NCG550525_Compliance Evaluation Inspection_20180921

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ROY COOPER NORTH CAROLINA
GovernorEnvironmental Quality
MICHAEL S.REGAN
Secretary
LINDA CULPEPPER •
RECEIVEDJDENI DWR
Interim Director September 21, 2018
OCT OB6�
2010
Liza Taylor - Water
1485 Double Creek Drive Permitting
Resources
Section
Section
Winston-Salem, NC 27023 •
SUBJECT: Compliance Evaluation Inspection
NC General Wastewater Permit NCG550000
Certificate of Coverage: NCG550525
Facility: 1485 Double Creek Drive, Winston-Salem, NC 27023
Owner: Liza Taylor
County: Forsyth
Dear Mrs. Taylor:
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 1485 Double Creek Drive in Winston-Salem, to conduct a compliance
evaluation inspection (CEI) of the home's wastewater treatment system, which
discharges the final treated effluent to Double Creek, which is located just north of your
home and is currently classified as class C waters. Double Creek is located in the Yadkin-
Pee Dee River Basin.
As such, your home's wastewater treatment system is regulated by DWR under NC
General Wastewater Discharge Permit NCG550000, with certificate of coverage (COC)
NCG550525. 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 Double Creek.
You initially contacted Mr. Boone via email on September 4th, 2018, informing him that
your family had just moved into the home and had the septic tank pumped. You were
referred to us by county health department personnel. The COC is currently under the
name of the previous owner (John R. Rotruff). This requires a name change on the COC.
As such, Mr. Boone began filling out a name change form for you. Please follow the
instructions on the form to send it to our home office in Raleigh to have the name changed.
Please note that the Division, in addition'to the name change form, requires a copy of the
deed showing you as the current owner of the property. Failure to provide this
documentation will result in the form being returned with no action taken. If, after
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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

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submitting the name change form, you don't hear back from our home office within 60
days, please contact Mr. Boone so he can investigate the status of the name change
request.
During the 9/19/2018 inspection, Mr. Boone determined that you know the location of the
septic tank, the chlorinator tube, and the discharge pipe, and verified that you just had the
tank pumped. Please review the NCG550000 permit, which Mr. Boone has provided to
you, in detail, to become thoroughly familiar with all operation and maintenance, testing,
and documentation requirements. It is suggested that you create a file folder in which you
can store all documentation related to the system in one place.
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 owner/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 into the system, guarantee the health and safety of your family,
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 [e-mail], or me at 336-776-9800 or
sherri.knightCa)_ncdenr.gov. Thank you for your time and attention to this matter.
Sincerely,
/44.6;4,,,:r 4-Z5<d
Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
cc: DWR_NP_DES-Unit
DWR Central Files
DWR/WSRO Files
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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

•
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 Li 2 [ I 3 I NCG550525 111 12 I 18/09/19 117 18 i,i 19 Is ' 2011
21I I I 1 I I I I I I II I I I I I I I I I I I I 1 1 1 11 1 I I I I I II A l i i 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
67 I I 70 Li 711 I 72 I N I 73 I I I74 75J II 111 I j80
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)
09 20AM 18/09/19 13/08/01
1485 Double Creek Drive
1485 Double Creek Dr Exit Time/Date Permit Expiration Date
Lewisville NC 27023 09 45AM 18/09/19 18/07/31
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
John R Rotroff,1485 Double Creek Dr Lewisville NC 270231/336-945-9632/
No
Section C.Areas Evaluated During Inspection(Check only those areas evaluated)
• Permit IN Flow Measurement is Operations&Maintenance • Records/Reports
NI Self-Monitoring Program I Facility Site Review El Effluent/Receiving Waters II Laboratory
Section D-Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
(See attachment summary) ,
Name(s)and Signature(s •f Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//336-776-9690/
il-)._...17/q
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
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EPA Form 3560-3(Rev 9-94)Previous editions are obsolete
Page# 1

NPDES yr/mo/day Inspection Type 1
31 NCG550525 11 121 1a/o9/19 117 18 Li
Section D.Summary of FindingiComments(Attach additional sheets of narrative and checklists as necessary)
For additional information, please refer to the accompanying inspection summary letter.
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Page# 2

Permit:.NCG550525 Owner-Facility 1485 Double Creek Drive
Inspection Date: 09/19/2018 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? • ❑ ❑ 0
#Are there any special conditions for the permit? 0 I 0 ❑
Is access to the plant site restricted to the general public? • 0 ❑ ❑
Is the inspector granted access to all areas for inspection? • ❑ ❑ ❑
Comment Name/Ownership Change Form needs to be submitted. New owner/permittee is now Liza
Taylor. Refer to inspection summary letter
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ❑ ❑ ❑ •
Are all other parameters(excluding field parameters)performed by a certified lab? ❑ ❑ ❑ U
#Is the facility using a contract lab'? ❑ ❑ ❑ •
#Is proper temperature set for sample storage(kept at less than or equal to 6 0 degrees 0 ❑ ❑ III
Celsius)?
Incubator(Fecal Coliform)set to 44 5 degrees Celsius+/-0 2 degrees? ❑ ❑ ❑ •
Incubator(BOD)set to 20 0 degrees Celsius+/-1 0 degrees? ❑ ❑ 0 •
Comment Mrs.Taylor is a brand new owner of the property and was not informed about the type of
wastewater system she had when she purchased the home No effluent sampling has be -
done as of yet.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ • ❑
Is sample collected below all treatment units? ❑ ❑ ❑ II
Is proper volume collected? ODOM
Is the tubing clean? ❑ ❑ IN ❑
#Is proper temperature set for sample storage(kept at less than or equal to 6 0 degrees ❑ ❑ 0 •
Celsius)?
Is the facility sampling performed as required by the permit(frequency, sampling type 0 ❑ ❑ II
representative)?
Comment. Mrs.Taylor is a brand new owner of the property and was not informed about the type of
wastewater system she had when she purchased the home No effluent sampling has be
done as of yet.
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit'? 0 ❑ ❑ •
Is all required information readily available, complete and current'? ❑ 0 ❑ IN
Page# 3

r
Permit: NCG550525 Owner-Facility: 1485 Double Creek Drive
Inspection Date: 09/19/2018 Inspection Type: Compliance Evaluation
Record Keeping Yes No NA NE
Are all records maintained for 3 years(lab. reg required 5 years)' ❑ ❑ ❑ •
Are analytical results consistent with data reported on DMRs? ❑ 0 II ❑
Is the chain-of-custody complete'? ❑ ❑ ❑ II
Dates, times and location of sampling ❑
Name of individual performing the sampling ❑
Results of analysis and calibration 0
Dates of analysis 0
Name of person performing analyses El
Transported COCs ❑
Are DMRs complete do they include all permit parameters'? 0 0 • ❑
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'? 0 ❑ II ❑
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'? • ❑ ❑ ❑
Facility has copy of previous year's Annual Report on file for review'? ❑ ❑ II ❑
Comment Mrs.Taylor is a brand new owner of the property and was not informed about the type of
wastewater system she had when she purchased the home No effluent sampling has be
done as of yet
Septic Tank Yes No NA NE
(If pumps are used) Is an audible and visJal alarm operational'? ❑ ❑ • ❑
Is septic tank pumped on a schedule'? • ❑ ❑ ❑
Are pumps or syphons operating properly'? 0 ❑ • ❑
Are high and low water alarms operating properly'? El ❑ II ❑
Comment Mrs Taylor is a brand new owner of the property and was not informed about the type of
wastewater system she had when she purchased the home No effluent sampling has be
done as of yet.
Sand Filters (Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational'? ❑ ❑ II ❑
Is the distribution box level and watertight'? ❑ ❑ ❑ MI
Is sand filter free of ponding'? ® ❑ ❑ ❑
Page# 4

N
Permit: NCG550525 Owner-Facility: 1485 Double Creek Drive
Inspection Date: 09/19/2018 Inspection Type: Compliance Evaluation
Sand Filters (Low rate) Yes No NA NE
Is the sand filter effluent re-circulated at a valid ratio? ❑ ❑ ❑ U
#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) 00 • 0
Comment: This is a non-recirculating system.
Flow Measurement- Effluent Yes No NA NE
#Is flow meter used for reporting? ❑ E ❑ ❑
Is flow meter calibrated annually? 00110
Is the flow meter operational? ❑ ❑ • ❑
(If units are separated) Does the chart recorder match the flow meter? 00 • O
Comment: None
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational? 11000
Are the tablets the proper size and type? 000 •
Number of tubes in use? 1
Is the level of chlorine residual acceptable? 000 •
Is the contact chamber free of growth, or sludge buildup? ❑ ❑ E ❑
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑ U
Comment. Mrs.Taylor is a brand new owner of the property and was not informed about the type of
wastewater system she had when she purchased the home No effluent sampling has be
done as of yet. She has not yet been able to acquire the proper chlorine tablets.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? U ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? • 000
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ E ❑
Comment* None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • 000
Does the facility analyze process control parameters, for ex MLSS, MCRT, Settleable ❑ ❑ E ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment None
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Permit: NCG550525 Owner-Facility: 1485 Double Creek Drive
Inspection Date: 09/19/2018 Inspection Type: Compliance Evaluation
Operations &Maintenance Yes No NA NE
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