NCG550450_Compliance Evaluation Inspection_20200116

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
Julia Shelton
1205 Tillotson Rd.
Pinnacle, NC 27043
NORTH CAROLINA
Environmental Quality
January 16, 2020
SUBJECT: Compliance Evaluation Inspection
Certificate of Coverage #NCG550450 — General Permit 550000
Single -Family NPDES Wastewater Treatment System
1205 Tillotson Rd. Pinnacle, NC 27043
Stokes County
Dear Ms. Shelton:
On January 9, 2020, 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 Mr. Justin Henderson. Ms. Julia Shelton was present during this
inspection. While inspection of the wastewater treatment system mostly reflects compliance with
Permit No. NCG550450, the following items of concern require your attention and action:
1) Failure to utilize wastewater grade (calcium hypochlorite) chlorine tablets to ensure
continuous and proper disinfection as required by Permit Condition Part I. Section D. (1.)
(a.). Wastewater grade (calcium hypochlorite) tablets shall be utilized in the tablet
chlorinator to provide proper disinfection.
2) The permittee was unsure of the last time that the septic tank was pumped out, and there
were no records available for review. Permit Condition Part I. Section D. (3.) (b.) states:
Septic tanks 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.
Permit Condition Part IL Section D. (6.) states: Records related to the Permittee's sewage
sludge use and disposal activities shall be retained for a period of at least five years.
3) Reportedly, discharge from the subject wastewater system has never been observed, thus
effluent monitoring as required by Permit Condition Part I. Section C. has never been
NORTH CAROLINAD_E Q��
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North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

conducted. Please be aware that should a discharge from the subject system occur that
effluent monitoring in accordance with Permit Condition I. C. would be required to be
conducted, and records of monitoring retained in accordance with Permit Condition Part I
D. (5.) (b.).
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
If you have any questions concerning this letter, you may contact Mr. Justin Henderson or me at
[phone].
Sincerely,
E145DocuSiiggned by:
B49E225C94EA...
Lon Snider, Regional Supervisor
Water Quality Regional Operation 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 NCG550450 111 12 I 20/01/09 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:OOAM 20/01/09
19/11/18
1205 Tillotson Road
1205 Tillotson Rd
Exit Time/Date
Permit Expiration Date
Pinnacle NC 27043
11:00AM 20/01/09
20/10/31
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
Kenneth G Shelton, 1205 Tillotson Rd Pinnacle NC 27043///
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
DocuSigned by:
US l&qtA I,_-b� DWR/WSRO WQ/336-776-9701/
Justin L Henderson D51F3525961`8113496...
1/13/2020
Signature of Management Q A usigned by: Agency/Office/Phone and Fax Numbers
Date
Luti ? Sti�du,
1/16/2020
145B49_225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
NCG550450 I11 121 20/01/09 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On January 9, 2020, 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 Mr. Justin Henderson. Ms. Julia Shelton was present during this inspection. While inspection of
the wastewater treatment system mostly reflects compliance with Permit No. NCG550450, the
following items of concern require your attention and action:
1) Failure to utilize wastewater grade (calcium hypochlorite) chlorine tablets to ensure continuous and
proper disinfection as required by Permit Condition Part I. Section D. (1.) (a.). Wastewater grade
(calcium hypochlorite) tablets shall be utilized in the tablet chlorinator to provide proper disinfection.
2) The permittee was unsure of the last time that the septic tank was pumped out, and there were no
records available for review. Permit Condition Part I. Section D. (3.) (b.) states: Septic tanks 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. Permit Condition Part 11. Section D. (6.) states:
Records related to the Permittee's sewage sludge use and disposal activities shall be retained for a
period of at least five years.
3) Reportedly, discharge from the subject wastewater system has never been observed, thus effluent
monitoring as required by Permit Condition Part I. Section C. has never been conducted. Please be
aware that should a discharge from the subject system occur that effluent monitoring in accordance
with Permit Condition I. C. would be required to be conducted, and records of monitoring retained in
accordance with Permit Condition Part I D. (5.) (b.).
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
If you have any questions concerning this letter, you may contact Mr. Justin Henderson or me at (336)
776-9800.
Page#

Permit: NCG550450
Inspection Date: 01/09/2020
Other
Comment:
Owner - Facility: 1205 Tillotson Road
Inspection Type: Compliance Evaluation
Yes No NA NE
Page#