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SENT VIA ELECTRONIC MAIL ONLY: NO HARD COPY WILL BE MAILED.
December 14, 2021
Susan Childers
Email: susan.childers44@gmail.com
SUBJECT: Compliance Inspection Report
2057 Black Oak Drive
NPDES WW Permit No. NCG550415
Jackson County
Dear Permittee:
The North Carolina Division of Water Resources conducted an inspection of the 2057 Black Oak Drive on
11/30/2021. This inspection was conducted to verify that the facility is operating in compliance with the
conditions and limitations specified in NPDES WW Permit No. NCG550415. The findings and comments
noted during this inspection are provided in the enclosed copy of the inspection report entitled
"Compliance Inspection Report".
There were no significant issues or findings noted during the inspection and therefore, a response to this
inspection report is not required.
If you should have any questions, please do not hesitate to contact me at 828-296-4500 or via email at
stephanie.williams@ncdenr.gov.
Sincerely,
Stephanie Williams, Environmental Specialist
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS: Inspection Report
Ec: Laserfiche
DocuSign Envelope ID: B535F225-AFA6-48C3-A573-8D6FE479C0DC
EPA
United States Environmental Protection Agency
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 Type Inspector Fac Type
1 N 52 NCG550415 21/11/30 C S31112171819 20
21 66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ----------------------Reserved-------------------
N67707172 73 74 75 80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
2057 Black Oak Drive
2057 Black Oak Dr
Sapphire NC 28774
Entry Time/Date Permit Effective Date
Exit Time/Date Permit Expiration Date
01:00PM 21/11/30 19/11/18
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
///
Other Facility Data
01:30PM 21/11/30 20/10/31
Name, Address of Responsible Official/Title/Phone and Fax Number
Durand Childers,2155 Safe Harbor Ln Fernandina Beach FL 32034//904-294-3484/Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Self-Monitoring Program 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
Lauren E Armeni DWR/ARO WQ/828-296-4500/
Stephanie A Williams DWR/ARO WQ/828-296-4500/
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
DocuSign Envelope ID: B535F225-AFA6-48C3-A573-8D6FE479C0DC
12/13/2021
12/13/2021
12/13/2021
NPDES yr/mo/day
21/11/30
Inspection Type
C3111218
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Stephanie Williams and Lauren Armeni, with the Asheville Regional Office, conducted a Compliance
Evaluation Inspection of the single-family wastewater disposal system that services 2057 Black Oak
Drive on November 30, 2021. This inspection was conducted to determine if the system is being
operated and maintained in compliance with General permit no. NCG550000. No deficiencies were
noted during the inspection.
The septic system is well-maintained and appeared to be in compliance with the General Permit. A
septic company checked the septic tank prior to the inspection and determined that pumping was not
necessary. Ms. Susan Childers, the homeowner, stated that the system does not discharge, and no
discharge was observed during the inspection.
NCG550415 17 (Cont.)
Page#2
DocuSign Envelope ID: B535F225-AFA6-48C3-A573-8D6FE479C0DC
Permit:NCG550415
Inspection Date:11/30/2021
Owner - Facility:
Inspection Type:
2057 Black Oak Drive
Compliance Evaluation
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?
# 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:
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 Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational?
Is septic tank pumped on a schedule?
Are pumps or syphons operating properly?
Are high and low water alarms operating properly?
The septic tank was last evaluated on 11/29/21 and it was determined that pumping
was not necessary at that time.
Comment:
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?
Is sand filter free of ponding?
Is the sand filter effluent re-circulated at a valid ratio?
# 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)
Comment:
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Page#3
DocuSign Envelope ID: B535F225-AFA6-48C3-A573-8D6FE479C0DC
Permit:NCG550415
Inspection Date:11/30/2021
Owner - Facility:
Inspection Type:
2057 Black Oak Drive
Compliance Evaluation
Effluent Sampling Yes No NA NE
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0
degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
representative)?
The system does not currently discharge. If the system ever begins to discharge,
annual sampling will be required.
Comment:
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?
If effluent (diffuser pipes are required) are they operating properly?
The effluent pipe is located on the bank by the water closely in line with the driveway. It
is best observed by crossing the stream. No discharge was observed at the time of the
inspection.
Comment:
Page#4
DocuSign Envelope ID: B535F225-AFA6-48C3-A573-8D6FE479C0DC