WA-26502_31701_I_O_20201124

North Carolina Department of Environmental Quality
Division of Waste Management
UST Section, Corrective Action Branch (CAB)

INSPECTION REPORT

Site Name: Wynne Residence Incident #: 31701 Risk: L
County: Martin Street Address: 1465 Big Mill Road, Williamston
Region: WaRO GPS Coordinates: N W - UST #: WA-

Site Information Checklist
Facility Information:
Residence? Yes No
Operating Facility? Yes No N/A
Valid UST permit? Yes No N/A
Number of Tanks: N/A
Site map/well map verified (if no, explain discrepancies in comments section)? Yes No
Any visible spills/leaks (if yes, explain in comments section)? Yes No
Any visible water supply wells? If yes, distance to closest (ft.)? Yes No

Remediation System(s) Information: Yes No

System 1 System 2 System 3
System Type?
Fully installed? Yes No Yes No Yes No
Operating? Yes No Yes No Yes No
Free product present (verified)? Yes No Yes No Yes No

Was RP/consultant/other on site? Yes No
Name of RP: Company:
Name of consultant: Company:
Name of other: Company:

Pictures taken? Yes No Location of photos:

Time spent on site (hrs): 15 mins

Comments: Confirmed that residence has active public water usage -

Date: 11/24/20 Inspector: ALW