NCG550169_Other Agency Documents_20110901

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
September 1, 2011
Mack Johnson
7111 Donnaha Road
Tobaccoville, North Carolina 27050
Subject: General Wastewater Permit NCG550169—Single Family Residence
7111 Donnaha Road,Tobaccoville, North Carolina
Forsyth County
Dear Mr. Johnson:
Jenny Graznak of the Winston-Salem Regional Office performed a Compliance Evaluation
Inspection on the sandfilter wastewater treatment system at your property located at 7111 Donnaha
Road in Tobaccoville, Forsyth County, North Carolina on August 26, 2011. This type of inspection
consists of two basic parts: a review of self-monitoring data, and an on-site inspection of the facility
and its discharge. No one was home during the inspection, but Ms. Graznak spoke to you afterward
via telephone.
You hold a General Permit to discharge Domestic Wastewaters from Single Family
Residences under the National Pollutant Discharge Elimination System (NPDES). According to our
files, the system has a septic tank, a subsurface sand filter, and a chlorinator. The septic tank was
last pumped out in 2009. The effluent from the system discharges to an unnamed tributary to the
Yadkin River in the Yadkin River Basin. The discharge pipe is approximately 30 feet from the
southern corner of the house, approximately 5 feet from Donnaha Road. The receiving stream
appeared clear with no traceable solids, and no odor was noted on the day of the inspection. You
stated that you add chlorine tablets to the chlorinator tubes on a monthly basis.
Please check the permit text Part I Section A (attached to this correspondence), which
specifies the limits and monitoring requirements for your permit. A Laboratory with North Carolina
Wastewater Certification (a list of nearby approved laboratories is attached) must perform the
monitoring. As a reminder, the permit also requires that you 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
If you have any questions regarding this letter, please contact Ms. Graznak or me at (336)
771-5000.
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 turi/
An Equal Opportunity 1 Affirmative Action Employer I LL

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Sincerely,
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
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SWP—WSRO

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 I NI 2 15I 31 NCG550169 111 121 11/08/26 117 181 ci 191 SI 201
Remarks
291 1 1 1 I I I I I I I I I I I I I I I I I I I ] I I I I I I I I I I I I I I I I I I I I III 66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ---------------------Reserved-------- —
67 I 169 701 I 711 I 721 NI 79 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)
11:00 AM 11/08/26 07/08/03
7111 Donnaha Road
7111 Donnaha Rd Exit Time/Date Permit Expiration Date
Tobaccoville NC 27050 11:45 AM 11/08/26 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
Mack Johnson,7111 Donnaha Rd Tobaccoville NC 27050//336-983-9874/ No
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
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/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
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EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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Permit: NCG550169 Owner-Facility: 7111 Donnaha Road
Inspection Date: 08/26/2011 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? ODNO
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 ■
Is the inspector granted access to all areas for inspection? U n n n
Comment:
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