NCG550079_Compliance Evaluation Inspection_20180205

Water Resources
Environmental Quality
Diane Townsend
1239 Pine Knolls Road
Kernersville, NC 27284
January 5, 2018
Subject: Compliance Evaluation Inspection
Certificate of Coverage: NCG550079
1239 Pine Knolls Road, Kernersville
Forsyth County
Dear Mrs. Townsend:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
RECEIVED/ 1CDE-01 Vv'
JAN 2 2 2017
perriljt,Ll11) soctSon
On January 3, 2018, Jenny Graznak of this office conducted a compliance evaluation inspection
on the wastewater discharge system located at the above address. According to county records,
you are the current owner of this property and were present during the inspection. The State
requires the Division of Water Resources to inspect these types of systems every five years. Our
office was saddened to hear about the loss of your husband, Mr. Richard Townsend in 2017.
The system consists of a 900 -gallon septic tank, primary and secondary filter fields, 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. You stated that the septic tank was last pumped out
in 2016. Please note that the permit requires you to have the tank pumped over every three to
five years. You also stated that your son-in-law has been adding chlorine tablets as needed to the
chlorinator unit. The unit appears to be in good condition.
A copy of all the Permit requirements, including monitoring requirements, is attached to this
letter. If you have any questions regarding this letter or the permit, please don't hesitate to
contact Ms. Graznak at [phone].
Sincerely,
Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
CC: WSRO Files
NPDES Unit
f` �Nothing Compares',- ,_
State of North Carolina I Environmental Qualdy
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[ EN j 2 15 1 3 I NCG550079 111 12 18/01/03 17
18 1131
19 I G I 20LJ
.
211
III1111I1111111111I IIIIII
IIIIIIII.._.1l 1616
IIIIII
Inspection Work Days Facility Self-Monitoring Evaluation Rating 61 QA
Reserved
I 72 1 n, �
_I
67 70 I I 71 IuL
LJ
73 �74 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)
10 OOAM 18/01/03
13/08/01
1239 Pine Knolls Road
Exit Time/Date
Permit Expiration Date
1239 Pine Knolls Rd _
10 30AM 18/01/03
18/07/31
Kernersville NC 27284
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
Richard Townsend,1239 Pine Knolls Rd Kernersville NC 27284//336-996-5362/
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
Jennifer F Graznak WSRO WQ//336-771-5000/
( 1Date
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page#

NPDES yr/mo/day Inspection Type (Cont )
31 NCG550079 I11 12 18/01/03 17 18 U
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. According to county records, you are the
current owner of this property and were present during the inspection. The State requires the Division
of Water Resources to inspect these types of systems every five years. Our office was saddened to
hear about the loss of your husband, Mr. Richard Townsend in 2017.
The system consists of a 900 -gallon septic tank, primary and secondary filter fields, 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 You stated that the septic tank was last pumped out In 2016.
Please note that the permit requires you to have the tank pumped over every three to five years. You
also stated that your son-in-law has been adding chlorine tablets as needed to the chlorinator unit. The
unit appears to be in good condition.
Updated phone # for Diane Townsend [phone]
She stated that they have never seen discharge from the pipe. Mrs. Townsend currently lives alone.
Page#

Permit* NCG550079 Owner - Facility 1239 Pine Knolls Road
Inspection Date. 01/03/2018 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
❑
❑
N
❑
application'?
Is the facility as described in the permit?
0
❑
❑
❑
# Are there any special conditions for the permit?
❑
❑
0
❑
Is access to the plant site restricted to the general public?
❑
❑
N
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment
Page# 3