WQ0014543_Regional Office Historical File Pre 2018 (2)

ATA
NCDENR
North Carolina Department of Environment and
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder
Governor Director
September 17, 2013
Mr. Joe Hudson — Water Resources Director
City of Statesville
PO Box 1111
Statesville, NC 28687-1111
Dear Mr. Hudson:
Natural Resources
7
III
__._._.__...
Secretary
LIL SEP 2 3 2013 i ,
L
NGDENR MRO
LD'h/f . - AgUifOr nrotC'rtio
Subject: Permit No. WQ0014543
Land Application of Class B
Residuals (Non -dedicated)
Iredell County
In accordance with your permit renewal request received July 12, 2013, we are forwarding
herewith Permit No. WQ0014543 dated September 17, 2013, to the City of Statesville for the operation of
the subject residuals management program as an emergency backup alternative to Permit No.
WQ0016247 (issued to Synagro Inc.) and Permit No. WQ0006245 (Sta-Lime distribution permit issued to
the City of Statesville). Please be advised that the approved land application sites listed on Attachment B
is not sufficient for land application of the residuals amount listed on Attachment A. Hence, additional
land application sites may be required and must be approved prior to utilization. Please note that this
renewed permit shall become effective on March 1, 2014 (i.e. the day after the expiration date of the
existing permit), which may differ from the issuance date of this letter.
This permit shall be effective from March 1, 2014 until February 28, 2019, and shall be subject to
the conditions and limitations as specified. therein. Please pay particular attention to the monitoring
requirements listed in Attachments A for they may differ from the previous permit issuance. Failure to
establish an adequate system for collecting and maintaining the required operational information shall
result in future compliance problems.
Please note that on September 1, 2006, North Carolina Administrative Code Title 15A
Subchapter 02T — Waste not Discharged to Surface Waters was adopted. Accordingly, this permit
incorporates the requirements of these rules, therefore, please take the time to review this permit
thoroughly.
If any parts, requirements or limitations contained in this permit are unacceptable, the Pennittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: http://portal.ncdenr.orq/web/wq/aps
An Equal Opportunity \ Affirmative Action Employer

Mr. Hudson
September 17, 2013
Page 2 of 2
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Chonticha McDaniel at
[phone] or [e-mail].
Sincerely,
Thomas A. Reeder
cc: Iredell County Health Department
Booresvi.11e Regional-O ce;,4quifer Protection Section
Beth Buffington, Aquifer Protection Section
Permit File WQ0014543
Notebook File WQ0014543

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS B RESIDUAL SOLIDS PERMIT (NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Statesville
Iredell County
FOR THE
operation of a residuals management program as an emergency backup alternative for the City of
Statesville and consisting of the land application of Class B residuals generated by the approved facilities
listed in Attachment A to the approved sites listed in Attachment B with no discharge of wastes to surface
waters, pursuant to the application received July 12, 2013, and in conformity with other supporting data
subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit. The use and disposal of residuals are regulated under Title 40 Code of
Federal Regulations Part 503. This permit does not exempt the Permittee from complying with the federal
regulations.
This permit shall be effective from March 1, 2014 until February 28, 2019, and shall be subject to the
following specified conditions and limitations:
I. SCHEDULES
1. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application.
2. Prior to land applying residuals to the approved land application sites listed on Attachment B, the
Permittee shall submit updated setback maps and O&M plan (in accordance with Condition III.4) to
the Mooresville Regional Office.
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II. PERFORMANCE STANDARDS
1. The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Mooresville regional office's supervisor, and take any
immediate corrective actions.
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs):
Parameter
Ceiling Concentration
(milligrams per kilogram)
CPLR
(pounds per acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
n/a
Nickel
420
374
Selenium
100
89
Zinc
7,500
2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application have not occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC
02T .1106 (a) and (c). Exceptions to this requirement shall be specified in Attachment A.
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to this requirement shall be specified in Attachment A.
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8. Setbacks for land application sites shall be as follows:
Setback Description
Setback by application type
(feet)
Vehicular
Surface
Application
Irrigation
Surface
Application
Injection /
In corporation
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
part of the project site
400
400
200
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
lessee/operator of the land to be maintained as part
of the project site
0
200
0
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams — intermittent and perennial,
perennial waterbodies, and wetlands)
100
100
50
Surface water diversions (ephemeral streams,
waterways, ditches)
25
100
25
Groundwater lowering ditches (where the bottom of
the ditch intersects the SHWT)
25
100
25
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
more in vertical height
15
15
15
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
9. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
10. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science (http://nutrients.soil.ncsu.edu/yields/index.php).
A copy shall be kept on file and reprinted every five years in accordance with Condition IV.7(j).
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c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncagr.gov/SWC/tech/documents/9th Guidance Doc100109.pdf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards (ftp://ftp-fc.sc.egov.usda.gov/NHQ/practice-standards/standards/590.pdf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards.
12. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied.
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee
shall maintain written records of these recommendations and details of their implementation.
14. The compliance boundary for residual land application sites shall be specified in accordance with
15A NCAC 02L .0107(b). These sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application
area. An exceedance of groundwater standards at or beyond the compliance boundary is subject to
remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B.
15. In accordance with 15A NCAC 02L .0108, the review boundary shall be established midway between
the compliance boundary and the residual land application area. Any exceedance of groundwater
standards at the review boundary shall require action in accordance with 15A NCAC 02L .0106.
III. OPERATION AND MAINTENANCE REQUIREMENTS
1, The residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards.
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2. The Mooresville Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall be notified at least
48 hours prior to the initial residuals land application to any new land application site. Notification to
the Aquifer Protection Section's regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on
Monday through Friday, excluding State Holidays.
3. The Mooresville Regional Office shall be notified via email or telephone, [phone], at least 24
hours prior to conducting any land application activity. Such notification shall indicate, at a
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply to additional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields.
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan) pursuant to
15A NCAC 02T .1110. Modifications to the O&M Plan shall be approved by the Division prior to
utilization of the new plan. The O&M Plan, at the minimum, shall include:
a) Operational functions;
b) Maintenance schedules;
c) Safety measures;
d) Spill response plan;
e) Inspection plan including the following information:
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, and
procedures to assure that the selected location(s) and inspection frequency are representative
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuant to the
noncompliance notification requirements under the monitoring and reporting section of the
permit;
f) Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for
any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that
land apply multiple times per year but have an annual sampling frequency, may need to
sample during winter months when pathogen reduction is most likely to be negatively
affected by cold temperatures).
5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee shall designate and employ a certified operator in
responsible charge (ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC 08G .0201. The ORC or their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204; or as specified in the most recently approved O&M plan (i.e., see Condition I11.4),
and shall comply with all other conditions of 15A NCAC 08G. 0204. For more information regarding
classification and designation requirements, please contact the Division of Water Resources's
Technical. Assistance & Certification Unit at [phone].
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M Plan shall
be maintained at the land application sites during land application activities.
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7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles.
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division.
9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied in accordance with the crop management plan
outlined by the local Cooperative Extension Office, the Department of Agriculture and Consumer
Services, the Natural Resource Conservation Service, or an agronomist and as approved by the
Division.
11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of
surface water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporated within
a 24-hour period following a residuals land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a final soil pH of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will be noted in this permit;
i. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in
a USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
g-
12. The following public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event.
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13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under D1.12 apply.
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
Duration
Animals shall not be allowed to graze during land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
prevent access after each land application event.
30 days
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for:
12 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e.g., tobacco, melons, cucumbers, squash, etc.)
shall not be harvested for:
14 months
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the land
surface (e.g., root crops such as potatoes, carrots, radishes, etc.) shall not be
harvested for:
20 months
When the residuals remain on the land surface for less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
surface shall not be harvested for:
38 months
15. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for
those operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (NRCS) or other State Agencies. The Permittee shall calculate allowable
nutrient loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan.
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LOAA)
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permit expiration date,
and shall be renewed during the permit renewal process.
IV. MONITORING AND REPORTING REQUIREMENTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed.
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2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)] shall be performed at the frequency specified in
Attachment A, and the Permittee shall maintain these results for a minimum of five years. If residuals
generated by a particular residuals source -generating facility are land applied at a frequency less than
that which is specified in the most recently -certified Attachment A of this permit, the analyses shall
be required for each residuals land application event. Any exceptions from the requirements in this
condition shall be specified in Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):
Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide)
(0.008)
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A,
the Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following parameters:
Aluminum
Mercury
Potassium
Ammonia -Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
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4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficient to demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
condition shall be specified in Attachment A.
5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomi/pubs.htm). The Permittee shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a period of no less than five years, and shall be made available to the Division upon request. At a
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc •
Copper
pH
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Permittee shall maintain records tracking all residual land application events. At a minimum,
these records shall include the following:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops to be grown on field;
j. Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in gallons per acre, cubic yard per acre, dry tons per acre, or wet
ton per acre;
1. Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
m. Volume of soil amendments (e.g., lime, gypsum, etc.) applied in gallons per acre, dry ton per
acre, or wet tons per acre; and
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n. Annual and cumulative totals in dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be limited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.
8. Three copies of an annual report shall be submitted on or before March r`. The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Forms. Instructions for reporting and annual report forms are available at
http://portal.ncdenr.org/web/wq/aps/lau/reporting, or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
9. Noncompliance Notification
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, as soon as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
V. INSPECTIONS
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
environment, a threat to human health or a public nuisance. The Permittee shall maintain an
inspection log that includes, at a minimum, the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this inspection log
for a period of five years from the date of inspection, and this log shall be made available to the
Division upon request.
WQ0014543 Version 3.0
Shell Version 130801 Page 10 of 12

3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or
copy any records required to be maintained under the terms and conditions of this permit; and may
collect groundwater, surface water or leachate samples.
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C.
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit.
3. This permit is effective only with respect to the nature and volume of residuals described in the
permit application and other supporting documentation.
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4
and under the Division's General Permit NCG010000; any requirements pertaining to wetlands under
15A NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of
Chapter 143 of the General Statutes.
5. In the event the residuals program changes ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner.
6 This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110.
7. Unless the Division Director grants a variance, . expansion of the permitted residuals program
contained herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC
02T .0120(b).
8. The Penmittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e)(3).
W00014543 Version 3.0
Shell Version 130801 Page 11 of 12

Permit issued this the 17th day of September 2013
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
A. Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0014543
WQ0014543 Version 3.0
Shell Version 130801 Page 12 of 12

ATTACHMENT A - Approved Residual Sources
City of Statesville
Certification Date: September 17, Z013 .
Permit Number: WQ0014543 Version: 3.0 •
Owner
Facility Name
County
Permit
Number
Biological
Residuals
Maximum
Dry Tons
Per Year 1
Monitoring
Frequency for
Non-hazardous
2
CharacteristicsNutrients
Monitoring
Frequency for
Metals and
Monitoring
Frequency for
Pathogen &
Vector Attraction
Reductions "'s
Approved
Mineralization
Rate
City of Statesville
Fourth Creek WWTP
Iredell
NC0031836
Yes
1,057
Annually
See Table Below
See Table Below
0.30
City of Statesville
Third Creek WWTP
Iredell
NC0020591
Yes
975
Annually
See Table Below
See Table Below
0.30
Total
2,032
I . The dry tons per year of residuals listed here represents the total maximum volume of residuals generated by th's facility and may not be equivalent to the volume of residuals that may be land
applied to the land application sites approved in the Attachment B. Note that residuals shall be land applied at or below agronomic rates (see Condition II.10) and, therefore, only certain volume
of residuals shall be applied at the approved sites.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IV.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T .1111)
<319
1/Year
=>319 - <1,650
1/ Quarter (4 times per year)
=>1,650 - <16,500
1/60 Days (6 times per year)
_> 16,500
1/month (12 times per year)
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is required), then no
sampling data is required during the period of inactivity. The annual report shall include an explanation for missing sampling data. Those required to submit the annual
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification.
Page 1 of 2

ATTACHMENT A - Approved Residual Sources Certification Date: September 17, 2013
City of Statesville Permit Number: WQ0014543 Version: 3.0
THIS PAGE BLANK
Page 2 of 2

ATTACHMENT B - Approved Land Application Sites
City of Statesville
Field/
Site
01
02
Total
Certification Date: September 17, 2013 .
Permit Number: WQ0014543 Version: 3.0 •
Owner
Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil Series
Footnotes
City of Statesville
Iredell
35°46'12"
80°47'24"
15.30
Lloyd
1
City of Statesville
Iredell
35°44'24"
80°50'24"
14.10
Cecil
1
29.40
1. The total net acreage associated with these land application sites is not sufficient to land apply the total maximum volume of residuals approved in the Attachment A at agronomic rates. Shoul
the Permittee require additional back-up sites, a permit modification application package shall be submitted no later than 180 calendar days prior to land application of residuals on the new sites.
Page 1 of 1

•
V
T Y MAP•
Third Creek g Fourth Craek Si

tesvil
15.1 I n g .4, 831
-
FIELD 14.1 L OO 14 543
FOURTH CREE.K .SITE
Tract Acreage: 15.3
Buffer Acreage: 7. 7'
. Total Acreage: 23.0
Drawing Scale: 1"=200'
Property One
City Limits Line.
OIMMI
•

1 !J3
-f
r' •f tLo #2 WQco 14543
THIRD CREEK SITE
Tract Acreage: 14.1
=Buffer Acreage: 7.2
Total Acreage: 21.3
•A
I
Drawing Scale: 1 "=200'

AQUIFER PROTECTION SECTION '- ; �P�
APPLICATION REVIEW REQUEST FORM ,_ i ,., J. _ti ,, , ;� ;; 0' ,J,
Date: July 17, 2013 �ja31 J 2 2t a20 (-', `` (�+/,'
oUn -U - uAU_,c- i,i.p1 C-
To: ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS, -�`t F' ` r"r`t ` ' `',
❑ ❑ Morella King, WiRO-APS Art Barnhardt, FRO-APS Zf;' :tckft J r _' fir,' `'
.,
® l\ndrewyittrewm Ro--7A-Psri ❑ Sherri Knight, WSRO-APS
❑ Rick Bolich, RRO-APS
From: Chonticha McDaniel ❑AFO❑GW Protection❑GW Planning ®LAU
E-Mail: chonticha.mcdaniel(a ncdenr.gov
Telephone: [phone] Fax:[phone]
A. Permit Number: WQ0014543 B. Owner: City of Statesville
C. Facility/Operation: City of Statesville Residuals Land Application
❑ Proposed ® Existing ❑ Facility ® Operation
D. Application:
1. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reclaimed ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
❑ UIC - (5A7) open loop geothermal ❑ Single Family Residence
Residuals
2. Project Type: ❑ New ❑ Major Mod. ❑ Minor Mod. ® Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will fmd all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
❑ Return a Completed APSARR Form.
❑ BIMS indicates monitoring wells locations are not complete. Please% update monitoring well
locations not currently in BIMS.
❑ BIMS indicates ongoing ❑ NDMR ❑NDAR ❑ GW monitoring violations. Please investigate
reoccurring compliance issues and summarize results in staff report.
❑ Attach Well Construction Data Sheet.
❑ Process Attachment B for Certification by the Land Application Unit (LAU).
❑ Issue an Attachment B Certification from the RO.*
*coordinating site visits and reviews, as well as additional information requests with other RO-APS
representatives in order to prepare a complete Attachment B for certification. Refer to the RPP SOP for
additional detail.
Please indicate the name and date assigned in the spaces below, make a copy of this sheet, and return it to
the appropriate Central Office -Aquifer Protection Section contact person listed above.
RO-APS Reviewer: Date:
FORM: APSARR 03/10 Page 1 of 1

ATA:
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Acting Director Secretary
July 17, 2013
Joe Hudson — Water Resources Director
City of Statesville
P.O. Box 1111
Statesville, NC 28687-1111
Dear Mr. Hudson:
Subject: Acknowledgement of
Application No. WQ0014543
City of Statesville Residuals
Land Application Program
Land Application of Residual
Solids (503) System
Iredell County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 07/12/2013. Your application package has been assigned the number listed
above, and the primary reviewer is Chonticha McDaniel.
Central and Mooresville Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Chonticha McDaniel at [phone] or [e-mail].
cerely,
for Jon Isgliard
Land Application Unit Supervisor
cc: {'Nlooreille Regi�onaL0ffice Aquifer Protectxon'Sectio
Permit File WQ0014543
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www.ncwaterouality.orq
An Equal Opportunity! Affirmative Action Employer
NorthCarolina
?attrrallji

;iIitg of
3ttttesnille
V. (I. dux 1111 • 'tatesuille, North TarnUna 211687
July 10, 2013
Mr. Ed Hardee
NCDENR — Division of Water Quality
Raleigh Central Office
1636 Mail Service Center
Raleigh, NC 27699-1617
CC: Files
w h IVEDAR
, Jv
Aqilleattmnon Section
EIVED/DENR/DWQ
JUL I
AQJiferP,rofection Section
Re: Form RLAP 01-12
Fourth Creek Wastewater Treatment Plant City Land Application Permit Renewal
Permit No. WQ0014543
Dear Mr. Hardee:
Enclosed you will find the RLAP 01-12 form and supporting information per the instruction sheet for
this form. As noted in previous permit applications, this permit has never been used since its inception.
The N-Viro process is the primary biosolids program for the 4th Creek WWTP. We have a contract with
Synagro to land apply dry cake biosolids from the 3`i Creek and 4th Creek WWTP's with the
understanding that this would be the secondary biosolids program. The permit that is associated with
the Synagro contract is in their name and they take care of all of the monitoring and general conditions
for that specific permit.
Should you require more information, or if further action is required, please contact me at 704- 878-
3438.
Sin ely
AidySm h
Plant Su -rvisor, Fourth Creek WWTP

FWATFn
QG RECEIVEDIDENRIDWQ State of North Carolina
JUL 12 2013 Department of Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 01-12
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information or for an electronic version of this form, visit the Land Application Unit (LAU) web site at:
http://portal. ncdenr. org/web/wq/aps/lazy
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 01-12) Application: (All Application Packages):
❑ Submit the completed and appropriately executed Residuals: Land Application Program (FORM: RLAP 01-12) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the
criteria in 15A NCAC 02T .0106(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
❑ Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. _ Application Fee (New and Major Modification Application Packages)
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environment and
Natural Resources (NCDENR).
❑ STANDARD REVIEW — Submit the appropriate fee for all new and major modification applications as listed in the table
below.
❑ EXPRESS REVIEW — Visit the Express Review webpage for the Express Fee Schedule:
STANDARD APPLICATION REVIEW FEES:
Facility Classification
Major (land are permitted for >— 300 acres)
New Permit
$1,310
Major Modification 1
$395
Minor (land are permitted for < 300 acres) $810 $245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved; adds additional residuals sources; or includes the addition of new
treatment or storage units/processes not previously permitted. There is no fee for minor permit modifications.
C. Cover Letter (All Application Packages)
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1 C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating 'factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 01-12
Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
El For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
❑ Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
❑ Maintenance schedules; may include equipments calibration, maintenance of signs, etc.
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
• Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
D Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Aquifer Protection Section if you need any assistance in determining whether your residuals program falls
under the dedicated program definitions.
G. Program Information
O Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
0 Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
INSTRUCTIONS FOR FORM: RLAP 01-12 Page 2 of 3

❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://portal_ncdenr.orc/web/wq/aps/lau/policies. The document shall be signed, sealed and dated by a qualified
professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated
site map specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previouslypermitted unless they are directly tied into the
new units or are critical to the understanding of the complete process;
Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities( or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: http://portal.ncdenr.org/web/wq/aps/lau/policies.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
Property ownership documentation shall consist of one of the following:
0 Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
0 Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
0 An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of 15A NCAC 02L .0107(f), or
0 A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
LAND APPLICATION UNIT
By U.S. Postal Service:
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 01-12
Page 3 of 3

RECEIVEDIDENR/DWO
J;UL 12
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
AquiferP
fry!
art Salm
I. APPLICANT INFORMATION:
RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 01-12
RECEVEDIDENRIDWO
JUL 12 ?
,A itiare'i ion Sectin'
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership 0 Privately -Owned Public Utility
Federal ❑ State X Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Joe Hudson Title: Water Resources Director
Applicant's mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] Email Address: [e-mail]
2. Consultant's name: N/A License Number (for P.E.):
Affiliation: El On Staff ❑ Retained (Firm: )
Consultant's mailing address:
City: State:
Telephone number: ( ) -
3. Agronomist's name: N/A
Affiliation: ❑ N/A 0 On Staff
Agronomist's mailing address:
City: State:
Telephone number: ( )
4. Soil Scientist's name:N/A
Affiliation: ❑ N/A ❑ On Staff
Soil Scientist's mailing address:
City: State:
Telephone number: (_) -
5. Fee submitted: $810.00(See Instruction B)
1. Applicant's name: City of Statesville
II. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑
Zip: -
Email Address:
License Number:
L Retained (Firm:
Zip:
Email Address:
License Number:
❑ Retained (Firm:
Zip:
Email Address:
new, ❑ modified,
X renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00014543
Date of most -recently issued permit: March 11, 2005
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 01-12
Page 1,of5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: 28677-
Coordinates: Latitude: 35° 46' 29"N Longitude: 80° 48' 50"W
Datum: Level of accuracy:
Method of measurement: GPS
2. County where residuals land application program is headquartered: Iredell
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification
Number
ORC
Andy Smith
City of Statesville
LA 985516
Back -Up ORC
Scott Austin
City of Statesville
LA 991939
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide
the candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training
school and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in
the following table:
Maximum amount of residuals to be certified: 4th Creek —1056/ 3`a Creek — 973 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
4th _ rd
4 / 3 _ 4.0
4.117/3 a3.88
Five -Year Maximum Adjusted
19.5/19.95
20586/19409
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
15.3
Corn & small grain. (4th Creek )
Hay
14.1
Fescue hay. (3`d Creek )
Pasture
Total:
Methods
Surface
FORM: RLAP 01-12
Page 2 of 5

Incorporation or Injection
Total:
c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
4th 82.3/3`d 77.64
4d' 411.7/3rd
388.2
100
4"' 41.17/3`d
38.82
4th 205.85/3`d 194
150
4t 27.4/3`d 25.88
4t 137/3`d 129.4
200
w th
4 19.4i 3
4th 102.9/3`d 97
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): X Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Not required if no new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Not required if no new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification.doc
FORM: RLAP 01-12 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation:
feet below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHWT and
ground surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
(in/hr)
Recommended
Loading Rate
(in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or D No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field /Zone
Design Area
(ft2)
Number of
Nozzles
Maximum Application
Rate (gallons/hr)
Design Annual Loading
Rate (gallons/yr)
Total
(4
,ft.)_.' ..>, .�..
a
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 01-12
Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T.0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
anyve compliance schedule, and do not have any overdue annual fees under Rule I5A NCAC 02T .0105.
Yes
111 No, Explain;
1,� � � t� cA. c> j
(Signature Authority's Name — PLEASE PRINT) r (Title)
attest that this application for kit diC,-- A --da..tr/a,_-1-ed- �.`S \o.. c c (inIi�\^^
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Quality
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless
specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Quality should a condition of this permit be violated. I also understand that if all required parts of this application
are not completed and that if all required supporting information and attachments are not included, this application package will be
returned to me as incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any
false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: 777
RECEIVEDIDENR/DWO
JUL 122013
Aquifer Protection Section
FORM: RLAP 01-12
Page 5 of 5

SPILL CONT ' OL PLAIN
FOR RESIDUALS TRANSFER BETWEEN PLANTS, BY WATER RESOURCES DEPARTMENT PERSONNEL
IN TIIE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE IMMEDIATELY TAKEN:
1. MANAGEMENT OF CLEAN UP ACTIVITIES: The first Water Resources Department
representative at the scene will begin procedures to halt the spill and initiate clean up activities. Upon
arrival, the Director or Assistant Director will take immediate action to coordinate all activity. City of
Statesville labor and equipment are to be utilized. In the event additional labor and equipment are
required, assistance shall be requested from private contractors (see attached list). The Public
Information Director shall also communicate with the public on the scene, answering questions and
advising of the clean up activities.
2. HALT SOURCE OF SPILL: Such as a ruptured container or damaged transport unit.
3. CONTAIN SPILL: Form a barrier. Sufficient quantities of straw shall be used for such purpose.
Earthen barriers may be constructed to augment the straw bale containment area. The person in charge
on the spill site will advise the clean up personnel where to get the straw, lime, and other items
necessary to complete the clean up operation, i.e. local farmers, farm supply center, nursery, etc.
4. CLEAN UP: Employ front end loaders, vacuum equipment, sludge application vehicle, and/or local
septic tank service to remove as much of the spilled material as possible. Straw and/or sand should be
scattered in the spill area to soak up the remaining material. The straw and sand soaked material will be
collected and removed to a disposal area approved by representatives of the State regulatory agency.
5. FINAL CLEAN UP: Employ rotary brush sweeper if needed, and apply lime to the spill area upon the
approval of the clean up efforts by the State regulatory representative. If the event occurs on private
property, the clean up will be completed to the satisfaction of the property owner and State regulatory
representatives. The ultimate goal will be to restore the spill area to its original condition, if possible.
6. NOTIFICATION*: As soon as possible after the spill occurs, the Water Resource Department or
assistant will notify the Mooresville Regional Office, and they will also be responsible for notifying
other key City personnel.
7. REPORTING: Regional personnel and/or city/project personnel will notify the Regional Office of the
D.E. M. by telephone as soon as possible, but not more than 24 hours, or on the next working day
following the occurrence. The Director or Assistant Director shall provide a written report to the
appropriate regional office of the D.E. M. within 5 days of the occurrence. The report shall list all
relative information and actions taken.
11Page

Spill Emergency Call List
Water Resource Director
Name: Joe Hudson
Telephone: [phone]
Mobile: [phone]
Water Resource, Assistant Director
Name: Jerry Byerly
Telephone: [phone]
Mobile: [phone]
City Residuals Coordinator
Name: Andy Smith
Telephone: [phone]
Mobile: [phone]
Plant Operator
Fourth Creek Office
Name: Andy Smith
Phone: [phone]
Plant Mobile: [phone]
Third Creek Office
Name: Scott Austin Mobile: [phone]
Phone: [phone]
Plant Mobile: [phone]
Water Treatment Plant
Name: Weston Johnson Mobile: [phone]
Phone: [phone]
Plant Mobile: [phone]
PUBLIC UTILITIES DIRECTOR
Name: Scott Harrell
Telephone: [phone]
Mobile: [phone]
City Public Information Director
Name: Nancy Davis
Telephone: [phone]
Mobile: [phone]
LOCAL POLICE — FIRE EMERGENCY: 911
DENR-WQ Regional Office: Mooresville: 704-663-1699
State of N.C. Warning Point: 1-800-662-7956 (Emergency # for nights, weekends and holidays)
2IPage

SPILL/EMERGENCY INFORMATION
TO BE USED FOR SLUDGE TRANSPOR1ED WITHIN WA'l'ER RESOURES.
List below the names of companies, addresses, telephone numbers, and any other pertinent data.
If you apply in or travel through more than one county, please include information for each of them.
SEPTIC COMPANY
Lentz Septic Service
Office: 704-876-1834
BACKHOE
Gilbert Engineering Inc.
704-872-0986
STRAW
Tractor Supply
704-838-0220
LIME
Tractor Supply
704-838-0220
SAND
Church Sand and Stone
704-872-4862
LOCAL POLICE
911
LOCAL FIRE DEPT.
911
Wage

Beverly Eaves Perdue
Governor
NCDENIZ
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins Dee Freeman
Director I� ,aECH E retary
Mr. Joe Hudson - Water Resources Director
City of Statesville
Post Office Box 1111
Statesville, North Carolina 28687-1111
Dear Mr. Hudson:
October 7, 2009
OCT - 9 2009
NC DfENR2 Ri�ii j
DVVQ Ac uifer Protection
Subject: Permit Extension and Return of
Renewal Application
Permit No. WQ0014543
Iredell County
On August 5, 2009, Session Law 2009-406, entitled "An Act to Extend Certain Government
Approvals Affecting the Development of Real Property Within the State," was enacted by the General
Assembly and signed into law. The Act, known as the Permit Extension Act of 2009, extends the
expiration date of certain government approvals and permits until February 28, 2013.
Non -discharge permit WQ0014543, issued by the Division of Water Quality, falls within the
scope of this Act and is therefore being extended until February 28, 2013. ' With this letter, the permit
renewal application received August 5, 2009 is being returned. Please note per your permit, a renewal
application must still be submitted six months in advance of the extended expiration date.
If you have any questions regarding this request, please contact Division staff at [phone].
Thank you in advance for your cooperation.
Sincerely,
pao,;„
David Goodrich
Aquifer Protection Section
Enc: Permit Renewal Application
cc: Mooresville Regional -Office, Aquifer Protection_5ection,
Permit File WQ0014543
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] \ FAX 1: 919-715-0588; FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.orq
An Equal Opportunity \ Afrirmative,Action Employer
One
N©rthCaro :ina
I aura//

or
AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 31, 2009
To: ❑ Landon Davidson, ARO-APS
❑ Art Barnhardt, FRO-APS
X Andrew Pitner, MRO-APS
❑ Jay Zimmerman, RRO-APS
FILE
❑ David May, WaRO-APS
❑ Charlie Stehman, WiRO-APS
❑ Sherri Knight, WSRO-APS
From: David Goodrich , Land Application Unit t ,
Telephone: [phone] Fax: 919 file•048
E-Mail: [e-mail]
l � err3 - 9 2009
A. Permit Number: WQ0014543
....�
B. Owner: City of Statesville
M gal
F'
r}Alpt't __ �,r;,.Elft?; !�SC��`'GcIo9'!
C. Facility/Operation: City of Statesville Residual Land Application Program (503)
❑ Proposed ® Existing ® Facility X Operation
D. Application:
1. Permit Type: ❑ Animal n Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
❑ UIC - (5A7) open loop geothermal
For Residuals: ❑ Land App. ❑ D&M n Surface Disposal
X 503 ❑ 503 Exempt ] Animal
2. Project Type: ❑ New Il Major Mod.. 7 Minor Mod. X Renewal n Renewal w/ Mod.
E. Comments/Other Information: n I would like to accompany you on a site visit.
Statutory Date: 11/03/2009
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
® Return a Completed APSARR Form.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write yourname and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above. ,
Date:
.: '1
! �
LC .
FORM: APSARR 07/06
Page 1 of 1

NON -DISCHARGE REGIONAL WATER QUALITY
STAFF REPORT AND RECOMMENDATIONS
Date: April 16, 2009
To: Non -Discharge Permitting Unit
NDPU Reviewer: David Goodrich
County: Iredell
Permitee: City of Statesville
Application No.: W00014543
GENERAL INFORMATION
1. This application is (check all that apply): ❑ New Renewal
❑ Minor Modification ❑ Major Modification
n Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
® Land Application of Residuals ❑ Attachment 3B included as appropriate ® 503 regulated ❑ 503
exempt
❑ Distribution of Residuals ❑ Surface Disposal
2. Was a site visit conducted in order to prepare this report? ❑ Yes or ® No.
a. Date(s) of site visit(s): N/A
b. Person contacted and contact information: Scott Berg. 336/998-7150 ext. 13
c. Site visit conducted by: N/A
d. Inspection report attached: ❑ Yes or ® No.
e. A review of all the new and modified sites was conducted.
3. Is the following information entered into the BIMS record for this application correct?
® Yes or❑No.
For Treatment Facilities:
a. Location: 4th Creek WWTP and 3rd Creek WWTP info in BIMS is correct.
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
Municipal wastewater
For Disposal Sites: This field is located at the 4th Creek WWTP
a. Location(s): 693 Bell Farm Road,Statesville, NC
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
FORM: NDSRR 03/02 1

Permit renewal City of Statesville
September 9, 2009
DESCRIPTION OF WASTE(S) AND FACILITIES
1. Are there appropriately certified ORCs for the facilities? ® Yes or ❑ No.
Operator in Charge: Andy Smith Certificate #: LA 985516
Back- Operator in Charge: Scott Austin Certificate #: LA-991939
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage,
effluent storage, etc) of the treatment facilities adequate for the type of waste and disposal system?
Yes or ❑ No. If no, please explain:
3. Are the site conditions (soils, topography, etc) maintained appropriately and adequately assimilating
the waste? ® Yes or ❑ No. If no, please explain:
4. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
Yes or ❑ No. If no, please explain:
6.
7. Is the type and/or volume of waste(s) as written in the existing permit correct? /1 Yes or ❑ No. If
no, please explain:
8. Is the description of the facilities as written in the existing permit correct? ® Yes or ❑ No. If no,
please explain:
9. Has a review of all self monitoring data been conducted? ® Yes or ❑ No. Please summarize any
findings resulting from this review: The annual report reflects compliance.
10. Check all that apply: ►1 No compliance issues; n Notice(s) of violation within the last permit cycle;
5. Are the existing application rates (hydraulic or nutrient) still acceptable? /1 Yes or ❑ No. If no,
please explain:
Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ® No
f Current enforcement action(s) ❑ Currently under SOC; n Currently under JOC; ❑ Currently
under moratorium. If any items checked, please explain and attach any documents that may help
clarify answer/comments (such as NOV, NOD etc):
11. Have all compliance dates/conditions in the existing permit, SOC, JOC, etc. been complied with?
❑ Yes or ❑ No. N/A
12. Are there any issues related to compliance/enforcement that should be resolved before issuing this
permit? ❑ Yes or ❑ No. N/A
FORM: NDSRR 03/02 2

EVALUATION AND RECOMMENDATIONS
I. Provide any additional narrative regarding your review of the application.: This permit is for
emergency use only. This permit is basically and insurance policy for the City in the event of a need
to change contractors. the City has a permit in place to add or transfer fields to.. The land already
permitted for this sludge source is in SYNAGRO's name.
2. List any items that you would like NDPU to obtain through an additional information request. Make
sure that you provide a reason for each item: NIA
3. List specific Permit conditions that you recommend to be removed from the permit when issued.
Make sure that you provide a reason for each condition: N/A
4. List specific special conditions or compliance schedules that you recommend to be included in the
permit when issued. Make sure that you provide a reason for each special condition: N/A
5. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office;
n Hold, pending review of draft permit by regional office; ® Issue; n Deny. If deny, please state
reasons:
6. Signature of report preparer:
Signature of WQS regional supervisor:
Date: r+r -O
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
No additional items.
FORM: NDSRR 03/02 3

Permit Number WQ0014543
Central Files: APS SWP
08/31/09
Permit Tracking Slip
Program Category
Non -discharge
Permit Type
Land Application of Residual Solids (503)
Primary Reviewer
david.goodrich
Coastal SW Rule
Permitted Flow
Facility
Status Project Type
In review Renewal
Version
A
Permit Classification
Individual
Permit Contact Affiliation
Lenwood F. Hudson Jr.
PO Box 1111
Statesville
NC 286871111
Facility Name Major/Minor Region
City of Statesville Residuals Land Application Minor Mooresville
Program
Location Address County
PO Box 1111 Iredell
Statesville
Owner
NC 286871111 Facility Contact Affiliation
Owner Name Owner Type
City of Statesville Government - Municipal
Owner Affiliation
Robert W. Hites Jr.
PO Box 1111
Statesville
Dates/Events
NC 286871111
Orig Issue App Received Draft Initiated
02/17/98 08/05/09
Scheduled
Issuance
Public Notice Issue
Regulated Activities Requested/Received Events
Wastewater treatment and disposal
Outfall NULL
RO staff report requested
RO staff report received
Effective Expiration
Waterbody Name Stream Index Number Current Class Subbasin

4
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Coleen H. Sullins
Director
August 31, 2009
Joe Hudson, Water Resources Director
City of Statesville
P.O. Box 1111
Statesville. NC 28687-1111
Subject: Acknowledgement of Application No. WQ0014543
City of Statesville Residuals Land Application Program
Land Application of Residual Solids (503)
Iredell
Dear Mr. Hudson:
SEP
Dee Freeman
Secretary
an
2 2009
C DFNR MR0
DWQ _ A uifer Protection
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on August 5, 2009. This application package has been assigned the number listed above and will be reviewed by
David Goodrich.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact David Goodrich at 919-715-6162, or via e-mail at [e-mail]. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http://h2o.enr.state.nc.us/documents/dwq orgchart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
for Jon Risgaard
LAU Supervisor
cc:Mooresyille Regtonalquifer 2rotect>on Secion
Andy Smith, Creek WWTP Supervisor (City of Statesville)
Permit Application File WQ0014543
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604
Phone: [phone] ! FAX 1: 919-715-0588 FAX 2: 919-715-6048 \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer
NNlonAhCarolina
Tat rai/

ias
'�
#'tatr� uillz
13. ®. +.Jux 1111 s 'tatesuille. Nurtll Tarulina 28687
RECEIVED I DEoN section
Aquifer .
AIJ Cz 5 2009
July 22, 2009
Mr. Ed Hardee
Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Permit # WQ0014543
City Land Application Permit Renewal Application and Attachments
Forms NDRLAP, RSCA, & LASCA
Dear Mr. Hardee:
NC DFNR MRO
D - A. •uifer Protection
Enclosed, you will find the forms, information and the required attachments per the instructions for the
application. As noted in previous permit applications, this permit has never been used since its inception. The
N Vro process is the primary biosolids program for the 4th Creek WIMP. We have a contract with Synagro to
land apply dry cake biosolids from the 3"' Creek and 4th Creek WWTP's with the understanding that this would
be the secondary biosolids program. The permit that is associated with the Synagro contract is in their name
and they take care of all of the monitoring and general conditions for that specific permit.
Should you require more information, or if further action is required, please contact me at 704- 878-
3438.
Sinrel
l
Fourth WWTP Supervisor

State of North Carolina
Department of Environment and Natural Re
ivision of Water Quality
ih
NON-IEDICATED RESI UAL S LAND APPLICAT
(FORM: NDRLAP 070807)
The Division of Water Quality will not accept this application unless all the instructions are followed. Failure to
submit all of the required items will lead to additional processing and review time.
For more information, visit our web site at: Info: 172o. e nr.star•_ . nc. us luu main. hnml
eesSEP - 2 2009
NC DENT- iVIRO
ft r. otection
A. Application Form: (All Application Packages):
✓ Submit one original and two copies of the completed application package. Any changes made to this form will result in the
application being returned. The Division of Water Quality will only accept application packages that have been fully
completed and all applicable items are addressed.
✓ Non -dedicated residuals land application programs are ones in which all land application sites do not meet the criteria in 15A
NCAC 2T .1102(12). Specifically, a residuals land application program cannot be designated as non -dedicated if any of the
following is applicable:
• Any land application site certified for the residuals land application program that receives residuals at rates or
frequencies greater than agronomic rates.
• Any land application site certified for the residuals land application program that is used primarily for residuals
disposal, and agricultural crop production is of secondary importance.
a Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
✓ The signing official must meet the criteria stipulated in 15A NCAC 2T .0106(b). An alternate person may be designated as
the signing official, provided that a delegation letter from a person who meets the referenced criteria is submitted. The
delegation letter does not have to be resubmit(ed if the signing official has not changed since the last permitting action
associated with this residuals land application program.
• If this project involves a modification of an existing permit, submit one copy of the existing permit.
✓ Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility (ies) for application packages involving new or changes to treatment and storage units.
13. Application Fee (New and Major Modification Application Packages):
✓ For new permits submit a check in the amount of $I,310 if over or equal to 300 acres of land are being permitted for
application (Major Permit), or $810 if less than 300 acres of land are being permitted for application (Minor Permit), made
payable to: North Carolina Depai tment of Environment and Natural Resources (NCDENR). Major modification fee are $395
and $245, respectively.
C. Cover Letter (Ail Application Packages)
✓ Submit a cover letter, which lists all items and attachments included in the application package as well as a brief project
description.
✓ If necessary for clarity, include attachments to the application form. Such attachments will be considered part of the
application package and should be numbered to correspond to the section to which they refer.
D. Environmental Assessments (May be Required — See 15A NCAC IC .0300):
✓ Submit one copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
Submission of Application Packages:
✓ To determine which attachment forms and supplemental attachments are required to make a complete application package,
read the instructions of each attachment form carefully. Application packages should be organized and bound (i.e., stapled,
placed in three-ring binder, etc.) in the following order prior to submission:
• Cover letter and application fee.
• Attachment Order 1: Non -Dedicated Residuals Land Application Programs (FORM: NDRLAP).
> Attachment Order 1-a: Signing official delegation letter.
• Attachment Order 2: Residuals Source Certification Attachment (FORM: RSCA).
• Attachment Order 3: Land Application Site Certification Attachment (FORM: LASCA).
✓ The application package should be sent to the address at the end of this application form. Do not submit this application
package to any Division regional office.
r.
FORM: NDRLAP 070807
Page 1 of 6 Attachment Order 1

RECENED I DENRI D oC1
Mau.- Protect,on S
State of North Carolina F,111 /) 5 2009
Department of Environment and Natural Resources
Divisions of Water Quality
NON -DEDICATED RESIDUALS LAND APPLICATION PROGRAMS
(FORM: NDRLAP 070807)
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
Application Number: (tq,_b V �r� Lle''Ite�d-byWQ
I. OWNERSHIP INFORMATION:
Tyc
1. Specify whether the process facility is owned by:
❑ County; ❑ Federal; X Municipal; ❑ State; ❑ Non -Government.
2. Owner's name (please specify the name of the municipality, corporation, individual, e
City of Statesville
Mailing address: PO Box 1111
City: Statesville
Physical address: 693 Bell Farm Road
City: Statesville
S EP - 2 2009
NC DENR MRO
DVVQ - A Iiifer Protection
State: NC Zip: 28687-1111
State: NC Zip: 28677
Telephone number: ( 704) 878-3438 Facsimile number: ( 704) 878-8655
E-mail address: asnrith0,:statesvillenc.net
3. Signing official's name and title: (See Instruction A)
Joe Hudson, Water Resources Director
Mailing address: P.O. Box 1111
City: Statesville
Physical address: 693 Bell Farm Road
City: Statesville
State: NC Zip: 28687-1111
State: NC Zip: 28677
Telephone number: ( 704) 704-878-3438 Facsimile number: ( 704) 878-8655
E-mail address: jhuclsoii rstatesvillenc.net
H. PERMIT INFORMATION:
1. Application is for: ❑ new, ❑ modified, XEI renewed permit (check all that apply).
2. Fee Submitted: $ 810.00 (See Instruction B)
3. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number WQ001453
Most recent issuance date March 11, 2005, and the expiration date February 28, 2010.
Date of most -recently certified Attachment A:
Date of most -recently certified Attachment B:
FORM: NDRLAP 070807
Page 2 of 6 Attachment Order 1

4. Check all that apply to the requested permit modification:
❑ INCREASE 0 DECREASE the maximum permitted annual dry tonnage for existing residuals
source -generating facility (ies) certified.
❑ ADD ❑ DELETE residuals source -generating facility (ies) to/from those certified.
O INCREASE ❑ DECREASE the acreage associated with land applications site(s).
❑ ADD 0 DELETE land application site(s) to/from those certified.
O OTHER. Explain:
III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. County where residuals land application program is headquartered: Iredell County
2. County(ies) where residuals source -generating facilities are located: Iredell County
3. County(ies) where land application sites are located: Iredell County
4. Program contact person and/or consulting firm who prepared application:
Andv Smith, 4th Creek WWTP Supervisor
Mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: 28677
Telephone number: [phone] Facsimile number: ( 704 ) 878-8655
E-mail address: asmit/Tr�i stnlesrNlenc. net
5. Who will be responsible for the day-to-day management of the residuals land application program:
X Permittee or ❑ residuals management firm. If a residuals management firm, complete the following:
Firm contact person and title:
Firm name:
Mailing address:
City: State: Zip:
Telephone number: ( ) Facsimile number: ( )
E-mail address:
FORM: NDRLAP 070807
Page 3 of 6 Attachment Order 1

6. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application
program, their certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification
Number
ORC
Andy Smith
City of Statesville
LA 985516
Back -Up ORC
- Soul Austin
City of Statesville
LA 991939
Additional Back -Up ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application
program, provide the candidates' names, affiliations, and an estimated time schedule for each candidate's
completion of the required training school and certification test:
7. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated
by all residuals source -generating facilities as currently certified and proposed for certification with this
application and list the results in the following table:
Maximum amount of residuals to be certified: 4th Creek-1,056/ 3`d Creek- 973 dry tons per
year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
4rh-3.9/3'd-4.0
m /3( d
4 3,882
Five-Year Maximum Adjusted
19.5/19.95
20586/19409
b. Land Application Site Use Summary: Summarize information regarding the land application sites as
currently certified and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
15.3
Corn and small grain. (4`h Creek)
Hay
14.1
Fescue Hay (3' 1 Creek )
Pasture
Total:
29.4
Methods
Surface
29.4
Incorporation or Injection
Total:
29.4
Restrictions
Year -Round
Double cropped (spring &fall )
Seasonal
29.4
land crop not to exceed 50 lbs/ac/yr
FORM: NDRLAP 070807
Page 4 of 6
Attachment Order 1

Total:
c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the
residuals as currently certified and proposed for certification assuming the scenarios listed in the
following table:
Assumed
App.icatio i Rate
(lbs PAN/ac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted :'AN '
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
4th 82.34/3rd 77.64
41h 411.7/3rd 388.2
100
4th 41.17/3'd 38.82
4th 205.85/3` 1194
150
41h 274/3'125.88
41h 137/3r1129.4
200
4th 20.58/3`a 19.41
4th 102.9/ 3rd 97
8. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application
of the proposed residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage,
not enough land, vector reduction practices not in place, etc.)
***FORM: NDRLAP CONTINUES ON NEXT PAGE***
FORM: NDRLAP 070807
Page 5 of 6 Attachment Order 1

RECEIVED / DENR / DWQ
Aquifer Protection Section
AUG 0 5 2009
Applicant's Certification:
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater
facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or
abandoned, are compliant with any active compliance schedule, and do not have any overdue annual fees under Rule
2T .0105.
s ❑ No, Explain;
I, attest that this application for /g%Ojj . leoc/ 74e0f
ji&-5# i44et if .4ope,G Q � �l�'dpy /' ,-0d has been reviewed by me and is
accurate and complete to the beat' f myknowledg e. and tand that the Division of Water Quality may not
conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless
specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an
immediate enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I
will make no claim against the Division of Water Quality should a condition of this permit be violated. I also
understand that if all required parts of this application are not completed and that if all required supporting
information and attachments are not included, this application package will be returned to me as incomplete. Note:
In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly
makes any false statement, representation, or certification in any application shall be guilty of a Class 2
misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
THE COMPLETED APPLICATI s N PACKAGE,
INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
LAND APPLICATION UNIT
By U.S. Postal Service:
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
By Courier/Special Delivery:
2728 CAPITAL BOULEVARD
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
FORM: NDRLAP 070807
Page 6 of 6 Attachment Order 1

State of North Carolina
epartment of Environment and Natural Resour
MIECIEHE
SEP - 2 2009
SEP 2 2009
Division of Water Quality L----
NC DENR MFR0
RESIDUALS SOURCE CERTIFICATION ATTACIAV� Aauiinr protection
(FORM: RSCA 070807)
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality (Division) will not accept this attachment unless all the instructions are
followed. Failure to submit all required items will lead to additional processing and review time.
For more information, visit our web site at: htlp://h2o.enr•.state.nc.rrs/Inrumain.htnrl
INSTRUCTIONS TO THE APPLICANT: 4" Creek WillTP
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding residuals program application
form (FORM: NDRLAP, FORM: DRS, or FORM: SDRS).
✓ Any changes to this attachment form will result in the application package being returned.
✓ For new residuals programs or renewed residuals programs, submit a separate attachment form for each
residuals source -generating facility to be certified for this residuals program.
✓ For modified residuals programs in which any modification to the certified residuals -source generating
facilities is proposed, submit a separate attachment form for only those residuals source -generating facilities
that are affected by the proposed modification.
✓ The attachment should be organized prior to submission in the following order (i.e., by facility):
o Attachment Order 2: Residuals Source Certification Attachment (FORM: RSCA).
> Attachment Order 2-a: Vicinity map.
> Attachment Order 2-b: Process flow diagram and/or narrative.
> Attachment Order 2-c: Quantitative justification for residuals production rate.
> Attachment Order 2-d: Sampling plan.
> Attachment Order 2-e: Laboratory analytical reports and operational data.
B. Residuals Source -Generating Facility Information:
✓ Attach a vicinity map that shows the location of the facility and meets all of the criteria in the latest version of
the document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs."
✓ Attach a detailed narrative and/or process flow diagram that describes how the residuals are to be generated,
treated, processed, and stored at the facility.
✓ Attach a quantitative justification for the value provided in Item I. 8. Ensure that the amount of residuals
listed is the maximum amount expected to be generated by the facility for the life of the permit. In addition,
ensure that this amount is equivalent to that which is actually to be land applied, distributed, and/or disposed,
including any chemicals, amendments, or other additives that are added to the residuals during processing.
C. Residuals Quality Information:
✓ Attach a detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In
addition, ensure that the plan details how the facility and/or the residuals are monitored for any applicable
pathogen reduction and vector attraction reduction requirements. Note that all sampling and monitoring must
be completed on the residuals as they are to be land applied, distributed, and/or disposed.
✓ Attach reports for all laboratory analyses used to complete this attachment form. Attach documentation that
the facility complies and/or the residuals comply with any applicable pathogen reduction and vector attraction
reduction requirements.
✓ Item II. 3. Does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only.
FORM: RSCA 070807
Page 1 of 8 Attachment Order 2

State of North Carolina
Department of E.rvironment and Natural Resources
Division of Water Quality
RECEIVED / DENR / DWQ
Aquifer Protection Section
AUG 0 5 2009
RESIDUALS SOURCE CERTIFICATION ATTAC! I F
(FORM: RSCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL;
—1 SEP — 2 2009
Applicant's name: City of Statesville/ -!th Creel, 11 II "TP
Check all that apply:
❑ INCREASE
lJ V
p} NCC DENR MRO
ID NEW RESIDUALS PROGRAM X RENEWED RESIDLj -I'1 ! Asuifer Protection
❑ DECREASE the maximum permitted annual dry tonnage for this residuals
generating facility certified for this residuals program.
Current: 1,057 Dry Tons/yr. and proposed: 1,057 Dry Tons/yr.
source-
❑ ADD ❑ DELETE this residuals source -generating facility to/from those certified for this
residuals program.
❑ OTHER Explain:
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Name of facility: 4`h Creek WWTP
2. Facility permit holder: City of Statesville
Facility permit holder is (check one): ❑ federal, ❑ state, X local government, or ❑ private.
Facility permit number: NC0031836
Facility permit issued by (check one): X Div. of Water Quality, ❑ Div. of Environmental Health, or
❑ other (explain: ).
3. If the facility permit is not issued by the Div. of Water Quality, complete the following:
a. Facility contact person and title:
Facility complete mailing address:
City: State: Zip:
Telephone number: ( ) Facsimile number: ( )
E-mail address:
b. Facility complete location address:
City: State: Zip:
Latitude: and longitude:
4. County where facility is located: Iredell
5. Purpose of the facility (check one):
❑ treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
X treatment of industrial wastewater mixed with domestic wastewater, or
(approximate percentages: 40 % industrial and 60 % domestic)
❑ other (explain:
FORM: RSCA 070807
Page 2 of 8 Attachment Order 2

6. Does the facility have an approved pretreatment program:
X yes ❑ no
7. Facility permitted/design flow: 6 MGD and facility average daily flow: 3 MGD.
8. Average amount of residuals being generated at this facility dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 1.5 Million Gallon aerobic digester. 3 meter, 3 belt press.
Dewatering polymer.
Type and volume of residuals storage (i.e., outside of residuals treatment units): 1/3 acre concrete pad.
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under (check one): ❑ 40 CFR Part 503 or ❑ 40 CFR Part 257.
2. Specify if residuals are intended for (check one):
❑ Land Application/Distribution (Class A or Equivalent).
Complete all items EXCEPT Items II. 4b. 7b. and 7c.
X Land Application (Class B or Equivalent).
Complete all items EXCEPT Items II. 4b. 7a. and 7c.
❑ Surface Disposal.
Complete all items EXCEPT Items II. 4a. 5. 7a., 7b., and 8.
***FORM: RSCA CONTINUES ON NEXT PAGE***
FORM: RSCA 070807
Page 3 of 8 Attachment Order 2

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non-
hazardous under RCRA:
a. Are the residuals are listed in 40 CFR §261.31-§261.33: ❑ yes X no.
If yes, List the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
§261.24: ❑ yes X no. Fill in the following tables with the results of the latest toxicity
characteristic leaching procedure (TCLP) analysis as well as those for corrosivity, ignitability, and
reactivity: laboratory: Prism Laboratory and date of analysis: 7/28/08
Passed corrosivity test: X yes ❑ no. pH: s.u. (2 < pH < 12.5).
Passed ignitability test: X yes ❑ no. Flashpoint: °F (> 140°F).
Passed reactivity test: X yes ❑ no. HCN: mg/kg (<250) & H2S:
mg/kg (<500).
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
Arsenic
5.0
<0.050
Hexachlorobenzene
0.13
<0.010
Barium
100.0
<5.0
Hexachloro-1,3-
Rntadiene
0.5
<0.050
Benzene
0.5
<0.050
Hexachloroethane
3.0
<0.050
Cadmium
1.0
<0.025
Lead
5.0
<0.050
Carbon Tetrachloride
0.5
<0.050
Lindane
0.4
<0.0005
Chlordane
0.03
<0.025
Mercury
0.2
<0.010
Chlorobenzene
100.0
<0.050
Methoxychlor
10.0
<0.0005
Chloroform
6.0
<0.050
Methyl Ethyl Ketone
200.0
<0.50
Chromium
5.0
<0.25
Nitrobenzene
2.0
<0.050
m-Cresol
200.0
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
Pyridine
5.0
<0.25
p-Cresol
200.0
Selenium
1.0
<0.050
Cresol
200.0
Silver
5.0
<0.25
2,4-D
10.0
ND
Tetrachloroethylene
0.7
<0.050
1,4-Dichlorobenzene
7.5
<0.050
Toxaphene
0.5
<0.025
1,2-Dichloroethane
0.5
<0.050
Trichloroethylene
0.5
<0.050
1,1-Dichloroethylene
0.7
<0.050
2,4,5-Trichlorophenol
400.0
<0.25
2,4-Dinitrotoluene
0.13
<0.012
2,4,6-Trichlorophenol
2.0
<0.10
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
0.00500
Heptachlor and its Hydroxide
0.008
<0.0005
Vinyl Chloride
0.2
<0.020
FORM: RSCA 070807
Page 4 of 8
Attachment Order 2

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the
residuals do not violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Class A or Class B: Fill in the following table with the results of the latest analyses (i.e., on a dry
weight basis) for the following metal parameters:
Laboratory: and date of analysis:
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(ForClass A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
Cadmium
85
39
Copper
4,300
1,500
No Residuals
Lead
840
300
have been applied.
Mercury
57
17
Molybdenum
75
n/a
Nickel
420
420
Selenium
100
100
Zinc
7,500
2,800
b. For Surface Disposal: Fill in the following table with the results of the latest analyses (i.e., on a dry
weight basis) for the following metal parameters:
Laboratory: and date of analysis:
Closest Distance
to Property Lines
(meters)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
> 0 but < 25
30
200
210
>_ 25 but < 50
34
220
240
>_ 50 but < 75
39
260
270
> 75 but < 100
46
300
320
> 100 but < 125
53
360
390
> 125 but < 150
62
450
420
>_ 150
73
600
420
FORM: RSCA 070807
Page 5 of 8
Attachment Order 2

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 19 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the
following nutrient and micronutrient parameters: laboratory: 4`" Creek WWTP Laboratory and date of
analysis: Ongoing weekly.
Parameter
Result
(mg/kg, dry weight)
Aluminum
Ammonia -Nitrogen
Calcium
No residuals have been applied
Magnesium
Nitrate -Nitrite Nitrogen
pH (Standard Unit)
Phosphorus
Potassium
Sodium
Total Kjeldahl Nitrogen
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR):
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the
residuals: %. This rate is a ❑ default value or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or
provide technical justification as to why the selected default value is appropriate to be applied to these
residuals:
Calculate the PAN for the residuals (i.e., on a dry weight basis) and list the results in the following table:
Application Method
First Year
PAN
(mg/kg)
Five -Year
Maximum Adjusted
PAN
(mg/kg)
Surface
3.9
19.5
Injection/Incorporation
e. Are the residuals a registered fertilizer with the NC Department of Agriculture and Consumer Services:
❑ yes X no. If yes, provide date of registration approval:
the current registration number:
and the fertilizer equivalent:
FORM: RSCA 070807
%, %, and
Page 6 of 8
%.
Attachment Order 2

6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the
residuals and list the results of the latest analyses:
7. Pathogen Reduction Determi ratio a: Specify which alternative(s) will be used to meet the pathogen
reduction requirements:
a. For Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids.
OR
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the following (except for residuals regulated under 40 CFR Part 257 that are to be distributed):
❑ Alternative 1 [40 CFR §503.32 (a)(3)] - Time/Temperature Compliance.
❑ Alternative 2 [40 CFR §503.32 (a)(4)] - Alkaline Treatment.
❑ Alternative 3 [40 CFR §503.32 (a)(5)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [40 CFR §503.32 (a)(6)] - No Prior Testing for Enteric VirusNiable Helminth Ova.
❑ Alternative 5 [40 CFR §503.32 (a)(7)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment, ❑ pasteurization,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation, or ❑ gamma ray irradiation.
❑ Alternative 6 [40 CFR §503.32 (a)(8)] - PFRP-Equivalent Process.
Explain:
b. For Class B or Equivalent:
X Alternative 1 [40 CFR §503.32 (b)(2)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [40 CFR §503.32 (b)(3)] - Process to Significantly Reduce Pathogens (PFRP).
Specify one: X aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
❑ Alternative 3 [40 CFR §503.32 (b)(4)] - PSRP-Equivalent Process.
Explain:
❑ Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
c. For Surface Disposal:
❑ Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover.
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
FORM: RSCA 070807
Page 7 of 8 Attachment Order 2

8. Vector Attraction Reduction Determination: Specify which alternative(s) will be used to meet the vector
attraction reduction requirements:
❑ Alternative 1 [40 CFR §503.33 (b)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [40 CFR §503.33 (b)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [40 CFR §503.33 (b)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [40 CFR §503.33 (b)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
X Alternative 5 [40 CFR §503.33 (b)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [40 CFR §503.33 (b)(6)] - Alkaline Stabilization.
❑ Alternative 7 [40 CFR §503.33 (b)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [40 CFR §503.33 (b)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [40 CFR §503.33 (b)(9)] - Injection.
❑ Alternative 10 [40 CFR §503.33 (b)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover.
❑ Alternatives for Animal Processing Residuals Only:
Specify one: ❑ injection, ❑ incorporation, or ❑ lime addition to raise pH to 10.
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
FORM: RSCA 070807
Page 8 of 8 Attachment Order 2

scNoi 0(
`Illy cred WurP
�

ATTACHMENT 2b
4th CREEK & 3rd CREEK WIN R NARRATIVE
Both of the WWTP's utilize a conventional activated sludge process that primarily treats domestic and
industrial waste water generated from areas within and outside of the city. The raw sewage enters the
WWTP via gravity main and from there it flows into a wet well or pump station. The flow enters one of
two perforated panel type bar screens. At this point the raw sewage is mixed with return activated
sludge and distributed into two aeration basins. The mixed liquor flows into secondary clarifiers . and
then the RAS is pumped back into the influent of the WWTP. The effluent gravity flows from the
secondary clarifiers to the chlorine contact basins where the final effluent is treated with Sodium
Bisulfite for de -chlorination as it flows to the receiving stream.
Both WWTP's generate biosolids that are currently stabilized using an aerobic digester, and dewatered
using a belt press. After dewatering, the residuals are transferred to the N-Viro lime stabilization process
area where the biosolids are set aside for contract land application off of the plant site. The primary
method of biosolids disposal is the N-Viro process.
9

PLANT INFLUENT
o MH
BAR SCREENS
INFLUENT
PUMP STATION
DECHLORINATION
BUILDING
CLARIFIERS
❑ 0--
AERATION
BASIN
NO. 'I
AERATORS
* FLOW
DISTRIBUTION
BOX
METERING
FLUME
EFFLUENT
M.-
FLOW
SPLITTER
BOX
WAS
—❑ ❑
AERATION
BASIN
❑ ❑
NO. 2
AERATORS
L —
STALIME
SLUDGE
TREATMENT
FACILITIES
CONVEYOR
SLUDGE
PUMPS
COVERED
SLUDGE
STORAGE
SLUDGE
STORAGE
PAD
FLOW SCHEMATIC & WATER BALANCE
FOURTH CREEK WASTEWATER TREATMENT PLANT
CITY OF STATESVILLE

tLit of
ftt#eSltiilE
. (4). lax 1111 tateout11e, Wurt11 Carolina 28687
July 21, 2009
Mr. Ed Hardee
Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Permit # WO0014543 , `u&a a
Quantitative Justification for Residuals Production Rate
f�1}
Fourth Creek WWTP
Dear Mr. Hardee:
The 4th Creek WWTP would generate approximately 2,000 dry tons per year of biosolids. This would
all go to the N-Viro process and /or the contracted Land Application contractor unless extenuating
circumstances prevailed.
Should you require more information, or if further action is required, please contact me at 878-3438.
Sincerel
r
Forth C k WWTP Supervisor

Eit of
'tatzo utile
. ().'Snx 1111 ° 'tat£Suille, Nardi (Carolina 28687
July 21, 2009
Mr. Ed Hardee
Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Permit # WQ0014543 J-KAN .t,02 d-
Biosolids Sampling Plan
Fourth Creek WWTP
Dear Mr. Hardee:
The 46' Creek WWTP is currently using a 3 belt sludge press that pumps sludge out to the N-Viro
process. As the press is operating, the operator would collect the required amount of sample per the
permit to send to the designated lab.
Should you require more information, or if further action is required, please contact me at 878-3438.
Sincer y,
/1(2114
Fourth reek WWTP Supervisor

Full Service Awe & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID: Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Parameter
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COG Group:
Time Collected:
Time Submitted:
4TH Creek Sludge
220582
G0708776
07/28/08 11:30
07/28/08 15:35
Result Units Report MDL Dilution
Limit Factor
pH, Corrosivity
pH
Ignitability of Solids
Ignitability
Reactive Cyanide
Subcontract Report
Method Analysis
DateiTime
Analyst Batch
ID
6.9 pH units 0.10 0.10 1
Negative N/A
See
Attached
* Analysis Note for Subcontract Report:
9045C
08/01/08 11:46 kpowers
Q34366
1030 07/30/08 14:40 rloftin Q34306
See Attached
Subcontracted to NC Certified Lab 618.
Reactive Sulfide
Subcontract Report See 1 See Attached
Attached
* Analysis Note for Subcontract Report: Subcontracted to NC Certified Lab 618.
TCLP Extraction for Metals and/or Non -Volatile Organics
TCLP Extraction (Metals/Organics) Complete
Zero Headspace Extraction for Volatiles
TCLP Extraction (ZHE-Volatiles) Complete
Acid Herbicicides in TCLP Leacheate by GC-ECD
Subcontract Report
See
Attached
* Analysis Note for Subcontract Report:
TCLP Leachable Mercury by CVAA
Mercury
Sample Preparation:
TCLP Leachable Metals by ICP
Arsenic
Barium
Cadmium
BRL
1 1311 08/05/08 11:30 mbarber
1 1311 08/11/08 17:00 wconder
Subcontracted to NC
mg/L 0.010 0.000014 1
BRL mg/L
BRL mg/L
BRL mg/L
0.050
5.0
0.025
20 mL / 30 mL
0.0029
0.0019
0.00034
8151A
Certified Lab 618.
7470A 08/08/08 18:07 mcampbell Q34590
7470A 08/08/08 9:30 mbarber P27775
6010B 08/07/08 1:47 mcampbell Q34496
6010E 08/07/08 1:47 mcampbell Q34496
601013 08/07/08 1:47 mcampbell Q34496
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page of12

Full Service Anatytiul & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID: Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
4TH Creek Sludge
220582
G0708776
07/28/08 11:30
07/28/08 15:35
Parameter
Chromium
Lead
Selenium
Silver
Result Units Report MDL Dilution Method
Limit Factor
Analysis
Date/Time
Analyst Batch
ID
Sample Preparation:
BRL mg/L 0.25 0.0006 1
BRL mg/L 0.050 0.0021 1
BRL mg/L 0.050 0.0035 1
BRL mg/L 0.25 0.00025 1
TCLP Leachable Organochlorine Pesticides by GCIECD
Chlordane
Endrin
Heptachlor
Heptachlor Epoxide
Lindane
Methoxychlor
Toxaphene
Sample Preparation:
6010E
6010E
60108
6010B
50 mL / 50 mL 3010A
BRL mg/L 0.0025 0.00072 1
BRL mglL 0.0005 0.000041 1
BRL mglL 0.0005 0.000079 1
BRL mg/L 0.0005 0.000044 1
BRL mg/L 0.0005 0.000041 1
BRL mg/L 0.0005 0.000087 1
BRL mg/L 0.025 0.00074 1
TCLP Leachable Semi -volatile Organics by GCI@AS
1,4-Dichlorobenzene
2,4,5-Trichlorophenol
2,4, 6-Trichlorophenol
2,4-Dinitrotoluene
2-Methylphenol
3&4-Methylphenol
Hexachlorobenzene
Hexachlorobutadiene
8081A
8081A
8081A
8081A
8081A
8081A
8081A
200 mL / 10 mL 3510C
Surrogate
08/07/08 1:47 mcampbell
08/07/08 1:47 mcampbell
08/07/08 1:47 mcampbell
08/07/08 1:47 mcampbell
08/06/08 9:40 mbarber
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 23:25 jvogel
08/07/08 6:00
% Recovery
Tetrachloro-m-xylene (TCMX) 98
Decachlorobiphenyl (DCB)
88
Q34496
Q34496
Q34496
034496
P22258
Q34533
Q34533
Q34533
Q34533
Q34533
Q34533
Q34533
smanivanh P22264
Control Limits
40 - 134
13-186
BRL mg/L 0.050 0.0028 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.25 0.0044 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.10 0.0046 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.012 0.0030 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.050 0.0052 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.050 0.0056 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.010 0.0014 1 8270C 08/12/08 8:08 kcampigotto
BRL mg/L 0.050 0.0022 1 8270C 08/12/08 8:08 kcampigotto
Q34621
Q34621
Q34621
Q34621
Q34621
Q34621
Q34621
Q34621
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 2 of 12

Full Service Analytical & EnulronnmNal Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID:
Sample Matrix:
Parameter
Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
4TH Creek Sludge
220582
G0708776
07/28/08 11:30
07/28/08 15:35
Result Units Report MDL Dilution Method Analysis Analyst
Hexachloroethane
Nitrobenzene
Pentachlorophenol
Pyridine
BRL mg/L
BRL mg/L
BRL mg/L
BRL mg/L
Limit
0.050
0.050
0.25
0.25
Factor
0.0046 1
0.0030
0.0042
0.0036
One surrogate recovery was outside of the control
Sample Preparation:
TCLP Leachable Volatile Organics by GCIMS
1,1-Dichloroethene
1,2-Dichloroethane
1,4-Dichlorobenzene
Benzene
Carbon tetrachloride
Chlorobenzene
Chloroform
Methyl ethyl ketone (MEK)
Tetrachloroethene
Trichloroethene
Vinyl chloride
BRL mglL 0.050
BRL mg/L 0.050
BRL mg/L 0.050
mg/L 0.050
mglL 0.050
mg/L 0.050
mg/L 0.050
mg/L 0.50
mg/L 0.050
mg/L 0.050
mg/L 0.020
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
Daterme
Batch
ID
8270C 08/12/08 8:08 kcampigotto
8270C 08/12/08 8:08 kcampigotto
8270C 08/12/08 8:08 kcampigotto
8270C 08/12/08 8:08 kcampigotto
limits. Matrix interference is suspected.
Q34621
Q34621
Q34621
Q34621
200 mL / 1 mL 3510C 08/11/08 13:00 smanivanh P22306
Surrogate % Recovery Control Limits
Terphenyl-d14 91 41 - 136
Phenol-d5 9 # 10 - 78
Nitrobenzene-d5 52 13 -107
2-Fluorophenol 14 10 - 75
2-Fluorobiphenyl 56 27 -107
2,4,6-Tribromophenol 49 38 -117
0.013 10
0.0021 10
0.0033 10
0.0028 10
0.0012 10
0.00094 10
0.017 10
0.017 10
0.0036 10
0.0033 10
0.011 10
8260B 08/12/08 13:44 erussell
8260B 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260B 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
8260B 08/12/08 13:44 erussell
8260E 08/12/08 13:44 erussell
Thls report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Page 3 of 12

Full Service Analytical & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
Parameter
Sample Comment(s):
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID: Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
4TH Creek Sludge
220582
G0708776
07/28/08 11:30
07/28/08 15:35
Result Units Report MDL Dilution Method Analysis
Limit Factor Date/Time
Analyst Batch
ID
Surrogate % Recovery Control Limits
Toluene-d8 99 75 -121
Dibromofluoromethane 102 74 -133
Bromofluorobenzene 102 69 - 139
BRL = Below Reporting Limit
Values are reported down to the reporting limits only. No J-Nags applied.
The results in this report relate only to the samples submitted for analysis and meet state certification requirements other than
NELAC certification except for those instances indicated in the case narrative and/or test comments.
All results are reported on a wet -weight basis
Angela D. Overcash, V.P. Laboratory Services
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number:1-800/529-6364 - Fax: [phone]
Page 4 of 12

GCAL ID a_ Client.ID
2080731.1901 •220582.• 7
ricIL u
Matrix. • Collect Datell ime Receive Date/Time
' .Solid 07/28/2008 11:30 07/31/2008 0931
SW-846 8151 A TCLP
Prep Date Prep Batch
08/08/2008 17:30 394786
Prep Method
3510C
Dilution Analyzed By Analytical Batch
1 08/11 /2008 04:44 TLS 395060
CAS#
94-75-7
93-72-1
Parameter
2.4'-D
2,4,5-TP (Silvex)
CAS# Surrogate
19719-28-9 DCAA
RESULTS REPORTED ON A WET WEIGHT BASIS
Result
0.00000U
0.00001 U
RDL
0.00500
0.00500
MDL
0.00000
0.00001
Units
mg/L
mg/L
Conc. Spiked Conc. Rec Units % Recovery Rec Limits
20 13.9 ug/L 70 41 - 128
GCAL Report 208073119

GCAL ID Client lD :u:
208073.11901. 220582 7�'(-re
Matrix. CollectpateNme.
Receive-Datemme
Solid . 07/28,2008 11:30 07/31/2008 09:31 :
SW-846 9012A Reactivity CN
Prep Date Prep Batch
08/02/2008 09:00 394040
Prep Method
7.3.3.2
Dilution Analyzed By Analytical Batch
1 08/07/2008 15:04 AEL 394657
CAS#
Parameter
57-12-5R Reactivity Cyanide
RESULTS REPORTED ON A WET WEIGHT BASIS
Result
250U
RDL
250
MDL
250
Units
mg/kg
GCAL Report 208073119

GCAL ID -,:,;Client ID , C-C.ek iVlatrhc Collect Datefriroe Receive Date/Time
• • . • . SI Solid
20807311901 220582 - je 07/2812008 11:30 07/31/2008 0931
SW-846 9034 Reactivity Sulfide
I Prep Date Prep Batch Prep Method
08/02/2008 09:00 394041 Sec 7.3.4.2
Dilution Analyzed By Analytical Batch
1 08/04/2008 04:30 JEM 394347
CAS# Parameter
18496-25-8R Reactivity Sulfide
RESULTS REPORTED ON A WET WEIGHT BASIS
Result RDL MDL
80U 80 80
Units
mg/kg
GCAL Report 208073119

State of North Carolina
Department of Environment and Natural Res
Division of Water Quality
RESIDUALS SOURCE CERTIFICATION ATT .CRAW
(FORM: RSCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality (Division) will not accept this attachment unless all the instructions are
followed. Failure to submit all required items will lead to additional processing and review time.
For more information. visit our web site at: httpr%h2o.cnr.state.nc.urs,!lurr'main.html
INSTRUCTIONS TO THE APPLICANT: 3" r Creel, ► Jt'TP
pir,fla16)
ILO
__
S EP - 2 2009
uifer Protection
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding residuals program application
form (FORM: NDRLAP, FORM: DRS, or FORM: SDRS).
✓ Any changes to this attachment form will result in the application package being returned.
✓ For new residuals programs or renewed residuals programs, submit a separate attachment form for each
residuals source -generating facility to be certified for this residuals. program.
✓ For modified residuals programs in which any modification to the certified residuals -source generating
facilities is proposed, submit a separate attachment form for only those residuals source -generating facilities
that are affected by the proposed modification.
✓ The attachment should be organized prior to submission in the following order (i.e., by facility):
® Attachment Order 2: Residuals Source Certification Attachment (FORM: RSCA).
> Attachment Order 2-a: Vicinity map.
> Attachment Order 2-b: Process flow diagram and/or narrative.
> Attachment Order 2-c: Quantitative justification for residuals production rate.
> Attachment Order 2-d: Sampling plan.
> Attachment Order 2-e: Laboratory analytical reports and operational data.
B. Residuals Source -Generating Facility Information:
✓ Attach a vicinity map that shows the Location of the facility and meets all of the criteria in the latest version of
the document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs."
✓ Attach a detailed narrative and/or process flow diagram that describes how the residuals are to be generated,
treated, processed, and stored at the facility.
✓ Attach a quantitative justification for the value provided in Item I. 8. Ensure that the amount of residuals
listed is the maximum amount expected to be generated by the facility for the life of the permit. In addition,
ensure that this amount is equivalent to that which is actually to be land applied, distributed, and/or disposed,
including any chemicals, amendments, or other additives that are added to the residuals during processing.
C. Residuals Quality Information:
✓ Attach a detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In
addition, ensure that the plan details how the facility and/or the residuals are monitored for any applicable
pathogen reduction and vector attraction reduction requirements. Note that all sampling and monitoring must
be completed on the residuals as they are to be land applied, distributed, and/or disposed.
✓ Attach reports for all laboratory analyses used to complete this attachment form. Attach documentation that
the facility complies and/or the residuals comply with any applicable pathogen reduction and vector attraction
reduction requirements.
✓ Item It 3. Does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only.
FORM: RSCA 070807
Page 1 of 8 Attachment Order 2

State of North Carolina
Department of Environment and Natural Resotyl ee ---
Division of Water Quality l SEP - 2 2009
RESIDUALS SOURCE CERTIFICATION ATTACH ENT
(FORM: RSCA 070807)" iri ff `���•�-�,....
PIC D?�i�l�t ��fii�;0
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGI A L) DWC) - Acuifer Protection
Applicant's name: City ofStatesville/ 3" r Creek Ih`II'"TP
Check all that apply: ❑ NEW RESIDUALS PROGRAM X RENEWED RESIDUALS PROGRAM
❑ INCREASE ❑ DECREASE the maximum permitted annual dry tonnage for this residuals source -
generating facility certified for this residuals program.
Current: 1,000 Dry Tons/yr. and proposed: 1,000 Dry Tons/yr.
❑ ADD ❑ DELETE this residuals source -generating facility to/from those certified for this
residuals program.
❑ OTHER Explain:
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Name of facility: 3'1 Creek WWTP
2. Facility permit holder: City of Statesville
Facility permit holder is (check one): ❑ federal, ❑ state, X local government, or ❑ private.
Facility permit number: NC0020591
Facility permit issued by (check one): X Div. of Water Quality, ❑ Div. of Environmental Health, or
❑ other (explain: ).
3. If the facility permit is not issued by the Div. of Water Quality, complete the following:
a. Facility contact person and title:
Facility complete mailing address:
City: State: Zip:
Telephone number: ( ) Facsimile number: ( )
E-mail address:
b. Facility complete location address:
City: State: Zip:
Latitude: and longitude:
4. County where facility is located: Iredell
5. Purpose of the facility (check one):
❑ treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
X treatment of industrial wastewater mixed with domestic wastewater, or
(approximate percentages: 60 % industrial and 40 % domestic)
❑ other (explain:
FORM: RSCA 070807
Page 2 of 8 Attachment Order 2

6. Does the facility have an approved pretreatment program:
X yes ❑ no
7. Facility permitted/design flow: 4 MGD and facility average daily flow: 2 MGD.
8. Average amount of residuals being generated at this facility dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 0.9 Million Gallon aerobic digester, belt filter press. Dewatering
polymer.
Type and volume of residuals storage (i.e., outside of residuals treatment units): 1/3 acre concrete pad.
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under (check one): ❑ 40 CFR Part 503 or ❑ 40 CFR Part 257.
2. Specify if residuals are intended for (check one):
❑ Land Application/Distribution (Class A or Equivalent).
Complete all items EXCEPT Items II. 4b. 7b. and 7c.
X Land Application (Class B or Equivalent).
Complete all items EXCEPT Items II. 4b. 7a. and 7c.
❑ Surface Disposal.
Complete all items EXCEPT Items 11. 4a. 5. 7a., 7b., and 8.
***FORM: RSCA CONTINUES ON NEXT PAGE***
FORM: RSCA 070807
Page 3 of 8 Attachment Order 2

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non-
hazardous under RCRA:
a. Are the residuals are listed in 40 CFR §261.31-§261.33: ❑ yes X no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
§261.24: ❑ yes X no. Fill in the following tables with the results of the latest toxicity
characteristic leaching procedure (TCLP) analysis as well as those for corrosivity, ignitability, and
reactivity: laboratory: Prism Laboratory and date of analysis: 7/28/08
Passed corrosivity test: X yes ❑ no. pH: s.u. (2 < pH < 12.5).
Passed ignitability test: X yes ❑ no. Flashpoint: °F (> 140°F).
Passed reactivity test: X yes ❑ no. HCN: mg/kg (<250) & H2S:
mg/kg (<500).
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
Arsenic
5.0
<0.050
Hexachlorobenzene
0.13
<0.010
Barium
100.0
<5.0
Hexachloro-1,3-
R11t4diene
0.5
<0.050
Benzene
0.5
<0.050
Hexachloroethane
3.0
<0.050
Cadmium
1.0
<0.025
Lead
5.0
<0.050
Carbon Tetrachloride
0.5
<0.050
Lindane
0.4
<0.0005
Chlordane •
0.03
<0.0025
Mercury
0.2
<0.010
Chlorobenzene
100.0
<0.050
Methoxychlor
10.0
<0.0005
Chloroform
6.0
<0.050
Methyl Ethyl Ketone
200.0
<0.50
Chromium
5.0
<0.25
Nitrobenzene
2.0
<0.050
m-Cresol
200.0
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
Pyridine
5.0
<0.25
p-Cresol
200.0
Selenium
1.0
<0.050
Cresol
200.0
Silver
5.0
<0.25
2,4-D
10.0
ND
Tetrachloroethylene
0.7
<0.050
1,4-Dichlorobenzene
7.5
<0.050
Toxaphene
0.5
<0.025
1,2-Dichloroethane
0.5
<0.050
Trichloroethylene
0.5
<0.050
1,1-Dichloroethylene
0.7
<0.050
2,4,5-Trichlorophenol
400.0
<0.25
2,4-Dinitrotoluene
0.13
<0.012
2,4,6-Trichlorophenol
2.0
<0.10
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
0.00500
Heptachlor and its Hydroxide
0.008
<0.0005
Vinyl Chloride
0.2
<0.020
FORM: RSCA 070807
Page 4 of 8
Attachment Order 2

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the
residuals do not violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Class A or Class B: Fill in the following table with the results of the latest analyses (i.e., on a dry
weight basis) for the following metal parameters:
Laboratory: and date of analysis:
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(For Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
Cadmium
85
39
Copper
4,300
1,500
No Residuals
Lead
840
300
have been applied
Mercury
57
17
Molybdenum
75
n/a
Nickel
420
420
Selenium
100
100
Zinc
7,500
2,800
b. For Surface Disposal: Fill in the following table with the results of the latest analyses (i.e., on a dry
weight basis) for the following metal parameters:
Laboratory: and date of analysis:
Closest Distance
to Property Lines
(meters)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
> O but < 25
30
200
210
> 25 but < 50
34
220
240
>_ 50 but < 75
39
260
270
>_ 75 but < 100
46
300
320
> 100 but < 125
53
360
390
> 125 but < 150
62
450
420
> 150
73
600
420
FORM: RSCA 070807
Page 5 of 8
Attachment Order 2

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 19 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the
following nutrient and micronutrient parameters: laboratory: 4th Creek WWTP Laboratory and date of
analysis: Ongoing weekly.
Parameter
Result
(mg/kg, dry weight)
Aluminum
Ammonia -Nitrogen
Calcium
No residuals have been applied.
Magnesium
Nitrate -Nitrite Nitrogen
pH (Standard Unit)
Phosphorus
Potassium
Sodium
Total Kjeldahl Nitrogen
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR):
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the
residuals:
%. This rate is a ❑ default value or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or
provide technical justification as to why the selected default value is appropriate to be applied to these
residuals:
Calculate the PAN for the residuals (i.e., on a dry weight basis) and list the results in the following table:
Application Method
First Year
PAN
(mg/kg)
Five -Year
Maximum Adjusted
PAN
(mg/kg)
Surface
4
19.95
Injection/Incorporation
e. Are the residuals a registered fertilizer with the NC Department of Agriculture and Consumer Services:
❑ yes X no. If yes, provide date of registration approval:
the current registration number:
and the fertilizer equivalent: %, %, and %.
FORM: RSCA 070807
Page 6 of 8
Attachment Order 2

6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the
residuals and list the results of the latest analyses:
7. Pathogen Reduction Determination: Specify which alternative(s) will be used to meet the pathogen
reduction requirements:
a. For Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids.
OR
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the following (except for residuals regulated under 40 CFR Part 257 that are to be distributed):
❑ Alternative 1 [40 CFR §503.32 (a)(3)] - Time/Temperature Compliance.
❑ Alternative 2 [40 CFR §503.32 (a)(4)] - Alkaline Treatment.
❑ Alternative 3 [40 CFR §503.32 (a)(5)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [40 CFR §503.32 (a)(6)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [40 CFR §503.32 (a)(7)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment, ❑ pasteurization,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation, or ❑ gamma ray irradiation.
❑ Alternative 6 [40 CFR §503.32 (a)(8)] - PFRP-Equivalent Process.
Explain:
b. For Class B or Equivalent:
X Alternative 1 [40 CFR §503.32 (b)(2)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [40 CFR §503.32 (b)(3)] - Process to Significantly Reduce Pathogens (PFRP).
Specify one: X aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
❑ Alternative 3 [40 CFR §503.32 (b)(4)] - PSRP-Equivalent Process.
Explain:
❑ Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
c. For Surface Disposal:
❑ Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - SoiVOther Material Cover.
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
FORM: RSCA 070807
Page 7 of 8 Attachment Order 2

8. Vector Attraction Reduction Determination: Specify which alternative(s) will be used to meet the vector
attraction reduction requirements:
❑ Alternative 1 [40 CFR §503.33 (b)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [40 CFR §503.33 (b)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [40 CFR §503.33 (b)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [40 CFR §503.33 (b)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
X Alternative 5 [40 CFR §503.33 (b)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [40 CFR §503.33 (b)(6)] - Alkaline Stabilization.
❑ Alternative 7 [40 CFR §503.33 (b)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [40 CFR §503.33 (b)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [40 CFR §503.33 (b)(9)] - Injection.
❑ Alternative 10 [40 CFR §503.33 (b)(10)] - Incorporation.
El Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover.
El Alternatives for Animal Processing Residuals Only:
Specify one: ❑ injection, ❑ incorporation, or ❑ lime addition to raise pH to 10.
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
FORM: RSCA 070807
Page 8 of 8 Attachment Order 2

ji
3 n? C1 0s-
wao2A

ATTACHMENT 2b
4th CREEK & 3rn' CREEK WWTP NARRATIVE
Both of the WWTP's utilize a conventional activated sludge process that primarily treats domestic and
industrial waste water generated from areas within and outside of the city. The raw sewage enters the
WWTP via gravity main and from there it flows into a wet well or pump station. The flow enters one of
two perforated panel type bar screens. At this point the raw sewage is mixed with return activated
sludge and distributed into two aeration basins. The mixed liquor flows into secondary clarifiers . and
then the RAS is pumped back into the influent of the WWTP. The effluent gravity flows from the
secondary clarifiers to the chlorine contact basins where the final effluent is treated with Sodium
Bisulfite for de -chlorination as it flows to the receiving stream.
Both WWTP's generate biosolids that are currently stabilized using an aerobic digester, and dewatered
using a belt press. After dewatering, the residuals are transferred to the N-Viro lime stabilization process
area where the biosolids are set aside for contract land application off of the plant site. The primary
method of biosolids disposal is the N-Viro process.
*IA

it of
-ftttesniUc
II. CO. Jnx 1111 • 3tatesuille, Nnrtll attrolina 28G87
July21, 2009
Mr. Ed Hardee
Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Permit # WO0014543
Quantitative Justification for Residuals Production Rate
Third Creek WWTP
Dear Mr. Hardee:
)40,07.1-A
The 3`d Creek WWTP would generate approximately 973 dry tons per year of biosolids. This would
all go to the N-Viro process and /or the contracted Land Application contractor unless extenuating
circumstances prevailed.
Should you require more information, or if further action is required, please contact me at 878-3438.
Sin
Fourth Creek WWTP Supervisor

OEit of
3tttte�nille
1,. (!. Nnx 1111 • 'ttttesuille, Nurtli Cnttrulina 28687
July 21, 2009
Mr. Ed Hardee
Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
Re: Permit # WQ0014543 2,
Biosolids Sampling Plan/XS
Third Creek WWTP
Dear Mr. Hardee:
The 3`d Creek WWTP is currently using a 2 belt sludge press for the process of its sludge. As the
press is operating, the operator would collect the required amount of sample per the permit to send to
the designated lab.
Should you require more information, or if further action is required, please contact me at 878-3438.
Sincerely,
Fourth reek VWVTP Supervisor

Full Service Analytical & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID: Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
3RD Creek Sludge
220583
G0708776
07/28/08 11:30
07/28/08 15:35
Parameter
pH, Corrosivity
pH
Ignitability of Solids
Ignitability
Result Units Report MDL Dilution Method Analysis
Limit Factor Date/Time
Analyst Batch
ID
6.0 pH units 0.10 0.10
Negative N/A
1
9045C 08/01/08 11:44 kpowers
1030 07/30/08 14:44 rloftin
Reactive Cyanide
Subcontract Report See 1 See Attached
Attached
* Analysis Note for Subcontract Report: Subcontracted to NC Certified Lab 618.
Reactive Sulfide
Subcontract Report See 1 See Attached
Attached
* Analysis Note for Subcontract Report: Subcontracted to NC Certified Lab 618.
TCLP Extraction for Metals and/or Non -Volatile Organics
TCLP Extraction (Metals/Organics) Complete
Zero Headspace Extraction for Volatiles
TCLP Extraction (ZHE-Volatiles) Complete
1
1
1311 08/05/08 11:30 mbarber
1311 08/11/08 17:00 winder
Acid Herbicicides in TCLP Leacheate by GC-ECD
Subcontract Report See 1 8151A
Attached
* Analysis Note for Subcontract Report: Subcontracted to NC Certified Lab 618.
TCLP Leachable Mercury by CVAA
Mercury BRL mg/L 0.010 0.000014 1 7470A
Sample Preparation: 20 mL / 30 mL 7470A 08/08/08 9:30
TCLP Leachable Metals by ICP
Arsenic
Barium
Cadmium
BRL mg/L 0.050 0.0029 1 6010B 08/07/08 2:07
BRL mg/L 5.0 0.0019 1 6010B 08/07/08 2:07
BRL mg/L 0.025 0.00034 1 6010B 08/07/08 2:07
034366
Q34306
08/08/08 18:19 mcampbeli Q34590
mbarber P22275
mcampbell
mcampbell
mcampbell
Q34496
Q34496
Q34496
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page5of12

Full Service Analytical & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID:
Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
3RD Creek Sludge
220583
G0708776
07/28/08 11:30
07/28/08 15:35
Parameter
Chromium
Lead
Selenium
Silver
Result Units Report MDL Dilution
Limit Factor
Method Analysis
Date/Time
Analyst Batch
ID
Sample Preparation:
BRL mg/L 0.25 0.0006 1
BRL mg/L 0.050 0.0021 1
BRL mg/L 0.050 0.0035 1
BRL mg/L 0.25 0.00025 1
TCLP Leachable Organochlorine Pesticides by GC/ECD
Chlordane BRL mg/L
Endrin
Heptachlor
Heptachlor Epoxide
Lindane
Methoxychlor
Toxaphene
Sample Preparation:
50 mL / 50 mL
0.0025 0.00072
BRL mg/L 0.0005 0.000041
BRL mg/L 0.0005 0.000079
BRL mg/L 0.0005 0.000044
BRL mg/L 0.0005 0.000041
BRL mg/L 0.0005 0.000087
BRL mg/L 0.025 0.00074
TCLP Leachable Semi -volatile Organics by GC/MS
1,4-Dichlorobenzene BRL
2,4,5-Trichlorophenol
2,4,6-Trichlorophenol
2,4-Dinitrotoluene
2-Methylphenol
3&4-Methylphenol
Hexachlorobenzene
Hexachlorobutadiene
BRL
BRL
BRL
BRL
BRL
BRL
BRL
1
1
1
1
1
1
200 mL / 10 mL
6010E 08/07/08 2:07
6010E 08/07/08 2:07
6010E 08/07/08 2:07
6010B 08/07/08 2:07
3010A 08/06/08 9:40
8081A
8081A
8081A
8081A
8081A
8081A
8081A
mcampbell Q34496
mcampbell Q34496
mcampbell Q34496
mcampbell Q34496
mbarber P22258
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
08/08/08 0:06 jvogel
3510C 08/07/08 6:00
Surrogate % Recovery
Tetrachloro-m-xylene (TCMX) 84
Decachlorobiphenyl (DCB)
Q34533
Q34533
Q34533
Q34533
Q34533
Q34533
Q34533
smanivanh P22264
Control Limits
40-134
77 13-186
mg/L 0.050 0.0028 1 8270C 08/12/08 9:43 kcampigotto 034621
mg/L 0.25 0.0044 1 8270C 08/12/08 9:43 kcampigotto 434621
mg/L 0.10 0.0046 1 8270C 08/12/08 9:43 kcampigotto Q34621
mg/L 0.012 0.0030 1 8270C 08/12/08 9:43 kcampigotto Q34621
mg/L 0.050 0.0052 1 8270C 08/12/08 9:43 kcampigotto Q34621
mg/L 0.050 0.0056 1 8270C 08/12/08 9:43 kcampigotto Q34621
mg/L 0.010 0.0014 1 8270C 08/12/08 9:43 kcampigotto Q34621
mg/L 0.050 0.0022 1 6270C 08/12/08 9:43 kcampigotto Q34621
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 6 of 12

Full Service Analytical & Environmental &Miens
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID: Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Sample Matrix: Solid
Laboratory Report
08/14/08
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
3RD Creek Sludge
220583
G0708776
07/28/08 11:30
07/28/08 15:35
Parameter
Result Units Report MDL Dilution Method
Limit Factor
Hexachloroethane
Nitrobenzene
Pentachlorophenol
Pyridine
Sample Preparation:
BRL mg/L 0.050 0.0046 1
Analysis
Date/Time
Analyst Batch
ID
8270C 08/12/08 9:43
BRL mg/L 0.050 0.0030 1 8270C
BRL mg/L 0.25 0.0042 1 8270C
BRL mg/L 0.25 0.0036 1 8270C
TCLP Leachable Volatile Organics by GC/MS
1,1-Dichloroethene BRL mg/L
1,2-Dichloroethane BRL mg/L
1,4-Dichlorober¢ene BRL mg/L
Benzene BRL mg/L
Carbon tetrachloride BRL mg/L
Chlorobenzene BRL mg/L
Chloroform BRL mg/L
Methyl ethyl ketone (MEK) BRL mg/L
Tetrachloroethene BRL mg/L
Trichloroethene BRL mg/L
Vinyl chloride BRL mg/L
08/12/08 9:43
08/12/08 9:43
08/12/08 9:43
kcampigotto Q34621
kcampigotto Q34621
kcampigotto Q34621
kcampigotto Q34621
200 mL / 1 mL 3510C 08/11/08 13:00 smanivanh P22306
0.050
0.050
0.050
0.050
0.050
0.050
0.050
0.50
0.050
0.050
0.020
Surrogate
Terphenyl-d14
Phenol-d5
Nitrobenzene-d5
2-Fluorophenol
2-Fluorobiphenyl
2,4,6-Tribromophenol
% Recovery
Control Limits
88
11
64
14
65
38
41 -136
10-78
13-107
10-75
27-107
38 -117
0.013 10
0.0021 10 .
0.0033 10
0.0028 10
0.0012 10
0.00094 10
0.017 10
0.017 10
0.0036 10
0.0033 10
0.011 10
8260B
8260B
8260E
8260E
8260B
8260E
826013
8260B
8260E
8260B
8260B
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 erussell
08/12/08 14:15 enm-J.li
Q34644
034644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
Q34644
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 7 of 12

Full Srwleo Analytical & Environmental Solutions
City of Statesville
Attn: Mr. Andy Smith
P.O. Box 1111
Statesville, NC 28687
Parameter
Sample Comment(s):
NC Certification No. 402
SC Certification No. 99012
NC Drinking Water Cert. No. 37735
Project ID:
Sample Matrix:
Sta-Lime, 3rd Creek and
4th Creek Sludge with
TCLP
Solid
Laboratory Report
Client Sample ID:
Prism Sample ID:
COC Group:
Time Collected:
Time Submitted:
08/14/08
3RD Creek Sludge
220583
G0708776
07/28/08 11:30
07/28/08 15:35
Result Units Report MDL Dilution
Limit Factor
Method Analysis
Date/Time
Surrogate
Toluene-d8
Dibromofluoromethane
Bromofluorobenzene
Analyst Batch
ID
% Recovery Control Limits
99 75 - 121
101 74 -133
102
69-139
BRL = Below Reporting Limit
Values are reported down to the reporting limits only. No J-flags applied.
The results in this report relate only to the samples submitted for analysis and meet state certification requirements other than
NELAC certification except for those instances indicated in the case narrative and/or test comments.
All results are reported on a wet -weight basis
Angela D. Overcash, V.P. Laboratory Services
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 8 of 12

GCAL„ip :. Clieiiii&.
2080731<1902 220583.'
Matrix : Collect DateiTime: Receive Datemme
Solid
07/28/200811:30
07/31/2008 09:31
SW-846 9034 Reactivity Sulfide
Prep Date Prep Batch
08/02/2008 09:00 394041
Prep Method
Sec 7.3.4.2
Dilution Analyzed By Analytical Batch
1 08/04/2008 04:30 JEM 394347
CAS# Parameter
18496-25-8R Reactivity Sulfide
RESULTS REPORTED ON A WET WEIGHT BASIS
Result
80U
RDL
80
MDL
B0
Units
mg/kg
GCAL Report 208073119

GCALID: Client ID •
=20807311902.;..; :.220583 3 ..
Matrix
Solid
Collect patelTime.
07/28/200cs ,1130--:
Receive DatefTime
7/31f2008 09:31 .
•
SW-846 9012A Reactivity CN
Prep Date Prep Batch
08/02/2008 09:00 394040
Prep Method
7.3.3.2
Dilution Analyzed By Analytical Batch
1 08/07/2008 15:05 AEL 394657
CAS#
57-12-5R
Parameter
Reactivity Cyanide
RESULTS REPORTED ON A WET WEIGHT BASIS
Result
250U
RDL
250
MDL
250
Units
mg/kg
GCAL Report 208073119 ,

SCAL.ID ' Client ID
2080731.1902... 220583
Matrix CollectDate/Time.
toJ �e. Solid . 07/28/2008 11:30
Receive DatelTime.
• 07/31/2008 09:31
SW-846 8151A TCLP
Prep Date Prep Batch
08/08/2008 17:30 394786
Prep Method
3510C
Dilution Analyzed By Analytical Batch
1 08/11/2008 05:13 TLS 395060
CAS#
94-75-7
93-72 1
CAS# Surrogate
Parameter
2,4'-D
2,4,5-TP (Silvex)
19719-28-9 DCAA
RESULTS REPORTED ON A WET WEIGHT BASIS
Result
RDL
MDL
Units
0.00000U 0.00500 0.00000 mg/L
0.00001U 0.00500 0.00001 mg/L
Conc. Spiked Conc. Rec Units % Recovery Rec Limits
20 15.8 ug/L 79 41 - 128
GCAL Report 208073119

State of North Carolina
Department of Environment and Natural Reso
Division of Water Quality
LAND APPLICATION SITE CERTIFICATION ATT
(FORM: LASCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality (Division) will not accept this attachment unless all the instructions are followed.
Failure to submit all required items will lead to additional processing and review time.
For more information, visit our web site at:lutp:t/h7p.erer.state.nc.us/iauhnain.html
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding residuals program application form (FORM:
NDRLAP).
✓ Any changes to this attachment form will result in the application package being returned.
✓ For new residuals land application programs or renewed residuals land application programs, submit the requested
information for all land application sites to be certified for this residuals land application program.
✓ For modified residuals land application programs in which any new/transferred land application sites or modification to the
certified land application sites are proposed, submit the requested information for only those land application sites that are
new/transferred or affected by the proposed modification.
B. Land Application Site Information:
✓ Additional copies of Page 4 of 4 of this attachment form may be used if necessary.
✓ The status of the land application site with respect to this residuals land application program must be provided in the table in
Item I. 1. The status categories and their corresponding codes are as follows:
• New (N) • Renewed (R) ♦ Modified (M)
rip E.OTW E
SEP - 2 2009
D�"bNO Acuif=;r Protection
+ Transferred (T)
✓ If this is the first time that an application package is being submitted using Form NDRLAP, then a Watershed Classification
Attachment (FORM: WSCA) must be completed for all existing land application sites.
✓ For each land application site with a status code of N, attach the following in the order specified:
♦ Attachment Order 3: Land Application Site Certification Attachment (FORM: LASCA).
➢ Attachment Order 3-a: Watershed Classification Attachment (FORM: WSCA).
➢ Attachment Order 3-b: County Manager Notification Attachment (FORM: CMNA).
> By Land Application Site:
■ Attachment Order 3-c: Landowner Agreement Attachment (FORM: LOAA).
• Attachment Order 3-d: Setback Waiver Agreement Attachment (FORM: SWAA).
• Attachment Order 3-e: An updated vicinity/buffer map that meets all of the criteria in the latest version of the
document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs.", including review and compliance boundaries.
■ Attachment Order 3-f: A soils and agronomic evaluation that meets all of the criteria in the latest version of
the document entitled "Soil Scientist Evaluation Guidance Document."
✓ For each land application site with a status code of R, attach the following in the order specified:
• Attachment Order 3: Land Application Site Certification Attachment (FORM: LASCA).
> By Land Application Site:
■ Attachment Order 3-c: Landowner Agreement Attachment (FORM: LOAA).
• Attachment Order 3-d: Setback Waiver Agreement Attachment (FORM: SWAA).
■ Attachment Order 3-e: An updated vicinity/buffer map (i.e., see above for criteria guidance).
■ Attachment Order 3-g: An updated accounting of the land application site's cumulative pollutant loading rates
(CPLRs) that are required by the permit of the residuals land application program from which the site is being
transferred.
***INSTRUCTIONS CONTINUE ON NEXT PAGE***
FORM: LASCA 070807
Page 1 of 3 Attachment Order 3

• Attachment Order 3-h: (For sites without a previously permitted soil series name indicated in Attachment
"B") County Soil Survey Map (or equivalent) clearly indicating the location and name of the all land
application sites without a previously permitted soil type. The map must be legible and to a scale where the
sites can be easily identified and differentiated from adjacent sites. The predominant soil -mapping units must
be shown for each site. The map must include the mapping unit legend, the County name, the Applicants
name, and the permit number. The Permittee must note in the narrative and provide documentation supported
by a licensed soil scientist for approval of any soil -mapping unit submitted in this form that has not been
previously approved and differs from that shown in the County Soil Survey.
✓ For each land application site with a status code of M. contact the appropriate Division's regional office to determine
attachment requirements.
✓ For each land application site with a status code of T attach the following in the order specified:
• Attachment Order 3: Land Application Site Certification Attachment (FORM: LASCA).
➢ Attachment Order 3-a: Watershed Classification Attachment (FORM: WSCA).
➢ Attachment Order 3-b: County Manager Notification Attachment (FORM: CMNA).
> By Land Application Site:
• Attachment Order 3-c: Landowner Agreement Attachment (FORM: LOAA).
■ Attachment Order 3-d: Setback Waiver Agreement Attachment (FORM: SWAA).
• Attachment Order 3-e: An updated vicinity/buffer map that meets all of the criteria in the latest version of the
document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs."
• Attachment Order 3-g: An updated accounting of the CPLRs (i.e., see above for criteria guidance).
■ Attachment Order 3-i: Acknowledgement of field transfer from Permittee relinquishing field.
• Attachment Order 3-i: Acknowledgement of field transfer from Land Owner. Fields may not be permitted to
multiple Permitees over the same time period.
✓ Crop Type should include the most likely crop types for the life of the permit (5 years).
✓ Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
✓ Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
• Sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), may determine the representative slope by using
the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
♦ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil
scientist.
FORM: LASCA 070807
Page 2 of 4 Attachment Order 3

Applicant's name: City of Statesville
Check all that apply: ❑ NEW RESIDUALS LAND APPLICATION PROGRAM X RENEWED RESIDUALS LAND APPLICATION PROGRAM
❑ ADD ❑ DELETE this/these land application site(s) to/from those certified for this residuals land application program.
❑ INCREASE ❑ DECREASE the net acreage associated with this/these land application site(s) currently certified.
❑ OTHER Explain:
Land application sites currently certified: 4`J' —15. 3/ 3'd —14,1 net acres and Total to be certified: 29,4
I. LAND APPLICATION SITE INFORMATION (See Instruction B.):
1. Complete the following table with the requested information:
net acres.
Status
Code a
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series
Name*
Mapping
Unit or Rep.
Slope **
R
01
City of Statesville
City of Statesville
15.3
Iredell
Corn/small grain
Lloyd
LcD3
R
02
City of Statesville
City of Statesville
14.10
Iredell
Fescue hay
Cecil
Cfc2
s Status Code for land application sites are: • N (New) • R (Renew)
* Soil Series Name (i.e Cecil)
FORM: LASCA 070807
o M (Modified) e T (Transferred)
Page 3 of4
Attachment Order 3

Cumulative Pollutant Loading Rate
2009
Parameters Kilograms/Hectare LBS/Acre
Arsenic 41 36
Cadmium 39 34
Copper 1,500 1,338
Lead 300 267
Mercury 17 15
Molybdenum NA NA
Nickel 420 374
Selenium 100 89
Zinc 2,800 2,498

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
March 11, 2005
MR. L. F. "JoE" HUDSON, JR., DIRECTOR OF WATER RESOURCES
CITY OF STATESVILLE
POST OFFICE BOX 1111
STATESVILLE, NC 28677
Dear Mr. Hudson:
Alan W. Klimek, P.E. Director
Division of Water Quality
ari�CC9i;]i��I
SEP - 2 2009
NC DF,NR MRO
DWQ - Ac uifor Protection
Subject: Permit No. WQ0014543
. City of Statesville
City of Statesville Residuals Land
Application Program
Land Application of Residual Solids (503)
Iredell County
In accordance with your permit renewal application package received on May 20, 2002 as well as
the additional information received on August 9, 2002 and June 27, 2003; we are forwarding herewith a
modified and renewed Permit No. WQ0014543, dated March 11, 2005, to the City of Statesville for the
subject residuals land application program.
This permit shall be effective from the date of issuance until February 28, 2010; shall void Permit
No. WQ0014543, issued on February 16, 1998 and shall be subject to the conditions and limitations as
specified therein. Make note of this permit's expiration date and the fact that a permit renewal
application is due to the Division of Water Quality (Division) no later than six months prior to that date
(i.e., see Condition VI. 7.), as the Division does not send reminders to apply for permit renewal.
This permit is being issued to approve the continued operation of the residuals land application
program for another five-year cycle as an emergency backup alternative to Permit No. WQ0016247. (a
residuals land application permit issued to Synagro-WWT, Inc.) and Permit No. WQ0006245 (Sta-Lime
distribution permit issued to the City of Statesville). Please be advised that the land application area
being approved in the enclosed Attachment B is not sufficient to land apply all of the residuals being
approved in the enclosed Attachment A. Hence, additional land application sites must be approved prior
to land application of all of the residuals being approved in Attachment A. As always, remember to take
the time to review this permit thoroughly, as some of the conditions contained therein may have been
added, changed, or deleted since the last issuance. Pay particular attention to the monitoring requirements
in this permit. Failure to establish an adequate system for collecting and maintaining the required
operational information will result in future compliance problems.
If any parts, requirements, and/or limitations contained in this permit are unacceptable, you have
the right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request shall be in the from of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes and filed with the' Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, North Carolina 27699-6714. Unless such demands are made, this permit shall be final
and binding.
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone [phone] Customer Service
Internet: http://h2o.enr.state.nc.us 2728 Capital Boulevard Raleigh, NC 27604 Fax [phone]
An Equal opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper Fax [phone]
Onc
Carolina
Naturally

L: F. "Joe" Hudson, Jr.
March 11, 2005
Page 2
If you need any additional information concerning this matter, please contact Mr. J. R. Joshi by
telephone at [phone], or via e-mail at jaya joshi @ncmail.net.
Sincerely,
or Alan W. Klimek, P.E.
cc: .Iredell County Health Departinent
Mooresville Regional Office -Aquifer Protection Section
Technical Assistance and Certification Unit.
APS Central Files
APSuFiles?
LAU Residuals Program Coordinator

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF RESIDUAL SOLIDS (503) PERMIT.
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Statesville
Iredell County
FOR THE
continued operation of a residuals land application program for the City of Statesville and consisting of the
land application of residuals generated by the residuals source -generating facilities listed in the most
recently -certified Attachment A to the land application sites listed in the most recently -certified
Attachment •B with no discharge of wastes to surface waters, pursuant to the permit modification and
renewal application package received on May 20, 2002 as well as the additional information received on
August 9, 2002 and June 27, 2003; and in conformity with the project plan, specifications, and other
supporting data subsequently filed and approved by the Department of Environment and Natural
Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until February 28, 2010; shall void Permit
No. WQ0014543, issued on February 16, 1998; and shall be subject to the following specified conditions
and limitations:
. PERFORMANCE STANDARDS
1. The residuals land application program shall be effectively maintained and operated as a non -
discharge system to prevent the discharge of any wastes resulting from the operation of this
program.
2. This permit shall become voidable if the soils of the land application sites fail to assimilate the
residuals adequately and may be rescinded unless the land application sites are maintained and
operated in a manner that will protect the assigned water quality standards of the surface
waters and groundwater.
3. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to
surface waters or groundwater resulting from the operation of this residuals land application
program.
1

4. In the event that the residuals land application program is not operated satisfactorily, including
the creation of nuisance conditions, the Permittee shall cease land applying residuals to the
site, contact the Aquifer Protection Section of the appropriate Division of Water Quality's,
(Division) regional office, and take any immediate corrective actions as may be required by
the Division.
5. No residuals other than those generated by the residuals source -generating facilities listed in
the most recently -certified Attachment A of this permit shall be approved for land application
in accordance with this permit.
. The pollutant concentrations in any residuals that are land applied to any land application site
shall not exceed the following Ceiling Concentrations (i.e., dry weight basis):
Parameter
Ceiling Concentration
(milligrams per kilogram)
Arsenic
75
Cadmium
85
Copper
4,300
Lead
840
Mercury
57
Molybdenum
. - 75
Nickel
420 -
Selenium
100
Zinc
7,500 .
7. When residuals are land applied under the conditions of this permit, the Class A pathogen
requirements and site restrictions . in 40 CFR Part 503.32(a) or the Class B pathogen
requirements and site restrictions in 40 CFR Part 503.32(b), and one of vector attraction
reduction requirements in 40 CFR Part 503.33 shall be met. Additionally, an evaluation shall
be performed that demonstrates the residuals' ability to comply with this requirement. Upon
request, a copy of this evaluation, including all test results and calculations, shall be
submitted. Only residuals that are generated by the residuals source -generating facilities that
are identified as being exempt from this condition in the most recently -certified Attachment A
shall not be required to comply with, the specified pathogen reduction and vector attraction
reduction requirements.
8 Only the land application sites listed in the most recently -certified Attachment B of this permit
are approved for residuals land application.
9. This permit shall become . voidable unless the agreements between the Permittee and the
landowners and lessees or operators of any land application sites listed in the most recently -
certified Attachment B of this permit not owned by the Permittee are in full force and effect.
These agreements shall be considered expired concurrent with the expiration date ' of the
permit and shall be renewed at the same time the permit is renewed.
10 The appropriate local governmental official (i.e., county manager,. city manager, etc.) shall be
notified at. least 24 hours prior to the initial residuals land application event to any new land
application site. In addition, the appropriate county manager's office shall be notified prior to
the initial residuals land application event on any new site so that they will be aware that
residuals land application activities have commenced on the site.

11. The Aquifer Protection Section of the appropriate Division's regional office shall be notified
at. least 24 hours prior to the initial residuals land application event on any new land
application site. Such notification to the Regional Water Quality Supervisor shall be made
during normal office hours (i.e., from 8:00 a.m. until 5:00 p.m.) between Monday and Friday,
but excluding State Holidays. A list of the Division's regional offices, their county coverage,
and their contact information may be downloaded from the web site at
http://h2o.enr.state.nc.us/ndpu/.
II. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities and land application sites shall be properly maintained and operated at all times.
2. Upon classification of the residuals land application program by the Water Pollution Control
System Operators Certification Commission (WPCSOCC), the Permittee shall designate a
certified land application/residuals operator to be in responsible charge (ORC) of the program.
The operator shall hold a certificate of the type classification assigned to the program by the
WPCSOCC. The Permittee shall also designate a certified back-up operator of the appropriate
type to comply with the conditions of 15A NCAC 8G .0202.
3. No residuals shall be. stored at any land application site at any time, unless written approval
has first been requested and obtained from the Division.
4. A copy of this permit shall be maintained in all manned equipment at the land application sites
when residuals are being land applied during the life of this permit. A spill prevention and
control plan shall be maintained in all residuals transport and application vehicles.
5. When land applying residuals to any land application site, the following buffer zones shall be
maintained at all times:
a. 400 feet from residences or places of public assembly under separate ownership for
surface application methods; however, the buffer zone requirement may be reduced to a
minimum of 100 feet upon written consent of the owner and approval from the Aquifer
Protection Section of the appropriate Division's regional office in Attachment B of this
permit;
b. 200 feet from residences or places of public assembly under separate ownership for
subsurface application methods; however, the buffer zone requirement may be reduced to
a minimum of 100 feet upon written consent of the owner and approval from the Aquifer
Protection Section of the appropriate Division's regional office in Attachment B of this
permit;
c. 100 feet from any public or private water supply source, waters classified as SA or SB,
and any Class I or Class II impounded reservoir used as a source of drinking water for
both methods;
d. 100 feet from any streams classified as WS or B, any other stream, canal, marsh or coastal
waters and any other lake or impoundment for surface application;
e. 50 feet from any streams classified as WS or B, any other stream, canal, marsh or coastal
waters and any other lake or impoundment for subsurface application;
f. 50 feet from property lines for both surface and subsurface application methods;
g. 50 feet from public right of ways for both surface and subsurface application methods;

h. . 10 feet from upslope interceptor drains and surface water diversions for both surface and
subsurface application methods; and
i. 25 feet from downslope interceptor drains, surface water diversions, groundwater drainage
systems, and surface drainage ditches for both surface and subsurface application methods.
6. Maximum slope for land application of residuals shall be 10 percent for surface application
methods and 18 percent for subsurface application methods.
7. Specific residuals land application area boundaries shall be clearly marked on each land
application site prior to and during a residuals land application event.
8. The metal loading rates on any land application site shall not exceed the following
Cumulative Pollutant Loading Rates (CPLRsI:
Parameter
CPLR
(kilograms per hectare)
CPLR
(pounds per acre)
Arsenic
41
36
Cadmium
39
34
Copper
1,500
1,338
Lead
300
267
Mercury
17
15
Molybdenum
n/a
n/a
Nickel
420
374
Selenium
100
89
Zinc
2,800
2,498
An acceptable pH shall be maintained in the soil, residuals and lime mixture, greater than .6.0,
on all land application sites onto which residuals are land applied to ensure optimum yield for
the crops specified in Condition II. 13. The agronomist shall provide information on the pH
best suited for the specified crop and the soil type.
10. Should any of the residuals generated by the residuals source -generating facilities listed in the
most recently -certified Attachment A of this permit contain a high salt content (i.e., high
sodium adsorption ratio (SAR) of five or higher), the exchangeable sodium percentage (ESP)
or other method as approved by the Division, using the results from the annual soils analysis
as required by this permit, shall be monitored on all of the land application sites. The local
Cooperative Extension Office, the Department of Agriculture and Consumer Services, the
Natural Resource Conservation Service, a North Carolina -licensed Soil Scientist, or other
agronomist shall review the results and make recommendations regarding soil amendments
(e.g., gypsum, etc.) or other ameliorative mechanism for maintaining the integrity of the site in
terms of suitability for land application of residuals and maintaining conditions conducive to
crop growth. The Permittee shall implement such recommendations accordingly and shall
maintain written records of each monitoring event that includes details of the sites covered
and rate of soil amendment application.

11. Prior to land applying residuals to any land application site that has previously received or is
intended to receive animal waste (e.g., poultry litter, etc.) or other source of nutrients (e.g.,
fertilizer, etc.) in the future, the Permittee shall obtain information pertaining to the volume
and analysis of the applied waste/nutrients from the landowner and/or lessee/operator of the
site. The Permittee shall be responsible for verifying the volume of residuals that may be land
applied to the site such that the plant available nitrogen (PAN) loading rate for the specified
crop (i.e., see Condition II. 13.) shall not be exceeded by all of the sources of PAN applied.
Should the maximum PAN loading rate be met or exceeded, then no additional residuals shall
be land applied to the site.
12. A suitable vegetative cover, as listed in Condition II. 13., shall be maintained on land
application sites onto which residuals are land applied in accordance with the crop
management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, or other
agronomist and as approved by the Division.
13. Residuals and other sources of PAN shall be land applied to all land application sites at
agronomic rates in accordance with the crop management plan outlined by the local
Cooperative Extension Office, the North Carolina Department of Agriculture and Consumer
Services, the Natural Resource Conservation Service, or other agronomist. Under no
circumstances shall the following PAN loading rates land applied to any site exceed the
following for the specified crops:
Crop
PAN
(pounds per
Crop
PAN
(pounds per
acre per year)
Alfalfa
200
Forest
(Hardwood or'Softwood)
75
Bermuda Grass
(Hay or Pasture)
220
Milo
100
Blue Grass
120
Small Grain
(Wheat, Barley, or Oats)
100
Corn
(Grain)
160
Sorghum or Sudex
(Pasture)
180
Corn
(Silage)
200
Sorghum or Sudex
(Silage)
220
Cotton
70
Soybeans
200
Fescue •
250
Timothy, Orchard, or
Rye Grasses
200
The Permittee shall apply for and receive a modification of this permit before land applying
residuals on any land application site that is to be established in a crop other than those listed
above. A maximum PAN loading rate for the desired crop shall be approved with the permit
modification. .
If the land application sites are to be overseeded (e.g., bermuda grass in the summer and rye
grass in the winter with BOTH crops to receive residuals), then the second crop shall receive
an application of PAN at a rate of no greater than 50 pounds per acre per year. This practice
shall be allowed as long as the second crop is to be harvested. If the second crop is to be
planted for erosion control only and is to be tilled into the soil, then no residuals shall be land
applied to these sites because the PAN will essentially be retumed to the soil.
5

Residuals shall not be land applied at rates greater than agronomic rates, unless authorized by
the Division.
14. Animals shall not be grazed on any land application site for 30 days after any residuals land
application event. Sites that are to be used for grazing shall have fencing that will be used to
prevent access after each event.
15. Food crops, feed crops, and fiber crops that do not come in contact with the residuals shall not
be harvested for 30 days after any residuals land application event.
16. Food crops with harvested parts that touch the residual/soil mixture and .are totally above the
land surface (e.g., tobacco, melons, cucumbers, squash, etc.) shall not be harvested for 14
months after any residuals land application event.
17. Food crops with harvested parts below the surface of the land (i.e., root crops such as potatoes,
carrots, radishes, etc.) shall not be harvested for 20 months after any residuals land application
event when the residuals remain on the land surface for four months or longer prior to
incorporation into the soil.
18. Food crops with harvested parts below the surface of the land shall not be harvested for 38
months after any residuals land application event when the residuals remain on the land
surface for less than four months prior to incorporation into the soil.
19. Turf shall not be harvested for one year after any residuals land application' event.
20. Adequate provisions shall be taken to prevent wind erosion and surface runoff from conveying
residuals from the land application sites onto adjacent properties or into any surface waters.
21. Adequate procedures shall be provided to prevent surface runoff from carrying any land
applied or stored residuals into any surface waters.
22. Surface -applied residuals shall be plowed or disced within 24 hours after land application on
land application sites with no cover crop established.
23. For land application sites that are prone to flooding or within the 100-year flood elevation,
residuals shall be land applied only during periods of dry weather. The residuals shall be
incorporated into the soil within 24 hours after land application.
24. Residuals shall not be land applied during inclement weather or until 24 hours following a
rainfall event of 0.5-inch or greater in 24 hours. Any emergency residuals land application
measures shall first be approved in writing by the Division.
25. Residuals shall not be land applied to any land application site that is flooded, frozen, or
snow-covered.
26 Appropriate measures shall be taken to control public access to the land application sites
during active site use and for the 12-month period following the last residuals land application
event. Such controls may include the posting of signs indicating the activities being
conducted at each site.

I1T. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (Le., including groundwater, surface water, residuals, soil, or plant tissue
analyses) deemed necessary by the Division to ensure protection of the environment shall be
established, and an acceptable sampling and reporting schedule shall be followed.
2. Residuals generated by each residuals source -generating facility listed in the most -recently -
certified Attachment A of this permit shall be analyzed to demonstrate that they are non-
hazardous under the Resource Conservation and Recovery Act (RCRA). A corrosivity,
ignitability, and reactivity analysis as well as a•Toxicity Characteristics Leaching Procedure
(TCLP) analysis shall be conducted on residuals generated by .each .residuals source -
generating facility listed in the most recently -certified Attachment A of this permit. The
analyses shall be performed at the frequency specified in the most recently -certified
Attachment A of this permit, and the results shall be maintained on file by the Permittee for a
minimum of five years. If residuals generated by a particular residuals source -generating
facility are land applied at a frequency less than that which is specified in the most recently -
certified Attachment A of this permit, the analyses shall be required for each residuals land
application event. Only residuals that are generated by the residuals source -generating
facilities that are identified as being exempt from this condition in the most recently -certified
Attachment A of this permit shall not be. required to comply with this monitoring requirement.
The TCLP analysis shall include the following parameters (i.e., note the regulatory level in
milligrams per liter in parentheses):
Arsenic (5.0)
Barium (100.0)
Benzene (0.5)
Cadmium (1.0)
Carbon tetrachloride (0.5)
Chlordane (0.03)
Chlorobenzene (100.0)
Chloroform (6.0)
Chromium (5.0)
m-Cresol (200.0)
o-Cresol (200.0)
p-Cresol (200.0)
Cresol (200.0)
2,4-D (10.0)
1,4-Dichlorobenzene (7.5)
1,2-Dichloroethane (0.5)
1,1-Dichloroethylene (0.7)
2,4-Dinitrotoluene (0.13)
Endrin (0.02)
Hexachlorobenzene (0.13)
Heptachlor (and its hydroxide) (0.008)
Hexachloro-1,3-butadiene (0.5)
Hexachloroethane (3.0)
Lead (5.0)
Lindane (0.4)
Mercury (0.2)
Methoxychlor (10.0)
Methyl ethyl ketone (200.0)
Nitrobenzene (2.0)
Pentachlorophenol (100.0)
Pyridine (5.0)
Selenium (1.0)
Silver (5.0)
Tetrachloroethylene (0.7)
Toxaphene (0.5)
Trichloroethylene (0.5)
2,4,5-Trichlorophenol (400.0)
2,4,6-Trichlorophenol (2.0)
2,4,5-TP (Silvex) (1.0)
Vinyl chloride (0.2)
After the residuals have been monitored as specified above for two years at the frequency
specified in the most recently -certified Attachment A of this permit, the Permittee may submit
a request to the Division for a permit modification to request a reduction of this monitoring
requirement. In no case, however, shall the frequency of monitoring be less than once per
permit cycle.

3. An analysis shall be conducted on residuals generated by each residuals source -generating
facility listed in the most recently -certified Attachment A of this permit. The analysis shall be
performed at the frequency specified in the most recently -certified Attachment A of this
permit, and the results shall be maintained on file by the Permittee for a minimum of five
years. If residuals generated by a particular residuals source -generating .facility are land
applied at a frequency less than that which is specified in the most recently -certified
Attachment A of this permit, an analysis shall be required for each residuals land application
event. The analysis shall include, but shall not necessarilybe limited to, the following
parameters:
Aluminum
Ammonia -Nitrogen
Arsenic
Cadmium
Calcium
Copper
Lead
Magnesium
Mercury
Molybdenum
Nickel
Nitrate -Nitrite Nitrogen
Percent Total Solids
pH
Phosphorus
Potassium
Selenium.
Sodium
Total Kjeldahl Nitrogen
Zinc
Plant Available Nitrogen.
(by calculation)
After the residuals generated by a particular residuals source -generating facility have been
monitored for two years at the frequency specified in the most recently -certified Attachment A
of this permit, the Permittee may submit a request to the Division for a permit modification to
reduce the frequency of this monitoring requirement. In no case, however, shall the frequency
of this monitoring be less than once per year when a residuals land application event of
residuals generated by the residuals source -generating facility occurs during that year.
4. Residuals generated by each residuals source -generating facility listed in the most recently -
certified Attachment A of this permit shall be monitored for compliance with Condition I. 7.
The monitoring shall be performed at the frequency specified in the most recently -certified
Attachment A of this permit, and data to verify pathogen and vector attraction reduction of the
residuals shall bemaintained on file by the Permittee for a minimum of five years. The
required data shall be specific to the stabilization process utilized, but also shall be sufficient
to demonstrate clear compliance with the Class A pathogen reduction requirements in 40 CFR
Part 503.32(a) or the Class B pathogen reduction requirements and site restrictions in 40 CFR
Part 503.32(b) as well as one of vector attraction reduction requirements in 40 CFR Part
503.33. In addition, the Environmental Protection Agency (EPA) certification statements
concerning compliance with pathogen reduction requirements, vector attraction reduction
requirements, and management practices shall be completed at the frequency specified in the
most recently -certified Attachment A of this permit by the proper authority or authorities, if
more than one is involved (i.e., either the person who prepares the residuals, the person who
derives the material, or the person who applies the residuals). Only residuals that are
generated by the residuals source -generating facilities that are identified as being exempt from
Condition I. 7. in the most recently -certified Attachment A of this permit shall not be required
to comply with this monitoring requirement.
5. Laboratory analyses as required by Condition III. 2., Condition III. 3., and Condition III. 4.
shall be performed/gathered on the residuals - as they are to be land applied. Furthermore,
analytical determinations made pursuant to the monitoring and reporting requirements of this
permit shall be made by a laboratory certified by the Division for the required parameter(s)
under 15A NCAC 2H .0800 or 15A NCAC 2H .1100.
8

6. Proper records shall be maintained by the Permittee tracking all residuals land application
events. These records shall include, but are not necessarily limited to, the following
information:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number);
d. Method of land application;
e. Weather conditions (i.e., sunny, cloudy, raining, etc.);
f. Soil conditions (i.e., dry, wet, frozen, etc.);
g.
Type of crop or crops to be grown on field;
h. Volume of residuals land applied in gallons per acre, dry tons 'per acre, or kilograms per
hectare;
i. Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per
=acre, or kilograms per hectare (if applicable);
Volume of soil amendments (i.e., lime, gypsum, etc:) applied in gallons per acre, dry ton
per acre, or kilograms per hectare (if applicable); and
k. Annual and cumulative totals of dry tons per acre of residuals as well as animal waste and
other sources of nutrients (i.e., if applicable), annual and cumulative pounds per acre of
each heavy metal (i.e., shall include, but shall not be limited to, arsenic, cadmium, copper,
lead, mercury, molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN,
and annual pounds per acre of phosphorus applied to each field.
7. A representative annual soils analysis (i.e., Standard Soil Fertility Analysis) shall be
conducted on each land application site on which a residuals land application event in the
respective calendar year has occurred or is to occur, and the results shall be maintained on file
by the Permittee for a minimum of five years. The Standard Soil Fertility Analysis shall
include, but is not necessarily limited to, the following parameters:
Acidity
Calcium
Cation Exchange Capacity
Copper
Base Saturation (by calculation)
Exchangeable Sodium Percentage (by calculation)
Magnesium Phosphorus
Manganese
Percent Humic Matter
pH
Potassium
Sodium
Zinc.
8. Three copies of all required monitoring and reporting requirements as specified in Condition
III. 1., Condition III. 2., Condition III. 3., Condition M. 4., Condition III, 5., Condition III, 6.,
and Condition III. 7. shall be submitted annually on or before March 1st of the year following
the residuals land application event to the following address:
NCDENR-DWQ
Information Processing. Unit.
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

9. Noncompliance Notification:
The Permittee shall report by telephone to the Aquifer Protection Section of the Division's
Mooresville Regional Office at telephone number 704-663-1699, as soon as possible, but in no
case more than 24 hours or on the next working day following the occurrence or first
knowledge of the occurrence of any of the following:
a. Any occurrence with the residuals land application program that results in the land
application of significant amounts of residuals that are abnormal in quantity or
characteristic.
b. Any failure of the residuals land application program resulting in a release ofmaterial to
receiving waters.
c. Any time that self -monitoring information indicates that the residuals land application
program has gone out of compliance with the conditions and limitations of this permit or
the parameters on which the program system was designed.
d. Any process unit failure, due to known or unknown reasons, that render the residuals land
application program incapable of adequate residuals treatment. _
e. Any spillage or discharge from a vehicle or piping system transporting residuals to the
application site.
Persons reporting such occurrences by telephone shall also file a written report in letter form
within five days following first knowledge of the occurrence. This report shall outline the
actions taken or proposed to be taken to ensure that the problem does not recur.
IV. GROUNDWATER REQUIREMENTS
1. Land Application Site Requirements:
a. Each land application site identified with a GW-A in the most recently -certified
Attachment B of this permit is dominated by soils with a mean seasonal high water table
greater than three feet below the land surface. Residuals land application events may
occur on these sites throughout the year.
b. Each land application site identified with a GW-B in the most recently -certified
Attachment B of this permit is dominated by soils with a mean seasonal high water table
between one and three feet below the land surface. Residual land application events on
these sites shall be prohibited from December through March, inclusive. No residuals
shall be land applied to these sites when the vertical separation between the depth of
residuals land application and the water table is less than three feet. The actual water
table depth for seasonally -restricted soils shall be verified by soil borings within 24 hours
prior to any residuals land application event that occurs from April through November,
inclusive. The number of borings advanced shall be sufficient to characterize water table
conditions across the land application site adequately. Any open borings shall be properly
filled with native soil, prior to the residuals land application event, to decrease the chance
of any residuals contaminating the groundwater.
10

2. Applicable Boundary Requirements:
a. The COMPLIANCE BOUNDARY for residuals land application programs is specified by
regulations in 15A NCAC 2L (i.e., "Groundwater Classifications and Standards"). The
Compliance Boundary for each land application site is established at either 250 feet from
the residuals land application area or 50 feet within the property boundary, whichever is
closest to the residuals land application area. An exceedance of Groundwater Quality
Standards at or beyond the Compliance Boundary is subject to immediate remediation
action according to 15A NCAC 2L .0106 (d)(2).
b. The REVIEW BOUNDARY shall be established around each land application site
midway between the Compliance Boundary and the perimeter of the residuals land
application area. Any exceedance of Groundwater Quality Standards at the Review
Boundary shall require action in accordance with 15A NCAC 2L .0106 (d)(2).
3. Additional Requirements:
a. Any groundwater quality monitoring, as deemed necessary by the Division, shall be
provided.
V. INSPECTIONS
1. Prior to each residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport, and application facilities to prevent malfunctions and
deterioration, operator errors, and discharges that may cause or lead to the release of wastes to
the environment, a threat to human health, or a nuisance. The Permittee shall maintain an
inspection Iog or summary including at least the.. date and time of inspection, observations
made, and any maintenance, repairs, or corrective actions taken by the Permittee. This log of
inspections shall be maintained by the Permittee for a period of five years from the date of the
inspection and shall be made available to the Division or other permitting authority, upon
request.
2. Any duly authorized officer, employee, or representative of the Division may, upon
presentationof credentials, enter and inspect any property, premises, or place on or related to
the land application sites or facilities at any reasonable time for the purpose of determining
compliance with this permit; may inspect or copy any records that must be kept under the
terms and conditions of this permit; and may obtain samples of groundwater, surface water, or
leachate.
VI. GENERAL CONDITIONS
1. This permit shall become voidable unless the residuals land application events are carried out
in accordance with the conditions of this permit, the supporting materials, and in the manner
approved by the Division.
2.. This permit shall be effective only with respect to the nature and volume of residuals described
in the application and other supporting data.
3. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division in accordance with North Carolina General
Statutes § 143-215.6A through § 143-2.15.6C.
11

4. The annual administering and compliance fee shall be paid by the Permittee within 30 days
after being billed by the Division. Failure to pay the fee accordingly may cause the Division
to initiate action to revoke this permit, as specified by 15 NCAC 2H .0205 (c)(4).
5 The issuance of this permit does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(i.e., local, state, and federal) which have jurisdiction, including, but not limited to, applicable
river buffer rules in 15A NCAC 2B .0200, soil erosion and sedimentation control requirements
in 15A NCAC Chapter 4 and under the Division's General Permit NCG010000, and any
requirements pertaining to wetlands under 15A NCAC 2B .0200 and 15A NCAC .0500.
6. This permit may be modified, revoked, and/or reissued to incorporate any conditions,
Iirnitations and monitoring requirements the Division deems necessary in order to protect the
environment and public health adequately.
7. The Permittee, at least six months prior to the expiration of this permit, shall request its
extension. Upon receipt of the request, the Division shall review the adequacy of the facilities
and residuals land application program described therein, and if warranted, shall extend the
permit for such period of time and under such conditions and limitations as it may deem
appropriate.
8. This permit shall not be automatically transferable. In the event that there is a desire for the
residuals land application program to change ownership or to change the name of the
Permittee, a formal permit request shall be submitted to the Division documentation from the
parties involved and other supporting materials as may be appropriate. The approval of this
request shall be considered on its merits and may or may not be approved.
Permit issued this the eleventh day of March, 2005.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0014543
12

ATTACHMENT A - Approved Residual Source -Generating Facilities
Permit No. WQ00014543
City of Statesville
City of Statesville Residuals Laud Application Program
Owner
Facility Name
County
Permit Number
Issued By
Is 503?
Maximum
Dry Tons
Per Year
Monitoring
Frequency for
Condition III. 2.
Monitoring Frequency
for Condition III. 3.
and Condition III. 4.
Approved
Mineralization
Rate
City of Statesville
Fourth Creek WWTPa
Iredell
NC0031836
DWQ
503
1057.00
Annually
Quarterly
.30
City of Statesville
Third Creek WWTPa
Iredell
NC0020591
DWQ
503
975.73
Annually
Quarterly
.30
Total
2,032.73
he dry tons per year of residuals listed for this residuals source -generating facility represents the total maximum volume of residuals generated by this facility and may not be
equivalent to the volume of residuals that may be land applied to the land application sites approved in the most recently -certified Attachment B per year. In accordance with
Condition II. 13., residuals shall be land applied at not greater than agronomic rates and, therefore, only that volume of residuals that may be assimilated by the approved sites
shall be land applied.
Permit No. WQ0014543
Page 1 of 1 Certification Date: March 11, 2005

' li ,4%-
11 itY71! •
7
N
T V
Third. Creek g Fourzn
ID ;\,1 A
•
III 1--k
Creek Sizes

-
Property Line
City Limits Line-
100. 00'
\j6Li#1, I- Do 14543
FOURTH CREEK SITE
Tract Acreage: 15.3
Buffer Acreage: 7.7
Total : Acreage: 23. 0
Drawing Scale: 1 =200'

Watson, Edward M
From:
Sent:
To:
Subject:
Andy Smith <[e-mail]>
Wednesday, November 21, 2018 10:16 AM
Watson, Edward M
[External] 4th Creek Contact Information
Ed, Ken Galloway is now the 4th Creek WWTP Supervisor and will be your contact for all of the residuals. You can reach
him at the office # 704-878-3438 and his email is Ken Galloway <[e-mail]>
Andy Smith,
Assistant Director Water Resources
Pursuant to NCGS Chapter 132, Public Records, this electronic mail message and any attachments hereto, as
well as any electronic mail messages that may be sent in response to it may be considered public record and as
such are subject to request and review by anyone at any time. If you are not the intended recipient of this
message, please delete this message and inform the sender.
i

D_ R
_ _
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON -DISCHARGE APPLICATION REVIEW REQUEST FORM
To: I O-WQ:RTOS-: An drew Pitney
July 26, 2018 RECEIVED/NCDENR/DWR
/1@orey asing+
From: Troy Doby, Water Quality Permitting Section - Non -Discharge Branch
JUL 31 2018
WQROS
MOORESVILLE REGIONAL OFFICE
Permit Number: WQ0014543 Permit Type: Land Application of Residual Solids (503)
Applicant: City of Statesville Project Type: Renewal
Owner Type: Municipal Owner in BIMS? Yes
Facility Name: City of Statesville RLAP Facility in BIMS? Yes
Signature Authority: Andy Smith Title: Assistant Director of Water Resources
Address: PO Box 1111, Statesville, NC 28687-1111 County: Iredell
Fee Category: Non -Discharge Minor Fee Amount: $0 - Renewal
Comments/Other Information:
Attached, you will find all information submitted in support of the above -referenced application for your review,
comment, and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed. I Return a completed staff report.
n Attach an Attachment B for Certification. ❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer: Date:
FORM: WQROSNDARR 09-15 Page 1 of 1

ROY COOPER
cAlwonor
MICHAEL S. R EGAN
Secr ears.
LINDA CULPEIPPER
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NORTH CAROLINA
Environmental Quality
July 27, 2018
ANDY SMITH —ASSISTANT DIRECTOR OF WATER RESOURCES
CITY OF STATESVILLE
PO BOx 1111
STATESVILLE, NORTH CAROLINA 28687-1111
Subject: Acknowledgement of
Application No. WQ0014543
City of Statesville RLAP
Residuals Management System
Iredell County
Dear Mr. Smith:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on July 25, 2018. Your application package has been assigned the
number listed above, and the primary reviewer is Troy Doby.
Central and Regional Office staff will perform a detailed review of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Troy Doby at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: MporesSille"1Ze ionalzOfice;-7ater,,Quah yt R�eg_ibnal7,Op anions-e ctionr
Permit File WQ0014543
ivaeerr.idlir 7e,niarti�,� \.dore‘
North Carolina Department of Environmental Quality I Division of Water Resources I Non -Discharge Branch
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.3654

CITYt of \'/
tae
ejNORTH CAROLINA
May 11,2018
Mr. Troy Doby, PhD, PE
Non -Discharge Permitting Unit
Water Quality Permitting Section
Raleigh Central Office
1617 Mail Service Center
Raleigh, NC 27699-1636
Re: City of Statesville Land Application Program Permit Renewal
Permit No. WQ0014543
Dear Mr. Doby:
The City of Statesville is requesting a permit renewal for permit # WQ0014543.
RECEIVED/NCDEQ/DWR
JUL 2 5 2018
Non-pischarge
Permitting Unit
Enclosed you will find Forms RLAP 06-16, RSC 06-16 and LASC 06-16 with additional supporting
documents per the instruction sheet for the aforementioned forms. The following is a list of these
documents.
• A brief narrative explaining how the City of Statesville handles its bio solids. How the residuals
are processed and treated, where the residuals will be stored and how the residuals will be
distributed.
• Lab data.
• Vicinity maps.
• Flow Schematic.
• Spill Control Plan.
• Sampling schedule for the bio-solids.
• Sample and Monitoring Plan Narrative.
CC: City of Statesville
PO Box 1111 • Statesville, NC 28687 • ci.statesville.nc.us

CITY of
tatee
NORTH CAROLINA
The following is a brief narrative regarding the sludge management plan for the City of Statesville:
• Bio solids generated at both of the WWTP's. The bio-solids at both of these facilities
are currently stabilized using an aerobic digester and dewatered using a 2 meter belt
filter press. After dewatering, the residuals are transferred by a dump truck to the
sludge storage pad or pumped to the existing Sta-Lime processing area. After the Sta-
Lime process has been completed, the final product is made available to the local
farmers at no cost or set aside for land application by a private contractor through an
existing agreement held with the City.
The permit WQ0014543 has never been utilized and is considered a back-up to the existing
permit's in the City of Statesville sludge management program.
Should you require more information, or if further action is required, you can contact me at
704-878-3438 or email me at [e-mail]
ndy S . ith
Plant Supervisor, Fourth Creek WWTP
PO Box 1111 • Statesville, NC 28687 • ci.statesville.nc.us

Dvision of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with _OA NOAC 0 .0106N. An
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the
criteria in i A NCAC On .O i 06(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification
New Permit Major Modification 1
Major (land are permitted for > 300 acres)
$1,310 i $395
Minor (land are permitted for < 300 acres)
$810 j $245
1- A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes
not previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (Maybe Required — See 15A NCAC 1C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities. RECEIVEDINC®EU®WR
INSTRUCTIONS FOR FORM: RLAP 06-16
JUL 2 5 2018
Non -Discharge
Permitting Unit Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
® Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
® Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
® Safety measures; may include safety training program, manuals, signs, etc.
® Spill response plan; including control, containment, remediation, emergency contact information, etc.
E Inspection plan including the following information;
Names and titles of personnel responsible for conducting the inspections.
E Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
® Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncompliance is observed.
E Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
►1
Detailed description of monitoring procedures including parameters to be monitored.
Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in i $A NCAO ill
11 OM). Vi). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

7
Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1 104(d)(2). For Modifications, submit an updated
site map specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the
new units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 1 A N AC 02T .11941(1)(5) and current Division Policy
available at: http;[Lwwoutcwater,or$/Rules_ Pelir,it jnd, ettlat(on L.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., MR, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of I sA CAC f1 1i .0101(1j, or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16
Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name:
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State X❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Andy Smith Title: Assistant Director of Water Resources
Applicant's mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] Email Address: [e-mail]
2. Consultant's name: License Number (for P.E.):
Affiliation: ❑ On Staff
❑ Retained (Film: )
Consultant's mailing address:
City: State:
Telephone number: (
3. Agronomist's name:
Affiliation: ❑ N/A ❑ On Staff
Agronomist's mailing address:
City: State:
Telephone number: (_) 4. Soil Scientist's name:
Affiliation: ❑ N/A ❑ On Staff
Soil Scientist's mailing address:
City: State:
Telephone number: ( )
5. Fee submitted: $810 (See Instruction B)
')
H. PERMIT INFORMATION:
Zip:
Email Address:
License Number:
111 Retained (Firm:
Zip: -
Email Address:
License Number:
❑ Retained (Firm:. )
Zip:
Email Address:
RECEIVED/NCDEQ/DWR
JUL 2 5 2018
Non -Discharge
Permitting Unit
1. Application is for (check all that apply): ❑ new, ❑ modified, X❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00014543
Date of most -recently issued permit: September, 2013
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16
Page 1 of 5

6
III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: 28677-
Coordinates: Latitude: 25° 46' 29 N" Longitude: 80° 48' 50 W"
Level of accuracy:
Datum:
Method of measurement: GPS
2. County where residuals land application program is headquartered: Iredell
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Andy Smith
City of Statesville
LA 985516
Back -Up ORC
Scott Austin
City,of Statesville
LA 991939
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide
the candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training
school and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in
the following table:
Maximum amount of residuals to be certified: 4th Creek @ 1,056 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
36.6 mg/kg
38,6501bs
Five -Year Maximum Adjusted
183 mg/kg
193,2481bs
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
15.3
Corn & Small Grain
Hay
Pasture
Total:
Methods
Surface
Incorporation or Injection
Total:
FORM: RLAP 06-16
Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
773
3,865
100
387
1,935
150
258
1,290
200
193
965
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): X❑ Non -dedicated❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Site
Certification. doc
FORM: RLAP 06-16
Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation:
feet below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHWT and
ground surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
EI Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
(in/hr)
Recommended
Loading Rate
(in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why .g) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field / Zone
Design Area
(ft2)
Number of
Nozzles
Maximum Application
Rate (gallons/hr)
Design Annual Loading
Rate (gallons/yr)
Total
>,
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
' ft
Wetted area of nozzles
ft2
Nozzle capacity
: gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16
Page 4 of 5

attest that this application for
Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
,rYes ❑ No, Explain;
1, s4\-c\�
Lr Qe5ocS
(Signature Authority's Name — PLEASE PRINT) (Title)
rt _ . C, GcC rw do G�l, �c- Cal i�
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water
Resources may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes
unless specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any
false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: RLAP 06-16
Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
® For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Out tiatiN rot'
i.@gliatiAN LAM ApplitAtiun P m to".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Andy Smith
Status
Code a
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
City of Statesville
4th Creek WWTP
Iredell
NC0031836
1,057
N/A
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 06-16
Page 1

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: 4th Creek WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, El Local Government, or ❑ Private.
Facility permit issued by: El;' Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ' O.
3. Facility contact person and title: Andy Smith
Complete mailing address: PO Box 1111
City: Statesville State: NC Zip: -28687
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: -28687
Coordinates: Latitude: 35° 46' 29 N" Longitude: 80° 48' 50 W"
Datum: i 1 Level of accuracy: _ I
Method of measurement: GPS
5. Purpose of the facility:
E treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
treatment of potable water, ❑ treatment of 100% industrial wastewater,
E treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: 40 % industrial and 60 % domestic)
El other (explain: " ).
6. Does the facility have an approved pretreatment program: ® Yes ❑ No
7. Facility permitted/design flow: 6.0 MGD and facility average daily flow: 2.5 MGD
8. Average amount of residuals being generated at this facility 1,235 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 3 meter belt press
Type and volume of residuals storage (i.e., outside of residuals treatment units): 1.5 MG aerobic digester
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
E 40 CFR Part 503 or El 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
E Biological ❑ Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes El no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ®', no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Prism Labs and Date of analysis: 8/22/17
Passed corrosivity test: yes ❑', no. pH: s.u. (2 <pH < 12.5)
Passed ignitability test: El yes ❑' no. Flashpoint: I °F (> 140°F)
Passed reactivity test: ® yes Eno. HCN: i mg/kg (<250) & H2S: mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
<0.050
Hexachlorobenzene
0.13
<0.050
Barium
100.0
<5.0
Hexachloro-1,3-Butadiene
0.5
<0.050
Benzene
0.5
<0.025
Hexachloroethane
3.0
<0.050
Cadmium
1.0
<0.025
Lead
5.0
<0.050
Carbon Tetrachloride
0.5
<0.025
Lindane
0.4
Chlordane
0.03
<0.0025
Mercury
0.2
<0.010
Chlorobenzene
100.0
<5.0
Methoxychlor
10.0
<0.00050
Chloroform
6.0
<0.30
Methyl Ethyl Ketone
200.0
<10
Chromium
5.0
<0.25
Nitrobenzene
2.0
<0.050
m-Cresol
200.0
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
Pyridine
5.0
<0.25
p-Cresol
200.0
Selenium
1.0
<0.10)
Cresol
200.0
Silver
5.0
<0.25
2,4-D
10.0
Tetrachloroethylene
0.7 ,
<0.035
1,4-Dichlorobenzene
7.5
<0.38
Toxaphene
0.5
<0.025
1,2-Dichloroethane
0.5
<0.025
Trichloroethylene
0.5
<0.025
1,1-Dichloroethylene
0.7
<0.035
2,4,5-Trichlorophenol
400.0
<0.25
2,4-Dinitrotoluene
0.13
<0.050
2,4,6-Trichlorophenol
2.0
<0.10
Endrin
0.02
<0.00050
2,4,5-TP (Silvex)
1.0
Heptachlor and its Hydroxide
. 0.008
<0.00050
Vinyl Chloride
0.2
<0.020
FORM: RSC 06-16
Page 2 of 5

Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e.,
basis) for the following metal parameters:
Laboratory: Waypoint Analytical and Date of analysis: 10/4/17
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
3.13
Cadmium
85
39
2
Copper
4,300
1,500
242
Lead
840
300
18.9
Mercury
57
17
0.601
Molybdenum
75
n/a
9.9
Nickel
420
420
19.5
Selenium
100
100
<5
Zinc
7,500
2,800
307
residuals do not
on a dry weight
b. For Surface Disposal Unit (land/ill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:.
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
[� > 0 but < 25
30
200
210
0' > 25 but < 50
34
220
240
[t > 50 but < 75
39
260
270
Q > 75 but < 100
46
300
320
0 > 100 but < 125
53
360
390
0! > 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16
Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 14.08 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Waypoint Analytical and Date of analysis: 10/4/17
Parameter
Result
(mg/kg)
Aluminum
22,700
Ammonia -Nitrogen
9,510
Calcium
3,440
Magnesium
1,160
Nitrate -Nitrite Nitrogen
<2.39
pH (Standard Unit)
5.11
Phosphorus
23,600 .
Potassium
1,770
Sodium
311
Total Kjeldahl Nitrogen
48,800
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.4378
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Depaitiuent of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to,be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): ❑ default value, or ® actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1st) Year PAN
(mg/kg)
Five -Year
Maximum Adjusted PAN
(mg/kg)
Surface
36.6
183
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses: ;___
FORM: RSC 06-16
Page 4 of 5

Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑j A fecal colifoini density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑''. A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
El Alternative 1 [15A NCAC 02T.1106(b)(3)(A)] - Time/Temperature Compliance.
❑. Alternative 2 [15A NCAC 02T.1106(b)(3)(B)] - Alkaline Treatment.
Q Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑' Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: Q composting, ❑ heat drying, El heat treatment,
❑j thermophilic aerobic digestion, ❑'' beta ray irradiation,
❑i! gamma ray irradiation, or ❑' pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
Q Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: IZ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
El composting, or ❑' lime stabilization.
c. For Surface Disposal:
ID Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
El Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑' Exempt - If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
• Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 1 NCAC t3 T.1 101, specify how residuals will meet the VAR requirements:
Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑( Alternative 2 [15A NCAC 02T.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
[I] 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑' Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
0: Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
El Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
• Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
El Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
El Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16
Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
R The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) + Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
doc
/
County
Notification.
Board
`r
`/
`/
Land Owner
Agreement
(If applicable)
Setback Waiver
Agreement
✓
✓
✓
✓
An updated
for Residuals
vicinity/setback map in accordance with the "Map Guidance
V
`./
✓*
Land Application Permits"
A soils and
Evaluation Policy"*
agronomic evaluation in accordance with the "Soil Scientist
✓
INSTRUCTIONS FOR FORM: LASC 06-16 Page 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs)
•
✓
V
Required Item
Status Code
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same time period)
✓
* This item may be required for land application site with a status code "M", p ease contact the Division if you need assistant in
determining attachment requirements.
• Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Merc (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: hitillLdeq,ite ; out/dlvlsi.s nsiwater-
resoure s/p1ann tnR/classificatlo_n-statxdards/r iassificatidns
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http :fide q.nc,gov/contact/regional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to- stream name" as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

Fr 2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
IIIKNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(1).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16
Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Statesville
Land application sites currently certified: 29.4 net acres and Total to be certified: 29.4 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code
Site/Field
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
SeriesMapping
Nameb
Unit
or Rep. Slope'
R
01
City of Statesville
4th Creek WWTP
15.30
Iredell
Corn & Small Grain
Lloyd
LcC2 6-10%
N
,
___ ]
±
N
_— 1
�_
!- ..
-..
j
l
-
N
—
---
.--�
(
t f
'_-1
—
Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
`Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class p
01
35° 46'
12"
80° 47' 24"
NAD 83
ADD
Nearest Second
03-07-06/03040102
C
_
C
_.0
I
NAD 83
ADD
Nearest Second
(
_'°
"
° '' "'
NAD 83
ADD
Nearest Second
- 1
-
5° ` I
__III
0'' _"
NAD 83
ADD
Nearest Second
i__ 1
1_ __.1
° r... "'
'° ' " "
NAD 83
ADD
Nearest Second
i
1— T'
-
1
° , _, ,
NAD 83
ADD
Nearest Second
1
L _--I
:_. _:
° �"
,,
F
E '° -''_"
NAD 83
ADD
Nearest Second
I 1
° , ,,
' "
'' '° ' , '
NAD 83
ADD
Nearest Second
I
�i
: Please keep the site information (I.) and waterbody information (IL) of the same field on the same page.
FORM: LASC 06-16

Full -Service Analytical &
Environmental Solutions
LABORATORIES, INC.
City of Statesville, NC
Andy Smith
P.O. Box 1111
Statesville, NC 28687
NC Certification No. 402
NC Drinking Water Cert No. 37735
SC Certification No. 99012
Project: Sludge (Hazardous Testing)
Project No.: 4th Creek Sludge
Lab Submittal Date: 08/22/2017
Prism Work Order: 7080390
Case Narrative
09/11 /2017
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Narrative Notes:
Reactivity analysis was subcontracted to GCAL. TCLP Herbicide analysis was subcontracted to AES.
Laboratory reports are attached.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
-ge-'.;
Robbi A. Jones Reviewed By Robbi A. Jones
President/Project Manager
President/Project Manager
Data Qualifiers Key Reference:
CCV CCV result is above the control limits. Analyte not detected in the sample. No further action taken.
D RPD value outside of the control limits.
ICV ICV result is above the control limits. Analyte not detected in the sample. No further action taken.
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 1 of 24

Client Sample ID
Fourth Creek Sludge
Full -Service Analytical &
Environmental Solutions
Sample Receipt Summary
09/11/2017
Prism Work Order: 7080390
Lab Sample ID Matrix Date Sampled Date Received
7080390-01 Solid 08/22/17 08/22/17
Samples were received in good condition at 3.9 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 2 of 24

7 1
JP ISM
LABORATORIES, INC.
City of Statesville, NC
Attn: Andy Smith
P.O. Box 1111
Statesville, NC 28687
Full-Servioe Analytical &
Environmental Solutions
Project: Sludge (Hazardous Testing)
Project No.: 4th Creek Sludge
Sample Matrix: Solid
Laboratory Report
09/11/2017
Client Sample ID: Fourth Creek Sludge
Prism Sample ID: 7080390-01
Prism Work Order: 7080390
Time Collected: 08/22/17 11:50
Time Submitted: 08/22/17 15:30
Parameter
Result
Units Report MDL
Limit
Dilution Method Analysis Analyst
Factor DateMme
Batch
ID
General Chemistry Parameters
% Solids
Corrosivity-pH
Ignitability
TCLP Extraction by EPA 1311
15.1 % by 0.100
Weight
5.9 pH Units
Pass mm/sec 0.10
0.100 1 *SM2540 G 8/31/17 16:00 JLB P7I0012
1 *9045D 8/24/17 10:47 BMS P7H0445
1 *1030 8/24/17 9:00 BMS P7H0440
TCLP Extraction
TCLP Extraction
TCLP Metals
Complete
Complete
N/A
N/A
1 *1311 8/26/17 10:05 JAB P7H0487
1 *1311 ZHE 9/6/17 12:34 KDM
P710063
Mercury
Arsenic
Barium
Cadmium
Chromium
Lead
Selenium
Silver
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
TCLP Organochlorine Pesticides by GC/ECD
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
0.010
0.050
5.0
0.025
0.25
0.050
0.10
0.25
0.000030 1
0.012 1
0.0065 1
0.00065 1
0.0038 1
0.0080 1
0.022 1
0.00050 1
*7470A
*6010D
*6010D
*6010D
*6010D
*6010D
*6010D
*6010D
9/1/17 12:34
8/28/17 15:18
8/28/17 15:18
8/28/17 15:18
8/28/17 15:18
8/28/17 15:18
8/28/17 15:18
8/28/17 15:18
JAB
JAB
JAB
JAB
JAB
JAB
JAB
JAB
P7H0572
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
Chlordane
Dieldrin
Endrin
gamma-BHC
Heptachlor
Heptachlor Epoxide
Methoxychlor
Toxaphene
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRLCCV
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
0.0025
0.00050
0.00050
0.00050
0.00050
0.00050
0.00050
0.025
0.00047 1
0.000070 1
0.000075 1
0.000065 1
0.000085 1
0.000065 1
0.00020 1
0.00037 1
*8081B
*8081B
*8081B
*8081B
*8081B
*8081B
*8081B
*8081B
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
8/28/17 17:23 JMC
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
Surrogate
Recovery Control Limits
Decachlorobiphenyl
Tetrach to ro-m-xyl a ne
TCLP Semivolatile Organic Compounds by GC/MS
73 % 13-186
81 % 40-134
2,4, 5-Trichlo rophe nol
2,4,6-Trichlo roph enol
2,4-Dinitrotoluene
2-Methylphenol
3/4-Methylphenol
Hexachlorobenzene
Hexachlorobutadiene
Hexachloroethane
Nitrobenzene
Pentachlorophenol
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRLicv
BRL
BRL
mg/L 0.25 0.0016 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.10 0.0018 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0014 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0018 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0015 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0013 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0021 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0017 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.050 0.0026 1 *8270D 8/29/17 18:32 JMV P7H0520
mg/L 0.25 0.0012 1 *8270D 8/29/17 18:32 JMV P7H0520
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 3 of 24

Full -Service Analytical &
Environmental Solutions
City of Statesville, NC
Attn: Andy Smith
P.O. Box 1111
Statesville, NC 28687
Project: Sludge (Hazardous Testing)
Project No.: 4th Creek Sludge
Sample Matrix: Solid
Laboratory Report
09/11/2017
Client Sample ID: Fourth Creek Sludge
Prism Sample ID: 7080390-01
Prism Work Order: 7080390
Time Collected: 08/22/17 11:50
Time Submitted: 08/22/17 15:30
Parameter
Result
Units Report
Limit
MDL Dilution Method Analysis Analyst
Factor Date/Time
Batch
ID
Pyridine
BRLICV
mg/L 0.25 0.0010
1 *8270D 8/29/17 18:32 JMV
P7H0520
Surrogate
Recovery Control Limits
2,4,6-Tribromophenol
2-Fluorobiphenyl
2-Fluorophenol
Nitrobenzene-d5
Phenol-d5
Terp henyl-d 14
TCLP Volatile Organic Compounds by GC/MS
71
63
40
61
23
84
43-140
44-119
19-119
44-120
11-52
50-134
1,1-Dichloroethylene
1,2-Dichloroethane
1,4-D ichloro benzene
Benzene
Carbon Tetrachloride
Chlorobenzene
Chloroform
Methyl Ethyl Ketone (2-Butanone)
Tetrachloroethylene
Trichloroethylene
Vinyl chloride
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
mg/L 0.035 0.00083 1 *8260B
mg/L 0.025 0.00066 1 *8260B
mg/L 0.38 0.00050 1 *8260B
mg/L 0.025 0.00048 1 *8260B
mg/L 0.025 0.0011 1 *82603
mg/L 5.0 0.00062 1 *8260B
mg/L 0.30 0.00076 1 *8260B
mg/L 10 0.0024 1 *8260B
mg/L 0.035 0.00098 1 *8260B
mg/L 0.025 0.00078 1 *8260B
mg/L 0.020 0.00097 1 *8260B
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
9/6/17
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
14:02 KDM P710064
Surrogate
Recovery Control Limits
4-Bromofluorobenzene
Dibromofluoromethane
Toluene-d8
101
99
98
80-124
75-129
77-123
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Spring brook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 4 of 24

Sample Extraction Data
ep Method: Solids, Dry Weight
Lab Number
Batch Initial Final Date/Time
7080390-01
Prep Method: 1311
P710012 30 g 30 g 08/31/17 16:00
Lab Number Batch Initial Final Date/Time
7080390-01
7080390-01
Prep Method: 3010A
Lab Number
P710063
P7H0487
Batch
12.5 g 250 mL
100 g 2000 mL
09/05/17 15:33
08/25/17 15:30
Initial Final Date/Time
7080390-01
Prep Method: 7470A
Lab Number
P7H0505 10 mL 50 mL 08/28/17 10:25
Batch Initial Final Date/Time
7080390-01
Prep Method: 3510C GC
Lab Number
P7H0572 20 mL 30 mL 09/01/17 7:25
Batch
Initial Final Date/Time
7080390-01
Prep Method: 3510C MS
Lab Number
P7H0495 200 mL 10 mL 08/28/17 9:49
Batch
Initial Final Date/Time
7080390-01
Prep Method: 5030E
Lab Number
P7H0520 200 mL 1 mL 08/29/17 9:41
Batch
Initial Final Date/Time
7080390-01 P710064 1 mL 10 mL 09/06/17 9:52
Subcontracted Analyses
The following analyses were subcontracted to Analytical Environmental Services , Inc.
Lab Number Analysis
7080390-01 Herbicides TCLP (Sub)
The following analyses were subcontracted to Gulf Coast Analytical Labs, Inc.
Lab Number Analysis
7080390-01 Reactivity, Cyanide (Sub)
7080390-01 Reactivity, Sulfide (Sub)
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 5 of 24

LABORATORIES, INC.
44'1 Sprinjbrootc Road
Phone 704/520-(-364
11
Ciiient Company Name: a �/
Full -Service Analytical R:
Environmental Solutions
Charlotte, r iG .25217
Fax: [phone]a
ab S , s'r fro IDS
Report To/Contact Mame: _{i cog s, co NA
Reporting Address:
•
CMAII
OF CUSTODY L CO{ D >`
CAGE ©F QUOTE. 0 T© ENSURE PROPER SOLLOMO:
Project Name:
Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
"Please ATTACH any project specific reporting (QC LEVEL 0 OI DI0 IV)
provisions and/or QC Requirements
Invoice To:
Address:
'.yam if ,„:
'..YES .•NO
Sentples`INTACT upon al'rivdt?
Rc,colvcd:ON WLT ICI ?
PRO;PD PRESERVATIVE'S indlcatecl?
RoceivOc11NIT1-11N HOLDING TIMES?
.CUSTODY, SL-.ALS'IN7ACT?..:'`
• 'VOLAr iI E$ reo'd IN/QU7•1=1EADS ACE?
PROPER CONTAINERS : used? :: '
TEMP: 'felrD 812-T7`Odq, �OCC;51 Cl•
u"Mone: Ill"-a6 - c9'11 4 cax((Vej-9 (b9o): jUrli' i I'' " rJ 6 "J
TO BE FILLED IN BY CLOENT/SAMPLD G PERSONNEL
Certification: ilEOaAC D®D FL MC
Purchase Order No./Filling Reference
Email Address: Requested Due
Date O 1 Day U 2 Days ❑ 3 Days U 4 Days 0 5 Days
EDD Type: PDF_Excei Other "Working Days" ID 6-9 Days ❑ Standard 10 days U Be
SC OTHER N/A
pre A porovedust
Site: Location Mame: Samples received after 14:00 will be processed next business day.
Water Chlorinated: YES MO
Sarripie iced Upon Coilection: YES— NO
Site Location Physical Address: Turnaround time is based on business days, excluding weekends and holidays.
(SEE REVERSE FOR TERMS U: CONDITIONS REGARDING SERVICES
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
CLIENT
SAMPLE DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MATRIX
(SOUL,
SAMPLE CONTAINER R
PRESERVA-
TIVES
ANALYSIS REQUESTED
REMARKS
/// /
PRISM
LAB
ID NO.
"TYPE
SEE BELOW
NO.
SIZE
MILITARY
HOURS
WATER OR
SLUDGE)
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Sampled By
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(Print Name) �,liy a� 1 ,f1C6(
Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitted in writingto the PrismProject Manager. There will be charges for any changes after analyses have been initialized.
*-+ �� �°+ter
i. � Ihn`'p
Relinguhed By: (Signalur) ."p'�
�j 17 ;� / c ,./`
R56S> ed y: (Signs ur
a �I
Date
Military/Hoursi
s
Additional
Comments:
Stel�nivalTlme
Religci'f bed By: (Signat&re)
jr rr� —2 %'
k'adeived By: (Signaturc;'� "
date
; Site' -De /alture•Tlliie...
,�j0
--r, ` ).-- 1t)
/p h
-ig0Iohed By: (Signals re)
Received .+6r.hris ',yLaboratorie� Syr !
Date
' Field.Tsch•Fein
{J�
(Q`r��
l � �/ktts
4s--Z P —17/j' I Sad
Mileage;
!v
,od of Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT WITH CU ODY SEALS FORT JSPORTArION ID THE LABORATORY.
COC Grou No.
(Q
O)
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC UN(IIL RECEIVED AT TI-lt LABORATORY.CD
ad Ex ❑ UPS 0 Hand -delivered q,-47 m Field Service 0 Other
!
't. U tly v } q/
O
DES:
UST:
GR .X1 HATER:
DRINKING WATER:
SOLID WASTE:
RCRA:
CERCLA
LANDFOLL
OTI-IER:
"leis R
.rT „1
,IC IDSC
UNC ®SC
�0(I�C ®SC
©NC USC
UNC USC
UNCUSC
UNC USC
UNC USC
UNC USC
�sRiV("sa; or"o_ii
�" sr'
iv
U
®
®
U
®
®
®
U 2.P.'G1 ,,1 J.
)NTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Orcaanics Analysis (Zero Head Space)

ACCESS
ANAL ` flCAL,
A ALYT CAL REPORT
CLIENT
Prism Laboratories
PO Box 240543
Charlotte, NC 28224
ATTENTION
Robbi Jones
PROJECT ID
7080390
LABORATORY REPORT NUMBER
217082415
DATE
08/29/2017
Primary Data Review By
f,
Authorized Signature
PLEASE NOTE:
Secondary Data Review By
Ashley B. Amick
Project Manager, Access Analytical, Inc.
[e-mail]
- Unless otherwise noted, ail analysis on this report performed at Gulf Coast Analytical Labs (GCAL),
7979 innovation Park Dr., Baton Rouge, LA 70820.
- GCAL is SCDHEC certified laboratory # 73006, NCDENR certified lab # 618, GA certified lab # LA-01955,
NELAP certified laboratory 01955
- Local support services for this project are provided by Access Analytical, Inc.. Access Analytical is a
representative of GCAL serving clients in the SC/NC/GA areas. All questions regarding this report should be
directed to your local Access Analytical representative at 803.781.4243 or toll free at 888.315.424.3.
Lab Report#: 217082415
Page 1 of 11
Page 7 of 24

4.hhILYTdC,L-1 LAlifigATEUIEE, LLC
A
LYT
NELAP CERTIFICATE NUMBER: 01955
DOD ELAP CERTIFICATE NUMBER: L14-243
CAL RESULTS
PERFORMED BY
GCAL, LLC
7979 kmovation Park Dr.
Baton R uge, LA 71:i20
*
Report Date 08/29/2017
GCAL Rep
*
't 217082415
Project 7080390
ever To
Robbi Jones
Prism Laboratories
PO Box 240543
Charlotte, NC 28224
800-529-6364
Addigional Recipients
NONE
TeMral,g,
DbD ELAF
Lab Report4: 217082415
Pale 2 of 11
Page 8 of 24

LIANALYTICAL LAC'OPATOFIES.
Report#.: 217082415
Project ID: 7080390
Lab.rat®ry Endorsement
Report Date: 08/29/2017
Sample analysis was performed in accordance with approved methodologies provided by the Environmental Protection Agency or other recognized
agencies. The samples and their corresponding extracts will be maintained for a period of 30 days unless otherwise arranged. Following this
retention period the samples will be disposed in accordance with GCAL's Standard Operating Procedures.
Common Abbreviations that may be Utilized in this Report
ND Indicates the result was Not Detected at the specified reporting limit
NO Indicates the sample did not ignite when preliminary test performed for EPA Method 1030
DO Indicates the result was Diluted Out
MI Indicates the result was subject to Matrix Interference
TNTC Indicates the result was Too Numerous To Count
SUBC Indicates the analysis was Sub -Contracted
FLD Indicates the analysis was performed in the Field
DL Detection Limit
DL Diluted analysis — when appended to Client Sample ID
LOD Limit of Detection
LOQ Limit of Quantitation
RE Re -analysis
CF HPLC or GC Confirmation
00:01 Reported as a time equivalent to 12:00 AM
Reporting Flags that may be Utilized in this Report
J or I Indicates the result is between the MDL and LOQ
J DOD flag on analyte in the parent sample for MS/MSD outside acceptance criteria
U Indicates the compound was analyzed for but not detected
B or v Indicates the analyte was detected in the associated Method Blank
Q Indicates a non -compliant QC Result (See Q Flag Application Report)
Indicates a non -compliant or not applicable QC recovery or RPD — see narrative
B The result is estimated because it exceeded the instrument calibration range
E Metals - % diference for the serial dilution is > 10%
P RPD between primary and confirmation result is greater than 40
Sample receipt at GCAL is documented through the attached chain of custody. In accordance with NELAC, this report shall be reproduced only in
full and with the written permission of GCAL. The results contained within this report relate only to the samples reported. The documented results
are presented within this report.
This report pertains only to the samples listed in the Report Sample Summary and should be retained as a permanent record thereof. The results
contained within this report are intended for the use of the client. Any unauthorized use of the information contained in this report is prohibited.
I certify that this data package is in compliance with The NELAC Institute (TNI) Standard 2009 and terms and conditions of the contract and
Statement of Work both technically and for completeness, for other than the conditions in the case narrative. Release of the data contained in this
hardcopy data package and in the computer readable data submitted has been authorized by the Quality Assurance Manager or his/her designee,
as verified by the following signature.
Estimated uncertainty of measurement is available upon request. This report is in compliance with the DOD QSM as specified in the contract if
applicable.
7
Authorized Signature
GCAL Report 217082415
Lab Report#: 217082415 Pace 3 of 11
Page 9 of 24

Report#: 217082415
Project ID: 7080390
Certifications
Report Date: 08/29/2017
Certification
Certification Number
DOD ELAP
L14-243
Alabama
01955
Arkansas
12-060-0
Colorado
0'1955
Delaware
01955
Florida
E87854
Georgia
01955
Hawaii
01955
Idaho
01955
Illinois
200048
Indiana
01955
Kansas
E-10354
Kentucky
95
Louisiana
01955
Maryland
01955
Massachusetts
01955
Michigan
01955
Mississippi
01955
Missouri
01955
Montana
N/A
Nebraska
01955
New Mexico
01955
North Carolina
618
North Dakota
R-195
Oklahoma
9403
South Carolina
73006001
South Dakota
01955
Tennessee
01955
Texas
T104704178
Vermont
01955
Virginia
460215
USDA Soil Permit
P330-10-00117
Lab Report#: 217082415
Panes 1 of 11
I Page 10 of 24

Report#: 217082415
Project ID: 7080390
Case Narrative
CDient: Access Analytical Report: 217082415
Report Date: 08/29/2017
Gulf Coast Analytical Laboratories received and analyzed the sample(s) listed
on the Report Sample Summary page of this report. Receipt of the sample(s) is documented
by the attached chain of custody. This applies only to the sample(s) listed in this report.
No sample integrity or quality control exceptions were identified unless noted below.
No anomalies were found for the analyzed sample(s).
Lab Report`: 217082415
o....= A of 44
I Page 11 of 24 I

aNALVTICAL tIC
GCAL ID
21708241501
Client ID
Fourth Creek Sludge
Report#: 217082415
Project ID: 7080390
Sample Summary
Matrix Collect. Daterfirne
Solid 08/22/2017 11:50
Report Date: 08/29/2017
Receive Date/Tirne
08/24/2017 11:20
Lab Report#: 217082415
Panp of 11
I Page 12 of 24

L'
?fit/, I.Yili:kL LAGOP.OMPI_S. LLG
Report#: 217082415
ProjectIJ: 7080390
Summary of Compounds Detected
No analytes were detected for analyses performed by GCAL.
Report Date: 08/29/2017
Lab Report : 217082415 Pang 7 of 11
I Page 13 of 24

.S L.trICAL L s29RAt G5Ii5. LLC
Fourth Creek % Age
EPA 9012E
Prep Date
08/24/2017 12:00
CAS#
57-12-5R
EPA 9034
Prep Date
08/24/2017 12:00
CASE`
18496-25-8R
Prep Batch
616831
Parameter
Reactivity Cyanide
Prep Batch
616832
Parameter
Reactivity Sulfide
Report#+': 217082415
Project ID: 7080390
SampleResults
Collect Date 08/22/2017 11:50
Receive Date 08/24/2017 11:20
Prep Method
EPA 7.3.3.2
Prep Method
EPA 7.3.4.2
Dilution Analysis Date
1 08/25/2017 15:43
Report Date: 08/29/2017
GCAL ID 21708241501
Matrix • Solid
By Analytical Batch
DMT 616946
Result DL
250U 250.
Dilution Analysis Date
1 08/25/2017 14:00
LOQ
250
By Analytical Batch
MOS 616937
Result DL
250U 250
LOQ
250
Units
mg/kg
Units
mg/kg
Lab Report#: 217082415
Paae8of11
Page 14 of 24

ULY rlctL LCL'°P:.T°PIES. LLC
L'
Report#: 217082415
Project ID: 7080390
eneral Chemistry QC Summary
Report Date: 08/29/2017
Analytical Batch Client ID
616937 GCAL ID
Prep Batch Sample Type
616832 Prep Date
Prep Method Analysis Date
EPA 7.3.4.2 Matrix
MB616832
1714951
MB
08/24/2017 10:00
08/25/2017 14:00
Solid
LCS616832
1714952
LCS
08/24/2017 10:00
08/25/2017 14:00
Solid
EPA ���
Units
Result
mg/kg
DL
Spikel
Added
Result
%RI
Control
Limits%R
Reactivity Sulfide 118496-25-8R
250U
250
1000 1074
107
47 -135
Analytical Batch Client ID
616937 GCAL ID
Prep Batch Sample Type
616832 Prep Date
Prep Method Analysis Date
EPA 7.3.4.2 Matrix
ATF 17-003; ATF Leaded ..
21708222001
SAMPLE
08/24/2017 10:00
08/25/2017 14:00
Solid
1714285DUP
1714953
DUP
08/24/2017 10:00
08/25/2017 14:00
Solid
EPA 9034
Units
Result
I mg/kg
DL
Result
RPD
RPD
Limit
Reactivity Sulfide f 18496-25-8R
0
250
0
0
25
Analytical Batch Client ID
616946 GCAL ID
Prep Batch Sample Type
616831 Prep Date
Prep Method Analysis Date
EPA 7.3.3.2 Matrix
MI3616831
1714948
MB
08/24/2017 10:00
08/25/2017 15:11
Solid
LCS616831
1714949
LCS
08/24/2017 10:00
08/25/2017 17:36
Solid
EPA 90 12E
Units
Result
mg/kg
_ DL
Spikel
Added
Result
%R
Control
Limits%R
Reactivity Cyanide I 57-12-5R
250U
250
250
3.2
1
1 - 25
Analytical Batch Client ID
616946 GCALID
Prep Batch Sample Type
616831 Prep Date
Prep Method Analysis Date
EPA 7.3.3.2 Matrix
ATF 17-003; ATF Leaded ..
21708222001
SAMPLE
08/24/2017 10:00
08/25/2017 15:16
Solid
1714285DUP •
1714950
DUP
08/24/2017 10:00
08/25/2017 15:18
Solid
EPA 90 2
Units
Result
mg/kg
DL
Result)
RPD
I RPD
Limit
Reactivity Cyanide I 57-12-5R
0.0
250
0.0
0
20
Lab Report#: 217082415
pane Qof11
Page 15 of 24 I

Client ID, • Recess Analytical,
t-_-',-
tom'
LABORATORIES,
@
INC
LL.t SIDG 1 062415
Full -Service Analytical `4' •'T ' ill P. AEC
Environmental Solutions
SUBCONTRACT ORDER -
1
.
1
t
Prism Laboratories, Inc_
Certification: NEji AC_ USACE
NC, -r SC__ Other
7080390
NJA
SENDING
--.--
If ABORATORV: RECEIVING LA:DORATORY:
Prism Lab,
P. O. Box
Charlotte;
Phone: 80C-529-6364
Fax: [phone]
Project Maraeer:
ratories, Inc. Gulf Coast Analytical Labs, Inc.
tff40543 1078) Coursey Blvd
,4C 28224-0543 Baton Rouge, LA 70816
Phone :[phone]
Fax: [phone]
Robbi A. Jones
Analysis
Due Expires Laboratory ID Comments
Sample ID:
7080390-01 Solid Samulcd:0Si' 22/17 II:50 i''.,.3 ..: ` is " `) 3 0: 1 9e_->
Reactivity,
Reactivity,
containers S
pZ
ullide (Sub) 08/29/17 11:50 L..)
yanide (Sub) 09/05/17 11:50
ipplied
`E e
P).. C?lv\
-
t r -. l bO-lb1 -Zcl
—_.....-------?.-A-11 ,— o()dn-0
Wased I3v
L?
Date Received By Date
L ,-rtr-1-7 T i6C> s-V6q.L (T- - -
Released B
, Data Receiv- Ni
L=i C- (� I Dais
Released B
i Date ReccivedBy Dale
Date
Received By
Date
Page1of1
Page 16 of 24.

173 Jo L e6e d
AFIALVIIICAL 1.,111..ATOMES.
SAMPLE RECEIVING CHECKLIST
2 1 0 8 2 4 5
SAMPLE DELIVERY GROUP 217082415
CHECKLaST YES NO
Client PM AM
4565 - Access Analytical
Transport Method
fedex
Samples received with proper thermal preservation?
Radioactivity is <1600 cpm? If no, record cpm value
COC relinquished and complete (including samplelDs,
All containers received in good condition and within
All sample labels and containers received match the
• _ -
131
in notes section. V LI
Profile Humber
80251
Received IS'iy
Savage, Tiffany R
collect times, and sampler)? ISI
hold time? v.
Line Item(s)
4 - Solid
Receive Date(s)
08/24/17
chain of custody? ..
Preservative added to any containers?
If received, was headspace for VOC water containers
Samples collected in containers provided by GCAL?
IS
< 6mm?
s
v
COOLERS
DISCRE-PANCOES
LAB PRESERVATaONS
Airbiii Thermometer ID: E29
Temp °C
Nbne
None
7700 9612 2948
4.5
NOTES
'
Revision 1.6
Page 1 of 1
Lab Report*: 217082415
Page 11 of 11

Act.- ESS
,NA L IC L NC,.
ANALYTICAL REPORT
CLIENT
Prism Laboratories
PO Box 240543
Charlotte NC 282240543
ATTENTION
Robbi A. Jones
PROJECT ID
7080390
LABORATORY REPORT MJMBER
1708N85
DATE
September 08, 2017
Primary Data Review Bv Secondary Data Review Bv
(Z 7.7 /
Chris Pafford
Project Manager, AES
PLEASE NOTE:
Ashley Amick
Project Manager, Access Analytical
[e-mail]
Unless otherwise noted, all analysis on this report performed at Analytical Environmental Services Inc. (AES Inc),
3080 Presidential Drive, Atlanta, GA30340.
AES is SCDHEC certified laboratory # 98016, NCDENR certified lab # 562, GA certified lab # FL-E87582,
NELAP certified laboratory # E87582
AfflA-LAP,LLC Laboratory ID:100671 for Industrial Hygiene samples (Organics, Metals, PCM Asbestos,
Gravimetric), Environmental Lead (Paint, Soil, Dust wipes, Air), and Environmental Microbiology (Fungal)
Direct Examination.
Local support services for this project are provided by Access Analytical, Inc. Access Analytical is a
representative of AES serving client in the SC/NC/GA areas. All questions regarding this report should be directed
to your local Access Analytical representative at 803.781.4243 or toll fee at 883.315.4243
Page
I Page 18 of 24

-,L'LABORATOR ES, INC
I Full -Service Analytical &
Environmental Solutions
SUBCONTRACT ORDER
Prism Laboratories, Inc.
7080390
Certification: NACUSACE
NC L Sc Other
N/A
SENDING LABORATORY:
Prism Laboratories, Inc.
P. O. Box 240543
Charlotte, NC 28224-0543
Phone: [phone]
Fax: [phone]
Project Manager: Robbi A. Jones
RECEIVING LABORATORY:
Analytical Environmental Services, Inc.
3080 Presidential Parkway
Atlanta, GA 30340
Phone :[phone]
Fax: NA
Analysis Due
Expires
Sample ID: 7080390-01 Solid
Herbicides TCLP (Sub)
Containers Supplied:
Sampled;08/22/17 11:50
08/29/17 11:50
Reused B}% -
kL(
Released By
Date
g-at/-r-7
Date
Laboratory En
Comments
rt
-
Received Byy Date
Received By ate
s" d
Released By Date
Received By Date
Released By Date
Received By Date
Page 1 of 1
Page
Page 19 of 24

Full -Service Analytical &
Environmental Solutions
SENDING LABORATORY:
Prism Laboratories, Inc_
P. 0. Box 240543
Charlotte, NC 28224-0543
Phone: [phone]
Fax: [phone]
Project Manager: Robbi A. Jones
Analysis
Due
Sample ID: 7080390-01 Solid
Herbicides TCLP (Sub)
Containers Supplied:
Vo 7-
Reused B
Released By
JEJ
SUBCONTRACT ORDER
Prism Laboratories, Inc.
7080390
Expires
S a m alg d:08/22/1711:50
Date
Date
08/29/1711:50
7
Certification:
NC
N/A
l ACUSACE
SC Other
RECEIVING LABORATORY:
Analytical Environmental Services, Inc.
3080 Presidential Parkway
Atlanta, GA30340
Phone :[phone]
77
Fax: NA
Laboratory ID Comments
Received
Received By
u GS
Date
1•3 0
Released By Date
Received By
/013:
Released By Date Received By I;
Date •
Page I of 1
Page
Page 20 of 24

r
Aualytiecafl Environmental Services, Inc
La
Client: Prism Laboratories
Project: 7080390
b ID: 1708N85
Sample Receiving Nonconformance:
Date: 8-Sep-17
Case Narrative
Insufficient sample was received 08-24-17 for TCLP SW 1311/8151A. Additional sample was received 08-31-17 c@r 10.30.
Page
Page 21 of 24

Analytiical Enviitroia esital Services, inc
Client: Prism Laboratories
Lab Order 1708N85
Project Name: 7080390
Lab ID: 1708N85-001A
Date:
8-Sep-17
Client Sample ID:
Tag Number:
Collection Date:
Matrix:
Fourth Creek Sludge
7080390-01
8/22/2017 11:50:00 AM
Solid
Analyses
Result Qual MDL
Reporting
Units BatchlD DF Date Analyzed Analyst
Limit
HERBICIDES, TCLP SW131.1/8151A
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
BRL
BRL
82.8
0.030
0.051
0
0.20
0.20
50.1-132
(SW351OC)
mg/L 247636
mg/L 247636
%REC 247636
09/07/2017 13:23
09/07/2017 13:23
09/07/2017 13:23
El
EI
EI
Qualifiers: ' Value exceeds maximum contaminant level
BRL Not Detected at MDL
H Holding times for preparation or analysis exceeded
N Analyte not NELAC certified
B Analyte detectedin the associated method blank
E Estimated value above quantiation ranee
S Spike Recovery outside limits due to matrix
> Greater than Result value
J Estimated value detected below Reporting Limit
< Less than Result value
Page
Page 22 of 24

bZ Jo £Z e6ed
AES
ANALYTICAL
ENVIRONMENTAL
SjRVICLS, INC.
1. Client Name: Access Anaiyticafi, inc.
SAMPLE/COOLER RECEIPT CHECKLIST
2. Carrier: FedEx Q UPS ❑ Usps❑ Client El Courier Other
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Yes
No
N/A
AES Work Order Number: 17081'485
Details
Comments
Shipping container/cooler received in good condition? I
0
C
lJ
damaged • leaking I. other.
Custody seals present on shipping container?
r '
o'�
Custody seals intact on shipping container?
Temperature blanks present?
Cooler temperature(s) within limits of 0-6°C? [See item 13 and 14 for
temperature recordings.]
y
�i
.
r)
Cooling initiated for recently collected samples / ice
present 1
Chain of Custody (COC) present?
n
Chain of Custody signed, dated, and timed when relinquished and received?
Sampler name and/or signature on COC?
o'
r
Were all samples received within holding time?
(o
(1
TAT marked on the COC?
to
0
If no TAT indicated, proceeded with standard TAT per Te ms & Conditions. El
13. Cooler 1 Temperature 1.3
14, Cooler 5 Temperature
15. Comments:
16.
17.
18.
19.
20.
21.
22.
23,
24.
25.
26.
°C Cooler 2 Temperature
°C Cooler 6 Temperature
°C Cooler 3 Temperature
°C Cooler 7 Temperature
°C Cooler 4 Temperature °C
°C Cooler 8 Temperature
°c
Yes
No
N/A
I certify that I have completed sections 1-15 (dated initials).
Details Comments
TD 8/24/17
Were sample containers intact upon receipt?
©.)
()
O
Custody seals present on sample containers?
)
io
Custody seals intact on sample containers?
00
F/
Do sample container labels match the COC?
0
0
Q
incomplete info illegible •
no label 1 other •
Are analyses requested indicated on the COC?
t^'
Were all of the samples listed on the COC received?
0
samples received but not listed on COC •
samples listed on COC not received ■
Was the sample collection date/time noted?
;o
Did we receive sufficient sample volume for indicated analyses?
o
0
Were samples received in appropriate containers?
o
C
Were VOA samples received without headspace (< 1/4" bubble)?
(4`.)
;®'
Were trip blanks submitted?
0
ro
listed on COC • not listed on COC •
27. Comments:
28.
29.
30.
This section only applies to samples where pH can be
checked at Sample Receipt.
Yes
No
N/A
Details
I certify that I have completed sections 16-27 (dated initials).
Comments
MJ 8/24/17
Have containers needing chemical preservation been checked?"'
v
I I
Containers meet preservation, guidelines?
—0
�''
J I (30_
Was pH adjusted at Sample Receipt?
f�
�LJ
( I)
Note: Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Coliforms, VOCs and Oil & Grease/TPH.
I certify that I have completed sections 28-30 (dated initials).
Checklist 6.9.17 Rev 2
MJ 8/24/17
Page 6 of 7

17Z 10 tZ abed
Analytical Environmental Services, Inc
Date: 8-Sep-17
Client:
Project Name:
Worlcorder:
Prism Laboratories
7080390
1708N85
ANALYTICAL QC SUMMARY REPORT
1BatchlD: 247636
Sample ID: MB-247636 Client ID:
SampleType: MBLK
Analyte
TestCode: HERBICIDES, TCLP SWI311/8151A
Units: ug/L
BatchID: 247636
Prep Date: 09/05/2017 Rim No: 351385
Analysis Date: 09/06/2017 Seq No: 7728375
Result RPT Limit SPI( value SPIC Ref Val %REC Low Limit Iligh Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Suer: DCAA
BRL
BRL
0.3448
0.20
0.20
0
0.5000
69.0 50.1
132
Sample ID: LCS-247636 Client ID:
SampleType: LCS
TestCode: HERBICIDES, SW1311/13151A
Units: ng/L
BatchlD: 247636
Prep Date: 09/05/2017 Run No: 351385
Analysis Date: 09/06/2017 Seq No: 7728376
Analyte Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
0.2936
0.2616
0.3058
0.20
0.20
0
0.5000
0.5000
0.5000
58.7
52.3
61.2
50.7
50.1
50.1
117
119
132
Sample ID: 1708544-001BMS Client ID:
SampleType: MS
Analyte
TestCode: HERBICIDES, TCLP SW1311/8151A
Units: mng/L
BatchTD: 247636
Prep Date: 09/05/2017 Run No: 351385
Analysis Date: 09/06/2017 Seq No: 7728379
Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
0.03509
0.2194
0.3162
0.20
0.20
0
0.5000
0.5000
0.5000
7.02
43.9
63.2
46.3
43.3
50.1
126
132
132
JS
Qualifiers:
> Greater than Result value
BRL Below reporting limit
J Estimated value detected below Reporting Limit
Rpt Lim Reporting Limit
< Less than Result value
E Estimated (value above quentitation range)
N Analyte not NELAC certified
S Spike Recovery outside limits due to matrix
13 Analyte detected in the associated method blank
I -I Holding times for preparation or analysis exceeded
R RPD outside limits due to matrix
Pagei7 of 7

Fourth MA
Fourth Creek WWTP
Vicinity Map
600
Feet
Date: January 21, 2015
Dwg: 2015SWR004

PLANT INFLUENT
MH
BAR SCREENS
INFLUENT
PUMP STATION
Raw Influent ►
DECHLORINATION
BUILDING
CHLORINE
BASIN
METERING
FLUME
CLARIFIERS
RAS
RAS
WET
WELL
SLUDGE
PSTMP
A.
AERATION
BASIN
1J
NQ.
Ell
AERATORS
* FLOW
DISTRIBUTION
BOX
EFFLUENT
FLOW
SPLITTER
BOX
E
AERATION
BASIN
NO. 2
B
WAS
AERATORS
L -
STALIME
SLUDGE
TREATMENT
FACILITIES
CONVEYOR
SLUDGE
PUMPS
COVERED
SLUDGE
STORAGE
SLUDGE
STORAGE
PAD
FLOW SCHEMATIC & WATER BALANCE
FOURTH CREEK WASTEWATER TREATMENT PLANT
CITY OF STATESVILLE

SPILL RESPONSE PLAN
OJECT: City of Statesville Land Application Permit WQ0014543
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
1. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Fourth Creek WWTP Supervisor shall take immediate charge and initiate clean-up activities. The City of Statesville
labor and equipment is to be utilized. In the event additional labor and equipment is required, assistance may be requested
from the NC Department of Transportation and other private contractors as necessary.
2. HALT THE SOURCE OF THE SPILL: Such as
a ruptured container or damaged transport unit.
3. CONTAIN THE SPILL:
Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The Operations Manager or the person in charge on the spill site will
advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-up operation,
i.e., local farmers, farm supply centers, nurseries, etc.
4. CLEAN-UP:
Employ front-end loaders, vacuum equipment, sludge application vehicles, and/or local septic tank service to remove as
much of the spilled material as possible. Straw and/or sand should be scattered in the spill area to soak up the remaining
material. The straw- and sand -soaked material will be collected and removed to a disposal area approved by representatives
of the state regulatory agency.
5. FINAL CLEAN-UP:
Employ rotary brush sweeper if needed, and apply lime to the spill area upon the approval of the clean-up efforts by the state
regulatory representative. If the event occurs on private property, the clean-up will be completed to the satisfaction of the
property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original condition
if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs, the City of Statesville Operations staff will notify the Fourth Creek WWTP
Supervisor, and they will then be responsible for notifying other key City of Statesville personnel.
7. REPORTING:
The City of Statesville personnel will notify the Mooresville Regional office [phone] as soon as possible, but not
more than 24 hours after, or on the next working day following the occurrence. The Fourth Creek WWTP Supervisor shall
provide a written report within 48 hours of the spill to the Technical Services Director. The report shall list all relative
information and actions taken. The City of Statesville personnel will file a written report to the Mooresville Regional office
of the NCDENR within 5 days of the occurrence. For after-hours reporting the Division's emergency number shall be called
to report all incidences (800-662-7956 or 800-858-0368 or 919-733-3300)
11Page
5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Inspection Plan
ections for the Land Application site will be conducted on an as needed basis. The inspection frequency is based on the time frame
t it is going to take to complete the project and the amount of dry tons to be processed from this facility. The inspections will
onsist of inspecting the Bio-Solids loading area. These inspections will consist of:
1. Verifying that all of the equipment is working properly.
2. Verify that all containment walls and curbing are working properly.
3. Insure that all manned equipment has a copy of the spill control plan, the permit, and the operations and maintenance
plan
4. Verifying that the correct number samples of the Class B product have been taken and that it meets the criteria for the
Land Application Permit.
5. The records will be kept in the project files in the respective office for the project.
6. The Permittee or Inspector shall report by telephone to the Mooresville Regional Office at 704-235-2198 as soon as possible
but no later than 24 hours after or the next working day following the occurrence or the first knowledge of the occurrence of
the following.
• Any occurrence with the distribution program resulting in the land application of significant amounts of material that is
abnormal in quantity or characteristics.
• Any time that self -monitoring indicates that the facility has gone out of compliance with the permit.
• Any process failure that results in the system not adequately treating the residuals.
• Any spill or discharge from a vehicle or piping system during residuals transportation.
• Any release that requires immediate reporting outside of normal business hours shall be called in to DENR at 1800-
662-7956, 1-800-858-0368, or 1-919-733-3300. These numbers are to be called in the event of a release to surface
waters, imminent failure of a storage system when the event occurs outside of normal business hours.
• Within 5 days of the first notice of on occurrence a written response in the form of a letter shall be sent to DENR
outlining the actions taken or purposed actions taken to ensure that the problem does not recur. Persons responsible
for inspections on this project are as follows:
Andy Smith, 4th Creek WWTP ORC or his designee
Andy Smith is the designated WWTP ORC for this project and his designees are the backup ORC's for this project.
2IPage
5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Sampling Plan
Sampling for this project consists of sampling the residuals during the time that land application is occurring. This
will result in one round of sampling to occur before land application commences in order to insure that the residuals
are suitable for land application. Based on the dry tonnage of this plant this will be six samples for all parameters per
year.
The residuals shall be sampled annually for the following: (Regulatory level
Arsenic (5.0) 1, 4-Dichlorobenzene (7.5)
Barium (100.0) 1, 2-Dichloroethane (0.5)
Benzene (0.5) 1, 1-Dichloroethylene (0.7)
Cadmium (1.0) 2, 4-Dinitrotoluene (0.13)
Carbon tetrachloride Endrin (0.02)
(0.5) Chlordane
(0.03)
Chlorobenzene
(100.0) Chloroform
(6.0) Chromium (5.0)
M-Cresol (200.0) o-
Cresol (200.0) p-
Cresol (200.0) Cresol
(200.0) 2,4-D (10.0)
in milligrams per liter in parentheses.)
Nitrobenzene (2.0)
Pentachlorophenol (100.0)
Pyridine (5.0)
Selenium (1.0)
Silver (5.0)
Hexachlorobenzene (0.13 Tetrachloroethylene (0.7)
Heptachlor (and its hydroxide) (0.008)Toxaphene (0.5)
Hexachloro-1,3-butadiene (0.5) Trichloroethylene (0.5)
Hexachlorethane (3.0)
Lead (5.0)
Lindane (0.4)
Mercury (0.2)
Methoxychlor (10.0)
Methyl ethyl ketone (200.0)
2,4,5-Trichlorophenol (400.0)
2,4,6-Trichlorophenol (2.0)
2,4,5 TP (Silvex) (1.0)
Vinyl Chloride (0.2)
The residuals will also be sampled based on the chart below for the following constituents
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1 time per year
=>319-<1,650
1 per Quarter (4 times per year)
=>1,650-<16,500
1 every 60 days (6 times per year)
=>16,500
1 every month (12 times per year)
Aluminum
Ammonia -Nitrogen
Arsenic
Cadmium
Calcium
Copper
Lead
Sodium Adsorption Ratio (SAR)
Magnesium
Mercury
Molybdenum
Nickel
Nitrate -Nitrite Nitrogen
Phosphorous
Potassium
pH
Plant Available Nitrogen (calculation)
Selenium
Sodium
% Total Solids
Total Kjeldahl Nitrogen
Zinc
In order to meet pathogen and vector requirements the material will go through an aerobically digested treatment process. The
residuals will meet pathogen and vector requirements through pH, time and temperature requirements. The samples will be
pulled from the storage pads that are currently holding the Sta-Lime product. The samples that will be pulled are a TCLP and
nutrient and metals sample to prove that the material is suitable for distribution. The nutrient and metal and TCLP sample will be
collected randomly and consist of individual samples mixed together in order to get the composite sample for these parameters.
This material is very consistent based on the fact that these residuals are thoroughly digested and mixed before processing and
should not experience any seasonal fluctuations in the residuals.
The following people are responsible for sampling:
Andy Smith, Plant Manager or his designee.
31Pae
5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Operational Functions
The operation function of this project is going to involve loading dewatered belt press sludge. The dewatered belt press
sludge will be loaded into the trucks that are suitable to transport and spread this product without spillage or leakage
during transport. The dewatered belt press sludge will be spread at agronomic rates that are determined by the soil
samples from the fields that the City of Statesville staff has collected.
SAFETY MEASURES
The City of Statesville believes in operating in a safety conscious manner and is has all employees participate in monthly
safety courses that are designed to help its employees recognize safety issues and take steps to prevent accidents from
occurring. In addition all City of Statesville, Water Resources employees have the authority to stop operations if they think
any aspect of the operation is going to cause environmental or personal harm.
Maintenance Schedule
The City of Statesville will follow the maintenance schedule as recommended by the processing equipment
manufacturer.
Wage
5/2/2018

of Water Resources
V1sion
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
lease use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
structions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for -treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with I3A NCAC 0 T .0106(b). An
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the
criteria in 1SA N0.Ar, .0106).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit
Major Modification
Major (land are permitted for > 300 acres)
$1,310
$395
Minor (land are permitted for <300 acres)
$810
$245
1- A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes
not previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (Maybe Required — See 15A NCAC IC .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
® Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
Ei Safety measures; may include safety training program, manuals, signs, etc.
®I Spill response plan; including control, containment, remediation, emergency contact information, etc.
-.-Inspection-plan-including_the following information;
®' Names and titles of personnel responsible for conducting the inspections.
® Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
® Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncompliance is observed.
El Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
▪ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures. '
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15 NF' ( On
:1161(1 ). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within, 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

ect Evaluation and Receiver Site Management Plan (A11 New Application Packages or Modifications that include new
s)
Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their ability to accept the proposed application rates.
Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑, Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.orc/Rules Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated
site map specific to the modification(s) only.
❑ The design documents must include the following minimum items:
Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the
new units or are critical to the understanding of the complete process;
El Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 021 1104(c1).(5) and current Division Policy
available at: Itti-p://mmAymovitcr.orgautes_ Policies ..and _Reg tions/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
El Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., Ci1g, deed or article of incorporation),'or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of i. A NCAC OIL .0 i on, or
El A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
Page 3 of 3

`DIvision of Water Resources
State of North Carolin�
Department of Environmental Q uality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name:
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
Federal ❑ State NO Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Andy Smith Title: Assistant Director of Water Resources
Applicant's mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] Email Address: [e-mail]
2. Consultant's name: License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm: )
Consultant's mailing address:
City: State: Zip: '
Telephone number: (_) . Email Address:
3. Agronomist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip:
Telephone number: ( ) — Email Address:
4. Soil Scientist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Fuui:.
Soil Scientist's mailing address:
City: State: ; Zip: 1
Telephone number: ( ) - Email Address:
5. Fee submitted: $810 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, X❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00014543
Date of most -recently issued permit: September, 2013
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page 1 of 5

r1.
SIDUALS LAND APPLICATION PROGRAM INFORMATION:
Residuals Processing Facility's physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: 28677-
Coordinates: Latitude: 25° 46' 29 N" Longitude: 80° 48' 50 W"
Datum:
Method of measurement: GPS
2. County where residuals land application program is headquartered: Iredell
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Level of accuracy:
Designation
Name
Affiliation
Certification Number
ORC
Andy Smith
City of Statesville
LA 985516
Back -Up ORC
Scott Austin
City of Statesville
LA 991939
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide
the candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training
school and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitroffen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in
the following table:
Maximum amount of residuals to be certified: 4th Creek @ 1,056 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
27.24 mg/kg
26,5051bs
Five -Year Maximum Adjusted
136.19
mg/kg
132,5231bs
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
Hay
14.1
Fescue Hay
Pasture
Total:
Methods
Surface
Incorporation or Injection
Total:
FORM: RLAP 06-16
Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currentl
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
530
2,650
100
265
1,325.25
150
177
884
200
133
663
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): X❑ Non -dedicated❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification. doc
FORM: RLAP 06-16
Page 3 of 5

rote: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: '
feet below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHWT and
ground surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
El Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
(in/hr)
Recommended
Loading Rate
(in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why i3A NtA(1 On is not met: ;
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field / Zone
Design Area
(ft2)
Number of
Nozzles
Maximum Application
Rate (gallons/hr)
Design Annual Loading
Rate (gallons/yr)
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
LL
Nozzle capacity
? gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16
Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
Yes El No, Explain;
SitvA U1zfe'(us Auc-,. veczrer
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for 3
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water
Resources may not -conduct a technical review of this program and approval does not constitute a variance to any rules or statutes
unless specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any
false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
0(f
FORM: RLAP 06-16
Page 5 of 5

Division of Water Resources
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Mop ailidOtiPP fOf
i §tll
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Andy Smith
Status
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
City of Statesville
3rd Creek WWTP
Iredell
NC0020591
975
N/A
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 06-16
Page 1

litWR
<„------ - ,, ,___-----,---
D" ivision of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: 3th Creek WWTP
2. Facility permit holder is: ❑ Federal, Ol State, E Local Government, or 0; Private.
Facility permit issued by: ® Div. of Water Resources, 0 Div. of Environmental Health,
or 0 Other (explain:1).
3. Facility contact person and title: Andy Smith, Assistant Director
Complete mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 444 Third Creek Road
City: Statesville State: NC Zip: 2867711
Coordinates: Latitude: 35° 75' N" Longitude: 80° 84' W"
Datum: 1 Level of accuracy: , a- __ _ a
Method of measurement: GPS
5. Purpose of the facility:
treatment of municipal wastewater,
0 treatment of 100% domestic wastewater,
0 treatment of potable water, 0 treatment of 100% industrial wastewater,
El treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: 60 % industrial and 40 % domestic)
0 other (explain: 1).
6. Does the facility have an approved pretreatment program: ►! Yes 0; No
FORM: RSC 06-16
7. Facility permitted/design flow: 6.0 MGD and facility average daily flow: 0.9 MGD
8. Average amount of residuals being generated at this facility 500 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Two 2 meter belt presses
Type and volume of residuals storage (i.e., outside of residuals treatment units): 3 million gallon aerobic digester
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or 0' 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Biological 0 Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: Q yes El no.
If yes, list the nnmber(s): �T1
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: 0yes El no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Prism and Date of analysis: 8/22/17
Passed corrosivity test: i yes Li no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: E yes 0 no. Flashpoint: i I °F (> 140°F)
Passed reactivity test: w yes Lino. HCN: I mg/kg (<250) & H2S: ; mg/kg (<500)
TCLP Parameter
Limit
(mg/l)
Result
(mg/l)
TCLP Parameter
Limit
(mg/I)
Result
(mg/l)
Arsenic
5.0
<0.050
Hexachlorobenzene
0.13
<0.050
Barium
100.0
<5.0
Hexachloro-1,3-Butadiene
0.5
<0.050
Benzene
0.5
<0.025
Hexachloroethane
3.0
<0.050
Cadmium
1.0
<0.025
Lead
5.0
<0.050
Carbon Tetrachloride
0.5
<0.025
Lindane
0.4
Chlordane
0.03
<0.0025
Mercury
0.2
<0.010
Chlorobenzene
100.0
<5.0
Methoxychlor
10.0
<0.00050
Chloroform
6.0
<0.30
Methyl Ethyl Ketone
200.0
<10
Chromium
5.0
<0.25
Nitrobenzene
2.0
<0.050
m-Cresol
200.0
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
I Pyridine
5.0
<0.25
p-Cresol
200.0
Selenium
1.0
<0.10
Cresol
200.0
Silver
5.0
<0.25
2,4-D
10.0
Tetrachloroethylene
0.7
<0.035
1,4-Dichlorobenzene
7.5
<0.38
Toxaphene
, 0.5
<0.025
1,2-Dichloroethane
0.5
<0.025
Trichloroethylene
0.5
<0.025
1,1-Dichloroethylene
0.7
<000083
2,4,5-Trichlorophenol
400.0
<0.25
2,4-Dinitrotoluene
0.13
<0.050
2,4,6-Trichlorophenol
2.0
<0.10
Endrin
0.02
<0.00050
2,4,5-TP (Silvex)
1.0
Heptachlor and its Hydroxide
0.008
<0.00050
Vinyl Chloride
0.2
<0.20
FORM: RSC 06-16
Page 2 of 5

pir
Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Waypoint and Date of analysis: 1/13/17
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
3.34
Cadmium
85
39
13.2
Copper
4,300
1,500
327
Lead
840
300
84.6
Mercury
57
17
<0.400
Molybdenum
75
n/a
19.4
Nickel
420
420
53.3
' Selenium
100
100
6.87
Zinc
7,500
2,800
1,020
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: i and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
Q >0but<25
30
200
210
OI > 25 but < 50
34
220
240
> 50 but < 75
39
260
270
> 75 but < 100
46
300
320
Q > 100 but < 125
53
360
390
> 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16
Page 3 of 5

Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 13.96 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Waypoint and Date of analysis: 1/13/17
Parameter
Result
(mg/kg)
Aluminum
14,400
Ammonia -Nitrogen
2,650
Calcium
14,300
Magnesium
3,280
Nitrate -Nitrite Nitrogen
159
pH (Standard Unit)
6.61
Phosphorus
16,300
Potassium
3,490
Sodium
1,310
Total Kj eldahl Nitrogen
43,100
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): _}
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: %.
This rate is a (check one): 0default value, or Q actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals: , .._.
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1st) Year PAN
(mg/kg)
Five -Year
Maximum Adjusted PAN
• (mg/kg)
Surface
27.24
Injection/Incorporation
136.19
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16
Page 4 of 5

ra.
thogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
For Distribution/Land Application of Class A or Equivalent:
❑; A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑,, Altemative 1 [15A NCAC 02T.1106(b)(3)(A)] - Time/Temperature Compliance.
❑! Altemative 2 [15A NCAC 02T.1106(b)(3)(B)] - Alkaline Treatment.
❑; Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
El Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑{ composting, ❑; heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
❑' Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ►1 aerobic digestion, El air drying, ❑ anaerobic digestion,
❑I composting, or ❑', lime stabilization.
c. For Surface Disposal:
❑'; Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
• Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
El Exempt - If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
1
8. Vector Attraction Reduction (VAR): Per 1 $A NhA 09T:1 107, specify how residuals will meet the VAR requirements:
Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
El Alternative 2 [15A NCAC 02T.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Er Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Z Altemative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
• Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
❑; Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
❑; Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
El Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
• Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(b)(2)].
El Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

WR
'vision of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
R The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
+ New (N) + Renewed (R) ♦ Modified (M) 0 Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
County Board
Notification.
doc
tiff
✓
'/
'/
*
Land Owner
Agreement
(If applicable)
✓
✓
✓
✓
Setback Waiver
Agreement
An updated
for Residuals
vicinity/setback map in accordance with the "Map Guidance
✓
✓
✓
Land Application Permits"
A soils and
Evaluation Policy"
agronomic evaluation in accordance with the "Soil Scientist
✓
INSTRUCTIONS FOR FORM: LASC 06-16
Page 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs)
✓
V
Required Item
Status Code
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
✓
✓
V
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same time period)
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS-(GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Mere (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: p;//deb, o, an/aboutidivi.8 I tt,/water_
ro mime sflal ann ingLeJ as sfte ationl•siandardsLeinaifieations
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact infoiuiation may be downloaded at:
http://deq,nc,gov/contact/re gional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering ,Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16
Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Statesville
Land application sites currently certified: 29.4 net acres and Total to be certified: 29.4 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction 13):
Status
Code"
Site/Field
ID
Landowner(s)
Lessee(s) or•Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slope`
R
02
City of Statesville
3rd Creek WWTP
14.10
Iredell
Fescue Hay
Cecil
CeB2 2-6%
N
-
—,
N
1
N-
-
--
- --
_
— _,
N
--
i 1
N
}
t
N
r
i
N
______ ,
—
:_�—
_ t
... __-1
i
d Status Code for land application sites are: + N (New) ♦ R (Renewed) + M (Modified) + T (Transferred) e D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
'Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
p
Class
02
35° 44' 24"
80° 50' 24"
NAD 83
ADD
Nearest Second
03-07-06/03040102
C
C
° II°
' "
NAD 83
ADD
Nearest Second
1
8
0 "
° ' ' '"
NAD 83
ADD
Nearest Second
,
1
0 ' '' i- If
° ' "
NAD 83
ADD
Nearest Second
° ; _ . __II
° •„
NAD 83
ADD
Nearest Second
1 j
!
,.
NAD 83
ADD
Nearest Second
;
_.
—
° '`°
r� , _
°
- ` �
NAD 83
ADD
Nearest Second
[ -- -I
_
° , —.
�° `" _:°
NAD 83
ADD
Nearest Second
_ _I
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16

ISM
LABORATORIES, INC.
City of Statesville, NC
Andy Smith
P.O. Box 1111
Statesville, NC 28687
IFull -Service Analytical &
Environmental Solutions
NC Certification No. 402
NC Drinking Water Cert No. 37735
SC Certification No. 99012
Project: Sludge (Hazardous Testing)
Project No.: 3rd Creek Sludge
Lab Submittal Date: 08/22/2017
Prism Work Order: 7080391
Case Narrative
09/11/2017
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Narrative Notes:
Reactivity analysis was subcontracted to GCAL. TCLP Herbicide analysis was subcontracted to AES.
Laboratory reports are attached.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Robbi A. Jones Reviewed By Robbi A. Jones
President/Project Manager
President/Project Manager
Data Qualifiers Key Reference:
CCV CCV result is above the control limits. Analyte not detected in the sample. No further action taken.
D RPD value outside of the control limits.
ICV ICV result is above the control limits. Analyte not detected in the sample. No further action taken.
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 1 of 24

R aI M Full -Service Analytical &
I Environmental Solutions
LSBORATORIE$ ING
ent Sample ID
Third Creek Sludge
Sample Receipt Summary
09/11/2017
Prism Work Order: 7080391
Lab Sample ID Matrix Date Sampled Date Received
7080391-01 Solid 08/22/17 08/22/17
Samples were received in good condition at 3.9 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
I Page 2 of 24 I

Full -Service Analytical &
Environmental Solutions
77LABORATORIES ING
ity of Statesville, NC
Attn: Andy Smith
P.O. Box 1111
Statesville, NC 28687
Project: Sludge (Hazardous Testing)
Project No.: 3rd Creek Sludge
Sample Matrix: Solid
Laboratory Report
09/11/2017
Client Sample ID: Third Creek Sludge
Prism Sample ID: 7080391-01
Prism Work Order: 7080391
Time Collected: 08/22/17 11:55
Time Submitted: 08/22/17 15:30
Parameter
Result
Units Report
Limit
MDL Dilution Method Analysis Analyst
Factor Date/Time
Batch
ID
General Chemistry Parameters
% Solids
Corrosivity-pH
Ignitability
TCLP Extraction by EPA 1311
23.2
4.8
Pass
% by 0.100
Weight'
pH Units
mm/sec 0.10
0.100 1 *SM2540 G 8/31/17 16:00 JLB P710012
1 *9045D 8/24/17 10:47 BMS P7H0445
1 *1030 8/24/17 9:00 BMS P7H0440
TCLP Extraction
TCLP Extraction
TCLP Metals
Complete
Complete
N/A
N/A
1 *1311 8/26/17 10:05 JAB P7H0487
1 *1311 ZHE 9/6/17 12:34 KDM P710063
Mercury
Arsenic
Barium
Cadmium
Chromium
Lead
Selenium
Silver
BRL
BRL
BRL
BRL
BRL
BR L
BRL
BRL
TCLP Organochlorine Pesticides by GC/ECD
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
0.010
0.050
5.0
0.025
0.25
0.050
0.10
0.25
0.000030 1
0.012 1
0.0065 1
0.00065 1
0.0038 1
0.0080 1
0.022 1
0.00050 1
*7470A
*6010D
*6010D
*6010D
*6010D
*6010D
*6010D
*6010D
9/1/17 12:38 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
8/28/17 15:44 JAB
P7H0572
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
P7H0505
Chlordane
Dieldrin
Endrin
gamma-BHC
Heptachlor
Heptachlor Epoxide
Methoxychlor
Toxaphene
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRLCCV
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
0.0025
0.00050
0.00050
0.00050
0.00050
0.00050
0.00050
0.025
0.00047 1
0.000070 1
0.000075 1
0.000065 1
0.000085 1
0.000065 1
0.00020 1
0.00037 1
*8081B
*8081B
*8081B
*8081B
*8081B
*8081B
*8081 B
*8081B
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
8/28/17 17:35 JMC
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
P7H0495
Surrogate
Recovery
Control Limits
Decachlorobiphenyl
Tetrachloro-m-xylene
TCLP Semivolatile Organic Compounds by GC/MS
83 %
81 %
13-186
40-134
2,4,5-Trichlorophenol
2,4,6-Trichlo roph enol
2,4-Dinitrotoluene
2-Methylphenol
3/4-Methylphenol
Hexachlorobenzene
Hexachlorobutadiene
Hexachloroethane
Nitrobenzene
Pentachlorophenol
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRLICv
BRL
BRL
mg/L 0.25 0.0016 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.10 0.0018 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0014 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0018 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0015 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0013 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0021 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0017 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.050 0.0026 1 *8270D 8/29/17 18:54 JMV P7H0520
mg/L 0.25 0.0012 1 *8270D 8/29/17 18:54 JMV P7H0520
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 3 of 24

IS
LABORATORIES, INM
0.
y of Statesville, NC
ttn: Andy Smith
P.O. Box 1111
Statesville, NC 28687
Parameter
Full -Service Analytical &
Environmental Solutions
Result
Project: Sludge (Hazardous Testing)
Project No.: 3rd Creek Sludge
Sample Matrix: Solid
Units Report MDL
Limit
Laboratory Report
09/11/2017
Client Sample ID: Third Creek Sludge
Prism Sample ID: 7080391-01
Prism Work Order: 7080391
Time Collected: 08/22/17 11:55
Time Submitted: 08/22/17 15:30
Dilution Method Analysis Analyst
Factor Date/Time
Batch
ID
Pyridine
BRLICV
mg/L 0.25 0.0010
1 *8270D 8/29/17 18:54 JMV
P7H0520
Surrogate
Recovery Control Limits
2,4,6-Tri bromophenol
2-Fluorobiphenyl
2-Fluorophenol
Nitrobenzene-d5
Phenol-d5
Terphenyl-d14
TCLP Volatile Organic Compounds by GC/MS
71 %
71 %
49 %
60 %
32 %
83 %
43-140
44-119
19-119
44-120
11-52
50-134
1,1-Dichloroethylene
1,2-Dichloroethane
1,4-Dichlorobenzene
Benzene
Carbon Tetrachloride
Chlorobenzene
Chloroform
Methyl Ethyl Ketone (2-Butanone)
Tetrachloroethylene
Trichloroethylene
Vinyl chloride
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
BRL
mg/L 0.035 0.00083 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.025 0.00066 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.38 0.00050 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.025 0.00048 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.025 0.0011 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 5.0 0.00062 1 *82603 9/6/17 14:28 KDM P710064
mg/L 0.30 0.00076 1 *82608 9/6/17 14:28 KDM P710064
mg/L 10 0.0024 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.035 0.00098 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.025 0.00078 1 *8260B 9/6/17 14:28 KDM P710064
mg/L 0.020 0.00097 1 *8260B 9/6/17 14:28 KDM P710064
Surrogate
Recovery Control Limits
4-Bromofluorobenzene
Dibromofluoromethane
Toluene-d8
103 %
102 %
99 %
80-124
75-129
77-123
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 4 of 24

Sample Extraction Data
Method: Solids, Dry Weight
Number
Batch Initial Final Date/Time
80391-01 P710012 30 g 30 g 08/31/17 16:00
Prep Method: 1311
Lab Number Batch Initial Final Date/Time
7080391-01
7080391-01
Prep Method: 3010A
Lab Number
P710063
P7H0487
Batch
12.5 g
100 g
250 mL
2000 mL
09/05/17 15:33
08/25/17 15:30
Initial Final Date/Time
7080391-01
Prep Method: 7470A
Lab Number
P7H0505 10 mL 50 mL 08/28/17 10:25
Batch Initial Final Date/Time
7080391-01
Prep Method: 3510C GC
Lab Number
P7H0572 20 mL 30 mL 09/01/17 7:25
Batch
Initial Final Date/Time
7080391-01
Prep Method: 3510C MS
Lab Number
P7H0495 200 mL 10 mL 08/28/17 9:49
Batch
Initial Final Date/Time
7080391-01
Prep Method: 5030B
Lab Number
P7H0520 200 mL 1 mL 08/29/17 9:41
Batch
Initial Final Date/Time
7080391-01 P710064 1 mL 10 mL 09/06/17 9:52
Subcontracted Analyses
The following analyses were subcontracted to Analytical Environmental Services , Inc.
Lab Number Analysis
7080391-01 Herbicides TCLP (Sub)
The following analyses were subcontracted to Gulf Coast Analytical Labs, Inc.
Lab Number Analysis
7080391-01 Reactivity, Cyanide (Sub)
7080391-01 Reactivity, Sulfide (Sub)
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/529-6364 - Fax: [phone]
Page 5 of 24

II
NN 07 CUSTODY' RECORD
R It })
LAaOnA'I"OnIEs. INC.
49 Spr'nghrook Road •
Phone 794152e- 364
Client Company Name: C u �,
Report To/Contact Name: A
Full -Service Analytical &
Environmental Solutions
Charlotte, NC 25217
Fax: 7t)k/525.4499
svra ' g e rr :Drc.
Reporting Address:
6'Jwipi_ i5Jai) Q° , -i
r
PAGE DC (MIPSTE 0 70 EMS!U! D3C PROPER MUMS:
Project Name:
Short Hold Analysis: (Ves) (No) UST Project: (Ves) (NO)
`:Please ATTACH any project specific reporting (QC LEVEL i Dl Oil DV)
provisions and/or QC Requirements
invoice To:
Address:
S.emples IN'FAC'i won arrial?:
Received ON`WET ICE?<• `.
PROPER'PRESERVATIVES iiidicted?
Receivers WITHIN:HcLD1NG TIMES?
CUST(1D'YSEAI S NTACT?
VOLATILESIIec,;d W/OU:C.I tDSPAC? •
PROPER CONTAINERS used? Lq- F _
TEMP: Therm {C!i_:� � "'. -Obsei:ved: ' y °C i. Carl :E_ °C
YES.
intone: o e- Y •- O a u v rg) Irax YcY2sy (Nol: et3'r-o'V " 00)30
TO BE POLLED ON BY CLIENT/SAMPLING PERSONNELEmail
Certification: IELAC Do® FL MC
Purchase Order No./Billing Reference
Address:
Requested Due Date O 1 Day O 2 Days O 3 Days ® 4 Days O 5 Days
Type: PDFr_Excel Other "Wonting Days" ® 6-9 Days Be
SC ®�GiEG� N/A
EDD
O Standard 10 days ®pue Appoovedust
Site Location Herne: Samples received after 14:00 will be processed next business day.
Water Chlorinated: YES NO
Sample Iced Upon Collection: YES NO_
Side Location Physical Address: Turnaround time is based on business days, excluding weekends and holidays.
(SEE REVERSE FOR TERMS Si CONDITIONS REGARDING SERVICES
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
CLIENT
DESCRIPTION
DATE
COLLECTED
TIME
COLLECTED
MATRIX
(SOIL,
SAMPLE CONTAINER
PRESERVA-
TIVES
TIVES
ANALYST :REQUESTED
//// / REMARKS
//
PRISM
LAB
ID MO.
*TYPE VPE
SEE BELOW
NO.
SIZE
MVLDTARY
HOURS
WATER OR
SLUDGE)
7g9a0J Caccif
g fici
55
to
"
aI10a
( p"
11 a
qi
TC1�P
lk."r
SQQ
qI'
v
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RE
-4Fes`it0'(f0
r/r1LJ
0
4
?L_Si
l
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4All1' :.
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ti
Vol
v
red
3 pc
d
;9 Hr,
ICE
P ll
RL;
FOCI e
f 'J
Sampler's Signature y �.�°r�;�i�
! + 'f
Sampled By Name)19 &] �r�
t '.'� B © Y fig !T3rviy4R[ip,}1�L} r1O!Fu Ts
l Cs'ri
(Print q9' u9,%� A c�b
Affiliation
Upon relinquishing, this Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be
submitted in writing to the Prism Project Manager. There will be charges for any changes after analyses have been initialized.
r( _ -.�wFp
{. t!r!�,4i]
A
Resin fished By: (Signa { e)
Vic' ti //
Reei e B SI n7<ue�
t 9 1
rf ,�"✓
Dal
:-- ' - •.
Military/Hours /Hours
ry
'')
Additional Comments
sitO A!rlVe Time:
Re1J s .tshed By: (Signature) "'-_
R'.,ce1,ed By: (Signature) '�'
Date
S!te e nrtU e Time:
�1
P
gp! We Bi y: (Sig `a ure)
Received F`'� Prism,-y]boratories lay
��c /
Date
f=!old :Tech l-oc,
� ii ?i i (� ��N: 0 f'1, i',�
'C') - V " I -2
@ 530
-:Mifeade:
v
od of Shipment: NOTE: ALL SAMPLE COOLERS SHOULD BE TAPED SHUT WITH CU.��rr"rODY SEALS FOR TRA ilSPORTATION TO THE LABORATORY.
COC Group No.
CO
0)
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC UNYIL RECEIVED AT THE LABORATORY.
G
d Ex ❑UPS ❑ Hand -delivered C�ism Field Service ❑ Other -
7 oto r `I
o
)ES:
LIST: --
CRjj6�UNDWATER:
(DRINKING WATER:
SOLID WAS T P:
RCRA:
CERCLA
LAl�°[r�i OLL
OTl D�CLv:
r't -
lv
C®SC
©NC ©SC
0IC ®SC
1 NC ®SC
INC ®SC
ElNC0SC
C11NC 0SC
®NC ®SC
ONC ®SC
.
R�
` `° I°`
®
O
O
o
®
0
0
®
_INTAENER
Oi=lsrw+if•_,`-i-
TYPE CODES: A = Amber C = Clear G= Glass P = Plastic: TL = Teflon -Lined Can VIA = Vntatile Clrnanina Anakrcts 17arr I -foam Snaral

:-"
AccESS
A NA LYTICA INC.
MALY MAL REPORT
CLIENT
Prism Laboratories
PO Box 240543
Charlotte, NC 28224
ATTENTION
Robbi Jones
PR...MOT D
7080391
LABORATORY REPORT NUMBER
217082416
DATE
08/29/2017
Primary Data Review By Secondary Data Review By
f" " i ./ ..---,--L----/--ti:i —
4
Authorized Signature
PLEASE NOTE:
Ashley B. Amick
Project Manager, Access Analytical, Inc.
[e-mail]
- Unless othenrrise noted, all analysis on this report per at Gulf Coast Analytical Labs (GCAL),
7979 Innovation Park Dr., Baton Rouge, LA 70320.
- GCAL is SCDHEC certified laboratory # 73006, 11lCDEHR certified lab # 618, GA certified lab # LA-01955,
NELAP certified laboratory 01955
- Local support services for this project are provided by Access Analytical, Inc.. Access Analytical is a
representative of GCAL serving clients in the SC/NC/GA areas. All questions regarding this report should be
directed to your local Access Analytical representative at 803.781.4243 or toll free at 888.315.4243.
Lab Report#: 217082416
Poe 1 of 11
I Page 7 of 24

AttAt.S71e:A. t'-o.31.")Recr-tiR17.5, LLC
NELAP CERTIFICATE NUMBER: 01955
DOD ELAP CERTIFICATE NUMBER: L14243
NALYT1CAL RESULTS•
PERFORMED BY
GCAL, LLC
7979 Innovation Park Dr.
Baton Rouge, LA 70820
Report Date 08/29/2017
GCAL Report 217082416
iI
Project 7080391
Deliver To
Robbi-Jones
Prism Laboratories
PO Box 240543
Charlotte, NC 28224
800-529-6364
Additional Recipients
NONE
PJLA
Test trig
DtiD ELAP
Lab Reportg: 217082416
13(-ir, 9 nf I I
I Page 8 of 24

9
t iILAL L CJFATORI,,S. LLC
Report#: 217082416
Project ID: 7080391
Report Date: 08/29/2017
Laboratory Endorsement
Sample analysis was performed in accordance with approved methodologies provided by the Environmental Protection Agency or other recognized
agencies. The samples and their corresponding extracts wit be maintained for a period of 30 days unless otherwise arranged. Following this
retention period the samples will be disposed in accordance with GCAL's Standard Operating Procedures.
Common Abbreviations that may be Utilized in this Report
ND Indicates the result was Not Detected at the specified reporting limit
NO Indicates the sample did not ignite when preliminary test performed for EPA Method 1030
DO Indicates the result was Diluted Out
illrl Indicates the result was subject to Matrix Interference
TN T C Indicates the result was Too Numerous To Count
SUBC Indicates the analysis was Sub -Contracted
FLD Indicates the analysis was performed in the Field
DL Detection Limit
DL Diluted analysis — when appended to Client Sample ID
LOD Limit of Detection
LOQ Limit of Quantitation
RE Re -analysis
CF HPLC or GC Confirmation
00:01 Reported as a time equivalent to 12:00 AM
Reporting Flags that may be Utilized in this Report
J or I Indicates the result is between the MDL and LOQ
J DOD flag on analyte in the parent sample for MS/MSD outside acceptance criteria
U Indicates the compound was analyzed for but not detected
B or V Indicates the analyte was detected in the associated Method Blank
Q Indicates a non -compliant QC Result (See Q Flag Application Report)
Indicates a non -compliant or not applicable QC recovery or RPD — see narrative
E The result is estimated because it exceeded the instrument calibration range
E Metals - % diference for the serial dilution is > 10%
P RPD between primary and confirmation result is greater than 40
Sample receipt at GCAL is documented through the attached chain of custody. In accordance with NELAC, this report shall be reproduced only in
full and with the written permission of GCAL. The results contained within this report relate only to the samples reported. The documented results
are presented within this report.
This report pertains only to the samples listed in the Report Sample Summary and should be retained as a permanent record thereof. The results
contained within this report are intended for the use of the client. Any unauthorized use of the information contained in this report is prohibited.
I certify that this data package is in compliance with The NELAC Institute (TNI) Standard 2009 and terms and conditions of the contract and
Statement of Work both technically and for completeness, for other than the conditions in the case narrative. Release of the data contained in this
hardcopy data package and in the computer readable data submitted has been authorized by the Quality Assurance Manager or his/her designee,
as verified by the following signature.
Estimated uncertainty of measurement is available upon request. This report is in compliance with the DOD QSM as specified in the contract if
applicable.
i ( { t ` /////ire ,
Authorized Signature
GCAL Report 217082416
Lab Report#: 217082416
Ponca of 11
I Page 9 of 24
r.:

G
1 LVTICAL I&OoR:TO PIES, ILC
Report#: 217082416
Project ID: 7080391
Report Date: 08/29/2017
Certifications
Certification
Certification Number
DOD ELAP
L14-243
Alabama
01955
Arkansas
12-060-0
Colorado
01955
Delaware
01955
Florida
E87854
Georgia
01955
Hawaii
01955
Idaho
01955
Illinois
200048
Indiana
01955
Kansas
E-10354
Kentucky
95
Louisiana
01955
Maryland
01955
Massachusetts
01955
Michigan
01955
Mississippi
01955
Missouri
01955
Montana
N/A
Nebraska
01955
New Mexico
01955
North Carolina
618
North Dakota
R-195
Oklahoma
9403
South Carolina
73006001
South Dakota
01955
Tennessee
01955
Texas
T104704178
Vermont
01955
Virginia
460215
USDA Soil Permit
P330-10-00117
Lab Reportt: 217082416
Porno ^_ of 11
I Page 10 of 24

eO AfQRI_S. LLC
Reperi#: 217082416
Project ID: 7080391
Case Narralve
Client: Access Analytical Report: 217082416
Report Date: 08/29/2017
Gulf Coast Analytical Laboratories received and analyzed the sample(s) listed
on the Report Sample Summary page of this report. Receipt of the sample(s) is documented
by the attached chain of custody. This applies only to the sample(s) listed in this report.
No sample integrity or quality control exceptions were identified unless noted below.
o anon ales were found for the Analyzed sample(s).
Lab Report#: 217082416
Pan. F of 11
Page 11 of 24

ANALVTICAL L•1130!“101:111S. LLG
GCAL ID Client ID
21708241601 Third Creek Sludge
Report#: 217082416
Project ID: 7080391
Sampe Summary
Ililatrin Collect Date/Time
Solid 08/22/2017 11:55
Report Date: 08/29/2017
Receive Date/Time
08/24/2017 11:20
Lab Report#: 217082416
PR,-ir 6 nf 11
Page 12 of 24 I

01.
ANALY iltAL 1 ARONATO RISS. I.LC
Report#: 217082416
Project ID: 7080391
Report Date: 08/29/2017
Summary of Compounds Detected
No analytes were detected for analyses performed by GCAL.
Lab Report#: 217082416 Panp 7 nf 11
I Page 13 of 24

LVTILAL LSB•-i:I STokc_5 LLC
Report#: 217082416-
Project ID: 7080391
Report Date: 08/29/2017
Sample Results
Third Creek Sludge
Collect Date 08/22/2017 11:55
Receive Date 08/24/2017 11:20
GCAL ID 21708241601
Matrix Solid
EPA 9012B
Prep Date
08/24/2017 12:00
Prep Batch
616831
Prep Method
EPA 7.3.3.2
Dilution Analysis Date
1 08/25/2017 15:46
By Analytical Batch
DMT 616946
CAS;r'
57-12-5R
EPA 9034
Parameter
Reactivity. Cyanide
Result DL
250U 250
LOQ
250
Units
mg/kg
Prep Date
08/24/2017 12:00
Prep Batch
616832
Prep Method
EPA 7.3.4.2
Dilution Analysis Date
1 08/25/2017 14:00
By Analytical Batch
MOS 616937
CAS#
18496-25-8R
Parameter
Reactivity Sulfide
Result
250U
DL
250
LOQ
250
Units
mg/kg
Lab Report#: 217082416
Pane R of 11
I Page 14 of 24 . I

ALVTICSL 1.I!°F41°^nlc.5. LtC
Report#: 217082416
Project ID: 7080391
Report Date: 08/29/2017
General Chemistry QC Summary
Analytical Batch Client ID
616937 GCAL ID
Prep Batch Sample Type
616832 Prep Date
Prep Method Analysis Date
EPA 7.3.4.2 Matrix
MB616832
1714951
MB
08/24/2017 10:00
08/25/2017 14:00
Solid
LCS616832
1714952
LCS
08/24/2017 10:00
08/25/2017 14:00
Solid
EPA 9034
Units
Result
I mg/kg
DL
Spike
Added
Result
%R
Control
Limits%R
Reactivity Sulfide 118496-25-8R
250U
250
1000
1074
107
47 - 135
Analytical Batch Client ID
616937 GCALID
Prep Batch Sample Type
616832 Prep Date
Prep Method Analysis Date
EPA 7.3.4.2 Matrix
ATF 17-003; ATF Leaded ..
21708222001
SAMPLE
08/24/2017 10:00
08/25/2017 14:00
Solid
1714285DUP
1714953
DUP
08/24/2017 10:00
08/25/2017 14:00
Solid
EPA 9034
Units
Result
I mg/kg
DL
Result
RPD
RPD
Limit
Reactivity Sulfide 118496-25-8R
0
250
0
0
25
Analytical Batch Client ID
616946 GOAL ID
Prep Batch Sample Type
616831 Prep Date
Prep Method Analysis Date
EPA 7.3.3.2 Matrix
MB616831
1714948
MB
08/24/2017 10:00
08/25/2017 15:11
Solid
LCS616831
1714949
LCS
08/24/2017 10:00
08/25/2017 17:36
Solid
EPA 9012B
Units
Result
I mg/kg
DL
Spike
Added
Result
%R
Control
Limits%R
Reactivity Cyanide I 57-12-5R
250U
250
250
3.2
1
1 - 25
Analytical Batch Client ID
616946 GCALID
Prep Batch Sample Type
616831 Prep Date
Prep Method Analysis Date
EPA 7.3.3.2 Matrix
ATF 17-003; ATF Leaded ..
21708222001
SAMPLE
08/24/2017 10:00
08/25/2017 15:16
Solid
1714285DUP
1714950
DUP
08/24/2017 10:00
08/25/2017 15:18
Solid
EPA 9012B
Units
Result
mg/kg
DL
Result
RPD
RPD
Limit
Reactivity Cyanide I 57-12-5R
0.0
250
0.0
0
20
Lab Report#: 217082416
IPana p of 11
Page 15 of 24

Ciis t uD 565 Access Analytical
tr .
;.
�• i - 1. ' ,-t l SDG
`
l a I Fun -Service Analytical a l -IC pjii
Environmental Solutions
SUBCONTRACT ORDER
Prism Laboratories, Inc.
7080391
1 /Uc5Z'16
C AE
:Iy
(1
`�
Certification: LAC_
NC SC
IA
NIA
USACE_
Other
____
SENDING
LABORATORV:
_
RECEIVING LABORATORY:
Prism Lab
P. O. Box
Charlotte;
Phone: [phone]
Fax: 704-'i75-0409
Project Manager;
,raforias, Inc.
F40543
rc 23224-0543
Robbi A. Jones
Gulf Coast Ana .1ylical Labs, Inc.
10781 Coursey Blvd
Baton Rouge, LA 70316
Phone :[phone]
Fax: [phone] i 7
Analysis
Due
Expires
Laboratory ID Comments
Sample HDi
7030391-0H. Solid
S::mpled:C31Z2/I7 it:5�
. �.. . c{
i
)'
Reactivity,
Reactivity,
'onlahters S
Su1fidc (Sub)
Cyanide (Sub)
y.+plied:
08/29/17 11:55
09/05/17 11:55
Li, 5-C
3 - CM
} ev
524
Gar 0 , 1 Y 0
-_
�. � _ ) o
-,1J-1-i.
l L
3-a3-i7
case B5
.�
Date
Received By
t f
Date
Released B
•
Date
Retj\ (1133x, ;a i ,;
Date
Release B
✓
Date
Received By
Date
Dale
ecerved by
Faze l of 1
Page 16 of 24

bZ Jo Li, abed
SAMPLE RECEIVING CHECKLIST
1
1
III
LL
2
1
7°
8
2 4
1
6
SAMPLE DF UVERY GROUP 217032416
CHECKLIST YES NO
Client PP`Vi AEC
4565 -Access Analytical
Transport Method
I LupC
Samples received with proper thermal preservation? err'
Radioactivity is <1600 cpm? If no, record cpm value in notes section. Pi .
Profile Number
80251
Received By
Savage, Tiffany R
COC relinquished and complete (including samplelDs, collect times, and sampler)? U
_.-. .. ------- ..... —._... _. _... - __..._...... .
All containers received in good condition and within hold time?
All sample labels and containers received match the chain of custody? Mil[
_.___ _...._ .
Preservative added to any containers? [ ae
If received, was headspace for VOC water containers < 6mm? v [
Samples collected in containers provided by GOAL?
Line ltem(s)
4 - Solid
Receive Date(s)
08/24/17
COOLERS
D9SCRIEPANCIES
LAB PR IESERVATIONS
Airbill Thermometer ID C-29
Temp °C
None
l .bne
7700 9612 2948
4.5
NOTES
Revision 1.6
Page 1of1
Lab Report t: 217082416
Page 11 of 11

•
XESS
A N A :NC
-
ANALYTICAL REPORT
CLIENT
Prism Laboratories
PO Box 240543
Charlotte NC 282240543
ATTENTION
Robbi A. Jones
PROJECT ID
7080391
LABORATORY REPORT `UMBER
1708N87
DATE
September 08, 2017
Primary Data Review By
Chris Pafford
Project Manager, AES
PLEASE NOTE:
Secondary Data Review By
Ashley Amick
Project Manager, Access Analytical
[e-mail]
Unless otherwise noted, all analysis on this report performed at Analytical Environmental Services Inc. (AES Inc),
3080 Presidential Drive, Atlanta, GA 30340.
AES is SCDHEC certified laboratory # 98016, NCDENR certified lab # 562, GA certified lab # FL-E87582,
NE LAP certified laboratory # E87582
ALMA-LAP,LLC Laboratory ID:100671 for Industrial Hygiene samples (Organics, Metals, PCM Asbestos,
Gravimetric), Environmental Lead (Paint, Soil, Dust Wipes, Air), and Environmental Microbiology (Fungal)
Direct Examination.
Local support services for this project are provided by Access Analytical, Inc. Access Analytical is a
representative of AES serving client in the SC/NC/GA areas. All questions regarding this report should be directed
to your local Access Analytical representative at 803.781.4243 or toll fee at 883.315.4243
E=:
Page
Page 18 of 24

Full -Service Analytical &
Environmental Solutions
6S air 03iffi i 0t`
Si
SUBCONTRACT ORDER
Prism Laboratories, Inc.
7080391
Orl
Certification: DIBLACUSACB
NC t7 SC_ Other
N/A
SENDING LABORATORY:
Prism Laboratories, Inc.
P.O. Box 240543
Charlotte, NC 28224-0543
Phone: [phone]
Fax: [phone]
Project Manager: RobbiA. Jones
Analysis Due
Expires
Sample ID: 7080391-01 Said Sampled:08./22/1711:55
Herbicides TCLP (Sub)
Containers Supplied:
08/29/17 11:55
RECEIVING LABORATORY:
Analytical Enviromnental Services, Inc.
3080 Presidential Parkway
Atlanta, GA 30340
Phone :[phone]
Fax: NA
Releed By
rfeCA C�
Released By
c may-/7
Date
Date
Released By Date
Released By Date
Date
Advs. g(a4n- i
ES
Date
Page
Page 19 of 24

Full -Service Analytical
Environmental Solutions
IABORA1 RIEa ING
SENDING LABORATORY:
Prism Laboratories, Inc.
P. 0. Box 240543
Charlotte, NC 28224-0543
Phone: [phone]
Fax: [phone]
Project Manager: RobbiA. Jones
Analysis Due
Sample ID:7080391-01 Solid
Herbicides TCLP (Sub)
Containers Supplred-
ilD
S'd{{ o k6s Dtl rg)Z .11:-
.5. M -
SUBCON d RACT ORDER
Prism Laboratories, Inc.
708 392
Expires
SamplFd:08/22/17 I1:55
08/29/17 11:55
Certification_ I1BLAC USACE
NC '-f SC Other
N/A
RECEIVING LABORATORY:
Analytical Environmental Services, Inc.
3080 Presidential Parkway
Atlanta, GA 30340
Phone :[phone]
Fax: NA
Laboratory ID
Comments
Rele ' ' By / Date
Released By
Date
Released By Date
Released By Dare
Received B}l
PLA
Received B
7 6 (JI /I
I A,fi `l'S/ 1 (1 fc0 l r
Date
gMg- /cop
Received 111W
Received By
Date
Date
Date
Page I of I
Page
Page 20 of 24

Analytical Environmentai Services, Inc
Date: 8-Sep-17
Client: Prism Laboratories
Project: 7080391
Lab ID: 1708N87
Case Narrative
Sample Receiving Nonconformance:
Insufficient sample was received 08-24-17 for TCLP SW1311/8151A. Additional sample was received 08-31-17(0/10.30.
Page
Page 21 of 24

Analytical Environmental Services, }Inc
Date:
8-Sep-17
Client:
Lab Order
Project Name:
Lab ID:
Prism Laboratories
1708N87
7080391
1708N87-001A
Client Sample ID:
Tag Number:
Collection Date:
Matrix:
Third Creek Sludge
7080391-01
8/22/2017 11:55:00 AM
Solid
Analyses
Result Qual MDL
Reporting
Limit
Units BatchED DF Date Analyzed Analyst
HERBICIDES, TCLP SW131I/8151A
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
BRL
BRL
79
0.030
0.051
0
0.20
0.20
50.1-132
(SW3SIOC)
tng/1. 247636
tng/L 247636
%REC 247636
09/07/2017 13:54
09/07/2017 13:54
09/07/2017 13:54
EI
EI
EI
Qualifiers:
Value exceeds maximum contaminant level
BRL Not Detected at MDL
H Holding times for preparation or analysis exceeded
N A.ialyte not NELAC certified
B Analyte detected in the associated method blank
E Estimated value above gtantitation range
S Spike Recovery outside limits due to matrix
> Greater than Result value
J Estimated value detected below Reporting Limit
< Less than Result value
Page
I Page 22 of 24

-frZ to EZ e6ed
AES
ANALYTICAL
it,i n.VatzoNMENTAL
SEIWICES,1NC.
1. Client Name: Access Aft afivUcii,, fnc.
SAMPLE/COOLER RECEIPT CHECKLIST
2. Carrier: FedEx°❑ UPS ❑ USPS❑ Client ❑ Courier❑ Othei
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Yes
No
N/A
AES Work Order Number: 1703ICI87
Shipping container/cooler received in good condition?
(o
()
damaged • leaking • other.
Custody seals present on shipping container?
('
i6'
Custody seals intact on shipping container?
T)
o
Temperature blanks present?
0
(Y'
0
Cooler temperature(s) within limits of 0-6°C? [See item 13 and 14 for
temperature recordings.]
�o
0
' -'
") /
-'
Cooling Initiated for recently collected samples / ice
present •
Chain of Custody (COC) present?
io
Chain of Custody signed, dated, and timed when relinquished and received?
fO
V�y�
Sampler name and/or signature on COC?
o
I
\.J�
/
Were all samples received within holding time?
is.,,) )
TAT marked on the COC? ()
o
�(;`.
If no TAT indicated, proceeded with standard TAT per Terms & Conditions. El
13. Cooler 1 Temperature 1.3
14. Cooler 5 Temperature
15. Comments:
16.
17.
18.
19.
20.
21.
22,
23.
24.
25.
26.
°C Cooler 2 Temperature
°C Cooler 6 Temperature
°C Cooler 3 Temperature
°C Cooler 7 Temperature
°C Cooler 4 Temperature
°C Cooler 8 Temperature
oc
oC
Yes
No
N/A
I certify that I have completed sections 1-15 (dated initials).
TD 8/24/17
Were sample containers intact upon receipt?
1.
0(' .
Custody seals present on sample containers?
l)°
Custody seals intact on sample containers?
(-'.
0
;o
-
Do sample container labels match the COC?
00
incomplete info • illegibleNI
no label • other •
Are analyses.requested indicated on the COC?
()
Were all of the samples listed on the COC received?
(o.
0
0
samples received but not listed on COC •
samples listed on COC not received ■
Was the sample collection date/time noted?
'o
Did we receive sufficient sample volume for indicated analyses?
io.
�
Were samples received in appropriate containers?
(o
(
0
Were VOA samples received without headspace (< 1/4" bubble)?
0.
Were trip blanks submitted?
` J
o.
listed on COC il not listed on COC •
27, Comments:
28.
29.
30.
This section only applies to samples where pH can be
checked at Sample Receipt.
Yes
No
N/A
Details
I certifythat I have completed sections 16-27 (dated initials).
MJ 8/24/17
Have containers needing chemical preservation been checked? '' I 0
Containers meet preservation guidelines? I
Was pH adjusted at Sample Receipt? I 0
0-1 e---
Note: Certain analyses require chemical preservation but must be checked in the laboratory and not upon Sample Receipt such as Coliforms, VOCs and OII & GreasefrPH.
I certify that I have completed sections 28-30 (dated initials).
Checklist 6.9.17 Rev 2
MJ 8/24/17
Page 6 of 7
reaa

173 Jo 17z abed
Analytical Environmental Services, Inc
Client:
Project Name:
Worlcortler:
Prism Laboratories
7080391
1708N87
Date: 8-Sep-17
ANALYTICAL QC SUMMARY REPORT
atchID: 247636
Sample ID: MB-247636 Client ID:
SampleType: MBLK
Analyte
TestCode: HERBICIDES, TCLP SW1311/8151A
Units: mg/L
BatchID: 247636
Prep Date: 09/05/2017 Run No: 351385
Analysis Date: 09/06/2017 Seq No: 7728375
Result RPT Limit SPK value SPK Ref Val %REC Low Limit high Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
BRL
BRL
0.3448
0.20
0.20
0
0.5000
69.0 50.1
132
Sample ID: LCS-247636 Client ID:
SampleType: LCS
Analyte
TestCode: HERBICIDES, TCLP SW1311/8151A
Units: nig/L
BatcllID: 247636
Prep Date: 09/05/2017 Run No: 351385
Analysis Date: 09/06/2017 Seq No: 7728376
Result RPT Limit SPK value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
0.2936
0.2616
0.3058
0.20
0.20
0
0.5000
0.5000
0,5000
58.7
52.3
61.2
50.7
50.1
50.1
117
119
132
Sample ID: 1708S44-001BMS Client ID:
SampleType: MS
Analyte
TestCode: HERBICIDES, TCLP SW1311/8151A
Units: ing/L
BatchlD: 247636
Prep Date: 09/05/2017 Run No: 351385
Analysis Date: 09/06/2017 Seq No: 7728379
Result RPT Limit SPIC value SPK Ref Val %REC Low Limit High Limit RPD Ref Val %RPD RPD Limit Qual
2,4,5-TP (Silvex)
2,4-D
Surr: DCAA
0.03509
0.2194
0.3162
0.20
0.20
0
0.5000
0.5000
0.5000
7.02
43.9
63.2
46.3
43.3
50.1
126
132
132
JS
Qualifiers:
> Greater than Result value
BRL Below reporting limit
J Estimated value detected below Reporting Limit
Rpt Lim Reporting Limit
< Less than Result value
E Estimated (value above quantization range)
N Analyte not NELAC certified
S Spike Recovery outside limits due to matrix
B Analyte detected in the associated method blank
H Holding times for preparation or analysis exceeded
R RPD outside limits due to matrix
Page 7of7
,111111.

Legend
Date: May 10, 2018
Dwg: 2018SWR003

INFLUENT FINE -
SCREENS
48-
AEROBIC DIGESTER #1
0 0 0
BELT FILTER
PRESS FEED
PUMP STATION
HAUL -
SCREENINGS
INFLUENT PUMP
STATION
24-
a
n _
FLOW METER GRIT
VAULT CHAMBER
SPUTTER
BOX
V
HAUL_
GRIT
9S
BELT FILTER I`
PRESSES
HAUL SLUDGE CAKE
TO 4TH CREEK WWTP
McGill
ASSOCIATES
ENGINEERING•PLANNING•PINANCE
I2858STAF8F,LWHNW IIIIXWLY,NC28601 88R21)UbiV4 FIRMIIOPL®IC915,
AEROBIC DIGESTER #2
(0 0 0 0 0 0
TO PLANT SANITARY
SEWER SYSTEM
24'
ANOXIC
BASINS
BIGI
ANAERO
BASINS
OXIDATION DITCHES
O
38
WAS UNE
%"7"//7,3"
AS UNE
FLOW METER
VAULT
WAS VALVE
& METER
RAS/WAS
PUMP STATION
.0
FUTURE
POTENTIAL
PROCESSES
I I
r - i i.
I- i
I H -
I I i
Ir
J
SPUTTER
BOX
CLARIFIERS
SPUTTER
ae' BOX
x-
CHLORINE
CONTACT
1 r-
I I FUTURE I I
--1 POTENTIAL f --1
PROCESS I
L J
NON -POTABLE
WATER
POST
AERATION
FLOW
METER
FIGURE - PROCESS FLOW DIAGRAM
THIRD CREEK WASTEWATER TREATMENT PLANT EXPANSION
CITY OF STATESVILLE
IREDELL COUNTY, NORTH CAROLINA

SPILL
f!
ESPONSE PLAN
PROJECT: City of Statesville Land Application Permit W00014543
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
1. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Fourth Creek WWTP Supervisor shall take immediate charge and initiate clean-up activities. The City of Statesville
labor and equipment is to be: utilized. In the event additional labor and.equipment is required, assistance may be requested
from the NC Department of Transportation and other private contractors as necessary.
2. HALT THE SOURCE OF THE SPILL: Such as
a ruptured container or damaged transport unit.
3. 'CONTAIN THE SPILL:
Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The Operations Manager or the person in charge on the spill site will
advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-up operation,
i:e., local farmers, farm supply centers, nurseries, etc.
4. CLEAN-UP:
Employ front-end loaders, vacuum equipment, sludge application vehicles, and/or local septic tank service to remove as
much of the spilled material as possible. Straw and/or sand should be scattered in the spill area to soak up the remaining
material. The straw- and sand -soaked material will be collected and removed to a disposal area approved by representatives
of the state regulatory agency.
5. FINAL CLEAN-UP:
Employ rotary brush sweeper if needed, and apply lime to the spill area upon the approval of the clean-up efforts by the state
regulatory representative. If the event occurs on private property, the clean-up will be completed to the satisfaction of the
property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original condition
if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs, the City of Statesville Operations staff will notify the Fourth Creek WWTP
Supervisor, and they will then be responsible for notifying other key City of Statesville personnel.
7.. REPORTING:
The City of Statesville personnel will notify the Mooresville Regional office [phone] as soon as possible, but not
more than 24 hours after, or on the next working day following the occurrence. The Fourth Creek WWTP Supervisor shall
provide a written report within 48 hours of the spill to the Technical Services Director. The report shall list all relative
information and actions taken. The City of Statesville personnel will file a written report to the Mooresville Regional cake
of the NCDENR within 5 days of the occurrence. For after-hours reporting the Division's emergency number shall°be=called
to report all incidences (800-662-7956 or 800-858-0368 or 919-733-3300) •
11Pa.ge
5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Inspection Plan
Inspections for the Land Application site will be conducted on an as needed basis. The inspection frequency is based on the time frame
that it is going to take to complete the project and the amount of dry tons to be processed from this facility. The inspections will
consist of inspecting the Bio-Solids loading area. These inspections will consist of:
1. Verifying that all of the equipment is working properly.
2. Verify that all containment walls and curbing are working properly.
3. Insure that all manned equipment has a copy of the spill control plan, the permit, and the operations and maintenance
plan.
4. Verifying that the, correct number samples of the Class B product have been taken and that it meets the criteria for the .
Land Application Permit.
5. The records will be kept in the project files in the respective office for the project.
6. The Permittee or Inspector shall report by telephone to the Mooresville Regional Office at 704-235-2198 as soon as possible
but no later than 24 hours after or the next working day following the occurrence or the first knowledge of the occurrence of
the following.
• Any occurrence with the distribution program resulting in the land application of significant amounts of material that is
abnormal in quantity or characteristics.
• Any time that self -monitoring indicates that the facility has gone out of compliance with the permit.
• Any process failure that: results in the system not adequately treating the residuals.
• Any spill or discharge from a vehicle or piping system during residuals transportation.
• •Any release that requires immediate reporting outside of normal business hours shall be called in to DENR at 1800-
662-7956, 1-800-858-0368, or 1-919-733-3300. These numbers are to be called in the event of a release to surface
waters, imminent failure of a storage system when the event occurs outside of normal business hours.
• Within 5 days of the first notice of on occurrence a written response in the form of a letter shall be sent to DENR
outlining the actions taken or purposed actions taken to ensure that the problem does not recur. Persons responsible
for inspections on this project are as follows:
Andy Smith, 4th Creek. WWTP ORC or his designee
Andy Smith is the designated WWTP ORC for this project and his designees are the backup ORC's for this project.
21Pa.ge
5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Sampling Plan
Sampling for this project consists of sampling the residuals during the time that land application is occurring. This
will result in one round of sampling to occurbefore land application commences in order to insure that the residuals
are suitable for land application. Based on the dry tonnage of this plant this will be six samples for all parameters per
year.
The residuals shall be sampled annually for the following: (Regulatory level in milligrams per liter in parentheses.)
Arsenic (5.0) 1, 4-Dichlorobenzene (7.5) Nitrobenzene (2.0)
Barium (100.0) 1, 2-Dichloroethane (0.5) Pentachlorophenol (100.0)
Benzene: (0.5)
Cadmium (1.0)
Carbon tetrachloride
(0.5).Chlordane
(0.03)
Chlorobenzene
(100.0) Chloroform
(6.0) Chromium (5.0)
M-Cresol (200.0) o-
Cresol (200.0) p-
Cresol (200.0) Cresol
(200.0) 2,4-D (10.0)
1, 1-Diichloroethylene (0.7)
2, 4-Dinitrotoluene (0.13)
Endrin (0.02)
Hexachlorobenzene (0.13
Heptachlor (and its hydroxide) (0.008)
Hexachloro-1,3-butadiene (0.5)
Hexachlorethane (3.0)
Lead (5.0)
Lindane (0.4)
Mercury (0.2)
Methoxychlor (10.0)
Methyl ethyl ketone (200.0)
Pyridine (5.0)..
Selenium (1.0)
Silver (5.0)
Tetrachloroethylene (0.7)
Toxaphene (0.5)
Trichloroethylene (0.5)
2,4,5-Trichlorophenol (400.0)
2,4,6-Trichlorophenol (2.0)
2,4,5 TP ( Silvex) (1.0)
Vinyl Chloride (0.2)
The residuals will also be sampled based on the chart below for the following constituents
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1 time per year
=>319-<1,650
1 per Quarter (4 times per year)
=>1,650-<16,500
1 every 60 days (6 times per year)
=>16,500
1 every month (12 times per year)
Aluminum
Ammonia -Nitrogen
Arsenic
Cadmium
Calcium
Copper
Lead
Sodium Adsorption Ratio (SAR)
Magnesium
Mercury
Molybdenum
Nickel
Nitrate -Nitrite Nitrogen
Phosphorous
Potassium
pH
Plant Available Nitrogen (calculation)
Selenium
Sodium
% Total Solids
Total kjeldahl Nitrogen
Zinc
In order to meet pathogen and vector requirements the material will go through an aerobically digested treatment process. The
residuals will meet pathogen and vector requirements through pH, time and temperature requirements. The samples will be
pulled from the storage pads that are currently holding the Sta-Lime product. The samples that will be pulled are a TCLP and
nutrient and metals sample to prove that the material is suitable for distribution. The nutrient and metal and TCLP sample will be
collected randomly and consist of individual samples mixed together in order to get the composite sample for these parameters.
This material is very consistent based on the fact that these residuals are thoroughly digested and mixed before processing and
should not experience any seasonal fluctuations in the residuals.
The following people are responsible for sampling:
Andy Smith, Plant Manager or his designee.
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5/2/2018

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Land Application Permit WQ0014543
Operational Functions
The operation function of this project is going to involve loading dewatered belt press sludge. The dewatered belt press
sludge will be loaded into the trucks that are suitable to transport and spread this product without spillage or leakage.
during transport. The dewatered belt press sludge will be spread at agronomic rates that are determined by the soil
samples from the fields that the City of Statesville staff has collected.
SAFETY MEASURES
The City of Statesville believes in operating in a safety conscious manner and is has all employees participate in monthly
safety courses that are designed to help its employees recognize safety issues and take steps to prevent accidents from
occurring. In addition all City of Statesville, Water Resources employees have the authority to stop operations if they think
any aspect of the operation is going to cause environmental or personal harm.
Maintenance Schedule
The City of Statesville will follow the maintenance schedule as recommended by the processing equipment
manufacturer.
5/2/2018