NCG550079_Compliance Evaluation Inspection_20120131

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
January31, 2012y
Richard Townsend
1239 Pine Knolls Road FEB 0 7 Z01Z
Kernersville, NC 27284 Crt1 ';ram,: ,
Subject: Compliance Evaluation Inspection
NPDES General Wastewater Permit NCG550000
CAert sate of` o „g2 g ICI G5 ZW0. 79
1239 Pine Knolls Road, Kernersville
Forsyth County
Dear Mr. Townsend:
Ron Boone, of the NC Division of Water Quality (DWQ), Winston Salem Regional
Office (WSRO), conducted a compliance evaluation inspection of your single family
residence wastewater treatment system located at 1239 Pine Knolls Road, in
Kernersville, Forsyth County, NC, on January 31, 2012. Your assistance and
cooperation during the inspection was greatly helpful and appreciated. The findings of
the inspection are summarized below and an inspection report is attached for your
records.
Your single family residence wastewater treatment system is regulated under NC
NPDES General Wastewater Permit NCG550000 and has been issued certificate of
coverage (COC) number NCG550079. The system discharges to an unnamed tributary
to Belews Creek, which is located in the Yadkin Pee Dee river basin.
According to your design documents we have on file your system consists of a
900 gallon septic tank, primary and secondary filter fields, and a chlorinator. You were
able to show Mr. Boone the locations of the tank and filters. There was no evidence of
failure of any of those components. According to you the septic tank was pumped
approximately two years ago and you currently have it pumped about once every two
years. There are currently two people occupying the home. Please note that the
general permit requires you to have the tank pumped once every three to five years.
North Carolina Division of Water Quality,Winston-Salem Regional Office
Location:585 Waughtown Street.Winston-Salem,North Carolina 27107
Phone:[phone] FAX:[phone]\Customer Service 1-877-623-6748
Internet www.ncwaterouality.orq One An Equal Opportunity\Affirmative Action Employer NorthCai®l111a
Naturally

Richard Townsend
1239 Pine Knolls Road,Kernersville
NPDES General Wastewater Permit NCG550000
Certificate of Coverage NCG550079
Page 2 of 2,January 31,2012
The chlorinator was found and inspected. It did have chlorine in it and appears
to be functioning correctly.
The discharge pipe was found. There was a very slight trickle out the end of the
pipe during the inspection. The water was clear and there was no odor. There
appeared to be no negative impact of the discharge on the receiving stream.
Samples of the discharge have been taken in the past but none have been taken
recently. You stated that the past sample results were within limits. Please note it is
also a requirement of the general permit to have the discharge tested annually. All
annual permit fees have been paid and the permit is current and up to date.
You should keep all documentation pertaining to the system in a folder that's
readily available at all times. This would include tank pumping records, effluent
analytical results, any maintenance and/or repair records, design records, your permit
and certificate of coverage and your annual invoices from the Division.
If you have any questions or future problems with the system, please do not
hesitate to contact us. You can call me or Mr. Boone at 336-771-5000.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments:
1. Inspection Report
CC:
1. WSRO/SWP Files
2. tC ra1�Q'f i
3. NPDES Unit

r
United States Environmental Protection Agency Form Approved.
EPA Washington,D.C.20460 OMB No.2040-0057
Water CompIianhe Inspertinn 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 N I 2 U 31 NCG550079 11 121 12/01/31 117 18I C I 19I S I 20I
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII11166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA —— — Reserved
671 169 70I_I 711 I 72I N I 731 I 1 74 751 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)
10:30 AM 12/01/31 09/03/25
1239 Pine Knolls Road
1239 Pine Knolls Rd Exit Time/Date Permit Expiration Date
Kernersville NC 27284 11:00 AM 12/01/31 12/07/31
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
Richard Townsend,1239 Pine Knolls Rd Kernersville NC 27284//336-996-5362/ No
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
II Permit II Records/Reports •Facility Site Review III Effluent/Receiving Waters
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
Ron Boone WSRO WQ//336-771-4967/
a/L
Signature of
Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
S nr 2,0'
i v
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

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NPDES yr/mo/day Inspection Type 1
3I NCG550079 /11 121 12/01/31 117 181 CI
Section D: Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page# 2

Permit: NCG550079 Owner-Facility: 1239 Pine Knolls Road
Inspection Date: 01/31/2012 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? n n U n
Is the facility as described in the permit? n n ■ n
#Are there any special conditions for the permit? n ■ n n
Is access to the plant site restricted to the general public? ■ n n n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: None
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ■ n n n
Is all required information readily available, complete and current? anon
Are all records maintained for 3 years(lab. reg. required 5 years)? ■ n n n
Are analytical results consistent with data reported on DMRs? n n ■ n
Is the chain-of-custody complete? non .
Dates,times and location of sampling n
Name of individual performing the sampling n
Results of analysis and calibration n
Dates of analysis n
Name of person performing analyses n
Transported COCs n
Are DMRs complete:do they include all permit parameters? n n ■ n
Has the facility submitted its annual compliance report to users and DWQ? 0 0 • n
(If the facility is=or>5 MGD permitted flow)Do they operate 24/7 with a certified operator on each shift? n n ■ n
Is the ORC visitation log available and current? n n • n
Is the ORC certified at grade equal to or higher than the facility classification? n n ■ n
Is the backup operator certified at one grade less or greater than the facility classification? n n ■ n
Is a copy of the current NPDES permit available on site? ■ n n n
Facility has copy of previous year's Annual Report on file for review? n n ■ n
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? ■ n n n
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Permit: NCG550079 Owner-Facility: 1239 Pine Knolls Road
Inspection Date: 01/31/2012 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
Are the receiving water free of foam other than trace amounts and other debris? ■ ❑ ❑ 0
If effluent (diffuser pipes are required) are they operating pro erlY• 0 ❑
■
Comment: None
Page# 4