NCG550715_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 NCG550715 111 12 I 21/09/30 117
Type
181 p I
IIIIIIIIIII
Inspector Fac Type
191 S I 2011
IIIIIIIIIIIIIIIIII I IIIIII
P6
Inspection
671
Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
I 70I I 711 172 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 oermit Number)
495 Talley Road
495 Talley Rd
Reidsville NC 27320
Entry Time/Date
02:OOPM 21/09/30
Permit Effective Date
20/04/13
Exit Time/Date
02:05PM 21/09/30
Permit Expiration Date
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
David Wayne Goodson,495 Talley Rd Reidsville NC 27320///
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:
L—oA, —r. SA,acr 10/19/2021
35�i2
EPA Form6(Kev-9-94) Previous editions are obsolete.
Page# 1

31
NPDES yr/mo/day
N CG550715 111 121 21/09/30
117
Inspection Type
18[j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On Thursday, September 30, 2021, Alex Lowe of the WSRO attempted to conduct an unannounced
compliance inspection of the septic system at 495 Talley Road in Kernersville. No response came
from ringing the doorbell and knocking on the front door. Previous attempts to contact Mr. Goodson
(09/21/2021) were unsuccessful, as the number(s) on file in BIMS are disconnected.
Lowe will attempt to contact Mr. Goodson via letter to schedule a compliance inspection and remind
him of permit renewal requirements.
Page# 2

Permit: NCG550715
Inspection Date: 09/30/2021
Owner - Facility: 495 Talley Road
Inspection Type: Reconnaissance
Other
Comment:
Yes No NA NE
Page# 3