NCG550421_Compliance Evaluation Inspection_20190520

•
ROY COOPER
Governor
MICHAEL S.REGAN
Secretary
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
RECEIVED/NCDEQ/DWR
May 10, 2019
MAY 2 0 2019
Mrs. Laura Harrison
2031 Woodstock Rd. Water Quality
Clemmons, NC 27012 Permitting action
SUBJECT: Compliance Evaluation Inspection
Certificate of Coverage NCG550421
2031 Woodstock Rd
Forsyth County
Dear Mrs. Harrison,
On May 8, 2019 Kelli Park, of this office, met with you and performed a Compliance
Evaluation Inspection of the wastewater treatment system located at the above address.
The State requires the Division of Water Resources to inspect these types of systems at
least once every five years. The violations found from the inspection outlined below:
1) The chlorine you are using is pool grade. Via the permit wastewater grade chlorine
must be added to the system for proper disinfection. Information was shared with
you during the inspection about the appropriate tablets to use. Please begin using
the correct chlorine as soon as possible.
2) The effluent pipe was not visible. It is a permit requirement to know the location of
the pipe and to maintain the area around it at all times. Please locate the effluent
pipe as soon as possible.
3) The effluent has not been consistently tested by a laboratory. Water samples from
the effluent are required to be analyzed at least once a year by a certified
laboratory. These records are required to be maintained and should be shared with
NCDEQ upon request. A copy of the permit monitoring requirements and the
certified laboratories to do the analysis were given to you at the time of inspection
for reference of what should be monitored when you notice any discharge coming
out of the pipe during the year.
Failure to properly operate and maintain the system can result in expensive repair costs
as well as failure of the system to properly treat the wastewater. If you have any questions
regarding maintenance, operations, the permit, or this inspection do not hesitate to call
us.
® North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road,Suite 300 I Winston-Salem.North Carolina 27105
NOFCTH CARo,�D E
Desedmal flualie." 336.776.9800

Please keep this letter with your records for the system along with copies of invoices from
the Division for the annual permit fee, the Certificate of Coverage, records of septic tank
pumping, maintenance and repair records, etc.
Please be aware that violations of your NPDES permit, or the NC statutes and regulations
under which it is promulgated, are subject to fines of up to $25,000 per day, per violation,
as set forth in NC General Statute (NCGS) 143-215.6A, Enforcement Procedures, Civil
Penalties.
Please contact Miss Park at (336)-776-9689 or [e-mail] if you have any
further questions.
Sincerely,
e--Docusigned by:
Lo . i SMxv
145849E225C94EA...
Lon Snider
Assistant Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments: EPA Water Compliance Inspection Report
cc: WSRO
NPDES Unit
Page 2 of 2

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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 NCG550421 111 12 I 19/05/08 117
18 1,.1 19 I s I 201 1
211 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 I [66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved —
67 I I 70 I I 71 Li
72 LJ ti 731 I 174 751 I I I I I I 1 l80
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)
10130AM 19/05/08 13/08/01
2031 Woodstock Road
2031 Woodstock Rd Exit Time/Date Permit Expiration Date
Clemmons NC 27012 11:30AM 19/05/08 18/07/31
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
///
Name,Address of Responsible OfficiaVTitle/Phone and Fax Number
Contacted
Laura C Harrison,2031 Woodstock Rd Clemmons NC 27012//336-201-2266/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
IN Operations&Maintenance 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
Kelli A Park WSRO WQ//336-776-9689/
ta,r - 5/(O/ )
Signature of Management Q A Reviewer tbousigned by: Agency/Office/Phone and Fax Numbers Date
FL-o, T SM2Cf 5/10/2019
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type (Cont.) 1
31 NCG550421 111 121 19/05/08 117 18 C
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
On May 8, 2019 Kelli Park, of this office, met with you and performed a Compliance Evaluation
Inspection of the wastewater treatment system located at the above address. The State requires the
Division of Water Resources to inspect these types of systems at least once every five years. The
violations found from the inspection outlined below:
1) The chlorine you are using is pool grade.Via the permit wastewater grade chlorine must be added
to the system for proper disinfection. Information was shared with you during the inspection about the
appropriate tablets to use. Please begin using the correct chlorine as soon as possible.
2) The effluent pipe was not visible. It is a permit requirement to know the location of the pipe and to
maintain the area around it at all times. Please locate the effluent pipe as soon as possible.
3) The effluent has not been consistently tested by a laboratory. Water samples from the effluent are
required to be analyzed at least once a year by a certified laboratory. These records are required to be
maintained and should be shared with NCDEQ upon request.A copy of the permit monitoring
requirements and the certified laboratories to do the analysis were given to you at the time of inspection
for reference of what should be monitored when you notice any discharge coming out of the pipe during
the year.
Failure to properly operate and maintain the system can result in expensive repair costs as well as
failure of the system to properly treat the wastewater. If you have any questions regarding
maintenance, operations, the permit, or this inspection do not hesitate to call us.
Please keep this letter with your records for the system along with copies of invoices from the Division
for the annual permit fee, the Certificate of Coverage, records of septic tank pumping, maintenance
and repair records, etc.
Please be aware that violations of your NPDES permit, or the NC statutes and regulations under which
it is promulgated, are subject to fines of up to $25,000 per day, per violation, as set forth in NC General
Statute(NCGS) 143-215.6A, Enforcement Procedures, Civil Penalties.
Page# 2

Permit: NCG550421 Owner-Facility: 2031 Woodstock Road
Inspection Date: 05/08/2019 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? ❑ • ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? • 0 0 0
If effluent (diffuser pipes are required) are they operating properly? 0 ❑ III 0
Comment: Effluent pipe could not be found.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • 0 ❑ ❑
Are the tablets the proper size and type? ❑ II ❑ 0
Number of tubes in use? 1
Is the level of chlorine residual acceptable? ❑ 0 ❑ •
Is the contact chamber free of growth, or sludge buildup? ❑ 0 0 •
Is there chlorine residual prior to de-chlorination? ❑ 0 0 •
Comment: The chlorine tube was located, and is checked every few months. Chlorine is added as
needed. Chlorine was last added on 5/7/2019.
Pool tablets are currently being used. Please switch to wastewater grade tablets.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ 0
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ • ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Septic Tank Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational? ❑ 0 • 0
Is septic tank pumped on a schedule? • ❑ ❑ ❑
Are pumps or syphons operating properly? EIOND
Are high and low water alarms operating properly? ❑ 0 • ❑
Comment: Septic tank was due to be pumped, and was pumped the day of inspection. (5/8/2019)
Page# 3