Source Certifications

							State of North Carolina Department of Environment and Natural Resources Division of Water Quality RESIDUALS SOURCE CERTIFICATION ATTACHMENT
(FORM: RSCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)

The Division of Water Quality (Division) will not accept this attachment unless all the instructions are followed. Failure to submit all required items will lead to additional processing and review time.
For more information, visit our web site at: http://h2o.enr.state.nc.us/lau/main.html INSTRUCTIONS TO THE APPLICANT: A. Attachment Form:  Do not submit this attachment form for review without a corresponding residuals program application form (FORM: NDRLAP, FORM: DRS, or FORM: SDRS).  Any changes to this attachment form will result in the application package being returned.  For new residuals programs or renewed residuals programs, submit a separate attachment form for each residuals source-generating facility to be certified for this residuals program.  For modified residuals programs in which any modification to the certified residuals-source generating facilities is proposed, submit a separate attachment form for only those residuals source-generating facilities that are affected by the proposed modification.  The attachment should be organized prior to submission in the following order (i.e., by facility):  Attachment Order 2: Residuals Source Certification Attachment (FORM: RSCA).  Attachment Order 2-a: Vicinity map.  Attachment Order 2-b: Process flow diagram and/or narrative.  Attachment Order 2-c: Quantitative justification for residuals production rate.  Attachment Order 2-d: Sampling plan.  Attachment Order 2-e: Laboratory analytical reports and operational data. B. Residuals Source-Generating Facility Information:  Attach a vicinity map that shows the location of the facility and meets all of the criteria in the latest version of the document entitled “Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals Permitting Programs.”  Attach a detailed narrative and/or process flow diagram that describes how the residuals are to be generated, treated, processed, and stored at the facility.  Attach a quantitative justification for the value provided in Item I. 8. Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed, and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during processing. C. Residuals Quality Information:  Attach a detailed sampling plan for the residuals source-generating facility. Ensure that the plan identifies sampling points, sampling frequency, sample type, as well as the Division-certified laboratory to be used. In addition, ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as they are to be land applied, distributed, and/or disposed.  Attach reports for all laboratory analyses used to complete this attachment form. Attach documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector attraction reduction requirements.  Item II. 3. does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat 100% municipal, domestic wastewater only.

FORM: RSCA 070807

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Attachment Order 2

State of North Carolina Department of Environment and Natural Resources Division of Water Quality RESIDUALS SOURCE CERTIFICATION ATTACHMENT
(FORM: RSCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)

Applicant's name: Check all that apply: INCREASE Current: ADD OTHER I. 1. 2. DELETE Explain: NEW RESIDUALS PROGRAM DECREASE RENEWED RESIDUALS PROGRAM

the maximum permitted annual dry tonnage for this residuals sourcegenerating facility certified for this residuals program. Dry Tons/yr. and proposed: Dry Tons/yr.

this residuals source-generating facility to/from those certified for this residuals program.

RESIDUALS SOURCE-GENERATING FACILITY INFORMATION (See Instruction B.): Name of facility: Facility permit holder: Facility permit holder is (check one): Facility permit number: Facility permit issued by (check one): other (explain: 3. If the facility permit is not issued by the Div. of Water Quality, complete the following: a. Facility contact person and title: Facility complete mailing address: City: Telephone number: ( _____ ) E-mail address: b. Facility complete location address: City: Latitude: 4. 5. County where facility is located: Purpose of the facility (check one): treatment of municipal wastewater, treatment of potable water, treatment of 100% domestic wastewater, treatment of 100% industrial wastewater, State: and longitude: Zip: State: Zip: Div. of Water Quality, Div. of Environmental Health, or ). federal, state, local government, or private.

Facsimile number: ( _____ )

treatment of industrial wastewater mixed with domestic wastewater, or (approximate percentages: ________ % industrial and ________ % domestic) FORM: RSCA 070807 Page 2 of 9 Attachment Order 2

State of North Carolina Department of Environment and Natural Resources Division of Water Quality RESIDUALS SOURCE CERTIFICATION ATTACHMENT
(FORM: RSCA 070807)
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL) other (explain: ).

FORM: RSCA 070807

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Attachment Order 2

6. 7. 8. 9.

Does the facility have an approved pretreatment program:

yes

no

Facility permitted/design flow: ________ MGD and facility average daily flow: ________ MGD. Average amount of residuals being generated at this facility _______________ dry tons per year. Specify the following regarding treatment and storage volumes available at the facility: Type and volume of residuals treatment:

Type and volume of residuals storage (i.e., outside of residuals treatment units):

II. 1. 2.

RESIDUALS QUALITY INFORMATION (See Instruction C.): Specify if residuals are regulated under (check one): Specify if residuals are intended for (check one): Land Application/Distribution (Class A or Equivalent). Complete all items EXCEPT Items II. 4b., 7b., and 7c. Land Application (Class B or Equivalent). Complete all items EXCEPT Items II. 4b., 7a., and 7c. Surface Disposal. Complete all items EXCEPT Items II. 4a., 5., 7a., 7b., and 8. 40 CFR Part 503 or 40 CFR Part 257.

***FORM: RSCA CONTINUES ON NEXT PAGE***

FORM: RSCA 070807

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Attachment Order 2

3.

Hazardous Waste Determination: Complete the following to demonstrate that the residuals are nonhazardous under RCRA: a. Are the residuals listed in 40 CFR §261.31-§261.33: If yes, list the number(s): b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21§261.24: yes no. Fill in the following tables with the results of the latest toxicity yes no.

characteristic leaching procedure (TCLP) analysis as well as those for corrosivity, ignitability, and reactivity: laboratory: Passed corrosivity test: Passed ignitability test: Passed reactivity test: TCLP Parameter Arsenic Barium Benzene Cadmium Carbon Tetrachloride Chlordane Chlorobenzene Chloroform Chromium m-Cresol o-Cresol p-Cresol Cresol 2,4-D 1,4-Dichlorobenzene 1,2-Dichloroethane 1,1-Dichloroethylene 2,4-Dinitrotoluene Endrin Heptachlor and its Hydroxide yes yes yes and date of analysis: no. pH: ________ s.u. (2 < pH < 12.5). no. Flashpoint: ________ oF (> 140oF). no. HCN: ________ mg/kg (<250) & H2S: ________ mg/kg (<500). Limit (mg/L) 5.0 100.0 0.5 1.0 0.5 0.03 100.0 6.0 5.0 200.0 200.0 200.0 200.0 10.0 7.5 0.5 0.7 0.13 0.02 0.008 Result (mg/L) TCLP Parameter Hexachlorobenzene Hexachloro-1,3-Butadiene Hexachloroethane Lead Lindane Mercury Methoxychlor Methyl Ethyl Ketone Nitrobenzene Pentachlorophenol Pyridine Selenium Silver Tetrachloroethylene Toxaphene Trichloroethylene 2,4,5-Trichlorophenol 2,4,6-Trichlorophenol 2,4,5-TP (Silvex) Vinyl Chloride Limit (mg/L) 0.13 0.5 3.0 5.0 0.4 0.2 10.0 200.0 2.0 100.0 5.0 1.0 5.0 0.7 0.5 0.5 400.0 2.0 1.0 0.2 Result (mg/L)

FORM: RSCA 070807

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Attachment Order 2

4.

Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105. a. For Class A or Class B: Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following metal parameters: Laboratory: _____________________________________ and date of analysis: ___________________ Parameter Ceiling Concentration Limits (ClassA & ClassB) (mg/kg) Arsenic Cadmium Copper Lead Mercury Molybdenum Nickel Selenium Zinc b. 75 85 4,300 840 57 75 420 100 7,500 Monthly Average Concentration Limits (For Class A Only) (mg/kg) 41 39 1,500 300 17 n/a 420 100 2,800 Result

(mg/kg)

For Surface Disposal: Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following metal parameters: Laboratory: _____________________________________ and date of analysis: ___________________ Closest Distance to Property Lines (meters) > 0 but < 25 ≥ 25 but < 50 ≥ 50 but < 75 ≥ 75 but < 100 ≥ 100 but < 125 ≥ 125 but < 150 ≥ 150 Arsenic (mg/kg) 30 34 39 46 53 62 73 Chromium (mg/kg) 200 220 260 300 360 450 600 Nickel (mg/kg) 210 240 270 320 390 420 420

FORM: RSCA 070807

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Attachment Order 2

5.

Nutrient/Micronutrient Determination: Complete the following: a. b. Total solids: ________ %. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and micronutrient parameters: laboratory: and date of analysis: Parameter Aluminum Ammonia-Nitrogen Calcium Magnesium Nitrate-Nitrite Nitrogen pH (Standard Unit) Phosphorus Potassium Sodium Total Kjeldahl Nitrogen c. d. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): ________ . Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: ________ %. This rate is a default value or actually established. Result (mg/kg, dry weight)

If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical justification as to why the selected default value is appropriate to be applied to these residuals:

Calculate the PAN for the residuals (i.e., on a dry weight basis) and list the results in the following table: Application Method First Year PAN (mg/kg) Surface Injection/Incorporation e. Are the residuals a registered fertilizer with the NC Department of Agriculture and Consumer Services: yes no. If yes, provide date of registration approval: , , Five-Year Maximum Adjusted PAN (mg/kg)

the current registration number: and the fertilizer equivalent: ________ %, ________ %, and ________ %. FORM: RSCA 070807 Page 7 of 9 Attachment Order 2

6.

Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and list the results of the latest analyses:

7.

Pathogen Reduction Determination: Specify which alternative(s) will be used to meet the pathogen reduction requirements: a. For Class A or Equivalent: A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids. OR A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids. AND one of the following (except for residuals regulated under 40 CFR Part 257 that are to be distributed): Alternative 1 [40 CFR §503.32 (a)(3)] - Time/Temperature Compliance. Alternative 2 [40 CFR §503.32 (a)(4)] - Alkaline Treatment. Alternative 3 [40 CFR §503.32 (a)(5)] - Prior Testing for Enteric Virus/Viable Helminth Ova. Alternative 4 [40 CFR §503.32 (a)(6)] - No Prior Testing for Enteric Virus/Viable Helminth Ova. Alternative 5 [40 CFR §503.32 (a)(7)] - Process to Further Reduce Pathogens (PFRP). Specify one: composting, heat drying, heat treatment, pasteurization, gamma ray irradiation.

thermophilic aerobic digestion,

beta ray irradiation, or

Alternative 6 [40 CFR §503.32 (a)(8)] - PFRP-Equivalent Process. Explain: b. For Class B or Equivalent: Alternative 1 [40 CFR §503.32 (b)(2)] - Fecal Coliform Density Demonstration. Alternative 2 [40 CFR §503.32 (b)(3)] - Process to Significantly Reduce Pathogens (PFRP). Specify one: aerobic digestion, composting, or air drying, anaerobic digestion,

lime stabilization.

Alternative 3 [40 CFR §503.32 (b)(4)] - PSRP-Equivalent Process. Explain: Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution. c. For Surface Disposal: Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover. Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above. Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above. Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.

FORM: RSCA 070807

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Attachment Order 2

8.

Vector Attraction Reduction Determination: Specify which alternative(s) will be used to meet the vector attraction reduction requirements: Alternative 1 [40 CFR §503.33 (b)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion). Alternative 2 [40 CFR §503.33 (b)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion). Alternative 3 [40 CFR §503.33 (b)(3)] - 30-Day Bench Scale Test (Aerobic Digestion). Alternative 4 [40 CFR §503.33 (b)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion). Alternative 5 [40 CFR §503.33 (b)(5)] - 14-Day Aerobic Processes. Alternative 6 [40 CFR §503.33 (b)(6)] - Alkaline Stabilization. Alternative 7 [40 CFR §503.33 (b)(7)] - Drying of Stabilized Residuals. Alternative 8 [40 CFR §503.33 (b)(8)] - Drying of Unstabilized Residuals. Alternative 9 [40 CFR §503.33 (b)(9)] - Injection. Alternative 10 [40 CFR §503.33 (b)(10)] - Incorporation. Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover. Alternatives for Animal Processing Residuals Only: Specify one: injection, incorporation, or lime addition to raise pH to 10.

Not Applicable - Non-Biological Residuals with NO Domestic Wastewater Contribution.

FORM: RSCA 070807

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Attachment Order 2