NCG550592_ncg550592 EPA form CEI 11.6.2024_20241106

Docusign Envelope ID:006DOE08-D43A-45D8-B6EF-9E368OA2CO4D
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 NCG550592 111 121 24/10/17 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 24/10/17 21/12/07
6906 Innesbrook Way
6906 Innesbrook Way Exit Time/Date Permit Expiration Date
Bahama NC 27503 01:46PM 24/10/17 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
Joyce Pickett,6906 Innesbrook Way Bahama NC 27503//919-608-0306/
No
Section C:Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement 0 Operations&Maintenar 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 Docusigned by, DWR/RRO WQ/919-791-4200/
11/6/2024
9EC679823B1D478-
Signature of Manageme�tgQ�Reviewer Agency/Office/Phone and Fax Numbers Date
VaAA f:,SSa f, tl Atn 1.d 11/13/2024
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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Docusign Envelope ID:006DOE08-D43A-45D8-B6EF-9E368OA2CO4D
NPDES yr/mo/day Inspection Type 1
31 NCG550592 I11 12I 24/10/17 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:006DOE08-D43A-45D8-B6EF-9E368OA2CO4D
Permit: NCG550592 Owner-Facility: 6906 Innesbrook Way
Inspection Date: 10/17/2024 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 famiily wastewater system consisting of septic tank, single pass gravity
sandfilter, chlorinato and outlet pipe.
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:
Disinfection-Tablet Yes No NA NE
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: Heavy concrete lid covers chlorinator-did not accesss during inspection.
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