NCG550834_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)
Transaction
1
21IIIIII
Inspection
671
Code NPDES yr/mo/day Inspection
IN I 2 IL I 3 I NCG550834 111 121 21/09/30 117
Type
181 p I
IIIIIIIIIII
Inspector Fac Type
191 S I 2011
IIIIIIIIIIIIIIIIII I IIIIII
P6
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 Dermit Number)
1078 Browder Farm Road
1078 Browder Farm Rd
Germanton NC 27019
Entry Time/Date
12:OOPM 21/09/30
Permit Effective Date
19/11/18
Exit Time/Date
12:OOPM 21/09/30
Permit Expiration Date
20/10/31
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
Thomas E Wilson,1078 Browder Farm Rd Germanton NC 27019///
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
rDocuSigned by:
/�,,, 'r, 5,,,,dcr 10/19/2021
145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

3I
NPDES yr/mo/day
N CG550834 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 conducted a reconnaisance visit to 1078
Browder Farm Road. No one appeared to be present the the home, so Lowe did not enter the
driveway to approach the house.
Status of system unknown. Will mail letter with request inspection date and permit renewal.
Page# 2

Permit: NCG550834
Inspection Date: 09/30/2021
Owner - Facility: 1078 Browder Farm Road
Inspection Type: Reconnaissance
Other
Comment:
Yes No NA NE
Page# 3