NCG551110_202303CEI_20230328

DocuSign Envelope ID: 634E9DCC-EDA1 -4A5F-B1 7C-078B7C2FF5A8
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 NCG551110 111 121 23/03/24 I17 18 I C I 19 Ls_] 201 I
211111 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 I r6
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 J 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 23/03/24
21/08/12
Maple Springs Baptist Church
120 Casey's Branch Rd
Exit Time/Date
Permit Expiration Date
Purlear NC 28665
03:OOPM 23/03/24
25/10/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
/// Pastor David Winebarger 336-927-3724
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Connie H Williams,120 Casey's Branch Rd Purlear NC 28665//336-973-4506/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenar 0 Records/Reports Sludge Handling Dispo:
Facility Site Review 0 Effluent/Receiving Wate
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
Tricia Lowery DWR/WSRO WQ/336-776-9691/
bv: 3/31/2023
LDocusigned
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Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by:
4/4/2023
FLam - T.
"- 145B49E225C94EA...
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
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DocuSign Envelope ID: 634E9DCC-EDA1-4A5F-B17C-078B7C2FF5A8
NPDES yr/mo/day Inspection Type (Cont.)
NCG551110 I11 12I 23/03/24 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On 3/24/2023, Tricia Lowery met with David Winebarger to perform Compliance Evaluation Inspection
at Maple Springs Baptist Church (NPDES PERMIT# NCG551110) This inspection consisted of an
on -site inspection of the treatment facility. David Winebarger assisted inspector during the on -site
inspection. The attached EPA inspection form detail the areas that were evaluated with their
respective comments
Areas found to be of concern are:
1. Diagram shows chlorine chamber, however no evidence of chlorine chamber could be found
during inspection.
2. Inspector could not find effluent outfall pipe to stream.
3. Septic tank has not been serviced and/or maintained for over 5 years.
4. Two ground depressions are in the vicinity of septic system.
Regular scheduled maintanence of the septic system ensures proper operation and efficacy of
wastewater treatment. The two land depressions in the vicinity of the septic system could indicate the
system's infrastructure has been compromised. Therefore, it is highly recommended to have system
serviced as soon as possible.
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DocuSign Envelope ID: 634E9DCC-EDA1-4A5F-B17C-078B7C2FF5A8
Permit: NCG551110 Owner -Facility: Maple Springs Baptist Church
Inspection Date: 03/24/2023 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
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application?
Is the facility as described in the permit?
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0
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# Are there any special conditions for the permit?
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0
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Is access to the plant site restricted to the general public?
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0
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Is the inspector granted access to all areas for inspection?
0
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Comment: This is a qeneral NCG55 permit. Inspector could not visualize components of the
treatment system as it is subsurface. Inspector was given a diagram constructed on
graph paper of system. According to the diagram the system consists of: septic tank,
subsurface sand filter, chlorine contact chamber and outfall pipe. *Inspector took
photo of diagram*.
Inspector found no evidence of chlorine chamber tubes, effluent outfall pipe, or a clean
out / inspection well to sand filter. The area is completely covered with 2 areas of
depression (sinking ground) in the vicinity of the system.
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge Judge, and other that are applicable?
Yes No NA NE
Comment: There is no discharge coming from system, therefore no sampling has occurred. No
foul odor or evidence of septic system failure during inspection.
Septic Tank
Yes
No
NA NE
(If pumps are used) Is an audible and visual alarm operational?
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MEI
Is septic tank pumped on a schedule?
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0
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Are pumps or syphons operating properly?
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Are high and low water alarms operating properly?
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Comment: Mr. Winebarger stated the septic sysi
pastor and minimal information was c
years Church attendance averages
people on Wednesdays. This is a ve
activity.
Disinfection -Tablet
Are tablet chlorinators operational?
Are the tablets the proper size and type?
Number of tubes in use?
m has not been serviced since he became
fen to him by predecessors. *Pastor >5
4 DeoDle Der week on Sundav and —6-7
small cnu
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
r
Yes
No
NA NE
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DocuSign Envelope ID: 634E9DCC-EDA1-4A5F-B17C-078B7C2FF5A8
Permit: NCG551110
Inspection Date: 03/24/2023
Disinfection -Tablet
Is there chlorine residual prior to de -chlorination?
Owner - Facility: Maple Springs Baptist Church
Inspection Type: Compliance Evaluation
Yes No NA NE
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Comment: Inspector found no evidence of chlorination chamber. No tubes emerging above
ground. Last inspection indicated no chlorination unit was installed, but diagram shows
a chlorine chamber.
Effluent Pipe
Yes
No
NA NE
Is right of way to the outfall properly maintained?
0
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Are the receiving water free of foam other than trace amounts and other debris?
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If effluent (diffuser pipes are required) are they operating properly?
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Comment: Inspector could not find effluent pipe. No discharge could be found
going into stream.
The stream does not look impaired or had any evidence of being impacted
by
untreated wastewater discharging into stream.
Due to low use of system, no discharge occurs - septic tank handles all waste.
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