NCG550543_Compliance Evaluation Inspection_20180108 (2)

Water Resources
Environmental Quality
Donald Lynn and Sandra H Pridgen
1145 Pine Knolls Road
Kernersville, NC 27284
January 8, 2018
Subject: Compliance Evaluation Inspection
Certificate of Coverage: NCG550543
1145 Pine Knolls Road, Kernersville
Forsyth County
Dear Mr. and Mrs. Pridgen:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
JAN 2 2 2017
WaV,i
Permitting
On January 3, 2018, Jenny Graznak of this office conducted a compliance evaluation inspection
on the wastewater discharge system located at the above address. The State requires the Division
of Water Resources to inspect these types of systems every five years. According to county
records, you are the current owners of this property, but no one was home during the inspection.
Ms. Graznak was unable to reach you via telephone because our office does not have a current
phone number on file for you. The home at this address is for sale and appeared vacant.
According to our files, the system includes a 900 -gallon septic tank, a 391 square feet sub -surface
sand filter system, chlorination unit, and discharge pipe. Ms. Graznak located a discharge pipe
during her inspection, but it was dry. Please be aware that the Permit requires that the
chlorinator be adequately supplied with chlorine tablets for proper operation. The Permit also
requires that the septic tank contents be pumped out every 5 years to prevent solids from
clogging the sand filter system.
A copy of all the Permit requirements, including monitoring requirements, is attached to this
letter. Please contact Ms. Graznak at [phone] to discuss your wastewater system and the
accompanying permit and to make sure we have an accurate phone number on file.
CC: WSRO Files
NPDES Unit
Sincerely,
Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
State of North Carolina I Environmental Quality
450 W. Hanes Mill Road, Suite 300, Winston-Salem, North Carolina 27105
Phone: [phone] FAX [phone]

United States Environmental Protection Agency
Form Approved
EPA Washington, D C 20460
OMB No 2040-0057
Water Compliance Inspection Report
Approval expires B-31-98
Section A National Data System Coding (i e, PCS)
Transaction Code NPDES yr/mo/day Inspection Type
Inspector Fac Type
1 IN ) 2 15 1 3 I NCG550543 I11 12 18/01/03 17
-1
18 1,.1
=1
191 G j 20� I
211
I I I 1 I I I I 11 1 I I I I I I I I I I I I I I I
I I I l
l 11 l l 1_11 r6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved
67 70 LJ 71 I — 72 LNJ
73 75 80
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)
01 OOPM 18/01/03
13/08/01
1145 Pine Knolls Road
1145 Pine Knolls Rd
Exit Time/Date
Permit Expiration Date
Kemersville NC 27284
01 30PM 18/01/03
18/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Ill
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Donald L Pridgen,1145 Pine Knolls Rd Kernersville NC 27284//336-993-5732/
No
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
Jennifer F Graznak- WSRO WQ//336-771-5000/
ijv
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
00
,.� Y
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page#

NPDES yr/mo/day Inspection Type (Cont.) 1
31 NCG550543 I11 12 18/01/03 17 18 L2]
Section D Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On January 3, 2018, Jenny Graznak of this office conducted a compliance evaluation inspection on the
wastewater discharge system located at the above address. The State requires the Division of Water
Resources to inspect these types of systems every five years. According to county records, you are
the current owners of this property, but no one was home during the inspection. Ms. Graznak was
unable to reach you via telephone because our office does not have a current phone number on file for
you The home at this address is for sale and appeared vacant.
According to our files, the system includes a 900 -gallon septic tank, a 391 square feet sub -surface
sand filter system, chlorination unit, and discharge pipe Ms. Graznak located a discharge pipe during
her inspection, but it was dry. Please be aware that the Permit requires that the chlorinator be
adequately supplied with chlorine tablets for proper operation. The Permit also requires that the septic
tank contents be pumped out every 5 years to prevent solids from clogging the sand filter system.
Page#

Permit: NCG550543 Owner - Facility. 1145 Pine Knolls Road
Inspection Date 01/03/2018 Inspection Type- Compliance Evaluation
Permit
(If the present permit expires In 6 months or less) Has the permittee submitted a new
application?
Is the facility as described In the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the Inspector granted access to all areas for inspection?
Comment
Yes No NA NE
❑ ❑ N ❑
■ ❑ ❑ ❑
❑ ❑ ■ ❑
❑ ❑ ■ ❑
N ❑ ❑ ❑
Page# 3