NCG550355_Compliance Evaluation Inspection_20210930

United States Environmental Protection Agency
E PA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction
1 IN
21IIIIII
Code NPDES yr/mo/day Inspection
I 2 IL I 3 I NCG550355 111 121 21/09/20 117
Type
1810I
IIIIIIIIIII
Inspector Fac Type
19I S I 2011
IIIIIIIIIII IIIIIII I IIIIII
P6
Inspection
671
Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
I 70I3 I 711 1 72 I N I 73I 1 74 71
I I
I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES Dermit Number)
334 Singleton Road
334 Singleton Rd
Reidsville NC 27320
Entry Time/Date
01:50PM 21/09/20
Permit Effective Date
07/08/01
Exit Time/Date
02:20PM 21/09/20
Permit Expiration Date
12/07/31
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
Raymond Yarborough,647 Union St Orange NJ 07050///
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
Alex Lowe DWR/WSRO WQ/336-776-9689/
Signature
of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by: 10/19/2021
L—T. StiAcr
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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3I
NPDES yr/mo/day
N CG550355 111 121 21/09/20
117
Inspection Type
18 [j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On Monday, September 20, 2021, Alex Lowe of the WSRO conducted a routine Compliance
Evaluation Inspection at 334 Singleton Road. Permittee Mr. Raymond Yarborough was present for the
inspection.
Mr. Yarborough was unable to provide a copy of his permit and proof of the latest servicing of his
wastewater system. Because this was an unannounced visit on a strict time schedule, Lowe offered to
include a copy of his latest permit in the inspection report (see attached).
Chlorination tablets were observed to be of the proper variety and were being replaced every 2-3
months. Mr. Yarborough stated that he used to check more often, but because he lives alone the
water usage is limited and tablets last much longer than the monthly average.
Mr. Yarborough has not completed annual samplings in the past year. He requested a list of certified
laboratories, which Lowe has attached to this inspection report.
Mr. Yarborough provided the following phone number for scheduling future visits: [phone]
This system appears to be in good order. To fulfill compliance expectations, Mr. Yarborough must
only begin annual sampling of effluent and retain copies of all paperwork related to permit renewals
and system maintenance.
Page# 2

Permit: NCG550355
Inspection Date: 09/20/2021
Owner - Facility: 334 Singleton Road
Inspection Type: Compliance Evaluation
Other
Comment:
Yes No NA NE
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