WQ0003281_Residual Annual Report 2019_20200226

Initial Review
INITIAL REVIEW
Reviewer Williams, Kendall
Is this submittal an application? (Excluding additional information.)*
r Yes r No
If not an application r Annual Report
what is the submittal r Residual Annual Report
type?* r Additional Information
r Other
Annual Report 2019
Year*
Date Paper Copy 2/26/2020
Received:*
Project Number* WQ0003281
Email Notifications
Does this need review by the hydrogeologist?*
r Yes r No
Regional Office
CO Reviewer
Admin Reviewer [e-mail]

Submitted Form
Project Contact Information
Rease provide information on the person to be contacted by MB Staff regarding electronic subnittal, confirmation of receipt, and other issues.
..........................................................................................................................................................................................................................................................................................................................................................................
Name * Tanya Setzer
Email Address*
[e-mail]
Project Information
Submittal Type* r New Permit Application
r Renewal
r Annual Report
r Other
Permit Type * r Wastewater Irrigation
r Other Wastewater
r Closed -Loop Recycle
r Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?
r Yes r Nor N/A
Permit Number* WQ0003281
Applicant\Permittee * Adrian Miller
Facility Name * City of Belmont Wastewater Plant
Phone Number*
7048253791
r Modification (Major or Minor)
r Additional Information
r Residual Annual Report
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
Permit #WQ0003281
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
2019 Land App Annual Report.pdf 689.95KB
Upload only 1 R7F document. NL@iple documents must be combined into one R7F file.

For new and modification permit applications, a paper copy may be required. If you have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a paper 2-pol cation is required,
be advised, applications accepted for pre -review until both the paper and elect-c-ii.- --ol:ies have been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments {talcs, soils report, specs, etc.]
o One full-size engineering plan set
o One 11x17" engineering plan set
o One extra set of specifications
o Fee (if required)
Mailine address:
Division of Water Resources ! Division of Water Resources
Non -Discharge Branch I Non -Discharge Branch
1617 Mail Service Center I Att: Nathaniel Thornburg, P Floor, Office #942W
- =
Raleigh, NC 27699-1617 S12 N.5alisburySt.
For questions or problems contact Tessa Monday attessa.monday@)ncdenr.Qov or 919.707.3560.
* rJ By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. I also confirm that the uploaded document is a single PDF with
all parts of the application in correct order (as specified by the application).
Signature
Submission Date 2/20/2020

2019
City of Belmont
Wastewater Treatment Plant
2019 Annual Report
Land Application Program
Permit No. WQ0003281

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0003281 County:
Facility Name (as shown on permit):
Land Application Operator:
Year: 2019
City of Belmont
Southern Soil Builders, Inc. Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
0 Yes ❑ No - If No, skip Part A, and Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Total number of
Total number of fields utilized for land
Total amount of dry tons applied during the
Total number of acres utilizes for land
Part B - Annual Com iancc_Statement:
Gaston
ication fields in tite permit:
lication during the year: I
for all application sites: 84.76
lication during the year: 42
Facility was compliant during calendar year 2019 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. 0 Yes ❑ No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
1) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pH was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pH of at least 6.0 or
the limit specified in the permit.
3) Annual soils analysis were performed on each site receiving residuals during the past calendar year and three (3) copies
of laboratory results are attached.
4) Annual TCLP analysis (if required) was performed and three (3) copies of certified laboratory results are attached.
5) All other monitoring was performed in accordance with the permit and reported during the year as required and three
(3) copies of certified laboratory results are attached.
6) The facility did not exceed any of the Pollutant Concentration Limits in 15A NCAC 02T . 1105(a) or the Pollutant
Loading Rates in 15A NCAC 02T .1105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 15A NCAC 02T .I I 1 I were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of deviation, prior
authorization was received from the Division of Water Resources.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
1 1) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submittin false information, including the
possibili of Fines and imprisonment for knowing violations."
Permittee Name and Title (type r print) Signature of Permittee Date
SignaturAf Preparer*
Date
Signature of Land Annher
�—( >a
Date
(if different from Permittee) (if different from Permittee and Preparer)
* Preparer is defined in 40 CFR Part 503.9 (r) and 15A NCAC 02T .1 102 (26) DENR FORM ACF ti 71onnF�

ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Please note that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF - B
WQ Permit Number: WQ0003281
Facility Name: City of Belmont
Residual Source WQ # or
NPDES #: WQ0003281
WWTP Name:
e mont
Residual Analysis Data ttv o
Parameter
Limit
4/25/201
(mg/kg)
(mg/kg)"
9
Percent Solids (%)
NA
3.8C
Arsenic
75
6.4
Cadmium
85
1
Copper
4,300
324
Chromium
NA
90.7
Lead
840
25.1
Mercury
57
0.471
Molybdenum
75
4.4
Nickel
420
21.1
Selenium
100
6.35
Zinc
7,500
1570
Total Phosphorus
NA
20600
Laboratory: 1) Waypoint
2)
3)
4)
5)
or Composite Date
TKN NA 43100
Ammonia -Nitrogen NA 5380
Nitrate and Nitrite NA 4.84
a For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits.
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
1 ,
Signature U Preparer *
a a
Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF (12/2006)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM B
Report all sampling analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past
calendar year. Use additional forms as needed.
WQ Permit Number: WQ0003281
Facility Name:
Residual Source
NPDES # or WQ#:
City of Belmont
WQ0003281
WWTP Name: City of Belmont
Residual Analysis Data
Parameter
4-25-
(mg/kg)
2019
Phosphours
20600
Potassium
2150
Sulfur
10000
Calcium
11900
Magnesium
2680
Sodium
6060
Iron
24100
Aluminum
36900
Manganese
961
Organic N
37720
Phosphours
7.8
PAN
14010
SAR
2.55
Laboratory:
Sample or Composite Date
1)
2)
3)
4)
5)
Waypoint
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
i lanao
Date
*Preparer is defined in 40 CFR Part 5019(r) and 15A NCAC 2T .I 102 (26)
DENR FORM RSSF - 8 (12/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: City of Belmont Total Dry "Ions Applied (Annual): 84.76
Permit #: WQ000328 ! Cation Exchange Capacity (non 503 only):
Operator: Lori Warren Owner: Lori Warren Predominant Soil Series: GaB2
Acres Used: 42 Acres Permitted: 42 Site #: BT 9-1 Field #• BT 9-1
Residual Analysis Data (Heavy Metals and Total Phosphorus
Sample or 2 L3 4 5 J 6 7
Com-
posite
Date 4/25/ 19
% Solids 3.86
Arsenic 6.4
Cadmium 1
Copper 324
:hromium 90.7
Lead 25.1
Mercury 0.47I
Molyb-
4.4
Nickel 1
21.1
Selenium
6.35
Zinc
1570
Total
Kos-
20600
Annual Heavy
Total
DT/Ac./
App.
Event 2.02
Arsenic 0.026
Cadmiuml 0.004
Lead
Nickel
Selenium
Zinc
Total
Phos-
l.308
0.366
0.101
0.002
0.018
0.085
0.026
6.337
tai
0.000
a.o00
0.000
0.000
0.000
0.000
0.000
0.000
a.aoo
0.000
83.142 1 0.000
d Loadings (Calculated in lbs/acre):
a
in
0.000 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 0.026
0.000 0.000
0.000
0.000
0.000
0.000
0.0 00
2.020
0.000
0.000 0.004
0.000 0.000
0.000
0.000
1 5.000
0.000
0.000
0.000
0.000
0.000 1.308
0.000 a.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000 0.366
0.000 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
o.aoo 0.101
0.000 0.000
0.000
a.000
0.000
0.000
0.000
0.000
0.000
0.000 0.002
0.000 0,000
0,000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 0.018
0.000 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 0.085
0.000 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 0.026
0.000 OA00
0.000
0.000
OA00
O.Ooo
0.000
0.000
0.000
0.000 6.337
0.000 10.000 10.000 10.000 1 0.000' 0.000 1 0.000 10.000 10.000 1 0.000' 83.142
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered And evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations,,.
Signature of Land Applier
02 `a-o7r 4 U
Date
riDNID Cr1Dftn anri nr iw n.r.r......

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF
THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" 1N A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Belmonr
WQ Permit #: W 0003281 Field #:
Q BT 9-1
Land Owner: Lori Warren
Acres Utilized: 42
Annual Dry Tons Applied: 84.7465
Operator: Lori Warren
Site #: BT 9-1 Acres Permitted: 42
Predominant Soil Series: GaB2 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue
Crop 1 Max. PAN: 211 Crop 2 Name: Crop 2 Max. PAN:
o s
Volume applied
Volume
Residual Sources
SOil
Precip.
a
¢
o
K
1 z n
Nitrate
o
(enter one) Solids/
% Applied per
(NPDES #, WQ#,
Cond.
Past 24
n �
TKN
^ 21
PAN Applied Name of Crop Type
c�a
Liquid
Solids Acre
Fert., Anima!
(Dry,
Hrs.
r,•
o w
_
N
u
+ -.
00
r:
and
1 ) Receiving Residual
{ bs/acre
Cu. Yds
Gallons
(Dry Tons/Ac)
Waste, etc)
Wet,
a o.
,
a R
Nitrite
pp ' lion
Application
7-2019
526500
3.86 2.018
WQ0003281
Moist
dry
inches
D
0
o
7
mglkg
mg/kg
Mg/kg
Crop I
Crop 2 Crop 1
Crop 2
0.000
s
0.5
0.3
43100
5380
4.84
56.541
NA Fescue
0 000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.000
0 000
0.000
0.000
0,040
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM
FSF supp ( attach
FORM
FSF
0.0D0
0.000
roTAL.S;
ol
5265001
As
Cd
I Cu
Cr
Pb
H
Mo
Ni I
supp to this form):
Se
Annuallbs/acre
0.026
0.004
1.308
0,366
0.101
0.002
0.018
Zn
P
56.541
. 0.000 Lime Apelied
0.085
0.026
Prior Years Cumulative lbs/ac 0.3-2
0.121
25,707
28.977
3,435
0.058
0.364
6.337
83.142
Date
Ibs/ac
l.89
0.185
: urrent Cumulative Ibs/ac 0.398
0.125
27.015
29.343
3.536
0, 660
0.382
131.647
I I-2019
1000
1.975
D.211
137.984
'ermitted C. P. L. R.**** 36
34
NA
i338
267
IS
NA
37A
89
249$
'ermit PAN Limit IstClnd Crop
`I certify, under penalty of law, that this document was prepared under my direction or
211
lualified personnel properly gathered and evaluated
supervision in accordance with a system designed to assure that
the information
submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment
for knowing violations."
7�
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signatu a of Land Applier
Date }* Mineralization Rates: Compost -0.1, annerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

Report Number: 19-119-0202
Account Number: 46381
Send To: Southern Soil Builders
Dennis Key
95B Hoots Road
Roaring River, NC 28669
Waypointo
ANALYTICAL
Project: Belmont
7621 Whitepine Road, Richmond, VA 23237
Main 804-743 -9401 a Fax [phone]
www.waypointanaiytical.com
REPORT OFANALYSIS Date Sampled: 4/25/2019 12:30:00
Lab Number: 66081 Date Received: 04/29/2019 OO:DO
Sample Id : Belmont Date Reported: 05/07/2019
- - -- -
')•0V
oaouu
luu-u
ADM
04/30/2019 15-33
SM-254OG
Moisture `
96.10
100.0
ADM
04/30/2019 15:33
SM-254OG
Total Kjeldahl Nitrogen
4.31
43100
250
JPJ
05/05/2019 15-30
SM-4500-NH3C-TKN
Phosphorus
2.D6
20600
50.0
KKM
05/03/2019 02.09
6010D
Potassium
0.22
2150
50.0
BKN
05/03/2019 02.09
6010D
Sulfur
100
10000
50.0
KKM
05/03/2019 02:09
6010D
Calcium
1.19
11900
250
KKM
05/03/2019 02:09
6010D
Magnesium
0.27
2680
50.0
KKM
05/03/2019 02:09
6010D
Sodium
061
6060
250
KKM
05/03/2019 02:09
6010D
Iron
24100
50.0
BKN
05/03/2019 02:09
6010D
Aluminum
39600
50.0
BKN
05/031201917:03
6010D
Manganese
961
5-00
KKM
05/03/2019 02:09
6010D
Copper
324
2.50
KKM
05/03/2019 02:09
6010D
Zinc
1570
12.5
BKN
05/03/201917:03
6010D
Ammonia Nitrogen
0.54
5380
100
JPJ
05/06/2019 09:30
SM-4500-NI3C
Organic N
3.77
37720
250
05/05/201915:30
CALCULATION
Nitrate+Nitrite-N
<4.84
4.84
ZBD
05/021201914:08
4500NO3F-2011
All values are on a dry weight basis except as noted by asterisk. Detection
limit on all N series is on a wet basis.
8-Analyte detected in blank
H - Beyond Holding Time
Pam«
1'• M6 60wr
Our rep3rs anti relic•.; are forthf- ewfusr4e rr+,d ron, dents, J,c r,f,;::r rt-in;.>. jeinaynot t;e fey: naucad". s:^'J:e orptin, mor ; ,y my mAdrepce bL :nOdD
Patric McGroary
t9 t!:2 {ern fhe <ss:,;tx, If Itw,;nrana:ty ,n a,ty ack1e.=!s't:4• neV.s .:,r u!ite: Pvdtr.: an.^.ourrermar:ts 3•:.t1t:,u? ab:arn:ny rurpncr•m?7rEn ac.?h:i.^.1a:`,'r.•n
Agronomist
Page 3 of 6

Report Number: 19-119-0202
Account Number: 46381
Send To: Southern Soil Builders
Dennis Key
958 Hoots Road
Roaring River, NC 28669
Waypoint
ANALYTICAL
Project: Belmont
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
REPORT OFANALYSIS Date Sampled: 4/25/2019 12.30:00
Lab Number: 66081 Gate Received: 0412912019 00.00
Sample Id :Belmont Date Reported: 05/07/2019
--- -
I _uu
1.uo
KKM
05/03/2019 02-09
6010D
Chromium
90.7
2.50
KKM
05/03/2019 02:09
60100
Nickel
21.1
2.50
KKM
05/03/2019 02D9
6010D
Lead
25.1
3.00
KKM
05/03/2019 02-09
6010D
Arsenic
6.40
5.00
KKM
05/03/2019 02:09
6010D
Mercury
0.471
0.0154
KKM
051021201911:06
SW-7471B
Selenium
6.35
5.00
KKM
05/03/2019 02.09
6010D
pH.
7
JSL
05/06/2019 07.11
9045D
Molybdenum
4.40
2.50
KKM
05/03/2019 02:09
6010D
Comments:
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
B-Analyte detected in blank H - Beyond Holding Time
Our rr;xr)rs And le:ls.m are hw the exclusive &rir2 ,,^.on <dartial vie &-:)rr .-i.er:s. drxi raY n:f be rePr(40rad f.-q ::'TWO ;xgar, ,',or r,%aymy reFeleme be idv
I') th.? wn , Use reSU;rS, or flrr ceirrymnU irr any achreriis#.g, news )slPaxe yr �il)et pvbh—, am^r ace.ner.fs v.11kou! ab a!r)ny murprfcrari:;r--r.: un*rizaLo
PIS« me 6ewr
Paunc McGroary
Agronomist
Page 4 of 6

O
Mineralization
as decimal
ITotal dry
tonsiyear
Acres
_Applied on
Rate
0.3
TKN
43100
NH3 NO3
5380 4 84
NO2
0
% Solids
0 031
PAN Surface
l4010.84 mglkg
28.02168 lbs/dry ton
0 Ibs total PAN
#DIV101 Ibs PAN/acre
PAN Injection
16700.84 mglkg
33.40168 lbsldry ton
0
!bs total PAN
#DIV/01
jibs PAN/acre
Dry Tons11000 gal.
0.160962
1st year PAN
Surface Ibs.
0
1st year PAN
Injected lbs.
0
lbs.lacre
Surface
#DIVI01
lbs.lacre
Injected
#DIV/
MR(TKN-NH3)+ + .5(NH3)+NO3+NO2 =mglkg
mg/kg x .002 =lbsldry ton
MR(TKN-NH3)+ l(NH3)+NO3+NO2 =mglkg
mg/kg x .002 =lbsldry ton
1000 X 8.34 X %solids X sp. gravity "=dry tons11000gal."
2000

SAR
Sodium Absorption Ratio
Na: Sodium (MgIL) Equivalent weight: 23
Ca: Calcium (MgIL) Equivalent weight: 20
Mg : Magnesium (MgIL) Equivalent weight: 12
Milli Equivalent = MgIL I Equivalent weight
Na M IL Ca M /L M M IL
233.91 1 459.34 103.45
Na (ME) Ca (ME}-1 M, (ME)
10.17 1 22.967 8.620833
SAR= Na Milli Equivalentt[0.5 X (Ca Milli Equivalent + Mg Milli equivalent))0.5 power
SAR = 2.5590 4— (From MgIL entered above)
SAR= 2.516171 (From ME entered below)
Na ME C. a (ME)
10 1 22.97 $.62
The amour
amount of {
Permitting I

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 04.2512019
Reported: 06?0712019
For: Belmont
Comments:
f, STATESuILI F
ANALir 1 ILAL
b
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
190425-17-01 30 Day Benchscale Belmont 10.2 % EPA525-R•92M 04/2512019 WC
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 - 704/872/4697
Page 1 of 3

Analytical Results
Southern Soil For: Belmont
Entered: 04/25/2019
Reported: 06/07/2019
Sample ID: 190425-17
PARAMETER: Vector Attraction Reduction/Aerobically Digested „Sludge (30day)
Total Solids
Volatile Solids
% Volatile Solids
Week
1
1.65
0.96
0.5808
Week
2
1.78
1.04
0.5876
Week
3
1.51
1.08
0.7202
Week
4
1.35
0,74
0.5472
Week
5
1.41
0.78
0.5543
Volatile Solids Reduction: 0.5808 - 0.5543 X 100 = 10.2%
0.5808 - (0.5808 X 0.5543)
Respectfully submitted,
Dena Myers
Statesville Analytical, Inc.
NC WW Cert.# 440NC

Condition of Receipt
Sample Number 190425-17-01 Temp on Arrival: 3.2
Parameter Schedule;
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

ur`iA .,n o • f
AddfmS
S
.:/
K e!
Contact Person:
�r L ve,
Phone R 33c_ y 5-) 1
J ` FARM 33e ,.I; - S'/ye
PO R
Requisitioned by:
(r�ena oast
Custrner Labrr D
Sande eDs
Grab a,")
(Grab Onh4 'e
�� L.w Pumee.ert regemad car aulYsir
STATES V l LL$ A NALYTWAL
322 Cant Sane • P.O. B. 223
SruesrBk• Nt 79M
CM) 572-407
Chain of
Custody Record
Relinquished by:
Time dam,
rr pate Lf -L.), ]r l
Sampied by: 7�Y
Received by
Time / f
arrQQD4UZ t q
transported by
Relinquished by:
Time
am, pm Date J. /
Holding times met f
Received by:
Time
am, m Date
P J....J
Compliance work: �
r&mgosite Sampling
til:
Time begin
am, pm Date JJ�
Non-compliance work:
Time end
am, pm Date JJ
C-omposlte Sam
ing R2:
L8e Ca rrrnerets
P Transported On ice
lime begin
am, pm Date
Time end
am, pm Date J__./_
r-
rn
to
lzr M
ry `o
r`
00
w
a.
•
n
Do
u7
Do
N
V
z
w

Analytical Results A�.A STA-SEE 1LLE
ANALYTICAL
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 04/25/2019
Reported: 04/29/2019
For: Belmont
Comments: GM <546 MPN/g
Sample Number Parameter
Sample !D
Result
190425-21-01 Fecal Coliforms.
�1
Unit
Method
Analyzed
Analyst
190425-21-01 Percent Solids
Bi
<562
MPN/g
sMszzlcE-zoos
04/25/2019
WC
190425-21-02 Fecal Coliforms
B2
3.56
%
SM25406.2011
04/25/2019
WC
190425-21-02 Percent Solids
B2
<541
MPN/g
SM92210E•20os
04/25/2019
WC
190425-21-03 Fecal Coliforms
B3
3.7
%
sM2540e-2011
04/25/2019
WC
190425-21-03 Percent Solids
63
<542
MPN/g
sMszzlcE•zooe
04/25/20i9
WC
190425-21-04 Fecal Coliforms
B4
3.69
%
sM25408-2011
04/25/20i9
WC
190425-21-04 Percent Solids
B4
<555
MPN/g
SM92210E-20os
04/25/2019
WC
190425-21-05 Fecal Coliforms
B5
3.6
%
snnzsaos-zo11
04/25/2019
WC
190425-21-05 Percent Solids
Bg
<494
MPN/g
5M92210E•2006
04/25/2019
WC
190425-21-06 Fecal Coliforms
B6
4.05
%
SM2540B•2011
04/25/2019
WC
190425-21-06 Percent Solids
86
<504
MPNIg
SM92210E-2006
04/25/2019
WC
190425-21-07 Fecal Coliforms
87
3.97
%
5M25409•2051
04/25/2019
WC
190425-21-07 Percent Solids
137
<639
MPN/g
SM92210E•2006
04I2512019
WC
3.13
%
sM2540e-2011
04/25/2019
WC
Respectfully submitted,
top---'VO' O Yh�,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 4

Condition of Receipt
Sample Number 190425-21-01 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-02 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedufe: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-03 Temp on Arrival. 3.2
Parameter Schedufe: Percent Solids
Received on Ice
Parameter Schedule- Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-04 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-05 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 4

Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-06 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 190425-21-07 Temp on Arrival: 3.2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
PO box 228.5tatesvllle, NC 2868� --104197214697
Page 3 of 4

,dares` qS No�� d J --_
lab-w s
0: 3
" 93c- 9S,
1 F 7
�iCKl 1
rwinauished try: Time 2,
_ am•& Date Aj2jLj
lr
�sived try: Time T LA5 am,�Dale��
relinquished by:
Received by:
,rOW begin am, pm Date
Tmg end am, pm Date /
16 m Iln
•fie begin am, pm Date IJ
-roe end am. pm Date ^/ 1
Trme am, pm Date �J /
Time
am, pm Dale
Lab Cbrrmnont,
i22 CctWrt A o
eOX 4-al
jStakswk. NC 29W
b97
Chwn of
CUSWY Record
Sampled by
Transported try:
L
Holding times met:
Compliance work
Non-compliance work;
des T.MP k
rrWrws:

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 0412512019
Reported: 0610312019
For: Belmont
Comments:
ANALY'rICAL
J.
Sample Number
190425-19-01
Parameter
TC!_P
Sample ID
Belmont
Result
Sec, Alta-zhed
Unit Method Analyzed
Analyst
" "' "`, 04�2612019
PACE
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 - Statesville, NC 28687 - 704/872/4697
Pagel of 42

Condition of Receipt
-Sample Number 190425-19-01 Ternon Arrival: 3.2
Parameter Schedule: TCLP
Received on Ice
PO Box 228 - Statesville, NC 28687 - 704/872/4697
Page 2 of 42

r.
rn
w
� N
liertt
Se�}J.t*n So.l i3. (
N U
h
` ro
ddress
t.
s-rsrMNILLEANA
o M
h tL
YMAL
6Rr•, Q.r� �/t
122 Cart sheet- P.Q. Sox M3
SUVIville,NC2t:6t17
FK
mlact Pe;5 n:
Z (�
P thx�e
(701} 672 i6g7
00
rq
t
y 3�
Requisitioned by;
FARM —
remit; s f Y nil Chain of
N
z
comer
Too Am
Lab -ID s ane Sanptad
Date seupce
CUStody Record
ai
I�+,}
tcrae
I 1 19'3
(craooff,
uarriY
_ ,+ rr,MtnAnaroe ad3w
—
.I a �
7
�
ry
N
X
O
CO
0
rz
Relinquished by:
Received by:
Relinquished by:
Received by:
Co sHe li t1i:
Time begin am, pm Date
Time end am. pm Date
Com12Q, i%—*AMVI- hgAL
Time begin am, pm Date
Time end am, pm Dale
Time ) - f 5 am
Date � �S� pled by
Time /�-%!,5 am p�r 1 Date
Transported by: 7, �.
Time am, pm Date_1__/
Holding fines met
Time am, pm Date I�I
Compliance work.
Non-compliance word
Lab C rraneata
3amptes Transported On Ice:

2ceAnalXicala
mnr.Aam4Esaom
ANALYTICAL RESULTS
Pace Analytical Services, LLC
98D0 K,nceyAve Suite $Do
HL-Aersv Ile, NC 26o7a
[phone]
Projecl: TCLP
Pace Protect No.- 92427047
sampre: 190425-19.01
Results reported on a 'dry welghl'
Lab Ib: 92427047001 Collected: 04125119 14 30 Received- 04126/19 07.45 Malr x: Solid
basis
and are ad/lrsfed for pareanf mofsture, samPle size and any dilutions,
Parameters
Results Units Report Lim t OF Prepared Ana yzed CAS No. gust
80B7 TCLP Pesticides RVE
Analyl cai Method. EPA80B16 Preparation Methos: EPA3510C-��
eachate Method/pate: EPA 1311, 0510111919:00 Initial pH' , Fine, pH, 5
gamma-BHC (Lindane)
Chlordane (Technical)
NO ug1L 050 1 05102/1911:41 05/02/19 18 38 58-89.9
ND uglL
Enddn
3.0 1 05/02/19 11,41 05102119 18:38 57.74.9
NO ug/L
Hepta
Hoptachlor
0.50 1 051021191141 05102/19IUS 72.20.8
ND ug1L
Heptachlorepoxide
060 1 OW0211911:41 W0211918,38 76-44.8
NO uglL 0.50
Methoxychlor
1 05102/1911:41 0510211918:38 1024.57-3
NO ugh
Toxaphene
1000 1 05/02/19 1141 05/02/19 18 38 72.43.5
ND ug/L
Surrogates
3.0 1 0510211911,41 05/0211910.38 8001-35.2
Oacachlorobiphenyi IS)
41 %
Telrachlorc-m-xylene IS)
10.138 1 05/02/19 11 41 05/02/19 18 38 2051.24.3
51 %
8092 TCLP PCBs RVE
10.110 1 0510211911-41 0510211918.38 977.09.8
Analytical Method: EPA 0082A Preparation
MelhoM EPA 3510C
Lea=hale Melhad/Date. EPA 131,, G57D1119 19 OD
PCB-1016 (Arotlor 1016)
Initial pH: ; Final pH: 5
NO
PCB•1221 +Aroclor 1221)
ND ug/L 1000 1 05110/19 17.02 05113/19 09:03 12674-11.2 L]
9
PCB-1232 (Arodor 1232)
1000 1 05110/19 17:02 05l13l19 09 03 17104.28-2
NO ug1L
PC8.1242 (Arodor 1242)
1000 1 05/10119 17.02 05/13/19 09:03 11141-16.5
NO
PCB•1248 (Aroclor 1248}
ug1L 1000 1 05110/19 17 02 05/13/19 09,03 53489.21.9
ug1L
PCB•1248 (Arocror 1254)
ND 1000 1 05/10119 17:02 05/13/19 D9:03 1267249.6
ug/L
PC8-1260(Arodor1260)
1000 1 05110/19 17:02 0571311909:03 11097.69.1
ND ugll
Surrogates
1000 1 05110/19 17:02 05113/19 09-03 11096-82-5
DecachlorobiphenylIS)
69 %
6010 MET ICP, TCLP
10.132 1 05110/19 17'02 05/13/19 09,03 2051-24.3
Analytical Method: EPA 60101] Preparation Method' EPA 3010A
Laachate Method/Date: EPA 1311, 05-DB/19 23.16 Initial PH: 6.95; Final pH 4.5
Arsenic
Barium
NO m9lL 0,050 1 05/0911922:52 05110119 13 13 7440.38.2
0.58
Cadmium
mg1L 0.25 1 05/09/19 22:52 05/10/19 13:13 7440.39.3
NO mg1L
Chromium
0.0050 1 05109119.22 52 05/10/19 1113 744043.9
NO mg/L
Lead
0.050 1 05/09/19 22:52 05110119 13:13 7440.47-3
ND mgtL
Se'enium
0.025 1 05/09/19 22:52 05/10/19 13:13 7439.92.1
NO mg/L
Silver
0.10 1 05/09/19 22.52 05110/19 1113 7782.49-2
ND mg1L
7470 Mercury, TCLP
0.025 1 0510911922:52 0511011913:13 7440.22-4
Analylics; Method: EPA 7470A Preparation Method: EPA 7470A
Mercury
Lecchale Malhod/Date: EPA 1311; 0548119 23:16 initial PH' 6.95, Final PH, 4 5
6270E MSSV TCLP Sep Funnef
NO mgtL 0.00020 1 05110/1908:07 05/10/19 11;28 7439.97.6
Analytical Method: EPA 8270E Preparation Method: EPA 3510C
1,4-Dichlorobenzone
2 4-D niuotclua.le
NO u� 50,0 1 05109/19 13.13 05/09/19 14 42 106.46.7
ND
Hexachlaro-1,3-b;ladiene
ug/L 50.0 1 0510911913:13 05/09119 14 42 121.14.2
NO ug/L
Hexachloro-1.3-b a
50.0 1 05/09119 13:13 05/09/19 14:42 87-68-3
ND ug1L
Hexachoroathane
50,0 1 05f091]91313 05/091191442 119.74.7
u9ND
2•Mslhylpheno;o•Crasol)
�L 50.0 1 0510911913:13 DSMSV1914:42 67.72-1
NO ug ``
384-Melhy]pt ens (mdp Creaal)
50.0 1 0510911913:13 05/09/19 14-42 95.484
972
ugfL 50.0 1 05/09/19 13.13 051OW19 14 42 15831.10.4
REPORT OF LABORATORY ANALYSIS
Date: 052812019 05:02 PM
This relwrt shall not be repreduced, axcapt in full,
without the wrllfen consent or PscaMatyticsl Services, LLC
Page 4 or 39
PO Box 228 • Statesville, NC 28687 a 704/872/4697
Page 7 of 42

1!2C6Ana1j4ica1-
Wpavekbo-mm
ANALYTICAL RESULTS
Pace Analytical Services, LLC
95DO KlnceyAve. Suite too
Hunlerevilid, NC 28D78
[phone]
Projed: TCLP
PBae ProJect No.' 92427D47
Semple: 190425.19.01 Lab ID: 92427047001 Collected: 04r25119 12:30 Received, D4/26119 07:45 Matrix: Solld
Results reported on a 'dry weight' basis and are adjusted for
percent
moisture, sample
she and any dilutions.
Paramelere
Reeutls Units Report Limit
DF Prepared Analyzed CAS No. pual
8270E MSSV TCLP Sep Funnel
Analytical Method, EPA 8270E Preparation Method- EPA 3510C
1411robenzens
Penlachlorephenot
ND ug/L
NO
50.0
1 05/09/19 13:13 05/09/19 14:42 99.95-3 L1
Pyridine
ug1L
NO
100
1 05109/1913:13 05/09119141A2 87.80.5
2,4,5-Trichlorophenol
von
NO ug/L
50.0
1 05109/19 13 13 OSM1914:42 110-86.1 MI
orophenal
NO
50,0
1 06/09/1913:13 0510911914;42 95.95.4
Surr
Surrogates
ug1L
50.p
1 05109/19 13:13 05109/19 14;42 88.08.2
Nitrobenzene-0 (6)
2•Flucrobiphenyi (S)
33 %
12.102
1 05/09119 13.13 05109/19 14,42 4165.60.0
Terpherryl•d141 (S)
32 %
61
13.107
1 05/09/19 13:13 05/09/19 14:42 321.60.8
Phenot•d8 (S)
%
17
21-132
1 05/09/19 13113 05/09119 14A2 1718.51-0
2-Fiuorophanol (S)
%
23 %
10-110
1 05109/19 13-13 OS109/19 14:42 13127.88.3
2,4.6•Tribramophenol (S)
57 %
10-110
1 05/09119 13:13 05109119 14:42 387.124
27.108
1 05109119 13:13 05/09/19 14:42 118-79.6
82600 MSV 7CLP
Analytical Method, EPA 8260D
Benzene
Benzene {MEK)
NO ug/L
NO
100
20 05110/19 01:31 71.43-2
Carbon tetrachloride
ug/L
NO ugrL
20 05110l19 01:31 78.93.7
Chlorobenzene
NO ug/L
100
100
20 06/10119 01:31 56-23.5
Chloroform
NO ugiL
100
20 05110119 01:31 108.90-7
1,4-Dlchfarobenzene
NO v91L
100
20 05/1011901:31 67.66.3
1,2•Dichloroethane
NO ug/L
100
20 05/10/19 01:31 10e-46-7
1,S-Dlehloroethene
NO u0/L
100
100
20 0511011901:31 107.06-2
Tetrachlorcethene
NO uglL
20 05/10/1901:31 75.35.4
Trichloroethene
NO ug/L
100
20 0511011901.31 127-1B44
Vinyl chloride
NO ug/L
100
20 0511009 0131 79-01-6
Surrogates
100
20 05110-190131 75-01.4
1,2.01chlomethane-d4(S)
96 %
70-130
20
Toluene -de (S)
104 %
05110/19 01 31
20
4-Bromoeuorobenzene(S)
g8 °�
05/10119 0131 2037.2fi•5
2037.26.5
70.130
70.13Q
20 0511017901-31 480-D0.4
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
g4 6 %
0.10
1
04129/19 13 38
1010 Fleshpoint,Closed Cup
Analytical Method: EPA 1010A
Flashpalm
>200 dog F
70 0
1 OSr06+19 ' fi 27
9095 Paint Filter Liquid Test
Analytical Method: EPA 90958
Free Liquids
Fall
110
i 04/29/19 14:19
733C S Reactive Cyanide
Analytical Method: EPA 9014 Preparation Method SW-846
Cyanide, Reactive
NO mglk9
28.9
7.3.3.2
1 W02119 20 42 05/02/19 23:01
7345 Reactive Sulfide
Analyticai Method: SM 450QS2F•00 Preparat on Method SW-846 7.3 4.2
Sulfide, Reactive
NO mglkg
290
1 05/02/19 20*42 05 02119 20:53
REPORT OF LABORATORY ANALYSIS
Dale OSRB12p19 DS'D2 PM 7his report ehffiI not be reproduced, except In tull,
without Ile wriaen wnseni of Pace Analytical Services. LLC.
Page 5 of 39
PO Box 228 a Statesville, NC 28687 a 704/872/4697
Page 8 of 42

190425-19-01 SAMPLE RESULTS - 01 "046LAC NATIONiYI!)9
collecled dateltlme: 04125/10 12. ]O 0093797
Prl wiration by Metlu:ld 1311
Result
Analyst
TCLP Exlracdon
Ffuld 1
Initial pH 675
Final pH 4.59
Duallftef P1ep
Balch
dale! Liam
SJ412019 9-46:52 AM
WG1I76052
514120199:46.52AM
WG12760S2
514tMt9 94652 AM
WG1276052
Sr4r2019 9 40-52 AM
W131276052
Chlorinated Acid Herbicides (GC) by Method 8151A
Result OualWer RD! limit Dilution Analysts Balch
Anatyle rtgA mgA ing11 (late I tlma
2.4,5dP (SiWx) ND 0.00200 1 1 MOWN 16:58 WGI276472
2A4) ND O.OD200 10 1 051061201916:58 WGI276472
QZ4rDkWW pf rVAcepcAW 73.8 140.158 05+=01`916s8 V7G1776472
ACCOUNT:
PaCe Anatyafal HwdelsVtce, NC
Page 33 07 39
PROJECT SDG• DATCfFIME. PAGE:
92427047 U093787 OSi07r19it49 5011t
PO Box 228 + Statesville, NC 28687 • 704/872/4697
Page 36 of 42

NCDABCS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomtl
J4r
Client: Thomas Warren
Predictive 1401 Alexis Lucia Rd.
Stanley, NC 28164
Soil Report Mehlich-3 Extraction
Links to Hel fuSampled County: Gaston
l Intormalion
Sam led* 11/18l2019 R Client ID: 478946
r
eceived. 11l2212019 completed: 12/18/2019
Farm:
Sample ID: BT91
Recommendations:
Lime
Crop
(tons/acre)
N
Lime History:
1-FeScuatOGrassMm, M 0.4
120-200
2 -
0.0
Test Results [units - WN in g/crn3; CEC and Na In
megl100 cm3; NO3-N in mgldnt):
HM% WIV CEC
BS% Ac PH
P-1 K-1
Ca% Mg°/
056 0.91 9.3
82 1.7 5.8
250 28
66 14
Vorth Carolina
Report No. FY20-SL018289
Advisor: Zach Key
Southern Soil Builders,
Inc.
958 Hoots Rd
Roaring River, NC 28669
Advisor ID: 231531
P205 KzO
a
Mg
- --- ,--•-�- -1
S Mn Zn
More
Cu-5 Information
0 80
0
0
0 0
0 0 Note- 12
Soil Class:
Mineral
S-1 Mn-I
Mn-Ali
Mn-AI2
Zn4 Zn-Al
Cu-I Na ESP SS-1 NO3-N
67 275
182
1443 1443
855 0.2 2
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxler, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomtl
Thomas Warren
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Lime
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
ton/acre or Ibli 000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at or
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rats
is applied. If MG is recommended and lime is needed, use dotomitric lime.
Fertilizer
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
Iblacre unless otherwise specified). Recommendations for N (and sometimes for 8) are based on research/field studies
for the crop being grown, not on soil test results. K-I and P-1 values are based on test results and should be > 50. If they
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
only on reports for greenhouse soil or problem samples.
Farmers and other commercial producers should pay special attention to micronuf ient levels. If $, pH$, $pH. C or Z
notations appear on the soil report, refer to Note: Secondaiy Nutrients and Micronutrients In general, homeowners do not
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
ncagr.govtaqronomi/pubs.hlm.
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib11000 sq ft _ If you cannot find
the exact fertilizer grade recommended on the report, visit www.nca r. ovfa ronomilob art4.ht ind information that
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertiti7e,
Test Results
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pHj describe the soil and its degree of acidity. The
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-1, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESA, SS -I, NO3-N (not routinel
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.nca r. ov/a ronomiluvrghtm
Report No. FY20-SLO18289
Page 2 of 2
Report Abbreviations
Ac
exchangeable acidity
B
boron
BS%
% CEC occupied by basic cations
Ca%
% CEC occupied by calcium
CEC
cation exchange capacity
Cu-1
copper index
ESP
exchangeable sodium percent
HM%
percent humic matter
K-1
potassium index
K20
potash
Mg%
% CEC occupied by magnesium
MIN
mineral soil class
Mn
manganese
Mn-All
Mn-availability index for crop 1
Mn Al2
Mn-availability index for crop 2
Mn-I
manganese index
M-0
mineral -organic soil class
N
nitrogen
Na
sodium
NO3-N
nitrate nitrogen
ORG
organic soil class
PH
current soil pH
P-1
phosphorus index
P205
phosphate
S-1
sulfur index
SS-1
soluble salt index
WIV
weight per volume
Zn-AI
zinc availability index
Zn4
zinc index

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
Facility Name: City of Belmont WQ Permit Number: WQ0003281
WWTP Name: City of Belmont NPDES Number: NCO21381
Monitoring Period: From 1/1/2019 To 12/31/2019
Pathogen Reduction (15A NCAC 02T .1106) - Please indicate level achieved and alternative performed:
Class A: Alt. A (time/temp) p Alt B (Alk Treatment}❑ Alt. C (Prior Testhi )❑
A1t.D (No Prior Test) ❑ Process to Further Reduce Pathogengs ❑
If applicable to alternative performed (Class A only) indicate "Process to Fuillier Reduce Pathogens":
Compost ❑ Heat Drying ❑ Heat Treatment ❑ Thermophilic ❑
Beta Ray ❑ Gamma Ray ❑ Pasteurization ❑
Class B: Alt. (1) Fecal Densi C1 Alt. (2) Process to Significantly Reduce Pathogens ❑
If applicable to alternntive performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization ❑ Air Drying -❑ composting ❑ Aerobic Di gestion ❑
Anaerobic Digestion ❑
If applicable -to alternative performed (Class A or Class B) com fete the following monitorin data:
Parameter g en
Allowable Level Pathogen Density!Number of
Frequency Sample Analytical
in Sludge Minimu Excee- Geo. Mean !6139
Units
6th power of Analysis Type Tech-
2 x 10 to the MPN 494 546 MPN/g 0 7 grab sm9221
per gram of
Fecal Coliform total solids CFU
1000 mpn per gram
of total solid (dry
weight)
Salmonella bacteria 3 MPN per 4 grams
(in lieu of fecal total solid (dry
coliform wei ht)
Vector Attraction Reduction (15A NCAC 02T .1107) - Please indicate alternative performed:
Alt. I (VS reduction) ❑ Alt. 2 (40-day bench) R1 Alt. 3 (30-day bench) ❑ Alt. 4 (Spec. O> uptake) Li
Alt. 5 (14-Day Aerobic) ❑ Alt. 6 (Alk. Stabilization ❑ Alt 7 (Drying - Stable) ❑ Wt.-8 (Drying - Unstable) ❑
Alt. 9 (Injection) ❑ Alt. 10 (Incorporation) ❑ No vector attraction reduction alternatives were performed ❑
CERTIFICATION STATEMENT (please check the appropriate statement)
0 "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 have been met."
❑ "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 have not been met." (Please note
if you check this statement attach an explanation why you have not met one or both of the
requirements.)
"This determination has been made under my direction and supervision in accordance with the system
designed to ensure that qualified personnel properly gather and evaluate the information used to determine
that the pathogen and vector attraction reduction requirements have been met. I am aware that there are
significant penalties for false certification including fine and imprisonment."
Ie4+ -LVC, Dennis Key Southern Soil Builders, Inc.
Preparer Name and Title (type or print) Land Applier Name and Title (iFapplicable)(type or print)
14 g--`y-do?,
Signature of Preparer Date Sign tore of Land Applier (ifapplicable) Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM PVRF mT t1,)r9nnR)