NC0063860_Permit Modification_20160502

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit 000063860
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
yield to the next To check the b xes, click your mouse onto f ttre-bay-Otherwise, please print or type. -
1. Contact Information:
Owner Name Aqua North Carolina, Inc.
Facility Name Harbor Estates WWTP
Mailing Address 202 MacKenan Court
City Cary
State / Zip Code NC/27511
RECEIVED/N(DEDDVJR
Telephone Number [phone]
Fax Number [phone] MAY 0 2 2015
e-mail Address [e-mail] Water Quality
Permitting Section
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road NCSR 1 113 (Pine Harbor Road)
City Charlotte
State / Zip Code NC/28278
County Mecklenburg
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Aqua North Carolina, Inc.
Mailing Address 202 MacKenan Court
City Cary
State / Zip Code NC/27511
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1 of 4 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential X Number of Homes 102
— – School —❑- - -Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Domestic wastewater from subdivision.
Number of persons served: 255
This application is being submitted for a modification to to allow the existing wastewater treatment
facilities to receive a maximum of 500 gpd of backwash wastewater collected from nearby, existing
private community well water, uranium filtration systems. These existing community well water
systems are owned and operated by the applicant (Aqua North Carolina, Inc.)
The well water, uranium filter backwash wastewaters is collected and held in existing tanks at the well
sytems. This application requests the permission to periodically transport these collected uranium
backwash wastewaters via a tanker truck, to the existing Harbor Estates WWTP, where it will be
unloaded into a holding tank on site and introduced into the influent of the WWTP at a rate less than 1
gpm and controlled by a manual vavle.
An analysis of the collected uranium filter backwash wastewaters from each of the existing community
well systems in included in Attachment 1.
5. Type of collection system
X Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Lake Wylie (Catawba River Basin)
8. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
2 of 4 Form-D 11112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
0.0416 MGD extended aeration wastewater treatment system consisting of:
Effluent Pump station
Flow splitter
Bar Screen
Flow Equalization basin
Dual Aeration basins
Secondary clarifier
Sludge holding tank
Chlorine disinfection facilities (tablet)
Dechlorination facilities (tablet)
Effluent flow recording meter
Standby power
3 of 4 Form-D 11112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.0416 MGD
Annual Average daily flow 0.012 MGD (for the previous 3 years)
Maximum daily flow 0.130 MGD (for the previous 3 years)
11. Is this facility located on Indian country?_____________
❑ Yes X No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed. Fecal Conform, Temperature and pH shall be grab
samples,for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum)and Monthly Average over
the past 36 months for parameters currently in your permit. Mark other parameters "N/A".
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 13.3 1.8 mg/1
Fecal Coliform 310 8.6 #/100m1
Total Suspended Solids 27.3 5.4 mg/1
Temperature (Summer) 29 23.9 Deg. C
Temperature (Winter) 23 14.1 Deg. C
pH 8.2 7.3 s.u.
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES NC0063860 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Thomas J. Roberts President & Chief Operating Officer
Printe• : ,of Person Si: 'frig Title
C.ifJ
is ature of Applican e
North Carolina General Stat e 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (18 U.S.C.Section 1001
provides a punishment by a fine of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)
4 of 4 Form-D 11/12

ANC - Harbor Estates WWTP
NPDES Permit No. NC0063860
Application for Permit Modification
Old South Lane Well System Uranium Filter Backwash
Sample Results
Parameter Concentration Units
Aluminum ND ug/I
Iron ND ug/I
Manganese ND ug/I
Copper ND ug/I
Sodium 9540 ug/I
Zinc 88.2 ug/I
TDS 136 mg/I
TSS ND mg/I
Total nitrogen 0.28 mg/I
Fluoride 2.7 mg/I
Ammonia nitrogen ND mg/I
Total Kjeldahl nitrogen ND mg/I
Nitrogen, NO2 + NO3 0.27 mg/I
Phosphorous 0.041 mg/I
Chloride 1.4 mg/I
Gross Alpha 54.7 pCi/I
Gross Beta 13.3 pCi/I
Radium-226 0.254 pCi/I
Radium-228 0.696 pCi/I
Strontium-90 -0.177 pCi/I
Tritium -78.9 pCi/I
Total uranium 106 ugh
pH 7.4 s.u.
TRC 1.05 mg/I

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www pacelabs.cram [phone]
February 24, 2016
Michael Melton
Aqua America
RE: Project: Backwash Sampling
Pace Project No.: 92283327
Dear Michael Melton:
Enclosed are the analytical results for sample(s) received by the laboratory on January 18, 2016.
The results relate only to the samples included in this report. Results reported herein conform to the
most current TNI standards and the laboratory's Quality Assurance Manual, where applicable, unless
otherwise noted in the body of the report.
Analyses were performed at the Pace Analytical Services location indicated on the sample analyte
page for analysis unless otherwise footnoted.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
l
Chris Bishop for
Taylor Ezell
[e-mail]
Project Manager
Enclosures
cc: Ms.Debbie Dycus,Aqua North Carolina
Ms.Debbie Gentry,Aqua North Carolina
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
uwithout the written consent of Pace Analytical Services,Inc.. Page 1 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpace1abs.com [phone]
CERTIFICATIONS
Project: Backwash Sampling
Pace Project No.: 92283327
Pennsylvania Certification IDs
Georgia Certification#:C040 Montana Certification#:Cert 0082
1638 Roseytown Rd Suites 2,3&4,Greensburg,PA 15601 Nebraska Certification#:NE-05-29-14
L-A-B DOD-ELAP Accreditation#:L2417 Nevada Certification#:PA014572015-1
Alabama Certification#:41590 New Hampshire/TNI Certification#:2976
Arizona Certification#:AZ0734 New Jersey/TNI Certification#:PA 051
Arkansas Certification New Mexico Certification#:PA01457
California Certification#:04222CA New York/TNI Certification#: 10888
Colorado Certification North Carolina Certification#:42706
Connecticut Certification#:PH-0694 North Dakota Certification#:R-190
Delaware Certification Oregon/TNI Certification#:PA200002
Florida/TNI Certification#:E87683 Pennsylvania/TNI Certification#:65-00282
Georgia Certification#:C040 Puerto Rico Certification#:PA01457
Guam Certification Rhode Island Certification#:65-00282
Hawaii Certification South Dakota Certification
Idaho Certification Tennessee Certification#:TN2867
Illinois Certification Texas/TNI Certification#:T104704188-14-8
Indiana Certification Utah/TNI Certification#:PA014572015-5
Iowa Certification#:391 USDA Soil Permit#:P330-14-00213
Kansas/TNI Certification#:E-10358 Vermont Dept.of Health:ID#VT-0282
Kentucky Certification#:90133 Virgin Island/PADEP Certification
Louisiana DHH/TNI Certification#:LA140008 VirginiaNELAP Certification#:460198
Louisiana DEQ/TNI Certification#:4086 Washington Certification#:C868
Maine Certification#:PA00091 West Virginia DEP Certification#:143
Maryland Certification#:308 West Virginia DHHR Certification#:9964C
Massachusetts Certification#:M-PA1457 Wisconsin Certification
Michigan/PADEP Certification Wyoming Certification#:8TMS-L
Missouri Certification#:235
Asheville Certification IDs
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,Inc.. Page 2 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
/12eAnalytical Huntersville,NC 28078
www.pacelabs.com [phone]
SAMPLE ANALYTE COUNT
Project: Backwash Sampling
Pace Project No.: 92283327
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92283327001 Ole South Lane-0136280-BWS EPA 200.7 CDF 7 PASI-A
EPA 900.0 NEG 2 PASI-PA
EPA 903.1 WRR 1 PASI-PA
EPA 904.0 JLW 1 PASI-PA
EPA 905.0 SLA 1 PAST-PA
EPA 906.0 WRR 1 PAST-PA
ASTM D5174-97 RMK 1 PAST-PA
SM 2540C MSH 1 PAST-A
SM 2540D MJP 1 PAST-A
TKN+NO3+NO2 Calculation KDF1 1 PASI-A
EPA 300.0 MDW 1 PASI-A
EPA 350.1 SER 1 PAST-A
EPA 351.2 AES2 1 PAST-A
EPA 353.2 DMN 1 PASI-A
EPA 365.1 AES2 1 PAST-A
SM 4500-CI-E WRC 1 PAST-A
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,Inc.. Page 3 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical
� Huntersville,NC 28078
wwwpecelabs.com [phone]
ANALYTICAL RESULTS
Project: Backwash Sampling
Pace Project No.: 92283327
Sample: Ole South Lane-0136280- Lab ID: 92283327001 Collected: 01/15/16 17:09 Received: 01/18/16 09:15 Matrix: Water
BWS
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
200.7 MET ICP Analytical Method:EPA 200.7 Preparation Method:EPA 200.7
Aluminum ND ug/L 50.0 1 01/20/16 17:30 01/21/16 22:57 7429-90-5
Copper ND ug/L 2.5 1 01/20/16 17:30 01/21/16 22:57 7440-50-8
Iron ND ug/L 25.0 1 01/20/16 17:30 01/21/16 22:57 7439-89-6
Lead ND ug/L 2.5 1 01/20/16 17:30 01/21/16 22:57 7439-92-1
Manganese ND ug/L 2.5 1 01/20/16 17:30 01/21/16 22:57 7439-96-5
Sodium 9540 ug/L 2500 1 01/20/16 17:30 01/25/16 15:32 7440-23-5
Zinc 88.2 ug/L 2.5 1 01/20/16 17:30 01/21/16 22:57 7440-66-6
2540C Total Dissolved Solids Analytical Method:SM 2540C
Total Dissolved Solids 136 mg/L 25.0 1 01/19/16 22:41
2540D Total Suspended Solids Analytical Method:SM 2540D
Total Suspended Solids ND mg/L 2.5 1 01/20/16 10:10
Total Nitrogen Calculation Analytical Method:TKN+NO3+NO2 Calculation
Total Nitrogen 0.28 mg/L 0.12 1 02/01/16 08:53
300.0 IC Anions 28 Days Analytical Method:EPA 300.0
Fluoride 2.7 mg/L 1.2 5 01/21/16 09:41 16984-48-8
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.050 1 01/20/16 02:23 7664-41-7
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,Kjeldahl,Total ND mg/L 0.25 1 01/30/16 15:29 7727-37-9
353.2 Nitrogen,NO2/NO3 pres. Analytical Method:EPA 353.2
Nitrogen,NO2 plus NO3 0.27 mg/L 0.010 1 01/29/16 14:19
365.1 Phosphorus,Total Analytical Method:EPA 365.1
Phosphorus 0.041 mg/L 0.025 1 02/03/16 11:09 7723-14-0
4500 Chloride Analytical Method:SM 4500-Cl-E
Chloride 1.4 mg/L 0.50 1 01/26/16 20:29 16887-00-6
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 4 of 26

Pace Analytical Services,Inc.
ii
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: MPRP/20510 Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7 Analysis Description: 200.7 MET
Associated Lab Samples: 92283327001
METHOD BLANK: 1650965 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Copper ug/L ND 2.5 01/21/16 22:36
Lead ug/L ND 2.5 01/21/16 22:36
Sodium ug/L ND 2500 01/25/16 15:26
Zinc ug/L ND 2.5 01/21/16 22:36
LABORATORY CONTROL SAMPLE: 1650966
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Copper ug/L 500 469 94 85-115
Lead ug/L 500 462 92 85-115
Sodium ug/L 5000 5420 108 85-115
Zinc ug/L 500 454 91 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1650967 1650968
MS MSD
92283556001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L 22.8 500 500 504 510 96 97 70-130 1
Lead ug/L ND 500 500 459 465 92 93 70-130 1
Sodium ug/L 44800 5000 5000 48600 50000 75 104 70-130 3
Zinc ug/L 145 500 500 598 624 91 96 70-130 4
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 5 of 26

Pace Analytical Services,Inc.
aceAnalytical® 9800 Kincey Ave. Suite 100
/ Huntersville,NC 28078
wwv.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WET/42582 Analysis Method: SM 2540C
QC Batch Method: SM 2540C Analysis Description: 2540C Total Dissolved Solids
Associated Lab Samples: 92283327001
METHOD BLANK: 1650418 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Dissolved Solids mg/L ND 25.0 01/19/16 22:40
LABORATORY CONTROL SAMPLE: 1650419
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Dissolved Solids mg/L 250 254 102 90-110
SAMPLE DUPLICATE: 1650420
92283340002 Dup
Parameter Units Result Result RPD Qualifiers
Total Dissolved Solids mg/L 165 178 8 D6
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 6 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WET/42589 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92283327001
METHOD BLANK: 1650596 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 01/20/16 10:06
LABORATORY CONTROL SAMPLE: 1650597
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 244 98 90-110
SAMPLE DUPLICATE: 1650598
92283316001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L ND ND
SAMPLE DUPLICATE: 1650599
92283348002 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 26.2 21.8 18 D6
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 7 of 26

Pace Analytical Services,Inc.
21_1
av 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26155 Analysis Method: EPA 300.0
QC Batch Method: EPA 300.0 Analysis Description: 300.0 IC Anions
Associated Lab Samples: 92283327001
METHOD BLANK: 1650475 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Fluoride mg/L ND 0.25 01/20/16 15:53
LABORATORY CONTROL SAMPLE: 1650476
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Fluoride mg/L 2.5 2.5 101 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1650477 1650478
MS MSD
92283386012 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Fluoride mg/L ND 2.5 2.5 2.4 2.4 95 96 90-110 2
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 8 of 26

Pace Analytical Services,Inc.
aceAnalytical 9800 Kincey Ave. Suite 100
,././,1.11
Huntersville,NC 28078
wwwpacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26125 Analysis Method: EPA 350.1
QC Batch Method: EPA 350.1 Analysis Description: 350.1 Ammonia
Associated Lab Samples: 92283327001
METHOD BLANK: 1649248 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Ammonia mg/L ND 0.050 01/20/16 02:15
LABORATORY CONTROL SAMPLE: 1649249
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Ammonia mg/L 5 4.9 98 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1649250 1649251
MS MSD
92283310003 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,Ammonia mg/L 0.29 5 5 5.3 5.3 101 101 90-110 0
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right or the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 9 of 26

Pace Analytical Services,Inc.
aceAnalytical 9800 Kincey Ave. Suite 100
i Huntersviiie,NC 28078
www pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26264 Analysis Method: EPA 351.2
QC Batch Method: EPA 351.2 Analysis Description: 351.2 TKN
Associated Lab Samples: 92283327001
METHOD BLANK: 1657136 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Kjeldahl,Total mg/L ND 0.25 01/30/16 15:18
LABORATORY CONTROL SAMPLE: 1657137
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Kjeldahl,Total mg/L 10 10.1 101 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1657138 1657139
MS MSD
92283911001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,Kjeldahl,Total mg/L 1.6 10 10 12.5 12.0 109 105 90-110 4
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 10 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26260 Analysis Method: EPA 353.2
QC Batch Method: EPA 353.2 Analysis Description: 353.2 Nitrate+Nitrite,preserved
Associated Lab Samples: 92283327001
METHOD BLANK: 1656459 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,NO2 plus NO3 mg/L ND 0.010 01/29/16 13:58
LABORATORY CONTROL SAMPLE: 1656460
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,NO2 plus NO3 mg/L 2.5 2.4 95 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1656461 1656462
MS MSD
92284217001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,NO2 plus NO3 mg/L 0.17 2.5 2.5 2.5 2.5 92 93 75-125 1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1656463 1656464
MS MSD
92284158001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,NO2 plus NO3 mg/L 90.1 2.5 2.5 89.2 90.1 -37 2 75-125 1 M6
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 11 of 26

Pace Analytical Services,Inc.
e 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacetabs.corn [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26285 Analysis Method: EPA 365.1
QC Batch Method: EPA 365.1 Analysis Description: 365.1 Phosphorus,Total
Associated Lab Samples: 92283327001
METHOD BLANK: 1658703 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Phosphorus mg/L ND 0.025 02/03/16 11:02
LABORATORY CONTROL SAMPLE: 1658704
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Phosphorus mg/L 2.5 2.5 101 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1658705 1658706
MS MSD
92284161001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Phosphorus mg/L 7.6 2.5 2.5 10.4 10.4 111 113 90-110 1 M1
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 12 of 26

Pace Analytical Services,Inc.
e 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: WETA/26203 Analysis Method: SM 4500-CI-E
QC Batch Method: SM 4500-CI-E Analysis Description: 4500 Chloride
Associated Lab Samples: 92283327001
METHOD BLANK: 1653063 Matrix: Water
Associated Lab Samples: 92283327001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chloride mg/L ND 0.50 01/26/16 20:21
LABORATORY CONTROL SAMPLE: 1653064
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chloride mg/L 20 20.8 104 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1653065 1653066
MS MSD
92283919008 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chloride mg/L ND 20 20 23.0 22.9 115 115 90-110 0 M1
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 13 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
ANALYTICAL RESULTS -RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
Sample: Ole South Lane-0136280- Lab ID: 92283327001 Collected: 01/15/16 17:09 Received: 01/18/16 09:15 Matrix: Water
BWS
PWS: Site ID: Sample Type:
Parameters Method Act±Unc(MDC)Carr Trac Units Analyzed CAS No. Qual
Gross Alpha EPA 900.0 54.7±11.1 (2.19) pCi/L 01/31/16 14:27 12587-46-1
C:NA T:NA
Gross Beta EPA 900.0 13.3±3.30 (1.80) pCi/L 01/31/16 14:27 12587-47-2
C:NA T:NA
Radium-226 EPA 903.1 0.254±0.306 (0.467) pCi/L 02/03/16 18:42 13982-63-3
C:NA T:91%
Radium-228 EPA 904.0 0.696±0.427 (0.813) pCi/L 02/03/16 16:44 15262-20-1
C:85%T:84%
Strontium-90 EPA 905.0 -0.177±0.262 (0.710) pCi/L 01/31/16 08:54 10098-97-2
C:89%T:NA
Tritium EPA 906.0 -78.9±143 (260) pCi/L 01/29/16 02:22 10028-17-8
C:NA T:NA
Total Uranium ASTM D5174-97 106±1.953 (3.854) ug/L 02/09/16 16:44 7440-61-1
C:NA T:NA
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 14 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pecelabs.corn [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27751 Analysis Method: EPA 906.0
QC Batch Method: EPA 906.0 Analysis Description: 906.0 Tritium
Associated Lab Samples: 92283327001
METHOD BLANK: 1017597 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Tritium -51.2±146 (262)C:NA T:NA pCi/L 01/28/16 20:14
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 15 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
7!2ceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27714 Analysis Method: EPA 904.0
QC Batch Method: EPA 904.0 Analysis Description: 904.0 Radium 228
Associated Lab Samples: 92283327001
METHOD BLANK: 1015573 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Radium-228 0.495±0.370 (0.725)C:88%T:81% pCi/L 02/03/16 16:44
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 16 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelebs.com [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27707 Analysis Method: EPA 903.1
QC Batch Method: EPA 903.1 Analysis Description: 903.1 Radium-226
Associated Lab Samples: 92283327001
METHOD BLANK: 1015566 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Radium-226 0.122±0.292 (0.564)C:NA T:95% pCi/L 02/03/16 18:03
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 17 of 26

Pace Analytical Services,Inc.
/. ®
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.com [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27770 Analysis Method: EPA 905.0
QC Batch Method: EPA 905.0 Analysis Description: 905.0 Strontium 89/90
Associated Lab Samples: 92283327001
METHOD BLANK: 1017616 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Carr Trac Units Analyzed Qualifiers
Strontium-90 -0.123±0.179 (0.492)C:95%T:NA pCi/L 01/31/16 08:54
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 18 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.pacela6s.com [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27776 Analysis Method: EPA 900.0
QC Batch Method: EPA 900.0 Analysis Description: 900.0 Gross Alpha/Beta
Associated Lab Samples: 92283327001
METHOD BLANK: 1017630 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Gross Alpha -0.377±0.710 (2.13)C:NA T:NA pCi/L 01/31/16 16:16
Gross Beta 0.077±0.731 (1.81)C:NA T:NA pCi/L 01/31/16 16:16
Results presented on this page are in the units Indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 19 of 26

Pace Analytical Services,Inc.
/49800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
www.paceiabs.com [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92283327
QC Batch: RADC/27693 Analysis Method: ASTM D5174-97
QC Batch Method: ASTM D5174-97 Analysis Description: D5174.97 Total Uranium KPA
Associated Lab Samples: 92283327001
METHOD BLANK: 1014744 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Total Uranium 0.013±0.001 (0.193)C:NA T:NA ug/L 01/27/16 16:57
Results presented on this page are In the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,Inc.. Page 20 of 26

Pace Analytical Services,Inc.
9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
VAMpacelabs.com [phone]
QUALIFIERS
Project: Backwash Sampling
Pace Project No.: 92283327
DEFINITIONS
DF-Dilution Factor,if reported,represents the factor applied to the reported data due to dilution of the sample aliquot.
ND-Not Detected at or above adjusted reporting limit.
J-Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL-Adjusted Method Detection Limit.
PQL-Practical Quantitation Limit.
RL-Reporting Limit.
S-Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270.The result for each analyte is
a combined concentration.
Consistent with EPA guidelines,unrounded data are displayed and have been used to calculate%recovery and RPD values.
LCS(D)-Laboratory Control Sample(Duplicate)
MS(D)-Matrix Spike(Duplicate)
DUP-Sample Duplicate
RPD-Relative Percent Difference
NC-Not Calculable.
SG-Silica Gel-Clean-Up
U-Indicates the compound was analyzed for,but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether,Styrene,and Vinyl chloride.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Act-Activity
Unc-Uncertainty:SDWA=1.96 sigma count uncertainty,all other matrices=Expanded Uncertainty(95%confidence interval).
Gamma Spec=Expanded Uncertainty(95.4%Confidence Interval)
(MDC)-Minimum Detectable Concentration
Trac-Tracer Recovery(%)
Carr-Carrier Recovery(%)
Pace Analytical is TNI accredited.Contact your Pace PM for the current list of accredited analytes.
TNI-The NELAC Institute.
LABORATORIES
PASI-A Pace Analytical Services-Asheville
PASI-PA Pace Analytical Services-Greensburg
ANALYTE QUALIFIERS
D6 The relative percent difference(RPD)between the sample and sample duplicate exceeded laboratory control limits.
M1 Matrix spike recovery exceeded QC limits. Batch accepted based on laboratory control sample(LCS)recovery.
M6 Matrix spike and Matrix spike duplicate recovery not evaluated against control limits due to sample dilution.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 21 of 26

Pace Analytical Services,Inc.
® 9800 Kincey Ave. Suite 100
aceAnalytical Huntersville,NC 28078
wwwpacelabs.com [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Backwash Sampling
Pace Project No.: 92283327
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92283327001 Ole South Lane-0136280-BWS EPA 200.7 MPRP/20510 EPA 200.7 ICP/18507
92283327001 Ole South Lane-0136280-BWS EPA 900.0 RADC/27776
92283327001 Ole South Lane-0136280-BWS EPA 903.1 RADC/27707
92283327001 Ole South Lane-0136280-BWS EPA 904.0 RADC/27714
92283327001 Ole South Lane-0136280-BWS EPA 905.0 RADC/27770
92283327001 Ole South Lane-0136280-BWS EPA 906.0 RADC/27751
92283327001 Ole South Lane-0136280-BWS ASTM D5174-97 RADC/27693
92283327001 Ole South Lane-0136280-BWS SM 2540C WET/42582
92283327001 Ole South Lane-0136280-BWS SM 2540D WET/42589
92283327001 Ole South Lane-0136280-BWS TKN+NO3+NO2 WET/42786
Calculation
92283327001 Ole South Lane-0136280-BWS EPA 300.0 WETA/26155
92283327001 Ole South Lane-0136280-BWS EPA 350.1 WETA/26125
92283327001 Ole South Lane-0136280-BWS EPA 351.2 WETA/26264
92283327001 Ole South Lane-0136280-BWS EPA 353.2 WETA/26260
92283327001 Ole South Lane-0136280-BWS EPA 365.1 WETA/26285
92283327001 Ole South Lane-0136280-BWS SM 4500-CI-E WETA/26203
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 12:17 PM without the written consent of Pace Analytical Services,Inc.. Page 22 of 26
i

i
Document Name: Document Revised:260CT2015
geAnalt,�ICa,'A Sample Condition Upon Receipt(SCUR) Page 1 of 2
, �"` Document No.: Issuing Authority:
•
F-CHR-CS-003-rev.17 Pace Huntersville Quality Office
Sample Condition Client Name: Project M
Upon Receipt WOn : 92283327
Courier: OFed Ex ❑UPS ❑USPS ❑Client III III 1
Commercial ❑Pace DOther: 92283327
Custody Seal on Cooler/Box Present? Oyes ,❑No Seals Intact? Des ❑No
Packing Material: ❑Bubble Wrap ❑ J(3ubble Bags ['None ❑Other:
Thermometer 0 T1505 --'f
Used: Type of Ice: ON/et ['Blue alone ❑Samples on ice,cooling process has begun
Cooler Temp Corrected(°C): -j / Biological Tissue Frozen? Dyes ONo, ON/A
--
Temp should be above freezing to 6°C Correction Factor: 0.0°C Date and Initials of Person Examining Contents: ..li ,. /k" K.
USDA Regulated Soil(0 N/A,water sample)
Did samples originate-iiia quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
Dyes ❑N6 including Hawaii and Puerto Rico)? Dyes (Dfchi---
If Yes to either question,fill out a Regulated Soil Checklist and include with SCUR/COC paperwork.
COMMENTS:
Chain of Custody Present? ❑Yes QNoo ❑N/A 1. .
Chain of Custody Filled Out? Oyes l rf ❑N/A 2. it j v ) . "<° G 4I 1-C--
Chain of Custody Relinquished? DYet1 No ON/A 3.
Sampler Name and/or Signature on COC? �es ONo ON/A 4.
Samples Arrived within Hold Time? Ulics ONO -.ON/A 5.
Short Hold Time Analysis(<72 hr)? Dyes 1:i ON/A. 6.
Rush Turn Around Time Requested? Oyes '❑Na ON/A 7.
Sufficient Volume? es No ON/A 8. � n I /
r
/ c
Correct Containers Used? Yes ONo ON/A 9. If 5 1 '"
-Pace Containers Used? ❑Yeses ONo ON/A
Containers Intact? Oyes ONo ON/A 10.
Filtered Volume Received for Dissolved Tests? Oyes ❑No )]N/A 11. Note if sedime t is visible in the dissolved container
Sample Labels Match COC? ❑yesNo ON/A 12.
-Includes Date/Time/ID/Analysis Matrix:
All containers needing acid/base preservation have been / 13. / !r
U'i
checked? ❑Y4s ❑No ❑N/A
All containers needing preservation are found to be in
compliance with EPA recommendation?
(HNO3,H2SO4,HCI<2;NaOH>9 Sulfide,NaOH>12 Cyanide) es ONo ON/A
Exceptions:VOA,Coliform,TOC,Oil and Grease,
DRO/8015(water)DOC,LLHg Oyes ❑No ON/A
Samples checked for dechiorization Dyes
ONo QN/ 14.
Headspace in VOA Vials(>5-6mm)? ❑Yes ❑NoN/ /r 15. •
Trip Blank Present? Oyes ❑NoN/ 16.
Trip Blank Custody Seals Present? Oyes ❑No N/A
Pace Trip Blank Lot U(if purchased):
CLIENT NOTIFICATION/RESOLUTION Field Data Required? Oyes ❑No
Person Contacted: Date/Time:
Comments/Resolution:
Project Manager SCURF Review: (';-i:: Date: (r1$
Note: Whenever there is a discrepancy affecting North Carolina-compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certificatin Offt1 (ofe�s ut of
hold,incorrect preservative,out of temp,incorrect containers). 9

Document Name: Document Revised:260CT2015
a Sample Condition Upon Receipt(SCUR) Page 1 of 2
aceAna/ytical Document No.: Issuing Authority:
F-CHR-CS-003-rev.17 Pace Huntersville Quality Office
Sample.Condition, Client Name: Project#:
Upon Receipt
AqI,( k
Courier: OFed Ex ❑UPS ❑USPS ❑Chen T
❑Commercial ❑Pace ❑Other:
Custody Seal on Cooler/Box Present? ❑Yes ❑N( Seals Intact? ❑Yes ❑No
Packing Material: ❑B bble Wrap [(Bubble Bags ❑gone [(Other:
Thermometer 1505
Used: Type of Ice: QWet ❑Blue ONone ['Simples on ice,cooling process has begun
Cooler Temp Corrected(°C): ;j / Biological Tissue Frozen? Oyes ONo•• ON/A--
Temp
N/ATemp should be above freezing to 6°C Correction Factor: 0.0°C Date and Initials of Person Examining Contents: - (
USDA Regulated Soil(❑N/A,water sample) .
Did samples origie in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
Oyes ONo including Hawaii and Puerto Rico)? Oyes _ONo—
if
©No—If Yes to either question,fill out a Regulated Soil Checklist and include with SCUR/COC paperwork.
COMMENTS:
Chain of Custody Present? DYes (3No N/A 1.
Chain of Custody Filled Out? ❑Yes,/" o ❑N/A 2. A/ Ij t' ' -
Chain of Custody Relinquished? es No ON/A 3.
Sampler Name and/or Signature on COC? s ONo ON/A 4.
Samples Arrived within Hold Time? Dei ONo ON/A 5.
Short Hold Time Analysis(<72 hr)? Oyes ONo ON/A 6.
Rush Turn Around Time Requested? ❑Yes_, " No ON/A 7.
Sufficient Volume? Oyes ONo ON/A 8.
Correct Containers Used? Oyes ONo ON/A 9.
-Pace Containers Used? ❑Ye/ ONo ON/A
Containers Intact? metes ONo ❑N/A
Filtered Volume Received for Dissolved Tests?
QN/Ajjtelrsedi1ntisvjIblelntheaissoivedcontainer0 mSamPle Labels Match COC? ❑�es 10 ❑N/A
-Includes Date/Time/ID/Analysis Matrix:
All containers needing acid/base preservation have been /� 13.
checked? ❑ (s. ❑No ON/A
Alf containers needing preservation are found to be in
compliance with EPA recommendation?
(HNO3,H5SO4,HCI<2;NaOH>9 Sulfide,NaOH>12 Cyanide) Oyes ❑N ,ON/A
Exceptions:VOA,Coliform,TOC,Oil and Grease,
DRO/8015(water)DOC,LLHg Oyes [(No ON/„/A
Samples checked for dechlorization Oyes ONo ON/A 14.
Headspace in VOA Vials(>5-6mm)? Oyes ONO ON/A 15.
Trip Blank Present? ❑Yes ONo Qiv/A 16.
Trip Blank Custody Seals Present? Oyes ❑No [21/N/A •• • •
Pace Trip Blank Lot it(if purchased):
CLIENT NOTIFICATION/RESOLUTION Field Data Required? Oyes ONo
Person Contacted: Date/Time:
Comments/Resolution:
Project Manager SCURF Review: Date;
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e. Out of
hold,incorrect preservative,out of temp,Incorrect containers). Page 24 of 26

r
/cra��n�,,;� CHAIN-OF-CUSTODY/Analytical Request Document N
0
The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately. rn
N
Section A N
Section B Section C Of
Required Client Information: as
Required Project Information- Invoice Information: Page: 1 Of 1 d
Company: Aqua North Carolina 'Report To: Debbie Gentry Attention:
Address: 4163 Sinclair St. Copy To: Company Name:
Denver,NC 28037
Address: Regulatory Agency
Email: dagentry©aquaamerica.com _ Purchase Order#: Pace Quote:
Phone: [phone] JFax Project Name: Backwash Sampling Kits Pace Project Manager:
taylor.exell�pacelabs.com,Requested Due Date: •
Project#: Pace Profile#:
^-' Requested Analysis Filtered(YIN)
S: Z
I ATRIx COCA ts c V COLLECTED = Preservatives �-
Drinking Water On a O ..
Wale, WT U 0 C h-
Waste Water WW v_ as j el
Product P
y m
SAMPLE ID soe�uset,e a ' START END m Zi co o z E
One Character per box. Wipe WP w w a "' a E >, v_
At AR 0 D_ Q m m W H o ct p
(AZ 0.91. 1 O F 7 2 M 0 a$ A o y cLi
# Sample Ids must be unique Other Ts O w r"" LL
O in sr O c W m E m - i- m
f' a tJ n tOn O O h ‘-r-S' a' C c a .2 m 1-3 a y 1.
a
1 h DATE TIME DATE TIME to a -' -t- _ X 2 Z O st i-- V t- n- cC
1 Willard Oaks-0241-225-BWS-Wells 1 8 2-Backwash WT Iron.Copper,Zinc.Lead.
XXX X -X XX Manganese.Aluminum
2 Fleetwood Acres-01-36-133-BWS-Well n4-Backwash hon.Copper,Zinc.Lead,
WT X XX X X X X Manganese,Aluminum
3 Ole South Lane-01-36-280-BWS-Well#1-Backwash WT Iron,Copper,Zinc,Lead,
X XX XXX X Manganese,Aluminum
Iron,Copper.Zinc.Lead,
4 River Run-02.79.177-BWS-Wells 3 8 4-Backwash WT X X X X X XX
Manganese.Aluminum
5 Sundown Cove-20-49-006-BM-Well#2-Backwash WT Iron,Copper,Zinc,Lead,
XXX X XXX Manganese.Aluminum
1
6 Sunset Hills-99-18-158-BWS-Well#3-BackwashIron,Copper,Zinc,Lead,
WI X XX X X XX Manganese.Aluminum
.8
9
10
11
- - - - ,
12
AOOIUONAL COMMENTS - RELJNQUISHED BY/AFFILIATION •..DATE TIME... ACCEPTED BY I AFF A TION DATE _,TIME ;.r SAMPLE CON0f710NS
Alpha emitters,excluding radon and uranium(pCVL).Beta emitters,excluding r/) -N� I .�~ `:. . J/ l "`
pouuium.40 and other naturally occurring radionuclides �t(. h'71- f {-I q J // e 6-c' , � � .)-I JP j�'' 5-_,)
�-�
(grL).Radium-22B �) -t C/' `f� /-''' `✓ J
(pCi't),Strontium-90(pCilL),Tritium(pCi/L),Uranium u
(pCVL).Radium 228)(pCVI),Total iron(ugiL),Total
copper(ugh.),Total emorida(uyL),Total Zinc(ug4L).Total Lead(ug/L),Total
manganese(ugIL),Total aluminum(ug/L).Fluoride
dissolved solids(mg✓!),TSS(m{HL),pH(su)
SAMPLER NAME AND SIGNATURE
PRINT Name of SAMPLER: i 0 o
mSIGNATURE of SAMPLER: /k) DATE Signed wm ? m gz E z 4
, m

T
1ei ,ktr CHAIN-OF-CUSTODY 1 Analytical Request DocumentOp
- -- The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately. o
N
Section A Section B Section C
Required Client Information: Required Project Information: Invoice Information: Page: 1 Of 1 m
Q_
Company: Aqua Nor h Carolina Report To: Debbie Gentry Attention:
-
Address: 4163 Sinclair St. Copy To. Company Name:
Denver,NC 28037
Email: Address: Regulatory Agency
Email:
dagentryeaquaamerica.com Purchase Order#: Pace Quote:
Phone: [phone] IFax Project Name:
1 Backwash Sampling Kits Pace Project Manager• taylor.ezell k�pacelabs.com, State/Location
Requested Due Date: Project#: Pace Profile#.
Requested Analysis Filtered(YIN) - •
a z
o M
MATRIX cone : ir) COLLECTED Z Preservatives )-
Orating Watt+ OW g O Z
Worn WT s (-) U O m ,tWaal.Water W u _ Q L k7 m Vie. Z
SAMPLE ID a`�°'° O� 7. tl START END ,_ w F m n g a dE
One Character per box. Woo WP w w a F.Li N E n `o c c
# (A-Z,0-91,-) 44 AR a ocher or O a w F m m es m LL o co .c
Sample Ids roust be unique TIc;ue Ts w J p N ur O m a m .- rN74
-
u m n 2 o Z
W .( 2 C a. 0 0 N 5 - Q . a c m o m on
'Or:
I- N DATE TIME DATE TIME O ,n D _ X X z z 2 0 < t- F L0 i°- t- rs
Iron,Copper.Zine,Lead,
1 Willard Oaks-02.41-225-BWS-Wells 1&2-Backwash WT X XX X XX Manganese,Aluminum
Iron,Copper.Zinc,Lead,
2 Fleetwood Acres-01-36.133-BWS-Well#4-Backwash WT X XXX XX Manganese,Aluminum
Iron,Copper.Zinc,Lead.
3 Ole South Lane-01-36.280-BWS-Well#1-Backwash WT X X X X X XX Manganese,Aluminum
Iron.Copper,Zinc,Lead,
4 River Run-02-79.177-BWS-Wells 3&4-Backwash WT , XXX X XX Manganese,Aluminum
5 Sundown Cove-20-49-006-BWS-Well#2-Backwash WI' Iron,Copper.Zinc,Lead,
-
X X X X X X Manganese,Aluminum
Iron,Copper,Zinc,Lead, 1
6 Sunset Hills-99-18-158-BWS-Well#3-Backwash WT i X XX X X X Manganese,Aluminum
7
8
9
1 10
11
12
ADDITIONAL COMMENTS REUNOUISHED tiY/AFFILIATION DATE TIME ACCEPTED BY/AFFILIATION-, - DATE ' TIME . SAMPLE CONDMONS
Alpha emitters,excluding radon end uranium(pCit).Beta emitters,exclud rog ,re, .7 , /+ r fie'e,( //,'/ " _ r •
Potassium-40 and other naturalN occurring radionuclides f4L.
; ',_J �� l �. Z" �f�"/� 1)(7- �r o)(.y e C_, r�� �t'
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SAMPLER NAME AND SIGNATURE •
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INIC PAT MCCRORY
(;,rerun.
DONALD R. VAN DER VAART
secroory
WaterS. JAY ZIMMERMAN
Resources
Urrec(ur
ENVIRONMENTAL DUALITY
July 7, 2016
Mr. Thomas J. Roberts, President
Aqua North Carolina, Inc.
202 Mackenan Court
Cary,NC 2751.1
Subject: Permit Modification
Application No. NC0063860 .
Harbor Estates WWTP
Mecklenburg County
Dear Mr. Roberts:
The Water Quality Permitting Section has received your permit modification application on
May 02, 2016. A member of the NPDES Unit will review your application. They will contact you
if additional information is required to complete your permit renewal. Per G.S. 150B-3 your
current permit does not expire until permit decision on the application is made. Continuation of the
current permit is contingent on timely and sufficient application for renewal of the current permit.
Please respond in a timely manner to requests for additional information necessary to complete the
permit application. .
If you have any additional questions concerning renewal of the subject permit, please
contact Derek Denard at 919-807-6307 or [e-mail].
Sincerely,
'G' zea 7440,td
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Mooresville Regional Office
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300