NCG550402_2023_07_CEI_20230731

DocuSign Envelope ID: 7C6B5E35-3EAD-47EA-9612-20C1349E133D
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 2 u 3 I NCG550402 111 121 23/07/05 I17 18 I C 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 n, I 73 � I 74 79 I I I I I I I80
70 I 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)
10:30AM 23/07/05
21/08/09
158 Deep Gap Estates Road
158 Deep Gap Estates Rd
Exit Time/Date
Permit Expiration Date
Deep Gap NC 28618
11:00AM 23/07/05
25/10/31
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
Darlene Deyton,PO Box 152 Deep Gap NC 28618//336-877-3178/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Effluent/Receiving Wate
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
Patricia Lowery DWR/WSRO WQ/336-776-9691/
by: 7/31/2023
LDocuSigned
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Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by: 8/1/2023
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EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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DocuSign Envelope ID: 7C6B5E35-3EAD-47EA-9612-20C1349E133D
NPDES yr/mo/day Inspection Type
NCG550402 I11 12I 23/07/05 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On July 5, 2023, Division of Water Resources staff Tricia Lowery conducted a routine compliance
inspection at 158 Deep Gap Estates Rd (NCG550402). Darlene Deyton, homeowner, was present
during the inspection. A review of records, structures, and outfall was completed. This review
reflected compliance with the subject permit. No violations or concerns were noted during inspection.
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DocuSign Envelope ID: 7C6B5E35-3EAD-47EA-9612-20C1349E133D
Permit: NCG550402 Owner -Facility: 158 Deep Gap Estates Road
Inspection Date: 07/05/2023 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 ❑ ❑ 0 ❑
application?
Is the facility as described in the permit? 0 ❑ ❑ ❑
# Are there any special conditions for the permit? ❑ 0 ❑ ❑
Is access to the plant site restricted to the general public? ❑ ❑ 0 ❑
Is the inspector granted access to all areas for inspection? 0 ❑ ❑ ❑
Comment: This is an SFR. Two people occupy the home with low flow going into treatment
system. Ms. Denton keeps records of septic tank pumping. The last one was
conducted on 3/16/2023 by Doug Cox Backhoe Service (8046 Old Hwy 16, Crumpler
NC 28617). Inspection of tank at the time pumping did not reveal any issues and was
in good working order. The tank is pumped every 3-5 years.
Effluent Pipe
Yes
No
NA NE
Is right of way to the outfall properly maintained?
0
❑
❑ ❑
Are the receiving water free of foam other than trace amounts and other debris?
■
❑
❑ ❑
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
0 ❑
Comment: Outfall pipe in good condition. Visible and easily accessible. No discharge was
occuring at time of inspection and due to low flow into treatment system, no discharge
is suspected of reaching outfall as tank is pumped on regular basis. No impacts
to
stream observed during time of inspection.
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