NCG550103_Compliance Evaluation Inspection_20160907

PAT MCCRORY
Govnnm
t.m
DONALD R. VAN DER VAART
Secretory
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
September 7, 2016 Director
Dwight H. Simmons
4660 Doveland Circle
Winston-Salem, NC 27127
Subject; Compliance Evaluation Inspection
Permittee: Dwight H. Simmons, Owner
Facility: 4660 Doveland Circle, Winston-Salem, NC 27127
Permit: NCG550000 General Wastewater Permit
Certificate of Coverage: NCG550103
Forsyth County
Dear Mr. Simmons:
Ron Boone and Justin Henderson; of the Winston Salem Regional Office (WSRO) of the NC Division
of Water Resources (DWR or the Division), conducted a compliance evaluation inspection of the single
family wastewater system at your residence on September 2, 2016. The State requires the Division to
inspect these types of systems every five years. An inspection report is attached for your records and
the inspection findings are summarized below.
2. The system consists of a septic tank, filtration unit, chlorination unit, and the discharge pipe. The entire
system appears to be in good operating order. There was no discharge at the time of the inspection
and you have not been taking samples of the effluent as required in the permit.
3. The septic tank was last pumped within the last five years. You stated that you have it pumped a
minimum of every five years.
4. You have been adding chlorine tablets as needed to the chlorinator unit. The unit appears to be in
good condition. However, you are not using the correct type of chlorine. The chlorine you use is
intended for use in swimming pools, not for wastewater treatment. You should acquire wastewater
grade chlorine tablets. Please see the attachments for more information.
5. The permit fees of $60 per year have been paid annually as required and your permit is active and up
to date. You did not have a copy of the most recent Certificate of Coverage (COC). A copy is attached
for your records. Mr. Boone left you with a copy of the most recent general permit and technical bulletin.
6. Failure to properly operate and maintain your wastewater system can result in expensive repair costs
as well as failure of the system to properly treat the wastewater. It appears that your system is well
maintained.
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road, Suite 300 1 Winston-Salem, North Carolina 27105
336 776 9800

If you have any questions regarding this letter or the NCG550000 general permit, please don't hesitate
to contact us at 336-776-9800.
Sincerely,
'�/Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. Inspection Report
2. Certificate of Coverage NCG551106
3. Chlorine Technical Information
4. North Carolina & Other Chlorine Vendors
CC: WSRO Files
Central Files
NPDES Unit

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fad Type
1 IN ) 2 15 1 3 I NCG550103 I11 12 16/09/02 17
18 LCJ 19 1 c 1 201 I
211111111111111U11111111111111111111111111_
G6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating 131 CA
---------------Reserved-----------
67
L I 70 71 I 72 LnJ
73I I74 75L_L L L 180
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)
12:OOPM 16/09/02
13/08/01
4660 Doveland Circle
4660 Doveland Cir
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27127
01:OOPM 16/09/02
18/07/31
Names) of Onsite Repmsentative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Peggy S Simmons,4660 Doveland Cir Winston Salem NC 27127///
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)
Names) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Ron Boone WSRO WQ//336-776-9690/
del/L.1% //
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
31 NCG550103 J11 12 16/09/02 17 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

Permit: NCG550103
Inspection Date: 09/02/2016
Other
Owner - Facility: 4660 Doveland Circle
Inspection Type: Compliance Evaluation
Comment: Please refer to the attached inspection summary letter.
Yes No NA NE
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