NCG550834_Compliance Evaluation Inspection_20220128

ROY COOPER.
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Thomas E. Wilson
1078 Browder Farm Road
Germanton, NC 27019
NORTH CAROLINA
Environmental Quality
January 28, 2022
SUBJECT: Compliance Evaluation Inspection
Single Family Domestic Wastewater Discharge
NC General Permit Number: NCG550000
Certificate of Coverage: NCG550834
Address: 1078 Browder Farm Road, Germanton, NC 27019
Stokes County
Dear Mr. Wilson:
Mr. Ron Boone, of the NC Division of Water Resources (NCDWR), Winston-Salem Regional
Office (WSRO), met with you on January 20, 2022, to conduct a compliance evaluation inspection
of your Single Family Domestic Wastewater Treatment System, located at the above address.
Your assistance and cooperation was greatly appreciated. Inspection findings are detailed in the
attached Water Compliance Inspection Report and summarized below.
Mr. Boone did not note any signs of malfunction or failure of the wastewater system during
his visit to your home. The Chlorine tablets you are using are the correct size and type.
However, you are NOT completely compliant with all permit requirements. Please refer to
the attached Water Compliance Inspection Report for full details.
For your information, we have provided the following attachments to this letter to help you become
more familiar and compliant with all permit requirements:
1. NCG55_General_Permit.pdf
2. NCG55_Technical_Bulletin_20201030.pdf
3. Chlorine 20190409.xlsx
4. Chlorine Suppliers 20190226.xlsx
5. Norweco Bio-Sanitizer-Specifications.pdf
6. NC Certified Commercial In State Laboratories_202108.xlsx
7. New-Owner-Change-Form-202107.docx
Furthermore, if at any point in the future you sell your residence, you must properly disclose the
type of sewage disposal system employed at your home in item #16 of the "NC RESIDENTIAL
PROPERTY AND OWNERS' ASSOCIATION DISCLOSURE STATEMENT", which you
NORTH
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neo.rtm.m .f Envim.mo.t.i Ou.i`
North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

fill out and give to your real estate agent when placing your home on the market. Item #16 does
NOT provide a pre-printed checkbox for a "Single Family Domestic Wastewater Discharge",
which is the type of system employed at your home, so you must enter the system -type manually
in the "Other" section of item #16. You should also enter the Certificate of Coverage number,
found in the subject line of this letter, in item #16 of the disclosure form and then use attachment
#7, "New-Owner-Change-Form-202107.docx", to transfer ownership of the permit from you to
the new owner when someone does purchase the property.
Please be aware that the Division may take enforcement action against any permittee who fails to
comply with any requirement of their permit. Pursuant to NC General Statute (NCGS) 143-215.6A,
a civil penalty of not more than twenty-five thousand dollars ($25,000.00) may be assessed against
any person who violates or fails to act in accordance with the terms, conditions, or requirements
of any permit issued pursuant to G.S. 143-215.1.
If you have any questions or concerns, please do not hesitate to contact Mr. Boone by phone at
336-776-9690, or by email at [e-mail]. Thank you in advance for your time and
attention to this matter.
Attachments:
cc:
Sincerely,
DocuSigned by:
L-0A. T. SMJG'
145B49E225C94EA...
Lon T. Snider, Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
1. Water Compliance Inspection Report
2. NCG55_General_Permit.pdf
3. NCG55_Technical_Bulletin_20201030.pdf
4. Chlorine 20190409.xlsx
5. Chlorine Suppliers 20190226.xlsx
6. Norweco Bio-Sanitizer-Specifications.pdf
7. NC Certified Commercial In State Laboratories_202108.xlsx
8. New-Owner-Change-Form-202107.docx
Laserfiche
LD_E
NORTH CAROLINA
q.parhnam 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
EPA 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 IN
Code
I 2
IL
NPDES yr/mo/day Inspection Type Inspector Fac
I 3 I NCG550834 111 121 22/01/20 117 1810I 19I S I 2011
Type
21IIIIII
IIIIIIIIIII
IIIIIII
I
IIIIII
IIIIIIIIIII
P6
Inspection
671
Work Days
Facility Self -Monitoring
I 70I
Evaluation Rating
I 711
B1
1
72
QA
I N I
73I
1
I I
Reserved
74 71
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 Dermit Number)
1078 Browder Farm Road
1078 Browder Farm Rd
Germanton NC 27019
Entry Time/Date
10:OOAM 22/01/20
Permit Effective Date
21/11/17
Exit Time/Date
10:30AM 22/01/20
Permit Expiration Date
25/10/31
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
Thomas E Wilson,1078 Browder Farm Rd Germanton NC 27019///
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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
Ron Boone DWR/WSRO WQ/336-776-9690/
—Docusigned by: 1/27/2022 p
cooveriet
Signature
B201-8M5I2A.3460
of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by:
L—o, T. SA,acr 1/28/2022
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

3I
NPDES yr/mo/day
NCG550834 111 121 22/01/20
117
Inspection Type
18 [j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Billing is current.
No analytical monitoring has been conducted. Owner unaware of requirement.
No operation & maintenance records have been maintained, but the system appears in good
condition and operating properly.
The chlorine tab tubes were completely filled. It is recommended to add a maximum of six tablets at a
time. Tablets can absorb moisture, swell, and clog up vertical feed tube so tablets do NOT contact
water. Once it is known about how many tablets are needed per week, you can add that number each
time you check it. The permit requires you to check chlorinator once weekly.
No sewage seepage was detected during the inspection.
You stated the septic tank is pumped every 1 to 2 years. Please begin keeping records of tank
pumpings as proof of when it was pumped, i.e. the pumping invoice or receipt of payment. The permit
requires tank's solid's levels to be checked annually and pumped when the level reaches more than
1/3 the liquid depth, or every five years, whichever is sooner.
If there is an effluent filter on the tank it must be inspected, cleaned, reinstalled, or replaced annually.
All tank pump and alarm systems must be checked for proper operation monthly and repaired as
needed.
The permittee must notify the Division upon receipt of notice of non-compliance, such as exceedance
of the analytical limits.
The outfall location must be inspected and properly maintained at least twice per year to allow ready
access at all times.
The annual permit fee must be submitted before the due date indicated on the billing invoice.
The certificate of coverage will be automatically renewed as long as the annual permit fee is paid on
time. A renewal application is NOT required. However, unpaid annual fees will result in the COC not
automatically renewing and defaulting to expired status.
All data and records, analytical, operational, or administrative, must be kept on file on site for a
minimum of three years.
Page# 2

Permit: NCG550834
Inspection Date: 01/20/2022
Owner - Facility: 1078 Browder Farm Road
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 El El ❑
application?
Is the facility as described in the permit? • El El El
# Are there any special conditions for the permit? El • El El
Is access to the plant site restricted to the general public? • ❑ ❑ ❑
Is the inspector granted access to all areas for inspection? • El El El
Comment: Refer to summary page.
Page# 3