NCG550045_Compliance Evaluation Inspection_20210920

United States Environmental Protection Agency
EPA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction
1 IN I
21IIIIII
Code NPDES yr/mo/day Inspection
2 IL I 3 I NCG550045 111 121 21/09/20 117
Type
1810I
IIIIIIIIIII
Inspector Fac Type
19I S I 2011
IIIIIIIIIII IIIIIII I IIIIII
P6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
671 I 70I3 I 711 1 72 I N I 73I 1 74 71
I I
I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES oermit Number)
129 Forestdale Drive
129 Forestdale Dr
Reidsville NC 27320
Entry Time/Date
04:OOPM 21/09/20
Permit Effective Date
20/11/20
Exit Time/Date
04:25PM 21/09/20
Permit Expiration Date
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
Angela Yvonne Evans,129 Forestdale Dr Reidsville NC 27320//336-338-1092/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Records/Reports
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
Alex Lowe DWR/WSRO WQ/336-776-9689/
Signature
of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
FDocuSigned by:
L—o, T. SA,ac>_ 10/19/2021
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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3I
NPDES yr/mo/day
N CG550045 111 121 21/09/20
17
Inspection Type
18 [j
(Cont.)
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On Monday, September 20, 2021, Alex Lowe of the WSRO conducted a routine Compliance
Evaluation Inspection at 129 Forestdale Drive. Permittee Ms. Angela Evans was present for the
inspection. Ms. Evans was unable to provide a copy of her permit or proof of the latest servicing of
her wastewater system. However, she was able to confirm that the entire tank had been removed and
replaced within the last twelve months by Billingsley Septic Services. Mr. Lowe was able to confirm
this by contacting Billingsley directly (invoice attached). Lowe offered that a copy of the permit be
sent along to Ms. Evans with the inspections report for her records.
Chlorination tablets were observed to be of the proper variety and were being replaced monthly into
one of two contact chamber tubes. A tablet was observed in the tube closer to the house. Mr. Lowe
suggested using both tubes concurrently to ensure disinfection of waste.
Ms. Evans stated that she was unaware that the effluent would need to be tested by a third party to
retain compliance. Mr. Lowe offered to provide a list of certified laboratories with the inspection report
(see attached).
This system appears to be in good order. To fulfill compliance expectations, Ms. Evans must only
begin annual sampling of effluent and retain copies of all paperwork related to permit renewals and
system maintenance.
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Permit: NCG550045
Inspection Date: 09/20/2021
Owner - Facility: 129 Forestdale Drive
Inspection Type: Compliance Evaluation
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? ❑ ❑ ❑ ❑
Is access to the plant site restricted to the general public? ❑ ❑ ❑ ❑
Is the inspector granted access to all areas for inspection? ❑ ❑ ❑ ❑
Comment:
Record Keeping
Are records kept and maintained as required by the permit?
Is all required information readily available, complete and current?
Are all records maintained for 3 years (lab. reg. required 5 years)?
Are analytical results consistent with data reported on DMRs?
Is the chain -of -custody complete?
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
Has the facility submitted its annual compliance report to users and DWQ?
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified
operator on each shift?
Is the ORC visitation log available and current?
Is the ORC certified at grade equal to or higher than the facility classification?
Is the backup operator certified at one grade less or greater than the facility
classification?
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Comment:
Yes No NA NE
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