NCG551190_Compliance Evaluation Inspection_20191231

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
Terry Bridge
2628 Wessex Rd.
Winston-Salem, NC 27106
NORTH CAROLINA
Environmental Quality
December 31, 2019
Subject: Notice of Deficiency— (NOD-2020-PC-0000)
Wastewater System Inspection/General Permit NCG550000
2628 Wessex Rd. Winston-Salem NC 27106
Certificate of Coverage NCG551190
Forsyth County
Dear Mr. Bridge:
On December 31, 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 ensure continuous and proper disinfection, utilizing wastewater grade chlorine
tablets, as required by Permit Condition Part I Section D. (1.).
3) Failure to pay the Annual Administering and Compliance Monitoring Fee of $60/year
within 30-days of the invoice date, as required by Permit condition Part II. Section B. (14.)
Fees became overdue as of December 7, 2019.
Mr. Bridge reported during this inspection that payment of the annual fee had been
remitted on December 28, 2019.
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

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 to be conducted
within 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].
Sincerely,
DocuSig ed by:
, � . _'u�
for oriDiiice'r;'fegional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ-WSRO
Enc: Inspection Report
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 NCG551190 111 12 I 19/12/31 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)
11:00AM 19/12/31
13/08/01
2628 Wessex Road
2628 Wessex Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27106
11:50AM 19/12/31
18/07/31
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
Terry L Bridge,2628 Wessex Rd Winston Salem NC 27106//336-923-2804/
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 DouSigned by: DWR/WSRO WQ/336-776-9701/
UscLv, hA&k 6V'
D51F3525961`8113496..
12/31/2019
.
Signature of Management Q A Reviewer by: Agency/Office/Phone and Fax Numbers
Date
(DocuSigned
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
NCG551190 I11 121 19/12/31 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Dear Mr. Bridge:
On December 31, 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 ensure continuous and proper disinfection, utilizing wastewater grade chlorine tablets, as
required by Permit Condition Part I Section D. (1.).
3) Failure to pay the Annual Administering and Compliance Monitoring Fee of $60/year within 30-days
of the invoice date, as required by Permit condition Part II. Section B. (14.) Fees became overdue as of
December 7, 2019.
Mr. Bridge reported during this inspection that payment of the annual fee had been remitted on
December 28, 2019.
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 to be conducted within 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].
Page#

Permit: NCG551190
Inspection Date: 12/31/2019
Other
Comment:
Owner - Facility: 2628 Wessex Road
Inspection Type: Compliance Evaluation
Yes No NA NE
Page#