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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S.REGAN
Secretary
LINDA CULPEPPER
Interim Director October 4, 2018WR
RECENEDIDE”
Elizabeth Lucas 00 11 201E
4100 High Point Road
Winston Salem, NC 27107 Watemltting
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SUBJECT: Compliance Evaluation Inspection
NC General Wastewater Permit NCG550000
Certificate of Coverage: NCG550462
Facility: 4100 High Point Road, Winston Salem, NC 27107 per
Owner: Elizabeth Lucas
County: Forsyth
Dear Ms. Lucas:
Ron Boone, of the Winston-Salem Regional Office (WSRO) of the NC Division of Water
Resources (DWR or the Division), met with you on September 19, 2018, at your home
located at 4100 High Point Road, in Winston Salem, NC, to conduct'a compliance
evaluation inspection (CEI) of your home's wastewater treatment system, which
discharges the final treated effluent to South Fork Muddy Creek, which is located just
north of your home and is currently classified as class C waters in the Yadkin-Pee Dee
River Basin. However, you were preparing to go to work and didn't have enough time to
conduct a full inspection with Mr. Boone.
Your home's wastewater treatment system is regulated by DWR under general
wastewater permit NCG550000, with certificate of coverage (COC) NCG550462.
NCG550000 specifies your obligations and responsibilities, as owner and permittee, to
properly operate and maintain the system in order to properly and sufficiently treat your
home's domestic wastewater to within limits specified in the permit before it is discharged
to South Fork Muddy Creek.
During the 9/19/2018 inspection, Mr. Boone determined that you do not know the location
of any of the system's components, including the septic tank, so, it is unknown when the
tank was last pumped. The chlorinator and discharge pipe could not be located either.
You stated that your ex would have maintained the system, which explains your
unfamiliarity with it. Please note that the permit also requires that you test the effluent
from the system once per year. This also has not been done.
.D_E Q5
NORTH CAROLINA
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North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27103
336.776.9800
United States Environmental Protection Agency Form Approved.
E PA 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
1E 2H 3 NCG550462 ' 111 12 I 18/09/19 117 18I I 19 121 201
21/ 11111 111LII1111111111111111111 11111111111 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA -Reserved l
671 1 701 I 711 I 72 I N LJ I 731 1 174 751 1 1 1 1 1 1 1l80
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) 03 OOPM 18/09/19 13/08/01
4100 High Point Road
Exit Time/Date Permit Expiration Date
4100 High Point Rd
03 15 P M 18/09/19 18/07/31
Winston Salem NC 27107
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
Elizabeth Lucas,4100 High Point Rd Winston Salem NC 27107///
No
Section C Areas Evaluated During Inspection(Check only those areas evaluated)
IN Permit
• 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 'i ) WSRO WQ//336-776-9690/
9/,E
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers - Date
v"- F--.1..-.12/tirr /CPO
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EPA Form 3560-3(Rev 9-94)Previous editions are obsolete
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Permit: NCG550462 Owner-Facility: 4100 High Point Road
Inspection Date: 09/19/2018 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 0 0 0
II
application?
Is the facility as described in the permit'? 0 0 0
II
#Are there any special conditions for the permit'? ❑ 0 0 •
Is access to the plant site restricted to the general public'? 0 0 0
II
Is the inspector granted access to all areas for inspection'? ❑ ❑ ❑ •
Comment. Ms. Lucas was unaware that her house has a discharging wastewater treatment system
and did not have time to conduct the full inspection the day that Mr Boone visited because
she was just getting ready for work. Please contact Mr. Boone to schedule a follow-up
inspection.
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