WQ0013116_2023 Residual Annual Report_20240308 (2)

ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
PERMIT #: WQ0013116 FACILITY NAME: Waynesville Wastewater Treatment Plant
PHONE: [phone] COUNTY: Haywood OPERATOR: Mark Jones/Jeff Evans
FACILITY TYPE (please check one): 0 Surface Disposal(complete Part A (Source(s) and "Residual In" Volume only) and Part C)
❑ Distribution and Marketing (complete Parts A, B, and C)
Was the facility in operation during the past calendar year? 0 Yes El No No If No skip parts A, B, C and certify form below
Part A*: Part B*:
Sources s (include NPDES #if Volume (dry tons) Recipient Information
Month Amendment/ Volume (dry
applicable) Bulking Agent Residual In Product Out Name(s) tons) Intended use(s)
January
February
March
April
May
June
July
August
September
October
November
December
Totals: Annual (dry tons):1 0 0 0 0
Amendments used: Bulking Agent(s) used:
* If more space than given is required, please attach additional information sheet(s). ❑ Check box if additional sheet(s) are attached
Part C:
Facility was compliant during calendar year with all conditions of the permit (including but not limited to items 1-3 below) issued by the
Division of Water Resources. p Yes ❑ No If No, please provide a written description why the facility was not compliant.
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 Pf fine l and imprisonment for knowing violations."
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Signat e o ermittee Date Signatu e reparer** Date
(if different from Permittee) **Preparer is defined in 40 CFR Part 503.9(r)
DENR FORM DMSDF (11/2005)