NCG550540_Compliance Evaluation Inspection_20211118

ROY COOPER.
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Mr. & Mrs. Allred
4648 Shelton Ridge Road
Walkertown, NC 27051
NORTH CAROLINA
Environmental Quality
November 18, 2021
Subject: General Wastewater Permit Inspection
4648 Shelton Ridge Road, Walkertown
Certificate of Coverage # NCG550540
Forsyth County
Dear Mr. & Mrs. Allred:
On November 2, 2021, Gary Hudson of this office performed a Compliance Evaluation
Inspection on the wastewater treatment system at 4648 Shelton Ridge Road in
Walkertown, NC. Observations indicated that the subsurface sand filter was operating
properly. There was a clear path to the discharge pipe. Annual sampling is performed as
required.
• During the inspection it was noted that the septic tank contents are pumped out
every three years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator is inspected weekly to ensure there is an adequate supply of
tablets for continuous operation.
If you have any questions concerning this letter, please contact Gary Hudson at (336)
776-9694.
cc: Laserfiche
NORTH
D E
napaRmanl of EnvIronmonbl Malley
Sincerely,
DocuSigned by:
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r Lon gniaRegional Supervisor
Water Quality Regional Operations
Division of Water Resources
North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

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
21 1
Code NPDES yr/mo/day Inspection
I 2 LI 3 I NCG550540 111 121 21/11/02 117
Type
181 O I
I I 1 1 1
Inspector Fac Type
191 S I 201 I
1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 I I I I I
1 11
1 1 1 1 1 P6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
671 I 70 I I 711 172 I N I 73 _ I 74 71
I I
I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
4648 Shelton Ridge Rd
4648 Shelton Ridge Rd
Walkertown NC 27051
Entry Time/Date
10:OOAM 21/11/02
Permit Effective Date
19/11/05
Exit Time/Date
10:30AM 21/11/02
Permit Expiration Date
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
Gary F Allred,4648 Shelton Ridge Rd Walkertown NC 27051///
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)
f.a77i/add.,$)i.
18NOV21
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 ocu ign M nagernent Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FL—oA, T• '5ti'dc4- 11/18/2021
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

sI
NPDES yr/mo/day
N CG550540 111 121 21 /11 /02
117
Inspection Type
18 [j
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
*The single-family subsurface sand filter appeared to be very well maintained.
*The annual sampling of the effluent is being performed as required.
*Mr. & Mrs. Allred keep very good records on the system.
*The septic tank is pumped and inspected every three years.
*The effluent pipe was located, and a clear path is maintained to facilitate sampling.
*The system was not discharging during the time of the inspection.
Page# 2

Permit: NCG550540
Inspection Date: 11/02/2021
Owner - Facility: 4648 Shelton Ridge Rd
Inspection Type: Compliance Evaluation
Other
Comment: See Summary
Yes No NA NE
Page# 3