NCG550326_ncg550326 CEI EPA form 2024_20240705

DocuSign Envelope ID:B5150743-9284-4327-ABD5-4883161 D9692
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 NCG550326 111 121 24/06/19 I17 18 I C I 19 I G I 20U
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 70 J 71 Ity 72 L-J 73 1 74 79 I I I I 80
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) 11:48AM 24/06/19 19/03/11
269 Screech Owl Rd
269 Screech Owl Rd Exit Time/Date Permit Expiration Date
Moncure NC 27559 12:OOPM 24/06/19 20/10/31
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
Christopher Senior,405 Kinsey St Raleigh NC 27603//919-337-8385/
No
Section C:Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations&Maintenar 0 Records/Reports 0 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/
DocuSigned by:
y .; 7/7/2024
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by:
7/8/2024
Uatn c,ssa f. AQ' ut,(,
B2916E6AB32144F_.
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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DocuSign Envelope ID:B5150743-9284-4327-ABD5-4883161 D9692
NPDES yr/mo/day Inspection Type 1
31 NCG550326 I11 12I 24/06/19 11 7 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
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DocuSign Envelope ID:B5150743-9284-4327-ABD5-4883161 D9692
Permit: NCG550326 Owner-Facility: 269 Screech Owl Rd
Inspection Date: 06/19/2024 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: Single Family Resident- Single Pass Gravity Sandfilter-No signs of ponding, no solids
evident at outfall, no evident signs of system failure. Not discharging at time of
inspection. Chlorine present in chlorinator.
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:
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