NCG550366_Check Returned_20180125

1
a, ry
Water Resources
Environmental Quality
Nataly Gonzalez Velazquez
PO Box 158
Stoneville, NC 27048
January 25, 2018
Subject: Compliance Evaluation Inspection
Certificate of Coverage: NCG55025 3(o(.
4980 US Highway 220 Business, Stoneville
Rockingham County
Dear Ms. Velazquez:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
RECEIVED/DENRIDWR
FEB 0 5 2018
Water Resources
Permitting Section
On January 23, 2018, Jenny Graznak of this office conducted a compliance evaluation inspection
on the wastewater discharge system located at the above address. The State requires the Division
of Water Resources to inspect these types of systems every five years.
According to county records, you are the current owner of this property, which appears to be
have been vacant for many years. Ms. Graznak was unable to locate any components of the
wastewater system due to overgrown vegetation on the lot.
Please contact Ms. Graznak at [phone] to discuss your wastewater system and the
accompanying permit and to make sure we have an accurate phone number on file for you.
CC: WSRO Files
NPDES Unit
Sincerely,
X-R.� ' �-; /� 1119 9-R"'
Sherri V. Knight, P.E., Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
­ 57-, "'Nothing Compares'--,
State of North Carolina I Environmental Quality
450 W Hanes Mill Road, Suite 300, Winston-Salem, North Carolina 27105
Phone: [phone] FAX [phone]

Permit: NCG550366 Owner - Facility: 4980 U S Highway 220 Business
inspection Date: 01/23/2018 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
❑ ❑
M
❑
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?
❑ M
❑
❑
Comment: According to county records, you are the current owner of this property, which appears
to be
have been vacant for many years Ms. Graznak was unable to locate any components of the
wastewater system due to overgrown vegetation on the lot.
Page# 3

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 L�N � 2 15 1 3 I NCG550366 I11 12 18/01/23 17
18 1,.1 19 I s I 20�. I
211 1J1 1 1u1 1 1 1 1 11 1 I I I I I I I I I I 1 I I I I
I I 1 1 1 1 11 1 1 1 1 1 1616
.1
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved
67 70 I I 71 � 72 I N I
LJ u
73 74 75 80
L 1J
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)
04 OOPM 18/01/23
13/08/01
4980 U S Highway 220 Business
Exit Time/Date
Permit Expiration Date
4980 US Hwy 220 Business
04 30PM 18/01/23
18/07/31
Stoneville NC 27048
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Name, Address of Responsible OfficiaUTitle/Phone and Fax Number
Contacted
Richard Cunningham,4980 US Hwy 220 Business Stoneville NC
No
27048//336-573-3967/
Section C Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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
Jan n F Graznak WSRO WQ//336-771-5000/
/
/ Z 51,;?Vf
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
9 d� i f✓fiLv rGc• P
d I J
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page#

NPDES yr/mo/day Inspection Type (Cont)
31 NCG550366 I11 12 18/01/23 17 18 J,
Section D Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
On January 23, 2018, Jenny Graznak of this office conducted a compliance evaluation Inspection on
the wastewater discharge system located at the above address. The State requires the Division of
Water Resources to Inspect these types of systems every five years
According to county records, you are the current owner of this property, which appears to be have
been vacant for many years. Ms. Graznak was unable to locate any components of the wastewater
system due to overgrown vegetation on the lot.
Page#