NCG550184_Other Agency Documents_20150928

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
May 24, 2010
Basil R. Davis, Jr.
8608 Hickory Hill Lane
Kernersville, North Carolina 27284
Subject: General Wastewater Permit No. NCG550184—Single Family Residence
Basil Davis, 8608 Hickory Hill Lane, Kernersville, North Carolina
Forsyth County
Dear Mr. Davis:
Jenny Graznak of the Winston-Salem Regional Office performed a Compliance
Evaluation Inspection on the sandfilter wastewater treatment system at your property in Forsyth
County, North Carolina on May 13, 2010. This type of inspection consists of two basic parts: a
review of self-monitoring data, and an on-site inspection of the facility and its discharge. No one
was home during the inspection; however, Ms. Graznak was able to contact you via telephone
following the inspection to discuss the wastewater system and the inspection with you.
You hold a General Permit to discharge Domestic Wastewaters from Single Family
Residences under the National Pollutant Discharge Elimination System (NPDES). Two
chlorinator tubes were observed during the inspection. They are located in a large holding tank
with a cement cover. The discharge pipe was never located during the inspection. During your
telephone conversation with Ms. Graznak on May 21, 2010, you stated that the discharge pipe
is buried and does not actually discharge to the stream. You also stated that the septic tank
was pumped out approximately two (2) years ago.
Permit text Part I Section A (attached to this correspondence) specifies the
requirements and monitoring limits for your permit. You must also conduct and document the
following maintenance activities:
• Septic tanks shall be maintained at all times to prevent seepage of sewage
• Septic tanks will be checked at least yearly to determine if solids must be removed
• Septic tanks shall be pumped out within 3-5 years of issuance date of the Permit.
Contents removed from septic tanks shall be disposed of at a location and in a manner
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compliant with all local and state regulations
Our files on your wastewater system claim that your system is comprised of a 900-gallon
septic tank, two sub-surface sand filters (one is 390 square feet and the other 210 square feet),
a tablet chlorination unit in a 420-gallon holding tank, and a 5-step re-aeration system. If you
ever notice a discharge from your wastewater system, annual sampling of the effluent is
required. A Laboratory with North Carolina Wastewater Certification must perform the
North Carolina Division of Water Quality,Winston-Salem Regional Office
Location:585 Waughtown St.Winston-Salem,North Carolina 27107 One
Phone:[phone] FAX:[phone]\Customer Service:1-877-623-6748 NorthCarolina
Internet:www.ncwaterquality.org Naturally
An Equal Opportunity\Affirmative Action Employer

monitoring of the effluent sample. Thank you for your attention to this matter. Please contact
Ms. Graznak or me at [phone] if you have any questions regarding your permit or your
wastewater system.
Sincerely,
Steve W. Tedder
Regional Supervisor
Surface Water Protection Section
cc: SWP-Central Files
SWP-WSRO
NPDES Unit-Charles Weaver

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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 I NI 2 15I 31 NCG550184 111 121 10/05/13 117 181 ci 191 SI 20I
Remarks
211 I I I 1111111111111111 111111111111111111111111111
66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA — Reserved
671 169 701 31 711 I 721 NI 731 I 174 761 I I I I 1 1 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)
10:00 AM 10/05/13 07/08/01
8608 Hickory Hill Lane
8608 Hickory Hill Ln Exit Time/Date Permit Expiration Date
Kernersville NC 27284 11:00 AM 10/05/13 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
Basil R Davis,8608 Hickory Hill Ln Kernersville NC 27284/// No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
II Permit
Section D: Summary of Findinq/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
Jennifer F Graznak WSRO WQ//336-771-5000/
9,71*
Signature of Mana ent QA Rev r Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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Permit: NCG550184 Owner-Facility: 8608 Hickory Hill Lane
Inspection Date: 05/13/2010 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? 0 0 • 0
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?
Is the inspector granted access to all areas for inspection? ■ n n n
Comment:
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