NCG550586_Compliance Evaluation Inspection_20240305 (2)

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 NCG550586 111 121 24/02/08 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 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)
11:00AM 24/02/08
21/12/07
1550 Double Creek Drive
1550 Double Creek Dr
Exit Time/Date
Permit Expiration Date
Lewisville NC 27023
11:30AM 24/02/08
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
Jean T Blackwood, 1550 Dowble Creek Lewisville NC 27023//336-945-3969/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenar
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
DocuSigned by:
a th4sbw 3/4/2024
P?dlg j5`Mure(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Gary Hudson DWR/Division of Water Qua Iity/336-776-9694/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by: 3/5/2024
FL' -T. 5,,d r
EPA —orMI "WW9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
NCG550586 I11 12I 24/02/08 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
• The single-family subsurface sand filter appeared to be very well maintained.
• The effluent pipe was located, and a clear path is maintained to facilitate sampling.
• The system was not discharging during the time of the inspection.
• The chlorinator was not located during the inspection.
• The septic tank is pumped and inspected every three to five years.
• All permit renewal fees are up to date.
Page#

Permit: NCG550586
Inspection Date: 02/08/2024
Owner -Facility: 1550 Double Creek Drive
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: • The single-family subsurface sand filter appeared to be very well maintained.
• The effluent pipe was located, and a clear path is maintained to facilitate sampling.
Permit
Yes
No
NA
NE
(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?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
❑
❑
❑
Comment: • All permit renewal fees are up to date.
Page# 3