NCG510070_NCG510070 EPA form -Dixie Grocery 2024_20240808

Docusign Envelope ID:8BDA3417-BF99-4639-8E61-5FA621B32173
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 NCG510070 111 121 24/07/31 I17 18 I C I 19 I G I 201 I
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 70 J 71 Ity 72 L-J 73 1 74 79 I I I I 80
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 permit Number) 11:00AM 24/07/31 21/03/01
Dixie Grocery
4730 NC Hwy 39 S Exit Time/Date Permit Expiration Date
Henderson NC 27536 11:35AM 24/07/31 25/09/30
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
Dennis Poythress,4365 NC Hwy 39 S Henderson NC 27536//252-213-0016/
No
Section C:Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations&Maintenar 0 Facility Site Review 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
Stephen D Smith DWR/RRO WQ/919-791-4200/ 8/7/2024
Signature oflr�a er ynt Q A Reviewer Agency/Office/Phone and Fax Numbers Date
F�ocu
arnt,SSa f. I�La�n�,u,( s/7/zoz4
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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Docusign Envelope ID:8BDA3417-BF99-4639-8E61-5FA621B32173
NPDES yr/mo/day Inspection Type 1
31 NCG510070 I11 12I 24/07/31 11 7 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
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Docusign Envelope ID:8BDA3417-BF99-4639-8E61-5FA621B32173
Permit: NCG510070 Owner-Facility: Dixie Grocery
Inspection Date: 07/31/2024 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: select monitoring wells are Perodically sampled (e.g. every 6 months). Pump and treat
groundwater remedation system has not been operated since Aug 9, 2018.
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 onsite air sparse/soil vapor extraction shed resticts access to general public to
treatment unit componets. Note: outfall 001 observed. System was not in operation
and was not discharging at the time of the inspection.
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