NC0021181_Renewal (Application)_20231206

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Barry Webb
City of Belmont
PO Box 431
Belmont, NC 28012-0431
Subject: Permit Renewal
Application No. NCO021181
Belmont WWTP
Gaston County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
December 06, 2023
The Water Quality Permitting Section acknowledges the December 6, 2023 receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deg.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
D Q>
North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
704.663.1699

F)2
hdrinc.com
November 28, 2023
Mr. Gary Perlmutter, M.Sc.
Division of Water Resources
Water Quality Permitting Section — NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: NPDES Renewal Application
City of Belmont
Belmont WWTP
NCO021181
Dear Mr. Perlmutter,
RECEIVED
DEir 06 _023
NCDEQ1D WR/
NPpES
HDR Engineering, Inc. of the Carolinas (HDR), an authorized agent of the City of Belmont, is
submitting an NPDES permit renewal application to the North Carolina Department of
Environmental Quality (NCDEQ). There have been no expanded facilities since the last permit
submittal and the design flow rate is to remain the same. Enclosed are the following items for
your review for the referenced project:
• EPA Form 2A for new and existing publicly owned treatment works
• Topographic Map
• Flow Diagram
• Chemical Addendum to NPDES Application
• Mercury Minimization Plan
• Sludge Management Plan
• City of Belmont WWTP Effluent Pollutant Scans
Whole Effluent Toxicity Reports have been previously submitted to NCDEQ on the dates listed in
EPA Form 2A and therefore were not attached to the application per instruction item 3.19. An
additional Whole Effluent Toxicity Report will be submitted for 2023 after the NPDES renewal
application has been submitted.
Sincerely,
HDR Engineering, Inc. of the Carolinas
Will Shull, E.
Project Manager
440 S Church Street, Suite 1200, Charlotte, NC 28202-2075
704.338.6700

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WWTP
OMB No. 2040-0004
U.S. Environmental Protection Agency
L
EPA
Application for NPDES Permit to Discharge Wastewater
NEW AND EXISTING PUBLICLY OWNIMXREAktol W K
SECTION•N
INFORMATION FOR
Facility name
1.1
Belmont Wastewater Treatment Plant DEC 0
Mailing address (street or P.O. box)
PO Box 431
City or town
Stat
o
Belmont
NC
28012
E
Contact name (first and last)
Title
Phone number
Email address
Tanya S. Carter
[phone]
[e-mail]
c
'
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
298 Parkdale Dr.
City or town
State
ZIP code
Belmont
NC
28012
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑✓ No 4 SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
w
<a
E
`o
City or town
State
ZIP code
w-
c
ca
Contact name (first and last)
Title
Phone number
Email address
CL
a
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
❑ Owner ❑ Operator ❑✓ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑✓ Facility ❑ Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
r
number for each.
E
a5
Existing Environmental Permits
✓❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E:
NCO021181
2
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
N
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
EPA Form 3510-2A (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
acility Name
Form Approved 03/05/19
110000570338
NCO021181
=BelmontWWTP
OMB No. 2040-0004
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Served
Served
indicatepercentage)Ownership
Status
Belmont
100 % separate sanitary sewer
❑ Own ❑ Maintain
Z16,489
% combined storm and sanitary sewer
❑ Own ElMaintain
❑ Unknown
ElOwn ElMaintain
co
c
% separate sanitary sewer
ElOwn ElMaintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
cc
c
El Unknown
❑ Own El Maintain
a
% separate sanitary sewer
❑ Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own ❑ Maintain
c
❑ Unknown
❑ Own ❑ Maintain
a
% separate sanitary sewer
❑ Own ❑ Maintain
combined storm and sanitary sewer
❑ Own ❑ Maintain
co%
c
❑ Unknown
I ElOwn ❑ Maintain
Z
Total 16,489
Population
U
Served
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
100 %
°
13 /°
z'
1.8
Is the treatment works located in Indian Country?
c
_
0
V
ElYes ❑✓ No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes ❑✓ No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
5 mgd
R
=
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c
30
1.291 mgd
1.846 mgd
1.917 mgd
LZ
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
2.468 mgd
3.200 mgd
6.977 mgd
N
1.11
Provide the total number of effluent discharge points to waters of the United States by type.
r
oTotal
Number of Effluent Dischar a Points b Type
a a
a)
Combined Sewer
Constructed
T
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
Overflows
1
N/A
N/A
N/A
N/A
EPA Form 3510-2A (Revised 3-19) Page 2

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WW rP
OMB No. 2040-0004
Outfalls Other Than to Waters of the United States
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes ❑✓ No + SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
N/A
N/A gpd
❑ Intermittent
❑ Continuous
N/A
N/A gpd
❑ Intermittent
❑ Continuous
w
-a
N/A
N/A gpd
❑ Intermittent
w
1.14
Is wastewater applied to land?
M
❑ Yes ❑✓ No SKIP to Item 1.16.
0
1.15
Provide the land application site and discharge data requested below.
in
Land A lication Site and Discharge Data
o
Average Daily Volume
Continuous or
0
Location
Size
Applied
Intermittent
check one
N
0
N/A
N/A acres
N/A gp d
❑ Continuous
❑ Intermittent
c
N/A
N/A acres
N A gp
/ d
❑ Continuous
❑ Intermittent
0
c
N/A
N/A acres
N/A gpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes m No + SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
N/A
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ✓❑ No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter Data
Entity name
Mailing address (street or P.O. box)
N/A
N/A
City or town
State
ZIP code
N/A
N/A
N/A
Contact name (first and last)
Title
N/A
N/A
Phone number
Email address
N/A
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WWTP
OMB No, 2040-0004
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receivinq IF cilitv Data
Facility name
Mailing address (street or P.O. box)
N/A
N/A
City or town
State
ZIP code
U
N/A
N/A
N/A
U)
Contact name (first and last)
Title
0
N/A
N/A
d
Phone number
Email address
N/A
QNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate N/A mgd
fq
0
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
C
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
d
s
❑ Yes ❑✓ No 4 SKIP to Item 1.23.
A2
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
r
N/A
N/A
N/A acres
N/A d
gp
❑ Continuous
❑ Intermittent
N/A
N/A
N/A acres
N/A 9Pd
❑ Continuous
❑ Intermittent
N/A
N/A
N/A acres
N/A gpd
El Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
y
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Er
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑✓ No 4SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
c
Contractor name
N/A
N/A
N/A
ca
(company name
E
Mailing address
street or P.O. box
N/A
N/A
N/A
o
City, state, and ZIP
N/A
N/A
N/A
code
c
Contact name (first and
0
last
N/A
N/A
N/A
Phone number
Email address
N/A
N/A
N/A
Operational and
maintenance
N/A
N/A
N/A
responsibilities of
contractor
EPA Form 3510-2A (Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110000570338 NCO021181 City of Belmont WWTP OMB No. 2040-0004
SECTIOND• • •- •
o Outfalls to Waters of the United States
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o
RV Yes ❑ No 4 SKIP to Section 3.
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
20,000 d
gp
0
R
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration.
The facility inspects manholes regularly and cleans debris from the collection system to help minimize inflow and
R
3
infiltration.
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
cc
specific requirements.)
C
0
0
0
❑✓ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
0
(See instructions for specific requirements.)
_ a�
" o
❑✓ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑✓ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1. N/A
c
a�
E
aT
M
2. N/A
E
0 0
M
3. N/A
2
a
a�
4. N/A
Cn
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled
or Actual Dates of Com letion for Im rovements
E
0
>
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
Improvement
(list l
Construction
Construction
Discharge
Level
E
(from above)
number)
)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DDIYYYY
a
1.
N/A
a
a�
s
co
2.
N/A
3.
N/A
4.
N/A
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑✓ None required or applicable
Explanation:
N/A
EPA Form 3510-2A (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number
Facility Name Form Approved 03/05/19
110000570338 NCO021181
City of Belmont WWTP OMB No. 2040-0004
SECTION•'
• ON DISCHARGES
3.1
Provide the following information for each outfall. (Attach additional
sheets if you have more than three outfalls.)
Outfall Number 001
Outfall Number N/A
Outfall Number N/A
State
NC
N/A
N/A
w
County
Gaston
N/A
N/A
o
City or town
Belmont
N/A
N/A
0
c
w
Distance from shore
345 ft.
N/A ft.
N/A ft.
n
d
Depth below surface
12.23 ft.
N/A ft.
N/A ft.
0
Average daily flow rate
1.68 mgd
N/A mgd
N/A mgd
Latitude
3T 13 31'
N/A7 N/A' N/A"
N/A N/A N/A"
Longitude
81 od 52"
N/A N/A' N/A"
N/A- N/A' N/A"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
v
o
❑ Yes ✓❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
n
Outfall Number N/A
Outfall Number N/A
Outfall Number N/A
0
Number of times per year
discharge occurs
N/A
N/A
N/A
a
Average duration of each
0
discharge (specify units
N/A
N/A
N/A
oAverage
flow of each
N/A mgd
N/A mgd
N/A mgd
w
discharge
in
Months in which discharge
N/A
N/A
N/A
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
CL
Outfall Number N/A
Outfall Number N/A
Outfall Number N/A
N/A
N/A
N/A
0
vi
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
w
❑✓ Yes ❑ No -SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page 6

EPA Identification Number
NPCES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WWTP
OMB No.2040-0004
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 001
Outfall Number N/A
Outfall Number N/A
Receiving water name
Catawba River
N/A
N/A
Name of watershed, river,
Lake Wylie
N/A
N/A
0
or stream system
U.S. Soil Conservation
d
Service 14-digit watershed
N/A
N/A
N/A
o
code
m
CD
Name of state
managemenUriver basin
Catawba
N/A
N/A
U.S. Geological Survey
8-digit hydrologic
03050101
N/A
N/A
cataloging unit code
Critical low flow (acute)
N/A cfs
N/A cfs
N/A cfs
Critical low flow (chronic)
N/A cfs
N/A cfs
N/A cfs
Total hardness at critical
N/A mg/L of
N/A mg/L of
N/A mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information describing the treatment pr vided for discharges from each outfall.
Outfall Number 001
Outfall Number N/A
Outfall Number N/A
Highest Level of
0 Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
0 Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
0
a
Design Removal Rates by
N/A
N/A
Outfall
d
BOD5 or CBOD5
85 %
N/A %
N/A %
CD
d
E
w
d
TSS
85 %
N/A %
N/A
H
m Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
N/A %
N/A %
• Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
N/A %
N/A %
Other (specify)
0 Not applicable
❑ Not applicable
❑ Not applicable
%
N/A %
N/A %
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WWTP
OMB No. 2040-0004
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Chlorine disinfection is used in all seasons for the effluent.
a
a�
c
w
c
0
Outfall Number 001
Outfall Number N/A
Outfall Number N/A
0
♦/
.a
Disinfection type
Chlorine
N/A
N/A
Uf
N
Seasons used
All
N/A
N/A
0
E
Y
Dechlorination used?
❑ Not applicable
❑✓ Not applicable
❑✓ Not applicable
❑✓ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑✓ Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑✓ Yes ❑ No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number 001
Outfall Number N/A
Outfall Number N/A
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
0
20
N/A
N/A
N/A
N/A
water
Number of tests of receiving
N/A
N/A
N/A
N/A
N/A
N/A
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No 4 SKIP to Item 3.16.
Y
0
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
✓❑ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
w
❑✓ Yes ❑ No
3.16
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
Yes 4 Complete Tables C, D, and E as
© ❑ No 4 SKIP to Section 4.
applicable.
3.17
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑✓ Yes ❑ No
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑✓ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NCO021181
City of Belmont WWTP
OMB No.2040-0004
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
✓❑ Yes ❑ No + Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑✓ Yes ❑ No + Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DD/YYYY
One Chronic WET sample failed of the twenty samples on 8/9/2022. The
failed sampled was followed up with additional sampling on 9/14/2022
and 10/11/2022, both of which passed.
c
c
0
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
✓❑ Yes ❑ No 4 SKIP to Item 3.26.
Y
3.23
Describe the cause(s) of the toxicity:
The plant effluent chlorine levels were high.
a�
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑✓ No 4 SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
N/A
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑✓ Not applicable because previously submitted
information to the NPDES p rmitting authority.
SECTION-D•
i
Does the POTW receive discharges from SIUs or NSCIUs?
4.1
❑✓ Yes ❑ No 4 SKIP to Item 4.7.
d
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs
Number of NSCIUs
3
0
2
N/A
4.3
Does the POTW have an approved pretreatment program?
cc
`°
x
❑✓ Yes ElNo
4.4
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
application or (2) a pretreatment program?
y
❑✓ Yes El No -* SKIP to Item 4.6.
0
-a
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
U)
NCO021181_ Pretreatment _ Annual_ Report_20230213 02/13/2023
a
c
—
4.6
Have you completed and attached Table F to this application package?
✓❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 9

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
110000570338
NCO021181
City of Belmont WWTP
OMB No.2040-0004
4.7
Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes © No 4 SKIP to Item 4.9.
4.8
If yes, provide the follo ing information:
Annual
Hazardous Waste
Waste Transport Method
Amount of
Units
Number
(check all that apply)
Waste
Received
N/A
❑ Truck ❑ Rail
N/A
N/A
❑ Dedicated pipe ❑ Other (specify)
c
c
0
U
a
N/A
❑ Truck ❑ Rail
N/A
N/A
c
❑ Dedicated pipe ❑ Other (specify)
H
O
'0
ca
N/A
ElTruck ❑ Rail
N/A
N/A
_ ca
❑ Dedicated pipe ❑ Other (specify)
v
v
y
N
R
4.9
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
y
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
0
❑ Yes ❑✓ No 4 SKIP to Section 5.
�
4.10
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ✓❑ No
4.11
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater's hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
❑ Yes ❑✓ No
SECTION•
OVERFLOWS (40
Does the treatment works have a combined sewer system?
E
5.1
rn
❑ Yes No 4SKIP to Section 6.
m
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
`6
❑ Yes ❑✓ No
c
ca
5.3
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
0
L)
❑ Yes ❑✓ No
EPA Form 3510-2A (Revised 3-19) Page 10

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105119
110000570338
NCO021181
W
City of Belmont WTP
OMB No. 2040-0004
5.4
For each CSO outfall, provide the following information. Attach
additional sheets as necessary.)
CSO Outfall Number N/A
CSO Outfall Number N/A
CSO Outfall Number N/A
City or town
N/A
N/A
N/A
=
0
State and ZIP code
N/A
N/A
N/A
U
CD
o
County
N/A
N/A
N/A
=
Latitude
NIX N/A' N/A"
N/A' N/A' N/A"
N/A N/A N/A"
0
0
U)
Longitude
N/A° N/A' N/A'
N/A' N/A' N/A"
N/A N/A' N/A"
U
Distance from shore
N/A ft.
N/A ft.
N/A ft.
Depth below surface
N/A ft.
N/A ft.
N/A ft.
5.5
Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number N/A
CSO Outfall Number N/A
CSO Outfall Number N/A
Rainfall
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
rn
0
CSO flow volume
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO pollutant
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0
concentrations
U)
0
Receiving water quality
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO frequency
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Number of storm events
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5.6
Provide the following information for each of your CSO outfalls.
CSO Outfall Number N/A
CSO Outfall Number N/A
CSO Outfall Number N/A
CD
Number of CSO events in
N/A events
N/A events
N/A events
N
the past year
Average duration per
N/A hours
N/A hours
N/A hours
N
event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
o
N/A million gallons
N/A million gallons
N/A million gallons
Average volume per event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
Minimum rainfall causing
N/A inches of rainfall
N/A inches of rainfall
N/A inches of rainfall
a CSO event in last year
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
EPA Form 3510-2A (Revised 3-19) Page 11

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110000570338
NC0021181
City of Belmont WWTP
OMB No. 2040-0004
5.7
Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number N/A
CSO Outfall Number N/A
CSO Outfall Number N/A
Receiving water name
N/A
N/A
N/A
Name of watershed/
N
streams stem
N/A
N/A
N/A
d
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
Service 14-digit
c
watershed code
N/A
N/A
N/A
>
if known
Name of state
N/A
N/A
N/A
management/river basin
U.S. Geological Survey
❑ Unknown
❑ Unknown
❑ Unknown
8-Digit Hydrologic Unit
Code if known)N/A
N/A
N/A
Description of known
water quality impacts on
N/A
N/A
N/A
receiving stream by CSO
(see instructions for
examples)
SECTION•
i d (d
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section 1: Basic Application
w/ variance request(s) El w/ additional attachments
ElInformation
for All A licants
❑ Section 2: Additional
❑✓ w/ topographic map ✓❑ w/ process flow diagram
Information
❑ w/ additional attachments
❑✓ w/ Table A ❑✓ w/ Table D
❑ Section 3: Information on
❑ w/ Table B ❑ w/ Table E
c
Effluent Discharges
E
✓❑ w/ Table C ❑ w/ additional attachments
v
Section 4: Industrial
❑ w/ SIU and NSCIU attachments ❑✓ w/ Table F
co
❑✓ Discharges and Hazardous
❑
Wastes
w/ additional attachments
M
;�_
❑ Section 5: Combined Sewer
❑ w/ CSO map El w/ additional attachments
V_
Overflows
❑ w/ CSO system diagram
-a
m
Section 6: Checklist and
❑
El w/ attachments
r
Certification Statement
;e
6.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last namej,
Official title
isd:r IVED
C tt'rµ4G6Yt
Signature ;
Date signed
ll-2q- 23
EPA Form 3510-2A (Revised 3-19) NCDEQ /DWR /A i 9 DES Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
110000570338 1 NCO021181 City of Belmont WWTP 001
Form Appruvuu uA5119
OMB No. 2040-0004
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical
ML or MDL
Number
Value Units
Value
Units
Methods
(include units)
Samples
Biochemical oxygen demand
o BOD5 or ❑ CBOD5
66.0
mg/L
4.5
mg/L
1,146
SM 521OB-2016
DIVIL
0.18 mg/L © MDL
(report one
Fecal coliform
5,717
#/100 mL
263.9
#/100 mL
1,144
COLILERT-18 (2010)
N/A DIVIL
❑ MDL
Design flow rate
MGD
5
MGD
N/A
pH (minimum)
6.1
S.U.
)
pH (maximum)
7.7
S.U.
Temperature (winter)
36.6
degC
14.5
degC
465
Temperature (summer)
31.5
degC
23.5
degC
678
Total suspended solids (TSS)
260.0
mg/L
12.3
mg/L
1,147
SM 254OD-2015
1.0 mg/L 0 ML
© MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number I Facility Name Outfall Number
110000570338 NCO021181 City of Belmont WWTP
Form Approved 03/05/19
OMB No. 2040-0004
Pollutant
Maximum Daily
Discharge
Average Daily Discharge
Analytical
Method'
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
Ammonia (as N)
39.0
mg/L
2.2
mg/L
1,144
350.1
El IVIL
0.03 mg/L ❑O MDL
Chlorine
total residual, TRC 2
174.5
ug/L
29.3
ug/L
1,145
SM 4500-CL G-2
0.015 and O MDL
Dissolved oxygen
16.0
mg/L
8.9
mg/L
1,145
SM 4500-0 G-20
N/A MDL
Nitrate/nitrite
29.0
mg/L
11.3
mg/L
237
353.2
0.01 mg/L ©ML
MDL
Kjeldahl nitrogen
32.0
mg/L
3.4
mg/L
237
351.2
IAL
0.1 mg/L © MDL
Oil and grease
non -detect
mg/L
non -detect
mg/L
6
1664E
IVIL
1.4 mg/L © MDL
Phosphorus
7.20
mg/L
2.3
mg/L
237
365.1
0.02 mg/L © ML
MDL
Total dissolved solids
690
mg/L
515
mg/L
6
SM 2540C-2015
25 OML
© MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19) °age 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
110000570338 NCO021181 City of Belmont WWTP
•' I '•
Maximum Daily Discharge Average Daily Discharge
Pollutant
Value Units Value Units Number of
Samples
Form App-- 3/05/19
OMB No. 2040-0004
Analytical ML or MDL
Method' (include units)
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
74.0
mg/L
51.8
mg/L
54
SM 2340C-2011
2 mg/L 0 MIL
O MDL
Antimony, total recoverable
72.1
ug/L
300.0
ug/L
6
200.8
2 ug/L 0 IVIL
MDL
Arsenic, total recoverable
5.0
ug/L
2.2
ug/L
19
200.8
1.3 ug/L O MDL
Beryllium, total recoverable
ND
ug/L
ND
ug/L
6
200.8
0.4 ug/L 0IVIL
MDL
Cadmium, total recoverable
0.5
ug/L
0.5
ug/L
19
200.8
0.13 ug/L DIAL
O MDL
Chromium, total recoverable
5.0
ug/L
4.5
ug/L
19
200.8
0.13 ug/L O MDL
Copper, total recoverable
18.0
ug/L
10.7
ug/L
19
200.8
0.13 ug/L OvIL
O MDL
Lead, total recoverable
2.0
ug/L
1.9
ug/L
19
200.8
0.25 ug/L OvIL
O MDL
Mercury, total recoverable
6.5
ng/L
1.3
ng/L
35
1631E
0.2 ng/L 0 MIL
MDL
Nickel, total recoverable
5.0
ug/L
2.5
ug/L
19
200.8
1.3 ug/L 0 MIL
MDL
Selenium, total recoverable
5.0
ug/L
5.0
ug/L
19
200.8
0 MIL
1.3 ug/L O MDL
Silver, total recoverable
1.0
ug/L
1.0
ug/L
19
200.8
0.25 ug/L 0 IVIL
MDL
Thallium, total recoverable
ND
ug/L
ND
ug/L
6
200.8
0.5 ug/L ❑ MDL
Zinc, total recoverable
120.0
ug/L
69.1
ug/L
19
200.8
2.5 ug/L 0MIL
MDL
Cyanide
20.0
ug/L
10.0
ug/L
19
SM 4500-CN E2
5 ug/L 71 ML
❑ MDL
Total phenolic compounds
ND
mg/L
ND
mg/L
6
420.4
0.02 mg/L DIML
O MDL
Volatile Organic Compounds
Acrolein
ND
ug/L
ND
ug/L
6
624.1
OML
5 ug/L 0 MDL
Acrylonitrile
ND
ug/L
ND
ug/L
6
624.1
5 ug/L ML
0 MDL
Benzene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 VIL
MDL
Bromoform
ND
ug/L
ND
ug/L
6
624.1
1 ug/L O MDL
EPA Form 3510-2A (Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
110000570338 NCOO21181 City of Belmont WWTP
Ll ••
Maximum Daily Discharge Average Daily Discharge
Pollutant
Value Units Value Units Number of
Samples
Form Approved 03/05119
OMB No.2040-0004
Analytical ML or MDL
Method' (include units)
Carbon tetrachloride
ND
ug/L
ND
ug/L
6
624.1
1 ug/L © MDL
Chlorobenzene
ND
ug/L
ND
ug/L
6
624.1
IVIL
1 ug/L 0 MDL
Chlorodibromomethane
3.5
ug/L
6.1
ug/L
6
624.1
1 ug/L DIVIL
❑ MDL
Chloroethane
ND
ug/L
ND
ug/L
6
624.1
1 ug/L ML
0 MDL
2-chloroethylvinyl ether
ND
ug/L
ND
ug/L
6
624.1
IVIL
5 ug/L 0 MDL
Chloroform
5.3
ug/L
9.5
ug/L
6
624.1
1 ug/L❑ MDL
Dichlorobromomethane
1.6
ug/L
1.6
ug/L
6
624.1
IVIL
1 ug/L 0 MDL
1, 1 -dichloroethane
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
1,2-dichloroethane
ND
ug/L
ND
ug/L
6
624.1
DIVIL
1 ug/L 0 MDL
trans- 1, 2-dichloroethylene
ND
ug/L
ND
ug/L
6
624.1
ML
1 ug/L 0 MDL
1,1-dichloroethylene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 ML
MDL
1,2-dichloropropane
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
1,3-dichloropropylene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
Ethylbenzene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
Methyl bromide
ND
ug/L
ND
ug/L
6
624.1
2 ug/L 0 IVIL
MDL
Methyl chloride
ND
ug/L
ND
ug/L
6
624.1
2 ug/L © MDL
Methylene chloride
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
1,1,2,2-tetrachloroethane
ND
ug/L
ND
ug/L
6
624.1
IVIL
1 ug/L 0 MDL
Tetrachloroethylene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
Toluene
6
ug/L
6
ug/L
6
624.1
1 ug/L 0 IVIL
MDL
1,1,1-trichloroethane
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0 ML
MDL
1,1,2-trichloroethane
ND
ug/L
ND
ug/L
6
624.1
1 ug/L 0ML
MDL
EPA Form 3510-2A (Revised 3-19) °age 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
110000570338 NCO021181 City of Belmont WWTP
R- , -•
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of
Value Units Value Units Samples
Form App,,,_ 3/05/19
OMB No. 2040-0004
Analytical ML or MDL
Method' (include units)
Trichloroethylene
ND
ug/L
ND
ug/L
6
624.1
1 ug/L ©ML
MDL
Vinyl chloride
ND
ug/L
ND
ug/L
6
624.1
1 ug/L ©ML
MDL
Acid -Extractable Compounds
p-chloro-m-cresol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
2-chlorophenol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L El VIL
O MDL
2,4-dichlorophenol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
2,4-dimeth ylphenol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
4,6-dinitro-o-cresol
ND
ug/L
ND
ug/L
6
625.1
8 ug/L ©IVIL
MDL
2,4-dinitrophenol
ND
ug/L
ND
ug/L
6
625.1
8 ug/L O MDL
2-nitrophenol
ND
ug/L
ND
ug/L
6
625.1
3.2 ug/L OML
O MDL
4-nitrophenol
ND
ug/L
ND
ug/L
6
625.1
8 ug/L O MDL
Pentachlorophenol
ND
ug/L
ND
ug/L
6
625.1
8 ug/L OML
O MDL
Phenol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
2,4,6-trichlorophenol
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
Base -Neutral Compounds
Acenaphthene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Acenaphthylene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Anthracene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Benzidine
ND
ug/L
ND
ug/L
6
625.1
8 ug/L MIL
El MDL
Benzo(a)anthracene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
Benzo(a)pyrene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
3,4-benzofluoranthene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
EPA Form 3510-2A (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
110000570338 NC0021181 City of Belmont WWTP
• ••
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of
Value Units Value Units Sam les
Form Approved 03/05/19
OMB No. 2040-0004
Analytical ML or MDL
Method' (include units)
Benzo(ghi)perylene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MIL
0 MDL
Benzo(k)fluoranthene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
Bis (2-chloroethoxy) methane
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
Bis (2-chloroethyl) ether
ND
ug/L
ND
ug/L
6
625.1
ML
1.6 ug/L El MDL
Bis (2-chloroisopropyl) ether
OML
❑ MDL
Bis (2-ethylhexyl) phthalate
14.15
ug/L
26
ug/L
6
625.1
8 ug/L 1 VIL
MDL
4-bromophenyl phenyl ether
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
Butyl benzyl phthalate
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
2-chloronaphthalene
ND
ug/L
ND
ug/L
6
625.1
0 MIL
1.6 ug/L 0 MDL
4-chlorophenyl phenyl ether
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
Chrysene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L © ML
MDL
di-n-butyl phthalate
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L © ML
MDL
di-n-octyl phthalate
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L © VIL
MDL
Dibenzo(a,h)anthracene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 0 MDL
1,2-dichlorobenzene
ND
ug/L
ND
ug/L
2
625.1
1.6 ug/L 0 MDL
1,3-dichlorobenzene
ND
ug/L
ND
ug/L
2
625.1
1.6 ug/L 0 MIL
0 MDL
1,4-dichlorobenzene
ND
ug/L
ND
ug/L
2
625.1
ML
1.6 ug/L © MDL
3,3-dichlorobenzidine
ND
ug/L
ND
ug/L
6
625.1
8 ug/L ©ML
MDL
Diethyl phthalate
D
ug/L
ND
ug/L
6
625.1
1.6 ug/L ML
© MDL
Dimethyl phthalate
uML
g/L
ND
ug/L
6
625.1
1.6 ug/L © MDL
2,4-dinitrotoluene
D
END
ug/L
ND
ug/L
6
625.1
3.2 ug/L ML
©MDL2,6-dinitrotoluene
D
ug/L
ND
ug/L
6
625.1
3.2 ug/L © MIL
MDL
EPA Form 3510-2A (Revised 3-19) 'age 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Appiuveu u3/05/19
110000570338 NC0021181 City of Belmont WWTP
OMB No. 2040-0004
Maximu7DallyDischarge Average Daily Discharge
7Valueits
Pollutant
Analytical MLorMDL
Number of
Value Units
Method' (include units)
Samples
1,2-diphenylhydrazine
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Fluoranthene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L DIVIL
O MDL
Fluorene
ND
ug/L
ND
ug/L
6
625.1
DIVIL
1.6 ug/L O MDL
Hexachlorobenzene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
Hexachlorobutadiene
ND
ug/L
ND
ug/L
6
625.1
OML
1.6 ug/L O MDL
Hexachlorocyclo-pentadiene
ND
ug/L
ND
ug/L
6
625.1
8 ug/L O MDL
Hexachloroethane
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Indeno(1,2,3-cd)pyrene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L 11 MIL
O MDL
Isophorone
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L O MDL
Naphthalene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
Nitrobenzene
ND
ug/L
ND
ug/L
6
625.1
ML
1.6 ug/L © MDL
N-nitrosodi-n-propylamine
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L ML
© MDL
N-nitrosodimethylamine
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/I O MDL
N-nitrosodiphenylamine
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L El IVIL
O MDL
Phenanthrene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L DIVIL
O MDL
Pyrene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L OML
O MDL
1,2,4-trichlorobenzene
ND
ug/L
ND
ug/L
6
625.1
1.6 ug/L
O MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 21

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
110000570338 NCO021181 City of Belmont WWTP
OMB No. 2040-0004
Maximum Dail Discharge Average Dail Discharge
Pollutant Number of
Analytical ML or MDL
(list) Value Units Value Units
Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
Total Monthly Flow
74.86
MG/month
51.2
MG/month
55
N/A
❑ ML
N/A ❑ MDL
TN
33
mg/L
14.7
mg/L
237
N/A
0 ML
N/A ❑ MDL
TN
17,171
lb/month
6,152
Ib/mo
55
N/A
0 ML
N/A ❑ MDL
TN
13,369
lb/summer 2022
N/A
N/A
8
N/A
❑ ML
N/A ❑ MDL
TN
19,496
Ib/winter2022
N/A
N/A
4
N/A
N/A 0 ML
❑ MDL
TP
2,244
lb/month
949
lb/month
55
365.1
0.02 mg/L 0 MDL
TP
9,270
Ib/yr2022
N/A
N/A
12
365.1
0.02 mg/L 0 ML
❑O MDL
Total hardness - upstream
70
mg/L
19.1
mg/L
290
SM 2340C-2011
ML
2.0 mg/L © MDL
D.O. - upstream
14
mg/L
8.5
mg/L
405
SM4500-0 G-20
N/A 0 ML
❑ MDL
D.O. - downstream
13.9
mg/L
8.5
mg/L
404
SM4500-0 G-20
N/A 0 ML
❑ MDL
Temperature - upstream
33
degC
23.2
degC
405
N/A
N/A ❑ ML
❑ MDL
Temperature - downstream
32.5
degC
23.3
degC
404
N/A
N/A ❑ ML
❑ MDL
Conductivity - upstream
179
umhos/cm
58.6
umhos/cm
356
120.1
❑ ML
71 MDL
Conductivity - downstream
653
umhos/cm
59.5
umhos/cm
356
120.1
p MDL
Fecal coliform - upstream
9,500
#/100 mL
395.1
#/100 mL
404
SM 9222D-2015
0 ML
N/A ❑ MDL
Fecal coliform - downstream
5,500
#/100 mL
195.0
#/100 mL
404
SM 9222D-2015
N/A ❑ ML
❑ MDL
Molybdenum
Molybdenum
ug/L
11.2
ug/L
19
200.8
2.5 ug/L O MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) °age 23

EPA Identification Number NPDES Permit Number Facility Name
110000570338 NCO021181 City of Belmont WWTP
Form Appi vu 3105119
OMB No. 2040-0004
TA13LE F. INDUSTRIAL DISCHARGE IWORIVIATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU 0005
SIU 001E
SIU N/A
Name of SIU
Spartan Dyers
US Cotton
N/A
Mailing address (street or P.O. box)
217 Sterling Street
1000 Parkdale Drive Suite 1
N/A
City, state, and ZIP code
Belmont, NC 28012
Belmont, NC 28012
N/A
Description of all industrial processes that affect
Package Yarn Dyeing
Cotton Bleaching Operation
N/A
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Yarn, Electrolytes (NsCI, Na2SO4), Weak
Unbleached Cotton, Water, Chemicals
N/A
Organic Acid (acetic), Alkali (NsOH, Soda
Ash), Sodium Hydrosulphite, Hydrogen
Peroxide, Dispersing Agents, Softeners,
Detergents, Textile Dyes
Indicate the average daily volume of wastewater
discharged by the SIU.
223,000 gpd
50,800 gpd
N/A gpd
How much of the average daily volume is
attributable to process flow?
206,000 gpd
40,000 gpd
N/A gpd
How much of the average daily volume is
attributable to non -process flow?
17,000 gpd
10,800 gpd
N/A gpd
Is the SIU subject to local limits?
✓❑ Yes ❑ No
❑✓ Yes ❑ No
❑ Yes ❑ No
Is the SIU subject to categorical standards?
❑ Yes ✓❑ No
El Yes ❑✓ No
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 29

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
110000570338
NCO021181 City of Belmont WWTP OMB No. 2040-0004
TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU 000S
SIU 001E
SIU N/A
Under what categories and subcategories is the
40 CFR 410
40 CFR 410
N/A
SIU subject?
Has the POTW experienced problems (e.g.,
upsets, pass -through interferences) in the past 4.5
❑ Yes ❑✓ No
❑ Yes ❑✓ No
❑ Yes ❑ No
ears that are attributable to the SIU?
If yes, describe.
N/A
N/A
N/A
EPA Form 3510-2A (Revised 3-19) °age 30

IVlou-1 Mountain ,1
Holly-' Island
Quad. Lake Quad.
o
_ �= -
Ae, �
J„ N
ODROW AVf K 7IIp ^ r- .BtVO' It
�
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29
74
-- _ 73
ou
i Cem A �,�1 . ��� Ag �" I �tEKyAR�
h^ O
iL_ Belmont WWTP —�
35°13'53.7"N r'
81 °00'59.7"W r m
s -
S
IF Outfall
35*13'37.0"N p CARNEgpsC
81 °00'52.0'W 4
RD r: f
c .. dim
-
q n
LEGEND
0 OUTFALL t
STREAM FLOW DIRECTION
DEQ NC - SURFACE WATER CLASSIFICATION 6SO \t P
O 7.5 MINUTE INDEX
STATE-WIDE LAND USE
SINGLE-FAMILY RESIDENTIAL �\ 1\ �o "I
\\ / 4
MULTI-FMAILY RESIDENTIAL
COMMERCIAL 3
SCHOOL 3
MEDICAL/DENTAL OFFICE \� a
e �
RELIGIOUS Z�
OFFICE o ARE• ao \\ 3
PUBLIC UTILITIES aD 1
GOVERNMENT
VACANT ' I $ 600
INDUSTRIAL
\ --A
SOURCE: -. .. -
USGS TOPOGRAPHIC MAP
QUAD: C BELMONT 20220823 T34
H
2,00o FT. UC:03050101, SUBBASIN: 3-08-34
FIGURE 1
— BELMONT COUNTY, NC, USA

m
LEGEND:
SOLIDS TRAIN
LIQUID TRAIN
F)l bEV.qk
m
n
IN
CITY OF BELMONT - EXISTING WWTP PROCESS FLOW DIAGRAM
FIGURE 2.1.1

FN
Narrative Description of City of Belmont Process Flow Diagram
The Belmont Wastewater Treatment Plant (WWTP) is designed for an average daily flow of 5
MGD. The plant influent enters the headworks facility, consisting of bar screens followed by grit
sedimentation channels and a Parshall flume measuring structure. Following the Parshall flume,
the wastewater flows by gravity to the two aeration basins. Two final clarifiers accept the flow
from the aeration basins and the final clarifier effluent is chlorinated in the chlorine contact
basins before dichlorination and discharge into the Catawba River. The return activated sludge
from both final clarifiers is sent to the aeration basin influent and the waste activated sludge is
sent to the aerobic digesters. Digested sludge is stored in the sludge holding tank before
pumping the digested sludge out of the storage tank and into a truck. The solids are trucked to
permitted land sites by a certified contracted company, Southern Soil Builders, under Land
Application Permit #WQ003281. The Belmont WWTP has an emergency standby generator
rated for 350 kW.

EPA Identification Number
NPDES Number
Facility Name
Outfall Number
110000570338
NC0021181
City of Belmont WWTP
Pollutant (Required)
CAS number
Method Number
(if Applicable)
Reason Pollutant Believed Present in Discharge
Estimated Concentration (If
Known)
Perfluorooctanoic acid (PFOA)
335-67-1
Draft Method 1633
Believed absent
Samples have not been taken
Perfluorooctanesulfonic acid (PFOS)
1763-23-1
Draft Method 1633
Believed absent
Samples have not been taken
Perfluorohexanesulfonic acid (PFHxS)
355-46-4
Draft Method 1633
Believed absent
Samples have not been taken
Perfluorobutanesulfonic acid (PFBS)
375-73-5
Draft Method 1633
Believed absent
Samples have not been taken
Perfluorononanoic acid (PFNA)
375-95-1
Draft Method 1633
Believed absent
Samples have not been taken
GenX
Draft Method 1633
Believed absent
Samples have not been taken

This page is intentionally left blank.

City of Belmont Wastewater Treatment Plant
MODEL MUNICIPAL MERCURY MI 41�TION PLAN
[l]/l/2023]
SECTION I - PURPOSE
The purpose of this Mercury Minimization Plan ("MMP") is to describe best management practices
through which City of Belmont Wastewater Treatment Plant (WWTP) will seek to reduce the amount
of mercury discharged into its system and, ultimately, to the environment. The MMP compiles mercury
reduction -related efforts to -date and potential future action items. It is designed to be a working
document to help guide City of Belmont in its efforts to control mercury loadings discharged into its
Publicly -Owned Treatment Works (POTW) by users of the sewer system. Such a reduction in loadings to
the sewer system should translate to a reduction in the amount of mercury which is discharged from the
treatment plant. The management practices summarized below may also help control some of the
mercury reaching our storm sewer system as well.
SECTION II — FACILITY DESCRIPTION
The City of Belmont operates a publicly owned treatment works (POTW), including a collection system
and wastewater treatment plant (WWTP), that serves the City of Belmont, North Carolina.
The City of Belmont's WWTP is permitted to treat 5.0 MGD and breaks down/removes organic waste
through an Activated Sludge process. Our facility utilizes a three -step removal process inlcuding
preliminary treatment, secondary treatment, and sludge handling systems.
Our preliminary treatment begins when the wastewater enters our plant from various locations
throughout the City including both Residential and Industrial Users. The wastewater is received from the
collection system and is screened through an automatic bar -screen and grit chamber at the WWTP
Influent. The purpose of our preliminary treatment is to remove debris and inorganic matter from the
wastewater.
Secondary treatment is composed of two parts: biological nutrient removal and secondary clarification.
Biological nutrient removal begins when the wastewater travels from the preliminary treatment to the
aeration basins. Wastewater enters the aeration basins and microorganisms breakdown biodegradable
organic matter as the wastewater flows through the aeration basins. Aerators are used to sustain an
adequate level of oxygen for the survival of microorganisms as well to mix the wastewater. This process
aids in BOD, COD, Phosphorus, and Ammonia removals. Secondary clarification occurs when the water
travels from the aeration basins and splits off into one of two secondary clarifiers where settling occurs.
The wastewater then leaves the secondary clarifiers via v-notch weirs and travels to the chlorine contact
chambers for disinfection. After disinfection, the water is de -chlorinated and then discharged into the
Catawba River.
The settled solids either return to the aeration basins or the solids go to the aerobic digesters/sludge
holding tank for sludge removal. The aerobic digesters further break down organic material before the
solids are trucked offsite to be disposed of.

Most municipal treatment plants are not designed to remove mercury and it is exceedingly expensive to
do so to very low levels. Incidental mercury removal occurs through typical municipal treatment with
trace levels of mercury (and other metals) ending up in solids removed from the raw wastewater.
Mercury is not used in the treatment processes at the WWTP. Mercury may be introduced into the sewer
system through a variety of sources, such as from industrial users, laboratories, and other businesses.
Residual deposits of mercury are also possible in the sewer system from historic practices. Finally, trace
amounts from household products and atmospheric deposition (both wet and dry) contribute to sewer
system mercury loadings.
While there is typically some mercury contributed to public sewer systems statewide, it is usually in
minute quantities and comprises a tiny portion of the already insignificant statewide loading for all point
sources - just two percent of the annual mercury loadings to all State waters.
SECTION III — PROGRAM PLAN
A. EVALUATION OF POTENTIAL NON -DOMESTIC SOURCES CONTRIBUTING
MERCURY TO THE POTW
Within 24 months from the NPDES required 180-day period for development of an MMP, , the City of
Belmont will evaluate available information to assess the potential for non -domestic users of the sewer
system to contribute mercury to the system. The information to be reviewed may include: (1) POTW
influent and effluent mercury data and trends; (2) industrial user permits and associated mercury
monitoring data; (3) Toxics Release Inventory (TRI); (4) state hazardous site registry and the National
Priority List relating to mercury contamination; and (5) historical records of industrial sites which ffmy
have contributed mercury loadings to the sewer system.
The City of Belmont will also survey and evaluate the following common sources of mercury in its
service area: (1) dentist offices; (2) hospitals; (3) laboratories; (4) auto recyclers; and (5) other potential
sources of mercury based on existing information.
The City of Belmont will request that industrial users review mercury concentrations in high -volume
process chemicals and demonstrate that the mercury concentrations are below industry average. The City
of Belmont will request that alternative sources for chemicals be explored if the mercury levels are
determined to be significantly higher than would normally be expected.
The evaluation of potential non -domestic sources of mercury to the sewer system will be updated every
five years, as warranted by prior sampling results and any additional new potentially significant sources to
the system.
B. ADDITIONAL CONTROL MEASURES
This MMP identifies reasonable and cost-effective control measures to minimize mercury being
discharged into the POTW. Below is a listing of initial BMPs for this POTW.
Pollution Prevention
Substances used at the WWTP will be evaluated to determine if they contain mercury or mercury -based
compounds. Any such chemicals will be evaluated for substitution with non -mercury -containing
substances.

Housekeeping, Spill Control and Collection, and Education
The City of Belmont will develop procedures to minimize the possibility of any spill or release at the
WWTP involving mercury containing substances. The City of Belmont will add mercury identification
and proper disposal to ongoing and future operator training procedures.
Public Outreach
The City of Belmont will make available educational information regarding sources of household
mercury and appropriate use/disposal practices. This information may be posted on the City of Belmont
WWTP's website and copies will be made available at the City of Belmont's WWTP. The availability of
this information will be highlighted in the City of Belmont's bi-annual outreach to the City of Belmont's
customers. The City of Belmont will also facilitate public awareness regarding community collection
points for mercury -containing products from residents/customers for proper disposal. Periodic reminders
of such collection programs will be provided as part of City of Belmont's ongoing public outreach.
C. TRACKING AND MONITORING
In order to assess the implementation of the control measures, the Belmont WWTP proposes to undertake
the following evaluations beginning after the first full year that this MMP is implemented:
Survey annually at least ten percent (10%) of any non -domestic users identified as
possible significant sources of mercury to the POTW;
Track the implementation of the programs outlined above;
Monitor influent mercury at least annually. Require significant non -domestic sources of
mercury to monitor periodically, as warranted; and
Measure effluent mercury as required by the NPDES permit.
These efforts will allow the Belmont WWTP to establish a baseline of influent and effluent mercury
levels to assist in identifying any trends in mercury contributions from domestic and non -domestic users
of the sewer system. This baseline will be tracked annually.
SECTION IV — IMPLEMENTATION OF CONTROL MEASURES
The City of Belmont monitors mercury levels on all industrial users. At this time, the City of Belmont
does not see a need for implementation of mercury limits for our industrial users. The pretreatment
department continues to monitor our influent mercury levels for potential elevated concentrations. The
City will remain vigilant towards environmental concerns with regards to increased mercury levels.
The Belmont WWTP will implement the control measures summarized in Section III over the permit term
and will update this MMP as warranted.
SECTION V - REPORTING

A summary of the MNT activities will be submitted as part of the NPDES permit renewal process.

FN
Sludge Management Plan
After the sludge holding process, before being sent to the permitted land sites by a certified
contracted company, sludge sampling is conducted per our Land Application Permit
#WQ003281 and/or 503 regulations.
The sampling, testing, and monitoring is conducted by Southern Soil Builders. The City of
Belmont has a continuous contract with them to perform the above procedures. The contract
also includes hauling the sludge, soil testing, land preparation, record keeping and State
reporting.

This page is intentionally left blank.

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
City of Belmont
PO Box 431
Belmont, NC 28012
Attention: Sandra Craft
Project Name: Effluent Pollutant Scan
Lot Number:TD18073
Date Completed:05/07/2018
05/08/2018 10:15 AM
Approved and released by:
Project Manager: Kelly M. Nance
P
ARM
AC CA E 0 1 T E0
e / l-
00o EtAP
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 1 of 12

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Belmont
Lot Number: TD18073
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved NELAC standards, the Shealy Environmental Services, Inc. ("Shealy") Quality
Assurance Management Plan (QAMP), standard operating procedures (SOPS), and Shealy policies. Any
exceptions to the NELAC standards, the QAMP, SOPS or policies are qualified on the results page or
discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the
cover page.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 2 of 12

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
City of Belmont
Lot Number: TD18073
Sample Number Sample ID Matrix Date Sampled Date Received
001 Effluent Aqueous 04/18/2018 0936 04/18/2018
002 Effluent Aqueous 04/18/2018 0953 04/18/2018
(2 samples)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 3 of 12

Client:City of Belmont Laboratory ID:TD18073-001
Description: Effluent Matrix: Aqueous
de Sampled:04/18/2018 0936
e Received:04/1812018
Run Prep Method
Analytical Method
Dilution
Analysis Date Analyst
Prep Date
Batch
1 350.1
(Ammonia - N ) 350.1
1
04/19/2018 1552 DMA
69971
1
(Hardness (to) SM 2340C-2011
1
04/28/2018 1152 TAF
70843
1
(Nitrate-Nitr) 353.2
25
04/26/2018 1626 HKL
70623
1
(Phosphorus) 365.1
10
04/25/2018 1720 DMA
04/25/2018 1147 70431
1
(TDS) SM 2540C-2011
1
04/24/2018 1059 AMM1
70277
1 351.4
(TKN) 351.2
1
04/25/2018 1805 DMA
04/25/2018 1204 70430
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Ammonia - N (gas diffusion)
350.1
ND
0.10
mg/L
1
Hardness (total)
SM 2340C-
38
10
mg/L
1
Nitrate -Nitrite - N
353.2
20
0.50
mg/L
1
Phosphorus
7723-14-0 365.1
3.1
0.50
mg/L
1
TDS
SM 2540C-
690
25
mg/L
1
TKN
351.2
ND
0.10
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 4 of 12

Client:City of Belmont Laboratory ID:TD18073-001
Description: Effluent Matrix: Aqueous
Date Sampled:04/18/2018 0936
Date Received:04/18/2018
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
625.1 625.1 1 05/06/20181851 JCG 04/23/20181651 70206
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Acenaphthene
83-32-9
625.1
ND
1.6
ug/L
Acenaphthylene
208-96-8
625.1
ND
1.6
ug/L
Anthracene
120-12-7
625.1
ND
1.6
ug/L
Benzidine
92-87-5
625.1
ND
8.0
ug/L
Benzo(a)anthracene
56-55-3
625.1
ND
1.6
ug/L
Benzo(a)pyrene
50-32-8
625.1
ND
1.6
ug/L
Benzo(b)fluoranthene
205-99-2
625.1
ND
1.6
ug/L
Benzo(g,h,i)perylene
191-24-2
625.1
ND
1.6
ug/L
Benzo(k)fluoranthene
207-08-9
625.1
ND
1.6
ug/L
4-Bromophenyl phenyl ether
101-55-3
625.1
ND
1.6
ug/L
Butyl benzyl phthalate
85-68-7
625.1
ND
1.6
ug/L
bis (2-Chloro-l-methylethyl) ether
108-60-1
625.1
ND
1.6
ug/L
4-Chloro-3-methyl phenol
59-50-7
625.1
ND
1.6
ug/L
bis(2-Chloroethoxy)methane
111-91-1
625.1
ND
1.6
ug/L
bis(2-Chloroethyl)ether
111-44-4
625.1
ND
1.6
ug/L
2-Chloronaphthalene
91-58-7
625.1
ND
1.6
ug/L
2-Chlorophenol
95-57-8
625.1
ND
1.6
ug/L
4-Chlorophenyl phenyl ether
7005-72-3
625.1
ND
1.6
ug/L
Chrysene
218-01-9
625.1
ND
1.6
ug/L
Dibenzo(a,h)anthracene
53-70-3
625.1
ND
1.6
ug/L
1,2-Dichlorobenzene
95-50-1
625.1
ND
1.6
ug/L
Dichlorobenzene
541-73-1
625.1
ND
1.6
ug/L
Dichlorobenzene
106-46-7
625.1
ND
1.6
ug/L
3,3'-Dichlorobenzidine
91-94-1
625.1
ND
8.0
ug/L
2,4-Dichlorophenol
120-83-2
625.1
ND
1.6
ug/L
Diethylphthalate
84-66-2
625.1
ND
1.6
ug/L
Dimethyl phthalate
131-11-3
625.1
ND
1.6
ug/L
2,4-Dimethylphenol
105-67-9
625.1
ND
1.6
ug/L
Di-n-butyl phthalate
84-74-2
625.1
ND
1.6
ug/L
4,6-Dinitro-2-methylphenol
534-52-1
625.1
ND
8.0
ug/L
2,4-Dinitrophenol
51-28-5
625.1
ND
8.0
ug/L
2,4-Dinitrotoluene
121-14-2
625.1
ND
3.2
ug/L
2,6-Dinitrotoluene
606-20-2
625.1
ND
3.2
ug/L
Di-n-octylphthalate
117-84-0
625.1
ND
1.6
ug/L
1,2-Diphenylhydrazine(as azobenzene)
103-33-3
625.1
ND
1.6
ug/L
bis(2-Ethylhexyl)phthalate
117-81-7
625.1
2.3
1.6
ug/L
Fluoranthene
206-44-0
625.1
ND
1.6
ug/L
Fluorene
86-73-7
625.1
ND
1.6
ug/L
Hexachlorobenzene
118-74-1
625.1
ND
1.6
ug/L
Hexachlorobutadiene
87-68-3
625.1
ND
1.6
ug/L
Hexachlorocyclopentadiene
77-47-4
625.1
ND
8.0
ug/L
Hexachloroethane
67-72-1
625.1
ND
1.6
ug/L
Indeno(1,2,3-c,d)pyrene
193-39-5
625.1
ND
1.6
ug/L
Isophorone
78-59-1
625.1
ND
1.6
ug/L
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
t of holding time W = Reported on wet weight basis
_ -__ j Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 5 of 12

--.... r v. u..— v. yu...v vv...aiy vv/...v
Client:City of Belmont Laboratory ID:TD18073-001
Description: Effluent Matrix: Aqueous
Date Sampled:04/18/2018 0936
Date Received:04/18/2018
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
2 625.1 625.1 1 05/06/20181851 JCG 04/23/20181651 70206
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Naphthalene
91-20-3
625.1
ND
1.6
ug/L
2
Nitrobenzene
98-95-3
625.1
ND
1.6
ug/L
2
2-Nitrophenol
88-75-5
625.1
ND
3.2
ug/L
2
4-Nitrophenol
100-02-7
625.1
ND
8.0
ug/L
2
N-Nitrosodimethylamine
62-75-9
625.1
ND
1.6
ug/L
2
N-Nitrosodi-n-propylamine
621-64-7
625.1
ND
1.6
ug/L
2
N-Nitrosodiphenylamine (Diphenylamine)
86-30-6
625.1
ND
1.6
ug/L
2
Pentachlorophenol
87-86-5
625.1
ND
8.0
ug/L
2
Phenanthrene
85-01-8
625.1
ND
1.6
ug/L
2
Phenol
108-95-2
625.1
ND
1.6
ug/L
2
Pyrene
129-00-0
625.1
ND
1.6
ug/L
2
1,2,4-Trichlorobenzene
120-82-1
625.1
ND
1.6
ug/L
2
2,4,6-Trichlorophenol
88-06-2
625.1
ND
1.6
ug/L
2
Run 2 Acceptance
Surrogate
Q % Recovery Limits
2-Fluorobiphenyl
66 37-129
2-Fluorophenol
37 24-127
Nitrobenzene-d5
75 38-127
Phenol-d5
46 28-128
Terphenyl-d14
93 10-148
2,4,6-Tribromophenol
71 41-144
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 6 of 12

Client:City of Belmont Laboratory ID:TD18073-001
Description: Effluent Matrix: Aqueous
Date Sampled:04/18/2018 0936
)ate Received:04/18/2018
Prep Method
200.2
Analytical Method Dilution Analysis Date Analyst
200.8 1 04/21/2018 0031 BNW
Prep Date Batch
04/19/2018 2140 69973
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Antimony
7440-36-0 200.8
300
2.0
ug/L
1
Arsenic
7440-38-2 200.8
ND
2.0
ug/L
1
Beryllium
7440-41-7 200.8
ND
0.40
ug/L
1
Cadmium
7440-43-9 200.8
ND
0.50
ug/L
1
Chromium
7440-47-3 200.8
ND
5.0
ug/L
1
Copper
7440-50-8 200.8
13
5.0
ug/L
1
Lead
7439-92-1 200.8
ND
1.0
ug/L
1
Nickel
7440-02-0 200.8
ND
5.0
ug/L
1
Selenium
7782-49-2 200.8
ND
5.0
ug/L
1
Silver
7440-22-4 200.8
ND
1.0
ug/L
1
Thallium
7440-28-0 200.8
ND
0.50
ug/L
1
Zinc
7440-66-6 200.8
56
10
ug/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
of holding time W = Reported on wet weight basis
_..__., Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 7 of 12

Client:City of Belmont Laboratory ID:TD18073-002
Description: Effluent Matrix: Aqueous
ate Sampled:04/18/2018 0953
to Received:04/18/2018
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 10-204-00-1-X (Cyanide - To) SM 4500-CN E- 1 04/24/2018 0956 MSG 04/24/2018 0754 70267
1 (Phenolics) 420.4 1 04/21/2018 1424 MSG 04/20/2018 1125 70047
1 (HEM (oil and) 1664B 1 04/25/2018 0924 ARP 70391
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Cyanide - Total
Phenolics
HEM (oil and grease)
57-12-5 SM 4500-CN 0.011
420.4 ND
1664B ND
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
0.010 mg/L 1
0.020 mg/L 1
4.8 mg/L 1
Page 8 of 12

vY
Client:City of Belmont Laboratory ID:TD18073-002
Description: Effluent Matrix: Aqueous
)ate Sampled:O4/18/2018 0953
ate Received:O4/18/2018
Prep Method
Analytical Method Dilution Analysis Date Analyst
Prep Date
Batch
624.1
624.1 1 04/21/2018
2349 ECP
70102
CAS
Analytical
Parameter
Number
Method
Result Q
LCQ
Units
Run
Acrolein
107-02-8
624.1
ND
5.0
ug/L
1
Acrylonitrile
107-13-1
624.1
ND
5.0
ug/L
1
Benzene
71-43-2
624.1
ND
1.0
ug/L
1
Bromodichloromethane
75-27-4
624.1
5.1
1.0
ug/L
1
Bromoform
75-25-2
624.1
ND
1.0
ug/L
1
Bromomethane (Methyl bromide)
74-83-9
624.1
ND
2.0
ug/L
1
Carbon tetrachloride
56-23-5
624.1
ND
1.0
ug/L
1
Chlorobenzene
108-90-7
624.1
ND
1.0
ug/L
1
Chloroethane
75-00-3
624.1
ND
2.0
ug/L
1
2-Chloroethylvinylether
110-75-8
624.1
ND
5.0
ug/L
1
Chloroform
67-66-3
624.1
6.6
1.0
ug/L
1
Chloromethane (Methyl chloride)
74-87-3
624.1
ND
2.0
ug/L
1
Dibromochloromethane
124-48-1
624.1
1.6
1.0
ug/L
1
1,1-Dichloroethane
75-34-3
624.1
ND
1.0
ug/L
1
1,2-Dichloroethane
107-06-2
624.1
ND
1.0
ug/L
1
1,1-Dichloroethene
75-35-4
624.1
ND
1.0
ug/L
1
trans-1,2-Dichloroethene
156-60-5
624.1
ND
1.0
ug/L
1
1,2-Dichloropropane
78-87-5
624.1
ND
1.0
ug/L
1
cis-1,3-Dichloropropene
10061-01-5
624.1
ND
1.0
ug/L
1
trans-1,3-Dichloropropene
10061-02-6
624.1
ND
1.0
ug/L
1
Ethvibenzene
100-41-4
624.1
ND
1.0
ug/L
1
tylene chloride
75-09-2
624.1
ND
1.0
ug/L
1
?,2-Tetrachloroethane
79-34-5
624.1
ND
1.0
ug/L
1
Tetrachloroethene
127-18-4
624.1
ND
1.0
ug/L
1
Toluene
108-88-3
624.1
ND
1.0
ug/L
1
1,1,1-Trichloroethane
71-55-6
624.1
ND
1.0
ug/L
1
1,1,2-Trichloroethane
79-00-5
624.1
ND
1.0
ug/L
1
Trichloroethene
79-01-6
624.1
ND
1.0
ug/L
1
Vinyl chloride
75-01-4
624.1
ND
1.0
ug/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
Bromofluorobenzene
112 70-130
1,2-Dichloroethane-d4
113 70-130
Toluene-d8
113 70-130
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GG columns exceeds 40
t of holding time W = Reported on wet weight basis
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 9 of 12

Chain of Custody
and
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 10 of 12

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R' Chain of Custody Record
Shealy Environmental Services, Inc.
108 Vantage Pohl Drive
West Colurn'tia, South Carolina 29172
Telephone No, (803) 791-97100 Fax No. (803) 7g1-A11
w6w.shealvlab.00m
Number
Client
RPPKA to Crotnot
Sampler's Rigiature
!14—A I T* Sjtcy,
Uwote No
Relrncnt WWTD
Sandra Craft
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Printed Name
1472#3
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Reo-*%sd on Ice (Checki, � Y © K Ica =3tk
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91

SHEALY ENVIRONMENTAL SERVICES, INC.
Shealy Lnvironrumtal Svriom, Inc. Pup 1 or 1
E4=mml%um:xr: ME0015C•13 Flrwriwe M-Le: 415r2813
f ,
Sample Receipt Checklist (SRC}
Client: - I. c W10,1'(" Cooler lnspcctod by?daac. _( ! 4 16 • I"?. Lrt tr: -r0lbb-4 5
Means ofreceipr. SESI LIClient U UPS FcdEx Uthet:
.1 Y us
Mil
L Were custody seals present on the cools?
Yesl
❑ Nol
Z. NA12.
If cuntudy arils were present, were they inta_t and unbroken?
;HStrip ID. /$ _i120-;' Chlorine Strip ID: I$
;:uuler ID t Ormond tetrtperalure upon receipt f Derived (Corrected) temperature. upiln wce.ipt:
1 i_°C ? 1 °C r ! tC
r41ethod-.-ZTemperature Blank ❑Against %Wlw TR Gun ID: (-,j TR Gun Correction F.tor: _°C
Method ol-cnnlant_ if!rlYet Ice LJ Ice Packs ❑ Dry Ice ❑ Nolte
El Yes
❑ NoF�zJONA
)" If tempcyature of any cooler exceeded 6.0'C,'vas Pmjccr ManaFler Notified?
Phi was Notified by. phone l email,' face-to-face (circle one).
❑ Yes
ElNo
JaNA
form?
4. IS die commercial courier's packing slip attached to this fo?
Yes
No
S. Were proper custody procedures (nelin uished?received) followed?
Yes
n No
6. Wert: 1Ds listed un the COC?
Wert: ru
ra,
1 [Q No
7. Were sample 1Ds listed on all sample containers?
121 Y rs
❑ Nu
8. Was collection dale & time listed on the COCA
L Yas
❑ No
9. Was collection date & thnc listed on till sample containers?
�3'Yas
❑ No
10. Did all rontaincr label information (ID, datm. lane) amerce with the COC?
11. Were tests to be performed listed on the COC?
Yes
❑ No
12 Yes
I_ I No
12. Did all swnplzi, arrive in the p,uper containers for each test and?or in {rood condition
(unbroken, lids on, ctc.)?
-
Yes
Vo
113. Watt udcyuaw sample volwne available?
Yrs
No
14. Were all samples ttceived within `n the hording time or 48 hours, whichever comes tirsr'1
Yrs
u
l 5. Were any satnplzs containers missinglexcess (circle one) samples Not listed on COC?
n Yes
=.1 No
nA
16. For VOA Lind RSK-175 samples_ were bubbles present = "pea -size'' (i."ar 6mm in diameter) In
rely of the VOA vials?
ET Yes
U NO
UNA
I?. Were. all DRUlmetaiVnutrient samples received nt a pH of <2?
Yes
❑ No
ONA
I8. W'�rc all cyanide sianpies received at a pH,- 13 and sulfide samples received at a pli :- H?
2Yes
El No
❑ NA
19. % are all npplinhle NH jYKK,'cyanideiphenn1;625 (<0.5m.!�L) samples tree o; residual
chlorine?
Ca Yes
❑ NU
I Ir A
)n' %VC:M client mnruid:.s.'requests (i.e. requestcd dilutions, MS1MS[D dcsiWuliena,
correctly transcribed from the COC into the comment %=tinn in LUMS?
❑ yesi
_ No
21. Was the quotc n.nnber used taken from the container label'?
Sample Prc*crv2tioii (Must be completed for any sampie(sl inzorracd%, presmed or wa hesdspace.)
Sairp*s) ware rwviv-.4 incormvtly ptemved and were ad used accordirglti
in sample receiving with (MS04. HNO3. KC:1. NaOH) using SR R
Time of preservation
sarnple(s) were rcmivrd wish bubbles `-•6 min in diameter.
sarnples(s) . wcrc j=ivW with TRC > 0.5 mg+L (If 419 is me) and were
adjusted accordingly in sarnple receiving with sodium thiosulfate (Na2S201) witli Shealy ID:
SR barcode labels applied by: Date: �� • l Il ru
Comments:
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 12 of 12

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
City of Belmont
PO Box 431
Belmont, NC 28012
Attention: Tanya Setzer
Project Name: Effluent Pollutant Scan
Lot Number:UE15092
Date Completed:05/28/2019
05/29/2019 11:48 AM
Approved and released by:
Project Manager: Kelly M. Nance
A16
A C C R E D I T E D
e 00�-
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 1 of 12

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Belmont
Lot Number: UE15092
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved NELAC standards, the Shealy Environmental Services, Inc. ("Shealy") Quality
Assurance Management Plan (QAMP), standard operating procedures (SOPS), and Shealy policies. Any
exceptions to the NELAC standards, the QAMP, SOPS or policies are qualified on the results page or
discussed below.
If you have any questions regarding this report please contact the Shealy Project Manager listed on the
cover page.
Inorganic Non -Metals
The method blank associated with batch 17091 had TKN_ detected at a concentration that was above'/2
the LOQ. There were no detections for TKN in the sample associated with this method blank, negating
the possibility of false positives or sample contamination.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 2 of 12

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
City of Belmont
Lot Number: UE15092
Sample Number Sample ID Matrix Date Sampled Date Received
001 Effluent Aqueous 05/15/2019 0908 05/15/2019
002 Effluent Aqueous 05/15/2019 0921 05/15/2019
(2 samples)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 3 of 12

11 IV. <J_. ..- 1 - 1 1 I.l I".J
Client: City of Belmont Laboratory ID: UE15092-001
Description: Effluent Matrix: Aqueous
Date Sampled:05/15/2019 0908
Date Received:05/15/2019
Run Prep Method
Analytical Method
Dilution
Analysis Date Analyst
Prep Date Batch
1 350.1
(Ammonia - N) 350.1
1
05/17/2019 1528
DMA
17076
1
(Hardness (to) SM 2340C-2011
1
05/16/2019 1548
KFE
16973
1
(Nitrate-Nitr) 353.2
15
05/18/2019 1707
MDD
17139
1
(Phosphorus) 365.1
2
05/22/2019 1534
DMA
17494
1
(TDS) SM 2540C-2011
1
05/17/2019 1117
MGM
16997
1 351.4
(TKN) 351.2
1
05/20/2019 1218
DMA
05/17/2019 1729 17091
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Ammonia - N (gas diffusion)
350.1
ND
0.10
mg/L
1
Hardness (total)
SM 2340C-
58
10
mg/L
1
Nitrate -Nitrite - N
353.2
16
0.30
mg/L
1
Phosphorus
7723-14-0 365.1
2.2
0.10
mg/L
1
TDS
SM 2540C-
590
25
mg/L
1
TKN
351.2
ND
0.10
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 4 of 12

Client: City of Belmont Laboratory ID: UE15092-001
Description: Effluent Matrix: Aqueous
Date Sampled:05/15/2019 0908
Date Received:05/15/2019
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
625.1 625.1 1 05/22/2019 2228 JCG 05/16/2019 1658 16957
Parameter
CAS
Number
Analytical
Method
Result Q
LOQ
Units
Run
Acenaphthene
83-32-9
625.1
ND
1.6
ug/L
1
Acenaphthylene
208-96-8
625.1
ND
1.6
ug/L
1
Anthracene
120-12-7
625.1
ND
1.6
ug/L
1
Benzidine
92-87-5
625.1
ND
8.0
ug/L
1
Benzo(a)anthracene
56-55-3
625.1
ND
1.6
ug/L
1
Benzo(a)pyrene
50-32-8
625.1
ND
1.6
ug/L
1
Benzo(b)fluoranthene
205-99-2
625.1
ND
1.6
ug/L
1
Benzo(g,h,i)perylene
191-24-2
625.1
ND
1.6
ug/L
1
Benzo(k)fluoranthene
207-08-9
625.1
ND
1.6
ug/L
1
4-Bromophenyl phenyl ether
101-55-3
625.1
ND
1.6
ug/L
1
Butyl benzyl phthalate
85-68-7
625.1
ND
1.6
ug/L
1
bis (2-Chloro-1-methylethyl) ether
108-60-1
625.1
ND
1.6
ug/L
1
4-Chloro-3-methyl phenol
59-50-7
625.1
ND
1.6
ug/L
1
bis(2-Chloroethoxy)methane
111-91-1
625.1
ND
1.6
ug/L
1
bis(2-Chloroethyl)ether
111-44-4
625.1
ND
1.6
ug/L
1
2-Chloronaphthalene
91-58-7
625.1
ND
1.6
ug/L
1
2-Chlorophenol
95-57-8
625.1
ND
1.6
ug/L
1
4-Chlorophenyl phenyl ether
7005-72-3
625.1
ND
1.6
ug/L
1
Chrysene
218-01-9
625.1
ND
1.6
ug/L
1
Dibenzo(a,h)anthracene
53-70-3
625.1
ND
1.6
ug/L
1
1,2-Dichlorobenzene
95-50-1
625.1
ND
1.6
ug/L
1
)ichlorobenzene
541-73-1
625.1
ND
1.6
ug/L
1
)ichlorobenzene
106-46-7
625.1
ND
1.6
ug/L
1
3,3'-Dichlorobenzidine
91-94-1
625.1
ND
8.0
ug/L
1
2,4-Dichlorophenol
120-83-2
625.1
ND
1.6
ug/L
1
Diethylphtha late
84-66-2
625.1
ND
1.6
ug/L
1
Dimethyl phthalate
131-11-3
625.1
ND
1.6
ug/L
1
2,4-Dimethylphenol
105-67-9
625.1
ND
1.6
ug/L
1
Di-n-butyl phthalate
84-74-2
625.1
ND
1.6
ug/L
1
4,6-Dinitro-2-methylphenol
534-52-1
625.1
ND
8.0
ug/L
1
2,4-Dinitrophenol
51-28-5
625.1
ND
8.0
ug/L
1
2,4-Dinitrotoluene
121-14-2
625.1
ND
3.2
ug/L
1
2,6-Dinitrotoluene
606-20-2
625.1
ND
3.2
ug/L
1
Di-n-octylphthalate
117-84-0
625.1
ND
1.6
ug/L
1
1,2-Diphenylhydrazine(as azobenzene)
103-33-3
625.1
ND
1.6
ug/L
1
bis(2-Ethylhexyl) phtha late
117-81-7
625.1
26
8.0
ug/L
1
Fluoranthene
206-44-0
625.1
ND
1.6
ug/L
1
Fluorene
86-73-7
625.1
ND
1.6
ug/L
1
Hexachlorobenzene
118-74-1
625.1
ND
1.6
ug/L
1
Hexachlorobutadiene
87-68-3
625.1
ND
1.6
ug/L
1
Hexachlorocyclopentadiene
77-47-4
625.1
ND
8.0
ug/L
1
Hexachloroethane
67-72-1
625.1
ND
1.6
ug/L
1
Indeno(1,2,3-c,d)pyrene
193-39-5
625.1
ND
1.6
ug/L
1
Isophorone
78-59-1
625.1
ND
1.6
ug/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
t of holding time W = Reported on wet weight basis
Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 5 of 12

Client: City of Belmont Laboratory ID: UE15092-001
Description: Effluent Matrix: Aqueous
Date Sampled:05/15/2019 0906
Date Received:05/15/2019
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 625.1 625.1 1 05/22/2019 2228 JCG 05/16/2019 1658 16957
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Naphthalene
91-20-3
625.1
ND
1.6
ug/L
1
Nitrobenzene
98-95-3
625.1
ND
1.6
ug/L
1
2-Nitrophenol
88-75-5
625.1
ND
3.2
ug/L
1
4-Nitrophenol
100-02-7
625.1
ND
8.0
ug/L
1
N-Nitrosodimethylamine
62-75-9
625.1
ND
1.6
ug/L
1
N-Nitrosodi-n-propylamine
621-64-7
625.1
ND
1.6
ug/L
1
N-Nitrosodiphenylamine (Diphenylamine)
86-30-6
625.1
ND
1.6
ug/L
1
Pentachlorophenol
87-86-5
625.1
ND
8.0
ug/L
1
Phenanthrene
85-01-8
625.1
ND
1.6
ug/L
1
Phenol
108-95-2
625.1
ND
1.6
ug/L
1
Pyrene
129-00-0
625.1
ND
1.6
ug/L
1
1,2,4-Trichlorobenzene
120-82-1
625.1
ND
1.6
ug/L
1
2,4,6-Trichlorophenol
88-06-2
625.1
ND
1.6
ug/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
2-Fluorobiphenyl
61 37-129
2-Fluorophenol
61 24-127
Nitrobenzene-d5
60 38-127
Phenol-d5
74 28-128
Terphenyl-d14
101 10-148
2,4,6-Tribromophenol
80 41-144
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 6 of 12

Client: City of Belmont Laboratory ID: UE15092-001
Description: Effluent Matrix: Aqueous
Date Sampled:05/15/2019 0908
Date Received:05/15/2019
Prep Method
200.2
Analytical Method Dilution Analysis Date Analyst
200.8 1 05/21/20191513 BNW
Prep Date Batch
05/16/2019 1750 16950
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Antimony
7440-36-0 200.8
58
2.0
ug/L
1
Arsenic
7440-38-2 200.8
ND
2.0
ug/L
1
Beryllium
7440-41-7 200.8
ND
0.40
ug/L
1
Cadmium
7440-43-9 200.8
ND
0.50
ug/L
1
Chromium
7440-47-3 200.8
ND
5.0
ug/L
1
Copper
7440-50-8 200.8
10
5.0
ug/L
1
Lead
7439-92-1 200.8
ND
1.0
ug/L
1
Nickel
7440-02-0 200.8
ND
5.0
ug/L
1
Selenium
7782-49-2 200.8
ND
5.0
ug/L
1
Silver
7440-22-4 200.8
ND
1.0
ug/L
1
Thallium
7440-28-0 200.8
ND
0.50
ug/L
1
Zinc
7440-66-6 200.8
55
10
ug/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
t of holding time W = Reported on wet weight basis
--__j Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 7 of 12

Client: City of Belmont Laboratory ID: UE15092-002
Description: Effluent Matrix: Aqueous
)ate Sampled:05/15/2019 0921
ate Received:05/15/2019
Run Prep Method
Analytical Method
Dilution Analysis Date Analyst
Prep Date
Batch
1 10-204-00-1-X
(Cyanide - To) SM 4500-CN E-
1 05/22/2019 1723 MSG
05/22/2019 1331 17503
1
(Phenolics) 420.4
1 05/23/2019 1245 MSG
17637
1
(HEM (oil and) 1664B
1 05/23/2019 0946 ARP
17608
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Cyanide - Total
57-12-5 SM 4500-CN
0.016
0.010
mg/L
1
Phenolics
420.4
ND
0.0050
mg/L
1
HEM (oil and grease)
1664E
ND
5.0
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 8 of 12

Client: City of Belmont Laboratory ID: UE15092-002
Description: Effluent Matrix: Aqueous
Date Sampled:05/15/2019 0921
Date Received:05/15/2019
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
624.1 624.1 1 05/17/2019 0330 KGT 16984
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Acrolein
107-02-8
624.1
ND
5.0
ug/L
Acrylonitrile
107-13-1
624.1
ND
5.0
ug/L
Benzene
71-43-2
624.1
ND
1.0
ug/L
Bromodichloromethane
75-27-4
624.1
6.1
1.0
ug/L
Bromoform
75-25-2
624.1
ND
1.0
ug/L
Bromomethane (Methyl bromide)
74-83-9
624.1
ND
2.0
ug/L
Carbon tetrachloride
56-23-5
624.1
ND
1.0
ug/L
Chlorobenzene
108-90-7
624.1
ND
1.0
ug/L
Chloroethane
75-00-3
624.1
ND
2.0
ug/L
2-Chloroethylvinylether
110-75-8
624.1
ND
5.0
ug/L
Chloroform
67-66-3
624.1
9.5
1.0
ug/L
Chloromethane (Methyl chloride)
74-87-3
624.1
ND
2.0
ug/L
Dibromochloromethane
124-48-1
624.1
1.5
1.0
ug/L
1,1-Dichloroethane
75-34-3
624.1
ND
1.0
ug/L
1,2-Dichloroethane
107-06-2
624.1
ND
1.0
ug/L
1,1-Dichloroethene
75-35-4
624.1
ND
1.0
ug/L
trans-1,2-Dichloroethene
156-60-5
624.1
ND
1.0
ug/L
1,2-Dichloropropane
78-87-5
624.1
ND
1.0
ug/L
cis- 1,3-Dichloropropene
10061-01-5
624.1
ND
1.0
ug/L
trans-1,3-Dichloropropene
10061-02-6
624.1
ND
1.0
ug/L
Ethvlbenzene
100-41-4
624.1
ND
1.0
ug/L
iylene chloride
75-09-2
624.1
ND
1.0
ug/L
?,2-Tetrachloroethane
79-34-5
624.1
ND
1.0
ug/L
Tetrachloroethene
127-18-4
624.1
ND
1.0
ug/L
Toluene
108-88-3
624.1
ND
1.0
ug/L
1,1,1-Trichloroethane
71-55-6
624.1
ND
1.0
ug/L
1,1,2-Trichloroethane
79-00-5
624.1
ND
1.0
ug/L
Trichloroethene
79-01-6
624.1
ND
1.0
ug/L
Vinyl chloride
75-01-4
624.1
ND
1.0
ug/L
Run 1
Acceptance
Surrogate
Q % Recovery
Limits
Bromofluorobenzene
97
70-130
1,2-Dichloroethane-d4
102
70-130
Toluene-d8
96
70-130
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
t of holding time W = Reported on wet weight basis
_..__.; Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 9 of 12

Chain of Custody
and
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www,shealylab.com
Page 10 of 12

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Shealy Environmental Services, Inc_
CWA % niFDES
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Number
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No. ;803) 7�31-97D4 Fax Na. (8(l3) 791-91 ;1
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Quote No.
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3. RaGnquisMd, by Mile
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Note: All samples are retained for six week:; from receipt unless other LAB USE ONLY
Ree._ Tarnp. Ttintli, rank
arranq emsnta a Ire made
Received on !C (C,gck) N 0IIx Pack
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SHEALY ENVIRONMENTAL SERVICES, INC.
StxaMlGvimnmcnt#1Sc�victa,luc. [;,,,� ,.
DximmtNLLmbr--W 1ISC W ;:L:_avoEXII :7;'.'I
Sample Receipt Checklist (SRC)
Client. Belmont Cooler Inspected h •r'date: M r 5115A9 T-ut N: UE15092
Mrs of reCeipt-, 0 SESI ❑ Client ❑ UPS FcdEx El Other:
© Y cs
® No
1. W urc custody seals present on the cooler?
Yes
No
NA
2. If cuuod • seals were resent, were they intact and unbroken'.+
H Strip ID_ 111-2225 cWorine Strip TD: 19-35 7e�kxl JSI{
— by:J _
rigulal tentperaturc upon mccipt + Derived (Corrected) temperature upon rt:ceipt %Solid, Snap -Cup ID: NA
2.8 12.8 oC NA i NA vC NA (NA or NA /AlA 'C
cthnd: ( *re.mperature Blanl; ❑Agahlst Bottles IR Gun TD: 6 IR Gun Correction racwr: 0 °C
Icthod of coolant: ® Wet Tee ❑ lac Packs ❑ PEX Ice ❑ None
❑ Yes
❑ No
O NA
3. If tentperuturu of any cooler exceeded 6.0°C, uas Proj cot Manr get Nutifit%12 PM was Nolificd by, phone ,' email 1 face-lo-face (cur le one).
❑ Yes
❑ NO
® NA
4, U the commercial ootttier's packing; Aip atwhed to this film?
® Yes
❑ do
S. Were proper custody prtwedures (rclinquishecUreceived) fnlinwod?
Q� Yes
flu
6. Wcrc sample IDs listed on the MC?
® Yes
e1 N.,
7. Wcrr sample IDs listed on all sample cnntainers?
® Yer:
No
3. Wee: callcotirm date a time listed on the COC?
® Yesi
❑ No
9. Was colloedon date & time listed on all sample containers?
0 Yea
❑ No
10, Did all container IubCl information (ID, date, time') agree with the COC?
® Yes
❑ No
11. Wcre tests to be performed listed oil the COC?
® Yes
El12.
No
Thd all satnples arrive in the Praper contatnerF for each trot and?or in good oautslition
(unbroken, lids on, etc.)?
Ycxl
❑ No
113.
Was adequate sumpic volume available?
Vj ,. cs
No
14. Were all rnmplms received within ,S ttw bolding tune or 4li hamu, whichevercornes first?
yCSJ
W1 No
15. Were any sam Ica containtxs missirtgr'excesc eirck onc) samples Not listbd on COC?
® Y�-sl
❑ No
❑ NA
16. For VOA and KSK-175 samp1m, wcrc bubbles present>"pea-Size" (%"or 6mm in diameter)
to any of the Y0A vials?
® Yrs
L1 No
NA
17. Were all DRO..meuals."nutricnt Famples received at a pH Of < r?
Q] Yes
No
NA
IS. Werc all cynnidr samples received at a pH > 12 and sut1-L'& ham kit rcoutved at a p1I> 9?
® Yes
❑ No
❑ NA
1 R. were all applicable ,? ,cyanidrlphanuN625 (e 0,5mg�L) samples free of rsidua
chl(wine
Yes
❑ No
NA
20. Were client remarics4equests (i.e. ruqumled dilutions, iv VNISD desianadons, etc...)
correctly transcribed from the COC into the comment section in I.IMS?
LJ Yes
LQN*I
121.
was the cluote number listed on the containcr label'! If yes, Quote iJ NA
S,,iinple
PmservAtion (Must be completed for anv sample(s) incorrectly pt+r avoci or Mth headspace.)
tiamplc(s) NA wero Tweiv0d incorrectly pmcrved and t,.,crc adjusted U"ordingly
t'.1 sample receiving with NA ml- of circle one: TUS04, HNO3, HC I, NaOII using SR 4 NA _
lime oipreservatitm NA _ ._ If more than one preservative is needed, please note in the comments below.
(s l Qd='. (3) wcxr. received with bubbles >,6 mm in diameter.
s(s) NA wererocc ivcd K ith TftC > 0.5 m�7. (i F rq19 is rrn) ar_ti were
d accordingly in sample receiving with sodium thiosulfate (Nu2s,O.t} xzth Shealy 1T): NA
VR
r>sic hhcl�ap(?lied by: ]SN Date: 5135119
Comments:
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 12 of 12

aceAnalytical
(-,�
Report of Analysis
City of Belmont
PO Box 431
Belmont, NC 28012
Attention: Tanya Setzer
Project Name: Effluent Pollutant Scan
Lot Number:VH12113
Date Completed:08/31/2020
4 a,, - �,e dw �7
08/31 /2020 4:21 PM
Approved and released by:
Project Manager I: Hannah K. Lucas
o�
ANSI bric al Accreditation Scud
A C C R E D I T E D
TESTING LABORATORY
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Pace Analytical Services, LLC.
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172
Tel:[phone] Fax:[phone] www.pacelabs.com
Page I of 10

PACE ANALYTICAL SERVICES, LLC
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Belmont
Lot Number: VH12113
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved NELAC standards, the Pace Analytical Services, LLC ("Pace") Quality Assurance
Management Plan (QAMP), standard operating procedures (SOPS), and Pace policies. Any exceptions to
the NELAC standards, the QAMP, SOPS or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Pace Project Manager listed on the
cover page.
Pace Analytical Services, LLC (formerly Shealy Environmetal Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 2 of 10

PACE ANALYTICAL SERVICES, LLC
Sample Summary
City of Belmont
Lot Number: VH12113
Sample Number Sample ID Matrix Date Sampled Date Received
001 EFFLUENT Aqueous 08/12/2020 0904 08/12/2020
002 EFFLUENT Aqueous 08/12/2020 0859 08/12/2020
(2 samples)
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 3 of 10

II II I yJ"I I I l I I I I I I Ili-IJ
Client: City of Belmont Laboratory ID:VH12113-001
Description: EFFLUENT Matrix: Aqueous
ite Sampled:08/12/2020 0904
to Received:08/12/2020
Run Prep Method
Analytical Method
Dilution
Analysis Date Analyst
Prep Date
Batch
1 350.1
(Ammonia - N ) 350.1
1
08/14/2020 1554 DMA
63567
1 (Hardness
(to) SM 2340C-2011
1
08/18/2020 1524 KFE
63935
1
(Nitrate-Nitr) 353.2
15
08/19/2020 1612 AMR
64079
1
(Phosphorus) 365.1
1
08/18/2020 1516 DMA
63856
1
(TDS) SM 2540C-2011
1
08/17/2020 2232 MOM
63804
1 351.4
(TKN) 351.2
1
08/19/2020 1749 DMA
08/19/2020 1303 63990
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Ammonia - N (gas diffusion)
350.1
ND
0.10
mg/L
1
Hardness (total)
SM 2340C-2011
52
10
mg/L
1
Nitrate -Nitrite - N
353.2
23
0.30
mg/L
1
Phosphorus
7723-14-0 365.1
1.5
0.050
mg/L
1
TDS
SM 2540C-2011
410
25
mg/L
1
TKN
351.2
ND
0.10
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
H = Out of holding time W = Reported on wet weight basis
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 4 of 10

Client: City of Belmont Laboratory ID:VH12113-001
ascription: EFFLUENT Matrix: Aqueous
Sampled:08/12/2020 0904
Received: 08/12/2020
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
200.2 200.8 1 08/20/2020 1433 BPK 08/19/2020 1609 63931
Parameter
CAS Analytical
Number Method Result Q LOQ Units Run
Antimony
7440-36-0
200.8
9.6
2.0
ug/L
1
Arsenic
7440-38-2
200.8
ND
2.0
ug/L
1
Beryllium
7440-41-7
200.8
ND
0.40
ug/L
1
Cadmium
7440-43-9
200.8
ND
0.50
ug/L
1
Chromium
7440-47-3
200.8
ND
5.0
ug/L
1
Copper
7440-50-8
200.8
9.8
5.0
ug/L
1
Lead
7439-92-1
200.8
ND
1.0
ug/L
1
Nickel
7440-02-0
200.8
ND
5.0
ug/L
1
Selenium
7782-49-2
200.8
ND
5.0
ug/L
1
Silver
7440-22-4
200.8
ND
1.0
ug/L
1
Thallium
7440-28-0
200.8
ND
0.50
ug/L
1
Zinc
7440-66-6
200.8
52
10
ug/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
t of holding time W = Reported on wet weight basis
\nalytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 5 of 10

Client: City of Belmont Laboratory ID: VH12113-002
Description: EFFLUENT Matrix: Aqueous
ate Sampled:08/12/2020 0859
to Received:08/12/2020
Run Prep Method Analytical Method
Dilution
Analysis Date Analyst
Prep Date Batch
1 10-204-00-1-X (Cyanide - To) SM 4500-CN E-
1
08/13/2020 1523 KFE
08/13/2020 1306 63227
1 (Phenolics) 420.4
1
08/28/2020 1326 MSG
62991
1 (HEM (oil and) 1664B
1
08/25/2020 0932 GLT
64559
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Cyanide - Total
Phenolics
HEM (oil and grease)
57-12-5 SM 4500-CN E-2 ND
420.4 ND
1664E ND
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40
H = Out of holding time W = Reported on wet weight basis
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
0.010 mg/L 1
0.0050 mg/L 1
5.0 mg/L 1
Page 6 of 10

Client: City of Belmont Laboratory ID: VH12113-002
Description: EFFLUENT Matrix: Aqueous
Date Sampled:08/12/2020 0859
Date Received:08/12/2020
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
624.1 624.1 1 08/14/2020 0239 STM 63488
2 624.1 624.1 1 08/20/2020 0226 STM 64118
Parameter
CAS
Number
Analytical
Method
Result
Q
LOQ
Units
Run
Acrolein
107-02-8
624.1
ND
5.0
ug/L
1
Acrylonitrile
107-13-1
624.1
ND
5.0
ug/L
1
Benzene
71-43-2
624.1
ND
1.0
ug/L
1
Bromodichloromethane
75-27-4
624.1
1.8
1.0
ug/L
1
Bromoform
75-25-2
624.1
ND
1.0
ug/L
2
Bromomethane (Methyl bromide)
74-83-9
624.1
ND
2.0
ug/L
1
Carbon tetrachloride
56-23-5
624.1
ND
1.0
ug/L
1
Chlorobenzene
108-90-7
624.1
ND
1.0
ug/L
1
Chloroethane
75-00-3
624.1
ND
2.0
ug/L
1
2-Chloroethylvinylether
110-75-8
624.1
ND
5.0
ug/L
1
Chloroform
67-66-3
624.1
3.5
1.0
ug/L
1
Chloromethane (Methyl chloride)
74-87-3
624.1
ND
2.0
ug/L
1
Dibromochloromethane
124-48-1
624.1
ND
1.0
ug/L
1
1,1-Dichloroethane
75-34-3
624.1
ND
1.0
ug/L
1
1,2-Dichloroethane
107-06-2
624.1
ND
1.0
ug/L
1
1,1-Dichloroethene
75-35-4
624.1
ND
1.0
ug/L
1
trans- 1, 2-Dichloroethene
156-60-5
624.1
ND
1.0
ug/L
1
1,2-Dichloropropane
78-87-5
624.1
ND
1.0
ug/L
1
cis- 1,3-Dichloropropene
10061-01-5
624.1
ND
1.0
ug/L
1
trans-1,3-Dichloropropene
10061-02-6
624.1
ND
1.0
ug/L
1
(benzene
100-41-4
624.1
ND
1.0
ug/L
1
iylene chloride
75-09-2
624.1
ND
1.0
ug/L
1
1,1,2,2-Tetrachloroethane
79-34-5
624.1
ND
1.0
ug/L
1
Tetrachloroethene
127-18-4
624.1
ND
1.0
ug/L
1
Toluene
108-88-3
624.1
ND
1.0
ug/L
1
1,1,1-Trichloroethane
71-55-6
624.1
ND
1.0
ug/L
1
1,1,2-Trichloroethane
79-00-5
624.1
ND
1.0
ug/L
1
Trichloroethene
79-01-6
624.1
ND
1.0
ug/L
1
Vinyl chloride
75-01-4
624.1
ND
1.0
ug/L
1
Run 1 Acceptance
Run 2 Acceptance
Surrogate
Q % Recovery Limits
Q %
Recovery
Limits
Bromofluorobenzene
106 70-130
102
70-130
1,2-Dichloroethane-d4
86 70-130
106
70-130
Toluene-d8
94 70-130
108
70-130
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40 %
t of holding time W = Reported on wet weight basis
___ .analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 7 of 10

Chain of Custody
and
Miscellaneous Documents
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 8 of 10

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CWA / NPDES
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VVest Columbia. South Cafo;ir,a 20172
Telephone No. (8D,3)791-a7Q0 Fax Na- (&05)791-9111
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Sam .Shy lure
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Sandra Craft
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Note: All samples are retained for sic weeks from receipt unless other 11 An .L4F ONI Y
arranp arrmnts are made RacoMcd on I- (Check]
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PACE ANALYTICAL SERVICES, LLC
Shealy r§r inmmenl:J Kmvices, Inc
Jocur:rcnf Humber. M151M U-14
Sumple receipt Checklist (SRU)
Client; BEL,MONT Cooler Ins ected b ;date: CMs7 1 8112120 Lot #; VIi 121
Mums urrecc:ipt: Z SES1 ❑ Client ❑ UPS ❑ FedEx Other: _
n Yes Nol 11. We -c custody scale: t rtsent on the cooler?
1-1 Yes d Nol ® NA12. If custody seals were premert, were they intact 21ld urll'OUO
pl-T Strip 1D: 24-1455 Chlorine Strip ID. 20-153. Te b�tad''by, CMS?
Original icmperaturc upon rmcipt f LUcr:vcd (Corrm.LCd) t::mpurulurc upor• rcc6pt $ solid snap -CUT: 1=
2.6 r2.6 aC NA ,fNA aC NA !NA DC! NA /NA aC
T*-- I Oft
�12F;luc Date; arV2ulS
NA
Mel'rnn1: ®Tearperature Blank ❑Againsl RuILICs 1R Chin iD: i IR Gn-r Comxaion Factor;11
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Method cf caola-rt: Wet Ice ❑ Toe Packs ©Dtv lee ❑ -None ,
❑ Yes ❑ No ® NA 3. If icinpLTHIUM d' arty cuuh:r cxc:'7d 6.0°C, Has Project (Manager Notified'? '
FM was Notified by: phone ! email J faoe-to faoo ,oir.lc one}
Cl Yrs ❑ NU ®NA 4. Js tae cs+romenciaJ cotu'Am's pack;ng slip attar:hW to this Flinn?
91 Yes
0 No
5- W= pnnpor c4 mtody procedtlrcK (relmquishe&received) followed?
I Yrc
N4i
6. Were-mmple IEN l s'ed on the
® Yes
❑ No
7. Wcrc sample IN Estcd on al: sample oudainc:b?
® Yes
0 No
8- W03 collectiv:i dat. & time listc i on the COO j
® Yes
ElNo
_
9 Was collection date & time liStWI On all st_rnpie container :;
Ye s
❑ No
10. Did all container Iabc. information (1D, date, Iiume) agrt= with thr. COC?
V1 Yes
❑ No
11. Were tests to be narrommd Iiated on t}ic COC? i
91 Yes U No 12- CH all 4amplc: arrive ir the proper containers roe etu:h
(unbroken; lids on, etc.)?
® Yes [71 Nu 13_ Was adeyuutc Sam& eolumc avai:abl: ?
Yes r! No ].a. Wcrc all samples received w4hir ''A the hnl::ing time o
Yes ® No — 15- Were any samples eonwinurs missingicxcess (circle on
16. For VOA and RSI;-1 ,,5 samples, were bubbles present
® Yes ❑ No ©1tiA is artly of the VOA vials?
1 Yes No NA 7. Were all DRO? atetWsinument sampl_s cccivod at a p)
® Yes No El NA "S. We c all cyanide samples Tf.Mivrd at r. OH � 12 and set
W'e:e
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tpe it diameter)
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20. 11ir'ere clued rcrnarkslruqucsls (i.e. requested dihltinne. MS NTSD designatio.
Q Yes ❑ No ® NA correctly transcr,l ed front the COC into, the comment secriarm ir• LIN19?
0 Yes El Nol 121. Was the quote number liswd col tho container label? If ye*, Quote 0 147'
i Imnle Preservation (Must be completed Cur any sampidk} incorrectly preserved or w'ity h; adspace.}
iamplc,$) NA were rcccived irworrrmily prrseivod and were adj
u,trruple rccuiving wilh h'A ml. of ci -:e one: I i?504, HNO,. HCI, NaOH asiug SR 4 NA
ITr-e of preservation NA If more than ore pre:,ervative ;s ncxxled, pleasz noteirn l e comments 1
,.'ample(s) _ 02 (3) were rect'vcd w'th bubbles >6 nurr j
Sainpirs(s) NA _ - were received with TRC > 0. i mg?L (If ;f 19 is no
adjusted r. ordingty in sample reccitidng %Vito sodium thiosu.Wc W;t`r gleal.� IT): NA
barcode labels applied by; CM
Comments:
i?air.: V11120
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Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 10 of 10

aceAnalytical
Report of Analysis
City of Belmont
PO Box 431
Belmont, NC 28012
Attention: Tanya Setzer
Project Name: Effluent Pollutant Scan
Lot Number:V104079
Date Completed:09/16/2020
09/16/2020 4:40 PM
Approved and released by:
Project Manager I: Hannah K. Lucas
iA
lkiA
ANSI hti-i A—dit tW Bard
A C C R E D I T E D
TESTING LABORATORY
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Pace Analytical Services, LLC.
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172
Tel:[phone] Fax:[phone] www.pacelabs.com
Paget of 8

PACE ANALYTICAL SERVICES, LLC
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Belmont
Lot Number: V104079
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved NELAC standards, the Pace Analytical Services, LLC ("Pace") Quality Assurance
Management Plan (QAMP), standard operating procedures (SOPS), and Pace policies. Any exceptions to
the NELAC standards, the QAMP, SOPs or policies are qualified on the results page or discussed below.
If you have any questions regarding this report please contact the Pace Project Manager listed on the
cover page.
Pace Analytical Services, LLC (formerly Shealy Environmetal Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 2 of 8

PACE ANALYTICAL SERVICES, LLC
Sample Summary
City of Belmont
Lot Number: V104079
Sample Number Sample ID Matrix Date Sampled Date Received
001 Effluent Aqueous 09/04/2020 0901 09/04/2020
(1 sample)
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 3 of 8

J1 a I II V VI"-I1 - VVI I.V VV.I I-j .J.,,.-
Client: City of Belmont Laboratory ID: VI04079-001
Description: Effluent Matrix: Aqueous
Date Sampled:09/04/2020 0901
Date Received:09/04/2020
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 625.1 625.1 1 09/15/2020 1838 JCG 09/08/2020 1830 65987
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
Acenaphthene
83-32-9
625.1
ND
1.6
ug/L
Acenaphthylene
208-96-8
625.1
ND
1.6
ug/L
Anthracene
120-12-7
625.1
ND
1.6
ug/L
Benzidine
92-87-5
625.1
ND
8.0
ug/L
Benzo(a)anthracene
56-55-3
625.1
ND
1.6
ug/L
Benzo(a)pyrene
50-32-8
625.1
ND
1.6
ug/L
Benzo(b)fluoranthene
205-99-2
625.1
ND
1.6
ug/L
Benzo(g,h,i)perylene
191-24-2
625.1
ND
1.6
ug/L
Benzo(k)fluoranthene
207-08-9
625.1
ND
1.6
ug/L
4-Bromophenyl phenyl ether
101-55-3
625.1
ND
1.6
ug/L
Butyl benzyl phthalate
85-68-7
625.1
ND
1.6
ug/L
bis (2-Chloro-1-methylethyl) ether
108-60-1
625.1
ND
1.6
ug/L
4-Chloro-3-methyl phenol
59-50-7
625.1
ND
1.6
ug/L
bis(2-Chloroethoxy)methane
111-91-1
625.1
ND
1.6
ug/L
bis(2-Chloroethyl)ether
111-44-4
625.1
ND
1.6
ug/L
2-Chloronaphthalene
91-58-7
625.1
ND
1.6
ug/L
2-Chlorophenol
95-57-8
625.1
ND
1.6
ug/L
4-Chlorophenyl phenyl ether
7005-72-3
625.1
ND
1.6
ug/L
Chrysene
218-01-9
625.1
ND
1.6
ug/L
Dibenzo(a,h)anthracene
53-70-3
625.1
ND
1.6
ug/L
3,3'-Dichlorobenzidine
91-94-1
625.1
ND
8.0
ug/L
2,4-Dichlorophenol
120-83-2
625.1
ND
1.6
ug/L
Diethyl phthalate
84-66-2
625.1
ND
1.6
ug/L
Dimethyl phthalate
131-11-3
625.1
ND
1.6
ug/L
2,4-Dimethylphenol
105-67-9
625.1
ND
1.6
ug/L
Di-n-butyl phthalate
84-74-2
625.1
ND
1.6
ug/L
4,6- Din itro-2- methyl phenol
534-52-1
625.1
ND
8.0
ug/L
2,4-Dinitrophenol
51-28-5
625.1
ND
8.0
ug/L
2,4-Dinitrotoluene
121-14-2
625.1
ND
3.2
ug/L
2,6-Dinitrotoluene
606-20-2
625.1
ND
3.2
ug/L
Di-n-octylphthalate
117-84-0
625.1
ND
1.6
ug/L
1,2-Diphenylhydrazine(as azobenzene)
103-33-3
625.1
ND
1.6
ug/L
bis(2- Ethyl hexyl)phthalate
117-81-7
625.1
ND
8.0
ug/L
Fluoranthene
206-44-0
625.1
ND
1.6
ug/L
Fluorene
86-73-7
625.1
ND
1.6
ug/L
Hexachlorobenzene
118-74-1
625.1
ND
1.6
ug/L
Hexachlorobutadiene
87-68-3
625.1
ND
1.6
ug/L
Hexachlorocyclopentadiene
77-47-4
625.1
ND
8.0
ug/L
Hexachloroethane
67-72-1
625.1
ND
1.6
ug/L
Indeno(1,2,3-c,d)pyrene
193-39-5
625.1
ND
1.6
ug/L
Isophorone
78-59-1
625.1
ND
1.6
ug/L
Naphthalene
91-20-3
625.1
ND
1.6
ug/L
Nitrobenzene
98-95-3
625.1
ND
1.6
ug/L
2-Nitrophenol
88-75-5
625.1
ND
3.2
ug/L
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
NO = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 4 of 8

Client: City of Belmont Laboratory ID:V104079-001
Description: Effluent Matrix: Aqueous
Date Sampled:09/04/2020 0901
Date Received:09/04/2020
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
625.1 625.1 1 09/15/2020 1838 JCG 09/08/2020 1830 65987
Parameter
CAS
Number
Analytical
Method
Result Q
LOQ
Units
Run
4-Nitrophenol
100-02-7
625.1
ND
8.0
ug/L
1
N-Nitrosodimethylamine
62-75-9
625.1
ND
1.6
ug/L
1
N-Nitrosodi-n-propylamine
621-64-7
625.1
ND
1.6
ug/L
1
N-Nitrosodiphenylamine (Diphenylamine)
86-30-6
625.1
ND
1.6
ug/L
1
Pentachlorophenol
87-86-5
625.1
ND
8.0
ug/L
1
Phenanthrene
85-01-8
625.1
ND
1.6
ug/L
1
Phenol
108-95-2
625.1
ND
1.6
ug/L
1
Pyrene
129-00-0
625.1
ND
1.6
ug/L
1
1,2,4-Trichlorobenzene
120-82-1
625.1
ND
1.6
ug/L
1
2,4,6-Trichlorophenol
88-06-2
625.1
ND
1.6
ug/L
1
Run 1
Acceptance
Surrogate
Q % Recovery
Limits
2-Fluorobiphenyl
70
37-129
2-Fluorophenol
36
24-127
Nitrobenzene-d5
67
38-127
Phenol-d5
57
28-128
Terphenyl-d14
71
10-148
2,4,6-Tribromophenol
47
41-144
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
t of holding time W = Reported on wet weight basis
. --- .Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 5 of 8

Chain of Custody
and
Miscellaneous Documents
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 6 of 8

o�
cwa IlVPDFS
Charm' of Custody Record
Cliant Rcpnrl to Contfc
f3elm0nl WN'7P Tanva ScIzR
ITeaphoneNo. ; Fax No.;
Shl l4ly EnvirDrimenta! Services, Inc.
106 Vantage Pc'nr Drivo
"rest Col UMbIS, South Carolina Liu1 TL,
TalPphone No_ (80 1791-971DO Fax Nc. [phone]
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P-olec:NumGnr
PO'Number
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NumW et Containers
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V104079
RoSsiX! I-azard Iderdlicauon In.-w D'epcanl C OMMUnt
Non -He 8: Wnrnablc DSkln Ira�anl R=rn to 3Ilent ® Disposal W Lab
P4son UrY.n m
Turn Around -ime Nqulpp red (Prior lab atmrel ra;luinitl 'ur ;: puditcd TAT) QC RegLkernenls (FMn. t! Spearj)
GA Smderd ❑ hush IFkasc a ;
f Re!inqAehegby!Sampler Date TGie 1.Rereiwnl �p
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2. Rehn alwri Dale 'I-Wric _ ` -
_ 2. Recei,rJ ty'
1fJ( l�-ylJ l%7' �t ( \
9.!?el!ngUlSh&d by Dale -1me 3 L�ior..lor F?cei✓eC
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iVate: Alf Samples lire retained for six weeks from receipt unless oth&r L U USE ONLY
drranaernents are made Heiviw:d a., Ice (C nk) " 1—I114 F Ike peck
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PACE ANALYTICAL SERVICES, LLC
`yl:unlyEnvirrmwnialFwvkw,:na wAV I a't
Dc euneeol h`ur-Awn Mt?1101 Er:.' 4 1=tratne Daly 902-21i:1 R
Sample Receipt Checklist (SRC,
Oient. Belmont Crolcrinspected +date: Mra' i 0914,2020 lAr.#: V104079
earls ofneceipt: SESi []Cli.ut ❑ UPS [] pedSx F1 Other; --
i� Yes Nal
11. Were castotly seals presrm on 'die coo:t:r`1
Yes Nol
ha NA 2. if custocv seamis were . csr i• were tltev intact and turbrokan?
pH Strip ID-. na
Ch:orinc Strip 1D. NA Tesird by, h'A
_
Onginal temperature upon receipt l Derived (Corrected) :emperatury upon receipt °i6Solid Snap -Cup ID: NA
2.8 12.8 OC.
NA / NA vC NA /NA eC NA- ,NA -C --
Method_ 6dTcmperaturc Blank ❑AVainst Bottles bR Gun ID: _ 5 IR Gun CorrectionPaatnr: 0 vC,.
Nfe-thod of coolant: ® Wet Ice [I!ce Packs [ID [cc f : Iwte
©Y
El No
Nrl
i, if ten petaturti of uny cooler exceeded 6 0T. was Project 1 IAnagcr Nodried?
M was Notified by, phone i entail / face -no -face (circley 1e ),
© Yes
❑ No
© No
®hint
4, Is the commercial courier's packing slip attached to this fonr.?
5, Wuc propercu.Yiody prumxdtaes (relirlyuishtid.+received) falt<nve t''
Qj Yee
-- Ycs
I No
fi_ %Vrrr. sample IDs listed on fic COC?
® Yes
❑ Nv,
7. %Ycrc sample il)5 listed on all sample oonwncrs?
R_ Was collection tlalr: & time listed on the COC?
19. Was collection date & Lanc listed on all sample containem') _
110. Did tit; container label irforruation (ID, date, time) agree will the COC?
Ycs
(] Na
® ycsl
❑ No
M Yes
❑ No
® Yes
[] No
I I - Wr—e tests to be pe rti mcd lisped on the COC?
:2. Did ail samples arrive in the proper coatahters fur "A test and/or in grnod condi t on
® Ycs
El NO
(anbmkea, lids on, etc.):'
W] Yes
❑ NO
13. Was adequate sample volume available?
Y�
❑ No
14_'Afm rill samples reeeivcd within '/2 the holding time or 48 huurs, whichever a tires first?
15, Wm fury samples containers missac o-qs (circle one)samples Not listed on CCj(.? --�
Yes
0 No
❑ Yes
❑ No
0 NA
16• For VOA and RSK-1 75 samples, wum bubbles prescm>"pca.size" ('A"ar 6mm it diameter)
in tiny Df dic VOA via.s?
17. Were all DROimctalmiutrient samples received at u ptl of <2?
❑ Yesi
0 Mil
0 NA
❑ yes,
❑ No
0 NA
18. Were all c amide samples receiticd at a pl-I - 12 and sulf tde samples raceiwd a: a pl-1 >1r1
❑ Ycs
El No
® TtiA
19. Wcrc f applicable _+rKNlcyat t&-iphcnol/6?.i (<4,Smg/ samples ;t.e orreaM-W
chlorine?
20. Wern client rrmarksfrequests (i.c. requested d lutions, M.S MSD designations,
Q Ye!
❑ 2�0
O NA
cl)rretxly transcribed from :be COC into the eo nment section itt LIMS?
❑ Yes
Ww the quote nutobc- listed cui the container label? if yes, Quote # t+'A
Nn,
121.
Sample ['reservation (Must he completed fa- anw sumple(s) into: mly preserved or with hcadspace.)
Sample(s) NA
were received into rued- preserved aid wcre adjusted aucardin3ly
in xample 1*ce virg with NA mL of circle one: H2SO4, HNO3, I IC'I, NaOH using 5R 9 NA
_
Time of preservation NA _. If more Bran me pruscrvadve is needed, please note in the cormrenra helow,
Sample(s) NA
were rece;ved with bubbles =-5 mn: in diameter.
Sarrples(s) NA
wcre received wilt TRC > 0.5 ntg2 (if 19 is no) and ware
adjusted accotd'urgty Tr sernple retxivin� with sodium th:osuWho (NaiSzOs) W[tl: 911t:aly jr)- NA
R bu"xlc labels applied by: AHD Data, 09/4!1o20
Comments:
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 8 of 8

aceAnalytical
Report of Analysis
City of Belmont
PO Box 431
Belmont, NC 28012
Attention: Tanya Setzer
Project Name: Effluent Pollutant Scan
Lot Number:WK09070
Date Completed:12/09/2021
12/09/2021 11:38 AM
Approved and released by:
Project Manager II: Edward Barnett
ACAM2
ANSI NdNOnAI ACCM0010 8084
B
A C C R E D I T E D
TESTING LABORATORY
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Pace Analytical Services, LLC.
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172
Tel:[phone] Fax:[phone] www.pacelabs.com
Page 1 of 14

PACE ANALYTICAL SERVICES, LLC
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Belmont
Lot Number: WK09070
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved The NELAC Institute (TNI) standards, the Pace Analytical Services, LLC ("Pace")
Laboratory Quality Manual, standard operating procedures (SOPs), and Pace policies. Any exceptions to
the TNI standards, the Laboratory Quality Manual, SOPs or policies are qualified on the results page or
discussed below.
Pace is a TNI accredited laboratory; however, the following analyses are currently not listed on our TNI
scope of accreditation:
Biological Tissue: All, Non -Potable Water: SGT-HEM EPA 1664B, Silica EPA 200.7, Boron, Calcium,
Silicon, Strontium EPA 200.8, Bicarbonate, Carbonate, and Hydroxide Alkalinity SM 2320 B-2011, Fecal
Coliform SM 9221 C E-2006 & SM 9222D-2006, Strontium SW-846 601OD, VOC SM 6200 B-2011,
Drinking Water: VOC (excluding BTEX, MTBE, Naphthalene, & 1,2-dichloroethane) EPA 524.2, Solid
Chemical Material: TOC Walkley-Black.
If you have any questions regarding this report please contact the Pace Project Manager listed on the
cover page.
VOCs by GCMS
An LCS/LCSD was run in lieu of an MS/MSD for Analysis Batch 23265.
WK09070-002 (Effluent) (Run 1)
SVOCs by GCMS
The Metho Blank and laboratory control sample (LCS) for analytical batch 22804 exceeded control limits
for many analytes and surrogates due to heavy contamination from prep. The associated samples were
re -prepared and/or re -analyzed outside holding time. Both sets of data have been reported.
WK09070-001 (Effluent) (Run 1)
Pace Analytical Services, LLC (formerly Shealy Environmetal Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 2 of 14

PACE ANALYTICAL SERVICES, LLC
Sample Summary
City of Belmont
Lot Number: WK09070
Sample Number Sample ID Matrix Date Sampled Date Received
001 Effluent Aqueous 11/09/20210844 11/09/2021
002 Effluent Aqueous 11/09/2021 0900 11/09/2021
(2 samples)
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 3 of 14

11 I V I Lj"I I I V I I V I I j I I-1J
Client: City of Belmont Laboratory ID: WK09070-001
Description: Effluent Matrix: Aqueous
ate Sampled:11/09/2021 0844
Ite Received: 11 /09/2021
Run Prep Method
Analytical Method
Dilution
Analysis Date Analyst
Prep Date
Batch
1 350.1
(Ammonia - N) 350.1
1
11/20/2021 1814 DAK
23247
1 (Hardness (to) SM 2340C-2011
1
12/02/2021 0841 AAB
24308
1
(Nitrate-Nitr) 353.2
15
11/16/2021 1808 AAB
22741
1
(Phosphorus) 365.1
2
11/10/2021 1706 DMA
21986
1
(TDS) SM 2540C-2011
1
11/15/2021 1927 AMR
22557
1 351.4
(TKN) 351.2
1
11/17/2021 1639 DMA
11/17/2021 0931 22732
CAS Analytical
Parameter
Number Method
Result Q
LOO
Units
Run
Hardness (total)
SM 2340C-2011
54
10
mg/L
1
Ammonia - N (gas diffusion)
350.1
0.25
0.10
mg/L
1
Nitrate -Nitrite - N
353.2
25
0.30
mg/L
1
Phosphorus
7723-14-0 365.1
2.6
0.10
mg/L
1
TDS
SM 254OC-2011
470
25
mg/L
1
TKN
351.2
ND S
0.10
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range Q = Surrogate failure
NO = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40% L = LCS/LCSD failure
H = Out of holding time W = Reported on wet weight basis S = MSIMSD fa
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 4 of 14

Client: City of Belmont Laboratory ID: WK09070-001
Description: Effluent Matrix: Aqueous
Date Sampled:11/09/2021 0844
Date Received: 11 /09/2021
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
625.1 625.1 1 12/02/2021 1458 JCG 11/10/2021 1745 21969
2 625.1 625.1 1 12/02/2021 1522 JCG 11/23/2021 1552 23503
Parameter
CAS
Number
Analytical
Method
Result
Q
LOQ
Units
Run
Acenaphthene
83-32-9
625.1
ND
1.6
ug/L
1
Acenaphthylene
208-96-8
625.1
ND
1.6
ug/L
1
Anthracene
120-12-7
625.1
ND
1.6
ug/L
1
Benzidine
92-87-5
625.1
ND
L
8.0
ug/L
1
Benzo(a)anthracene
56-55-3
625.1
ND
1.6
ug/L
1
Benzo(a)pyrene
50-32-8
625.1
ND
1.6
ug/L
1
Benzo(b)fluoranthene
205-99-2
625.1
ND
1.6
ug/L
1
Benzo(g,h,i)perylene
191-24-2
625.1
ND
1.6
ug/L
1
Benzo(k)fluoranthene
207-08-9
625.1
ND
1.6
ug/L
1
4-Bromophenyl phenyl ether
101-55-3
625.1
ND
1.6
ug/L
1
Butyl benzyl phthalate
85-68-7
625.1
ND
1.6
ug/L
1
bis (2-Chloro-1-methylethyl) ether
108-60-1
625.1
ND
L
1.6
ug/L
1
4-Chloro-3-methyl phenol
59-50-7
625.1
ND
L
1.6
ug/L
1
bis(2-Chloroethoxy)methane
111-91-1
625.1
ND
L
1.6
ug/L
1
bis(2-Chloroethyl)ether
111-44-4
625.1
ND
L
1.6
ug/L
1
2-Chloronaphthalene
91-58-7
625.1
ND
1.6
ug/L
1
2-Chlorophenol
95-57-8
625.1
ND
L
1.6
ug/L
1
4-Chlorophenyl phenyl ether
7005-72-3
625.1
ND
1.6
ug/L
1
Chrysene
218-01-9
625.1
ND
1.6
ug/L
1
DihPnzo(a,h)anthracene
53-70-3
625.1
ND
1.6
ug/L
1
Dichlorobenzidine
91-94-1
625.1
ND
L
8.0
ug/L
1
)ichlorophenol
120-83-2
625.1
ND
L
1.6
ug/L
1
Diethylphthalate
84-66-2
625.1
ND
L
1.6
ug/L
1
Dimethyl phthalate
131-11-3
625.1
ND
1.6
ug/L
1
2,4-Dimethylphenol
105-67-9
625.1
ND
L
1.6
ug/L
1
Di-n-butyl phthalate
84-74-2
625.1
ND
1.6
ug/L
1
4,6-Dinitro-2- methyl phenol
534-52-1
625.1
ND
8.0
ug/L
1
2,4-Dinitrophenol
51-28-5
625.1
ND
8.0
ug/L
1
2,4-Dinitrotoluene
121-14-2
625.1
ND
3.2
ug/L
1
2,6-Dinitrotoluene
606-20-2
625.1
ND
3.2
ug/L
1
Di-n-octylphthalate
117-84-0
625.1
ND
1.6
ug/L
1
1,2-Diphenylhydrazine(as azobenzene)
103-33-3
625.1
ND
1.6
ug/L
1
bis(2-Ethylhexyl)phthalate
117-81-7
625.1
ND
8.0
ug/L
1
Fluoranthene
206-44-0
625.1
ND
1.6
ug/L
1
Fluorene
86-73-7
625.1
ND
1.6
ug/L
1
Hexachlorobenzene
118-74-1
625.1
ND
L
1.6
ug/L
1
Hexachlorobutadiene
87-68-3
625.1
ND
1.6
ug/L
1
Hexachlorocyclopentadiene
77-47-4
625.1
ND
8.0
ug/L
1
Hexachloroethane
67-72-1
625.1
ND
L
1.6
ug/L
1
Indeno(1,2,3-c,d)pyrene
193-39-5
625.1
ND
1.6
ug/L
1
Isophorone
78-59-1
625.1
ND
L
1.6
ug/L
1
Naphthalene
91-20-3
625.1
ND
1.6
ug/L
1
Nitrobenzene
98-95-3
625.1
ND
1.6
ug/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range Q = Surrogate failure
Nn = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40% L = LCS/LCSD failure
t of holding time W = Reported on wet weight basis S = MS/MSD failure
, Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 5 of 14

Client: City of Belmont Laboratory ID: WK09070-001
Description: Effluent Matrix: Aqueous
Date Sampled:11/09/2021 0844
Date Received:11/09/2021
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 625.1 625.1 1 12/02/2021 1458 JCG 11/10/2021 1745 21969
2 625.1 625.1 1 12/02/2021 1522 JCG 11/23/2021 1552 23503
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
2-Nitrophenol
88-75-5
625.1
ND
3.2
ug/L
1
4-Nitrophenol
100-02-7
625.1
ND
L
8.0
ug/L
1
N-Nitrosodimethylamine
62-75-9
625.1
ND
L
1.6
ug/L
1
N-Nitrosodi-n-propylamine
621-64-7
625.1
ND
L
1.6
ug/L
1
N-Nitrosodiphenylamine (Diphenylamine)
86-30-6
625.1
ND
1.6
ug/L
1
Pentachlorophenol
87-86-5
625.1
ND
L
8.0
ug/L
1
Phenanthrene
85-01-8
625.1
ND
1.6
ug/L
1
Phenol
108-95-2
625.1
ND
L
1.6
ug/L
1
Pyrene
129-00-0
625.1
ND
1.6
ug/L
1
1,2,4-Trichlorobenzene
120-82-1
625.1
ND
L
1.6
ug/L
1
2,4,6-Trichlorophenol
88-06-2
625.1
ND
1.6
ug/L
1
Run 1 Acceptance
Run 2
Acceptance
Surrogate
Q % Recovery Limits
Q % Recovery
Limits
2-Fluorobiphenyl
70 37-129
H
68
37-129
2-Fluorophenol
53 24-127
H
46
24-127
Nitrobenzene-d5
125 38-127
H
127
38-127
Phenol-d5
75 28-128
H
61
28-128
Terphenyl-d14
83 10-148
H
95
10-148
2,4,6-Tribromophenol
51 41-144
H
55
41-144
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range Q = Surrogate failure
NO = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40% L = LCS/LCSD failure
H = Out of holding time W = Reported on wet weight basis S = MS/MSD fa
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 6 of 14

Client: City of Belmont Laboratory ID: WK09070-001
Description: Effluent Matrix: Aqueous
Date Sampled:11/09/2021 0844
Date Received: 11 /09/2021
Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
625.1 625.1 1 12/02/2021 1458 JCG 11/10/2021 1745 21969
2 625.1 625.1 1 12/02/2021 1522 JCG 11/23/2021 1552 23503
Parameter
CAS
Number
Analytical
Method
Result
Q
LOQ
Units
Run
Acenaphthene
83-32-9
625.1
ND
H
1.6
ug/L
2
Acenaphthylene
208-96-8
625.1
ND
H
1.6
ug/L
2
Anthracene
120-12-7
625.1
ND
H
1.6
ug/L
2
Benzidine
92-87-5
625.1
ND
H
8.0
ug/L
2
Benzo(a)anthracene
56-55-3
625.1
ND
H
1.6
ug/L
2
Benzo(a)pyrene
50-32-8
625.1
ND
H
1.6
ug/L
2
Benzo(b)fluoranthene
205-99-2
625.1
ND
H
1.6
ug/L
2
Benzo(g,h,i)perylene
191-24-2
625.1
ND
H
1.6
ug/L
2
Benzo(k)fluoranthene
207-08-9
625.1
ND
H
1.6
ug/L
2
4-Bromophenyl phenyl ether
101-55-3
625.1
ND
H
1.6
ug/L
2
Butyl benzyl phthalate
85-68-7
625.1
ND
H
1.6
ug/L
2
bis (2-Chloro-1-methylethyl) ether
108-60-1
625.1
ND
H
1.6
ug/L
2
4-Chloro-3-methyl phenol
59-50-7
625.1
ND
H
1.6
ug/L
2
bis(2-Chloroethoxy)methane
111-91-1
625.1
ND
H
1.6
ug/L
2
bis(2-Chloroethyl)ether
111-44-4
625.1
ND
H
1.6
ug/L
2
2-Chloronaphthalene
91-58-7
625.1
ND
HL
1.6
ug/L
2
2-Chlorophenol
95-57-8
625.1
ND
H
1.6
ug/L
2
4-Chlorophenyl phenyl ether
7005-72-3
625.1
ND
H
1.6
ug/L
2
Chrysene
218-01-9
625.1
ND
H
1.6
ug/L
2
DihPnzo(a,h)anthracene
53-70-3
625.1
ND
H
1.6
ug/L
2
Dichlorobenzidine
91-94-1
625.1
ND
H
8.0
ug/L
2
Dichlorophenol
120-83-2
625.1
ND
H
1.6
ug/L
2
Diethyl phthalate
84-66-2
625.1
ND
H
1.6
ug/L
2
Dimethyl phthalate
131-11-3
625.1
ND
H
1.6
ug/L
2
2,4-Dimethylphenol
105-67-9
625.1
ND
H
1.6
ug/L
2
Di-n-butyl phthalate
84-74-2
625.1
ND
H
1.6
ug/L
2
4,6-Dinitro-2-methylphenol
534-52-1
625.1
ND
H
8.0
ug/L
2
2,4-Dinitrophenol
51-28-5
625.1
ND
H
8.0
ug/L
2
2,4-Dinitrotoluene
121-14-2
625.1
ND
H
3.2
ug/L
2
2,6-Dinitrotoluene
606-20-2
625.1
ND
H
3.2
ug/L
2
Di-n-octylphthalate
117-84-0
625.1
ND
H
1.6
ug/L
2
1,2-Diphenylhydrazine(as azobenzene)
103-33-3
625.1
ND
H
1.6
ug/L
2
b is (2- Ethyl hexyl) phtha late
117-81-7
625.1
ND
H
8.0
ug/L
2
Fluoranthene
206-44-0
625.1
ND
H
1.6
ug/L
2
Fluorene
86-73-7
625.1
ND
H
1.6
ug/L
2
Hexachlorobenzene
118-74-1
625.1
ND
H
1.6
ug/L
2
Hexachlorobutadiene
87-68-3
625.1
ND
H
1.6
ug/L
2
Hexachlorocyclopentadiene
77-47-4
625.1
ND
H
8.0
ug/L
2
Hexachloroethane
67-72-1
625.1
ND
H
1.6
ug/L
2
Indeno(1,2,3-c,d)pyrene
193-39-5
625.1
ND
H
1.6
ug/L
2
Isophorone
78-59-1
625.1
ND
H
1.6
ug/L
2
Naphthalene
91-20-3
625.1
ND
H
1.6
ug/L
2
Nitrobenzene
98-95-3
625.1
ND
H
1.6
ug/L
2
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
Nn = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
t of holding time W = Reported on wet weight basis
,analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Q = Surrogate failure
L = LCS/LCSD failure
S = MS/MSD failure
Page 7 of 14

Client: City of Belmont Laboratory ID: WK09070-001
Description: Effluent Matrix: Aqueous
Date Sampled:11/09/2021 0844
Date Received: 11 /09/2021
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 625.1 625.1 1 12/02/2021 1458 JCG 11/10/2021 1745 21969
2 625.1 625.1 1 12/02/2021 1522 JCG 11/23/2021 1552 23503
CAS
Analytical
Parameter
Number
Method
Result
Q
LOQ
Units
Run
2-Nitrophenol
88-75-5
625.1
ND
H
3.2
ug/L
2
4-Nitrophenol
100-02-7
625.1
ND
H
8.0
ug/L
2
N-Nitrosodimethylamine
62-75-9
625.1
ND
H
1.6
ug/L
2
N-Nitrosodi-n-propylamine
621-64-7
625.1
ND
H
1.6
ug/L
2
N-Nitrosodiphenylamine (Diphenylamine)
86-30-6
625.1
ND
H
1.6
ug/L
2
Pentachlorophenol
87-86-5
625.1
ND
H
8.0
ug/L
2
Phenanthrene
85-01-8
625.1
ND
H
1.6
ug/L
2
Phenol
108-95-2
625.1
ND
H
1.6
ug/L
2
Pyrene
129-00-0
625.1
ND
H
1.6
ug/L
2
1,2,4-Trichlorobenzene
120-82-1
625.1
ND
H
1.6
ug/L
2
2,4,6-Trichlorophenol
88-06-2
625.1
ND
H
1.6
ug/L
2
Run 1
Acceptance
Run 2 Acceptance
Surrogate
Q % Recovery
Limits
Q
% Recovery
Limits
2-Fluorobiphenyl
70
37-129
H
68
37-129
2-Fluorophenol
53
24-127
H
46
24-127
Nitrobenzene-d5
125
38-127
H
127
38-127
Phenol-d5
75
28-128
H
61
28-128
Terphenyl-d14
83
10-148
H
95
10-148
2,4,6-Tribromophenol
51
41-144
H
55
41-144
LOQ = Limit of Quantitation B = Detected in the method blank E - Quantitation of compound exceeded the calibration range Q = Surrogate failure
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40% L = LCS/LCSD fail,--
H = Out of holding time W = Reported on wet weight basis S = MS/MSD fa
Pace Analytical Services, LLC (formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.pacelabs.com
Page 8 of 14