NCG550231_Compliance Evaluation Inspection_20160920

44) : .: PAT MCCRORY
of. t s , •
17- Governorµ`-
DONALD R. VAN DER VAART
secretary
Water Resources
ENVIRONMENTAL QUALITY S. JAY ZIMMERMAN
September 16, 2016 Director
Donald L. Davis
5852 Robbins Country Rd.
Trinity, NC 27370
Subject: Compliance Evaluation Inspection
Permittee: Donald L. Davis, Owner RECEIVED
Facility: 5852 Robbins Country Rd. Trinity, NC 27370
Permit: NCG550000 General Wastewater Permit SEP 2 0 2016
Certificate of CoverageiN.C_G_560-2-311 CENTRAL FILES
Randolph County DWR SECTION
Dear Mr. Davis:
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 16, 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, and the discharge pipe.The entire
system appears to be in good operating order. There was no discharge at the time of the inspection.
Effluent sample results collected on June 13, 2016 were available for review during the inspection and
were in compliance with permitted limits.
3. The septic tank was last pumped by Queens Septic Tank on June 10, 2015, and a receipt was provided
for review during the inspection. 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 the chlorine vendors guide supplied to you by Mr. Henderson
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 have a copy of the most recent Certificate of Coverage (COC). 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
336 776 9800

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
CC: WSRO Files
oFentr IFzil
NPDES Unit

United States Environmental Protection Agency Form Approved.
EPA Q Washington,D C 20460 OMB No.2040-0057
1 /� 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 E 2 ILI 3 I NCG550231 111 121 16l09/16 117 18 LI, 19 [ G 201 I
211II111 IIIIIII111111111II IIIIIII IIIIIIIIIII l66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved-------------
67I 70 1 I 711 I 72 1 N I 731 174 751
III 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) 09:45AM 16/09/16 13/08/01
5852 Robbins Country Road
Exit Time/Date Permit Expiration Date
5852 Robbins Country Rd
16:15AM 16/09/16 18/07/31
Trinity NC 27370
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
Donald L Davis,5852 Robbins Country Rd Trinity NC 27370//336-431-5605/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
III 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
Vitell
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550231 111 121 16/09/16 117 18 Li
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Page# 2

Permit: NCG550231 Owner-Facility: 5852 Robbins Country Road
Inspection Date: 09/16/2016 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: Please refer to attached inspection summary letter.
Page# 3