NCG550452_Compliance Evaluation Inspection_20240604 (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 NCG550452 111 121 24/05/10 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)
03:OOPM 24/05/10
21/11/03
5619 Kane Drive
5619 Kane Dr
Exit Time/Date
Permit Expiration Date
Pfafftown NC 27040
03:30PM 24/05/10
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
John Mark Chambers,5619 Kane Dr Pfafftown NC 27040///
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)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Gary Hudson DWR/Division of Water Qua Iity/336-776-9694/
DocuSigned by:
Ras", 5/23/2024
al`%Af gement Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by:
Lon T. Snider 6/4/2024
"-145B49E2 G94EA.
EPA Form 3560-3 (Rev 9-94) Previous e ions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG550452 I11 12I 24/05/10 117 18 i c i
(Cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Mark Chambers — NCG550452 — May 10, 2024.
The single-family subsurface sand filter appeared to be very well maintained.
The septic tank is pumped and inspected every three to five years.
Mr. Chambers said that the septic tank had been pumped the first week in October 2023 but did not
save the receipt.
The effluent pipe was located, and a clear path is maintained to facilitate sampling. Mr. Chambers
said that he has never seen it discharge.
The chlorinator was located during the inspection, and it had the proper chlorinator tablets installed.
The system was not discharging during the inspection.
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Permit: NCG550452
Inspection Date: 05/10/2024
Owner -Facility: 5619 Kane Drive
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
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
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
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❑
■
❑
application?
Is the facility as described in the permit?
■
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❑
❑
# Are there any special conditions for the permit?
❑
■
❑
❑
Is access to the plant site restricted to the general public?
■
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Is the inspector granted access to all areas for inspection?
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Comment: The septic tank is pumped and inspected every three to five years.
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