WQ0038580_2022 Residual Annual Report_20230228 (2)

Initial Review
Reviewer
Nathaniel.Thornburg
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* 2022
Permit Number (IR) * WQ0038580
Applicant/Permittee Town of Hillsborough
Email Notifications
Does this need review by the hydrogeologist? * Yes No
Regional Office Raleigh
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* Brent Collins
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*
336-399-3646
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.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:* Wastewater Irrigation High -Rate Infiltration
Other Wastewater Reclaimed Water
Closed -Loop Recycle Residuals
Single -Family Residence Wastewater Other
Irrigation
Permit Number:* WQ0038580
Has Current Existing permit number
Applicant/Permittee Address* PO Box 429, Hillsborough, NC 27278
Facility Name* Town of Hillsborough 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.)
2022 Hillsborough Annual Report - WQ0038580.pdf 887.36KB
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 2/28/2023

February 28, 2023
DENR/Water Quality Section
Non -Discharge Compliance Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: 2022 Annual Report — Town of Hillsborough WTP
Treatment and Land Application of Residuals
Permit No. WQ0038580
Dear Sir or Madam:
Enclosed is the 2022 Annual Report for the above referenced land application permit.
There was no land application during 2022. Please contact Brent Collins - Director of
Technical Services if you have any further questions regarding this report.
Sincerely,
Brent Collins
Director of Technical Services
brent.collinskemaresourcesinc.com
Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

--Resources, Inc.
Town of Hillsborough
2022 Annual Report
Residuals Land Application
Permit No. WQ0038580
Prepared By:
EMA Resources, Inc.
Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0038580 FACILITY NAME:
Town of Hillsborough WTP
Orange OPERATOR: Town of Hillsborough WTP
❑ Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C)
1 Distribution and Marketing (complete Parts A, B, and C)
Was the facility in operation during the past calendar year? Yes ❑ No 21 0 If No skip parts A, B, C and certify form below
Il8[1L`LNi
CK�lIL`YY'1
FACILITY TYPE (please check one)
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)
0
0
0
0
Totals:
Annual (dry tons):
0
0
0
1
0
Amendment(s) used: I
Bulkin Agent(s) used:
(supp)): Total Number of Form DMSDF (Supp)l 0
* If more space is required, attach additional information sheets (FORM DMSDF
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 Quality: 0 No o 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 Quality.
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."
Nathan ,(l 7,29130823 EST)
Signature of Permittee
Feb 7, 2023
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)

2T Annual Report Forms
Final Audit Report 2023-02-07
Created: 2023-02-07
By: Brent Collins ([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAx7icLhYXm5xoNHCiHY23g6sWIXLdQBIV
"2T Annual Report Forms" History
Document created by Brent Collins ([e-mail])
2023-02-07 - 11:55:12 AM GMT- IP address: 206.85.202.26
Mo. Document emailed to Nathan Cates ([e-mail]) for signature
2023-02-07 - 11:55:49 AM GMT
Email viewed by Nathan Cates ([e-mail])
2023-02-07 - 1:22:56 PM GMT- IP address: 172.58.155.181
Document e-signed by Nathan Cates ([e-mail])
Signature Date: 2023-02-07 - 1:23:25 PM GMT - Time Source: server- IP address: 96.10.245.66
Agreement completed.
2023-02-07 - 1:23:25 PM GMT
a Adobe Acrobat Sign