WQ0035749_Renewal Application_20240315

Initial Review
Reviewer nathaniel.thorn burg
Is this submittal an application? (Excluding additional information.) *
Yes No
Permit Number (IR) * WQ0035749
Applicant/Permittee North Carolina Department of Transportation
Applicant/Permittee Address 1536 Mail Service Center, Raleigh, NC 27699-1536
Is the owner in BIMS? Yes NO Is the facility in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category Major
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
State
NCDOT DGS and HOS Class A Residuals Program
Multi
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
03115/2024
$0
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name* Jeremy Goodwin
Email Address*
[e-mail]
Project Information
.........................
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
919-707-2942
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation High -Rate Infiltration
Other Wastewater Reclaimed Water
Closed -Loop Recycle Residuals
Single -Family Residence Wastewater Other
Irrigation
Permit Number:*
WQ0035749
Has Current Existing permit number
Applicant/Permittee *
NCDOT DGS and HOS Class A Residuals Program
Applicant/Permittee Address*
1536 Mail Service Center, Raleigh, NC 27699-1536
Facility Name*
NCDOT DGS and HOS Class A Residuals Program
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Complete _DocuSign_NCDOT_WQ0035749_DGS_HOS.pdf 11.15MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has
been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the
North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
'Te e4rl 4'o00'w,ti
Submission Date 3/15/2024

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
March 14, 2024
NCDEQ/DWR
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Non -Discharge Permitting Unit
J.R. "JOEY" HOPKINS
SECRETARY
Reference: Application for Renewal and Modification of NCDOT Distribution and
Land Application of Diamond Grinding Slurry and Hydrodemolition
Operation Slurry Distribution Class A Residuals Statewide
Permit No. WQ0035749
North Carolina Department of Transportation
Non -Discharge Permitting Unit:
North Carolina Department of Transportation is submitting the enclosed Renewal and
Modification of NCDOT Distribution and Land Application of Diamond Grinding Slurry
and Hydrodemolition Operation Slurry Distribution Class A Residuals Statewide
application. The application package includes information for renewing and modification
of the referenced Permit. The table of contents list all of the required completed
documents for review of the application.
If there is any further information required or questions regarding this application, please
do not hesitate to contact Jeremy Goodwin, [phone], j agoodwinkncdot. gov for
further assistance.
Sincerely,
Jeremy Goodwin, PE
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
ROADSIDE ENVIRONMENTAL UNIT
1557 MAIL SERVICE CENTER
RALEIGH, NC 27699-1557
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
TRANSPORTATION BUILDING
1 SOUTH WILMINGTON STREET
RALEIGH, NC 27601

TABLE OF CONTENTS
APPENDIX TITLE
I DISTRIBUTION OF CLASS A RESIDUALS APPLICATION FORM
(FORM: DCAR 06-16)
COPY OF EXISTING PERMIT NO. WQ0035749
II NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
III FORM DCAR 06-16 (ITEM D. - PROGRAM INFORMATION)
IV FORM DCAR 06-16 (ITEM H. -OPERATION AND MAINTENANCE
PLAN)
V RESIDUALS SOURCE CERTIFICATION APPLICATION FORM
• DIAMOND GRINDING SLURRY (FORM: RSC 06-16)
• HYDRODEMOLITION OPERATION SLURRY (FORM: RSC
06-16)
VI EXISTING PERMIT - MODIFICATION REQUESTS
VII NCDOT FORMS
• UTILIZATION AGREEMENT
• PRODUCT INFORMATION LABEL
• pH LOG
• LAND APPLICATION LOG
• INSPECTION LOG
• SPILL CONTROL PLAN

APPENDIX I
DISTRIBUTION OF CLASS A RESIDUALS APPLICATION FORM
(DCAR 06-16)
COPY OF EXISTING PERMIT NO. WQ0035749

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — DISTRIBUTION OF CLASS A RESIDUALS
INSTRUCTIONS FOR FORM: DCAR 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
General — This application is for treatment, storage, transport, distribution, land application, and/or marketing of Class A (or Equivalent)
residuals under 15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Distribution of Class A Residuals (FORM: DCAR 06-16):
Submit the completed and appropriately executed Distribution of Class A Residuals (FORM: DCAR 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
The project name should be consistent on the plans, specifications, etc.
The Applicant's Certification on Page 3 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification
New Permit I Major Modification'
Major (residuals permitted for distribution > 3,000 dry tons/year) F $1,310 $395
Minor (residuals permitted for distribution < 3,000 dry tons/year) 1 $810
$245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional residuals sources; or includes the addition of new treatment or storage units/processes not previously permitted.
There is no fee for minor permit modifications.
C. Cover Letter (All Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
INSTRUCTIONS FOR FORM: DCAR 06-16 Page 1 of 3

D. Program Information (All Application Packages)
® Provide a narrative explaining the following:
® How the materials will be handled and transported from where the residuals were produced to where it will be treated.
® How the residuals will be processed/treated (attach process flow diagram).
® How leachate collection will be handled.
® Where the residuals will be stored until processed.
® How the final product will be distributed (packaging, bulk, etc.)
® What nutrients or other constituents (i.e. nitrogen, phosphorous, aluminum, calcium, etc.) are used or recommended as the
limiting parameter for determination of residuals loading rate to ensure that it does not overload the soil and cause
contravention of surface water or groundwater standards, limit crop growth, or adversely impact soil quality.
® Attach a marketability statement detailing destinations and approximate amounts of the final product to be distributed.
® Provide either a label that shall be affixed to the bagged processed residual or an information sheet that shall be provided to the
person who receives the processed residual. The label or information sheet shall contain, at a minimum, the following
information:
® Name and address of the person who prepared the residual that is sold or given away.
® A statement that application of the residuals to the land shall be in accordance with the instructions on the label or
information sheet.
® A statement that the residuals shall not be applied to any site that is flooded, frozen or snow-covered.
® A statement that adequate procedures shall be provided to prevent surface runoff from carrying any disposed or stored
residuals into any surface waters.
® Information on all applicable setbacks in accordance with 15A NCAC 02T . 1108(b).
® A statement that the residuals shall be applied at agronomic or recommended rates for intended uses.
E. Detailed Plans and Specifications (Application Involving New or Changes to Treatment or Storage Units)
❑ Submit detailed plans and specifications that have been signed, sealed, and dated by a NC Professional Engineer per 15A
NCAC 02T .1104(a). Specifications for standard equipment may only be omitted for municipalities with approved standard
specifications, but use of the standard specifications must be noted on each sheet of the plans.
❑ Plans must include the following minimum items: a general location map, a topographic map, plan and profile view of the
residuals treatment and storage units as well as the proximity of the residuals treatment and storage units to other utilities and
natural features within 500 feet of all treatment and storage facilities, and detail drawings of all items pertinent to the residuals
treatment and storage units. Depict minimum separations required in 15A NCAC 02T .I 108(a) on the plans.
❑ Specifications must include, at a minimum, the following for all items pertinent to residuals treatment and storage units:
description of materials to be used, methods of construction, quality of construction testing procedures to ensure the integrity
of the final product in accordance with 15A NCAC 02T .1104(a)(2)(B), including leakage and pressure testing as appropriate.
❑ Plans and specifications must not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans and specifications. However, the plans and
specifications may be labeled with the phrase: FINAL DESIGN — NOT RELEASED FOR CONSTRUCTION.
F. Engineering Calculations (Application Involving New or Changes to Treatment or Storage Units)
❑ Submit all design calculations that have been signed, sealed, and dated by a NC Professional Engineer per 15A NCAC 02T
.1104(a).
G. Environmental Assessments (Maybe Required— See 15A NCAC 1C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: DCAR 06-16 Page 2 of 3

H. Operation and Maintenance Plan (New and Renewal Application Packages)
® For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
® Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to function
and by whom the functions are to be conducted.
® Maintenance schedules; may include equipments calibration, maintenance of signs, etc.
® Safety measures; may include safety training program, manuals, signs, etc.
® Spill response plan; including control, containment, remediation, emergency contact information, etc.
® Inspection plan including the following information;
® Names and titles of personnel responsible for conducting the inspections.
® Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the selected
location(s) and inspection frequency are representative of the residuals management program.
® Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
® Sampling and monitoring plan including the following information;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
® Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature, flow,
and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The sampling
plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to meet
pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per year but have an annual
sampling frequency, may need to sample during winter months when pathogen reduction is most likely to be negatively affected
by cold temperatures.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: DCAR 06-16 Page 3 of 3

DWR
Division of Water Resources
L APPLICANT INFORMATION:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T 1100 — DISTRIBUTION OF CLASS A RESIDUALS
FORM: DCAR 06-16
1. Applicant's name: N. C. Department of Transportation
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal E State ❑ Municipal E County
Signature authority's name per 15A NCAC 02T .0106: Lamar Sylvester, PE
Applicant's mailing address: 1536 Mail Service Center
City: Raleigh State: NC Zip: 27699-1536
Telephone number: [phone] Email Address: lsylvesterkncdot.gov
2. Consultant's name: N/A License Number (for P.E.): _
Affiliation: ❑ On Staff Retained (Firm: )
Consultant's mailing address: M
City: State: Zip: M-
Telephone number: (_) = Email Address: MMM
3. Fee submitted: $0.00 (See Instruction B)
II=»I NuINd1►1TOt1l V.11N11105
Privately -Owned Public Utility
Title: Chief Engineer
1. Application is for (check all that apply): 0 new, N modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00035749
Date of most -recently issued permit: March 1, 2019
Date of most -recently certified Attachment A (if different than the permit): NA
III. FACILITY INFORMATION:
1. Name of residuals processing facility: Diamond Grinding / Hydrodemolition -- Statewide
City: N/A State: NC Zip: N/A
Coordinates: Latitude: _° Longitude:
Datum: N/A
Method of measurement: N/A
Level of accuracy: N/A
County where facility is located: Statewide
2. Facility contact (person familiar with residuals preparation):
Name: Jeremy Goodwin, PE Title: NCDOT State Roadside Erosion Control and Roadside Management Engineer
Mailing address: 1557 Mail Service Center
City: Raleigh State: NC Zip: 27699-1577
Telephone number: [phone] E-mail address: jagoodwinkncdot.gov
FORM: DCAR 06-16 Page 1 of 3

3. Is the residual process facility also the generator? ® Yes; ❑ No
If No, please specify delivery frequency and quantity of residual to be processed:
4. Length of residuals storage at facility: N/A (project by project basis) days (Note: the Division requires minimum 30 days
storage in units that are separate from treatment system, i.e. not in clarifiers, aeration basins, etc.)
IV. RESIDUALS QUALITY INFORMATION:
1. Specify how these residuals will be distributed:
sold or given away in bags or other containers; ❑ lawn (bulk); ❑ home garden (bulk), -
other (explain); Bulk land application on NCDOT right of way and private agricultural land
Note: Bulk residuals shall mean residuals that are transported and not sold or giving away in a bag or other receptacles with a
load capacity of one metric ton or less.
2. Complete the following if residuals are to be mixed with other materials:
Type of Materials Amounts to be added
per 1.0 dry ton of residuals (dry ton)
N/A
3. Approximate amounts of the residuals received and processed at the facility: N/A dry tons per year.
4. Approximate amounts of the final product (processed residuals) to be distributed: N/A dry tons per year.
5. Provide a description of the onsite storage management plan for the treated residuals (including estimated average and
maximum storage times prior to distribution): project by project basis: storage will comply with item III. (8) of current permit
6. Does the facility have a stormwater management plan? M Yes; ❑ No
Explain whether the treatment and storage areas are under roof or how stormwater runoff will be handled: NCDOT has an
individual NPDES TS4 stormwater hermit for construction operations and industrial & maintenance facilities. DGS/HOS
residuals generation is vacuumed and contained in sealed tanks within the boundaries of an approved construction SPPP. Most
temporary storage and treatment is also in sealed tanks. Any other temporary storage will be in compliance with NCDOT's
NPDES permit with implemented SPPP or a permit modification approved by DWR.
V. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the attached Residuals Source Certification and all associated documentation.
Q
RSC 06-16.doc
FORM: DCAR 06-16 Page 2 of 3

Professional Engineer's Certification: (Application Involving New or Changes to Treatment or Storage Units)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best of my knowledge
the proposed design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal package
may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I have reviewed
this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
Applicant's Certification:
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
I, Lamar Sylvester, PE Chief Engineer
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Renewal and Modification of NCDOT Distribution and Land Application of Diamond Grinding Slurry
and Hydrodemolition Operation Slurry Distribution Class A Residuals Statewide ( W00035749)
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
D Sig tl by:
�skr 03/15/2024
ar S l
Signature: '� Date:
FORM: DCAR 06-16 Page 3 of 3

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Environmental Quality
March 1, 2019
Tim M. LITTLE, PE — CHIEF ENGINEER
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
1536 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27601-1536
Subject: Permit No. WQ0035749
NCDOT DGS and HOS DCAR
Distribution of Class A Residuals
Statewide
Dear Mr. Little:
In accordance with your permit renewal request received July 27, 2018, and subsequent additional
information received October 11, 2018, December 13, 2018, January 14, 2019, and February 15, 2019, we
are forwarding herewith Permit No. WQ0035749 dated March 1, 2019, to North Carolina Department of
Transportation for the continued operation of the subject residuals management program.
This permit shall be effective from the date of issuance until May 31, 2024, shall void Permit No.
WQ0035749 issued June 3, 2014, and shall be subject to the conditions and limitations as specified therein.
Please pay particular attention to the monitoring requirements listed in Section IV for they may differ from
the previous permit issuance. Failure to establish an adequate system for collecting and maintaining the
required operational information shall result in future compliance problems.
Please note for the purposes of Permit No. WQ0035749 the Distribution of Class A Residuals
WAR) includes spreading Class A residuals directly from the grindine machine on NCDOT right-
of-way in compliance with the permit conditions therein and the requirements in 15A NCAC 02T
.1103(a)(5).
Please note the following permit conditions have been removed since the last permit issuance
dated June 3, 2014:
➢ Old Condition II.7. — This condition concerning agronomic rates has been replaced by
Condition II.7. The Old Condition was based upon nitrogen application rates, which were
deemed not appropriate because of the low nitrogen content of residuals. It is calcium
equivalent that is the basis of agronomic rates of application in the current Condition II.7.
➢ Old Conditions II1.9. and III.10. —These two conditions are replaced by Condition II1.9., which
requires that those receiving the residuals be informed that application of residuals cannot take
place as outlined in Condition III.7. or exceeding the lime equivalency provisions of Condition
II.7.
QE�..- North Carolina Department of Environmental Quality I Division of Water Resources
4;;�;7'�1/� 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NaRrH cnaauw+.
t 919.707.9000

Mr. Tim M. Little, Jr., PE
March 1, 2019
Page 2 of 4
In the application letter, changes were requested and here is a response to those requests:
Current Permit Condition II.4. — Pollutant Ceiling Concentration
Request: It was discussed that this condition should be removed since the Permit does not require
monitoring for any of the listed constituents.
Response: Although you are not currently required to monitor for these constituents, this condition
allows the Division to monitor as deemed necessary and provides a limit for these various constituents. In
addition, this is a requirement of 15A NCAC 02T .1105. Nevertheless, a modification is made to remove
the table while pointing out that there are limits to these constituents by referring to the regulation and
stating testing is required of the Permittee only for those constituents contained in Condition IV.2.
Current Permit Condition U.5. — Setbacks
Request: It was discussed on changing the setback distances to liquid only, since cake setbacks
currently do not apply, and having both listed is confusing to contractors utilizing the Permit.
Response: You are trying to produce cake residuals rather than so much water. For that reason, it
should remain in the permit for when you do produce cake residuals; otherwise you would have more
restrictive setbacks for all residuals.
Current Permit Condition II.7. — Agronomic Rates
Request: Request modification to the condition to more accurately reflect agronomic application
rates for lime equivalency versus plant available nitrogen (PAN) and phosphorus. Request that the
condition be changed to the following: "DGS/HOS shall not be applied in exceedance of agronomic rates
or hydraulic capacity of the soils; whichever is most limiting. Appropriate agronomic rates based on lime
equivalency shall be determined using one of the following methods:
a. The crop management plan outlined by the local Cooperative Extension Office, the Department
of Agriculture and Consumer Services, the Natural Resources Conservation Service, a licensed
soil scientist, or an agronomist, and
b. If the appropriate lime application rates cannot be determined, the Permittee shall contact the
Division to determine necessary action."
Response: This is acceptable.
Current Permit Condition III.2. — Regional Office Notification
Request: It was discussed that Regional Office notification could be deleted since Class A programs
are not currently required to meet this condition.
Response: This is a borderline hazardous material because of the pH. This material was being
processed at unpermitted facilities under the previous permit. Regional offices shall be notified to prevent
a recurrence.

Mr. Tim M. Little, PE
March 1, 2019
Page 3 of 4
Current Permit Condition III.7.L — Measurable Precipitation Event
Request: It was discussed on deleting "During a measurable precipitation event (i.e., greater than
0.01 inch per hour)". Also, request that the "or within 24 hours following a rainfall event of 0.5 inches or
greater in a 24-hour period" be changed to "Land application shall not be performed during inclement
weather or when the ground is in a condition that will cause ponding or runoff', as is currently written
within surface irrigation permits based upon [15A NCAC 02T .0108(b)(1)].
Response: The wording in Condition II1.71 will be changed to directly reflect the wording in 15A
NCAC 02T . 1 109(a)(1)(F): "during precipitation events or within 24 hours following a rainfall event of 0.5
inches or greater in a 24-hour period".
Current Permit Condition II1.7.g. — Slope Restrictions
Request: It was discussed on possibly changing this condition. Request a change to allow surface
application of DGS/HOS on slopes between 10% and 18%. Possible rewrite of this condition could be "If
slopes are greater than 10%, but less than 18% surface application will be allowed if the ground surface is
scarified prior to application."
Response: The wording for the condition is taken directly from 15A NCAC 02T .1109(b)(G) and
for that reason will not be changed.
Current Permit Condition III.8. — Alternate Storage
Request: Alternate Storage is addressed in Appendix IX — Storage Options Supplement. Also add
the statement "Temporary storage at a permitted wastewater treatment facility will be allowed."
Response: As for other alternative storage, you should apply for another wastewater treatment
permit for settling and separating the solids and liquid at temporary sites. A blanket permit throughout the
state with accepted designs is a definite possibility. However, this permit is not the place to allow this.
Current Permit Condition IV.2. — pH Sampling for Each Truckload
Request: Request that additional language be added for large projects that last beyond 2 weeks: "If
a DGS or HOS land application project / event occurs for a period of time greater than 2 weeks, pH sampling
can be reduced to once weekly beginning with the 3`a week of the land application project / event."
Response: Because many of the test results show pH > 12.0 but pH < 12.5, this Condition remains
unchanged.

Mr. Tim M. Little, PE
March 1, 2019
Page 4 of 4
Current Permit Condition IV.6. — Reporting
Request: Request that records of each DGS/HOS project be submitted by contractors to NCDOT
at the completion of each DGS/HOS project in the form of a HOS/DGS Project Completion Report. These
reports will be maintained by NCDOT for five years and provided to NCDEQ immediately upon request.
Request re -write of this condition to read: "All monitoring results and records tracking as required under
Condition IV.2 and IV.5 shall be incorporated into a HOS/DGS Project Completion Report and submitted
by the contractor to NCDOT for review and approval at the completion of each DGS/HOS project. NCDOT
shall maintain a copy of each final HOS/DGS Project Completion report on file for a period of five years.
The HOS/DGS Project Completion Reports shall be made available to NCDEQ immediately upon request."
Response: See Condition IV.6. for the agreed upon language.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Troy Doby at (919) 707-
3655 or tro�doby(a,ncdenr.gov.
Sincerely,
mda Culpepper, Director
Division of Water Resources
cc: Asheville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Fayetteville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Washington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Wilmington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Rob Willcox — Willcox & Mabe Soil Solutions (Electronic Copy)
Martin Mabe — Willcox & Mabe Soil Solutions (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
DISTRIBUTION OF CLASS A RESIDUALS
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
North Carolina Department of Transportation
Statewide
FOR THE
continued operation of a residuals management program for the North Carolina Department of
Transportation and consisting of the distribution of Class A residuals generated from diamond grinding
and hydrodemolition operations with no discharge of wastes to surface waters, pursuant to the application
received July 27, 2018, and subsequent additional information received by the Division of Water Resources,
and in conformity with other supporting data subsequently filed and approved by the Department of
Environmental Quality and considered a part of this permit. The use and disposal of residuals are regulated
under Title 40 Code of Federal Regulations Part 257. This permit does not exempt the Permittee from
complying with the federal regulations.
This permit shall be effective from the date of issuance until May 31, 2024, shall void Permit No.
WQ0035749 issued June 3, 2014, and shall be subject to the following specified conditions and limitations:
I. SCHEDULES
1. The Permittee shall notify the appropriate Regional Office (see Figure 1) at least 48 hours in advance
of any land application of Class A residuals. [15A NCAC 02T .0108(b)(1)]
2. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02T .0108(b)(2), 02T .0105(d), 02T .0109]
WQ0035749 Version 2.0 Shell Version 180711 Page 1 of 8

II. PERFORMANCE STANDARDS
The subject residuals management program shall be effectively maintained and operated at all times so
there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the operations fail to perform satisfactorily, including the creation of prolonged
nuisance conditions due to improper operation and maintenance, the Permittee shall immediately cease
distribution of residuals, contact the appropriate Regional Office supervisor (see Figure 1), and take
any immediate corrective actions. [G.S. 143-215.1]
2. This permit shall not relieve the Permittee of responsibility for damages to groundwater or surface
water resulting from the operation of this residuals management program. [15A NCAC 02B .0200,
02L .0100]
3. Only residuals generated by the diamond grinding process and/or the hydrodemolition operation are
approved for distribution in accordance with this permit. [G.S. 143-21.5.1]
4. Pollutant concentrations in residuals distributed or applied to any land application site shall not exceed
the Ceiling Concentrations or Monthly Average Concentrations (i.e., dry weight basis) pursuant to
the requirements in 15A NCAC 02T .1105. [15A NCAC 02T .1105]
5. Setbacks for Class A land applied bulk residuals shall be as follows:
Setback by residual type
Setback Description
(feet)
Liquid
Cake'
Private or public water supply
100
100
Surface waters (streams — intermittent and perennial,
100
25
perennial waterbodies, and wetlands)
Surface water diversions (ephemeral streams,
25
0
waterways, ditches)
Groundwater lowering ditches (where the bottom of
25
0
the ditch intersects the SHWT)
Wells with exception to monitoring wells
100
100
Bedrock outcrops
25
0
1 Cake residuals are those that have greater than 15% solids by weight and can be stacked without
flowing, as well as can be handled, transported and spread as a solid (e.g., using a backhoe, front
end loader, clinger spreader, broadcast spreader or other equipment designed for handling solid
materials) without leaving any significant liquid fraction behind.
[15A NCAC 02T .l 108]
6. Class A residuals permitted herein shall not be applied in exceedance of agronomic rates or hydraulic
capacity of the soils; whichever is most limiting. Appropriate agronomic rates based on lime
equivalency shall be determined using one of the following methods:
a. The crop management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, a licensed soil
scientist or an agronomist, and
b. If the appropriate lime application rates cannot be determined, the Permittee shall contact the
Division to determine necessary action.
[ 15A NCAC 02T .0I08(b)(1)]
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7. Class A residuals permitted herein shall not be applied in exceedance of the soil test results, or
recommendations from an agronomist or a licensed North Carolina Soil Scientist on the amount of
Class A residuals needed for soil pH adjustment (i.e., lime equivalency rates). [15A NCAC 02T
.0108(b)(1)]
8. Land application areas shall be clearly marked on each site prior to and during any land application
event. [ 15A NCAC 02T .0108(b)(1)]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards. [15A NCAC 02T .1110]
2. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan).
Modifications to the O&M Plan shall be approved by the Division prior to utilization of the new plan.
The O&M Plan, at the minimum, shall include:
a. Operational functions;
b. Maintenance schedules;
c. Safety measures;
d. Spill response plan;
e. Inspection plan; and
f. Sampling and monitoring plan.
[ 15A NCAC 02T .1100]
3. When the Permittee land applies bulk Class A residuals, a copy of this permit and a copy of O&M Plan
shall be maintained at the land application sites during land application activities. [ 15A NCAC 02T
.0108(b)(1)]
4. When the Permittee transports or land applies bulk Class A residuals, the spill control provisions shall
be maintained in all residuals transport and application vehicles. [15A NCAC 02T .1110]
5. When the Permittee land applies bulk Class A residuals, adequate measures shall be taken to prevent
wind erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters. [G.S. 143-215.1]
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6. Bulk Class A residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under section
4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of surface
water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of the
residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporated within a
24-hour period following a residuals land application event;
f. During precipitation events or within 24 hours following a rainfall event of 0.5 inches or greater in
a 24-hour period;
g. If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the land is not intended to be used for agriculture (or turf, ornamentals trees, and other vegetative
practices along NCDOT right-of-way) within 12 months following any previous residuals land
application event;
i. If the pH is greater than or equal to 12.5;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
[ 15A NCAC 02T. 1109]
7. The Permittee shall notify all third -party entities receiving bulk distributed Class A residuals that land
application activities occurring on the third -parry's property shall meet the requirements in 15A NCAC
02T .1108(b)(1) and 02T .1109(b) (i.e., Conditions IL7. and 1II.6., respectively). [15A NCAC 02T
.1103(5)]
8. All residuals shall be adequately stored to prevent runoff. The Class A residuals may be recovered and
stored in mobile storage units at or near each project site. Storage utilizing temporary earthen sites
shall be individually approved by the Division through a permit modification request. [ 15A NCAC 02T
.0108(b)(1)]
9. An information sheet shall be provided to the person who receives Class A residuals. At a minimum,
the label or information sheet shall contain the following:
a. Description of the Class A residuals and its contents (nutrients, lime value, etc.);
b. A statement that residual land application is prohibited except in accordance with the instructions
on the information sheet;
c. A statement identifying that the residuals shall be prevented from entering any public or private
water supply source (including wells) and any surface water (e.g., stream, lake, river, wetland, etc.);
d. A statement that the residuals shall be applied at agronomic rates, hydraulic capacity of the soils,
or lime equivalency, whichever is most limiting.
[I5A NCAC 02T. I 109(a)]
WQ0035749 Version 2.0 Shell Version 180711 Page 4 of 8

IV.
10. The Permittee shall not distribute bulk residuals to any person or entity known to be applying residuals
contrary to the conditions of this permit. The Permittee shall report to the appropriate Regional Office
(see Figure 1), as per reporting conditions under Condition IV.7., any person or entity known to be
applying residuals contrary to the condition of this permit. [15A NCAC 02T .1103(a)]
11. Land application of Class A residuals may occur within NC Department of Transportation rights -of -
way provided that a 25-foot setback to all drop inlets along the rights -of -way is maintained and
appropriate best management practices (BMPs) are used to prevent surface runoff from entering the
storm drain system unimpeded. Areas where groundwater is less than one foot from the ground surface
or areas with a defined channel shall be buffered out. [15A NCAC 02T .0108(b)(1)]
12. Class A residuals may be used as soil amendment and land applied by injection or incorporation within
roadbed fill areas where site grading is actively occurring. The Permittee shall recommend the suitable
application rate and receive approval from the Division prior to beginning land application within these
areas. Caution must betaken to prevent surface runoff. [15A NCAC 02T .0108(b)(1)]
MONITORING AND REPORTING REQUIREMENTS
1. Any Division -required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed. [ 15A NCAC 02T .0108(c)]
Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). Residuals that tests or is classified as a hazardous or toxic waste under 40
CFR Part 261 shall not be used or disposed under this permit. The analysis shall be conducted on the
Class A residuals from each road construction project prior to the initial land application event, and the
Permittee shall maintain the results for a minimum of five years. The analysis shall include the
following parameters:
Calcium Carbonate Percent Total Solids
Equivalence (CCE)
pH'
' pH shall be sampled for each truckload (or storage unit/tank provided that no additional waste is
added to the unit after the sampling event) to demonstrate that the residuals are non -hazardous
under the RCRA (i.e., 2.0 > pH < 12.5). If the waste is hazardous, i.e., has a pH > 12.5, the waste
must be treated as and disposed of as a hazardous waste.
[15A NCAC 02T. 11011
The Class A residual pH measurement shall be performed in accordance with the EPA Test Method
9040C (hqp://www.epa.gov/epawaste/hazard/testmethods/sw846/pdfs/9040c.pdf). [15A NCAC 02T
.0108(c)]
4. Laboratory parameter analyses shall be performed on the residuals after any polymer or chemical
additions, as they are distributed, and shall be in accordance with the monitoring requirements in 15A
NCAC 02B .0505. [15ANCAC 02B .0505]
WQ0035749 Version 2.0 Shell Version 180711 Page 5 of 8

5. The Permittee shall maintain records tracking all bulk residual distribution or land application events
performed by the Permittee. At a minimum, these records shall include the following:
a. Source of residuals (i.e., project name and location);
b. Date of distribution/land application;
c. Location of receiving site (i.e., land owner name, address, latitude and longitude);
d. Volume of residuals applied to each site (dry weight or in gallons with % solids included);
[15A NCAC 02T .0108(a)]
6. All monitoring results and records tracking as required under Conditions IV.2., IV.3., and IV.5. shall
be submitted on or before March 1 st of each year while the diamond grinding project or hydrodemolition
is in operation. The report shall meet the requirements described in the Instructions for Residuals
Application Annual ReportingForms. orms. Each report shall be submitted in electronic format to the
following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Non-Discharg_e.Reports cancdenr.gov
[15A NCAC 02T .1111(d)]
7. Noncompliance Notification
The Permittee shall report by telephone to the appropriate Regional Office (see Figure 1), as soon as
possible, but in no case more than 24 hours or on the next working day following the occurrence or first
knowledge of the occurrence of any of the following:
a. Distribution of residuals abnormal in quantity or characteristic.
b. Any failure of the distribution program resulting in a release of material to surface waters.
Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure that the problem does not recur. [ 15A NCAC 02T .0105(1), 02T A 108(b)(1)]
WQ0035749 Version 2.0 Shell Version 180711 Page 6 of 8

V. INSPECTIONS
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan. [15A NCAC 02T .0108(b)]
2. Prior to each bulk residual distribution or land application event, the Permittee or his designee shall
inspect the residuals storage, transport and application equipment to prevent malfunctions, facility
deterioration and operator errors that could result in discharges to the environment, a threat to human
health or a public nuisance. The Permittee shall maintain an inspection log that includes, at a minimum,
the date and time of inspection, observations made, and any maintenance, repairs, or corrective actions
taken. The Permittee shall maintain this inspection log for a period of five years from the date of
inspection, and this log shall be made available to the Division upon request. [15A NCAC 02T
.0108(b)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or copy
any records required to be maintained under the terms and conditions of this permit; and may collect
groundwater, surface water or leachate samples. [G.S. 143-215.3(a)(2)]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit. [ 15A NCAC 02T .0110]
3. This permit is effective only with respect to the nature and volume of residuals described in the permit
application and other supporting documentation. [G.S. 143-215.11
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under the Division's General Permit NCGO10000; any requirements pertaining to wetlands under 15A
NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter
143 of the General Statutes. [15A NCAC 02T .0105(c)(6)]
5. In the event the residuals program changes ownership or the Permittee changes his name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the program permitted herein until a permit is issued to the new owner. [15A
NCAC 02T .0104]
6. This permit is subject to revocation or unilateral modification upon 60-day notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
7. Unless the Division Director grants a variance, expansion of the residuals program contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b). [15A
NCAC 02T .0120]
WQ0035749 Version 2.0 Shell Version 180711 Page 7 of 8

8. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the Ist day of March 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
w
�w
�;;Unda Culpepper, Director
v Division of Water Resources Cj
By Authority of the Environmental Management Commission
Permit Number WQ0035749
WQ0035749 Version 2.0 Shell Version 180711 Page 8 of 8

North Carolina Department of Er. ronment and Natural Resources
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APPENDIX II
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE

State of North Carolina
Department of Environmental Quality
DM R Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION
This form is for ownership changes or name changes of a non -discharge system permit. Please note that "Permittee"
references the existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
A. Non -Discharge Permit Ownership/Name Change (FORM: NDPONC 06-16) Application (All Applications):
El Submit an original completed and appropriately executed Non -Discharge Permit Ownership/Name Change (FORM: NDPONC
06-16) application.
❑� The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.4106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
✓❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit.
C. Property Ownership Documentation (All Applications):
➢ Per 15A NCAC 02T .0504(f) 15A NCAC 02T .0604(e), 15A NCAC 02T .0704(fl, 15A NCAC 02T .0804, 15A NCAC 02T
.1004 d 15A NCAC 02T .1104(d)(7), 15A NCAC 02T .l104(e)(5), 15A NCAC 02U .0201(e) or l5A NCAC 02U .0202(f)
the Applicant shall demonstrate they are the owner of all property containing the non -discharge system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (All Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to
be sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Operation and Maintenance Agreement (All Applications for Single -Family Wastewater Irrigation Systems):
❑ Per 15A NCAC 02T .0604(h), submit an original of a notarized Operation and Maintenance Agreement (FORM: SFRWWIS
O&M) that has been signed and dated by all deeded property owners.
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service: By Courier/Special Delivery:
Non -Discharge Branch Non -Discharge Branch — Archdale 942W By Email:
Non -Discharae.Reports
1617 Mail Service Center 512 N. Salisbury St.
e,ncdenr.gov
Raleigh, NC 27699-1617 Raleigh, NC 27604
Telephone Number: [phone]
INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION Page I of I

State of North Carolina
nWR Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources FORM: NDPONC 06-16
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: N.C. Department of Transportation
2. Signature authority's name: Time Little, PE per 15A NCAC 02T .0106(b) Title: Chief Engineer
3. Permittee's mailing address: 1536 Mail Service Center
City: Raleigh State: NC Zip: 27601 - 1536
4. Permittee's contact information: Phone number: ( 919 ) 707 - 2500 Email Address: Retired from NCDOT
5. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Permittee or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or M No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ❑✓ No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ✓❑ No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ❑✓ No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or E]No
II. FACILITY INFORMATION:
1. Facility name: NCDOT Distribution and Land Application of Diamond Grinding Slurry and Hydrodemolition Operation Slurry Distribution Class A Residuals Statewide
2. Facility's physical address: Statewide
City: N/A State: NC Zip: - County: Select
III. PERMIT INFORMATION:
1. Existing permit number: WQ00 35749 and most recent issuance date: 3/l/2019
2. Existing permit type: Distribution of Residual Solids (503 Exempt)
3. Reason for the permit application: Other
4. Has the facility been constructed? []Yes or ❑ No
IV. APPLICANT INFORMATION:
1. Applicant's name: N.C. Department of Transportation
2. Signature authority's name: Lamar Sylvester, PE per 15A NCAC 02T .0106(b) Title: Chief Engineer
3. Applicant's mailing address: 1536 Mail Service Center
City: Raleigh State: NC Zip: 27.601- 1536
4. Applicant's contact information: Phone number: (919) 707 - 2500 Email Address: lylvester ncdot.gov
5. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or ❑✓ No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ❑✓ No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ❑✓ No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ❑✓ No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ❑✓ No
FORM: NDPONC 06-16 Page 1 of 2

Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, Tim Little, PE - Chief Engineer (Retired from NCDOT) attest that this application for
(Signature Authority's name & title from Application Item L2.)
NCDOT Distribution and Land Application of Diamond Grinding Slurry and Hydrodemolition Operation Slurry Distribution Class A 1
(Facility name from Application Item II.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of the existing permit be violated. I also understand that if all required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete. I further certify that the existing Permittee or any affiliate has not been convicted of an
environmental crime, has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where
all appeals have been exhausted or abandoned, are compliant with any active compliance schedule, and do not have any overdue annual
fees per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Tim Little, PE (Retired) Date: 3-15-2024
Applicant's Certification per 15A NCAC 02T .0106(b):
1, Lamar Sylvester, PE - Chief Engineer attest that this application for
(Signature Authority's name & title from Application Item IV.2.)
NCDOT Distribution and Land Application of Diamond Grinding Slurry and Hydrodemolition Operation Slurry Distribution Class A 1
(Facility name from Application Item II.L)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete. I further certify that the Applicant or any affiliate has not been convicted of an environmental
crime, has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where all appeals have
been exhausted or abandoned, are compliant with any active compliance schedule, and do not have any overdue annual fees per 15A
NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: I
Date:
03/15/2024
FORM: NDPONC 06-16 Page 2 of 2

APPENDIX III
FORM DCAR 06-16 (ITEM D. - PROGRAM INFORMATION)
D. Program Information (Diamond Grinding Slurry)
How the materials will be handled and transported from where the
residuals were produced to where it will be treated.
Diamond Grinding Slurry (DGS) will be recovered by vacuuming during the diamond
grinding operation and contained within the grinding vehicles until transported to the
application site or will be stored within mobile storage units or approved residuals
storage facilities at or near each road project that is scheduled for diamond grinding for
processing.
How the residuals will be processed/treated (attach process flow
diagram).
No processing or treatment of the Diamond Grinding Slurry will be required.
How leachate collection will be handled.
Leachate will not be generated during the diamond grinding process or storage process.
Where the residuals will be stored until processed.
Diamond Grinding Slurry residuals will be recovered and stored within mobile storage
units or approved residuals storage facilities at or near each road project that is scheduled
for diamond grinding.
How the final product will be distributed (packaging, bulk, etc.)
The final product will be land applied to NCDOT Rights of Way or private farmland at
agronomic rates or within the project grade as soil stabilization.
What nutrients or other constituents (i.e. nitrogen, phosphorous,
aluminum, calcium, etc.) are used or recommended as the limiting
parameter for determination of residuals loading rate to ensure that it
does not overload the soil and cause contravention of surface water or
groundwater standards, limit crop growth, or adversely impact soil
quality.
One of the primary benefits of Diamond Grinding Slurry in addition to the hydraulic
loading (irrigation capacity) will be its potential to be utilized as a liming amendment to
adjust soil pH of receiver soils. With the higher pH ranges of greater than 9.0 but less
than 12.5, the potential exists for the Diamond Grinding Slurry to react with the receiver
soils and adjust soil pHs upward. Target pH of mineral soils is typically around 6.5 and

most receiver soils will be below that target due to not receiving agricultural lime on an
as needed basis. Therefore, soil pH adjustment or soil neutralizing capability will be a
potential benefit associated with the Diamond Grinding Slurry. NC State University has
conducted greenhouse studies of the Diamond Grinding Slurry and soil interaction and
data associated with pH benefits is available. The studies were performed to evaluate the
liming potential or neutralizing capability of the Diamond Grinding Slurry. Suggested
nutrient limiting factors would be the calcium carbonate equivalent (CCE) of the residual
Attach a marketability statement detailing destinations and
approximate amounts of the final product to be distributed.
DGS residuals are not supplied outside of NCDOT permit WQ0035749. Residuals
applied on private farms are applied in accordance with the NCDOT Landowner
Utilization Agreement at agronomic rates. Product Information Label and Application
Information Sheet attached in Appendix VII.
• Provide either a label that shall be affixed to the bagged processed
residual or an information sheet that shall be provided to the person
who receives the processed residual. The label or information sheet
shall contain, at a minimum, the following information:
• Name and address of the person who prepared the residual that is
sold or given away.
• A statement that application of the residuals to the land shall be in
accordance with the instructions on the label or information sheet.
• A statement that the residuals shall not be applied to any site that is
flooded, frozen or snow-covered.
• A statement that adequate procedures shall be provided to prevent
surface runoff from carrying any disposed or stored residuals into any
surface waters.
• Information on all applicable setbacks in accordance with 15A
NCAC 02T.1108(b).
• A statement that the residuals shall be applied at agronomic or
recommended rates for intended uses.
Product Information Label and Application Information Sheet is attached in Appendix
VII.

D. Program Information (Hydrodemolition Operation Slurry)
How the materials will be handled and transported from where the
residuals were produced to where it will be treated.
HOS will be recovered and stored within mobile storage units or approved residuals
storage facilities at or near each bridge project that is scheduled for hydrodemolition.
How the residuals will be processed/treated (attach process flow
diagram).
No processing or treatment of the HOS will be required.
How leachate collection will be handled.
Leachate will not be generated during the hydrodemolition process or storage process
Where the residuals will be stored until processed.
No processing of the HOS will be required. HOS will be recovered and stored within
mobile storage units or approved residuals storage facilities at or near each bridge project
that is scheduled for hydrodemolition.
How the final product will be distributed (packaging, bulk, etc.)
The final product will be land applied to NCDOT Rights of Way or private farmland at
agronomic rates or soil stabilization within the project grade.
What nutrients or other constituents (i.e. nitrogen, phosphorous,
aluminum, calcium, etc.) are used or recommended as the limiting
parameter for determination of residuals loading rate to ensure that it
does not overload the soil and cause contravention of surface water or
groundwater standards, limit crop growth, or adversely impact soil
quality.
One of the primary benefits of HOS in addition to the hydraulic loading (irrigation
capacity) will be its potential to be utilized as a liming amendment to adjust soil pH of
receiver soils. With the higher pH ranges of greater than 9.0 but less than 12.5, the
potential exists for the HOS to react with the receiver soils and adjust soil pHs upward.
Target pH of mineral soils is typically around 6.0 and most receiver soils will be below
that target due to not receiving agricultural lime on an as needed basis. Therefore soil pH
adjustment or soil neutralizing capability will be a potential benefit associated with the

HOS. NC State University has conducted greenhouse studies of the HOS and soil
interaction and data associated with pH benefits is available. The studies were performed
to evaluate the liming potential or neutralizing capability of the HOS.
Attach a marketability statement detailing destinations and
approximate amounts of the final product to be distributed.
HOS residuals are not supplied outside of NCDOT permit WQ0035749. Residuals
applied on private farms are applied in accordance with the NCDOT Landowner
Utilization Agreement at agronomic rates. Product Information Label and Application
Information Sheet attached in Appendix VII.
• Provide either a label that shall be affixed to the bagged processed
residual or an information sheet that shall be provided to the person
who receives the processed residual. The label or information sheet
shall contain, at a minimum, the following information:
• Name and address of the person who prepared the residual that is
sold or given away.
• A statement that application of the residuals to the land shall be in
accordance with the instructions on the label or information sheet.
• A statement that the residuals shall not be applied to any site that is
flooded, frozen or snow-covered.
• A statement that adequate procedures shall be provided to prevent
surface runoff from carrying any disposed or stored residuals into any
surface waters.
• Information on all applicable setbacks in accordance with 15A NCAC
02T.1108(b).
• A statement that the residuals shall be applied at agronomic or
recommended rates for intended uses.
Product Information Label and Application Information Sheet attached in Appendix VII.

APPENDIX IV
FORM DCAR 06-16 (ITEM H. - OPERATION AND MAINTENANCE PLAN)

OPERATION AND MAINTENANCE PLAN
N.C. Department of Transportation
Permit No. WQ0035749
DIAMOND GRINDING SLURRY &
HYDRODEMOLITION OPERATION SLURRY
Operational Functions
Hydrodemolition Operation Slurry Description and Overview
The hydrodemolition operation slurry (HOS) is generated by the hydrodemolition of concrete on
bridge decks during the deck restoration process. The hydrodemolition operation will typically
generate a range of volumes per bridge with percent solids of the unfiltered water ranging from 0.5 to
10 percent. The hydrodemolition operation will typically generate a range of approximately 10,000 tc
50,000 gallons of HOS per bridge. The hydrodemolition process shall be managed, monitored,
collected, and properly disposed of as a portion of the bridge deck restoration process. Many
variables will determine the quantity, such as hydrodemolition contractor process, size of bridge
deck, total depth of concrete to be removed, etc. The generated water and solids (slurry) is stable and
contains a high calcium value for application as a lime amendment.
Diamond Grinding Slurry Description and Overview
The diamond grinding slurry (DGS) is generated by diamond grinding of concrete pavement which
generates a slurry material consisting of water and pulverized concrete. This material is collected in
trucks through a vacuum system concurrent with the grinding process. The generated slurry is stable
and also contains a high calcium value for application as a lime amendment. The diamond grinding
process shall be managed, monitored, collected, and properly disposed of. The diamond grinding of
concrete will generate a wide range of slurry volume per project. Many variables will determine the
quantity, such as contractor performing the diamond grinding, length of roadway, etc.
The HOS and DGS shall be collected, hauled, and discharged in accordance with local, state, and
federal regulations. The HOS and DGS will not be allowed to enter storm sewers, bridge drainage
downspouts or bridge approach downspouts, ditches, surface waters, floodplains or wetlands. The
HOS and DGS will be monitored to confirm its compliance with conditions in Non -Discharge Permit
No. WQ0035749 to include:
Calcium Carbonate Equivalence (CCE)
Percent Total Solids
Qs
When land application of HOS is not a feasible option, the primary method of disposal will be to
transport the HOS to a local publicly owned treatment works (POTW) or a licensed treatment or
disposal facility. When land application of DGS is not a feasible option, other methods of disposal

will be determined such as transport of the liquid portion to a local publicly owned treatment works
(POTW) or a licensed treatment or disposal facility and disposal of the solid portion in an approved
solid waste disposal facility.
II. Maintenance Schedules
Maintenance will be the responsibility of the Contractor performing the hydrodemolition or diamond
grinding operations. In addition, subcontractors must have a current Land Application of Residuals
"Operator in Responsible Charge" (ORC) as certified by the North Carolina Water Pollution Control
System Operators Certification Commission (WPCSOCC).
III. Safety Measures
Safety plans and training will be the responsibility of the Contractor performing the hydrodemolition
or diamond grinding operations. All subcontractors will be required to comply with safety plans and
training as applicable to the Contractor's performing the hydrodemolition or diamond grinding
operations. NCDOT recognizes that the safety of employees and contractors is paramount to the
maintenance and construction of the state transportation system. Therefore, NCDOT recognizes no
boundaries in the development and implementation of a world class safety and health program that
will protect their employees, contractors and the traveling public. The NCDOT Safety Philosophy is
as follows:
• All accidents and injuries can be prevented.
• Management/supervisors are responsible, and will be held accountable, for preventing
injuries and occupational illnesses.
• Occupational safety and health is part of every employee's total job performance.
• Working safely is a condition of employment.
• All workplace hazards can be safeguarded.
• Training employees to work safely is essential and is the responsibility of
management/supervision.
• Prevention of personal injuries and accidents is good business.
IV Spill Response Plan
Includes the following:
Spill Control Plan (Attached, see Appendix VII),
Spill Prevention Plan (Attached, see Appendix VII),
Spill Control, Containment and Cleanup Plan (Attached, see Appendix VII).

V. Sampline and Monitoring Plan
All sampling and monitoring shall be performed in accordance with current Permit No. WQ0035749,
NCDOT Distribution and Land Application of Diamond Grinding Slurry and Hydrodemolition
Operation Slurry Distribution Class A Residuals Statewide
An analysis shall be conducted on HOS or DGS from each road construction project prior to the
initial land application event to include the following parameters:
Calcium Carbonate Equivalence (CCE)
Percent Total Solids
pH*
*pH shall be sampled for each truckload to demonstrate that the HOS or DGS is non -hazardous
under the RCRA
Measurement of HOS/DGS pH shall be performed in accordance with the EPA Test Method 9040C.

APPENDIX V
RESIDUALS SOURCE CERTIFICATION APPLICATION FORM
• DIAMOND GRINDING SLURRY (FORM: RSC 06-16)
• HYDRODEMOLITION OPERATION SLURRY (FORM: RSC 06-16)

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

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: N.C. Department of Transportation
Status
Code a
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current n
Proposed
R
Lamar Sylvester, PE
NCDOT — Diamond
GrindingSlurryStatewide
WQ0035749
Reported on an
Annual Basis
R
Lamar Sylvester, PE
NCDOT — Hydrodemolition
Operation SlurryStatewide
WQ0035749
Reported on an
Annual Basis
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 06-16 Page 1

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: NCDOT — Diamond Grinding Slurry
2. Facility permit holder is: ❑ Federal, ® State, ❑ Local Government, or ❑ Private.
Facility permit issued by: ❑ Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Jeremy Goodwin, PE -NCDOT
Complete mailing address: 1557 Mail Service Center
City: Raleigh State: NC Zip: 27699-1557
Telephone number: [phone] E-mail address: jagoodwinkncdot.gov
4. Facility physical address: NCDOT — Diamond Grinding Slurry - Statewide
City: N/A State: N/A Zip: N/A
Coordinates: Latitude: _° _' _" Longitude:
Datum: N/A Level of accuracy: N/A
Method of measurement: N/A
5. Purpose of the facility:
❑ treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and % domestic)
® other (explain: construction/maintenance operation for concrete ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: N/A MGD and facility average daily flow: N/A MGD
8. Average amount of residuals being generated at this facility To be Reported Annually dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Project by Project Basis
Type and volume of residuals storage (i.e., outside of residuals treatment units): Project by Project Basis
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under
❑ 40 CFR Part 503 or ® 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
❑ Biological ® Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

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

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis: Metals Analysis not currently required by Permit
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mglkg)
Monthly Average
Concentration Limits
(Class A Only)
(mglkg)
Result
(mglkg)
Arsenic
75
41
Cadmium
85
39
Copper
4,300
1,500
Lead
840
300
Mercury
57
17
Molybdenum
75
n/a
Nickel
420
420
Selenium
100
100
Zinc
7,500
2,800
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg4g)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following: Not currently required by Permit
a. Total solids: %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: and Date of analysis: Only Lab Analysis Currently Required by Permit is pH, CCE, %Total
Solids
Parameter
Result
(mglkg)
Aluminum
Ammonia -Nitrogen
Calcium
Magnesium
Nitrate -Nitrite Nitrogen
pH (Standard Unit)
Phosphorus
Potassium
Sodium
Total Kjeldahl Nitrogen
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): N/A
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: N/A %. This
rate is a (check one): ❑ default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (15) Year PAN
Five -Year
Maximum Adjusted PAN
(mglkg)
(mg/kg)
Surface
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses: Only Lab Analysis Currently Required by Permit is pH, CCE, % Total Solids
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent: Not currently required by Permit
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B.
❑ Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T. 1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
Not currently required by Permit
❑ Alternative 1 [15A NCAC 02T.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

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

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: N. C. Department of Transportation
Status
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current n
Proposed
R
Lamar Sylvester, PE
NCDOT — Diamond
GrindingSlurryStatewide
WQ0035749
Reported on an
Annual Basis
R
Lamar Sylvester, PE
NCDOT — Hydrodemolition
Operation Slurry
Statewide
WQ0035749
Reported on an
Annual Basis
'Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 06-16 Page 1

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: NCDOT — Hydrodemolition Operation Slurry
2. Facility permit holder is: ❑ Federal, 0 State, 0 Local Government, or 0 Private.
Facility permit issued by: Div. of Water Resources, Div. of Environmental Health,
or Other (explain: _).
3. Facility contact person and title: Jeremy Goodwin, PE - NCDOT
Complete mailing address: 1557 Mail Service Center
City: Raleigh State: NC Zip: 27699-1577
Telephone number: [phone] E-mail address: jagoodwinkncdot.gov
4. Facility physical address: NCDOT — Hydrodemolition Operation Slurry - Statewide
City: N/A State: N/A Zip: N/A
Coordinates: Latitude: 01 0' 0" Longitude: 01 0' 0"
Datum: N/A Level of accuracy: N/A
Method of measurement: N/A
5. Purpose of the facility:
71 treatment of municipal wastewater, treatment of 100% domestic wastewater,
Ej treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
other (explain: demolition operation of concrete ).
6. Does the facility have an approved pretreatment program: Yes ® No
7. Facility permitted/design flow: N/A MGD and facility average daily flow: N/A MGD
8. Average amount of residuals being generated at this facility To be Reported Annually dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Project by Project Basis
Type and volume of residuals storage (i.e., outside of residuals treatment units): Project by Project Basis
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or ® 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Biological n Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

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

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105. Metals Analysis not currently required
by Permit
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: = and Date of analysis: Metals Analysis not currently required by Permit
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mglkg)
Monthly Average
Concentration Limits
(Class A Only)
(mglkg)
Result
(mglkg)
Arsenic
75
41
Cadmium
85
39
Copper
4,300
1,500
Lead
840
300
Mercury
57
17
Molybdenum
75
n/a
Nickel
420
420
Selenium
100
100
Zinc
7,500
2,800
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: _ and Date of analysis: _
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
F > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
> 50 but < 75
39
260
270
> 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg4g)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following: Not currently required by Permit
a. Total solids: EL. %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory:_= and Date of analysis: Only Lab Analysis Currently Required by Permit is pH, CCE, % Total Solids
Parameter
Result
(mglkg)
Aluminum
Ammonia -Nitrogen
Calcium
Magnesium
Nitrate -Nitrite Nitrogen
pH (Standard Unit)
Phosphorus
Potassium
Sodium
Total Kjeldahl Nitrogen
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): N/A
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: N/A %. This
rate is a (check one): ❑ default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, ex lain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1s) Year PAN
Five -Year
Maximum Adjusted PAN
(mglkg)
(mglkg)
Surface
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent: Not currently required by Permit
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
JJ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
IN Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
J Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
d Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
El Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, W heat drying, heat treatment,
thermophilic aerobic digestion, beta ray irradiation,
❑ gamma ray irradiation, or pasteurization.
b. For Land Application of Class B.
J Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
El Alternative 2 [15A NCAC 02T. 1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, I
air drying, ❑ anaerobic digestion,
El composting, or lime stabilization.
c. For Surface Disposal:
11 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
J Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
J Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
J Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
El Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
Alternative 7 [15A NCAC 02T. 1107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T. 1107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
El Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
a Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

APPENDIX VI
EXISTING PERMIT- MODIFICATION REQUESTS
The North Carolina Department of Transportation (NCDOT) would like to request a
modification to the existing March 1, 2019 WQ0035749 permit, to be included for with
the renewal of the permit for the next term. NCDOT requests consideration to modify the
following permit item:
Current Permit Condition II.5 — Setbacks
The NCDOT requests that setbacks be eliminated for application of DGS/HOS Class A
residuals on NCDOT Rights of Way for surface water diversions where the NCDOT has
control of stormwater inlets, pipes, and channels. The NCDOT shall temporarily seal off
the drainage inlets and conveyances to prevent migration of DGS/HOS Class A residuals
into and through the system as a condition of the setback elimination.

APPENDIX VII
WQ0035749 NCDOT FORMS
• UTILIZATION AGREEMENT
• PRODUCT INFORMATION LABEL
• pH LOG
• LAND APPLICATION LOG
• INSPECTION LOG
• SPILL CONTROL PLAN

• UTILIZATION AGREEMENT
The Landowner Utilization Agreement as attached is written based upon current permit
conditions. If permit modifications occur, the Utilization Agreement will be updated with
those changes for compliance with the permit conditions.

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
LANDOWNER UTILIZATION AGREEMENT FOR
NC DEPARTMENT OF TRANSPORTATION
Hydrodemolition Operation Slurry (HOS) is generated by the hydrodemolition of concrete on bridge
decks during the deck restoration process. The hydrodemolition operation will typically generate a range of
volumes per bridge with percent solids of the unfiltered water ranging from 0.5 to 10 percent. The generated
water and solids (slurry) is stable and contains a high calcium value for application as a lime amendment.
Diamond Grinding Slurry (DGS) is generated by diamond grinding of concrete pavement which generates
a slurry material consisting of water and pulverized concrete. This material is collected in trucks through a
vacuum system concurrent with the grinding process. The generated slurry is stable and also contains a high
calcium value for application as a lime amendment. Both products are permitted by the Division of Water
Quality (Permit WQ0035749) for distribution and land application. This agreement is to allow the
distribution and land application of HOS and/or DGS onto properties whose owner is herein giving written
consent for the responsible application of this resource.
INSTRUCTIONS TO THE APPLICANT:
A. Prepare a separate utilization agreement form for each landowner other than the applicant.
✓ A copy of the completed and appropriately executed utilization agreement form must be provided to the
landowner and the lessee/operator (if applicable).
B. If the landowner wishes to exclude certain fields from use, a list of excluded fields along with a
description of the excluded areas, shall be attached to this utilization agreement.
UTILIZATION AGREEMENT FOR THE LAND APPLICATION OF HYDRODEMOLITION
OPERATION SLURRY AND/OR DIAMOND GRINDING SLURRY
TO LAND APPLICATION SITES NOT OWNED BY THE PERMITTEE
The undersigned landowner or his representative hereby permits:
NC Department of Transportation
1558 Mail Service Center
Raleigh, North Carolina 27699
Telephone [phone]
E-mail: jagoodwinl,&ncdot.gov
hereinafter referred to as the Permittee, to land apply HOS and/or DGS, as defined above, to sites owned by
the undersigned landowner in the following counties: in accordance with the
stipulations and restrictions as given in this Agreement, provided the Permittee and the landowner or his
representative of the site agree to meet the requirements of, and follow, the Landowner Utilization
Agreement.
The lessee, the landowner or his representative receives, in consideration, full use of the liming value of the
applied HOS and/or DGS while the Permittee receives, in consideration, the use of the land application site(s)
described below for the beneficial use of the HOS and/or DGS. This Agreement shall remain in effect for the
length of the Division's permit for the HOS and/or DGS land application program and shall be renewed each
time this permit is renewed if necessary.
Land Application Sites (list field by parcel #, specific location, or other identifying manner):
FORM: NCDOT LUA —March 2024 Page 1 of 4

I. STIPULATIONS:
1. This Agreement shall be binding on the grantees, the successors, and assigns of the parties hereto with
reference to the subject matter of this Agreement.
2. Any duly authorized officer, employee, or representative of the Division may, upon presentation of
credentials, enter and inspect any property, premises, or place on or related to the land application site(s) at
any reasonable time for the purpose of determining compliance with the Division's HOS and/or DGS land
application program permit; may inspect or copy any records that must be kept under the terms and
conditions of this permit; or may obtain samples of groundwater, surface water, or leachate.
LANDOWNER RESPONSIBILITIES
3. The landowner or his representative authorizes the Permittee, local officials, and State officials or their
representatives to take necessary soil, surface water, and groundwater samples during the term of, and for
12 months after termination of, this Agreement.
4. The landowner or his representative will furnish the Permittee with information regarding the amount and
analysis of other sources of nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied
to the land application site(s). For fields operated by a lessee, the lessee will supply this information for the
landowner.
5. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or
their representatives to inspect the land application site(s) prior to, during, and after any HOS and/or DGS
land application event and to established monitoring facilities on or near the land application site(s) as
required by the HOS and/or DGS land application program permit.
6. By agreeing to accept the HOS and/or DGS, it is recognized that the application of these materials is
allowed under the conditions of this agreement. Land application of DGS/HOS is considered the beneficial
reuse of a waste under 15A NCAC 02T .1100, and has been deemed permitted under 15A NCAC 02T
.1103(4) provided the conditions of this agreement are met. Any action resulting in damages to surface
water or groundwater, caused by failure to follow the conditions of this agreement, is subject to Division
enforcement action.
7. The landowner or his representative accepting the HOS and/or DGS shall to the best of their knowledge
meet the following application requirements:
• HOS and/or DGS shall not be land applied under the following conditions:
a. If the HOS and/or DGS are likely to adversely affect a threatened or endangered species
listed under section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the HOS and/or DGS or the application causes the
contravention of surface water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that
runoff of the HOS and/or DGS would occur;
e. Within the 100-year flood elevation, unless the HOS and/or DGS are injected or
incorporated within a 24-hour period following a land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within
24 hours following a rainfall event of 0.5 inches or greater in a 24-hour period;
g. If the slope is greater than 10% for surface applied HOS and/or DGS, or if the slope is
greater than 18% for injected or incorporated HOS and/or DGS;
h. If the land is not intended to be used for agriculture (or turf, ornamentals trees, and other
vegetative practices along NCDOT right of way) within 12 months following the land
application event;
i. If the HOS and/or DGS pH is greater than or equal to 12.5;
j. If the vertical separation between the seasonal high water table and the depth of HOS
and/or DGS application is less than one foot;
k. If the vertical separation of bedrock and the depth of HOS/DGS application is less than
one foot;
1. If ground cover is less than 50% unless the HOS/DGS is incorporated or injected within a
24-hour period following a land application event.
HOS and/or DGS shall not be stockpiled or stored offsite for more than 60 days prior to land
application;
FORM: NCDOT LUA —March 2024 Page 2 of 4

• Application of HOS and/or DGS shall not occur within 100 feet of a public or private water supply
source;
• Application of HOS and/or DGS shall not occur within 100 feet of any well, with the exception of
Division approved monitoring wells;
• Application of HOS and/or DGS shall not occur within 25 feet of surface waters.
PERMITTEE RESPONSIBILITIES
Prior to the land application of HOS and/or DGS, the Permittee shall enter into an agreement with
the landowner that includes the following conditions:
8. The Permittee has provided the landowner or his representative with information and data concerning the
HOS and/or DGS land application program, including an analysis of constituents of the HOS and/or DGS.
9. The Permittee shall provide the landowner or his representative with a copy of the HOS and/or DGS land
application program permit that has been most -recently issued by the Division prior to commencement of
any HOS and/or DGS land application event. This permit will specify limitations and other restrictions
prescribed by the laws and regulations.
10. Within the limits of the Division's HOS and/or DGS land application program permit, the Permittee will
determine HOS and/or DGS application rates and schedules based on crop patterns and the current soil pH
of each respective field.
11. Specific HOS and/or DGS land application area boundaries shall be clearly marked on the land application
site(s) by the Permittee and/or his representative prior to and during a HOS and/or DGS land application
event.
12. The Permittee shall provide information on the proper use of the HOS and/or DGS. A copy of the product
information sheet for HOS and/or DGS will be provided.
13. The applicator or party accepting bulk residuals from the Permittee shall supply all third parties
receiving bulk residuals with documentation specifying that application shall occur consistent with
the utilization agreement.
14. Instructions, including contact information for key personnel, shall be provided to the applicator or
party receiving bulk residuals in the event that any requirements specified in the utilization
agreement are not met.
15. A copy of the Utilization Agreement shall be maintained at the land application sites when bulk
residuals are being applied.
FORM: NCDOT LUA —March 2024 Page 3 of 4

Landowner's Certification:
❑ I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to
make decisions regarding the use of the land application site(s) on behalf of other deeded landowners OR that I
am otherwise authorized, through a power of attorney or other legal delegation, to make decisions regarding the
use of the land application site(s) on behalf of the deeded landowners. I certify that I have read this Agreement,
understand the stipulations and restrictions, and do hereby grant permission to the Permittee to land apply
hydrodemolition operation slurry and/or diamond grinding slurry to the land application site(s) as specified
herein.
Landowner name:
Landowner address:
City: State: Zip:
Home/business phone: Cell phone:
Signature: Date:
Permittee's Certification:
❑ I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as
specified herein.
Permittee / Permittee's Representative:
Signature:
*** END OF FORM: NCDOT LUA — March 2024***
Shared\WMSS Projects\2017\17-01 Wood\Guidance Document\Atttachments\Attachment C\Landowner Utilization
Agreement - March 2019.docx
FORM: NCDOT LUA —March 2024 Page 4 of 4

• PRODUCT INFORMATION LABEL

DIAMOND GRINDING SLURRY AND HYDRODEMOLITION OPERATION SLURRY
PRODUCT INFORMATION LABEL
Produced By Preparer
NC Department of Transportation NC Department of Transportation
Raleigh, North Carolina Raleigh, North Carolina
For information on these products contact NC Department of Transportation
Jeremy Goodwin, NCDOT [phone]
Diamond Grinding Slurry (DGS) is generated by diamond grinding of concrete pavement which
generates a slurry material consisting of water and pulverized concrete. This material is collected in
trucks through a vacuum system concurrent with the grinding process.
Hydrodemolition Operation Slurry (HOS) is generated by the hydrodemolition of concrete on
bridge decks during the deck restoration process. The hydrodemolition operation will typically
generate a range of volume per bridge with percent solids of the unfiltered water ranging from 0.5 to
10 percent.
DGS/HOS is permitted for land application to private farmland and NC DOT right -of ways.
The generated water and solids (slurry) is stable and contain a high calcium value for application as a
lime amendment.
Provisions for Application
Application of DGS/HOS is prohibited except in accordance with the provisions specified in the
Application Information Sheet. Application must conform to standards identified in Permit
WQ0035749 and include but are not limited to:
Setback Description
Setback
(feet)
DGS/HOS
Private or public water supply sources
100
Surface waters (streams - intermittent and perennial, perennial
waterbodies, and wetlands)
100
Surface water diversions (ephemeral streams, waterways, ditches)
25
Groundwater lowering ditches (where the bottom intersects the SHWT)
25
Wells with exception to monitoring wells
100
Bedrock outcrops
25
DGS/HOS Product Information Label - March 2024

Application Information Sheet
1. DGS/HOS is intended for use as a liming amendment. Applications of DGS/HOS should
be made in accordance with approved application standards and WQ0035749 permit
conditions.
2. Applications and loading rates of DGS/HOS shall be applied at rates base on soil test results
or recommendations from an Agronomist on the amount of DGS/HOS needed for soil pH
adjustment (le: lime equivalency rates).
3. Application and storage of DGS/HOS must be conducted in such a way as to prevent runoff
from the application or storage site to any surface water and in accordance with the Clment
permit.
4. Applications of DGS/HOS shall be applied uniformly at a rate equal to or less than the
hydraulic rate for the site and the soils, at a rate not to smother the currently growing crop,
or at the agronomic rate of the crop as specified by the permit and most recent residuals
analysis; whichever is most limiting.
5. DGS/HOS shall not be applied if the land fails to assimilate the slurry or the application
causes the contravention of surface water or groundwater standards.
6. DGS/HOS shall not be applied to flooded, frozen, or snow covered areas.
7. DGS/HOS shall not be applied within the 100-year flood elevation, unless the
slurry are injected or incorporated within a 24-hour period following a residuals
land application event.
8. DGS/HOS shall not be applied during a measurable precipitation event (i.e., greater
than 0.01 inch per hour), or within 24 hours following a rainfall event of
0.5 inches or greater in a 24-hour period (language pending modification)
9. DGS/HOS shall not be applied if the slope is greater than 10% for surface applied
slurry, or if the slope is greater than 18% for injected or incorporated slurry. (language
pending modification)
10. DGS/HOS shall not be applied if the land is not intended to be used for
agriculture/cover crop within 12 months following the slurry land application event.
11. DGS/HOS shall not be applied if the slurry pH is greater than or equal to 12.5.
12. DGS/HOS shall not be applied if the vertical separation between the seasonal high
water table and the depth of residuals application is less than one foot.
13. DGS/HOS shall not be applied if the vertical separation of bedrock and the depth
of residuals application is less than one foot.
14. Applications of DGS/HOS must not be applied so thick as to damage existing vegetation.
Application that is made to sites with less than 50 percent ground cover should be
incorporated.
15. DGS/HOS shall not be stockpiled or stored offsite for more than 60 days prior to
land application.
Contact NCDOT for a copy of the most recent DGS/HOS analysis and loading rates.
DGS/HOS Product Information Label — March 2024

DGS/HOS RECEIPT FORM
I, (printed name) have received
gallons of the NCDOT DGS/HOS, a copy of
the DGS/HOS product information label, and a copy of the most
recent analysis of the product. I have read these documents and
agree to adhere to the directions specified on the Application
Information Sheet and the Product Information Label.
Signature of Receiver Date of Receipt
DGS/HOS Product Information Label — March 2024

• pH LOG

HYDRODEMOLITION OPERATION SLURRY / DIAMOND GRINDING SLURRY
pH LOG
Project Name
(Source of HOS/DGS):
Project Location:
Project Description:
Land Application
Operator in Responsible Charge:
Date pH Sample Collected
Date pH Analyzed / Reported
Lab or Field Sample
pH Measurement
Unit Sampled
(Truck, Frac Tank, Dewatering Box, etc.)
pH LOG - March 2024.doc

• LAND APPLICATION LOG

HYDRODEMOLITION OPERATION SLURRY / DIAMOND GRINDING SLURRY
LAND APPLICATION LOG
Project Name
(Source of HOS/DGS):
Project Location:
Project Description:
Land Application
Operator in Responsible Charge:
Date of Land
Application
Location of Receiving Site
(Land Owner Name)
Receiving Site Address or
Latitude / Longitude
Quantity Applied
(Gallons or Dry Weight)
% Solids
LAND APPLICATION LOG - March 2024.doc

• INSPECTION LOG

HYDRODEMOLITION OPERATION SLURRY / DIAMOND GRINDING SLURRY
INSPECTION LOG
Project Name
(Source of HOS/DGS):
Project Location:
Project Description:
Land Application
Operator in Responsible Charge:
*** Inspections should be made of storage, transport and application equipment to prevent malfunctions, deterioration and operator errors resulting in
discharges, which may cause the release of HOS or DGS to the environment, a threat to human health or a public nuisance ***
Date of Inspection
Time of Inspection
Observations Made
Maintenance, Repairs or
Corrective Actions Taken
March 2024.doc

• SPILL CONTROL PLAN

HYDRODEMOLITION OPERATION SL URRY
DIAMOND GRINDING SLURRY
SPILL CONTROL PLAN
FOR PERMIT WQ0035749
THE FOLLOWING ACTIONS MUST BE TAKEN IN THE EVENT OF A SPILL:
1. Halt the source of the spill: Ruptured line or valve, or damaged tank unit.
2. Contain spill: Use straw bales to form a barrier. Straw or hay bales can be obtained
from several sources for this purpose. Soil near the site can also be used to form a barrier
for containment.
3. Clean up: Use land application equipment to recover as much of the Hydrodemolition
Operation Slurry (HOS) or Diamond Grinding Slurry (DGS) as possible. After the
application equipment has recovered as much HOS as possible, it will be land applied as
per the management plan. A temporary sump pit may be dug in the containment area to
enhance recovery.
4. Notification: As soon as possible, but in no case more than 24 hours or on the next
working day following the occurrence, after a spill occurs notify:
• NC DOT: Resident Engineer and Division Environmental Officer
• NC Department of Environmental Quality
Division of Water Quality Regional Office
❖ Asheville Regional Office [phone]
❖ Fayetteville Regional Office [phone]
❖ Mooresville Regional Office [phone]
❖ Raleigh Regional Office [phone]
❖ Washington Regional Office [phone]
❖ Wilmington Regional Office [phone]
❖ Winston-Salem Regional Office [phone]
❖ Outside of normal business hours, call the emergency hot line: 1-800-858-0368
• Fire Department if assistance is required for wash down
5. Management of clean up efforts: The responsible party for land application shall take
immediate charge of the clean up activities. Additional labor will be requested as
needed.
6. Reporting: Within 24 hours of a spill the responsible parry for land application shall
present a written report detailing the cause of the spill and all action taken in response to
the spill.

SPILL PREVENTION PLAN
The spill prevention plan requires that all equipment used to transport HOS or DGS be subject to
periodic safety inspections. Tires, brakes, lights, and turn signals will be inspected for proper
working order. Each truck will be equipped with safety flares and appropriate signs to be used in
the event of a breakdown. Any deficiencies observed during the safety inspections will result in the
vehicle being removed from service and the responsible party for land application will be notified
so that these deficiencies can be corrected and documented.
Routes leading from the storage point to the land application sites will be inspected for road
hazards. The road hazards will be documented and the drivers will be informed of the hazards.
Alternate routes will be investigated and routes which minimize road hazards will be selected.
Hazardous situations resulting from rush-hour traffic will be avoided during hauling.
Drivers and management personnel associated with the hauling of HOS or DGS will be instructed
in the spill prevention plan and will be required to attend training sessions. Drivers will be trained
in defensive driving techniques in order to minimize road hazards. A driver who observes a road
hazard will be required to report the hazard to the field superintendent who, in turn, will warn other
drivers. As part of the spill prevention plan, drivers will be required to inspect the safety equipment
of their vehicles on a daily basis. Any deficiency in safety equipment will be noted for corrective
action. Drivers will be trained in the procedures to be taken in the event of a spill that occurs
during the hauling of HOS or DGS. These procedures are discussed in the spill control,
containment, and cleanup plan.

SPILL CONTROL, CONTAINMENT, AND CLEANUP PLAN
Spills that occur during loading or unloading HOS or DGS will occur at the generation point and
the land application sites, respectively. These spills will not involve an environmental hazard or an
over the road hazard and, therefore, will be handled using the equipment that will be available at
either site. Spills that occur over -the -road will be subject to the contingencies contained in the spill
control, containment, and cleanup plan. The equipment used in the spill control, containment, and
cleanup consists of the following:
Vacuum pump, pump truck or tanker truck. A vacuum truck, vacuum pump or tanker truck
will be used to assist with clean up of HOS or DGS spills.
2. Outside equipment if required
The following personnel will be involved in the spill control, containment, and cleanup.
The responsible party for land application will respond to the spill site and make an assessment
of the spill and determine the containment procedures to be initiated and the equipment to be
used to clean up the spill.
2. The responsible party for land application will be responsible for the direction of the cleanup
team.
In the event of a spill, the driver of the truck or application vehicle, if he has not sustained a
debilitating injury, will call the responsible party for land application and report the spill. The
responsible party for land application will notify the appropriate authorities and will also notify the
appropriate DWQ Regional Office. The driver will set up safety flares and signs to warn motorists
of the hazard. The responsible party for land application will mobilize the necessary equipment and
personnel to the site, and will initiate the containment procedures. When the cleanup team arrives
at the site, the site will be cleaned up according to the contingency plan. HOS or DGS cleaned up
from the site will be transported to the land application sites where it will be applied in accordance
with the permit. In the event that the driver is incapacitated due to personal injury, the responsible
parry for land application will mobilize the cleanup team as soon as the authorities notification of
an incident.
HOS and DGS Spill Control Plan - March 2024.doc