NCG550916_Compliance Evaluation Inspection_20221128 (2)

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 Code NPDES yr/mo/day Inspection
1 IN I 2 IL I 3 I NCG550916 111 121 22/11/09 117
Type
1810I
IIIIIIIIIII
Inspector Fac Type
19I S I 2011
21IIIIII IIIIIIIIIIIIIIIIII I IIIIII
P6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
671 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 permit Number)
3104 Drexdale Drive
3104 Drexdale Dr
Kernersville NC 27284
Entry Time/Date
11:30AM 22/11/09
Permit Effective Date
20/04/23
Exit Time/Date
12:15PM 22/11/09
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
Pearl Johnson,3104 Drexdale Dr Kernersville NC 27284///
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
Gary Hudson DWR/Division of Water Quality/336-776-9694/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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31
NPDES yr/mo/day
N CG550916 111 121 22/11/09
I17
Inspection Type
18 [j
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
*Ms. Rowley recently acquired the property, and no documents or records were provided to her.
*A thorough search was conducted by Ms. Rowley and Mr. Hudson for the chlorinator and the effluent
pipe. Neither one was located.
*Ms. Rowley said that her and her husband will continue to look for the effluent pipe and the
chlorinator as they continue to clear the fallen trees and limbs on the back of the property.
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Permit: NCG550916
Inspection Date: 11/09/2022
Owner - Facility: 3104 Drexdale Drive
Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new El El ❑
application?
Is the facility as described in the permit? • El El El
# Are there any special conditions for the permit? El El • El
Is access to the plant site restricted to the general public? ❑ ❑ • ❑
Is the inspector granted access to all areas for inspection? • El El El
Comment:
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