NCG550424_Compliance Evaluation Inspection_20190611

ROY COOPER �'` s
Governor
MICHAEL S.REGAN `,".
Secretary
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
June 3, 2019
Ms. Karen Crews
2031 Woodstock Rd.
Clemmons, NC 27012
SUBJECT: Compliance Evaluation Inspection
Certificate of Coverage NCG550424
2040 Woodstock Rd
Forsyth County
Dear Ms. Crews,
On May 28, 2019 Kelli Park, of this office, met with you and performed a Compliance
Evaluation Inspection of the wastewater treatment system located at the above address.
The State requires the Division of Water Resources to inspect these types of systems at
least once every five years. The violations found from the inspection outlined below:
1) The chlorine you are using is pool grade. Via the permit wastewater grade chlorine
must be added to the system for proper disinfection. Information was shared with
you during the inspection about the appropriate tablets to use. Please begin using
the correct chlorine as soon as possible.
2) The effluent pipe was not visible. It is a permit requirement to know the location of
the pipe and to maintain the area around it at all times. You and Ms. Park discussed
revisiting this in the winter due to the thick vegetation behind your house.
3) The effluent has not been consistently tested by a laboratory. Water samples from
the effluent are required to be analyzed at least once a year by a certified
laboratory. These records are required to be maintained and should be shared with
NCDEQ upon request. A copy of the permit monitoring requirements and the
certified laboratories to do the analysis were given to you at the time of inspection
for reference of what should be monitored when you notice any discharge coming
out of the pipe during the year.
Failure to properly operate and maintain the system can result in expensive repair costs
as well as failure of the system to properly treat the wastewater. If you have any questions
regarding maintenance, operations, the permit, or this inspection do not hesitate to call
us. RECEIVED/NCDEQ/DWR
JUN 1 1 2019
Water Quality
-D_E Q North Carolina Department of Environmental Quality I Division of Water ResourcesPernlitting$Oction
Winston-Salem Regional Office - 450 West Hanes Mill Road.Suite 300 I Winston-Salem.North Carolina 27105
NORTH CARpt INA
Ommteml r 336.776.9800

Please keep this letter with your records for the system along with copies of invoices from
the Division for the annual permit fee, the Certificate of Coverage, records of septic tank
pumping, maintenance and repair records, etc.
Please be aware that violations of your NPDES permit, or the NC statutes and regulations
under which it is promulgated, are subject to fines of up to $25,000 per day, per violation,
as set forth in NC General Statute (NCGS) 143-215.6A, Enforcement Procedures, Civil
Penalties.
Please contact Miss Park at (336)-776-9689 or [e-mail] if you have any
further questions.
Sincerely,
FDocuSigned by:
L-otiTS?4U
11 145849E225C94EA...
Lon Snider
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments: EPA Water Compliance Inspection Report
cc: WSRO
NPDES Unit
Page 2 of 2

a
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
IN I 2 I5 I 3' I NCG550424 111 121 19/05/28 117 18 Lej 19 I c I 2011
21111I 1 1 I N 111 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I. II. I I 1 : 1 1 r6
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved
67I I 70I I 71 .J
I I 72 I L_�, 1 73I 1 (74 75f1 1 1 1 1 1 1 180
L� 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) 10:00AM 19/05/28 13/08/01
2040 Woodstock Road
Exit Time/Date Permit Expiration Date
2040 Woodstock Rd
11:00AM 19/05/28 18/07/31
Clemmons NC 27012
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
Karen W Crews,2040 Woodstock Rd Clemmons NC
No
27 0 1 2//3 3 6-776-1 347/3 3 6 777 0 5 01
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
Operations&Maintenance El Facility Site Review Effluent/Receiving Waters
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
Kelli A Park WSRO WQ//336-776-9689/ •
c/611R
Signature of Management Q A Review,„LDocusigned by: Agency/Office/Phone and Fax Numbers Date
L.oti T 3M C1- 6/3/2019
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete. •
•
Page# 1

NPDES yr/mo/day Inspection Type (Cont.) 1
31 NCG550424 Ill 121 19/05/28 117 18 Li
I
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
On May 28, 2019 Kelli Park, of this office, met with you and performed a Compliance Evaluation
Inspection of the wastewater treatment system located at the above address.The State requires the
Division of Water Resources to inspect these types of systems at least once every five years.The
violations found from the inspection outlined below: •
1)The chlorine you are using is pool grade.Via the permit wastewater grade chlorine must be added to
the system for proper disinfection. Information was shared with you during the inspection about the
appropriate tablets to use. Please begin using the correct chlorine as soon as possible.
2)The effluent pipe was not visible. It is a permit requirement to know the location of the pipe and to
maintain the area around it at all times.You and Ms. Park discussed revisiting this in the winter due to
the thick vegetation behind your house.
3)The effluent has not been consistently tested by a laboratory.Water samples from the effluent are
required to be analyzed at least once a year by a certified laboratory.These records are required to be
maintained and should be shared with NCDEQ upon request.A copy of the permit monitoring
requirements and the certified laboratories to do the analysis were given to you at the time of inspection
for reference of what should be monitored when you notice any discharge coming out of the pipe during
the year. -
•
Other Findings:
1)The chlorine tube was located, and there were tablets in it.The tube is checked every month and
chlorine is added as needed. -
2)The'system was last pumped about 2 years ago.
•
•
•
•
Page# 2

Permit: NCG550424 Owner-Facility: 2040 Woodstock Road
Inspection Date: 05/28/2019 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? 01100
Are the receiving water free of foam other than trace amounts and other debris? • 0 0 0
If effluent (diffuser pipes are required) are they operating properly'? 0 0 � ❑
Comment: The effluent pipe could not be located.
Disinfection-Tablet Yes No NA NE
Are tablet chlorinators operational'? • 0 0 0
Are the tablets the proper size and type? ❑ • ❑ ❑
Number of tubes in use'? 1
Is the level of chlorine residual acceptable'? 0 0 0 •
Is the contact chamber free of growth, or sludge buildup'? 0 0 0 •
Is there chlorine residual prior to de-chlorination? ❑ ❑ ❑ •
Comment: Pool tablets are being used. Information was provided about the correct type of tablet to use.
Please begin using the correct tablets as soon as possible.
The pipe is located behind the house to the left on the other side of the fence near a gate.
The chlorine tube is checked every month and tablets are added as needed.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping'? • 0 0 0
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ • 0
Solids, pH, DO, Sludge Judge, and other that are applicable'?
Comment:
Page# 3