NCG550652_Compliance Evaluation Inspection_20210114

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
January 14, 2021
Anna Toulouse
191 Forestdale Drive
Reidsville, NC 27230
Subject: General Wastewater Permit Inspection
191 Forestdale Drive, Reidsville
Certificate of Coverage # NCG550652
Rockingham County
Dear Ms. Toulouse:
On November 18, 2020, Gary Hudson of this office performed a Compliance Evaluation
Inspection on the wastewater treatment system at 191 Forestdale Drive, Reidsville, 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:
• During the inspection, a receipt was provided showing that the septic tank was
pumped on November 15, 2020.
• 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.
cc: Laserfiche
D_E
NOR! H CAHOI INA
Sincerely,
DocuSigned by:
%n, JnnOcft'
Lori48iiti4,ERegional Supervisor
Water Quality Regional Operations
Division of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800
kgWNmBnt of EmIrOnmBntaI quAl�

United States Environmental Protection Agency
E PA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction
1 IN
Code NPDES yr/mo/day Inspection
2 I5 �-I 3 I NCG550652 111 121 20/11/18 117
Type
18 [=
73I I 174
L�
Inspector Fac Type
19 G I 201
21111111i
illiiiiii II iiilili i l IiiiiIiiiiiiiiii
Reserved
1 751
166
I I I 1 1 1 180
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
671I 7° I I 711I 72 I N I
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
191 Forestdale Drive
191 Forestdale Dr
Reidsville NC 27320
Entry Time/Date
10:OOAM 20/11/18
Permit Effective Date
13/08/01
Exit Time/Date
10:30AM 20/11/18
Permit Expiration Date
18/07/31
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
Anna Buccini Toulouse,141 Pritchett Rd Browns Summit NC 27214///
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 Agency/Office/Phone and Fax Numbers Date
�DocuSigned by:
L0A, 'C Sn.idtr 1/14/2021
145849E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

31
NPDES yr/mo/day
NCG550652 111 121 20/11/18
117
Inspection Type
18 [j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On November 18, 2020, Gary Hudson of this office performed a Compliance Evaluation Inspection on
the wastewater treatment system at 191 Forestdale Drive, Reidsville, 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:
• During the inspection a receipt was provided showing that the septic tank was pumped on
November 15, 2020.g
• 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].
Page# 2

Permit: NCG550652
Inspection Date: 11/18/2020
Owner - Facility: 191 Forestdale Drive
Inspection Type: Compliance Evaluation
Other
Comment: See Summary
Yes No NA NE
Page# 3