NC0078115_Permit Modification_20160425

111
M
AO U
Thomas J.Roberts,President and Chief Operating Officer
0:919.653.5770 • F:919.460.1788 • [e-mail]
April 25,2016
NC Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section—NPDES RECEIVEDINCDEQIDWR
1617 Mail Service Center
Raleigh,NC 27699-1617 MAY 0 2 2016
Subject: Application for Permit Modification Water Quality
Aqua North Carolina, Inc. Permitting Section
Greystone WWTP
NPDES No. NC0078115
Forsyth County
Gentlemen:
Attached are three(3)copies of the completed application Form D, a location map, a copy of the
sludge management plan and a check for the permit modification application processing fee
($ 260.00). This letter and attachments are our request to modify the subject permit to allow the
introduction of a maximum of 500 gallons per day of wastewater from several existing community
potable well water treatment systems. The existing well water systems are all owned and operated by
Aqua North Carolina, Inc.
Each of these existing community well water systems has existing uranium removal filter systems. In
the past,the wastewaters derived from the backwashing of these systems have been collected in
existing tanks located on the well sites and periodically removed by a licensed commercial hauler
(tanker truck)for disposal at treatment facilities off site. However,the hauler has advised that he will
no longer be able to continue providing this disposal service. Therefore, Aqua North Carolina, Inc. is
requesting that this NPDES permit be modified to allow the collected uranium filter backwash
wastewater to be transported to the existing Greystone WWTP and introduced into the influent.
The uranium filter backwash wastewater will be brought to the WWTP by tanker truck, offloaded
into a storage tank and fed slowly at a rate of less than one gallon per minute by means of a manually
operated valve, into the WWTP influent. We have included an analysis of the collected uranium
backwash wastewater in Attachment 1 of the application.
202 MacKenan Court Cary,NC 27511 • AquaAmerica.com

• Page Two
April 25, 2016
NC Department of Environmental Quality
Greystone WWTP
We appreciate your consideration of this request for modification. If you need any additional
information or assistance, please feel free to contact our engineer,Mr. J.Thurman Home, P.E.,
Horizon Engineering&Consulting, Inc.(704-788-4455.)
y,- 7:37
omas J. Robe
President and Chief Operating Officer
cc: Laurie Ison
J. Thurman Home
RECEIVEDINCDEUDWR
MAY 0 2 2016
Water Quality
Permitting Section

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 111C0078115
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise,please print or type.
1. Contact Information:
Owner Name Aqua North Carolina, Inc.
Facility Name Greystone Subdivision WWTP
Mailing Address 202 MacKenan Court
City Cary RECEIVED/NUVEQID
State / Zip Code NC/27511 WR
Telephone Number [phone] MAY 0 2 2016
Fax Number [phone]Water Quality sah.t�lun
e-mail Address tjrobertsiaquaamerica.com
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road Creek Bed Road-North Kernersville
City Kernersville
State / Zip Code NC/27284
County Forsyth
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 tjrobertsaaquaamerica.com
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 128
School ❑ Number of Students/Staff
Other 0 Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Domestic watewater from 128 residential connections.
Number of persons served: 320
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 Greystone Subdivision 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.
S. Type of collection system
X Separate (sanitary sewer only) 0 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? 0 Yes X No
7. Name of receiving streams) (NEW applicants:Provide a map showing the exact location of each
outfall):
Right Fork Belews Creek in the Yadkin River Basin
8. Frequency of Discharge: X Continuous 0 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-011/12

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

1
NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.032 MOD
Annual Average daily flow 0.025 MOD (for the previous 3 years)
Maximum daily flow 0.097 MOD (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 Coliform, 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) 33.4 5.4 mg/1
Fecal Coliform 290 9.2 #/100m1
Total Suspended Solids 12.7 5.5 mg/1
Temperature (Summer) 28 19.5 Deg. C
Temperature (Winter) 21.3 10.2 Deg. C
pH 8.4 7.1 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 NC0078115 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.
Th.m:s J. Roberts President 8s Chief Operating Officer
Print- - . :% of Person S.? ingae/
Title
ture of Applic: ate
North Carolina General .1 e 143-215.6 (bX2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, raped,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

Pace Analytical SeMees,Inc.
!N/'71K11 {/GIe 9800 Kincey Ave.:::Huntenville,NC 28078
• sawpsoakbs. n [phone]
I
February 24, 2016
Michael Melton
Aqua America
RE: Project: Backwash Sampling
Pace Project No.: 92282039
Dear Michael Melton:
Enclosed are the analytical results for sample(s) received by the laboratory on January 06, 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,/
Taylor Ezell
[e-mail]
Project Manager
Enclosures
cc: Ms.Debbie Dycus,Aqua North Carolina
Ma.Debbie Genby,Aqua North Carolina
T
REPORT OF LABORATORY ANALYSIS
iiii .01
This report shall not be reproduced,except in full,
a J.'J without the written consent of Pace Analytical Services,Inc.. Page 1 of 26

Pace Analytical Services,Inc.
7fLiCW KU ^A/• 9800 Kincey Ave. Suite 100
Huntersville,NC 28078
• wwwrrCMebtmn [phone]
CERTIFICATIONS
Project: Backwash Sampling
Pace Project No.: 92282039
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 it: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 It 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 PennsylvanialTNl Certification#:65-00282
Georgia Certification#:C040 Puerto Rico Certification it: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 it:P330-14-00213
Kansas/TNI Certification#:E-10358 Vermont Dept.of Health:ID#VT-0282
Kentucky Certification#:90133 Virgin IslandIPADEP Certification
Louisiana DHH/TNI Certification#:LA140008 VirginiaNELAP Certification#:460198
Louisiana DEO/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 it E87648 South Carolina Certification#:99030001
Massachusetts Certification it: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.
a 9800 nay Ave. 0
ceAnalytical HunbnWlle,NC 28078
' r.wpaaahestam [phone]
SAMPLE ANALYTE COUNT
Project: Backwash Sampling
Pace Project No.: 92282039
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92282039001 Millard Oaks-0241225-BWS EPA 200.7 CDF 7 PASI-A
EPA 900.0 FCC 2 PASI-PA
EPA903.1 WRR 1 PASI-PA
EPA 904.0 JLW 1 PASI-PA
EPA 905.0 SLA 1 PASI-PA
EPA 906.0 WRR 1 PASI-PA
ASTM D5174-97 RMK 1 PASI-PA
SM 2540C MSH 1 PASI-A
SM 2540D MSH 1 PAST-A
TKN+NO3+NO2 Calculation KDF1 1 PAST-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
EPA365.1 AES2 1 PASI-A
SM 4500-CI-E WRC 1 PAST-A
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced.except In full,
without the written consent of Pace Analytical Services,Inc.. Page 3 of 26

Pace Analytical Services,Inc.
ceArlyt is l a 9800 Kincey Ave. Suite 100
W/ Huntersville,NC 28078
• eewprpNbsawn [phone]
ANALYTICAL RESULTS
Project: Backwash Sampling
Pace Project No.: 92282039
Sample: Willlard Oaks-0241225- Lab ID: 92282039001 Collected: 01/05/16 10:45 Received: 01/06/16 14:30 Matrix:Water
BWS
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Dual
200.7 MET ICP Analytical Method:EPA 200.7 Preparation Method:EPA 200.7
Aluminum ND ug/L 50.0 1 01/07/16 17:00 01/08/16 23:32 7429-90-5
Copper ND ug/L 2.5 1 01/07/16 17:00 01/08/16 23:32 7440-50-8
Iron ND ug/L 25.0 1 01/07/16 17:00 01/08/16 23:32 7439-89-6
Lead ND ug/L 2.5 1 01/07/16 17:00 01/08/1623:32 7439-92-1
Manganese ND ug/L 2.5 1 01/07/1617:00 01/08/1623:32 7439-96-5
Sodium 84100 ug/L 2500 1 01/07/1617:00 01/08/16 23:32 7440-23-5
Zinc 21.6 ug/L 2.5 1 01/07/16 17:00 01/08/16 23:32 7440-66-6
2540C Total Dissolved Solids Analytical Method:SM 2540C
Total Dissolved Solids 277 mg/L 25.0 1 01/07/16 19:56
2540D Total Suspended Solids Analytical Method:SM 2540D
Total Suspended Solids ND mg/L 2.9 1 01/07/1617:13
Total Nitrogen Calculation Analytical Method:TKN+NO3+NO2 Calculation
Total Nitrogen 0.15 mg/L 0.12 1 01/26/16 16:44
300.0 IC Anions 28 Days Analytical Method:EPA 300.0
Fluoride 0.70 mg/L 0.25 1 01/11/16 17:48 16984-48-8
350.1 Ammonia Analytical Method:EPA 350.1
Nitrogen,Ammonia ND mg/L 0.050 1 01/13/1608:39 7664-41-7
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2
Nitrogen,KjeldaN,Total ND mg/L 0.25 1 01/12/16 14:40 7727-37-9
353.2 Nitrogen,NO2/NO3 pros. Analytical Method:EPA 353.2
Nitrogen,NO2 plus NO3 0.15 ng/L 0.010 1 01/13/16 17:59
385.1 Phosphorus,Total Analytical Method:EPA 365.1
Phosphorus ND mg/L 0.025 1 01/20/16 14:10 7723-14-0
4500 Chloride Analytical Method:SM 4500-CI-E
Chloride 2.8 mg/L 0.50 1 01/12/1620:51 16887-00-6
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 4 of 26

Pace Analytical Services,Inc.
/�,.,,�• 9800 Klncey Ave. Suite 100
UIJFV IQHuntersyile,NC 28078
wwepaeelebtcom [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: MPRPI20431 Analysis Method: EPA 200.7
QC Batch Method: EPA 200.7 Analysis Description: 200.7 MET
Associated Lab Samples: 92282039001
METHOD BLANK 1642489 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Aluminum ug/L ND 50.0 01/08/16 22:52
Copper ug/L ND 2.5 01/08/16 22:52
Iron ug/L ND 25.0 01/08/16 22:52
Lead ug/L ND 2.5 01/08/16 22:52
Manganese ug/L 3.8 2.5 01/08/16 22:52
Sodium tg/L ND 2500 01/08/16 22:52
Zinc ug/L ND 2.5 01/08/16 22:52
LABORATORY CONTROL SAMPLE: 1642490
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Aluminum ug/L 5000 4630 93 85-115
Copper ug/L 500 470 94 85-115
Iron ug/L 5000 4620 92 85-115
Lead ug/L 500 467 93 85-115
Manganese ug/L 500 464 93 85-115
Sodium ug/L 5000 4720 94 85-115
Zinc ug/L 500 467 93 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1642491 1642492
MS MSD
92281970001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Aluminum ug/L ND 5000 5000 4660 4480 93 89 70-130 4
Copper ug/L 14.6 500 500 487 466 94 90 70-130 4
Iron ug/L 32300 5000 5000 39200 37500 138 104 70-130 4 M1
Lead ug/L ND 500 500 434 419 87 84 70-130 3
Manganese ug/L 2950 500 500 3810 3480 133 104 70-130 4 M1
Sodium ug/L 525000 5000 5000 559000 543000 692 358 70-130 3 M1
Zinc ug/L 0.66 500 500 1190 1140 105 96 70-130 4
mg/L
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1642493 1642494
MS MSD
92282045001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Aluminum ug/L ND 5000 5000 4680 4530 92 89 70-130 3
Results presented on this page am In the units Indicated by the"Units'column except wham an alumna unit is presented to the right of the reewt.
REPORT OF LABORATORY ANALYSIS
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Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 5 of 26

Pace Analytical Services,Inc.
//gy�pp A�1^�e^� g a 9800 Kincey Ave. Suite 100
W/'VM Huntemrile,NC 28078
wuwpspelabsoom [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1642493 1642494
MS MSD
92282045001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Copper ug/L 8.7 500 500 471 452 92 89 70-130 4
Iron ug/L 294 5000 5000 4800 4610 90 86 70-130 4
Lead ug/L ND 500 500 441 429 88 86 70-130 3
Manganese ug/L 836 500 500 1340 1280 100 85 70-130 6
Sodium ug/L 33300 5000 5000 39800 37500 130 84 70-130 6
Zinc ug/L 25.2 500 500 474 458 90 86 70-130 4
Results presented on this page Sr.in the units Indicated by the"UMW column except eters an alternate unit is pneeMW to the right at the mut
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 6 of 26

Pace Analytical Services,Inc.
//9�pp//����e,�.a�� /���g • 9800 Kincey Ave. Suite 180
(9 Pace
HuntenWle,NC 28078
awageseba.kom [phone]
•
QUALITY CONTROL DATA
Project Backwash Sampling
Pace Project No.: 92282039
QC Batch: WET/42357 Analysis Method: SM 2540C
QC Batch Method: SM 2540C Analysis Description: 2540C Total Dissolved Solids
Associated Lab Samples: 92282039001
METHOD BLANK: 1643261 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Dissolved Solids mg/L ND 25.0 01/07/16 19:55
LABORATORY CONTROL SAMPLE: 1643262
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Dissolved Solids mg/L 250 254 102 90-110
SAMPLE DUPLICATE: 1643263
92281875001 Dup
Parameter Units Result Result RPD Qualifiers
Total Dissolved Solids mg/L 3010 2520 18 D6
SAMPLE DUPLICATE: 1643264
92281884001 Dup
Parameter Units Result Result RPD Qualifiers
Total Dissolved Solids mg/L 327 347 6 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
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Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 7 of 26

Pace Analytical Services,Inc.
/��p�., 9800 Klncey Ave. Suite 100
W A a Huntersville,NC 28078
• mnxpteatebsoom [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WET/42352 Analysis Method: SM 2540D
QC Batch Method: SM 2540D Analysis Description: 2540D Total Suspended Solids
Associated Lab Samples: 92282039001
METHOD BLANK: 1643074 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mglL ND 2.5 01/07/16 17:09
LABORATORY CONTROL SAMPLE: 1643075
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 250 100 90-110
SAMPLE DUPLICATE: 1643076
92281897001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 12.8 12.6 2
SAMPLE DUPLICATE: 1643077
92282044001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L ND ND
antes presented on thls page are In the units Indicated by the"UMW column except weave an Monate unit Is presented to the right MIM moult
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 8 of 26

C •
Pace Analytical Services,Inc.
Qin' a 9800 kx ccy Ave. Sud,100
V IytW' HunternWlle,NC 28078
rrnwyame46sadn [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26027 Analysis Method: EPA 300.0
QC Batch Method: EPA 300.0 Analysis Description: 300.0 IC Anions
Associated Lab Samples: 92282039001
METHOD BLANK: 1644493 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Fluoride mg/L NO 0.25 01/11/16 13:15
LABORATORY CONTROL SAMPLE: 1644494
Spike LCS LCS %Rec
Parameter Units Conc. Result 96 Rec Limits Qualifiers
Fluoride mg/L 2.5 2.4 94 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1644495 1644496
MS MSD
92281820001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Fluoride mg& ND 2.5 2.5 2.5 2.5 91 91 90-110 1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1644497 1644498
MS MW
92282168001 Spike Spike MS MSD MS MW %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Fluoride mg/L 19.0 2.5 2.5 20.7 20.6 67 64 90-110 0 M6
Results presented on this page are In the units Indicated by the"Units"column except when an alternate unit Is presented to the right of the nee.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 9 of 26

Pace Analytical Services,Inc.
CQ�lytica f
Gi 9800 Kinney Ave. Suite 100
!a Huntenville,NC 28079
anwpecdobacan [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26049 Analysis Method: EPA 350.1
QC Batch Method: EPA 350.1 Analysis Description: 350.1 Ammonia
Associated Lab Samples: 92282039001
METHOD BLANK: 1645309 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Ammonia mg/L ND 0.050 01/13/16 07:30
LABORATORY CONTROL SAMPLE: 1645310
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Ammonia mg/L 5 5.0 99 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1645311 1645312
MS MSD
92282015001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,Ammonia mg/L 1.7 5 5 6.5 6.5 97 97 90-110 0
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1645313 1645314
MS MSD
92282062001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,Ammonia mg/L 8.7 5 5 13.6 13.5 98 97 90-110 0
Results presented on this page ere In the units indicated by the"Units"column except when 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 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 10 of 26

Pace Analytical Services,Inc.
CQ ^' • 9800 Kinsey Ave. Suite 100
/1 �i I '4P' Huntenville,NC 28078
ItwwpeCereat n
[phone]
•
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26029 Analysis Method: EPA 351.2
QC Batch Method: EPA 351.2 Analysis Description: 351.2 TKN
Associated Lab Samples: 92282039001
METHOD BLANK: 1844906 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,Kjeldahl,Total mg/L ND 0.25 01/12/16 14:24
LABORATORY CONTROL SAMPLE: 1644907
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,Kjeldahl,Total mg/L 10 11.0 110 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1644908 1644909
MS MSD
92280516007 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,Kjeldahl,Total mg/L ND 10 10 12.1 11.3 118 109 90-110 7 M1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1644910 1644911
MS MSD
92282015001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Nitrogen,lgeldahl,Total mg/L 2.7 10 10 12.8 13.5 101 108 90-110 5
aeeuks presented on this page ere in the units indicated by the'UMW column except whin an alternate unit Is presented to the right of to remit
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 11 of 26

Pace Analytical Services,Inc.
W A &tical a 9800 Kinsey Ave. Suite 100
VG HunronNlle,NC 28078
wer[papaNEtmm (704)/375-9092
•
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26061 Analysis Method: EPA 353.2
QC Batch Method: EPA 353.2 Analysis Description: 353.2 Nitrate+Nitrite,preserved
Associated Lab Samples: 92282039001
METHOD BLANK: 1646532 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Nitrogen,NO2 plus NO3 mg/L ND 0.010 01/13/16 17:36
LABORATORY CONTROL SAMPLE: 1646533
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Nitrogen,NO2 plus NO3 mg/L 2.5 2.4 97 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1646534 1646535
MS MSD
92280516007 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 0.25 2.5 2.5 2.7 2.7 99 99 75-125 0
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1646536 1646537
MS MSD
92282138001 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 16.3 2.5 2.5 21.1 21.2 194 196 75-125 0 M6
Results proaanted on this page are In the urges Indicated by tM"Unitc column except where an alternate unit Is presented to the right oftM result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 12 of 26

Pace Analytical Services,Inc.
CQ a yn' • 9800 Kimay Ave. Suite 100
`i IJV ice' Huntersae,NC 28078
wwx'.WPMaSaam [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26144 Analysis Method: EPA 365.1
QC Batch Method: EPA 365.1 Analysis Description: 365.1 Phosphorus,Total
Associated Lab Samples: 92282039001
METHOD BLANK 1650303 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Phosphorus mg/L ND 0.025 01/20/16 13:55
LABORATORY CONTROL SAMPLE: 1650304
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Phosphorus mg/L 2.5 2.6 104 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1650305 1650306
MS MSD
92282760001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Phosphorus mg/L 7.1 2.5 2.5 9.4 9.5 94 97 90-110 1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1650307 1650308
MS MSD
92282945007 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Phosphorus mg/L 88.3 2.5 2.5 94.0 97.6 225 369 90-110 4 M6
Results presented on this pipe ere 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 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 13 of 26

Pace Analytical Services,Inc.
2CeAnaiyttai• 9800 Kincay Ave. Suite 100
Hummrsville,NC 28078
• wewpeeMMarom [phone]
QUALITY CONTROL DATA
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: WETA/26042 Analysis Method: SM 4500-CI-E
QC Batch Method: SM 4500-CI-E Analysis Description: 4500 Chloride
Associated Lab Samples: 92282039001
METHOD BLANK: 1645084 Matrix: Water
Associated Lab Samples: 92282039001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chloride mg/L ND 0.50 01/12/1620:36
LABORATORY CONTROL SAMPLE: 1645085
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chloride mg/L 20 20.2 101 90-110
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1645086 1645087
MS MSD
92281796001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chloride mg/L 1600 5000 5000 1430 1410 -4 -4 90-110 1 M6
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 1645088 1645089
MS MSD
• 92282075002 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chloride mg/L 12.5 40 40 51.9 52.0 99 99 90-110 0
Results presented en this pans an In the units Indicated by the"Units"column except when 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 11:24 AM without the written consent of Pace Analytical Services.Inc.. Page 14 of 26

Pace Analytical Services,Inc.
ceAnalyhccal a 9800 Kincey Ave. Suite 100
�i Hunteisville,NC 28078
ermpsrelsEscmm
[phone]
1
ANALYTICAL RESULTS-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
Sample: Millard Oaks-0241225- Lab ID: 92282039001 Collected: 01/05/16 10:45 Received: 01/06/16 14:30 Matrix:Water
BWS
PWS: Site ID: Sample Type:
Parameters Method Act t Unc(MDC)Carr Trac Units Analyzed CAS No. Qua!
Gross Alpha EPA900.0 11.212.22 (2.13) pCUL 01/21/16 15:04 12587-46-1
C:NA T.NA
Gross Beta EPA 900.0 2.17 t 0.827 (1.42) pCi/L 01/21/16 15:04 12587-47-2
C:NA T.NA
Radium-226 EPA903.1 -0.12710.393 (0.896) pCi/L 01/27/16 12:25 13982-63-3
C:NA T!86%
Radium-228 EPA 904.0 0.618±0.354 (0.889) pCUL 01/27/16 12:46 15262-20-1
C:86%M86%
Strontium-90 EPA 905.0 -0.0320 t 0.204 (0.515) pCUL 01/18/16 07:03 10098-97-2
C:94%T.NA
Tritium EPA 906.0 94.4 t 144 (245) pCi/L 01/15/16 02:13 10028-17-8
C:NA T.NA
Total Uranium ASTM D5174-97 8.61 t 0.132 (0.193) ug/L 01/25/16 15:27 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 15 of 26

Pace Analytical Services,Inc.
ceAnalyltical•a 9800 Kincey Ave. Suite 100
ri Huntersville,NC 28078
i w,peWtlasan [phone]
{
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27567 Analysis Method: EPA 905.0
QC Batch Method: EPA 905.0 Analysis Description: 905.0 Strontium 89/90
Associated Lab Samples: 92282039001
METHOD BLANK: 1010882 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Carr Trac Units Analyzed Qualifiers
Strontium-90 0.138 t 0.200 (0.445)C:95%T:NA pCUL 01/18/16 07:02
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 Kinsey Ave. Suits 100
CGe/ IAI Huntenville,NC 28078
rerxrpeoalsbatnm
[phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27612 Analysis Method: EPA900.0
QC Batch Method: EPA 900.0 Analysis Description: 900.0 Gross Alpha/Beta
Associated Lab Samples: 92282039001
METHOD BLANK 1012723 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Cart Trac Units Analyzed Qualifiers
Gross Alpha -0.327±0.189 (0.787)C:NA T:NA pCi/L 01/21/16 19:30
Gross Beta -0.199±0.485 (1.19)C:NA T:NA pCi/L 01/21/16 19:30
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

Pane Analytical SiMces,Inc.
• 9800 Kinney Ave. Suite 100
aceAnalytical Huntereville,NC 28078
wwrpspaMsrxsn [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27566 Analysis Method: EPA906.0
QC Batch Method: EPA 906.0 Analysis Description: 906.0 Tritium
Associated Lab Samples: 92282039001
METHOD BLANK: 1010881 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Carr Trac Units Analyzed Qualifiers
Tritium 71.4 t 143 (244)C:NAT:NA pCilL 01/14/16 18:03
Results presented on this page are In the units indicated by dr"Unit"column except ween an altania%unit is presented to the right of lite 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.
e
9800 Kinsey Ave. Suite 100
aceAnalytical Huntereville,NC 28078
tnra•.pepaebacamr [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27603 Analysis Method: EPA 904.0
QC Batch Method: EPA 904.0 Analysis Description: 904.0 Radium 228
Associated Lab Samples: 92282039001
METHOD BLANK: 1010918 Matrix: Water
Associated Lab Samples:
Parameter Act±Unc(MDC)Carr Trac Units Analyzed Qualifiers
Radium-228 0.0936±0.319 (0.721)C:83%T:80% pCl/L 01/27/1612:45
Results presented on this paps 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 shell not be reproduced,except In full,
without the written consent of Pace Analytical Services,Inc. Page 19 of 26

Pace Analytical Services,Inc.
22ceAnalyticale9800 Kincey Ave. Suite 100
Huntenville,NC 28078
wrrxpecehss rern [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27582 Analysis Method: ASTM 05174-97
QC Batch Method: ASTM 05174-97 Analysis Description: D5174.97 Total Uranium KPA
Associated Lab Samples: 92282039001
METHOD BLANK: 1010897 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Carr Trac Units Analyzed Qualifiers
Total Uranium 0.006 t 0.000 (0.193)C:NA TTNA ug/L 01/18116 12:41
Results presented on MIs page an In the units Indicated by the"Unite column except when an alternate unit Is presented to the right of are result
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full.
without the written consent of RaceAnalytcal Services,Inc.. Page 20 of 26

Pace Analytical SamIcn,Inc.
ceAnalytical a 9800 Kincey Ave. Suite 100
Huntemyille,NC 28078
wawpseaebtosm [phone]
QUALITY CONTROL-RADIOCHEMISTRY
Project: Backwash Sampling
Pace Project No.: 92282039
QC Batch: RADC/27598 Analysis Method: EPA 903.1
QC Batch Method: EPA 903.1 Analysis Description: 903.1 Radium-226
Associated Lab Samples: 92282039001
METHOD BLANK: 1010913 Matrix: Water
Associated Lab Samples:
Parameter Act t Unc(MDC)Carr Trac Units Analyzed Qualifiers
Radium-226 0.114 t 0.387 (0.747)C:NA T:93% pClll 01/27/16 12:01
Results presented on this page are In the units Indicated by the"Units"column except where an alternate unit Is presented to the tight of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except In full,
without the written consent of Pace Analytical SerAces,Inc.. Page 21 of 26

Pace Analytical Services,Inc.
7CBA11W Jf LiL&l e 9800 Klncey Ave. Suite 100
G Huntenvllle,NC 28078
aewpacelefi&own [phone]
• QUALIFIERS
Project: Backwash Sampling
Pace Project No.: 92282039
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-Nltrosodiphenylamine 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
PAST-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 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 22 of 28

Pace Analytical Services,Inc.
C8�41k lytiCc71• 9800 Kincey Ave. Suite 100
�i Huntersville,NC 28078
aexpseesbsmm (704)8759092
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Backwash Sampling
Pace Project No.: 92282039
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92282039001 WIIIIard Oaks-0241225-BWS EPA 200.7 MPRP/20431 EPA 200.7 ICP/18432
92282039001 WIIIIard Oaks-0241225-BWS EPA 900.0 RADC/27612
92282039001 WIIIIard Oaks-0241225-BWS EPA 903.1 RADC/27598
92282039001 WIIIIard Oaks-0241225-BWS EPA 904.0 RADC/27603
92282039001 WIIIIard Oaks-0241225-BWS EPA905.0 RADC/27567
92282039001 WIIIIard Oaks-0241225-BWS EPA 906.0 RADC/27566
92282039001 WIIIIard Oaks-0241225-BWS ASTM D5174-97 RADC/27582
92282039001 WIIIIard Oaks-0241225-BWS SM 2540C WET/42357
92282039001 WIIIIard Oaks-0241225-BWS SM 2540D WET/42352
92282039001 WIIIIard Oaks-0241225-BWS TKN+NO3+NO2 WET/42691
Calculation
92282039001 WIIIIard Oaks-0241225-BWS EPA 300.0 WETA26027
92282039001 Millard Oaks-0241225-BWS EPA 350.1 WETA/26049
92282039001 WIIIIard Oaks-0241225-BWS EPA 351.2 WETA/26029
92282039001 Millard Oaks-0241225-BWS EPA 353.2 WETA/26061
92282039001 WIIIIard Oaks-0241225-BWS EPA 365.1 WETN26144
92282039001 WIIIIard Oaks-0241225-BWS SM 4500-CI-E WETN26042
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:02/24/2016 11:24 AM without the written consent of Pace Analytical Services,Inc.. Page 23 of 26

Document Name: Document Revised:260CT2015
Sample Condition Upon Receipt(SCUR) Page 1 of 2
geAnalyticaf Document No.: Issuing Authority:
• F-CHR-CS-003-rev.17 Pace Huntersville Quality Office
Sample Condition Client Name: l-1 C� `�- J L vi 111L.u�r:c'ti e0< j �"
Upon Receipt Pro ect#; WO# a 92 282039
Courier: ❑Fed Ex ❑UPS ❑USPS ❑Client 11111111111111 lel I III
❑Commercial (pace DOther: 92282039
Custody Seal on Cooler/Box Present? ales No Seals Intact? Oyes , No
Packing Material: ❑bubble Wrap [Bubble Bags ['None ❑Other:
Thermometer ❑T1505
Used: Type of Ice: ®Wet ❑Blue ❑None ❑Samples on ice,cooling process has begun
Cooler Temp Corrected(°C): / • 6 Biological Tissue Frozen? Dyes No• ❑N/A
Temp should be above freezing to 6°C Correction Factor: 0.0"C Date and Initials of Person Examining Contgnts: ,l} r--6-/E
USDA Regulated Soil( N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
❑Yes No including Hawaii and Puerto Rico)? EYes alNo
If Yes to either question,fill out a Regulated Soil Checklist and include with SCUR/COC paperwork.
COMMENTS:
Chain of Custody Present? ®Yes ONo ON/A 1.
Chain of Custody Filled Out? gYes ❑No ON/A 2.
Chain of Custody Relinquished? ®Yes ❑No ON/A 3.
Sampler Name and/or Signature on COC? ®Yes ONo ON/A 4.
Samples Arrived within Hold Time? ®Yes ONo ON/A 5.
Short Hold Time Analysis(<72 he)? ❑Yes No ON/A 6.
Rush Turn Around Time Requested? Dyes ®No ON/A 7.
Sufficient Volume? fYes ❑No ON/A 8.
Correct Containers Used? ©Yes ONo ON/A 9.
-Pace Containers Used? ®Yes ONo ON/A
Containers Intact? ®Yes ❑No ON/A 10.
Filtered Volume Received for Dissolved Tests? Dyes ®No ON/A 11. Note if sediment is visible in the dissolved container
Sample Labels Match COC? Oyes No ON/A 12. N d T(01Ei1)c;i fa., 's\ 3 cw,.yte
-Includes Date/Time/ID/Analysis Matrix: L,L L
All containers needing acid/base preservation have been
checked? ®Yes ONo ON/A 11
All containers needing preservation are found to be in
compliance with EPA recommendation?
(HNO3,H2SO4,HCI<2;NaOH>9 Sulfide,NaOH>12 Cyanide) ®Yes ❑No ON/A
Exceptions:VOA,Coliform,TOC,Oil and Grease,
DR0/8015(water)DOC,LLHg ❑Yes ) plo ON/A
Samples checked for dechiorization ) Yes ONo ON/A 14.
Headspace in VOA Vials(>5-6mm)? Oyes No ON/A 15. •
Trip Blank Present? Dyes ONo ON/A 16.
Trip Blank Custody Seals Present? [(Yes c2No ON/A
Pace Trip Blank Lot q(if purchased):
CLIENT NOTIFICATION/RESOLUTION Field Data Required? Dyes ❑No
Person Contacted: Date/Time:
Comments/Resolution:
Project Manager SCURF Review: Date: 1/1
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

�4r��,� CHAIN-OF-CUSTODY I Analytical Request Document co
The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately.
rn
Section A N
Section B Section C g>
Required Client information: Required Project Information: Invoice Information: Page- 1 Of 1 0_
Company: Aqua North Carolina Report To: Debbie Gentry Attention:
Address: 4163 Sinclair St. Copy To: Company Name:
Denver,NC 26037 Address: - Regulatory Agency
Email: [e-mail] Purchase Order#: Paco Quote:
Phone: [phone] Fax Project Name: Backwash Sampli •Kits Pace Project Manager: taylor.ezell.rpacelabs.com, State/Location
Requested Due Date: Project#: Pace Profile it [;4 i Z 1-,3
—�
Requested Analysts Flltered(Y/N}
c
a Z
MATRIx CODE e U COLLECTED Z Preservatives >'-
DrokngW,ta� ow m O '.C� Z Y--
Ware WT 3 u o d _
Waste Wale; WW Iil Q m
ProdnO I' o: =1' in mit m .o z
SAMPLE ID Sos�sosd SL 9 d E r
9a OL k? START END N F- m N 2 m E m
One Character per box. wipe WPut Lu
o w y E ry >, ¢ c
(AZ •
,09/, } AN
OT O o_ w a m u�i ro to
LL Wc
Sample Ids must be unique u Z M 5+ m o .,',7
c�
TtmVo 75 x w O n e D c l0 m j b Z ~ 7
W E a- n cu.'.
m p M x c E mom! L..�. 4 1
~-
i N DATE TIME DATE TIME so ) = Z = Z z 1 o ¢ it i- 0 i- F r4 t
WT 1/J �'/� /}•I� I 0 / (1.. Iron.Copier,Zinc,Lead,
1 W I da Oaks-02-41-225-BWS-Wells I&2-Backwash X X X X X X X Manganese.. Le
Iron.Copper.Zinc.Lead,
(Fleetwood Acres-01-36-133-BWS-Well#4-Backwash ,WT X X X X X X X Manganese.Aluminum
Iron.Copper,Zinc.Lead,
3 Ole South Lane-01-36-280-BWS-Well#1-Backwash WT X X X X X X X Manganese,Aluminum
4 Iron,Copper.Zinc.Lead.
River Run-02-79-177-BWS-Wells 3&4-Backwash WT X X X X X X X Manganese,Aluminum
Iron.Copper,Zinc,Lead.
5 Sundown Cove-20-49-006-BWS-Well#2-Backwash WT X X X X .X X X Manganese,Aluminum
6 Iron,Copper,Zinc,Lead,
Sunset Hilts-99.18-156-BWS-Well#3-Backwash WT X X X X X X X Manganese,Aluminum t
7
8
9
10
11
12
j '. ADDITIONAL COMMENTS . : ,1 RELINQUISHED BY/AFFILIATION • `DATE TIME ACCEPTED BY/AFFILIATION: ' DATE 11ME' - 'SAMPLE CONDfT1ONSI
Alpha emitters•excluding radon and uranmm(pCUL).Beta emitters.exclumng / -
Potassium-40 and other naturally ocwmng radwnuciides ,�L,--"--..\---.T' ' '/;/f0 I� J1) 1 i2 -) t(.� (j`_ !-1..,.((.: /4.--3C �' C /� tJ
(pCirt),Strontium-90(pCUL),Tritium(pCitL),Uranium(ug/L),Radium-226 -mayf^ - /-
(pCJL),Rattan 228)(pCUI),Total iron(eg/L),Total i ././-`� -..7-1,----""--........---
1r(,/r6 j,.j U. .n )
copper OWL),Total Chloride(ug/L),Total Zinc(ug/L),Total Lead Mk).Total / G ! '2I/
.//`
manganese(ugfL),Total aluminum lug/l).Fluoride / /.6 I i.3
dissoMed solids(mgIL),TSS(mgiL),pH(au) :/: (,
SAMPLER NAME AND SIGNATURE '
c
PRINT Name of SAMPLER: • U o
SIGNATURE of SAMPLER: -�'-7 7/ I DATE Signed: �te%I l a - d `m -

ce�wr�(car CHAIN-OF-CUSTODY/Analytical Request Document N
The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately.y. (0
N
Section A Section B 5)
Section C m
Required Client Information: Required Project Information: m
Invoice Information: Page: 1 Of 1 a_
Company Aqua North Carolina Report To: Debbie Gentry Attention:
Address: 4163 Sinclair SI. Copy To;
Company Name;
Denver,NC 28037
Address: Regulatory Agency
Email: [e-mail] Purchase Order#: Pace Quote:
Phone: [phone] IFax Project Name:
Backwash Sampling Kits Pace Project Manager: taylor,ezallepacelabs.com, State/Location
Requested Due Date Project#; Pace Profile#:
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2 Fleetwood Acres-01-36-133 BWS-Well#4-Backwash WT Iron,copper,Zinc,Lead
X X XX X XX Manganese.Akminum
3 Ole South Lane-01-36-280-BWS-Well#1-Backwash WT Iron,Copper,Zinc,Lead, i
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4 River Run-02-79-177-BWS-Wells 3&4-Backwash WT , }r1'/ '--
X X X X XX X Manganese Aluminum
5 Sundown Cove-20-49-006-BWS-Well#2-Backwash WT iron.Copper,Zinc,Lead.
X X X X X X X Manganese,Aluminum
6 Sunset Hills-99-16-158-BWS-Well#3-Backwash WT on,Copper,Z nc,Lead,
XX XX XXX Manganese,Aluminum
7
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AOOMONAL COMMENTS ,.ii, ..RELIN�t11SNED BY/AFFIUATION DATE 'TIME:' ACCEPTED BY I AFFILIATION DATE TIME SAMPLE CONDITIONS
Alpha emitters,exGudng radon and uranium(RCA.).Hsu smilers,excluding /,rte ��/ /� _ r - ` ��''11 y )
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copper(ug7).Total Chloride(KA),Total Zinc(uBrl-).Total Lead(W!L).Total j1.-,A--:ii /'"J�
manganeseNg/L),Total aluminum(unit.).Fluoride :�'- 'l/ / ///"f /Z,// /7,..:0! ,.
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ANC - Greystone Subdivision WWTP
NPDES Permit No. NC0078115
Application for Permit Modification
River Run Well System Uranium Filter Backwash
Sample Results
Parameter Concentration Units
Aluminum 268 ug/I
Iron 13000 ug/I
Manganese 154 ug/I
Copper 98.4 ug/I
Sodium 10100 ug/I
Zinc 241 ug/I
TDS 249 mg/I
TSS 43.7 mg/I
Total nitrogen 23.6 mg/I
Fluoride ND mg/I
Ammonia nitrogen ND mg/I
Total Kjeldahl nitrogen ND mg/I
Nitrogen, NO2 + NO3 23.6 mg/I
Phosphorous 0.51 mg/I
Chloride 12 mg/I
Gross Alpha 317 pCi/I
Gross Beta 226 pCi/I
Radium-226 5.87 pCi/I
Radium-228 0.627 pCi/I
Strontium-90 0.112 pCi/I
Tritium 28.6 pCi/I
Total uranium 75.9 ug/I
pH 7.7 s.u.
TRC 1.84 mg/I

PAT MCCRORY
(ioverur
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Water Resources D,,ecrar
ENVIRONMENTAL QUALITY
July 7, 2016
Mr. Thomas J. Roberts, President
Aqua North Carolina, Inc.
202 Mackenan Court
Cary,NC 27511
Subject: Permit Modification
Application No.NC0078115
Greystone Subdivision WWTP
Forsyth 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 Sonia Gregory at 919-807-6333 or [e-mail].
Sincerely,
ZeleAt ? €4
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winton-Salem 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