NCG550092_Compliance Evaluation Inspection_20120113

AT-TrA,
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
January 13, 2012
Mr. Richard W. Abbott
5959 Holder Road
Clemmons, NC 27012
Subject: Compliance Evaluation Inspection
NPDES General Wastewater Permit NCG550000
Certificate of Coverage: NCG550092
5959 Holder Road, Clemmons
Forsyth County
Dear Mr. Abbott:
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 5959 Holder Road, in Clemmons,
Forsyth County, NC, on January 12, 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 NCG550092. The system discharges to an unnamed tributary
to Muddy Creek, this section of which is currently classified as Class C waters and is
located in the Yadkin Pee Dee river basin.
Your system consists of a septic tank and filter field. There is no chlorinator.
You told Mr. Boone that you last had the tank pumped in approximately July, 2009,
although records were not immediately available during the inspection. You are
reminded to have the tank pumped every three to five years in order to help keep the
system in top operating condition at all times.
There were no signs of system failure during the inspection. You were able to
show Mr. Boone the approximate location of the discharge pipe but it could not be
exactly located because of heavy overgrowth. There were no signs of any adverse
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:[phone]
Internet:www.ncwaternuality.orq One
An Equal Opportunity\Affirmative Action Employer NorthCarolina
Naturally

Richard W.Abbott
5959 Holder Road,Clemmons
NCG550092
January 13,2012,Page 2 of 2
effects of the discharge on the receiving stream. Samples of the discharge have not
been taken, except for those taken by the Division in years past. All annual fees have
been paid and the permit is current and up to date.
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. Also, our email
addresses are corey.basinger(a�ncdenr.gov and ron.boone(&ncdenr.gov, respectively.
Sincerely,
SC\kall&.
\,', 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. Central Office
3. [NPDES .Unit,

United States Environmental Protection Agency Form Approved.
EPAH Washington,D.C.20460 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 N 1 2 15I 31 NCG550092 111 121 12/01/12 117 18I C I 19151 20I II
Remarks
211 I I I IIIIIIII I I I I I I I I IIII IIIIIIIIIIIIIIIIIIIIIII66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved--------------------
67I 169 70I I 711 I 72I N I 731 1174 75I 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 12/01/12 07/08/02
5959 Holder Road
5959 Holder Rd Exit Time/Date Permit Expiration Date
Clemmons NC 27012 09:30 AM 12/01/12 12/07/31
Name(s)of Onsite Representative(s)fTitles(s)/Phone and Fax Number(s) Other Facility Data
///
Name,Address of Responsible Official/Title/Phone and Fax Number
Contacted
Richard W Abbott,5959 Holder Rd Clemmons NC 27012//336-766-7880/ No
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
MI Permit ®Facility Site Review ®Effluent/Receiving Waters
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
Ron Boone "' WSRO WQ//336-771-4967/
°)//.3/0 6/ 2_
C%.
yr_ •
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
(-
-,,La '4..k1\. �Ii \ - \-1,-\ --
EPA Form 3560-3(Rev 9-94)Previous editions al obsolete.
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NPDES yr/mo/day Inspection Type - 1
31 NCG550092 111 121 12/01/12 117 18I 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: NCG550092 Owner-Facility: 5959 Holder Road
Inspection Date: 01/12/2012 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 i
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 n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? n ■ n n
Are the receiving water free of foam other than trace amounts and other debris? ■ n n n
If effluent (diffuser pipes are required) are they operating properly? n n ■ n
Comment: None
•
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