NCG550092_Compliance Evaluation Inspection_20180926 (2)

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S.REGAN
Secretary LINDA
RECEIVED
CULPEPPER
Interim Director September 26, 2018
OCT o 2 2018
Richard W. Abbott CENTRAL FILES
5959 Holder Road DWR SECTION
Clemmons, NC 27012
SUBJECT: Compliance Evaluation Inspection •
NC General Wastewater Permit NCG550000
Certificate of Coverage: NCG550092
Facility: 5959 Holder Road, Clemmons, NC 27012
Owner: Richard W. Abbott
County: Forsyth
Dear Mr. Abbott:
Ron Boone, of the Winston-Salem Regional Office (WSRO) of the NC Division of Water
Resources (DWR or the Division), attempted to meet with you on September 19, 2018,
at your home located at 5959 Holder Road in Clemmons, NC, to conduct a compliance
evaluation inspection (CEI) of the home's wastewater treatment system, which
discharges the final treated effluent to Muddy Creek, which is located just east of your
home and is currently classified as class C waters. Muddy Creek is located in the Yadkin-
Pee Dee River Basin.At the time, you were, unfortunately, not able to talk with Mr. Boone.
A woman answered the door and invited Mr. Boone to go into your bedroom to discuss it
with you but Mr. Boone chose not to do so. Please call Mr. Boone to make an appointment
for a visit to conduct the inspection as soon as you're able.
Your home's wastewater treatment system is regulated by `DWR under NC General
Wastewater Discharge Permit NCG550000, with certificate of coverage (COC)
NCG550092. NCG550000 specifies your obligations and responsibilities, as owner and
permittee, to properly operate and maintain the system in order to properly and sufficiently
purify your home's domestic wastewater to within limits specified in the permit before it is
discharged to Muddy Creek.
Please ensure you keep records of the tank pumping along with all other documentation
related to the system, including inspection reports, such as this, and billing and permitting
documentation that you receive from our Central Office in Raleigh. It is suggested that
you create a file folder in which you can store all documentation related to the system in
one place.
NORTH CAROLJNA
Deantnent FnY4msnecdl UpW�
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27103
336.776.9800

•
Our database shows that you are up-to-date on the annual bill. Also, Forsyth County
shows you as the homeowner.
Please review the NCG550000 permit, which is attached, in detail, to become thoroughly
familiar with all operation and maintenance, testing, and documentation requirements.
Please note that failure to comply with the requirements of the NCG550000 general
permit and the NC general statutes and/or regulations under which it is promulgated, is a
violation of the permit and/or said statutes/regulations, and that such violations subject
the homeowner/permittee to civil penalties of not more than $25,000 per day, per
violation. It is in your and your family's best interest to comply with all permit conditions.
Doing so will minimize your investment in the system, guarantee the health and safety of
your family, and protect the environment.
If you have any questions whatsoever, please never hesitate to contact Mr. Boone by
phone at 336-776-9690, by email at [e-mail], or me at 336-776-9800 or
sherri.knight(cr�,ncdenr.gov. Thank you for your time and attention to this matter.
Sincerely,
Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. NC General Wastewater Discharge Permit NCG550000 for Single Family Residences
cc: DW_RNPDES Unit
DWR Central Files
DWR/ VSRO Files
DEQNORTH(:AROUNA
D.D.Monl of 9n oomentil MaYh�
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27103
336.776.9800

f ,
United States Environmental Protection Agency Form Approved.
EPA Washington,D.0 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 Fac Type
1 IN I 2 Li 3 I NCG550092 111 121 18/09/19 117 18 t 2 j 19 ISI 201 I
2111I11I 1111111111111111111 1 I1111 11111111I 11 r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
67I I 70I I 711 I 72 LJI N I 731 1 174 751
1 1 1 1 1 I I80
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) 11'00AM 18/09/19 13/08/01
5959 Holder Road
Exit Time/Date Permit Expiration Date
5959 Holder Rd
11.15AM 18/09/19 18/07/31
Clemmons NC 27012
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
Richard W Abbott,5959 Holder Rd Clemmons NC 27012//336-766-7880/
No
Section C.Areas Evaluated During Inspection(Check only those areas evaluated)
El Permit El Flow Measurement I Operations&Maintenance IN Records/Reports
III Self-Monitoring Program II Facility Site Review Effluent/Receiving Waters Laboratory
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/ //2_
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
//) r 1 70// /X
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete
Page# 1

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NPDES yr/mo/day Inspection Type 1
3I NCG550092 11 121 18/09/19 117 18 LI
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter for additional information.
Page# 2

s.
Permit: NCG550092 Owner-Facility: 5959 Holder Road
Inspection Date: 09/19/2018 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 •IN El
application?
Is the facility as described in the permit? 111 El 0 ❑
#Are there any special conditions for the permit? ❑ • 0 El
Is access to the plant site restricted to the general public? ❑ ❑ ❑
Is the inspector granted access to all areas for inspection? ❑ ❑ ❑
Comment: None
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ❑ El 0 •
Is all required information readily available, complete and current? El ❑ ❑ U
Are all records maintained for 3 years(lab. reg. required 5 years)? El ❑ ❑ •
Are analytical results consistent with data reported on DMRs? El El II ❑
Is the chain-of-custody complete? ❑ El ❑ •
Dates,times and location of sampling ❑
Name of individual performing the sampling ❑
Results of analysis and calibration El
Dates of analysis ❑
Name of person performing analyses El
Transported COCs El
Are DMRs complete: do they include all permit parameters') El 0 ® ❑
Has the facility submitted its annual compliance report to users and DWQ? ❑ El • ❑
(If the facility is=or>5 MGD permitted flow) Do they operate 24/7 with a certified operator El 0 III ❑
on each shift?
Is the ORC visitation log available and current? 0 El U 0
Is the ORC certified at grade equal to or higher than the facility classification? ❑ El III El
Is the backup operator certified at one grade less or greater than the facility classification? El El • ❑
Is a copy of the current NPDES permit available on site'? ❑ ❑ ❑ IN
Facility has copy of previous year's Annual Report on file for review? ❑ El III El
Comment: Mr.Abbott was not available for comment at the time of the inspection.
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ❑ ❑ ❑ •
Are all other parameters(excluding field parameters) performed by a certified lab? ❑ El El U
Page# 3

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Permit: NCG550092 Owner-Facility: 5959 Holder Road
Inspection Date: 09/19/2018 Inspection Type: Compliance Evaluation
Laboratory Yes No NA NE
#Is the facility using a contract lab? El ❑ 0 III
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees ❑ ❑ ❑ •
Celsius)?
Incubator(Fecal Coliform)set to 44.5 degrees Celsius+/-0.2 degrees? ❑ 0 0 •
Incubator(BOD)set to 20.0 degrees Celsius+/-1.0 degrees? El ❑ ❑ ■
Comment: None
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ M. ❑
Is sample collected below all treatment units? El ❑ 0 e
Is proper volume collected? El ❑ ❑ III
Is the tubing clean? ❑ ❑ U ❑
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees El ❑ 0 •
Celsius)?
• Is the facility sampling performed as required by the permit(frequency,sampling type ❑ El ❑ •
representative)?
Comment: None
Septic Tank Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational'? 0 El 0 III
Is septic tank pumped on a schedule? 0 El El •
Are pumps or syphons operating properly? El El ❑ •
Are high and low water alarms operating properly? ❑ ❑ ❑ III
Comment: None
Sand Filters (Low rate) Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational? ❑ 0 El •
Is the distribution box level and watertight'? El ❑ ❑ •
Is sand filter free of ponding? • El El ❑
Is the sand filter effluent re-circulated at a valid ratio? El • El El
#Is the sand filter surface free of algae or excessive vegetation? El El IN ❑
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) El U ❑ ❑
Comment: None
Page# 4

Permit: NCG550092 Owner-Facility: 5959 Holder Road
Inspection Date: 09/19/2018 Inspection Type: Compliance Evaluation
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? ❑ ❑ ❑ ■
, Are the tablets the proper size and type? ❑ ❑ ❑ •
Number of tubes in use?
Is the level of chlorine residual acceptable? ❑ ❑ ❑ •
Is the contact chamber free of growth, or sludge buildup? ❑ ❑ ❑
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑ •
Comment: None
Flow Measurement-Effluent Yes No NA NE
#Is flow meter used for reporting? DOND
Is flow meter calibrated annually? ❑ ❑ I ❑
Is the flow meter operational? ❑ ❑ M ❑
(If units are separated) Does the chart recorder match the flow meter? ❑ ❑ � ❑
Comment: None
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'? ❑ ❑ Cl •
Comment: None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? U ❑ ❑ ❑
Does the facility analyze process control parameters,for ex. MLSS, MCRT, Settleable DOOM
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Page# 5