WQ0000088_NOD-PC 2020-0112 Response_20200424

ACUA,.
April 24, 2020
Mr. Scott Vinson, Regional Supervisor
Water Quality Regional Operations
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Compliance Evaluation Inspection
Governors Club WWTP, Chatham County
Permit No. WQ0000088
Dear Mr. Vinson:
Np 4W Of enwroamoutd Qua I I r%
APR 2 9 a20
Aqua North Carolina, Inc. (Aqua) offers the following response to the above -referenced Compliance
Evaluation Inspection which required a response to two deficiencies, item 3) Operation and Maintenance
Requirements and item 4) Monitoring and Reporting Requirements.
Agua's Response:
All monitoring wells have been secured
III. Operation and Maintenance Requirements
n Condition 3- ORC Designation Form
o See attached A- Please note that this ORC form was submitted before the inspection.
IV. Monitoring and Reporting Requirements
o Condition 4-
• Please sec attached
■ Supervisor Jackie Jackson has also reached out for the updated forms.
o Condition 1 I-
■ Please sec attached
All of the requested information was also mailed via USPS on 4/23/2020. Electronic copies will be attached
to the emailed response.
If you have any questions or comments, please do not hesitate to contact me at [phone].
ercly,
obert er
Area Manager
cc: Joseph Pearce
202 MacKenan Court, Cary, NC 27511 • 919.467.8712 • AquaAmerica.com

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
Press TAB to enter information
Permittee Owner/Officer Name: Aqua North Carolina / Joseph R Pearce
Maifing Address: 202 MacKenan Court
City: Cary
Email Address: [e-mail]
Signature:
Facility Name: Governors Club
County: Wake
State: NC
Phone: [phone]
Zip: 27511
Date:
Permit # WQ0000088
NC Dept of Environmental Qud;ty
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type: WW
Facility Grade: II
APR 2 9 2020
Raleigh Regional Office
OPERATOR IN RESPONSIBLE CHARGE (ORC)
Print Full Name: Alfred L McNeill Work Phone: [phone]
Certificate Type: WW Certificate Grade: IV Certificate#€: 1008710
Email Address: ALMcNeill@,aquaamerica.com , /7 ft
Signature:
Effective Date: -4P1-Z0Z C7
"! certify that 1 agree t" y designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the
rules and regulations`{ rtaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: BACK UP HAS NOT CHANGED Work Phone:
Certificate Type: Select Certificate Grade: Select
Email Address: BACK UP HAS NOT CHANGED
Signature:
Certificate #:
Effective Date:
"1 certify that 1 agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone] Email: [e-mail]
ORIGINAL to: Raleigh, NC 27699-1618
Mail or Fax Asheville
Fayetteville
Mooresville
Raleigh
a COPY to: 2090 US Hwy 70
225 Green St., Suite 714
610 E. Center Ave., Suite 301
3800 Barrett Dr.
Swannanoa, NC 28778
Fayetteville, NC 28301-5043
Mooresville, NC 28115
Raleigh, NC 27609
Fax:[phone]
Fax:[phone]
Fax:[phone]
Fax:[phone]
Phone:[phone]
Phone:[phone]
Phone:[phone]
Phone:[phone]
Washington
943 Washington Sq. Mall
Washington, NC 27889
Fax:[phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]
Winston-Salem
45 W. Hanes Mall Rd.
Winston-Salem, NC 27105
Fax:[phone]
Phone: [phone]
Revised 412016

FORM. NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page �_ of 2-
Permit No.: W00000088 Facility Name: Governors Club County: Chatham Month: June Year. 2019
PPI: 001 Flow Measuring Paint: 01nt1uent lD Effkaft 0 No rtow geMotEd Parameter Monitoring Point: 0 Influent 0 Effluent © CkWidwater towering El Surface wader
Parameter Code 50450 40310 00530 31616 00610 40620 74300 04940 58660 110440 Ot}4Z6 l
c -
O
C C& i9 S' 9 a C
.@.
a S 1- O O e �- m� E .��. O c9 0` B,7 o x b
U. ~ � ¢
�rc
03
�� a z "tom jj-
i e
o ae Q
o
24-hr
hrs
GPD
mgfL
mgfL
#1100 mL
.mgll
mgfL
m91L
mg1L
mg1L
su
MNTU
1
101072.000000
100312.000000
I
0.6
2
0.80
0.7
1
5 2
J
1.8
35.8
3
0930
5.00
1.75
87918.000000
88307.000000
2.3
c2.5
<1
0.063
34
c.i
>:9
7.i
7.2
4
1030
5
0925
3.25
96548.000000
108122.000000
10181E"000000
0.16
0.18
0.68
7.1
7.1
71
1
1
1
6
1015
2.75
7
0855
4.00
8
125680.000000
133351.0D0000
1.5fp
2
w
O
91
10
0815
5.25
92449 000000
<,1
7.1
0,8
11
1115
4.00
90650 000000
0.22
0.52
7.2
7.2
0.8
0.9
A
12
0915
3.75
100353.00000D
_
.
13
0930
4.00
80387.000000
0:56
7.2
08 "-V,EEA
0830
1.00
76994.0000D0
Q.�S
7
14
0.7
a__
15
84106"000000
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06
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88983.ODOODO
<.1
-.9
7
7
0.6
0.6
1
5.5
17
0730
3.25
79941.0D0000
i
' 1.6
396
18
0850
3.75
102516.000000
2.8
C1:5
<1
0.05
38
19
1205
3.25
79266.000000
0.19
7.1
1.3
_
20
1005
4.50
96403.00DD0D
0.16
71
21
0845
2.75
74355 000000
_1
22
82835.000000
08
23
0905
75792.000000
0.
24
3.75
32539 000000
0.15
0.17
7.1
7.1
0.5
0.7
25
0840
2.75
89276.000000
26
0855
5,00
75026.000000
0.27
7
7.2
7.1
_
0.7
27
0840
3.00
72597.000000
0.63
0.32
0.6
28
0845
5.50
87331.000000
0.6
29
84278MOD00
82660,000000
-
0.60
30
31
_ Average:
90,729
2.55
0.00
1.00
0,06
36.00
0.25
0.65
5.35
1.70
37.70
Daily Maximum:
133.351
2.80 ;
2.50
1.00
0.06
38.00
0.68
7.20
'200.
5.50
1..80
39.6D
Daily Minimum:
1 72,597
2.30
2.50
1.00
US
34.00
0-10
7.00
0,50
5.20
1-60
35.80
Sampling Type:
Recorder
Composite
Composite
_ Grab
Composite
Composite
Corn posits
Composite
Grab
Grab
Recorder
Monthly Avg. Limit:
223,153
10
5
14
4
Daily Limit
Continuous
15
10
25
6
3 x Year
3 x Year
g_g
10
T
Sample Frequency:
2 x Month
2 x MDnlh
2 x Month
2x Month
2 x Month
5 x Week
5 x week
Cart .=,

FORM' NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page —IL of Z
Sampling Person(s) Certified Laboratories
Name: Eric Riggins Name: ENCO 591
Name:
Name:
Does all monitoring data and sampling frequencies meet the requirement, in Attachment A of your permit? El compriant 13 Nan-comoanr
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in yaur explanation the date(s) of the non-ompliance and describe the corrective
action(s) taken. Attach additional sheets if necessarv.
were
frequency.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Eric Riggins Permittee: Aqua North Carolina
Certification No.: 1000135 Signing Official: Jackie Jackson
Grade: 11 Phone Number. 9197578212 Signing Official's Title:
Has the ORC change since the prev! s NDMR? 7 Yes :J No Phone Number. 9196535773 Permit Expiration: 7/31/2023
<! I j
0
Signature Date Signature Date
By this senalure, i aerW that ties report is aecurrale and complete to the beet of my la—*dge.
certiy, raider penally of law, that thss document and an attachments were prepared under my daection or supemsion in
accordance w1th a system designed to aswm that al qualified personnel property gathered and evaluated the vdernnation
autxmtted. Based on my 6nqumry of the person or persons who manage the system, or those persons directly responsibie for
gathering the Womration, the asrormation submitted is, to the best of my "awsedge and bew tire, accurate, and complete. am
aware ttrat there are sigilftani penalties for submitting false information. inc�rding the poss>bky or fires and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDNIR) Page o` -4

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Page ,- of =
Sampling Person(s)
Name: Eric Riggins Name: ENCO 591
11
Name: Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
❑ Compliant 2) Non -Compliant
if the facility is non-comptiant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessarv.
were
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Eric Riggins Permittee: Aqua North Carolina
Certification No.: 1000135 Signing Official: Jackie Jackson
Grade: 11 Phone Number. 9197578212 Signing Official's Titie:
Has the ORC changed since the previous NDMR? © Yes E1 No Phone Number. 9196535773 Permit Expiration. 7131/2023
�a ao,2o
Signature Date Signature Date
By thissignature. certify that this report i5 arurrrdte and complete to the best of my krK wkedge. I certify. er penaPy of law, that this document and all attachments were prepared under my won or supenrisian in
accordance with a system designed to aswre that aA quaAried pwsonnef property gathered and evacuated the udormaw
submitted. Based on my inqury of the person or persons %to manage the system. or those persons directly responsible for
gathering the Information, the information submitted is, to the hest of my knowledge and belief. true. 00mrate, and complete. I am
aware that there are signiftant pennies for submitting false information, tntluding the poss9tifidy of tines and Imprisonment for
knowing violations.
Mail Original and Two Codes to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NI?MR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page T If
Permit No.: WQ0000088
Facility Name: Govemors Club
County: Chatham
Month: October Year. 2019
PPI: 001 Flow Measuring
Point: ❑ ineuent p Efikwd I7 No flaw gamated Parameter
Monitoring Point: 0 influent
D Muent O Grinwater towemV p surmM water
Parameter Code 0050
00310 00530 31616 00610 00620 "7631}0_'� 00940
E11296Ao 00400
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0:60. �
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5,90
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tK Y. 320l31
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,3 0.05r
39.00
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Monthly Avg. Limit
223153W
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Sample Frequency:
Cardinupiu
2 x Month
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2 x Month
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3 x Year
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114 OAKMONT DRIVE
GREENVILLE. N C 27858
GOVERNOR'S CLUB (AQUA NC)
MR. R.S. TUPPS
AQUA NORTH CAROLINA
202 MACKENAN CT.
CARY ,NC 27511
.. @W(Wol
PHONE [phone]
FAX [phone]
1:)#: 296
DATE COLLECTED: 03/14/19
DATE REPORTED : 03/22/19
R8VIEWED BY: ,
MW-lA
MW-3A
MW-7
MW-9
Analysis
Method
PARAMETERS
Date
Analyst
Code
I'H (field measurement), Units
6.7
6.5
6.7
7.1
03/14/19
PJC
450010-11
Fecal Collform (MT), /100 Mls
< 1
< 1
< 1
< 1
03/14/19
JTH
9222D-06
Total Suspended Residue, mg/l
22
20
16
46
03/15/19
JMH
254OD-11
Am inonia Nitrogen as N, mg/l
0.09
0.04
0.06
0.04
03/18/19
CLO
350.1 112-93
Nitrate Nitrogen as N, mg/1
0.13
<0.04
0.06
<0.04
03/15/19
DTL
353.2 R2-93
Total Phosphorus as P, mg11
0.16
0.I5
1.63
<0.04
03/21/19
TLI{
365.4.74
Total Organic Carbon, mg/l
1.30
1.32
4.91
2.24
03/18/19
SEJ
531OC-11
Chloride, mg/l
735
5
48
222
03/18/19
KDS
4500CLB-ll
Total Dissolved Residue, mg/1
1810
177
852
776
03/19/19
JMS
254OC-11
Temperature, °C
16
17
17
15
03/14/19
PJC
255OB-10
Time
11,23 AM
11:47 AM
12:30 PM
12:50 PM
03/14/19
PJC
Static Water Level, feet
21.95
25.26
22.00
1.67
03/14/19
PJC
Well Depth, feet
45.03
44.56
32.09
30.21
03/14/19
PJC
Water Bailed, Gals.
2.0
2.0
1.0
5.0
03/14/19
PJC
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yJrpnmenral
pual�ti
PR ? y ?07
0
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fOTAL CI ILQ»INt , litolld
OR ugll AT COLLECTION
6�mrr� In
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11 OF CONMINERS
~ Field pH > 'rr
Fecal Caliform 0 ro
TSR > ro O
Ammonia Nitro. n ro Oil
, Nitrate > ro
T. Phosphorus n ro H
TOC n ro
Chloride ;;t. IV
TDS a ro O
Temperature Y 'tijd
Field Parameter
PARAMETERS/TESTS
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ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
Mr. Shannon Becker
President, AQUA North Carolina, INC.
202 MacKenan Court
Cary, NC 27511
Mr. Becker,
NORTH CAROLINA
Environmental Quality
March 12, 2020
RRCEl�fR
NCZepto'fZ'n s"ro
mental Quali
APR 29 2020
'Weigh 'Regional
Subject: NOD-2020-PC-0112
Compliance Evaluation Inspection
Governors Club WWTP
Reclaimed Water Generation and Non -Conjunctive Utilization
System
Permit Number WQ0000088
Chatham County
On March 11, 2020, Rick Trone and Gary Kreiser of the Raleigh Regional Office conducted a compliance
evaluation inspection of the non -conjunctive wastewater treatment and reclaimed water generation system
located at Governors Club. The purpose of this inspection was to ensure compliance with the subject
permit. During the inspection, the cooperation of Mr. Jackie Jackson, Mr. Joe Pearce, and the Operator in
Responsible Charge (ORC), Alfred McNeill was helpful and appreciated.
This compliance evaluation inspection consisted of the following:
• Review of the permit;
• Review of the owner/facility information;
• Review of ORC logbooks, calibration documentation, Non -discharge wastewater monitoring
reports (NDMR), Non -discharge application reports (NDAR), Groundwater Monitoring Forms
(GW-59a) and;
• On -site inspection of treatment components and spray fields
The current permit was issued August 23, 2018 and expires on July 31, 2023. A permit modification
request was recently received to add a digester and repair the current one. The current digester is close to
structural failure. The inspection also included a review of the on -site components related to this change.
Components of the wastewater package plant appeared to be overall well -maintained and operational.
Water moving through the clarifier weirs was clear and free of solids. The ultraviolet lights were
D� WE'-'5A
North Carolina Department of Environmental Quality I Division of Water Resources
Ralelgh Regional l]ftice 13800 Barrett Drive I Raleigh. North Carolina 27609
919.791.4200

operational. The facility has plenty of chlorine tablets available. Monitoring WeII 7 was observed and
appeared free of damage,.The well cap was unlocked. Please ensure monitoring wells are secured.
The itispector reviewed the facilities Operation and Maintenance Plan which was found to be adequate.
Flowmeter and turbidimeter calibration records indicate both devices have been calibrated per permit
requirements (October 2019). The facility is certified to run a couple field parameters in house (e.g., pH).
A calibration log is maintained for the pH meter. A check of pH calibration standards found that pH 10
standard expires this month but was nearly empty. No issues were noted with the 5-day upset pond on the
day of the inspection. The pump station located at the 5-day upset pond has a lighted alarm and will call
the facility when in alarm status. The alarm functioned when a float was pulled, and the pumps could be
heard running.
Overall, the facility appears to be monitoring the package plant effluent according to permit requirements,
However, Total Nitrogen was not reported for the months of June, September, and October 2019. The
facility also. needs to have the NDMR forms updated, the current forms do not list Phosphorous, TKN,
and Total Nitrogen. Currently, the facility is having to write these parameters in by hand and several
months were missed. The facility reported the numbers, but without the headers for the columns. Two
random months of NDMR data were compared to lab results from Enco and no deficiencies were found.
No issues were noted with the NDAR reports. The facility always reports the same freeboard (91) for the
5-day upset pond. On the day of the inspection the freeboard about was 7'.
Monitoring well compliance sampling forms were compared against lab results from Environment 1.
Some minor errors were found on the November 2019 report which were discussed with Mr. Jackson.
Wells often have exceedances of groundwater standards for TDS and Chlorides. The facility needs to
submit form GW-59a Certification Form with each packet of GW 59's. GW-59's have not been received
by the Division for March 2019.
The facility maintains several spray fields located within an existing power line easement and a golf
course. Appropriate signage near the fields warns residents of the use of reclaimed water usage. No issues
were noted with the fields and golf course areas.
The following permit condition deficiencles were noted during the March 11, 2020 compliance
inspection and records review:
M. Operation and Maintenance Requirements
Condition 3, which states that, "Upon the Water Pollution Control System Operators Certification
Commission's classification of the subject non -discharge facilities... the Permittee shall designate and
employ a certified operator in responsible charge (ORC)..." W. Alfred McNeil is not listed as a certified
operator for permit WQ00000$$. Please have this updated to reflect the current operator:
h sa/de .nc. ov/abouttdivisions/water-resources/o erator-certification/wastewater-o erator
certification/wastewater-operator-certification-downloads
IV. MONITORING AND REPORTING REO1MMMENTS
Condition 4. which states that, "the Permittee shall monitor the reclaimed water from the generating
facility at the frequencies and locations for the parameters specified in Attachment A." The facility

should request updated NDMR forms from the Divisions Central Office, Non -Discharge Branch
that include Total Phosphorous, TKN, and Total Nitrogen. The facility failed to report Total
Nitrogen for the months of June, September, and October 2019. Please submit amended NDMR
forms for these months to the address on the form.
Condition l l,which states that, "Monitoring wells shall be sampled at the frequencies and for the
parameters specified in Attachment C." The facility has not submitted well sampling records for
March 2019. Please submit these documents to the address on the forms as soon as possible.
This office requests that you respond to this letter in writing within 30 days of receipt. Your
response should be sent to this office at the letterhead address. Your response should address the
following items as noted above. Please include in your response all corrective actions already taken and a
schedule for completion of any corrective actions not addressed.
If you have any questions about this inspection or this letter, please contact Rick Trone at
rick.trone&cdenr.g_ov or 919-791-4200.
Sincerely,
J��
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office, NCDEQ
Attachments: EPA Water Compliance Inspection Report
cc:
Central Files
RRO Files
Laserfiche

Compliance Inspection, Report
Permit: WQ0000088 Effective: 08123/18 Expiration: 07/31/23 Owner: Aqua North Carolina Inc
SOC: Effective: Expiration: Facility: Governors Club WWTP
County: Chatham Farrington Rd
Region: Raleigh
Chapel Hill NC 27517
Contact Person: Michael J Myers Title: Phone: [phone]
Directions to Facility:
Take Hwy. 64 West toward Pittsboro. Take a right onto Farrington Road. -The entrance for the Governors Club development is
located on the left, about 8.5 miles after this turn.
System Classifications: SI, WW2,
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/11/2020 Entry Time 10:OOAM Exit Time: 11:15AM
Primary Inspector: Rick V Trone Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine
Inspection Type: Compliance Evaluation
Permit Inspection Type: Reclaimed Water
Facility Status: ❑ Compliant
Not Compliant
Question Areas:
Miscellaneous Questions
■ Treatment
Treatment Barscreen
Record Keeping
Treatment influent Pump Station
® Treatment lagoons
0 Treatment Clarifiers
® End Use -Irrigation
Treatment Disinfection
Storage
Wells
E End Use -Reuse
Standby Power
(See attachment summary)
Page i of 7

Permit: WQ0000088 Owner -Facility: Aqua North Carolina Inc
inspection Date: 03/1112020 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page 2 of 7

Permit: WO00o0088 Owner - Facility:Aqua North Carolina Inc
Inspection Date: 03/11/2020 Inspection Type: Compliance Evaluation Reason for Visit: Routine
TWO
Yes No NA NE
Infiltration System
❑
Lagoon Spray, LR
❑
Single Family Spray, LR
❑
Activated Sludge Spray, LR
❑
Activated Sludge Spray, HR
❑
Activated Sludge Drip, LR
❑
Reuse (Quality)
❑
Recycle/Reuse
❑
Single Family Drip
❑
Treatment
Yes No NA NE
Are Treatment facilities consistent with those outlined in the current permit?
0000
Do all treatment units appear to be operational? (if no, note below.)
0000
Comment:
Treatment Influent Pump Station
Yes No NA NE
Is the pump station free of bypass lines or structures?
®(�
Is the general housekeeping acceptable?
E 11 11 ❑
Are all pumps present?
M11❑ ❑
Are all pumps operable?
0 0❑
Are ftoatsicontrols operable?
M❑ ❑ ❑
Are audio and visual alarms available?
❑ ❑ M ❑
Are audio and visual alarms operational?
❑ 0
# Are SCADAITelemetry alarms required?
❑ ❑ 0 ❑
Are SCADAITelemetry available?
❑ ❑ 0 ❑
Are SCADA!%lemetry operational?
❑ M ❑
Comment:
Standby Power Yes No NA NE
Is automatically activated standby power available? M 110 ❑
Is generator tested weekly by Interrupting primary power source? M ❑ ❑
Is generator operable? 0000
Does generator have adequate fuel? 0000
Comment:
Treatment Barscreen Yes No NA NE
Is it free of excessive debris? M 110 ❑
Page 3 of 7

Permit: WQ0000088 Owner - Facility:Aqua North Carollna Inc
Inspection Date: 03/11/2020 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Is disposal of screenings in compliance? E000
Are the bars spaced properly? 0000
Is the unit in good condition? 0 110 ❑
Comment:
Treatment Clarifiers
Yes No NA NE
Are the weirs level?
0000
Are the weirs free of solids and algae?
E ❑ ❑ ❑
Is the scum removal system operational?
E ❑ ❑ ❑
Is the scum removal system accessible?
0 ❑ 110
Is the sludge blanket at an acceptable level?
❑ ❑ ❑ n'
Is the effluent from the clarifier free of excessive solids?
■ ❑ ❑ ❑
Comment:
Treatment Disinfection
Yes No NA NE
Is the system working?
N 000
Do the fecal coliform results Indicate proper disinfection?
®❑ ❑ ❑
Is there adequate detention time (-30 minutes)?
N ❑ ❑ ❑
Is the system properly maintained?
0 000
If gas, does the cylinder storage appear safe?
❑ ❑ E ❑
Is the fan In the chlorine feed room and storage area operable?
-❑ ❑ No
Is the chlorinator accessible?
❑ ❑ 0 ❑
If tablets, are tablets present?
0 ❑ ❑ ❑
Are the tablets the proper size and type?
N ❑ ❑ ❑
Is contact chamber free of sludge, solids, and growth?
■ ❑ ❑ ❑
If UV, are extra UV bulbs available?
0 ❑ ❑ ❑
If UV, Is the UV intensity adequate?
■ ❑ ❑ ❑
# Is it a dual feed system?
s ❑ 110
Does the Stationary Source have more than 2500 lbs of Chlorine (CAS No. 7782-50-5)?
❑ Cl n ❑
If yes, then Is there a Risk Management Plan on site?
❑ ❑ ❑
If yeq, then what is the EPA twelve digit ID Number? (1000-_-T�
If yes, then when was the RMP last updated?
Comment:
Record Keeaina Yes No NA NE
Is a copy of current permit available? ❑ ❑ ❑
Are monitoring reports present: NDMR? 11110
NDAR? E 110 ❑
Page 4 of 7

Permit: W00000088 Owner - Facility: Aqua North Caro! na Inc
Inspection Date: 0311112020 Inspection Type: Compliance Evaluation Reason far Visit: Routine
Are flow rates less than of permitted flow?
E ❑ ❑ D
Are flow rates less than of permitted flow?
■ ❑ ❑ ❑
Are application rates adhered to?
0 ❑ ❑ ❑
Is GW monitoring being conducted, if required (GW-59s submitted)?
■ ❑ ❑ ❑
Are all samples analyzed for all required parameters?
❑ 0 ❑ ❑
Are there any 2L GW quality violations?
®❑ ❑ ❑
Is GW-59A certification form completed for facility?
El N ❑ ❑
Is effluent sampled for same parameters as GW7
0 [] ❑ ❑
Do effluent concentrations exceed GW standards?
■ ❑ ❑ ❑
Are annual soil reports available?
❑ ❑ E ❑
# Are PAN records required?
❑ ❑ so
# Did last soil report ,ndicate a need for I: me?
❑ ❑ E ❑
If so, has It been applied?
[] ❑ 0 ❑
Are operational logs present?
0 ❑ ❑ ❑
Are lab sheets available for review?
E ❑ ❑ ❑
Do lab sheets support data reported on NDMR?
■ ❑ ❑ ❑
Do lab sheets support data reported on GW 59s?
E ❑ ❑ ❑
Are Operational and Maintenance records present?
S ❑ ❑ ❑
Were Operational and Maintenance records complete?
0 ❑ ❑ ❑
Has permittee been free of public complaints in last 12 months?
■ ❑ ❑ ❑
Is a copy of the SOC readily available?
❑ ❑ n ❑
No treatment units bypassed since last inspection?
❑ 0 ■ ❑
Comment: Facility has not submitted GW-59 for March 2019. Facility
does not submit GW-59a forms.
Some parameters have been unreported on form NDMR
see summa
End Use -irrigation
Yes No NA NE
Are buffers adequate?
❑ ❑
Is the cover crop type specified In permit?
0 ❑ ❑ ❑
Is the crop cover acceptable?
M ❑ ❑ ❑
Is the site condition adequate?
0 ❑ ❑ ❑
Is the site free of runoff / ponding7
0 ❑ ❑ ❑
Is the acreage specifed In the permit being utilized?
N ❑ ❑ ❑
Is the application equipment present?
0 ❑ ❑ ❑
Is the application equipment operational?
S ❑ ❑ ❑
Is the disposal field free of limiting slopes?
0 ❑ ❑ ❑
Is access restricted and/or s-gns posted during active site use?
N ❑ ❑ ❑
Are any supply wells within the CB?
❑ ❑ ❑ a
Page 5 of 7

Permit: W00000088 Owner- Facility. -Aqua North Carolina Inc
Inspection Date: 03i11i2020 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Are any supply wells within 250' of the CB?
How close is the closest water supply well?
Is municipal water available In the area?
# Info only: Does the permit call for monitoring wells?
Are GW monitoring wells located properly wl respect to RB and CB?
Are GW monitoring wells properly constructed, Including screened interval?
Are monitoring wells damaged?
Commerit: .
End Use -Reuse
Is the acreage in the permit being utilized?
Does the acreage specified in the permit correspond to the measured acreage at the site?
Are all essential units provided in duplicate?
Is an automatically activated standby power source available?
Is the equalization capacity adequate?
Is aerated flow equalization present?
Has the turbidity meter been calibrated in the last 12 months?
Does the turbidity meter have recording capabilities?
is all flow diverted at the appropriate times?
Is all upset wastewater diverted from reuse storage unit?
Is all upset wastewater treated, retreated, or disposed of acceptably?
Is upset wastewater treated prior to discharge to irrigation storage?
Is public access restricted from irrigation area during active site use?
If golf course, Is a sign posted in plain sight on the club house?
Is the cover crop acceptable?
Are buffers adequate?
Is the site free of pondfnglrunoff?
Is the acreage In the permit being utilized?
Is the application equipment acceptable?
Is the application area free of limiting slopes?
How close is the closest water supply well?
Are any supply wells within the CB?
Are any supply wells within 250' of the CB?
Is municipal water available in the area?
Are GW monitoring welts required?
Are GW monitoring wells located properly wl respect to RB and CB7
Are GW monitoring wells properly constructed, Including screened interval?
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