NCG550097_Compliance Evaluation Inspection_20180205

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Water Resources
Environmental Quality
John T. Mastromonica
1149 Pine Knolls Road
Kernersville, NC 27284
January 5, 2018
Subject: Compliance Evaluation Inspection
Certificate of Coverage: NCG550097
1149 Pine Knolls Road, Kernersville
Forsyth County
Dear Mr. Mastromonica:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
R G4�� .D1 1N EdiDNNi�
JAN 2 9, M7
eager Quality
pe-im! Ung 5ecttor1
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, but no one was home during the inspection. Ms.
Graznak attempted to contact you at the phone number in our files: [phone], but she was
unable to reach you. The State requires the Division of Water Resources to inspect these types
of systems every five years.
According to our files, the system includes a septic tank, sub -surface sand filter system,
chlorination unit, and discharge pipe. Ms. Graznak was unable to locate a discharge pipe during
her inspection. 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.
Sincerely,
e �j %.ftp- �• ��
Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
CC: WSRO Files
NPDES Unit
- �Nothing Compares_"--__
State of North Carolina I Environmental Quality
450 W Hanes Mill Road, Suite 300, Winston-Salem, North Carolina 27105
Phone, 336-776-98001 FAX [phone]

United States Environmental Protection Agency
Form Approved
EPA 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 E 2 15 1 3 I NCG560097 I11 12 18/01/03 17
181,•1
191 c I 20L
211 1 1 1 1 1 111 111 1 11 11 1 11 111 1 1 1 11 1
11 111
111 I I I 1 1_16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved
67 70 Lj 71 Lj 72 1 N 1
LJ
73 LJJ I 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)
11 OOAM 18/01/03
13/08/01
1149 Pine Knolls Road
1149 Pine Knolls Rd
Exit Time/Date
Permit Expiration Date
Kernersville NC 27284
11 30AM 18/01/03
18/07/31
Name(s) of Onsite Representabve(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
John T Mastromonica,1149 Pine Knolls Rd Kernersville NC 27284//631-949-0373/
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 Iraznak WSRO WQ//336-771-5000/
L
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
l /
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
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NPDES yr/mo/day Inspection Type (Cont)
31 NCG550097 I11 12 18/01/03 17 18 ICI
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, but no one was home during the inspection. Ms. Graznak attempted to
contact you at the phone number in our files, [phone], but she was unable to reach you. The
State requires the Division of Water Resources to inspect these types of systems every five years.
According to our files, the system includes a septic tank, sub -surface sand filter system, chlorination
unit, and discharge pipe Ms. Graznak was unable to locate a discharge pipe during her inspection.
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#

L
Permit: NCG550097 Owner - Facility 1149 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
❑
❑
❑
application?
Is the facility as described in the permit?
❑
❑
❑
N
# Are there any special conditions for the permit?
❑
❑
0
❑
Is access to the plant site restricted to the general public?
❑
❑
S
❑
Is the inspector granted access to all areas for inspection?
❑
0
❑
❑
Comment, Ms Graznak was unable to locate a discharge pipe during her inspection.
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