WQ0002376_Renewal Application_20200103

Initial Review
INITIAL REVIEW
Reviewer Thornburg, Nathaniel
Is this submital an
application?*
r Yes r No
Is this a complete
application?* Complete App Date
r Yes r No 01/02/2020
Project Number* WQ0002376
Applicant/Permittee City of Reidsville
Applicant/Permittee 1100 Vance Street, Reidsville NC 27320
Address
Is the owner in BIMS?
r Yes r No
Owner Type
Facility Name
County
Municipal
City of Reidsville RLAP
Rockingham
Fee Category
Major
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if
non -application)
Email Notifications
Does this need O Yes
review by the r No
hydrogeologist? *
Regional Office Winston-Salem
Is the facility in BIMS?
r Yes r No
Fee Amount

CO Reviewer Ranveer Katyal: eads\rkatyal
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notification
Comments for Kendall
Comments for RO
Comments for Reviewer
Comments for Applicant

Submitted Form
Project Contact Information
Rease provide information on the person to be contacted by MB Staff regarding electronic subnittal, confirmation of receipt, and other issues.
.......................................................................................................................................................................................................................................................................................................................................................................................................
Name * City of Reidsville
Email Address*
[e-mail]
Project Information
........................................................................................................................................................................
Submittal Type* r New Permit Application
r Renewal
r Annual Report
Permit Type * r Wastewater Irrigation
r Other Wastewater
r Closed -Loop Recycle
r Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?*
r Yes r Nor N/A
Permit Number WQ0002376
currently has project
Applicant\Permittee * City of Reidsville
Phone Number*
336-399-3646
Applicant/Permittee 1100 Vance Street, Reidsville NC 27320
Address*
Facility Name * City of Reidsville WWTP
r Modification (Major or Minor)
r Additional Information
r Other
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
Permit Renewal - City of Reidsville - WQ0002376.pdf 66.04MB
upload only 1 R7F document. NL@iple documents must be combined into one R7F file.

For new and modification permit applications, a paper copy may be required. If you have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a paper --polka*-ion is required,
be advised, applications accepted' far pre -review until both the paper and eIect-c-,i_ co1)ies nave been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments (calcs, soils report, specs, etc.)
o One full-size engineering plan set
o One 11x17" engineering plan set
o One extra set of specifications
o Fee (if required)
MallinE address:
❑iuision of Water Resources1 Division of Water Resources
Non -Discharge Branch I Non -Discharge Branch
1617 Mail Service Center 1 Aft: Nathaniel Thornburg, 91° Floor, Cfice #942W
----------------------------------------------------------- -----------------------------------------
Raleih, NC 27699-1617 512 N. Salisbury St.
Far questions or problems contact Tessa Monday [e-mail] or 919.707.3560.
* W By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. 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).
Signature
Submission Date 12/23/2019

M
--Resources, Inc.
December 23, 2019
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
RE: Permit Renewal/Modification Application, Permit No. WQ0002376
To Whom It May Concern:
EMA Resources Inc. is submitting this application for the renewal and modification of permit
number WQ0002376. When approved, this renewal and modification will include the following
changes/additions:
• Delete multiple sites where deaths or new owners have decided not to participate
• 2 fields were split into new fields based on new parcel lines. No new permitted acreage
is involved but they are new field numbers. The sites are:
o Site RC125-03 has been split into two field (3 and 4) where parcels have been
sold
o Site RC125-02 has been split into two fields (2 and 5) because part of the field is
in grass and part is in row crop
We are requesting the following sites be renewed but the landowner agreements are
not included in this package. These sites will not be used until a completed landowner
agreement has been signed and submitted to DWR.
o Site RC019 — Mary Stanley has died and we are in the process of trying to
determine who is the current owner. The operator, Thomas Carter, is unsure of
who now owns it and the Rockingham County Tax office still shows Mary Stanley
as the owner. We will update as soon as we are able to determine who owns it.
o Site RC118 — Doug Merritt lives in Colorado and the operator, Barry Knight, is
having trouble getting in touch with him to get an landowner agreement signed
and notarized. We will update as soon as it is received.
In addition, all of the maps have been redrawn using ArcMap software and the acreages
are now more accurate to what they actually are.
Respectfullyy,�,// ��
Gam"_
Brent Collins
[e-mail]
Director of Technical Services
EMA Resources Inc.
Phone [phone] .. Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

Permit Renewal Request for Land Application of Residual Solids
Permit #WQ0002376 — City of Reidsville
Table of Contents
• Cover Letter
• Form RLAP
o Existing Permit WQ0002376
o Operation and Maintenance Plan
• Summary for Form RSC
• Form RSC
o Vicinity Map for the City of Reidsville WWTP
o Process Flow Narrative
o Quantitative Justification for Residuals Production Rate
o Residuals Quality Information (Nutrients, Metals, TCLP, Pathogen Reduction and
Vector Attraction -Reduction Analyses)
• Form LASC
o Site Specific Information
■ Landowner Agreement
■ Vicinity Map
■ Application Map
o Current Cumulative Pollutant Loading Data

Form RLAP

DWR
State of North Carolina
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: City of Reidsville
Applicant type: ❑ Individual 0 Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Chuck Smith Title: Public Works Director
Applicant's mailing address: 1100 Vance Street
City: Reidsville State: NC Zip: 27320-
Telephone number: [phone] Email Address: csmithnci.reidsville.nc.us
2. Consultant's name: License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm: )
Consultant's mailing address:
City: State:
Zip: -
Telephone number: (77) r-
Email Address:
3. Agronomist's name: a,—
License Number:
Affiliation: ❑ N/A ❑ On Staff
0 Retained (Firm: )
Agronomist's mailing address: —9
City: State:
Zip: -
Telephone number: (_) _-
Email Address:
4. Soil Scientist's name:
License Number: am
Affiliation: 0 N/A ❑ On Staff
N Retained (Firm: _)
Soil Scientist's mailing address: _
City: = State:
Zip: �-
Telephone number: () -
Email Address:
5. Fee submitted: 0 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check all that apply): M new, ® modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0002376
Date of most -recently issued permit: 05/15/2015
Date of most -recently certified Attachment A (if different than the permit): 05/15/2015
Date of most -recently certified Attachment B (if different than the permit): 0511512015
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 407 Broad St
City: Reidsville State: NC Zip: 27320-,
Coordinates: Latitude: 36° 19' 23" Longitude: 790 39' 30"
Datum: NAD83
Method of measurement: GPS
Level of accuracy: nearest second
2. County where residuals land application program is headquartered: Rockingham
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
Mike Collins
EMA Resources Inc.
LA24990
Back -Up ORC
Brent Collins
EMA Resources Inc.
LA27651
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 Nitrozen Summary: 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: 1300 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
24.7
34.37
32,110
44,681
Five -Year Maximum Adjusted
33.35
43.02
43,355
55,926
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
11.27
Hay/Pasture
613.48
Total:
624.75
Methods
Surface
624.75
Incorporation or Injection
0
Total:
624.75
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: 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
Application Rate
(lbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
642.2
893.62
867.1
1118.52
100
321.1
446.81
433.55
559.26
150
214.1
298.9
289
372.8
200
160.55
223.4
216.8
279.6
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.
w�
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.
M
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(p) 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: -9
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or 0 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
ftZ
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Pa a Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ftZ
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 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.
0 Yes EM No, Explain;
I, Charles Smith —Public Works Director
(Signature Authority's Name— PLEASE PRINT) (Title)
attest that this application for The Citv of Reidsville
(Facility Name)
has been reviewed by me and is accurate and complete to the best ofmy 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 condition 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 be 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:�Date: �?D tl
FORM: RLAP 06-16 Page 5 of 5

Current Permit

.1
~R
North Carolina Department liEnvironmentr Natural Resources
Pat McCrory Donald van der Vaart
Governor Secretary
May 15, 2015
Kevin Eason — Director of Public Works
City of Reidsville
1100 Vance Street
Reidsville, North Carolina 27320
Dear Mr. Eason:
Subject: Pennit No. WQ0002376
City of Reidsville
Land Application of Class B
Wastewater Treatment Plant
Residuals (Non -Dedicated)
Rockingham County
In accordance with your permit major modification and renewal request received December 2,
2014 and subsequent additional information received January 8, 2015, we are forwarding herewith Permit
No. WQ0002376 dated May 15, 2015, to the City of Reidsville for the continued operation of the subject
residuals management program.
Modifications to the subject pen -nit are as follows: 46 new fields are being added to the program,
of which 13 are being transferred into the pen -nit from Permit WQ0003760. Fifty-eight of the existing
fields are being renewed, and 38 of the existing fields are being removed from the program. These
modifications collectively result in a gain of 129 acres, from the 1016.80 acres approved on September 3,
2008 to the 1,145.80 acres approved in this permit of May 15, 2015.
This permit shall be effective from May 15, 2015 until April 30, 2020, shall void Perrnit No.
WQ0092376 issued May 19, 2006, and shall be subject to the conditions and linnitations as specified
therein. 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, 2006, North Carolina Administrative Code Title 15A
Subchapter 02T — Waste not Discharged to Surface Waters was adopted. Accordingly, this permit
incorporates the requirements of these rules; therefore, please take the time to review this permit
thoroughly. Regulatory references have been added to the Pen -nit Conditions. The following conditions
have been added, modified or deleted from those in the last pen -nit issuance:
Condition 1.1. — describes the procedure for renewing the permit
�, Condition I.2. — requires compliance with notification requirements
➢ Condition I.3. — requires submission of an Operation and Maintenance Plan
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: http://pogal.ncdenr.org/web/wa
An Equal Opportunity \ Affirmative Action Employer— Made in part with recycled paper

Mr. Kevin Eason
May 15, 2015
Page 2 of 4
➢ Condition I.4. — requires compliance with the application site signage requirements
➢ Condition II.1. — the program shall be effectively maintained and operated
➢ Condition II.5. — lists the Ceiling Concentrations and the Cumulative Pollutant Loading Rates
➢ Condition 11.6. —requires compliance with the pathogen reduction requirements
➢ Condition II.7. — requires a vector attraction reduction alternative to be met
➢ Condition II.8. —
lists the setback distances for the application sites
➢ Condition II.10.
—Realistic Yield Expectations shall be used to determine agronomic rates
➢ Condition H.11.
— the realistic nitrogen uptake rate shall be reduced for pastureland
➢ Condition H.12.
— application restrictions apply to sites which are over -seeded
➢ Condition H.13.
— residuals with a high Sodium Adsorption Ratio require special distribution
➢ Condition III.1.
— the program shall be properly maintained and operated
➢ Condition I112.
— addresses government notification for the initial land application event
➢ Condition III.3. - addresses government notification for subsequent land application events
➢ Condition III.4. — lists minimal requirements for the Operation and Maintenance Plan
➢ Condition 111.5. — requires retaining an ORC and backup ORC for the facility
➢ Condition 111.6. — copies of the permit and O&M plan must be present during applications
➢ Condition III.7. — spill controls are to be in effect on residuals transport / application vehicles
➢ Condition III.10. —a suitable vegetative cover is to be maintained on application areas
➢ Condition 111.11. —lists field conditions which preclude the application of residuals
➢ Condition IlI.12. —addresses public access restrictions
Condition III.13. — describes the signage requirements for the application sites
➢ Condition III.15. — information is required on prior nutrient application sources and events
➢ Condition IV.3. —lists metals analyses to be performed on the residuals
➢ Condition IV.4. — requires residuals monitoring for pathogen and vector attraction reduction
➢ Condition IV.7. — lists the minimal requirements for recording land application events
➢ Condition IV.8. — requires the submission of an annual report
➢ Condition IV.9. — addresses noncompliance events and proper actions and notifications

Mr. Kevin Eason
May 15, 2015
Page 3 of 4
➢ Condition. V.I. —the permittee must provide adequate inspection and maintenance
➢ Condition VIA
— the permittee must follow all other environmental regulations
➢ Condition VI.5.
— any change in ownership requires a modification of the permit
➢ Condition VIA
— the permit may be modified or revoked under certain circumstances
➢ Condition VI.7.
— the facilities may not be expanded if certain conditions prevail
➢ Condition VI.8.
— the annual fee must be paid on time
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatoiy 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. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact David Goodrich at (919)
807-6352 or by email at [e-mail].
Sincerely,
A7__�
S. Jay Zimmerman, Director
Division of Water Resources
cc: Guilford County Health Department (Electronic Copy)
Rockingham County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Brent Collins — EMA Resources, Inc., 755 Yadkinville Road, Mocksville, NC (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

LAI J! TPVL__1_CATI*,!11 if. F CLASS I "I TWSTE 7YATEA TYUAT-R1E0,T-P4.,'V1T 2U, SID J:Ai�S
PERMIT (NON -DEDICATED)
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
co
ity of RelidsvflN
Rockingham County I
continued operation of a residuals management program for the City of Reidsville and consisting of the
land application of Class B Wastewater Treatment Plant residuals generated by the approved facilities
listed in Attachinent A to the approved sites listed in Attachnient B with no discharge of wastes to surface
waters, pursuant to the application received December 2, 2014, subsequent additional infori-nation
received by the Division of Water Resources, and in confonnity with other supporting data subsequently
filed and approved by the Department of Environment and Natural Resources and considered a part of
this pen -nit. The use and disposal of residuals are regulated under Title 40 Code of Federal Regulations
Part 503. This pen -nit does not exempt the Pennittee from complying with the federal regulations.
This permit shall be effective from May 15, 2015 until April 30, 2020, shall void Permit No. WQ0002376
issued May 19, 2006, and shall be subject to the following specified conditions and limitations:
I. SCHEDULES
No later than six months prior to the expiration of this permit, the Pelinittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application. [15A NCAC 02T .0108(b)(2), 02T. 105(d), 02T.0109]
The perinittee shall be in full compliance with the regional office notification requirements
C,
established in Condition Ill.3. within 90 days of the effective date of this pern-lit. [15A NCAC 02T
.0108(b)(2)]
The pen-nittee shall submit the Operation and Maintenance (O&M) plan as required in Condition
111.4. to the Division within 90 days of the effective date of this permit. [15A NCAC 02T
.0108(b)(2)]
4. The pert ittee shall be in full compliance with the signage requirements established in Condition
111. 13. within 180 days of the effective date of this permit. [15A NCAC 02T .0108(b)(2)]
WQ0002376 Version 3.0 Shell Version 150101 Page 1 of 12

II. PERFORMANCE STANDARDS
1. The subject residuals management program shall be effectively maintained and operated at all times
,so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Winston-Salem regional office supervisor, and take any
immediate corrective actions. [G.S. 143-215.1]
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 02B
.0200, 02L .0100]
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit. [G.S. 143-215.1]
4. Only the sites listed in Attachment B are approved for residuals land application. [G.S. 143-215.1]
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs): [15A NCAC 02T .1105]
Parameter
Ceiling Concentration
(milligrams per kilogram)
CPLR
(pounds per acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
n/a
Nickel
420
374
Selenium
100
89
Zinc
7,500
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 have not occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC
02T .1106 (a) and (c). Exceptions to this requirement shall be specified in Attachment A. [15A
NCAC 02T .1106]
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shallmeetone of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to/this requirement shall be specified in Attachment A. [15A NCAC 02T .1107]
WQ0002376 Version 3.0 Shell Version 150101 Page 2 of 12

8. Setbacks for Class B land application sites shall be as follows: [I 5A NCAC 02T .1108]
Setback by application type
Setback Description
Vehicular
Irrigation
Surface
Surface
Injection
Application
Application
Incorporation
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
400*
400*
200*
part of the project site
Property lines
50
50
50
Public right of way
50
50
50
Private or public water supply source, waters
classified as SA or SB, and any Class I or Class 11
100
100
100
impounded reservoir used as a source of drinking
water
Surface waters (streams — intermittent and perem-iial,
perenriial waterbodies, and wetlands), any streams
classified as WS or B, or any other stream, canal,
100
100
50
marsh or coastal waters, more any other lake or
impoundment
Upslope interceptor drains or upslope surface water
10
10
10
diversions (ephemeral streams, waterways, ditches)
Downslope interceptor drains, downslope surface
water diversions, downslope groundwater drainage
25
25
25
systems, or downslope surface drainage ditches
*The setback requirement may be reduced to a minimum of 100 feet upon written consent of the
owner and approval from the Water Quality Regional Operations Section of the appropriate
Division's regional office in Attachment B of this pen -nit.
9. Land application areas shall be clearly marked on each site prior to and during any residuals
application event. [ I 5A NCAC 02T .0108(b)(1)]
10. Bulk 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: [I 5A NCAC 02T I 109(b)(l)(k)]
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 (http://lltitlients.soil.nesu.edu/yields/index.plip).
A copy shall be kept on file and reprinted every five years in accordance with Condition IV.6.
c. If the RYE carmot be determined using methods (a) or (b) above, the Peniiittee 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.
WQ0002376 Version 3.0 Shell Version 150101 Page 3 of 12

ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
alftp://www.neagr.gov/SWC/tech/doculuents/9th Guidance Doc 100109.pdf).
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 (ftp•//ftp-fc sc egov usda gov/NHQ/practice-standards/standards/590.pdf).
d. If the RYE and appropriate nutrient application rates cannot be determined,the Permittee shall
contact the Division to determine necessary action.
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with. the USDA-NRCS 590 Nutrient Management Standards. [15A NCAC 02T
.0108(b)(1)]
12. If 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)]
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, etc.), 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)]
14. These residuals land application sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application
area. An exceedance of groundwater standards at or beyond the compliance boundary is subject to
remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B. [15A NCAC 02L
.0107(a)]
15. The review boundary shall be established midway between the compliance boundary and the residual
land application area. Any exceedance of groundwater standards at the review boundary shall require
action in accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
III. OPERATION AND MAINTENANCE REQUIREMENTS
The residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards. [15A NCAC 02T .1110]
2. The Winston-Salem Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall be notified at least
48 hours prior to the initial residuals land application to any new land application site. Notification to
the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday,
excluding State Holidays. [15A NCAC 02T .0108(b)(1)]
WQ0002376 Version 3.0 Shell Version 150101 Page 4 of 12

3. The Winston-Salem Regional Office shall be notified via email or telephone, [phone], at least
24 hours prior to conducting any land application activity. Such notification shall indicate, at a
inininium, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary toapply toadditional fields due to unforeseen events, H the Regional Office shall be notified prior to commencing the application to those fields. [15A NCAC 02T .0108(b)(1)]
4. The Pen-nittee shall maintain an approved Operation and Maintenance Plan (O&M Plan)
Modifications to the O&M Plan shall be approved by the Division prior to utilization of the new plan.
The O&M Plan, at the minimum, shall include: [15A NCAC 02T.1100]
a) Operational functions;
b) Maintenance schedules;
c) Safety measures;
d) Spill response plan;
e) Inspection plan including the following information:
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. 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;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuant to the
noncompliance notification requirements under the inonitoring and reporting section of the
permit;
f) Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. 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).
Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Peirnittee shall designate and employ a certified operator in
responsible charge (ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC 08G .0201. The ORC or their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition
111.4.), and shall comply with all other conditions of 15A NCAC 08G. 0204. For more information
regarding classification and designation requirements, please contact the Division of Water
Resources' Techriical Assistance & Certification Unit at [phone]. [15A NCAC 02T .0117]
6. When the Penriittee land applies bulk residuals, a copy of this pern-ift and a copy of O&M Plan shall
be maintained at the land application sites during land application activities. [15A NCAC 02T
.0108(b)(1)]
7. When the Perinittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles. [15A NCAC 02T I I 10]
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division. [G. S. 143 -215, 1
WQ0002376 Version 3.0 Shell Version 150101 Page 5 of 12

9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters. [G.S. 143-215.1]
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied, or application shall be in accordance with the
crop management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, or an agronomist
and as approved by the Division. [15A NCAC 02T .1109(b)(1)]
11. Bulk residuals shall not be land applied under the following conditions: [15A NCAC 02T .1109]
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 prolonged 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 bulk residuals are injected or incorporated within
a 24-hour period following a residuals land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
g. If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a final soil pH of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will be noted in this permit;
i. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in
a USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
12. The following public access restrictions apply to residual land application sites: [15A NCAC 02T
.1109(b)(2)]
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days 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.
13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under 111.12 apply. [15A
NCAC 02T .0108(b)(1)]
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14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event: [15A NCAC 02T.1 109(b)(3)]
and Grazing Description
Restricted
___Harvesting
_—Duration----
Animals shall not be allowed to graze during land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
30 days
prevent access after each land application event.
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for:
12 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e.g., tobacco, melons, cucumbers, squash, etc.)
14 months
shall not be harvested for:
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the land
20 months
surface (e.g., root crops such as potatoes, carrots, radishes, etc.) shall not be
harvested for:
When the residuals remain on the land surface for less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
38 months
surface shall not be harvested for:
15. 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 Perinittee 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 (CMP), Waste Utilization Plan
(ATUP) or Certified Nutrient Management Plan (CLAMP) shall also be considered a Nutrient
Management Plan. [15A NCAC 02T .0108(b)(1), 02T .1104(c)(4)]
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attaclunent (LOAA)
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permit expiration date,
and shall be renewed during the permit renewal process. [I 5A NCAC 02T.1 104(c)(4)]
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed. [ I 5A NCAC 02T .0108(c)]
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)l shall be performed at the frequency specified in
Attachment A, and the Permittee shall maintain these results for a minimum of five years. Any
exceptions from the requirements in this condition shall be specified in Attachnient A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses): [ I 5A NCAC 13A .0 1 02(b), 02T . 110 1, 02T .1105]
WQ0002376 Version 3.0 Shell Version 150 101 Page 7 of 12

Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoltiene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
' Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide)
(0.008)
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0) .
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A,
the Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following parameters: [15A NCAC 02T .1101]
Aluminum
Mercury
Potassium
Anunonia-Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead .
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficient to demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
condition shall be specified in Attachment A. [15A NCAC 02T .1106, 02T. 1107, 02T. 111 l(c)]
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5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land_ application site listed in Attachment B_on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website(http://www.ncagr.gov/agrononni/pubs.htin). The Permittee shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a period of no less than five years, and shall be made available to the Division upon request. At a
nninimum, the Standard Soil Fertility Analysis shall include the following parameters: [15A NCAC
02T .1111(d)]
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Hunnic Matter
Zinc
Copper
pH
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Pernnittee shall maintain records tracking all residual land application events. At a minimum,
these records shall include the following: [15A NCAC 02T .0109(a)]
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attaclmment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., surly, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops to be grown on field;
j. Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in gallons per acre, cubic yard per acre, dry tons per acre, or wet
ton per acre;
Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
m. Volume of soil amendments (e.g., lime, gypsum, etc.) applied in gallons per acre, dry ton per
acre, or wet tons per acre; and
n. Annual and cumulative totals in dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be linnited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.
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8. Three copies of an annual report shall be submitted on or before March 1". The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Foams. Instructions for reporting and annual report forms are available at
http://portal.ncdenr.or web/wq/Ws/lau/reporting, or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address: [15A
NCAC 02T .1111(a)]
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
9. Noncompliance Notification
The Permittee shall report by telephone to the Winston-Salem Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following: [15A NCAC
02T .0105(1), 02T .0108(b)(1)]
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
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1. The Pennittee shall provide adequate inspection. and maintenance to ensure proper operation of the
_ su_bj ect facilities _and_ shall be in accordance with the approved O&M Plan.___[15A NCAC 02T
2. Prior to each bulk residuals land application event, the Pennittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
enviromnent, a threat to human health or a public nuisance. The Pernittee shall maintain an
inspection log that includes, at a minimum, the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Pennittee 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 .0108(b)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or
copy any records required to be maintained under the terms and conditions of this pen -nit; and may
collect groundwater, surface water or leachate samples. [G.S. 143-215.3(a)(2)]
1. Failure to comply with the conditions and limitations contained herein may subject the Pennittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C.
This pen -nit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit. [15A NCAC 02T .0110]
This permit is effective only with respect to the nature and volume of residuals described in the
pen -nit application and other supporting documentation. [G.S. 143-215.1]
4. The issuance of this permit does not exempt the Pen-nittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B .0200; erosion and sedimentation, control requirements in 15A NCAC Chapter 4
and under the Division's General Pen -nit NCGO10000; any requirements pertaining to wetlands under
15A NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of
Chapter 143 of the General Statutes.
Ill the event the residuals program changes ownership or the Pennittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Pen-nittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner. [15A NCAC 02T .0104]
6. This pennit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110.
7. Unless the Division Director grants a variance, expansion of the permitted residuals program
contained herein shall not be granted if the Pen-nittee exemplifies any of the criteria in 15A NCAC
02T .0120(b).
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8. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 151h day of May 2015
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
S. JAmmerman, Director
DivisiA of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0002376
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ATTACHMENT A - Approved Residual Sources
City of Reidsville
Certification Date:
Permit Number: WQ0002376
May 15, 2015
Version: 3.0
-
Approved
Monitoring
Monitoring
Monitoring I
Mineralization
Owner
Facility Name
County
Permit
Biological
Maximum
Dry Tons
Frequency for
Frequency for
Frequency for I
Patho en &
Rate
Number
Residuals
per Year
Non -hazardous
Characteristics -
Metals and
Nutrients 3,5
g
Vector Attraction
[Raw = 0.4;
Aerobic = 0.3;
Reductions 4,5
Anaerobic = 0.2;
Compost = 0.1 ]
City of Reidsville
City of Reidsville WWTP
Rockingham
NC0024881
Yes
1,300
Annually
See Table Below
See Table Below
0.3
Total
1,300
I
l . 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 1VA.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T .1111)
<319
1 /Year
=>319 - <1,650
1/ Quarter (4 times per year)
_> 1,650 - <16,500
1/60 Days (6 times per ear)
—16,500
1/month (12 times per 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
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification. i
Page 1 of 1

ATTACHMENT B - Approved Land Application Sites
City of Reidsville — Land Application Program
Certification Date:
Permit Number: WQ0002376
i
I
7ay
15, 2015
Version: 3.0
Field/ Site
Owner
Lessee
County
Latitude
Longitude
ANet
creage
Dominant Soil Series
I
Footnotes
NC-GU-008-03
Strader, Jill
Green, Steve
Guilford
36014'57"
79053'35"
7.0
CkB - Clifford
i
NC-GU-008-04
Strader, Jill
Green, Steve
Guilford
36014'50"
79053'35"
8.3
CkB - Clifford
i
i
NC-GU-013-01
Doggett, Mark
Guilford
36014'07"
79048'54"
13.7
Cecil
NC-GU-013-02
Doggett, Mark
Guilford
360I4'14"
79048'46"
17.7
Cecil
NC-GU-013-03
Doggett, Mark
Guilford
36012'40"
79053'12"
18.45
Cecil
NC-GU-013-04
Doggett, Mark
Guilford
36012'49"
79053'15"
4.3
Cecil
NC-GU-014-03
Doggett, Mark
Guilford
36014'02"
79053'51"
17.7
Cecil
j
NC-GU-014-04
Doggett, Mark
Guilford
36613'33"
79053'51"
20.65
Watere
NC-GU-014-05
Doggett, Mark
Guilford
36013'26"
79053'35"
29.1
Cecil
I
NC-GU-014-06
Doggett, Mark
Guilford
36013'23"
79053'39"
10.9
Udorthents
NC-GU-014-07a
Doggett, Mark
Guilford
36013'00"
79053'28"
2.2
Cecil
NC-GU-022-01'
Davenport, John
Guilford
36014'00"
79050'25"
12.0
Cecil
i
NC-GU-022-02`
Davenport, John
Guilford
36014'03"
79050'24"
1.5
Cecil
i
i
Total for County
Guilford
163.50
i
NC-RC-001-01
Marshall, Ronald
Rockingham
36017'59"
79058'20"
1.5
CgB2 - Clifford
NC-RC-001-02
Marshall, Ronald
Rockingham
36017'47"
79057'58"
5.0
Cg132 - Clifford
NC-RC-001-03
Marshall, Ronald
Rockingham
36017148"
79058'07"
11.5
Cg132 - Clifford
j
NC-RC-001-04
Marshall, Ronald
Rockingham
36017'48"
79058'16"
4.0
Cg132 - Clifford
NC-RC-002-01
Marshall, Jane
Marshall, Ronald
Rockingham
36017'56"
79058' 11"
15.0
Cg132 - Clifford
NC-RC-003-01
Middleton, Curtis
Marshall, Ronald
Rockingham
36017'58"
79057'28"
7.0
Cg132 - Clifford
NC-RC-003-02
Middleton, Curtis
Marshall, Ronald
Rockingham
36017'53"
79057'49"
6.5
CgB2 - Clifford
i
NC-RC-003-03
Middleton, Curtis
Marshall, Ronald
Rockingham
36017'56"
79°57'41"
10.0
FrD2— Fair view
i
Pagel of 5

ATTACHMENT B - Approved Land Application Sites
City of Reidsville — Land Application Program
Certification Date: May 15, 2015
Permit Number: WQ0002376 Version: 3.0
NC-RC-004-01
Neal, Catherine
Marshall, Ronald
Rockingham
36°17'57"
79"56'37"
27.45
Cg132 - Clifford
NC-RC-005-01
Albert, James
Marshall, Ronald
Rockingham -
36°17'22"
79058'13"
14.7
CgB2 - Clifford
NC-RC-005-02
Albert, James
Marshall, Ronald
Rockingham
36017'25"
79058'06"
14.0
FrD2 - Fairview
NC-RC-005-03
Albert, James
Marshall, Ronald
Rockingham
36°17'25"
79057'55"
5.0
CgB2 - Clifford
NC-RC-005-04
Albert, James
Marshall, Ronald
Rockingham
36017'31"
79058'05"
11.0
NaB - Nathalie
NC-RC-005-05
Albert, James
Marshall, Ronald
Rockingham
36017'34"
79058'15"
10.7
NaB - Nathalie
NC-RC-005-06
Albert, James
Marshall, Ronald
Rockingham
36017'25"
79058'24"
2:2
Cg132 - Clifford
NC-RC-006-01
Busick, William
Marshall, Ronald
Rockingham
36019' 14"
79056'46"
9.75
NaB - Nathalie
NC-RC-006-02
Busick, William
Marshall, Ronald
Rockingham
36018'54"
79056'32"
8.6
CgB2 - Clifford
NC-RC-006-03
Busick, William
Marshall, Ronald
Rockingham
36018'44"
79056'26"
5.1
CgB2 - Clifford
NC-RC-007-01
Roberts, Brenda
Marshall, Ronald
Rockingham
36019'09"
79056'51"
3.9
FrD2 - Fairview
NC-RC-008-01
Rogers, Frank
Rockingham
36°19'54"
79048'20"
21.0
RnD - Rhodhiss
NC-RC-009-01
Bray, Michael
Rockingham
36024'24"
79039' 12"
8.45
CgB2 - Clifford
NC-RC-009-02
Bray, Michael
Rockingham
36024'22"
79039'20"
7.8
CgB2 - Clifford
NC-RC-009-03
Bray; Michael
Rockingham
36024'20"
79039'47"
6.1
Cg132 - Clifford
NC-RC-010-01
Stocks, Dan
French, Auman
Rockingham
36023'28"
79051'04"
8.4
RnD - Rhodhiss
NC-RC-Ol 1-01
Purgason, Daisy
Sharpe, Harry
Rockingham
36018'48"
79051'04"
19.0
NaB —Nathalie
NC-RC-011-02
Sharpe, iris
Sharpe, Harry
Rockingham
36018'46"
79050'59"
13.8
NaB - Nathalie
NC-RC-012-01
McCollum, Lawrence
Sharpe, Harry
Rockingham
36019'36"
79050'47"
8.8
Cg132 - Clifford
NC-RC-013-04
Perkins,-J.N..
Rockingham
36017'20"
79037'00"
17.1
Cecil
NC-RC-013-05
Perkins, J.N.
Rockingham
36°17'25" .
79036'45"
3.6
Cecil
NC-RC-013-06
Perkins, J.N.
Rockingham
36017'15"
79036'45"
7.3
Cecil
NC-RC-018-01
Merritt, Melba
Knight, Barry
Rockingham
36017'58"
79058'29"
16.95
CgB2 - Clifford
NC-RC-018-02
Merritt, Melba
Knight, Barry
Rockingham
36018'07"
79°58'24"
14.7
CgB2 - Clifford
NC-RC-019-01
Stanley, Mary
Carter, Thomas
Rockingham
36016'44"
79°45'34"
6.0
CgB2 - Clifford
Page 2 of 5

ATTACE MENT fi - Approved Land Application Sites
City of Reidsville — Land Application Program
Certification Date:
Permit Number: WQ0002376
i
i
i May 15, 2015
Version: 3.0
NC-RC-019-02
Stanley, Mary
Carter, Thomas
Rockingham
36016'51"
79058'33"
2.0
CgB2 - Clifford
i
NC-RC-019-03
Stanley, Mary
Carter, Thomas
Rockingham
36016'48"
79058'22"
3.3
Cg132 - Clifford
NC-RC-019-04
Stanley, Mary
Carter, Thomas
Rockingham
36016'58"
79058734"
8.5
Cg132 - Clifford
NC-RC-019-05
Stanley, Mary
Carter, Thomas
Rockingham
36017'01"
79045'29"
7.1
Cg132 - Clifford
NC-RC-022-07
Pearson, Alton
Rockingham
36°16'54"
79044'20"
9.3
Cecil
NC-RC-041-01
Lovelace, Lofton
Lovelace, Donald
Rockingham
36"18'l8"
79032'l1"
11.6
Cecil
NC-RC-041-02'
Lovelace, Lofton
Lovelace, Donald
Rockingham
36018'16"
79032'23"
6.8
Cecil
NC-RC-041-03
Lovelace, Lofton
Lovelace, Donald
Rockingham
36018'13"
79032'32"
2.4
Cecil
NC-RC-041-04
Lovelace, Lofton
Lovelace, Donald
Rockingham
36018'25"
79032'14"
19.4
Cecil
NC-RC-108-01
Pearson, Alton
Rockingham
36017'45"
79052'25"
2.4
Rion
NC-RC-108-02
Pearson, Alton
Rockingham
36017'43"
79052'27"
7.5
Rion
NC-RC-108-03
Pearson, Alton
Rockingham
36017'50"
79052'40"
2.0
Rion
NC-RC-108-04
Pearson, Alton
Rockingham
36017'45"
79052'l1"
2.6
Rion
NC-RC-1 18-01
Carty, Johnie
Rockingham
36016'03"
79044'55"
11.4
Cecil
i
NC-RC-1 18-02
Carty, Johnie
Rockingham
36016'03"
79044'55"
5.6
Cecil
NC-RC-1 19-01
Carter, Thomas
Rockingham
36017'43"
79045'36"
23.0
Cecil
NC -RC -I 19-02
Carter, Thomas
Rockingham
36017'38"
79045336"
7.1
Cecil
j
NC-RC-1 19-03
Carter, Thomas
Rockingham
36017'30"
79045'36"
2.3
Cecil
NC-RC-119-04
Carter, Thomas
Rockingham
36017'18"
79045'39"
19.1
Cecil
j
NC -RC -I 19-05
Carter, Thomas
Rockingham
36017'08"
79045'43"
8.5
Cecil
NC-RC-1 19-06
Carter, Thomas
Rockingham
36017'53"
79045'35"
9.5
Cecil
i
NC-RC-1 19-08
Carter, Thomas
Rockingham
36017'22"
79045'48"
4.5
JkB — Jaekland
NC-RC-1 19-09
Carter, Thomas
Rockingham
36017'07"
79042'43"
13.5
Cecil
i
NC-RC-119-10
Carter, Thomas
Rockingham
36017'14"
79045'46"
6.6
CgB2—Clifford
i
NC-RC-119-11
Carter, Thomas
Rockingham
36°17'24"
79045'54"
20.0
CgB2—Clifford
Page 3 of 5

ATTACHMENT B - Approved Land Application Sites
City of Reidsville — Land Application Program
Certification Date: May 15, 2015
Permit Number: WQ0002376 Version: 3.0
NC-RC-I19-12
Carter, Thomas
Rockingham
36017'16"
79045'42"
2.6
NaB— Nathalie
NC-RC-124-01
Everhart, Rick
Rockingham
36016'30"
79052'54"
13.5
Cecil
NC-RC-124-02
Everhart, Rick
Rockingham
36°16'18"
79052'50"
16.0
Cecil
NC-RC-124-03
Everhart, Rebecca
Everhart, Rick
Rockingham
36016'22"
79053'05"
29.0
Cecil
NC-RC-125-01
Small, Gene
Rockingham
36016'45"
79051'46"
21.25
Cecil
NC-RC-125-02
Small, Gene
Rockingham
36016'41"
79051'47"
4.25
Cecil
NC-RC-125-03
Small, Gene
Rockingham
36017'24"
79045'54"
6.5
CgB2 - Clifford
NC-RC-125-04
Albert, Harvey
Small, Gene
Rockingham
36016'47"
79054'39"
9.9
NaB - Nathalie
NC-RC-125-05
Albert, Harvey
Small, Gene
Rockingham
36016'59"
79054'40"
9.5
CgB2 - Clifford
NC-RC-125-06
Sharpe, Harold
Small, Gene
Rockingham
36016'55"
79054'48"
25.0
RnD - Rhodhiss
NC-RC-126-01
French, Marian
French, Auman
Rockingham
36026'24"
79037'51"
14.0
Cecil
NC-RC-126-02
State of North Carolina
French, Auman
Rockingham
36023'41"
79043'18"
34.0
Cecil
NC-RC-126-03
French, Marian
French, Auman
Rockingham
36025'36"
79039'05"
17.15
CgB2 - Clifford
NC-RC-127-01
Brown, Donald
Rockingham
36017'25"
79033'55"
11.5
Helana
NC-RC-127-02
Brown, Donald
Rockingham
36017'37"
79033'54"
7.0
Vance
NC-RC-127-03-
Brown, Donald
Rockingham
36017'23"
79°33'42"
11.0
Vance
NC-RC-127-04
Brown, Donald
Rockingham
36017'43"
79034'15"
13.0
Cecil
NC-RC-127-05
Brown, Donald
Rockingham
36017'40"
79034'23"
10.0
Cecil
NC-RC-127-06
Brown, Donald
Rockingham `
36017'40"
79034'08"
11.0
Cecil
NC-RC-128-01
Williams, Dennis
Rockingham
36020'02"
79034'36"
23.5
Cecil
NC-RC-128-02
Stevens, Timothy
Williams, Dennis
Rockingham
36018'34"
79035'30"
4.0
Pacolet
NC-RC-128-03
Stevens, Timothy
Williams, Dennis
Rockingham
36018'22"
79035'30"
15.0
Pacolet
NC-RC-128-04
Bondurant, James
Williams, Dennis
Rockingham
36020'12"
79°35'04"
2.5
Pacolet
NC-RC-129-01
Page, Harold
Rockingham
36°24'30"
79037'l 1"
4.0
Rion
NC-RC-129-02
Page, Harold
Rockingham
36024'38"
79037'25"
5.0
Rion
Page 4 of 5

ATTACHMENT B - Approved Land Application Sites Certification Date: i May 15, 2015
City of Reidsville — Land Application Program
Permit Number: WQ0002376
Version: 3.0
NC-RC-129-03
Page, Harold
Rockingham
36024'36"
79037'07"
4.75
Rion
NC-RC-129-04
Page, Harold
Rockingham
36025'40"
79036'28"
5.0
Appling
NC-RC-129-05
Page, Harold
Rockingham
36020'47"
79036'14"
12.0
Appling
NC-RC-129-06
Page, Harold
Rockingham
36026'10"
79036'55"
7.0
Cecil
NC-RC-129-07
Page, Herold
Rockingham
36026' 18"
79037'49"
20.0
NaB — Nathalie
i
NC-RC-130-01
Martin, Ken
Rockingham
36025'25"
79048'08"
21.0
Mayodan
NC-RC-131-04
Crowder, Barbara
Crowder, Kenneth
Rockingham
36024'14"
79051'13"
34.0
Mayodan
NC-RC-132-01
Strader, Bryant
Rockingham
36024'34"
79°37'26"
10.5
Rion
Toted for County
Rockingham
982.30
I
i
I
Total
1145.80
a. A 250-foot buffer shall be maintained around the water supply well that is located within the compliance boundary of this land application site.
b. A reduced setback from residences under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residences
Robert Lee James (Mabe Marshall Road, Summerfield, NC 27358) and Samuel Kevin Cates (Summerfield, NC 27358), regardless of whether a surface or a subsurface applico
method is used.
C. A reduced butter fi•om residences under separate ownership has been approved for this land application site. Residuals may be land applied to within 100 feet of the residences
by Tammy Davenport Bridges (8164 Mabe Marshall Road, Summertield, NC 27358), regardless of whether a surface or a subsurface application method is used.
d. This land application site is dominated by soils or site conditions that readily produce perched water table conditions or have very shallow depths to bedrock. Residuals land al:
events shall be scheduled such that the total allowable PAN loading rate for a particular crop will not be applied in any single event. Events may occur on this site throughout t
provided that the vertical separation between the depth of residuals land application and the water table is greater than three feet.
Page 5 of 5
by
year,

Operation and Maintenance Plan

Standard Operating Procedure and Operation and
Maintenance Plan for the City of Reidsville - Land
Application Program
1. Purpose
a. Ensure the requirements of the City of Reidsville Non -Discharge
Permit#W00002376 are met.
2. Personnel
a. The following is a list of personnel in order they are to be contacted when
information needs to be shared.
i. EMA Resources Inc.
1. Boger Hartsell - Project Manager 336-407-4002
2. Mike Collins - Director of Operations. 336-399-6670
3. Brent Collins -Director of Technical Services 336-399-3646
ii. City of Reidsville
1. Ben Bani - Superintendent 336-264-1474
3. Operational Functions
a. The operational function of this project it going to involves transporting the
liquid residuals via tanker trailers to a staging area in the receiver sites. The liquid
residuals will be off-loaded into tractor/pull tank spreader and land applied in a
uniform application. It is going to be spread at agronomic rates that are
determined using the Realistic Yield Expectations (RYE) as outlined in the permit,
the amount of other nutrient sources the landowner and operator has applied,
and the residuals nutrient and metal sample that is current for that monitoring
period. The material is going to be land applied on fields that have a crop
growing on them that are going to either be grazed or cut for animal feed or row
crops for feed or fiber. Application rates will be reduced by 25% on fields that are
primarily used for grazing in accordance with USDA-NRCS 590. Grazed fields will
be determined by the farmers and EMA project managers.
4. Maintenance Schedule

a. EMA Resources Inc. will follow the maintenance schedule as recommended by
the EMA Resources EHS&T Director for the equipment necessary to complete the
job.
5. Safety Measures
a. The City of Reidsville and EMA Resources Inc. believe in operating in a safety
conscious manner and all employees participate in safety training that is
designed to help employees recognize safety issues and take steps to prevent
accidents from occurring. In addition, EMA Resources employees have the
authority to stop operations if they think any aspect of the operation is going to
cause environmental or personal harm.
6. Spill Response Plan
a. In the unlikely event of a spill, the following action shall be taken immediately.
i. Management of Spill Clean-up Activities: The EMA Resources Project
Manager shall take immediate charge and initiate clean-up activities.
EMA Resources labor and equipment is to be utilized. In the event
additional labor and equipment is required, assistance may be requested
from the City of Reidsville, The NC Department of Transportation, and
other private contractors as necessary.
ii. Halt the Source of the Spill: Such as a ruptured container or damaged
transport unit.
iii. Contain the Spill: 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 of the spill. The Operations Manager or
the person in charge on the spill site will be advise the clean-up
personnel where to get the straw, lime, and other items necessary to
complete the clean-up operation. le. local farmers, farm supply centers,
nurseries.
iv. Initial Clean -Up: Employ front-end loaders, vacuum equipment, sludge
application vehicles, and/or local 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 sand
soaked material will be collected and removed to a disposal area
approved by representatives of the state regulatory agency.
v. 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 satisfactory of the property owner and

state regulatory representatives. The ultimate goal will be restore the
spill area to its original condition if possible.
vi. Notification: As soon as possible after the spill occurs, the EMA
Resources Project Manager or designee will notify the City of Reidsville
and the EMA Resources main office. EMA Resources office staff is then
responsible for notifying other key EMA Resources personnel.
vii. Reporting_ EMA Resources staff will notify the Winston-Salem regional
office of the NCDENR by telephone [phone] as soon as possible,
but not more than 24 hours after, or on the next working day following
the occurrence. The EMA Project Manager shall provide a written report
with 48 hours of the spill to the EMA Resources Director of Technical
Services and the City of Reidsville staff. The report shall list all relative
information and actions taken. With the assistance of EMA Resources
personnel, and the City of Reidsvlle personnel, a written report will be
filed with the Raleigh regional office within 5 days of the occurrence. For
after-hours reporting, the Division's emergency number shall be called to
report all incidences [phone].
7. Inspection Plan
a. Inspection for the land application of residuals will conducted on a minimum of
a weekly basis at the land application site during land application activities. The
inspection frequency is based on the time frame that it is going to take to
complete the project and the amount of dry tons to be land applied from this
facility. The inspections will consist of inspecting a current field that is being
applied as well as inspecting random fields that have been completed.
Inspections will be conducted by Boger Hartsell - Project Manager. These
inspections will consist of the following:
i. Verifying the application rates for each field that plan on receiving
material.
ii. Checking the calculated loads to ensure the correct amount of residuals
are being land applied.
iii. Ensure that all manned equipment has a copy of the permit and the
operation and maintenance plan.
iv. Ensure that the field has been flagged properly and that all buffers are
being adhered to.
v. Ensure proper signage has been posted
vi. Verify that the proper number of samples of the residuals have been
taken and that it meets the criteria for land application.

vii. The records will be kept in the EMA Resources project files in the main
office. Copies of all analyses and records will be forwarded to the City of
Reidsville and kept on file.
viii. EMA Resources and the City of Reidsville staff will immediately inform the
other party if any of the following conditions are noted.
1. Any occurrence with the distribution program resulting in the
land application of significant amounts of material that is
abnormal in quantity or characteristics.
2. Any failure of the distribution system that results in the release to
surface waters.
3. Any time that self -monitoring indicates that the facility has gone
out of compliance with the permit.
4. Any process failure that results in the system not adequately
treating the residuals.
5. Any spill or discharge from a vehicle or piping system during
residuals transportation.
6. Any release that requires immediate reporting outside normal
business hours shall be called in by EMA Resources staff to DWR
at [phone]. This number is to be called in the event of a
release to surface waters or imminent failure of a storage system
when the event occurs outside of normal business hours.
8. Sampling and Monitoring Plan
a. Sampling for this project consists of sampling the residuals prior to land
application occurring in order to ensure that the residuals are suitable for land
application.
b. The samples will be collected from the two storage lagoons that holds the
residuals
c. Boger Hartsell, Brent Collins, or other designee will be responsible for sample
collection for nutrient and metal, TCLP, and fecal coliform.
d. Nutrient, metal and TCLP sample aliquots will be collected randomly and consist
of at least 7 individual aliquots mixed together in order to get the composite
sample for these parameters.
e. The residuals will be sampled annually for TCLP including the RClls.
f. Metal and nutrient parameters will be collected and analyzed based on the
requested dry ton numbers in the permit application.

g. Residuals will be sampled for fecal coliform to demonstrate pathogen
requirements have been met. Seven separate samples will be collected and
analyzed.
9. Environmental Impacts
a. The environmental impacts for residuals may be affected by this procedure.
b. This procedure helps assure that land application is conducted in a safe and
efficient manner while ensuring compliance with the laws and regulations and
to minimize exposure, negative environmental impacts and public relation
concerns.

Form RSC

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: City of Reidsville
Status a
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current
Proposed
R
City of Reidsville
Reidsville WWTP
Rockingham
WQ0002376
1300
1300
a 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).
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: City of Reidsville WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, ®, Local Government, or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, IN Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Ben Bani — Superintendent/ORC
Complete mailing address: 1100 Vance Street
City: Reidsville State: NC Zip: 27320-
Telephone number: [phone] E-mail address: bbani(a)ci.reidsville.nc.us
4. Facility physical address: 407 Broad St
City: Reidsville State: NC Zip: 27320-
Coordinates: Latitude: 36' 19' 23" Longitude: 79' 39' 30"
Datum: NAD83 Level of accuracy: nearest second
Method of measurement: GPS
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: 42 % industrial and 58 % domestic)
❑ other (explain: _ ).
6. Does the facility have an approved pretreatment program: ® Yes No
7. Facility permitted/design flow: 7_5 MGD and facility average daily flow: 2_4 MGD
8. Average amount of residuals being generated at this facility 1300 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Two circular aerobic digesters of 500,000 gallons, two squared digesters of
1,000,000 gallons, wasting approximately 60,000 gallons per daX
Type and volume of residuals storage (i.e., outside of residuals treatment units): 2 train holding basin of 2,500,000 gallons
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
® 40 CFR Part 503 or fj 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 1 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: ❑I 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: Pace Analytical and Date of analysis: 1/15/2019
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: >170 °F (> 140°F)
Passed reactivity test: Dyes Ono. HCN: <0.25 mg/kg (<250) & HzS: <25 mg/kg (<500)
TCLP Parameter
Limit
(Mg/1)
Result
(Mg/1)
TCLP Parameter
Limit
(Mg/1)
Result
(Mg/1)
Arsenic
5.0
<.05
Hexachlorobenzene
0.13
<.1
Barium
100.0
<.15
Hexachloro-1,3-Butadiene
0.5
<.1
Benzene
0.5
<.05
Hexachloroethane
3.0
<.1
Cadmium
1.0
<.05
Lead
5.0
<.05
Carbon Tetrachloride
0.5
<.05
Lindane
0.4
<.005
Chlordane
0.03
<.005
Mercury
0.2
.001
Chlorobenzene
100.0
<.05
Methoxychlor
10.0
<.005
Chloroform
6.0
<.25
Methyl Ethyl Ketone
200.0
<.5
Chromium
5.0
<.05
Nitrobenzene
2.0
<.1
m-Cresol
200.0
<.1
Pentachlorophenol
100.0
<.1
o-Cresol
200.0
<.1
Pyridine
5.0
<.1
p-Cresol
200.0
<.1
Selenium
1.0
<.05
Cresol
200.0
<.1
Silver
5.0
<.05
2,4-D
10.0
<.002
Tetrachloroethylene
0.7
<.05
1,4-Dichlorobenzene
7.5
<.1
Toxaphene
0.5
<.O1
1,2-Dichloroethane
0.5
<.05
Trichloroethylene
0.5
<.05
1,1-Dichloroethylene
0.7
<.05
2,4,5-Trichlorophenol
400.0
<.1
2,4-Dinitrotoluene
0.13
<.1
2,4,6-Trichlorophenol
2.0
<.1
Endrin
0.02
<.005
2,4,5-TP (Silvex)
1.0
<.002
Heptachlor and its Hydroxide
0.008
<.005
Vinyl Chloride
0.2
<.05

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: Waypoint Analytical and Date of analysis: 10/3/2019
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/w
Monthly Average
Concentration Limits
(Class A Only)
(mg1kg)
Result
(mglkg)
Arsenic
75
41
<27.9
Cadmium
85
39
3.65
Copper
4,300
1,500
325
Lead
840
300
98
Mercury
57
17
1.67
Molybdenum
75
n/a
13.3
Nickel
420
420
25.9
Selenium
100
100
34.1
Zinc
7,500
2,800
1160
b. For Surface Disposal Unit (landrill): 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: "M and Date of analysis:
Ik-
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
> 0 but < 25
30
200
210
> 25 but < 50
34
220
240
e > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg/kg)
5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.52 %.
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
micronutrient parameters:

Laboratory: Waypoint Analytical and Date of analysis: 10/3/2019
Parameter
Result
(mg/kg)
Aluminum
22500
Ammonia -Nitrogen
9670
Calcium
21100
Magnesium
4300
Nitrate -Nitrite Nitrogen
306
pH (Standard Unit)
7.1
Phosphorus
26200
Potassium
4450
Sodium
8800
Total Kjeldahl Nitrogen
33700
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 1.77
[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].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 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:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First Q') Year PAN
Five -Year
Maximum Adjusted PAN
(mg1kg)
(mglkg)
Surface
49400
66700
Injection/Incorporation
68540
86040
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: AL
7. Pathouen 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 1 [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. 1 106(c)(1)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: 8 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 I1.8. 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. 1 107(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. 1 107(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. 1107(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)].
LJ 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.

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REFERENCE:
GIs DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
Esri, HERE, Garmin, USGS; Intermap,
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY , METI, Esri China (Hong Kong), Esri
WWINO.
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.
) OpenStreetMap �Contributors, and the
SCALE: " = 0.5 mII2S
vMALand
City of Reidsville°ATE:12-23-19
Application Program
FIGn
-�Re ources, Inc.
Reidsville Wastewater
DRAWN BY: BC
PROJECT NO:
tArnnnnO�7a
Treatment Plant

Process Flow Narrative

Process Flow Narrative
The sludge is pulled directly from the bottom of the clarifiers with the WAS pumps
(a total of 4) to the rotary drum thickener. The thickened sludge is pumped into the
new digester and aerated for at least 15 days. The sludge in the new digesters is
transferred by gravity into the circular digesters (known as old digesters) and
aerated before been pumped into the holding basin, and then hauled to the
permitted land. Also, the sludge is wasted into the new digesters with the WAS
pumps coupled with a booster pump when the rotary drum thickener is not
running.

Quantitative Justification

Quantitative Justification for Residuals Production Rate
Facility:
City of Reidsville WWTP
Requested Permitted Rate:
1300 dry tons/year— WWTP
Justification WWTP:
The City of Reidsville WWTP currently produces roughly 500-1000 dry tons of biosolids,
based on the calculations below.
Calculations:
Based on the most recent hauling year of 2018, there were 8,593,000 gallons applied.
Using 8,593,000 in our calculation and the most recent sampling data showing 1.52%
residual solids.
(8,593,000 gal/yr) x (1.52% solids) x (8.34 Ibs/gal) = 545 dt/yr
(2,000 Ibs/ton)

Residuals Quality Information

Waypointo
ANALYTICAL
10/25/2019
EMA Resources Inc
Brent Collins
755 Yadkinville Rd
Mocksville, NC, 27028
2790 Whitten Road, Memphis, TIN 38133
Main 901.213.2400 ° Fax [phone]
www,way po inta n a lyti ca 1. co m
Ref: Analytical Testing
Revised Lab Report Number: 19-277-9006 (Original Report 19-277-0006)
Client Project Description: Reidsville, NC
Dear Brent Collins:
Waypoint Analytical, LLC. received sample(s) on 10/4/2019 for the analyses presented in the following report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Where the laboratory was not responsible for the sampling
stage (refer to the chain of custody) results apply to the sample as received.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule August 2017) and NELAC unless otherwise indicated. Any
parameter for which the laboratory is not officially NELAP accredited is indicated by a'—' symbol. These are not
included in the scope because NELAP accreditation is either not available or has not been applied for. Additional
certifications may be held/are available for parameters, where NELAP accreditation is not required or applicable.
A full list of certifications is available upon request.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Danyale Love
Project Manager
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Alabama #40750 Louisiana #04015
Mississippi California #2904
Kentucky #90047 Tennessee #TN02027
VA NELAP #460181
NC #415
EPA #TN00012
Texas #T104704180 Arkansas #88-0650
Oklahoma #9311 SC #84002
Kentucky UST #80215 PA DEP #68-03195
Z� l
Page 1 of 7

Waypointo
ANALYTICAL
Client: EMA Resources Inc
Project: Reidsville, NC
Lab Report Number: 19-277-9006
Date: 10/25/2019
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Client questioned moisture results for L98488. The sample was reanalyzed and the results have been
updated.
Metals Analysis Method 6010D
Sample 98490
Analyte: Aluminum
QC Batch No: L458204
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Calcium
QC Batch No: L457636
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Iron
QC Batch No: L457636
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Potassium
QC Batch No: L458057
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Manganese
QC Batch No: L458057
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Phosphorus
QC Batch No: L457636
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Zinc
QC Batch No: L457636
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Solids Total Mercury Analysis - CVAA Method 7471A
Sample 91943
Analyte: Mercury
QC Batch No: L459028
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A post
digestion spike was performed and passed quality control acceptance ranges. No matrix interference is
suspected.
Page 2 of 7

0 2790 Whitten Road, Memphis, TN 38133
Waypoint, Main 901.213.2400 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
46245
EMA Resources Inc Original Report Date : 10/15/2019
Brent Collins Project Reidsville, NC Revised Report Date: 10/25/2019
755 Yadkinville Rd Information : Received : 10/04/2019
Mocksville , NC 27028
Report Number : 19-277-9006 REPOR T OF A NA L YSIS
Lab No : 98488
Matrix: Solids
Sample ID : Reidsville
Sampled:
10/3/2019
11:00
Test
Results
Units
MDL
MQL
DF
Date / Time
By
Analytical
Analyzed
Method
Moisture
98.5
%
0.010
1
10/24/19 18:17
ADM
SW-DRYWT
Ammonia Nitrogen
9670
mg/Kg - dry
1670
1
10/15/19 13:00
JPJ
4500NH3C-2011
Nitrate+Nitrite-N
<306
mg/Kg - dry
306
306
1
10/14/19 13:49
ZBD
4500NO3F-2011
Organic N
24000
mg/Kg - dry
66.67
3333
1
10/14/19 14:51
DH
CALCULATION —
pH
7.1
S.U.
1
10/14/19 08:04
JSL
9045D
Total Solids
1.52
%
0.010
0.010
1
10/24/19 18:17
ADM
2540G-2011
Total Volatile Solids
68.0
%
0.010
0.010
1
10/24/19 18:17
ADM
2540G-2011
Total Kjeldahl Nitrogen
33700
mg/Kg - dry
66.7
3330
1
10/14/19 14:51
CLP 4500NORGD-2011
Phosphorus
26200
mg/Kg - dry
171
333
1
10/07/19 19:41
BKN
6010D
Aluminum
22500
mg/Kg - dry
135
333
1
10/07/19 19:41
BKN
6010D
Arsenic
<27.9
mg/Kg - dry
27.9
33.3
1
10/07/19 19:41
BKN
6010D
Cadmium
3.653
mg/Kg - dry
3.30
6.67
1
10/07/19 19:41
BKN
6010D
Calcium
21100
mg/Kg - dry
1120
1670
1
10/07/19 19:41
BKN
6010D
Chromium
64.4
mg/Kg - dry
12.7
16.7
1
10/07/19 19:41
BKN
6010D
Copper
325
mg/Kg - dry
9.67
16.7
1
10/07/19 19:41
BKN
6010D
Iron
19300
mg/Kg - dry
283
333
1
10/07/19 19:41
BKN
6010D
Lead
98.0
mg/Kg - dry
9.93
20.0
1
10/07/19 19:41
BKN
6010D
Magnesium
4300
mg/Kg - dry
148
333
1
10/07/19 19:41
BKN
6010D
Manganese
960
mg/Kg - dry
12.2
33.3
1
10/07/19 19:41
BKN
6010D
Mercury
1.67
mg/Kg - dry
0.211
0.953
1
10/15/19 12:39
TJS
7471A
Molybdenum
13.33
mg/Kg - dry
8.67
16.7
1
10/07/19 19:41
BKN
6010D
Nickel
25.9
mg/Kg - dry
11.0
16.7
1
10/07/19 19:41
BKN
6010D
Potassium
4450
mg/Kg - dry
199
333
1
10/08/19 14:38
BKN
6010D
Qualifiers/ DF
Dilution Factor
J
Estimated value
Definitions L
Limit Exceeded
MQL
Method Quantitation Limit
Page 3 of 7

0 2790 Whitten Road, Memphis, TN 38133
Waypoint, Main 901.213.2400 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
46245
EMA Resources Inc Original Report Date : 10/15/2019
Brent Collins Project Reidsville, NC Revised Report Date: 10/25/2019
755 Yadkinville Rd Information : Received : 10/04/2019
Mocksville , NC 27028
Report Number : 19-277-9006 REPOR T OF A NA L YSIS
Lab No : 98488
Sample ID : Reidsville
Matrix: Solids
Sampled: 10/3/2019 11:00
Test
Results
Units
MDL
MQL
DF
Date / Time By
Analytical
Analyzed
Method
Selenium
34.1
mg/Kg - dry
32.7
33.3
1
10/07/19 19:41 BKN
6010D
Sodium
8800
mg/Kg - dry
515
1670
1
10/07/19 19:41 BKN
6010D
Zinc
1160
mg/Kg - dry
72.0
83.3
1
10/07/19 19:41 BKN
6010D
Sulfur
12900
mg/Kg - dry
326
333
1
10/07/19 19:41 BKN
6010D
Sodium Absorption Ratio
<2.22
Ratio
2.22
5.00
1
10/07/19 19:41
CALCULATION
Qualifiers/ DF Dilution Factor
Definitions L Limit Exceeded
J Estimated value
MQL Method Quantitation Limit
Page 4 of 7

0 2790 Whitten Road, Memphis, TN 38133
Waypoint, Main 901.213.2400 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
46245
EMA Resources Inc Original Report Date : 10/15/2019
Brent Collins Project Reidsville, NC Revised Report Date: 10/25/2019
755 Yadkinville Rd Information : Received : 10/04/2019
Mocksville , NC 27028
Report Number : 19-277-9006 REPOR T OF A NA L YSIS
Lab No : 98489 Matrix: Solids
Sample ID : Reidsville VS IN Sampled: 10/3/2019 11:15
Test Results Units MDL MQL DF Date / Time By Analytical
Analyzed Method
Moisture 99.5 %
Total Volatile Solids 52.7 %
Qualifiers/ DF Dilution Factor
Definitions L Limit Exceeded
1 10/08/1917:09 ADM SW-DRYWT
0.010 0.010 1 10/08/19 17:09 ADM 2540G-2011
I Estimated value
MQL Method Quantitation Limit
Page 5 of 7

WayPAoint.
NALYTICAL
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 46245
Customer Name: EMA Resources Inc
Report Number: 19-277-0006
Shipping Method
0 Fed Ex 0 US Postal 0 Lab 0 Other:
0 UPS 0 Client 0 Courier Thermometer ID: #39
Shipping container/cooler uncompromised?
0 Yes
0 No
Number of coolers received
Custody seals intact on shipping container/cooler?
0 Yes
0 No
Not Required
Custody seals intact on sample bottles?
0 Yes
0 No
Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
0 Yes
0 No
COC properly completed
0 Yes
0 No
Samples in proper containers?
0 Yes
0 No
Sample containers intact?
® Yes
0 No
Sufficient sample volume for indicated test(s)?
0 Yes
0 No
All samples received within holding time?
0 Yes
0 No
Cooler temperature in compliance?
0 Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
0 Yes
0 No
Water - Sample containers properly preserved
0 Yes
0 No
N/A
Water - VOA vials free of headspace
0 Yes
0 No
N/A
Trip Blanks received with VOAs
0 Yes
0 No
N/A
Soil VOA method 5035 — compliance criteria met
0 Yes
0 No
® N/A
F High concentration container (48 hr) F_ Low concentration EnCore samplers (48 hr)
F_ High concentration pre -weighed (methanol -14 d) Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included?
0 Yes
0 No
Comments:
Signature: Kristina A. McAdams Date & Time: 10/04/2019 08:24:09
Page 6 of 7

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Page 7 of 7

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Page 1
Contact: Brent Collins Report Date: 10/9/2019
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028 Date Sample Rcvd: 10/1/2019
Meritech Work Order # 10011918 Sample: Reidsville #1 Grab 10/1/19
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.43 % 10/2/19 0-100 % SM 2540B
Fecal Coliform (Sludge) 8264 col/g dry wt 10/1/19 130 col/g dry wt SM 9222D
Meritech Work Order #
10011919 Sample:
Reidsville #2 Grab
10/1/19
Parameters
Result
Analysis Date
Reporting Limit
Method
% Total Solids
1.48 %
10/2/19
0-100 %
SM 2540B
Fecal Coliform (Sludge)
6143 col/g dry wt
10/1/19
130 col/g dry wt
SM 9222D
Meritech Work Order #
10011920 Sample:
Reidsville #3 Grab
10/1/19
Parameters
Result
Analysis Date
Reporting Limit
Method
% Total Solids
1.46 %
10/2/19
0-100 %
SM 2540B
Fecal Coliform (Sludge)
10586 col/g dry wt
10/1/19
130 col/g dry wt
SM 9222D
Meritech Work Order #
10011921 Sample:
Reidsville #4 Grab
10/1/19
Parameters
Result
Analysis Date
Reporting Limit
Method
% Total Solids
1.77 %
10/2/19
0-100
%
SM 2540B
Fecal Coliform (Sludge)
5136 col/g dry wt
10/1/19
130
col/g dry wt
SM 9222D
Meritech Work Order #
10011922 Sample:
Reidsville #5 Grab
10/1/19
Parameters
Result
Analysis Date
Reporting Limit
Method
% Total Solids
1.50 %
10/2/19
0-100
%
SM 2540B
Fecal Coliform (Sludge)
6667 col/g dry wt
10/1/19
130
col/g dry wt
SM 9222D
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Meritech Worlc Order # 10011923 Sample: Reidsville #6 Grab
Parameters Result Analysis Date
% Total Solids 1.60 % 10/2/19
Fecal Coliform (Sludge) 4546 col/g dry wt 10/1/19
Meritech Work Order # 10011924 Sample: Reidsville #7 Grab
Parameters
Result Analysis Date
Page 2
Report Date: 10/9/2019
Date Sample Rcvd: 10/1/2019
Reporting Limit Method
0-100
%
SM
2540B
130
col/g
dry wt
SM
9222D
Reoorting Limit Method
%Total Solids
1.40
%
10/2/19
0-100
%
SM
2540B
Fecal Coliform (Sludge)
10389
col/g dry wt
10/1/19
130
col/g dry wt
SM
9222D
I hereby certify that I have reviewed and approve these data.
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date: 11/4/2019
Date Sample Rcvd: 10/1/2019
Vector Attraction Reduction / Aerobically Digested Sludge (30 Day Test)
Meritech Work Order # 10011917 Sample: Reidsville Grab 10/1/19
Total Solids Volatile Solids % Volatile Solids
Week 1 1.31 0.910 0.695
Week 2 1.26 0.860 0.687
Week 3 1.35 0.940 0.697
Week 4 1.15 0.810 0.705
Weelc 5 1.08 0.760 0.705
Van Kleelc Reduction (%): -4.47
/hereby certify that I have reviewed and approve these data.
Pass or Fail
Pass
Laboratory Kepresentative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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�FaceAnalXical o ANALYTICAL REPORT
National Center for Testing & Innovation January 25, 2019
EMA Resources
Sample Delivery Group: L1061377
Samples Received: 01/16/2019
Project Number:
Description: Reidsville
Report To: Mr. Brent Collins
755 Yadkinville Road
Mocksville, NC 27028
Entire Report Reviewed By:
Cassandra Foster
Project Manager
t
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be
reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace National
is performed per guidance provided in laboratory standard operating procedures: 060302, 060303, and 060304.
V
PIP 0 a
0110
A111111116sAOOO
�"--q
qk

TABLE OF CONTENTS
ONE LAB. NATIONWIDE.
Cp: Cover Page
1
Fn
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
FS
REIDSVILLE L1061377-01
5
[Cn]
Qc: Quality Control Summary
7
Wet Chemistry by Method 9012 B
7
Fr
Wet Chemistry by Method 9034-9030B
8
Wet Chemistry by Method 9045D
9
RC
Wet Chemistry by Method D93/1010A
10
F
Mercury by Method 7470A
11
Metals (ICP) by Method 6010D
12
rAl
Volatile Organic Compounds (GC/MS) by Method 8260B
13
Chlorinated Acid Herbicides (GC) by Method 8151A
15
FSC
Pesticides (GC) by Method 8081B
16
Semi Volatile Organic Compounds (GC/MS) by Method 8270D
17
GI: Glossary of Terms
19
Al: Accreditations & Locations
20
Sc: Sample Chain of Custody
21
ACCOUNT: PROJECT: SDG:
DATE/TIME: PAGE:
EMA Resources L1061377
01/25/19 13:00 2 of 21

SAMPLE SUMMARY ONE LAB. NATIONWIDE.
Collected by Collected date/time Received date/time
REIDSVILLE L1061377-01 Waste Brent Collins 01/15/1910:00 01/16/1908:30 C
P
Method
Preparation by Method 1311
Preparation by Method 1311
Wet Chemistry by Method 9012 B
Wet Chemistry by Method 9034-9030B
Wet Chemistry by Method 9045D
Wet Chemistry by Method D93/1010A
Mercury by Method 7470A
Metals (ICP) by Method 6010D
Volatile Organic Compounds (GC/MS) by Method 8260B
Chlorinated Acid Herbicides (GC) by Method 8151A
Pesticides (GC) by Method 8081B
Semi Volatile Organic Compounds (GC/MS) by Method 8270D
Batch
WG1226240
WG1226323
WG1226690
WG1227454
WG1224499
WG1227145
WG1226579
WG1226617
WG1226698
WG1226568
WG1225807
WG1225806
Dilution Preparation
date/time
1 01/21/19 09:52
1 01/21/1910:45
1 01/22/19 21:58
1 01/24/1916:06
1 01/17/1913:00
1 01/23/1916:40
1 01/22/19 07:22
1 01/22/19 08:26
1 01/22/1916:25
1 01/22/19 09:15
1 01/24/1910:17
1 01/22/1918:33
Analysis Analyst
date/time
01/21/19 09:52
01/21/1910:45
01/23/1912:38
01/24/1916:06
01/17/1915:11
01/23/1916:40
01/22/1911:44
01/22/1911:39
01/22/1916:25
01/22/1918:20
01/24/1915:52
01/23/1913:14
TM
CGD
JER
MJA
Sim
MJA
ABL
CCE
DWR
TD
RP
AO
FTC
M
[Cn]
FSr
RC
F,
FAI
FSC
ACCOUNT: PROJECT: SDG:
EMA Resources L1061377
DATE/TIME:
01/25/19 13:00
PAGE:
3of21

CASE NARRATIVE
ONE LAB. NATIONWIDE.
All sample aliquots were received at the correct temperature, in the proper containers, with the FP1
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples FTChave been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my FSS
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data.
FSr
FC-1
GI
Cassandra Foster rAl
Project Manager
FSC
Project Narrative
All Reactive Cyanide results reported in the attached report were determined as totals using method 9012B.
All Reactive Sulfide results reported in the attached report were determined as totals using method 9034/9030B.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 4 of 21

REIDSVILLE
Collected date/time: 01/15/19 10:00
Preparation by Method 1311
Result
Analyte
TCLP Extraction
TCLP ZHE Extraction -
Fluid 1
Initial pH 7.11
Final pH 4.95
Wet Chemistry by Method 9012 B
SAMPLE RESULTS - 01
L1061377
Qualifier Prep Batch
date / time
1/21/2019 9:52:39 AM WG1226240
1/21/201910:45:55 AM WG1226323
1/21/2019 9:52:39 AM WG1226240
1/21/2019 9:52:39 AM WG1226240
1/21/2019 9:52:39 AM WG1226240
Result Qualifier
RDL
Analyte mg/kg
mg/kg
Reactive Cyanide ND
0.250
Wet Chemistry by Method 9034-9030B
Result Qualifier
RDL
Analyte mg/kg
mg/kg
Reactive Sulfide 54.6
25.0
Wet Chemistry by Method 9045D
Dilution Analysis Batch
date / time
1 01/23/201912:38 WG1226690
Dilution Analysis Batch
date / time
1 01/24/2019 16:06 WG1227454
Result Qualifier Dilution Analysis
Analyte su date / time
Corrosivity by pH 7.37 T8 1 01/17/201915:11
Sample Narrative:
L1061377-01 WG1224499: 7.37 at 19C
Wet Chemistry by Method D93/1010A
Batch
WG1224499
Result Qualifier Dilution Analysis Batch
Analyte Deg. F date / time
Ignitability DNI at 170 1 01/23/201916:40 WG1227145
Mercury by Method 7470A
Result
Analyte mg/I
Mercury ND
Metals (ICP) by Method 6010D
Qualifier RDL Limit
mg/I mg/I
0.0100 0.20
Result
Qualifier RDL
Limit
Analyte
mg/I
mg/I
mg/I
Arsenic
ND
0.100
5
Barium
ND
0.100
100
Cadmium
ND
0.100
1
Chromium
ND
0.100
5
Lead
ND
0.100
5
Selenium
ND
0.100
1
Silver
ND
0.100
5
Volatile Organic Compounds (GC/MS) by Method 8260B
Analyte
Benzene
Carbon tetrachloride
Chlorobenzene
Result
Qualifier RDL
Limit
mg/I
mg/I
mg/I
ND
0.0500
0.50
ND
0.0500
0.50
ND
0.0500
100
ND
0.250
6
ACCOUNT: PROJECT
EMA Resources
Dilution Analysis
date / time
1 01/22/201911:44
Batch
WG1226579
Dilution Analysis
Batch
date / time
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
1 01/22/201911:39
WG1226617
ONE LAB. NATIONWIDE.
Cp
FTc
FSS
4
Cn
Fc
7G1
FAI
FSC
Dilution Analysis
Batch
date / time
1 01/22/201916:25
WG1226698
1 01/22/201916:25
WG1226698
1 01/22/201916:25
WG1226698
1 01/22/201916:25
WG1226698
SDG:
DATE/TIME: PAGE:
L1061377
01/25/19 13:00 5 of 21

ONE LAB. NATIONWIDE.
REIDSVILLE SAMPLE RESULTS - 01
Collected date/time: 01/15/19 10:00 L1061377
Volatile Organic Compounds (GC/MS) by Method 8260B
Result
Qualifier RDL
Limit
Dilution
Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
1,2-Dichloroethane
ND
0.0500
0.50
1
01/22/201916:25
WG1226698
1,1-Dichloroethene
ND
0.0500
0.70
1
01/22/201916:25
WG1226698
2-Butanone (MEK)
ND
0.500
200
1
01/22/201916:25
WG1226698
Tetrachloroethene
ND
0.0500
0.70
1
01/22/201916:25
WG1226698
Trichloroethene
ND
0.0500
0.50
1
01/22/201916:25
WG1226698
Vinyl chloride
ND
0.0500
0.20
1
01/22/201916:25
WG1226698
(S) Toluene-d8
108
80.0-120
011221201916.25
WG1226698
(S) Dibromofluoromethane
101
75.0-120
011221201916.25
WG1226698
(S) a,a,a-Trifluorotoluene
101
80.0-120
011221201916.25
WG1226698
(S) 4-Bromof/uorobenzene
105
77.0-126
011221201916.25
WG1226698
Chlorinated Acid Herbicides (GC) by
Method 8151A
Result
Qualifier RDL
Limit
Dilution
Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
2,4,5-TP (Silvex)
ND
0.00200
1
1
01/22/201918:20
WG1226568
2,4-D
ND
0.00200
10
1
01/22/201918:20
WG1226568
(S)2,4-Dich/oropheny/Acetic Acid
58.0
14.0-158
011221201918:20
WG1226568
Pesticides (GC) by Method 8081B
Result
Qualifier RDL
Limit
Dilution
Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
Chlordane
ND
0.00500
0.03
1
01/24/201915:52
WG1225807
Endrin
ND
0.00500
0.02
1
01/24/201915:52
WG1225807
Heptachlor
ND
0.00500
0.0080
1
01/24/201915:52
WG1225807
Lindane
ND
0.00500
0.40
1
01/24/201915:52
WG1225807
Methoxychlor
ND
0.00500
10
1
01/24/201915:52
WG1225807
Toxaphene
ND
0.0100
0.50
1
01/24/201915:52
WG1225807
(S) Decachlorobipheny/
95.1
10.0-128
011241201915.52
WG1225807
(S) Tetrach/oro-m-xy/ene
71.7
10.0-127
011241201915.52
WG1225807
Semi Volatile Organic Compounds
(GC/MS) by Method 8270D
Result
Qualifier RDL
Limit
Dilution
Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
1,4-Dichlorobenzene
ND
0.100
7.50
1
01/23/201913:14
WG1225806
2,4-Dinitrotoluene
ND
0.100
0.13
1
01/23/201913:14
WG1225806
Hexachlorobenzene
ND
0.100
0.13
1
01/23/201913:14
WG1225806
Hexachloro-1,3-butadiene
ND
0.100
0.50
1
01/23/201913:14
WG1225806
Hexachloroethane
ND
0.100
3
1
01/23/201913:14
WG1225806
Nitrobenzene
ND
0.100
2
1
01/23/201913:14
WG1225806
Pyridine
ND
0.100
5
1
01/23/201913:14
WG1225806
3&4-Methyl Phenol
ND
0.100
400
1
01/23/201913:14
WG1225806
2-Methylphenol
ND
0.100
200
1
01/23/201913:14
WG1225806
Pentachlorophenol
ND
0.100
100
1
01/23/201913:14
WG1225806
2,4,5-Trichlorophenol
ND
0.100
400
1
01/23/201913:14
WG1225806
2,4,6-Trichlorophenol
ND
0.100
2
1
01/23/201913:14
WG1225806
(S) 2-Fluorophenol
32.9
10.0-120
011231201913:14
WG1225806
(S) Phenol-d5
23.2
10.0-120
011231201913:14
WG1225806
(S) Nitrobenzene-d5
35.6
10.0-127
011231201913:14
WG1225806
(S) 2-F/uorobipheny/
35.1
10.0-130
011231201913:14
WG1225806
(S) 2,4,6- Tribromophenol
37.4
10.0-155
011231201913:14
WG1225806
(S) p-Terphenyl-d14
48.8
10.0-128
011231201913:14
WG1225806
ACCOUNT:
PROJECT:
SDG:
DATE/TIME: PAGE:
EMA Resources
L1061377
01/25/19 13:00 6 of 21
Fp
FTc
FSS
[Cn]
6
QC
7G1
FAI
E

WG1226690
Wet Chemistry by Method 9012 B
Method Blank (MB)
(MB) R3378005-1 01/23/1912:33
MB Result
Analyte mg/kg
Reactive Cyanide U
MB Qualifier MB MDL MB RDL
mg/kg mg/kg
0.0390 0.250
L1061511-34 Original Sample (OS) • Duplicate (DUP)
(OS) L1061511-34 01/23/1912:39 • (DUP) R3378005-3 01/23/1912:40
Original Result DUP Result Dilution DUP RPD
Analyte mg/kg mg/kg %
Reactive Cyanide ND 0.000 1 0.000
L1061511-74 Original Sample (OS) • Duplicate (DUP)
QUALITY CONTROL SUMMARY
L1061377-01
DUP Qualifier DUP RPD
Limits
20
(OS) L1061511-74 01/23/1912:54 • (DUP) R3378005-6 01/23/1912:55
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte mg/kg mg/kg % %
Reactive Cyanide ND 0.000 1 0.000 20
Laboratory Control Sample (LCS)
(LCS) R3378005-2 01/23/1912:34
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte mg/kg mg/kg % %
Reactive Cyanide 2.50 2.54 102 50.0-150
L1061511-46 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061511-46 01/23/1912:43 • (MS) R3378005-4 01/23/1912:46 • (MSD) R3378005-5 01/23/1912:47
Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec.
Analyte mg/kg mg/kg mg/kg mg/kg % %
Reactive Cyanide 1.67 ND 1.52 1.56 91.3 93.8
L1061511-78 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061511-78 01/23/1912:58 • (MS) R3378005-7 01/23/1912:59 • (MSD) R3378005-8 01/23/1913:00
Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec.
Analyte mg/kg mg/kg mg/kg mg/kg % %
Reactive Cyanide 1.67 ND 1.47 1.38 88.0 82.9
ACCOUNT: PROJECT:
EMA Resources
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
1 75.0-125 2.76
ONE LAB. NATIONWIDE.
RPD Limits
20
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD RPD Limits
1 75.0-125 5.95 20
SDG: DATE/TIME: PAGE:
L1061377 01/25/19 13:00 7 of 21

WG1227454
Wet Chemistry by Method 9034-9030B
Method Blank (MB)
(MB) R3378449-1 01/24/1916:06
MB Result MB Qualifier MB MDL
Analyte mg/kg mg/kg
Reactive Sulfide U 7.63
L1061511-10 Original Sample (OS) • Duplicate (DUP)
MB RDL
mg/kg
25.0
(OS) L1061511-10 01/24/1916:06 • (DUP) R3378449-3 01/24/1916:06
Original Result DUP Result Dilution DUP RPD
Analyte mg/kg mg/kg
Reactive Sulfide 78.9 78.9 1 0.000
Laboratory Control Sample (LCS)
(LCS) R3378449-2 01/24/19 16:06
Spike Amount LCS Result LCS Rec.
Analyte mg/kg mg/kg
Reactive Sulfide 100 85.0 85.0
QUALITY CONTROL SUMMARY
L1061377-01
DUP Qualifier DUP RPD
Limits
o�
20
Rec. Limits LCS Qualifier
70.0-130
ONE LAB. NATIONWIDE.
— I
Cp
FTc
FSS
4
— Cn
FSr
— �GI
FAI
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 8 of 21

WG1224499 QUALITY CONTROL SUMMARY
Wet Chemistry by Method 9045D L1061377-01
L1061309-02 Original Sample (OS) • Duplicate (DUP)
(OS) L1061309-02 01/17/1915:11 • (DUP) R3376686-3 01/17/1915:11
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte su su % %
Corrosivity by pH 3.58 3.56 1 0.560 1
Sample Narrative:
OS: 3.58 at 19.1C
DUP: 3.56 at 19C
Laboratory Control Sample (LCS)
ONE LAB. NATIONWIDE.
(LCS) R3376686-1 01/17/1915:11
Spike Amount LCS Result LCS Rec. Rec. Limits LCS Qualifier
Analyte su su % %
Corrosivity by pH 10.0 9.96 99.6 99.0-101
Sample Narrative:
LCS: 9.96 at 18.5C
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 9 of 21
FP1
FTc
FSS
H
FSr
�GI
FAI
[Sc

WG1227145 QUALITY CONTROL SUMMARY
Wet Chemistry by Method D93/1010A L1061377-01
L1O61O97-01 Original Sample (OS) • Duplicate (DUP)
(OS) L1061097-01 01/23/1916:40 • (DUP) R3378298-2 01/23/1916:40
Original Result DUP Result Dilution DUP RPD DUP Qualifier DUP RPD
Limits
Analyte Deg. F Deg. F % %
Ignitability DNIat170 DNIat170 1 0.000 10
Laboratory Control Sample (LCS)
(LCS) R3378298-1 01/23/1916:40
Spike Amount LCS Result LCS Rec.
Analyte Deg. F Deg. F %
Ignitability 82.0 83.1 101
Rec. Limits LCS Qualifier
96.0-104
ONE LAB. NATIONWIDE.
— I
Cp
FTc
FSS
4
Cn
FSr
�GI
FAI
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 10 of 21

WG1226579
Mercury by Method 7470A
Method Blank (MB)
(MB) R3377643-1 01/22/19 11:19
MB Result
Analyte mg/1
Mercury U
MB Qualifier MB MDL MB RDL
mg/I mg/I
0.00330 0.0100
QUALITY CONTROL SUMMARY
L1061377-01
Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD)
(LCS) R3377643-2 01/22/1911:22 • (LCSD) R3377643-3 01/22/1911:29
Spike Amount LCS Result LCSD Result LCS Rec. LCSD Rec. Rec. Limits LCS Qualifier LCSD Qualifier RPD RPD Limits
Analyte mg/I mg/I mg/I % % % % %
Mercury 0.0300 0.0307 0.0299 102 99.6 80.0-120 2.68 20
L1061608-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061608-02 01/22/1911:31 • (MS) R3377643-4 01/22/1911:34 • (MSD) R3377643-5 01/22/1911:36
Spike Amount Original Result MS Result MSD Result MS Rec. MSD Rec. Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
Analyte mg/I mg/I mg/I mg/1 % % % %
Mercury 0.0300 ND 0.0304 0.0291 101 96.9 1 75.0-125 4.40
ONE LAB. NATIONWIDE.
RPD Limits
20
— I
Cp
FTc
FSS
4
— Cn
FSr
— �GI
— $AI
[Sc
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 11 of 21

WG1226617
Metals (ICP) by Method 6010D
Method Blank (MB)
(MB) R3377629-1 01/22/1911:05
MB Result
Analyte mg/I
Arsenic
Barium
Cadmium
Chromium
Lead
Selenium
Silver
U
U
U
U
0.0996
U
U
MB Qualifier MB MDL
mg/I
0.0333
0.0333
0.0333
0.0333
J 0.0333
0.0333
0.0333
MB RDL
mg/I
0.100
0.100
0.100
0.100
0.100
0.100
0.100
QUALITY CONTROL SUMMARY
L1061377-01
Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD)
(LCS) R3377629-2 01/22/1911:08 • (LCSD) R3377629-3 01/22/1911:11
Spike Amount
LCS Result
LCSD Result
LCS Rec.
LCSD Rec.
Rec. Limits
LCS Qualifier LCSD Qualifier RPD
RPD Limits
Analyte
mg/I
mg/I
mg/I
%
%
%
%
%
Arsenic
10.0
9.98
10.0
99.8
100
80.0-120
0.238
20
Barium
10.0
10.2
10.3
102
103
80.0-120
0.918
20
Cadmium
10.0
10.2
10.3
102
103
80.0-120
0.796
20
Chromium
10.0
9.18
9.10
91.8
91.0
80.0-120
0.884
20
Lead
10.0
9.76
9.80
97.6
98.0
80.0-120
0.430
20
Selenium
10.0
10.5
10.6
105
106
80.0-120
0.828
20
Silver
2.00
1.88
1.87
93.8
93.6
80.0-120
0.281
20
L1061608-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061608-02 01/22/1911:14 • (MS) R3377629-5 01/22/1911:19 • (MSD) R3377629-6 01/22/1911:22
Spike Amount
Original Result
MS Result
MSD Result
MS Rec.
MSD Rec.
Analyte
mg/I
mg/I
mg/I
mg/I
%
%
Arsenic
10.0
ND
10.2
10.2
102
102
Barium
10.0
0.753
11.1
11.1
103
103
Cadmium
10.0
ND
10.4
10.4
104
104
Chromium
10.0
ND
9.18
9.21
91.8
92.1
Lead
10.0
ND
9.82
9.81
97.7
97.5
Selenium
10.0
ND
10.7
10.8
107
108
Silver
2.00
ND
1.89
1.90
94.5
95.1
Dilution Rec. Limits
MS Qualifier MSD Qualifier RPD
1 75.0-125
0.100
1 75.0-125
0.225
1 75.0-125
0.216
1 75.0-125
0.264
1 75.0-125
0.142
1 75.0-125
0.242
1 75.0-125
0.633
ONE LAB. NATIONWIDE.
RPD Limits
20
20
20
20
20
20
20
FP1
FTc
FSS
4
Cn
FSr
�GI
FAI
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ACCOUNT:
EMA Resources
PROJECT:
SDG: DATE/TIME:
L1061377 01/25/19 13:00
PAGE:
12 of 21

WG1226698 QUALITY CONTROL SUMMARY ONE LAB. NATIONWIDE.
Volatile Organic Compounds (GC/MS) by Method 8260B L1061377-01
Method Blank (MB)
(MB) R3377739-3 01/22/1915:05
MB Result
Analyte mo/I
uenzene
u
Carbon tetrachloride
U
Chlorobenzene
U
Chloroform
U
1,2-Dichloroethane
U
1,1-Dichloroethene
U
2-Butanone (MEK)
U
Tetrachloroethene
U
Trichloroethene
U
Vinyl chloride
U
(S) Toluene-d8
108
(S) Dibromofluoromethane
103
(S) a,a,a-Trifluorotoluene
101
(S) 4-Bromof/uorobenzene
107
MB Qualifier
MB MDL
mg/I
0.0165
0.0165
0.0165
0.0825
0.0165
0.0165
0.165
0.0165
0.0165
0.0165
MB RDL
mg/I
0.0500
0.0500
0.0500
0.250
0.0500
0.0500
0.500
0.0500
0.0500
0.0500
80.0-120
75.0-120
80.0-120
77.0-126
Laboratory Control Sample (LCS) • Laboratory Control Sample Duplicate (LCSD)
(LCS) R3377739-1 01/22/1912:43 • (LCSD) R3377739-2 01/22/1913:03
Spike Amount
LCS Result
LCSD Result
LCS Rec.
LCSD Rec.
Rec. Limits
LCS Qualifier LCSD Qualifier RPD
RPD Limits
Analyte
mg/I
mg/I
mg/I
%
%
%
%
%
Benzene
0.0250
0.0239
0.0246
95.7
98.6
70.0-123
2.98
20
Carbon tetrachloride
0.0250
0.0231
0.0239
92.4
95.6
68.0-126
3.38
20
Chlorobenzene
0.0250
0.0261
0.0269
105
108
80.0-121
2.93
20
Chloroform
0.0250
0.0250
0.0247
100
98.8
73.0-120
1.26
20
1,2-Dichloroethane
0.0250
0.0245
0.0239
98.1
95.6
70.0-128
2.58
20
1,1-Dichloroethene
0.0250
0.0263
0.0271
105
108
71.0-124
3.05
20
2-Butanone (MEK)
0.125
0.180
0.186
144
149
44.0-160
3.05
20
Tetrachloroethene
0.0250
0.0261
0.0273
104
109
72.0-132
4.22
20
Trichloroethene
0.0250
0.0273
0.0271
109
108
78.0-124
0.716
20
Vinyl chloride
0.0250
0.0254
0.0261
102
104
67.0-131
2.82
20
(S) Toluene-d8
102
106
80.0-120
(S) Dibromofluoromethane
100
99.2
75.0-120
(S) a,a,a-Trifluorotoluene
99.6
101
80.0-120
(S) 4-Bromofluorobenzene
110
110
77.0-126
FP1
FTc
FSS
4
Cn
FSr
�GI
FAI
FSC
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 13 of 21

WG1226698 QUALITY CONTROL SUMMARY
Volatile Organic Compounds (GC/MS) by Method 8260B L1061377-01
L10617O4-02 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061704-02 01/22/19 20:27 • (MS) R3377739-4 01/22/19 20:47 • (MSD) R3377739-5 01/22/19 21:07
Spike Amount
Original Result
MS Result
MSD Result
MS Rec.
MSD Rec.
Analyte
mg/I
mg/I
mg/I
mg/I
%
%
Benzene
1.25
ND
1.04
1.22
83.2
97.9
Carbon tetrachloride
1.25
ND
1.01
1.20
81.2
96.3
Chlorobenzene
1.25
ND
1.08
1.32
86.5
106
Chloroform
1.25
ND
1.08
1.27
86.1
101
1,2-Dichloroethane
1.25
ND
1.00
1.22
80.1
97.3
1,1-Dichloroethene
1.25
ND
1.18
1.37
94.7
110
2-Butanone (MEK)
6.25
ND
6.83
8.41
109
135
Tetrachloroethene
1.25
ND
1.04
1.30
83.1
104
Trichloroethene
1.25
ND
1.06
1.28
85.0
103
Vinyl chloride
1.25
ND
1.11
1.28
88.8
103
(S) Toluene-d8
105
104
(S) Dibromofluoromethane
103
100
(S) a,a,a-Trifluorotoluene
101
101
(S) 4-Bromof/uorobenzene
109
110
Dilution Rec. Limits MS Qualifier
ii.v-lots
23.0-159
33.0-152
29.0-154
29.0-151
11.0-160
10.0-160
10.0-160
10.0-160
10.0-160
80.0-120
75.0-120
80.0-120
77.0-126
MSD Qualifier RPD
16.2
17.0
20.2
16.4
19.4
14.9
20.8
22.2
18.9
14.4
ONE LAB. NATIONWIDE.
RPD Limits
27
28
27
28
27
29
32
27
25
27
FP1
FTc
FSS
4
Cn
FSr
�GI
FAI
[Sc
ACCOUNT: PROJECT:
EMA Resources
SDG:
L1061377
DATE/TIME:
01/25/19 13:00
PAGE:
14 of 21

WG1226568
Chlorinated Acid Herbicides (GC) by Method 8151A
Method Blank (MB)
(MB) R3377792-1 01/22/1917:53
MB Result
Analyte mg/I
2,4-D U
2,4,5-TP (Silvex) U
(S)2,4-Dichloropheny/Acetic 64.2
Acid
MB Qualifier MB MDL
mg/I
0.000667
0.000667
Laboratory Control Sample (LCS)
(LCS) R3377792-2 01/22/1918:06
Spike Amount
LCS Result
LCS Rec.
Analyte
mg/I
mg/I
%
2,4-D
0.0500
0.0416
83.2
2,4,5-TP (Silvex)
0.0500
0.0374
74.8
(S) 2,4-Dichloropheny/Acetic
68.6
Acid
QUALITY CONTROL SUMMARY
L1061377-01
MB RDL
mg/I
0.00200
0.00200
14.0-158
Rec. Limits LCS Qualifier
50.0-120
50.0-125
14.0-158
L1061680-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061680-01 01/22/1918:33 • (MS) R3377792-3 01/22/1918:47 • (MSD) R3377792-4 01/22/1919:00
Spike Amount
Original Result
MS Result
MSD Result
MS Rec.
MSD Rec.
Analyte
mg/I
mg/I
mg/I
mg/I
%
%
2,4-D
0.0500
ND
0.0366
0.0377
73.2
75.4
2,4,5-TP (Silvex)
0.0500
ND
0.0342
0.0345
68.4
69.0
(S)2,4-Dichloropheny/Acetic
66.6
63.8
Acid
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
1 50.0-120 2.96
1 50.0-125 0.873
14.0-158
ONE LAB. NATIONWIDE.
RPD Limits
o�
20
20
FP1
FTc
3
SS
4
Cn
FSr
�GI
FAI
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ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 15 of 21

WG1225807
Pesticides (GC) by Method 8081B
Method Blank (MB)
(MB) R3378405-2 01/24/1914:25
MB Result
Analyte
mg/I
Gamma BHC
U
Endrin
U
Heptachlor
U
Methoxychlor
U
Chlordane
U
Toxaphene
U
(S) Decachlorobipheny/ 101
(S) Tetrach/oro-m-xy/ene 75.5
MB Qualifier MB MDL MB RDL
mg/I mg/I
Laboratory Control Sample (LCS)
QUALITY CONTROL SUMMARY
L1061377-01
0.00167
0.00500
0.00167
0.00500
0.00167
0.00500
0.00167
0.00500
0.00167
0.00500
0.00333
0.0100
10.0-128
10.0-127
(LCS) R3378405-1 01/24/19 14:13
Spike Amount
LCS Result
LCS Rec.
Rec. Limits LCS Qualifier
Analyte
mg/I
mg/I
%
%
Gamma BHC
0.0100
0.00894
89.4
55.0-129
Endrin
0.0100
0.00965
96.5
57.0-134
Heptachlor
0.0100
0.00710
71.0
27.0-132
Methoxychlor
0.0100
0.0108
108
54.0-155
(S) Decachlorobiphenyl
95.6
10.0-128
(S) Tetroch/oro-m-xy/ene
73.9
10.0-127
L1061100-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1061100-01 01/24/1915:02 • (MS) R3378405-3 01/24/1915:15 • (MSD) R3378405-4 01/24/1915:27
Spike Amount
Original Result
MS Result
MSD Result
MS Rec.
MSD Rec.
Dilution Rec. Limits
Analyte
mg/I
mg/I
mg/I
mg/I
%
%
%
Gamma BHC
0.0100
ND
0.00868
0.00877
86.8
87.7
1 14.0-141
Endrin
0.0100
ND
0.00931
0.00966
93.1
96.6
1 10.0-160
Heptachlor
0.0100
ND
0.00728
0.00718
72.8
71.8
1 16.0-136
Methoxychlor
0.0100
ND
0.0114
0.0117
114
117
1 10.0-160
(S) Decachlorobipheny/
91.9
92.7
10.0-128
(S) Tetrach/oro-m-xylene
75.4
72.9
10.0-127
ONE LAB. NATIONWIDE.
MS Qualifier MSD Qualifier RPD RPD Limits
1.03 40
3.69 39
1.38 40
2.60 34
FP1
FTc
FSS
4
Cn
FSr
�GI
FAI
[Sc
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 16 of 21

WG1225806
Semi Volatile Organic Compounds
Method Blank (MB)
QUALITY CONTROL SUMMARY
(GC/MS) by Method 8270D L1061377-01
ONE LAB. NATIONWIDE.
FP1(MB)
R3378025-2 01/23/1910:03
MB Result
MB Qualifier
MB MDL
MB RDL
Analyte mg/I
mg/I
mg/I
FTC
1,4-Dichlorobenzene U
0.0333
0.100
2,4-Dinitrotoluene U
0.0333
0.100
FSS
Hexachlorobenzene U
0.0333
0.100
Hexachloro-1,3-butadiene U
0.0333
0.100
Hexachloroethane U
0.0333
0.100
rCn
Nitrobenzene U
0.0333
0.100
Pyridine U
0.0333
0.100
FSr
2-Methylphenol U
0.0333
0.100
3&4-Methyl Phenol U
0.0333
0.100
Pentachlorophenol U
0.0333
0.100
2,4,5-Trichlorophenol U
0.0333
0.100
2,4,6-Trichlorophenol U
0.0333
0.100
7G1
(S) Nitrobenzene-d5 38.5
10.0-127
(S) 2-F/uorobipheny/ 37.1
10.0-130
(S) p-Terphenyl-d14 54.0
10.0-128
FAI
(S) Phenol-d5 22.4
10.0-120
(S) 2-Fluorophenol 33.4
10.0-120
FSC
(S)2,4,6-Tribromopheno/ 34.4
10.0-155
Laboratory Control Sample (LCS)
(LCS) R3378025-1 01/23/19 09:39
Spike Amount
LCS Result
LCS Rec.
Rec. Limits LCS Qualifier
Analyte mg/I
mg/I
%
%
1,4-Dichlorobenzene 0.0500
0.0193
38.6
18.0-120
2,4-Dinitrotoluene 0.0500
0.0394
78.8
49.0-124
Hexachlorobenzene 0.0500
0.0343
68.6
44.0-120
Hexachloro-1,3-butadiene 0.0500
0.0191
38.2
19.0-120
Hexachloroethane 0.0500
0.0193
38.6
15.0-120
Nitrobenzene 0.0500
0.0207
41.4
27.0-120
Pyridine 0.0500
0.00921
18.4
10.0-120
2-Methylphenol 0.0500
0.0208
41.6
28.0-120
3&4-Methyl Phenol 0.0500
0.0226
45.2
31.0-120
Pentachlorophenol 0.0500
0.0340
68.0
23.0-120
2,4,5-Trichlorophenol 0.0500
0.0296
59.2
44.0-120
2,4,6-Trichlorophenol 0.0500
0.0272
54.4
42.0-120
(S) Nitrobenzene-d5
33.0
10.0-127
(S) 2-F/uorobipheny/
36.2
10.0-130
(S) p-Terphenyl-d14
66.2
10.0-128
ACCOUNT:
PROJECT: SDG:
DATE/TIME: PAGE:
EMA Resources
L1061377
01/25/19 13:00 17 of 21

WG1225806 QUALITY CONTROL SUMMARY
Semi Volatile Organic Compounds (GC/MS) by Method 8270D L1061377-01
Laboratory Control Sample (LCS)
(LCS) R3378025-1 01/23/19 09:39
Spike Amount LCS Result
na yte
(S) Phenol-d5
(S) 2-Fluorophenol
(S) 2,4,6-Tribromophenol
LCS Rec.
Rec. Limits LCS Qualifier
19.8
10.0-120
28.4
10.0-120
54.0
10.0-155
L1060425-01 Original Sample (OS) • Matrix Spike (MS) • Matrix Spike Duplicate (MSD)
(OS) L1060425-01 01/23/1910:50 • (MS) R3378025-3 01/23/1911:14 • (MSD) R3378025-4 01/23/1911:38
Spike Amount
Original Result
MS Result
MSD Result
MS Rec.
MSD Rec.
Analyte
mg/I
mg/I
mg/I
mg/I
%
%
1,4-Dichlorobenzene
0.500
ND
0.239
0.257
47.8
51.4
2,4-Dinitrotoluene
0.500
ND
0.358
0.389
71.6
77.8
Hexachlorobenzene
0.500
ND
0.317
0.346
63.4
69.2
Hexachloro-1,3-butadiene
0.500
ND
0.237
0.268
47.4
53.6
Hexachloroethane
0.500
ND
0.248
0.271
49.6
54.2
Nitrobenzene
0.500
ND
0.249
0.277
49.8
55.4
Pyridine
0.500
ND
0.0994
0.100
19.9
20.0
2-Methylphenol
0.500
ND
0.251
0.281
50.2
56.2
3&4-Methyl Phenol
0.500
ND
0.281
0.309
56.2
61.8
Pentachlorophenol
0.500
ND
0.342
0.387
68.4
77.4
2,4,5-Trichlorophenol
0.500
ND
0.325
0.368
65.0
73.6
2,4,6-Trichlorophenol
0.500
ND
0.314
0.367
62.8
73.4
(S) Nitrobenzene-d5
39.9
43.5
(S) 2-F/uorobipheny/
41.9
48.6
(S) p-Terphenyl-d14
55.2
6t9
(S) Phenol-d5
26.4
28.4
(S) 2-F/uorophenol
36.7
40.0
(S)2,4,6-Tribromophenol
54.5
60
Dilution Rec. Limits MS Qualifier MSD Qualifier RPD
17.0-120
39.0-125
35.0-122
12.0-120
10.0-120
12.0-120
10.0-120
10.0-120
10.0-120
10.0-128
33.0-120
26.0-120
10.0-127
10.0-130
10.0-128
10.0-120
10.0-120
10.0-155
7.26
8.30
8.75
12.3
8.86
10.6
0.602
11.3
9.49
12.3
12.4
15.6
ONE LAB. NATIONWIDE.
RPD Limits
40
25
24
34
40
30
37
30
36
37
31
31
FP1
FTc
FSS
[Cn]
FSr
�GI
FAI
[Sc
ACCOUNT: PROJECT:
EMA Resources
SDG:
L1061377
DATE/TIME:
01/25/19 13:00
PAGE:
18 of 21

GLOSSARY OF TERMS
ONE LAB. NATIONWIDE.
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and if you have additional questions please contact your project representative.
Abbreviations and Definitions
MDL
Method Detection Limit.
ND
Not detected at the Reporting Limit (or MDL where applicable).
RDL
Reported Detection Limit.
Rec.
Recovery.
RPD
Relative Percent Difference.
SDG
Sample Delivery Group.
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
(S)
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U
Not detected at the Reporting Limit (or MDL where applicable).
Analyte
The name of the particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
If the sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
Dilution
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample
The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications of the Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. If there was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
FP1
FTC
FSS
[Cn]
FSr
6
QC
FAI
FSC
Uncertainty
(Radiochemistry)
Confidence level of 2 sigma.
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn)
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
This section of the report includes the results of the laboratory quality control analyses required by procedure or
Summary (Qc)
analytical methods to assist in evaluating the validity of the results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc)
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession of the
samples from the time of collection until delivery to the laboratory for analysis.
This section of your report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr)
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)
This section of the Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier
Description
J
The identification of the analyte is acceptable; the reported value is an estimate.
T8
Sample(s) received past/too close to holding time expiration.
ACCOUNT:
PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources
L1061377 01/25/19 13:00 19 of 21

ACCREDITATIONS & LOCATIONS ONE LAB. NATIONWIDE.
Pace National is the only environmental laboratory accredited/certified to support your work nationwide from one location. One phone call, one point of contact, one laboratory. No other lab is as
accessible or prepared to handle your needs throughout the country. Our capacity and capability from our single location laboratory is comparable to the collective totals of the network
laboratories in our industry. The most significant benefit to our one location design is the design of our laboratory campus. The model is conducive to accelerated productivity, decreasing FP1
turn -around time, and preventing cross contamination, thus protecting sample integrity. Our focus on premium quality and prompt service allows us to be YOUR LAB OF CHOICE.
Not all certifications held by the laboratory are applicable to the results reported in the attached report.
Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace National. Z
Tc
State Accreditations
f—�
Alabama
40660
Nebraska _
NE-OS-15-05
SS
Alaska
17-026
Nevada
TN-03-2002-34
Arizona
AZO612
New Hampshire
2975
Arkansas
88-0469
New Jersey_NELAP
TNO02
C n
California
2932
New Mexico
n/a
Colorado
TN00003
New York
11742
s
Connecticut
PH-0197
North Carolina
Env375
Sr
Florida
E87487
North Carolina'
DW21704
Georgia
NELAP
North Carolina'
41
Georgia'
923
North Dakota
R-140
RC
Idaho
TN00003
Ohio—VAP
CL0069
Illinois
200008
Oklahoma
9915
Indiana
C-TN-01
Oregon
TN200002
G
Iowa
364
Pennsylvania
68-02979
Kansas
E-10277
Rhode Island
LA000356
Kentucky76
90010
South Carolina
84004
Kentucky 2
16
South Dakota
n/a
Louisiana
A130792
Tennessee' 4
2006
Louisiana'
LA180010
Texas
T 104704245-17-14
[SC
Maine
TN0002
Texas'
LABO152
Maryland
324
Utah
Massachusetts
M-TNO03
Vermont
Michigan
9958
Virginia
Minnesota
047-999-395
Washington
Mississippi
TN00003
West Virginia
Missouri
340
Wisconsin
Montana
CERT0086
Wyoming
Third Party
Federal Accreditations
A21LA — ISO 17025
1461.01
AIHA-LAP,LLC EMLAP
A21LA — ISO 17025 5
1461.02
DOD
Canada
1461.01
USDA
EPA—Crypto
TN00003
' Drinking Water 'Underground
Storage Tanks 3 Aquatic Toxicity 4 Chemical/Microbiological 5 Mold
6 Wastewater n/a Accreditation not applicable
Our Locations
TN00003
VT2006
460132
C847
233
9980939910
A2LA
100789
1461.01
P330-15-00234
Pace National has sixty-four client support centers that provide sample pickup and/or the delivery of sampling supplies. If you would like assistance from one of our support offices, please contact
our main office. Pace National performs all testing at our central laboratory.
WA
ME
MT NO
OR MN
T ID t WI NY
SD
WY MI
NV
t NE IA OH PA
T f IL Ills WV
vA
UT T
CA�� T
KS MO KY
N
NM O� AR SC
T MS AL`7GA
T TX * LA
T
AK
q FL
wo HI
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1061377 01/25/19 13:00 20 of 21

EMA Resources
755 YadklnviIle Rajilt1
kflatksvllie, NC 27D78
Report to:
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755 Yadkinwrlle Road
Mocksville, NC 27028
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Form LASC

Applicant's name: City of Reidsville
Land application sites currently certified: 1145.80 net acres and Total to be certified: 624.75 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Codes
Site/Field
ID
Landowners
� �
Lessees or Operator(s)
��
Net Acres
Count y
Crop(s) s
P�)
Predominant Soil
Series Name n
Mapping Unit
or Rep. Slope'
D
GU-008-03
Jill Strader
Steve Green
7.0
Guilford
D
GU-008-04
Jill Strader
Steve Green
8.3
Guilford
D
GU-013-01
Mark Doggett
13.7
Guilford
D
GU-013-02
Mark Doggett
17.7
Guilford
D
GU-013-03
Mark Doggett
18.45
Guilford
D
GU-013-04
Mark Doggett
4.3
Guilford
D
GU-014-03
Mark Doggett
17.7
Guilford
D
GU-014-04
Mark Doggett
20.65
Guilford
D
GU-014-05
Mark Doggett
29.1
Guilford
D
GU-014-06
Mark Doggett
10.9
Guilford
D
GU-014-07
Mark Doggett
2.2
Guilford
D
GU-022-01
John Davenport
12.0
Guilford
D
GU-022-02
John Davenport
1.5
Guilford
M
RC-001-01
Ronnie Marshall
1.02
Rockingham
Hay/Pasture
Clifford
C9132
M
RC-001-02
Ronnie Marshall
3.86
Rockingham
Hay/Pasture
Clifford
C9132
M
RC-001-03
Ronnie Marshall
14.72
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-001-04
Ronnie Marshall
3.07
Rockingham
Hay/Pasture
Clifford
C9132
M
RC-002-01
Jane Marshall
Ronnie Marshall
9.98
Rockingham
Hay/Pasture
Clifford
C9132
D
RC-003-01
Curtis Middleton
7.0
Rockingham
D
RC-003-02
Curtis Middleton
6.5
Rockingham
D
RC-003-03
Curtis Middleton
10.0
Rockingham

M
RC-004-01
Jennifer Johnson
Ronnie Marshall
26.24
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-005-01
James Albert
Ronnie Marshall
15.41
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-005-02
James Albert
Ronnie Marshall
15.39
Rockingham
Hay/Pasture
Fairview
FrD2
M
RC-005-03
James Albert
Ronnie Marshall
2.11
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-005-04
James Albert
Ronnie Marshall
9.45
Rockingham
Hay/Pasture
Nathalie
NaB
M
RC-005-05
James Albert
Ronnie Marshall
10.46
Rockingham
Hay/Pasture
Nathalie
NaB
M
RC-005-06
James Albert
Ronnie Marshall
1.86
Rockingham
Hay/Pasture
Clifford
CgB2
D
RC-006-01
William Busick
Ronnie Marshall
9.75
Rockingham
D
RC-006-02
William Busick
Ronnie Marshall
8.6
Rockingham
D
RC-006-03
William Busick
Ronnie Marshall
5.1
Rockingham
D
RC-007-01
Brenda Roberts
Ronnie Marshall
3.9
Rockingham
D
RC-008-01
Frank Rogers
21.0
Rockingham
M
RC-009-01
Michael Bray
8.17
Rockingham
Hay/Pasture
Clifford
C9132
M
RC-009-02
Michael Bray
6.11
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-009-03
Michael Bray
4.64
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-010-01
Marilyn Stocks
Auman French
8.49
Rockingham
Hay/Pasture
Rhodhiss
RnD
M
RC-011-01
Daisy Purgason
21.23
Rockingham
Hay/Pasture
Nathalie
NaB
M
RC-011-02
Iris Sharpe
9.34
Rockingham
Hay/Pasture
Nathalie
NaB
M
RC-012-01
Lawrence McCollum
8.95
Rockingham
Hay/Pasture
Clifford
C9132
D
RC-013-04
J.N. Perkins
17.1
Rockingham
D
RC-013-05
J.N. Perkins
3.6
Rockingham
D
RC-013-06
J.N. Perkins
7.3
Rockingham
M
RC-018-01
Doug Merritt
Barry Knight
17.7
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-018-02
Doug Merritt
Barry Knight
15.89
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-019-01
Mary Stanley
Thomas Carter
11.19
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-019-02
Mary Stanley
Thomas Carter
4.46
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-019-03
Mary Stanley
Thomas Carter
3.66
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-019-04
Mary Stanley
Thomas Carter
6.95
Rockingham
Hay/Pasture
Clifford
Cg132
M
RC-019-05
Mary Stanley
Thomas Carter
4.34
Rockingham
Hay/Pasture
Clifford
Cg132

D
RC-022-07
Alton Pearson
9.3
Rockingham
M
RC-041-01
Lofton Lovelace
Donald Lovelace
11.09
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-041-02
Lofton Lovelace
Donald Lovelace
9.05
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-041-03
Lofton Lovelace
Donald Lovelace
1.99
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-041-04
Lofton Lovelace
Donald Lovelace
17.2
Rockingham
Hay/Pasture
Cecil
CdB2
D
RC-108-01
Alton Pearson
2.4
Rockingham
D
RC-108-02
Alton Pearson
7.5
Rockingham
D
RC-108-03
Alton Pearson
2.0
Rockingham
D
RC-108-04
Alton Pearson
2.6
Rockingham
M
RC-118-01
Johnie Carty
Thomas Carter
8.55
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-118-02
Johnie Carty
Thomas Carter
5.2
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-01
Thomas Carter
36.1
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-02
Thomas Carter
8.57
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-03
Thomas Carter
8.43
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-04
Thomas Carter
20.14
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-05
Thomas Carter
9.87
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-06
Thomas Carter
10.58
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-08
Thomas Carter
7.64
Rockingham
Hay/Pasture
Jackland
JkB
M
RC-119-09
Thomas Carter
14.2
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-119-10
Thomas Carter
6.52
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-119-11
Thomas Carter
23.83
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-119-12
Thomas Carter
2.79
Rockingham
Hay/Pasture
Nathalie
NaB
D
RC-124-01
Rick Everhart
13.5
Rockingham
D
RC-124-02
Rick Everhart
16.0
Rockingham
D
RC-124-03
Rebecca Everhart
Rick Everhart
29.0
Rockingham
M
RC-125-01
Gene Small
20.59
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-125-02
Gene Small
4.33
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-125-03
Gene Small
5.39
Rockingham
Hay/Pasture
Clifford
C9132
M
RC-125-04
James Jones
9.24
Rockingham
Hay/Pasture
Nathalie
NaB

M
RC-125-05
Gary Albert Trustee
Gene Small
10.06
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-125-06
Harvey Sharpe
Gene Small
19.92
Rockingham
Hay/Pasture
Rhodhiss
RnD
D
RC-126-01
Marian French
14.0
Rockingham
M
RC-126-02
State of North Carolina
Auman French
18.33
Rockingham
Hay/Pasture
Clifford
CgB2
M
RC-126-03
Auman French
5.2
Rockingham
Hay/Pasture
Clifford
CgB2
N
RC-126-04
James Tardiff
Auman French
5.18
Rockingham
Hay/Pasture
Clifford
CgB2
N
RC-126-05
State of North Carolina
Auman French
11.27
Rockingham
Row Crops
Clifford
CgB2
D
RC-127-01
Donald Brown
11.5
Rockingham
D
RC-127-02
Donald Brown
7.0
Rockingham
D
RC-127-03
Donald Brown
11.0
Rockingham
D
RC-127-04
Donald Brown
13.0
Rockingham
D
RC-127-05
Donald Brown
10.0
Rockingham
D
RC-127-06
Donald Brown
11.0
Rockingham
M
RC-128-01
Dennis Williams
14.66
Rockingham
Hay/Pasture
Cecil
CdB2
M
RC-128-02
Timothy Stevens
Dennis Williams
4.2
Rockingham
Hay/Pasture
Pacolet
PcD2
M
RC-128-03
Timothy Stevens
Dennis Williams
10.7
Rockingham
Hay/Pasture
Pacolet
PcD2
D
RC-128-04
James Bondurant
2.5
Rockingham
D
RC-129-01
Harold Page
4.0
Rockingham
D
RC-129-02
Harold Page
5.0
Rockingham
D
RC-129-03
Harold Page
4.75
Rockingham
D
RC-129-04
Harold Page
5.0
Rockingham
D
RC-129-05
Harold Page
12.0
Rockingham
D
RC-129-06
Harold Page
7.0
Rockingham
D
RC-129-07
Harold Page
20.0
Rockingham
M
RC-130-01
Ken Martin
39.24
Rockingham
Hay/Pasture
Mayodan
MdB
D
RC-131-04
Barbara Crowder
Kenneth Crowder
34.0
Rockingham
Mayodan
D
RC-132-01
Bryant Strader
10.5
Rockingham

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — 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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permift&g 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 Land Application Site Certification (FORM: LASC 06-16) form. Please do
not matte 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
*he undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville _
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:
Site/Field ID
Lease
(yes/no)
(Y )
Land Use or
Cropping Patterns
Rp S
Intended Use of Crops
Residuals Source
o tional
(optional)
Special note
(no-till/over-seed/
pasture)
RC001-(1-4)
No
Hay i Pasture
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.
0 his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall 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 I of 3

1. STIPULATIONS:
I. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 time 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 time 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 Permittec, 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 Ieachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
�. RESTRICTIONS:
I . 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 i 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

. Landowner's Certification:
certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to snake decisions
regarding the use or 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, acknowiedgcnient of
field transfer, and do hereby grant permission to the Penniace to land apply residuals to Ilic land application sitc(s) as specified
herein.
Landowner name:
Address:
City: �aa)11(5rjItIe_ Slaw 1!&_ Zip: � %
Phone: ' e" Z ``) E-inaiI address:
Signature: Z4444QZ Date:
NORTH CAROLINA, k . o,++ COUNTY
I, the undersigned Notary Public do hereby certify that & n., - t I
personally appeared before me this day and acknowledged the due execution of the forgoing instrunicnl.
WITNESS my hand and official seal this the
day of i]Pr.,b" _ , 20 /q
Signature and seal:
I
My commission expires: a /71zoz I
Lessee's/Operator's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Datc:
lip:
1 certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing oMcial name- Chuck Smith — I'ublic Works Dire
Signature: Date:
60� 0�
U'O
FORM: LOA 06-16
Page 3 of 3

► � �A N
1 '
Simpson Rd ' -
i .M.MI
♦\
■ 2
4 3 i ■
M
�r, • ,■ � �`r' [ � ;�'",tit y "� !� � � ` � � � � .. Yf' r
x •� t}'� , f�' ♦ Structure
• Well
On Site Dwelling
Field Total Acres Applicable Acres ■ Off Site Dwelling
1 3.7 1.02
x — x - Fenceline
2 9.58 3.86
3 17.52 14.72 ® Buffer
4 6.3 3.07 `
r. Pond
REFERENCE: '
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL Field Boundary I
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BYTHE USER BASED UPON THIS INFORMATION. SfI, DigifadGiobe, RID, IGNGAI&IN1 Eart Property Boundary
AeroG, and• � � � �
SCALE: 1 - 440 "`� " FIGURE NO.
- City of Reidsville _
DATE: 12-09-19 EMA Land Application Program
DRAWN BY: BC --Re ources, Inc. 2
PROJECT NO: N C-RC-001
1A%nnnn0'Q79 Ronnie Marshall

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
0 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 Annlicant 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 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 .1 100. 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 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.
❑ 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
Ohe undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC002-01
No
Hay / Pasture
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.
*his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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

1. 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.
403. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 time 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 Permittec, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the Iand 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.
�. 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 shalt 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.
Ill. 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 oroaram:
(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 nin authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners QR that I am otherwise authorized, throngh
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalfof 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: Jane Mg5hall
Address: ✓{-1 _ham;]-.> r1_I•} ,_ ___�-----
City: c� -IL iJ r� � ('� State: zip.
Phone: _A _� �� '� ) '1 �._I�� E-mail address:
Signaturr 1 i IN _-�_. � Date:
NORTHPAI'WLINA, Uovte COUNTY
1, the undersigned Notary Public do hereby certify that ,! on c lNef LArt ,��ti�tltltN�r�
personally appeared before me this day and acknowledged the due execution of the forgoing instru,*``�����'
WITNESS my hand and official seal this the / 3
tl, ~' TAA?, N
day of IJ Pe AA 4jar 200 9 : � '►(1$t 1t✓
Signature and seal: �fF O a`I
�Hrrrt��►t<��
My commission expires:
Lessee's/Operator's Certification:
1 certify that I have read this Agreement and do liereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: ��F SL�4 )� -- State: ` zip: �735
Phone: E-mail address:_._-- -.
Signature: i� Date: !? ' I�
Permittee's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
FORM: LOA 06-I6
(� _ r�•�du:ll�
Date: I +
Pau
e 3 of 3

OF 0
4
Simpson
now-
jr
■
40 Well
A Structure
N Off Site Dwelling
k
On Site Dwelling
x Drain
Field Total Acres Applicable Acres Buffer
1 20.83 9.98 Pond
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL Field Boundary
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Sill 35 1Globe, GeoEye, Eart Property Boundary
0- G1 _(Arirn) IRA
SCALE: 1 440' FIGURE NO.
City of Reidsville
DATE 12-09-19EMA Land Application Program
DRAWN BY: BC —Re ources, Inc. 2
'ROJECT NO: NC-RC-002
1A/nnnn0'Q79 tv Jane Marshall

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 copies of the application and
sunporting 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 .I 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
hereinafter referred to as the Permittee, to land apply residuals from the following racility(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:
SitetField ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
R0004-01
No
Hay/Pasture
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall 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 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Chit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 he 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. . 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 i2-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 residuaWsoil 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, l 5A NCAC 02'T .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 Certifleation:
I certify that 1 am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding (lie 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. Furthermorc, I certify that 1 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.
Landown
Address:
City: _ 4;AT �.t2 _ State: C Zip: `� S
Phone: M 3� - 3 ° E-mail address: �� t�t�t gT Q-:� r "e }}L C►.S . G el 100—
Signature: Date:
NORTH CAROLINA, f��t<,,��um, _ COUNTY
I, the undersigned Notary Public do hereby certify that 50,44
personally appeared before me this day and acknowledged the due execution of the forgoing
WITNESS my hand and official seal this the
-yi ti
day of fJPe4,, , 20 1
• Signature and seal:
My commission expires:
Lessee's/Operator's Certifications
I certify that I have read this
Lessee/operator name:
':Z/:7/zox/
t�QT'IHa-
%Boo
and do hereby agree to abide by the stipulations and restrictions as specified herein.
r lM :t�;Lt a
Address: '1 2',
City: Kr `1 c• State: _ i') t Zip: Z j1
Phone: 7 -AY-7- (✓ % E-mail address:
Signature: Date:
Permittee's Certification:
I certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name;
p 7, Z.I
Signature: 'Q1�c.tr�w�sS �u►. hate: 1 i L�
FORM: LOA 06-16 Page 3 of 3 1

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — 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 copies of the application and
supporting 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 13 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 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.
❑ 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: Ci of Reidsville
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:
SitetField ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC005-(1-6)
No
Hay/Pasture
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.
his 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.
I. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 sitc(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 Pertittee.
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 Pertnittee, 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.
�. RESTRICTIONS:
1. Appropriate measures must be taken by the Petmittee 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 residuaWsoil 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.
IIi1.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 sitc(s) on behalf of other deeded landowners OR that f am otherwise authorized, through
a power of attorney or other legal delegatiun, to [Hake decisions regarding the use of ttre 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. Furthennore. i certify that 1 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 [lie Pennittce to land apply residuals to [lie land application site(s) as specified
herein.
Landowner nanne;
Address: -�1�
City: 1�fu�rS�,P�s State: zip: _ Z 7 1��7
Phone:. :33L, - 92- 2- 4) :�'L))_ F-mail address:
Signature: rj Date: —
NORTH CAROLINA, COUNTY
1, the undersigned Notary Public do hereby certify that _.��.� �s A 1 b'et _
personally appeared before me this day and acknowledged the due execution ofthe forgoing instrument `0r,t1111off/,//
WITNESS my hand and official seal this the 1 � � %
day of CT o"* 6rf 2019
• Signature and seal:
My commission exp
Lessee's/Operator's Certification:
I ceilify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator nalrie: � r. 'Y _
Address:
City: Jim �ri[ rer � _ State:..___.���
Phone: I.31, /,I /, �Z2 f E-mail address:
Signature: Z- /% , , .r —
Permittee's Certification:
Zip: Z 7 3'_7 _.._.._.—
Date:
f certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
1-4 � 4 L.-CU
Date:
DORM: LOA 06-16 Page 3 43

DWIIR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —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 copies of the application and
swpporting 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 .l 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 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.
❑ 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
0he undersigned landowner or his representative hereby permits:
Applicant's name. City of Reidsville
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:
Site/Field 1D
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC009-(1-3)
No
Hay/Pasture
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
hall 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:
I. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 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 ]cachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
�. 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 I2-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.
111.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 02"L.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 of3

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 sitc(s) on behalf of other deeded landowners Qi 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 Penniltee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address;
City:
State:
zip: 1:3 310
Phone: E-mail address:
Signature: `1 I `�+I� 1.}'iu {�f Date:
NORTH CAROLINA, COUNTY ��Q'01 C04
1, the undersigned Notary Public do hereby certify that /}t; J`'r
personally appeared before me this day and acknowledged the due execution of the forgoing instraicnl.
WITNESS my hand and official seal this the
day of }..:.. , 20 �' V ". iE,
lltltlit��
. Signature and seal:
My commission expires: 2 /7
Lessee's/Operator's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address;
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
FORM: LOA 06- l6
Date:
Page 3 of 3

X—
A
A A 4
"A A
2
0
/I
I
0
-Z. Y.
A t
0
CA
Well
A Structure
On Site Dwelling
0 Off Site Dwelling
t-4'p;
Field Total Acres Applicable Acres V,
1 8.17 8.17 Stream
2 9.72 6.11 Buffer
3 8.42 4.64 rw I Field Boundary
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
Pond
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY —minif Mims
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Aill iiiii, iiiii 1111 1151 nnil 1 Property Boundary
SCALE: 1 440, FIGURE NO.
- City of Reidsville
DATE
12-10-19 EMA Land Application Program
DRAWN BY: 2
PROJECT NO: BC ources, Inc. NC-RC-009
L W00002376 �iw Michael Bray

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Dhrislon of Water Resources 15A NCAC 02T .1100 — 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 copies of the application and
sup ortin2 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 .1 100. 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 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.
❑ 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
40he undersigned landowner or his representative hereby permits:
Applicant's name: Cijy of Reidsville
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:
Site/Field ID
Lease
Lease
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RCO10-01
No
May 1 Pasture
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.
@his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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; �TiPULATIONS:
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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 Perrttittee 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 terns 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.
.. 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 shalt 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)
I SA 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 nroeram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of

Landowner's Certification:
I certify that I am a deeded landowner of the above-rcferenced 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 Perntittee to land apply residuals to the land application sites) as specified
herein.
Landowner name: mmariulyui
AddressK IAAJ t l s U
City: L(� tr{S Ij 'I ! (�
r�
State: "Lip:
Phone. 3 '3 t � � ," .0 (-) ` E-mail address: --
SignatureDate: /
NORTH CAROLINA,COUNTY
1, the undersigned Notary Public do hereby certify that � more 6, 540cV}
N0111111111,��
personally appeared before me this day and acknowledged the clue execution of the forgoing instrume`,k%%��T Cot eery'
WITNESS my hand and official seal this the
day of � erRAI . 20 1? T
AU B1-� U
2:
Signature and seal:
My commission expires: .717E;07
Lessee's/Operator's Certification:
cet•tify that i have read fife eciment and do
Lesseeloperator name:
C
agree to abide by the stipulations and restrictions as specified herein.
Address: / t�t��u >rC l r/l/Gf - -- - ---—
City: - -- �(W els ei.%%� Slate:. Zip:
Phone: q V-_-vZ , --3 E-mail acldress:7 s-a��`•�r?'�. P //o1mi� %moo"
Signature: �'�' Date: /1 /O
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:
Signature:
Date: —trL
FORM: LOA 06-16 Page 3 of

t
n
1•M t��
#l.
�A=a
a W�0"O"'ron
Structure
14 Well
r '4 On Site Dwelling
+ ■ Off Site Dwelling
Stream
Field Total Acres Applicable Acres ® Buffer
1 16.83 8.49`
Field Boundary
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL ® Flood Zone
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. 9r1, DIgIGIII
Obe, GeoEye, Eart' Property Boundary
USG-,AeroGRID,IGN,and �����
SCALE: 1 - 440 ' City of " Reidsville FIGURE NO.
DATE: 12-10-19 EMA Land Application Program
DRAWN BY: BC —Re ources, Inc. 2
PROJECT NO: N C-RC-01 0
W00002376 Marilyn Stocks/Durham Living Trust

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 on inal and two copies of the application and
supporting 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 . 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 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.
❑ 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 I es see /operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
*he undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC011-01
No
Hay/Pasture
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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] 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.
0 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 Emit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 patters 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.
. 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.
S. 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 021" .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 nroaram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of3

•
Landowner's Certification:
1 certify that I am a deeded landowner of the above -referenced land application site(s) and ant 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 die land application site(s) on behalf of the
deeded landowners. I certify that the abovc-referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthurmure, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply welts inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Perinittee to land apply residuals to the land application site(s) ns specified
herein.
Landowner name: Daisy PLj gson
Address: w 62011 AK 14—) G S
City: �e,XrV"(I /— State: NC Zip: 27.720
Phone: E-mail address:_ f ,
Signature: c� Date:
NORTH CAROLINA,
Roslc.yl
1, the undersigned Notary Public do hereby certify that
COUNTY
Tr: a 5k
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS any hand and official seal this the /31A
day of r] ec rm b--
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
a 17'llvx t
20
AU9V
�lf111111{tip,,` �
i certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lesseeloperator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
'Lip:
1 certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 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 — 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 copies of the application and
surmort ne documentation
For more information, visit the Water Quality Permitting Section's Non-DischgL a Permittft 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 l 5A NCAC 02T . l 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant`s name: _ City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC011-02
No
Hay/Pasture
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall 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

1. 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.
103. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 Pertnittee 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 PeAnittee, 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.
�. 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.
W. 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

0 Landowner's Certification:
t certify that I am a deeded landowner of the above -referenced land application site(s) and ant authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners QR 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. Fw1hermore, 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:
Address: 9/ 3 Ons/VW br.
City: _State:
NZ_
Phone: _ 11 E-mail address:
Signature: % ) L �.L �1� _ Date:
NORTH CAROLINA, I?urt.-�4s4" COUNTY
[, the undersigned Notary Public do hereby certify that 7r,'s Vooq.e
Zip: A7•!0 g
a/,/,14w/q
personally appeared before me this day and acknowledged the due execution of the forgoing instrun'`ot NN C0C(;y�
1VITNESS my hand and official seal this the--
dayof
Signature and seal: Ay.
My commission expires: ,41714u7/
Lessee's/Operator's Certification:
,20 /9
I certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
Cite:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certiR, that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16 n— 11 -CI

2
Its
PNA�f IN
P, �71
POP,
102
AIM
On Site Dwelling
N Off Site Dwelling
A Structure
40 Well
10 .0% - - - Stream
Field Boundary
Field Total Acres Applicable Acres
2 19.66 9.34 Buffer
REFERENCE:
G 'Is'T Property Boundary
IS DATA LAYERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES
OSS
URPOSESONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
'U ' 'T' 0 ONLY.
'C
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY M
EarO
DECISION , "0
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Pond
.... U=G
SCALE: 1 440' FIGURE NO.
City of Reidsville
DATE 12-20-19ELand Application Program
DRAWN BY: BC -Re ources, Inc. 2
PROJECT NO: NC-RC-011
W00002376 tv Iris Sharpe

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 —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
supporting 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 1 SA NCAC 02T .1 100. 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 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.
❑ 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: Ct of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC012-01
No
Hay/Pasture
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.
&his 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 of3

1. 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 [I) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Chit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
. 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 behatfof other deeded landowners QR 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. l 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. FUrthemtorc, 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: Lawrence McCollum
Address:g54 ,-, ,,— DA-- - -- - —
City: Rs.-4 r. l 11c— State: A) L Zip: _�Z73 zO
Plione: E-mail address:
Signature: i- Date: ��� �� ji
NORTH C�ROLINA, Roe"kv.r. � COUNTY
I, the undersigned Notary Public do hereby certify that L2%'" e c e-
personally appeared before me this day and acknowledged the due execution of the forgoing instrumen
WITNESS my hand and official seal this the ! 31 h
day of t7e.,e-6,-- 20 /S
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
a/712o2r
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lesseeloperator name:
Address:
City:
Phone:
Signature:
Permillee's Certification:
State:
E-mail address:
Date:
Zip:
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:
Signature:
�Job,
Date:
�tP
FORM: LOA 06-16
Page 3 of 3

Field Total Acres
Applicable Acres
1 11.34
11.19
2 5.38
4.46
3 4.41
3.66
4 8.39
6.95
5 7.49
4.34 _
REFERENCE:
GIS DATA LAYERS WERE OBTAINED
FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES ONLY. IT IS NOT
MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.
SCALE:
tv
♦ Structure
• Well
On Site Dwelling
■ Off Site Dwelling
Stream
Pond
Buffer
Field Boundary
Property Boundary
City of Reidsville
DATE: 12-10-19 Land Application Program
DRAWN BY: BC ources, Inc.
'ROJECT NO: N C-RC-01 9
W00002376 Mary Stanley
I,

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — 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 copies of the apglication and
suaaortim 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 Iand application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .I 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: Cijy of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC041-(1-4)
No
Hay/Pasture
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.
1 his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall 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 I 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.
0 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
0I. 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 t4-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 021'.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 nroeram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
. 1 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 sire(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that 1 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, 1 ( 1
Landowner name: 1r1-t`l-n
Address:
City: State:, Yet- Zip: 2737t��_
Phone; jL-_`Z Lam�% `l_ r� E-mail address:
Signature: t- Date: 2 8 41
NORTH CAROLINA, Qoc1M� r•, COUNTY
I, the undersigned Notary Public do hereby certify that 14 OV. )v4 /AC ..tI111140._
personally appeared Y g forgoing �. CD
ersonall a eared before me this day and acknowledged the due execution of the for oin i nt. r
WITNESS my hand and official seal this the �TaR yN
day of
. Signature and seal:
My commission expires: ZI7I70ZI ��il�oar OU►►���`
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: �)Q"\C 1 1-0✓c1Gtce
Address: III (\ . \ 5li ._ .. --
City: 910-1 1 State: RL dip: , 7-3 110
Phone: -mail address: 2
Signature: Date.
c
Permittee's Certification:
1 certify that 1 have read this Agreement and�du hereby agree to abide by the stipulations and restrictions as specified herein.
Signing officials roe: 61 6f �ar Y,��'c iWaliej A're��G31S{{a/
Signature: - Date: l j, Z4;
FORM: LOA 46-16 Nate 3 of 3

4
3
1
A Structure
40 Well
On Site Dwelling
N Off Site Dwelling
Field Total Acres Applicable Acres Drain
1 11.89 11.09 Stream
2 9.3 9.0s . . . . . . . . . .
3 2.14 1.99 Buffer
4 17.72 17.2
Field Boundary
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
Property Boundary
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO 9ho 1 1 ONE
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY Sri Digital Globe., P P, Pond
Eart
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. 'I 10.11 1 171 P
SCALE: 1 440' City of Reidsville FIGURE NO.
DATE 12-10-19 EMA Land Application Program
DRAWN BY: BC —Re ources, Inc. 2
PROJECT NO: NC-RC-041
k 1A/nnnn0'Q79 Lofton Lovelace

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T A 100 — 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 copies of the application and
supportine documentation
For more information, visit the Water Quality Permitting Section's Nan -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 .1 100. 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: Cijy of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed)
pasture)
RC118-(1-2)
No
Has/Pasture
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.
*hisAgreement shall remain in effect for the length of the Division's permit for the residuals land application program and
his
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] of 3

I. STIPULATIONS:
I. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
�. 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 sitc(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 residuais/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,
HLALTERNATIVES 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)
is❑ 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 nroeram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

0 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 QR that 1 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:
Address: —D 1- &
City:
/1 ' zip: `' 1/1:_3. [�
Phone: 3.:)/'' j 7 `! ') / t�1 F-mail address:
Signature: i4'.��.R;i'r:.t1:�_ Dale:
T
NORTH CAROLINA, - - R1bC ki n q h (V71 COUNTY
I, the undersigned Notary Public do hereby certify that �0�1h1 Car
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS
December
my hand and official seal this the
'
day of ecem her GRACE A. SIMPS-0 I
t tayy Public,, No, A-carijil 0-
! ROWrQham unty
Signature and seal: C. �'� l �i Co
My commission expires: 10 Z20/ 20 20 �sr. _rr5P- j C. -
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: : r
Address: ' v,--
City:_7�_tl 1 Q-e--.. State:C lip:
Phone: LfV -.Xa,6 3 I: -mail address:
Signature: 71dh t-Date:
Permittee's Certification:
I certify flint I have read This Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16
Page 3 of 3

or
7
A Structure
• Well
7%
4
7
0 Off Site Dwelling
On Site Dwelling
19
x — x - Fenceline
— — — Stream 4
4*
Flood Zone
Field Total Acres Applicable Acres
1 10.12 8.55 Buffer
2 6.5 5.2 Field Boundary
REFERENCE:
IS DATA LAYERS Property Boundary
I T L
LGDA A A ERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
S Y S
PURPOSES
, SS
URPOSESONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO ILE 1 111 1
0 ONLY
GUARANTEES
'T"S R ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.Sf GeoEyeEart Pond
UARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY i ji 111 11 . . . . . .
DECISION
10,
DECISION MADE 0
USG AeroGRID, IGN, and
SCALE:
1 440' City of Reidsville FIGURE NO.
DATE 12-10-19 EMA Land Application Program
DRAWN BY: BC —Re ources, Inc. 2
PROJECT NO: NC-RC-118
V W00002376 Johnie Carty

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 _copies_of_the application and
sunaorting 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 .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 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.
❑ 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
he undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilitover-seed/
pasture)
RC119-(1-6,8-12)
No
Hay/Pasture
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.
10his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
1hall 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.
403. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617,
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 time 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 leachatc, surface water. groundwater, or soil samples during the
term of and 12 months after termination of, this Agreement.
�. 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.
HLALTERNATIVES 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 1 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:
• 1 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 QR 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 -re fere need 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 Perinittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: 1
Address: ,r�;� (_cA,(- RI) - —�
City: �e�c�lJSv'.�1c. State:_ nC. Zip: 27320
Phone: 7I e) �' r E-mail address:
Signature: v,_Z 6 ?-IvtC 1Cr� G? C`-�' Date: �c z) • `-
c• J�
NORTH CAROLINA, [to c K hs -COUNTY �%*.tiNT tC04
[,the undersigned Notary Public do hereby certify that horn r s �or! r i
personally appeared before the this day and acknowledged the due execution of the forgoing itec'fnnentAAr S
WITNESS my hand and official seal this the 1�1A %BVIO "- —
day of ��na 2019 i.._it/�111��`
• Signature and seal:
My commission expires: 217112a4 1
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:
Address:
City:
Phone. -
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official ame: clovrlr 5", 1/1 - AO,., t-vilr
u� ��
Signature: Q e f ]� � �1� /, - Date:
t�G�.a45 t 1(4e
rZ-4L
FORM: LOA 06-16 Page 3 of 3

Field Total Acres Applicable Acres
1 38.58 36.1
2 10.79 8.57
3 10.89 8.43
4 22.6 20.14
5 11.54 9.87 ,
6 11.02 10.58
8 8.06 7.64
10 7.43 6.52
11 24.43 23.83
12 3.14 2.79
-r
�� •Y 4
8
' 12
3� L
'k A
'fit, . V",
sump
0
2
r
9
10 40 Well
♦ Structure `
i
C
5 On Site Dwelling
y� ■ Off Site Dwelling
� � C
Stream
Field Boundary
Property Boundary
REFERENCE: V '
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL ®Buffer I
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO cm)
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY Srl, Digi4alGlobe, GeoEye, Eart Pond
DECISION MADE OR ANY ACTIONS TAKEN BYTHE USER BASED UPON THIS INFORMATION. U - AeroGRID, IGN,.and
c
SCALE: 1 �� - 660 "`� " FIGURE NO.
- City of Reidsville _
DATE: 12-11-19 EMA Land Application Program
DRAWN BY: BC --Re ources, Inc. 2
'ROJECT NO: N C-RC-119
1Ainnnn0'Q79 Thomas Carter

r
}� Y
ov
rq
•
1.
Ag
j4,.
?A 444
el
jo
•
F.
1
. , _ �: • Well
M". A `�■�f=,'' 1 ♦ Structure
NJ Ift
On Site Dwelling
■ Off Site Dwelling
M • *, ��
_.._.._ Stream
Field Total Acres Applicable Acres M ;p Field Boundary
9 20.55 14.2 i � i �
Property Boundary
REFERENCE: '
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL ® Buffer I
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. I GeoEye, Earn Pond
U'G , AeroGRID, IGN, and
SCALE: 1 - 440 "`� " FIGURE NO.
- City of Reidsville _
DATE: 12-11-19 EMA Land Application Program
DRAWN BY: BC --Re ources, Inc. 2
PROJECT NO: N C-RC-119
1Ainnnn0'Q79 Thomas Carter

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — 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
supporting 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 .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 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.
❑ 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
We undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed!
pasture)
RC125-(1-3)
No
Hay lPasture
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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 I of 3

1. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 time mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee wiI] 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 he 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.
�. RESTRICTIONS:
l . 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 t2-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 he 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:
t 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. Furthennore, I certify that I have read this Agreement,
understand (lie stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Perinittec to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address:
City:
i'hane: %
Signature: .�
Stater Zip:
E-mail
Date:
NORTH CAROLINA, �COUNTY
1, [lie undersigned Notary Public do hereby certify that 501a lI _ �itlUltH
Nv CO4 �!
personally appeared be-forc me this day and acknowledged the clue execution of the forgoing instrunteni�� Q.
w
WITNESS my hand and official seal this the 10�t' _ - ARp
s
20 / 7 oc'_._. _C
Signature and seal:%• �� ��9 '.
My commission expires: .�%T��z ,����H11 h►�`
Lessee's/Operator's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City,
Phone:
Signature:
Permittee's Cerlificalion:
State:
E-mail address:
Date:
Zip:
I certify that I have rend this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signattre:
Date: �� t
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
IDWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — 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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Nan -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 15 A NCAC 0" F . 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 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.
❑ 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
Ohe undersigned landowner or his representative hereby permits:
Applicant's name:
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC 125-04
No
Hay/Pasture
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.
*his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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] of 3

1. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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).
I I. 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 Penmittee 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.
�. 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 residualsisoil 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

Landowner's Certification:
• I certify that I am a deeded landowner of the above -referenced land application sitc(s) and ant authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners 4$ 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 natne: James Jones
Address: 21 Griffin Rd
City: Stokesdale State: NC Zip: 27357 -
Phone: A 11 A _ E-mail address: f `
Signature: A, f Date: I Cl 7
NORTH CAROLINA, COUNTY
1, the undersigned Notary Public do hereby certify that �aMe s 4r �ku r� • )o it s
personally appeared before me this day and acknowledged the due execution of the forgoing instrument. tCO4114
WITNESS my hand and oifiicial seal this the ) 9 dh 1�ft_4V ���L_
dayof_ (irrr.NSrw
Signature and seal:
My commission expires:
Lessee'slOperator's Certification:
?/71Zvz 1
Z� .Z �kpTAq$
.4ula -o U
ME
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator nanie:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip.
certify that I have read this Agreement and do hereby agree to abide by (lie stipulations and restrictions as specified herein.
Signing off
Signature:
64 a�lzof -
FORM: LOA 06-16 Page 3 of

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 copies of the application and
supporting 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 . 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 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.
❑ 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
Ohe undersigned landowner or his representative hereby permits:
Applicant's name: Cijy of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC 125-05
No
Hay/Nasture
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.
*his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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 I of

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.
103. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
M. 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.
�. RESTRICTIONS:
1. Appropriate measures must betaken 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 residuaWsoil 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 shal I 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.
IILALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
5A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0I 05(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, helshe 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 Certifieation:
1 certify that I am a deeded landowner of the above -referenced laid application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners QR 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 Pennittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Garver bM J'r4st�e_._.—._
Address: £S1100 NG•✓�'«, 6�
City: _-�4k+sdsi, State:
Zip: �7357
Phone: E-mail address:
Signature: Date:
NORTH CAROLINA, I[ orkCOUNTY
I, the undersigned Notary Public do hereby certify that � S��rpG
personally appeared before me this day and acknowledged the due execution of the forgoing instrument. 0�N� tC��
i
WITNESS my hand and official seal this the
day of «rr+or , 20 I i
r r
�[jBt�G
Signature and seal:
My commission expires: v2 f7/lv�/
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:
Address:
City:
State:
Zip:
Phone: E-mail address: r n
Signature: A.0 � Date:.,I ;y : ! 1y
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:
Signature:
FORM: LOA gib-:E
Date:
Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
1 SA NCAC 02T .1100 — LANDOWNER 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 copies of the application and
supporting 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 . 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 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.
❑ 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
40he undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
SitelField ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC 125-06
No
Hay / Pasture
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.
*his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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 of3

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 a]I 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 shal l 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 leaebate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
�. 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.
IILALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
I5A 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 moeram:
(Name of the new program)
NORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that i am a deeded landowner of the above -referenced land application sitc(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners O$ that I am otherwise authorized, through
a power of attomey 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 %vells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application sitc(s) as specified
herein.
Landowner name: I larvey Shar e
Address: V30 NC
City: 5}bk��riat State: Aj
Zip: 2:1
Phone: F-mail address:
A Signature: Bate: 1A `lr+'/Q
NORT14 CAROLINA, . _ ...__. Rotx; ^�. �� COUNTY
I, the undersigned Notary Public do hereby certify that �_J4 r%,ty y,o.pc
personally appeared before me this day and acknowledged the due execution of the forgoing inst
WITNESS my hand and official seal this (lie
/6-14
day of e, Mbr,r
Signature and seal: 4
My commission expires: �ywz r
Lessee'slOperator's Certification:
111111N1
,,1 C04
20 19 •t��ARy
►'Ut3��
sttlot
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:. am 5m, !�
Address:
City:
State:
Zip:
Phone: E-mail address: --
Signature: Date:
Perrnittee's Certification:
I certif+- that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Sit -nine official name:
5ienature:
FOR.\I: LOA 06-16
Date:
Page 3 of 3

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GIs DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL _ __
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PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO Sri, HEREGarmin, USGSInterm
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY METI, Esri China (Hong Kong), E Field Boundary
DECISION MADE OR ANY ACTIONS TAKEN BYTHE USER BASED UPON THIS INFORMATION. ) OpenStreetMap ContribUtOfS, and y
SCALE: 1 = 0.5 miles FIGURE NO.
City of Reidsville
DATE: 12-23-19MA Land Application Program
DRAWN BY: BC —Re ources, Inc.
PROJECT NO: NC -RC-1 25
W00002376 James Jones/Gary Albert Trustee/Harold Sharpe

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Field Boundary
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX PLEASE NOTE THIS MAP IS FOR INFORMATIONAL Property Boundary
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO qE I I Mr
GUARANTEES ABOUT ITS ACCURACY EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Sfl, DigittalGlobe,e Eart Pond
USG-, AeroGRID, IGN, and
SCALE: 1 440' FIGURE NO.
City of Reidsville
DATE 12-11-19 EMA Land Application Program
DRAWN BY: BC —Re ources, Inc. 2
PROJECT NO: NC-RC-125
1A/nnnn0'Q79 James Jones

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 copies of the application and
suuyorting_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 . l 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 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.
❑ 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
We undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC126-02
No
Hay/Pasture
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.
Qhis Agreement shall remain in effect for the length o€ the Division's permit for the residuals land application program and
all 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:
I. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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,
�. 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 residuaWsoil 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.
ID. 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:
i1 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 Pcrmittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: 02]7e("'_tSCCAlt -h 5�aT-dr\
Address:
City: f.G•r�S�/� 1 lC State; zip:
Phone: 336 3 `l — F,7 -f 7 E-mail address: DC_ fec n. L,s Cxj'�t _ e�
Signature: k.Date: ib7 / Z 2, of g
NORTH CAROLINA, ko clt I^y A0In COUNTY
I, the undersigned Notary Public do hereby certify that jot e c4 �`���tlitttN�. Lo,
- 0 / �A
personally appeared before me this day and acknowledged the due execution of the forgoing instnq it, apTAR ��
WITNESS nay hand and official seal this the it 10/
day of
40 Signature and seal: 0ev' k3��� y COUNx �
F11111111-
My commission expires: I— J— I
Lessee's/Operator's Certifcation:
I certify that t have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
11'ermittee's Certification:
State:
E-mail address:
Date:
Zip:
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: c rI cr A v7 a!�'c a/vs A"Ie rt�r
Signature: �Wo<ti 'F1 r /I ``e l''1at' Date: 4 t
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
IDWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T A 100 —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 copies of the armlication and
supnortine 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 . 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 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.
❑ 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
Ahe undersigned landowner or his representative hereby permits:
Applicant's name: _ City of Reidsville
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:
Site/Field ID
Lease
es/no
(Y ?
Land Use or
Cropping Patterns
PP g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed!
pasture)
RC126-03
No
Hay/Pasture
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall 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 I 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 sitc(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 sites) 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 Pcnnittec, 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.
. RESTRICTIONS:
L 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 residuaWsoil 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 .01051h1 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:
1 certify that I am a deeded landowner of the above -referenced land application site(s) and am audiorized to make decisions
regarding the use of the land application sitc(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 sitc(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(%) 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 Elie stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do here grant permission to the Perntittee to land apply residuals to the land application site(s) as specified
herein. I
Landowner nan►e: . z 11.VAL � .'h4ue+ r
Address:
City: 1
Phone: 5 . f
Signature:
E-mail address:
NORTH CAROLINA, — l C °�'`' ,..�... COUNTY
Date:,_ - 2-7-- / !,
I, the undersigned Notary Public do hereby certify that AMP, Frr Ntttttt'1
CO.
personally appeared before me this day and acknowledged the due execution of the forgoing instrumQ�t�, C��.��
WITNESS my hand and official seal this the �� NQrA•Q.� N
day of %Flay __. 20
Signature and seal: __-f!/• 29_2r_1
My commission expires: 217120Z1
Lessee's/Operator's Certification:
M0
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: _•�SU, 1 `C� - State:
Phone:
Signature:
Permittee's Certification:
E-mail
A L --Zip: _U132_o
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official natne: li v c tc Sih,14 _ R V, � Z,/v� kl D,', r e A"
Signature:
0 e�i t Qt1A V. (Are -
Date: � zJa CL Z,
FORM: LOA 06-16 Page 3 of

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T A 100 — 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 A licant shall submit one original and two copies of the yonfication and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge PermittingUnit.
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 1 SA NCAC 02T . l 10-0. 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 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.
❑ 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
We undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilt/over-seed/
pasture)
RC 126-04
No
Hay I Pasture
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.
Whis Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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:
4. 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
�. RESTRICTIONS:
L 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 021'.0105th 1 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)
40 ❑ 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 Ccrifflention:
certify that I am a deeded landowner of the above -referenced land application site(s) and ant authorized to make decisions
regarding the use ofthe land application site(s) on behalf of other deeded landowners OR that I not otherwise authorized, through
a power of attorney or other legal delegation, to [Hake decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. 1 certify that the above-rcfercneed land application sile(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. furthermore, I certify Owl 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 Perrnittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: James T• rdiff
AddressJ6 jfL a
:I I-y7-cde Ri)
City: -1 ZL=1 t-State: Zip:
phone: ( z� ' 5 t
71 ` _-.- } -mail address: TmV—(>,VG QA 1,2 f0C-1 y)ArL Ly M-
Signature: - -z _. Datc: /i- - /0 1 9
NORTH CAROLINA, COUNTY
1, the undersigned Notary Public (to hereby certify [fiat ,.-tea lo,d;- 4
personally appeared before me this day and acknowledged the due execution of•the forgoing instrument.
WITNESS my hand and official seal this the 10a1,
day of l) «f., bo,
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
2%740o-/
t )'i:ertify that I have read this gr enient and do
`t Lessee/operator name: aria
Address: 161 -,),
COUN�i,
F11t111011i
agree to abide by the stipulations and restrictions as specified herein.
i
J
City: ���1 c,t1 state: � r �� Zip: -
Phone: �`J�-_� E-mail address: r.c L s��•�,.. ! .,1��.,,
Signature• c Datc.:, J/a
Permittee's Certification:
1 certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: i 2—jr i
FORM: LOA 06-16 Page 3 of

Ali
IMF 't Ok
x� t
' ,,
0 0
.*07
1 .
3 S 1 t t
Y � '
1.
Uk
L \ Y 0 • �� R� T'. • C
• Well
■ Off Site Dwelling
Stream
Field Total Acres Applicable Acres ^ ® Buffer
3 13.17 5.2 Field Boundary
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL Property Boundary I
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO qE I I M
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Sfl, Digit�alGloPond
U=G-, AeroGRID, IGN, and
SCALE: 1 - 440 ' "`� " FIGURE NO.
- City of Reidsville _
DATE: 12-11-19 EMA Land Application Program
DRAWN BY: BC --Re ources, Inc. 2
PROJECT NO: NC-RC-126
1Arnnnn0'Q79 Auman French

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LANDOWNER 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 Anylicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Wafer 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 .I 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: Cijy of Reidsville
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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC128-01
No
HaylPasture
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.
&his 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 I 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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 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.
l0. 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.
�. RESTRICTIONS:
I. 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, l5A NCAC 02T .01051h1 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 he 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:
• 1 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 QR that I ant otherwise authorized, through
a power of a"oniey 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,
understated the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledge inent 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:
Address:
City: _ state: Zip:
Signature:�IGLP
Date: _ =.� z 9
NORTH t A'ROLINA, 90cV 5,%Shcpt COUNTY
I, the undersigned Notary Public do hereby certify that � i+ ���a s (.1� I Ngen '�Ntillt1lq ---,
personally appeared before me this day and acknowledged the due execution of the forgoing in!ent.�Tp =
WITNESS my hand and official seal this the 29 A
day of 20
• Signature and seal:
�'►�11l1
My commission expires: �Z%7%Z vZ /
Lessee's/Operator's Certification:
1 certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City;
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official ante: ( )/hi?A - Ytbr-L WtVW 444( e-
Signature: 't- Wiw&J Date: i '2-, 4
ie GtaA Ulm
FORM: LOA 06-1 b Page 3 of 3

DWR-1-
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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
supportine 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' .l 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: City of Reidsville
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:
Site/Field ID
Lease
estno
(Y )
Land Use or
Cropping Patterns
1'P g
Intended Use of Crops
Residuals Source
o tionai
(optional)
Special note
(no-ti11/over-seed!
pasture)
RC 128-(2-3)
No
Hay/Pasture
Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Perm ittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
01'his 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 of3

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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Pcrmittee 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, unrcgulated 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.
�. 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 Drop -ram.
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
. 1 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 sitc(s) on behali'of other deeded landowners OR that I am otherwise authorized, through
a power ofattorney 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. f urthennore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledge nient of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application sites) as specified
herein. _
Landowner name: C-
•
E
Address;
City: Ili.
1 "1 l7Xc%/
state: Jr�
zip: "11119Yd -
Phone;
l���
I: -mail address: f
Jwa-11 e 2Y(J Ccfl
Signature: �J11ti
�d=,
Date: l� %I�
NORTH CAROLINA, __ 901ckx!.� kv&1 COUNTY
1, the undersigned Notary Public do hereby certify that % M SirJt.►y �•`'Q��NT C�<<�'�i.
personally appeared before me this day and acknowledged the due execution of the forgoing instrubt'I�t. pTAiV N ?
WITNESS my hand and official seal this the A141 �lBt�G C,
day of 7
Signature and seal:
My Commission expires:
Lessee's/Operator's Certification:
2171Zoz t
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:
Address:
LJ,
City: � C 11,11 P r State; '�� Zip:
--- --�•
Rhone; 3 - F-mail address: /
Signature: ' Dater JC
Permittce's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signinb official name; "a 5,;m ~ r '�''''z po/kJ
Signature: ���� tttitn.. Date:
rv1
FORM: LOA 06-15 Page 3 of 3

■
*
Field Total Acres Applicable Acres
1 16.12 14.66
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.
SCALE:
♦ Structure
• Well
■ Off Site Dwelling
On Site Dwelling
-- Stream
Buffer
Field Boundary
Property Boundary
Pond
tv
1 " = 440' City of Reidsville
DATE: 12-12-19 Land Application Program
DRAWN BY: BC ources, Inc.
'ROJECT NO: NC-RC-128
1Ainnnn0'Q79 Dennis Williams
FIGURE NO.
2

4 h.
fill
2
!■
' ♦ Structure
• Well
IN Off Site Dwelling
t• _
Stream
Field Boundary
Field Total Acres Applicable Acres
2 5.92 4.2 ® Flood Zone
3 14.26 10.7 ® Buffer
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM XXXXXX. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL 1 Property Boundary
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY. EMA RESOURCES INC. ASSUMES NO RESPONSIBILITY FORANY
DECISION MADE OR ANYACTIONS TAKEN BYTHE USER BASED UPON THIS INFORMATION. Sfl, Digi4alGlobe, GeoEye, Eart' Pond
U'G , AeroGRID, IGN, and
a
SCALE: 1 440 "`� "� FIGURE NO. '
City of Reidsville
DATE: 12-12-19 EMA Land Application Program
DRAWN BY: BC --Re ources, Inc. 2
PROJECT NO: NC—RC-128
W0000237Fi Timothy Stevens

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — 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 Avolicant 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 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 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.
❑ 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
ke undersigned landowner or his representative hereby permits:
Applicant's name: Ci of Reidsville
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ics) 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:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
RC 130-01
No
Hay 1 Pasture
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.
*his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all 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

L 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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
�. 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 residuaWsoil 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.
HLALTERNATIVES 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 .0105fh1 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 rc-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 ccrlify that I am a deeded landowner of (lie above -referenced land application site(s) and am nuthorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otllCrwrse authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land npplication site(s) oil 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 1 ]lave read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside tlhe compliance boundary, acknowledgement of
field transfer, and do hereby grata permission to the Permittee to land apply residuals to the land application sile(s) as specified
herein.
Landowner name: K n Mjjrtin _
Address: —
City: /C_ a 5_✓<<� - State: . Zip:
Phone: ��.. G( E-mail
Signature:_-
NOR114 CAROLINA, go ,, COUN"fY
1, the undersigned Notary Public do hereby certify that„sc� If
Date:
personally appeared before me this day and acknowledged the due execution of the forgoing instrurrt
WITNESS rnv hand and official seal this the 1014
day of 1je4V n
Signature and sea):
My commission exf
Lessee's/Operator's Certification:
COG/�tS�•'�.
I certify that i have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessec/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
F-ntnil address:
Date:
Zip:
1 certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: 12-b et It
FORM: LOA 06-1 G Page 3 o l' 3

Current Cumulative Loading Data

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 1.5
Land Owner: Ronnie Marshall Annual Dry Tons Applied: 0.58 Site #: RC001 Acres Permitted: 1.5
Operator: Ronnie Marshall Predominant Soil Series: CgB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
may,
co o
a c
*
o
*
°o
7y
?:
*
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/18
13000
1.07
0.387
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
17.828
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
130001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
17.828
0.00o
Lime Applied
Annuallbs/acre
0.004
0.002
0.108
0.027
0.029
0.000
0.004
0.013
0.004
0.353 16.331
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.01
0.007
0.515
0.111
0.076
0.002
0.02
0.067
0.016
1.118
Current Cumulative lbs/ac
0.014
1 0.009
0.623
0.138
0.105
0.002
0.024
0.080
0.020
1.471
Permitted C. P. L. R.****
36
34
1 1338
1
1 267
1 15
1
1 374
1 89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized:
Ronnie Marshall Annual Dry Tons Applied: 3.47 Site #: RC001 Acres Permitted:
Ronnie Marshall Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
C
r
r,
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co '2
c
*
o
* N
Z
7y C
?: 't
*
o
TKN
mg/kg
Z
o
M o
�2.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
2/4
58500
1.42
0.693
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
56600
16100
3.65
27.994
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
585001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
27.994
0.000
Lime Applied
Annuallbs/acre
0.007
0.003
0.220
0.054
0.045
0.002
0.007
0.029
0.010
0.621 22.176
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.014
0.008
0.643
0.15
0.095
0.003
0.026
0.091
0.022
1.399
Current Cumulative lbs/ac
0.021
0.011
0.863
0.204
0.140
0.005
0.033
0.120
0.032
2.020
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 27.45
Land Owner: Catherine Neal Annual Dry Tons Applied: 71.15 Site #: RC004 Acres Permitted: 27.45
Operator: Ronnie Marshall Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
CD N'
7y C
?: 't
D
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
4/29
78000
2.57
0.305
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
15.378
NA
Fescue
4/30
169000
2.57
0.660
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
33.320
NA
Fescue
511
143000
2.57
0.558
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
28.194
NA
Fescue
9/25
123500
0.908
0.170
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
8.081
NA
Fescue
9/26
162500
0.908
0.224
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
10.633
NA
Fescue
9/27
130000
0.908
0.179
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
1 21600
498
8.506
NA
Fescue
12/6
91000
1.52
0.210
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
5.190
NA
Fescue
12/7
123500
1.52
0.285
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
7.044
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
1020500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
116.346
0.00o
Lime A lied
Annuallbs/acre
0.130
0.018
1.249
0.257
0.349
0.015
0.055
0.148
0.153
4.526 123.093
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.066
0.025
2.026
0.474
0.355
0.008
0.074
0.262
0.071
4.337
Current Cumulative lbs/ac
0.196
0.043
3.275
0.731
0.704
0.023
0.129
0.410
0.224
8.863
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 14.7
Land Owner: James Albert Annual Dry Tons Applied: 8.50 Site #: RC005 Acres Permitted: 14.7
Operator: Ronnie Marshall Predominant Soil Series: CgB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
c
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* Z
o
* N'
0
7y
?:
D
� o'
TKN
mg/kg
90700
Z.
o
ac o
�.
mg/kg
32400
Nitrate
and
Nitrite
mg/kg
2
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/13
97500
1.08
0.299
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
20.128
NA
Fescue
7/14
91000
1.08
0.279
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
90700
32400
2
18.786
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
188500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
38.914
0.000
Lime Applied
Annuallbs/acre
0.005
0.002
0.163
0.044
0.025
0.000
0.007
0.023
0.006
0.384 23.236
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
2000
Current Cumulative lbs/ac
0.005
0.002
0.163
0.044
0.025
0.000
0.007
0.023
0.006
0.384
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 14
Land Owner: James Albert Annual Dry Tons Applied: 7.70 Site #: RC005 Acres Permitted: 14
Operator: Ronnie Marshall Predominant Soil Series: FrD2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 115 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* Z
o
* N'
0
7y
?:
D
� o'
TKN
mg/kg
Z.
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
3/29
84500
1.42
0.357
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
56600
16100
3.65
14.442
NA
Fescue
3/30
45500
1.42
0.192
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
56600
16100
3.65
7.776
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
130000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
22.218
0.000
Lime Applied
Annuallbs/acre
0.005
0.002
0.175
0.043
0.036
0.001
0.006
0.023
0.008
0.493 17.600
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.003
0.002
0.137
0.033
0.021
0
0.005
0.017
0.005
0.316
Current Cumulative lbs/ac
0.008
0.004
0.312
0.076
0.057
0.001
0.011
0.040
0.013
0.809
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
115
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 5 Acres Utilized: 10.7
Land Owner: James Albert Annual Dry Tons Applied: 29.29 Site #: RC005 Acres Permitted: 10.7
Operator: Ronnie Marshall Predominant Soil Series: NaB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 178 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
CD N
7y C
?: 't
o'
TKN
mg/kg
Z.
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
6/11
123500
1.46
0.703
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
21.225
NA
Fescue
6/13
175500
1.46
0.999
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
30.162
NA
Fescue
6/14
149500
1.46
0.851
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
25.694
NA
Fescue
6/15
32500
1.46
0.185
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
5.586
NA
Fescue
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
481000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
82.666
0.000
Lime Applied
Annuallbs/acre
0.016
0.011
0.985
0.328
0.337
0.016
0.027
0.183
0.027
2.786 86.489
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.024
0.012
0.964
0.224
0.166
0.004
0.035
0.12
0.036
2.386
2000
Current Cumulative lbs/ac
0.040
0.023
1.949
0.552
0.503
0.020
0.062
0.303
0.063
5.172
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
178
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 8.45
Land Owner: Michael Bray Annual Dry Tons Applied: 31.83 Site #: RC009 Acres Permitted: 8.45
Operator: Auman French Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* o°n
o
* N'
7y
?:
D
o'
TKN
mg/kg
Z.
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
4/3
84500
2.57
1.072
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
54.120
NA
Fescue
4/4
162500
2.57
2.061
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
104.078
NA
Fescue
10/26
84500
1.52
0.634
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
15.656
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
331500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
173.854
0.00o
Lime Applied
Annuallbs/acre
0.136
0.021
1.797
0.364
0.503
0.028
0.069
0.178
0.161
6.408 175.460
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.064
0.029
2.551
0.612
0.57
0.01
0.094
0.319
0.079
6.594
Current Cumulative lbs/ac
0.200
0.050
4.348
0.976
1.073
0.038
0.163
0.497
0.240
13.002
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 7.8
Land Owner: Michael Bray Annual Dry Tons Applied: 2.61 Site #: RC009 Acres Permitted: 7.8
Operator: Auman French Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
Q
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
may,
co '2
a c
*
o
*
Z
7y C
?: 't
D
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/7
58500
1.07
0.335
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
15.428
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
58500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
15.428
0.000
Lime Applied
Annuallbs/acre
0.003
0.001
0.094
0.023
0.025
0.000
0.003
0.011
0.003
0.306 14.137
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.004
0.002
0.189
0.046
0.03
0.001
0.007
0.025
0.005
0.389
Current Cumulative lbs/ac
0.007
0.003
0.283
0.069
0.055
0.001
0.010
0.036
0.008
0.695
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 6.1
Land Owner: Michael Bray Annual Dry Tons Applied: 2.90 Site #: RC009 Acres Permitted: 6.1
Operator: Auman French Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* Z
o
* N'
0
7y
?:
D
� o'
TKN
mg/kg
Z.
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
1/11
32500
0.67
0.149
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
98500
23500
2.23
10.197
NA
Fescue
3/30
71500
0.67
0.327
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
98500
23500
2.23
22.434
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
104000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
32.631
0.000
Lime Applied
Annuallbs/acre
0.003
0.002
0.161
0.042
0.057
0.001
0.005
0.022
0.005
0.530 21.420
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.024
0.011
1.038
0.254
0.169
0.004
0.04
0.141
0.032
2.284
Current Cumulative lbs/ac
0.027
0.013
1.199
0.296
0.226
0.005
0.045
0.163
0.037
2.814
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 8.4
Land Owner: Dan Stocks Annual Dry Tons Applied: 10.05 Site #: RC010 Acres Permitted: 8.4
Operator: Auman French Predominant Soil Series: RnD Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 141 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
CD N
7y C
?: 't
o'
TKN
mg/kg
Z.
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
3/25
78000
0.854
0.331
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
78800
40000
585
21.312
NA
Fescue
3/27
52000
0.854
0.220
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
78800
40000
585
14.208
NA
Fescue
8/20
123500
0.908
0.557
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
26.407
NA
Fescue
8/21
19500
0.908
0.088
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
4.170
NA
Fescue
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
273000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
66.097
0.000
Lime Applied
Annuallbs/acre
0.118
0.014
0.661
0.127
0.167
0.002
0.037
0.094
0.139
2.299 71.038
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.049
0.026
1.859
0.493
0.389
0.014
0.083
0.272
0.066
5.416
Current Cumulative lbs/ac
0.167
0.040
2.520
0.620
0.556
0.016
0.120
0.366
0.205
7.715
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
141
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 19
Land Owner: Daisy Purgason Annual Dry Tons Applied: 15.75 Site #: RCOl l Acres Permitted: 19
Operator: Harry Sharpe Predominant Soil Series: NaB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 178 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
* N'
7y C
?: 't
D
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
8/30
97500
0.908
0.194
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
9.217
NA
Fescue
8/31
156000
0.908
0.311
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
14.747
NA
Fescue
9/3
117000
0.908
0.233
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
11.060
NA
Fescue
9/4
45500
0.908
0.091
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
4.301
NA
Fescue
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
416000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
39.325
0.00o
Lime A lied
Annuallbs/acre
0.077
0.009
0.366
0.081
0.097
0.001
0.024
0.075
0.090
1.411 40.455
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.076
0.027
2.243
0.569
0.392
0.007
0.085
0.312
0.073
4.767
Current Cumulative lbs/ac
0.153
0.036
2.609
0.650
0.489
0.008
0.109
0.387
0.163
6.178
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
778
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 13.8
Land Owner: Iris Sharpe Annual Dry Tons Applied: 8.96 Site #: RCOl l Acres Permitted: 13.8
Operator: Harry Sharpe Predominant Soil Series: NaB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 178 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
may,
co o
a c
* �
o
*
Z
7y
?:
*
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/12
50
21.28
0.649
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
41300
4460
2
17.251
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
501
01
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
17.251
0.00o
Lime Applied
Annuallbs/acre
0.005
0.003
0.191
0.048
0.034
0.001
0.008
0.025
0.006
0.453 22.455
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.002
0.001
0.099
0.025
0.015
0
0.004
0.014
0.003
0.203
2000
Current Cumulative lbs/ac
0.007
0.004
0.290
0.073
0.049
0.001
0.012
0.039
0.009
0.656
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
178
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 8.8
Land Owner: Lawrence McCollum Annual Dry Tons Applied: 5.26 Site #: RC012 Acres Permitted: 8.8
Operator: Harry Sharpe Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
may,
co o
a c
*
o
*
°o
7y
?:
*
o'
TKN
mg/kg
98500
Z.
o
M o
�.
mg/kg
23500
Nitrate
and
Nitrite
mg/kg
2.23
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
3/29
188500
0.67
0.598
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
40.998
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
188500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
40.998
0.000
Lime A lied
Annuallbs/acre
0.004
0.002
0.202
0.053
0.072
0.001
0.007
0.027
0.006
0.666 26.910
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.038
0.021
1.778
0.441
0.268
0.008
0.069
0.266
0.053
3.707
2000
Current Cumulative lbs/ac
0.042
0.023
1.980
0.494
0.340
0.009
0.076
0.293
0.059
4.373
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 16.95
Land Owner: Melba Merritt Annual Dry Tons Applied: 19.73 Site #: RC018 Acres Permitted: 16.95
Operator: Barry Knight Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
c
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* �°n
o
*
7y CD
?: -t
o'
TKN
mg/kg
Z
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/13
123500
1.07
0.325
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
14.988
NA
Fescue
7/14
104000
1.07
0.274
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
12.622
NA
Fescue
7/17
123500
1.07
0.325
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
14.988
NA
Fescue
7/18
91000
1.07
0.240
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
11.044
NA
Fescue
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
4420001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
53.642
0.00o
Lime Applied
Annuallbs/acre
0.011
0.005
0.326
0.080
0.087
0.001
0.012
0.039
0.012
1.062 49.121
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.087
0.027
2.346
1.214
0.296
0.01
0.101
0.462
0.059
5.612
Current Cumulative lbs/ac
0.098
0.032
2.672
1.294
0.383
0.011
0.113
0.501
0.071
6.674
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 14.7
Land Owner: Melba Merritt Annual Dry Tons Applied: 4.07 Site #: RC018 Acres Permitted: 14.7
Operator: Barry Knight Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
c
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* �
o
*
Z
7y CD
?: -t
o'
TKN
mg/kg
Z
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
10/31
149500
0.6
0.254
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
210000
20000
4.43
34.099
NA
Fescue
11/1
13000
0.6
0.022
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
210000
20000
4.43
2.965
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
162500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
37.064
0.00o
Lime Applied
Annuallbs/acre
0.003
0.002
0.120
0.026
0.034
0.001
0.004
0.013
0.003
0.343 12.631
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.077
0.015
1.423
0.802
0.189
0.006
0.066
0.296
0.03
3.624
Current Cumulative lbs/ac
0.080
0.017
1.543
0.828
0.223
0.007
0.070
0.309
0.033
3.967
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized:
Mary Stanley Annual Dry Tons Applied: 2.71 Site #: RC019 Acres Permitted:
Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
Z
6
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co '2
0c
*
o
N
*
Z
7y C
?: 't
FL
*
o
TKN
mg/kg
Z
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
12/21
84500
0.77
0.452
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
64900
27300
2
22.549
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
22.549
0.000
Lime A lied
Annuallbs/acre
0.005
0.002
0.192
0.047
0.029
0.001
0.011
0.024
0.005
0.372 19.436
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.061
0.0191
1.3158
0
0.1603
0.0072
0.1136
0.3326
0.0193
3.8262
2000
Current Cumulative lbs/ac
0.066
0.021
1.507
0.047
0.189
0.008
0.124
0.357
0.025
4.199
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized:
Mary Stanley Annual Dry Tons Applied: 4.88 Site #: RC019 Acres Permitted:
Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
2
2
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co '2
c
*
o
* N
Z
7y C
?: 't
*
o
TKN
mg/kg
Z
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/6
45500
2.57
2.438
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
123.124
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
455001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
123.124
0.000
Lime A lied
Annuallbs/acre
0.079
0.013
1.078
0.219
0.295
0.020
0.041
0.113
0.092
3.842 110.685
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.159
0.046
3.484
1.727
0.55
0.021
0.177
0.74
0.108
11.743
Current Cumulative lbs/ac
0.238
0.059
4.562
1.946
0.845
0.041
0.218
0.853
0.200
15.585
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 3.3
Land Owner: Mary Stanley Annual Dry Tons Applied: 2.30 Site #: RC019 Acres Permitted: 3.3
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
Z
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
12/21
71500
0.77
0.696
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
64900
27300
2
34.690
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
71500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
34.690
0.000
Lime Applied
Annuallbs/acre
0.007
0.003
0.295
0.072
0.045
0.001
0.017
0.038
0.008
0.574 29.928
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.055
0.0172
1.2183
0
0.1392
0.0077
0.1015
0.3091
0.0219
3.4218
2000
Current Cumulative lbs/ac
0.062
0.020
1.513
0.072
0.184
0.009
0.118
0.347
0.030
3.995
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 4 Acres Utilized: 8.5
Land Owner: Mary Stanley Annual Dry Tons Applied: 14.63 Site #: RC019 Acres Permitted: 8.5
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �
o
*
Z
4
7y CD
?:
D
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/6
6500
2.57
0.082
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
4.139
NA
Fescue
5/7
130000
2.57
1.639
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
82.772
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
136500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
86.911
0.00o
Lime Applied
Annuallbs/acre
0.055
0.009
0.761
0.155
0.208
0.014
0.029
0.080
0.065
2.712 78.133
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.167
0.064
4.354
2.219
1.031
0.027
0.204
0.984
0.121
14.121
Current Cumulative lbs/ac
0.222
0.073
5.115
2.374
1.239
0.041
0.233
1.064
0.186
16.833
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 5 Acres Utilized:
Mary Stanley Annual Dry Tons Applied: 11.84 Site #: RC019 Acres Permitted:
Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
7.1
7.1
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co '2
a c
*
o
* N'
Z
4
7y CD
?:
D
o'
TKN
mg/kg
Z
o
ac o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/8
110500
2.57
1.668
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
84.230
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
110500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
84.230
0.00o
Lime Applied
Annuallbs/acre
0.054
0.009
0.737
0.150
0.201
0.014
0.028
0.077
0.063
2.629 75.727
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.116
0.033
2.764
1.154
0.467
0.021
0.138
0.635
0.067
8.155
Current Cumulative lbs/ac
0.170
0.042
3.501
1.304
0.668
0.035
0.166
0.712
0.130
10.784
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 11.6
Land Owner: Lofton Lovelace Annual Dry Tons Applied: 6.33 Site #: RC041 Acres Permitted: 11.6
Operator: Donald Lovelace Predominant Soil Series: CaD Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 150 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
42200
Z
o
m.
mg/kg
12200
Nitrate
and
Nitrite
mg/kg
2.48
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
6/6
39000
1.46
0.205
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
6.183
NA
Fescue
6/7
65000
1.46
0.341
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
10.304
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
104000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
16.487
0.000
Lime Applied
Annuallbs/acre
0.003
0.002
0.197
0.065
0.067
0.003
0.005
0.037
0.005
0.556 17.254
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.28
0.251
10.389
1.295
2.253
0.047
0.515
1.489
0.378
19.659
Current Cumulative lbs/ac
0.283
0.253
10.586
1.360
2.320
0.050
0.520
1.526
0.383
20.215
Permitted C. P. L. R.****
1 36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
150
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 6.8
Land Owner: Lofton Lovelace Annual Dry Tons Applied: 5.54 Site #: RC041 Acres Permitted: 6.8
Operator: Donald Lovelace Predominant Soil Series: CdB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
Z
4
7y CD
?D
*
o'
TKN
mg/kg
42200
Z
o
ac o
m.
mg/kg
12200
Nitrate
and
Nitrite
mg/kg
2.48
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
6/9
91000
1.46
0.815
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
24.609
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
91000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
24.609
0.000
Lime Applied
Annuallbs/acre
0.005
0.003
0.293
0.098
0.100
0.005
0.008
0.055
0.008
0.830 25.754
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.218
0.241
8.08
0.664
1.692
0.035
0.391
1.096
0.303
15.858
Current Cumulative lbs/ac
0.223
0.244
8.373
0.762
1.792
0.040
0.399
1.151
0.311
16.688
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 2.4
Land Owner: Lofton Lovelace Annual Dry Tons Applied: 3.21 Site #: RC041 Acres Permitted: 2.4
Operator: Donald Lovelace Predominant Soil Series: FrD2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 154 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
Z
o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/4
32500
1.48
0.836
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
60400
12100
2.38
34.336
NA
Fescue
5111
19500
1.48
0.501
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
60400
12100
2.38
20.602
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
52000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
54.938
0.000
Lime A lied
Annuallbs/acre
0.008
0.005
0.342
0.096
0.087
0.002
0.013
0.047
0.013
1.072 46.795
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.344
0.289
9.32
0.731
1.715
0.132
0.419
1.175
0.415
16.485
Current Cumulative lbs/ac
0.352
0.294
9.662
0.827
1.802
0.134
0.432
1.222
0.428
17.557
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
154
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 4 Acres Utilized: 19.4
Land Owner: Lofton Lovelace Annual Dry Tons Applied: 23.38 Site #: RC041 Acres Permitted: 19.4
Operator: Donald Lovelace Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
Z
o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
2/23
182000
0.67
0.262
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
98500
23500
2.23
17.956
NA
Fescue
2/24
45500
0.67
0.066
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
98500
23500
2.23
4.489
NA
Fescue
6/7
104000
1.46
0.326
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
9.858
NA
Fescue
6/8
175500
1.46
0.551
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
16.636
NA
Fescue
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
507000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
48.938
0.000
Lime Applied
Annuallbs/acre
0.007
0.005
0.427
0.134
0.147
0.006
0.012
0.074
0.012
1.258 42.473
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.286
0.272
11.243
2.041
2.238
0.054
0.544
1.541
0.391
22.059
Current Cumulative lbs/ac
0.293
0.277
11.670
2.175
2.385
0.060
0.556
1.615
0.403
23.317
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
269
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 11.4
Land Owner: Johnie Carty Annual Dry Tons Applied: 18.31 Site #: RC118 Acres Permitted: 11.4
Operator: Johnie Carty Predominant Soil Series: CcB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
n 'a
0
* �°n
o
*
4
7y
?:
D
o'
TKN
mg/kg
65800
Z
o
M o
m.
mg/kg
17300
Nitrate
and
Nitrite
mg/kg
2050
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
6/3
39000
2.57
0.367
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
18.515
NA
Fescue
6/4
78000
2.57
0.733
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
37.030
NA
Fescue
10/17
65000
1.52
0.361
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
8.927
NA
Fescue
10/18
26000
1.52
0.145
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
3.571
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
208000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
68.042
0.000
Lime Applied
Annuallbs/acre
0.064
0.010
0.815
0.164
0.232
0.011
0.032
0.077
0.076
2.908 76.454
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.523
0.444
30.892
1.23
5.974
0.156
1.17
4.35
0.682
52.289
Current Cumulative lbs/ac
0.587
0.454
31.707
1.394
6.206
0.167
1.202
4.427
0.758
55.197
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 5.6
Land Owner: Johnie Carty Annual Dry Tons Applied: 4.53 Site #: RC118 Acres Permitted: 5.6
Operator: Johnie Carty Predominant Soil Series: CcB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
°�
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
10/18
71500
1.52
0.809
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
19.989
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
71500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
19.989
0.00o
Lime Applied
Annuallbs/acre
0.045
0.006
0.526
0.104
0.159
0.003
0.022
0.042
0.055
1.877 42.392
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.525
0.473
39.875
1.31
7.499
0.177
1.243
5.509
0.673
62.982
Current Cumulative lbs/ac
0.570
0.479
40.401
1.414
7.658
0.180
1.265
5.551
0.728
64.859
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 23
Land Owner: Thomas Carter Annual Dry Tons Applied: 42.78 Site #: RC119 Acres Permitted: 23
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
Z
o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/30
110500
2.57
0.515
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
26.001
NA
Fescue
5/31
123500
2.57
0.575
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
29.060
NA
Fescue
10/24
149500
1.52
0.412
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
10.176
NA
Fescue
10/25
130000
1.52
0.358
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
8.849
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
5135001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
74.087
0.00o
Lime Applied
Annuallbs/acre
0.078
0.011
0.982
0.197
0.283
0.012
0.039
0.090
0.093
3.504 89.834
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.373
0.37
24.566
1.107
4.268
0.129
1.012
3.918
0.56
40.115
Current Cumulative lbs/ac
0.451
0.381
25.548
1.304
4.551
0.141
1.051
4.008
0.653
43.619
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized:
Thomas Carter Annual Dry Tons Applied: 21.76 Site #: RC119 Acres Permitted:
Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
7.1
7.1
0
c
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co
0
* o°n
o
* N
4
7y
?:
o'
TKN
mg/kg
65800
Z
o
ac o
m.
mg/kg
17300
Nitrate
and
Nitrite
mg/kg
1 2050
PAN A lied
pp
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
6/3
130000
2.57
1.962
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
99.094
NA
Fescue
10/25
91000
1.52
0.812
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
20.066
NA
Fescue
10/26
32500
1.52
0.290
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
7.166
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
253500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
126.326
0.00o
Lime A lied
Annuallbs/acre
0.125
0.019
1.584
0.319
0.453
0.020
0.062
0.148
0.149
5.651 146.872
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.381
0.35
24.011
1.232
4.12
0.133
0.929
3.774
0.542
38.568
Current Cumulative lbs/ac
0.506
0.369
25.595
1.551
4.573
0.153
0.991
3.922
0.691
44.219
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

SITE MONITORING REPORT
In pounds per acre
Project:
Reidsville
Owner:
Thomas Carter
Permit #:
W00002376
Crop:
Fescue
Weather Code
2
Operator:
Clinton Hanks
Field #:
RC119-03
Acres:
2.3
Site Code
2
Application Method
Surface
Date
Gallons % Solids
Gal/Ac
Dt/Ac
PAN
NO3-NO2
NH3
P
K
Pb
Zn
Cu
Ni
Cd
As
Hg
Se
Me
07/08/08
45,500 1.60
19782.61
1.3199
41.9331
0.3300
14.7828
6.3355
4.2237
0.0132
0.1109
0.0686
0.0132
0.0026
0.0066
0.0011
0.0079
0.0132
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
Totals:
Annual:
45,500
19782.61
1.3199
1 41.9331
0.3300
14.7828
6.3355
4.2237
0.0132
0.1109
0.0686
0.0132
0.0026
0.0066
0.0011
0.0079
0.0132
Total Cumulatives:
0.4989
5.6963
3.2795
0.3100
0.1375
0.0795
0.0119
0.0969
0.1481
Prior Years Cumulatives:
0.4857
5.5854
3.2109
0.2968
0.1349
0.0729
0.0108
0.0890
0.1349
Annual Dry Tons
3.0358
FAN
267.00 1 2498.00 1 1338.00 1 374.00 1 34.00 1 36.00 1 15.00 1 89.00
(Lifetime Permit Limits)
SOIL MONITORING
Soil pH Lime Appl. Ton/AC
Weather Code: 1) >90F 2) 70-90F 3)32-70F ****** A) Less than 1/2 inch rainfall B) Greater than 1/2 inch rainfall in past 24 hours
Site Condition Code: 1) Excessively Dry 2) Dry 3) Moist 4) Wet
I, , representative of EMA Resources, Inc., hereby certify that this site was operated in compliance with the conditions of Nondischarge Permit No. WQ0002376

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 4 Acres Utilized: 19.1
Land Owner: Thomas Carter Annual Dry Tons Applied: 46.68 Site #: RC119 Acres Permitted: 19.1
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
Z
o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/23
91000
2.57
0.511
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
25.785
NA
Fescue
5/24
91000
2.57
0.511
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
25.785
NA
Fescue
5/28
188500
2.57
1.058
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
53.412
NA
Fescue
5/29
65000
2.57
0.365
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
18.418
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
435500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
123.400
0.000
Lime Applied
Annuallbs/acre
0.079
0.013
1.080
0.220
0.295
0.020
0.041
0.113
0.092
3.852 110.958
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.294
0.323
21.598
0.76
3.637
0.12
0.86
3.514
0.489
34.516
Current Cumulative lbs/ac
0.373
0.336
22.678
0.980
3.932
0.140
0.901
3.627
0.581
38.368
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 5 Acres Utilized: 8.5
Land Owner: Thomas Carter Annual Dry Tons Applied: 18.11 Site #: RC119 Acres Permitted: 8.5
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
?:
D
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/9
39000
2.57
0.492
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
24.832
NA
Fescue
5110
130000
2.57
1.639
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
82.772
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
169000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
107.604
0.000
Lime Applied
Annuallbs/acre
0.069
0.011
0.942
0.192
0.257
0.018
0.036
0.098
0.080
3.358 96.747
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.394
0.309
15.394
2.001
2.887
0.077
0.645
2.052
0.507
31.283
Current Cumulative lbs/ac
0.463
0.320
16.336
2.193
3.144
0.095
0.681
2.150
0.587
34.641
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 6 Acres Utilized: 9.5
Land Owner: Thomas Carter Annual Dry Tons Applied: 26.72 Site #: RC119 Acres Permitted: 9.5
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
n 'a
0
* �°n
o
*
7y
?:
D
o'
TKN
mg/kg
Z
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/29
123500
2.57
1.393
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
70.356
NA
Fescue
5/30
110500
2.57
1.247
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
62.951
NA
Fescue
10/24
26000
1.52
0.173
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
4.285
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
2600001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
137.592
0.00o
Lime Applied
Annuallbs/acre
0.095
0.015
1.279
0.260
0.353
0.022
0.049
0.131
0.111
4.562 128.921
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.178
0.067
5.523
1.221
0.846
0.029
0.266
0.738
0.205
12.274
Current Cumulative lbs/ac
0.273
0.082
6.802
1.481
1.199
0.051
0.315
0.869
0.316
16.836
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 8 Acres Utilized: 4.5
Land Owner: Thomas Carter Annual Dry Tons Applied: 5.57 Site #: RC119 Acres Permitted: 4.5
Operator: Thomas Carter Predominant Soil Series: JkB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 87.75 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
Z
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/22
52000
2.57
1.238
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
62.539
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
52000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
62.539
0.00o
Lime Applied
Annuallbs/acre
0.040
0.007
0.547
0.111
0.150
0.010
0.021
0.057
0.047
1.951 56.205
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.057
0.014
1.126
0.044
0.204
0.006
0.055
0.159
0.061
2.111
Current Cumulative lbs/ac
0.097
0.021
1.673
0.155
0.354
0.016
0.076
0.216
0.108
4.062
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
87.75
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 9 Acres Utilized: 13.5
Land Owner: Thomas Carter Annual Dry Tons Applied: 16.83 Site #: RC119 Acres Permitted: 13.5
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
n 'a
0
* �°n
o
*
7y
?:
D
o'
TKN
mg/kg
42200
Z
o
M o
m.
mg/kg
12200
Nitrate
and
Nitrite
mg/kg
2.48
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/24
117000
1.46
0.528
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
15.937
NA
Fescue
5/25
91000
1.46
0.410
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
42200
12200
2.48
12.396
NA
Fescue
8/30
91000
1.1
0.309
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
46800
15300
2.25
10.576
NA
Fescue
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
299000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
38.909
0.00o
Lime A lied
Annuallbs/acre
0.009
0.005
0.464
0.139
0.152
0.006
0.014
0.076
0.012
1.296 42.310
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.179
0.082
5.559
1.268
0.898
0.028
0.22
0.743
0.224
12.067
Current Cumulative lbs/ac
0.188
0.087
6.023
1.407
1.050
0.034
0.234
0.819
0.236
13.363
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 10 Acres Utilized: 6.6
Land Owner: Thomas Carter Annual Dry Tons Applied: 13.23 Site #: RC119 Acres Permitted: 6.6
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
D
o'
TKN
mg/kg
Z
o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN App lied
lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/8
32500
2.57
0.528
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
26.650
NA
Fescue
5/9
91000
2.57
1.478
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
74.620
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
123500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
101.271
0.000
Lime A lied
Annuallbs/acre
0.065
0.011
0.886
0.180
0.242
0.017
0.034
0.093
0.075
3.160 91.027
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.084
0.035
1.712
0.747
0.263
0.014
0.118
0.43
0.047
5.283
Current Cumulative lbs/ac
0.149
0.046
2.598
0.927
0.505
0.031
0.152
0.523
0.122
8.443
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 11 Acres Utilized: 20
Land Owner: Thomas Carter Annual Dry Tons Applied: 9.06 Site #: RC119 Acres Permitted: 20
Operator: Thomas Carter Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
°�
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/22
84500
2.57
0.453
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
22.866
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
1
0.000
0.000
0.000
1
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
845001
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
22.866
0.00o
Lime Applied
Annuallbs/acre
0.015
0.002
0.200
0.041
0.055
0.004
0.008
0.021
0.017
0.714 20.566
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.074
0.023
1.573
0.691
0.202
0.01
0.089
0.371
0.04
4.291
Current Cumulative lbs/ac
0.089
0.025
1.773
0.732
0.257
0.014
1 0.097
1 0.392
0.057
5.005
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 12 Acres Utilized: 2.6
Land Owner: Thomas Carter Annual Dry Tons Applied: 2.02 Site #: RC119 Acres Permitted: 2.6
Operator: Thomas Carter Predominant Soil Series: NaB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 133.5 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
*
o
*
°�
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/22
26000
1.86
0.776
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
39.169
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
26000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
39.169
0.00o
Lime Applied
Annuallbs/acre
0.025
0.004
0.343
0.070
0.094
0.006
0.013
0.036
0.029
1.223 35.230
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.111
0.069
3.752
0.789
0.441
0.012
0.184
0.85
0.076
8.405
Current Cumulative lbs/ac
0.136
0.073
4.095
0.859
0.535
0.018
0.197
0.886
0.105
9.628
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
133.5
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 21.25
Land Owner: Gene Small Annual Dry Tons Applied: 8.97 Site #: RC125 Acres Permitted: 21.25
Operator: Gene Small Predominant Soil Series: CdB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
may,
co o
a c
* �
o
*
Z
7y
?:
*
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/7
50
21.28
0.422
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
41300
4460
2
11.203
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
501
01
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
11.203
0.00o
Lime Applied
Annuallbs/acre
0.003
0.002
0.124
0.031
0.022
0.000
0.005
0.016
0.004
0.295 14.601
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
2000
Current Cumulative lbs/ac
0.003
0.002
0.124
0.031
0.022
0.000
0.005
0.016
0.004
0.295
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 6.5
Land Owner: Gene Small Annual Dry Tons Applied: 8.96 Site #: RC125 Acres Permitted: 6.5
Operator: Gene Small Predominant Soil Series: CdB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
�y
co
c
* �
o
*
Z
4
7y CD
?D
*
o'
TKN
mg/kg
Z
o
ac o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/7
50
21.28
1.379
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
41300
4460
2
36.626
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
50
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
ZnJJP$36.1626
0.00o
Lime A lied
Annuallbs/acre
0.011
0.006
0.405
0.102
0.072
0.001
0.017
0.052
0.014
0.963
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.011
0.006
0.405
0.102
0.072
0.001
0.017
0.052
0.014
0.963
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 4 Acres Utilized: 9.9
Land Owner: Harvery Albert Annual Dry Tons Applied: 25.08 Site #: RC125 Acres Permitted: 9.9
Operator: Gene Small Predominant Soil Series: NaB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 178 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z
o
CD N
0
7y C
?: 't
� o'
TKN
mg/kg
Z.
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/2
143000
2.57
1.548
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
78.174
NA
Fescue
5/21
91000
2.57
0.985
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
49.747
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
234000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
127.921
0.00o
Lime A lied
Annuallbs/acre
0.082
0.014
1.120
0.228
0.306
0.021
0.042
0.117
0.095
3.992 114.998
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.037
0.02
1.639
0.416
0.361
0.011
0.058
0.241
0.051
4.008
Current Cumulative lbs/ac
0.119
0.034
2.759
0.644
0.667
0.032
0.100
0.358
0.146
8.000
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
778
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 5 Acres Utilized: 9.5
Land Owner: Harvery Albert Annual Dry Tons Applied: 33.44 Site #: RC125 Acres Permitted: 9.5
Operator: Gene Small Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z
o
CD N
0
7y C
?: 't
� o'
TKN
mg/kg
Z.
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/3
188500
2.57
2.126
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
107.386
NA
Fescue
5/4
123500
2.57
1.393
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
70.356
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
312000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
177.743
0.000
Lime Applied
Annuallbs/acre
0.113
0.019
1.556
0.317
0.425
0.029
0.059
0.163
0.132
5.548 159.808
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.037
0.019
1.599
0.422
0.31
0.01
0.057
0.235
0.051
3.775
Current Cumulative lbs/ac
0.150
0.038
3.155
0.739
0.735
0.039
0.116
0.398
0.183
9.323
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 6 Acres Utilized: 25
Land Owner: Harold Sharpe Annual Dry Tons Applied: 28.55 Site #: RC125 Acres Permitted: 25
Operator: Gene Small Predominant Soil Series: RnD Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 141 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z
o
CD N
0
7y C
?: 't
� o'
TKN
mg/kg
65800
Z.
o
M o
m.
mg/kg
17300
Nitrate
and
Nitrite
mg/kg
2050
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
5/18
188500
2.57
0.808
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
40.807
NA
Fescue
5/20
78000
2.57
0.334
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
16.886
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
266500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
57.692
0.000
Lime Applied
Annuallbs/acre
0.037
0.006
0.505
0.103
0.138
0.009
0.019
0.053
0.043
1.800 51.847
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.035
0.019
1.586
0.406
0.304
0.01
0.059
0.239
0.052
3.713
Current Cumulative lbs/ac
0.072
0.025
2.091
0.509
0.442
0.019
0.078
0.292
0.095
5.513
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
141
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized: 34
Land Owner: State of N.C. Annual Dry Tons Applied: 64.06 Site #: RC126 Acres Permitted: 34
Operator: Auman French Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 209 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
* N'
7y C
?: 't
D
o'
TKN
mg/kg
Z.
o
M o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
3/27
58500
0.854
0.061
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
78800
40000
585
3.949
NA
Fescue
3/28
136500
0.854
0.143
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
78800
40000
585
9.214
NA
Fescue
3/29
149500
0.854
0.157
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
78800
40000
585
10.092
NA
Fescue
4/1
84500
2.57
0.266
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
65800
17300
2050
13.450
NA
Fescue
4/2
1
97500
1 2.57
0.307
Reidsville WWTP
Dry
<.5"1
S
0.5
0.3
65800
17300
2050
15.520
NA
Fescue
4/3
71500
2.57
0.225
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
1 65800
17300
1 2050
11.381
NA
Fescue
8/21
162500
0.908
0.181
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
8.584
NA
Fescue
8/27
45500
0.908
0.051
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
2.404
NA
Fescue
8/28
136500
0.908
1 0.152
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
7.211
NA
Fescue
8/29
221000
0.908
0.246
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
11.675
NA
Fescue
8/30
84500
0.908
0.094
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
4.464
NA
Fescue
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
1248000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
97.944
0.000
Lime A lied
Annuallbs/acre
0.131
0.017
0.919
0.185
0.241
0.008
0.046
0.126
0.154
3.278 97.526
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.073
0.038
2.834
0.9
0.852
0.016
0.123
0.462
0.098
8.499
Current Cumulative lbs/ac
0.204
0.055
3.753
1.085
1.093
0.024
0.169
0.588
0.252
11.777
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 17.15
Land Owner: Marian French Annual Dry Tons Applied: 23.34 Site #: RC126 Acres Permitted: 17.15
Operator: Auman French Predominant Soil Series: Cg132 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 185 Crop 2 Name: Crop 2 Max. PAN:
Q
Volume applied
(enter one) Solids/
Liquid
9
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
� �.
* Z°n
o
* �'
7y C
A
�. N•
*w
o'
TKN
mg/kg
Z.
o
pQ o
� �2.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
4/11
78000
2.55
0.484
Unifi Inc.
Dry
<.5"
S
0.5
0.3
25500
7200
2980
11.675
NA
Fescue
4/12
19500
2.55
0.121
Unifi Inc.
Dry
<.5"
S
0.5
0.3
25500
7200
2980
2.919
NA
Fescue
4/17
45500
2.55
0.282
Unifi Inc.
Dry
<.5"
S
0.5
0.3
25500
7200
2980
6.810
NA
Fescue
8/19
117000
0.908
0.258
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
12.253
NA
Fescue
8/20
97500
0.908
0.215
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
10.211
NA
Fescue
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
357500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
43.868
0.00o
Lime Applied
Annuallbs/acre
0.074
0.009
0.465
0.133
0.164
0.003
0.023
0.072
0.086
1.829 33.420
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.016
0.009
0.782
0.18
0.14
0.004
0.032
0.105
0.025
1.788
Current Cumulative lbs/ac
0.090
0.018
1.247
0.313
0.304
0.007
0.055
0.177
0.111
3.617
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
1 15
1
1 374
89
2498
Permit PAN Limit 1 st/2nd Crop
185
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 23.5
Land Owner: Dennis Williams Annual Dry Tons Applied: 18.33 Site #: RC128 Acres Permitted: 23.5
Operator: Dennis Williams Predominant Soil Series: CdB2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Pasture Crop 1 Max. PAN: 156 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.y
Past 24
Hrs.
inches
co 'a
0
* �°n
o
*
4
7y CD
?:
D
o'
TKN
mg/kg
31600
Z
o
ac o
m.
mg/kg
5340
Nitrate
and
Nitrite
mg/kg
728
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
12/13
71500
2.05
0.260
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
5.866
NA
Fescue
12/14
117000
2.05
0.426
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
31600
5340
728
9.598
NA
Fescue
12/15
26000
2.05
0.095
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
31600
5340
728
2.133
NA
Fescue
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
214500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
17.597
0.000
Lime Applied
Annuallbs/acre
0.005
0.003
0.008
0.008
0.008
0.002
0.008
0.008
0.008
0.618 23.244
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.022
0.009
0.763
0.157
0.106
0.003
0.031
0.105
0.019
1.613
Current Cumulative lbs/ac
0.027
0.012
0.771
0.165
0.114
0.005
0.039
0.113
0.027
2.231
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
156
"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
2/7/2017 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
City of Reidsville WQ Permit #: WQ0002376 Field #: 2 Acres Utilized:
Kimmy Hanks Annual Dry Tons Applied: 8.05 Site #: RC128 Acres Permitted:
Dennis Williams Predominant Soil Series: PcD2 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 158 Crop 2 Name: Crop 2 Max. PAN:
4
4
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* o°n
o
* N'
7y
?:
D
o'
TKN
mg/kg
65700
Z.
o
ac o
�.
mg/kg
14100
Nitrate
and
Nitrite
mg/kg
2
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
4/3
26000
1.98
0.537
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
24.185
NA
Fescue
5/6
71500
1.98
1.476
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65700
14100
2
66.508
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
97500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
90.693
0.00o
Lime A lied
Annuallbs/acre
0.012
0.008
0.580
0.133
0.081
0.003
0.024
0.093
0.020
1.184 64.819
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.0032
0.0011
0.1023
0.0203
0.0143
0.0004
0.0041
0.0134
0.0023
0.2184
Current Cumulative lbs/ac
0.015
0.009
0.682
0.153
0.095
0.004
0.028
0.106
0.022
1.402
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
158
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 3 Acres Utilized: 15
Land Owner: Kimmy Hanks Annual Dry Tons Applied: 33.81 Site #: RC128 Acres Permitted: 15
Operator: Dennis Williams Predominant Soil Series: PcD2 Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 158 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co
0
* o°n
o
* N'
7y
?:
D
o'
TKN
mg/kg
65700
Z.
o
ac o
�.
mg/kg
14100
Nitrate
and
Nitrite
mg/kg
2
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
4/3
91000
1.98
0.501
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
22.573
NA
Fescue
4/6
78000
1.98
0.429
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65700
14100
2
19.348
NA
Fescue
515
84500
1.98
0.465
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65700
14100
2
20.960
NA
Fescue
5/6
91000
1.98
0.501
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
65700
14100
2
22.573
NA
Fescue
5/7
1
65000
1 1.98
0.358
Reidsviile WWTP
Dry
<.5"1
S
0.5
0.3
65700
14100
2
16.123
NA
I Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4-0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
0
409500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
101.577
0.000
Lime Applied
Annuallbs/acre
0.014
0.009
0.649
0.149
0.090
0.004
0.027
0.104
0.023
1.325 72.579
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.0095
0.0032
0.3001
0.0595
0.0419
0.0012
0.0122
0.0392
0.0068
0.6407
Current Cumulative lbs/ac
0.023
0.012
0.949
0.208
0.132
0.005
0.039
0.143
0.029
1.966
Permitted C. P. L. R.****
36
1 34
1 1338
1
1 267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
158
"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
1/18/2016 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially 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 FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1 Acres Utilized: 21
Land Owner: Ken Martin Annual Dry Tons Applied: 37.07 Site #: RC130 Acres Permitted: 21
Operator: Ken Martin Predominant Soil Series: CmB Cation Exchange Capacity (non 503): 0
Crop 1 Name: Fescue -Hay Crop 1 Max. PAN: 146 Crop 2 Name: Crop 2 Max. PAN:
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
co 'a
0
* Z°n
o
CD N
7y C
?: 't
o'
TKN
mg/kg
Z.
o
M o
m.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
9/5
84500
0.908
0.152
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
7.227
NA
Fescue
9/6
110500
0.908
0.199
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
63000
21600
498
9.451
NA
Fescue
10/18
104000
1.52
0.314
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
7.753
NA
Fescue
10/19
182000
1.52
0.549
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
33700
9670
306
13.568
NA
Fescue
12/7
1
32500
1 1.52
0.098
Reidsviile WWTP
Dry
<.5"1
S
0.5
0.3
33700
9670
306
2.423
NA
Fescue
12/8
149500
1.52
0.451
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
1 33700
9670
1 306
11.145
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM
FSF supp ( attach FORM
FSF supp
to this form):
TOTALS:
01
663000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
51.568
0.00o
Lime A lied
Annuallbs/acre
0.112
0.014
1.074
0.216
0.318
0.005
0.048
0.105
0.135
3.877 91.219
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.131
0.064
5.295
1.515
0.956
0.029
0.213
0.812
0.168
12.677
Current Cumulative lbs/ac
0.243
0.078
6.369
1.731
1.274
0.034
0.261
0.917
0.303
16.554
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
446
"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
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)