NCG550426_Compliance Evaluation Inspection_20191219

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Environmental Quality
December 19, 2019
CERTIFIED MAIL # 7013 1710 0002 1922 4068
REUTURN RECEIPT REQUESTED
Melanie Brauer
11800 Grant Rd. APT 6403
Cypress, TX 77429
Subject: Notice of Deficiency — (NOD-2019-PC-0258)
Wastewater System Inspection/General Permit NCG550000
530 Shadow Ln. Winston-Salem NC 27107
Certificate of Coverage NCG550426
Forsyth County
Dear Ms. Brauer:
You are receiving this correspondence as the listed property owner of the subject property,
according to Forsyth County tax records.
On December 18, 2019, staff of the North Carolina Division of Water Resources, Winston-Salem
Regional Office (DWR) performed a compliance inspection of the single-family NPDES
wastewater treatment system located at the subject property. This compliance inspection was
conducted by DWR staff person Justin Henderson. This inspection reflects non-compliance with
the subject permit. The following deficiencies require your attention and action:
1) Failure to conduct annual effluent monitoring as required by Permit Condition Part I
Section C.
2) Failure to maintain wastewater system records in accordance with Permit Condition Part I.
Section D. (5), and Part II. Section D. (6.). There were no effluent monitoring records nor
septic tank pumping records available for review during this inspection
3) Failure to pay the Annual Administering and Compliance Monitoring Fee of $60/year, as
required by Permit condition Part IL Section B. (14.) Fees are currently overdue for the
following years: 2017, 2018, 2019.
Copies of the invoices for the overdue fees are enclosed with this Notice. Please remit
payment at your earliest convenience.
D North Carolina Department of Environmental Quality I Division of Water Resources
EQ�p
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
NORTH CAROLINA �
o•o•°"•mme""°"^•"vin"•i� /� 336.776.9800

4) Failure to submit the NPDES Certificate of Coverage (CoC) NCG550000 Ownership
Change Form to have permit transferred into the currently property owner's name as
required by Permit Condition Part II. Section E. (4.).
A copy of the Ownership Change Form is enclosed with this Notice. Please complete and
submit the form to request the subject permit be transferred appropriately. According to
Forsyth County tax records, you obtained ownership of the subject property on or before
April 17, 2013.
In addition to the deficiencies described above, the following items of concern also warrant your
attention:
a) A tree had fallen in the back yard and was partially covering the subsurface treatment filter.
Vegetation surrounding the fallen tree had been allowed to become overgrown, thus
impeding accessibility to this treatment unit to allow for proper inspection of system
performance. Proper operation and maintenance of all facilities and systems of treatment
and control are required to be conducted per Permit Condition Part II. Section C. (2.).
b) A chlorinator was not observed during this inspection, however the presence/absence this
unit could not be confirmed due to the overgrown vegetation located adjacent to the
subsurface treatment filter. Please be aware that should a chlorinator be present,
disinfection must be provided, utilizing wastewater grade chlorine tablets, in accordance
with Permit Condition Part I. Section D. (L)
c) In accordance with Permit Condition Part I. Section D. (3.) the septic tank shall be pumped
out at least once every five years or when the solids level is found to be more than 1/3 of
the liquid depth in any compartment, whichever is greater. Records of the most recent
solids removal from the septic tank were not available for review during this inspection.
Failure to abide by the conditions contained in your permit may subject the permittee to
enforcement action by DWR in accordance with North Carolina General Statute 143-215.6A to
143-215.6C and/or revocation of this permit. A follow-up inspection is planned in the next 120-
days to evaluate your response to the system deficiencies described in this Notice. If you have any
questions concerning this letter, you may contact Justin Henderson or me at [phone].
Sl Docu gn¢dbY:
" , -T SMdcr
Loris�nider, 'egional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ-WSRO
Eric: Inspection Report
NPDES Certificate of Coverage (CoC) NCG550000 Ownership Change Form
Invoice copies for overdue fees for 2017-2019.
Cc: Laserfiche Files (electronic copies)

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 IN I 2 15 I 3 I NCG550426 111 12 I 19/12/18 I17
18 I S J 19 L G] 201 I
211111 1 1 I I I I II I I I I I I I I I I I I 1 I I I I
I I I I I I II I I I I I f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating 131 QA
---------------------- Reserved -------------------
671
70 I I 71 I I 72 I r I
u ty
73 I I 174 751 I I I I I I I80
I I i
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 oermit Number)
10:30AM 19/12/18
09/09/01
530 Shadow Lane
530 Shadow Ln
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27107
11:15AM 19/12/18
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
David W Branch,530 Shadow Ln Winston Salem NC 27107H336-788-7217/
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
Justin L Henderson DoLLuSigned by: DWR/WSRO WQ/336-776-9701/
D5F3c,2,,6F,1B4.6..
12/19/2019
.
Signed by: Agency/Office/Phone and Fax Numbers
Signature of Management Q A RevieF�'QU'Q
Date
T 1-5,dtc
12/19/2019
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
NCG550426 I11 12, 19/12/18 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On December 18, 2019, staff of the North Carolina Division of Water Resources, Winston-Salem
Regional Office (DWR) performed a compliance inspection of the single-family NPDES wastewater
treatment system located at the subject property. This compliance inspection was conducted by DWR
staff person Justin Henderson. This inspection reflects non-compliance with the subject permit. The
following deficiencies require your attention and action:
1) Failure to conduct annual effluent monitoring as required by Permit Condition Part I Section C.
2) Failure to maintain wastewater system records in accordance with Permit Condition Part I. Section
D. (5.), and Part II. Section D. (6.). There were no effluent monitoring records nor septic tank pumping
records available for review during this inspection
3) Failure to pay the Annual Administering and Compliance Monitoring Fee of $60/year, as required by
Permit condition Part II. Section B. (14.) Fees are currently overdue for the following years: 2017, 2018,
2019.
Copies of the invoices for the overdue fees are enclosed with this Notice. Please remit payment at your
earliest convenience.
4) Failure to submit the NPDES Certificate of Coverage (CoC) NCG550000 Ownership Change Form
to have permit transferred into the currently property owner's name as required by Permit Condition
Part II. Section E. (4.).
A copy of the Ownership Change Form is enclosed with this Notice. Please complete and submit the
form to request the subject permit be transferred appropriately.
In addition to the deficiencies described above, the following items of concern also warrant your
attention:
a) A tree had fallen in the back yard and was partially covering the subsurface treatment filter.
Vegetation surrounding the fallen tree had been allowed to become overgrown, thus impeding
accessibility to this treatment unit to allow for proper inspection of system performance. Proper
operation and maintenance of all facilities and systems of treatment and control are required to be
conducted per Permit Condition Part Il. Section C. (2.).
b) A chlorinator was not observed during this inspection, however the presence/absence this unit could
not be confirmed due to the overgrown vegetation located adjacent to the subsurface treatment filter.
Please be aware that should a chlorinator be present, disinfection must be provided, utilizing
wastewater grade chlorine tablets, in accordance with Permit Condition Part I. Section D. (1.)
c) In accordance with Permit Condition Part I. Section D. (3.) the septic tank shall be pumped out at
least once every five years or when the solids level is found to be more than 1/3 of the liquid depth in
any compartment, whichever is greater. Records of the most recent solids removal from the septic
tank were not available for review during this inspection.
Failure to abide by the conditions contained in your permit may subject the permittee to enforcement
action by DWR in accordance with North Carolina General Statute 143-215.6A to 143-215.6C and/or
revocation of this permit. A follow-up inspection is planned in the next 120-days to evaluate your
response to the system deficiencies described in this Notice.
Page#

Permit: NCG550426
Inspection Date: 12/18/2019
Other
Comment: See attached sum
Owner - Facility: 530 Shadow Lane
Inspection Type: Compliance Evaluation
Yes No NA NE
Page#