NCG551014_Compliance Evaluation Inspection_20240122 (2)

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 NCG551014 111 121 23/12/21 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 ni 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:OOAM 23/12/21
13/08/01
2624 Wessex Road
2624 Wessex Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27106
10:30AM 23/12/21
18/07/31
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
Ed Flowers,2624 Wessex Rd Winston Salem NC 27106//336-922-0332/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenar
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
DocuSigned by:
('h4sbw 1/19/2024
Na ate AigrcaWre(.$) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Gary Hudson DWR/Division of Water Qua Iity/336-776-9694/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by:
1/22/2024
FLam - T.
'-- 145ME225CMEA-
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
NCG551014 I11 12I 23/12/21 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
*The single-family subsurface sand filter appeared to be very well maintained.
*The septic tank is pumped and inspected every three to five years.
*The effluent pipe was not located during the inspection.
*The tablet chlorinator was located in the backyard.
Page#

Permit: NCG551014
Inspection Date: 12/21/2023
Owner -Facility: 2624 Wessex Road
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: *The single-family subsurface sand filter appeared to be very well maintained.
*The septic tank is pumped and inspected every three to five years.
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new
application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment: *The effluent pipe was not located during the inspection.
*The tablet chlorinator was located in the backyard.
Yes No NA NE
❑ ❑ ■ ❑
■ ❑ ❑ ❑
❑ ❑ ■ ❑
❑ ❑ ❑
■ ❑ ❑ ❑
Page# 3