WQ0019504_Residual Annual Report 2020_20210222

Initial 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)* WQ0019504
Applicant/Permittee City of Belmont
Email Notifications
Does this need review by the hydrogeologist?* r Yes r No
Regional Office Mooresville
CO Reviewer
Admin Reviewer

Submittal Form
Project Contact Information
Rease provide inforration on the person to be contacted by N B Staff
Name * Joseph Roy
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
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*
704-901-2077
O Modification - Minor
C Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r 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:* W00019504
Fbs Current Existing perm number
Applicant/Permittee Address* 205 N 10th St., PO BOX431, Belmont, NC 28012
Facility Name * City of Belmont DCAR
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Specifications, Calculations, Bc.)
Land Application Report 2020 WQ0019504.pdf 864.94KB
Upload only 1 FLFdocurrent (less than 250 NB). Miltiple documents rust be contained into one FDFfile 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
Submission Date 2/22/2021

2020
City of Belmont
Water Treatment Plant
2020 Annual Report
Land Application Program
Permit No. WQ0019504

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0019504 County: Gaston Year:
Facility Name (as shown on permit):
Land Application Operator:
2020
City of Belmont
US Biosoilds, Inc. Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
❑ Yes 0 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 application fields in thepermit:
NA
"total number of fields utilized for land application during the year:
0
Total amount of dry tons applied 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 2020 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 ❑ No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
I ) Only residuals approved for this permit were applied to the permitted sites.
2) Soil plI 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 .1 105(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. I I I I were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the pen -nit were complied with or, in the case of 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.
I I ) Vegetative cover was maintained and proper crop management was performed on, each site receing residuals, as
specified in the permit.
12) No runoff of residuals from 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 submittipg false information, including the
possibility of fines and imprisonment for knowing violations.XA
Permittee Name and Title (ype or print) Signature of Permittee Date
- (6- -2 / 1-/�' 2-1a-a0o I
Si a re f Preparer* 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 Blemont's Water Treatment Plant were stored in the clarifier at
the Water Treatment Plant. A land application event will be needed as soon as field and weather
conditions start to cooperate.