NCG550057_Compliance Evaluation Inspection_20230302

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 NCG550057 111 121 23/02/06 I17 18 I C I 19 I s I 20L]
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 1166
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67
I 72 I ni I 73 � I 74 79 I I I I I I I80
70 I I 71 I LL -1 I I
LJ
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 Dermit Number)
02:OOPM 23/02/06
12/08/01
1046 Whirl -Win Drive
1046 Whirl -Win Dr
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27107
02:15PM 23/02/06
13/07/31
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
George T Thompson,1046 Whirl -Win Dr Winston Salem NC 27107//336-725-2887/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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
Gary Hudson DWR/Division of Water Qua Iity/336-776-9694/
zDocuSigned by:
�t� ('�dsbt& 2/28/2023
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by:
� _ T. 15 ,,dcr 2/28/2023
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EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type
NCG550057 I11 12I 23/02/06 117 18 i c i
(Cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
*The new homeowner needs to submit an "Ownership Change Form" included with this report.
*October 31, 2022 — "Please Contact Me" letter sent.
*December 6, 2022 - "Please Contact Me" letter sent.
*January 6, 2023 - "Please Contact Me" letter sent, Certified Mail. Green Card came back with covid —
19 in place of the signature.
*February 6, 2023 — Made site visit. The home appeared occupied, with no one home. The
chlorinator was located near a gravel road. The inspector walked the creek but could not find the
discharge pipe.
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Permit: NCG550057
Inspection Date: 02/06/2023
Owner -Facility: 1046 Whirl -Win Drive
Inspection Type: Compliance Evaluation
Permit
(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: The new homeowner needs to submit an "Ownership Change Form."
Yes No NA NE
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