NCG550133_Compliance Evaluation Inspection_20210930

United States Environmental Protection Agency
E PA 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)
1
21IIIIII
671
Transaction Code NPDES yr/mo/day Inspection
IN I 2 IL I 3 I NCG550133 111 121 21/09/30 117
Type
181 p I
IIIIIIIIIII
Inspector Fac Type
191 S I 2011
IIIIIIIIIIIIIIIIII I IIIIII
P6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved
I 70I I 711 172 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)
142 Cedar Run Drive
142 Cedar Run Dr
Reidsville NC 27320
Entry Time/Date
01:45PM 21/09/30
Permit Effective Date
13/08/01
Exit Time/Date
01:50PM 21/09/30
Permit Expiration Date
18/07/31
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
Tommy Wayne Stanley,142 Cedar Run Reidsville NC 27320///
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Other
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,acr 10/19/2021
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

31
NPDES yr/mo/day
N CG550133 111 121 21/09/30
117
Inspection Type
18[j
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On Thursday, September 30, 2021, Alex Lowe of the WSRO attempted to conduct an unannounced
compliance inspection of the septic system at 142 Cedar Run Drive. No response came from ringing
the doorbell and knocking on the front door. Previous attempts to contact Mr. Stanley were
unsuccessful, as the number(s) on file in BIMS are disconnected.
Page# 2

Permit: NCG550133
Inspection Date: 09/30/2021
Owner - Facility: 142 Cedar Run Drive
Inspection Type: Reconnaissance
Other
Comment:
Yes No NA NE
Page# 3