NCG550335_NCG550335 CEI EPA form 2024_20240705

DocuSign Envelope ID:9E71BA9F-48D7-4111-B719-82408180F2AF
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 NCG550335 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) 01:15PM 24/06/19 19/10/29
3806 Cox Mill Road
3806 Cox Mill Rd Exit Time/Date Permit Expiration Date
Sanford NC 27330 01:22PM 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
Melvin James Hart,5292 Cox Mill Rd Sanford NC 27330//919-258-9964/
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
Stephe ASEigned by: DWR/RRO WQ/919-791-4200/
7/7/2024
L9EC679823B1D478...
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
DocuSigned by: 7/9/2024
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EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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DocuSign Envelope ID:9E71BA9F-48D7-4111-B719-82408180F2AF
NPDES yr/mo/day Inspection Type 1
31 NCG550335 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:9E71BA9F-48D7-4111-B719-82408180F2AF
Permit: NCG550335 Owner-Facility: 3806 Cox Mill Road
Inspection Date: 06/19/2024 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
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?
Comment: Single Family Resident- Single Pass Gravity Sandfilter treatement system
Unable to contact permitee. Did not return call, did not answer, left informaiton packet
and will request a phone call by letter to disucss permit, system operations and
monitoring.
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? ❑ ❑ ❑ ❑
Comment: Permit is expired 10.31.2020. Unable to contact owner.
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