NCG550535_Regional Office Historical File Pre 2018

FILE- COOPER
Governor
MICHAEL S. RRGAN
Secretary
Environmental S. JAY ZIMMERMAN
Quality Director
February 7, 2017
Mr. Jerry Ray Love
203 Forestway Dr.
Mount Holly, NC 28120
Subject: Compliance Evaluation Inspection
203 Forestway Drive
Certificate of Coverage No. NCG550535
Gaston County
Dear Mr. Love:
Enclosed is a copy of the Compliance Evaluation Inspection for the inspection conducted
at the subject facility on February 2, 2017, by Ori Tuvia. Your cooperation during the site visit
was much appreciated.
If you have any questions,please contact Ori Tuvia at(704) 235-2190, or via email at
ori.tuviaa.ncdenngov.
Sincerely,
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DEQ
Mooresville Regional Office
Location:610 East Center Ave.,Suite 301 Mooresville,NC 28115
Phone:[phone] Fax:[phone] Customer Service:1-877-623-6748
Internet:www.ncwaterquality.org

United States Environmental Protection Agency Form Approved.
EPA Washington,D.C.20460 OMB No.2040-0057
Water Compliance Inspection Report 4 , 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 u 2 �—�5 I 3 I NCG550535 111 12 I 17/02/02 117 18 i�.i 19 i C i 201
21I I I I II I I I I I I I I I I I I I l I I I I l I l l l l l l l l l l l I I I I I r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA -- -Reserved-
67 Ito I 70 LJ id i 71 I„ 1 72 I N I 731
I 174751 I I I I I I 180
Section B:Facility Data I
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)
12:45PM 17/02/02 13/08/01
203 Forestway Drive
203 Forestway Dr Exit Time/Date Permit Expiration Date
Mount Holly NC 28120 01:30PM 17/02/02 18/07/31
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
///
Jerry Ray Love///
Name,Address of Responsible Official/Tide/Phone and Fax Number
Contacted
Jerry Ray Love,203 Forestway Dr Mount Holly NC 28120/1704-827-2757/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
III Permit I Operations&Maintenance Records/Reports I. Self-Monitoring Program
111 Facility Site Review a 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
Ori A Tuvia MRO WQ//704-663-1699/
2/ 71/3_
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
W.Corey Basinger MRO WQ//704-235-2194/
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete. "}
EiLDcaZ
.Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550535 111 121 17/02/02 117 18 L'
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Page# 2

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 02/02/2017 Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new ❑ 0 • ❑
application?
Is the facility as described in the permit? • 0 0 0
#Are there any special conditions for the permit? 0 III 0 0
Is access to the plant site restricted to the general public? 0 0 • 0
Is the inspector granted access to all areas for inspection? 11 0 0 0
Comment: The subject permit expires on 7/31/2018. System (Septic tank,Sand filter and chlorinator
box)located in front yard of 203 Forestway Dr.,discharges into tributary of Taylors Creek
which is in the Catawba River Basin.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • 0 0 0
Does the facility analyze process control parameters,for ex: MLSS,MCRT,Settleable 0 • 0 0
Solids,pH, DO,Sludge Judge,and other that are applicable?
Comment: Discharge pipe is not accessible after the drainage culvert was replaced by DOT.Analytical
data has not been completed due to sample not being able to be obtained due to no flow.
Chlorinator box is under concrete and it is evident that very little flow, if any, pass through the
pipe.The tow flow is due to evaporation from sand filter area and absorption by vegetation
roots reduces the discharge volume.
Sand Filters (Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational? 0 11 0 0
Is the distribution box level and watertight? 0 0 0 •
Is sand filter free of ponding? • 0 0 0
Is the sand filter effluent re-circulated at a valid ratio? ❑ 0 • ❑
#Is the sand filter surface free of algae or excessive vegetation? • 0 0 0
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) 0 0 • 0
Comment: Sand filter is grassed over in front yard prior to chlorination dispenser.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • 0 0 0
Are the tablets the proper size and type? 11 0 0 0
Number of tubes in use? 2
Is the level of chlorine residual acceptable? 0 0 0 •
Is the contact chamber free of growth,or sludge buildup? 0 0 0 •
Is there chlorine residual prior to de-chlorination? 0 0 • 0
Page# 3

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 02/02/2017 Inspection Type: Compliance Evaluation
Disinfection-Tablet Yes No NA NE
Comment: Dechlorination is not required since this system was installed prior to regulations. Installation
was prior to 1969.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? 0 0 II 0
Is sample collected below all treatment units? 0 ❑ I ❑
Is proper volume collected? 0 MI 0 ❑
Is the tubing clean? ❑ 0 • 0
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees 0 0 11 ❑
Celsius)?
Is the facility sampling performed as required by the permit(frequency,sampling type 0 0 • 0
representative)?
Comment: Analytical data has not been completed due to sample not being able to be obtained due to
no flow
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? • ❑ 0 ❑
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 0 11 ❑
Comment: Crosses neighbors property and enters culvert at side of the road.
Page# 4

United States Environmental Protection Agency Form Approved.
E PA 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 LN ] 2 � 3 I NCG550535 111 121 14/09/04 117 18 I r.I 19 I S I 20
21I� I I I I I I I I I II I I I I I I I I I I I I I I I I I I I I I I I II I I I I I r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
67I LJ
701, I 71 I I 72 u 73I I 174 791 I I I I I lI'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) 03:30PM 14/09/04 13/08/01
203 Forestway Drive
203 Forestway Dr Exit Time/Date Permit Expiration Date
04:30PM 14/09/04 18/07/31
Mount Holly NC 28120
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
Jerry Ray Love,203 Forestway Dr Mount Holly NC 2 81 2 01/7 0 4-827-2 7 57/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
Permit Operations&Maintenance Records/Reports Self-Monitoring Program
II Facility Site Review • 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
Barbara Sifford Division of Water Quality//704-663-1699
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550535 111 121 14/09/04 117 18 I
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Discharge pipe is not accessible after the drainage culvert was replaced by DOT. Analytical has not
been completed due to sample not being able to be obtained from discharge pipe. Chlorinator box is
under concrete and very little flow if any. Evaporation from sand filter area and absorbed by vegetation
roots reduces the discharge volume.
Page# 2

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 09/04/2014 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • ❑ ❑ ❑
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 has raised lid for easy access.
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new ❑ ❑ ❑
application?
Is the facility as described in the permit? M000
#Are there any special conditions for the permit? ❑ • ❑ ❑
Is access to the plant site restricted to the general public? ❑ ❑ � ❑
Is the inspector granted access to all areas for inspection? • ❑ ❑ ❑
Comment: located in front yard of 203 Forestway Dr., discharges into tributary of Taylors Creek which
is in the Catawba River Basin.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? M000
Are the receiving water free of foam other than trace amounts and other debris? E000
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ 1E ❑
Comment: Crosses neighbors property and enters culvert at side of the road.
Sand Filters (Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational? ❑ • ❑ ❑
Is the distribution box level and watertight? 00011
Is sand filter free of ponding? • ❑ ❑ ❑
Is the sand filter effluent re-circulated at a valid ratio? 01100
#Is the sand filter surface free of algae or excessive vegetation? ❑ ❑ ❑
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) 00110
Comment: Sand filter is grassed over in front yard prior to chlorination dispenser.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • ❑ ❑ ❑
Are the tablets the proper size and type? • ❑ ❑ ❑
Number of tubes in use? 2
Page# 3

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 09/04/2014 Inspection Type: Compliance Evaluation
Disinfection-Tablet "" Yes No NA NE
Is the level of chlorine residual acceptable? ❑ ❑ El II
Is the contact chamber free of growth, or sludge buildup? ❑ ❑ ❑ •
Is there chlorine residual prior to de-chlorination? Cl ❑ III 0
Comment: Dechlorination is not required since this system was installed prior to regulations.
Installation was prior to 1969.
Page# 4

ROY COOPER
F
I LE
„...
Environmental
Quality
January 11, 2017
Mr. Jerry Ray Love
203 Forestway Dr.
Mount Holly,NC 28120
Subject: Compliance Evaluation Inspection
203 Forestway Drive
Certificate of Coverage No.NCG550535
Gaston County
Dear Mr. Love:
Please be advised that NCDEQ inspector will be coming to inspect subject permit on
February 1, 2017, at about 2:30 PM. Your presence during the inspection is advised to discuss
compliance with the conditions listed in subject permit(see attached).
If you wish to reschedule or have any questions, please contact Ori Tuvia at(704) 235-
2190, or via email at [e-mail].
Sincerely,
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DEQ
Mooresville Regional Office
Location:610 East Center Ave.,Suite 301 Mooresville,NC 28115
Phone:[phone] Fax:[phone] Customer Service:1-877-623-6748
Internet www.ncwaterquality.org

�AT&
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
September 29, 2014
Mr. Jerry Ray Love
203 Forestway Drive
Mount Holly,NC 28120
Subject: Single Family Residence Wastewater
Treatment System
NPDES General Wastewater Permit
No./Certificate of Coverage
NCG550535
Compliance Evaluation Inspection
Dear Mr. Love:
A compliance evaluation inspection (CEI) of the wastewater treatment system that serves your
single family residence (SFR) was conducted on September 4, 2014. Your cooperation and
assistance during the inspection was greatly appreciated. Enclosed is a copy of the CEI.
Overall the facility was in good operational condition and well maintained.
The report should be self-explanatory. Please note that Part I, Section A of the permit includes
analytical testing for total residual chlorine(TRC)along with the footnote that indicates that instream
TRC levels are not to exceed 17ug/1. Please submit a copy of the analytical results and chain of
custody forms from your 2014 annual testing for our records.
If you have any questions,comments, or need assistance with understanding any aspect of your permit
or this report, please do not hesitate to contact Ms. Sifford or myself at(704)-663-1699.
Attachments:
CEI-Report(BIMS)
NCG550000 General Permit
Cc: MSC-1617 Central Files
MRO files-Love SFR
Sincerely,/
U<C[l 1.
Barbara Sifford
Technical Consultant
Water Quality Regional Operations
Mooresville Regional Office—NCDENR
Mooresville Regional Office,610 East Center Avenue,Mooresville,North Carolina 28155
Phone:[phone]\Internet:www.ncdenr.gov
An Equal Opportunity Affirmative Action Employer-Made in part by recycled paper

United States Environmental Protection Agency Form Approved.
E PA 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
[N j 2 I5 I 3 I NCG550535 111 12 1 14/09/04 117 18 19 LI 2011
211IIIII IIII11I1l111111111 11 il111 111111l li 1l
Inspection Work Days Facility Self-Monitoring Evaluation Rating 81 QA Reserved---
67 1 LJ 70�, I 71 Li
i 72 .LJ1 7311 I 174 75J I I I I I I 180
Section B:FacilityData
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) 03:30PM 14/09/04 13/08/01
203 Forestway Drive
203 Forestway Dr Exit Time/Date Permit Expiration Date
Mount Holly NC 28120 04:30PM 14/09/04 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
Jerry Ray Love,203 Forestway Dr Mount Holly NC 2 8 1 2 0//7 0 4-827-2 7 5 7/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
In Permit • Operations&Maintenance 111 Records/Reports II Self-Monitoring Program
Ill Facility Site Review • 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
Barbara Sifford Division of Water Quality//704-663-1699
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550535 I11 121 14/09/04 117 18
Li
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Discharge pipe is not accessible after the drainage culvert was replaced by DOT. Analytical has not
been completed due to sample not being able to be obtained from discharge pipe. Chlorinator box is
under concrete and very little flow if any. Evaporation from sand filter area and absorbed by vegetation
roots reduces the discharge volume.
Page# 2

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 09/04/2014 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • ❑ 0 ❑
Does the facility analyze process control parameters,for ex: MLSS, MCRT, Settleable 0 11 0 0
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: Septic tank has raised lid for easy access.
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new ❑ 0 IN 0
application?
Is the facility as described in the permit? • 0 0 0
#Are there any special conditions for the permit? 0 • 0 0
Is access to the plant site restricted to the general public? 0 0 • 0
Is the inspector granted access to all areas for inspection? 11 0 0 0
Comment: located in front yard of 203 Forestway Dr., discharges into tributary of Taylors Creek which
is in the Catawba River Basin.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? • 0 0 0
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 0 MI 0
Comment: Crosses neighbors property and enters culvert at side of the road.
Sand Filters (Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational? 0 U 0 0
Is the distribution box level and watertight? 0 0 0 •
Is sand filter free of ponding? • 0 0 0
Is the sand filter effluent re-circulated at a valid ratio? 0 11 0 ❑
#Is the sand filter surface free of algae or excessive vegetation? • 0 0 0
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) 0 0 • 0
Comment: Sand filter is grassed over in front yard prior to chlorination dispenser.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • 0 0 0
Are the tablets the proper size and type? • 0 0 0
Number of tubes in use? 2
Page# 3

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 09/04/2014 Inspection Type: Compliance Evaluation
Disinfection-Tablet Yes No NA NE
Is the level of chlorine residual acceptable? 0 0
Is the contact chamber free of growth, or sludge buildup? 0 0 0 •
Is there chlorine residual prior to de-chlorination? 0 ❑ II 0
Comment: Dechlorination is not required since this system was installed prior to regulations.
Installation was prior to 1969.
Page# 4

Aids,
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
August 18, 2014
Mr. Jerry Ray Love
203 Forest Way Drive
Mt. Holly, NC 28120
Subject: Single Family Residence Wastewater
Treatment System
NPDES General Wastewater Permit
No./Certificate of Coverage
NCG550535
Compliance Evaluation Inspection
Dear Mr. Love:
Division of Water Quality (DWQ) database records show that you currently
own/operate a single family residence (SFR) wastewater treatment and disposal system.
DWQ personnel from the Mooresville Regional Office (MRO) need to conduct a
comprehensive review of your system with you in order to verify that your system is operating
properly and to determine the compliance status of the system pursuant to your NCG550486
permit. We anticipate such a review would take approximately one to two hours, provided
that all needed documentation and data is readily available at the time of the site visit.
Due to the difficulties involved with catching owners at home during the workday,
we would like to pre-schedule this site visit with you to ensure we can meet and complete the
required system review as expeditiously as possible. In order to facilitate this we ask that you
contact Ms. Barbara Sifford, of our office, at 704-235-2196, between the hours of 9AM and
4PM, Monday through Friday. Please contact Ms. Sifford within the next 10 days to identify
the best possible time for her to evaluate your SFR WW system and conduct this review with
you.
Also, in the interest of conducting the most efficient evaluation possible, we ask that you have
certain items of documentation on hand at the time of the site visit. These items include the
following:
1. Permit/Certificate of Coverage: Issued by DWQ.
2. A Schematic of the Treatment/Disposal System: Please have available all
schematics or other technical drawings and/or design specifications that show the
complete and/or partial layout of your treatment/disposal system.
3. Documentation of Analytical Monitoring: Required in Part I(A) of the general
NCG550000 permit, please have available all official records of analytical
monitoring conducted to date.
Mooresville Regional Office,610 East Center Avenue,Mooresville,North Carolina 28155
Phone:[phone]\Internet:www.ncdenr.gov
An Equal Opportunity\Affirmative Action Employer-Made in part by recycled paper

NI
�O qp Michael F.Easley, vemor
cO G�
� • William G.Ross,Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Coleen H.Sullins,Director
Division of Water Quality
20 June 2008
Mr. Jerry Ray Love
203 Forestway Drive
Mount Holly,NC 28120
Subject: Compliance Evaluation Inspection
Single Family Residence Wastewater Treatment
System
NPDES General Wastewater Permit No./Certificate
of Coverage NCG550535
Gaston County
Dear Mr. Love:
1. Mr. Ron Boone of the NC Division of Water Quality (DWQ), Mooresville Regional Office (MRO)
conducted a compliance evaluation inspection (CEI) of the wastewater treatment system (WWTS) that
serves your single family residence (SFR) on 18 June 2008. Your cooperation and assistance during the
CEI was greatly appreciated. This letter is a summary/follow up for the CEI and inspection checklists are
attached for your records.
2. Inspection of the system revealed only two concerns:
A. The effluent flow from your system currently discharges into a stormwater catch basin that is located
on the northwest corner of Forestway Drive and Vina Place. The catch basin is covered with a very
large concrete lid, which could not be removed during the CEI. Please be aware that the lid will
need to be removed during future CEIs to facilitate inspection of the discharge pipe, effluent flow
and receiving water. You will be responsible to have the lid removed. There was no discharge at
the time of this inspection because the tank had just been pumped.
B. Analytical monitoring is not being conducted in accordance with Part I(A) of the permit. You must
complete this monitoring annually using a NC certified laboratory.
3. No other discrepancies were noted during the inspection. The system appears to be well operated and
maintained. There were no signs of system failure noted.
4. Please take all steps necessary to correct the discrepancies noted above in paragraph 2. You should be
aware that failure to comply with any condition of your permit (NCG550535) constitutes a failure to
comply with NC General Statute (NCGS) 143-215.1, for which the Department has been delegated the
authority to assess civil penalties not to exceed $25,000 per day, per violation, in accordance with NCGS
143-215.6A.
One
Carolina NorurallyNat
North Carolina Division of Water Quality Mooresville Regional Office Surface Water Protection Phone[phone] Customer Service
Internet: h2o.enr.state.nc.us 610 East Center Avenue,Suite 301 Mooresville,NC 28115 FAX [phone]
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

Jerry Ray Love Single Family Residence Wastewater Treatment System
NCG550535 Compliance Evaluation Inspection,20 June 2008
5. We appreciate your time and understanding of our mission to preserve the natural resources of our great
state. Should you have any questions about the inspection or this letter, please contact Ms. Barbara
Sifford at 704-663-1699.
Sincerely,
k. Robert B. Krebs
Surface Water Protection Section Supervisor
Division of Water Quality
Mooresville Regional Office
Attachments:
1. Water Compliance Inspection Report
2. Field Inspection Checklist
CC: NPDES West Unit
Central Files

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 NI 2 � 5� 3I NCG550535 111 121 08/06/18 1 17 181l 2Jl 19t .¢1 20I
J u Remarks U L!
211IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII HIM 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
671 169 701 I 71I I 72I_=.1 731 1174 751 11 1 1 1 1 1"
Section B: Facility Data u
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)
12:50 PM 08/06/18 07/08/01
203 Forestway Drive
203 Forestway Dr Exit Time/Date Permit Expiration Date
Mount Holly NC 28120 01:27 PM 08/06/18 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
Jerry Ray Love,203 Forestway Dr Mount Holly NC 28120//704-827-1171/ No
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
Permit II Operations&Maintenance II Records/Reports II Self-Monitoring Program
1111 Sludge Handling Disposal •Facility Site Review Effluent/Receiving Waters II Laboratory
Other
Section D: Summary of Findinq/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
Ron Boone MRO WQ//704-663-1699 Ext.2202/
Signature of Management Q A Revie r Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type (cont.) 1
31 NCG550535 11
12I 08/06/18 117 18
Section D: Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please see summary letter. Mr. Love now has a copy of the general permit and is aware of the analytical
monitoring requirements. He is doing everything else he needs to be doing. No signs of system failure
detected. Mr. Love just had tank pumped when he received our first letter 2 to 3 weeks ago so the tank was
not yet full and there was no discharge at the time of the inspection. He is arranging to have samples taken
at first possible opportunity and will send the test results to the Division. Mr. Love has been living at this
house since 1963.
Page# 2

•
Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 06/18/2008 Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? n n ■ n
Is the facility as described in the permit? ■ n ❑ n
#Are there any special conditions for the permit? n ■ n n
Is access to the plant site restricted to the general public? ■ n n n
Is the inspector granted access to all areas for inspection? ■ n ❑ n
Comment: Facility is secured as much as can practically be expected for an SFR.
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ■ ❑ ❑ n
Is all required information readily available,complete and current? ■ n n n
Are all records maintained for 3 years(lab. reg. required 5 years)? ■ n n n
Are analytical results consistent with data reported on DMRs? 0 0 ■ 0
Is the chain-of-custody complete? n n ■
Dates,times and location of sampling 0
Name of individual performing the sampling 0
Results of analysis and calibration 0
Dates of analysis 0
Name of person performing analyses 0
Transported COCs n
Are DMRs complete:do they include all permit parameters? 0 0 • 0
Has the facility submitted its annual compliance report to users and DWQ? 0 0 ■
(If the facility is=or>5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? 0 0 • 0
Is the ORC visitation log available and current? 0 0 • 0
Is the ORC certified at grade equal to or higher than the facility classification? 0 0 • 0
Is the backup operator certified at one grade less or greater than the facility classification? n n ■ ❑
Is a copy of the current NPDES permit available on site? ■ n 0 n
Facility has copy of previous year's Annual Report on file for review? 0 0 • 0
Comment: Annual report, ORC/BORC, visitation log and DMRs not required.
Permittee has not conducted analytical monitoring to date and denies knowledge of the
requirement up to now. Permittee is now coordinating sampling of the effluent but just
had the tank pumped so there is no discharge at this time.
Operations&Maintenance Yes No NA NE
Page# 3

•
Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 06/18/2008 Inspection Type: Compliance Evaluation
Operations&Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ■ ❑
Judge, and other that are applicable?
Comment:
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? • ❑ n ❑
Are the receiving water free of foam other than trace amounts and other debris? ■ ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? 0 0 ■ 0
Comment:
Other Yes No NA NE
Comment: No other notes.
Septic Tank Yes No NA NE
(If pumps are used)Is an audible and visual alarm operational? 0 0 • 0
Is septic tank pumped on a schedule? • ❑ ❑ ❑
Are pumps or syphons operating properly? 0 0 ■ 0
Are high and low water alarms operating properly? 0 0 ■ 0
Comment:
Sand Filters(Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational? 0 0 ■ 0
Is the distribution box level and watertight? 0 0 0 ■
Is sand filter free of ponding? 0 0 0 ■
Is the sand filter effluent re-circulated at a valid ratio? 0 • 0 0
#Is the sand filter surface free of algae or excessive vegetation? 0 0 0 •
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) 0 ■ 0 0
Comment: Filter is a single pass buried filter. The items above could not be evaluated.
There were no apparent ground level indicators of system failures or problems.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ E ❑
Is sample collected below all treatment units? 0 • 0 0
Is proper volume collected? 0 • 0 0
Is the tubing clean? 0 0 • 0
Page# 4

Permit: NCG550535 Owner-Facility: 203 Forestway Drive
Inspection Date: 06/18/2008 Inspection Type: Compliance Evaluation
Effluent Sampling Yes No NA NE
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees Celsius)? n n • n
Is the facility sampling performed as required by the permit(frequency, sampling type representative)? 0 • 0 0
Comment: Permittee has not conducted analytical monitoring as required as of yet.
Permittee stated he was unaware of the requirement to do so. He is currently trying to
schedule with a contractor for samples to be taken but the tank was just recently
pumped out and there is no discharge right now. Permittee said he'd send test results to
the Division once received.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • n n n
Are the tablets the proper size and type? U ❑ 0 n
Number of tubes in use? 2
Is the level of chlorine residual acceptable? 0 0 0 •
Is the contact chamber free of growth, or sludge buildup? 0 0 0 •
Is there chlorine residual prior to de-chlorination? 0 0 • 0
Comment: Cl2 residual not tested. Contact chamber cannot be inspected but flow
through channel of chlorinator is clear and free of solids/buildup. Permittee is not
required to dechlorinate; system built prior to 1 August 2007.
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? 0 0 • 0
Are all other parameters(excluding field parameters)performed by a certified lab? 0 0 • 0
#Is the facility using a contract lab? 001. 0
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees Celsius)? 0 0 ■ 0
Incubator(Fecal Coliform)set to 44.5 degrees Celsius+/-0.2 degrees? 0 0 • 0
Incubator(BOD)set to 20.0 degrees Celsius+/- 1.0 degrees? n n U n
Comment: Permittee has not conducted analytical monitoring as required as of yet.
Permittee stated he was unaware of the requirement to do so. He is currently trying to
schedule with a contractor for samples to be taken but the tank was just recently
pumped out and there is no discharge right now. Permittee said he'd send test results to
the Division once received.
Page# 5

Form 101 NC Division of Water Quality
Surface Water Protection Section
SINGLE FAMILY WASTEWATER TREATMENT/DISPOSAL SYSTEM FIELD
INSPECTION CHECKLIST
Inspector Name(s): Ron Boone Date of Inspection: 18 Arrival Time: 1250 Departure Time: 1327
June 2008
Property Owner Name: Jerry Love Phone Number(s): Certificate of Coverage#:
NCG550535
Address: 203 Forestway Drive City: Mount Holly Zip Code: County: Gaston
28120
Question Yes No N/A N/E Remarks:
I. Residency/Ownership
Is the Permittee the current owner of the Single Family
1 Home? (Verify current ownership of the location X
producing the discharge.)
II. System LayoutlPermittee's Knowledge of System
1 Does permittee have a map showing the layout of the X
treatment system?
2 Does permittee know where the septic tank is located? X
3 Does permittee know where the sandfilter(s) is/are X
located?
4 Does permittee know where the Chlorinator is located? X
5 Does permittee know where chlorine tablets go? If not, X
instruct them.
Does permittee know where the dechlorination unit is? Dechlorination not present and not
(Only new facilities constructed after August 1, 2007
6 {Effective date of latest general permit}are required to X required; system built prior to 1
install dechlorination.) August'07.
Does permittee know the location of the outlet/discharge?
7 X
III. System History
1 Has sewage ever backed up into the house? X
2 Have there been any other sewage problems at all? X
IV. Analytical Monitoring
Has the permittee conducted the required analytical No analytical monitoring has ever
monitoring? been conducted. Permittee denies
1 X knowledge of the requirement; has
never seen a copy of the general
permit until now.
2 Does permittee have analytical monitoring results on site? X
3 Is analytical monitoring conducted by a NC certified X
laboratory?
Do analytical monitoring results show compliance with
4 permit limits? (Check for compliance with permit limits X
using Form 102.)
V. Septic Tank
Has the septic tank been pumped in last 3 to 5 years? If Pumps septic tank once/yr; has
1 yes, when? X receipts.
Page 1 of 3 SFR Inspection Checklist Jerry Lee Love Mount Olive Gaston Cty NCG550535 0806 CEI.xls 6/19/2008, 1:55 PM

Form 101 NC Division of Water Quality
Surface Water Protection Section
Question Yes No N/A NIE Remarks:
VI. Chlorination
Are the chlorine tablets wastewater rated? (Inspect
1 original container for wastewater rating. If not, require X
permittee to get tablets rated for wastewater.)
2 Are there chlorine tablets in the chlorinator? X
VII. Dechlorination
Are the dechlorination tablets wastewater rated? (Inspect
original container for wastewater rating. If not, require Dechlorination not present and not
1 permittee to get tablets rated for wastewater. Only new X required; system built prior to 1
facilities constructed after August 1, 2007 (Effective date August'07.
of latest general permit}are required to install
dechlorination.)
2 Are there dechlorination tablets in the dechlorinator? X
VIII. Ultraviolet(UV)
1 Is the UV disinfection system working? X
2 Does permittee know how to determine if the UV system X
is working?
3 Do they know how to clean and replace UV bulbs? X
4 Do they have extra UV bulbs on site? X
IX. Pump Systems
1 Is/are the pump(s)working? X
2 Is the high water alarm in the pump tank operational? X
3 Does the permittee know how to check the pump and X
high water alarm to ensure operability?
X. Detecting Possible Problems/System Failure
1 Is there any evidence of sewage surfacing or ponding X
anywhere on the grounds?
2 Is there any overflow or soggy soils on the property? X
Is there any sewage on the ground near the septic tank,
3 distribution box(es), sand filters or contact chambers, X
indicating a possible failure of the system?
Does any area of the property appear to be greener with
4 vegetation growth than any where else on the property? X
(Indicates a possible sandfilter failure.)
If standing sewage or possible system failure is observed,
are there signs of human and animal traffic in the area?
5 (Need to understand if human contact/vector concerns X
are evident/prevalent.)
If the system shows failure advise the owner that the
system must be replaced. The system must be designed
6 for 120 gallons per bedroom. They should contact the
Mooresville Regional Office, Surface Water Protection at
704-663-1699.
Xl. Effluent Pipe& Discharge
Did you observe the end of the discharge pipe? Cannot actually see the outlet; it
1 X discharges into a SW catch basin
that's covered with a massive
square concrete lid.
Page 2 of 3 SFR Inspection Checklist Jerry Lee Love Mount Olive Gaston Cty NCG550535 0806 CEI.xls 6/19/2008,1:55 PM

Form•101 NC Division of Water Quality
Surface Water Protection Section
Question Yes No N/A N/E Remarks:
2 Was the outlet discharging? X
3 Was the discharge clear and free of solids? X
4 Is there any evidence of solids at the end of the pipe or in X
nearby ditches or creeks?
Is the outlet submerged in stream flow, or does it appear Open stream is no more than 1 foot
that it may become submerged under slightly higher downstream of catch basin that
stream flows? (Outlet should never be submerged.) discharge pipe is in. Inspection of
5 X stream revealed no concerns; water
looks clear, clean and there are no
odors or other indicators of
pollutants.
XII. Illegal Discharges
Is all wastewater from the home connected to drain into
1
the septic tank? X
Is there any discharge of gray water(i.e. washing
machine or dishwashing machine wastewater)from the
2 residence straight into the creek, ditch, stream, etc? (If X
yes, then the discharge must be connected to drain into
the septic tank immediately. Any discharge of untreated
wastewater into the environment is illegal.)
NOTES: Mr. Love now has a copy of the general permit and is aware of the analytical
monitoring requirements. He is doing everything else he needs to be doing. No signs of
system failure detected. Mr. Love just had tank pumped when he received our first letter 2
to 3 weeks ago so the tank was not yet full and there was no discharge at the time of the
inspection. He is arranging to have samples taken at first possible opportunity and will send
the test results to the Division. Mr. Love has been living at this house since 1963.
Page 3 of 3 SFR Inspection Checklist Jerry Lee Love Mount Olive Gaston Cty NCG550535 0806 CEI.xls 6/19/2008, 1:55 PM

`� "rQ Michael F.Easley,Governor
G
Cq William G.Ross,Jr.,Secretary
> North Carolina Department of Environment and Natural Resources
t7 �
Coleen H.Sullins,Director
Division of Water Quality
23 May 2008
Mr. Jerry Ray Love
203 Forestway Drive
Mount Holly,NC 28120
Subject: Single Family Residence Wastewater Treatment
System
NPDES General Wastewater Permit No./Certificate
of Coverage NCG550535
Compliance Evaluation Inspection
Dear Mr. Love:
Division of Water Quality (DWQ) database records show that you currently own/operate a single
family residence (SFR) wastewater treatment and disposal system. DWQ personnel from the 1Vlooresville
Regional Office (MRO) need to conduct a comprehensive review of your system with you in order to
verify that your system is operating properly and to determine the compliance status of the system
pursuant to your NCG550535 permit. We anticipate such a review would take approximately one to two
hours,'provided that all needed documentation and data is readily available at the time of the site visit.
Due to the difficulties involved with catching owners at home during the workday, we would like
to pre-schedule this site visit with you to ensure we can meet and complete the required system'review as
expeditiously as possible. In order to facilitate this we ask that you contact Mr. Ron Boone, of our office,
at 704-663-1699, between the hours of 8AM and 4PM, Monday through Friday. Please contact Mr.
Boone within the next 10 days to identify the best possible time for an evaluator to visit your SFR and
conduct this review with you.
. Also, in the interest of conducting the most efficient evaluation possible, we ask that you have
certain items of documentation on hand at the time of the site visit. These items include the following:.
1. Permit/Certificate of Coverage: Issued by DWQ, you would have received this via regular U.S.
' Postal Service mail.
2.. A Schematic of the Treatment/Disposal System: Please have available all schematics or other
. technical drawings and/or design specifications that show the complete and/or partial layout of
your treatment/disposal system.
3. Documentation of Analytical Monitoring: Required in Part I(A) of the general NCG550000
permit,please have available all official records of analytical monitoring conducted to date.
4. Documentation of Septic Tank Inspections/Pumping: Required in Part I(A) of the general
NCG550000 permit, please have available all records of annual septic tank inspections and septic
tank pumping.
S. Chlorination/Dechlorination Tablets: Please have available the original containers in which
' both the chlorination and dechlorination tablets were stored when you purchased them.
North Carolina Division of Water Quality Mooresville Regional Office Surface Water Protection Phone[phone] Customer Service
Internet: h2o.enr.state.nc.us 610 East Center Avenue,Suite 301 Mooresville,NC 28115 FAX [phone]
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper NorthCarolina
,Naturally

rt550535 23 May 2008
We appreciate your time and understanding of our mission to preserve the natural resources of our
great state and look forward to you contacting us to schedule this site visit. If for some reason you're
unable to contact us, we will make every effort to contact you to schedule the review of your system. If
you have questions or concerns about this letter or the required review, please contact Mr. Boone between
the hours of 8AM and 4PM, Monday through Friday at 704-663-1699. If he is not there when you call,
please leave your name and a good contact phone number and he will return your call as soon as possible.
Sincerely,
21 4 e.-----
Robert B. Krebs
Surface Water Protection Section Supervisor
Division of Water Quality
Mooresville Regional Office

• A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross,Jr., Secretary
Coleen H.Sullins, Director
July 27,2007
Jerry Ray Love
203 Forestway Dr
Mount Holly,NC 28120
Subject: Renewal of coverage/General Permit NCG550000
203 Forestway Drive
Certificate of Coverage NCG550535
Gaston County
Dear Permittee:
In accordance with your renewal application [received on January 17, 2007],the Division is renewing
Certificate of Coverage(CoC)NCG550535 to discharge under NCG550000. This CoC is issued pursuant to the
requirements of North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection agency dated May 9, 1994 [or as subsequently amended].
If any parts,measurement frequencies or sampling requirements contained in this General Permit are
unacceptable to you,you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made,the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to the
Division. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Mooresville Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning the requirements of the General Permit,please contact Toya
Fields [919 733-5083, extension 551 or [e-mail]] or Susan Wilson [919 733-5083,extension 510
or [e-mail]].
Sincerely, AND;.',`t" r 1 \Qld.m4=,C
goomz ,..6„„crZler
.04
for Coleen H. Sullins -. r
cc: Central Files < - #
NPDES file
Wki ' ;,,TY ScTIOV
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquality.org Naturally
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550535
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1,other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Jerry Ray Love
is hereby authorized to discharge domestic wastewater [360 GM] from a facility located at
203 Forestway Drive
Mount Holly
Gaston County
to receiving waters designated as an unnamed tributary to Taylors Creek in subbasin 03-
08-33 of the Catawba River Basin in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This certificate of coverage shall become effective August 1, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 27, 2007.
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

_ ..-41
...4" NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
ÀY/i
NCDENR DIVISION OF WATER QUALITY
June 15, 1999
JAMES B.HUNT JR.
GOVERNOR Jerry Ray Love
203 Forestway Drive
Mount Holly, North Carolina 28120
WAYNE MCDEVITT ,. . Subject: Wastewater Discharge Permit
SECRETARY
. Jerry Ray Love
NPDES Permit No. NCG550000
_ � > Cert. of Coverage No.
"- - . ` =.0,i, NCG550535
F Gaston County, NC
Dear Mr. Love:
.: ,k'
r- ,. ,�. Our files indicate that the subject wastewater discharge permit was issued to Mr.
, z q4 J tiR T
w Jerry Ray Love for a wastewater discharge from the subject residence. The Mooresville
_.- -s ,. Regional Office requests that you contact this Office if you do not have a copy of the
- subject permit, if a change in property ownership has occurred, or if you have any
,�y _ questions regarding this matter.
` ' ` Pursuant to conditions of North Carolina General Permit Number NCG550000,
tf the following documentation must be kept and readily available for inspection for a
period of at least three years:
E
f
► required maintenance activities relating to the wastewater treatment system
. •, ► yearly sample analyses results for the parameters listed on the effluent
_ , �. limitation/monitoring page of the permit
�'" ---- ► required inspections of disinfection apparatus and septic tanks
.4r....-....01,- _-
.. = Please do not hesitate to contact Roberto Scheller at [phone] if you have
'r_- any questions.
Sincerely,
:. I -*" , ii4 D. Rex Gleason, P.E.
Water Quality Regional Supervisor
I_• �. cc: Gaston County Health Department
�"' . '
rls 919 NORTH MAIN STREET, MOORESVILLE,NORTH CAROLINA 281 15
PHONE [phone] FAX [phone]
.' a k. ;' •}. AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER-50%RECYCLED/10%POST-CONSUMER PAPER

State of North Carolinar A
Department of Environment,
Health and Natural Resources • •
Division of Environmental Management
11 'jJames B. , , Gen
�IZ Jonathan Hunt B. Howes Jr. , Secretary p E I—II N Fl
A. Preston Howard, Jr., P.E., Director
June 23, 1993 r. C. rEPT' oR NATURAL
")URGES AND
aro. ''Y D"DEVELOPMEIV' •
Jerry Ray Love JUN 2 5 1993
203 Forest Way
Mt. Holly, NC 28120 1;iMklik6E111
�u1�nW�1 RUIN!. OFFICE
Subject: Permit No. NC0077895
Authorization to Construct
Love Residence
Wastewater Treatment Facility
Gaston County
Dear Mr Love:
A letter of request for an Authorization to Construct was received February 11, 1993 by the
Division and final plans and specifications for the subject project have been reviewed and found to be
satisfactory. Authorization is hereby granted for the construction of a chlorine contact disinfection unit as
an addition to an existing septic tank and subsurface sand filter with discharge of treated wastewater into
Taylors Creek in the Catawba River Basin.
This Authorization to Construct is issued in accordance with Part III, Paragraph B of NPDES
Permit No. NC0077895 issued January 8, 1990, and shall be subject to revocation unless the wastewater
treatment facilities are constructed in accordance with the conditions and limitations specified in Permit No.
NC0077895.
The sludge generated from these treatment facilities must be disposed of in accordance with G.S.
143-215.1 and in a manner approved by the North Carolina Division of Environmental Management.
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance
conditions, the Permittee shall take immediate corrective action,including those as may be required by this
Division, such as the construction of additional or replacement wastewater treatment or disposal facilities.
Failure to abide by the requirements contained in this Authorization to Construct may subject the
Permittee to an enforcement action by the Division of Environmental Management in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C.
The issuance of this Authorization to Construct does not preclude the Permittee from complying
with any and all statutes, rules, regulations, or ordinances which may be imposed by other government
agencies (local, state, and federal)which have jurisdiction.
P.O.Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%post-consumer paper

Permit No. NC0077895
Authorization to Construct
Jerry Ray Love Residence
June 23, 1993
Page 2
If you have any questions or need additional information, please contact Sean Goris, telephone
number 919/733-5083.
S" cer ly,
. Preston ard, r., P.E.
cc: Gaston County Health Department
stelantteviliwitegional'Office,Water Quality .
Facilities Assessment Unit

rPermit No. NC0077895
Authorization to Construct
Jerry Ray Love Residence
June 23, 1993
Page 3
Engineer's Certification
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically,weekly, full time)the construction of the
project, , for the
Project Name Location
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the construction such that the construction was observed to be built within substantial compliance and
intent of the approved plans and specifications.
Signature Registration No.
Date