WQ0030998_More Information (Received)_20221102

Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map tsuuidance for
Residu�tl5.._�.., nd Ai��llcat c7r7,._P nzl, is".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constricted and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

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Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
L RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name:
2. Facility permit holder is: ❑i Federal, ❑ State, ❑ Local Government, or ❑i Private.
Facility permit issued by: ❑i Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑i Other (explain:
3. Facility contact person and title:
Complete mailing address:
City: State: Zip: -
Telephone number: ( ) — E-mail address:
4. Facility physical address:
City: State: Zip: -
Coordinates: Latitude: _° ' _" Longitude:
Datum: Level of accuracy:
Method of measurement:
5. Purpose of the facility:
treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
treatment of potable water, ❑ treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and % domestic)
❑'! other (explain: ; ).
6. Does the facility have an approved pretreatment program: ❑ Yes ❑ No
7. Facility permitted/design flow: MGD and facility average daily flow: _ MGD
8. Average amount of residuals being generated at this facility dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment:
Type and volume of residuals storage (i.e., outside of residuals treatment units):
IL RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
040 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.1102(6) as:
❑ Biological ❑ Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that
treat 100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ❑ no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑; yes ❑ 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: i and Date of analysis:
Passed corrosivity test: ❑, yes ❑, no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: 0, yes 0, no. Flashpoint: OF (> 140°F)
Passed reactivity test: ❑ yes ❑no. HCN: mg/kg (<250) & H2S: mg/kg (<500)
TCLP Parameter
Limit
(mg//)
Result
(mg//)
TCLP Parameter
Limit
(mg//)
Result
(mg//)
Arsenic
5.0
Hexachlorobenzene
0.13
Barium
100.0
Hexachloro-1,3-Butadiene
0.5
Benzene
0.5
Hexachloroethane
3.0
Cadmium
1.0
Lead
5.0
Carbon Tetrachloride
0.5
Lindane
0.4
Chlordane
0.03
Mercury
0.2
Chlorobenzene
100.0
Methoxychlor
10.0
Chloroform
6.0
Methyl Ethyl Ketone
200.0
Chromium
5.0
Nitrobenzene
2.0
m-Cresol
200.0
Pentachlorophenol
100.0
o-Cresol
200.0
Pyridine
5.0
p-Cresol
200.0
Selenium
1.0
Cresol
200.0
Silver
5.0
2,4-D
10.0
Tetrachloroethylene
0.7
1,4-Dichlorobenzene
7.5
Toxaphene
0.5
1,2-Dichloroethane
0.5
Trichloroethylene
0.5
1,1-Dichloroethylene
0.7
2,4,5-Trichlorophenol
400.0
24-Dinitrotoluene
0.13
2,4,6-Trichlorophenol
2.0
Endrin
0.02
2,4,5-TP (Silvex)
1.0
Heptachlor and its Hydroxide
0.008
Vinyl Chloride
0.2
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: i and Date of analysis:
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg1k-g)
Monthly Average
Concentration Limits
(Class A Only)
(mg1k-g)
Result
(mg1k-g)
Arsenic
75
41
Cadmium
85
39
Copper
4,300
1,500
Lead
840
300
Mercury
57
17
Molybdenum
75
n/a
Nickel
420
420
Selenium
100
100
Zinc
7,500
2,800
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:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but < 25
30
200
210
❑'! > 25 but < 50
34
220
240
> 50 but < 75
39
260
270
> 75 but < 100
46
300
320
> 100 but < 125
53
360
390
❑'! > 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: %.
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
micronutnent parameters:
Laboratory: i and Date of analysis:
Parameter
Result
(mg1k-g)
Aluminum
Ammonia -Nitrogen
Calcium
Magnesium
Nitrate -Nitrite Nitrogen
pH (Standard Unit)
Phosphorus
Potassium
Sodium
Total Kjeldahl Nitrogen
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR):
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: %.
This rate is a (check one): 0, default value, or F-1 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 (lgt) Year PAN
Five -Year
Maximum Adjusted PAN
(mg1k-g)
(mg/kg)
Surface
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

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
❑, A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑, heat treatment,
❑, thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.1106(c)(1)] -Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(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 IL8. below [15A NCAC 02T.1106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T. I 107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. I 107(b)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

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

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
1. Facility Name: Summerhouse WRF
2. Facility permit holder is: 0 Federal, El State, 9 Local Government, or D Private.
Facility permit issued by: Z Div. of Water Resources, El Div. of Environmental Health,
or E] Other (explain:
3. Facility contact person and title: Kary Hemdon, ORC
Complete mailing address: 228 Georgetown Road
City: Jacksonville State: NC Zip: 28584-
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 211 King Creek Parkway.
City: Holly Ridge State: NC Zip: 28584-
Coordinates: Latitude: 34* 29' 45.59" Longitude: 77' 30' 13.87"
Datum: NAD83 Level of accuracy: Hundredths of second
Method of measurement: MAP
5. Purpose of the facility:
El treatment of municipal wastewater, N treatment of 100% domestic wastewater,
El treatment of potable water, E] treatment of 100% industrial wastewater,
El treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and — % domestic)
E] other (explain: _ ).
6. Does the facility have an approved pretreatment program: El Yes No
7. Facility permitted/design flow: 0.4 MGD and facility average daily flow: 0®2 MGD
8. Average amount of residuals being generated at this facility 35 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 4 - 44,000 gallon MBR basins, 2 — 129,400 gallon aerobic digesters
Type and volume of residuals storage (i.e., outside of residuals treatment units): N/A
1. Specify if residuals are regulated under:
0 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 .1 5A NCAC 02T. 1102(6) as:
M Biological E] Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed m40 CFR §261.31-§26133: Ej yes El no.
If yes, list the number(s): _
b, Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261 ,21-
26 1 ,24: 0 yes 11 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: Environmental Chemists Inc. and Date of analysis: _jRly 20 2021
Passed corrosivity test: Z yes E] no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: Z yes 0 no. Flashpoint: >200°F (> 140°F)
Passed reactivity test: Zyes E]no, HCN:<I.Omg/kg(<250)&H2S:0.15mg/kg(<500)
TCLP Parameter
Limit
Result
TCLP Parameter
Limit
Result
(mg/1)
(mg/1)
(mg/1)
(mg/1)
Arsenic
5.0
<1.0
Hexachlorobenzene
O° 13
<0.05
Barium
100.0
<1.0
Hexachloro- 1,3-Butadiene
0,5
<0.05
Benzene
0.5
<0.01
Hexachloroethane
10
<0.05
Cadmium
Lo
<L0
Lead
5.0
<1.0
Carbon Tetrachloride
0.5
<Ul
Lindane
0.4
<U005
Chlordane
U3
<0.02
Mercury
0.2
<U002
Chlorobenzene
IOU
<U I
Methoxychlor
10.0
<0.0005
Chloroform
6.0
<0.01
Methyl Ethyl Ketone
200.0
<0.05
Chromium
5,0
<L0
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.01
Pentachlorophenol
IOU
<0.25
o-Cresol
200.0
<0.05
Pyridine
5.0
<0.05
p-Cresol
200.0
<0.05
Selenium
1.0
<1.0
Cresol
200.0
<0.05
Silver
5,0
<1.0
2,4-D
10.0
<0.003
Tetrachloroethylene
0.7
<0.01
1,4-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.01
Trichloroethylene
0.5
<0.01
I,I-Dichloroethylene
0.7
<0.01
2,4,5-Trichlorophenol
400.0
<0.05
2,4-Dinitrotoluene
0.13
<U5
2,4,6-Trichlorophenol
2.0
<0.05
Endrin
0.02
<0°0005
2,4,5-TP (Silvex)
1.0
<0.003
Heptachlor and its Hydroxide
0.008
<U005
Vinyl Chloride
0.2
<0.01
FORM: RSC 06-16 Page 2 of 5

111111!1 1 1111111 Pill III I "i 11111111111�111111qil� I I 11�M,7=10111��zglll 11111!, 11 111111111111 111111111
violate the ceiling concentrations for metals regulated under 15A NQAQ 02T .1105.
MM=
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mglk-g)
(mg1k-g)
NOW)
Arsenic
75
41
<31.60
Cadmium
85
39
<31.60
Copper
4,300
1,500
92.70
Lead
840
300
<31.60
Mercury
57
17
<2.39
Molybdenum
75
n/a
<31.60
Nickel
420
420
<31.60
Selenium
100
100
<31.60
Zinc
7,500
2,800
1,540.00
f I L-dr,—*dMffLCr&.
Laboratory: and Date of analysis:
Distance from Disposal
Arsenic
Chromium
Nickel
Unit to Boundary to
Closest Property Line
(meters, check- one)
(niglkg)
(niglk-g)
(mglk-g)
Ej > 0 but < 25
30
200
210
El> 25 but < 50
34
220
240
0> 50 but < 75
39
260
270
El >75 but< 100
46
300
320
[-] > 100 but< 125
53
360
390
El > 125
62
450
420
Result (mglk-g)
FORM: RSC 06-16 Page 3 of 5