WQ0019504_Residual Annual Report 2019_20200226

Initial Review
INITIAL REVIEW
Reviewer Williams, Kendall
Is this submittal an application? (Excluding additional information.)*
r Yes r No
If not an application r Annual Report
what is the submittal r Residual Annual Report
type?* r Additional Information
r Other
Annual Report 2019
Year*
Date Paper Copy 2/26/2020
Received:*
Project Number* WQ0019504
Email Notifications
Does this need review by the hydrogeologist?*
r Yes r No
Regional Office
CO Reviewer
Admin Reviewer [e-mail]

Submitted Form
Project Contact Information
Rease provide information on the person to be contacted by MB Staff regarding electronic subnittal, confirmation of receipt, and other issues.
..........................................................................................................................................................................................................................................................................................................................................................................
Name * Joseph Roy
Email Address*
[e-mail]
Project Information
Submittal Type* r New Permit Application
r Renewal
r Annual Report
r Other
Permit Type * r Wastewater Irrigation
r Other Wastewater
r Closed -Loop Recycle
r Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?
r Yes r Nor N/A
Permit Number* WQ0019504
ApplicantTermittee * City of Belmont- Adrian Miller
Facility Name * PO BOX 431
Phone Number*
7049012077
r Modification (Major or Minor)
r Additional Information
r Residual Annual Report
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
Land Application Report 2019 2-20-2020.pdf 3.21 MB
Upload only 1 R7F document. NL@iple documents must be combined into one R7F file.

For new and modification permit applications, a paper copy may be required. If you have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a paper 2-pol cation is required,
be advised, applications accepted for pre -review until both the paper and elect-c-ii.- --ol:ies have been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments {talcs, soils report, specs, etc.]
o One full-size engineering plan set
o One 11x17" engineering plan set
o One extra set of specifications
o Fee (if required)
Mailine address:
Division of Water Resources ! Division of Water Resources
Non -Discharge Branch I Non -Discharge Branch
1617 Mail Service Center I Att: Nathaniel Thornburg, P Floor, Office #942W
- =
Raleigh, NC 27699-1617 S12 N.5alisburySt.
For questions or problems contact Tessa Monday attessa.monday@)ncdenr.Qov or 919.707.3560.
* rJ By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. I also confirm that the uploaded document is a single PDF with
all parts of the application in correct order (as specified by the application).
Signature
Submission Date 2/21/2020

2019
City of Belmont
Water Treatment Plant
2019 Annual Report
Land Application Program
Permit No, WQ0019504

ANNUAL LAND APPI-4ICATION CERTIFICATION FORM
WQ Permit#: WQ0019504 County: Gaston Year:
2019
Facility Name (as shown on permit):
Land Application Operator:
Southern Soil Builders, Inc.
City of Belmont
Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
0 Yes 21 No - If No, skip Part A, and Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A - Residuals Application Summary:
Total number of a22lication fields in ±Lper=mit. NA
Total number of fields utilized for land application during the year:
0
Total amount of dry tons appl ied during the year for all application sites:
0
Total number of acres utilizes for land application during the year:
0
Part B - Annual Compiance Statement:
Facility was compliant during calendar year 2019 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. 0 Yes El No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
1) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pl-1 was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pH of at least 6.0 or
the limit specified in the permit.
3) Annual soils analysis were performed on each site receiving residuals during the past calendar year and three (3) copies
of laboratory results are attached.
4) Annual TCLP analysis (if required) was performed and three (3) copies of certified laboratory results are attached.
5) All other monitoring was performed in accordance with the permit and reported during the year as required and three
(3) copies of certified laboratory results are attached.
6) The facility did not exceed any of the Pollutant Concentration Limits in 15A NCAC 02T .1 105(a) or the Pollutant
Loading Rates in 15A NCAC 02T. I 105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 15A NCAC 02T .1 1 1 1 were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior
authorization was received from the Division of Water Resources.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
1 1) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff ofresiduals fi-om the application sites onto adjacent property or nearby surface waters has occurred.
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitti false information, including the
possibility of fines and imprisonment for knowing violations."
>41rv"il
�-' T
A41r
Permittee Name and Title (type or print) Signature of Permittee Date
STOature of Pre4av6r* T Date Signature of Land`Applier Date
(if different from Permittee) (if different from Permittee and Preparer)
* Preparer is defined in 40 CFR_ Part 503.9 (r) and 15A NCAC 02T .1102 (26) DENR FORM ACF (12/2006)

All the residuals produced by the City of Belmont's Water Treatment Plant where stored in the clarifier
at the Water Treatment Plant. A land application event is planned as soon as weather and fields
conditions allow.