NCG550181_Compliance Evaluation Inspection_20201230

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANI£L SMITH
Director
Charles Tillotson
2117 Bethlehem Church Road
Eden, NC 27288
NORTH CAROLINA
Environmental Quality
December 29, 2020
Subject: General Wastewater Permit Inspection
2117 Bethlehem Church Road
Certificate of Coverage # NCG550181
Rockingham County
Dear Mr. Tillotson:
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation
Inspection on the wastewater treatment system at 2117 Bethlehem Church Road, Eden,
NC. Observations indicated that the subsurface sand filter was operating properly. There
was no evidence of a discharge during the inspection. Please note some of the activities
that must be conducted and documented, in addition to the laboratory analyses required if
the system discharges:
Please be aware that the Permit requires that the septic tank contents be pumped
out every five years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate
supply of tablets for continuous operation. Be sure to order more tablets and
replace them often enough to ensure continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at (336)
776-9694.
Sincerely,
Docusigned by:
"_ "T .5-.1-
on5 hIder, Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
cc: Laserfiche
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North Carolina Department of Environmental Quality 1 Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 1 Winston-Salem, North Carolina 27105
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cewnme��ar Emnonma�� nuai� �� 336,776,9800

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 NCG550181 I11 121 20/11/03 I17 18 n 19 L G j 201
2111111�-1111111111111111111111111111111111111 f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 CA ---------------------- Reserved -------------------
67
I 71 I I 72 L n, � 73 LLI74 71 I I I I I I I80
70 Iu ty LJ
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)
10:OOAM 20/11/03
19/02/18
2117 Bethlehem Church Road
2117 Bethlehem Church Rd
Exit Time/Date
Permit Expiration Date
Eden NC 27288
10:15AM 20/11/03
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
Charles B Tillotson,2117 Bethlehem Church Rd Reidsville NC 27320//336-635-9256/
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
Gary Hudson DWR/Division of Water Quality/336-776-9694/
Signature of Management Q A Reviewer Numbers Date
Agency/Office/Phone and FaxED-
ocuSigned by:
—r Stiidu 12/29/2020
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
31 NCG550181 I11 12I 20/11/03 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
OnOn November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection or
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
Page#

Permit: NCG550181
Inspection Date: 11/03/2020
Owner - Facility: 2117 Bethlehem Church Road
Inspection Type: Compliance Evaluation
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets andreplace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
Page#

Permit: NCG550181
Inspection Date: 11/03/2020
Owner - Facility: 2117 Bethlehem Church Road
Inspection Type: Compliance Evaluation
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• Thetablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
Page#

Permit: NCG550181
Inspection Date: 11/03/2020
Owner - Facility: 2117 Bethlehem Church Road
Inspection Type: Compliance Evaluation
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
Page#

Permit: NCG550181
Inspection Date: 11/03/2020
Owner - Facility: 2117 Bethlehem Church Road
Inspection Type: Compliance Evaluation
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Please note some of the activities that must be conducted and documented, in addition
to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped out every five
years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate supply of tablets
for continuous operation. Be sure to order more tablets and replace them often enough to ensure
continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at [phone].
On November 3, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 2117 Bethlehem Church Road, Eden, NC. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a discharge during
the inspection. Plea
Page#

Permit: NCG550181
Inspection Date: 11/03/2020
Other
Comment: See Summary
Owner - Facility: 2117 Bethlehem Church Road
Inspection Type: Compliance Evaluation
Yes No NA NE
Page#