NCG550983_EPA form 2024 ncg550983_20240621

EPA
United States Environmental Protection Agency
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 Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 N 52 NCG550983 24/06/11 C S31112171819 20
21 66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ----------------------Reserved-------------------
N67707172 73 74 75 80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
3784 Mount Gilead Church Road
3784 Mt Gilead Church Rd
Pittsboro NC 27312
Entry Time/Date Permit Effective Date
Exit Time/Date Permit Expiration Date
01:30PM 24/06/11 21/12/17
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
///
Other Facility Data
01:53PM 24/06/11 25/10/31
Name, Address of Responsible Official/Title/Phone and Fax Number
Mary Riggsbee,PO Box 218 Pittsboro NC 27312//919-548-2222/Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Facility Site Review
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
Stephen D Smith DWR/RRO WQ/919-791-4200/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#1
DocuSign Envelope ID: 9E3EE00C-594B-419F-95BE-86129AAD1DF5
6/21/2024
DocuSign Envelope ID: 9C255594-A118-4EF9-8008-3E3F230E0D81
6/27/2024
NPDES yr/mo/day
24/06/11
Inspection Type
C3111218
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
NCG550983 17
Page#2
DocuSign Envelope ID: 9E3EE00C-594B-419F-95BE-86129AAD1DF5DocuSign Envelope ID: 9C255594-A118-4EF9-8008-3E3F230E0D81
Permit:NCG550983
Inspection Date:06/11/2024
Owner - Facility:
Inspection Type:
3784 Mount Gilead Church Road
Compliance Evaluation
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?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Single Family Gravity Sandfilter... slight discharge observed, chlorine tablets present,
no evedience of solids/ponding or faiilure.
Comment:
Page#3
DocuSign Envelope ID: 9E3EE00C-594B-419F-95BE-86129AAD1DF5DocuSign Envelope ID: 9C255594-A118-4EF9-8008-3E3F230E0D81