NCG550220_Compliance Evaluation Inspection_20150928

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NCDENR
North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
September 28, 2015
Mary F. Saunders
540 Shadow Lane
Winston-Salem, NC 27107 RECTIVFE,
Subject: Compliance Evaluation Inspection UL I 0 9 u ID
Permittee: Mary F. Saunders, Owner CENTRAL FILES
Facility: 540 Shadow Lane, Winston Salem, NC 27107 DWR SECTION
Permit: NCG550000 General Wastewater Permit
Certificate of Coverage:aN' G550220j
Forsyth County
Dear Ms. Saunders:
1. Ron Boone, of the Winston Salem Regional Office (WSRO) of the NC Division of Water Resources
(DWR or the Division), attempted to conduct a compliance evaluation inspection of the single family
wastewater system at your place of residence on September 22, 2015, but you were not home.
2. The State requires the Division to inspect these types of systems every five years.Your system was last
inspected in October, 2009.
3. Because you were not there during Mr. Boone's visit on 9/22/2015, he could not inspect the whole
system. However, 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.
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.
6. The chlorinator could not be located during the inspection. It is unknown whether there is chlorine in it or
not. If not, please acquire chlorine tablets and begin placing them in the chlorinator 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. Please call Mr. Boone at
his direct extension which is 336-776-9690, so that he can schedule a full inspection with you.
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,
sj— �-
j' W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. Inspection Report yZb
2. Copy of latest Certificate of Coverage NCG5508+
3. Copy of NCG550000
4. Technical Bulletin
CC: WSRO Files
e1b--F Files
DES Unit

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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
2 [ I 3 I NCG550220 I11 12 I, 15/os/22 117 18 19I G 201 I
21II1111 IIIIIIIII II IIIIIII I I IIIII IIIIII [ II Il f6
Inspection Work Days Facility Self-Monitoring Evaluation Rating •B1 QA ----------Reserved-----
67 I I 70 I I 71 I 72 Lit J 73 I I I74 75I I I I I I I Il80
Section B:Facility Data J
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) 02•00PM 15/09/22 13/08/01
540 Shadow Lane
Exit Time/Date Permit Expiration Date
540 Shadow Ln
• 03:OOPM 15/09/22 18/07/31
Winston Salem NC 27107
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
Mary F Saunders,540 Shadow Ln Winston Salem NC 27107//336-785-9272/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
IIII 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/
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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 NCG550220 111 121 15/09/22 I17 18 I I
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Owner not home at time of inspection.
Location of septic tank unknown but no apparent problems.
Chlorinator not found.
Discharge pipe not found.
Unknown whether effluent has ever been tested.
Please call Mr. Boone at 336-776-9690 to schedule a full inspection.
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Permit: NCG550220 Owner-Facility: 540 Shadow Lane
Inspection Date: 09/22/2015 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: None
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