NCG550280_Compliance Evaluation Inspection_20180927 (2)

ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER September 27. 2018
Interim Director R g e E I V E D
Ray McCoy OCT 05 2018
6911 Mendelssohn Drive
Clemmons, NC 27012 CENTRAL FILES
DWR SECTION
SUBJECT: Compliance Evaluation Inspection
NC General Wastewater Permit NCG550000
Certificate of Coverage: NCG550280
Facility: 6911 Mendelssohn Drive, Clemmons, NC 27012
Owner: Ray McCoy
County: Forsyth
Dear Mr. McCoy:
Ron Boone, of the Winston-Salem Regional Office (WSRO) of the NC Division of Water
Resources (DWR or the Division), met with you on September 19, 2018, at your home located at
6911 Mendelssohn Drive in Clemmons, NC, to conduct a compliance evaluation inspection (CEI)
system, which discharges of the home's wastewater treatment its final treated effluent to Johnson y
and is currently which is located east of your home classified as class water supply IV
(WS-IV) waters. Johnson Creek is located in the Yadkin-Pee Dee River Basin.
Your home's wastewater treatment system is regulated by DWR under NC General Wastewater
Discharge Permit NCG550000, with certificate of coverage (COC) NCG550280. NCG550000
specifies your obligations and responsibilities, as owner and permittee, to properly operate and
maintain the system in order to properly and sufficiently purify your home's domestic wastewater
to within limits specified in the permit before it is discharged to Johnson Creek.
You were home the day of the inspection and able to speak with Mr. Boone. Mr. Boone determined
that you knew the location of the septic tank, chlorinator, and discharge pipe. The exact location
of the sand filter was unknown. You stated that you had the tank pumped about 5 years ago.
Please note then that it is now time to have it pumped again. You should have it pumped every 3
to 5 years, depending on use. The chlorinator is located in the back yard and there are two pipes
that stick up out of the ground about 4 feet. Both tubes we nearly filled with disintegrated,
hardened chlorine tablets that were stuck in the pipe so you couldn't see the bottom, so, it is
unknown whether the flow was actually being chlorinated. Mr. Boone also determined that you
were using swimming pool grade chlorine tablets. You should use wastewater grade chlorine
tablets, which Mr. Boone provided a list of potential suppliers for. Additionally, you have never
had the effluent from the system tested as required by the permit. Please note the permit requires
you to have the water tested annually.
Please ensure you keep records of the tank pumping along with all other documentation related
to the system, including inspection reports. such as this one, and billing and permitting
D_E
NORTH cAROUNA
OeOWmnt W th*O MBi OrMb\
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27103
336.776.9800

documentation that you receive from our Central Office in Raleigh. It is suggested that you create •
a file folder in which you can store all documentation related to the system in one place.
Our database shows that you are up-to-date on the annual bill. Also, Forsyth County property
records show Cornelia L. Corey as the current homeowner. The homeowner/permittee in our
database should match this information. Therefore, please submit the attached Name/Ownership
Change Form, which Mr. Boone has mostly filled out for you, as directed by the instructions on
the form, to our Central Office in Raleigh, to have the owner's name changed in our database to
Ms. Corey. Please note that you must also submit a copy of the current property deed showing
Ms. Corey as the current homeowner or the Central Office may return your form without action.
Please review the NCG550000 permit, which is also attached, in detail, to become thoroughly
familiar with all operation and maintenance, testing, and documentation requirements.
Please note that failure to comply with the requirements of the NCG550000 general permit and
the NC general statutes and/or regulations under which it is promulgated, is a violation of the
permit and/or said statutes/regulations, and that such violations subject the homeowner/permittee
to civil penalties of not more than $25,000 per day, per violation. It is in your and your family's
best interest to comply with all permit conditions. Doing so will minimize your investment in the
system, guarantee the health and safety of your family and others in your community, and protect
the environment.
If you have any questions whatsoever, please never hesitate to contact Mr. Boone by phone at
336-776-9690, by email at ron.boone(c�ncdenr.gov, or me at 336-776-9800 or
sherri.knightncdenr.gov. Thank you for your time and attention to this matter.
Sincerely,
1“-"- 17' /21HP)1
Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. Name/Ownership Change Form
2. NC General Wastewater Discharge Permit NCG550000 for Single Family Residences
3. Water Compliance Inspection Report
cc: DWR NPDES Unit
DWR Central Files
DWR/WSRO Files
NOR CAROUNA
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 Hanes Mill Road,Suite 300 Winston-Salem,North Carolina 27103
336.776.9800

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 �N 2 u 3 I NCG550280 111 12 1 18/09/18 117 18 19 I g I 201 I
21I11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 [ I 1 1 1 r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA -Reserved
67 1 I 7° l 1 I 71 L_J 1 I 72 I N I 731 1 174 751
1 1 1 1 1 1 180
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) 12:30PM 18/09/18 13/08/01
6911 Mendelssohn Drive
Exit Time/Date Permit Expiration Date
6911 Mendelssohn Dr
01:OOPM 18/09/18 18/07/31
Clemmons NC 27012
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
Ray McCoy,6911 Mendelssohn Dr Clemmons NC 27012//336-766-2012/
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
Permit Flow Measurement II Operations&Maintenance Records/Reports
II Self-Monitoring Program Facility Site Review Effluent/Receiving Waters Laboratory
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/
/1)/ ///
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
et1.V-- �. lr /0////r,
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550280 111 121 18/09/18 117 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 for additional information.
Page# 2

Permit: NCG550280 Owner-Facility: 6911 Mendelssohn Drive
Inspection Date: 09/18/2018 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 00 . 0
application?
Is the facility as described in the permit? • ❑ 0 0
#Are there any special conditions for the permit? ❑ • ❑ ❑
Is access to the plant site restricted to the general public? I1000
Is the inspector granted access to all areas for inspection? • ❑ ❑ ❑
Comment: None
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ❑ • ❑ ❑
Is all required information readily available, complete and current? ❑ ❑ ❑
Are all records maintained for 3 years(lab. reg. required 5 years)? 0 • ❑ ❑
Are analytical results consistent with data reported on DMRs? ❑ ❑ • ❑
Is the chain-of-custody complete? ❑ ❑ ❑ •
Dates,times and location of sampling ❑
Name of individual performing the sampling ❑
Results of analysis and calibration ❑
Dates of analysis ❑
Name of person performing analyses ❑
Transported COCs ❑
Are DMRs complete: do they include all permit parameters? ❑ ❑ • ❑
Has the facility submitted its annual compliance report to users and DWQ? ❑ ❑ • ❑
(If the facility is=or>5 MGD permitted flow) Do they operate 24/7 with a certified operator ❑ ❑ • 0
on each shift?
Is the ORC visitation log available and current? ❑ ❑ • ❑
Is the ORC certified at grade equal to or higher than the facility classification? ❑ ❑ • ❑
Is the backup operator certified at one grade less or greater than the facility classification? ❑ ❑ • ❑
Is a copy of the current NPDES permit available on site? 01. ❑ ❑
Facility has copy of previous year's Annual Report on file for review? ❑ ❑ U ❑
Comment: None
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ❑ ❑ 0 •
Are all other parameters(excluding field parameters)performed by a certified lab? 000IM
Page# 3

Permit: NCG550280 Owner-Facility: 6911 Mendelssohn Drive
Inspection Date: 09/18/2018 Inspection Type: Compliance Evaluation
Laboratory Yes No NA NE
#Is the facility using a contract lab? ❑ ❑ ❑ II
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees ❑ ❑ ❑ II
Celsius)?
Incubator(Fecal Coliform)set to 44.5 degrees Celsius+/-0.2 degrees? ❑ ❑ 0
Incubator(BOD)set to 20.0 degrees Celsius +/-1.0 degrees? ❑ ❑ ❑ •
Comment: Samples have never been taken yet.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ ❑
Is sample collected below all treatment units? ❑ ❑ 0 •
Is proper volume collected? ❑ ❑ ❑ •
Is the tubing clean? ❑ ❑ • ❑
#Is proper temperature set for sample storage(kept at less than or equal to 6.0 degrees ❑ ❑ ❑ •
Celsius)?
Is the facility sampling performed as required by the permit(frequency, sampling type ❑ ❑ ❑ II
representative)?
Comment: Only grab samples are required. No samples taken as of yet.
Septic Tank Yes No NA NE
(If pumps are used)Is an audible and visual alarm operational? ❑ • ❑ ❑
Is septic tank pumped on a schedule? • ❑ 0 ❑
Are pumps or syphons operating properly? ❑ ❑ IN ❑
Are high and low water alarms operating properly? ❑ ❑ 10 ❑
Comment: None
Sand Filters (Low rate) Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational? CIE ❑ ❑
Is the distribution box level and watertight? ❑ ❑ ❑ II
Is sand filter free of ponding? • ❑ ❑ ❑
Is the sand filter effluent re-circulated at a valid ratio? ❑ • ❑ ❑
#Is the sand filter surface free of algae or excessive vegetation? 00110
#Is the sand filter effluent re-circulated at a valid ratio?(Approximately 3 to 1) ❑ • ❑ ❑
Comment: Single pass subsurface filter. No problems detected.
Page# 4

Permit: NCG550280 Owner-Facility: 6911 Mendelssohn Drive
Inspection Date: 09/18/2018 Inspection Type: Compliance Evaluation
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? ❑ ❑ ❑
Are the tablets the proper size and type? ❑ • ❑ ❑
Number of tubes in use? 2
Is the level of chlorine residual acceptable? ❑ ❑ ❑ III
Is the contact chamber free of growth, or sludge buildup? 0 ❑ • 0
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑ II
Comment: Using swimming pool tablets. Must use wastewater grade tablets. Provided sources of
supply.Advised Mr. McCoy to only place 3 to 5 tablets in each tube at a time to minimize
clogging in the pipes.
Flow Measurement-Effluent Yes No NA NE
#Is flow meter used for reporting? 0 ❑ • ❑
Is flow meter calibrated annually? ❑ ❑ • ❑
Is the flow meter operational? ❑ ❑ • ❑
(If units are separated) Does the chart recorder match the flow meter? ❑ ❑ • ❑
Comment: Flow should be estimated. This has not been accomplished.
Effluent Pipe
Yes No NA NE
Is right of wayto the outfall properly maintained? • ❑ ❑ ❑
9
Are the receiving water free of foam other than trace amounts and other debris? • ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? 0 ❑ • ❑
Comment: None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ U ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Page# 5

•
cc: Tech. Services (Marcia Toler-McCullen)
Permits and Engineering
County Health Dept.
Central Files
WSRO
Date September 13 , 1989
NPDES STAFF REPORT AND RECOMMENDATIONS
County Forsyth
NPDES Permit No. N€ ^` "'' O. _
QCGSSo 80 Rr 1 k
PART I - GENERAL INFORMATION
SEP 1 41969,
1. Facility and Address: HPi���L SUPPORT BRANCH
Mr. Paul H. Latham (Lot #14 Tax Block 420
(formerly Mr. Tommy Anthony, SFR)
6911 Mendelssohn Drive '
Clemmons, NC 27012
2. Date of Investigation: September 12, 1989
3. Report Prepared by: Mike Mickey, Environmental
Technician V
4. Persons Contacted and Telephone Number:
Mr. Bob Westerberg, Builder, ph 724-3254 ( 1606) and
924-6665 (Home)
5. Directions to Site:
Take Middlebrook Drive off of Hwy 158 in Clemmons.
Proceed 0. 3 mile and then turn right onto Greenbrook
Drive, left onto Breckinridge Lane and then right onto
Mendelssohn. The Latham SFR is the first on the right.
6. Discharge Point - Latitude: 80° 23 ' 14"
Longitude: L336° 00 ' 53"
Attach a USGS Map Extract and indicated treatment plant
site and discharge point on map.
USGS Quad No. C17SW or USGS Quad Name Clemmons, NC
7. Size ( land available for expansion and upgrading) :
There is adequate land available for expansion.
8. Topography (relationship to flood plain included) :
The system is to be located in a low area adjacent to
the creek. The flat terrain makes installation of dual
filters unfeasible
9. Location of nearest dwelling:
The residence is in a subdivision with other dwellings
located nearby