❑
9
❑
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
❑
❑
W
❑
Comment: Facility does not discharge. All wastewater is recycled.
Effluent Sampling
Yes No NA NE
Is composite sampling flow proportional?
❑
❑
M
❑
Is sample collected below all treatment units?
❑
❑
0
❑
Is proper volume collected?
❑
❑
®
❑
Is the tubing clean?
❑
❑
®
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
®
❑
Celsius)?
Is the facility sampling performed as required' by the permit (frequency, sampling type
❑
❑
®
❑
representative)?
Comment: Facility does not discharge. All wastewater is recycled.
(Flow Measurement- Effluent
Yes No NA NE
# Is flow meter used for reporting?
❑
❑
®
❑
Is flow meter calibrated annually?
❑
❑
A
❑
Is the flow meter operational?
❑
❑
®
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
®
❑
Comment: Facility does not discharge. All wastewater is recycled.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? ® ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? R ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ ® ❑
Comment: None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? A ❑ ❑ ❑
Page# 4

Permit: NCO086011
Inspection Date: 10/23/2014
Operations & Maintenance
Owner - Facility: Neilson WTP
Inspection Type: Compliance Evaluation
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Yes No NA NE
■ ■ ■
Page#

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C.20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires B-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day - Inspection Type Inspector Fac Type
1 IN 1 2 15 I 3 1 NCO079821 111 121 14/10/23 117 181, 1 19 Lj 201 I
211111111111111111111111111111111 IIIIIIIIIII r6
I
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA -- --Reserved------ - --
67
72 L�J 73I 4 751 11 1 1 I
70LJ 71 ilJ
80
Section B: FacilityData
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date_
POTW name and NPDES permit Number)
11:00AM 14/10/23
09/09/01
RA Thomas WTP
1201 Martin Luther King J
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27107
12:OOPM 14/10/23
14/06/30
Name(s) of Onsite Representative(s)/Tities(s)/Phone and Fax Number(s)
Other Facility Data
Kenneth Craig Atkins/ORC/336-784-7597/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Edward Nathaniel Davis, PO Box 2511 Winston Salem NC 271079998//336-784-7597/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
® Permit ® Flow Measurement Operations & Maintenance IN Records/Reports
® Self -Monitoring Program Sludge Handling Disposal Facility Site Review ® Effluent/Receiving Waters
® Laboratory
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
Ron Boone WSRO WQ//336-771-4967/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
V
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type 1
31 NCO079821 I11 12 14/10/23 17 18 I s
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

Permit: NCO079821 Owner - Facility: RA Thomas WTP
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
®
❑
application?
Is the facility as described in the permit?
®
❑
❑
❑
# Are there any special conditions for the permit?
❑
®
❑
❑
Is access to the plant site restricted to the general public?
®
❑
❑
❑
Is the inspector granted access to all areas for inspection?
®
❑
❑
❑
Comment: None
Laboratory
Yes No NA NE
Are field parameters performed by certified personnel or laboratory?
IN
❑
❑
❑
Are all other parameters(excluding field parameters) performed by a certified lab?
9
❑
❑
❑
# Is the facility using a contract lab?
®
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
❑
Celsius)?
Incubator -(Fecal Coliform) set to 44:5 degrees Celsius+/- 0.2 degrees?
❑
❑
®
❑
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
❑
❑
A
El
Comment: None
Effluent Sampling
Yes No NA NE
Is composite sampling flow proportional?
❑
❑
N
❑
Is sample collected below all treatment units?
®
❑
❑
❑
Is proper volume collected?
®
❑
❑
❑
Is the tubing clean?
❑
❑
®
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
®
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
®
❑
❑
❑
representative)?
Comment: None
Record Keepinq
Yes No NA NE
Are records kept and maintained as required by the permit?
9
❑
❑
❑
Is all required information readily available, complete and current?
®
❑
, ❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
N
❑
❑
❑
Are analytical results consistent with data reported on DM Rs?
®
❑
❑
❑
Page# 3

Permit: NCO079821
Inspection Date: 10/23/2014
Owner - Facility: RA Thomas WiP
Inspection Type: Compliance Evaluation
Record Keeping
Yes No NA NE
Is the chain -of -custody complete?
M
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
FA
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
®
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
®
❑
❑
❑
on each shift?
Is the ORC visitation log available and current?
®
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
W
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
01
❑
❑
❑
Is a copy of the current NPDES permit available on site?
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
IN
❑
Comment: None
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
®
❑
❑
❑
Is flow meter calibrated annually?
NN
❑
❑
❑
Is the flow meter operational?
®
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
IN
❑
Comment: None
De -chlorination
Yes No NA NE
Type of system ?
Liquid
Is the feed ratio proportional to chlorine amount (1 to 1)?
❑
❑
❑
09
Is storage appropriate for cylinders?
❑
❑
®
❑
# Is de -chlorination substance stored away from chlorine containers?
M
❑
❑
❑
Are the tablets the proper size and type?
❑
❑
®
❑
Comment: None
Are tablet de -chlorinators operational? ❑ ❑ M ❑
Page# 4

Permit: NCO079821 Owner - Facility: RA Thomas WTP
Inspection Date: 10/23/2014 Inspection Type: Compliance Evaluation
De -chlorination Yes No NA NE
Number of tubes in use?,
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? ® ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? M ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ N ❑
Comment: None
Operations & Maintenance- Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ® ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ® ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Page# 5

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and ihd.ORCaSse 15ANZ,AC'08G.6204�hdr�il�ig,to do"so,can resulfin.Disciplinary
A,ctions,byjhd Water 61bution Cbtitrtjl,,�'Syst�rifppOratprs,lpertificatidn,CoiTiinil' 'on."-
......... .................... .. . .... ............
Bacic-uo OpeirAtok'Ift ResponsibkChtge_(BU.- ORC);
Fiirft Vufl Nanf&.':
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rifles,4fid tcg*ulation§.,p artniffffig, to,Ahq� responsibilities -of the BU: 01W a]� kt.'%fth in I'SANC-At, 08G.'0203,and"Mil 44�'& so,orf - re , s , u i t in
D_ isciplmary Actfons;bythe ,Water ',P611tiiwn,Control System Operatorstefti catto'n-itomm ission
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Fayetteville
�iooresYille,.
Riddlig&,
-2090.Us*%V06
225Preen.St
66 EXenter Ave
31846. Barrett Er
Swahn-an66128778
Suite-7f',4
,
Raleigh
-
I iIle #j6f404j,
Mopre'syillq�281 i�s�
Fax:OA57.f.41 It,
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�Ubfic:92k'296.4500
,8 A 07,
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h ne: M791.4200
P h 0 %10.433.33Q0
Mhdi704.663.16,99
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Fddlity'Narne::
. ........... ............. ?.., .......................... I ........... .......... ............................... .........................
Wck-U,p:Operator i' R n e po�jba gle Ch r-- qie (")3U QRCj
Print Full Name:.
Sigtiatfim C__ Date:: 'I IS tk'j-
'.Tce&*, that I agree-to-r!iy,designati,on,as<a,B'Ac'k'-up-
Operator in Responsible Charge for the Facility. noted. l rs_t4nA.an8,,,wilI ay-ide by the,
rules and -rc&lhiiorfs,o-crtainingto,th-d.rdsponsibilities-of the BUORC as sctfoklfift I-5ANCAC 086.0205 and -failing to do so can result in
Disc! A�ctiof&by,�thq Wa . tbrTol lutiqn.Contr6l;S�srcrn Oifefator�,C��i-icati6n-Cbnimissibn.'� .I OJIM6 ­ I., 1—. 1­1 ­,­­ I. -I .. .1 . I- � . -
]U,O=Uo ®peril
Prifit,FUIIN'Ani&,�,
Signature:
Z Grad _- W M�mbor,48
-'
qrI �honle#:
-Date:
v
111:ccffi fV that I a'a- ­­ designation _B_ k- ' '0"'- Operator -in Rcs06hsible_Chft6. for the lbn&rst'�iid-a� will;abide h'
grectoipy..esign , as,a7 ac -up pera. nd yt c,
Ftiles,and-regu]4tibns.portai6ingt6qhe rqi't, ppq;jsi4iljtiOs;qPthe,BQ. ORC'as: set forth inwl 5A,M�'AC 09G .;0205- and, titiling;to.46 s
Disciplinary AetionsU�the� , onr'61, Sysitern. OP'e iator'stcrtl t1c6i'to"n Commission:"
"Wkerli6ilut
................ i ...................... ..............................................
Back -Up Operator irr ResP'qnsi-bl C44 r e,,(�U ORC
Pritit Fufl'Name:�
C tJ t t I fic ate .-Ty p & /'G ra d i2U-Nuffi b&-" Work"Phond.;#:
Signature:
Date:
I'certify thdlqgNc3q my: dqigpadon zs.a-,'Back-up'Qpprstmin, Responsible, Charge for the fhcil ity. noted, f.unde-rstand,and ,.viifabidc,'bythe
'rL p I s A Ok6as'sct ' 'I ",
es�ah,df6gulatio-n--s.,�il�iihing�6'tfiere�p'o'n�ib.'Iiiid"bfth6 'U NC,.CO86.0205'and..faiing.todo.so.eanresut,in
Disciplinary;Actions bythe Water PiAlution'Conp! 5ystern Operator qqrtificali" Q
....... . ... . . . . . . . . . . . ............. . ... . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m . . . . . . . . . . . ...................................
WckVp bperpior in Resnonsible Charge-OU, ORQ�
Print Fiji! Name:,
f&ffificaieTyel 0 'IGia& / Nifinbev- Work Phdil e'#:
Signature: Date:
."I certify that I agree to*rnydesignpliomas a:ij'ack,-up,()p,crator.',in,Resp-citisible Chatge.for,il-h-c-ticil'ity,noted..1 wddrstand and 'M Abide,by'the
' ' - I ''responsibilities
I - � I - I- . I I ' k
es an regu ations - " - to the rules d 0- " pertitining, responsi6i]]�ties'oti�e,b(J'"'Oi�it'a's' set lb�h in I 5ANC 020 and failing to.do so.can result in,
P isfeip, initry, Actipns'by the Watdr;P.0ll(ttion'POriRq I S)i5timi 0 erat&i-s,4;!ertificatib6-Cohiniis§ioii..!'
.............. . ..... ....................................... i ; .......... 1 ................. ............ :4 ........... ......
RevM03- , 2014