WQ0014105_Staff Report_20221202

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December 2, 2022
State of North Carolina
Division of Water Resources
Water Quality Regional Operations Section
Staff Report
To: DWR Central Office — WQ, Non -Discharge Unit Application No.: W00014105
Attn: Cord Anthony Facility name: 4933 Stafford Mill Rd SFR
From: Caitlin Caudle
Winston-Salem Regional Office
Note: This form has been adapted from the non -discharge facility staff report to document the review of both non -discharge and NPDES permit applications and/or renewals. Please complete all sections as they are applicable.
L GENERAL AND SITE VISIT INFORMATION
1. Was a site visit conducted? ® Yes or ❑ No
a. Date of site visit: 8/31/2022
b. Site visit conducted by: J. Gonsiewski
c. Inspection report attached? ® Yes or ❑ No
II. EXISTING FACILITIES: MODIFICATION AND RENEWAL APPLICATIONS
1. Are there appropriately certified Operators in Charge (ORCs) for the facility? ❑ Yes ❑ No ® N/A
2. Are the design, maintenance and operation of the treatment facilities adequate for the type of waste and disposal
system? ® Yes or ❑ No
3. Are the site conditions (e.g., soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating the waste? ® Yes or ❑ No
4. Has the site changed in any way that may affect the permit (e.g., drainage added, new wells inside the compliance
boundary, new development, etc.)? ❑ Yes or ® No
5. Are the existing application rates (e.g., hydraulic, nutrient) still acceptable? ® Yes or ❑ No
6. Are there any setback conflicts for existing treatment, storage and disposal sites? ❑ Yes or ❑ No
7. Is the description of the facilities as written in the existing permit correct? ® Yes or ❑ No
8. Are there any permit changes needed in order to address ongoing BIMS violations? ❑ Yes or ® No
9. Check all that apply:
® No compliance issues ❑ Current enforcement action(s) ❑ Currently under JOC
❑ Notice(s) of violation ❑ Currently under SOC ❑ Currently under moratorium
Have all compliance dates/conditions in the existing permit been satisfied? ® Yes ❑ No ❑ N/A
10. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit?
❑ Yes ®No❑N/A
FORM: WQROSSR 04-14 Page 1 of 2

III. REGIONAL OFFICE RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes or ® No
2. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office
® Hold, pending review of draft permit by regional office
❑ Issue upon receipt of needed additional information
❑ Issue
❑ Deny (Please state reasons: )
�Docuftned by:
3. Signature of report preparer:
Signature of regional supervisor:
Date: 12/2/2022
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The last compliance inspection reflected compliance with the subject permit. The report is attached. A site map made
by a previous inspector is also included for reference.
FORM: WQROSSR 04-14 Page 2 of 2

Compliance Inspection Report
Permit: WQ0014105 Effective: 01/01/18 Expiration: 12/31/22 Owner: Jeff M Cobb
SOC: Effective: Expiration: Facility: 4933 Stafford Mill Rd. SFR
County: Alamance 4933 Stafford Mill Rd
Region: Winston-Salem
Liberty NC 27298
Contact Person: Jeff M Cobb Title: Phone:
Directions to Facility:
From 185/40 take NC Hwy 62S. Go past where Hwy 61 veers off to R and take the 1 st L on Spoon Rd. Spoon Rd turns into Stafford
Mill Rd at the next intersection (site is on left past Cobb Rd).
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 08/31/2022 Entry Time 11:05AM Exit Time: 12:10PM
Primary Inspector: Jim J Gonsiewski Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Single -Family Residence Wastewater Irrigation
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions Permit Status Septic Tank
Disinfection Tablets Pump Tank Drip or Irrigation
General
(See attachment summary)
Page 1 of 4

Permit: WQ0014105 Owner - Facility: Jeff M Cobb
Inspection Date: 08/31/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On August 31, 2022, staff of the North Carolina Division of Water Resources Winston-Salem Regional Office (DWR)
performed a compliance inspection of the subject wastewater irrigation system. This compliance inspection was conducted
by DWR staff person Jim Gonsiewski. The system was in good working order and well maintained. The permit will expire on
12/31/2022. The inspection generally reflects compliance with the permit. .
Page 2 of 4

Permit: WQ0014105 Owner - Facility: Jeff M Cobb
Inspection Date: 08/31/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Permit Status Yes No NA NE
# Is the current resident in the home the Permittee? ❑ ❑ ❑
# If not, does the resident rent from the Permittee? ❑ ❑ ❑
Change of Ownership form needed? (Mail the form with the inspection letter) ❑ ❑ ❑
# Is there an inspection and maintenance agreement with a contractor? ❑ ❑ ❑
If YES, who is the contractor (include contact info)?
Comment:
Septic Tank Yes No NA NE
*** The septic tank and filters should be checked annually and pumped/cleaned as needed. **
Is all wastewater from the home connected to the septic tank? 0 ❑ ❑ ❑
# Does the permittee/resident know where the septic tank is located? ❑ ❑ ❑
Has the septic tank been pumped in the last 5 years? ❑ ❑ ❑
If YES, describe if known and proof (include date pumped):
# Does the septic tank have an EFFLUENT FILTER or SANITARY T? ❑ ❑ ❑
If FILTER, when was the filter cleaned and by who? Unknown
Comment:
Disinfection Tablets Yes No NA NE
*** Tablet chlorinator unit shall be checked weekly to ensure continuous and proper operation. ***
Does the permittee have the correct chlorine tablets? (If none, mark No) ❑ ❑ ❑
# Does the Permittee know the location of the chlorinator? ❑ ❑ ❑
Were chlorine tablets observed in the chlorinator? ❑ ❑ ❑
Are tablets contacting water? (If possible, poke them to determine.) 0 ❑ ❑ ❑
Comment:
Pump Tank Yes No NA NE
*** All pump and alarm sytems shall be inspected monthly. (Non -Discharge) ***
Is the pump working? ❑ ❑ ❑
Is the audible and visual high water alarm operational? ❑ ❑ ❑
# Does the permittee know how to check the pump & high water alarm? 0 ❑ ❑ ❑
# Last functional test:
Comment:
Drip or Irrigation Yes No NA NE
*** Irrigation sysetm shall be inspected monthly to ensure system is free of leaks and equipment is operating
as designed. ***
# Type of system (DRIP or IRRIGATION):
Page 3 of 4

Permit: WQ0014105 Owner - Facility: Jeff M Cobb
Inspection Date: 08/31/2022 Inspection Type: Compliance Evaluation Reason for Visit: Routine
# If IRRIGATION, number of sprinkler heads:
Are buffers and setbacks adequate?
Is the site free of ponding and runoff?
Does the application equipment appear to be working properly?
Is there a minimum two wire fence surrounding the entire irrigation area?
Comment:
General
# Are the treatment units locked and/or secured?
# Has resident had any sewage problems?
If YES, explain:
Does the system match the permit description?
If NO, explain:
Is the system compliant?
Is the system failing? (If yes, take pictures if possible)
If system is failing, describe any exposures to people/animals or environmental risks.
Comment: See Narrative
• ❑ ❑ ❑
• ❑ ❑ ❑
❑❑❑■
■❑❑❑
Yes No NA NE
■❑❑❑
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Page 4 of 4

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