NCG550177_Compliance Evaluation Inspection_20180929

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North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
September 29, 2015
Jack R. Elliott RECEIVED
5080 McGee Road O C T 0 9 2 015
Walkertown, NC 27051 CENTRAL, FILES
DWR SECTION
Subject: Compliance Evaluation Inspection
Permittee: Jack R. Elliott, Owner
Facility: 5080 McGee Road, Walkertown, NC 27051
Permit: NCG550000 General Wastewater Permit
Certificate of CoveragfVO-G51)1g7
Forsyth County
Dear Mr. Elliott:
1, Ron Boone, 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 place of residence on September 22, 2015. Your assistance and cooperation was greatly
appreciated. An inspection checklist is attached and the inspection findings are summarized below.
2. The State requires the Division to inspect these types of systems every five years. Your system was last
inspected in September, 2010.
3. The wastewater system at your residence appears to operating properly and Mr. Boone found no
discrepancies or problems that indicated anything was wrong.
4. At this point it is probably most prudent that you have the septic tank pumped at least every three to five
years, depending on how many people are living in the residence. Please keep records of septic tank
pumping on hand as a historical record and proof that you had the tank pumped. The permit does
require that you have the tank pumped as required. The tank was last pumped two years ago.
5. It is unknown whether the effluent water has ever been tested by a laboratory. This is also a requirement
of the permit, to have the effluent water tested once per year. You can contact a local commercial
laboratory and inquire as to whether they can perform the testing required by the permit. Please refer to
the copy of the permit attached to this letter, It will be impossible to collect a sample however until you
are able to locate the end of the discharge pipe. It was not located during the inspection.
6. The chlorinator is located in the front yard. It did have chlorine tablets in it at the time of the inspection.
You stated that you add more tablets as needed.
7. The permit fees have been paid as required and your permit is active and up to date. The permit fee is
$60.00 per year.
450 West Hanes Mill Road,Suite#300,Winston-Salem,North Carolina 27105
Phone:[phone] Internet:www.ncdenr.gov
An Equal Opportunity\Affirmative Action Employer—Made in part by recycled paper

8. Please keep this letter with your records for the system along with copies of invoices from the Division
for the annual permit fee, the Certificate of Coverage, records of septic tank pumping, maintenance and
repair records, etc.
9. These types of systems should be inspected at least every five years to ensure they're properly
operated and maintained. Failure to properly operate and maintain the system can result in expensive
repair costs as well as failure of the system to properly treat the wastewater. Also, you need to have
your septic tank pumped once every three to five years, depending on usage.
10. 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,
A �
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
• Division of Water Resources
Attachments:
1. Inspection Report
2. Copy of latest Certificate of Coverage NCG550177
•
3. Copy of NCG550000
4. Technical Bulletin
CC: WSRO Files
Central ri es
NPDES Unit

i .
United States Environmental Protection Agency Form Approved.
EPAP1 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 [ i 2 [ I 3 I NCG550177 111 12 I 15/09/22 117 18 L 19 I s I 201 I
211 111 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 II I I I I I 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ----- - —Reserved-----------
67 I I 70 I I 711
I 72 I N I 731 I 174751
7511 I I I I I I 180
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) 03'OOPM 15/09/22 13/08/01
5080 McGee Road
Exit Time/Date Permit Expiration Date
5080 McGee Rd
05:OOPM 15/09/22 18/07/31
Walkertown NC 27051
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
Jack R Elliott,5080 McGee Rd Walkertown NC 27051//336-595-6848/
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/ 7/2 9 /�--
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type 1
31 NCG550177 I11 121 15/09/22 117 18 LI
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
• Location of septic tank known. It was pumped about two years ago.
Location of chlorinator known. There was chlorine in it at the time of the inspection and you stated that
you add chlorine as needed.
Discharge pipe could not be located.
The effluent has never been tested.
•
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•
Permit: NCG550177 Owner-Facility: 5080 McGee Road
Inspection Date: 09/22/2015 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: None
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