NCG550481_Compliance Evaluation Inspection_20221230 (3)

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
David Lawson
2081 Piney Grove Road
Kernersville, NC 27284
NORTH CAROLINA
Environmental Quality
January 9, 2023
SUBJECT: Compliance Evaluation Inspection
Single Family Residence
2081 Piney Grove Road
Permit #: NCG550481
Forsyth County
Dear Mr. Lawson:
On December 30, 2022, Gary Hudson of this office performed a Compliance Evaluation
Inspection on the wastewater treatment system referenced above. Observations indicated
that the subsurface sand filter was not installed as of the date of the inspection. When the
system is installed;
• Please be aware that the Permit requires that the septic tank contents be pumped
out every five years to prevent solids from clogging the sand filter 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.
GDE
NORTH C OLI JA '
o mm m�� ep..of o�.i
Sincerely,
�— DocuSigned by.
L_o T. by�Jn.iJCr
145B49E225C94EA...
Lon Snider, Regional 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 W. Hanes Mill Rd, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

United States Environmental Protection Agency
EPA 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
I 2
IL
NPDES yr/mo/day Inspection Type Inspector Fac
I 3 I NCG550481 111 121 22/12/30 117 1810I 19I S I 2011
Type
21IIIIII
IIIIIIIIIII
IIIIIII
I
IIIIII
IIIIIIIIIII
P6
Inspection
671
Work Days
Facility Self -Monitoring
I 70I
Evaluation Rating
I 711
B1
1
72
QA
I N I
73I
1
I I
Reserved
74 71
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 oermit Number)
Piney Grove Road / Lot 5417
2081 Piney Grove Rd
Kernersville NC 27284
Entry Time/Date
09:30AM 22/12/30
Permit Effective Date
21/11/22
Exit Time/Date
10:OOAM 22/12/30
Permit Expiration Date
25/10/31
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
David Lee Lawson,2081 Piney Grove Rd Kernersville NC 27284//336-996-6747/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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/
DocuSigned by: LG1/9/2023
� Ni�.�,saw
SignateiP
2P1Viiii ment Q A Reviewer Agency/Office/Phone and Fax Numbers Date
r;iDocuSigned by:
-eti ?. SA,acr 1/9/2023
145B4 5 9 A.
EPA Form 35F60-3� (Rev 9-94) Previous editions are obsolete.
Page# 1

sI
NPDES yr/mo/day
N C G 550481 111 121 22/12/30
I17
Inspection Type
18 [j
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
*The facility has not beenbuilt yet.
*A site visit was conducted to confirm this.
*Mr. & Mrs. Lawson want to keep the permit active for any future development.
Page# 2

Permit: NCG550481
Inspection Date: 12/30/2022
Owner - Facility: Piney Grove Road / Lot 5417
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 El El ❑
application?
Is the facility as described in the permit? El El • El
# Are there any special conditions for the permit? El • El El
Is access to the plant site restricted to the general public? • ❑ ❑ ❑
Is the inspector granted access to all areas for inspection? • El El El
Comment:
Page# 3