NCG550749_Compliance Evaluation Inspection_20180924

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S.REGAN
Secretory
LINDA CULPEPPER
Interim Director September 24, 2018
RECEIVEDIDE��D�
Robin O. Jarvis OCT 0 2 201$
5600 Styers Ferry Road
Wter .
Clemmons, NC 27012 Pearm►tting Sect on
SUBJECT: Compliance Evaluation Inspection
NC General Wastewater Permit NCG550000
Certificate of Coverage: NCG550749
Facility: 5600 Styers Ferry Road, Clemmons, NC 27012
Owner: Robin O. Jarvis
County: Forsyth
Dear Ms. Jarvis:
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 5600 Styers Ferry Road in Clemmons, NC, to conduct a compliance evaluation
inspection (CEI) of the home's wastewater treatment system, which discharges the final
treated effluent to Blanket Creek, which is located just east of your home and is currently
classified as class water supply (WS) IV waters. Blanket 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)
NCG550749. 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 Blanket Creek.
During the 9/19/2018 inspection, Mr. Boone determined that you know the location of the
septic tank. The chlorinator and discharge pipe could not be located. According to you,
Mr. Jarvis used to care for the system and he passed away approximately 5 years ago,
at which point you knew very little about the system. You stated that you have had the
septic tank pumped. Please note that the permit also requires that you test the effluent
from the system once per year. This also has not been done. ,
Please ensure you keep records of the tank pumping along with all other documentation
related to the system, including inspection reports, such as this, and billing and permitting
' filli"-----E
n aarauntalEnvYmmentalauu sy/df
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

F
documentation that you receive from our Central Office in Raleigh. It is suggested that
you create a file folder in which you can store all documentation related to the system in
one place.
Our database shows that you are up-to-date on the annual bill, however, Richard is still ,
listed as the owner of the home. Please fill out the attached Name/Ownership Change
Form, which Mr. Boone has already mostly filled out for you (add your email address and
sign the form), and remit it to our Central Office, following all instructions listed in the form.
Doing so will change the owner's name in our database to you for proper accountability
and record keeping. Please note you'll need to submit a copy of the current property deed,
showing you as the homeowner, along with the form to show proof of ownership. If you
. fail to do so the form will likely be returned to you unactioned.
Please review the NCG550000 permit, which is also attached, in detail, to become
thoroughly familiar with all operation and maintenance, testing, and documentation
requirements.
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 homeowner/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 in 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.knight(c ncdenr.gov. Thank you for your time and attention to this matter.
Sincerely,
„J_e,,,,,--v. 14„-eit,fi
Sherri V. Knight, P.E.
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. Name/Ownership Change Form
2. NC General Wastewater Discharge Permit NCG550000 for Single Family Residences
cc: L D.WR NPDES tirlitT3
DWR Central Files
DWR/WSRO Files
NORTH CAROLINA !'
Deaanmemal BMm, 'th lb\ /—
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(t e,PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 E 2 IS I 3 I NCG550749 111 121 18/09/19 117 18 Lill 191 2 I 201 1
21111111I111IIIIIIIIII 1111IIIIIII ill III 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved l
671 I 70 1 I 71 1 I 72 I I 731 I 174 75i I 1 1 1 1 1 180
Section B Facility Data LJ
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 15AM 18/09/19 13/06/01
5600 Styers Ferry Road
Exit Time/Date Permit Expiration Date
5600 Styers Ferry Rd
10 45AM 18/09/19 18/07/31
Clemmons NC 27012
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
/11
Name,Address of Responsible Official/Title/Phone and Fax Number •
Contacted
Richard Tennyson Jarvis,5600 Styers Ferry Rd Clemmons NC 27012/1/
No
Section C Areas Evaluated During Inspection(Check only those areas evaluated)
Permit • Flow Measurement El Operations&Maintenance • Records/Reports
III Self-Monitoring Program II Facility Site Review 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)of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone 1 i WSRO WQ//336-776-9690/
2/2 SYi gs
Signature of Management Q A Reviewerl�- Agency/Office/Phone and Fax Numbers Date
,:r.. � /`� g ILLe' lU
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete
Page# 1

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NPDES yr/mo/day Inspection Type 1
3 NCG550749 I11 121 18/09/19 117 18 IA
I Section D Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter for further information.
s
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Permit: NCG550749 Owner-Facility: 5600 Styers Ferry Road
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? ❑ • ❑ ❑
Is access to the plant site restricted to the general public? • ❑ 0 0
Is the inspector granted access to all areas for inspection? • ❑ ❑ ❑
Comment: None
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? ❑ II ❑ ❑
Are all records maintained for 3 years(lab. reg required 5 years)? ❑ I ❑ ❑
Are analytical results consistent with data reported on DMRs? 0 0 • ❑
Is the chain-of-custody complete? ❑ ❑ II ❑
Dates,times and location of sampling ❑
Name of individual performing the sampling ❑
Results of analysis and calibration ❑
Dates of analysis 0
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? ❑ ❑ I ❑
(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 0 • ❑
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? ❑ ❑ MI ❑
Is a copy of the current NPDES permit available on site? ❑ U ❑ 0
Facility has copy of previous year's Annual Report on file for review? 0 ❑ U El
Comment It is suggested that you keep a file readily available that contains all pertinent information
related to the system such as billing invoices, certificates of coverage, NCG550000, tank
pumping records, maintenance/repair records, testing records, etc.
Laboratory Yes No NA NE
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Permit. NCG550749 Owner-Facility: 5600 Styers Ferry Road
Inspection Date. 09/19/2018 Inspection Type: Compliance Evaluation
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory'? 0500
Are all other parameters(excluding field parameters)performed by a certified lab'? 0500
#Is the facility using a contract lab'? ❑ • ❑ ❑
#Is proper temperature set for sample storage(kept at less than or equal to 6 0 degrees ❑ ❑ ❑ S
Celsius)'
Incubator(Fecal Coliform)set to 44 5 degrees Celsius+/-0 2 degrees'? ❑ ❑ ❑ M
Incubator(BOD)set to 20.0 degrees Celsius+/-1 0 degrees'? 0005
Comment: Effluent has never been tested as required.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional'? 00 • O
Is sample collected below all treatment units'? 0 • 00
Is proper volume collected'? 0 • 00
Is the tubing clean' 00 • 0
#Is proper temperature set for sample storage(kept at less than or equal to 6 0 degrees 00011
Celsius)?
Is the facility sampling performed as required by the permit(frequency, sampling type 00011
representative)'
Comment: None
Septic Tank Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational'? 00 • O
Is septic tank pumped on a schedule'? • 000
Are pumps or syphons operating properly'? 00 • 0
Are high and low water alarms operating properly'? 00 • 0
Comment Ms. Jarvis indicated that she pumps the tank as needed
Sand Filters (Low rate) Yes No NA NE
(If pumps are used)Is an audible and visible alarm Present and operational'? 00 • 0
Is the distribution box level and watertight'? 000 •
Is sand filter free of ponding? • 000
Is the sand filter effluent re-circulated at a valid ratio'? ❑ • ❑ ❑
#Is the sand filter surface free of algae or excessive vegetation'? 0050
#Is the sand filter effluent re-circulated at a valid ratio'?(Approximately 3 to 1) 0 • 1=10
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Permit: NCG550749 Owner-Facility. 5600 Styers Ferry Road
Inspection Date. 09/19/2018 Inspection Type: Compliance Evaluation
Sand Filters (Low rate) Yes No NA NE
Comment. This is a subsurface sand filter
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational'? 0 • ❑ ❑
Are the tablets the proper size and type'? El El • 0
Number of tubes in use'? 0
Is the level of chlorine residual acceptable'? 0 ■ ❑ ❑
Is the contact chamber free of growth, or sludge buildup'? . ❑ ❑ III 0
Is there chlorine residual prior to de-chlorination? 0 ❑ • ❑
Comment Chlorinator cannot be located.
Flow Measurement- Effluent Yes No NA NE
#Is flow meter used for reporting'? El 0 II 0
Is flow meter calibrated annually'? ❑ 0 • El
Is the flow meter operational'? 0 0 II 0
(If units are separated) Does the chart recorder match the flow meter? ❑ 0 • ❑
Comment. Flow needs to be estimated.This has never been accomplished.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained'? 0 U El El
Are the receiving water free of foam other than trace amounts and other debris'? El El ❑ ■
If effluent (diffuser pipes are required) are they operating properly'? 0 ❑ • 0
Comment: Discharge pipe cannot be located.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? • 0 El ❑
Does the facility analyze process control parameters, for ex MLSS, MCRT, Settleable ❑ • El El
Solids, pH, DO, Sludge Judge, and other that are applicable'?
Comment None
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