NCG550201_Compliance Evaluation Inspection_20240930

ROY COOPER
Governor
MAKY PENNY KELLEY
Secretary
RICHARD E. ROGERS, JP,.
Director
Andrea Sias
291 North Hughes Boulevard
Hickory, NC 28601
NORTH CAROLINA
Environmental Quality
September 30, 2024
SUBJECT: Compliance Evaluation Inspection
291 Hughes Boulevard North Single Family Residence Wastewater Treatment System
NPDES General Permit No. NCG550201
Alexander County
Dear Ms. Sias:
Enclosed is a copy of the Compliance Evaluation Inspection (CEI) Report for the inspection
conducted at your residence on September 30, 2024, by Mr. Alex Brown of this Office. As noted in the
inspection you are not noted as the current owner of this property. A name/ownership change has been
attached to this report. It has been indicated to our office that the property was purchased in November
2019. Annual permit fees for 2019 to 2023 are currently past due. Please see the attached invoices of past
permit fees needing remittance.
Please note that G.S. 143-215.6A provides for a civil penalty of not more than twenty-five
thousand dollars ($25,000.00), or twenty-five thousand dollars ($25,000.00) per day when the violation is
of a continuing nature, against any person who violates or fails to act in accordance with the terms,
conditions, or requirements of any permit issued pursuant to G.S. 143-215.1.
Should you have any questions concerning this report, please do not hesitate to contact Mr.
Brown at [phone] or at alex.browngdeq.nc.gov.
Sincerely,
DocuSigned by:
A HP
F161 F669A2D84A3...
Andrew Pitner, P.G.
Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
E Q�� North Carolina Department of Environmental Quality I Division of Water Resources
_ Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
NORTH CAROLINA
Depanmem of EnvirDnmemai auar� /` 704.663.1699

Attachments: Ownership Change Form, Compliance Evaluation Inspection, Annual Fees
Cc: Andrea Sias (via eCopy)
NPDES Program Files — Laserfiche
North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
NORT�CARQ�UNA
D.Ped .d&EnAwn-dalUw�� 704.663.1699

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I III II I II I I III I II II II II II
INVOICE * 2 0 1 9 P R 0 1 0 6 3 0
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated
with your permit. It is required of any person holding a permit for any time during the annual fee period, regardless
of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and
you later decide a permit is needed, you must reapply, with the understanding the permit request may be denied
due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2019PRO10630
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Annual Fee Period: 12/01/2019 to 11/30/2020
Invoice Date: 11/05/2019
Due Date: 12/05/2019
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://epay.deg.nc.gov/wq-epayments.htmi to pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $35.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-506.
6. The Department cannot accept checks older than 6 months under Uniform Commercial Code 4-404.
7. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
8. Should you need to update any Owner/Permit/Contact information or have any questions regarding this invoice, please send
email to dwgepay(cDdeg.nc.goy or you may also contact the following:
- NPDES WW Program Administrative Contact at 919-707-3601 or
- Annual Administering and Compliance Fee Coordinator at 919-707-3698
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2019PRO10630
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Overdue
Annual Fee Period: 12/01/2019 to 11/30/2020
Invoice Date: 11/5/2019
Due Date: 12/5/2019
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I II I I II II I I III I II II I III II
INVOICE * 2 0 2 0 P R 0 1 0 6 1 3
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated
with your permit. It is required of any person holding a permit for any time during the annual fee period, regardless
of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and
you later decide a permit is needed, you must reapply, with the understanding the permit request may be denied
due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2020PRO10613
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Annual Fee Period: 12/01/2020 to 11/30/2021
Invoice Date: 11/05/2020
Due Date: 12/05/2020
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://epay.deg.nc.gov/wq-epayments.htmi to pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $35.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-506.
6. The Department cannot accept checks older than 6 months under Uniform Commercial Code 4-404.
7. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
8. Should you need to update any Owner/Permit/Contact information or have any questions regarding this invoice, please send
email to dwgepay(cDdeg.nc.goy or you may also contact the following:
- NPDES WW Program Administrative Contact at 919-707-3601 or
- Annual Administering and Compliance Fee Coordinator at 919-707-3698
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2020PRO10613
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
..o.00ao,o,,,.
Overdue
Annual Fee Period: 12/01/2020 to 11/30/2021
Invoice Date: 11/5/2020
Due Date: 12/5/2020
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I II I II III I I III I III II I I I II
INVOICE * 2 0 2 1 P R 0 1 0 8 8 9
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated
with your permit. It is required of any person holding a permit for any time during the annual fee period, regardless
of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and
you later decide a permit is needed, you must reapply, with the understanding the permit request may be denied
due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2021 PRO10889
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Annual Fee Period: 12/01/2021 to 11/30/2022
Invoice Date: 11/02/2021
Due Date: 12/02/2021
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://epay.deg.nc.gov/wq-epayments.htmi to pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $35.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-506.
6. The Department cannot accept checks older than 6 months under Uniform Commercial Code 4-404.
7. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
8. Should you need to update any Owner/Permit/Contact information or have any questions regarding this invoice, please send
email to dwgepay(cDdeg.nc.goy or you may also contact the following:
- NPDES WW Program Administrative Contact at 919-707-3601 or
- Annual Administering and Compliance Fee Coordinator at 919-707-3698
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2021 PRO10889
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Overdue
Annual Fee Period: 12/01/2021 to 11/30/2022
Invoice Date: 11/2/2021
Due Date: 12/2/2021
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I II I II III I I III II I II III I II
INVOICE * 2 0 2 2 P R 0 1 1 0 0 5
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated
with your permit. It is required of any person holding a permit for any time during the annual fee period, regardless
of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and
you later decide a permit is needed, you must reapply, with the understanding the permit request may be denied
due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2022PRO11005
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Annual Fee Period: 12/01/2022 to 11/30/2023
Invoice Date: 11/02/2022
Due Date: 12/02/2022
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://epay.deg.nc.gov/wq-epayments.htmi to pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $35.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-506.
6. The Department cannot accept checks older than 6 months under Uniform Commercial Code 4-404.
7. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
8. Should you need to update any Owner/Permit/Contact information or have any questions regarding this invoice, please send
email to dwgepay(cDdeg.nc.goy or you may also contact the following:
- NPDES WW Program Administrative Contact at 919-707-3601 or
- Annual Administering and Compliance Fee Coordinator at 919-707-3698
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2022PRO11005
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Slas
291 Houghes Blvd N
Hickory, NC 28601
..o..oao„oo,.
Overdue
Annual Fee Period: 12/01/2022 to 11/30/2023
Invoice Date: 11/2/2022
Due Date: 12/2/2022
Annual Fee: $60.00
Check Number:

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I II I III II I I III I II I I I II I II
INVOICE * 2 0 2 3 P R 0 1 0 9 2 1
Annual Permit Fee Overdue
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated
with your permit. It is required of any person holding a permit for any time during the annual fee period, regardless
of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and
you later decide a permit is needed, you must reapply, with the understanding the permit request may be denied
due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2023PRO10921
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
Annual Fee Period: 12/01/2023 to 11/30/2024
Invoice Date: 11/03/2023
Due Date: 12/03/2023
Annual Fee: $60.00
Notes:
1. You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
2. If payment is by check/money order, please remit payment to:
NCDEQ - Division of Water Resources
Attn: Animal/Discharge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, please see https://epay.deg.nc.gov/wq-epayments.htmi to pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A $35.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-506.
6. The Department cannot accept checks older than 6 months under Uniform Commercial Code 4-404.
7. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
8. Should you need to update any Owner/Permit/Contact information or have any questions regarding this invoice, please send
email to dwgepay(cDdeg.nc.goy or you may also contact the following:
- NPDES WW Program Administrative Contact at 919-707-3601 or
- Annual Administering and Compliance Fee Coordinator at 919-707-3698
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2023PRO10921
Permit Number: NCG550201
Alexander County
291 Hughes Boulevard North
Andrea Sias
291 Houghes Blvd N
Hickory, NC 28601
..o.,oao,o,.,.
Overdue
Annual Fee Period: 12/01/2023 to 11/30/2024
Invoice Date: 11/3/2023
Due Date: 12/3/2023
Annual Fee: $60.00
Check Number:

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permittee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
❑ Submit an original completed and appropriately executed application (PNOCF 01-16).
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
❑ Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Deliverv:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

DWR
Division of Water Resources
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name:
2. Signature authority's name:
3. Signature authority's title:
4. Permittee's mailing address:
City: State:
5. Permittee's contact information
II. APPLICANT INFORMATION:
1. Applicant's name:
2. Signature authority's name:
3. Signature authority's title:
4. Applicant's mailing address:
City: State:
5. Applicant's contact information:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
per 15A NCAC 02T .0106(b)
Zip: -
Phone number: (_)
Email Address:
per 15A NCAC 02T .0106(b)
6. Representative's name:
7. Representative's title:
8. Representative's contact information
III. PERMIT INFORMATION:
Zip: -
Phone number: ()
Email Address:
Phone number: (_) _-
Email Address:
1. Existing permit number: and most recent issuance date:
2. Reason for the permit application: Select If other, attach detailed explanation
3. Has the facility been constructed? ❑ Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ❑ Yes or ❑ No
Fax Number (_) _-
Fax Number () --
Fax Number (_) _-
FORM: PNOCF 01-16 Page 1 of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Applicant's Certification per 15A NCAC 02T .0106(b):
Date:
I, attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: PNOCF 01-16 Page 2 of 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 1 2 u 3 I NCG550201 111 121 24/09/30 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
1.0 701� I 71I LI 72 I rL., I 71 I 74 79
LJ -1 I I I I I I I I I80
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 permit Number)
09:OOAM 24/09/30
13/08/01
291 Hughes Boulevard North
291 Houghes Blvd N
Exit Time/Date
Permit Expiration Date
Hickory NC 28601
09:15AM 24/09/30
18/07/31
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 Bollinger,291 Houghes Blvd N Hickory NC 28601///
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenar Records/Reports
Self -Monitoring Progran 0 Sludge Handling Dispo: Facility Site Review Effluent/Receiving Wate
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
Alex Brown Docusigned by: DWR/MRO WQ/707-235-2100/
t" $��9/30/2024
EADE20AD9DB597452...
��dRs eviewer Agency/Office/Phone and Fax Numbers Date
Signature of Ma7�AMUA3—
Andrew Pit e ' H P' "k9WR/MRO WQ/704-663-1699 Ext.2180/ 9/30/2024
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
NCG550201 I11 12I 24/09/30 117 18 i c i
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#

Permit: NCG550201 Owner - Facility:
291 Hughes Boulevard North
Inspection Date: 09/30/2024 Inspection Type:
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?
■
❑
❑
❑
Comment: Permit fees are currently overdue, permitee acquired the property in November 2019.
The permitee has been informed that a change of ownership/name
must be completed
and remit past due payments.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
❑
❑
❑
Is all required information readily available, complete and current?
■
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
❑
❑
■
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
■
❑
Is the chain -of -custody complete?
❑
❑
■
❑
Dates, times and location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
❑
❑
■
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
■
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified
❑
❑
■
❑
operator on each shift?
Is the ORC visitation log available and current?
❑
❑
■
❑
Is the ORC certified at grade equal to or higher than the facility classification?
❑
❑
■
❑
Is the backup operator certified at one grade less or greater than the facility
❑
❑
■
❑
classification?
Is a copy of the current NPDES permit available on site?
❑
❑
■
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
■
❑
Comment:
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Permit: NCG550201
Inspection Date: 09/30/2024
Owner - Facility: 291 Hughes Boulevard North
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:
Septic Tank
Yes
No
NA
NE
(If pumps are used) Is an audible and visual alarm operational?
❑
❑
0
❑
Is septic tank pumped on a schedule?
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❑
❑
Are pumps or syphons operating properly?
❑
❑
■
❑
Are high and low water alarms operating properly?
❑
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0
❑
Comment: Septic tank was last pumped November 27, 2019. Permitee has indicated that pumping
will occur again on that date at the 5 year mark.
Disinfection -Tablet
Are tablet chlorinators operational?
Are the tablets the proper size and type?
Number of tubes in use?
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
Is there chlorine residual prior to de -chlorination?
Comment: Permitee has the correct size and make of tablets.
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0
degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
representative)?
Comment: Permitee has not performed sampling due to the system having no flow.
Yes
No
NA
NE
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❑
❑
❑
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2
Yes No NA NE
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