NCG550543_Compliance Evaluation Inspection_20221230

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Brandy Norman
1145 Pine Knolls Road
Kernersville, NC 27284
NORTH CAROLINA
Environmental Quality
January 9, 2023
SUBJECT: Compliance Evaluation Inspection
Single Family Residence
1145 Pine Knolls Road
Permit #: NCG550543
Forsyth County
Dear Ms. Norman:
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 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 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,
,- OocuSiggned by:
L-n, ol . <�iM k-
IT::11-rgHiiier, Regional Supervisor
Water Quality Regional Operations
Division of Water Resour
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 NCG550543 111 121 22/12/30 117 1810I 19I S I 2011
Type
21IIIIII
IIIIIIIIIII
IIIIIII
I
IIIIII
IIIIIIIIIII
t66
l
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)
1145 Pine Knolls Road
1145 Pine Knolls Rd
Kernersville NC 27284
Entry Time/Date
10:OOAM 22/12/30
Permit Effective Date
13/08/01
Exit Time/Date
10:30AM 22/12/30
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
Donald L Pridgen,1145 Pine Knolls Rd Kernersville NC 27284//336-993-5732/
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/
1— DocuSigned by:
OUrt1 Raw, 1/9/2023
Signature
813D228241-Cbb4A6...
of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by:
L—o, T. Sti t...r 1/9/2023
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

sI
NPDES yr/mo/day
N C G 550543 111 121 22/12/30
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 effluent pipe was located, and a clear path is maintained to facilitate sampling.
*The system was not discharging during the time of the inspection.
*The chlorinator was located during the inspection.
*A change of ownership form is included with this inspection report.
Page# 2

Permit: NCG550543
Inspection Date: 12/30/2022
Owner -Facility: 1145 Pine Knolls Road
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