NCG550210_Compliance Evaluation Inspection_20101025

A•A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
October 25th, 2010
Jay Christopher Brewer, Owner
4668 Palace Avenue
Winston-Salem, NC 27101
Subject: Compliance Evaluation
NPDES General Wastewater Discharge Permit— NC550000
Certificate of Coverage NCG550210
Single Family Residence 4668 Palace Avenue, Winston-Salem, NC 27101
Forsyth County
Dear Mr. Brewer:
Mr. Ron Boone, of the Winston-Salem Regional Office of the North Carolina Division of Water
Quality (DWQ or the Division), conducted a compliance evaluation inspection (CEI) of your single
family residence wastewater treatment system located at 4668 Palace Avenue, in Winston Salem,
Forsyth County, North Carolina, on October -1.5th, 2010. Your assistance and cooperation was
greatly appreciated. Inspection findings are summarized below and an inspection report is attached
for your records.
According to Forsyth County tax records, you took ownership of the property in 2001. The
Division had sent several pieces of correspondence to that address since then which were addressed
to Frances Meacham or Current Owner. No response to that correspondence was ever received. It
is noted that the physical address of the residence actually changed from 4526 to 4668 sometime in
the past ten years. Please let us know exactly when the address was changed.
There were no records available at the time of the inspection, including blueprint drawings,
maintenance records, records of the septic tank being pumped, effluent analytical records, etc. Mr.
Boone advised you to start keeping all records as required by the permit.
Mr. Boone could not locate the chlorinator or the discharge pipe. The stream did not exhibit
any adverse conditions that may have been related to the discharge. No samples were taken
however.
Please continue to search for original record drawings and other records that may assist you in
locating the chlorinator and discharge pipe and notify this office if and when you do locate either. The
Forsyth County Health Department may be able to assist you in finding original record drawings for
the property. You may also contact them through their website. Attached is a copy of the general
permit, its technical bulletin, a list of chlorine suppliers, and a record drawing from our files that may
help you locate the chlorinator and discharge pipe.
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
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An Equal Opportunity\Affirmative Action Employer �/ i�` l`

•
Jay Christopher Brewer
4668 Palace Ave,Winston Salem,NCG550210
Compliance Evaluation Inspection
October 25,2010
Page 2
Mr. Boone also gave you a Name/Ownership Change form during the inspection. Please fill
out the form completely and send it to the address located on the bottom of the second page. Failure
to do so by November 15th will result in this office taking further action.
Thank you again for you assistance and cooperation in this matter. Please do not hesitate to
contact Mr. Boone or me if you have any questions regarding the inspection, this letter, or the permit,
at 336-771-5000.
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. BIMS Inspection Report
2. NCG550000 General Permit
3. NCG550000 Technical Bulletin
4. List of Chlorine Suppliers
5. System Drawing
cc: WSRO — SWP w/ atch
Central Files w/ atch
iNPDES West Unit, Charles Weaver

United States Environmental Protection Agency
EPA Washington,D.C.20460 Form Approved.
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 5 31
NCG550210 111 121 10/10/15 117 181 CI 19I SI 20III
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII68
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
671 169 70III 711 I 72I NI 731 I 174 751 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)
03:00 PM 10/10/15 97/09/01
4526 Palace Avenue
4526 Palace Ave Exit Time/Date Permit Expiration Date
Winston Salem NC 27101 03:30 PM 10/10/15 02/07/31
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
Frances Meacham,4526 Palace Ave'Winston Salem NC 27101//910-725-8018/
0
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 WSRO WQ//704-663-1699 Ext.2202/ te.2A51(..
V
Signature of Manage t Q A Review Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

\1
NPDES yr/mo/day Inspection Type (cant.) 1
3, NCG550210 1
11 121
10/10/15 I17 181
CI
Section D: Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
New owner is Jay Christopher Brewer since 2001. Mr. Brewer could not locate documentation of tank
pumping but stated it was done within the past 5 years. Mr. Brewer was unaware that it is a discharging
system and of the permit. Gave him an Ownership/Name change form to fill out and send to Raleigh.
Neither the chlorinator nor the discharge pipe was located. Stream appeared fine but did not take samples.
Told Mr. Brewer he needs to locate chlorinator and begin using WW rated chlorine tablets as required. Gave
him copy of NCG550000 permit, tech bulletin, and list of chlorine suppliers. Will email it to him also at
jb61 01 @yahoo.com.
Page# 2

Permit: NCG550210 Owner-Facility: 4526 Palace Avenue
Inspection Date: 10/15/2010 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 Y ❑ 0
Is the facility as described in the permit? n ■ n n
#Are there any special conditions for the permit? norm
Is access to the plant site restricted to the general public? n n m n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: New owner is Jay Christopher Brewer since 2001. Mr. Brewer could not
locate documentation of tank pumping but stated it was done within the past 5 years.
Mr. Brewer was unaware that it is a discharging system and of the permit. Gave him an
Ownership/Name change form to fill out and send to Raleigh. Neither the chlorinator nor
the discharge pipe was located. Stream appeared fine but did not take samples. Told
Mr. Brewer he needs to locate chlorinator and begin using WW rated chlorine tablets as
required. Gave him copy of NCG550000 permit, tech bulletin, and list of chlorine
suppliers. Will email it to him also at [e-mail].
Page# 3