WQ0018007_Renewal Application_20240712

Initial Review
Reviewer nathaniel.thornburg
Is this submittal an application? (Excluding additional information.) *
Yes No
Permit Number (IR) * WO0018007
Applicant/Permittee Town of Broadway
Applicant/Permittee Address PO Box 130 Braodway, NC 27505
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Municipal
Town of Broadway Class B Residuals Program
Lee
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
07/12/2024
$0
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO
Yes No

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
....................................................................................................................................................................................................................................................................................... ... ... ... ... ... .. ... ... ... ... ..
Name* Robert T. Branch
Email Address*
[e-mail]
Project Information
.........................
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
3363129007
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0018007
Has Current Existing permit number
Applicant/Permittee *
Town of Broadway
Applicant/Permittee Address*
PO Box 130 Braadway, NC 27505
Facility Name *
Town of Broadway Class B Residuals Program
Please provide comments/notes on your current submittal below.
Renewal only, no modification fee required.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
TOB_Renewal_2024 _Final.pdf 4.02MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has
been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the
North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 7/12/2024

APPLICATION FOR PERMIT
RENEWAL
TOWN OF BRODWAY
PERMIT NO. WQ0018007
BROADWAY, NORTH CAROLINA
Prepared For:
Town of Broadway
P.O. Box 130
Broadway, NC 27505
Prepared By:
Branch Residuals & Soils, LLC
1735 Heckle Blvd. Suite 103-291
Rock Hill, SC 29732
July 2024

BRANCH RESIDUALS & SOILS, LLC
1735 Heckle Blvd, Suite 103-291, Rock Hill, SC 29732
PHONE [phone] CELL [phone]
July 11, 2024
NCDENR -Division of Water Resources
Permitting Section — Land Application Unit
Mail Service Center 1617
Raleigh, North Carolina 27699-1617
Attention: Mr. Nathaniel Thornburg
Reference: PERMIT RENEWALAND MODIFICATION WQ0018007
Town of Broadway
Broadway, North Carolina
BR&S Job No. 2002-09
Dear Mr. Thornburg:
Branch Residuals & Soils, LLC is under contract with the Town of Broadway to provide assistance
in the preparation of a permit renewal for their existing land application permit. The Town of
Broadway has elected to drop one field from the land application program.
Your attention in the review of this application would be greatly appreciated. Please contact me
immediately at [phone], if you require additional information or have questions in the review
of the permit application.
Sincerely,
Robert T. Branch, L. S. S.
Project Manager
cc: Mr. Jonathan Godfrey— Broadway Town Manager

TABLE OF CONTENTS
Section No. Title
NON -DEDICATED RESIDUALS LAND APPLICATION FORM
Copy of Existing Permit
Operations and Maintenance Plan
II RESIDUALS SOURCE CERTIFICATION ATTACHMENT FORM
Facility vicinity map
Process flow diagram and narrative
Justification for residuals production rate
Residuals sampling plan
Analytical Data From the Town of Broadway
(TCLP and Nutrient & Metal)
III LAND APPLICATION SITE CERTIFICATION ATTACHMENT FORM
Landowner Operator Agreement Forms
Vicinity and Buffer Maps
Cumulative Pollutant Loading Rates

RESIDUALS LAND APPLICATION PROGRAM FORM

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supportins documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
® If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification
Major (land are permitted for > 300 acres) $1,760 $528
Minor (land are permitted for < 300 acres) $1,160 $348
- A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (Maybe Required— See 15A NCAC IC .0.300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plan in accordance with 15A NCAC 02T. I 110 and include at a minimum:
❑ Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
❑ Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.110202). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I V by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: httD://www.ncwater.or2/Ruies Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .I 104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: httD://www.ncwater.orii/Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Deliverv:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Broadwav
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: John Godfrev Title: Town Manaser
Applicant's mailing address: P.O. Box 130
City: Broadwav State: NC Zip: 27505-
Telephone number: (2L9) 258-9922 Email Address: manaeerAbroadwavnc.com
2. Consultant's name: Branch Residuals & Soils, LLC License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: )
Consultant's mailing address: 1735 Heckle Blvd, Suite 103-291
City: Rock Hill State: SC Zip: 29732-
Telephone number: [phone] Email Address: bbranchabranchrs.com
3. Agronomist's name: Robert T. Branch License Number:
Affiliation: ❑ N/A ❑ On Staff ® Retained (Firm: )
Agronomist's mailing address:
City: State: Zip: -
Telephone number: (_) = Email Address:
4. Soil Scientist's name: Robert T. Branch License Number: 1180
Affiliation: ❑ N/A ❑ On Staff ® Retained (Firm: )
Soil Scientist's mailing address:
City: State: Zip: -
Telephone number: (_—) _- Email Address:
5. Fee submitted: 0.00 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00018007
Date of most -recently issued permit: March 7, 2019
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 6614 Bradley Road
City: Broadway State: NC Zip: 27505-
Coordinates: Latitude: 35' 27' 37.65" Longitude: 79. 1' 29.90"
Datum: NAD 83 Level of accuracy: 1'
Method of measurement: Man
2. County where residuals land application program is headquartered: Lee
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation Name Affiliation Certification Number
ORC William Craig Buchanan Town of Broadway 17572
Back -Up ORC George Wayne Watson Local Farmer 23353
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summarv: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 40 dry tons per year.
PAN Pounds of PAN per Dry Ton
Pounds of PAN per Year
(Weighted Average)
Surface Incorporation
Surface Incorporation
or Injection
or Injection
First -Year 33.75 34.40
1,349.89 1,375.93
Five -Year Maximum Adjusted 53.62 54.27 2,144.90 2,170.94
b. Land Application Site Use Summarv: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Crops
Forest or Plantation
0
Row Crops
8.3
Hay
7.97
Pasture
0
Total:
16.27
Methods
Surface
7.97
Incorporation or Injection
8.3
Total:
16.27
Comments
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summarv: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
(Ibs PAN/ac yi)
Concentrations
Surface Incorporation or
Surface Incorporation or
Injection
Injection
50
27.00 27.52
42.90 43.42
100
13.50 13.76
21.45 21.71
150
9.00 9.17
14.30 14.47
200
6.75 6.88
10.72 10.85
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
I ]
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
111
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505(n) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Recommended Recommended
Soil Series Fields within Soil Area Loading Rate Loading Rate
(in/hr) (in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field /Zone Design Area Number of Maximum Application Design Annual Loading
(ft2) Nozzles Rate (gallons/hr) Rate (gallons/yr)
Total
Spray Irrigation Design Element
Wetted diameter of nozzles
1 Wetted area of nozzles
Nozzle capacity
Nozzle manufacturer / model
Elevation of highest nozzle
Plan Sheet Specification
Number Page Number
_ ft _ ... - --- --I
ft'-
gpm
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance ►vatic 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
❑ Yes ❑ No, Explain;
1, John Godfrev
(Signature Authority's Name - PLEASE PRINT)
attest that this application for
(Facility Name)
"Town Manager
(Title)
Town of Broadway Land Aimlication Permit
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a conditions of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will he returned to me as
incomplete.
Note, In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:_r—
Date: 67 /�� /0�012 /f
FORM: RLAP 06-16 Page 5 of 5

Copy of Existing Permit

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
DUSTIN KORNEGAY — TOWN MANAGER
TOWN OF BROADWAY
POST OFMCE Box 130
BROADWAY, NORTH CAROUNA 27505
Dear Mr. Konlegay:
NORTH CAROLINA
Environmental Quality
March 7, 2019
Subject: Permit No. WQ0018007
Town of Broadway RLAP
Land Application of
Class B Residuals
Lee County
In accordance with your permit renewal request received January 16, 2019, we are forwarding
herewith Permit No. WQ0018007 dated March 7. 2019, to the Town of Broadway for the continued
operation of the subject residuals management program. Please note that this renewed permit shall become
effective on August 1, 2019 (i.e., the day after the expiration date of the existing permit).
Modifications to the subject permit are as follows: The dry tonnage is decreased from 80 to 40 dry
tons per year, and the total acreage has decreased from 23.95 to 17.87.
This permit shall be effective from August 1, 2019 through December 31, 2024, shall void Permit
No. WQ0018007 issued February 18, 2014, and shall be subject to the conditions and limitations as
specified therein. The Permittee shall submit a renewal application no later than July 4, 2024.
Please pay particular attention to the monitoring requirements listed in Attachment A for they may
differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
Please note that on September 1, 2018, North Carolina Administrative Code Title 15A Subchapter
02T — Waste not Discharged to Surface Waters was readopted. Accordingly, this permit incorporates the
requirements of these rules, therefore, please take the time to review this permit thoroughly.
The Division has removed the permit conditions since the last permit issuance dated February
18, 2014:
Old Condition 1I.8. — Replaced by Condition 11.8.
➢ Old Condition Ill.10. — Redundant since covered by Old Condition III.1 Li. and Condition
Ill. I0.i.
Old Condition I1I.1 l.h. — The soil pH condition is redundant since covered by Old Condition
III. l l I. and Condition 111.101.
➢ Old Condition 111.13. — The means of guaranteeing public access control to sites is no longer
specified.
.Ile ��� North Caraimii Department o* Environmental Quality (t7ivisinn of Water Resources
517. North Salisbury Street 1 1617 Mail Service Center 1 Raleigh, North Carolina 27b99-1617
--r • �� R 9191019000

Mr. Dustin Komegay
March 7, 2019
Page 2 of 2
> Old Condition IV.8. — Replaced by Condition IV.8.
> Old Condition VI.2. — This condition has been removed because the pen -nit is not voidable.
The following permit condition is new since the last permit issuance dated February 18, 2014:
➢ Condition II.8. — Setbacks that have changed are distance to surface waters (100 feet to 32.8
feet [i.e., 10 meters]) and a note that two adjoining properties owned by the same landowner
does not need a setback to property line. Although not stated in the permit, the Permittee should
be aware that two adjoining, separate landowners can have their property setbacks at 0 feet if
they obtain a setback waiver that is registered with the appropriate Register of Deeds.
Additionally, the setback to a habitable residence may be reduced to 100 feet with a setback
waiver registered with the appropriate Register of Deeds.
Condition 1I1.10.1. — The watersheds in which bulk residuals are not to be applied.
Condition IV.8. — The annual report condition changes from three paper copies to one paper
copy and one electronic copy (PDF).
Condition VI.3. — This condition states that unless specifically requested and approved in the
permit, there are no variances to administrative codes or general statutes governing the
construction or operation of the permitted facilities.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, .Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Troy Doby at (919) 707-
3655 or trov.dobvnncdennizov.
Sincerely,
C-in a Culpepper, Director
" Division of Water Resources
cc: Lee County Health Department (Electronic Copy)
Raleigh Regional Office; Water Quality Regional Operations Section (Electronic Copy)
Bob Branch, LSS — Branch Residuals & Soils, LLC (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION 1S HEREBY GRANTED TO
Town of Broadway
Lee County
FOR THE
continued operation of a residuals management program for the Town of Broadway and consisting of the
land application of Class B residuals generated by the approved facility listed in Attachment A to the
approved fields listed in Attachment B, with no discharge of wastes to surface waters, pursuant to the
application received January 16, 2019, and in conformity with other supporting data subsequently filed and
approved by the Department of Environmental Quality and considered a part of this permit. The disposal
of residuals is regulated under Title 40 Code of Federal Regulations Part 503. This permit does not exempt
the Permittee from complying with Federal Regulation 40 CFR Part 503.
This permit shall be effective from August 1, 2019 through December 31, 2024, shall void Permit No.
WQ0018007 issued February 18, 2014, and shall be subject to the following conditions and limitations:
1. SCHEDULES
1. The Permittee shall request renewal of this permit on Division -approved forms no later than July 4,
2024. [15A NCAC 02T .0105(b), 02T .0109]
II. PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject residuals management program so there is no
discharge to surface waters, nor any contravention of groundwater or surface water standards. In the
event the residuals management program fails to perform satisfactorily, including the creation of
nuisance conditions due to improper operation and maintenance, the Permittee shall immediately cease
land applying residuals, take immediate corrective actions, and contact the Raleigh Regional Office
supervisor. [15A NCAC 02T .0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this residuals management program. [15A NCAC 02T
.0 1 08(b)(1)(A)]
3. Only residuals generated by the facility listed in Attachment A are approved for land application in
accordance with this permit. [15A NCAC 02T .1 101]
WQ0018007 Version 4.0 Shell Version 181130 Page 1 of 12

4. Only the fields listed in Attachment B are approved for residuals land application. [G.S. 143-
215.1(a)(9)]
5. Pollutant concentrations in residuals land applied to the sites listed in Attachment B shall not exceed
the following Ceiling Concentrations or Cumulative Pollutant Loading Rates (CPLRs), on a dry
weight basis:
Ceiling I
Concentration Cumulative Pollutant Loading Rates
Parameter
(mg/kg,
(kg/ha)
, gbs/ac)
Arsenic I
75
41
36
Cadmium (
85
39
34
Copper
4,300
1,500
1,338
Lead I
840
300
267
f
Mercury 57 17 15
Molybdenum 75 N/A N/A
Nickel 420 420 374
Selenium 100 100 89
i
Zinc 7,500 2,800 2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application has not occurred or for which the required data is incomplete,
by determining background concentrations through representative soil sampling.
[15A NCAC 02T .1105(a), 02T .l 105(b)]
6. Class B biological residuals shall meet the pathogen reduction requirements in 15A NCAC 02T .1106
(b). Exemptions to this requirement shall be specified in Attachment A. [15A NCAC 02T .1 106(b),
02T .1106(d)]
7. Class B biological residuals shall meet one of the vector attraction reduction alternatives in I5A NCAC
02T .1107(a). Exemptions to this requirement shall be specified in Attachment A. [15A NCAC 02T
.1107(a), 02T . 1107(c)]
WQ0018007 Version 4.0 Shell Version 181130 Page 2 of 12

8. Setbacks for Class B land application sites are as follows (all distances in feet):
Surface
Irrigation
Injection /
Application
Surface
Incorporation
by Vehicle
Application
i. Each habitable residence or place of assembly
400
400
200
under separate ownership:
ii. Each habitable residence or places of assembly
owned by the Permittee, the owner of the land,
0
200
0
or the lessee or operator of the land:
iii. Each property line:
501
1501
501
iv. Public right of way:
50
50
50
v. Each private or public water supply source:
100
100
100
vi. Surface waters such as intermittent and
perennial streams, perennial waterbodies, and
32.8
32.8
32.8
wetlands:
vii. Surface water diversions such as ephemeral
25
25
25
streams, waterways, and ditches:
viii.Groundwater lowering ditches where the
25
100
25
bottom of the ditch intersects the S14WT:
ix. Subsurface groundwater lowering systems:
0
100
0
x. Each well with exception of monitoring wells:
100
100
100
xi. Bedrock outcrops:
25
25
25
xii. Top of slope of embankments or cuts of two
15
15
15
feet or more in vertical height:
xiii.Each building foundation or basement:
0
15
0
xiv. Each water line:
0
10
0
xv. Nitrification field:
0
20
0
1 Setbacks to property lines are not applicable when
the Permittee,
or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
[15A NCAC 02T .1 108(c)]
9. Class B land application areas shall be clearly marked on each site prior to and during any residuals
application event. [15A NCAC 02T .0110(g)]
WQ0018007 Version 4.0 Shell Version 181130 Page 3 of 12

10. Residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in exceedance of
agronomic rates. Appropriate agronomic rates shall be calculated using expected nitrogen requirements
based on the determined Realistic Yield Expectations (RYE) using any of the following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina State
University Department of Soil Science (httT)://nutrients.soil.ncsu.edu/Nields/index.t)hr)). A copy
shall be kept on file and reprinted every five years in accordance with Condition IV.6.
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncaer.i!ov/SWC,Itech/documents/9th Guidance Doc 100109.Ddf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (MRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards(ftD:/iftp.-fc.sc.eaov.usda.eov/NHO/practice-standards/standards/590.ndn.
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
[I 5A NCAC 02T . 1109(a)(1)(K)]
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25%. [15ANCAC 02T.0 I 08(b)(l)(A)]
12..If residuals land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the
summer and rye grass in the winter with both crops to receive residuals), then the second crop can
receive an application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This
practice may be allowed as long as the second crop is to be harvested or grazed. If the second crop is
to be planted for erosion control only and is to be tilled into the soil, then no additional PAN shall be
applied. [15A NCAC 02T .0108(b)(1)(A)]
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, eta), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee shall
maintain written records of these recommendations and details of their implementation. [ 15A NCAC
02T .0108(b)(1)(A)]
14. Residuals land application fields permitted on or after December 30, 1983 have a compliance boundary
that is either 250 feet from the residual land application area, or 50 feet within the property boundary,
whichcver is closest to the residual land application area. Any exceedance of groundwater standards
at or beyond the compliance boundary shall require corrective action. Division -approved relocation
of the compliance boundary shall be noted in Attachment B. Multiple contiguous properties under
common ownership and permitted for use as a disposal system shall be treated as a single property
with regard to determination of a compliance boundary. [15A NCAC 02L .0106(d)(2), 02L .0107(b),
02T .0I05(h), G.S. 143-215. 1 (i), G.S. 143-215.1(k)]
WQ0018007 Version 4.0 Shell Version 181130 Page 4 of 12

15. The review boundary is midway between the compliance boundary and the residual land application
area. Any exceedance of groundwater standards at or beyond the review boundary shall require
preventative action. [15A NCAC 02L .0106(d)(1), 02L .0108]
III. OPERATION AND MAINTENANCE REOUIREMENTS
1. The Permittee shall operate and maintain the residuals management program as a non -discharge system.
[15A NCAC 02T .1100]
2. The Permittee shall notify the Raleigh Regional Office, telephone number [phone], and the
appropriate local government official (i.e., county manager, city manager, or health director) at least
two business days in advance of a site's initial residuals land application event. [15A NCAC 02T
.0108(b)(1)(A)]
3. The Permittee shall notify the Raleigh Regional Office, telephone number [phone], at least one
business day in advance of conducting any land application activity. Notification shall include the
anticipated application date, time, and field name as listed in Attachment B. Exceptions to this
requirement shall be approved by the Raleigh Regional Office. [15A NCAC 02T .0108(b)(1)(A)]
4. The Permittee shall maintain a Division -approved Operation and Maintenance Plan that shall include:
a. Description of the program, and associated facilities and equipment, in sufficient detail to show
what operations are necessary for the program to function and by whom the functions are to be
conducted;
b. Description of anticipated maintenance of facilities and equipment associated with the program;
c. Include provisions for safety measures, including restriction of access to sites and equipment;
d. Spill control provisions:
i. Response to upsets and bypasses including control, containment, and remediation; and
ii. Contact information for plant personnel, emergency responders, and regulatory agencies;
e. Detailed inspection procedures:
i. Names or titles of personnel responsible for conducting inspections:
ii. Frequency and location of inspections, and procedures to assure that the selected locations and
inspection frequency are representative of the residuals management program; and
iii. Description of record keeping and actions to be taken by the inspector in the event that
noncompliance is observed:
f. Detailed sampling and monitoring procedures:
i. Names or titles of personnel responsible for conducting sampling and monitoring:
ii. Description of monitoring procedures including parameters to be monitored; and
iii. Sampling frequency and procedures to assure that representative samples are collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for any
foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to
meet pathogen and vector attraction reduction requirements.
[ l 5A NCAC 02T . I 110(a)]
5 Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the residuals management program, the Permittee shall designate and employ a
certified operator in responsible charge (ORC), and one or more certified operators as back-up ORCs.
The ORC or their back-up shall visit the facilities in accordance with 15A NCAC 08G 0204 and shall
comply with all other requirement in 15A NCAC 08G 0204. [15A NCAC 02T .0117, 08G .0204]
WQ0018007 Version 4.0 Shell Version 181130 Page 5 of 12

6. The Permittee shall ensure that a copy of this permit and the Division -approved Operation and
Maintenance Plan is available when land applying residuals. [15A NCAC 02T .1110(b)]
7. The Permittee shall ensure that spill control provisions are available when residuals are transported or
land applied. [ 15A NCAC 02T .1 I l 0(a)(4)]
8. Class B residuals shall not be stored or staged at any land application site without prior written approval
from the Division. Class B residuals approved for storage shall be stored or staged in a manner to
prevent runoff of leachate and other wastewaters generated. [15A NCAC 02T .1110(c), 02T .1110(e)]
9. Adequate measures shall be taken to prevent wind erosion and runoff from the land application sites
listed in Attachment B. [15A NCAC 02T .0108(b)(1)(A)]
10. Class B residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under section
4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of surface
water or groundwater standards;
d. If the land is flooded, frozen, or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100-year flood elevation, unless the residuals are injected or incorporated within a 24-
hour period following a residuals land application event;
f. During precipitation events, or within 24 hours following a rainfall event of 0.5 inches or greater
in a 24-hour period;
g. If the slope of the land is greater than 10% when liquid residuals are surface applied, or if the slope
of the land is greater than 18% when liquid residuals are injected or incorporated;
h. If the land does not have an established vegetative cover crop unless the land is a Division -approved
no -till site, or the residuals are incorporated within a 24-hour period following the injection or
application of residuals;
i. If the vertical separation of the seasonal high water table and the depth of residuals application is
less than one foot;
j. If the vertical separation of the depth to bedrock and the depth of residuals application is less than
one foot;
k. If the application exceeds agronomic rates;
1. If the land application sites are located within a WS-I watershed pursuant to 15A NCAC 02B .0212
or within the Critical Area of a WS-11 pursuant to Sub -Item (4)(g) of Rule 15A NCAC 02B .0212,
or within the Critical Area of a WS-III or WS-IV watershed pursuant to Sub -Item (4)(h) of Rules
15A NCAC 0213.0215, and .0216.
[I 5A NCAC 02T . 1109(a)(1)]
WQ0018007 Version 4.0 Shell Version 181130 Page 6 of 12

11. Class B land application sites shall have the following public access restrictions:
a. Public access to public contact sites shall be restricted for one calendar year after a residuals land
application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event;
c. Public access to land associated with a dedicated land application site shall be restricted
continuously while the land is permitted for active use, and for one calendar year after the final
land application of residuals.
[ 15A NCAC 02T . 1109(a)(2)]
12. Class B land application sites shall have the following harvesting and grazing restrictions:
a. Animals shall not be allowed to graze on land for 30 calendar days after any land application of
residuals:
b. Food crops, feed crops, and fiber crops shall not be harvested for 30 calendar days after any land
application of residuals;
c. Food crops with harvested parts that touch the mixture of residuals and soil and are totally above
the land surface shall not be harvested for 14 months after any land application of residuals;
d. Food crops with harvested parts below the land surface shall not be harvested for 20 months after
any land application of residuals if the residuals remain on the land surface for four months or
longer prior to incorporation into the soil;
e. Food crops with harvested parts below the land surface shall not be harvested for 38 months after
any land application of residuals if the residuals remain on the land surface for less than four months
prior to incorporation into the soil; and
f. Turf grown on land where residuals are applied shall not be harvested for one calendar year after
any land application of residuals.
[I 5A NCAC 02T .I109(a)(3)]
13. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for those
operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (MRCS) or other State Agencies. The Pennittee shall calculate allowable nutrient
loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CLIP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CLAMP) shall also be considered a Nutrient
Management Plan. [15A NCAC 02T .0108(b)(1)(A), 02T .1104(c)(3)]
14. Class B residuals shall not be land applied to the fields listed in Attachment B unless the Land Owner
Agreement between the Permittee and the respective field owners or lessees/operators of the land
application site is valid. The Land Owner Agreements shall expire concurrent with the permit
expiration date of December 31, 2024. [15A NCAC 02T .1104(c)(4)]
WQ0018007 Version 4.0 Shell Version 181130 Page 7 of 12

IV. MONITORING AND REPORTING REOUIREMENTS
l . The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
program's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. The residuals from each source generating facility shall be analyzed to demonstrate they are non-
hazardous under the Resource Conservation and Recovery Act (RCRA). Residuals that test or are
classified as a hazardous or toxic waste under 40 CFR Part 261 shall not be land applied. The analyses
(i.e., corrosivity, ignitability, reactivity, and toxicity characteristic leaching procedure (TCLP)) shall be
perfonned at the frequency specified in Attachment A, and the Permittee shall maintain these results
for five years. Any exemptions from the requirements in this condition shall be specified in Attachment
A. The TCLP analysis shall include the following parameters, and the Federal regulatory level (mg1L)
is in parentheses:
Arsenic
Barium
Benzene
Cadmium
Carbon tetrachloride (0.5)
Chlordane (0.03)
Chlorobenzene (100.0)
Chloroform (6.0)
Chromium (5.0)
m-Cresol (200.0)
o-Cresol (200.0)
p-Cresol (200.0)
Cresol (200.0) Methoxy
2,4-D (10.0) Methyl ethyl
[15A NCAC 13A .0102(b), 02T J101, 02T .1105]
1,4-Dichlorobenzene (7.5)
1,2-Dichloroethane (0.5)
1, 1 -Dichloroethylene (0.7)
2,4-Dinitrotoluene (0.13)
Endrin (0.02)
Heptachlor (and its epoxide)
(0.008)
Hexachlorobenzene (0.13)
Hexachlorobutadiene(0.5)
Hexachloroethane (3.0)
Lead (5.0)
Lindane (0.4)
Mercury (0.2)
chlor(10.0)
ketone (200.0)
Nitrobenzene (2.0)
Pentachlorophenol(100.0)
Pyridine (5.0)
Selenium (1.0)
Silver (5.0)
Tetrachloroethylene (0.7)
Toxaphene (0.5)
Trichloroethylene (0.5)
2,4,5-Trichlorophenol (400.0)
2,4,6-Trichlorophenol(2.0)
2,4,5-TP (Silvex) (1.0)
Vinyl chloride (0.2)
3. The residuals from each source generating facility shall be analyzed at the frequency specified in
Attachment A. and the Permittee shall maintain the results for a minimum of five years. Each analysis
shall include the following parameters:
I
Aluminum Mercury
Ammonia -Nitrogen Molybdenum
Arsenic Nickel
Cadmium
Calcium
Copper
Lead
Magnesium
[15A NCAC 02T .1101]
Nitrate -Nitrite Nitrogen
Percent Total Solids
pH
Phosphorus
Plant Available Nitrogen
(by calculation)
Potassium
Selenium
Sodium l
Sodium Adsorption Ratio
(SAR)
TKN
Zinc
WQ0018007 Version 4.0 Shell Version 181130 Page 8 of 12

4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A. The monitoring results shall specify the
stabilization process utilized, and demonstrate compliance with the Class B pathogen reduction
requirements in 15A NCAC 02T .l 106(b), and one vector attraction reduction requirement in 15A
NCAC 02T .1107(a) shall be met. Any exemptions from the requirements in this condition shall be
specified in Attachment A. [15A NCAC 02T .1106(b), 02T .1107(a), 02T .1111(c)]
An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B that received residuals during the calendar year. This
analysis shall be in accordance with the soil sampling guidance located in the Sampling Instructions
section of the NC Department of Agriculture & Consumer Services website
(httn://a-ww.ncavr.eov/aQronoinUvubs.htm). The Pcrmittee shall maintain these results for a period of
no less than five years, and these results shall be made available to the Division upon request. Each
Standard Soil Fertility Analysis shall include the following parameters:
Acidity (Exchangeable Sodium Percentag9 Phosphorus
jBase Saturation (by calculation) Magnesium Potassium
Calcium Manganese Sodium
Cation Exchange Capacity Percent Humic Matter Zinc
Copper I 1?H--
[ 15A NCAC 02T .0108(c), 15A NCAC 02T .111 1(d)]
6. Representative samples of residuals that are prepared for land application shall be collected and
analyzed. [15A NCAC 02T .1111(a)]
The Permittee shall maintain records for all residual land application events. These records shall
include the following:
a. Residuals source (as listed in Attachment A);
b. Date of application;
c. Location of land application (field name as listed in Attachment B);
d. Approximate acreage applied;
e. Method of application;
f. Weather conditions:
g. Dominant soil series;
h. Soil conditions;
i. Proposed crop;
j. Nitrogen Application Rate based on RYEs;
k. Volume of residuals applied per acre in gallons, cubic yards, dry tons, or wet tons;
1. Volume of animal waste or other nutrient source applied per acre in gallons, cubic yards, dry tons,
or wet tons;
m. Volume of soil amendments applied per acre in gallons, cubic yards, dry tons, or wet tons; and
n. Annual and cumulative totals applied to each field for the following:
i. Class A and Class B residuals (dry tons per acre);
ii. Animal waste and other sources of nutrients (dry tons per acre);
iii. Heavy metals as specified in Condition 11.5. (pounds per acre);
iv. Plant available nitrogen (pounds per acre); and
v. Phosphorus (pounds per acre).
[15A NCAC 02T .0108(c)]
WQ0018007 Version 4.0 Shell Version 181130 Page 9 of 12

8. One hard copy and one electronic copy of an annual report shall be submitted on or before March lg`.
The annual report shall meet the requirements described in the Instructions for Residuals Application
Annual Reuortinu, Forms. Instructions for reporting and annual report forms are available at
bttn:Hden.nc.L,ov/about/d ivis ions/water-resources/water-resources-nermits/wastewater-branch/non-
discharee-permitting-unit/reoortina-forms. or can be obtained by contacting the Non -Discharge Branch
directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[15A NCAC 02T .1111(d)]
9. Noncompliance Notification
The Permittee shall report to the Raleigh Regional Office, telephone number [phone], within
24 hours of first knowledge of the:
a. Any process unit failure (e.g., mechanical, electrical, etc.) rendering the facility incapable of
adequate residual treatment.
b. Any failure resulting in a discharge to surface waters.
c. Any time self -monitoring indicates the program has gone out of compliance with its permit
limitations.
d. Land application of residuals abnormal in quantity or characteristic.
e. Any discharge from a vehicle or piping system transporting residuals.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Raleigh Regional Office within five days
of first knowledge of the occurrence, and this report shall outline the actions proposed or taken to ensure
the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the storage,
distribution, and application facilities. [15A NCAC 02T .1110(f)]
2. The Permittee shall inspect the residuals storage, transport, and application facilities to prevent
malfunctions, facility deterioration, and operator errors that may result in discharges of wastes to the
environment, threats to human health, or public nuisances. The Permittee shall maintain an inspection
log that includes the date and time of inspection, observations made, and maintenance. repairs. or
corrective actions taken. The Permittee shall maintain this inspection log for a period of five years
from the date of inspection, and this log shall be made available to the Division upon request. [15A
NCAC 02T .0 1 08(b)(1 )(A), 02T .I I I0(f)]
Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the land application sites or facilities permitted herein at any
reasonable time for determining compliance with this permit. Division authorized representatives may
inspect or copy records maintained under the terms and conditions of this permit, and may collect
groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
WQ0018007 Version 4.0 Shell Version 181 l30 Page 10 of 12

VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215.1(d)]
3. Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes. rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
5. If the permitted residuals program change ownership, or the Permittee changes their name, the
Permittee shall submit a permit modification request on Division -approved forms. The Permittee shall
comply with all terms and conditions of this permit until the permit is transferred to the successor -
owner. [G.S. 143-215.1(d3)]
6. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02T:
b. obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
i. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants;
d. the Permittee's failure to pay the annual fee for administering and compliance monitoring; or
e. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[15A NCAC 02T .01 l0]
WQ0018007 Version 4.0 Shell Version 181130 Page 11 of 12

7. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.6B, or tinder Federal law that would otherwise be
prosecuted under G.S. 143-215.6B, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Penmittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[ 15A NCAC 02T .0120(b), 02T .0120(d)]
8. This permit shall not be renewed if the Permittee or any affiliation has not paid the required annual fee.
[15A NCAC 02T .0120(c)]
Permit issued this the 7111 day of March 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
aina;Cu�lpepper, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0018007
WQ0018007 Version 4.0 Shell Version 181 130 Page 12 of 12

ATTACHMENT A — APPROVED RESIDUAL SOURCES Certification Date: March 7, 2019
Town of Broadway Permit Number: WQ0018007 Version: 4.0
onitoring
onitoring Men I
—ma
Approved
Owner FacilityName y 1 County _ Permit Biological i Dry xTo s Frequency or r Frequency for Piinum athogen &r I Mineralization f
ty Number Residuals per Year Non-hazardousMetals and Vector Attraction Rate
Z `
I Characteristics Nutrients Reductions°,s
Town of Broadway Broadway WWTP Lee NC0059242 I Yes 40 Once per permit Annually Annually 0.3
c% Cie
I Total i � 40 u.�..
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
1� Monitoring Frequency 1
Dry Tons Applied 1,
Dry Tons Applied (metric tons) (40 CFR 503 and 15A NCAC 02T
(short tons per year) lllllc))
290 < 319 Once per year (Annually)
.
.... ....
..
>
290 to < 1,500 >_ 319 to < 1,650 Once per quarter (4 x Year)
> 1,500 to 15,000 > 1,650 to < 16,500 Once per 60 days (6 x Year)
> 15,000 > 16,500 Once per month (12 x Year)
If no land application events occur during a required sampling period (e.g., no land application occur during an entire year when annual monitoring is -required), then no sampling data is
required during the period of inactivity. The annual report shall include an explanation for missing sampling data. Those required to submit the annual reportto United States Environmental
Protection Agency (US EPA) may be required to make up the missed sampling. Contact the US EPA for additional information.
WQ0018007 Version 4.0 Attachment A Page 1 of 1

a

ATTACHMENT B — APPROVED LAND APPLICATION SITES
Town of Broadway — Town of Broadway RLAP
Certification Date: March 7, 2019
Permit Number: WQ0018007 Version: 4.0
Field
Owner
-._...... . —
"Town of Broadway
Lessee
-._.....
County
- —
Latitude
Longitude
e
Acreage
--..... ........ -
Dominant Soil Series
Buffer Maps
1
01
Harnett
, 35.4608530
-79.0248890
1.6
-- -
EnB - F,non
- 03A
Buchanan, William H.; Buchanan, Annie B.
Harnett
35.4973560
-78.9909530
4.2
CeB - Cecil-
i 2
03B
Buchanan, William H.; Buchanan, Annie B.
�_`--
I Harnett
35.4963530
-78.9914420
-
4.1
CeB - Cecil
,
2
04
Cox, Steven M.
--
I Lee
I 35.4769280
-79.0262250
I 6
--
VaB - Vaucluse
--
3
05
I Cox, Steven M.
Lee
35.4743940
-79.026017'
1.97
DoB - Dothan—
3
Total
17.87
�.. --
.................... .... ----
---- ........ .......... ------ -
WQ0018007 Version 4.0 Attachment B Page 1 of 1

l
tM
Compliance Boundary is eid= 250 feet franc ft residuals land
applicaton area or 50 feet within the property line, whichever is
closest. The Review Boundary is midway bctween the Compliance
Boundary and the parimeter of the residuals sand application area.
SCAL 1 `} = 400 ft \
RIB
DRAWN ft; P1TB itF S.
I1 C
t2.i712oI8+ '+ �I i .L
DATE: -
Legend
House
structure
0 Well
-- Farm Road
F- x Fenceline
Property Line
Roads
Stream
Waterway
Buffer
Fields
pond
Town of Broadway
Lmd Application Program Buffer
Town of Broadway Farm p,,,lap
1
HR5 2002-09

if,
ulf
s
Legend
r °
i
House
. +,•
L
a_
Structure
■
Well
Farm Road
Fenceline
' '�'�
r ' "
•'
Property Lint!=
Roads
r j Stream
R+
f Waterway
•' # X Z Buffer
Ar
�h Fields i
Pond _
•Held 1-3A;' 77
i ��'
Field 1-3B
iT t
S j
xq
Compliance Boundary is either 250 feet from the residuals land
applicaton area or 50 feet within the property line, whichever is
closest. The Review Boundary is midway between the Compliance
Boundary and the perimeter of the residuals land application area.
�sau e: 1 " =400 ft
Cf{ECKBD 81': RTB
� rRRAN(—' Ii
DRAIYN BY: RTB
DATE:
12/7/2018
Y .._ .
r e raw
/ a +
Town of Broadway
Land Application Program
William Craig Buchanan Fare
Pmjeo Na BRS 2002-09
Buffer
Map
2

j I FI/fr1A'`-J�' f
M1 � f. Y f � � • r:
.L
■ •f 1
Legend
House
Structure
well
Farm Road
a
{Fee�n�cclliine
Roads
i A
f Stream
-- w „f' _ waterway
A t . e• .' r Buffer
Fields
1't+ud
t W�
J�
L ..
Compliance Boundary is either 250 feet front the residual, land
applicaton area or 51 feet within the prc,perty hne, whtchevu is t
closest. The Review &,undury i, midwa% 6ctD Len the ( untpliuncc
Boundary and the perimeter of the residuals land application area,
SCALE: 1 " = 400 ft Town of Broadway
CHECKED DY, RTB _ Land Application Program Buffer
RTB F3ik�»`kN H Steven Cox Farm Map
Drtnwr ey: RE Si I ©UA LS
Itit SUlI.S I I C Project Ne.
DATE: I2/;/2O1R � � BRS 2002-09 '

Operation and Maintenance Plan

Operation & Maintenance Plan
Town of Broadwav
The WWTP ORC (or Backup ORC if ORC is unavailable) shall be in charge of the following
items as it relates to the current land application program:
• Collection of W WTP Samples
o TCLP Samples
o Pathogen reduction samples
o Vector attraction reduction samples
o Collection of Nutrient and Metal Analyses
• Buffering Land Application Fields
• Spreading Materials at Rates Given for Field, Crop & Soil.
• Calibrating Spreader
• Inspections and Inspection log
• Record keeping regarding disbursement & location of material spread.
• Spill Response
• Signage
• As Preparer for this facility under 40 CFR Part 503
o Being the individual that is familiar with the routine operation of this facility with
includes:
■ Insuring solids are ready for land application
■ Insuring solids have undergone proper treatment
■ Proper operation of treatment units
■ Proper operation of sludge holding units
■ Proper maintenance of treatment and storage units
■ Notification of state and land appliers of abnormal conditions
■ All inspections and maintenance of facilities at this plant
Both the WTTP ORC or it's assigned representative will complete the aforementioned
responsibilities before the commencement of each land applying event. In the event that an area
of noncompliance is observed, the NCDENR office will be contacted as well as Bob Branch.
Inspections should be performed in the field at the beginning of every land application event,
with every change in loading rate, and post application event for run off. An additional
inspection will be performed if rain occurs after the application event and before the residuals
have had time to desiccate (typically 3 - 5 days). Each field will be inspected pre and post with
each application event. The frequency of inspections will depend on the frequency of application
events.
A copy of the Sampling and Monitoring Plan is attached.

Operation and Maintenance Plan
Town of Broadway
Title
Name
Office Phone
Cell Phone
WWTP ORC
William C. Buchanan
919.258-9922
919.478-9108
Backup ORC
Jacob Melvin
919.258-9922
919.478-0483
Last Date Modified
7/ l 1 /24
Name
Robert T. Branch
Signature
2

Spill Control Plan
Project: Town of Broadway
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE
IMMEDIATELY TAKEN:
1. MANAGEMENT OF CLEAN UP ACTIVITIES:7he WWTP ORC shall take
immediate charge and initiate cleanup activities. The ORC may elect someone else to be in
charge of the spill if someone more experienced is available. The Town of Broadway's labor
and equipment are to be utilized. In the event additional labor and equipment are required,
assistance shall be requested from the plant operator. The ORC will communicate to the
Town Manager who will communicate with the public on scene, answering questions and
advising of the clean- up activities.
2. HALT SOURCE OF SPILL : Such as ruptured container or damaged transport unit.
3. FORM A BARRIER : Sufficient quantities of straw shall be used for such purposes.
Earthen barriers may be constructed to augment the straw bale containment area.
The ORC or the person in charge on the spill site will advise the clean-up personnel
where to get the straw, lime and other items necessary to complete the clean-up
operations, ie. local fanners, farin supply center, nursery, etc.
4. CLEAN-UP : Employ front end loaders, vacuum equipment, sludge application
equipment, and/or septic tank service to remove as much of the spilled material as
possible. Straw and/or sand should be scattered in the spill area to soak up the remaining
material. The straw and soaked material will be collected and remove to a disposal area
approved by representatives of the state regulatory agency.
5. FINAL CLEAN-UP : Employ rotary brush sweeper if needed, and apply lime to the
spill area upon the approval of the clean- up efforts by the state regulatory representative.
If the event occurs on private property, the clean- up will be completed to the satisfaction
of the property owner and state representatives. The ultimate goal will be to restore the
spill area to its original condition if possible.
6. Notification: As soon as possible after the spill occurs the WWTP ORC will notify the
Town Manager and the calling list.
7. Reporting : The Town of Broadway will notify the Regional Office of the NCDENR
(North Carolina Department of Environment and Natural Resources) by telephone as soon
as possible, but not more than 24 hours, or the next working day following the occurrence.
The Town Manager or his assigned representative shall provide a written report within 48
hours of the spill to Residuals Management Coordinator and the Director of Utilities (or
appropriate project personnel). The report shall list all relative information and actions
taken. The Town of Broadway will file a written report to the appropriate regional office of
NCDENR. Within 5 days of the occurrence.
* SEE NEXT PAGE FOR NOTIFICATION LIST.

Spill Control Plan
WWTP ORC:
Telephone:
BACKUP ORC:
Telephone:
Town Manager:
Telephone:
LOCAL POLICE, FIRE,EMERGENCIES:
NCDEQ REGIONAL OFFICE:
STATE OF NC WARNING POINT:
OUT OF STATE INFORMATION:
William Craig Buchanan
919.478-9108
Jacob Melvin
919.478-0483
John Godfrey
919-258-9922
911 or
919.791-4200
800.662-7956
For projects not in NC please
list please personnel with
phone numbers who should be
contacted if a spill occurs.

RESIDUALS SAMPLING PLAN
Annually, prior to application, multiple grab residual solid samples are collected from the Storage units. These
samples are composited for nutrient and metal analyses. The composited sample is mixed to provide a
representative sample. Individual grab samples can be collected and sent for fecal coliform analysis, but stored
biosolids meet Class B air drying standards. The Town of Broadway would request that volatile solids be
calculated for the biosolids with samples for the influent collected prior to entering the oxidation ditch and samples
of the biosolids be collected for the end process. Currently vector attraction reduction standards are met through
incorporation within 6 hours.
Annually, or when the residual solids are to be land applied, a composite residual solid sample will be analyzed
for: Arsenic, Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia —
Nitrogen, Calcium, Nitrate -Nitrite, Nitrogen, Magnesium, % Total Solids, pH, Phosphorus, Potassium, TKN, and
Sodium. From this information, the Plant Available Nitrogen (PAN) will be calculated. Once per permit cycle,
a composite TCLP sample will be collected to include:
Arsenic
Hexachlorobenzene
ph for Corrosivity
Barium
Hexachloro-1,3-Butadiene
Benzene
Hexachloroethane
Flash point for ignitability
Cadmium
Lead
Carbon Tetrachloride
Lindane
Sulfides and Cyanides for reactivity
Chlordane
Mercury
1,2-Dichloroethane
Chlorobenzene
Methoxychlor
1,1-Dichloroethylene
Chloroform
Methyl Ethyl Ketone
2,4-Dinitrotoluene
Chromium
Nitrobenzene
Endrin
m-Cresol
Pentachlorophenol
Heptachlor and its Hydroxide
o-Cresol
Pyridine
Trichloroethylene
p-Cresol
Selenium
2,4,5-Trichlorophenol
Cresol
Silver
2,4,6-Trichlorophenol
2,4-D
Tetrachloroethylene
2,4,5-TP (Silvex)
1,4-Dichlorobenzene
Toxaphene
Vinyl Chloride

RESIDUALS SOURCE CERTIFICATION FORM

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

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Town of Broadway, Broadway, NC
Status Facility Permit Holder
Code 11
R Town of Broadway
Facility Name County Permit Number
Broadway WWTP Lee WQ0018007
Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
Maximum Dry Tons Per Year
Current b Proposed
40
!it
SUMMARY FOR FORM: RSC 06-16 Page 1

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of Broadwav
2. Facility permit holder is: ❑ Federal, ❑ State, ❑ Local Government, or ® Private.
Facility permit issued by: ❑ Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Mr. John Godfrev. Town Manager
Complete mailing address: P.O. Box 130
City: Broadwav State: NC Zip: 27505-
Telephone number: (2 0) 258-9922 E-mail address: manager(a,broadwavnc.com
4. Facility physical address: 6614 Bradlev Road
City: Broadwav State: NC Zip: 27505-
Coordinates: Latitude: 35' 27' 37.65" Longitude: 79. 1' 29.90"
Datum: NAD 83 Level of accuracy: 1'
Method of measurement: Man
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: 0.145 MGD and facility average daily flow: 0.08 MGD
8. Average amount of residuals being generated at this facility 40 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: (4) - 30 ft X 50ft drving beds with 84 cubic vard storage pad
Type and volume of residuals storage (i.e., outside of residuals treatment units): None
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
® Biological ❑ Non -Biological
FORM: RSC 06-16 Page l of
5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and
fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow
that treat 100%
non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as well
as those for corrosivity, ignitability, and reactivity:
Laboratory: Environmental Chemists, Inc. and Date of analysis: January 16. 2024
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: ND <0.8 mm/sec (> 140°F)
Passed reactivity test: ® yes ❑no. HCN: 1.97 mg/kg (<250) & H2S: 2.98 mg/kg (<500)
TCLP Parameter Limit Result TCLP Parameter
Limit
Result
(mg/1) (mg/1)
(mg/1)
(mg/l)
Arsenic 5.0 <1.0 Hexachlorobenzene
0.13
<0.05
Barium 100.0 <1.0 Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene 0.5 <0.01 Hexachloroethane
3.0
<0.05
Cadmium 1.0 <1.0 Lead
5.0
<1.0
Carbon Tetrachloride 0.5 <0.01 Lindane
0.4
<0.0005
Chlordane 0.03 <0.02 Mercury
0.2
<0.0002
Chlorobenzene 100.0 <0.01 Methoxychlor
10.0
<0.0005
Chloroform 6.0 <0.01 Methyl Ethyl Ketone
200.0
0.09
Chromium 5.0 <1.0 Nitrobenzene
2.0
<0.05
m-Cresol 200.0 <0.05 Pentachlorophenol
100.0
<0.25
o-Cresol 200.0 <0.05 Pyridine
5.0
<0.50
p-Cresol 200.0 <0.05 Selenium
1.0
<1.0
Cresol 200.0 <0.05 Silver
5.0
<1.0
2,4-D 10.0 <0.003 Tetrachloroethylene
0.7
<0.01
1,4-Dichlorobenzene 7.5 <0.05 Toxaphene
0.5
<0.05
1,2-Dichloroethane 0.5 <0.01 Trichloroethylene
0.5
<0.01
1,1-Dichloroethylene 0.7 <0.01 2,4,5-Trichlorophenol
400.0
<0.05
2,4-Dinitrotoluene 0.13 <0.05 2,4,6-Trichlorophenol
2.0
<0.05
Endrin 0.02 <0.0005 2,4,5-TP (Silvex)
1.0
<0.003
Heptachlor and its Hydroxide 0.008 <0.0005 Vinyl Chloride
0.2
<0.01
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not violate
the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Wavnoint Analvtical and Date of analysis: October 3.2023
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & C1assB)
(Class A Only)
(mglkg)
(mg/kg)
(mg/kg)
Arsenic
75
41
3.40
Cadmium
85
39
1.58
Copper
4,300
1,500
225.00
Lead
840
300
18.50
Mercury
57
17
9.18
Molybdenum
75
n/a
6.37
Nickel
420
420
15.70
Selenium
100
100
4.24
Zinc
7,500
2,800
1,070.00
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
❑ > 0 but < 25
❑ > 25 but < 50
❑ > 50 but < 75
❑ >_ 75 but < 100
❑ > 100 but < 125
❑ > 125
Result (mg/kg)
Arsenic
Chromium
Nickel
(mglkg)
(mglkg)
(mglkg)
30
200
210
34
220
240
39
260
270
46
300
320
53
360
390
62
450
420
FORM: RSC 06-16 Page 3 of
5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 92.6 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
C
d.
e.
micronutrient parameters:
Laboratory: Wavnoint Analvtical and Date of analysis: October 3.2023
Parameter
Result
(nzglkg)
Aluminum
7,530.00
Ammonia -Nitrogen
651.00
Calcium
8,920.00
Magnesium
4,240.00
Nitrate -Nitrite Nitrogen
3.39
pH (Standard Unit)
6.70
Phosphorus
15,300.00
Potassium
1,490.00
Sodium
393.00
Total Kjeldahl Nitrogen 55,800.00
Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.82
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity and
conditions conducive to crop growth].
Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 0.30 %. This
rate is a (check one): ® default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method First (15f) Year PAN Five -Year
Maximum Adjusted PAN
(mg1kg) (mg/kg)
Surface 16,874 26,811
Injection/Incorporation 17,199 27,137
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of
5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative I [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
❑ Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
® Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ® air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
c. For Surface Disposal.
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
❑ Alternative 1 [15A NCAC 02T. I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T. 1 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
® Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically occur
when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

It ' as
i' KeKIelj
O
cif ��1
`\ eel
Town of Broadway WWTP
Bradley . omc
it j, }
'0
Sion Kel
d ..� Watson lake c
�.,
CI v ��m
r I 0
CD
G o
\0
�•,
Prince
7?
SCALE: 1 " = 1,500 ft
CHECKED BY: RTB
DRAWN BY: RTB
DATE: 7/11/2024
BRANCH
RESIDUALS
8i SOILS, LLC
Lawrence
�e
0
Sources Esri, HERE FDeLorme, USGS, Intermap, INCREMENT P,
NRCan, Esri Japan, MET I) sri China (Hong Kong), Esri Korea, Esri
(Thailand), Mapmylndia NGC�C., © OpenStreetMap contributro rs, and the
GIS User Community ? N
Town of Broadway Site
Land Application Program Vicinity
Broadway WWTP Map
Projnl No. I 2002-09

Process Flow Diagram and Narrative

WASTEWATER TREATMENT PLANT PROCESS
The Town of Broadway operates a less than 1.0 MGD facility which utilizes an oxidation ditch type
wastewater treatment plant, processing municipal wastewater. Untreated influent enters the Town of
Broadway WWTP and is screened by a manual bar screen before passing through a Parshall flume.
The flume is equipped with a sonar that measures flow. A sampler has been integrated into the sonar
for the collection of flow -weighted samples. After passing through the Parshall flume, the wastewater
is passed to a wet well where it is pumped up to the first oxidation ditches. The oxidation ditches are
aerated using two brush rotators. Wastewater flows by gravity to a weir and to the center well of the
clarifier. Floaters are skimmed and sent to the sludge return where it is pumped back to the oxidation
ditch or sent to one of four drying beds. After drying on the drying beds, biosolids are transferred to
the dried sludge storage unit. The storage unit has a concrete floor and is equipped with a drain to
direct any liquids back to the oxidation ditch. Liquids generated from both the drying beds and storage
units are sent back to the oxidation ditch. Clear effluent from the clarifier is chlorinated and cascaded
before discharge into Daniel's Creek.
A process schematic for the Town of Broadway WWTP is presented on the following page.

z
w
a
z
w
3 c
w
o�
z mw
n-
3
tnv� 03
i
iU
0
xo
to
W
a

Justification for Residuals Production Rate

JUSTIFICATION FOR WWTP RESIDUALS PRODUCTION RATE
The dry tons permitted for this facility is currently 40 dry tons. The past several years the dry tons
applied have not approached the 40 dry tons limit.

Residuals Sampling Plan

WWTP SAMPLING PLAN — TOWN OF BROADWAY
Annually, prior to application, multiple grab residual solid samples are collected from the Storage
units. These samples are composited for nutrient and metal analyses. The composited sample is
mixed to provide a representative sample. Individual grab samples can be collected and sent for fecal
coliform analysis, but stored biosolids meet Class B air drying standards. The Town of Broadway
would request that volatile solids be calculated for the biosolids with samples for the influent collected
prior to entering the oxidation ditch and samples of the biosolids be collected for the end process.
Currently vector attraction reduction standards are met through incorporation within 6 hours.
Annually, or when the residual solids are to be land applied, a composite residual solid sample will
be analyzed for: Arsenic, Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc,
Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -Nitrite, Nitrogen, Magnesium, % Total Solids,
pH, Phosphorus, Potassium, TKN, and Sodium. From this information, the Plant Available Nitrogen
(PAN) will be calculated. Once per permit cycle, a composite TCLP sample will be collected to
include:
Arsenic
Hexachlorobenzene
ph for Corrosivity
Barium
Hexachloro-1,3-Butadiene
Benzene
Hexachloroethane
Flash point for ignitability
Cadmium
Lead
Carbon Tetrachloride
Lindane
Sulfides and Cyanides for reactivity
Chlordane
Mercury
1,2-Dichloroethane
Chlorobenzene
Methoxychlor
1, 1 -Dichloroethylene
Chloroform
Methyl Ethyl Ketone
2,4-Dinitrotoluene
Chromium
Nitrobenzene
Endrin
m-Cresol
Pentachlorophenol
Heptachlor and its Hydroxide
o-Cresol
Pyridine
Trichloroethylene
p-Cresol
Selenium
2,4,5-Trichlorophenol
Cresol
Silver
2,4,6-Trichlorophenol
2,4-D
Tetrachloroethylene
2,4,5-TP (Silvex)
1,4-Dichlorobenzene
Toxaphene
Vinyl Chloride

Analytical Data — Town of Broadway
TCLP and Nutrient & Metal

Waypointo
ANALYTICAL
22972
Branch Residuals and Soils LLC Project
Mr. Bob Branch
1735 Heckle Blvd Information
Suite 103-291
Rock Hill , SC 29732
Report Number : 23-263-0110
Lab No : 92544
Sample ID: TOB
Test
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytica1.corn
Town of Broadway, NC
REPORT OFANAL YSIS
Results Units MQL
Report Date : 10/03/2023
Received : 09/20/2023
Matrix: Solids
Sampled: 9/ 19 / 2023 11:00
DF Date / Time By Analytical
Analyzed Method
Neutralizing Value (%CCE)
8.2
%
0.1
1
09/28/23 14:58
DXT
AOAC 955.01
Moisture
7.38
%
0.010
1
09/22/2315:55
CAH
254OG-2011
Ammonia Nitrogen
651
mg/Kg - dry
212
1
09/27/23 15:00
JPJ
4500NH3C-2011
Nitrate (NO3-N)
<3.39
mg/Kg - dry
3.39
1
09/22/23 16:25
SDS
9056A
Nitrite (NO2-N)
<3.39
mg/Kg - dry
3.39
1
09/22/23 16:25
SDS
9056A
Nitrate+Nitrite-N
<3.39
mg/Kg - dry
3.39
1
09/22/23 16:25
9056A
pH
6.7
S.U.
1
09/27/2317:21
CNB
9045D
Total Solids
92.6
%
0.010
1
09/22/23 15:55
CAH
254OG-2011
Total Kjeldahl Nitrogen
55800
mg/Kg - dry
2710
10
09/27/23 13:50
ANH
4500NORGD-2011
Phosphorus
15300
mg/Kg - dry
27.0
5
09/25/23 16:48
TJS
6010D
Aluminum
7530
mg/Kg - dry
5.40
1
09/22/23 21:28
JTR
6010D
Arsenic
3.40
mg/Kg - dry
0.539
1
09/22/23 21:28
JTR
6010D
Cadmium
1.58
mg/Kg - dry
0.108
1
09/22/23 21:28
JTR
6010D
Calcium
8920
mg/Kg - dry
54.0
1
09/22/23 21:28
JTR
6010D
Copper
225
mg/Kg - dry
0.540
1
09/22/23 21:28
JTR
6010D
Lead
18.5
mg/Kg - dry
0.323
1
09/22/23 21:28
JTR
6010D
Magnesium
4240
mg/Kg - dry
5.40
1
09/22/23 21:28
JTR
6010D
Mercury
9.18
mg/Kg - dry
1.91
10
09/26/23 16:11
JTR
7471A
Molybdenum
6.37
mg/Kg - dry
0.269
1
09/22/23 21:28
JTR
6010D
Nickel
15.7
mg/Kg - dry
0.269
1
09/22/23 21:28
JTR
6010D
Potassium
1490
mg/Kg - dry
54.0
5
09/25/23 16:48
TJS
6010D
Selenium
4.24
mg/Kg - dry
0.539
1
09/22/23 21:28
JTR
6010D
Sodium
393
mg/Kg - dry
27.0
1
09/22/23 21:28
JTR
6010D
Qualifiers/ DF Dilution Factor
Definitions
MQL Method Quantitation Limit
Page 6 of 9

wai Dointo
ANALYTICAL
22972
Branch Residuals and Soils LLC
Mr. Bob Branch
1735 Heckle Blvd
Suite 103-291
Rock Hill , SC 29732
Report Number:23-263-0110
Lab No : 92544
Sample ID : TOB
Test
Zinc
Qualifiers/ DF Dilution Factor
Definitions
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 Fax [phone]
www.waypointanalytical.com
Project Town of Broadway, NC
Information :
REPORT Of ANAL YSIS
Results Units MQL
1070 mg/Kg - dry 1.35
Report Date : 10/03/2023
Received : 09/20/2023
Matrix: Solids
Sampled: 9/19/2023 11:00
DF Date / Time By Analytical
Analyzed Method
1 09/22/23 21:28 JTR 6010D
MQL Method Quantitation Limit
Page 7 of 9

Environmental Chemists, Inc.
envirochem 1 6602 Windmill Way, Wilmington, NC 28405 ' 910.392.0223 Lab ' 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab Fax
ANALYTICAL & CONSULTING CHEMISTS info a eneironmentalcheniists.com
Branch Residuals/Bob Branch
Date of Report: Jan 16, 2024
1735 Heckle Blvd Suite 103-291
Customer PO #:
Rock Hill SC 29732
Customer ID: 15060009
Attention:
Report #: 2023-29821
Project ID: TOB
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
23-72288 Site: Sludge
12/20/2023
11:07 AM Solid/Sludge Bob Branch
Test
Method
Results Date Analyzed
Chlordane (TCLP)
SW-846 8081 B
<0.02 mg/L
12/27/2023
Endrin (TCLP)
SW-846 8081 B
<0.0005 mg/L
12/27/2023
Heptachlor (TCLP)
SW-846 8081 B
<0.0005 mg/L
12/27/2023
Heptachlor epoxide (TCLP)
SW-846 8081 B
<0.0005 mg/L
12/27/2023
Lindane (TCLP)
SW-846 8081 B
<0.0005 mg/L
12/27/2023
Methoxychlor (TCLP)
SW-846 80818
<0.0005 mg/L
12/27/2023
Toxaphene (TCLP)
SW-846 80818
<0.05 mg/L
12/27/2023
2.4,5-TP (TCLP)
SW-8468151 A
<0.003mg/L
01/02/2024
2.4-D (TCLP)
SW-8468151 A
<0.003mg/L
01/02/2024
1,4-Dichlorobenzene (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
2,4,5-Tdchlorophenol (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
2,4,6-Tdchlorophenol (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
2,4-Dinitrotoluene (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Cresol (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Hexachloro-1.3-butadiene (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Hexachlorobenzene (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Hexachloroethane (TCLP)
SW-846 6270 E
<0.050 mg/L
01/03/2024
m + p-Cresol (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Nitrobenzene (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
o-Cresol (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
Pentachlorophenol (TCLP)
SW-846 8270 E
<0.250 mg/L
01/03/2024
Pyridine (TCLP)
SW-846 8270 E
<0.050 mg/L
01/03/2024
1,1-Dichloroethylene (TCLP)
SW-846 Method 8260D
< 0.01 mg/L
12/29/2023
1,2-Dtchloroethane(TCLP)
SW-846 Method 82600
<0.01mg/L
12/29/2023
Benzene (TCLP)
SW-846 Method 8260D
< 0.01 mg/L
12/29/2023
Carbon Tetrachloride (TCLP)
SW-846 Method 82600
< 0.01 mg/L
12/29/2023
Report N 2023-29821 Page 1 of 2

ANALYTICAL ✓& CONSULTING CHEMISTS
Branch Residuals/Bob Branch
1735 Heckle Blvd Suite 103-291
Rock Hill SC 29732
Attention:
Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab Fax
255-A Wilmington Highway, Jacksom ille, NC 28540 • 910.347.5843 Lab Fax
info c environmentalchemists.conl
Date of Report: Jan 16, 2024
Customer PO #:
Customer ID: 15060009
Report #: 2023-29821
Project ID: TOB
Chlorobenzene (TCLP) SW-846 Method 8260D < 0.01 mg/L 12/29/2023
Chloroform (TCLP) SW-846 Method 8260D < 0.01 mg/L 12/29/2023
Methyl ethyl ketone (TCLP) SW-846 Method 8260D 0.09 mg/L 12/29/2023
Tetrachloroethylene (TCLP) SW-846 Method 8260D < 0.01 mg/L 12/29/2023
Trichloroethylene (TCLP) SW-846 Method 8260D < 0.01 mg/L 12/29/2023
Vinyl Chloride (TCLP) SW-846 Method 82600 < 0.01 mg/L 12/29/2023
RCI
Cyanide SM 4500 CN D-2016 1.97 mg/kg 12/29/2023
Sulfide SM 4500 S D-2011 2.98 mg/kg 01/02/2024
Ignitability SW 846 method 1030 <0.800 mm/sec 01/05/2024
pH SW 846Method 9045D 6.59 units 01/16/2024
Result estimated. Analyzed out of 15 minutes hold time.
TCLP Metals
Arsenic (TCLP) EPA 200.7, Rev 4 4, 1994 <1.0 mg/L 12/29/2023
Barium (TCLP) EPA 200.7, Rev 4 4, 1994 <1.0 mg/L 12/29/2023
Cadmium (TCLP) EPA 200.7, Rev 4 4. 1994 <1.0 mg/L 12/29/2023
Chromium (TCLP) EPA 200.7, Rev 4 4, 1994 <1.0 mg/L 12/29/2023
Lead (TCLP) EPA 200.7, Rev 4 4. 1994 <1.0 mg/L 12/29/2023
Selenium (TCLP) EPA 200.7, Rev 4 4, 1994 <1.0 mg/L 12/29/2023
Silver (TCLP) EPA 200.7, Rev 4 4, 1994 <1.0 mg/L 01/02/2024
Mercury (TCLP) EPA 245.1 <0.0002 mg/L 12/28/2023
Comment: �(,
Reviewed by:
flepoit A 2023.29821 Page 2 of 2

Environmental Chemist, Inc., Wilmington, NC Lab #94 6602 Windmill Way
Wilmington, NC 28405
910.392.0223
Sample Receipt Checklist
Client: � M Date: -A � U� 1Q,) Report Number: _ 2023-
Receipt of sample:
ECHEM Pickup qQ Client Delivery ❑ IUPS ❑ FeclEx ❑ Other ❑
❑
YES
❑
NO
Z
N/A
Were custody seals present on the cooler?
❑
YES
10
NO
❑O
N/A
11',
2. If custody seals were present, were they intact/unbroken?
Original temperature upon receipt (,�Q—'C Corrected temperature upon receipt _ _ _ _ `C
How temperature
taken:
❑ Temperature Blank OO Against Bottles
IR Gun ID: Thomas
Traceable S/N 210886869 IR Gun Correction Factor °C: 0.0
N
YES
❑
NO
3.
If temperature of cooler exceeded 6°C, was Project Mgr./QA notified?
O
YES
❑
NO
4.
Were proper custody procedures (relinquished/received) followed?
•
YES
❑
NO
S.
Were sample ID's listed on the COC?
O
YES
❑
NO
6.
Were samples ID's listed on sample containers?
O
YES
❑
NO
7.
Were collection date and time listed on the COC?
O
YES
❑
NO
8.
Were tests to be performed listed on the COC?
O
YES
❑
NO
9.
Did samples arrive in proper containers for each test?
O
YES
❑
NO
10.
Did samples arrive in good condition for each test?
O
YES
❑
NO
11.
Was adequate sample volume available?'
ED
YES
❑
NO
12.
Were samples received within proper holding time for requested tests?
❑
YES
❑
NO
13.
Were acid preserved samples received at a pH of <2?
❑
YES
❑
NO
14.
Were cyanide samples received at a pH >12?
❑
YES
❑
NO
15.
Were sulfide samples received at a pH >9?
❑
YES
❑
NO
16.
Were NH3/TKN/Phenol received at a chlorine residual of <0.5 m/L? **
❑
YES
0
NO
17.
Were Sulfide/Cyanide received at a chlorine residual of <0.5 m/L?
❑
YES
❑
NO
18.
Were orthophosphate samples filtered in the field within 15 minutes?
* TOC/Volatiles are pH checked at time of analysis and recorded on the benchsheet.
** Bacteria samples are checked for Chlorine at time of analysis and recorded on the benchsheet.
Sample Preservation: (Must be completed for any sample(s) incorrectly preserved or with headspace)
Sample(s) were received incorrectly preserved and were adjusted accordingly
by adding (circle one): H2SO4 HNO3 HCI NaOH
Time of preservation: If more than one preservative is needed, notate in comments below
Note: Notify customer service immediately for incorrectly preserved samples. Obtain a new sample or
notify the state lab if directed to analyzed by the customer. Who was notified, date and time:
Volatiles Sample(s) were received with headspace
COMMENTS:
DOC. QA.002 Rev 1

ENVIRONMENTAL CHEMISTS,
Way ton
6602
INC OFFICE:910-3 2-03iIFAX910-3 2-44245
Analytical mmismooppConsulting Chemists NCDENR:
DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION #
37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: Branch Residuals/Bob Branch
PROJECT NAME: TOB
REPORT NO: 2-0 --4
ADDRESS:
CONTACT NAME: Bob Branch
PO NO:
REPORT TO:
PHONEIFAX:
COPY TO:
email:
Sampled By: o. ( n�-L
SAMPLE TYPE: I = Influent, E = Effluent, W = Well, ST = Stream, SO = Soil, SL = Sludge, Other:
_
Collection
_
a m a PRESERVATION
Sample Identification
m ct9 y� o ?w
n °a,5 b o p a - m cc _ -+ o
O
p p o ul w ANALYSIS REQUESTED
Date Time Temp
a
U.
IL o
C P
Sludge
G G k� X
Full TCLP + RCI
C P
G G
C + P
G I G
C P
I
G I G
i
CIP
I
G G
I
I
GIG
G
G
C I P
f
G I G
I
NOTICE - DECHLORINATION: Samples for Ammonia, TKN, Cyanide, Phenol and Bacteria must be dechlorinated (0.5 ppm or less) in the field at the time of collection. See reverse for Instructions
Transfer Relinquished By.
Date/Time
Received By: DateMme
1.
2.
Temperature whe Received °C:_� c_
Delivered By: �^- �a''
Accepted! / Reejjec`ted':
Received By: ri�dY
Resample a ested:
Date: c.), r.3 Time:1 ,
Comments:
TURN O ND:

LAND APPLICATION SITE CERTIFICATION FORM

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall submit one original and two conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharee Permitting Unit
General - This certification provides detailed information of receiving sites for land application of Class B residuals (may include water
treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the proposed
modification.
B. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item N R T M
®
County Board
Notification.doc
"Ll V V, V
Land Owner
Agreement
(If applicable)
✓ ✓ ✓ ✓
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "elan Guidance ✓ ✓ ✓
for Residuals Land Aonlicatim Permits'
A soils and agronomic evaluation in accordance with the "Sail Scientist ✓
Fvaluation POliCV-
INSTRUCTIONS FOR FORM: LASC 06-16Page 1 of

An updated accounting of the land application site's cumulative pollutant
loading rates (CPLRs)
Status Code
Required Item
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist B aluatiun Pulic\ "
Acknowledgement of field transfer from Land Owner (Fields may not be
permitted to multiple Permittees over the same time period)
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or name
of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each site
must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please note
that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct mapping
unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the residuals
program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each map portion
must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: httD:Hdeo.nc.eov/about/divisions/water-
resources/Dlannins/classification-standards/classifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
htti)://dea. nc.2 ov/c ontact/reeional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as "UT
to stream name" as the waterbody name.
3. Open the link httD:Hdea.ne.2ov/about/divisions/water-resources/t)lannin2/classification-standards/classifications,.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16Page 2 of 3

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301M.
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Little Tennesse River
Basin And Savannah
River Drainage Area
French Broad River
Basin
Watauga River Basin
Broad River Basin
New River Basin
Catawba River Basin
Yadkin -Pee Dee River
Basin
Lumber River Basin
Roanoke River Basin
Chowan River Basin
Tar -Pamlico River
Basin
Pasquotank River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
Streams entering Tennessee will be classified "B."
Streams entering the State of Tennessee are classified "C."
Streams entering South Carolina are classified "C."
Streams entering the State of Tennessee are classified "C."
Streams entering South Carolina are classified "C."
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Streams entering South Carolina are classified "C Sw."
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr Reservoir
and the North Carolina portion of streams tributary thereto not otherwise named or described
shall carry the classification "B," and all backwaters of Lake Gaston and the North Carolina
portion of streams tributary thereto not otherwise named or described shall carry the classification
"C and B."
Streams entering Virginia are classified "C."
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16Page 3 of

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Town of Broadway.
Land application sites currently certified: 17.87 net acres and Total to be certified: 16.27 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowner() s Lessee() Operator(s) y Crop(s) or O s Net Acres Count Cro s)
Code' ID Series Name Mapping Unit
or Rep. Slope`
D
01
Town of Broadway
1.60
Harnett
Fescue
Enon fine sandy
EnB
loam
R
03A
William H. Buchanan
4.2
Harnett
Corn, Wheat, Soybeans
Cecil fine sandy
CeB
loam y-8%
R
03B
William H. Buchanan
4.1
Harnett
Corn, Wheat, Soybeans
Cecil fine sandy
CeB
loam 2 — 8 %
N
04
Steven M. Cox
6.0
Lee
Corn, Wheat, Soybeans
Vaucluse gravelly
VaB
sandy loam 2 — 8 %
N
05
Steven M. Cox
1.97
Lee
Coastal Bermudagrass
Dothan loamy sand
DoB
2-8%
a Status Code for land application
sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
`Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID Latitude
Longitude
Location
Location Method Code
Waterbody Subbasin and Current and Proposed
Location Accuracy
Datum
Stream Index No. Class
° '
° 'itNAD
83
ADD
Nearest Second
° '
° ' it
NAD 83
ADD
Nearest Second
° ' ff
° ' 11
NAD 83
ADD
Nearest Second
'
° ' if
NAD 83
ADD
Nearest Second
° ' 11
° ' 11
NAD 83
ADD
Nearest Second
° '
° ' it
NAD 83
ADD
Nearest Second
° ' it
° '
NAD 83
ADD
Nearest Second
° ' if
° ' ff
NAD 83
ADD
Nearest Second
Note: Please keep the site information (1.) and waterbody information (11.) of the same field on the same page.
FORM: LASC 06-16 Page 1

Landowner Operation Agreement Forms

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Aanlicant shall submit one original and two conies of the apDlication and
supaortinz documentation
For more information, visit the Water Quality Permitting Section's Non-Discharee Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: William C. Buchanan
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease Land Use or Residuals Source Special note
Site/Field ID es/no Cropping Patterns Intended Use of Crops o tional (no-till/over-seed/
(Y ) pp g (optional) pasture)
1-3A No Row Crop Animal Feed
1-3B No Row Crop Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV.ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: . is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: IV i C l 6l ✓Vl. (—?
Address:
City:State: /v zip: 713 d
Phone: q lq z1%9 4 lea E- all address:
Signature: � , cy. Date: � 19 .2 y In7- �,�. i �'�
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that 1.c9 i ( k i C< Ind G v �� c�t� C�.1/1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of t.: e , 20 `�' %�i�RRISe
Signature and seal: 60Li P, 140TAPL •!?
My commission expires: do 0, 1 - ['
US L1G
Lessee's/Operator's Certification: UN"-,
I certify that I have read this Agreement and do hereby agree to abi a by the stipulations and restrictions as specified herein.
Lessee/operator name: i �l r1j^
&%_ �= A etAddress: 8 qT- A, 0
City: _ ., % oo
Phone: T/ 4 'I M
Signature:
Permittee's Certification:
State:
q16 2 E-mail address:
2
zip: A T 3 3t-D
Date: �10 —I b ' �?-el
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: _ - f/"/ a 0-Dore fY
Signature: Date:
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two conies of the application and
suaaortine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T A 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Steven Cox
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease Land Use or Residuals Source Special note
Site/Field ID es/no Cropping Patterns Intended Use of Crops o tional (no-tilUover-seed/
(y ) pp g (optional) pasture)
24 No Row Crop Animal Feed
2-5 No Hay Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: . is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. 1 certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: -5 &V e4,
Address: ?ice
r
City: S"?"PIS
Phone: �?/ P 35-3-4) 16 L
Signature:
NORTH CAROLINA, "1(2--
State: IV6—
E-mail address: ! ZZ-/ /vw
I, Qjq,w 6vsWned Notary Public do hereby certify that
.%110' WR/,,
COUNTY
Zip: 2-7f 30
Date: 6 — 2_�- 2 LI
I
;so �yrap w6d before me this day and acknowledged the due execution of the forgoing instrument.
R Wiy F6W and official seal this the t�
=Z• :Gr'
u Oayp[tPl_t� ZO
010 co U NI-4
ivfyocuagii"ibn expires:
ti
J
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to Abide by the stipulations and restrictions as specified herein.
Lessee/operator name: 14,X Z4 �_ , ex
Address:
City: :S LM4,Al State: IV C- Zip: _V j 3 e�)
Phone: j�' �% `� �/� ' E-mail address:
Signature: ���1�r� ;r J.>I r/t Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: 76_4r�J
Signature: Date: ! o " o? S - 2C1
FORM: LOA 06-16 Page 3 of 3

Updated Maps

Site Vicinity Maps

a
-Vl Cre6-
0
17li
iE
Q)
Smith Tfi-Ai�s
.." I
N
Steven Cox Farm
A
Thomas
) t
Sources: Esri, HERE. DeLorme. USGS, Intermap, INCREMENT Pr
NRCan, Esri Japan, METI, Esri China (Hong Kong). Esri Korea, Esri
(Thailand), Mapmylndia,,PJGCC, Cc) OpenSti;eetMAp contributors, and the
GIS User -Community ==1
SCALE: I = 1,500 ft
CHECKED HY: RTB
RTB BRANCH
DRAWN BY:
+RESIDUALS
a SC
DATE: 7/11/2024 OILS, LLC
Town of Broadway Site
Land Application Program Vicinity
Steven Cox Farm Map
Project No. 1 2002-09 1

scA�e: 1 " = 1,500 ft
CHECKED BY: RTB
DRAWN Bv: RTB
DATE: 7/11/2024
f!,
,�
C°} ___
O°y\e
RbundFrsb '
Fa\\ Greek
BRANCH
RESIDUALS,
8t SOILS, LLC
Ih
i
10
ly
Co
(m
(r
rj
s
William Craig Buchanan Farm
Sources Esri, HERE, Del-orme, USGS, Intermap, INCREMENT P.
NRCan, Esri Japan, METI. Esri China (Hong Kong). Esri Korea, Esri
(Thailand). Mapmylndia, NGCC, C3 OpenStreetMap contributors. and the
GIS User Community .
Town of Broadway Site
Land Application Program Vicinity
William C. Buchanan Farm Map
Projw No. I 2002-09

Buffer Maps

Legend 4;
House • . i y '
Structure �.: •T -
i
� Well
0r.
Farm Road n
s .
Fenceline f ,J Field 2-4
Propert} Line ;
/
Roads
Stream
r
Waters, a-,
Buffer /
_.
Fields rw.• • � � , : �
Garden ;.'Y' Field 2-4
Pond ff�
Field 2-5 rf f
r•
f
r {
,
Compliance Boundary is either 250 feet from the residuals land ),
applicaton area or 50 feet within the property line. whichever is {
closest. The Review Boundary is midway between the Compliance
Boundary and the perimeter of the residuals land application area. i.
sc.► E, 1 " = 200 ft Town of Broadway
CHECKED BY: RTB Land Application Program Buffer
BRANCH Steven Cox Farm Map
DaAwN BY: RTB RESIDUALS
DATE:
7/ 11 /2024 & SOILS, LLC Project No BD S 2OU2—O9
I 1

Cumulative Pollutant Loading Rates

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE
MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH
APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility
Name:
Town of Broadway WQ Permit #: WQ0018007
Field #: I
Acres Utilized:
Owner:
William H. Buchanan Annual Dry Tons Applied: #VALUE!
Site #: 3A
Acres Permitted:
4.20
Operator:
William H. Buchanan Predominat Soil Series
CeB Cation Exchange Capacity (non 503):
NA
Crop 1 Name: #N/A Crop 1 Max PAN: #N/A
Crop 2 Name: #N/A
Crop 2 Max. PAN
#N/A
Specify
Wet Tons
Site
"/o Solids Volume Residual Sources Cond. Precip.
< �
�' Z
Nitrate PAN Applied
Must Select
o
Cu.Yd.
Totals As Applied per (NPDES #, WQ#, (Dry, Past 24 �.
m w 'w_ TKN 0 o
and (lbs/acre)
Crop 1 or Crop 2
CD
Report
Per Acre Acre Fert., Animal Waste, Hrs. n C
Decimal
N * N °
*
Nitrite
Totals
etc.) e* °o
o
Crop 1 Crop 2
Crop 1 Crop 2
in Gal.
(DT/AC)Moist) Inches
❑ mg/kg mg/kg
mg/kg
TOTALS: 1 0 As Cd Cr Cu Pb Hg Mo Ni Se Zn P PAN 1 PAN 2 Lime Applied
Annuallbs/acre 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Date lbs/ac
Current Cumulative lbs/acre 0.15 0.18 NA 29.54 2.69 0.36 NA 2.50 0.25 40.48 Dec-06 1,000
Prior Years Cumulative lbs/acre 0.15 0.18 NA 29.54 2.69 0.36 NA 2.50 0.25 40.48
Permitted C. P. L. R.**** 36 34 NA 1,338 267 15 NA 374 89 2,498
Permit PAN Limit 1 st/2nd Crop - - - #N/A
"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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date ***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE
MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH
APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility
Name:
Town of Broadway WQ Permit #: WQ0018007
Field #: I
Acres Utilized:
4.10
Owner:
William H. Buchanan Annual Dry Tons Applied: 5.56
Site #: 3B
Acres Permitted:
4.10
Operator:
William H. Buchanan Predominat Soil Series
CeB Cation Exchange Capacity (non 503):
NA
Crop 1 Name: Corn Crop 1 Max PAN: 131.00
Crop 2 Name: #N/A
Crop 2 Max. PAN
#N/A
Specify
Wet Tons
Site
a/o Solids Volume Residual Sources Cond. Precip. 3
< �
2.�' z
Nitrate PAN Applied
Must Select
o
Cu.Yd.
Totals As Applied per (NPDES #, WQ#, (Dry Past 24
?j TKN o0 o
and (lbs/acre) Crop 1 or Crop 2
Report
Per Acre Acre Fert., Animal Waste, Hrs. °n °
Decimal Wet -
* N * 7 �
* w
Nitrite
Totals
etc.) *
Moist) °
0 0
Crop 1 Crop 2 Crop
1 Crop 2
In Gal.
(DT/AC) Inches
5 mg/kg mg/kg
mg/kg
Jun-23
6
1.46 92.60 1.36 Broadway W WTP INC
1.00 0.30 55,800 651
3 46.61
X
TOTALS: 1 ....
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P PAN 1 PAN 21
Lime Applied
Annual lbstacre
0.01
0.00
0.00
0.61
0.05
0.02
0.02
0.04
0.01
2.90
41.47 46.61 0.00
Date lbs/ac
Current Cumulative lbs/acre
0.12
0.20
NA
33.37
2.91
0.44
NA
3.23
0.29
45.17
Dec-06 1,000
Prior Years Cumulative lbs/acre
0.11
0.19
NA
32.76
2.86
0.41
NA
3.19
0.28
42.27
Permitted C. P. L. R.****
36
34
NA
1,338
267
15
NA
374
89
2,498
Permit PAN Limit l st/2nd Crop
...... ............
131.00
"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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date ***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE
MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH
APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility
Name:
Town of Broadway WQ Permit #: W00018007
Field #: 2
Acres Utilized:
Owner:
Steven M. Cox Annual Dry Tons Applied: #VALUE!
Site #: 4
Acres Permitted:
6.00
Operator:
Steven M. Cox Predominat Soil Series
VaB Cation Exchange Capacity (non 503):
NA
Crop 1 Name: #N/A Crop 1 Max PAN: #N/A
Crop 2 Name: #N/A
Crop 2 Max. PAN
#N/A
C7
Specify.
wet Tons
Site >
Up Solids Volume Residual Sources Cond. Precip. K
5 ZEl
Nitrate PAN Applied
Must Select
o
Cu.Yd.
Totals AS Applied per (NPDES #, WQ#, (Dry, Past 24 S n.
d w d TKN o0 c
and (lbs/acre)
Crop 1 or Crop 2
°
E
Report
Per Acre Acre Fert., Animal Waste, Hrs. CL w
Decimal Wet,
* N ; N ? 7
* * N w
Nitrite
_Totals
a
etc.) Moist) * °
0 5•
Crop 1 Crop 2
Crop 1 Crop 2
in Gal.
(DT/Ac) Inches
=1 mgtkg mg/kg
mWkg
TOTALS: 0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn P PAN 1 PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 0.00 0.00 0.00
Date lbs/ac
Current Cumulative lbs/acre
0.01
0.01
NA
0.69
0.05
0.01
NA
0.08
0.02
2.07
Prior Years Cumulative lbslacre
0.01
0.01
NA
0.69
0.05
0.01
NA
0.08
0.02
2.07 ... .
Permitted C. P. L. R.****
36
34
NA
1,338
267
15
NA
374
89
2,498 .... ... ...
Permit PAN Limit 1st/2nd Crop
......:.: #N/A
"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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date ***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE
MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH
APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility
Name:
Town of Broadway WQ Permit #: WQ0018007
Field #: 2
Acres Utilized:
Owner:
Steven M. Cox Annual Dry Tons Applied: #VALUE!
Site #: 5
Acres Permitted:
1.97
Operator:
Steven M. Cox Predominat Soil Series
DoB Cation Exchange Capacity (non 503):
NA
Crop 1 Name: #N/A Crop 1 Max PAN: #N/A
Crop 2 Name: #N/A
Crop 2 Max. PAN
#N/A
Specify
We, Tons
Site
%Solids Volume Residual Sources Cond. Precip.
< �
o z
Nitrate PAN Applied
Must Select
o
Cu.Yd.
Totals As Applied per (NPDES #, WQ#, 1Dry, Past 24 s �.
w w a R TKN 0 o
and (lbs/acre)
Crop 1 or Crop 2
o -
Report
Per Acre Acre Fert., Animal Waste, Hrs. °n w
Decimal Wet, =
* N * N g 2
* *
Nitrite
Totals
*
etc.) Moist) °
°
°o
Crop 1 Crop 2
p p
Crop 1 Crop 2
p p
in Gal.
(DT/AC) Inches
mg/kg mgtkg
mWkg
TOTALS: 0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P PAN 1 PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 0.00 0.00
Date lbs/ac
Current Cumulative lbs/acre
0.01
0.01
NA
0.76
0.06
0.02
NA
0.10
0.02
2.54
Apr-18 2,000
Prior Years Cumulative lbs/acre
0.01
0.01
NA
0.76
0.06
0.02
NA
0.10
0.02
2.54
Permitted C. P. L. R.****
36
34
NA
1,338
267
15
NA
374
89
2,498
Permit PAN Limit l st/2nd Crop
.. ......
............
...............
:::.::......:...::::.:......
..
......
:::..
#N/A
"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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)