WQ0018688_Residual Annual Report 2021_20220224

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) * WQ0018688
ApplicantlPermittee Town of Dallas
Email Notifications
Does this need review by the hydrogeologist?* Yes No
Regional Office
CO Reviewer
Admin Reviewer

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* TOWN OF DALLAS WTP
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*
7049221309
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-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.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Perm it Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number: *
WQ0018688
Has Current Existing permit number
Applicant/Permittee Address*
1342 Dallas Stanley Hwy Dallas NC 28034
Facility Name*
Town of Dallas Class A Residuals Program
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 Plans, Specifications, Calculations, Etc.)
2021 Annual Permit (WQ0018688).pdf 364.74KB
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
za ¢r'� fay
Submission Date 2/24/2022

ANNUAL LAND APPLICATION CERTIFICATION FORM
Permit#: WQ0018688 County: GASTON Year: 2021
TOWN OF DALLAS WTP
Facility Name (as shown on permit):
Land Application Operator:
ZACH KEYS Phone: [phone]
Land application of residual solids as allowed by the permit occurred during the past calendar year?
❑ Yes o No If No, skip Part A, and Part B and proceed to the certification. Also, if residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A:
Total number of application fields in permit:
Total number of fields land application occurred during the year:
Total amount of dry tons applied during the year for all application sites:
Total number of acres land application occurred during the year:
Part B:
Facility was compliant during calendar year 365 with all conditions of the land application permit
(including but not limited to items 1-12 below) issued by the Division of Water Resources.o Yes 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 pH 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 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 Table 1 of 40 CFR Part 503.13 or the
Pollutant Loading Rates in Table 2 of 40 CFR part 503.13 (applicable to 40 CFR Part 503 regulated facilities).
7. All general requirements in 40 CFR Part 503.12 and management practices in 40 CFR Part 503.14 were
complied with (applicable to 40 CFR Part 503 regulated facilities).
8. 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.
9. No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of
violations are attached to include appropriate actions and remediations.
10. Vegetative cover as specified in the permit was maintained on this site and the crops grown were removed
in accordance with the crop management plan.
11. No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
12. All buffer requirements as specified on the permit were maintained during each application of residuals.
"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."
Zackery Foreman / Water Superintendent
Permittee Name and Title (type or print)
Signature of Permittee
Date
Signature of Preparer* Date Signature of Land Applier Date
(if different from Permittee)
* Preparer is defined in 40 CFR Part 503.9 (r)
(if different from Permittee and Preparer)
DENR FORM ACF (5/2003)