NCG550933_Compliance Evaluation Inspection_20220207

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Frances Jane Hoskins
1046 Pine Knolls Road
Kernersville, NC 27284
NORTH CAROLINA
Environmental Quality
February 7, 2022
SUBJECT: Compliance Evaluation Inspection
Hoskins Single Family Residence
1046 Pine Knolls Road, Kernersville
Permit #: NCG550933
Forsyth County
Dear Ms. Hoskins:
On January 7, 2022, Gary Hudson of this office performed a Compliance Evaluation
Inspection on the wastewater treatment system referenced above. Observations indicated
that the subsurface sand filter was operating properly. There was no evidence of a
discharge during the inspection. Please note some of the activities that must be conducted
and documented, in addition to the laboratory analyses required if the system discharges:
• Please be aware that the Permit requires that the septic tank contents be pumped
out every five years to prevent solids from clogging the sandfilter system.
• The tablet chlorinator should be inspected weekly to ensure there is an adequate
supply of tablets for continuous operation. Be sure to order more tablets and
replace them often enough to ensure continuous disinfection.
If you have any questions concerning this letter, please contact Gary Hudson at (336)
776-9694.
cc: Laserfiche
NORTH
D E
Department of Envimemomni au.i`
Sincerely,
,—DocuSigned by:
1.-0ti l . 3n.1Af.,
'-145B49E225C94EA_.
Lon Snider, Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

LD_E
NORTH CAROLINA
gapartmeM of Environmental quaky
North Carolina Department of Environmental Quality j Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

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
1
21IIIIII
Code NPDES yr/mo/day Inspection
IN I 2 IL I 3 I NCG550933 111 121 22/01/07 117
Type
1810I
IIIIIIIIIII
Inspector Fac Type
19I S I 2011
IIIIIIIIIII IIIIIII I IIIIII
P6
Inspection
671
Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
I 70I I 711 172 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)
1046 Pine Knolls Road
1046 Pine Knolls Rd
Kernersville NC 27284
Entry Time/Date
11:OOAM 22/01/07
Permit Effective Date
13/08/01
Exit Time/Date
11:30AM 22/01/07
Permit Expiration Date
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
Frances Jane Hoskins,1046 Pine Knolls Rd Kernersville NC 27284///
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Other
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Gary Hudson DWR/Division of Water Quality/336-776-9694/
Signature
of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by:
L—o, T. Stiacr 2/7/2022
EPAForm5 5b c( ev 9-94) Previous editions are obsolete.
Page# 1

3I
NPDES yr/mo/day
NCG550933 111 121 22/01/07
I17
Inspection Type
18 [j
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Matt Gibson [phone], Ms. Hoskins son-in-law called and said that Ms. Hoskins passed away 5
years ago. The house has not been occupied since then. He gave me permission to go on the
property but could not meet me. I arrived at the property on January 7, 2022. I could not locate any of
the components of the system.
Page# 2

Permit: NCG550933
Inspection Date: 01/07/2022
Owner - Facility: 1046 Pine Knolls Road
Inspection Type: Compliance Evaluation
Other
Comment: See Summary.
Yes No NA NE
Page# 3