NC0044750_Compliance Evaluation Inspection Report_20170724

I stet' Re'S431t t ces
OKVIR*XK�KTAL QUAUTY
July 24, 2017
Tonya Hemric
Granite Falls Ltc LLC
1721 Bald Hill Loop
Madison, NC 27025
Subject: Compliance Evaluation Inspection Report
NPDES Permit NCO044750
Jacob's Creek Nursing & Rehabilitation Center, Rockingham County
Dear Ms. Hemric:
ROY COOPER
aamnar
MICHAEL: S. RECON
Smadey
S. JAY ZIMMERMAN
lJlmdar
On July 11, 2017, Paul DiMatteo of the Division of Water Resources ("Division"), Winston-Salem Regional Office
conducted a Compliance Evaluation Inspection of the above referenced wastewater treatment system. Clifford Cain,
Operator in Responsible Charge (ORC), was present for the inspection. An inspection summary follows and an inspection
report is attached for your records.
Site Review
1. Permit
The current permit became effective on August 1, 2012 and expired on May 31, 2017. A new permit has
been drafted; the facility is permitted to operate under the expired permit until a decision is made on the
new application. Permitted components include aeration basins, clarifiers, sand filter, and UV disinfection.
2. Facility Site Review
The facility is permitted to include a comminutor; however, this was recently replaced with a screening box.
This discrepancy will be addressed during the permit renewal. Otherwise, the facility was as described in the
permit. Wastewater flows from the equalization basin to one of two separate aerator and clarifier systems.
Water then combines and flows to a single sand filter, is disinfected, and is contained in an aerated holding
tank until it is pumped to the outfall.
3. Operation and Maintenance
The sand filter did not appear to be functioning properly. Significant amounts of water were observed to be
flowing over the overflow weir and not passing through the filter media. Please ensure that all system
components are properly maintained at all times to ensure compliance with effluent limitations.
All other components appeared to be well maintained and functioning properly. Replacement bulbs for the
UV system are maintained on site and the ORC has access to chlorination tablets in case of UV failure. The
ORC or his designated backup visit the facility as required.
4. Flow Measurement
The permit requires continuous flow measurement at the influent or effluent. The flow meter was last
calibrated on July 5, 2017 by M. Chrysler.
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road. Suite 300. Winston-Salem. NC 27105

Effluent/Receiving Waters
The effluent is discharged into Hogan's Creek near the intersection of Bailey Road and NC -704. A path to the
outfall is maintained and the outfall was accessible during the inspection. Effluent appeared clear with no
visible impact to the receiving stream.
Documentation Review
6. Records/Reports
Discharge Monitoring Reports (DMRs) and lab data are maintained according to the permit. DMRs include all
permit parameters. Copies of DMRs, operator visitation logs, lab reports and Chain -of -Custody forms were
available for review during the inspection.
7. Self -Monitoring Program
A review of DMRs from July, 2015 through May, 2017 showed violations which are summarized below.
These violations have been addressed through previous correspondence from this office.
VIOLATIONDATE PARAMETER VIOLATION ACTION
07/08/2015 Coliform, Fecal MF, MFC Broth, 44.5 C Proceed to NOV
07/15/2015 Coliform, Fecal MF, MFC Broth, 44.5 C Proceed to NOV
11/05/2016 Temperature, Water Deg. Centigrade Proceed to NOD
A comparison of submitted DMR data and field records showed no errors or concerns.
8. Laboratory
All required parameters are measured by R&A Labs under certification # 34. All samples are taken from the
aerobic digester. Chain -of -custody forms were complete and available for all parameters measured off site.
Records for parameters measured on-site were complete.
9. Sludge Handling Disposal
Sludge is removed from the plant as needed. Sludge was last removed on June 28, 2017 by Billingley Septic
Tank Company.
We appreciate your efforts in effectively operating and maintaining this treatment system. No additional
response to this report is required. If you should have any questions, please do not hesitate to contact Paul DiMatteo at
[phone] or our office at [phone].
Sincerely,
{
12 Sherri V. Knight, P.E., R Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
Enclosures — Inspection Report and Summary
CC: WQS Winston-Salem Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
Central Files
State of North Carolina I Environmental Quality I Water Resources
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105

United States Environmental Protection Agency
Form Approved
EPA Washington, D C 20460
OMB No 2040-0057
Water Compliance Inspection Report
Approval expires 6-31-96
Section A National Data System Coding (i e, PCS)
Transaction Code NPDES yr/mo/day inspection Type Inspector Fac Type
1 IN 1 2 IS 1 3 I NC0044750 I11 12 17/07/11 17 18 [,j 19 1 !j 20I I
2111111111111111111111111111111111111111111l J6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----Reserved--
— --Reserved67
67170 L_j 71 I I 72 1 N 1 73 I I 174 75III 80
LJ I I I
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)
10 OOAM 17/07/11
12/06/01
Jacob's Creek Nursing t£ Rehabilitation Center
Exit Time/Date
Permit Expiration Date
1721 Bald Hill Rd
11 15A 17/07/11
17/05/31
Madison NC 27025
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
Toyna Hemnc,1721 Bald Hill Loop Madison NC 27025M
No
Section C Areas Evaluated During Inspection (Check only those areas evaluated)
Permit N Flow Measurement operations & Maintenance Records/Reports
Self -Monitoring Program 0 Sludge Handling Disposal 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
Paul DiMatteo - WSROWQ//336-776-96911 -71zL�/�
nagement Q A Rfeviewer Agency/Office/Phone and Fax Numbers Date
Y 9��.1n 4,Lr 2 g 1
rf
1
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page#

NPDES yr/mo/day Inspection Type 1
(Cont.)
31 Nc00447! I11 12 17/07/11 17 18 1x.1
Section D Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Site Review
1. Permit
The current permit became effective on August 1, 2012 and expired on May 31, 2017. A new permit
has been drafted; the facility is permitted to operate under the expired permit until a decision is made
on the new application. Permitted components include aeration basins, clarifiers, sand filter, and UV
disinfection.
2. Facility Site Review
The facility is permitted to Include a comminutor; however, this was recently replaced with a screening
box. This discrepancy will be addressed during the permit renewal Otherwise, the facility was as
described in the permit. Wastewater flows from the equalization basin to one of two separate aerator
and clarifier systems Water then combines and flows to a single sand filter, is disinfected, and is
contained in an aerobic digester until it is pumped to the outfall.
3. Operation and Maintenance
The sand filter did not appear to be functioning properly. Significant amounts of water were observed to
be flowing over the overflow weir and not passing through the filter media. Please ensure that all
system components are properly maintained at all times to ensure compliance with effluent limitations.
All other components appeared to be well maintained and functioning properly. Replacement bulbs for
the UV system are maintained on site and the ORC has access to chlorination tablets in case of UV
failure. The ORC or his designated backup visit the facility as required.
4. Flow Measurement
The permit requires continuous flow measurement at the influent or effluent. The flow meter was last
calibrated on July 5, 2017 by M. Chrysler.
5. Effluent/Receiving Waters
The effluent is discharged into Hogan's Creek near the intersection of Bailey Road and NC -704. A path
to the outfall is maintained and the outfall was accessible during the inspection. Effluent appeared clear
with no visible impact to the receiving stream.
Documentation Review
6. Records/Reports
Discharge Monitoring Reports (DMRs) and lab data are maintained according to the permit. DMRs
include all permit parameters. Copies of DMRs, operator visitation logs, lab reports and
Chain -of -Custody forms were available for review during the inspection.
7. Self -Monitoring Program
A review of DMRs from July, 2015 through May, 2017 showed violations which are summarized below.
These violations have been addressed through previous correspondence from this office.
VIOLATIONDATE PARAMETER ' VIOLATION ACTION
07/08/2015 Coliform, Fecal MF, MFC Broth, 44.5 C Proceed to NOV
07/15/2015 Coliform, Fecal MF. MFC Broth, 44.5 C Proceed to NOV
11/05/2016 Temperature, Water Deg. Centigrade Proceed to NOD
A comparison of submitted DMR data and field records showed no errors or concerns.
8. Laboratory
Page#
4

Permit: NCO044750
Inspection Date 07/11/2017
Owner - Facility, Jacob's Creek Nursing & Rehabilitation Center
Inspection Type, Compliance Evaluation
All required parameters are measured by R&A Labs under certification # 34. All samples are taken
from the aerobic digester. Chain -of -custody forms were complete and available for all parameters
measured off site Records for parameters measured on-site were complete.
9. Sludge Handling Disposal
Sludge is removed from the plant as needed. Sludge was last removed on June 28, 2017 by Billingley
Septic Tank Company.
Page#

Permit: NC00-4750 Owner - Facility. Jacob's Creek Nursing & Rehabilitation Center
Inspection Date 07/117,2017 Inspection Type: Compliance Evaluation
Operations & MAntenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility amlyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑
Solids, pH, DO, S:.idge Judge, and other that are applicable?
Comment: Settlable Solids
Permit
Yes No NA NE
(If the presentpermit expires in 6 months or less) Has the permittee submitted a new
0
❑
❑
❑
application?
0
❑
❑
❑
Is the facility -as described in the permit?
❑
❑
❑
❑
# Are thereany special conditions for the permit?
❑
❑
❑
❑
Is access b the plant site restricted to the general public?
M
❑
❑
❑
Is the insaector granted access to all areas for inspection?
0
❑
❑
❑
Comment. Permitted facilities Include a comminutor, however, the comminutor was recently replaced
with a sort of screening box. This will be addressed during the permit renewal process.
Reccrd Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
M
❑
❑
❑
Is ai� required information readily available, complete and current?
0
❑
❑
❑
Are all records maintained for 3 years (lab reg required 5 years)?
❑
❑
❑
❑
AL-_ analytical results consistent with data reported on DMRs?
❑
❑
❑
❑
Is the chain -of -custody complete?
0
❑
❑
❑
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?
❑
❑
0
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
M
❑
on each shift?
Is the ORC visitation log available and current?
0
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
M
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
0
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Page#
4

Permit: NCO044750 Owner - Facility: Jacob's Creek Nursing & Rehabilitation Center
Inspection Date: 07/11/2017 Inspection Type Compliance Evaluation
Record Keeping Yes No NA NE
Facility has copy of previous year's Annual Report on file for review? ❑ ❑ 0 ❑
Comment:
Effluent Pipe
Yes No NA NE
Is right of way to the outfall properly maintained?
0 ❑
❑
❑
Are the receiving water free of foam other than trace amounts and other debris?
0 ❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑ ❑
0
❑
Comment Per the ORC, before the last inspection he did not have a clear idea of where the outfall
❑
❑
was, because the previous ORC did not provide that information before leaving
and it is not
❑
❑
in the location indicated on the permit Since then, the ORC has located the outfall, and the
Are all pumps operable?
0
path to this pipe was accessible.
❑
❑
Are float controls operable?
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
0
❑
❑
❑
Is flow meter calibrated annually?
0
❑
❑
❑
Is the flow meter operational?
M
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
❑
0
Comment- Last calibrated on July 5, 2017 by M. Chrysler.
Equalization Basins
Yes No NA NE
Is the basin aerated?
0
❑
❑
❑
Is the basin free of bypass lines or structures to the natural environment?
M
❑
❑
❑
Is the basin free of excessive grease?
0
❑
❑
❑
Are all pumps present?
M
❑
❑
❑
Are all pumps operable?
0
❑
❑
❑
Are float controls operable?
0
❑
❑
❑
Are audible and visual alarms operable?
❑
❑
M
❑
# Is basin size/volume adequate?
M
❑
❑
❑
Comment: Alarms are not installed. The basin bypasses into the treatment plant.
Secondary Clarifier
Yes No NA NE
Is the clarifier free of black and odorous wastewater?
M
❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
M
❑
Are weirs level?
0
❑
❑
❑
Page# 5

"i
Permit: NCO044750
Owner - Facility
Jacob's Creek Nursing & Rehabilitation Center
Inspection Date: 07/11/2017
Inspection Type.
Compliance Evaluation
❑
Is the mixing adequate?
0
Secondary Clarifier
❑
Yes No NA NE
Is the site free of weir blockage?
0
❑
❑
❑
Is the site free of evidence of short-circuiting?
❑
M
❑
❑
❑
Is scum removal adequate?
❑
M
❑
❑
❑
Is the site free of excessive floating sludge?
0
❑
❑
❑
Is the drive unit operational?
❑
❑
M
❑
Is the return rate acceptable (low turbulence)?
0
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
0
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately
'/e of the sidewall depth)
❑
❑
❑
M
Comment: Some algae growth on weirs.
Filtration (High Rate Tertiary)
Type of operation -
Is the filter media present?
Is the filter surface free of clogging?
Is the filter free of growth?
Is the air scour operational?
Is the scouring acceptable?
Is the clear well free of excessive solids and filter media?
Yes No NA NE
Down flow
❑ ❑ ❑ M
❑ ■ ❑ ❑
❑ ❑ ❑ M
❑ ❑ ■ ❑
❑ ❑ M ❑
* ❑ ❑ ❑
Comment: Significant amount of water observed to be flowing over the weir. Filter media was not
visible. Per ORC he has not performed any maintenance on this component.
Aerobic Digester
Yes No NA NE
Is the capacity adequate?
0
❑
❑
❑
Is the mixing adequate?
0
❑
❑
❑
Is the site free of excessive foaming in the tank?
❑
❑
❑
# Is the odor acceptable?
❑
❑
❑
# Is tankage available for properly waste sludge?
0
❑
❑
❑
Comment
Disinfection - UV
Yes No NA NE
Are extra UV bulbs available on s.te?
M
❑
❑
❑
Are UV bulbs clean?
0
❑
❑
❑
Is UV intensity adequate?
❑
❑
❑
Is transmittance at or above designed level?
❑
❑
❑
Page# 6

I
Permit- NCO044750 Owner - Facility: Jacob's Creek Nursing & Rehabilitation Center
Inspection Date: 07/11/2017 Inspection Type: Compliance Evaluation
Disinfection - UV
Is there a backup system on site?
Is effluent clear and free of solids?
Yes No NA NE
■ ❑ ❑ ❑
■ ❑ ❑ ❑
Comment UV disinfection system consists of 2 "sets" in series. Pool use chlorine _granules are
maintained on site. Per CIRC, wastewater chlorine tablets are accessible in case of UV
system failure. In case of such failure, a proper backup disinfection system should be
employed (i.e. wastewater -grade chlorine rather than pool -grade).
Effluent Sampling
Yes No NA NE
Is composite sampling flow proportional?
❑
❑
0
❑
Is sample collected below all treatment units?
0
❑
❑
❑
Is proper volume collected?
0
❑
❑
❑
Is the tubing clean?
❑
❑
0
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
❑
M
Celsius)?
❑
❑
❑
0
Is the facility sampling performed as required by the permit (frequency, sampling type
❑
❑
❑
0
representative)?
Comment- Only grab samples.
Pump Station - Effluent
Yes No NA NE
Is the pump wet well free of bypass lines or structures?
M
❑
❑
❑
Are all pumps present?
M
❑
❑
❑
Are all pumps operable?
0
❑
❑
❑
Are float controls operable?
M
❑
❑
❑
Is SCADA telemetry available and operational?
❑
❑
M
❑
Is audible and visual alarm available and operational?
❑
❑
❑
0
Comment,
Septic Tank
Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational?
❑
❑
0
❑
Is septic tank pumped on a schedule?
0
❑
❑
❑
Are pumps or syphons operating properly?
0
❑
❑
❑
Are high and low water alarms operating properly?
❑
❑
M
❑
Comment- Aerated holding tank - stores treated effluent until it is pumped to the outfall.
Page# 7