WQ0013116_Residual Annual Report 2021_20220119

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
En.anmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
If not an application what is the submittal type?*
Annual Report
Residual Annual Report
Additional Information
Other
Annual Report Year* 2021
Permit Number (IR) * WQ0013116
Applicant/Permittee Town of Waynesville
Email Notifications
Does this need review by the hydrogeologist?* Yes • No
Regional Office
CO Reviewer
Admin Reviewer
Asheville

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name*
Preston Gregg
Email Address*
[e-mail]
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
8284009353
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
Residual Annual Report
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.deg.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Permit Number: *
Applicant/Permittee Address*
Facility Name*
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
W00013116
Has Current Existing permit number
566 Walnut Trail Rd., Waynesville NC 28785
Town of Waynesville Class A Residuals Program
Please provide comments/notes on your current submittal below.
No Class A residuals applied in year 2021.
100% hauled off to county landfill facility
High -Rate Infiltration
Reclaimed Water
Residuals
Other
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 Plans, Specifications, Calculations, Etc.)
Online Land Application Form DMSDF.pdf 392.35KB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
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 1/19/2022

CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0013116 FACILITY NAME:
WAYNESVILLE WWTP
PHONE: [phone] COUNTY: HAYWOOD
OPERATOR:
MARK JONES / JEFF EVANS
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 -* If No skip 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
February
March
April
May
June
July
August
September
October
November
December
Total from FORM DMSDF (sup)
Totals:
I Annual (dry tons):
0
0
0
0
Amendment(s) used: I
Bulking Agent(s) used:
DMSDF (Supp)
* If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit
(including but not limited to items 1-3 below) issued by the Division of Water Resources:
0 Yes
❑ No 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.
3. 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."
cTeljf Sthres - Public Services Director
Signature of Permittee
1-19-2022
Date
**Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Signature of Preparcr**
(if different from Permittee)
1-19-2022
Date
DENR FORM DMSDF (12/2006)