NCG551312_202309CEI_20230921

DocuSign Envelope ID: 825DCC5F-FD69-460B-9AA1 -1 4D9D1 E936B6
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 NCG551312 111 121 23/09/14 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 I r6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------------------- Reserved -------------------
67
I 72 I n, 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)
01:30PM 23/09/14
21/08/31
10890 NC Highway 105 South
10890 Hwy 105 S
Exit Time/Date
Permit Expiration Date
Banner Elk NC 28604
02:30PM 23/09/14
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
Robert D Ruggles, 10890 Hwy 105 S Banner Elk NC 28604//828-963-8633/
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
Patricia Lowery DWR/WSRO WQ/336-776-9691/
by: 9/21/202 3
FDocuSigned
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Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
by:
9/26/2027
FDocuSiqned
�_ -T. 5 ,,dcr
EPA F ro m1Hb5(Wev 9-94) Previous editions are obsolete.
42
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DocuSign Envelope ID: 825DCC5F-FD69-460B-9AA1-14D9D1E9361B6
NPDES yr/mo/day Inspection Type
NCG551312 I11 12I 23/09/14 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On 9/14/2023, Division of Water Resources staff Tricia Lowery went to conduct a routine compliance
inspection for a Single -Family Residence (NCG551312) located at 10890 NC Hwy 105 S in Watauga
County. This system is no longer in operation as the facility discharges into Valley Creek Apartments
WWTP (NPDES Permit #NC0033448). Inspector was shown connection to WWTP and confirmed no
SFR system is in operation. Permit needs to become inactive/rescinded.
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DocuSign Envelope ID: 825DCC5F-FD69-460B-9AA1-14D9D1E93666
Permit: NCG551312
Inspection Date: 09/14/2023
Other
Comment: See Summary Section
Owner -Facility: 10890 NC Highway 105 South
Inspection Type: Compliance Evaluation
Yes No NA NE
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