NCG550102_Compliance Evaluation Inspection_20160908

Water Resources
ENVIRONMENTAL QUALITY
September 8, 2016
Gary M. Slate
1701 Brookford Road
Kernersville, NC 27284
Subject: Compliance Evaluation Inspection
Permittee: Gary M. Slate, Owner
Facility: 1701 Brookford Road, Kernersville, NC 27284
Permit: NCG550000 General Wastewater Permit
Certificate of Coverage: NCG550102
Forsyth County
Dear Mr. Tate:
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretory
S. JAY ZIMMERMAN
Director
Ron Boone and Justin Henderson, of the Winston Salem Regional Office (WSRO) of the NC Division
of Water Resources (DWR or the Division), conducted a compliance evaluation inspection of the single
family wastewater system at your residence on September 2, 2016. The State requires the Division to
inspect these types of systems every five years. An inspection report is attached for your records and
the inspection findings are summarized below.
2. The system consists of a septic tank, filtration unit, chlorination unit, and the discharge pipe. The entire
system appears to be in very good operating order. There was no discharge at the time of the
inspection. You have been taking samples as required in the permit each year.
3. The septic tank was last pumped sometime within the last few years. You have it pumped a minimum
of every five years.
4. You have been adding chlorine tablets as needed to the chlorinator unit. The unit appears to be in
good condition. However, you are not using the correct type of chlorine. The chlorine you use is
intended for use in swimming pools, not for wastewater treatment. You should acquire wastewater
grade chlorine tablets. Please see the attachments for more information.
5. The permit fees of $60 per year have been paid annually as required and your permit is active and up
to date. You did not have a copy of the most recent Certificate of Coverage (COC). A copy is attached
foryour records. Mr. Boone left you with a copy of the most recent general permit and technical bulletin.
6. Failure to properly operate and maintain your wastewater system can result in expensive repair costs
as well as failure of the system to properly treat the wastewater. It appears that your system is very
well maintained and should last a very long time if you continue to maintain it as well as you have up
to this point.
State of North Carolina j Environmental Quality I Water Resources
450 West Hanes Mill Road Suite 300 1 Winston-Salem, North Carolina 27105
336 776 9800

If you have any questions regarding this letter or the NCG550000 general permit, please don't hesitate
to contact us at 336-776-9800.
Sincerely,
"/herri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. Inspection Report
2. Certificate of Coverage NCG550102
3. Chlorine Technical Information
4. North Carolina & Other Chlorine Vendors
CC: WSRO Files
Central Files
NPDES Unit

IJnitetl 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 Fee Type
1 L 2 15 I 3 I NCG550102 I11 12 16/09/02 17
18 ICI
19 Li I 201
21111111111111111111111111111111111111111111
J6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 31 CA
-------------Reserved----------
67I �I 701_71 I 72 L�J
73I 174 75M I L I
BO
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)
09:OOAM 16/09/02
13/08/01
1701 Brookford Road
1701 Brookford Rd
Exit Time/Date
Permit Expiration Date
Kernersville NC 27284
10:00AM 16/09/02
18/07/31
Names) of Onsite Representative(s)/Tilles(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///
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
Ron Boone WSRO WQ//336-776-9690/
'''
-7 /
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#

NPDES yr/ma/day Inspection Type 1
31 NCG550102 I11 12 16/09/02 17 18 I C
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

Permit: NCG550102
Inspection Date: 09/02/2016
Other
Owner -Facility: 1701 Brookford Road
Inspection Type: Compliance Evaluation
Comment: Please refer to the attached inspection summary letter.
Yes No NA NE
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