NCG550567_Follow-up BIMS Report_20191125

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 NCG550517 111 12 I 19/11/25 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)
09:30AM 19/11/25
19/11/05
1795 YMCA Camp Road
1795 YMCA Camp Rd
Exit Time/Date
Permit Expiration Date
King NC 27021
10:15AM 19/11/25
20/10/31
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
Peggy H Smith,1745 Y M C A Camp Rd King NC 27021//336-983-3424/
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
DocuSigned by:
Justin L Henderson U SI tLIA �t,lA (�DWR/WSRO WQ/336-776-9701/
,t
DV SbIA
11/25/2019
51F3525961`8113496...
Signature of Management Q A Agency/Office/Phone and Fax Numbers
igned by:
Date
rj�ocuevie%wer
11/25/2019
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type (Cont.)
NCG550517 111 121 19/11/25 117 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On November 25, 2019 DWR staff person Justin Henderson conducted a follow-up inspection to the
Notice of Deficiency Compliance Inspection that was conducted on November 6, 2019. This follow-up
was requested by the permittee's nephew Drew Smith, who was present during the follow-up meeting.
The findings are summarized below:
1) Wastwater grade chlorine tablets had been obtained and were present in both chlorinator tubes.
2) The woody debris and leaf litter had been removed from the cascade aerator, no longer impacting
the effluent quality.
3) Mr. Drew Smith produced a receipt for the most recent septic tank pumping which had a date of
August, 2015. (Septic tank pumping will be due by August 2020 to remain compliant with the permit
required frequency of 1/5 years.
Mr. Smith was reminded that annual effluent monitoring is required in accordance with Permit
Condition Part I. Section C.
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Permit: NCG550517
Inspection Date: 11/25/2019
Permit
Owner - Facility: 1795 YMCA Camp Road
Inspection Type: Compliance Evaluation
(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?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
Yes No NA NE
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