NCG550095_Compliance Evaluation Inspection_20171016

ROY COOPER
Governor
.c.
?,a
MICHAEL S. REGAN
Secretary
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY Director
10 October 2017
Mrs. Carol Brummitt
17632 Randalls Ferry Road
Norwood, NC 28128 RECEIVED
SUBJECT: Compliance Evaluation Inspection OCT 16 2017
Single Pass Filter System CENTRAL FILES
NPDES Permit N 150095 DV11R SECTION
Stanly County, NC
Dear Ms. Brummitt:
On October 5, 2017, Roberto Scheller of this Office conducted a compliance inspection at the
subject residence. This inspection was conducted as a Compliance Evaluation Inspection (CEI)
to insure compliance with permit requirements and conditions. During the subject inspection, Mrs.
Brummitt noted a name change on the current permit. Enclosed is a copy of a "Permit
Name/Ownership Change Form". Please complete and mail to the address on the back of the
form. Also enclosed is a copy of the Technical Bulletin for General permit NCG550000 and a
copy of your General Permit. At the time of inspection, treatment works appeared to be well
maintained and operated. We wish to thank Mrs. Brummitt for her assistance regarding this
inspection.
The enclosed report should be self-explanatory; however, should you have any questions, or
require assistance with the Name/Ownership Change Form, please do not hesitate to contact me
or Roberto Scheller at [phone] or roberto.schellerAncdenr.gov.
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office, DEQ
Enclosed
@c': Tin W ' r
State of North Carolina I Environmental Quality I Water Resources
512 N.Salisbury Street 11611 Mail Service Center I Raleigh.NC 27699-1611
919.707.9000

United 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 Fac Type
1 2 Li 3 I NCG550095 111 12 I 17/10/05 117 18l I 19 I s I 201 I
2111I I I 1 I I I I II I I I I I I I I I I I I I I I I I I I 1 1 1 111 1 1 I I I r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA --- Reserved-------------
67 I I 70 71 I I 72 E1 731 I 174 "1 11 1 -I I I I80
LJ 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) 10 43AM 17/10/05 13/08/01
17632 Randalls Ferry Road
Exit Time/Date Permit Expiration Date
17632 Randalls Ferry Rd
11.30AM 17/10/05 18/07/31
Norwood NC 28128
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
J Donald Brummitt,17632 Randalls Ferry Rd Norwood NC 28128//704-474-5476/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated) '
111 Permit • Operations&Maintenance 1.1 Records/Reports • Self-Monitoring Program
Sludge Handling Disposal II 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
Roberto Scheller MRO WQ//252-946-6481/
(DyJ)—
IDAQ/NO
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
W. Corey Basinger MRO WQ//704-235-2194/
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete. / , ' /071'•
7t14-
Page# 1

NPDES yr/mo/day Inspection Type
31 NCG550095 Ill 121 17/10/05 I 17 18 Li
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
•
,
Page# 2

Permit: NCG550095 Owner-Facility: 17632 Randalls Ferry Road
Inspection Date: 10/05/2017 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 111 ❑
application?
Is the facility as described in the permit? • ❑ ❑ El
#Are there any special conditions for the permit'? El • ❑ ❑
Is access to the plant site restricted to the general public? ❑ El • El
Is the inspector granted access to all areas for inspection? ❑ ❑ El
Comment: The current permit was issued in 2013 and is good for 5 years. If house is sold the permit
should be transfered to new owners.
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 El El • ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: Septic tank is pumped yearly by A.L. Lowder Inc. of Albemarle, NC.
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ❑ ® ❑ ❑
Is all required information readily available, complete and current'? • El ❑ ❑
Are all records maintained for 3 years(lab. reg. required 5 years)? • ❑ ❑ El
Are analytical results consistent with data reported on DMRs? El El • El
Is the chain-of-custody complete? • ❑ ❑ El
Dates, times and location of sampling
Name of individual performing the sampling • •
Results of analysis and calibration
Dates of analysis •
Name of person performing analyses •
•
Transported COCs •
Are DMRs complete. do they include all permit parameters? El El I El
Has the facility submitted its annual compliance report to users and DWQ? El El 111 El
(If the facility is=or>5 MGD permitted flow) Do they operate 24/7 with a certified operator El El El
on each shift?
Is the ORC visitation log available and current? El El • El
Is the ORC certified at grade equal to or higher than the facility classification? ❑ El I ❑
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? ❑ El • El
Page# 3

L
Permit: NCG550095 Owner-Facility: 17632 Randalls Ferry Road
Inspection Date: 10/05/2017 Inspection Type: Compliance Evaluation
Record Keeping Yes No NA NE
Facility has copy of previous year's Annual Report on file for review'? ❑ ❑ MI El
Comment: It is required that the permittee sample annually for Flow, BOD,Total Suspended Solids
(TSS), Fecal Coliform, and Total Residual Chlorine. The permittee may estimate flows.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? • ❑ El ❑
Are the receiving water free of foam other than trace amounts and other debris? • ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly'? • El ❑ ❑
Comment: It was noted that broken effluent discharge pipe has been repaired.
Septic Tank •
Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational'? ❑ ❑ ❑ •
Is septic tank pumped on a schedule? • ❑ ❑ El
Are pumps or syphons operating properly? ❑ ❑ ❑ U
Are high and low water alarms operating properly? ❑ ❑ ❑ MI
Comment: Septic tank is being pumped by A.L. Lowder, Inc.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? • ❑ ❑ ❑
Are the tablets the proper size and type? ❑ ❑ ❑
Number of tubes in use? 1
Is the level of chlorine residual acceptable? DOOM
Is the contact chamber free of growth, or sludge buildup? • ❑ ❑ ❑
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑ •
Comment: There was no discharge at time of inspection.
Page# 4

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information(if different from the person legally responsible for the permit)
Permit contact:
First MI Last
/l/7Title
Mailing Address
City State Zip
( )
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
❑ Yes
n No (please explain) A /,4
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
® This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale)is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
this application package will be returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I, &iR D l '. w,cumil'!; , attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
this application package will be returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 512012

•
■ \p�pF W ATFgOG Beverly Eaves Perdue,Governor
Dee Freeman,Secretary
• j . • North Carolina Department of Environment and Natural Resources
o
Charles Wakild,P.E.,Director
Division of Water Quality
OD/WA=W&TEAR PRO ECTICR SE T'O
" PE °a„ ITN , € /4 ` ' R;+H�IiP x.F® : .a '
I. Please enter the permit number for which the change is requested.
Primary Related Permit (or) Certificate of Coverage
N C 05 5 0 0 0 0 N S 5 O U 9 S
II. Permit status prior to status change.
a. Permit issued to(company name):
b. Person legally responsible for permit: Sel.A ,(�. Oit knt�;
First MI Last
Title
/ 7k.72. Z4,v //.r ferdy /ld
Permit Holder Mailing Address
/l/o/Viln Ge vC- 2?'/
City State Zip
(7°f )9 '-s97G ( )
Phone Fax
c. Facility name(discharge):
d. Facility address:
Address
City State Zip
e. Facility contact person: ( )
First /MI/Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain: m-rn 74 Al u fat«
b. Permit issued to(company name):
c. Person legally responsible for permit: CA p/ ;F?Ruriirja;/74—
First MI Last
Title
/74 32_ 7e4 'cla//r
ot
�f /Permit Holder Mailing Address
/r'ritioa /✓C— 2P12cr
City State Zip
( 7011) Inc(-Sy74
Phone E-mail Address
d. Facility name(discharge):
e. Facility address:
Address
City State Zip
f. Facility contact person:
First MI Last
( )
Phone E-mail Address
Revised 512012