NC0020290_Renewal Application_20150331

Theresa Coletta Town Of burn viRc 'ow dors:
If
a) 1`uth L. Banks
Judy Buchanan
Jeanne Martin �It,o suQN`s, Ron PuWell
Town Cleik Ao `�� William D. Wheeler
Jadd Brewer
Water quality Lab & Operations
1522 Tynecastle Highway �2ECEIVEDIDENRIDWR
Banner Elk, NC 28604
March 24, 2015 MAR 3 1. 2015
Ms. Wren Thedford WaterQua1hy
NC DENR/DWR/ NPDES Permitting Secdon
1617 Mail Service Center
Raleigh, NC 27699-161
Dear Ms. Wren Thedford:
This is a request for renewal of the permit for Town of Burnsville Waste Water Treatment Plant. We
have included the required 1 original set and 2 copy sets of the following:
• Written documentation showing authority delegated to us, the Authorized Representative
• Application Form
• 3 Priority Pollutant Analysis Tests
0 Sludge Management Plan for the Facility
• 4 Detailed Maps with Narrative
The 4 toxicity tests will be completed by doing one each in the months of April, May,June and July. As
soon as the completed reports are available,they will be forwarded to you along with the completed
Part E section of the application form.
There have been no changes since the last permit.
Sincer ,
Jadd ew
W er ality Lab & Operations
P.O. Box 97 0 Burniwille, Nofth Carolina 28714 • Phone [phone] FAX [phone]

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
FORM
2A NPDES FORM 2A APPLICATION OVERVIEW
NPDES
APPLICATION OVERVIEW
Form 2A has been developed in a modular format and consists of a "Basic Application Information" packet
and a "Supplemental Application Information" packet. The Basic Application Information packet is divided
into two parts. All applicants must complete Parts A and C. Applicants with a design flow greater than or
equal to 0.1 MGD must also complete Part B. Some applicants must also complete the Supplemental
Application Information packet. The following items explain which parts of Form 2A you must complete.
BASIC APPLICATION INFORMATION:
A. Basic Application Information for all Applicants. All applicants must complete questions A.1 through A.8. A treatment works
that discharges effluent to surface waters of the United States must also answer questions A.9 through A.12.
B. Additional Application Information for Applicants with a Design Flow>_0.1 MGD. All treatment works that have design flows
greater than or equal to 0.1 million gallons per day must complete questions B.1 through 13.6.
C. Certification. All applicants must complete Part C(Certification).
SUPPLEMENTAL APPLICATION INFORMATION:
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waters of the United States and meets
one or more of the following criteria must complete Part D(Expanded Effluent Testing Data):
1. Has a design flow rate greater than or equal to 1 MGD,
2. Is required to have a pretreatment program(or has one in place), or
3. Is otherwise required by the permitting authority to provide the information.
E. Toxicity Testing Data. A treatment works that meets one or more of the following criteria must complete Part E(Toxicity Testing
Data):
1. Has a design flow rate greater than or equal to 1 MGD,
2. Is required to have a pretreatment program(or has one in place), or
3. Is otherwise required by the permitting authority to submit results of toxicity testing.
F. Industrial User Discharges and RCRA/CERCLA Wastes. A treatment works that accepts process wastewater from any
significant industrial users(SIUs)or receives RCRA or CERCLA wastes must complete Part F(Industrial User Discharges
and RCRA/CERCLA Wastes). SIUs are defined as:
1. All industrial users subject to Categorical Pretreatment Standards under 40 Code of Federal Regulations(CFR)403.6 and
40 CFR Chapter I, Subchapter N(see instructions); and
2. Any other industrial user that.
a. Discharges an average of 25,000 gallons per day or more of process wastewater to the treatment works(with certain
exclusions);or
b. Contributes a process wastestream that makes up 5 percent or more of the average dry weather hydraulic or organic
capacity of the treatment plant;or
C. Is designated as an SIU by the control authority.
G. Combined Sewer Systems. A treatment works that has a combined sewer system must complete Part G(Combined Sewer
Systems).
ALL APPLICANTS MUST COMPLETE PART C (CERTIFICATION)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 1 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
BASIC APPLICATION INFORMATION
PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatment works must complete questions A.1 through A.8 of this Basic Application Information Packet.
A.1. Facility Information.
Facility Name Town of Burnsville WWTP
Mailing Address P O Box 1167
Banner Elk NC 28604
Contact Person Jadd Brewer
Title ORC
Telephone Number [phone]
Facility Address 812 Pine Swamp Road
(not P.O.Box) Burnsville. NC 28714
A.2. Applicant Information. If the applicant is different from the above,provide the following:
Applicant Name Town of Burnsville t+ 1
Mailing Address P O Box 97
SWR
Burnsville.NC 28714
Contact Person Anthony Hensley AR 3 1 2015
Title Public Works Director P Water Quality
Qvcuon
Telephone Number [phone]
Is the applicant the owner or operator(or both)of the treatment works?
® owner ❑ operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
® facility ❑ applicant
A.3. Existing Environmental Permits. Provide the permit number of any existing environmental permits that have been issued to the treatment works
(include state-issued permits).
NPDES NCO020290 PSD
UIC Other
RCRA Other
A.4. Collection System Information. Provide information on municipalities and areas served by the facility. Provide the name and population of each
entity and.if known,provide information on the type of collection system(combined vs.separate)and its ownership(municipal,private,etc.).
Name Population Served Type of Collection System Ownership
Town of Burnsville 1051 Separate Burnsville
Total population served 1051
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 2 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
A.5. Indian Country.
a. Is the treatment works located in Indian Country?
❑ Yes ® No
b. Does the treatment works discharge to a receiving water that is either in Indian Country or that is upstream from(and eventually flows
through)Indian Country?
❑ Yes ® No
A.S. Flow. Indicate the design flow rate of the treatment plant(i.e.,the wastewater flow rate that the plant was built to handle). Also provide the
average daily flow rate and maximum daily flow rate for each of the last three years. Each year's data must be based on a 12-month time period
with the 12°i month of'this year'occurring no more than three months prior to this application submittal.
a. Design flow rate 0.800 MGD
Two Years Aao Last Year This Year
b. Annual average daily flow rate 0.485 0.590 0.492
C. Maximum daily flow rate 1.030 1.545 1.197
A.7. Collection System. Indicate the type(s)of collection system(s)used by the treatment plant. Check all that apply. Also estimate the percent
contribution(by miles)of each.
® Separate sanitary sewer 100 %
❑ Combined storm and sanitary sewer %
A.S. Discharges and Other Disposal Methods.
a. Does the treatment works discharge effluent to waters of the U.S.? ® Yes ❑ No
If yes,list how many of each of the following types of discharge points the treatment works uses:
i. Discharges of treated effluent 1
ii. Discharges of untreated or partially treated effluent 0
iii. Combined sewer overflow points 0
iv. Constructed emergency overflows(prior to the headworks) 0
V. Other 0
b. Does the treatment works discharge effluent to basins,ponds,or other surface impoundments
that do not have outlets for discharge to waters of the U.S.? ❑ Yes ® No
If yes,provide the following for each surface impoundment:
Location:
Annual average daily volume discharge to surface impoundment(s) 0 MGD
Is discharge ❑ continuous or ❑ intermittent?
C. Does the treatment works land-apply treated wastewater? ❑ Yes ® No
If yes,provide the following for each land application site:
Location:
Number of acres:
Annual average daily volume applied to site: 0 MGD
Is land application ❑ continuous or ❑ intermittent?
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works? ❑ Yes ® No
EPA Form 3510-2A(Rev.1-99). Replaces EPA fors 7550-6&7550-22. Page 3 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
If yes,describe the mean(s)by which the wastewater from the treatment works is discharged or transported to the other treatment works
(e.g.,tank truck,pipe).
If transport is by a party other than the applicant,provide:
Transporter Name
Mailing Address
Contact Person
Title
Telephone Number
For each treatment works that receives this discharge,provide the following:
Name
Mailing Address
Contact Person
Title
Telephone Number ( 1
If known,provide the NPDES permit number of the treatment works that receives this discharge
Provide the average daily flow rate from the treatment works into the receiving facility. MGD
e. Does the treatment works discharge or dispose of its wastewater in a manner not included
in A.8.through A.8.d above(e.g.,underground percolation,well injection): ❑ Yes ® No
If yes,provide the following for each disposal method:
Description of method(including location and size of site(s)if applicable):
Annual daily volume disposed by this method:
Is disposal through this method ❑ continuous or ❑ intermittent?
EPA Forth 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 4 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
WASTEWATER DISCHARGES:
H you answered"Yes"to question A.B.a,complete questions A.9 through A.12 once for each outfall(including bypass points)through
which effluent Is discharged. Do not include Information on combined sewer overflows in this section. If you answered"No"to question
A.8.a.go to Part B."Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 MGD.'
A.g. Description of Outfall.
a. Outfall number 1
b. Location Burnsville 28714
(City or town,if applicable) (Zip Code)
Yancey NC
(County) (State)
350 54' 17' 821 19' 59"
(Latitude) (Longitude)
C. Distance from shore(if applicable) n/a ft.
d. Depth below surface(if applicable) n/a ft.
e. Average daily flow rate .522 MGD
f. Does this outfall have either an intermittent or a periodic discharge? ❑ Yes ® No (go to A.g.g.)
If yes,provide the following information:
Number f times per year discharge occurs:
Average duration of each discharge:
Average flow per discharge: MGD
Months in which discharge occurs:
g. Is outfall equipped with a diffuser? ❑ Yes ® No
A.10. Description of Receiving Waters.
a. Name of receiving water Cane River
b. Name of watershed(if known)
United States Soil Conservation Service 14-digit watershed code(if known):
C. Name of State ManagemenURiver Basin(if known):French Broad
United States Geological Survey 8-digit hydrologic cataloging unit code(if known):
d. Critical low flow of receiving stream(if applicable)
acute n/a cis chronic n/a cis
e. Total hardness of receiving stream at critical low flow(if applicable): n/a mg/I of CaCO3
EPA Forth 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550.22. Page 5 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
A.11. Description of Treatment
a. What level of treatment are provided? Check all that apply.
❑ Primary ® Secondary
❑ Advanced ❑ Other. Describe:
b. Indicate the following removal rates(as applicable):
Design BOD5 removal or Design CBOD5 removal 85 %
Design SS removal 85 %
Design P removal 75 %
Design N removal 75 %
Other %
C. What type of disinfection is used for the effluent from this outfall? If disinfection varies by season,please describe:
chlorine
If disinfection is by chlorination is dechlorination used for this outfall? ® Yes ❑ No
Does the treatment plant have post aeration? ❑ Yes ® No
A.12. Effluent Testing Information. All Applicants that discharge to waters of the US must provide effluent testing data for the following
parameters. Provide the indicated effluent testing required by the permitting authority for each outfall through which effluent is
discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data
collected through analysis conducted using 40 CFR Part 136 methods. In addition,this data must comply with QA/QC requirements of
40 CFR Part 136 and other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a
minimum,effluent testing data must be based on at least three samples and must be no more than four and one-half years apart.
Outfall number: 001
MAXIMUM DAILY VALUE AVERAGE DAILY VALUE
PARAMETER
Value Units Value Units Number of Samples
pH(Minimum) 6.25 s.u.
pH(Maximum) 6.75 S.U.
Flow Rate 1.545 mg/d ,522 mg/d 3
Temperature(Winter) 8 C 5.33 C 3
Temperature(Summer) 26 C 23.66 C 3
'For pH please report a minimum and a maximum daily value
MAXIMUM DAILY AVERAGE DAILY DISCHARGE
DISCHARGE ANALYTICAL
POLLUTANT METHOD ML/MDL
Conc. Units Conc. Units Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN BOD5 7.2 m /I 5.66 m /l 3 SM-52108 2.0
DEMAND(Report one) CBOD5 - _ - - _ _
FECAL COLIFORM 1600 m /I 30 Mg/1 3 SM-9222D 1
TOTAL SUSPENDED SOLIDS(TSS) 30 mg/I 8.66 mg/1 3 SM-2540D 1
END OF PART A.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 6 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
BASIC APPLICATION INFORMATION
PART B. ADDITIONAL APPLICATION INFORMATION FOR APPLICANTS WITH A DESIGN FLOW GREATER THAN OR
EQUAL TO 0.1 MGD(100,000 gallons per day).
All applicants with a design flow rate>_0.1 MGD must answer questions B.1 through B.6. All others go to Part C(Certification).
B.1. Inflow and Infiltration. Estimate the average number of gallons per day that flow into the treatment works from inflow and/or infiltration.
0.030 gpd
Briefly explain any steps underway or planned to minimize inflow and infiltration.
Leaks are being fixed as they are found and some dying of lines are being done.
B.2. Topographic Map. Attach to this application a topographic map of the area extending at least one mile beyond facility property boundaries. This
map must show the outline of the facility and the following information. (You may submit more than one map if one map does not show the entire
area.)
a. The area surrounding the treatment plant,including all unit processes.
b. The major pipes or other structures through which wastewater enters the treatment works and the pipes or other structures through which
treated wastewater is discharged from the treatment plant. Include outfalls from bypass piping,if applicable
c. Each well where wastewater from the treatment plant is injected underground.
d. Wells,springs,other surface water bodies,and drinking water wells that are: 1)within'/.mile of the property boundaries of the treatment
works,and 2)listed in public record or otherwise known to the applicant.
e. Any areas where the sewage sludge produced by the treatment works is stored,treated,or disposed.
f. If the treatment works receives waste that is classified as hazardous under the Resource Conservation and Recovery Act(RCRA)by truck,rail,
or special pipe,show on the map where the hazardous waste enters the treatment works and where it is treated,stored,and/or disposed.
B.3. Process Flow Diagram or Schematic. Provide a diagram showing the processes of the treatment plant,including all bypass piping and all
backup power sources or redunancy in the system. Also provide a water balance showing all treatment units,including disinfection(e.g.,
chlorination and dechlorination). The water balance must show daily average flow rates at influent and discharge points and approximate daily flow
rates between treatment units. Include a brief narrative description of the diagram.
B.4. Operation/Maintenance Performed by Contractor(s).
Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works the responsibility of a
contractor? ® Yes ❑ No
If yes,list the name,address,telephone number,and status of each contractor and describe the contractor's responsibilities(attach additional
pages if necessary).
Name: Water Quality Lab&Operations
Mailing Address: PO Box 1167
Banner Elk, NC 28604
Telephone Number: [phone]
Responsibilities of Contractor: Monitoring and Operations
B.S. Scheduled improvements and Schedules of Implementation. Provide information on any uncompleted implementation schedule or
uncompleted plans for improvements that will affect the wastewater treatment,effluent quality,or design capacity of the treatment works. If the
treatment works has several different implementation schedules or is planning several improvements,submit separate responses to question B.5
for each. (If none,go to question B.6.)
a. List the outfall number(assigned in question A.9)for each outfall that is covered by this implementation schedule.
None
b. Indicate whether the planned improvements or implementation schedule are required by local,State,or Federal agencies.
❑ Yes ® No
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 7 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
C. If the answer to 6.5.b is"Yes,"briefly describe,including new maximum daily inflow rate(if applicable).
d. Provide dates imposed by any compliance schedule or any actual dates of completion for the implementation steps listed below,as
applicable. For improvements planned independently of local,State,or Federal agencies,indicate planned or actual completion dates,as
applicable- Indicate dates as accurately as possible.
Schedule Actual Completion
Implementation Stage MM/DD/YYYY MM/DD/YYYY
Begin Construction l ! 1 I
End Construction
Begin Discharge
Attain Operational Level
e. Have appropriate permits/clearances concerning other Federal/State requirements been obtained? ❑ Yes ❑ No
Describe briefly:
B.6. EFFLUENT TESTING DATA(GREATER THAN 0.1 MGD ONLY).
Applicants that discharge to waters of the US must provide effluent testing data for the following parameters. Provide the indicated
effluent testing required by the permitting authority for each outfall through which effluent is discharged. Do not include information
on combine sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition,this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate
QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a minimum effluent testing data must be
based on at least three pollutant scans and must be no more than four and one-half years old.
Outfall Number: 001
MAXIMUM DAILY AVERAGE DAILY DISCHARGE
DISCHARGE ANALYTICAL
POLLUTANT METHOD ML/MDL
Conc. Units Conc. Units Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA(as N) .98 mg/I .72 mg/I 3 ammonia 0.5
CHLORINE(TOTAL <0.015 mg/l <0.015 mg/I 3 SM19 450OG 0.015
RESIDUAL,TRC)
DISSOLVED OXYGEN 6.5 mg/I 5 mg/I 3 SM19 450OG 0.1
TOTAL KJELDAHL 8.98 mg/1 7.79 mg/I 3 SM19 450ON 0.5
NITROGEN(TKN)
NITRATE PLUS NITRITE 8.01 mg/I 5.68 mg/1 3 SM19 450ON 0.08
NITROGEN
OIL and GREASE <5 mgfl 4.13 mg/1 3 SM19 55208 5
PHOSPHORUS(Total) 5.17 mg/l 3.16 mg/I 3 EPA 365.2 0.5
TOTAL DISSOLVED SOLIDS 349 mg/I 264.6 mg/I 3 SM19 2540C 1
(TDS)
OTHER Hardness 77.8 mg/I 38.03 mg/I 3 SM19 2340B 0.662
END OF PART B.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 8 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
BASIC APPLICATION INFORMATION
PART C. CERTIFICATION
All applicants must complete the Certification Section. Refer to instructions to determine who is an officer for the purposes of this
certification. All applicants must complete all applicable sections of Form 2A,as explained in the Application Overview. Indicate below which
parts of Form 2A you have completed and are submitting. By signing this certification statement,applicants confirm that they have reviewed
Form 2A and have completed all sections that apply to the facility for which this application is submitted.
Indicate which parts of Form 2A you have completed and are submitting:
® Basic Application Information packet Supplemental Application Information packet:
® Part D(Expanded Effluent Testing Data)
® Part E(Toxicity Testing: Biomonitoring Data)
® Part F(Industrial User Discharges and RCRA/CERCLA Wastes)
❑ Part G(Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel property gather and evaluate the information submitted. Based on my inquiry of the person or persons who
manage the system or those persons directly responsible for gathering the information,the information is,to the best of my knowledge and belief,true,
accurate,and complete I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment
for knowing violations.
Name and official title A?Vftnv Hensley Public Works Director
Signature
Telephone number [phone] 68
Date signed , 7 "73--
Upon
2 S—'Upon request of the permitting authority,you must submit any other information necessary to assure wastewater treatment practices at the treatment
works or identify appropriate permitting requirements.
SEND COMPLETED FORMS TO:
NCDENR/ DWQ
Attn: NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 9 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
SUPPLEMENTAL APPLICATION INFORMATION
PART D. EXPANDED EFFLUENT TESTING DATA
Refer to the directions on the cover page to determine whether this section applies to the treatment works.
Effluent Testing: 1.0 MGD and Pretreatment Works. If the treatment works has a design flow greater than or equal to 1.0 MGD or it has(or is required
to have)a pretreatment program,or is otherwise required by the permitting authority to provide the data,then provide effluent testing data for the following
pollutants. Provide the indicated effluent testing information and any other information required by the permitting authority for each outfall through which
effluent is discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data collected
through analyses conducted using 40 CFR Part 136 methods. In addition,these data must comply with QA/QC requirements of 40 CFR Part 136 and
other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. Indicate in the blank rows provided below
any data you may have on pollutants not specifically listed in this form. At a minimum,effluent testing data must be based on at least three pollutant
scans and must be no more than four and one-half years old.
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL ML/MDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
METALS(TOTAL RECOVERABLE),CYANIDE,PHENOLS,AND HARDNESS.
ANTIMONY mg/I mg/I 3 EPA 200.7 0.025
ARSENIC mg/I ' mg/I 3 EPA 200.7 0.01
BERYLLIUM mg/I ' mg/I 3 EPA 200.7 0.005
CADMIUM mg/I mg/I 3 EPA 200.7 0.002
CHROMIUM 0.001 mg/I .0028 Ib/d 0.0003 mg/I .0009 Ib/d 3 EPA 200.7 0,005
COPPER 0.069 mg/I .197 Ib/d 0.026 mg/I .074 Ib/d 3 EPA 200.7 0.002
LEAD mg/I ' mg/I 3 EPA 200.7 0.01
MERCURY mg/I ' mg/I 3 EPA 245.1 0.0001
NICKEL 0.006 mg/I .017 Ib/d 0.0026 mg/I .0074 Ib/d 3 EPA 2003 0.01
SELENIUM ' mg/I ' mg/I 3 EPA 200.7 0.01
SILVER 0.001 mg/I .0028 Ib/d 0.0003 mg/I .0009 Ib/d 3 EPA 200.7 0.005
THALLIUM mg/1 mg/I 3 EPA 200.7 0.02
ZINC 0.063 mg/I .180 Ib/d 0.039 mg/l .111 Ib/d 3 EPA 200.7 0.01
CYANIDE 0.006 mg/I .017 Ib/d 0.002 mg/I .005 Ib/d 3 SM19 4500C 0.005
TOTAL PHENOLIC 0.019 mg/I .054 Ib/d 0.01 mg/I .028 Ib/d 3 EPA 420.1 0.01
COMPOUNDS
HARDNESS(as CaCO3) 77.8 mg/I 220.60 Ib/d 38.03 mg/I 109.10 Ib/d 3 SM 19 2340B 0.662
Use this space(or a separate sheet)to provide information on other metals requested by the permit writer
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 10 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL MUMDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
VOLATILE ORGANIC COMPOUNDS
ACROLEIN ug/I ug/I 3 EPA 624 50
ACRYLONITRILE ug/l ug/l 3 EPA 624 10
BENZENE ' ug/I ug/I 3 EPA 624 1
BROMOFORM ug/l ug/I 3 EPA 624 1
CARBON ug/l ug/I 3 EPA 624 1
TETRACHLORIDE
CHLOROBENZENE ug/l ug/l 3 EPA 624 1
CHLORODIBROMO- ug/1 ug/I 3 EPA 624 1
METHANE
CHLOROETHANE ' ug/I ug/I 3 EPA 624 5
2-CHLOROETHYLVINYL ug/l • ug/l 3 EPA 624 5
ETHER
CHLOROFORM 13 ug/l 37.29 Ibld 6.86 ug/l 19.68 Ib/d 3 EPA 624 1
DICHLOROBROMO- ug/I ug/l 3 EPA 624 1
METHANE
1,1-DICHLOROETHANE ug/l ug/I 3 EPA 624 1
1,2-DICHLOROETHANE • ug/I ' ug/l 3 EPA 624 1
TRANS-I,2-DICHLORO- ug/l ' ug/l 3 EPA 624 1
ETHYLENE
1,1-DICHLORO- ug/l ug/l 3 EPA 624 1
ETHYLENE
1,2-DICHLOROPROPANE ug/I ug/l 3 EPA 624 1
1,3-DICHLORO- ug/I ug/l 3 EPA 624 1
PROPYLENE
ETHYLBENZENE ' ug/I ug/I 3 EPA 624 1
METHYL BROMIDE ' ug/I ug/l 3 EPA 624 5
METHYL CHLORIDE ' ug/l ' ug/l 3 EPA 624 1
METHYLENE CHLORIDE ugll ug/l 3 EPA 624 5
1,1.2,2-TETRA- • ug/l ug/l 3 EPA 624 1
CHLOROETHANE
TETRACHLORO- ug/I ug/I 3 EPA 624 1
ETHYLENE
TOLUENE ug/I ug/I 3 EPA 624 1
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 11 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL MUMDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
I
ug/1 ug/I 3 EPA 624 1
TRICHLOROETHANE
1'1'2- ug/I ug/1 3 EPA 624 1
TRICHLOROETHANE
TRICHLOROETHYLENE ug/I ug/I 3 EPA 624 1
VINYL CHLORIDE ug/I ug/1 3 EPA 624 5
Use this space(or a separate sheet)to provide information on other volatile organic compounds requested by the permit writer
ACID-EXTRACTABLE COMPOUNDS
P-CHLORO-M-CRESOL ug/I ug/I 3 EPA 625 10
2-CHLOROPHENOL ug/I ug/I 3 EPA 625 10
2,4-DICHLOROPHENOL ug/I ug/l 3 EPA 625 10
2,4-DIMETHYLPHENOL ug/I ug/I 3 EPA 625 10
4,6-DINITRO-0-CRESOL ug/I ug/I 3 EPA 625 10
2,4-DINITROPHENOL ug/I ug/I 3 EPA 625 10
2-NITROPHENOL ug/l ug/I 3 EPA 625 10
4-NITROPHENOL " ug/I ug/I 3 EPA 625 10
PENTACHLOROPHENOL ug/I ug/I 3 EPA 625 10
PHENOL ' ug/l ug/I 3 EPA 625 10
2.4.6- ug/I ug/I 3 EPA 625 10
TRICHLOROPHENOL
Use this space(or a separate sheet)to provide information on other acid-extractable compounds requested by the permit writer
BASE-NEUTRAL COMPOUNDS
ACENAPHTHENE ug/I " ug/I 3 EPA 625 10
ACENAPHTHYLENE ug/I ug/I 3 EPA 625 10
ANTHRACENE ' ug/I ug/I 3 EPA 625 10
BENZIDINE ug/I ug/I 3 EPA 625 10
BENZO(A)ANTHRACENE " ug/I ug/I 3 EPA 625 10
BENZO(A)PYRENE ug/I ug/I 3 EPA 625 10
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 12 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL ML1MDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
3,4 BENZO- ug/I ug/I 3 EPA 625 10
FLUORANTHENE
BENZO(GHI)PERYLENE ` ug/I ug/l 3 EPA 625 10
BENZO(K) ug/I ug/I 3 EPA 625 10
FLUORANTHENE
BIS(2-CHLOROETHOXY) ug/I ug/I 3 EPA 625 10
METHANE
BIS(2-CHLOROETHYL} ug/I ug/I 3 EPA 625 10
ETHER
BIS(2-CHLOROISO- ug/I ug/I 3 EPA 625 10
PROPYL)ETHER
BIS(2-ETHYLHEXYL) ug/I ug/I 3 EPA 625 10
PHTHALATE
4-BROMOPHENYL ug/I ug/I 3 EPA 625 10
PHENYLETHER
BUTYL BENZYL ug/I ug/1 3 EPA 625 10
PHTHALATE
2-CHLORO- ug/l ug/I 3 EPA 625 10
NAPHTHALENE
4-CHLORPHENYL • ug/I ` ug/I 3 EPA 625 10
PHENYL ETHER
CHRYSENE ` ug/I ug/I 3 EPA 625 10
DI-N-BUTYL PHTHALATE ug/I ug/I 3 EPA 625 10
DI-N-OCTYL PHTHALATE ug/I ` ug/I 3 EPA 625 10
DIBENZO(A,H) • ug/I ug/l 3 EPA 625 10
ANTHRACENE
1,2-DICHLOROBENZENE ug/I ` ug/I 3 EPA 625 10
1,3-DICHLOROBENZENE ug/I ug/I 3 EPA 625 10
1,4-DICHLOROBENZENE ug/I ' ug/I 3 EPA 625 10
3,3-DICHLORO- ug/I ug/I 3 EPA 625 10
BENZIDINE
DIETHYL PHTHALATE ` ug/I ug/I 3 EPA 625 10
DIMETHYL PHTHALATE ug/I ug/1 3 EPA 625 10
2,4-DINITROTOLUENE ug/I ug/I 3 EPA 625 10
2,6-DINITROTOLUENE ug/I ` ug/I 3 EPA 625 10
1,2-DIPHENYL- ug/I ug/I 3 EPA 625 10
HYDRAZINE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 13 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL ML/MDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
FLUORANTHENE ug/I ug/I 3 EPA 625 10
FLUORENE ug/I ug/I 3 EPA 625 10
HEXACHLOROBENZENE ug/I ug/I 3 EPA 625 10
HEXACHLORO- ug/I ug/I 3 EPA 625 10
BUTADIENE
HEXACHLOROCYCLO- ug/I ug/I 3 EPA 625 10
PENTADIENE
HEXACHLOROETHANE ug/I ' ug/I 3 EPA 625 10
INDENO(1,2,3-CD) ug/I ug/I 3 EPA 625 10
PYRENE
ISOPHORONE ug/I ug/I 3 EPA 625 10
NAPHTHALENE ug/I ug/I 3 EPA 625 10
NITROBENZENE ug/I ug/I 3 EPA 625 10
N-NITROSODI-N- ug/I ug/l 3 EPA 625 10
PROPYLAMINE
N-NITROSODI- ug/I ug/I 3 EPA 625 10
METHYLAMINE
N-NITROSODI- ug/l ug/l 3 EPA 625 10
PHENYLAMINE
PHENANTHRENE ug/I ug/I 3 EPA 625 10
PYRENE ug/l ug/l 3 EPA 625 10
1'2'4- ug/l ug/I 3 EPA 625 10
TRICHLOROBENZENE
Use this space(or a separate sheet)to provide information on other base-neutral compounds requested by the permit writer
Use this space(or a separate sheet)to provide information on other pollutants(e.g.,pesticides)requested by the permit writer
END OF PART D.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 14 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1)POTWs with a design flow rate greater than or equal to 1.0 MGD;2)POTWs with a pretreatment program(or those that are
required to have one under 40 CFR Part 403);or 3)POTWs required by the permitting authority to submit data for these parameters.
• At a minimum,these results must include quarterly testing for a 12-month period within the past 1 year using multiple species(minimum of two
species),or the results from four tests performed at least annually in the four and one-half years prior to the application,provided the results
show no appreciable toxicity,and testing for acute and/or chronic toxicity,depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition,this data must comply with QA1QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition,submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity,provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation,if one was conducted.
• If you have already submitted any of the information requested in Part E,you need not submit it again. Rather,provide the information
requested in question EA for previously submitted information. If EPA methods were not used,report the reasons for using altemate methods.
If test summaries are available that contain all of the information requested below,they may be submitted in place of Part E.
If no biomonitoring data is required,do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
EA. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
❑ chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
column per test(where each species constitutes a test). Copy this page if more than three tests are being reported.
Test number: Test number: Test number:
a. Test information.
Test Species&test method number
Age at initiation of test
Outfall number
Dates sample collected
Date test started
Duration
b. Give toxicity test methods followed.
Manual title
Edition number and year of publication
Page number(s)
c. Give the sample collection method(s)used. For multiple grab samples,indicate the number of grab samples used.
24-Hour composite
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
After dechlorination
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 15 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Test number: Test number: Test number:
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
f. For each test,include whether the test was intended to assess chronic toxicity,acute toxicity,or both
Chronic toxicity
Acute toxicity
g. Provide the type of test performed.
Static
Static-renewal
Flow-through
h. Source of dilution water. If laboratory water,specify type;if receiving water,specify source.
Laboratory water
Receiving water
i. Type of dilution water. If salt water,specify"natural"or type of artificial sea salts or brine used.
Fresh water
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Salinity
Temperature
Ammonia
Dissolved oxygen
I. Test Results.
Acute:
Percent survival in 100% ado ado
effluent
LC50
95%C.I. % % %
Control percent survival % % %
Other(describe)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 16 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
Chronic.
NOEC % % %
IC25 % % %
Control percent survival % % %
Other(describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test
run(MM/DD/YYYY)?
Other(describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ❑ No If yes,describe:
EA. Summary of Submitted Biomonitoring Test Information. If you have submitted biomonitoring test information,or information regarding the
cause of toxicity,within the past four and one-half years,provide the dates the information was submitted to the permitting authority and a summary
of the results.
Date submitted: / / (MM/DD/YYYY)
Summary of results: (see instructions)
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 1 7 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
SUPPLEMENTAL APPLICATION INFORMATION
PART F.INDUSTRIAL USER DISCHARGES AND RCRA/CERCLA WASTES
All treatment works receiving discharges from significant industrial users or which receive RCRA,CERCLA,or other remedial wastes must
complete part F.
GENERAL INFORMATION:
F.1. Pretreatment program. Does the treatment works have,or is subject to,an approved pretreatment program?
E Yes ❑ No
F.2. Number of Significant Industrial Users(SIUs)and Categorical Industrial Users(CIUs). Provide the number of each of the following types of
industrial users that discharge to the treatment works.
a. Number of non-categorical SIUs. 1
b. Number of Cl Us. 0
SIGNIFICANT INDUSTRIAL USER INFORMATION:
Supply the following information for each SIU. If more than one SIU discharges to the treatment works,copy questions F.3 through F.8 and
provide the information requested for each SIU.
F.3. Significant Industrial User Information. Provide the name and address of each SIU discharging to the treatment works. Submit additional pages
as necessary.
Name: Altec Industries
Mailing Address: 150 Altec Drive
Burnsville NC 28714
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
E-coat process Chemical precipitation
F.5. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw materials that affect or contribute to the SIU's
discharge.
Principal product(s): Truck bodies
Raw material(s): mild steel
F.6. Flow Rate.
a. Process wastewater flow rate. Indicate the average daily volume of process wastewater discharge into the collection system in gallons per
day(gpd)and whether the discharge is continuous or intermittent.
13.500 gpd ( continuous or X intermittent)
b Non-process wastewater flow rate. Indicate the average daily volume of non-process wastewater flow discharged into the collection system
in gallons per day(gpd)and whether the discharge is continuous or intermittent.
6890 gpd ( X continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits E Yes ❑ No
b. Categorical pretreatment standards ❑ Yes E No
If subject to categorical pretreatment standards,which category and subcategory?
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 18 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems(e.g.,
upsets,interference)at the treatment works in the past three years?
❑ Yes ® No If yes,describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck,rail or dedicated pipe?
❑ Yes ® No(go to F.12)
F.10. Waste transport. Method by which RCRA waste is received(check all that apply):
❑ Truck ❑ Rail ❑ Dedicated Pipe
F.11. Waste Description. Give EPA hazardous waste number and amount(volume or mass,specify units).
EPA Hazardous Waste Number Amount Units
CERCLA(SUPERFUND)WASTEWATER, RCRA REMEDIATION/CORRECTIVE ACTION
WASTEWATER, AND OTHER REMEDIAL ACTIVITY WASTEWATER:
FA 2. Remediation Waste. Does the treatment works currently(or has it been notified that it will)receive waste from remedial activities?
❑ Yes(complete F.13 through F.15.) ® No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates(or is excepted to origniate in
the next five years).
F.14. Pollutants. List the hazardous constituents that are received(or are expected to be received). Include data on volume and concentration,if
known. (Attach additional sheets if necessary.)
F.15. Waste Treatment.
a. Is this waste treated(or will be treated)prior to entering the treatment works?
❑ Yes ❑ No
If yes,describe the treatment(provide information about the removal efficiency):
b. Is the discharge(or will the discharge be)continuous or intermittent?
❑ Continuous ❑ Intermittent If intermittent,describe discharge schedule.
END OF PART F.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 19 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
SUPPLEMENTAL APPLICATION INFORMATION
PART G. COMBINED SEWER SYSTEMS
If the treatment works has a combined sewer system,complete Part G.
G.1. System Map. Provide a map indicating the following: (may be included with Basic Application Information)
a All CSO discharge points.
b. Sensitive use areas potentially affected by CSOs(e.g.,beaches,drinking water supplies,shellfish beds,sensitive aquatic ecosystems,and
outstanding natural resource waters).
C. Waters that support threatened and endangered species potentially affected by CSOs.
G.2. System Diagram. Provide a diagram,either in the map provided in G.1 or on a separate drawing,of the combined sewer collection system that
includes the following information.
a. Location of major sewer trunk lines,both combined and separate sanitary.
b. Locations of points where separate sanitary sewers feed into the combined sewer system.
c. Locations of in-line and off-line storage structures.
d. Locations of flow-regulating devices.
e. Locations of pump stations.
CSO OUTFALLS:
Complete questions G.3 through G.6 once for each CSO discharge point.
G.3. Description of Outfall.
a. Outfall number
b. Location
(City or town,if applicable) (Zip Code)
(County) (State)
(Latitude) (Longitude)
c Distance from shore(if applicable) ft.
d. Depth below surface(if applicable) ft.
e. Which of the following were monitored during the last year for this CSO?
❑ Rainfall ❑ CSO pollutant concentrations ❑ CSO frequency
❑ CSO flow volume ❑ Receiving water quality
f_ How many storm events were monitored during the last year?
GA. CSO Events.
a Give the number of CSO events in the last year.
events (❑actual or❑approx.)
b. Give the average duration per CSO event.
hours (❑actual or❑approx.)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 20 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Burnsville, 20290 Renewal French Broad
C. Give the average volume per CSO event.
million gallons(❑actual or❑approx.)
d. Give the minimum rainfall that caused a CSO event in the last year
Inches of rainfall
G.5. Description of Receiving Waters.
a. Name of receiving water:
b. Name of watershed/river/stream system:
United State Soil Conservation Service 14-digit watershed code(if known):
C. Name of State Management/River Basin:
United States Geological Survey 8-digit hydrologic cataloging unit code(if known):
G.6. CSO Operations.
Describe any known water quality impacts on the receiving water caused by this CSO(e.g.,permanent or intermittent beach closings,permanent or
intermittent shell fish bed closings,fish kills,fish advisories,other recreational loss,or violation of any applicable State water quality standard).
END OF PART G.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 21 of 22

i
Thereba Coleua Towfl of Burn8ville C_OMIllorX
Ma)or Puth L. Banks
Judy Buchanan
Jeanne Martin �,of OUR Ron Powen
Toms! Orrk William D. Wheeler
March 20, 2015
To Whom it May Concern,
I hereby authorize Jadd Brewer with Water Quality Labs to prepare the Town of
Burnsville's NPDES permit renewal, # NC0020290.
Anthony Hensley
Public Works Director
P.O. Box 97 • Burnsville, North Carolina 28714 • Phone [phone] • FAX [phone]

Jadd Brewer
Water Quality Lab & Operations
1522 Tynecastle Highway
Banner Elk, NC 28604
March 24, 2015
Ms. Wren Thedford
NC DENR/DWR/NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Sludge Management Plan
The majority of the sludge from the Burnsville WWTP is hauled to the foothills landfill in Lenoir,
NC. What is not hauled,we build a Compost Pile.This averages 1 per year,the analysis is
included for the past year.The compost is given to local farmers and residents for land
reclamation, flowers and landscaping.
If more information is needed, please contact Jadd Brewer 828-260-2027.

Theresa Coletta COLUXAMR
'Town of Burnsville Puth L. Banks
Judy Buchanan
SOF 8URNSL Pon Povell
Jeanne Martin Aos' .•�"�a� •4� William D. Wheeler
T007 CIC-4
Mr. Ed Hardee
Division of Water Quality
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Mr. Hardee,
The Town of Burnsville, North Carolina hauled 248.29 tons of 18%pressed bio-solids to the Foothills
Environmental Landfill, Lenoir, North Carolina. Attached are the Load Manifests. If you have any
questions please give me a call.
828-260-2027
Tgayou
Jrewer
Own of Burnsville,WWTP
7-/5
cop 46 Ed 1`* r 1 eC
13ev. POCC
P.O. Box 97 0 Burnsville, North Carolina 28714 0 Phone [phone] • FAX [phone]

Rn
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NON-HAZARDOUS WASTE MANIFEST 1.4 5 3 8 6 4
Please print or type.
1.Generator's US EPA ID Number Manifest Document Number 2.Page 1 of
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5. Generating Location(if different)
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11.US EPA ID Number 12.Transporter#2's Phone
13.Designated T/S/D Facility Name and Site Address
14.US EPA ID Number 15. Facility's Phone
2,900 Ci emv R63J
17.Allied Waste Approval#and Exp.Date 18.Containers 19,Total 20.Unit
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27. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest(except as noted in Item 19)
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NON-HAZARDOUS WASTE MANIFEST117
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10.Transporter#2 Company Name
13.Designated TIS/D Facility Name and Site Address
14.US EPA ID Number 15.Facility's Phone
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14.US EPA ID Number 15. Facility's Phone
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NON-HAZARDOUS WASTE MANIFEST . , i.5 6 7
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1.Generator's US EPA ID Number Manifest Document Number 2.Page 1 of
;. Generator's Name and Mailing Address 5. Generating Location(if different)
Town of Ritn vdlc Pim.Svbxtitp ROW
2 Town Squue. 29714
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Phone
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7.Transporter#1 Company Name
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11. US EPA ID Number 12.Transporter#2's Phone
10.Transporter#2 Company Name
13.Designated T/S/D Facility Name and Site Address
14. US EPA ID Number 15.Facility's Phone
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21. Addifional Descriptions for Materials Listed Above
22. Special Handling Instructions and Additional Information
123. GENERATOR'S CERTIFICATION: I certify the materials described on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste.
SignatuFe � �/ gDeyfayntgOfTyped Name ,' t p / /
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iW .24._Tfagsporter#1: Acknowledgement of Receipt of Materials
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RS-F15

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NON-HAZARDOUS WASTE MANIFEST 1 - '°� J
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1.Generators US EPA ID Number Manifest Do=age 1 of
5- Generating Location(if different)
3. Generators Name and Mailing Address
pine Swamp Road
fizwn"A$runs it3r
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7.Transporter#1 Company Name
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10.Transporter#2 Company Name
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22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION: I certify the materials described on this manifest are not subject to fMonth ederal regulations for reporting proper disposal of Hazardous Was Day Year
Da ar
Signature
Pdnted/Typed Name / i ;' ' I ` �'�"r��'•

c�R7�REPUBLIC
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NON-HAZARDOUS WASTE MANIFEST
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1.Generator's US EPA ID Number Manifest Document Number 2. Page 1 of
5. Generating Location(if different)
Generator's Name and Mailing Address
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10.Transporter#2 Company Name
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22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION: I certify the materials described on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste.
`% / Moi Day
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27. Facility Owner or Operator: Certification of receipt of waste materials covered by this manifest(except as noted in Item 19)
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NON-HAZARDOUS WASTE MANIFEST 3870'
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1.Generators US EPA ID Number Manifest Document Number 2.Page 1 of
Generators Name and Mailing Address
5. Generating Location(it different)
tilurT► �fi�l2:_"tit" :`�4'r l.1,
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21. Additional Descriptions for Materials Listed Above
22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION: I certify the materials described on this manifest are not subject.t federal regulations for reporting proper disposal of Hazardous Wh9ontb Day Year
I Signature `. i j �� -
Printed/Typed Name ; I f %
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NON-HAZARDOUS WASTE MANIFEST
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1.Generator's US EPA ID Number Manifest Document Number 2.Page 1 of
5. Generating Location(if different)
Generators Name and Mailing Address
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10.Transporter#2 Company Name
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21. Additional Descriptions for Materials Listed Above
22. Special Handling Instructions and Additional Information
l regulations for repo t ng proper disposal of Hazardous Waste.
23. GENERATOR'S CERTIFICATION: I certify the materials described on this manifest are not subject to federaonth Day Year
Signature
PrintedlTyped Name
W 24. Transporter#1: Acknowledgement of Receipt of Materials Month Day YearLLIt
Signaiture
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W 25. Transporter#2: Acknowledgement of Receipt of Materials ,
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26. Discrepancy Indication Space
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27. Facility Owne
Month Day Year
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RS-F15

�Y REPUBLIC
NON-HAZARDOUS WASTE !MANIFEST 14%53872
L Vis,QS EPA ID Number Mangy Cloarmerrt Number 2.Page 1 of
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L Generalor's Name and Mating Address 5- GF tg Location(if different)
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13,nmamomd T/SID FaaTrty Name and Sfte-Address 14.US EPA ID Number 15.Facilitys Phone
16 IIAr SFapptng Name and Description17_AfT e
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21_ AdrMional Desmpbans for MalEiiats Listed Above
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!D P*ftd/1.Wed Name 1(orah Day Year
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NON-HAZARDOUS WASTE MANIFEST 1"Y
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1_GeneraPc s. E'A!D Number ? N'II"� 2 pawl of
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NON44AZARDOUS WASTE MANIFEST 1,453874
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C,eneraor's Name wzd Uaffrc Address 5- �SrQ L---ion(iwry
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PrmredR ed trerllB j 1 t skirlat— Mono Dai ,Year
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Rtf1S

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SERVICES
f NON-HAZARDOUS WASTE MANIFEST
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1.Generator's US EPA ID Numr 5. G -.
enerating Location(if different)
3, Generators Name and Mailing Address vim suvwp R-O&I
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6. Phone ( )
9.Transporter#1's Phone
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11.US EPA ID Number
10.Transporter#2 Company Name
14.US EPA ID Number
15.Facility's Phone
13.Desi@rated T/S/D Facility Name and Site Address
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21. Additional Descriptions for Materials Listed Above
22. Special Handling instructions and Additional Information t
1 � t 7 ;•• � i 1 ^, r disposal of Hazardous waste.
the materials desamed on this manifest /
are not subject to federal regulations for reporting proper Month Day Year
L.
23: GENERATOR'S CERTIFICATION: 1 certify Sioaatu CJ f ly
Name Irl "/r- -(- �C='•.z!)
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,1 . e Month Day Year
N25. Transporter#2: Acknowledgement of Receipt of Materials Signature
Prmtedrryped Name
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26. Discrepancy Indication Space
_ of waste materials covered by this manifest(except as noted in Item 19)
J
27. Facility Owner or Operator-
Month
of receipt
Month Day Year
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RS-F15

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4*3 SERVICES
NON-HAZARDOUS WASTE MANIFEST
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Manifest Document Number 2.Page 1 0
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13.Designated TISID Facility Name and Site Address
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21. Additional Descriptions for Materials Listed Above
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1 22. Special Handling Instructions and Additional Information
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Month DaY
{ the materials described on this Waste-
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1{
—273—GENERATOR'S CERTIFICATION: i certiN Signatufe ,��a-
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Printed/Typed Name �/ : Mor Da) i ea
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24. Transporter 41: Acknowledg eSi at�re'
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1.Generator's US EPA ID Number Manifest Document Number 2. Page 1 of
1.Generator's US EPA ID Numbe�_7
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1. Generator's Name and Mailing Address 5. Generating Location(if different)
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13.Designated T/S/D Facility Name and Site Address 14. US EPA ID Number 15. Facility's Phone
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21. Additional Descriptions for Materials Listed Above
22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION: I certify the materials described•on This manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste.
Printed/Typed Name i i , ^ I I l Signatures/J// // �\ ��/, Month �y Yej�
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26. Discrepancy Indication Space
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SERVICES U.
NON-HAZARDOUS WASTE MANIFEST
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•. Manifest Document Number 2.Page 1 of
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5. Generating location(if different)
3..Generator's Name and Mailing Address t1At11
p
'f'i't'•ii =}1,.ti•. ?1:f ' tt
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21. Additional Descriptions for Materials Listed Above
22. Special Handling Instructions and Additional Information ;
proper disposal of Hazardous Waste..
Month Day
Year
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I 23. GENERATOR'S CERTIFICATION: I wrt!N Signature
Name / -�'^ I__.. s. l.<,i(.:•1 i
1 PrintedlTYP�
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. ! Month Day. Year
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SERVICES a r,
NON-HAZARDOUS WASTE MANIFEST
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Manifest Document Number 2.page
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5. Generating Location
3. Generator's Name and Mailing Address
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1453880
NON-HAZARDOUS--WASTE MANIFEST
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-, 1.Generator's US EPA ID Number Manifest Document Number 2.Page I-of 9
5. Generating Location(if different)
J. Generator's Name and Mailing Address
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23. GENERATOR'S CERTIFICATION: I certify Month Day
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3. Generator's Name and Mailing Address
5. Generating Location(if different)
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10.Transporter#2 Company Name '
11.US EPA ID Number 12.Transporter#2's Phone
13.Designated T/S/D Facility Name and Site Address
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22. Special Handling Instructions and Additional Information
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26. Discrepancy Indication Space
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COM000033
l"RANSPORTER #2

REPUBLIC
J_a SERVICES
NON-HAZARDOUS WASTE MANIFEST ¢,=rp,
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7.Transporter#1 Company Name 8.US EPA ID Number( ) 9_Transporter#1's Phone
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10.transporter#2 Company Name 11.US EPA ID Number 12.Transporter#2's Phone
13.Designated T/S/D Facility Name and Site Address 14.US EPA ID Number 15.Facility's Phone
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22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION:I hereby certify that the above named matM` ,!0rioN hazardous waste as defined by 40 CFR 261 or arty applicable state law,has
been properly described,classified and packaged,and is in proper condition for transportation according to applicable regulations;AND,if this waste is a treatment residue
of a preyiquslyrestricted hazardous waste.subject-to-the,Land,Disposal•Restrictions.I certify and warrant.ttlat-thg waste has been treated in acconiacaee with the-requiremerim
of40 CFR 268 and is no longer hazardous•waste-as defined,by.40-CFR 261.
Printed/Typed Name Signature Afeni h Day Year
W Z01hransporter#1: Acknowledgement of Receipt�of Materials
Printed/Typed Name Signature Mortar Day Year
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26. Discrepancy Indication Space
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LI0, N im
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REPUBLIC
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NON-HAZARDOUS WASTE MANIFEST 2081720
Please print or type.
1.Generator's US EPA ID Number Manifest Document Number 2.Page i of v�r 4 `- ,M
Generators Name and Mailing Address 5. Generating Location(if different)
owft rows tai Burt sville
1i C) B,,r 97 Pine Sm ilp ROad
R1.nw-ville,,2t''C 29-14 Photic: s Phot PY-MS'"'e-Ne'7-87�
4. Phone ( )
7.Transporter#1 Company Name 8.US EPA ID Number 9.Transporter#1's Phone
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10.Transporter#2 Company Name 11. US EPA ID Number 12_Transporter#2's Phone
13.Designated T/S/D Facility Name and Site Address 14.US EPR ID Number 15.Facility's Phone /4 ,tj�7fi5
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22. Special Handling Instructions and Additional Information
23. GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous waste as dem by 40 CFR 261 or any appkcable state law,has
been properly described,classified and packaged,and is in proper condition for transportation according to applicable regulations:AND,it this`Haste is a treahr>ent residue
of a previously restricted hazardous waste subject to the Land Disposal Restrictions.I certify and warrant that the waste has been treated in accordance with the requirements
of 40 CFR 268 and is no longer a hazardous waste as defined by 40 CFR 261.
Kong+ D Year
Printed/Typed Name l \ Signatute`�, / i��(/ /y / 1, /
41
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PrintedJryped Name
Signature uxi& Day Year
t-
26. Discrepancy Indication Space
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27. Facility Owner or Operator. Certification of receipt of waste materials covered by this manifest(except as noted in item 19)
tittills � 'ctf l �tful
Prioted/Type I Name ture Albrtlt Day Year
f'
COPY
RS-F15

_ Theresa Coletta Town Of BurneSville C"� IA°rs.
Haver Muth L. Banks
Judy Buchanan
Jeanne Martin s"oor-auRPon Pomeil
Tome Clerk ° `�� William D. Wheeler
February 27,2015
Mr. Ed Hardee
Division of Water Quality
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Mr. Hardee,
i
Please find enclosed the Town of Burnsville's Bio-Solids Annual Report for your review and approval.
Please let me know if you have any questions.
~Y
Thank you,
i
Anthony Hensley
Public Works Director
MCI jCd J ) 7-/,5
C)- Copes
CappV r1cc
I_
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P.O. Box 97 • Burnsville, North Carolina 28714 • Phone [phone] • FAX [phone] J

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM(02T Rules)
Facility Name: Town of Burnsville WQ Permit Number: W00002834
WWTP Name: Town of Burnsville NPDES Number. NCO020290
Monitoring Period: From 1/1/2014 To 12/31/2014
Pathogen Reduction(15A NCAC 02T.1106)-Please indicate level achieved and alternativeperformed:
Class A: Alt. A(time/temp) bK I Alt B(Alk Treatment)❑ r Alt.C(Prior Testing]
AIt.D(No Prior Test) ❑ I Process to Further Reduce Pathogengs ❑
If applicable to alternative performed Class A on indicate"Process to Further Reduce Pathogens":
Compost ❑ Heat Drying ❑ Heat Treatment ❑ Thermophilic ❑
Beta Ra ❑ Gamma Rav ❑ Pasteurization ❑
Class B: All.(1)Fecal Density ❑ Alt.(2)Process to Significantly Reduce Pathogens ❑
If applicable to alternative performed Class B only)indicate"Process to Significantly Reduce Pathogens":
Lime Stabilization ❑ Air Drying ❑ Composting ❑ JAerobic Digestion ❑
Anaerobic Digestion ❑
If applicable to alternative performed Class A or Class B complete the following monitoring data:
Parameter Allowable Level Pathogen Density Excee° Frequency Sample Analytical
Tech-
in Sludge Minimunj Geo.Mean Maximum Units of Analysis Type
2 x 10 to the WN
6th power
Per gn-of
Fecal Coliform total solids CFU
1000 mpn per gram
of total solid (dry <5 <9 mpm/kg 0 only pile G m9221 e2
weight)
Salmonella bacteria 3 MPN per 4 grams
(in lieu of fecal total solid(dry
coliform) wei t
Vector Attraction Reduction(15A NCAC 02T.1107)-Please indicate alternative performed:
Alt.I (VS reduction) ❑ Alt.2(40-day bench) ❑ Alt.3(30-day bench) ❑JAIL 4(Spec.02 uptake) ❑
Alt.5(14-Day Aerobic) Alt.6(Alk.Stabilization [I Alt 7(Drying-Stable) ❑ Alt.8(Drying-Unstable) ❑
Alt.9(Injection) ❑ Alt. 10(Incorporation) ❑ No vector attraction reduction alternatives were performed ❑
CERTIFICATION STATEMENT(please check the appropriate statement)
"I certify,under penalty of law,that the pathogen requirements in 15A NCAC 02T.1106 and the
vector attraction reduction requirement in 15A NCAC 02T.1107 have been met"
❑ "I certify,under penalty of law,that the pathogen requirements in 15A NCAC 02T.1106 and the
vector attraction reduction requirement in 15A NCAC 02T.1107 have not been met" (Please note
if you check this statement attach an explanation why you have not met one or both of the
requirements.)
"This determination has been made under my direction and supervision in accordance with the system
designed to ensure that qualified personnel properly gather and evaluate the information used to determine
that the pathogen and vector attraction reduction requirements have been met I am aware that there are
significant penalties for false certification including fine and imprisonment"
Preparer Name and Title(type or print) Land Applier Name and Title(if applicablextype or print)
Signature of Preparer* Date Signature of Land Applier(if applicable) Date
*Preparer is defined in 40 CFR Part 503.9(r)and 15A NCAC 2T.1102(26)
DENR FORM PVRF 02T(12/2006)

CLASS A ANNUAL DISTRIBUTION AND MARKETING/SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT#: WQ0002834 FACILITY NAME: Town of Burnsville
PHONE: [phone] COUNTY: Yancey OPERATOR: Jadd Brewer
FACILITY TYPE(please check one): ❑ Surface Disposal(complete Part A(Source(s)and "Residual In" Volume only)and Part C)
:W Distribution and Marketing(complete Parts A, B,and C)
Was the facility in operation during the past calendar year? Yes :9 No ❑ if No skip parts A, B,C and certify form below
Part A*: Part B*:
Sources(s)s)(include NPDES#if Volume(d tons) Reci lent Information
Month Amendment/
applicable) Bulking Agent Residual In Product Out Name(s) Volume(dry tons) Intended use(s)
January NCO020290 POTW Dennis Hughes 2 Mulch
February Digester
March
April
May
June
July
August
September
October
November
December
Total from FORM DMSDF(sup)
Totals: Annual(dry tons): 0 0 0 2
Amendment(s)used:1 1 Bulking Agent(s))used:
* If more space is required,attach additional information sheets(FORM DMSDF(supp)): Total Number of Form DMSDF(Supp)
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit ❑ Yes
(including but not limited to items 1-3 below) issued by the Division of Water Resources: ❑ No ► If No, Explain in Narritive
1. All monitoring was done in accordance with the permit and reported for the year as required and three(3)copies of certified laboratory results are attached.
2. All operation and maintenance requirements were compiled with or, in the case of a deviation, prior authorization was received from the Division of Water Resources.
3. No contravention of Ground Water Quality Standards occurred at a monitoring well.
"I certify, under penalty of law,that the above information is,to the best of my knowledge and belief,true,accurate and complete. I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee Date Signature of Preparer** Date
(if different from Permittee)
**Preparer is defined in 40 CFR Part 503.9(r)and 15A NCAC 2T.1 102(26)
DENR FORM DMSDF (12/2006)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Please note that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF-B
WQ Permit Number: WQ0002834 Laboratory: 1) Blue Ridge Labs
Facility Name: Town of Burnsville 2) Water Quality Labs
Residual Source WQ#or NCO020290 3) Environmental Testing Solutions
NPDES#: 4)
WWTP Name: Town of Burnsville 5)
Residual Analysis Data
Conc. Sam le or C mposite Date
Parameter Limit
(mfg) m a 12/9/14
Percent Solids(%) NA 26
Arsenic 75 <7.65
Cadmium 85 <3.06
Copper 4,300 149
Chromium NA <0.10
Lead 840 31.2
Mercury 57 1.8
Molybdenum 75 < 7.65
Nickel 420 55.2
Selenium 100 <7.65
Zinc 7,500 941
Total Phosphorus NA 11700
TKN NA 20400
Ammonia-Nitrogen NA 5000
Nitrate and Nitrite NA 48.5
For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits.
"I certify,under penalty of law,that this document was prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant
penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
Signature of Preparer* Date
*Preparer is defined in 40 CFR Part 503.9(r)and 15A NCAC 2T.1102(26) DENR FORM RSSF(12/2006)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Report all sampling analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past
calendar year. Use additional forms as needed.
WQ Permit Number: WQ0002834 Laboratory: 1) Blue Ridge Labs
Facility Name: Town of Burnsville 2) Water Quality Labs
Residual Source NCO020290 3) Environmental Testing Solutions
NPDES#or WQ#: 4)
WWTP Name: Town of Burnsville 5)
Residual Analysis Data
Sam le or C mposite Date
Parameter
(mg/kg) 12/9/14
PH 7.5
PAN 1548.5
Potassium 3390
Magnesium 3310
Calcium 8570
"I certify, under penalty of law,that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
Signature of Preparer* Date
*Preparer is defined in 40 CFR Part 503.9(r)and 15A NCAC 2T .1102(26) DENR FORM RSSF-B(12/2006)

Narrative of the Maps for Town of Burnsville WWTP
Map 1—Topographic Map
This map shows the the facility location and the surrounding terrain as well as the river placement.
It also shows the direction of outfall from the facility.
Map 2—Ariel View
This map has 4 descriptive tabs that describe what can be seen from above.
1- Ariel Gravity Influent Tab with a directional arrow
2- Influent Tab with a directional arrow and line to show how it enters the facility
3- Sludge Drying Beds Tab with a location arrow
4- Outfall Tab with a line and directional arrow
Map 3—Zoomed in Ariel View of the Facility -
This map has 5 descriptive tabs that describe what can be seen from above.
1- Manhole Tab with a black dot to show location
2- Influent Tab with directional arrow and line to show how it enters the facility
3- Ariel Gravity Influent Tab with a directional arrow
4- Sludge Drying Beds Tab with a location arrow
5- Effluent Tab with a line and directional arrow
Map 4—Facility Flow Diagram
This map is a detail description of the waste water treatment plant flow diagram.
From the top middle of the page it shows the
-Influent -Mechanical Bar Screen -Flow Division
From there it divides into the 2 large circles:
RIGHT circle is the Contact Stabilization.5 MGD Plant with directional arrows:
-Reaeration Zone -Clarifier -Sludge Return -Chlorine Contact
-Effluent -Digester -Waste Sludge -Sludge to Dewatering
LEFT circle is the Contact Stabilization.3 MGD Plant with directional arrows:
-Reaeration Zone -Clarifier -Sludge Return -Chlorine Contact
-Effluent -Digester -Waste Sludge -Sludge to Dewatering
From the Sludge Dewatering Press. there is an arrow showing the Sludge Compost Facility towards the bottom left
corner of the page and there is an arrow continuing from the Sludge Dewatering Press.around the left circle showing
the Sludge Pressate Return.
From the two large circles coming back together in the center there are directional arrows for the Effluent Dechlorine
that goes to the Cane River Outfall showing the Upstream and Downstream.

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. Annual Monitoring and Pollutant Scan
Permit No. Month
Outfall Year
Facility Name: Town of Burnsville ORC : Jadd Brewer
Date of sampling : 8/29/2014 Phone : [phone]
Analytical Laboratory : Blue Ridge Labs
Sample Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Ammonia (as N) Composite ammonia 0.5 0.98 n:gj i 1
bissolved oxygen Grab SM19 450OG 0.1 2.5 mg/1 1
Nitrate/Nitrite Composite SM19 450ON 0.08 3.7 mg/l 1
Total Kjeldahl nitrogen Composite SM19 450ON 0.5 6.44 mg/l 1
Total Phosphorus Composite EPA 365.2 0.5 5.17 mg/1 1
Total dissolved solids Composite SM19 2540C 1 261 mg/1 1
Hardness Composite SM19 2340B 0.662 36.3 mg/l 1
Chlorine (total residual, TRC) Grab SM19 450OG 0.015 <0.015 mg/l 1
bil and grease Grab SM19 5520B 5 <5 mg/1 1
Metals(total recoverable), cyanide as 1t'd& ,phenols
Antimony Composite EPA 200.7 0.025 mg/I 1
Arsenic Composite EPA 200.7 0.01 mg/1 1
Beryllium Composite EPA 200.7 0.005 * mg/1 1
Cadmium Composite EPA 200.7 0.002 * mg/l 1
Chromium Composite EPA 200.7 0.005 0.001 mg/l 1
Copper Composite EPA 200.7 0.002 0.007 mg/l 1
Lead Composite EPA 200.7 0.01 * mg/1 1
Mercury Composite EPA 245.1 0.0001 * mg/I 1
Nickel Composite EPA 200.7 0.01 0.006 mg/1 1
Selenium Composite EPA 200.7 0.01 * mg/I 1
Silver Composite EPA 200.7 0.005 0.001 mg/l 1
Thallium Composite EPA 200.7 0.02 * mg/1 1
Zinc Composite EPA 200.7 0.01 0.039 mg/l 1
Cyanide Grab ISM19 4500C 0.005 * mg/l 1
Total phenolic compounds Grab EPA 420.1 0.01 0.019 mg/1 1
Volatile organic compounds
Acrolein Grab EPA 624 50 * ug/1 1
Acrylonitrile Grab EPA 624 10 ug/l 1
Benzene Grab EPA 624 1 * ug/I 1
Bromoform Grab EPA 624 1 * ug/1 1
Carbon tetrachloride Grab EPA 624 1 * ug/I 1
Chlorobenzene Grab EPA 624 1 * ug/1 1
Chlorodibromomethane Grab EPA 624 1 * ug/1 1
Chloroethane Grab EPA 624 5 * ug/1 1
2-chloroethylvinyl ether Grab EPA 624 5 * ug/1 1
Chloroform Grab EPA 624 1 * ug/1 1
Dichlorobromomethane Grab EPA 624 1 * ug/1 1
1,1-dichloroethane Grab EPA 624 1 * ug/1 1
1,2-dichloroethane Grab EPA 624 1 * ug/I 1
Trans-l,2-dichloroethylene Grab EPA 624 1 * ug/1 1
Form - DMR- PPA-1 Page 1

Annual Monitoring and Pollutant Scan
Permit No. Month
Outfall Year
Sample Analytical (quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Volatile organic compounds (Cont.)
1,1-dichloroethylene Grab EPA 624 1 ug/I 1
1,2-dichloropropane Grab EPA 624 1 ug/1 1
1,3-dichloropropylene Grab EPA 624 1 * ug/1 1
Ethylbenzene Grab EPA 624 1 * ug/1 1
Methyl bromide Grab EPA 624 5 * ug/1 1
Methyl chloride Grab EPA 624 1 * ug/1 1
Methylene chloride Grab EPA 624 5 * ug/1 1
1,1,2,2-tetrachloroethane Grab EPA 624 1 * ug/1 1
Tetrachloroethylene Grab EPA 624 1 * ug/1 1
Toluene Grab EPA 624 1 * ug/1 1
1,1,1-trichloroethane Grab EPA 624 1 * ug/1 1
1,1,2-trichloroethane Grab EPA 624 1 ug/l 1
Trichloroethylene Grab EPA 624 1 * ug/1 1
Vinyl chloride Grab EPA 624 5 * ug/1 1
Acid extractable compounds
P-chloro-m-creso Grab EPA 625 10 * ug/1 1
2-chlorophenol Grab EPA 625 10 * ug/1 1
2,4-dichlorophenol Grab EPA 625 10 ug/1 1
2,4-dimethylphenol Grab EPA 625 10 ug/1 1
4,6-dinitro-o-cresol Grab EPA 625 10 * ug/1 1
2,4-dinitrophenol Grab EPA 625 10 * ug/1 1
2-nitrophenol Grab EPA 625 10 ug/1 1
4-nitrophenol Grab EPA 625 10 * ug/1 1
Pentachlorophenol Grab EPA 625 10 * ug/1 1
Phenol Grab EPA 625 10 ug/l 1
2,4,6-trichlorophenol Grab EPA 625 10 * ug/1 1
Base-neutral oompouids z
Acenaphthene Grab EPA 625 10 * ug/1 1
Acenaphthylene Grab EPA 625 10 ug/l 1
Anthracene Grab EPA 625 10 * ug/1 1
Benzidine Grab EPA 625 10 * ug/1 1
Benzo(a)anthracene Grab EPA 625 10 * ug/1 1
Benzo(a)pyrene Grab EPA 625 10 ug/1 1
3,4 benzofluoranthene Grab EPA 625 10 ug/1 1
Benzo(ghi)perylene Grab EPA 625 10 ug/1 1
Benzo(k)fluoranthene Grab EPA 625 10 * ug/1 1
Bis (2-chloroethoxy) methane Grab EPA 625 10 ug/1 1
Bis (2-chloroethyl) ether Grab EPA 625 10 ug/1 1
Bis (2-chloroisopropyl) ether Grab EPA 625 10 * ug/1 1
Bis (2-ethylhexyl) phthalate Grab EPA 625 10 ug/1 1
4-bromophenyl phenyl ether Grab EPA 625 10 * ug/1 1
Butyl benzyl phthalate Grab EPA 625 10 ug/1 1
2-chloronaphthalene Grab EPA 625 10 ug/1 1
Form - DMR- PPA-1 Page 2

Annual Monitoring and Pollutant Scan
Permit No. Month
Outfall yem-
4-chlorophenyl phervl ether Grab EPA 625 10 ug/1 1
Sample' Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
)ase-neutral compounds (cont.) -
Chrysene Grab EPA 625 10 * ug/l 1
Di-n-butyl phthalate Grab EPA 625 10 ug/I 1
Di-n-octyl phthalate Grab EPA 625 10 ug/1 1
Dibenzo(a,h)anthracene Grab EPA 625 10 ug/1 1
1,2-dichlorobenzene Grab EPA 625 10 ug/1 1
1,3-dichlorobenzene Grab EPA 625 10 * ug/1 1
1,4-dichlorobenzene Grab EPA 625 10 ug/l 1
3,3-dichlorobenzidine Grab EPA 625 10 * ug/l 1
Diethyl phthalate Grab EPA 625 10 ug/1 1
Dimethyl phthalate Grab EPA 625 10 ug/1 1
2,4-dinitrotoluene Grab EPA 625 10 * ug/1 1
2,6-dinitrotoluene Grab EPA 625 10 * ug/1 1
1,2-diphenylhydrazine Grab EPA 625 10 * ug/l 1
Fluoranthene Grab EPA 625 10 * ug/1 1
Fluorene Grab EPA 625 10 ug/1 1
Hexachlorobenzene Grab EPA 625 10 * ug/1 1
Hexachlorobutadiene Grab EPA 625 10 * ug/1 1
Hexachlorocyclo-pentadiene Grab EPA 625 10 ug/l 1
Hexachloroethane Grab EPA 625 10 * ug/I 1
Indeno(1,2,3-cd)pyrene Grab EPA 625 10 * ug/I 1
Isophorone Grab EPA 625 10 * ug/1 1
Naphthalene Grab EPA 625 10 * ug/l 1
Nitrobenzene Grab EPA 625 10 ug/l 1
N-nitrosodi-n-propylamine Grab EPA 625 10 * ug/l 1
N-nitrosodimethylamine Grab EPA 625 10 ug/l 1
N-nitro sodiphenylamine Grab EPA 625 10 * ug/l 1
Phenanthrene Grab EPA 625 10 ug/l 1
Pyrene Grab EPA 625 10 t ug/l 1
1,2,4,-trichlorobenzene Grab EPA 625 10 * ug/l 1
I certify under penalty of law that this document and all attachments were prepared under my direction
and supervision in accordance with a system to design to assure that qualified perdonnel properly
gather and evaluat the information submitted. Based on my inquiry of the person or persons that
manage the system, or those persons directly responsibel for gathering the information, the
information submitted is , to the best of my knowledge and belief, true, accurate and complete. I am
aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations.
Authorized Representative name
Signature
Form - DMR- PPA-1 Page 3

Annual Monitoring and FoUntaut Scan
Permit NO. Mona,
Outer- Year
Date
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M
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Form- DMR PPA 1 pov 4
Alii

Annual Monitoring and Pollutant Scan
Permit No. Month
Outfall Year
Facility Name: Town of Burnsville ORC : Jadd Brewer
Date of sampling : 10/29/2013 Phone : [phone]
Analytical Laboratory : Blue Ridge Labs
Sample Analytical Quantitation Sample- Units of Number of
Parameter Type Method Level Result Measurement samples
Ammonia (as N) Composite ammonia 0.2 <0.20 mg/l 1
Dissolved oxygen Grab SM19 450OG 0.1 6 mg/l 1
Nitrate/Nitrite Composite SM19 450ON 0.08 5.34 mg/l 1
Total Kjeldahl nitrogen Composite SM19 450ON 0.5 7.98 mg/l 1
Total Phosphorus Composite EPA 365.2 0.5 1.76 mg/1 1
Total dissolved solids Composite SM19 2540C 1 184 mg/l 1
Hardness Composite SM19 2340B 0.662 mg/l 1
Chlorine (total residual, TRC) I Grab ISN119 450OG 0.015 I <0.015 1 mg/l 1
Oil and grease Grab SM 195,520B 5 <5 mg/l 1
Me"(total recoverable), cyanide;.d nd total phenols
Antimony Composite EPA 200.7 0.025 * mg/1 1
Arsenic Composite EPA 200.7 0.01 * mg/l 1
Beryllium Composite EPA 200.7 0.005 * mg/l 1
Cadmium Composite EPA 200.7 0.002 mg/l 1
Chromium Composite EPA 200.7 0.005 * mg/1 1
Copper Composite EPA 200.7 0.002 0.003 mg/1 1
Lead Composite EPA 200.7 0.01 * mg/I 1
Mercury Composite EPA 245.1 0.0001 mg/I 1
Nickel Composite EPA 200.7 0.01 0.002 mg/l 1
Selenium Composite EPA 200.7 0.01 * mg/l 1
Silver Composite EPA 200.7 0.005 mg/1 1
Thallium Composite EPA 200.7 0.02 * mg/l 1
Zinc Composite EPA 200.7 0.01 1 0.015 mg/I 1
Cyanide Grab SM19 4500C 0.005 1 0.006 mg/l 1
Total phenolic compounds Grab EPA 420.1 0.01 0.011 mg/1 1
Volatile organic compounds
Acrolein Grab EPA 624 50 * ug/1 1
Acrylonitrile Grab EPA 624 10 * ug/l 1
Benzene Grab EPA 624 5 * ug/l 1
Bromoform. Grab EPA 624 5 ug/l 1
Carbon tetrachloride Grab EPA 624 5 ug/l 1
Chlorobenzene Grab EPA 624 5 ug/l 1
Chlorodibromomethane Grab EPA 624 5 ug/1 1
Chloroethane Grab EPA 624 5 ug/1 1
2-chloroethylvinyl ether Grab EPA 624 5 * ug/l 1
Chloroform Grab EPA 624 5 7.6 ug/l 1
Dichlorobromomethane Grab EPA 624 5 ug/l 1
1,1-dichloroethane Grab EPA 624 5 ug/1 1
1,2-dichloroethane Grab EPA 624 5 Wug/1 1
Trans-l,2-dichloroethylene Grab EPA 624 5 ug/l 1
Form - DMR- PPA-1 Page 1

Annual Monitoring and Pollutant Scan
Permit No. _ _ Month
Outfall Year
Sample Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Volatile organic compounds (Cont.)
1,1-dichloroethylene Grab EPA 624 5 * ug/1 1
1,2-dichloropropane Grab EPA 624 5 * ug/l 1
1,3-dichloropropylene Grab EPA 624 5 * ug/1 1
Ethylbenzene Grab EPA 624 5 * ug/1 1
Methyl bromide Grab EPA 624 5 * ug/1 1
Methyl chloride Grab EPA 624 5 * ug/1 1
Methylene chloride Grab EPA 624 5 * ug/1 1
1,1,2,2-tetrachloroethane Grab EPA 624 5 * ug/1 1
Tetrachloroethylene Grab EPA 624 5 ug/1 1
Toluene Grab EPA 624 5 ug/1 1
1,1,1-trichloroethane Grab EPA 624 5 * ug/1 1
1,1,2-trichloroethane Grab EPA 624 5 ug/1 1
Trichloroethylene Grab EPA 624 5 ug/1 1
Vinyl chloride Grab EPA 624 5 ug/1 1
Acid-extractable compounds
P-chloro-m-creso Grab EPA 625 10 * ug/1 1
2-chlorophenol Grab EPA 625 10 ug/1 1
2,4-dichlorophenol Grab EPA 625 10 * ug/1 1
2,4-dimethylphenol Grab EPA 625 10 * ug/1 1
4,6-dinitro-o-cresol Grab EPA 625 10 * ug/1 1
2,4-dinitrophenol Grab EPA 625 10 * ug/1 1
2-nitrophenol Grab EPA 625 10 * ug/1 1
4-nitrophenol Grab EPA 625 10 * ug/1 1
Pentachlorophenol Grab EPA 625 10 * ug/1 1
Phenol Grab EPA 625 10 * ug/1 1
2,4,6-trichlorophenol Grab EPA 625 10 * ug/1 1
Baseeutral'compounds AMSIM
Acenaphthene Grab EPA 625 10 ug/1 1
Acenaphthylene Grab EPA 625 10 * ug/1 1
Anthracene Grab EPA 625 10 ug/1 1
Benzidine Grab EPA 625 10 ug/1 1
Benzo(a)anthracene Grab EPA 625 10 ug/l 1
Benzo(a)pyrene Grab EPA 625 10 * ug/1 1
3,4 benzofluoranthene Grab EPA 625 10 * ug/1 1
Benzo(ghi)perylene Grab EPA 625 10 * ug/l 1
Benzo(k)fluoranthene Grab EPA 625 10 * ug/1 1
Bis (2-chloroetho3y) methane Grab EPA 625 10 * ug/1 1
Bis (2-chloroethyl) ether Grab EPA 625 10 * ug/1 1
Bis (2-chloroisopropyl) ether Grab EPA 625 10 * ug/1 1
Bis (2-ethylhexyl) phthalate Grab EPA 625 10 * ug/1 1
4-bromophen_vl phenyl ether Grab EPA 625 10 ug/1 1
Butyl benzyl phthalate Grab EPA 625 10 * ug/1 1
2-chloronaphthalene Grab EPA 625 10 * ug/1 1
Form - DMR- PPA-1 Page 2

Annual Monitoringand Pollutant t t Scan
Permit No. Month
Outfall year
4-chlorophenyl phenyl ether Grab EPA 625 10 ug/1 1
Sample Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Base-neutral compounds (cont.)
Chrysene Grab EPA 625 10 * ug/l 1
Di-n-butyl phthalate Grab EPA 625 10 * ug/l 1
Di-n-octyl phthalate Grab EPA 625 10 * ug/l 1
Dibenzo(a,h)anthracene Grab EPA 625 10 * ug/l 1
1,2-dichlorobenzene Grab EPA 625 10 * ug/1 1
1,3-dichlorobenzene Grab EPA 625 10 * ug/l 1
1,4-dichlorobenzene Grab EPA 625 10 * ug/l 1
3,3-dichlorobenzidine Grab EPA 625 10 * ug/1 1
Diethyl phthalate Grab EPA 625 10 * ug/l 1
Dimethyl phthalate Grab EPA 625 10 ug/1 1
2,4-dinitrotoluene Grab EPA 625 10 ug/1 1
2,6-dinitrotoluene Grab EPA 625 10 ug/l 1
1,2-diphenylhydrazine Grab EPA 625 10 ug/1 1
Fluoranthene Grab EPA 625 10 * ug/1 1
Fluorene Grab EPA 625 10 * ug/l 1
Hexachloro benzene Grab EPA 625 10 ug/1 1
Hexachlorobutadiene Grab EPA 625 10 ug/1 1
Hexachlorocyclo-pentadiene Grab EPA 625 10 * ug/1 1
Hexachloroethane Grab EPA 625 10 ug/1 1
Indeno(1,2,3-cd)pyrene Grab EPA 625 10 * ug/1 1
Isophorone Grab EPA 625 10 * ug/1 1
Naphthalene Grab EPA 625 10 ug/l 1
Nitrobenzene Grab EPA 625 10 ug/1 1
N-nitrosodi-n-propylamine Grab EPA 625 10 ug/1 1
N-nitrosodimethylamine Grab EPA 625 10 * ug/1 1
N-nitrosodiphenylamine Grab EPA 625 10 ug/1 1
Phenanthrene Grab EPA 625 10 ug/l 1
Pyrene Grab EPA 625 10 * ug/1 1
1,2,4,-trichlorobenzene Grab EPA 625 10 ug/l 1
I certify under penalty of lav that this document and all attachments were prepared under my direction
and supervision in accordance with a system to design to assure that qualified perdonnel properly
gather and evaluat the information submitted. Based on my inquiry of the person or persons that
manage the system, or those persons directly responsibel for gathering the information, the
information submitted is , to the best of my knowledge and belief, true, accurate and complete. I am
aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations.
Authorized Representative name
Signature
Form - DMR- PPA-1 Page 3

Annud Mouftwing and PbUutant&mn
PuNo. mouth
�t Date Yair -
Form-DMR PPA 1 Page.4

Annual Monitoring and Pollutant Scan
Permit No. Month
Outfall Year
Facility Name: Town of Burnsville ORC : Jadd Brewer
Date of sampling : 10/23/2012 Phone : [phone]
Analytical Laboratory : Blue Ridge Labs
Sample Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Ammonia (as N) Composite ammonia 0.5 0.98 mg/l i
Dissolved oxygen Grab SM19 450OG 0.1 6.5 mg/1 1
Nitrate/Nitrite Composite SM19 450ON 0.08 8.01 mg/l 1
Total Kjeldahl nitrogen Composite SM19 450ON 0.5 8.96 mg/l 1
Total Phosphorus Composite EPA 365.2 0.5 2.57 mg/l 1
Total dissolved solids Composite SM19 2540C 1 349 mg/l 1
Hardness Composite SM19 2340BI 0.03 1 77.8 1 mg/l I1
Chlorine (total residual, TRC) Grab SM19 450OG 0.015 <0.015 mg/l 1
Oil and grease Grab SM19 5520B 1 2.4 mg/l 1
Metals(tom recoverable,cyanide and total
Antimony Composite EPA 200.7 0.025 * mg/l 1
Arsenic Composite EPA 200.7 0.01 * mg/l 1
Beryllium Composite EPA 200.7 0.005 * mg/l 1
Cadmium Composite EPA 200.7 0.002 * mg/l 1
Chromium Composite EPA 200.7 0.005 * mg/1 1
Copper Composite EPA 200.7 0.002 0.069 mg/l 1
Lead Composite EPA 200.7 0.01 * mg/l 1
Mercury Composite EPA 245.1 0.0001 * mg/l 1
Nickel Composite EPA 200.7 0.01 * mg/1 1
Selenium Composite EPA 200.7 0.01 * mg/l 1
Silver Composite EPA 200.7 0.005 * mg/l 1
Thallium Composite EPA 200.7 0.02 * mg/l 1
Zinc Composite EPA 200.7 0.01 0.063 mg/l 1
Cyanide I Grab SM19 4500C 0.005 mg/l 1
Total phenolic compounds I Grab EPA 420.1 0.01 * mg/1 1
Volatile organic compounds .
Acrolein Grab EPA 624 50 * ug/1 1
Acrylonitrile Grab EPA 624 10 ug/l 1
Benzene Grab EPA 624 1 * ug/l 1
Bromoform Grab EPA 624 1 * ug/1 1
Carbon tetrachloride Grab EPA 624 1 * ug/1 1
Chlorobenzene Grab EPA 624 1 * ug/1 1
Chlorodibromomethane Grab EPA 624 1 * ug/l 1
Chloroethane Grab EPA 624 5 * ug/1 1
2-chloroethylvinyl ether Grab EPA 624 5 * ug/1 1
Chloroform Grab EPA 624 1 13 ug/1 1
Dichlorobromomethane Grab EPA 624 1 * ug/1 1
1,1-dichloroethane Grab EPA 624 1 ug/1 1
1,2-dichloroethane Grab EPA 624 1 * ug/1 1
Trans-l,2-dichloroethylene Grab EPA 624 1 * ug/l 1
Form - DMR- PPA-1 Page 1

Annual Monitoring and Pollutant Scan
Permit No. Month _
Outfall year
_ -
Sample Analytical Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
Volatile organic compounds(Cont.)
1,1-dichloroethylene Grab EPA 624 1 ug/1 1
1,2-dichloropropane Grab EPA 624 1 * ug/1 1
1,3-dichloropropylene Grab EPA 624 1 * ug/1 1
Ethylbenzene Grab EPA 624 1 * ug/1 1
Methyl bromide Grab EPA 624 5 * ug/1 1
Methyl chloride Grab EPA 624 1 ug/1 1
Methylene chloride Grab EPA 624 5 * ug/l 1
1,1,2,2-tetrachloroethane Grab EPA 624 1 * ug/1 1
Tetrachloroethylene Grab EPA 624 1 * ug/1 1
Toluene Grab EPA 624 1 * ug/1 1
1,1,1-trichloroethane Grab EPA 624 1 * ug/l 1
1,1,2-trichloroethane Grab EPA 624 1 ug/l 1
Trichloroethylene Grab EPA 624 1 * ug/1 1
Vinyl chloride Grab EPA 624 5 ug/l 1
Acid-extractable compounds
P-chloro-m-creso Grab EPA 625 10 * ug/1 1
2-chlorophenol Grab EPA 625 10 ug/1 1
2,4-dichlorophenol Grab EPA 625 10 * ug/1 1
2,4-dimethylphenol Grab EPA 625 10 * ug/1 1
4,6-dinitro-o-cresol Grab EPA 625 10 * ug/1 1
2,4-dinitrophenol Grab EPA 625 10 * ug/1 1
2-nitrophenol Grab EPA 625 10 * ug/1 1
4-nitrophenol Grab EPA 625 10 * ug/1 1
Pentachlorophenol Grab EPA 625 10 * ug/1 1
Phenol Grab EPA 625 10 * ug/1 1
2,4,6-trichlorophenol Grab EPA 625 10 ug/1 1
$ase-neutral carmpounds w1 T' � E
Acenaphthene Grab EPA 625 10 ug/1 1
Acenaphthylene Grab EPA 625 10 * ug/1 1
Anthracene Grab EPA 625 10 ug/l 1
Benzidine Grab EPA 625 10 * ug/1 1
Benzo(a)anthracene Grab EPA 625 10 * ug/1 1
Benzo(a)pyrene Grab EPA 625 10 * ug/1
hene 1
3,4 benzofluorantGrab EPA 625 10 * ug/1 1
Benzo(ghi)perylene Grab EPA 625 10 * ug/1 1
Benzo(k)fluoranthene Grab EPA 625 10 * ug/1 1
Bis (2-chloroethoxy) methane Grab EPA 625 10 * ug/1 1
Bis (2-chloroethyl) ether Grab EPA 625 10 * ug/1 1
Bis (2-chloroisopropyl) ether Grab EPA 625 10 * ug/1 1
Bis (2-ethylhexyl) phthalate Grab EPA 625 10 ug/l 1
4-bromophenyl phenyl ether Grab EPA 625 10 * ug/l 1
Butyl benzyl phthalate Grab EPA 625 10 ug/1 1
2-chloronaphthalene Grab EPA 625 10 * ug/1 1
Form - DMR- PPA-1 Page 2

Annual Monitoring and Pollutant Scan
Permit No. Month _
Outfall year
4-chlorophenyl phenyl ether Grab EPA 625 10 ug/1 1
Sam Quantitation Sample Units of Number of
Parameter Type Method Level Result Measurement samples
_Base-neutral compounds (cont)
Chrysene Grab EPA 625 10 ug/l 1
Di-n-butyl phthalate Grab EPA 625 10 ug/1 1
Di-n-octyl phthalate Grab EPA 625 10 * ug/l 1
Dibenzo(a,h)anthracene Grab EPA 625 10 ug/1 1
1,2-dichlorobenzene Grab EPA 625 10 * ug/l 1
1,3-dichlorobenzene Grab EPA 625 10 * ug/1 1
1,4-dichlorobenzene Grab EPA 625 10 ug/l 1
3,3-dichlorobenzidine Grab EPA 625 10 * ug/l 1
Diethyl phthalate Grab EPA 625 10 * ug/1 1
Dimethyl phthalate Grab EPA 625 10 ug/l 1
2,4-dinitrotoluene Grab EPA 625 10 * ug/l 1
2,6-dinitrotoluene Grab EPA 625 10 * ug/1 1
1,2-diphenylhydrazine Grab EPA 625 10 ug/1 1
Fluoranthene Grab EPA 625 10 * ug/I 1
Fluorene Grab EPA 625 10 * ug/1 1
Hexachlorobenzene Grab EPA 625 10 * ug/l 1
Hexachlorobutadiene Grab EPA 625 10 * ug/1 1
Hexachlorocyclo-pentadiene Grab EPA 625 10 * ug/1 1
Hexachloroethane Grab EPA 625 10 * ug/1 1
Indeno(1,2,3-cd)pyrene Grab EPA 625 10 * ug/1 1
Isophorone Grab EPA 625 10 * ug/l 1
Naphthalene Grab EPA 625 10 * ug/1 1
Nitrobenzene Grab EPA 625 10 * ug/l 1
N-nitrosodi-n-propylamine Grab EPA 625 10 * ug/1 1
N-nitrosodimethylamine Grab EPA 625 10 * ug/1 1
N-nitrosodiphenylamine Grab EPA 625 10 * ug/l 1
Phenanthrene Grab EPA 625 10 * ug/1 1
Pyrene Grab EPA 625 10 * ug/1 1
1,2,4,-trichlorobenzene I Grab EPA 625 10 * ug/l 1
I certify under penalty of law- that this document and all attachments were prepared under my direction
and supervision in accordance with a system to design to assure that qualified perdonnel properly
gather and evaluat the information submitted. Based on my inquiry of the person or persons that
manage the system, or those persons directly responsibel for gathering the information, the
information submitted is , to the best of my knowledge and belief, true, accurate and complete. I am
aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations.
Authorized Representative name
Signature
Form - DMR- PPA-1 Page 3

-717
Annud N aitoslag and Panutiat Bois
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Outfall Year
Date
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