NCG550493_Rick_Shoemaker_SFR_CEI_Report_20240530

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 IN 2 u 3 I NCG550493 111 121 24/04/04 I17 18 I C I 19 I s I 20L]
21111I I I I I I I II I I I I I I I I I I I I I I I I I I I I I I I II I I I I I r6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67
I 72 I ni I 73 � I 74 79 I I I I I I I80
70 I I 71 I LL -1 I I
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 Dermit Number)
02:OOPM 24/04/04
20/01/02
2030 Woodstock Road
2030 Woodstock Rd
Exit Time/Date
Permit Expiration Date
Clemmons NC 27012
02:30PM 24/04/04
20/10/31
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
Rick F Shoemaker,2030 Woodstock Rd Clemmons NC 27012//336-699-4644/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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 cuSigned by: DWR/WSRO WQ/336-776-9690/
Do
5/30/2024
Ea& Boom
an
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
ocuSigned by:
Lon T. Snider F�- T. 5,,dcr 5/30/2024
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG550493 I11 12I 24/04/04 117 18 ici cJ
(Cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On April 4th, 2024, Ron Boone, of the Winston-Salem Regional Office of the NC Division of Water
Resources, conducted a compliance evaluation inspection of your single family wastewater treatment
system. Thank you for assisting Mr. Boone in completing the inspection. The inspection results are
summarized below:
You told Mr. Boone that the septic tank has been pumped at least within the last five years. Please
note that the permit requires you to pump the tank every three to five years. This will keep the tank in
good condition and prevent loss of solids to the subsurface sand filter, which would clog the filter and
require it to be repaired or replaced at a high cost. There are two people living in the home so
pumping the tank every four to five years would likely be ideal for your home.
You showed Mr. Boone that you are using the correct type of chlorine tablets. Be careful with these
tablets as they're toxic. Skin, eye, and respiratory protection should always be worn when handling
them. You should keep each chlorinator tube constantly stocked with 2 to 3 tablets. We have
attached some helpful information about chlorine.
The location of the discharge pipe is known. It is quite far from the home down in a wooded area and
somewhat difficult to access. Mr. Boone advised you that the permit (attached) requires annual
samples be taken at the discharge pipe. No samples of the effluent have been taken yet. We have
also attached a list of certified laboratories where you may take samples for the required analysis.
You are currently not required to submit test results to the Division but you must keep them on file
with all your other related records such as the certificate of coverage, permit fee invoices, tank
pumping invoices, etc. Please do share the test results with Mr. Boone when you get them so we can
get an idea of how well your system is functioning.
Annual fees for this permit are $60. Not all fees have been paid in full to date. You should be
receiving an annual invoice from the Division for this fee. Please pay the fees on time.
The general permit number is NCG550000, and your specific permit #, otherwise known as your
certificate of coverage #, under the general permit, which is assigned specifically to your home, is
NCG550493. If you ever sell the home in the future it is imperative that you ensure full transfer of the
permit to the new owner. You can do this by downloading a copy of the Name/Ownership Change
form from our website at:
https://www.deq.nc.gov/coastal-management/gis/data/esmp-data/2010/july/npdes/new-owner-changef
orm-
202107/download
You are technically non -compliant with the permit at this time due to not having the effluent tested
annually.
If you have any questions or concerns about compliance, the inspection, or this report, please
contact Mr. Boone by phone at 336-776-9690, or by email at [e-mail].
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Permit: NCG550493
Inspection Date: 04/04/2024
Owner -Facility: 2030 Woodstock Road
Inspection Type: Compliance Evaluation
Permit
(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: Please refer to the inspection summary section of this report.
Yes No NA NE
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