NCG550061_Compliance Evaluation Inspection_20120113 (2)

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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
January 13, 2012
M .. Sam Bradley 120 Roswell Drive RECEIVED
Kernersville, NC 27284
JAN 2 6 2012.
Subject: Compliance Evaluation Inspection
NPDES General Wastewater Permit NCG550000 CED`TRA6�QSS
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120 Roswell, Kernersville
Forsyth County •
Dear Mr. Bradley:
Ron Boone, of the NC Division of Water Quality (DWQ), Winston Salem Regional
Office (WSRO), conducted a compliance evaluation inspection of your single family
residence wastewater treatment system located at 120 Roswell Drive, in Kernersville,
Forsyth County, NC, on January 12, 2012. The assistance and cooperation of Mrs.
Sally Bradley was greatly helpful and appreciated. The findings of the inspection are
summarized below and an inspection report is attached for your records.
Your single family residence wastewater treatment system is regulated under NC
NPDES General Wastewater Permit NCG550000 and has been issued certificate of
coverage (COC) number NCG550061. The system discharges to an unnamed tributary
to Belews Creek, which is currently classified as Class C waters and is located in the
Roanoke river basin.
Your system consists of a septic tank, filter field and a chlorinator. The tank was
last pumped in approximately 2007, although records were not immediately available
during the inspection. You are reminded to have the tank pumped every three to five
years in order to help keep the system in top operating condition at all times.
There were no signs of system failure during the inspection. Due to standing
water in the tubes, chlorine tablets could not be seen in the chlorinator tubes but Mrs.
Bradley assured me that tablets are added as required. Mrs. Bradley was also able to
show Mr. Boone the approximate location of the discharge pipe but it could not be
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:[phone]
Internet:www.ncwaterqualitvorq One
North Carolina
An Equal Opportunity\Affirmative Action Employer

Sam Bradley
120 Roswell Drive,Kernersville
NCG550061
January 13,2012,Page 2 of 2
exactly located because of heavy overgrowth. Please note that if the discharge pipe is
partially blocked on the end by the heavy overgrowth this may explain the standing
water in the chlorinator tubes. The end of the discharge pipe should be found and
cleared.
There were no signs of any adverse effects of the discharge on the receiving
stream. Samples of the discharge have not been taken. All annual fees have been
paid and the permit is current and up to date.
3..n
7- 11 d 000-n y questions or future problems with the system, please do not
hesitate to contac(us. You can call me or Mr. Boone at 336-771-5000. Also, our email
addresses are.corey.basingera@,ncdenr.gov and ron.boonencdenr.gov, respectively.
Sincerely,
t'ySL , 0-Q
• W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments:
1. Inspection Report
CC:
1. WSRO/SWP Files
2. LCentral-OOffice
3. NPDES Unit

di
United States Environmental Protection Agency Form Approved.
E PA Washington,D.C.20460 OMB No.2040-0057
Approval expires 8-31-98
Water Cnmplianne Inspentinn eppnrt
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I N 1 2 1 51 31 NCG550061 111 121 12/01/12 1 17 181 C I 191 S I 20I 11
Remarks
211111111111111111111111111111111111111111111111166 ,
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
671 169 7°1 11 711 11 721 N 1 731 1 1 74 751 I I I 1 1 I 1 80
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)
120 Roswell Drive 01:00 PM 12/01/12 07/08/01
120 Roswell Dr Exit Time/Date Permit Expiration Date
Kernersville NC 27284 01:30 PM 12/01/12 12/07/31
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
Sam M Bradley,120 Roswell Dr Kernersville NC 27284//336-996-2753/3369967148 No
Section C: Areas Evaluated During Inspection(Check only those areas evaluated)
El Permit ®Facility Site Review El 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
Ron Boone WSRO WQ//336-771-4967/
OJ//.3/24,''/Z
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
\ ,... z .. t ` . IV\ u \ - (-1-
EPA Form 3560-3(Rev 9-94)Previous editions a, obsolete.
Page# 1

NPDES yr/mo/day Inspection Type
31 NCG550061 111 121 12/01/12 117
18I CI
Section D: Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inpsection summary letter.
Page# 2

Permit: NCG550061 Owner-Facility: 120 Roswell Drive
Inspection Date: 01/12/2012 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 application? n n ® n
Is the facility as described in the permit? n n ■ n
#Are there any special conditions for the permit? n ■ n n
Is access to the plant site restricted to the general public? ■ n n n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? norm
Are the receiving water free of foam other than trace amounts and other debris? ■ n n n
If effluent (diffuser pipes are required) are they operating properly? n n ■ n
Comment: None
Page# 3