NCG550993_NOV-2021-PC-0344_20210712

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
July 121h, 2021
Certified Mail # 7017 2680 0000 2237 2898
Return Receipt Requested
James E. Dixon
3216 Hursey St.
Durham, NC 27703
Subject: NOTICE OF VIOLATION
Tracking Number: NOV-2021-PC-0344
Compliance Evaluation Inspection
Single Family Wastewater Treatment System
NPDES General Permit NCG550000
Certificate of Coverage NCG550993
Facility Name: 3216 Hursey Street
Durham County
Dear Mr. Dixon:
On July 1, 2021, Josh Brigham from the Raleigh Regional Office visited your single-family
residence (SFR) wastewater treatment system to evaluate compliance with the subject General
NPDES Permit. No one was at home at the time of the inspection. The inspector left a packet of
information regarding Single Family Treatment Systems and the requirements of the General
Permit at the residence.
Our records indicate the treatment system consists of a septic tank, sub -surface sand filter, tablet
chlorinator with chlorine contact chamber, and discharge pipe.
General NPDES Permit NCG550000 and Certificate of Coverage (COC) NCG550993 authorize
the discharge of domestic wastewater from your treatment system to receiving waters designated
as an unnamed tributary to Little Lick Creek (classified WS-IV; NSW) in the Neuse River Basin.
The authorized discharge is in accordance with the effluent limits and monitoring requirements
established within the General Permit. The items below show what conditions were noted at
your facility:
Findings during the inspection were as follows:
1. Treatment system operation: The wastewater treatment system shall be maintained at
all times to prevent seepage of sewage to the surface of the ground.
2. Pumping the septic tank: You are required to inspect the septic tank at least yearly to
determine if solids must be removed or if other maintenance is necessary. Septic tanks
D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
,, - o- - Raleigh Regional Office 13800 Barrett Drive I Raleigh, North Carolina 27609
NORTH CA13OLINA _�
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James E. Dixon, NCG550993
July 12, 2021
Page 2 of 4
should be pumped out every five years or when the solids level is found to be more than
1/3 of the liquid depth in the septic tank compartment, whichever is greater. A pumping
company can check the status periodically and determine when pumping is required.
Within 30-days of receiving this letter, please send a copy of the most recent
receipdinvoice to this office showing the date the septic tank was last checked and/or
pumped out. The General NPDES Permit requires the permittee to retain records
associated with sewage disposal activities for a period of at least 5 years.
3. Chlorine tablets in the chlorinator: You are reminded that it is required that chlorine
tablets be maintained in the chlorinator to ensure proper disinfection of the discharged
wastewater. Chlorine tablets provide effective disinfection and prevent/limit harmful
bacteria from discharging to the environment. The product label for these tablets must
indicate the tablets are approved for wastewater use and not for swimming pools. Part
1, Section D (1) of General NPDES Permit NCG550000 requires the permittee to inspect
the tablet chlorinator weekly to ensure there is an adequate supply of tablets for
continuous and proper operation. Section D (4) requires the permittee to maintain all
system components, including disinfection units at all times and in good operating order.
The inspector did not observe the chlorinator and therefore could not observe any
chlorine tablets in the chlorinator. Please ensure the correct type of tablets are used and
maintained in the chlorinator as required by the General NPDES Permit.
4. Analyzing the effluent: Part 1. C., Effluent Limitations and Monitoring Requirements,
within General Permit NCG550000 requires a permittee to sample and analyze the
effluent leaving his/her treatment system prior to discharge annually. Parameters to be
sampled and analyzed include Flow, BOD (Biochemical Oxygen Demand), Total
Suspended Solids, and Fecal Coliform. In the last inspection letter dated May 17, 2017,
you were requested to sample your effluent and to submit the analytical results to this
office. The Raleigh Regional Office has not received the requested results. Within 30-
days of receiving this letter, please let this office know if you have monitored your
effluent discharge within the last 12 months, and provide this office with a copy of the
lab results if you have. If you have not monitored your effluent, then please collect a
representative sample of the effluent, have it analyzed by a certified commercial
laboratory and submit the results to this office no later than September 15, 2021. If,
during this time, you are unable to collect a representative sample of the effluent
discharge due to insufficient flow from the discharge pipe, then update this office with
that information and continue to monitor the discharge and if conditions for sampling
become favorable, then arrange to collect a sample. Failure to monitor the effluent
discharge as required is a violation of NPDES General Permit NCG550000.
5. Locations of treatment units are unknown: Within 30-days of receiving this letter,
provide this office with a sketch or map of the location of the treatment units (septic tank,
sub -surface sand filter, tablet chlorinator with chlorine contact chamber, and discharge
pipe) in relation to the permitted residence.
6. Discharge outlet location. The permittee is required to conduct a visual review of the
outfall location at least twice each year (one at the time of sampling) to ensure that no
visible solids or other obvious evidence of system malfunctioning is observed. Any
visible signs of a malfunctioning system shall be documented and steps taken to correct
North Carolina Department of Environmental Quality I Division of Water Resources
Raleigh Regional Office 13800 Barrett Drive I Raleigh, North Carolina 27609
NORTH VAHOLINA
°epitl ffl 0 ¢me-tw C-I� 919.791.4200

James E. Dixon, NCG550993
July 12, 2021
Page 3 of 4
the problem. The end of discharge pipe was not visible nor accessible the day of the
inspection. To comply with the general permit monitoring requirements, you need to be
able to sample and analyze the effluent from your SFR system through the discharge
pipe. You need to keep the area around the discharge pipe cleared of vegetation, soil and
leaves. Please take the necessary steps to ensure the discharge outlet is visible and
accessible. Maintaining the area will allow you to monitor the discharge and to collect
effluent samples as required by the subject permit.
Part II Section B.14 of General Permit NCG550000 requires the permittee to "pay the annual
administering and compliance monitoring fee within thirty days after being billed by the
Division." The annual fee ($60 per year) for the period October 1, 2016 through September 30,
2017 was due by October 7, 2016. The annual fee ($60 per year) for the period October 1, 2017
through September 30, 2018, was due by October 8, 2017. The annual fee ($60 per year) for the
period October 1, 2018 through September 30 2019, was due by October 7, 2018. The annual
fee ($60 per year) for the period October 1, 2019 through September 30, 2020, was due by
October 5, 2019. The annual fee ($60 per year) for the period October 1, 2020 through
September 30, 2021, was due by October 2, 2020. These fees have not been paid and are
overdue. Payment in the amount of $300 must be remitted to the Division as indicated on the
attached Annual Permit Fee Invoices.
The wastewater treatment system should be periodically inspected to ensure the treatment
components are always maintained and in good operating order. You are also reminded to
maintain all monitoring data and associated maintenance records onsite for a minimum of
three years and available for inspection.
This inspection report is being issued as a Notice of Violation because the Division does not
have records of effluent analysis and does not know the location of the treatment units. Within
30-days receipt of this letter, please submit a written response to this office indicating the
actions you will take or have taken to comply with or resolve the issues noted in items 2-6
above.
If you have questions or comments about this inspection or the requirements to take corrective
action (if applicable), then please contact Josh Brigham at 919-791-4251.
Sincerely,
Vanessa E. Manuel, Assistant Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
D EQ:>
North Carolina Department of Environmental Quality I Division of Water Resources
R
_aleigh Regional Office 13800 Barrett Drive I Raleigh, North Carolina 27609
NORTH CARUUNA
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James E. Dixon, NCG550993
July 12, 2021
Page 4 of 4
Attachment(s): EPA Water Compliance Inspection Report
Annual Permit Fee Invoice 2016PR008173
— Due October 7, 2016
Annual Permit Fee Invoice 2017PR008508
— Due October 8, 2017
Annual Permit Fee Invoice 2018PR008591
— Due October 7, 2018
Annual Permit Fee Invoice 2019PR008472
— Due October 5, 2019
Annual Permit Fee Invoice 2020PR008444 — Due October 2, 2020
Cc: RRO/SWP Files
Laserfiche
E��North Carolina Department of Environmental Quality I Division of Water Resources
NORfMCAHOIINA Raleigh Regional Office 13800 Barrett Drive I Raleigh, North Carolina 27609
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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 1 2 15 1 3 I NCG550993 111 121 21/07/01 117 18 Li 191 G I 201 I
21111 1 1 1 1 1 1 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 111 1 1 1 1 1 166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67 70 U 711 I 72 L1J N 1 73 Ljj74 71 1 1 1 1 I I 180
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 permit Number)
07:45AM 21/07/01
17/02/17
3216 Hursey Street
3216 Hursey St
Exit Time/Date
Permit Expiration Date
Durham NC 27703
08:OOAM 21/07/01
18/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
ur
Name, Address of Responsible Official/Title/Phone and Fax Number
James E Dixon,3216 Hursey St Durham NC 27703/// Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenar E Records/Reports Self -Monitoring Progran
Effluent/Receiving Wate 0 Laboratory
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
Joshua S Brigham DWR/RRO WQ/919-791-4200/
Signature of Management Q A Reviewer ency/Office/Phone and Fax Date
jNumbers
70- ,- r z3z 1,71
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type 1
31 NCG550993 I11 12 21/07/01 _j 17 18 I�
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Could not locate chlorinator or discharge pipe.
Packet left on door 7/1
Page# 2

Permit: NCG550993 Owner -Facility: 3216 Hursey Street
Inspection Date: 07/01/2021 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 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Septic Tank
Yes
No
NA
NE
(If pumps are used) Is an audible and visual alarm operational?
❑
❑
M
❑
Is septic tank pumped on a schedule?
❑
❑
❑
Are pumps or syphons operating properly?
❑
❑
❑
■
Are high and low water alarms operating properly?
❑
❑
❑
Comment:
Sand Filters (Low rate)
Yes
No
NA
NE
(If pumps are used) Is an audible and visible alarm Present and operational?
❑
❑
❑
0
Is the distribution box level and watertight?
❑
❑
0
❑
Is sand filter free of ponding?
0
❑
❑
❑
Is the sand filter effluent re -circulated at a valid ratio?
❑
❑
❑
# Is the sand filter surface free of algae or excessive vegetation?
0
❑
❑
❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
❑
❑
❑
Comment:
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
❑
❑
❑
Are the tablets the proper size and type?
❑
❑
❑
M
Number of tubes in use?
Is the level of chlorine residual acceptable?
❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
❑
❑
❑
0
Is there chlorine residual prior to de -chlorination?
❑
❑
❑
Comment: Chlorinator could not be located
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
❑
❑
❑
Are the receiving water free of foam other than trace amounts and other debris?
❑
❑
❑
Page# 3

Permit: NCG550993
Inspection Date: 07/01/2021
Owner -Facility: 3216 Hursey Street
Inspection Type: Compliance Evaluation
Effluent Pipe
If effluent (diffuser pipes are required) are they operating properly?
Comment: Effluent Pipe could not be located.
Permit
(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?
# 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: Could not locate treatment units.
Yes No NA NE
❑ ❑ ❑ N
Yes No NA NE
❑ ❑ ■ ❑
❑ N ❑ ❑
❑ ❑ ❑ ■
❑ ❑ ❑
■ ❑ ❑ ❑
Page# 4

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I IIIIIIIII II Iltllll IIII III II IIII II
INVOICE * 2 0 1 6 P R 0 0 8 1 7 3
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facili
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2016PR008173 Annual Fee Period: 2016-10-01 to 2017-09-30
Permit Number: NCG550993 Invoice Date: 09/07/2016
Durham County
3216 Hursey Street Due Date: 10/07/2016
James Dixon Annual Fee: $60.00
3216 Hursey St
Durham, NC 27703
Notes:
1. You may pay either by mail with checklmoney order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://deg.nc.gov/epayments/wg to pay electronically. Payments by eCheck will debit your
checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-3698.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2016PR008173
Permit Number: NCG550993
Durham County
3216 Hursey Street
James Dixon
3216 Hursey St
Durham, NC 27703
II Illllll lllllliil'iIIIIIPII III IIIIIiH
Overdue
Annual Fee Period: 2016-10-01 to 2017-09-30
Invoice Date: 9/7/2016
Due Date: 10/7/2016
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II Illl III II (IIII lill IIII IIII II I IIII I
INVOICE 2 0 1 7 P R 0 0 8 5 0 8
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facili
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2017PR008508
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham, NC 27703
Annual Fee Period: 2017-10-01 to 2018-09-30
Invoice Date: 09/08/2017
Due Date: 10/08/2017
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://deg.nc.gov/epayments/wq to pay electronically. Payments by eCheck will debit your
checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-3698.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2017PR008508
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham. NC 27703
ullllllll''lllllllllllllulllliibl f II
Overdue
Annual Fee Period: 2017-10-01 to 2018-09-30
Invoice Date: 9/8/2017
Due Date: 10/8/2017
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I III III I II I I II III II I I II I II
INVOICE 2 0 1 8 P R 0 0 8 5 9 1
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facili
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2018PR008591
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham, NC 27703
Annual Fee Period: 2018-10-01 to 2019-09-30
Invoice Date: 09/07/2018
Due Date: 10/07/2018
Annual Fee: $60.00
Notes
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://deg.nc.-gov/epayments/wq to pay electronically. Payments by eCheck will debit your
checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-3698.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2018PR008591
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham, NC 27703
Overdue
Annual Fee Period: 2018-10-01 to 2019-09-30
Invoice Date: 9/7/2018
Due Date: 10/7/2018
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I�III II I II I I II III I II III I II
INVOICE * 2 0 1 9 P R 0 0 8 4 7 2
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facili.
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2019PR008472
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St.
Durham, NC 27703
Annual Fee Period: 2019-10-01 to 2020-09-30
Invoice Date: 09/05/2019
Due Date: 10/05/2019
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://deci.nc.gov/epayments/wq to pay electronically. Payments by eCheck will debit your
checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-3698.
(Return This Portion With Check)
II 1 1 II I I I I II I I II II I I I I II I I II
* 2 0 1 9 P R 0 0 8 4 7 2
ANNUAL PERMIT INVOICE
Overdue
Invoice Number: 2019PR008472
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham, NC 27703
Annual Fee Period: 2019-10-01 to 2020-09-30
Invoice Date: 9/5/2019
Due Date: 10/5/2019
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II II II (I II II'I Il,illiIII I I I II II I
INVOICE * 2 0 2 0 P R 0 0 8 4 4 4
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facili
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2020PR008444
Permit Number:
James E. Dixon
3216 Hursey St
Durham, NC 27703
NCG550993
Durham County
3216 Hursey Street
Annual Fee Period: 2020-10-01 to 2021-09-30
Invoice Date: 09/02/2020
Due Date: 10/02/2020
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see hftps://deg.nc.gov/epaVments/wq to pay electronically. Payments by eCheck will debit your
checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance Fee
Coordinator at 919-707-3698.
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2020PR008444
Permit Number: NCG550993
Durham County
3216 Hursey Street
James E. Dixon
3216 Hursey St
Durham, NC 27703
IIIIIIIIII IIIIWIPdlllilllllllllllll II
Overdue
Annual Fee Period: 2020-10-01 to 2021-09-30
Invoice Date: 9/2/2020
Due Date: 10/2/2020
Annual Fee: $60.00
Check Number:

Inspection Date: Z D 2 Start Time: 7 • _`IS ``M End Time: r
SINGLE FAMILY WASTEWATER SYSTEM CHECKLIST
srrsao1s
Permittee: M(fx' 12� �Y C
Permit:
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Address: 16 H v rSf �j V /' 11AM E-mail-
Phone:(_, Cell Phone:( 1l ) ES6c - 7D `f-5
County: f dam
The Permittee is responsible for the operation and maintenance of the entire wastewater treatment and disposal system.
Doesn't
Did Not
Yes
No
Apply
Investigate
1. Is the current resident in the home the Permittee?
2. If not does the resident rent from the permittee7
3. Change of Ownership form needed? (mail the form with the inspection letter)
1:1
El
4. Is there a inspection and maintenance agreement with a contractor?
5. If yes to #4 who is the contractor?
SEPTIC TANK The septic tank and fitters should be checked annually and pumpedldeaned as needed.
6. Is all wastewater from the home connected to the septic tank?
7. Does the permittee/resident know where the septic tank is located?
8. Has the septic tank been pumped in the last 5 years?
El
El
El
9. If yes to #8 date, if known If proof, describe
10. Does the septic tank have an EFFLUENT FILTER or SANITARY T? (circle one)
11. If Yes to filter when was the filter cleaned? 6y whom?
SAND FILTER I TREATMENT PODS YES NO =
If no proceed to the next section.
Accessible sand fitter surfaces shall be raked and leveled every six months and any vegetative growth shall be removed manually.
12. Is system something other than a sandfilter?
13, If yes, what kind? (examples - Peat, Textile, Other or brand name - Advantex, etc.)
14. Does the permittee know where the sandfilter is located?
15. Does the sandfilter require maintenance?
It maintenance Is required explain in the comment section.
DISINFECTION I W YES NO PC
if no proceed to the next section.
The ultraviolet unit shall be checked weekly. The lamps and sleeves should be cleaned or replaced as needed to ensure r disinfection.
16. Is UV working?
❑
17. Has the W Unit been serviced and bulbs cleaned?
0
18. Who completes the weekly check for the UV?( Non -Discharge)
DISINFECTION 1 TABLETS YES W NO
If no proceed to the next section.
The tablet chlorinator unit shall be checked weekly to ensure continuous and proper operation.
19. Does the permittee have the correct chlorine tablets?(If none, mark No)
20. Does the Permittee know the location of the chlorinator?
❑
21. Were chlorine tablets observed in the chlorinator?
10
22. Are tablets contacting water? If possible poke them to determine.
❑
DECHLOR (Discharge only) YES NO
If no proceed to the next section.
The dechlorinator unit shall be checked weekly to ensure continuous and proper operation.
23. Does the permittee know where the dechlor is?
0
24. Does the permittee have the correct dechlor tablets?
25. Were dechlor tablets observed in the dechiorination chamber?
26. Are tablets contacting water? If possible poke them to determine.

Doesn't
Did Not
Yes
No
Apply
Investigate
PUMP TANK YES NO
If no proceed to the next section.
All pump and alarm sytems shall be Inspected monthly. (non -discharge)
27. Is the pump working?
❑
❑
❑
❑
28. Are the audible and visual high water alarms operational?
❑
❑
❑
❑
29. Does the pelmittee know how to check the pump & high water alarm?
❑
❑
❑
30. Last functional test: PUMP AUDIBLE & VISUAL
DISCHARGE ONLY YES Q NO
if no proceed to the next section.
A visual review of the outfall location shall be executed twice each year (one at the time of sampling to ensure no visible solids or evidence of a malfunction.
31. Does the permittee know where the outfall is located?
❑
❑
❑
fD
32. Were you able to locate the outfall?
❑
1&
❑
33. Is the end of the discharge pipe visible and accessible?
❑
❑
34. Is outlet discharging?
1:3
❑
❑�7I
35. Is right of way maintained around the discharge point?
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❑
0wpp11!
36. Any Lab Results available?
❑
❑
❑
6�
37. Is there evidence of solids around the discharge point?
❑
❑
❑
DRIP or SPRAY YES Lj NO
If no proceed to the next section.
The irrigation system shall be inspected monthly to ensure the system is free of leaks and equipment is operating as designed.
38. Is the system DRIP or IRRIGATION (circle one)? If irrigation number of
sprinkler heads.
39. Are the buffers adequate?
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❑
❑
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40. Is the site free of ponding and runoff?
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41. Does the application equipment appear to be working properly?
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❑
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42. Is there a minimum two wire fence surrounding entire irrigation area?
❑
❑
❑
❑
GENERAL
43. Are the treatment units locked and or secured?
❑
❑
❑
44. Has resident had any sewage problems? If yes explain in the comment section.
❑
❑
45. Does the system match the permit description? If no explain In the comment section.
❑
El46.
154
Is the system compliant?
❑
((❑VV11
w�
❑
❑
47. Is the system failing? If yes, take pictures if possible.
❑
❑
48. If system is failing, any sign of children or animals contacting sewage? ❑
NOD Sent #: - NOV Sent #: 0 �0 Z 1
❑ .a
- C.
❑
Comments: Photos( Taken?
YES
NO
II
'�74'-%a1lr
�/
LL ke Y 6,� c- r • 2'
INSPECTOR: J / SIGNATURE:
1'