NCG550102_Compliance Evaluation Inspection_20210726

United States Environmental Protection Agency
E PA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection
1 IN I 2 IL I 3 I NCG550102 111 121 21/07/26 117
Type
1810I
IIIIIIIIIII
Inspector Fac Type
19I S I 2011
21IIIIII IIIIIIIIIII IIIIIII I IIIIII
P6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
671 I 70I3 I 711 1 72 I N I 73I 1 74 71
I I
I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES oermit Number)
1701 Brookford Road
1701 Brookford Rd
Kernersville NC 27284
Entry Time/Date
02:OOPM 21/07/26
Permit Effective Date
18/10/30
Exit Time/Date
02:30PM 21/07/26
Permit Expiration Date
20/10/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
///
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Gary M Slate,1701 Brookford Rd Kernersville NC 27284//336-420-1825/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
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
Alex Lowe DWR/WSRO WQ/336-776-9689/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by: 8/2/2021
IL- T. Stiacr
EPA Fbi4W
39(1Ikbv 9-94) Previous editions are obsolete.
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31
NPDES yr/mo/day
N CG550102 111 121 21/07/26
117
Inspection Type
18 [j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On Monday, July 26, 2021, Alex Lowe of the WSRO conducted a routine Compliance Evaluation
Inspection of the Single -Family Residence treatment system at 1701 Brookford Road in
Winston-Salem. Mr. Gary Slate led Lowe through the system, and shared the documentation
available for review.
It was noted that the permit held by Mr. Slate was expired in October of 2020, so Lowe provided a
copy of the paperwork needed to renew the permit. Mr. Slate stated that he would return the
application to Raleigh Central Office promptly. Despite the permit falling out of date, no lapse in
yearly fees had occured.
Mr. Slate provided proof of the septic tank was pumped on 3/19/2021 and 9/7/2016.
Mr. Slate provided proof of the effluent being sampled, but it had not been done within the previous
12 months. Lowe reminded him that the permit requires an annual sample to be collected and tested.
In a phone -based follow-up conversation on 7/28/2021, Mr. Slate confirmed that he would be
contacting Pace Analytical in Kernersville to complete testing soon.
Upon review of the system, the sand filter appears to be removing all solids, and the chlorination
tablets are being properly monitored and regularly replaced.
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Permit: NCG550102
Inspection Date: 07/26/2021
Owner -Facility: 1701 Brookford Road
Inspection Type: Compliance Evaluation
Yes No NA NE
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