NCG550092_Compliance Evaluation Inspection_20240305 (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 NCG550092 111 121 24/02/06 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)
11:00AM 24/02/06
21/08/05
5959 Holder Road
5959 Holder Rd
Exit Time/Date
Permit Expiration Date
Clemmons NC 27012
11:30AM 24/02/06
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
Rhonda Baxley,5959 Holder Rd Clemmons NC 27012//757-879-3344/
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)
ocu ign d by:
F ('h4sbw 3/4/2024
Names 9R&t2i16&AW9(s) 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:
FL- T. 5 ,,o r 3/5/2024
EPA For 3m 5W8'YWev ) �-�4 Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG550092 I11 12I 24/02/06 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
-The septic tank is pumped and inspected every three to five years.
-The chlorinator was not located during the inspection.
-The effluent pipe was not located during the inspection.
-The permit ownership has been changed and all permit renewal fees are up to date.
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Permit: NCG550092
Inspection Date: 02/06/2024
Owner -Facility: 5959 Holder 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 septic tank is pumped and inspected every three to five years.
•The chlorinator was not located during the inspection.
•The effluent pipe was not located during the inspection.
Permit
Yes
No
NA NE
(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?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
❑
❑
❑
Comment: •The permit ownership has been changed and all permit renewal fees are up to date.
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