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HomeMy WebLinkAboutNCG550491_Compliance Evaluation Inspection_20191031ROY COOPER Governor MICHAEL S. REGAN Secretary LINDA CULPEPPER Director Donald Davis 2055 Davis Ridge Rd. Kernersville, NC 27284 NORTH CAROLINA Environmental Quality October 31, 2019 SUBJECT: Compliance Evaluation Inspection Certificate of Coverage #NCG550491 — General Permit 550000 Single -Family NPDES Wastewater Treatment System 2055 Davis Ridge Rd. Kernersville, NC 27284 Forsyth County Dear Mr. Davis: On October 23, 2019, staff of the North Carolina Division of Water Resources' Winston-Salem Regional Office (DWR) performed a compliance inspection of the single-family NPDES wastewater treatment system located at the subject property. This compliance inspection was conducted by DWR staff person Mr. Justin Henderson. Inspection of the wastewater treatment system reflects compliance with Permit No. NCG550491. If you have any questions concerning this letter, you may contact Justin Henderson or me at (336) 776-9800. Sincerely, EDocuSigned by: �� z SMatr 145B49E225C94EA... Lon Snider, Regional Supervisor Water Quality Regional Operations Section Division of Water Resources, NCDEQ-WSRO enc: Inspection Report cc: Laserfiche (electronic copies) D E Q�� North Carolina Department of Environmental Quality I Division of Water Resources Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105 NoanacaaouNn ^ o.P.ro�wmm�w�mmviw.i� /� 336.776.9800 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 IN I 2 15 I 3 I NCG550491 111 12 I 19/10/23 I17 18 I S J 19 L G] 201 I 211111 1 1 I I I I II I I I I I I I I I I I I 1 I I I I I I I I I I II I I I I I f6 Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ---------------------- Reserved ------------------- 671 70 I I 71 I I 72 I r I u ty 73 I I 174 751 I I I I I I I80 I I i 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 oermit Number) 09:OOAM 19/10/23 13/08/01 2055 Davis Ridge Road 2055 Davis Ridge Rd Exit Time/Date Permit Expiration Date Kernersville NC 27284 10:OOAM 19/10/23 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 Donald F Davis,2055 Davis Ridge Rd Kernersville NC 27284//336-454-2795/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Other 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 Justin L Henderson DocuSigned by: DWR/WSRO WQ/336-776-9701/ t,tshv, hA&k V 6V' D51F3525961`8113496.. 10/31/2019 Signature of Management Q A R PcuSigned by: Agency/Office/Phone and Fax Numbers Date �~'u 7�1451349E225C94EA 10/31/2019 ... EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page# NPDES yr/mo/day Inspection Type NCG550491 I11 121 19/10/23 117 18 ICI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) Dear Mr. Davis: On October 23, 2019, staff of the North Carolina Division of Water Resources' Winston-Salem Regional Office (DWR) performed a compliance inspection of the single-family NPDES wastewater treatment system located at the subject property. This compliance inspection was conducted by DWR staff person Mr. Justin Henderson. Inspection of the wastewater treatment system reflects compliance with Permit No. NCG550491. Page# Permit: NCG550491 Inspection Date: 10/23/2019 Other Comment: Owner - Facility: 2055 Davis Ridge Road Inspection Type: Compliance Evaluation Yes No NA NE Page#