WQ0006245_Application_20200214

Permit Number W00006245
Program Category
Non -discharge
Permit Type
Distribution of Residual Solids (503)
Primary Reviewer
erickson.saunders
Coastal SWRuIe
Permitted Flow
Facility
Central Files: APS _ SWP _
2/17/2020
Permit Tracking Slip
In review Renewal r
Version Permit Classification
C Individual
Permit Contact Affiliation
Andy Smith
Residuals Supervisor
PO Box 1111
Statesville NC 286871111
Facility Name r Region
City of Statesville Sta-Lime Processing Facility and Distribution Program Major Mooresville
Location Address County
693 Bell Farm Rd Iredell
Facility Contact Affiliation
Statesville NC 28687
Owner
Owner Name Owner Type
City of Statesville Government - Municipal
Owner Affiliation
Ron Smith
PO Box 1111
Dates/Events Statesville NC 28687111
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
3/5/1992 2/14/2020
Regulated Activities Requested /Received Events
Wastewater treatment and disposal Region comments on draft requested
Region comments on draft received
RO staff report received
RO staff report requested 2/17/20
Outfall
Waterbody Name Streamindex Number Current Class Subbasin

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
2� "Mc STATf rk'!'
°...a
AY� _ 9•.
NORTH CAROLINA
Environmental Quality
February 17, 2020
ANDY SMITH — OPERATION MANAGER
CITY OF STATESVILLE
POBox 1111
STATESVILLE, NORTH CAROLINA 28687-1111
Subject: Acknowledgement of
Application No. WQ0006245
City of Statesville DCAR
Residuals Management System
Iredell County
Dear Mr. Smith:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on February 14, 2020. Your application package has been assigned the
number listed above, and the primary reviewer is Erick Saunders.
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
Erick Saunders at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: Mooresville Regional Office, Water Quality Regional Operations Section
Permit File WQ0006245
North Carolina Department of Environmental Quality I Division of Water Resources
•/ 512 North Salisbury Street 1 1617 Mail Service Center Raleigh, North Carolina 27699-1617
- _ — 919.707.9000

'3 CITY of
NORTH CAROLINA
February 12, 2020
NCDENR — Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
Raleigh Central Office
1636 Mail Service Center
Raleigh, NC 27699-1636
RE -GE �! D!�� 'nFC IDWR
CC: Files
FEB 1 4 2020
Re: Form: DCAR 06-16
City of Statesville Fourth Creek WWTP Sta-Lime Processing and Distribution
Program Non -Discharge
Permit No. W00006245
Permitting Unit
Dear Mr. Thornburg:
The City of Statesville is requesting a permit renewal for permit # W00006245.
Enclosed you will find the DCAR 06-16 form and supporting information per the
instruction sheet for
this form. The following is a list of these documents.
• A brief narrative explaining how the product is handled, transported, how the residuals are
processed and treated. How the leachate is handled, where the residuals will be stored and
how the final product will be distributed.
• What nutrients are used as the limiting parameters.
• Marketability Statement.
• A statement regarding the application of the final product in accordance with the information
sheet.
• Flow Schematic.
• Spill Control Plan.
• Copy of the inspection report form.
• Sampling schedule for Sta-Lime.
• Sample and Monitoring Plan Narrative.
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]
Sincerely,
Ken Galloway
Plant Supervisor, Fourth Creek WWTP
PO Box 1111 • Statesville, NC 28687 • ci.statesville.nc.us

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — DISTRIBUTION OF CLASS A RESIDUALS
INSTRUCTIONS FOR FORM: DCAR 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 website
General — This application is for treatment, storage, transport, distribution, land application, and/or marketing of Class A (or Equivalent)
residuals under 15A NCAC 02T .1100. gr-c'eVEDIN ; IrIJIIgAll,
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documer}talLLUU 2disted
below. FEB 1 LEI
A. Distribution of Class A Residuals (FORM: DCAR 06-16):
® Submit the completed and appropriately executed Distribution of Class A Residuals (FORM: DCAR 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 project name should be consistent on the plans, specifications, etc.
® The Applicant's Certification on Page 3 of this form shall be signed in accordance with 15A NCAC 02T .0106[bl. 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 021.0106(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 Environmental
Quality (NCDEQ).
Facility Classification
Major (residuals permitted for distribution > 3,000 dry tons/year)
Minor (residuals permitted for distribution < 3,000 dry tons/year)
New Permit Major Modification 1
$1,310 $395
$810 7$245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
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.
INSTRUCTIONS FOR FORM: DCAR 06-16 Pagel of 3

D. Program Information (All Application Packages)
® Provide a narrative explaining the following:
® How the materials will be handled and transported from where the residuals were produced to where it will be treated.
How the residuals will be processed/treated (attach process flow diagram).
How leachate collection will be handled.
®; Where the residuals will be stored until processed.
®; How the final product will be distributed (packaging, bulk, etc.)
® What nutrients or other constituents (i.e. nitrogen, phosphorous, aluminum, calcium, etc.) are used or recommended as the
limiting parameter for determination of residuals loading rate to ensure that it does not overload the soil and cause
contravention of surface water or groundwater standards, limit crop growth, or adversely impact soil quality.
® Attach a marketability statement detailing destinations and approximate amounts of the final product to be distributed.
® Provide either a label that shall be affixed to the bagged processed residual or an information sheet that shall be provided to the
person who receives the processed residual. The label or information sheet shall contain, at a minimum, the following
information:
® Name and address of the person who prepared the residual that is sold or given away.
® A statement that application of the residuals to the land shall be in accordance with the instructions on the label or '
information sheet.
® A statement that the residuals shall not be applied to any site that is flooded, frozen or snow-covered.
® A statement that adequate procedures shall be provided to prevent surface runoff from carrying any disposed or stored
residuals into any surface waters.
® Information on all applicable setbacks in accordance with 15A NCAC 02T .11.081b]
® A statement that the residuals shall be applied at agronomic or recommended rates for intended uses.
E. Detailed Plans and Specifications (Application Involving New or Changes to Treatment or Storage Units)
❑ Submit detailed plans and specifications that have been signed, sealed, and dated by a NC Professional Engineer per IJAA
NCAC 021.1104(a). Specifications for standard equipment may only be omitted for municipalities with approved standard
specifications, but use of the standard specifications must be noted on each sheet of the plans.
❑ Plans must include the following minimum items: a general location map, a topographic map, plan and profile view of the
residuals treatment and storage units as well as the proximity of the residuals treatment and storage units to other utilities and
natural features within 500 feet of all treatment and storage facilities, and detail drawings of all items pertinent to the residuals
treatment and storage units. Depict minimum separations required in 1.5A NCAC 02T .1 ! 08(al on the plans.
❑ Specifications must include, at a minimum, the following for all items pertinent to residuals treatment and storage units:
description of materials to be used, methods of construction, quality of construction testing procedures to ensure the integrity
of the final product in accordance with 15A NCAC 02T .I 104(a)(2)(13), including leakage and pressure testing as appropriate.
❑ Plans and specifications must 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 and specifications. However, the plans and
specifications may be labeled with the phrase: FINAL DESIGN — NOT RELEASED FOR CONSTRUCTION.
F. Engineering Calculations (Application Involving New or Changes to Treatment or Storage Units)
❑ Submit all design calculations that have been signed, sealed, and dated by a NC Professional Engineer per 15A NCAC 02T
.1104(a).
G. 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.
INSTRUCTIONS FOR FORM: DCAR 06-16 Page 2 of 3

H. 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 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.
Z 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.
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
Br U.S. Postal Service: By Courier/Special Deliverv:
1617 MAIL SERVICE CENTER 512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: DCAR 06-16 Page 3 of 3

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — DISTRIBUTION OF CLASS A RESIDUALS
FORM: DCAR 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Statesville
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal
❑ County
Signature authority's name per 15A NCAC 02T .0106: Andy Smith
Title: Operation Manager Water Resources
Applicant's mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] Email Address: Asmith( ,statesvillenc.net RE�,t1V
2. Consultant's name: N/A License Number (for P.E.):
FEB 1 4 202�
Affiliation: ❑ On Staff ❑ Retained (Firm: )
Consultant's mailing address:
Perm i'Ltmo
City: State: Zip: -
Telephone number: ( — Email Address:
3. Fee submitted: . (See Instruction B)
H. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0006245
Date of most -recently issued permit: October 1. 2015
Date of most -recently certified Attachment A (if different than the permit):
M. FACILITY INFORMATION:
1. Name of residuals processing facility: 41 Creek WWTP
City: Statesville State: NC Zip: 28687-1111
Coordinates: Latitude: 35' 46' W" Longitude: 80' 47' 15"
Datum: Level of accuracy:
Method of measurement:
County where facility is located: Iredell
2. Facility contact (person familiar with residuals preparation):
Name: Kenneth Gallowav Title: 4' Creek Supervisor
Mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] E-mail address: k--,allowavra statesvillenc.net
FORM: DCAR 06-16 Pagel of 3

3. Is the residual process facility also the generator? N Yes; ❑ No
If No, please specify delivery frequency and quantity of residual to be processed: _
4. Length of residuals storage at facility: 30 days (Note: the Division requires minimum 30 days storage in units that are separate
from treatment system, i.e. not in clarifiers, aeration basins, etc.)
IV. RESIDUALS QUALITY INFORMATION:
1. Specify how these residuals will be distributed:
❑ sold or given away in bags or other containers; ❑; lawn (bulk); ❑ home garden (bulk);
® other (explain); Ch[ employees load Sta-Lime into customers' trucks / trailers / etc. free of charge.
Note: Bulk residuals shall mean residuals that are transported and not sold or giving away in a bag or other receptacles with a
load capacity of one metric ton or less.
2. Complete the following if residuals are to be mixed with other materials:
Type of Materials Amounts to be added
per 1.0 dry ton of residuals (dry ton)
3. Approximate amounts of the residuals received and processed at the facility: 900 dry tons per year.
4. Approximate amounts of the final product (processed residuals) to be distributed: 1500 dry tons per year.
5. Provide a description of the onsite storage management plan for the treated residuals (including estimated average and
maximum storage times prior to distribution): 6 months
6. Does the facility have a stormwater management plan? ® Yes; ❑ No
Explain whether the treatment and storage areas are under roof or how stormwater runoff will be handled: Approximately 30%
of stora_=e area is under a roof. The remainin,, storaLe area drains storm water to the WWTP headworks.
V. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the attached Residuals Source Certification and all associated documentation.
RSC 06-16.doc
FORM: DCAR 06-16 Page 2 of 3

Professional Engineer's Certification: (Application Involving New or Changes to Treatment or Storage Units)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best of my knowledge
the proposed design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal package
may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I have reviewed
this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
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 15A NCAC 02T .0105..
® Yes, ❑ No, Explain;
I, 14 n 6 f V or,\ k 0,A S )Nl v ye i—
(Signature Authority's Naam, ee —P(L/EASE PRINT) (Title)
attest that this application for w W� LrO�, 5 �` \ � `�� O� c,,\��V1
(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 §143-215.613, 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: r Date:
FORM: DCAR 06-16 Page 3 of 3

Sta-Lime Processing and Distribution Program Narrative
Sludge is pumped into a 1.5-million-gallon digester as Waste Activated Sludge.
The digested sludge is then pumped into the dewatering process onto a three -
belt, 3-meter press. The dewatered sludge is conveyed into a live bottom hopper
via a progressing cavity pump at the end of the belt press, and from there the
sludge is conveyed to a pug mill to be blended with Lime Kiln Dust. From this
point in the process on, the material is considered Sta-Lime.
The Sta-Lime is discharged from the pug mill onto a covered conveyor belt that
carries the Sta-Lime to covered pulse bins, where the Sta-Lime is held until the pH
and temperature requirements are met. From the pulse bins the Sta-Lime is
moved to a 170' by 70' covered storage pad, where is can be loaded by City
employees onto customers trucks / trailers.
There are two smaller live bottom hoppers that can receive dewatered sludge
from the City Water Plant and / or Third Creek WWTP for processing into Sta-Lime
as well.
All stormwater runoff from the sludge holding area is directed to the headworks
of the WWTP.
There was a Capital expenditure project in 2015 that update the Sta-Lime making
equipment and configuration from previous permit cycles, but the process has
remained relatively unchanged.

-..-r - - - �ulununuc uivision Phone: [phone]
Predictive
Waste Report
Website: www.ncagr.gov/agronomi/
Client: Andy Smith
City of Statesville
PO Box 1111
Statesville, NC 28687
Iredell County
'�2unneng! ' Links to Her fur Ppfo mmigim»m Sampled: 05/08/2018
Received: 05/09/2018
Farm: WWTP 4th Creek Completed: 05/15/2018 PALS #• 96310
Sample Information
ID: 01
Code: IOL
Description: Lime
By -Products
Grower Comments:
Not Provided
Application Method:
Broadcast
Soil Incorporated
Advisor
Nutrient Measurements are given in units of parts per million (ppm), unless utherwise specifed.
Lkqqm_CNL I P K Ca Mg S Fe Mn Zn Cu B Mo
Total N: 7070 I 3710 2600 399000 2680 4310 6230 346 78.8 40.0 22.0
Inorganic: 151 1 - -
Report No. FY18-WO06843
PALS #:
Other Results
C Al Na Cl
- 7200 567 -
NH4-N131--------------- - - - - -
-I--
NOs-N 19.1 5 S EC pH BD CCE ALE C:N DM - - - -
(10 S/cm) (MS/CM) (Unitless) (Ib/yd3) N (tons) (Unitless) N614 6.14 12.05 - 93.0 1.26
76.7
Estimate of Nutrients Available for First Year (lb/ton)
Other Results (lb/ton)
N P205 K20 Ca Mg S Fe Mn Zn Cu B Mo
10.9 13.0 4.79 613 4.11 6.62 9.57 0.53 0.12 0.- 06 0.03 Al Na CI
10.9 13.0 4.79 613 4.11 6.62 9.57 0.53 0.12 0.06 0.03 I 11.1 0.-
� 11.1 0.0101 -
Heavy Metals are given in units of parts per million (ppm).
As Cd Cr Ni Pb Se
- 0•29 - 6.85 4.41 -
Heavy Metals Estimate of Availability (lb/ton)
Application Method: I As Cd Cr Ni Pb Se
Broadcast I - T - 0.01 0.01 Soil Incorporated I - T - 0.01 0.01 -
Agronomist's Comments: Insufficient information is available regarding the first year availability of nutrients in this material. The nutrient availability reported here is
therefore the TOTAL nutrients in the material. Samples submitted prior to 2016 reported an estimated value rather than total nutrient levels. Please contact me if you have
any questions. Hunter G. Landis 5/14/2018 9:50 AM
r.
North Carolina
Tobacco Trust fund Commisslon
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 ofAgriculture.

PLANTINFLUENT
MH
BAR SCREENS
INFLUENT
PUMP STATION
11p
COVERED
METERING
DECHLORINATION FLUME EFFLUENT
STALIME
SLUDGE
BUILDING
SLUDGE
STORAGE
TREATMENT
FACILITIES
CHLORINE
LIME
BASIN
CONVEYOR
SLUDGE
STORAGE
PAD
RAS
BELT
PRESS
CLARIFIERS
RAS
WET
WELL
SLUDGE
FLOW
PUMP
SPUTTER
SLUDGE
STA.
BOX
PUMPS
WAS
I
I
AEROBIC
AERATION
AERATION
SLUDGE
BASIN
*
BASIN
DIGESTER
NO. 1
NO.2
AERATORS
AERATORS
AERATORS
_
L
* FLOW
DISTRIBUTION
BOX
FLOW SCHEMATIC & WATER BALANCE
FOURTH CREEK WASTEWATER TREATMENT PLANT
CITY OF STATESVILLE

SPILL RESPONSE PLAN
PROJECT: City of Statesville Sta-Lime Permit W 0006245
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)

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Sta-Lime Permit WQ0006245
Inspection Plan
Inspections for the Sta-Lime processing will be conducted during the processing and loading activities of this project. The
inspection frequency will be based on production. The inspections will consist of inspecting the processing system and the
Sta-Lime 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. Ensure that all manned equipment has a copy of the spill control plan, the permit, and the operations and
maintenance plan.
4. Ensure that the Sta-Lime product information sheet has been distributed to new customers.
5. Verifying that the correct number samples of the Sta-Lime product have been taken and that it meets the
criteria for the Sta-Lime Permit.
6. The records will be kept in the project files in the respective office for the project.
7. 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:
The 4tb Creek WWTP ORC or their designee
Ken Galloway is the designated WWTP ORC for this project and his designees are the backup ORC's
for this project.

The City of Statesville Sta-Lime Permit WQ0006245
Sampling Plan
Sampling for this project consists of sampling the residuals during the time of production.
This will ensure sampling occurs before land application commences in order to ensure that the
residuals are suitable for land application. Based on the dry tonnage of this plant this will be four 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)
Pentachloro henol 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
Chlordane 0.03
Hexachlorobenzene 0.13)
Tetrachloroethylene 0.7
Chlorobenzene 100.0)
He tachlor (and it hydroxide) (0.008)
Toxa hene 0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroeth lene (0.5)
Chromium 5.0)
Hexachloroethane 3.0)
2,4,5-Trichloro henol (400.0
m-Cresol 200.0)
Lead
2,4,6-Trichloro henol
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP Silvex (1.0)
-Cresol 200.0)
Mercun (0.2)
Vin 1 chloride (0.2
Cresol (200.0)
Methox chlor 10.0)
2,4-D (10.0).
Methyl ethyl ketone (200.0)
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 er vear
=>1,650-<16,500
1 eves - 60 days (6 times per near
=>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
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 nutrient
and metals sample to prove that the material is suitable for distribution. The nutrient and metal sample will be thoroughly
digested and mixed before processing and should not experience any seasonal fluctuations in the residuals. TCLP testing to
be conducted annually.
The following people are responsible for sampling: Ken Galloway, Plant Supervisor or his designee.

OPERATIONS AND MAINTENANCE PLAN
The City of Statesville Sta-Lime Permit WQ0006245
OPERATIONAL FUNCTIONS
The operation function of this project is going to involve processing dewatered belt press sludge and Lime Kiln
Dust. The Sta-Lime product will be loaded into the customer trucks that are suitable to transport this product
without spillage or leakage during transport. The Sta-Lime product will be spread at agronomic rates that are
determined by the soil samples from the fields that the customer/farmer has collected.
SAFETY MEASURES
The City of Statesville believes in operating in a safety conscious manner and 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.

SPILL EMERGENCY CALL LIST
Water Resources Executive Director
Name: Scott Harrell
Telephone: [phone]
Mobile: [phone]
Fourth Creek WWTP Supervisor
Name: Ken Galloway
Telephone: [phone]
Mobile: [phone]
Plant Operator
Fourth Creek
Telephone: [phone]
Mobile: [phone]
Third Creek WWTP Supervisor
Name: Scott Austin
Telephone: [phone]
Mobile: [phone]
Water Treatment Plant
Name: Harry Hull
Telephone: [phone]
Mobile: [phone]
Public Utilities Director
Name: William "Bill" Vaughn
Telephone: [phone]
Mobile: [phone]
City Public Information Director
Name: Nancy Davis
Telephone: [phone]
Mobile: [phone]
LOCAL POLICE — FIRE DEPARTMENT: 911
DENR-WQ Regional Office: Mooresville: 704-663-1699
State of NC Warning Point: 1-800-66207956 (Emergency # for nights, weekends, and holidays)

SPILL/EMERGENCY INFORMATION
TO BE USED FOR SLUDGE TRANSPORTED WITHIN WATER RESOURCES.
Listed below are 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 & Stone
704-872-4862
LOCAL POLICE/LOCAL FIRE DEPT. 911

S-4MP1JWC
.ACC Units are in mg/kg
Parameters ICeiCing Conc.-MonthCy Avg
.Arsenic/ .As
75
Cadmium / Cd
85
39
Copper / Cu
4,300
1,500
Lead/ Pb
84o
300
Nercrury / Hg
17
NoCybdenum / Mo
75
N/.A
NickeC/ Ni
420
420
Selenium / Se
100
100
Zinc / Zn
7,500
,800
yH
12 or above
.N/A
or 3 days
Temp.
52 degrees C or
N/.A
above for 12 hrs
°o Solids
50°0 or above
NIA
2/0.3/20

Sta-Lime Sampling & Monitoring Plan Narrative
Ken Galloway, 41h Creek WWTP Supervisor and Brian Dishman, 4th Creek WWTP
Senior Operator are responsible for sampling and monitoring of the Sta-Lime.
Once the Sta-Lime has been processed, it is conveyed into 1 of 8 pulse bins.
Samples are collected for pH and temperature. After 3 days, samples are
collected again from the same pulse bin for pH. These samples maintain a pH of
12 or greater for 3 days, and a temperature of 52 degrees C for 12 hours while the
pH is above 12 before leaving the plant site.
Sta-Lime samples will be collected quarterly per the permit, sampling includes
metals, fecal and nutrient parameters. Annually we conduct TCLP, Hazardous,
Reactivity and Ignitability testing.
If any of these samples are over the permit limit or do not meet the permit
requirements, this product does not leave the plant site. In the event that any Sta-
Lime does not meet parameters, the City will re -process the Sta-Lime and re
sample as needed.

Fourth Creek Sta-Lime Inspection Report
Inspector:
Date:
Time:
Storage Facilities:
Maintenance or Repair:
Other Comments:
Fourth Creek Sta-Lime Inspection Report
Inspector:
Date:
Time:
Storage Facilities:
Maintenance or Repair:
Other Comments:
Fourth Creek Sta-Lime Inspection Report
Inspector:
Date:
Time:
Storage Facilities:
Maintenance or Repair:
Other Comments:
Fourth Creek Sta-Lime Inspection Report
Inspector:
Date:
Time:
Storage Facilities:
Maintenance or Repair,
Other Comments:

The City of Statesville manufactures Sta-Lime from
dewatered municipal wastewater sludge, cement kiln dust
or quicklime. These ingredients are blended together in a
stabilization process to produce a material valuable to the
agricultural community as a soil liming agent and minor
macronutrient source. Sta-Lime meets the Environmental
Protection Agency's Part 503 sludge regulations, which
apply to all municipal wastewater treatment facilities and
regulate production and quality of biosolids.
Sta-lime is not sludge - it is a stabilized sludge product.
Pathogenic bacteria are destroyed by combining these two
products in an EPA approved process so this valuable
product can be safely recycled on land. This process meets
the EPA 503 regulations for pathogen reduction through
Alternative 2 and vector attraction reduction through
Option 6.
The primary use of Sta-Lime is as an agricultural liming
material. it reacts in the soil root zone to adjust soil pH,
improve soil productivity, and help provide optimum crop
production. The additional nutrients supplied may also help
to reduce fertilizer costs for Phosphorus and Potassium.
Users of this product should review the following
information on Sta-Lime's lime value, nutrient content,
application methods, and races of application in order to
receive the maximum benefit from this valuable product.
STA-LIME ALKALINE LIMING MATERIAL DATA
Average Density
65 pounds per cubit foot
Solids Content
80%
Agriculture Line Equivalency
85%
CaCo3 Content
76.5%
Calcium Content
367 pounds per ton
Magnesium Content
10 pounds per ton
STA -LIME MAJOR NUTRIENT CONTENT
Plant Available Nitrogen
2.0 pounds
per ton
Phosphorus
6.5 pounds
Potassium
30.0
pounds per ton
APPLICATION RATE FOR STA-LIME
The ratio of application for agricultural lime versus Sta-Lime
is 1 : 1.51 meaning that for every ton of agricultural lime
normally applied, one and one-half tons of Sta-Lime should
be applied. For example, if a recent soil report recommends
that 2 tons per acre of agricultural lime should be applied to
a particular corn field, then 3 tons per acre of Sta-lime
should be applied (2 X 1.5 = 3). Sta-Lime should be applied
in the same manner as any other agricultural soil
amendment, such as fertilizer or agricultural lime, using the
same methods and procedures as one would for any
farming operation which practices sound environmental
techniques, including the following:

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
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 "lylap Guidance for
Residuals Und Amlicati®n Permits".
® 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: City of Statesville
Status a
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current
Proposed
R
City of Statesville
Sta-Lime Processing & Dist.
Iredell
WQ0006245
7,000
7,000
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

DWR
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: Ciri' of Statesville
2. Facility permit holder is: Federal, ED State, Local Government, or [] Private.
Facility permit issued by: Div. of Water Resources, Div. of Environmental Health,
or Other (explain: ).
3. Facility contact person and title: Ken Galloway 41 Cree Supervisor
Complete mailing address: PO Box 1111
City: Statesville State: NC Zip: 28687-1111
Telephone number: [phone] E-mail address: kaallowav,i%statesvillenc.net
4. Facility physical address: 693 Bell Farm Road
City: Statesville State: NC Zip: 28687-111I
Coordinates: Latitude: 35' 46' W" Longitude: 80' 47' 15"
Datum: -� Level of accuracy: `
Method of measurement: i
5. Purpose of the facility:
treatment of municipal wastewater, E] treatment of 100% domestic wastewater,
treatment of potable water, F1 treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: 40 % industrial and 60 % domestic)
other (explain: ).
6. Does the facility have an approved pretreatment program: Yes [ No
7. Facility permitted/design flow: 6 MGD and facility average daily flow: 3_2 MGD
8. Average amount of residuals being generated at this facility 1500 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. 3 belt press
Type and volume of residuals storage (i.e., outside of residuals treatment units): 265' x 145' pad
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
0 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, 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: W yes 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 EM 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: 8/07/19
Passed corrosivity test: M yes []- no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: M. yes �i no. Flashpoint: -'qq °F (> 140°F)
Passed reactivity test: E]yes []no. HCN: mg/kg (<250) & H2S: M mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(Mg/1)
Arsenic
5.0
<0.10
Hexachlorobenzene
0.13
<0.020
Barium
100.0
<5
Hexachloro-1,3-Butadiene
0.5
<0.050
Benzene
0.5
<0.05
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
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
<0.15
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
<0.012
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
<0.010
FORM: RSC 06-16 Page 2 of 5

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 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: Prism and Date of analysis: 11/25/19
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
13
Cadmium
85
39
<0.75
Copper
4,300
1,500
54
Lead
840
300
9
Mercury
57
17
0.095
Molybdenum
75
n/a
Nickel
420
420
15
Selenium
100
100
27
Zinc
7,500
2,800
100
b. For Surface Disposal Unit Ilandrlll: 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: r
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
E] > 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
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 66.3 %.
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: Prism and Date of analysis: 11/25/19
Parameter
Result
(mg1kg)
Aluminum
Ammonia -Nitrogen
120
Calcium
2400
Magnesium
<1
Nitrate -Nitrite Nitrogen
9.3
pH (Standard Unit)
12.55
Phosphorus
4300
Potassium
4600
Sodium
1100
Total Kjeldahl Nitrogen
4000
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): 1_0
[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: 30 %. This
rate is a (check one): 0 default value, or im 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 (11� Year PAN
Five -Year
Maximum Adjusted PAN
(mg1kg)
(mg/kg)
Surface
1233.3
1,932.463
Injection/Incorporation
1293.3
1,992.463
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

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land A plication 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):
Alternative 1 [15A NCAC 02T. I 106(b)(3)(A)] - Time/Temperature Compliance.
Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.I 106(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.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, ❑ heat drying, fa heat treatment,
❑
0 thermophilic aerobic digestion, beta ray irradiation,
El gamma ray irradiation, or pasteurization.
b. For Land Application of Class B:
El Alternative 1 [15A NCAC 02T. 1 106(c)(1)] - Fecal Coliform Density Demonstration.
rl Alternative 2 [15A NCAC 02T. 1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: D aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
composting, or ❑ lime stabilization.
c. For Sur ace Dis osah
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item Il. 7a. above.
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 I1.8. below [15A NCAC 02T.1106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, 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.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
[] Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T. I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
0 Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
® Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
El Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T. 1107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
0 Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(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