NCG550214_Compliance Evaluation Inspection_20160920

PAT MCCRORY
s Gavema•
E _ _ DONALD R. VAN DER VAART
Sec elm y
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
September 12, 2016 Drrecto,•
Coyd M. Holgen
330 Circle Drive
Archdale, NC 27263
Subject: Compliance Evaluation Inspection RECEIVED
Permittee: Coyd M. Holgen, Owner
Facility: 330 Circle Drive Archdale, NC 27263 SEP 2 © ?Uib
Permit: NCG550000 General Wastewater Permit CENTRAL.FILES
Certificate of Coverage: NM-502710k DWR SECTION
Randolph County
Dear Mr. Holgen:
1. Justin Henderson, 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 residence on September 9, 2016.The State requires the Division to inspect
these types of systems every five years. An inspection report is attached for your records and the
inspection findings are summarized below,
2. The system consists of a septic tank, filtration unit, chlorination unit, chlorine contact deep well, and
the discharge pipe. The entire system appears to be in good operating order. There was no discharge
at the time of the inspection and you have not been taking samples of the effluent as required in the
permit.
3. The septic tank was last pumped within the last five years. You stated that you have it pumped a
minimum of every five years.
4. You have been adding chlorine tablets as needed to the chlorinator unit. The unit appears to be in
good condition. However, you are not using the correct type of chlorine. The chlorine you use is
intended for use in swimming pools, not for wastewater treatment. You should acquire wastewater
grade chlorine tablets. Please refer to chlorine technical information, provided to you during the
inspection.
5. The permit fees of$60 per year have been paid annually as required and your permit is active and up
to date.You did not have a copy of the most recent Certificate of Coverage (COC)• A copy is attached
for your records. Mr. Henderson left you with a copy of the most recent general permit and technical
bulletin.
6. Failure to properly operate and maintain your wastewater system can result in expensive repair costs
as well as failure of the system to properly treat the wastewater. It appears that your system is well
maintained.
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27105
ter; 336 776 9800
{x.;;I' J"'3>cJz' .,,, i`"NF, ."`;==0.'"3•"; ` „� 7*.r ,"." x' oe i ^git ", ,•. .'w,.x ,rn _ ., - ° - _ _� . z . . ... ex-

7. 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,
Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1, Inspection Report
2. Certificate of Coverage NCG551106
3. Sketch of wastewater system
CC: WSRO Files
VAri glls
NPDES Unit

AqpA
NcENrNorth Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross,Jr., Secretary
Coleen H.Sullins, Director
July 27, 2007
Coyd Marlin Hoglen
330 Cir Dr
Archdale,NC 27263
Subject: Renewal of coverage/General Permit NCG550000
• 330 Circle Drive
Certificate of Coverage NCG550214
Randolph County
Dear Petuiittee:
In accordance with your renewal application [received on January 17,2007],the Division is renewing
Certificate of Coverage (CoC)NCG550214 to discharge under NCG550000. This CoC is issued pursuant to the
requirements of North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection agency dated May 9, 1994 [or as subsequently amended].
If any parts,measurement frequencies or sampling requirements contained in this General Permit are
unacceptable to you,you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made,the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to the
Division. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Winston-Salem Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning the requirements of the General Permit,please contact Toya
Fields [919 733-5083, extension 551 or [e-mail]] or Susan Wilson [919 733-5083, extension 510
or [e-mail]].
Sincerely,
•
for Coleen H. Sullins
cc: Central Files
Winston-Salem'RegionalOff'ice/Surface WaterProtection
NPDES file
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 - One
512 North Salisbury Street,Raleigh,North Carolina 27604 c orthCar®lina
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquality.org Naturally
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
SCE .,TIFIC TE I'F C VE ' A GE NCG550214
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE
NATIONAL POLLUTANT ISCHARGE ELIMINATI N SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
Coyd Marlin Hoglen
is hereby authorized to discharge domestic wastewater [150 GPD] from a facility located at
330 Circle Drive
Archdale
Randolph County
to receiving waters designated as an unnamed tributary to Uwharrie River in subbasin 03-
07-09 of the Yadkin River Basin in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This certificate of coverage shall become effective August 1, 2007.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 27, 2007.
rr
7 1
df t
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

United States Environmental Protection Agency
Form Approved.
E PA 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^I I 2 IS I 3 I NCG550214 I11 12 I 16/09/09 117 18[2]
19 I S I 201 I
211111 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-------------
67I I 70I I 711 I 72 L-1[ �, 73I I I" 75] 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)
01:45PM 16/09/09 13/08/01
330 Circle Drive
330 Cir Dr Exit Time/Date Permit Expiration Date
Archdale NC 27263 02:40PM 16/09/09 18/07/31
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
Coyd Marlin Hoglen,330 Cir Dr Archdale NC 27263/1336-431-1819/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
II 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
Justin L henderson WSRO WQ//336-776-9701/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
-�,, . v. , ., 0,1/ zit,
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550214 11 121 16/09/09 117 18 U
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page# 2

Permit: NCG550214 Owner-Facility: 330 Circle Drive
Inspection Date: 09/09/2016 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: Please refer to attached inspection summary.
•
Page# 3

t,'1
I mo " €"3 L;.! f ' "S t/?j - >
M.
J�
„r S xa o r�
kn
I t)• •
"" -P
f
• !IN- % ..
! ''' A : ' ..
1-N.
e J