HomeMy WebLinkAboutWQ0019753_Residual Annual Report 2020_20210122Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
If not an application what is the submittal type?* r Annual Report
r Residual Annual Report
r Additional Information
r Other
Annual Report Year* 2020
Permit Number (IR)* WQ0019753
Applicant/Permittee Town of Madison
Email Notifications
Does this need review by the hydrogeologist?* r Yes r No
Regional Office Winston-Salem
CO Reviewer
Admin Reviewer
Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by N B Staff regarding electibnittal, confirmation of receipt, other
.......................................................... electronic surece, aner correspondence.
_ -
Name * J Kevin Yates
Email Address*
madisonvAp@tomofmadison.org
Project Information
........ ......... .......................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
3364273971
O Modification - Minor
C Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
IT Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:* r Wastewater Irrigation r High -Rate Infiltration
r Other Wastewater r Reclaimed Water
r Closed -Loop Recycle r Residuals
r Single -Family Residence Wastewater r Other
Irrigation
Permit Number:* W00019753
Fbs Current Existing permt number
Applicant/Permittee Address* 403 Lindsey Bridge Rd.
Facility Name * Madison Water Plant
Please provide comments/notes on your current submittal below.
No land application in 2020. We have two lagoons that we plan to land apply in 2021.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at nathaniel.thornburg@ncdenr.gov.
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form} Engineering Rans, Specifications, Calculations, Bc.)
2020 land app.pdf 21.57KB
Upload only 1 RFdocurent (less than 250 fv8). Miltiple documents rust be confined into one RJFfile unless file is larger than
upload limit.
* V By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). 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).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature r�
0 c)(�Z-e q�t2
Submission Date 1/22/2021
CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0019753 FACILITY NAME:
Town of Madison WTP
PHONE: (336) 427-3971 COUNTY: Rockingham OPERATOR: J. Kevin Yates
FACILITY TYPE (please check one): ❑ Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C)
0 Distribution and Marketing (complete Parts A, B, and C)
Was the facility in operation during the past calendar year? Yes ❑ No ❑ m, If No slip parts A, B, C and certify form below
Part A*:
Part B*:
Month
Sources(s) (include NPDES # if
applicable)
Volume (dry tons)
Recipient Information
Amendment/
Bulking Agent
Residual In
Product Out
Name(s)
Volume (dry tons)
Intended use(s)
January
Did not land apply in 2020
February
March
April
May
June
July
August
September
October
November
December
Total from FORM DMSDF (sup)
Totals:
Annual (dry tons):
0
0
0
0
Amendment(s) used: Bulkingnt(s) used:
* If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form DMSDF (Supp)
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit ❑ Yes
(including but not limited to items 1-3 below) issued by the Division of Water Resources: ❑ No 0 If No, Explain in Narritive
1. All monitoring was done in accordance with the permit and reported for the year as required and three (3) copies of certified laboratory results are attached.
2. All operation and maintenance requirements were compiled with or, in the case of a deviation, prior authorization was received from the Division of Water Resources.
No contravention of Ground Water Quality Standards occurred at a monitoring well.
"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 submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee
Date Signature of Preparer**
(if different from Permittee)
**Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Date
DENR FORM DMSDF (12/2006)