NCG550059_Other Agency Documents_19970721 (2)

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
July 15, 2010
Mr. Mike Cservenko
4663 Paula Drive
Winston-Salem, North Carolina 27127
Subject: General Wastewater Permit No. NCG550059 — Single Family Residence
Forsyth County
Dear Mr. Cservenko:
Jenny Graznak of the Winston-Salem Regional Office performed a Compliance
Evaluation Inspection on the sandfilter wastewater treatment system at your property in Forsyth
County on July 14, 2010. Your son was home during the inspection. Ms. Graznak was able to
contact you via telephone following the inspection to discuss the wastewater system and the
inspection with you.
• You hold a General Permit to discharge Domestic Wastewaters from Single Family
Residences under the National Pollutant Discharge Elimination System (NPDES). The exact
age of the wastewater system is unknown. The discharge pipe crosses under a gravel drive
before discharging into the small stream adjacent to the horse pasture. The pipe was
completely submerged in water on the day of the inspection. The chlorinator is underneath a
well tile cover in the backyard. You stated that you add chlorine tablets to the system on a
monthly basis.
The permit requires that you take an annual analytical sample of the discharge from the
pipe. Permit text Part I Section A (attached to this correspondence) specifies the limits and
monitoring requirements. A Laboratory with North Carolina Wastewater Certification (a list of
approved laboratories is attached) must perform the monitoring. You must also conduct and
document the following maintenance activities:
• Septic tanks shall be maintained at all times to prevent seepage of sewage
• Septic tanks will be checked at least yearly to determine if solids must be removed
• Septic tanks shall be pumped out within 3-5 years of issuance date of the Permit.
Contents removed from septic tanks shall be disposed of at a location and in a manner
compliant with all local and state regulations
You received a Notice of Violation, dated April 19, 2010, from the Division of Water
Quality for failure to pay your permit's annual fee. Please pay the $60 annual fee as soon
as possible to avoid a civil penalty or revocation of the permit. A copy of the invoice is
attached. Please contact Ms. Graznak or me at [phone] if you have any questions
regarding your permit or your wastewater system.
North Carolina Division of Water Quality,Winston-Salem Regional Office
Location:585 Waughtown St.Winston-Salem,North Carolina 27107 One
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 NorthCarolina
Internet:www.ncwaterquality.org Naturally
An Equal Opportunity\Affirmative Action Employer ;/

Sincerely,
Steve W. Tedder
Regional Supervisor
Surface Water Protection Section
cc: SWP—Central Files
SWP—WSRO
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United States Environmental Protection Agency
EPA Washington,D C.20460 Form Approved.
OMB No.2040-0057
Water Compliance Inspection Report Approval expires 8-31-98
Section A: National Data System Coding(i.e, PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCG550059 111 121 10/07/14 117 181 cl 191 S I 20III
Remarks
211 III 1 I I I I I I I I I I I I III I I 'I I I I I I I I I I I III I I I I I I I I I I 166
Inspection Work Days Facility Self-Monitonng Evaluation Rating B1 QA ---
67 I 169 70 13 I 711 I 721 NI 731 I 174 751 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 Entry Time/Date Permit Effective Date
POTW name and NPDES permit Number)
09:00 AM 10/07/14 09/04/06
4663 Paula Drive
4663 Paula Dr Exit Time/Date Permit Expiration Date
Winston Salem NC 27127 09:30 AM 10/07/14 12/07/31
Name(s)of Onsite Representative(s)ffitles(s)/Phone and Fax Number(s) Other Facility Data
///
Name,Address of Responsible Official/Title/Phone and Fax Number
Contacted
Mike Cservenko,4663 Paula Dr Winston Salem NC 27127//336-720-2197/ No
Section C. Areas Evaluated During Inspection(Check only those areas evaluated)
III Permit
Section D: Summary of Findinq/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
Jennifer F Graznak WSRO WQ//336-771-5000/
(iltp
Signature of Manag ent Q A Revie Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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)J
Permit: NCG550059 Owner-Facility: 4663 Paula Drive
Inspection Date: 07/14/2010 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 application? 0 0 • 0
Is the facility as described in the permit? ■ n n n
#Are there any special conditions for the permit? n i n n
Is access to the plant site restricted to the general public? n ❑ ■ n
Is the inspector granted access to all areas for inspection? ■ n n
Comment: Although this area was annexed to Winston-Salem in 2006, the area still
does not have sewer available.
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