NC0037834_Pretreatment Complaince Inspection BIMS Report_20201202

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 1 2 u 3 I NC0037834 I11 121 20/11/17 I17 181 D I 19 I s I 20L]
21111I I I I I I I II I I I I I I I I I I I I I I I I I I I I I I I II I I I I I r6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67
I 72 I ni I 71 I 74 79 I I I I I I I80
70I I 71 I LL -1 I I
LJ
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 Dermit Number)
10:OOAM 20/11/17
17/08/01
Archie Elledge WWTP
2801 Griffith Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 271036417
11:20AM 20/11/17
22/06/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Ozie Keith Jones/ORC/336-397-7679/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Jon M Southern,2801 Griffith Rd Winston Salem NC
271036417//336-397-7600/3366594320 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Records/Reports 0 Self -Monitoring Progran 0 Pretreatment
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
Jim J Gonsiewski Docusigned by: DWR/Division of Water Qua Iity/336-776-9704/ 12/2/2020
Alex Lowe E� �o�w��( DWR/WSRO WQ/336-776-9689/
E197B66F179D45F...
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
Docusigned by:
oti '? Snider 12/2/2020
FL
14bB49E22bU94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCO037834 I11 12I 20/11/17 117 18 i p i
(Cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On November 17, 2020 a Pretreatment Compliance Inspection (PCI) was performed by Jim
Gonsiewski and Alex Lowe of the Winston-Salem Regional Office. Mr. Joel Freeman, Mr. Olu Browne,
and Mr. Michael Gearren were present for the inspection. The purpose of this inspection was to
determine the effectiveness of the Town's pretreatment program, which includes reviewing the files,
POTW plant performance, industry monitoring data, and adherence to the enforcement response plan
(ERP).
The pretreatment program was found to be satisfactory.
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Permit: NC0037834
Inspection Date: 11/17/2020
Owner -Facility: Archie Elledge WWTP
Inspection Type: Pretreatment Compliance
Yes No NA NE
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