WQ0003281_More Information Received_20210316

Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
If not an application what is the submittal type?*
Permit Number (IR)*
Applicant/Permittee
Email Notifications
Does this need review by the hydrogeologist?*
Regional Office
CO Reviewer
Admin Reviewer
Annual Report
Residual Annual Report
r Additional Information
r Other
WQ0003281
City of Belmont
r Yes r No

Submittal Form
Project Contact Information
Rease provide inforration on the person to be contacted by N B Staff
Name * Zach Key
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ .....................................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
c Additional Information
r Other
Phone Number*
3369577871
O Modification - Minor
C Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WQ0003281
Fbs Current Existing perrrit number
Applicant/Permittee Address*
PO Box431 Belmont, NC 28012
Facility Name *
City of Belmont RLAP
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form} Engineering Rans, Specifications, Calculations, Bc.)
Additional Information Request W00003281.pdf 596.4KB
Upload only 1 RFdocurrent (less than 250 NB). Miltiple documents rust be contained into one RJFfile unless file is larger than
upload limit.
* V By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature f�
Submission Date 3/16/2021

PO Box 146 Ronda, NC 28670
336-777-6909
www.usbiosofids.com
Monday, March 8, 2021
Vivien Thong
NCDEQ-Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: Application WQ0003281
City of Belmont
Additional Information Request
A letter of request for additional information was received concerning the review of the City of
Belmont's Land Application Permit WQ0003281 renewal. The letter had five items of concern.
This first item is concerning the five-year maximum adjusted Plant available nitrogen. This calculation
has been redone and an updated form RLAP 06-16 has been included with this letter.
The second item was the box on form RSC 06-16 was checked in Section H1.3.a stating that the residuals
were listed in 40 CFR 261.31-261.33. This was a mistake, as the residuals are NOT listed in 40 CFR
261.31-261.33; an updated form RSC 06-16 has been included with this letter.
Item C in the letter requested the cumulative pollutant loading rates (CPLR) be submitted. These have
been submitted with this letter.
Item D is regarding the setback map for field 09-01. The buffers where set years ago due to decorative
shrubbery and trees that was planted between the residences, and the field. The buffers where set so
residuals spreading equipment would disturb the shrubbery and trees. We also have no objections to
the footnote being removed for field 09-01.

The last item, item E, is concerning the ORC form. The ORC form as been updated and included with this
letter. The ORC designation has also been updated in section III part 3 of form RLAP 06-16
If you have any questions or concerns, please contact me via e-mail at: [e-mail] or at
me direct line at 336-957-7871.
Sincerely,
�4 �
Zach Key
U.S. Biosolids, Inc.

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Belmont
Applicant type: ❑ Individual [❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Adrian Miller Title: City Manager
Applicant's mailing address: PO Box 431
City: Belmont State: NC Zip: 28012
Telephone number: [phone] Email Address: [e-mail]
2. Consultant's name: Zach Ka License Number (for P.E.):
Affiliation: ❑ On Staff 0 Retained (Firm: US Biosolids Inc.)
Consultant's mailing address: 958 Hoots Road
City: Roaring River State: NC Zip: 28669-9148
Telephone number: [phone] Email Address: zachke cr,usbiosolids.com
3. Agronomist's name: License Number:
Affiliation: ❑ NIA 0 On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip: -
Telephone number: (-____) - Email Address:
4. Soil Scientist's name: License Number:
Affiliation: ❑ NIA 0 On Staff ❑ Retained (Firm: )
Soil Scientist's mailing address: .
City: State: Zip: -
Telephone number: (_) _- Email Address:
5. Fee submitted: $0.00 (See Instruction B)
IL PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, 11 renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0003281
Date of most -recently issued permit: 5-31-2016
Date of most -recently certified Attachment A (if different than the permit): 5-31-2016
Date of most -recently certified Attachment B (if different than the permit): 5-31-2016
FORM: RLAP 06-16 Page I of 5

Ill. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 298 Parkdale Drive
City: Belmont State: NC Zip: 28102
Coordinates: Latitude: 35' 13' 50" Longitude: 81° 01' 50"
Datum: NAD83 Level of accuracy: 1I"
Method of measurement: MAP
2. County where residuals land application program is headquartered: Gaston
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Zach Key
US Biosolids, Inc.
27660
Back -Up ORC
David Key
US Biosolids, Inc.
23629
Additional Back -Up
ORCs
(if applicable)
Dennis Key
US Biosolids, Inc.
15704
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 300 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
28.442
31.772
8532.6
9531.6
Five -Year Maximum Adjusted
29.222
32.552
8766.6
9765.6
b. Land Applicalion She Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
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 06-16
a._
Page 2 of 5

Residuals Land Application Summary. Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
Concentrations
(lbs PAN/ac-yr)
Surface
Incorporation or
Surface
Incorporation or
Injection
Injection
50
170.65
190.63
175.33
195.3
100
85.32
95.31
87.66
97.65
150
56.88
63.54
58.44
65.1
200
42.66
47.65
43.83
48.83
6. if applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation ofNorth Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
[] Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source CertiTcation and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

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

Applicant's Certification (signing authority must be in compliance with ISA NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T _0105.
® Yes ❑ No, Explain-,
I, Adrian Miller _ City Manager
(Signature Authority's Name -- PLEASE PRINT) (Title)
attest that this application for City_of Belmont. W WTP
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against [he Division of Wafter
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to S25,000 per violation.
#�
Signature: ` __ _ Dale: 12/10/20
FORM: RLAP 06-16 Page 5 of 5

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: City of Belmont
Status Maximum Dry Tons Per Year
Codes Facility Permit Holder Facility Name County Permit Number
Current n Proposed
R City of Belmont City of Belmont W WTP Gaston WQ0003281 300 300
0
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) • M (Modified) ♦ D (Deleted)
h The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 06-16 Page 1

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: City of Belmont Waste Water Treatment Plant
2. Facility permit holder is: Federal, 0 State, 0 Local Government, or El Private.
Facility permit issued by: [ Div. of Water Resources, [] Div. of Environmental Health,
or Other (explain }.
3. Facility contact person and title: Tanya S. Carter WWTP Superintendent- 0 RC
Complete mailing address: PO Box 431
City: Belmont State: NC Zip: 28012
Telephone number: [phone] E-mail address: tsetzer(a)cityofbelmont.org_
4. Facility physical address: 298 Parkdale Drive
City: Belmont State: NC Zip: 28012
Coordinates: Latitude: 35' 1" 50.54" Longitude: 81° 01' 03.61"
Datum: WGS84 Level of accuracy: .01
Method of measurement: MAP
5. Purpose of the facility:
treatment of municipal wastewater, ( treatment of 100% domestic wastewater,
treatment of potable water, treatment of 100% industrial wastewater,
Ej treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: ;,;_:_:_` % industrial and ,-. % domestic)
0 other (explain ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 5 MGD and facility average daily flow: 332 MGD
8. Average amount of residuals being generated at this facility 99.26 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 1.7 Million Gallon Sludge Holding Tank
Type and volume of residuals storage (i.e., outside of residuals treatment units)
[1. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
ED 40 CFR Part 503 or [,] 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257,
2. Specify if residuals are defined under 15A NCAC 02T. ] 102(6) as:
E Biological Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page I of

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261,31-§261.33: Q. yes 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: Q yes 0 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: PACE Analytical and Date of analysis: 8/18/2020
Passed corrosivity test: 0 yes El no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: 2 yes 0 no. Flasbpoint: 200 IF (> 140°F)
Passed reactivity test: 0 yes ]no. HCN: ND mglkg (<250) & H2S: ND mglkg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(m9/0
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Tetrachloride
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
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
l,l-Dichloroethylene
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
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under i 5A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Waypoint Analytical and Date of analysis: 8/ 18/2020
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg}
Result
(mg/kg)
Arsenic
75
41
12.5
Cadmium
85
39
2.5
Copper
4,300
1,500
343
Lead
840
300
31.3
Mercury
57
17
0.973
Molybdenum
75
n/a
6,25
Nickel
420
420
23.2
Selenium
100
100
12.5
Zinc
7,500
2,800
1610
b. For Surface Disposal Unit (Ian : Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory.and Date of analysis.
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mglkg)
> 0 but < 25
30
200
210
> 25 but < 50
34
220
240
> 50 but < 75
39
260
270
Q > 75 but < 100
46
300
320
E > 100 but < 125
53
360
390
> 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 3.95 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Waypoint Analytical and Date of analysis: 08/18/2020
Parameter
Result
(mg/kg)
Aluminum
47800
Ammonia -Nitrogen
3330
Calcium
13100
Magnesium
3080
Nitrate -Nitrite Nitrogen
35
pH (Standard Unit)
7.3
Phosphorus
22200
Potassium
2650
Sodium
6100
Total Kjeldahl Nitrogen
44000
c. Using the results listed in item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.417
[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): a default value, or . actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
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
Maximum Adjusted PAN
(mg�k�
(mg/kg)
Surface
14221
15216.5
I nj ection lln corporation
15886
16998
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:a�''l'''
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent.,
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
El A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
[] Alternative 1 [15A NCAC 02T.1 106(b)(3)(A)] - Time/Temperature Compliance.
1 . Alternative 2 [15A NCAC 02T.1 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.1 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova,
0 Alternative 5 [15A NCAC 02T. 1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: 0 composting, 0 heat drying, 0 heat treatment,
thermophilic aerobic digestion, beta ray irradiation,
gamma ray irradiation, or pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T, i 106(c)(2) - Process to Significantly Reduce Pathogens (PSRP).
Specify one: EJ aerobic digestion, Q air drying, El anaerobic digestion,
El composting, or 0 lime stabilization.
c. For Surface Disposal:
Select One of the Class A or Equivalent Pathogen Reduction Alternatives in item II. 7a. above.
El Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
Exempt - If Daily Cover Alternative is chosen in Item 11.8. below [ 15A NCAC 02T.1 106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107, specify how residuals will meet the VAR requirements:
Alternative I [15A NCAC 02T.I 107(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.1 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.1 107(a)(5)1 - 14-Day Aerobic Processes.
[] Alternative 6 (15A NCAC 02T.1 107(a)(6)] - Alkaline Stabilization.
0 Alternative 7 [15A NCAC 02T.1 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T.1 107(a)(8)] - Drying ofUnstabilized Residuals.
El Alternative 9 (15A NCAC 02T.1 107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
0 Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. l 107(b)(2)].
0 Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED A?ND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: C:in of Belmont WQ Permit##: WQ000378I Field 9: BT 6-1 Acres Utilized: 27
Land Owner: Tong Tones Annual Dr% Tons Applied: 20.3586 Site #: BT 6-t. Acres Permitted: 27
Operator: Tony Jones Predominant Soil Series: CeB2 Cation Exchance Capacity (non iO3):
Crop I Name:_. fescue Crop I Max. PAN: 211 Crop 2 Name: Cron 2 Max. PAN:
Volortic applied
Volume
Residual Sources
Soil
Preci P
Y
C
_
Z -
N:!rate
Namc of Crop f�'pc
o
w
(voter rate) So€ids:
o
Applied per
(NP]:)1:S -_ W r:.
Q
Cortd.
Past 24
0 -
-
_
TKN
- _
o y
and
PAN Applied
Reccr�tn" RCs7dttA1
ca
Q
Liquid
Solids
Acre
FerL. Animal
(1)n"
1 [rs.
C o
r-
-
*
=
*
�'
Nitrite
(lbsiacre}
.
App€icatton
Co Yds Gallons
(Dry TonslAc)
Waste- cic)
Wet -
1VIoi51}
inches
inches
=
�. =
m !k
9 9
m !k
9 9
m !k
9 J
Crop 1
Crop �'
Crop 1
Crop ?
7-2017
188500
2.59
0.754
WQ0001281
1 dr%
0
s
0.5
41500
34G0
1690
26.891
NA
Fescue
0.000
o.o[)n
c).cmo
0 000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
a.000
o.000
o tux)
0.000
0.000
0.000
0.nno
0.000
0.000
0.000
0.000
0.000
rW00
0.000
0.000
0.000
0.000
1)_000
0.000
0.000
tr,or)0
Residuals Applications totals on FORM
FSF supp ( attach FORM FSF supp to this form):
Tzr1:�t,s n l sssua
As Cd Cu Cr Pb Ho Mo Ni Se Zrt P 26.89 ___ D 01)u
Lime Applied
Annual lbs/acre
0.006 0.f)03 0.410 0.103 0.033 0.001 0 008 0,020 0.008 1.9-15 26.692
Date Ibs/ac
Prior Years Cunutlative lbs/ac
0.151 0.175 62.981 1.965 5.456 0.114 0466 2.359 0.18 100,644
0.157 0.178 G3.391 2.071 iA89 0.1 15 0 474 = ,79 0 188 102.589
Current Cui.imla[i��e lbs/ac
Permitted C P. L. R. *
36 34 1 NA 1338 267 15 NA 374 89 2498
Permit PAN L,innt 1st/2nd Crop
211
t vt:, tr,., i1 IMI- 1.1crian\of i:ov, inat tnts document was prepared under my direction or supervision in accordance with a s}•stem designed to assure that
qualified personnel properly ;;atherccl and e. aivated the infO1-m2ttion submitted. I am more that there are significant penalties for submitting false
information, including the possibility of tines and imprisonment for knowing violations."
Signature of Land Applier
- I I- I'd
Date
*Application Method: S - Surface, IN - In INC - Incorporation
"Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anacrobiall-v di-ested -0.2, aerobicaIIN
dioestcd -0.3, ra" slud4we -0.4
'**C'.P_L.R.: Cumulative Pollutant Loadin6 Rate
DFNR 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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Cite of Belmont WQ Permit #: WQ0003281 Field #: BT 6-3 Acres Utilized: 12,9
Land Owner: l ony ,loner Annual Dr% Tons Applied: 294848 Site #: BT 6-3 Acres Permitted: 12.9
Operator: Tony Jones Predominant Soil Series: CeB2 Cation Exchange Capacity (non 503):
Crop 1 Name: l"escuc Crop 1 Max- PAN: -'- I I Crop 2 Name: Crop 2 Max. PAN:
=_
�-
cs o
VOILMIC applied
PP
(enter one) Solids
Liquid
Cu. Yds I Gallons
n
Solids
Volume
died per
Applied p
Acre
(Dry Tons/Ac)
Residual Sources
(NI 1)1,:S ;s. \N'Q' .
Ferl.. Animal
Wasle. etc)
Soil
Cond.
(f:)n_
44et,
Moist)
Precip
Past _ 1
Hrs.
Inches
>
K
n
n
c
1
r =
-
r
# =
�'
_
fKAI
mg/kg
Z _
= _
d
°
mglkg
Nitrite
and
Nitrite
mglkg
PAN Applied
( lbs acre)
Name of Crop Type
Receiving Residual
Applicsation
Crop 1
Crop 2
Cron 1
Crop 3
7-2017
273000
2.59
2.296
WQ0003281
dry
0
S
0.5
0.;
41300
3460
4690
81.513
NA
FeSCUe
0,000
0000
0,000
0 000
0.000
0.000
0.0W
0J)00
0.000
0.000
0.00()
0.000
0,000
0.000
0.(r00
0.000
0.000
0.000
0.000
0.000
0.000
0_00I)
0.000
0.000
0.000
0.000
0.000
tl_000
0.000
0.000
0,000
0'(0)
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTAT�
O
z73otta
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
91.51.5
0.000
Lime Applied
Atmual
lbs/acre
0.019
0.009
1 244
0.313
0 101
0.002
0.023
0.060
0.023
5 998
80.924
Date
lbs/ac
Prior Years Cumulative lbs/ac
t) 5S5
060.4
36 1
0.168
0.177
34
59.162
60.406
NA 1
1 708
2021
1338 1
5.275
5.376
267 1
0.099
0 101
IS 1
04-15
0 468
NA 1
2.249
2.309
374 1
0.981
1.004
89 1
87.397
93.295
2498
1 I-17
1000
Current Cutnula€ivc Ibs/ac
Penmitted C. R L. Ri ***A
Permit PAN Limit I s1/2nd Crop
711
"I certtty, under penalty ut laiv, that this document was prepared under m,*- direction or supervision in accordance with a system designed to assure that
qualified personnel properlY gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
"Application Method: S - Surface, IN - Injection, INC - Incorporation
";`Volatilization Rate: Surface -03,In.jection/Incorporation - 1.0
Signature old Land Applier Date Mineralization Rates: Compost --0.1, anaerobially digested -0.2, aerobically
(Ii�„ested -0.3, ra►r sludge -0.4
"C.P.L.R.: Cumulati-e 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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Belmonr WQ Permit #: WQ0003281 Field #: BT 9-1 Acres Utilized: 42
Land Owner: Lori Warren Annual Dry Tons Applied: 84.7465 Site #: BT 9-1 Acres Permitted: 42
Operator: Lori Warren Predominant Soil Series: GaB2 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 211 Crop 2 Name: Crop 2 Max. PAN:
`- u
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/AC)
Residual Sources
(NPDES #, WQ#,
Fert.. Animal
Waste, etc)
Soil
Cond.
(Dry'
Wet'
Moist)
Precip.
Past 24
11rs.
inches
D
� �
FD
o ,mow*
a
*
o
';
-
; N'
o
a
K
� �
w d
N
* w
o'
TKN
mglkg
z
o �
ao o
w
mgtkg
Nitrate
and
Nitrite
rnglkg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop I
Crop 2
7-2019
526500
3.86
2.018
W00003281
dry
0
s
0.5
0.3
43100
5380
4.84
56,541
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
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
J
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
01
526500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
56.541
0.000
Lime Applied
Annuallbslacre
0.026
0.004
1.308
0.366
0.101
0.002
0.018
0.085
0.026
6,337
83.142
Date
lbs/ac
Prior Years Cumulative Ibs/ac
0.372
0.121
25.707
28.977
3.435
0.058
0.364
1.89
0.185
131,647
11-2019
1000
Current Cumulative lbs/ac
0.398
0.125
27.015
29.343
3.536
0.060
0.382
1
1,975
0.211
137.984
Permitted C. P. L. R.****
36
34
NA
1338
1 267
1 15
NA
374
89
2498
Permit PAN Limit 1 st/2nd Crop
211
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*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 (1212006)

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
Press TAB to enter information
Permittee Owner/Officer Name: City of Belmont WWTP/ Adrian Millet'
Mailing Address: PO Box 431
city: Belmont
Email Address: amiller i
Signature:
Facility Name: City of Belmont
County: Gaston
State: NC
Phone: [phone]
zip: 28012
Date: 3/8/21
Permit # WQ0003281
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type:
I LA
0
Facility Grade:
NIC
[�
OPERATOR IN RESPONSIBLE CHARGE (ORC)
Print Full Name: Zach D Key Work Phone: [phone]
Certificate Type: LA I] Certificate Grade: I Certificate 4: 27660
Email Address: [e-mail] _
Signature:?rtoining
1� Effective Date: 3- �• �o�
certify that l agreation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulationthe responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name. David W Key Work Phone:[phone]
Certificate Type. LA El Certificate Grade: I 0 Certificate tt:23629
Email Address: David key@usbiosolids-corn
Signature: / Effective Date: _3 - 0
"I certify that / agree to my designation as a Sack -up Operator in Responsible Charge for the facility noted. i understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 06G .0204 and foiling to do so can result in
Disciplinary Actions by the Water Pollution Control5ystem Operators Certification Commission."
Mail, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone] Email: [e-mail]
ORIGINAL to: Raleigh, NC 27699-1618
Mail or Fax Asheville
a COPY to: 2090 US Hwy 70
Swannanaa, NC 29778
Fax;828-299-7043
Phone:[phone]
Fayetteville
225 Green St., Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Mooresville
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax;704-663-6040
Phone:[phone]
Washington Wilmington Winston-Salem
943 Washington Sq. Mail 127 Cardinal Dr. 45 W. Hanes Mail Rd.
Washington, NC 27889 Wilmington, NC 28405-2845 Winston-Salem, NC 27105
Fax:[phone] Fax:[phone] Fax: [phone]
Phone:[phone] Phone:[phone] Phone: [phone]
Raleigh
3800 Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone.-919-791-4200
Revised 4/2016

WPCSOCC Operator Designation Form (continued)
Facility Name: City of Belmont
Permit M WQ0003281
BACKUP ORC
Print Full Name: Dennis Key Work Phone:[phone]
Certificate Type: LA Q Certificate Grade: I Certificate it: 15704
Email Address: [e-mail]
Page 2
Signature: Effective Date: �2
`4 certify that l agree topmy designatron as a Back-up Operator in Responsible Charge for the facility noted. ! understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address:
Signature:
Effective Date:
"1 certify that 1 agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. t understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 1SA NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Print Full Name:
Certificate Type: Select
Email Address:
BACKUP ORC
Certificate Grade: Select
Work Phone:
Certificate #:
Signature: Effective Date:
"! certify that 1 agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 086 .0204 and failing to do so con result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: Work Phone:
Certificate Type: Select
Email Address:
Signature:
Certificate Grade: Select
Certificate #:
Effective Date:
'Icertify that l agree to my designation as a Bock -up Operator in Responsible Charge for the facility noted. 1 understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission.'
Revised 412016