WQ0003281_Regional Office Historical File Pre 2018

Water kesqurces'
ENWRONMENTAL-,.QUALITY=
Mull, 106
.ADRLkN,,'F.MILLER -0TYMANAGER;
'cuy OPBELMONY
MT _`OFFICE 'B'O­_X­-, 431.1
)jgL-MpN �N . " -)LIN 28012
�,T� �01� 'Qwl _A,,
Dear,'Mr.,Miller:
PAT M,OCkORY
Ganernor
ki'Y"AN DER-VAAk-T
Secrdaiy
_S. JAYZIMMERMAN
giibjedt P&imif.No. WQ0003281-
City Pf 00inoPi'.1.
Land Applicatibri.bfIC16ssB
Resid0s,(Non !-,D"W,i*cated)
Gaston County
2015- �afidl-gvbsequent
14 accordance 6�f tdb6ivtd December;
_K� mpg_ with r, permi , renewal rpqu 4�v,
addidonalihformdfion iw- 'ZO
y9,' ''16,.ah&Mardh-.,7.,' 1'6,,we,are,fbrwardihgherewith,P'erniii.
WQ00032'8T dAjq4 May, 3;I, 2016,j nfinu-ed,pper4l' cf.fhe� i'l pct'
to,, 81 �j
46 new fialt become" ;fe§i4d' management p-tq4'k TiW T!6690� that ththisb&permi s 6Mdtiv 0. h July
after 'the -ext)lra'-ti'on,:daieofthe: exiitii pertnit),
1�9
lo.rdlep-mo re acqqrgp114PPIng'
.T,hi§. perinrt s6!f be effective T, 1,'shall V,6,ld,'Permit,Nb-
robiluly 1, 2016 uhtil,Altid, -30, 202
'as spe ifi6&tfierein,
I issued' Jul NO, and shallbesuct folhe.condifions 4ndlunitabops c.
0.60328 y'12
J;l Pleasep.y; paim'piat,a"tt60tib! to the monitoring...' requirements"
listed
in, Attachment 'A Bbr�.
they m differ
.from the previous.pennit-issiaice. Ta'il&&-to,ekab.1M Aft,ade4uAt&.-_,'§y.4em for'colledtffig and maintain i
Rg
thpw
�,Teired operational infonnatioshall result iwkrp,u c omplxance problems:
Pl
'S`e:n6fe,. the ToMwing permit, coihiditionis5 are--new-or ew -6k afe, gignificantly, modified; since the.
last-permii-i'ssp.anc'eld-Aied Ad
, -, "
ghonlf"0—T condition:re UM.th ptb,, ejp,
UP.e- grazed,pasiur6land.
.Condi46A IIIA "-T-W ah.0 'afi 'd Maintenan Tlj�m, Operation' Ce..
S,eoidition Ires-Opipso,
)0 Co- n I dftl6it-JILI 3. —This cb h ditloft, fc,4iiiresJbd,p6,9tifi cr, ap . O fa- , 'sq-, atI , plic4fiowsites.
.9�gns.,can
- >- 00 IVJ..—TW Ondtiq4f-feq d feA41 ahaiysis for. 6!Sodium Adsorption Ratio.
Stafe of Noitt'Carohna j Egvaonntentat Qtiality � water Resources � tlVater Quality Permltting��IorwDtscharge Permitting'.
7 Iylailsq uter Raleigh, North Caroluaa 27699A e5j . 7, 1
.91907,6464

I
Mr Adrian T Jvlller,;
Mty 3 1, 2016
Page ,24`2
Condition FVA = This -condition. requires oorftollaificd'With° the sampling and mtionftort g
Seefibris-dthe ,-a Od.Q
pprov, X,pqr4fOfi� Maintenance ifitenance Plan.
> 'C,,ondi6on:IV.8This condiit'o'
_igsi6hbfanannuafreport;p rio '"to Marchjwqf
the follpwirig'x cat
'Condition VI'7.—This tb­i­d.it_id'- "Qh1bIit expansion of e
ttah,,coAditi ons.
If any -parts, rdtfuk6nients or'limitations."contafnediti.,this :,ijer"r,n'itare lihA6bcotable, the Pemittee
has: the right to, request, an adjpdicaiory, heating Von wiit(Oft request within 3'0 days following receipt of.
,jbsp.e,r,mit, This request .8h.allb�e;int.he.,fO'u'n.,cif'a,,writtenpefition,..conforming,tp,C-h;ap .15013oftlfe;Nbrth
Carolina. General Statutes, and filed with the Office of Administrative Hearings:at, 6,714 Mail Service"
such 'demand reJmde,:his permitAAb fi_and binding.
If you additional ,,information ;concerning th". Perri it, please ;contact.David Goodrich ai (0.19)
804352 1 or, ncdenr.gov
' 'S Ay ? Zimmerman, _O_P G'�-,_ Difector
Division of-W,,iterRc4 - -
Resources
Gaston County HealthDepartment, Electronic
Copy)
Lincoln Couii4,14ealfh--I)epM-6ftlent"(IB106!tOAI'O,,C6p,y
MooresvilleRegional. IQ 0 at n`Section.
.'05'e, WOO Quality-Aegi n�I'Oper io &
Z4ch Key " Southern.
Beth 8uT­m.gton.Pr" _p"tw.,_ t oand Enforcement: ,andb(Electronic Copy)
Di9itktPpkmj%.Axch4ve(�lecIronieCppy. Central, Filies,

NORTH.CAROLINA,
tXVIRONM] NTAL 1VIAIVAGEMENT OM00$$"
DEPARTMENT, OFENVI[RONMENTAL QUALITY'
'IbkLEIGH
LAND APPLICATION OF ttAS&B RESIDUALS PERMIT (NON-DEDICA!MD)'
In aqpqr4aT1fco,,whh the- pmvigion,s,of I Artic1e21ofChapter -143,,General `Statutes dfNorth 'Carolina as,
amended, a
lationsl
Ldiliprcab ­ap I.J. _AeL
dd: p p,',Ws-P',bW, and Rep
PERMISSION IS. ]HEREBY GRANTED T.O.
City of"Belm.ont
GastowCOUnty.
FOkWTf.1t,
.continued operation of a-residudls:managppae:nt,prograDx,f6ir,th6'.City -,6fB'6!moiit anidtofisistih9" of the
application ,-,fC199s*ids �ythpprov d­fakiii sli diq.A#t_chmqu j9A-egpprqyedl
ites, listed Im"_Attachincht. R with no,, 6schArge. of wastes: to surface. waters, pursliaiff to the application, received subsequent additional informatio'n,received bythaDiVis" ' December 2015 and ' subse I-on..of
'Resourcps. and in .conformity with, othersupporting
gdata, ;subsequently Ale and,; , by the:
DeOartmenfofEnvironmerftal Quality and considered apartof this permit: The'.'-use°an.d.disposaI ofresidual&
;are: re i4ed under Title ,40)C, al- Regulations Part SQ3, This ,permit does riot:1
Pertnitfee from. complying with -the federal rd­gulatiofis.
This, pprmjt- shall be qffeqti ftoT_'July 1A !"Vjfd:P No.." WO 2­94
"A 11 June
July-12, 2007, shall bo_�sill ectlotht following specified c,oh, dhtions�. rfd limitations:
C_ B, I ED U, _L E` S`
1- No 1later than six monthspribr to the ekpifati&oif this p'ehiffit 'the-,Permitteeushalt;r6qae§t renewal '.of
this.ggin't pp, officialDivision 5,� Upon roceipf-of'-f Division
will :die'
adequdcybf the-facilitjes.desdibed�thprdin, anOif WT p permit _dn460-.6f. time and under such conditions ad,liraftations asit may deem appropriate,.. Please: note Rule.: 15`A.-
NCAC_submitted),requJan map to _w ih dipporm­trenewal
'[15A,NC,AC�02T.0,108(,b)(2),02T:.i0I05(d), 02T'.,0.1,09]
z. The ,n�
Petmifte halt be Ift..mi compliance,itfilih pap'fOqu tn ab�ishddjq Condition
,
Wq
within L8.0.,da.ys.-of,,theeffect-ive..-.date of:.this!pei�nii., BA.NCA-0O2T.010(13)(�.)]
11
VJQ0003281 VersionSWI.Version._I$,1201,

PERPORMANCE-STANDARDS-
-.The, subjeUxesiduals managpment.progyaM shall beeffje�otiv.e.lymaititaiiied.aiidoperated.,ai,-all'tiipaes.so
s, nor any
there is. no discharge to surface- water ;contraventionI of groundwater odt gurfa e
water
standards. -1n-the event the,,,faciliiies fail'toped6Tin satisfactorily;. in I-'d H9the-creation of
nuisance
conditions Atie to: improper .operation :and maintenance,. the Pe.rm'-ittee.shalf immediate tease land
applying residuals to` :the site;contact the Mooresville kegiond''OMIce supervisor, an d 'take any
immediate: corrective actions. [G.SA4S-2'f'5,A]
This. ,permit ",,shall not 'r&lidvb the Permift6e of responsibility for damages'; o grOtin-dWWr oi%',surface
water resulting from the operation of this residuals management
p jograin.. [15A XCAC.'0213';0I
02L . 04 0,01 00,
3. biity residuals, generated by the fficififies.listed.. in Attachment A are approved for land application, in
-accordance, withthis 'permit. [G.S. 143_'21,5A]
4. Qnly',tho sites listed in,AttachM'eftt'B are. approved 43,215.1]
-proved for residuals lana application.. [G" Ation is .1
5. 'Pollutant ,concentrations in residuals -'ed to land application sites listed in.Attachment f shaft not,
exc
eed
I the following_ 'Ceiling Coxi6intritions (he.3* dry. weight.basis) or, Cumulative PollutanU
Loading Rates (CPLRs):
CeilingParawter Concentration
milli &4nmqrkilogain
)
CPLR
OUnds-PLe
acre)P
(P
Arsenic
75
36,
-Codiniluni
85
_4
Copper
4,30O:
Lead
840
267
57
1-5
Molybdenum..
75
n/a
'Nickel
420
374
.selenium,
Zinc;-7,500
2,498.
The -P , ermittee, shalltdptermingtqQmplia4pe With the CPLR-s-using onelofthe f6flowing methods:
-
a. By calculating the existing cumulative 4evel:of P911141ts. using :actual analytical
alytkal data from all
.Historical land application_events-ofyesi
b: :For land where resid`uals`apphcation has'not -occurred 16rwhichf�q-
or Js ftidbioplete,
by det6rmining.:background.,concenirationg through representative; soil sampling.
6. Residuals that areJAnd anDlied, shall meet-Class'.'9 p4 N 904-red f��quifemefits in, ISN CkC.02T
1( and 1"06, d Exceptionst .1q rem 0shal l,bespecified: i�a-..Atfa6hmeniA. [13 O_Ac,'
2T
Al 09
;.711. _qthis.... " , - �
7. 8 d during the :treatment of domestic
umii pr9w, wastewater; or, or �an
thebi I I i I-Ared ent of indusirial,wastew"Ater,. and 1 tM
io ogica id"
4sWeIR-U., inAttabliment,A).
that are- land applied shah meet one .ofifie-vector fttha t' dupti6n alternatives in 15k.14CAC. 02T,
kidno lo this 602T,1107f
7 �xccp s is,r��quhlem&iitsball'be�pecifi�dinAit�94M*.A�- [l5A`N­Q`A",
1 06611, 1 Uersian 3 ti Shell

Setback_
tbac
feet.'
MOO
'Habitabte residence or place of public� assenibly. under separate ownership or not
,'to be tapiptai0ed as ';art of ptqjpct,'site.
1W
Pr'Opert'y'lines;
501
:Pf.' - aw-of public water supply
166,
Siirface.,waterS­(streams ,—intermittent and peferimi-ail,perennial .w I aterbodie"s— and
50
'Wellswith .exception - to: monitoring wells
NQAQ 9- T.,
-9,. Setbacks Tor, Class Bland applkationisite§ shall be as follows;
Setbk,k,by. appficatiodAm,
(feet)
Injection
ScitbaekDesc 'nti6d
Surace,
Surface
InIcor W p n
or a, o
Applidatibn
Application
, , ,
Habitablelesidence -orTlac�6 ' of publicassembly
tind­ t-o', cr,h' pruot, -to"b&rnaitfainedas.
_qr, s, pgq,e. wn s. �p�
4,66
406,
-200
ilo& t edt:.�ftb� Part PrOi
HAitAble r6sfdonce:.-or,-Pt;icos;i6f,publi6 assembly
owned the fftiWk. ihe, w6tr of the and 0- the
y , o,, , land, � , 0.
'0
240
'0
lessee/operator of the io. be maintained. as�parf­
o'f the !Iebt site
Propertylines
-5.0
150
50
Public
� right of way
,P,nvate:,or-publie,wdter,,Sup.ply
10,0
_10.0,
Surface ­. w- atIeIts (streams ihtqMittqgt an4yogeqzua
J00
1,00,
50
pdrenniatwaterbodies,and Wetlands)
Surface water -Aiv
25
100,
25
*4tqxyay ditches.
'Groundwater 'lq*er . iq ditches (where the* bottorti'of
25.
100
25,
jhedjtch ihtef$bifts, the RHWT)
Subsurface groundwater lowering,system
WeIls With exception to monitoring wells
100
100
100
gedkock-6utcrom
25
Top of slope of e-nihank-mehts--or,-cuts eof"tw.bfoet4it�-I
15.
15"
1.5
more In",vertteal, Wghi
Building foundations or b &tits
I OW
�0,
is
'0
Water lines
10
0,
'NitrificAtion
_,O
20
0
NC , j,,,AQ - QZT 0)
,WQ000528I:Vei§fofi3`i.9 "'Page 3._-.dfT2'

'ti10. Land app cation Areas :sha, I d- clicarlyrnark d on, each site prior to and during any residuals 4pplidatlbn
event: [.1 5A NCAC 02T .01 08(b)(1)]
11 Bi&res1i,d.u10s and, other sources:dPlAnt, Available Nitrogen (PAN) shall not be applied in ex6eeda'n'de
ag—ro n,,,o,, m, 1, rates. Appropriate agronomic rates shall, be calculated us" d using 0 ic.aic­ nitrogen
requirements based on the.determined Realistic Viol -any.ofilie following
d Expectations
methods,:
(RYE) using
spe- f
a:, Division7.s pre; -approved site ,specific -historical dat& for ci I '-crop-: - soil .-types -by calculating..
c,. 6�
the mean of the; best thrice yiold8, of the: lastfiv&cbnwcuti ilicid,
ve crop�harvests fo.r,each.. . fI..
North Carolina Historical Dafa.for° specific crop and soil types as provided by_N',6ft 6Carolina State:
University Department of Soil .Science
.,,(hiW://nutribnt!§:soil.ncsu.edu%yields/index 'A copy'
-
shall .be ,kept ,onfile ati 16 ki dvveryfive-
p years in accordance with Condition IvA,
-c. 'IftheRYEcannot, be determined using xneihods,_(a) Or (b)-aboVO, -the.Yerihittee may -use the RYE
and'4PPTQp i te nutrient , ap plicAd_ionrae.s,repote Inanyofthe161lowin-d6cu ments:
jw, Crop management ,pilau as, outlined by the local, Cooperative- Extension Office- the North
Carolina Department; AgricultureI , an , d .Consumer , Services, the Natural. Resource
Cotig6iuAt,ion,See'rvi"c'e,, or other sagronomist.
ii. Waste UfflUation, Plan as -, outlined by to Senate Bill 1217 ffiticira9 ency "Group- -Guidance
.
Document: Chapter 1
littn://w�vw.ncagr:aov/SWC/tech/documents/9th Guidance Doc 100109pd Q',
in. Certffio& Nu#x eat 1Vlanagement Plan as outlined• by.- the Natural Resources COnserMid' n
Services (NRCS). These plans must meet-, th:e USDA MRCS, 5,00 MItfidilt MR
ana ement
Standards, "ftp-Op-fc.sc.e'g'ov.usda.z6v/NHO/prActice-stafi,dards/stindards/590.pdL.
d. Ifthe ,RYE and lap appropriate hutrient:a plication rates cannot be: diciermiq
pf p the PerrififteVAall
coniact-Ahe Division' io4ctermine necessaiy, action.
1,2-. When residtials are1and.applied fo-gr PA by;
.47 nitrogen sturp, hay crop fd listic i itrpgen rate shall be
2510 in accordance with the USVA­NRCS, 590 NutrientManagement Standards:, [1,5A, kO 02T
.0108(b)(M]
13, If land 4pplic�afton��ites.are-tbbcov6r,:-'§ded-&d'�ordbtible-cropped (e.g., Bermudagrassint summeir
­
fd
And,, 8g..iiiihowijiter.w-iih.,bo.th.crops-.t6.rec&iv-e.res ual thcAthe�.!se.Ohd ,crop canreceiv -.an
application of 'PAN at -a, rate not to -exqeed. 5 0 - .
-_-i pound peracreper year. (lbs/a'c/Yr)..'This ,practice , : may
be 4116*ed,d�lbhg-4s thesecond xrop is.tobe harvested,or grazed, If the'secord cYppjsjozj*, PIaitedfor erosion-conirol :only and is to be iffied'into di-6 qO,_theff 'd _­
AP.,.0d.iti6hal RAN --applied.
16 1 b') ,
NCAC'02Y.0 _8(
14,,,Pn,or ioJand applicdti6n.ciftesiduals confainin.' M g a sodium adsorption ratio ($AR) of 10 -,Onhigjier, ..the
Permittee:shdit obtaiff and -.'iinpl&inetit"ttc6mhrldiidEitidns.,ft6rfi at'least.-one bf:thefollowing ,thic local
,Coqpiefad Ex en§ibn Office;� the, Department : .of A and, Agriculture Consumer Servicesd' Namtal
,Resource Service; _&NOrih 'Carolina, Licensed d ;Soil $c 'i -ientist! oranagronomik The
'tebbOuneridAtii shall 'address the sodium application rate, soil amendments fe;
mechanism for rnaintain i- ing-site'liftegfity-qud 'Condi iojls,conduc'ivoltb'OPP-OroMh,'Tb- rinittee shall
_f thicserecoifimicndatiofi�.-afid detail-s of their ,, implementation. [15ANt�AC-:
,,,maintain written records,of
02T,,.Q108(b)(1)
V Q 9' W", Version 6t,Vdisibfi 1, 1-201 '-Piip 4 ofif_12

�id s f 4pp �Pq. op, SIPS _1VVPre.,individually_ , permitted:,
T f ti "' pennitied on or after 'December 30, 1 q83;!
,g either 250 feet- ft.,qm ft f
therefore , th& complianceboundary is established rpqj44a application
bou _1i atl6n
area, or- 5-0 -feet ,within the -prop­e1rty,boundaty;w- Ih-i'c,hever-is_:c:t.o,se, §, t1�t,o.thc.r"eSi.d allandapplicationarea
:
e9deudPACP, �Woo#dyatr qpn standards at or Beyond ,the compliance boundPy`is subject to
remediation
action,. according to: 15.A NCAC 02L, 0106(d) ( U as Well zs',:enfbrC'm-'e- ;enforcement actions irr acoordance,}wiih,'North",Carolina:General Statute '141215-.6Afhroug_h 141115.6C. Any -approved
relocation�,OIJXIOA -Wli 1� .
f tAd, Q 11 be noted iriA ,a
.01071(a)]
16. The review i oundary shall be established,midway, between the compliance and the residual
land application area., Any txceedance of groundw.Aet standards atthe l review boundary shalttdquke
Actioh.,inac oroanc.ev 15A. CAQ 2L,.01'0,6 [t5AT4 C I
-,.C, R­­­ 0- ­ '' .' 0 LAIN_ � _ ­1 Q.. 1, - 0 1. _ CA _
OPERATION AND MAINTENANCE REQUMEMEENTS
I. The ;residuals management, pr_QgAT:9halI beoperated properly maffitatn-e'd, and The;
program shall be; effectively maintained. and <,operated,as.,a, non-disehatge,­systern to prevent any
contravention of 8u&a wat&pr-grq4pdwaier-siandqrds.rl- 5 A - 02-
,
".5i The Mooresville Regional'OM-'ee:shall ,b6notified via email,ort6lephone,,(704)663-.il699, dfleast-24
hours pnor to=conducting any land application activity. 'SuchJni mum,
&I, indicate,, V ­
01PRO., 414A
the: anticipatedapplication times,,tlQld-Is, and locitimi,df land app
lication activities. If it:
PCc9ss4ryIq qp d ional fields due unforeseen events, the Regional: Oft ,pjyl-tb"a di't UeA0 u led,
qq�sl�gll be,,notff
prQr .. ..mrnprping._p�app application _014$jl�ANC
A
4'. Tfie'Permfttpqshall ,Mafnt_ , aftyan approved Operation -and Maffifenance,Plain Plan) Modifications
;tO,the; .O&M Plan .shall b,OtApgr'ov.ed_,bytl ie,Divisiozr prior to utilization, of the new plan! the 04'M ]Plan',.
afthe,minimum, shallinclude-
it.. .Operational irwictio , lis,
b< Maintenance schediiles,!
d�. Safety measures;
: te:s;
d. Spill.r6spofig"laii
Inspection " I d" the°following infolpnartiori.l
i,.- Names and/or titles:of personnel "s e�. nfio . ns rsonn respon ibld�f6f c6fidiicffig th 'isped
'liz Frequency
, - location iftspectiqrs; including, ihoso to�be conducted the ' J;
pi6cddfreI0,assure &au,,e sepc,ed,l0catibn( and bmspectifte4ue .frequency re r,es n at v
ofthe-residuals ,mana me rogram;-, management
'i -Dbtaled d&sd6'o0­o,-8tInspcA,i61prddedure, s including AUi­onst6'beAak6h,,
'bylhe.- ihspectorin't1w event.1hat- iance s observed noncom 'I",.-Pursuanf to the noncompliance p i.
oil
fi,: Sampling an&monkoffng,,-plan including the following -information
-
is Names . and/or titles. of L 8poosi-ble-f6kc9nd4cimgthe sampling and monitoring;..
I di 41- Detailed.-description;--ofmonitoringproceduresinc u iq,,parame ers;-,to-bemonftored,-..
W - '294 Vdf§i6fi 3'O of 1',,2

i!) Sampling, ftoqueAcy and Procedures t6 assure that representative sanpI:are bei g,do! acted,
Fluctuation in temperature; flow,,,and other operating coed ftio
ns.can dffect the quality. of the
re pduals; ''h - -d during sampling event; The sarn . lingplan shaltac count'
s4tere p -for Any.
foreseen fluctuations4n residuals quality and indicate the mosf-firn , Affig'Airneg Bbrre§iJuAl§,to
meet pathogen andvector attraction red4ctW requirements (e.$ facilities "that land apply
multiple ti A but have an Annual. sampling frequenc 'need to sample during
mes.pqr.yeg y; may
'need
when pathogen reduction is most likely t" be,, negdtiVely lw ',,affecby --cold.
temperatures):
rt5kXi- 1
. ­ QAC 02T, J,00
Upon the Water P61lution Control "System Operators Certification Commission's
-(W-PCSOCC)
tiob-O
.0tassificaf the f it'y,,.ft Permitted ; shall, designate and employ a.certified .operator iWfpspOnsible
charge-('ORC) and oneor.more certifiedoperators,,as back-up ORCs: in accordance With ISA NCAC
I ,
080.02011. or shdll,vi§tth6.Tacilitids `-NCAC PAO:0204,
Thc ORC 1­1 . i in accordance wiffil5A
,or ,,As specified :hfthia�ynost recently O&M plan (i.e., see Condition comply
ly
with all other conditions of 15ANCAG,108G. K04.'Fdruiort�ifif6hhatibn fegarding.classification,,an,d
i contact Pj ase" -the Division of Water Resources' Pfote,qfiori a,ud'EOokcempnt
Branch at (919) 707-91055.,[15A NCAC 02T .0117]
6. When the -Piland -applies,",s N 1k,fdsidual ;, a,c6py of this permit -an . d a copy of O&W'lan shift be
'A
ru I aifitained at the land application sites during. land Application activities.NCAC[15A. . , 02T
7., When the Pei-mittee transports or `Iand,.applies bulk residuals,, the- spill c OntrOl ,provisions shall be,
.maintained in altresidu I Is transport and application ve ehicls — [I 5A NiCAC 0.2T fft 0]
S., Residuals -shall not ,,be stored, at arty land application site;:unlbss written -approval has --t
een requested.
and received from the Division. [G.S. 11437'2;15j]
9, When .the _Nrmittee'land applies, bulk residuals, adequate measures: shall be taken '- app prevent Wind
,erosion and surface runoffIrom: -conveying.xe8iduals 6brft.'the, land 'application sites 'onto adjacent.
properties o,r-into surface waters.
1O.'When -the Permitted .land app
lies bulk residuals, a: suitable e cover
vegetative co r shall be maintained on land
application ,sjtes:onto which residuais,Are.appfie4, or application shall bedn accordance:,withAhe abij
management plan outlined by the. local Cooperative Extension Office, the Department of Agr
iculture
and Consumer 'Servlices.;the ,.Natural kesource- o"sPfYAti0n_Servi
ce, or an.agronormst: and as approyed
w the NVI'sion'. [15ANCAC-02T.11.09(b)(1)]
IL -8ulk, residuals shall not be land; A p the following vlic4 tin..der conditions:
,A. Itthe
are y �Jik I ' t adversely AMU. athreatened or,endangqred,,speC' s4i ted under. 0, o a verse,y 10 s ersection
4-ofthe-EndangeredSpecies Act or its, designated -critical- habitat;t
b. If the. application causes " 10 , 'ed,huisd6ce vonditions;
-Pro - ng
C. Ifthe.,Iaridfails to,,qssitnilai6-thebulk,,r6sidualsor-th64t),olic:aiibii.causes _the 'contravention Usurface
water, or groundwater standards;
'
If the ;land is flooded, frozen 6rsnowmcoveredoris,o
', t4em.ise —I in , a
condition S0dhthat .runoff of the,
-residuals would occur,
e.. Witliiiithe.1,00=ye-arfood elevation, unless the bulk.residuEils.areipieciedo-'riryc'--'
orparatOwl in A:
�hour:veii6d,fdflow�ing-,a-r��id als"land
247 u t,
f. 0 bl '
, C tAti6ft Oent. (i.e., greater: than 0 .0.1. inch, per. hour); or -2 4
- e
hours::
Nirm log -a rainfgl,.e.v'eiit--of--0.,�5inohes:or-.gre,ater,in a.24=hour period;
Version
.15,12011Page-&ptjl

'if. ifiCI j e,is greater t.hdi 1,0/;,fo,rI _ffi, "e,app-tedliquidi re-si-uai s, orjfthe ,,slope 'i greater thah
for 'ect s;.
,18% ii�ij ed�,or,incorpor.ate�d'b:ulk.i.liquid residual'
fi..If the :soil pff, is "not -maintained, ,at 6--.0. -or greater,uol'ess. sufficient amounts ofluilie are applied to:
achi6vd.a::firiat_soil pH.ofatleast 6-O,o'rifan4groii'orhist-,,ptoVid6§iiifoftdti ffididatingthiitthe:
pH,pft.,,spilire,$iduals�,and ,fiin,cmixture is suitable:f6r-the. specified crop, Any approved:variations
to the acceptable soil pH,(O.0) will be;noted in this perni14l
is If the land does not -have an, established vegetative, cover ,unless the residuals are4ticorporated'or
Injected within . `11'
YVI a'raidb land,qpp*io qyqot,. Any fid'14-that is, 144;
USDA no-till,p.rogram,,shalfbe,6k6mpted from -meeting this- v­,`6 e-t6tivecoverrequkernent;
If the vertical ,separation, I between the._,,seasona I :High water table, and the depth of residuals' -application- is less ftii,on& foot;.
k. If the vertical .separation ofbedrock and the depth of residuals qpplibation isless than one fool;
11 A00liciftiOn exceeds agronomic rates;
12. 'The .foll6* piiblC. i access: .fd§tficti6ft§�.;p I to residual larid<application sites
:
a 10 'Publi access 4o public contact sites '( ., - .field& etc.) shall'be restricted. p.g., golf courses parks ball' Oqs after -a residuals or appl
ication event;
b. 'Public access -40 non-public -contact sites -shall, _be :restricted 'for,10 days after a residuals land.
application event.
[15ANCAC 02T,,,.1109._(b)(2)]
Pubitc.add ess-,do t,rq18 s-fiall' 6,1ude he pasting' signs w 'a min
imum area of'3 sq0-$0,q (e;g.
,�X,
L-57, T). Edch;sign shall,,indidater the activities.cotidiictedlateach site, p6rrAit,hufiiber, alid,name and..
:contact information; bic1uai4gthe ,:Pierm`1ftee or Aqggr ap 's t6 Op4p uniber. ,Signs shall posted,
In a clearly visible dnd_coijspJqupqs, ni -er at the entrance to each land ..Ap*Wdn siWi during it land.
in' ,application, event _and,for --as 'long as the; public access restrictionsT,xquired., under"Conditiom .12,
Apply: [j 5AN 62T .6 i J;0)
(1)]
14. The,f&llowingi harvesting and, grazing restrictionsapplyto residuat'land application :e
ach
ach
;land application event; '
Arqstfng,4"d-Gr g Oescflppifon
Restricted
ni
g­­qppli,cI-a-tq activities and
..
Yegt4tUdperiQd 'Sitesthatare.to be'used forgrazIng-'sallh­ve fencing -to:
30 days.
prevent access afterea6h. land, appficitionevetit.
food jcrops;edd ctpps�,-and fihdr.c-fogg, ihall t'b'- harvested
Tu Spw-hon" land. where ce" & b map e or:, ;applied §ha1l.A6,tbd',har­ve§t d'f
12 months
Food il mixture and
I
totally'Al ove..the land ��surfif de,(O;f;.,_tobacc_Q; ijaclotis;,cticiuiiher.§,squash, etc;):
.14.1mi-onth&'
shilfnofbeha
rvested for;'
'W_h0fthe rogi&a'10 a thq land fitg�f ogths,-&'16ggo�t"pri9r,tQ
,-"incorporationhtcthe soil,food crops with harvested p*t§:beloW_The,land
'10 months
surface. :�o t1C crops such potatoes, ;carrbts,,radishes..6tcshall ,not he
.Vheh,the,residuals remain,66"., is aftid:s-b"M Q;B006§911i bidr-."inofift, prior o
,incorporationInto the soil, bod:crOps:with harvested pads .below the ]arid
3.8 monihs"
surface shall not �e harvested %�-; -
WQ0605281 Vefsion'3.0 ShOLV.6rsi I 15120'1 Page '7:�6fff

[15A. C"PT'. 11 199(U)(3)]
15. The Permiftee. shall acqui
re from each landov T Ids - 61 'or a Statement d6tailing,,Ihc volume,
of'other nutrient sources: (i.e.,manuflictdred fertilizers' manures, or other animal vaste,-pf.oductS)'thdt
t s
.have been applied to, thesite; and & copy of the mo,txeccnfNptr e AgOrpO Plan (NNW)'for.those.
operations .where aNMP.is,re-quirea by the U$ DepAf0hbfrof Agriculture - National,kesources
Conservation S&rvice.(NRC$) of other,Stdtei Agencies. The Permittee',shallcalc6l,iite allowable nutrient.
'loadingrEfies based on the'proVidedijitortp information d u- appropriate . i . ateJ .1 du cti'O'hs'-.. at use -4. ap rp
p
For .the &rp6S9 ofthis ;permit condition,
. a: Cf,op Maliagement'Plan- (CMP), Waste'Utilization Plan
(WUP) or Certified, Nutrient. Management Plan (CLAMP) shall also. b6, considered' a,'Nutrient.
:Management Plan. [1SANWAC;0 . 2T.0108(b) _02T!:.'1 1'04(c)(4)]
16. No rdsiduals shall, be land applied unless -the ,submitted' LaOdOwner gedhe t- ttabfimbit
(LOAA)
between the Ferniiftee and landowners -or oper4t rs� lesSees/ of thelazed application site is in full, f6ree,.
__. ..
,and effeqL-. These agreements Shall be considered -expired concurrent with the permit-, expiration date,
°and shall bexenew.ed-duringthe permitrenewal process'. tI5ANCNCO2TI.110.4(
IV. MOMTORING AND -REPORTING REQUIREMENT&
L Any Division required monitoring (including groundwater, plant tissue, soi . tand surface water analyses'
bece§9aty'.t.to ensure groundWater and, surface, Water protection shall be established; "q an a6ce tMable
sample reporting schedule shall, befollo'wed. [I 5.A. N.CAC 02T..01,08(c)]
1, Residual shall,,
041y.,204 tddqrft0pW.AtO they af d. non 'hazardous -under the Resource Conservation
and Recovery Act:(RCRA).. Residuals, that tests or is classified as a hazardous or toxic l waste under 40
reactivity, and tdxkity ,chard
disposed under ' thisermit
i_Thp analyses [corrosi*fty, igntibillCFR Paft:261 shall, not be used oderiStk leathingpiocedire shall be ppiformed at. the
frequency Specified in AttachmenvA, and -the Permitted 'shall maintain these results for aminimum f
0
five years, An eXcepti6ifs fro' -the requirements .,in, s
this condition shall, beFspecifi
ed in Attachment A.
The TUPandlysisshall include the following parameters .(the ,rdgu- ifig
xory—ow illigfarpslper.liter.
is,in_parentheses)�-
Arsenic (5gO).
1,4=Dichlorobenzene
Barium�(1000):
'Dic
1'2 N6rb&thane,(O 5)
Pentachloro �ph
"Be"hzdne, (0.5),
1,17'DicWoroethyldne (03).
Pyridine (5Q yri. i
Cadmium 0)
2i+Diriitrot6lddne (0.13,)
Selenium. (1.0)
.Cdrb6h"te&dchlbri&
Ehdrin (0.02)
.Chlordane!,(O."03.)i
Ilexgehloroben2ene
I I K ord6thy 6ne 7),
Onzdi.1
Heptachlor (and itshydroxide)
0.008
C-Moroform,6'A
Hexa Autadie -(0.5), phloro4,3 ne,
TrichloroethAene (0.5):
�O-O
Hc-n(
t3.0
_,Tbh(4)ChromiU
4c
C, Sol' m, re
2,4,&,TTichlorophen 01 (2.O
O=Cresol.(200.0)
Linidane.'(9,A)'
2' 5 TP'(9ij
p�Q '(2 jesol PQ.0)
Moreliry,- (0q)
Vinyl bhloride(0 '2),
MOhoxychlor (tO.0)
'2AD"(10-0)
Methyl ethyl ketone
-o:2
io J NVS f­1­

'Oneeihe.residuAls-have-'beenkmonitored f6rliwo-vears atthe AitadhmentAj the:
Perrriitlee may ,submit' a permit; modification 'request t' 6 Iho-= frequency''Of this�;' r ing. , , p, reduce
,requirement. -In,.no case: shall the�.monitonngl,frequency.,be,less.thanonce per. permit cycle..
' N - - [15,-A TCAC,_13-A.6t62(b'_ )j OTT A 11101, -02T:. 1-1,05],
.I., Ant analysis, hall 'be :conducted .on residuals :from each source- generating Mcility at the frequency,
specified in Attachment Aj. abdAheoPerinittee shall maffitain the results for a minimum of fiV6vears>.
The ,analysis shall include the fol,lov�nng parameters::.
Aluminum
Mercury
Potassium
Amftionia-Nitrogen,
-Molybdenum,
Selenium:
Arsenic
Nickel
Sodium
Nitrate=Nitrite Nitrogen.
sbdium.Adsorption-Ratio
(9A,
Calcium
Percent Total Solids,
TKN
,Copper-'
pH-'
Zinc
Lead
Phosphorus
Magnesium
`PlantAvailable.Nitrogen.
,.
(by calculation) _.
C-T
­2 11011
..
4. Re§iduals, 'shall be monitored Tor compliance with: pathopn.:'atid- vector : reduction: attracti'oil ,.,
requirpffidnts at, _b�yequpncyspecked 'rnA
ttachmentA, #nd'At thd `time indicated inthe sarirplrng.and,
:monitoring ; sections ofthe. approved O&M plan., The:required.datashall bespecific to the stabilization
, pathogen 'reduction proqess_ utwzed,,and sufficient � to demonstrate compliance with the,, Class
uiremeift4n,
-eq
ISIX NCAC 02T-1-107 (zt),Shallbe, mei.-"Any exceptions -:from
_ . * '­ ._ the
1xequffenents-in-this condition shall'
bo� specified " AM AiANQAC QZTIIQ� 2T,.I07, 02T Tjjl-
5, _Awannudt representative soils analysis ! O;e..- 'Standard Soil16rfility, Analysis., shall be ,conductbd,oq.
each': bd apphcatiori si40o-ist0l i`h'Att4ch­r­fteIhtB.o#,which 4—x g­idu,al­' land application Oofitvill occur"'
in the respective calendar jeaf.- This; analysis, shall be. in accordance wwithlhe,'"Guid.anceon Soil."
Mp 449located IPIPated in ��qTp`jiqg,..'Tnstnf9O Instructions section �of the �A re
"I Obric Of Agriculture
Consumer S&Viceg' *615§ite (httD://wWW.ndAO. g6v agr. onomi Pu6slititi). ThePermiltee shallindifitain.
these results and ,adiDscripfion,oft,hesampling,methodologiegused--t6,,deter,tftine-,,gdi fertility for a:pefibd.
of no less than five -d` hall b
e..made .available
ionupon request.At:A--- ifiinnlri,,,rthd,
'SUndar,d;,Soil,,Feitiiit.y,,Aiialy,*s'is shall"include,the following parametcrs:
Acidity
Exchan -
geable 5b'dium ..Perpen a .,ge
'Phosphorus
Base Saturation,(byzalculatiorij.
MEgne� In.
;potassiumAu
Calcium;
Manganese
Sbdium,
'Cafion"Exchan9P Capacity
4ty
Percent-flumic Matter,
Zinc:
;Capper
`pH
,[15X,NCAC- 02TAIIII(0)]
Wt be p- applied, -and .6� t&r4 parameter analyses ti 'ioAdWs��,4s�, land"'1;Aalt
'A -
..bein accordance wiffithe,-monitoring,re4uirements in 16A, NCAC62ff--_05654 115 it X 50,5
S '5­

7. ThePprinfitee:,shall maifitaiare.cordsAracking.all-residuaI land application-everits.Ata in' in
records shall'inclade-the fbll-owinig-, iftium,
a.. Source' of residuaals;:
b: Date:dfland 4pplibation,-,
c. Location ,6,f'land ,application or'z6tie,;numberas',Ii§ted,ihAtta6h Attachment nt, B);
A. Approxinate areas ap6lied to (acre
s);,.
e.. Method, of land application;' _
T W6ather,condifions (e,.g.-j.sunny,, cloudy, rai 4g,�;_etc., _ni
Ptea in -8oifk ,ping . U nit (e.g:, CbB2)';
h. Soil conditions- (e.g.,, dry, wet" frozen -etc.);
is � Type.-- of crop or crops; o
be'grown on field;
i Nitrogen Application',Rate based on RYEs (Jfuis�ffig data, obtained " on! State
Vniversity-Department of Soil Weibs4ej,� , he, printout ,page shall be kept.on file and reprinted
every five years); -
k. Volume of residuals) applied 'in'gallonst)-ar°acrel. I yard "pPr Acre, cubic-. dry' Ion s per --acre or -wet
top, per acre;
1. Volume. of animal wasfe..,or other nutrient source -applied 'in gallons per acre; dry:w
per.acre, or
'wet tons ,Peracre4,
M. Volume of biFame ndm6nts li �ey, acre, -
me, gy.psum,,ete'�applied'iii-�gE(Iloits.p dU't
PrIper el
,or wet tons 1)eracre*,� and
Annual, and ,cumulative totals in dry tons per Acre; of residuals as well as animal waste and',-piftr
sources.ofhtitr,ients'('e.g,.;,if,,app'licable);annual atfd,cumufati,Vopounds per 'acfd--ofeach hdavy'metal:
(e: -, shall jW4&, but shall not, N limited to arsenic, , , cadmium:copper, lead; ead,,mercury,.,
ifiolybdenim,,rfick&l',I,selenium, ,:and.zin6),.,annual',pou'nds per acre of PAN, And :annual, pounds. per:
acre of phosphorus 4ppliddtq.�eadh field.
_p p - -
[15ANCAC 0271.0409(a)]
Threecopies f,annual,-"1 1, be copie : o, anrq�port sho ., submitted :on or befom M shall
- - ,requirements
_§ - I__ArQh P%. The annual'r
me6t,the�req ' uirdnient§Aese-ribed in the l,hist.ructions.for Residuals Applicafign.-Annual Reporting Forms;
`Initructions for repo and'. annual fq, forrris: are -available. At,
:http://portaI.nq&nr,.or,Ww 'QV ci/aDs/1' quVreporting, or can be, obtained. b9
y contacting thel Land
Application Unit directly: The Annualrep.6rshall besubmitted tiothe following
bly"Isi6ii of Water -Rqs6 Resource
s
t Itiforination..Ptocessing'Unif
1611 - i , Mail SerYicjeCehtor
[15AN CAC 02T .41,11 (6)]
W, ers Q,900.328,1 Ve idn,3 O� ;Shdll'V ion-J51201 tt _ , 'T
. #g

9.: '1�Toacgmplfiance Not#`zcatoi
The'" Pennittee-,shall rep ort'by-telephbi,icto.�the, Mooresville Regiarial. Office? telephone.nui ber (70'4).
663-1699, as-soorras possible but jn no. case more. than',24 hours or.on;the nextworking day following,
the 606 dice or first knowledge of the occutreote of any of .the foll'-Wuig
a. tand application -of -residuals abnormal in quaiitityor characteristic.
b. A6yI5 ilure of tt e land application program"resulting in a'reiease :of rnater al to $uzface waters.
c Any" time- self: monitoring indicates the facility has goner out of -compliance with its permit.
limitations; ,
A. An unit failure; due to ,known or unknown reason's,, rendering the facility incapable :of
adequate-lresidual treatineint:
e. Any spill.or discharge-froiii avehicle or piping system duriig residuals transportation.
Any°emergency requiring mmediate'reporttngF(e;g.; dischaiges°to surfgce waters, imminent°;failure of
a,st6i-age,struct&e etc.) outside noriinal business :liours..shall be reported to :the Division's Eniergency
Response'personnel at telephone".number (80% 662-7956; (8001858=0368, or;(919) 733 33.00.Persons
;reporting $uch occu%renees ;by "telephone shall_ also the a wrote report in letter forin withii dye days:.
following firstknowledge:ofthe.oec."uirence. This report shall outlineahe:actions taken:or pioposed.to.
be taken,to;ensure that ihe:problem-doesnot"recur: r1.5A'.NCAC OZT'0105(1), 02T :0108(b) ("1-,)]-
V. `INSPECTIONS'
1, The Permitted shall.'provide adequate °inspection; and iim'amtenance to=ensure' proper operation of: tlie-
subjectfacilities.and shall.he.in;accordance Witt _the approved .0'&M'Plan 5A [1NC/AC 02T.0108(l )j'
2. Prior"to each b"ilk residualland applicahon event, the Perinttee, or hisdesignee "shall ;inspect: the
residuals sididge, transport -and application facilitiesato peeve it malfi rictions,;&61ity' deterio' A" ' and
operator errors r,esultmg; in. diseharges, whi&,rnay:cause the release of wastes to the environment; a,
threat to to. human ,health 'or `a public nuisance. The Pernnittee $hall maintainan inspection; log "thiat:
includes" at a minimum, the .date and time ,of, inspection;. observations:. made, and any maintenance;,
-repairs , or cdrrective actions taken; The Permrttee shall maintain this in specti. - log fora period of five
years from the date .of inspectiori;;and,.ths log slall.he made: availableto :the'Divisori'upon iequest
[15A'NCAC'0?T 0.108(b)] -
3
.Any-.duly.authorized Division represe'ritative.iriay, upon presentation of credentials, enter and inspect,
any ;property, prem ses'oc place on or.related to he. and application sites or facilities .germitted`herem
at,ariy'reasonabletlme for -the purpose of uetermi7
any,records.required to be.maintained under the
groundwater; aurface water or'leachate sa#nples:�
' ,L GENEPAI COl J►ITTONS.
1. Failure to ;comply with the conditions: and limitations contained'herein,may subjecttl e P.ermitt6& to im
enforcement action by the=Division€in::accordancewith.North. Carolina.`General Sfiaiuies 1.4"3'-215.6kto
143 2'15 6C: [G S 143 215 6A to'143, 2t5 6C]
'. This permit: shall. become �void"able if 'the: residuals land application: events are not carried. out 'pia.
accgrdance with thecandztaans of this permit, [ lA NCAC 02T Q1.10]
3-.: This ;perniit is effective,only, with respect to, the, nature::and,volume :of fesiduals=described in the. permit-
application and other stupparting documentation: [G, 143-Z15 l]
WQ0.003281 V,49i6ri3";0` he1l.,Versi¢n Mal :Page'1:1,0€-12,

41i The issuance Of this permit .does :not exempt,theTermitteff from comp
lying: with. any and all statutes,
rules, :regulations; ,zor ordinances,, which -'b d
may � P impose , by other jurisdictional government
en, agencies,
(Og_JqqM,, state, and f-6d
dfdt}-. -Of gaftitular concern to the Divisionar-e-qppjicable. river buffer rules:` in•
15ANCAQ 02B >. 0200; erosion.;and sedimentation control requirements! ift 15A NCAC Chapter 4 and.
under the Divisibn�.s General Permit 9C0QlQQ6Q,,any requiremenperiaining-6. wetlands under I 15A
NCAC 62B,:02Q0and -02H_00 -5,0 - and documentation of compliance with, Article, 21 Part,6 of Chapter,
.
143 of the General Siatutes. [F5ANCA&0_2T_.0 105(p)(6)]
'5.1. 'In the event the., residuals trognam, changes: ownership or the-Pei-mifteechanges his namz;.A formal..
permit, modification request shallbe submitted to the Division. This request shall, be made' -
on official
Divisions forms, and shall include - appropriate documentation
from the, parties
rinvolved. olved and other
.supporting doquhe tat*onas�necossary The Permittee ofrecordshall remainffiIIy.responsible-kr maintaining and" operating the residuals°program permitted herein until a permit is, -,issued to the. new,
94]
6. This permit is subj-e&t:to revocation or, unilateral' ific ti -'60'd#s'_ notice from the Division
_MOO 4tqriupQn
Vag -for the requirpmentsi listed in f5ANCA - C 02T.01 16. 4' T 1 .0.1 1 1 1 0]
$A NCAQ 02
7., Uriles§'the Division,Ditector graifts a -variance expansion gffho, per 'iffted,rdsiduals pro gram,contained.
here in-shaffriot,begranted If th'eftrmittee, ONp#i0lifie& any
oftW critetia-in. 15A NCAG,02,T.:0l2Q(b),I,
[ISANCAC02T.0120]
"The:Perrnittee shall Ipay .the annual fee whfi'
i.n.,3,0'.'44ys,'-,tfterbditigbilledby. the -Division.. Failure topay
thb: annual ,fee 'AccotdiAgly shall be cause: for -the: Division to-,jqyQk th' � 0- 0A NC C.62T P J is'p MY A
Permzt;issued this the 3.4-11"Iday Of M420(16
NORTH- CARPILINA_JENVIRONWNTAL MANAGEMENT _COMMISSION'
SS Jay-,Z Zimmerman; ., Director, , jffi map, P-G
Division of'%fdrResources:
ByAuthprity-of iheEftVironmental Management . Commission
.
Nimit Nii m'­,b.er'WQ.q0,03281
W—Q-00
SMI'Version:,.15f201 P;ig!i TZ of 12;

ATTACEMENT'A -A-pprovedRegidual Sources.:
City -of 1§01monit
Residuals Source=G6nerafing.Facilfty,
Permit Numbor WQ000181, Vers'ion:3.0
Approved
M
'MAxirn:Um--
Monitoring
1Vlomtorin'',
Mbqif6 rHI9:
Frequency for
Min6raUafi fi
%. R , at c
tDwner
Facility -Name,
Termlt�
-.Nu.mb..er
AesiOual.s'.
MyTons
Frequency f6r
Non -hazardous aza'rd6us
6equency,or
Mitals.-arid
Pathogen &-.
[Raw. -- 0.4-
Per 'Year I-
-Z
Characteriiiies'
Ved'of Attractio-fi.
Reductions as
-Adobic: * 0,3;
Anaerobic
co mpost'= 011
City of Belmont;
y�of
Annually -Annually,
Annua y
U. 34
T6taV
300
T611sper.W . ear amount is,the.am t of'residuals ,approved -for land application:from,Cichpertnifted WiIiM.
2. ,Analyses;to demonstrate hat residuals are non hazardous t' dtPi jgnitZ6 reactivity; anif corrosIvio-asstipulated imder p n: IV,
permitCondition -.,2.
Testing-qf -41&,40tje#�
Ps'stioul4te4iffi,d_fpeM�t.C6 Idit,.i— n.1
Analyses of stipulaiedund -penilif Condition IVA. pithogen,and vector attraction er.
b fess, specified 5.;'M - ics.�are'based OnAeactual jq. tons�app6 d-per year using '' if
omforkg�&quenci; gthetable elow,,,uti s icd above—,
bryTons-Geucrated
'Mooftoring.,frequency.
(Established in,40,tCFR Mazid ISA.W AC 02TAID)
I/ Qtfarter(4--tifiiespery ear
=�1,650-46,3,00
I'Z60 paysO-.'tijines &ryLar).
>I 6�600
Vftiofith ',(12,.times 1*e,,ear)
lf`fto..Ian-d appli6tiowevenis occur during a required sampling period land :application. occur during an,entireyear:-when annual monitoring is required)i then,no
sampling data is ihe,-iperlod 6f"4hacdVItY: The annual report. shall include -an,explanation --for, missingaampfing ddtak Those- req.tifred.tio submitAfie:annual
Report to E1PA may be for Aditi6natin Pi6miAtion And clarific6tiono
required to n-i'a-kei u- missed sampling,:cO c th'OTPA
p
Wq00632971- ersion 1.0' Att4litrfent.A. Page Lof . I

" `0 � a � ; �

,A*TAQl.MEN rovAd-Land, A pleatlossites
City orReilanon
f
,Certification Date: May 3J-j 2916
Tbrmit.,Number..'WQ606jlgi Versifjnt 10'
FieldIrSite
Owner
Lessee:.
COU14-
Latitude'
Longitude:
Neil
-Acrem lie
minant'Soil'Seri6s
F66t-uoles.
BT 641, 7 NC' -L"16,000-01
Tony Jones,-
t,iiicohi,
35'A64147'
-81.w 1 28330
270
CeM.-Cecil Sandy :Clay LOarn
3 JNC -�L 46-03
Tony Jones,
.8.0391,759�
-
2 T
C691,Cecil S4ndy,Clg:YL6am
BT 0m01-d-NO'O''A'w.009-01
`Lon. Warren
Gaston
35,390806-'
Al..'Om470'
42A
iiaB2 Gaston UICIq Loam Sand
Total
82.3-
-i- Aqis,plyp'pp.r,ycpnLa-ins twqreqenqes. Kqsicuais',may.beillana.qpplicc.,t6 Within IOU LorWArrm.resider0eat -1407,Alekis-Lucia Road asw OlLas the
Idsi eaceownpOyJhomas,Warrenaf 1401'Alexis-Lucia Road, regardless of wheihera surface it a subsurface application method is,used.
WQ0003281 Versib&3.'0
Attachment'A
Page `i of I

FOR SITES BT 64.01 '&'ST 6-03

•
L
i= wom Luc penmciereTuse mstauai appacation area or5o fect within
tfte pipperty- boundiay, -ibipfiever is ploser. The Review Boundary is established midway betwden the q0mpliaP;p,,E!oUndary
and the perirneta 'of thc:rasiduals appik0tion area.
-jl�-Wl'u V-vj�
27.-0 Ac.,rp,S
Buffe,rc
Properly Line (59
nnfal Stream6,te WaterteeAt 4.j
Per 0
r 0 R.,qht-6 (501)
Progery Line�—fie ''Bbund6r-y f Wetl
Percinnial- Stre'am. House
=D Surface- Waof TOSURE 2 M-ROUREM2
Unused Area CITY O� BEL
CITY OF
on Tony" Buffers Mapf. 564 LAND APPLICATION, PROORAM
i
P p Ir
ree 3691304282
. ounty, Rp GASTON COUNTY,
itedn C zoo,
Lill
jaM3281
- -01 -& S T6
t"OR SITES,'� � Vt 6 I-'03

RAM
FQR SITE 0T 9-01

•
` hd Comptiaitce T3oundaru is astablis[ ed either 250 feet frcit`r the perr�riPter of thetresiduals applica ion ar a or 51 'feet within'
ie,propgny, boundary, whichever i�.elvser 7'l e R� view Bvundary is establcshetl'i�PdFvay t eti�leen''t�ie Compliance �ouiiilary' � ,
�( a��d the perimeter of tlti; residuals application area
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Gas#on Counfy, RAG o '606 9 Apo 2SO.01 lllli l i €3 "
35 39435`2, 81,0, 4 .North carol,n Stat Plana NAG?83 SITE 0 TIC L MAP
z r
F,�~Sf' 9'-�i

Xi�•iJ
RECEIVED/NCDENRlowa
`�^�
�s
%%''
MAR 9 2016
x a
'�- x � ^^
fll10ORES`J1Li_f= R-
�GIONAL OFFICE
[Water Resources
ENVIRONMENTAL QUALITY
January 14, 2016
BARRY WEBB — CITY MANAGER
CITY OF BELMONT
POST OFFICE BOX 431
BELMONT, NORTH.CAROLINA 28012
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secre(nrl
S. JAY ZIMMERMAN
Dlreeror
Subject: Application No. WQ0003281
Additional Information Request
City of Belmont RLAP
Residuals Management System
Gaston County
Dear Mr. Webb:
Division of Water Resources' Central and Regional staff has reviewed the application package received
December 28, 2015. However, additional information is required before the review may be completed.
Please address the items on the attached pages no later than the close of business on February 15, 2016.
Please be aware that you are responsible for meeting all requirements set forth in North Carolina rules and
regulations. Any oversights that occurred in the review of the subject application package are still the
Applicant's responsibility. In addition, any omissions made in responding to the outstanding iterns in
Sections A, B, or C, or failure to provide the additional information on or before the above requested date
may result in your application being returned as incomplete. .
Please reference the subject application number when providing the requested information. All revised
and/or additional documentation shall be signed, sealed and dated (where needed), with three copies
submitted to my attention at the address below.
If you have any questions regarding this request, please do not hesitate to contact me at [phone] or
[e-mail]. Thank you for your cooperation.
Sincerely,
David Goodrich, Hydrogeologist
Division of Water Resources
cc: Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Zach Key — Southern Soil Builders, Inc.([e-mail]) (Electronic Copy)
Permit Application File WQ0003281
Suite ol'North Carolina I Enviroamcnhil Quality I Water Resuurces I Water Quality Permitting I Nun -Discharge Permittitlg
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919 807 6464

Mr. Barry Webb
January 14, 2016
Page 2 of 2
A. Site Detail Maps:
1. The site Buffer Maps submitted with the renewal application should include the names of the roads
Which appear on those maps. The Buffer maps should also include the following statement:
The Compliance Boundary is established either 250 feet from the perimeter of the residuals
application area or 50 feet within the property boundary,' whichever is closer. The Review
Boundary is established midway between the Compliance Boundary and the perimeter of the
residuals application area.
The coordinates on the Overview Map and Buffer Map for Field BT 9-01 are incorrect.
Please provide us with revised maps which include these additions.
B. Spill Control Plan:
1. The mill Plan submitted with the renewal application should include the following in Section 6C:
NCDEQ, Mooresville Regional Office:
The Permittee shall report by telephone to the Mooresville.Regional Office, telephone number (704)
663-1699, assoon as possible, but in no case more than 24 hours or on the next working day following
the occurrence or first knowledge of the occurrence of any of the following:
a. Surface disposal of residuals abnormal in quantity or characteristic.
b. Any failure of -the surface disposal program resulting in a release of material to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons,. rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system-dur.ing residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
Please add the above verbiage to the Spill Plan.
C. Sammons Plan:
1. The Sampling Plan submitted with the renewal application should accurately describe where
the samples are collected. It is our understanding that the samples for 38% Volatile Solids
Reduction are collected at the Holding Tank (not to be confused with the plant aeration basin)
and at the Storage Tank (not to be confused with the plant digesters).
Please revise the Sampling Plan to accurately describe where each of the samples is collected.

southern
soil
Builders, Inc.
Friday, March 04, 2016
958 Hoots Road Roaring River, NC 28669
[phone] Fax [phone]
David Goodrich
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting
Non -Discharge Section
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: City of Belmont, WWTP
Permit No. WQ0003281
Additional Information Request
Dear Mr. Goodrich:
CEIVEDINCDEQIDWR
MAR m 7 2016
Non -Discharge
Permitting Unit
Enclosed with this letter, in triplicate, is the requested additional information that was requested
for the permit renewal package of the City of Belmont's land application permit WQ0003281.
The information included is:
A. Setback wavier for field 9-01 from Lori Warren, for the residence at 1407 Alexis -Lucia
Road
B. Setback wavier for field 9-01 from Thomas "Tom" Warren, for the residence at 1401
Alexis -Lucia Road.
If you have any questions or concerns, please contact me at [e-mail]
or at 336-957-7871.
Sincerely,
Zach Key
Southern Soil Builders,.Inc.

f State of North Carolina
W'R
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources op, S BACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
�Inn-piscy�arc�2 FORM: SWA 11-13
� t;�it't►n9
Please use the following instructions as a checkli t m 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 conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
http://portal.ncdem org/1�eb/tivc aps/lap
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b)(2Hfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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.
❑ Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: Q Jrn 0.1 t
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within l 0 0 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 19 0 X�` S Y �- c: �� ie oa d cc��
City: State: N G zip: cx I L+
This Agreemen shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
❑ I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner nine: �'� o I'mN.S l J a r re
Signature: 4 !/�_1j �GK,�--t Date: 7
FORM: SWA 11-13
Page 1 of 1

State of North Carolina
W_R
..r tpartment of Environment and Natural Resources
Division of Water Resources
Division of Water Resources �AR _SgTVAkK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
,rn 5 FORM: SWA 11-13
Clo, nib
Please use the following instructions as a checklViLI Mtixde�l A 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 at:
http: //portal. ncdenr. org/web/wg/aps/lazy
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T ,1108 b 2 for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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.
❑ Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: :4�h of sle erne„ '�
Applicable Field ID: Wr 9"
hereinafter referred to as the Permittee, to land apply residuals within 100 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following: /
Location address of property: LJ CI ) 6 / eX;S Ly e ci Roach
City: S an i,Q State: Ne Zip:
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
❑ I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: L C) r rr e n
Signature: / Date: -- -� ^ Ll ` l�
FORM: SWA 11-13 Page 1 of 1

1"�&:'�4 At�
The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary. whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
IN, r
i r
06
g.
+�9ar
J
C �
�t-t , 05'.
{
Field 6-03'
' 27.0 !`*
Acres
fit..
�b
Buffers
Property Line (50')
Perennial Stream (�100')
Surface Water (10 ')
Road Right -of -Way (50')
House 400')
Well (100') '
Legend - a
= Propery Line,
Field Boundary © Well
,I Perennial Stream A House
C — Surface Water I!
Unused Area t*�r gWap„NC C�enterfor.Geographlc)In_formation and Anaig
Jones,_ /311 'board d ♦� ., y
Tony: Buffers Map
Parcel: 3691304282 `
Lincoln County, NC 0 500 1.000 2,000 Feet
I ' -I-- ' I I I I I Produced:October2015
35.4079-81.0358 North Carolina Stateplane, NAD83 Shaffer Soil Services LLC

Southern
'Soil
Builders, Inc.
Monday, February 08, 2016
1,1140
958 Hoots Road Roaring River, NC 28669
[phone] .9 Fax [phone]
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting
Non -Discharge Permitting
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: City of Belmont, WWTP
Permit No. WQ0003281
Additional Information Request
Dear Mr. Goodrich:
RECEIVED/NCDENR/DWR
F g 12016
WQROS
MOORESVILLE REGIONAL OFFICE
RECEIVEDINCDEOUNR
FES ® 20116
Non -Discharge
peri`nitting Unit
Enclosed with this letter, in triplicate, is the requested additional information for the permit
renewal package for the City of Belmont's land application permit WQ0003281.
The information included is:
A. Site detail maps have been updated to include:
a. Road Names on the Overview and Buffer Maps
b. Compliance Boundary and Review Boundary statement on the Buffer Maps
c. Correct coordinates on the Overview and Buffer Maps for field BT9-1
B. Spill Control plan has been updated to include the requested information.
C. The Sampling Plan has been updated to accurately describe the location of where the
samples are collected.
If you have any questions or concerns, please contact me at [e-mail]
or at 336-957-7871.
Sincerely,
Zach Key
Southern Soil Builders, Inc.

SPILL CONTROL PLAN- Southern Soil Builders, Inc.
M
FEB 112016
ICE
City of Belmont, NC - WQ0003281
I
In the event of a spill, the following should be taken IMME:DITALY.
I
`EB - 9 T,3
Man-Disah 190
pen-n WD9
l . Make sure all personal and bystanders are safe-- if not contact emergency
services
2. Halt ;the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain t I
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as muc
of the spilled material as possible. Use straw to soak -up the remaining material.
Dispose of the some in a landfill.
i
5. Flush ;the roadways with water if needed. If the spill occurred on a tillable area,
the some into the soil and spread lime if necessary. If a spill occurs on private
property, final clean-up should be to the satisfaction of the owner.
6. Notification. (This should be done as soon as safely possible.)
A. Southern Soil Builders, Inc. Main Office [phone]
B. City of Belmont, WWTP- Sandra Craft [phone]

k
C. NCDEQ-Mooresville Regional Office [phone]
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting:
The Permit:tee shall report by telephone to the Mooresville Regional Office,
telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day following the occurrence or first knowled e
of the occurrence of any of the following:
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any; failure of the surface disposal program resulting in a release of
material to surface waters.
C. Anytime self -monitoring indicates the facility has gone out of compliar ce
with, its permit limitations.
D. Any�process unit failure, due to known or unknown reasons, rendering the
facility incapable of adequate residual treatment
E. Any;spill or discharge ,from a vehicle or piping system during residuals
transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface
waters, imminent failure of a storage structure, etc.) outside of normal businE,.s
hours shall be reported to the Division's Emergency Response personnel at
telephone number (800) 662=7956, [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in lette
form within ifive days following first knowledge of the occurrence. This report sh DII
outline the actions taken or proposed to be taken to ensure that the problem
does not recur.
8. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed
C. Inspe;ct all seals and replace if necessary.

City of Belmont, WWTP
Permit No. WQ00031.81
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the sludge holding
tank and digesters. These samples will be combined to form individual grab samples to be sent to a
laboratory for analysis. If a land application event is to occur in the early part of a calendar year (i.e.
January or early February) these samples may have to be taken in December so results can be obtained
before the land application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform analysis, volatile solids
reduction, nutrient analysis, and a TCLP test. These tests will be taken by Southern Soil Builders, Inc. Pll
samples with the excieption of the composite residual sample will bE! taken to Statesville Analytical, The
composite residual simple will be sent to Waypoint Analytical. All samples taken will be taken in the
same condition as the residuals are to be land applied.
The volatile solids reduction requirement will first be attempted by using option 1 [503.33(b)
(1)1; Reduction of volatile solids by at least: 38%. The "IN" sample will be taken from the digester and t
"OUT" sample from the sludge holding tank. If this requirement can't be met, a gallon of residuals wi I
be sampled from the isludge holding tank and analyzed for option 3 503.33(b) (3); known as a 30 day
bench scale. This test, requires less than 15% additional volatile solids reduction during bench -scale
aerobic batch digestion for 30 days.
Fecal Coliform are gather in seven (7) individual samples from -the sludge holding tank and
tested to meet the requirements of [503.32(b)(2)]. This requirement is for the geometric mean fecal
coliform density of th'ie samples be less than two million (2,000,000) MPN per gram. These samples w II
be placed in 250ml containers and placed on ice, in a cooler for transport to the laboratory before 16 0
hours (4pm) the same day the samples are obtained.
Annually, if land application occurs, a composite residual sample will be collected from the
sludge holding tank a l d analyzed, prior to a land application event for: Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate
Nitrogen, Magnesium; % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information
the Plant Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sampl
will collected in a non breakable container, at least one quart in size.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the sludge holding tank. This test will be run annually, unless prior approval is grantee
from the division to reduce this requirement to once per permit cycle.

r
s
' ,F yf � � N' r �d • p'.
• Po tom' g,pp,!"'"� '� }
In
0.
77
� 40
OF
•
J
Buffers
Surface
Propert
Perennial Stre
• y
_•y,,i RRoad Right -of -Way (SO')
a
House
Well 1 1
LegendA
r •ex _
i,_ r
m r
PerennialField Boundary 0 Well
_am House
r
Surface Water
ed Area
4. s
Tony: Buffers
3691304282
inc
• • i li Ili iti Feet
1 f . • • • �. �.1

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
v 5h
Well (1 0")
Legend
x
Propery Line
Field Boundary
- == Perennial Stream
Surface Water
p Well�Yr
A House
Xp4ry
Em Unused Area
e for
OeTd
Warren, Lori: Buffers Map
Parcel: 173022, 173326
Gaston County, NC 0 500 1,000 2,000 Feet
I I I I I- 1 _- ! 1
35.390352,-81.054716 North Carolina Stateplane, NAD83
N
s
Produced: October. 2015
Shaffer Soil Services. LLC

Schutte, Maria FILE
From:
Schutte, Maria
Sent:
Wednesday, January 13, 2016 2:27 PM
To:
Goodrich, David
Cc:
Pitner, Andrew
Subject:
WQ0003281 Belmont Staff Report
Hello David,
I would like this email to serve as the staff report for this City of Belmont WWTP RLAP Renewal. 1 think this will be pretty
short.
It would be helpful if the field buffer maps showed the Main Road names:
BT-06-01 & 03 —are located off of June Dellinger Road also known as Old Lowesville Road.
BT-09-01 is located off Alexis Lucia Road; and, this map has the wrong coordinates noted in the lower
left-hand corner
The field naming scheme is "unique". How difficult would it be to rename these fields to conform to the
NC-GA-006-01 naming method? It's not important if too complicated.
The Spill Plan should be corrected to show Mooresville as the Regional Office to contact & the "reporting"
permit language used — 24hrs to contact, written response in 5 days.
The sampling Plan does not appear to accurately describe where samples are collected. Per discussion with the
WWTP ORC, the samples for 38% VS reduction are collected at the Holding Tank (it is aerated, but should not be
confused with the plant aeration basin) & the Storage Tank (appears to be a digester, but should not be
confused with the plant digesters).
There is also a statement that says samples will be collected in December to receive results in time to land
apply in January or February. Does it cause an
issue sampling in Dec. 2015 and LA in Jan. 2016.?
keep everything within the same calendar year &
sample in Jan. to allow for LA in Feb.?
Or rather than even ask the question, is it best to just
I am okay with renewal, upon receipt of any additional information you feel is warranted.
Thanks!
Maria
Maria Schutte
Environmental Specialist
Water Quality Regional Operations Section
Division of Water Resources
North Carolina Department of Environmental Quality
704 663 1699 office
704 235 2184 direct
Maria. schutte(c")-ncdenr.gov
610 East Center Avenue
Suite 301
Mooresville, NC 281.15
I

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON -DISCHARGE APPLICATION REVIEW REQUEST FORM
December 29, 2015
To: ;IRO-Q!R®S=Andrew P�itner�/hCoreyBasin
From: David Goodrich, Water Quality Permitting Section - Non -Discharge Permitting Unit
Permit Number: WQ0003281
Applicant: City of Belmont
Owner Type: Municipal
Facility Name: City of Belmont RLAP
Fee Category: Non -Discharge Minor
Comments/Other Information:
RECEIVED/NCDENR/DWR
DEC 3 I 'Lilly
WQROS
MOORESVILLE REGIONAL OFFICE
Permit Type: Land Application of Residual Solids (503)
Project Type: Renewal
Owner in BIMS? Yes
Facility in BIMS? Yes
Fee Amount: $0
Attached, you will find all information submitted in support of the above -referenced application for your review..
comment, and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed.
❑ Attach an Attachment B for Certification
® Return a completed staff report.
❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer: `
Date: /2
FORM: WQROSNDARR 09-15 Page 1 of 1

'r ater Y?Sv^unCes
iRONM E1,17 A.L +UAL! i .
BARRY WEBB — CITY 'I\/IAANAGER
CITY OF BELMONT
POST OFFICE BOX 431
BELMONT, NORTH CAROLINA 28012
Dear NIr. Webb:
PAT TVICCRORY
cio;vnr
DONALD R. VAN DER `JAART
Sa:rrun ;
S. JAY ZINIMERNIAN
RECEIVED/NCDENR/DWR
December 29, 2015
DEC 3 1 2u,:)
MOORESVILWQROS
LE REGIONAL OFFICE
Subject: Acknowledgement of
Application No. WQ0003281
City of Belmont RLAP
Residuals Management System
Gaston County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on December 28, 2015. Your application package has been assigned
the number listed above, and the primary reviewer is David Goodrich.
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 50 to 90 days
after receipt of a complete application. If you have any questions, please contact
David Goodrich at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc:LMLoesiv�i<lle e.gorua + ce--, W e-r Q alitky RegMi. nil �,perati�''etion
Permit File WQ0003281
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919 807 6464
_. g
_ �; �- tun r'"�g' x" 3 s >.:Y -k �y�. 3'^ 'C >�(:,o��
E• -�
.•,m.�.S�z�,�.�i�'_ � � V � t• -�'� ��'-��� t ,�i'`911i � aq

S Southern
S Soil
B Builders, Inc.
Friday, December 11, 2015
958 Hoots Road Roaring River, NC 28669
[phone] Fax [phone]
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section
Land Application Unit
512 N. Salisbury Street
Raleigh, NC 27604
Reference: City of Belmont WWTP
Permit No. WQ0003281
Land Application Permit Renewal
RECEIVED/NCDENR/DWR
DEC 3 1 ZU15
WQROS
MOORESVILLE REGIONAL OFFICEE
RECEIVEDIDE lR DWR
DEC 2 8 2015
Water Quality
Permitting Section
Southern Soil Builders, Inc. is assisting the City of Belmont with the renewal of the land
application permit of residuals from the waste water treatment plant. There have been no changes
since the last issuance of the permit, except for a minor gain in total acreage. A total gain of 2.4
acres is the result of improved mapping.
Your attention to this permit modification package is greatly appreciated. If you should have any
questions or concerns, please contact me at [e-mail] or at 336-957-7871.
Thank You,
Zach Key
Southern Soil Builders, Inc.

Division of Water
Please use the following in
instructions and checking
information requested. Fa
permit application. Unles
supporting documentation
For more
General — This application is
are generated from a water tre
15A NCAC 02T .l 100.
Unless otherwise noted, the A
below.
A. Residuals Land Applica
❑ Submit the completes
do not make any una
to the application ma
refer.
❑ The Applicant's Cer
alternate person may
criteria in 15A NCA(
❑ If this project is for a
❑ Please submit this aI
operation of propose(
RECFoVEDIDENRIDJF RECEIVEDINCDENRIDWR
L9 �1 State of North Carolina
og 28 2M DEC 3 1 Wfiartment of Environmental Quality
)Division of Water Resources
VUaieYQUgitoCAL'Vpart:=OOE-FBt�,LVF§IWND WQROS
APPLICATION PROGRAM
NNISTRUCTIONS FOR FORM: RLAP 11-15 & SUPPORTING DOCUMENTATION
fictions as a checklist in order to ensure all required items are submitted. Adherence to these
provided boxes will help produce a quicker review time and reduce the amount of additional
e to submit all of the required items will lead to additional processing and review time for the
herwise noted. the ADDlicant shall submit one original and two conies of the annlieation and
visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
http:ll tal.ncdenr.org/webliXI -1lau
treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
ent plant or other type facilities) on the proposed or currently approved land application site(s) under
licant shall submit one original and two copies of the application and supporting documentation listed
on Program (FORM: RLAP 11-15) Application: (All Application Packages):
and appropriately executed Residuals Land Application Program (FORM: RLAP 11-15) form. Please
:horized content changes to this form. If necessary for clarity or due to space restrictions, attachments
be made, as long as the attachments are numbered to correspond to, the section and item to which they
fication on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .01O!k (b. An
be designated as the signing official if a delegation letter is provided from a person who meets the
modification of an existing permit, submit one copy of the existing permit.
1lication form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New an Major Modification Application Packages)
❑ Submit a check, mo Iley order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility i lassification New Permit Major Modification 1
Major (land are pe itted for > 300 acres) $1,310 1 $395
Minor (land are pemitted for < 300 acres) i $810 i $245
' - A major modifications all be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes
not previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1 C .03-OD)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any nitigating factor(s) fi•om the Environmental Assessment (EA) that impact the construction of the
residuals treatment a d storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 11-15 Page 1 of 3

E. Operation and Maintem nee Plan (New and Renewal Application Packages)
❑ For Modification Apf lication, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plai i in accordance with 15A NCAC 02T .1110 and include at a minimum:
❑ Operational funct ons; describe the operation of the program to show what operations are necessary for the program to
function and by w iom the functions are to be conducted.
__ ❑ Maintenance sche�ules; may include equipment calibration, maintenance of signs, etc.
❑ Safety measures, may include safety training program, manuals, signs, etc.
❑ Spill response pla ; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan in t luding the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and to ation of .inspections, including those to be conducted by the ORC., and procedures to assure that the
selected location(sl and inspection frequency are representative of the residuals management program.
❑ Detailed descripti n of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncom Dliance is observed.
❑ 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 y and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other of ierating 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 aanual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDIT ONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED ]PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals IE nd application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
1102 12 . Specific lly, a residuals land application program is designated as dedicated if any of the following are
applicable:
❑ Any land applicati n site certified for the residuals land application program that receives residuals at rates or fi•e,quencies
greater than agrongmic rates.
❑ Any land applicati:) n site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop p production is of secondary importance.
❑ Any land applica ion site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals :program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanatio of the dedicated system and its operation.
H. Detailed Site Maps (All I ew or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modificatjons, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of a 1 wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the -eview and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T. 1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as khey will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM RLAP 11-15 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their abilit) to accept the proposed application rates.
J. Hydrogeologie Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed h}'drogeologic evaluation in accordance with 15A NCAC 02T .1104(41(4) and current Division Policy
available at: tal.ncdeiu;o/web/w�
professional. c /a s/lau/policies. The document shall be signed, sealed and dated by a, qualified
K. Engineering Design Do
facilities fed through fixe
❑ Submit engineering
and/or Professional I
site map specific to tl
❑ The design document
❑ Engineering plan
new units or are c
❑ Specifications de:
finished product i;
❑ Engineering calci
curve analysis for
❑ Soil mapping unit
L. Water Balance (All Ne)
irrigation facilities fed thr
❑ Submit a completed
available at: http://po
M. Property Ownership Do
or irrigation components)
❑ Property ownership d
❑ Legal documentat
❑ Written notarized
❑ An easement runn
of 15A NCAC 02I
❑ A written notarize
survey map.
ONE ORIGINAL
SUPPORTING 1
1617 MAIL Sl
RALEIGH, NORTH
TELEPHONE
iments (All New or Modification Application Packages with fixed irrigation facilities or irrigation
supply system)
-sign documents that have been signed, sealed, and dated by a 14C licensed Professional Engineer
and Surveyor in accordance with 15A NCAC 02T 110)�d�(2). ForModifications, submit an updated
modification(s) only.
must include the following minimum items:
for the facility and equipment except those previously permitted unless they are directly tied into the
tical to the understanding of the complete process;
ribing materials to be used, method of construction, and means for ensuring quality and integrity of the
;luding leaking testing; and
ations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
ach pump, and irrigation design.
shown on all disposal sites.
Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
.rgh fixed supply systems)
.d accurate water balance in accordance with 15A NCAC 02T .110/1(d)(5) and current Division Policy
entation (All New or Modification Application Packages involving new and/or relocated treatment
;umentation shall consist of one of the following:
n of ownership (i.e., GIS, deed or article of incorporation), or
tent to purchase agreement signed by both parties with a plat or survey map, or
g with the land specifically indicating the intended use of the property and meeting the requirements
0107(f), or
lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
ZMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
CE CENTER
:OLINA 27699-1617
: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 11-15 Page 3 of 3

Division of Water
I. APPLICANT INFORMATION:
�tAp State of North Carolina
Department of Environmental[ Quality
2r}5 Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
�m g010It FORM: RLAP 11-15
1. Applicant's name: City of Belmont
Applicant type: ❑ ]ndividual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ 7ederal ❑ State ® Municipal ❑ County
Signature authority's iame per 15A NCAC 02T .0106: Barry Webb Title: City Manager
Applicant's mailing a
dress: PO Box 431
City: Belmont St
: NC Zip: 28012-
Telephone number: �;040
825-5586 Email Address: bwebbna,cityofbelmont.org
I
2. Consultant's name: Zach
Key License Number (for P.E.):
Affiliation: ❑ On Staff
® Retained (Finn: Southern Soil Builders, Inc.)
Consultant's mailing
ddress: 958 Hoots Road
City: Roaring River
State: NC Zip: 28669-
Telephone number: (3T
na) 957-7871 Email Address: [e-mail]
3. Agronomist's name:
License Number:
Affiliation: ❑ N/A
❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing
address:
City: State:
Zip: -
Telephone number:
_ Email Address:
4. Soil Scientist's name
License Number:
Affiliation: ❑ N/A
On Staff ❑ Retained (Firm: )
Soil Scientist's mailing,address:
City: State:
Zip: -
Telephone number: ()
_- Email Address:
5. Fee submitt
ed: $0.00 (ee Instruction B)
H. PERMIT INFORMA
1. Application is for (
2. If this application is b
Permit number: WQ0
Date of most -recently
Date of most -recently
Date of most -recently
all that apply): ❑ new, ❑ modified, ® renewed permit
submitted to renew or modify an existing permit, provide the following:
81
permit: 7-12-2007
d Attachment A (if different than the permit): 7-12-2007
d Attachment B (if different than the permit): 7-12-2007
FORM: RLAP 11-15 Page 1 of 5

III. RESIDUALS LAND Al
1. Residuals Processing
City: Belmont
Coordinates: Latitude
Datum: NAD83
Method of measurers
2. County where resi&
3. List the Operator In
certification numbers
PLICATION PROGRAM INFORMATION:
Facility's physical address: 298 Parkdale Drive
State: NC Zip: 28102-
350 13' 50" Longitude: 81' 01' 50"
Level of accuracy: 1"
nt: MAP
.s land application program is headquartered: Gaston
tesponsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Dennis Key
Southern Soil Builders, Inc.
15704
Back -Up OR
David Key
Southern Soil Builders, Inc.
23629
Additional Back
ORCs
(if applicable),
Up
Zach Key
Southern Soil Builders, Inc.
27660
If an ORC and at
the candidates' n,
school and certific
4. Complete the folli
a. Plant Available N
source -generating
the following table
Maximum amoun
t one Back -Up ORC are not currently designated for this residuals land application program, provide
, affiliations, and an estimated time schedule for each candidate's completion of the required training
r test:
g tables regarding management of the residuals land application program:
rogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
.cilities as currently certified and proposed for certification with this application and list the results in
of residuals to be certified: 300 dry tons per year.
PAN
Pounds of PAN per Dry Ton
Pounds of PAN per Year
(Weighted Average)
Surface
Incorporation
Surface
Incorporation
or Injection
or Injection
First -Year
27.456
33.236
8236.8
9970.8
Five -Year Maxi
um Adjusted
29.52
35.73
8856.77
10721.29
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for ce tification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
0
Hay
42.4
Pasture
39.9
Total:
82.3
Methods
Surface
82.3
Incorporation
or Injection
0
Total:
82.3
FORM: RLAP 11-15 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and propoised for certification assuming the scenarios listed in the following table:
Assumed
Application Ra
gbs PAN/ac yr
a
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
164.73
199.41
177.13
214.42
100
82.36
99.70
88.56
107.21
150
54.91
66.47
59.04
71.47
200
41.18
49.85
44.28
53.60
6. If applicable, provide�a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the I iolation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.): N/A
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specifyhe following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, e plain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of se ondary importance, explain;
❑ Residuals prograip contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain;
W. RESIDUALS SOURCE
Complete and submit the
Residuals Source
Certification
V. LAND APPLICATION
Complete and submit the
1
i
Land Application Site
Certification. doc
[ATION: (Required for all new, renewed, or modified residuals source)
Residuals Source Certification and all associated documentation.
INFORMATION: (Required for all new, renewed, or modified land application site)
Land Applications Site Certification and all associated documentation.
FORM: RLAP 11-15
Page 3 of 5

Note: Item VI. Appli
VI. DESIGN INFORMA1
1. The irrigation syste
2. Disposal system is:
3. Minimum depth to
feet below ground;
ground surface.
4. Are there any artifii
❑ Yes or ❑ No
structures are to be
5. Loading rates
ble to Dedicated Program with fixed irrigation system only.
)N FOR FIXED IRRIGATION SYSTEM
is: ❑ Spray ❑ Drip
] existing ❑ proposed.
can seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation:
face. Rules 15A NCAC 02T .0505 ) requires at least one -foot vertical separation between S!HWT and
drainage or water movement structures within 200 feet of any irrigation area?
If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
ntained or modified:
nded by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A N_CAC 021' .0505(nj is not met:
7. Non -dedicated S ste Desig
n gn (fill in the appropriate information for either a spray or drip irrigation system):
Field Zone
Design
Area
(ft2
Number of
Nozzles
Maximum Application
Rate ( allons/hr)
Design Annual Loading
Rate (gallons/ r
Total
���u �"�r�iaAl���s�`���,���, �` `'��' �''�`���a
'���6 a $
2
Spray Irrigation De
ign Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufactured/
model
/
Elevation of highest nozzle
ft
FORM: RLAP 11-15 Page 4 of 5

Applicant's Certification
The applicant or any affiH
proper closure, does not ha
any active compliance schei
4 Yes ❑ No,
I,
(Si
ing authority must be in compliance with 1SA N(CAC 02T .0106):
has not been convicted of an environmental crime, has not abandoned a wastewater facility without
an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
and do not have any overdue annual fees under Rule 15A NCAC 02T ,0105.
attest that this application for U'
's Name — PLEASE PRINT)
(Title)
164
��5 ��JIQ rAl1 P QI cz r�v�
(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 atechnical 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 Ndrth Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any
:alse statement, representation or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
rot to exceed $10,000 as well qs civil penalties up to $25,000 per violation.
Signature: L / Date:
FORM: RLAP 11-15 Page 5 of 5

Operation and Maintenance Plan
City of Belmont
Permit No. WQ0003281
In accordance to the requirements set forth by the North Carolina
Department of Environmental and Natural Resources using
NCGS 143-215.1 and 143-215.3(a) based on 15A NCAC 02T .110, The City
of Belmont is implementing this Operation and Maintenance Plan.
The project -manager of the land application event will make sure a daily
check off isiperformed at the start of each work day. This inspection is to
prevent any spills, leaks, or run-offs.
The daily check -off will consist of inspection the following items:
1. Access to the facility will be controlled with a locked gate and
signs to prevent any unauthorized entry into the complex.
2. All pumps and hose will be checked at the start of each day for
leaks or loose fittings.
3. All! tanker valves are closed prior to loading and lids are closed
prior to transport.
4. Alldump trailers or dump trucks gates are tightly fastened and
do not leak prior to transport.
5. Allion road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
6. Allequipment is secured at the end of each working day to
prevent any tampering or unauthorized use.
The ORC or back up ORC will inspect the field after each land application
event to make sure all regulations as required by the permit are followed.
Also the project manager at the end of each working day during a land
application ;event will make sure that all gates if present are closed.
All samples shall be taken as early as possible before the first application
event of the, calendar year to make sure the facility is compliance.
The samples; will be taken in a matter that is representative of the residuals
and all grab, samples will be mixed prior to be placed in to the containers

that will go to the laboratory. These samples must be collected and
transported as outlined in the Sampling Plan attached to this O&M Plan.
All records of these laboratory results as well as the annual report and
loading rates will be kept on file for a minimum of five (5) years.
Also, in the unlikely event of a spill or unintended release of residuals,
actions should be immediately taken as outlined in a copy of the
spill control plan attached.

City of Belmont, WWTP
Permit No. WQ0003281
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the digester.
Samples from the digester will be combined to form individual grab samples to be sent to a laboratory
for analysis. If a land application event is to occur in the early part of a calendar year (i.e. January or
early February) these samples may have to be taken in December so results can be obtained before the
land application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform analysis, volatile solids
reduction, nutrient analysis, and a TCLP test. These tests will be taken by Southern Soil Builders, Inc. All
samples with the exception of the composite residual sample will be taken to Statesville Analytical. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The volatile solids will first be attempted to be achieved using option 1 [503.33(b)(1)]; 38%
volatile solids reduction. This option will be attempted first due to it being the most cost effective. One
sample will be taken at the aeration basin and labeled "B". The next sample will be labeled "A" and be
taken from the digester.
If the option 1 cannot be achieved to meet the volatile solids reduction, a 30 day bench scale
option 3 [503.33(b)(3)] test will be used. This sample will be taken from the digester with the sample
being at least a quart in quantity.
If both option 1 and 3 are used and volatile solids reduction cannot be achieved; the sludge
holding tank will be,stabilized using sufficient alkaline to meet option 6 [503.33(b)(6)], commonly known
as lime stabilization.
Fecal Coliform is gather in seven (7) individual samples and tested to meet the requirements of
[503.32(b)(2)]. This requirement is for the geometric mean fecal coliform density of the samples be less
than two million (2,000,000) MPN per gram. These samples will be placed in 250ml containers and
placed on ice, in a cooler for transport to the laboratory before 1600 hours (4pm) the same day the
samples are obtained.
Annually, if band application occurs, a composite residual sample will be analyzed, prior to a land
application event for:
Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia
Nitrogen, Calcium, Nitrate Nitrogen, Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN,
Sodium
From this information, the Plant Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR)
will be calculated. This sample will collected in a non -breakable container, at least one quart in size. This
sample will be taken: from the digester. This test will be done by A&L Labs.

SPILL CONTROL PLAN- Southern Soil Builders Inc.
City of Belmont NC - WQ0003281
In the event of a spill, the following should be taken IMMEDITALY.
1. Make sure all personal and bystanders are safe- if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain the
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as much
of the spilled material as possible. Use straw to soak -up the remaining material.
Dispose of the same in a landfill.
5. Flush the roadways with water if needed. If the spill occurred on a tillable area, till
the same into the soil and spread lime if necessary. If a spill occurs on private
property, final clean-up should be to the satisfaction of the owner.
6. Notification. (This should be done as soon as safely possible.)
A. Southern Soil Builders, Inc. Main Office [phone]
B. City of Belmont, WWTP Sandra Craft [phone]

C. NCDENR, Morresville Regional Office [phone] %
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting. The project manager shall detail how the spill occurred and all action
that was taken. A written report shall be given to then gts%,FRpgional Office as
soon as possible, and within 24 hours of the spill, or next working day. j-
8. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed.
C. Inspect all seals and replace if necessary.

State of North Carolina
Division of Water Rv
Please use the following ii
instructions and checking
information requested. F,
permit application. Unles
supporting documentation
For more
General — This certification
application, distribution, or di
a corresponding application
Unless otherwise noted, the A
below.
A. Residuals Source Certif
❑
Submit the complete
make any unauthoriz
application may be rr
❑
For new or renewed 1
❑
For modified permits
❑
Complete the residua
13. Residuals Source-Gener
❑
For each source facili
❑ Vicinity map - A
❑ Process flow diag
are to be generate(
❑ Quantitative justi:
Ensure that the an
the permit. In ad
and/or disposed,
processing.
❑ Sampling plan - .
sampling points, s
ensure that the pla
vector attraction ri
they are to be land
C. Residuals Quality Inforn
❑ For each source facilil
❑ Laboratory analyti
❑ Documentation th;
attraction reductioi
❑ For new facility t
attach analytical re
facilities.
RECEIVED/NCDENR/DWR Department of Environment and Natural Resources
DEC 3 �Ui� '
:Division of Water Resources
�.
RESIDUALS SOURCE CERTIFICATION
WOROS INSTRUCTIONS FOR FORM: RSC 1.1-13
MOORESVILLE REGIONAL OFFICE
ructions as a checklist in order to ensure all required items are submitted. Adherence to these
e provided boxes will help produce a quicker review time and reduce the amount of additional
ire to submit all of the required items will lead to additional processing and review time for the
visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
1�:/lortal. ncdenr. o Zl i eb/ivq ).s/lau
les detailed information of residuals source generating facility and its residuals quality for land
hi accordance with 15A NCAC 02T . 1100. Do not submit this certification for review without
(FORM: RLAP 11-13, FORM: DCAR 11-13, or FORM: SDR 11-13).
nt shall submit one original and two copies of the application and supporting documentation listed
ation (FORM: RSC 11-13):
and appropriately executed Residuals Source Certification (FORM: RSC 11-13) form. Please do not
d content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
.de, as long as the attachments are numbered to correspond to the section and item to which they refer.
mrmits, submit a separate certification for each source facility.
submit a separate certification for only those facilities that are affected by the proposed modification.
source facility summary page. List all new, renewed, or modified facilities.
►g Facility Information:
attach the following:
map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
in and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
treated, processed, and stored at the facility,
ration for residuals production rate - A quantitative justification for the value provided in Item I. 8.
unt of residuals listed is the maximum amount expected to be generated by the facility for the life of
tion, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
icluding any chemicals, amendments, or other additives that are added to the residuals during
detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
npling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
uction requirements. Note that all sampling and monitoring must be completed on the residuals as
)plied, distributed, and/or disposed.
, attach the following:
al reports and operational data - reports for all laboratory analyses used to complete this certification.
the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
requirements.
at may have not yet been constructed and analytical results of residuals cannot be obtained, please
ults of residuals generated from a similar facility along with the description of similarities of the two
INSTRUCTIONS FOR FORM RSC 11-13
i
Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: City of Belmont
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) s M (Modified) ♦ D (Deleted)
b
The amount of residuals currently permitted for distribution,iand a„„•i;•,__,+•o•, or diS^OSal �" i.e, riot app,ilcabb,,
e to new facility).
SUMMARY FOR FORM: RSC 11-13
Page 1

Division of Water
I. RESIDUALS
Department of
TING FACILITY INFORMATION (See
1. Facility Name: City of Belmont Water Treatment Plant
2. Facility permit holder is: ElFederal, ElState, E9 Local Gove
Facility permit issded by: Div. of Water Resources, ❑ Div.
or ElOther (explain: ).
3. Facility contact pefison and title: Sandra Craft, Senior WWTP Operator
Complete mailing 'address: PO Box 431
i
City: Belmont State: NC Zip: 28012
Telephone numberi [phone] E-mail address: scraftna cityofbelmont org
4. Facility physical address: 298 Parkdale Drive
City: Belmont I State: NC Zip: 28012
Coordinates: Latitude: 350 13' 50 541, Lon itud 81 ° M I Kitt
5. Purpose of the fa(
0 treatment of i
Eltreatment of 1
Ej treatment of i
a
7.
8.
6
(approximate I
Elother (explain:
Datum: WGS84
Method of measurement: MAP
Level of accuracy: ±0.01
al wastewater, ❑ treatment of 100% domestic wastewater,
water, ❑ treatment of 100% industrial wastewater,
it wastewater mixed with domestic wastewater,
% industrial and . % domestic)
Does the facility halve an approved pretreatment program: Yes ❑
Facility permitted/design flow: 5 MGD and facility average daily flow: 3_2 MGD
Average amount of tesiduals being generated at this facility 99.26 dry tons per year.
Specify the following regarding treatments torage volumes available at the facility
Type and volume oresiduals treatment: �1.7 Million Gallons Sludge Holding Tank
Type and volume o�residuals storage (i.e., outside of residuals treatment units):
II. RESIDUALS QUALI7
1. Specify if residuals
Z 40 CF
Note: Only residual
CFR Part 503, other
2. Specify if residuals
Biolog
Note: Biological re:
processing wastewa
biological processes
FORM: RSC 11-13
'INFORMATION (See Instruction C.):
e regulated under:
Part 503 or ❑ 40 CFR Part 257.
m
Z
that are generated during domestic/municipal wastewater treatment processes are regulated under 40
'ise, the residuals are regulated under 40 CFR Part 257.
e defined under 15A NCAC 02T'. 1102(6) as:
al ❑ Non -Biological
ivals are residuals that have been generated during the treatment of domestic wastewater; animal
r, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
icluding lagoons, activated sludge systems, extended aeration systems, and fixed film system$).
Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
- " 100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes 0 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: ❑ ryes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those fob corrosivity, ignitability, and reactivity: .
Laboratory: Paae Analytical and Date of analysis: 04-07-2015
Passed corrosivty test: 2 yes ❑ no. pH: s.u. (2 <pH < 12.5)
Passed ignitability test: E yes ❑ no. Flashpoint: 200 T (> 140T)
Passed reactivity test: N yes ❑no. HCN: ND mglkg (<250) & H2S: ND mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(Mg/1)
Result
(er9/1)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
0.79
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Teitrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
0-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
1•]D
2,4 D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
A1D
1,2-Dichlgroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloioethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
1`dD
Heptachlor andi
its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
FORM: RSC 11-13
Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
i
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: A&L Eastern Labs and Date of analysis: 04-23-2015
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(m9/k9)
Arsenic
75
41
17
Cadmium
85
39
2
Copper
4,300
1,500
599
Lead
840
300
41
Mercury
57
17
2
Molybdenum
75
n/a
5
Nickel
420
420
24
Selenium
100
100
5
Zinc
7,500
2,800
786
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distan=Disposa]ArsenicrsenicChromium
Unit Closes(met(mg/kg)
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but 25
30
200
210
> 25 but j< 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46EE
300
320
❑ > 100 but, < 125
53
360
390
❑ _> 125
62
450
420
Result (mg/;kg)
FORM: RSC 11-13 j Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 3.461%
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: A&L Eastern Labs and Date of analysis: 4-20-2015
Parameter
Result
(mg/kg)
Alumijnum
46800
Ammonia -Nitrogen
5780
Calcium
9520
Magnesium
283
Nitrate -Nitrite Nitrogen
2
pH (Standard Unit)
7.04
Phosphorus
15000
Potassium
3150
Sodium
1960
Total KjeldaW Nitrogen
41900
c. Using the results listed in Item Il. 5b. above, calculate the sodium adsorption ration (SAR): 0.849
[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 0 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: Default for Aerobic
Digestion
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 (1") Year PAN
Five -Year
(mg/kg)
Maximum Adjusted PAN
(mg/kg)
Surface
13728
14761.29
Injection/Incorporation
16618
17868.81
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: N/A
FORM: RSC 11-13
Page 4 of 5

Pathogen Reduction: !'Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑ A fecal colifolm density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
El 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.1106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [115A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [115A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ! ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
0 Alternative 1 [15A NCAC 02T.1106(c)(1)] -Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
, ❑ composting, or ❑ lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt- If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable, - Non -Biological Residuals with NO Domestic Wastewater Contribution.
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.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
® Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic; Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T. I 107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. 1 107(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 11-13
Page 5 of 5

gc!&JY HAP
City of Belmont
Waste 'Water Treatment Plant
m___,
__t,NC 28012
i
Goo§|e
i
(

SEWER
COLLECa
O
SYST
PARSHALL FLUME
& FLOW METER
SLUDGE HOLDING H AEROBIC
TANK DIGESTERS
(2)
E. AERATION
BASIN
(BACKUP UNIT)
W. AERATION
BASIN
(PRIMARY)
SLUDGE
PUMPING
OFF -SITE SLUDGE DRYING
DISPOSAL BEDS
(BACKUP UNITS)
CITY OF BELMONT
WASTEWATER TREATMENT PLANT
FLOW DIAGRAM DISCHARGEBA TO
CATAFIGURE 1-1 (LAKE WYLIE)
k. nH I I Ury HJJUGIA 1 t5, NC
SECONDARY
CLARIFIERS
(2)
CHLORINE
CONTACT
PARSHALL FLUME
& FLOW METER
Consulting Engineers
T
G�
C
m
m

Quantitative Justification for Residuals Production Rate:
In the 7 years since the last permit was issued, the City of Belmont Waste Water Treatment Plant
has produced the, flowing amount of residuals in Dry Tons per year.
Dry Tons
[Year
2008
175.12
2009
49.56
2010
177.04
2011
96.43
2012
111.87
2013
85.7
2014
99.26
This an average of 113.56 Dry Tons per year, which is less than the 300 dry tons currently
allowed by permit WQ0003281. This will allow any growth that the Waste Water Treatment
Plant may occur during the next permit cycle.

r
City of Belmont, WWTP
Permit No. WQ0uQ3281 /
SAMPLING PLAN
Annually, if a land application event occurs, grab samples'
Samples from the digester will be combined to form individual gr�
for analysis. If a land application event is to occur in the early part ota,
early February) these samples may have to be taken in December so results
land application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform analysis, volat lie su,.,-
reduction, nutrient analysis, and a TCLP test. These tests will be taken by Southern Soil Builders, Inc. All
samples with the exception of the composite residual sample will be taken to Statesville Analytical. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The volatile solids will first be attempted to be achieved using option 1 [503.33(b)(1)]; 38%
volatile solids reduction. This option will be attempted first due to it being the most cost effective. One
sample will be taken at the aeration basin and labeled "B". The next sample will be labeled "A" and be
taken from the digester.
If the option 1 cannot be achieved to meet the volatile solids reduction, a 30 day bench scale
option 3 [503.33(b)(3)] test will be used. This sample will be taken from the digester with the sample
being at least a quart in quantity.
If both option 1 and 3 are used and volatile solids reduction cannot be achieved; the sludge
holding tank will be;stabilized using sufficient alkaline to meet option 6 [503.33(b)(6)], commonly known
as lime stabilization;.
Fecal Coliform is gather in seven (7) individual samples and tested to meet the requirements of
[503.32(b)(2)]. This requirement is for the geometric mean fecal coliform density of the samples be less
than two million (2,000,000) MPN per gram. These samples will be placed in 250ml containers and
placed on ice, in a cooler for transport to the laboratory before 1600 hours (4pm) the same day the
samples are obtained.
Annually, if band application occurs, a composite residual sample will be analyzed, prior to a land
application event for:
Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia
Nitrogen, Calcium, Nitrate Nitrogen, Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN,
Sodium
From this information, the Plant Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR)
will be calculated. This sample will collected in a non -breakable container, at least one quart in size. This
sample will be takenfrom the digester. This test will be done by A&L Labs.

Page: 1 of 2 ReportNumber: 15-113-0205 AFL EaStG'm Laboratories, Inc.
Account Number: 46381 @P.
7621 Whitepine Road Richmond, Virginia 23237 [phone] Fax [phone]
www.aloastem.com
Send To: SOUTHERN SOIL BUILDERS Project: BELMONT
DENNIS KEY NC CERT#257
958 HOOTS ROAD
ROARING RIVER, NC 28669
REPORT OF ANALYSIS Date Sampled: 4/20/2015 15:00:00
Lab Number: 61568 Date Received: 04/23/2015 00:00
Sample ld : BELMONT Date Reported: 04/29/2015
Total Solids
3.46
34600
100.0
BW
04/23/2015 15:00
SM-2540G
Moisture *
96.54
100.0
BW
04/23/2015 15:00
SM-2540G
Total Kjeldahl Nitrogen
4.19
41900
10.0
JM
04/24/2015 09:00
SM-4500-NH3C-TKN
Total Phosphorus
1.50
15000
100
KM
04/24/2015 11:56
SW 6010C
Total Potassium
0.32
3150
100
KM
04/24/2015 11:56
SW 6010C
Total Sulfur
0.67
6710
100
KM
04/24/2015 11:56
SW 6010C
Total Calcium
0.95
9520
100
KM.
04/24/2015 11:56
SW 6010C
Total Magnesium
0.26
2640
100
KM
04/24/2015 11:56
SW 6010C
Total Sodium
0.20
1960
100
KM
04/24/2015 11:56
SW 6010C
Total Iron
23100
100
KM
04/24/2015 11:56
SW 6010C
Total Aluminum
46800
100
KM
04/24/2015 11:56
SW 6010C
Total Manganese
283
5
KM
04/24/2015 11:56
SW 6010C
T • , ,•
iota! Copper
599
5
KM
04!24/2015 11:56
SW 6010C
Total Zinc
786
5
KM
04/24/2015 11:56
SW 6010C
Ammonia Nitrogen
0.58
5780
10.0
JM
04/24/2015 09:00
SM-4500-NI3C
Organic N
3.61
36120
10.0
04/24/2015 09:00
CALCULATION
Nitrate+Nitrite-N
<2.00
2.00
JM
04/27/2015 09:25
SM-450ONO3F
Total Cadmium
<2.0
2.0
KM
04/24/2015 11:56
SW 6010C
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis. A�p(/// /{lA/1/
Cur reports and letters are for the ex.^_hrsrve and confdentiai use o{our clients. and m.^v not be reproduced III, whole or pat, nor nnay any reference be made `—`�� `l
to the work, the results. or the co; rnpary in any advertisr7g hers release, or other public announcements !:vrfhout obtaining our prior written authorization.
Debbie Holt

Page: 2 of 2 _
Report Number: 15-113-0205 A&L Eastern Laboratories Inc.
Account Number: 46381 --
7621 Whitepine Road Richmond, Virginia 23237 [phone] Fax [phone]
RU-L
wwwaleastem.com
Send To: SOUTHERN SOIL BUILDERS Project: BELMONT
DENNIS KEY NC CERT#257
958 HOOTS ROAD
ROARING RIVER, NC 28669
REPORT OF ANALYSIS Date Sampled: 4/20/2015 15:00:00
Lab Number: 61568 Date Received: 04/23/2015 00:00
Sample Id : BELMONT Date Reported: 04/29/2015
04
5
KM
04/24/2015 11:56
SW 6010C
Total Nickel 24
5
KM
04/24/2015 11:56
SW 6010C
Total Lead 41
5
KM
04/24/2015 11:56
SW 6010C
Total Arsenic 17.0
3.0
KM
04/24/2015 11:56
SW 6010C
Total Mercury 2.0
0.4
KM
04/24/2015 09:00
SW-7471 B
Total Selenium <5.0
5.0
KM
04/24/2015 11:56
SW 6010C
pH (Standard Units) * 7.04
2.00
JM
04/27/2015 09:24
SW-9045D
Total Molybdenum <5
5
KM
04/24/2015 11:56
SW 6010C
Comments:
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
QUALIFIER: THE MATRIX SPIKE WAS OUT OF LIMITS FOR "Ca" AND "S".THE RPD
WAS OUT OF
LIMITS FOR "NO3/NO2-N". ALL OTHER
QC DATA
ACCEPTABLE.
IS
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a vet basis.
^.ur reports and lerters are for the exclusive and conn.'dentiai use of cur clients. and Wray not be reprrduced in whole or part. nor r„ay any reference be made
to the work. the results. or the cor npany i;, any advertising. news release, or other public announcements without obtaining our Prior written authorization.
II '
Debbie Holt

SAR
'J Sodium Absorption
'
atio
NafMcl Ca M /L. M � /L
-- Na: Sodium (Mg/L)
Equivalent weight: 23
67.816 329.39 f91.344
Ca: Calcium (Mg/L)
Equivalent weight: 20
Mg : Magnesium (Mg/)
Equivalent weight: 12
NafMC).
Ga MQ
f _q i'ME)
Milli Equivalent = Mg/L
/ Equivalent weight
7.948522
1G.�z69v
7.612
The amour
SAR= Na Milli Equivale�t/[0.5
X (Ca Milli Equivalent
+ Mg Milli equivalent)]0.5 power amount of (
SAR = 0,849723 1 From Mg/I. entered above:)
(From ME entered below)
Permitting I
Na ME
Ca (MEN
M ME
2.94 1
16.46
1 7.61

PAN
Mineralization
Rate
—
TKN
NH3
N 0 3
0.3
41900
57,.qn
�N ��2
PAN Surface
7 2
27 z.45C-, ibs/dry tor,
82�36.8 lbs total PAIN!
i )8_
v'G.0826 lbs PANfacre
PAN Injection
01 3 lirrigglkag—
33.236 lbsldry ton
_9970.8 jibs to. -jai pAN
4 11 4 — RAN.lacre
Dry Tons/1000
al.
MAIR-282
1st year PAN
lbs./acre
Surface lbs.
Surface
8236.81
1 100.0826245
1st year PAN
lbs./acre
Injected lbs.
injected
as aecimai Total dry Acres
% Solids tons/year ARR!Led on
0.0346 1 300 1 82.3 !
MR(TKN-NH3)+ +.5(NH3)+NO3+NO2 =mg/kg
mg/kg x .002 =Ibs/dry ton
MR(TKN-NH3) + I(NH3)+NO3+NO2 =mg/kg
mg/kg x.002 =Ibs/dry ton
.1000 X 8.34 X %solids X sp. gravity
2000
"=dry tons/1 000gal."

Analytical Results
Southern Soil Bq'ilders
958 Hoots Road j
Roaring River, NC 28669
Receive Date: 14/07/2015
Reported: 64/27/2015
For: elmont
Comments: '
Sample Number Parameter
Sample ID
Result
Unit Method
Analyzed
Analyst
150407-39-01 Corrosivity
Belmont
See
SW-846
04/15/2015
PACE
Attached
150407-39-01 Ignitability
Belmont
See
1010M
04/15/2015
PACE
Attached
150407-39-01 Reactivity
Belmont
See
SW-846
04/15/2015
PACE
Attached
150407-39-01 TCLP
Belmont
See
as Noted
04/15/2015
PACE
i
Attached
Respectfully
submitted,
i
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 •Statesville, NC 28687 • 704/872/4697
Page 1 of 1

_ ceAnalXical
www.pacelabs.com
Project: 150407-39
Pace Project No.: 92244570
Qaulplu. 10u'+u/-.5U
Parameters
8081 GCS Pesticides, TCLP
gamma-BHC (Lindane)
Chlordane (Technical)
Endrin
Heptachlor epoxide
Methoxychlor
Toxaphene
Surrogates
Decachlorobiphenyl (S)
Tetrachloro-m-xylene (S)
ANALYTICAL RESULTS
Lab ID: 92244570001 Collected: 04K
Results Units Report Liml
Analytical Method: EPA 8081
Preparation N
Leachate Method/Date: EPA 1311; 04/21/15
ND ug/L
0 5
ND ug/L
3.
ND ug/L
0.5
ND ug/L
0.5
ND ug/L
100
ND ug/L
3.
8151 Chlorinate Herbicide TCLP '
2,4-D
2,4,5-TP (Silvex)
Surrogates
2,4-DCAA (S)
6010 MET ICP, TCLP
--isenic
Barium
Cadmium
Chromium
Lead
Selenium
Silver
7470 Mercury, TCLP
Mercury
8270 MSSV TCLP Sep Funnel
1,4-Dichlorobenzene
2,4-Dinitrotoluene
Hexachloro-1,3-butadiene
Hexachlorobenzene
Hexachloroethane
2-Methylphenol(o-Cresol)
3&4-Methylphenol(m&p Cresol)
Nitrobenzene
Pentachlorophenol
Pyridine
2,4,5-Trichlorophenol
2,4,6-Trichlorophenol
Surrogates
benzene-d5 (S)
Date: 04/24/2015 11:41 AM
Pace Analytical Services, Inc.
9800 KinceyAve. Suite 100
Huntersville, NC 28078
[phone]
/15 12:20 Received: 04/08/15 16:23 Matrix: Water
DF
Prepared
Analyzed
CAS No. Qual
hod: EPA 3510
a:00
1
04/23/15 08:45
04/23/15 13:18
58-89-9
1
04/23/15 08:45
04/23/15 13:18
57-74-9
1
04/23/15 08:45
04/23/15 13:18
72-20-8
1
04/23/15 08:45
04/23/15 13:18
1024-57-3
1
04/23/15 08:45
04/23/15 13:18
72-43-5
1
04/23/15 08:45
04/23/15 13:18
8001-35-2
53 %
10-13
1
04/23/15 08:45 04/23/15 13:18 2051-24-3
56 %
10-11
1
04/23/15 08:45 04/23/15 13:18 877-09-8
Analytical Method: EPA 8151
Preparation MIthod:
EPA 3510
ND mg/L
ND
0.010 1
04/20/15 08:00 04/21/15 01:13
94-75-7
mg/L
0.0101 1
04/20/15 08:00 04/21/15 01:13
93-72-1
88 %
42-142i 1
04/20/15 08:00 04/21/15 01:13
19719-28-9
Analytical Method: EPA 6010
Preparation Method: EPA
3010
Leachate Method/Date: EPA 1311;
04/13/15 01:30
ND mg/L
0,050 1
04/14/15 21:35
04/15/15 19:43
7440-38-2
0.79 mg/L
0.25 1
04/14/15 21:35
04/15/15 19:43
7440-39-3
ND mg/L
ND
0.0050 1
04/14/15 21:35
04/15/15 19:43
7440-43-9
mg/L
0.025 1
04/14/15 21:35
04/15/15 19:43
7440-47-3
ND mg/L
ND
0,025 1
04/14/15 21:35
04/15/15 19:43
7439-92-1
mg/L
ND
0.10 1
04/14/15 21:35
04/15/15 19:43
7782-49-2
mg/L
0.025 1
04/14/15 21:35
04/15/15 19:43
7440-22-4
Analytical Method: EPA 7470 Preparation Method: EPA 7470
Leachate Method/Date: EPA 1311; 04/13/15 01:30
ND mg/L
0.00020 1
04/15/15 09:50
04/15/15 15:07
7439-97-6
Analytical Method: EPA 8270 Preparation Method: EPA 3510
Leachate Method/Date: EPA 1311; 04/21/15 09:00
ND ug/L
ND
50.0 1
04/22/15 09:50
04/24/15 08:56
106-46-7
ug/L
ND
50.0 1
04/22/15 09:60
04/24/15 08:56
121-14-2
ug/L
ND
50.0 1
04/22/15 09:50
04/24/15 08:56
87-68-3
ug/L
ND
50.0 1
04/22/15 09:50
04/24/15 08:56
118-74-1
ug/I-
50.0 1
04/22/15 09:50
04/24/15 08:56
67-72-1
ND ug/L
50.0 1
04/22/15 09:50
04/24/15 08:56
95-48-7
ND ug/L
50.0 1
04/22/15 09:50
04/24/15 08:56
L2
ND ug/L
50.0 1
04/22/15 09:50
04/24/15 08:56
98-95-3
ND ug/L
ND
100 1
04/22/15 09:50
0-4/24/15 08:56
87-86-5
ug/L
ND
50.0 1
04/22/15 09:50
04/24/15 08:56
110-86-1
ug/L.
ND
50.0 1
04/22/15 09:50
04/24/15 08:56
95-95-4
ug/L
50.0 1
04/22/15 09:50
04/24/15 08:56
88-06-2
55 % 12-102 1 04/22/15 09:50 04/24/15 08:56 4165-60-0
REPORT OF LABORATORY ANALYSIS
i
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 4 of 20

® Pace Analytical Services, Inc.
aGeAl' In alyticaI 9800 KinceyAve. Suite 100
wvnvpacelabs.com'
Huntersville, NC 28078
[phone]
Project: 150407-39
Pace Project No.: 92244570
Sample: 150407-39
Parameters
8270 MSSV TCLP Sep Funnel
Surrogates
2-Fluorobiphenyl (S)
Terphenyl-d14 (S)
Phenol-d6 (S)
2-Fluorophenol (S)
2,4,6-Tribromophenol (S)
8260 MSV TCLP
Benzene
2-Butanone (MEK)
Carbon tetrachloride
Chlorobenzene
Chloroform
1,4-Dichlorobenzene
1,2-Dichloroethane
1,1-Dichloroethene
T trachloroethene
chloroethene
­ oyl chloride
Surrogates
1,2-Dichloroethane-d4 (S)
Toluene-d8 (S)
4-Bromofluorobenzene (S)
1010 Flashpoint,Closed Cup
Flashpoint
9040 pH
pH
733C Reactive Cyanide
Cyanide, Reactive
734S Reactive Sulfide
Sulfide, Reactive
Date: 04/24/2015 11:41 AM
ANALYTICAL RESULTS
Lab ID: 92244570001 Collected: 04/07/15 12:20 Received: 04/08/15 16:23 Matrix: Water
Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Analytical Method: EPA 8270 Preparation Method: EPA 3510
Leachate Method/Date: EPA 1311; 04/21/15 09:00
51 %
13-107
1
04/22/15 09:50 04/24/15 08:56
321-60-8
83 %
21-132
1
04/22/15 09:50 04/24/15 08:56
1718-51-0
20 %
10-110
1
04/22/15 09:50 04/24/15 08:56
13127-88-3
27 %
10-110
1
04/22/15 09:50 04/24/15 08:56
367-12-4
53 %
27-108
1
04/22/15 09:50 04/24/15 08:56
118-79-6
Analytical Method: EPA 8260 Leachate Method/Date:
EPA 1311; 04/09/15 14:16
ND ug/L
125
25
04/20/1514:11
71-43-2
ND ug/L
250
25
04/20/1514:11
78-93-3
ND ug/L
125
25
04/20/1514:11
56-23-5
ND ug/L
125
25
04/20/1514:11
108-90-7
ND ug/L
125
25
04/20/1514:11
67-66-3
ND ug/L
125
25
04/20/1514:11
106-46-7
ND ug/L
125
25
04/20/1514:11
107-06-2
ND ug/L
125
25
04/20/1514:11
75-35-4
ND ug/L
125
25
04/20/1514:11
127-18-4
ND ug/L
125
25
04/20/1514:11
79-01-6
ND ug/L
125
25
04/20/1514:11
75-01-4
105 %
70-130
25
04/20/1514:11
17060-07-0
98 %
67-135
25
04/20/1514:11
2037-26-5
103 %
70-130
25
04/20/1514:11
460-00-4
Analytical Method: EPA 1010
>200 deg F
70.0
1
04/16/15 14:00
Analytical Method: EPA 9040
5.0 Std. Units
0.10
1
04/09/15 16:15
H6
Analytical Method: SW-846 7.3.3.2
ND mg/L
0.010
1
04/15/1519:00
Analytical Method: SW-846 7.3.4.2
ND mg/L
1.0
1
04/15/1515:00
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 5 of 20

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
I
Receive Date: 04/07/2015
Reported: 04/09/2015
For: Belmont
Comments: Geometric Mean 768 MPN/g
Sample Number Pa
IVV-rVI -V/ -V I
150407-37-01
150407-37-02
150407-37-02
150407-37-03
150407-37-03
150407-37-04
,150407-37-04
150407-37-05
150407-37-05
150407-37-06
150407-37-06
150407-37-07
150407-37-07
Respectfully
submitted,
Sample ID Result
Unit Method
Analyzed Analyst
Fecal Coliforms
1
<758
MPN/g
SM92210E-2006
04/07/2015
CL
Percent Solids
1
2.64
%
SM254OB-1997
04/07/2015
CL
Fecal Coliforms
2
<760
MPN/g
SM9221 CE-2006
04/07/2015
CL
Percent Solids
2
2.63
%
SM2540B-1997
04/07/2015
CL
Fecal Coliforms
3
<760
MPN/g
SM92210E-2006
04/07/2015
CL
Percent S',olids
3
2.63
%
SM2540B-1997
04/07/2015
CL
Fecal Coliforms
4
<787
MPN/g
SM92210E-2006
04/07/2015
CL
Percent Solids
Fecal Coliforms
4
2.54
%
SM2540B-1997
04/07/2015
CL
5
<760
MPN/g
SM92210E-2000
04/07/2015
CL
Percent Solids
5
2.63
%
SM2540B-1997
04/07/2015
CL
Fecal Coliforms
6
<778
MPN/g
SM92210E-2006
04/07/2015
CL
Percent Solids
6
2.57
%
SM25406-1997
04/07/2015
CL
Fecal Coliforms
7
<775
MPN/g
SM92210E-200f3
04/07/2015
CL
Percent Solids
7
2.58
%
SM2540B-1997
04/07/2015
CL
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 9

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28660
Receive Date: 04/07/2015
Reported: 05/08/2015
For: Belmont
Comments:
Sample Number Parameter
150407-40-01 30 Day Bien(
Respectfully
submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
Sample ID Result Unit Method
scale Belmont <1 % EPA625-R-92/C)
Analyzed Analyst
04/08/2015 WI_
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 1

Division of Water
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 08-13
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking t �e provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Fai ure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Anolicant shall submit one original and two copies of the application and
supporting documentation
For more informatipn or for an electronic version of this form, visit the Land Application Unit (LAU) web site at:
hyp://?ortyl.i cdenf.orb/web/N Ly/lau
General — This certification rovides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other pe residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 08-13 or FORM: SDR 08-13).
Unless otherwise noted, the Al
below.
A. Land Application Site C
❑
Submit the completec
make any unauthoriz(
application may be in
❑
For new or renewed F
❑
For modified permit
proposed modificatioi
{. Land Application Site In
❑
The status of the land
status categories and t
♦ New (N) ♦ Ri
❑
Attach the following i
;ant shall submit one original and two copies of the application and supporting documentation listed
(FORM: LASC 08-13):
and appropriately executed Residuals Source Certification (FORM: LASC 08-13) form. Please do not
I content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
de, as long as the attachments are numbered to correspond to the section and item to which they refer.
=its, submit the requested information for all land application sites,
submit the requested information for only those sites that are new, transferred or affected by the
ormation:
application site with respect to this residuals land application program must be provided in table I. The
.eir corresponding codes are as follows:
aewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
. accordance with each status code:
Required Item
Status Code
N
R
T
M
County Manage
Notification
(ii• :.:
Land Owner
`/
✓
Agreement
(If applicable)
ji i• t
✓
✓
✓
✓
Setback Waiver
Agreement
An updated vici
'ty/setback map in accordance with the "Mau Guidance
t_bi_Residuals Land
A jj1ication Permits"
✓
✓
✓
A soils and agro
omic evaluation in accordance with the "Soil Sciit r
Evaluation Policy"
—el —is
✓
An updated accounting
of the land application site's cumulative
pollutant loading(rates
(CPLRs)EI
✓
✓
INSTRUCTIONS FOR FORM: LASC 08-11 Page 1 of 3

Required Item
Status Code
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly ✓
indicate the loc ition of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
Acknowledgemient of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same timeperiod)
* This item may e required for land application site with a status code "M", please contact the Division if you need assistant in
determining atta hment requirements.
❑ Crop Type should inc ude the most likely crop types for the life of the permit (five years).
❑ Predominant Soils Se ies Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil serie as provided by the licensed soil scientist.
❑ Predominant Soil Ma ping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a re Presentative slope is provided, it must be determined accordingly:
❑ For sites previously pennitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on b th the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
❑ Acceptable methods or determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching
Aerial Photography I with Ground Control (AER)
• Cadastral Survey (;
• Conversion from C
• Conversion from T,
• Conversion from U
• Map Interpretation
C. Waterbody and Classifi
❑ Use an 8.5 by 114
residuals program ac
map portion must be
❑ Surface water body (
❑ Any questions cc
❑ A list of the Di,
❑ General Inst
subbasins, to
Plane (CP)
-Section-Range (TSR)
Trans Mere (UTM)
Digital or Manual Extraction (MAP)
ons Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
C copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
ivities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
labeled with the map name and number, the identified location, and be of clear and reproducible quality.
i ssifications information may be found at: ht_// tgl.nederLr.org/w(b/ /ps/csu
i erring the waterbody and its classification, please contact the Division's regional offices.
i ion's regional offices, their county coverage, and their contact information may be downloaded at:
s: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the awes of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the lin]
htt�:// ortal.ncd
waterbodies.
❑ Stream Classificati
❑ KNOWN BASI
1.Select prop(
Hydrologics
runs.
INSTRUCTIONS FOR FORM:
littp://h2 ..err.state_ne,us/bimsh•eL: ortsh•eportsWB.hhnl. If this link does not work, open
nir.org/web/wa/ps/csu/classifications and download weekly -updated classification lists for named
Process: One of the options below may be used depending on the known initial project information.
WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
basin from the List all Waterbodies in Neuse ---�
Basin sorted
report. Sort hydrologically as this will provide the proper location descriptions if multiple
08-13
Page 2 of 3

2. Locate the n me of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN CO NTY WHERE CLOSEST DOWN SLOPE SUURRF_ACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in 1 - iarr nce _J_ county, hydrologically report.
2. Locate the n me of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in t e description means the beginning of the waterbody segment (most upstream point).
4. Record all Bpsins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clictable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the n me of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed treams specifically described in the schedule of classifications;
(B) unnamed eshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse Rive
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basil
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basirl
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Base}
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification 'B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basinj
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasuotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORN�: LASC 08-13 Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Belmont
Land application sites currently certified: 79.9 net acres and Total to be certified: 82.3 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
-
Site/Field
ID
------
Landowner(s)
- -- - - - -
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Scries-Name-
Mapping Unit
----—_-—
-- - -
---
--- --
-- - -- ---------
-
or ep. Slope
R
BT 6-01
Tony Jones
27.0
Lincoln
Hay
Cecil
CeB2
R
BT 6-03
Tony Jones
12.9
Lincoln
Hay
Cecil
CeB2
R
BT 9-01
Lori Warren
42.4
Gaston
Hay
Cecil
GaB2
'Status Code
for land application
sites are: ♦ N (New) ♦ R
(Renewed) ♦ M di'f d
fi
n Soil Series Name (i.e. Appling, Cecil, etc.) (Mo e ) ♦ T (Transferred) ♦ D (Deleted)
Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
U. WATERBODX AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class
BT 6-01
35° 24.17.09"
081° 01'58.20"
NAD 83
GPS
Nearest Second
Killian Creek 11-119-2-(4)
WS-IV
WS-IV
BT-6-03
350 24'.21.56
0810 02'21.03"
NAD 83
GPS
Nearest Second
Killian Creek 11-119-2-(4)
WS-IV
WS-IV
BT 9-01
350 23'26.9"
081003'18.89"
NAD 83
GPS
Nearest Second
Leepers Creek 11-119-1-(12)
WS-IV
WS-IV
Nearest Second
Nearest Second
0
Nearest Second
Nearest Second
Note: Please keep the site
O r it
information (I ) and
O I
waterbodY information
(II
f A, f
Nearest Second
I
E]
) o e same field on the same page.
FORM: LASC 08-13
Page 1

State of North Carolina
j Department of Environmental Quality
DWJ',It Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 11-15
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 I
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit we site at;
17t ;//portal.nedenr.org/web/wq/aps/Xazr
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCA.0 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreementi(FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 11-15) form. Please
do not make any una thorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application ma I be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: o A
hereinafter referred to as'the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
(yes/no)
ease
I
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/aver-seed/
pasture)
T
N, ri
Fescu
/91);0v l Te,d
A; ev.I Feed
I
i
i
I
i
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
'ermittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
;his Agreement shall remain' in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
FORM: LOA 11-15 Pagel of 3

The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the lane} application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his repiesentative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his repiresentative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazgd on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events. 1
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
M.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15f1 allows the
NCAC 02T' .0105(1�) compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
El re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
A re -defined compliance boundary is not needed for this site.
1. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
ElThe land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: _. The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 11-15

Landowner's Certification
I certify that I am a dE
regarding the use of the
a power of attorney or
deeded landowners. I c
agreement with another
understand the stipulatic
field transfer, and do he
herein.
Landowner name: �1 C
Address:
City:
Phone:
Signature:
led landowner of the above -referenced land application site(s) and am authorized to make decisions
nd application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
ier legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
tify that the above -referenced land application site(s) are not included in any waste disposal contract or
unicipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
by grant permission to the Permittee to land apply residuals to the land application site(s) as specified
n v1 �'
14-1t
wa
State: jVC Zip:
E-mail address:
Date: l a -q -dais
NORTH CAROLINA, L n e o I►, COUNTY
I, the undersigned Notary Public do hereby certify that T�'�
v
personally appeared lbefore me this day and acknowledged the due execution of the forgoing instrument.
.tt.
WITNESS my handOd official seal this the (,t
p'e C ¢
day of rr �, tt "
i
20 1 ,�
Signature and seal: Al / 2",
My conunission expis: �� C, a 0 1 p `
U i,Fy =
I
0
Lessee's/Operator's Certification; /fill I gl[;q\1��a``
I certify that I have read t�is Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name: 1
Address:
City: State: Zip:
Phone: E-mail address:
I
Signature: Date:
Permittee's Certification:
I certify that I have read tl}is Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature: Date: ill ( 7
I
FORM: LOA 11-15 n r�

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resou Ices 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 11-15
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking t e provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Fai ure to submit all of the required items will lead to additional processing and review time for the
permit application. Unlessl otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more inform4tion, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit we site at:
I?ttp:I1portal.ncclel7f'.Ur _ LLI�w /a�s/laat
General — This document is n agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .l 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Ipplicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA .11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 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,
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT
The undersigned la
Applicant's name:
THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
or his representative hereby permits:
n45 8(,' dn. 61'% ,-
hereinafter referred to as he Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
(Y
ease
es/no )
Land Use or
Cropping Patterns
pp g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
i
eSev
ONs) e�
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consieration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed,
FORM: LOA 11-15 Page 1 of 3

The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
I. STIPULATIONS:
1. The landowner or his rep esentative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) speci ied by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
- be responsible to ensure t�iat the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his rep In
shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellatipn of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Ral fth, NC 27699-1617.
5. The Permittee must requi
landowner. In addition, tl
land application site(s).
6. The Permittee has provide
including an analysis of c
the equipment used by thf
7. The Permittee will provi<
land application event an(
8. If the soil pH of the land
soil pH of at least 6.0, un
the specified crop.
9. The landowner or his reps
soil samples, and the pern
10. The landowner or his re
nutrients (e.g., fertilizer, t
11. The landowner or his reps
the land application site(
application events at appr
12. Specific residuals land ap
his representative prior to
13. The landowner or his rep
inspect any property, pre
compliance with the pem
that must be kept under tt
term of, and 12 months al
Il. RESTRICTIONS:
1.
Appropriate measures m
application site(s) during
posting of signs that indic
2.
Animals shall not be graz
sites that are to be used
application events.
3.
Food crops, feed crops, ai
4.
Food crops with harveste
month period following a
5.
Food crops with harvests
application event when th
6.
Food crops with harvests
application event when th
7.
Turf grown on land where
4 and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
d the landowner or his representative with information and data concerning the residuals land application program,
mstituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
Permittee.
the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
a copy of the results of each soil analysis.
application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
-ss an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
tentative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
ted application limits.
esentative will provide the Permittee with information regarding the amount and analysis of other sources of
-egulated animal waste, etc.) that have been applied to the land application site(s).
sentative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
�riate periods.
ication area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
id during a residuals land application event.
sentative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
ises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
r termination of, this Agreement.
be taken by the Permittee and/or the landowner or his representative to control public access to the land
ive use and for the 12-month period following a residuals land application event. Such controls may include the
the activities being conducted at the land application site(s).
on the land application site(s) for a 30-day period following a residuals land application event. Land application
grazing shall have fencing that will be used to prevent access during these periods after such residuals land
I fiber crops shall not be harvested for a 30-day period following a residuals land application event.
I parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
•esiduals land application event.
d parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
residuals remain on the land surface for four months or longer prior to incorporation into the soil.
d parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
residuals remain on the land surface for less than four months prior to incorporation into the soil.
residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(ti). allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance Boundary is needed for field(s) ID:
(Please include the ratio e for the requested re -location of the compliance
compliance boundary to toe application package)
® A re -defined compliance toundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
boundary and attach a map showing the newly proposed
❑ The land application field s) ID: is currently permitted under another
residuals land application, rogram; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requ sting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new nroaram;
(Naive of the new program)
FORM: LOA 11-15
Page 2 of I

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or otter legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I clfy that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein. / ) �1
Landowner name:
Address: C—� CA J 1,` � X � `T —� r�
City: J ( State: Zip: C� I
t�_ ( 1
Phone: 70 L ' 2, "� E-mail address: o Y f _W .�v\ -en )�c. SO
Signature: Date: t
NORTH CAROLIN
I, the undersigned N
personally appeared
WITNESS my hand
day of 4JnneCQ,�N
Signature and seal:
My commission exp
Lessee's/Operator's Certifii
I certify that I have read
Lessee/operator name: _
Address:
City:
Phone:
Signature:
Permittee's Certification:
G O— S 4 COUNTY
f
.ry Public do hereby certify that u Ui C'r f e i
fore me this day and acknowledged the due execution of the forgoing instrument.
\\\I1111 i i �7A40U®
d official seal this the ►� �\\PGHEfzY'��yd`°,�+J
Notary NO` -
Wilkes County
—i/ % jy' IC IR�U\\��C
Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: fZ 0 / �-
FORM: LOA 11-15 I Page 3 of 3

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 "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Belmont WQ Permit #: W • Q0003281 Field #: BT 6-1 Acres Utilized: 14.6
Land Owner: Tony Jones Annual Dry Tons Applied: 20.4697 Site #: BT 6-1 Acres Permitted: 14.6
Operator: Tony Jones Predominant Soil Series: Cecile Cation Capacity Exchange Ca g p ty (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 211 Crop 2 Name: Crop 2 Max. PAN:
0-
Volume applied
t --
-(enter-one)-Solids/-
o/a -
a 0
Liquid
Solids
Cu. Yds Gallons
t-2014
1
208000
1 2.36
TALSI 01 208000
inuallbs/acre
for Years Cumulative lbs/ac
trrent Cumulative lbs/ac
n-nitted C. P. L.
-mit PAN Limit lst/2nd Crop
Volume
Residual Sources
Applied per
Acre
(Dry Tons/Ac)
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
1.402
1 WQ0003281
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
As
Residuals
Cd
Applic
Cu
0.011
0.006
1.584
0.132
0.166
60.771
0.143
0.172
62.355
36
34
NA
Soil
Precip.
>
Cond
Past 24
--Ts
cD
-- -o-. -
- --� --
❑
w C;
(Dn ,
Hrs.
o
?:
w
Wet,
a
w
vloist)
inches
o
0
dry
0
s
0.5
0.3
tions totals
Cr
on FORM
Pb
FSF
H
0.163
0.093
0.005
1.658
5.319
0.108
1.821
5.412
0.113
1338
267
15
`q and
TKN ago 0
• Nitrite
mg/kg mg/kg mg/kg
50800 7630 1510
ipp ( attach
Mo
FORM
Ni
FSF
Se
0.014
0.064
0.014
0.444
2.263
0.158
0.458
2.327
0.172
NA 1
374 1
89
PAN Applied '"a"'� vi �,rvp type
( lbs/acre) Receiving Residual
Crop 1
51.247
0.0 00
0.000
0.00
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1p to this form):
Zn I P 1 51.247
5.019 47.948
93.147
98.166
2498
Application
Crop 2 Crop 1 Crop 2
NA Fescue
0.000
0.000
0.000
0.000
0.000
60 00
0.000
0.000
0.000
0.000
0.000
0.000
Date I lbs/ac
_.... 211
certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
alified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
brmation, including the possibility of fines and imprisonment for knowing violations."
�� *Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/200R)

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 "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Belmont WQ Permit #- W- Q0003281 Field #: BT 6-3 Acres Utilized: 23.3
Land Owner: Tony Jones Annual Dry Tons Applied: 20.4697 Site #- BT 6-3 Acres Permitted: 23.3
Operator: Tony Jones Predominant Soil Series: Cecile Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Cron 1 Max. PAN! 211 Cm *7 Nmm-.
o
- �-
�' o
Q 0
3-2014
Volume applied
-(enter-one)-SoIids -
Liquid
Cu. Yds Gallons
208000
- o
/o
Solids
2.36
Volume
Applie3 per
Acre
(Dry Tons/Ac)
0.879
Soil C
Residual Sources Precip_ y ° _ CD _z Nitrate_
Cond. - - - -- --- ❑ - --- ---
(NPDES #, WQ#, Past 24 � L? g TKN o 5 and
Fert., Animal (Dry, Hrs. o ;v ° CD � °° °
Wet, !, - * t' E Nitrite
Waste, etc) inches 0 ° - o
Moist) ° mg/kg mg/kg mg/kg
WQ0003281 dry0 s 0.5 0.3 50800 7 330 1510
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
Cd Cu Cr Pb I H I gMo Ni Se Zn P
0.004 0.990 0.102 0.058 0.003 0.009 0.040 0.009 3.136 29.959
0.156 56.769 1.277 5.119 0.094 0.417 2.137 0.953 78.701
0.160 57.759 1.379 5.177 0.097 0.426 2.177 0.962 81.837
34 NA 1338 267 15 NA 374 89 2498
W __� ____ _
._ _ _.
PAN Applied
( lbs/acre
Crop 1
32.112
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
32.112
211
__ __
)
Crop 2
NA
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Name-of-Cro -' e-
ReceivingResidual
Application
Crop 1
Crop 2
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
)TALs: OT 208000
nnuallbs/acre
Tor Years Cumulative lbs/ac
arrent Cumulative lbs/ac
Xmitted C. P. L. R.****
:rmit PAN Limit 1 st/2nd Crop
certify_ under nvnalta7 of I.-+6.,+
As
0.007
0.559
0.566
36
_ . ..
+i.: a
Lime Applied
Date
lbs/ac
_ - - -- --a t Faa uu uuuCr ruy uirection or supervision in accordance with a system designed to assure that
lalified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
formation, including the possibility of fines and imprisonment for knowing violations."
- *Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

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 "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE
Facility Name: City of Belmont WQ Permit #: WQ0003281 Field #: BT 9-1 Acres Utilized: 42
Land Owner: Lori Warren Annual Dry Tons Applied: 58.2107 Site #: BT 9-1 Acres Permitted: 42
Operator: Lori Warren Predominant Soil Series: GaB2 Cation Exchan a Ca Capacity
g p ty (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 211 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
a) Z - -(enter-one)-Solids/
a 0Liquid
Cu. Yds Gallons
7-2014 143000
i-2014 448500
TALS:1 01 591500
mual lbs/acre
Volume
Residual Sources
Soil
cip.Applied-per-
WDES #�WQ#,
Cond:
24Solids
F:-t
Acre
Fert., Animal
(De ,s.
W
t�
(Dry Tons/Ac)
rite, etc)
2.36
2.36
0.335
1.051
0.000
WQ0003281
WQ0003281
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 I
for Years Cumulative lbs/ac
irrent Cumulative lbs/ac
rmitted C. P. L. R.****
-nit PAN Limit lst/2nd Crop
inches
0
0
a
o
z
Nitrate
TKN
o
o
*
* N'
Nitrite
a
0
mg/kg
mg/kg
mg/kg
s
0.5
0.3
50800
7630
1510
s
0.5
0.3
50800
7630
1510
As
Residuals
Cd
0.006
Applications
Cu
1.571
totals
I Cr
0.161
on FORM
Pb
0.092
FSF
I Hg
0.005
supp ( attach
Mo
0.014
FORM
Ni
0.064
FSF supp
Se
0.014
to this
Zn
4.976
0.011
0.164
0.072
14.881
27.415
2.704
6.031
0.077
1.395
0.063
103.182
0.175
0.078
16.452
27.576
2.796
0.036
0.091
1.459
0.077
108.158
36
34
NA
1338
267
15
NA
374 1
89
2498
PAN Applied
( lbs/acre)
Crop 1 Crop 2
12.247 NA
38.412 NA
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 0.000
0.000 0.000
Receiving Residual
Application
Crop 1 Crop 2
Fescue
Fescue
io rm):
P 50.660 0.000 Lime Applied
47.538 1Date I lbs/ac
211
certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
alified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
brmation, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1 I **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

- s
a;
'+�fy � :� ,-. '� �! �s $j4,#r Grp• '. .I'f•I,�r
�`'j/f s 1 i✓�v
I ♦: f ��j
Bonn
4 r• s
• d
A
Buffers
Property Line (50'
Perennial Stream 100')
Surface Water (10 ')
Road Right -of -Way (50 )�i
House 400')
Well (100')
Legend
Propery Line
Field Boundary © Well
Perennial Stream p House
o Surface Water
EM Unused Area
Jones, Tony: Buffers Map
'arcel: 3691304282
psi
art
f4 4
j.
r�
S
,Q.
rfbrY(,Reographiisltorrrratibn
antlArialysis,'
icoln County, NC 0 500 1,000 2,000 Feet
I ' I I Produced: October201
�^71 81 0358 N rth C I'
aro ina Stateplane, NAD83
ic.c} � ,�D