NCG550098_Compliance Evaluation Inspection_20160926 (2)

PAT MCCRORY
:;
, Governor
,..r DONALD R. VAN DER VAART
Secretary
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
September 26, 2016 Director
Stanley J. Potoczny
3050 Cedar Creek Drive
Kernersville, NC 27284
Subject: Compliance Evaluation Inspection
Permittee: StanleyJ. Potoczny, Owner ' ` Ed'V D
Y � �, �..
Facility: 3050 Cedar Creek Drive, Kernersville, NC 27284 OCT 4 2016
Permit: NCG550000 General Wastewater Permit
Certificate of Coverage:-NCG550098-- CENTRAL FtLE.S
Forsyth County D\JR SFGTt0',1
Dear Mr. Potoczny:
1. Ron Boone, 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 23, 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 inspelction
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 spring. Please not the permit requires you to have it pumped every three to
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. We have attached a copy of the general permit and technical bulletin, as well as technical
information on the proper type of chlorine to use.
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 fairly
well maintained at this time.
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27105
336 776 9800

7. 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
1(
' Ys
Attachments: 5
1. Inspection Report
2. Chlorine Technical Information
3. North Carolina& Other Chlorine Vendors
4. NCG550000 General Permit
5. NCG550000 Technical Bulletin
CC: WS.,0 Eiles_
�entral'Files- '
NPDES Unit

{
United States Environmental Protection Agency Form Approved.
EPA 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 , 2 [ I 3 I NCG550098 111 12 1 16/09/23 '117 18 Li, 19 Li I 201 I
21111111 1111111111111111111111111 11111111111166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA -- --Reserved— l
671 I 701 1 71 1 I 72 I N I 731 1 174 751 1 1 1 1 1 1 180
Section B:Facility Data Li
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) 05:00PM 16/09/23 13/08/01
3050 Cedar Creek Drive
Exit Time/Date Permit Expiration Date
3050 Cedar Creek Dr
05.30PM 16/09/23 18/07/31
Kernersville NC 27284
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
Stanley Potoczny,3050 Cedar Creek Dr Kernersville NC 27284//336-996-7294/
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)
Name(s)and Signature(s)of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//336-776-9690/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date//
�� 7/ l;4
O' �Ci UCl Y'
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

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NPDES yr/mo/day Inspection Type 1
31 NCG550098 11 121 16/09/23 117 18 (;I
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summmary letter.
Page# 2

Permit: NCG550098 Owner-Facility: 3050 Cedar Creek Drive
Inspection Date: 09/23/2016 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: Everything looks fairly good. Mr. Potoczny is not using the proper chlorine. I'm sending him
info on proper chlorine to use. He has never pulled a sample and stated he wasn't aware he
was required to. I'm also sending him a copy of the general permit, and technical bulletin.
•
Page# 3