WQ0037637_Renewal with Major Modification_20200317

Initial Review
INITIAL REVIEW
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Is this a complete
application?*
Complete App Date
r Yes r No
03/19/2020
Project Number* WQ0037637
Applicant/Permittee Craven Ag Services, Inc.
Applicant/Permittee 2115 NC Highway 55 NewBern, NC 28562
Address
Is the owner in BIMS?
Is the facility in BIMS?
r Yes r No
r Yes r No
Owner Type Organization
Facility Name Craven Ag Services RLAP
County Craven
Fee Category
Fee Amount
Minor
245
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if
non -application)
Email Notifications
Does this need review by the hydrogeologist?*
r Yes r No
Regional Office Washington
CO Reviewer Erick Saunders: eads\egsaunders

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 * Robert T. Branch
Email Address*
[e-mail]
Project Information
Submittal Type* r New Permit Application
r Renewal
r Annual Report
r Other
Renewal with Major Modification
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 WQ0037637
currently has project
Applicant\Permittee * Craven Ag Services, Inc.
Phone Number*
336.510-0340
Applicant/Permittee 2115 NC Highway 55 NewBern, NC 28562
Address*
Facility Name * Craven Ag Services RLAP
r Modification (Major or Minor)
r Additional Information
r Residual Annual Report
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
This is a renewal and modification to the current permit.
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
Craven Renewal Final.pdf 10.06MB
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 3/17/2020

APPLICATION FOR PERMIT RENEWAL
AND MODIFICATION
CRAVEN AG SERVICES, INC.
LAND APPLICATION PROGRAM
PERMIT #WQ0037637
CRAVEN COUNTY, NORTH CAROLINA
Prepared For:
Craven Ag Services, Inc.
2115 NC Highway 55
New Bern, North Carolina 28562
Prepared By:
Branch Residuals & Soils, LLC
1735 Heckle Blvd. Suite 103-291
Rock Hill, SC 29732
March 2020

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
1. APPLICANT INFORMATION:
1. Applicant's name: Craven Ag Services, Inc.
Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Mr. John W. Dunham Title: President
Applicant's mailing address: 2155 NC Highway 55
City: New Bern State: NC Zip: 28562-
Telephone number: 252 633-5334 Email Address: cravenagservices.gmail.com
2. Consultant's name: Robert T. Branch License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: Branch Residuals & Soils. LLC.)
Consultant's mailing address: 1735 Heckle Blvd. Suite 103-291
City: Rock Hill State: SC Zip: 29732-
Telephone number: [phone] Email Address: [e-mail]
3. Agronomist's name: Robert T. Branch License Number:
Affiliation: ❑ NIA ❑ On Staff ® Retained (Firm: Branch Residuals & Soils LLC)
Agronomist's mailing address: Same As Above
City: State: Zip: -
Telephone number: (_) = Email Address:
4. Soil Scientist's name: Robert T. Branch License Number: 1180
Affiliation: ❑ NIA ❑ On Staff ® Retained (Firm: Branch Residuals & Soils. LLC.)
Soil Scientist's mailing address: Same As Above
City: State: Zip: -
Telephone number: (_) = Email Address:
5. Fee submitted: $245.00 (See Instruction B)
11. PERMIT INFORMATION:
I . Application is for (check all that apply): ❑ new, ® modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00037637
Date of most -recently issued permit: April 17, 2015
Date of most -recently certified Attachment A (if different than the permit): June 21,2017
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Pagel of 5

BRANCH RESIDUALS & SOLLS, LLC
1735 Heckle Blvd, Suite 103-291, Rock Hill, SC 29732
PHONE [phone]
March 16, 2020
NCDEQ -Division of Water Resources
Non -Discharge Branch
Mail Service Center 1617
Raleigh, North Carolina 27699-1617
Attention: Mr. Nathaniel Thornburg
Reference: PERMIT MODIFICATION WQ0037637
Craven Ag Services, Inc. Land Application Program
Craven County, North Carolina
BR&S Job No. 2019-132
Dear Mr. Thornburg:
Branch Residuals & Soils, LLC is under contract with Craven Ag Services, Inc. to provide
assistance in the preparation of a permit renewal and modification to include a new source
(Riverbend) to be added to Attachment A for land application. The dry tons will be adjusted for the
sources that are listed for this permit. The current production of the facilities listed on this permit,
are overstated based on their potential due to their designed size rather than actual production.
Acreage changes are the result of changes in the buffers based on the 2T rules.
Your attention in the review of this application would be greatly appreciated. Please contact me
immediately at [phone], if you require additional information or have questions in the
review of the permit application. The $245.00 minor modification fee is included.
Sincerely,
Robert T. Branch, L. S. S.
Project Manager
cc: Mr. Billy Dunham — Craven Ag Services, Inc.

APPLICATION FOR PERMIT RENEWAL
AND MODIFICATION
CRAVEN AG SERVICES, INC.
LAND APPLICATION PROGRAM
PERMIT #WQ0037637
CRAVEN COUNTY, NORTH CAROLINA
Prepared For:
Craven Ag Services, Inc.
2115 NC Highway 55
New Bern, North Carolina 28562
Prepared By:
Branch Residuals & Soils, LLC
1735 Heckle Blvd. Suite 103-291
Rock Hill, SC 29732
March 2020

BRANCH RESIDUALS & SOILS, LLC
17355 Heckle Blvd, Suite 103-291, Rock Hill, SC 29732
PHONE [phone]
March 20, 2020
NCDEQ -Division of Water Resources
Non -Discharge Branch
Mail Service Center 1617
Raleigh, North Carolina 27699-1617
Attention: Mr. Nathaniel Thornburg
Reference: PERMIT MODIFICATION WQ0037637
Craven Ag Services, Inc. Land Application Program
Craven County, North Carolina
BR&S Job No. 2019-132
Dear Mr. Thornburg:
Branch Residuals & Soils, LLC is under contract with Craven Ag Services, Inc. to provide
assistance in the preparation of a permit renewal and modification to include a new source (
Riverbend) to be added to Attachment A for land application. The dry tons will be adjusted for the
sources that are listed for this permit. The current production of the facilities listed on this permit,
are overstated based on their potential due to their designed size rather than actual production.
Your attention in the review of this application would be greatly appreciated. Please contact me
immediately at [phone], if you require additional information or have questions in the
review of the permit application. The $245.00 minor modification fee is included.
Sincerely,
Robert T. Branch, L. S. S.
Project Manager
cc: Mr. Billy Dunham — Craven Ag Services, Inc.

TABLE OF CONTENTS
Section No. Title
I RESIDUALS LAND APPLICATION PROGRAM — RLAP 06-16
Residual Source Workbook
Copy of Existing Permit
Operation and Maintenance Plan
II RESIDUALS SOURCE CERTIFICATION MAYSVILLE— RSC 06-16
Facility Vicinity Map
Process Flow Narrative
Justification for Residuals Production Rate
Residuals Sampling Plan
Lab Analytical Reports and Operational Data
III RESIDUALS SOURCE CERTIFICATION BRIDGETON— RSC 06-16
Facility Vicinity Map
Process Flow Narrative
Justification for Residuals Production Rate
Residuals Sampling Plan
Lab Analytical Reports and Operational Data
IV RESIDUALS SOURCE CERTIFICATION PRUITT HEALTH sEALEVEL,Nc— RSC 06-16
Facility Vicinity Map
Process Flow Narrative
Justification for Residuals Production Rate
Residuals Sampling Plan
Lab Analytical Reports and Operational Data
V RESIDUALS SOURCE CERTIFICATION RIVERBEND— RSC 06-16
Facility Vicinity Map
Process Flow Narrative
Justification for Residuals Production Rate
Residuals Sampling Plan
Lab Analytical Reports and Operational Data
VI LAND APPLICATION SITE CERTIFICATION — LASC — 06-16
Landowner Agreement Attachments
Updated Maps
Site Vicinity Map
Buffer Map
Cumulative Pollutant Loading Rates

RESIDUALS LAND APPLICATION PROGRAM

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0I06(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification
Major (land are permitted for > 300 acres) $1,310 $395
Minor (land are permitted for < 300 acres) $810 $245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC I C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page] of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
® For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
® Submit the O&M Plan in accordance with 15A NCAC 02T. 1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
® Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
® Safety measures; may include safety training program, manuals, signs, etc.
® Spill response plan; including control, containment, remediation, emergency contact information, etc.
® Inspection plan including the following information;
® Names and titles of personnel responsible for conducting the inspections.
® Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
® Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
® Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
® Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.110202). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11 " by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

1. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: http://www.ncwater.or,/Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., G1S, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Craven Ag Services, Inc.
Applicant type: ❑ Individual N Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Mr. John W. Dunham Title: President
Applicant's mailing address: 2155 NC Highway 55
City: New Bern State: NC Zip: 28562-
Telephone number: [phone] Email Address: cravenagservices.I;mail.com
2. Consultant's name: Robert T. Branch License Number (for P.E.):
Affiliation: ❑ On Staff N Retained (Firm: Branch Residuals & Soils LLC.)
Consultant's mailing address: 1735 Heckle Blvd. Suite 103-291
City: Rock Hill State: SC Zip: 29732-
Telephone number: [phone] Email Address: bbranch(c�r�,branchrs.com
3. Agronomist's name: Robert T. Branch License Number:
Affiliation: ❑ N/A ❑ On Staff N Retained (Firm: Branch Residuals & Soils. LLC)
Agronomist's mailing address: Same As Above
City: State: Zip:
Telephone number: (_) _ _ Email Address:
4. Soil Scientist's name: Robert T. Branch License Number: H 80
Affiliation: ❑ N/A ❑ On Staff N Retained (Firm: Branch Residuals & Soils, LLC.)
Soil Scientist's mailing address: Same As Above
City: State: Zip: -
Telephone number: (_) _- Email Address:
5. Fee submitted: 810.00 (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, N modified, N renewed permit
2. If this application is being submitted to renew or modify an existing pen -nit, provide the following:
Permit number: W00037637
Date of most -recently issued permit: April 17, 2015
Date of most -recently certified Attachment A (if different than the permit): June 21,2017
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 2115 NC Highway 55.
City: New Bern State: NC Zip: 28562-
Coordinates: Latitude: 35' 09' 58" N Longitude: 77 09' 40" W
Datum: WGS84 Level of accuracy: I'
Method of measurement: Gooele Earth
2. County where residuals land application program is headquartered: Craven
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
John W. Dunham, Sr.
Craven Ag Services, Inc.
LA 13203
Back -Up ORC
Mac Dunham
Craven Ag Services, Inc.
LA24992
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 NitroPeu 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: Attached is a table with the weighted averages for the 4 sources that total 51 dry tons.
Maximum amount of residuals to be certified: 51 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
25.97
29.49
1 1,324.22
1,504.00
Five -Year Maximum Adjusted
1 38.71
42.23
1 1,974.16
2,153.94
b. Laud 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
199.21
Hay
16.65
Pasture
0
Total:
215.85
215.86 Subsurface/ 180.7 Surface
Methods
Surface
0
Incorporation or Injection
215.86
215.86 can be used for Subsurface application of this
180.7 Acres can be used for Surface
Total:
1 215.86
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summarv: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
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
26.48
30.08
39.48
43.08
100
13.24
15.04
19.74
21.54
150
8.83
10.03
13.16
14.36
200
6.62
7.52
9.87
10.77
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.
L
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.
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:
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 ❑ 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
W
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft-
Nozzle capacity
gpm
Nozzle manufacturer/ model
1
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.
® Yes ❑ No, Explain;
1, John W. Dunham, Sr. President
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Craven At; Services, Inc. Land Application Program
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a 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 § 143-215.613, 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:
FORM: RLAP 06-16 Page 5 of 5

Residual Source Workbook

PAN Surface
Facility
Dry tons
First Year
mg/Kg
#/DT
Town of Maysville
30
8,944
268320
40.52498
Town of Bridgeton
5
13,761
68807.14
10.3921
Pruitt Health at Sea Le
1
9,323
9322.94
1.408065
Town of River Bend, N
15
21,044
315660
47.67485
0
0
5,924
0
0
0
0
6,292
0
0
0
0
17,652
0
0
0
0
2,466
0
0
0
0
9,530
0
0
0
0
13,794
0
0 Weighted Average
0
0
7,298
0
0 mg/Kg #/DT
0
0
25,598
0
0
Totals
Facility
Town of Maysville
Town of Bridgeton
Pruitt Health at Sea Le
Town of River Bend, N
0
0
0
Totals
Facility
Town of Maysville
Town of Bridgeton
Pruitt Health at Sea Le
Town of River Bend, N
0
0
0
Totals
Facility
Town of Maysville
Town of Bridgeton
Pruitt Health at Sea Le
Town of River Bend, N
0
0
0
Totals
51
Dry tons
Five Year
30
13,748
5
21,992
1
14,875
15
29,987
0
20,747
0
11,199
0
35,592
51
Dry tons
First Year
30
9,764
5
13,799
1
9,398
15
25,379
0
17,149
0
8,738
0
29,718
51
Dry tons
Five Year
30
14,568
5
22,030
1
14,950
15
34,322
0
24,102
0
12,639
0
39,712
51
662110.08 12982.55 25.9651
PAN Surface
mg/Kg #/DT
412441.2497 41.78389
109958.514 11.13976
14874.81561 1.506948
449807.3673 45.5694
0 0 Weighted Average
0 0 mg/Kg #/DT
0 0
987081.9466 19354.55 38.7091
PAN Injection
mg/Kg
#/DT
292920
38.95211
68997.49
9.175194
9397.89
1.249719
380685
50.62298
0
0
Weighted Average
0
0
mg/Kg #/DT
0
0
752000.38
14745.11 29.49021
PAN Injection
mg/Kg #/DT
437041.2497 40.58055
110148.864 10.22764
14949.76561 1.388129
514832.3673 47.80368
0 0 Weighted Average
0 0 mg/Kg #/DT
0 0
1076972.247 21117.1 42.23421

Total PAN For All Sources
NDRLAP Section III 7a. Page 4 of 6
PAN
Pounds of PAN per Dry
First -Year
Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation or
Injection
Surface
Incorporation
or Injection
25.97
29.49
1,324.22
1,504.00
Five Year Maximum Adjusted
38.71
42.23
1,974.16
2,153.94
Most Restricting PAN 1,974.16

Copy of Existing Permit

North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 17, 2015
Mr. John W. Dunham — President
Craven Ag Services, Inc.
2111 NC Highway 55
New Bern, NC 28562
Subject: Permit No. WQ0037637
Craven Ag Services RLAP
Land Application of Class B Residuals (503)
Craven County
Dear Mr. Dunham:
Donald R. van der Vaart
Secretary
In accordance with your permit application request received March 5, 2015, and subsequent
additional information received April 9, 2015 and April 10, 2015, we are forwarding herewith Permit No.
WQ0037637 dated April 17, 2015, to Craven Ag Services, Inc. for the operation of the subject residuals
management program.
This permit shall be effective from the date of issuance until March 31, 2020, and shall be subject
to the conditions and limitations as specified therein. Please pay particular attention to the monitoring
requirements listed in Attachments A and B.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this permit, please contact Troy Doby at (919)
807-6336 or [e-mail].
Sincerely,
�,� lJa)�Director
Division of Water Resources
cc: Craven County Health Department[[e-mail]] (Electronic Copy)
Washington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Karl Shaffer, LSS — Shaffer Soils [[e-mail]] (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Non -Discharge Permitting Unit
1617 Mail service Center, Raleigh. North Carolina 27699-1617
Phone: [phone] Internet: htw/portaimcdencomAne6Am l
An Equal Opportunity1 Aff rmative Action Employer— Made in part with recycled paper

Mr. John W. Dunham
April 17, 2015
Page 2 of 2
Digital Permit Archive (Electronic Copy)
Central Files

I.
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT (503)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Craven Ag Services, Inc.
Craven County
FOR THE
operation of a residuals management program for Craven Ag Services, Inc, and consisting of the land
application of Class B residuals generated by the approved facilities listed in Attachment A to the
approved sites listed in Attachment B with no discharge of wastes to surface waters, pursuant to the
application received March 5, 2015, and subsequent additional information received by the Division of
Water Resources, and in conformity with other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit. The use and
disposal of residuals are regulated under Title 40 Code of Federal Regulations Part 503. This permit does
not exempt the Permittee from complying with the federal regulations.
This permit shall be effective from the date of issuance until March 31, 2020, and shall be subject to the
following specified conditions and limitations:
SCHEDULES
No later than six months prior to the expiration of this permit, the Permittee 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]
2. The Permittee shall be in full compliance with the regional office notification requirements
established in Condition III.3. within 90 days of the effective date of this permit. [15A NCAC 02T
.0108(b)(2)]
3. The Permittee shall be in full compliance with the signage requirements established in Condition
I11.13. within 180 days of the effective date of this permit. [15A NCAC 02'r .0108(b)(2)]
Uunnnz'7417 llarc;nn i n Shell Version 150101 Page 1 of 12

H. PERFaRMANCE 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 Washington Regional Office supervisor, and take any
immediate corrective actions. [G.S. 143-215.1)
2. This permit shall not relieve the Permittee of 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):
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.
[15A NCAC 02T .1105]
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 shall meet one 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]
WQ0037637 Version 1.0 Shell Version 150101 Page 2 of 12

8. Setbacks for treatment and storage facilities shall be as follows:
Setback
Setback Description
feet
Habitable residence or place of public assembly under separate ownership or not
100
to be maintained as part of the project site
Property lines
50
Private or public water supply
100
Surface waters (streams — intermittent and perennial, perennial waterbodies, and
50
wetlands
Wells with exception to monitoring wells
100
[15A NCAC 02T .1108]
9. Setbacks for Class B land application sites shall be as follows:
Setback by application type
(feet)
Vehicular
Irrigation
Injection /
Setback Description
Surface
Surface
Incorporation
Application
Application
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
400
400
200
art of the project site
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
0
200
0
lessee/operator of the land to be maintained as part
of the project site
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams — intermittent and perennial,
100
100
50
perennial waterbodies and wetlands
Surface water diversions (ephemeral streams,
25
100
25
waterways, ditches)
Groundwater lowering ditches (where the bottom of
25
100
25
the ditch intersects the SHWT
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
15
15
15
more in vertical height
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
[15A NCAC 02T .1108]
_. 01.-11 Ar.....;..., t CAIAI Pane i of 17

10. Land application areas shall be clearly marked on each site prior to and during any residuals
application event. [15A NCAC 02T .0108(b)(1)]
11. 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:
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://nutrients.soil.ncsu.edu/},ields/index.php).
A copy shall be kept on file and reprinted every five years in accordance with Condition IV.5.
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncagr.gov/SWC/tech/documents/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.Eov/NHO/practice-standards/standards/590.12df).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
[15A NCAC 02T .] 109(b)(1)(k)]
12. 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)]
13. 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. (I5A
NCAC 02T .0108(b)(1)]
14. 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)]
W00037637 Version 1.0 Shell Version 150101 Page 4 of 12

15. 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)]
16. 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 REOUIREMENTS
1. 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 Washington 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)]
3. The Washington 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
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply to additional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields. [15A NCAC 02T .0108(b)(1)]
4. The Permittee 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:
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 locations) 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 monitoring 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;
W(10017617 Veninn 1 0 Shell Version 150101 Paae 5 of 12

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).
[15A NCAC 02T .1100]
5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee 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 his back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved 0&M plan (i.e., see Condition III.
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' Protection and Enforcement Branch at [phone]. [15A NCAC 02T .0117]
6. When the Permittee land applies bulk residuals, a copy of this permit 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 Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles. [15A NCAC 02T .1110]
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)
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 .I 109(b)(1)]
11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes 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;
WQ0037637 Version 1.0 Shell Version 150101 Page 6 of 12

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.
[15A NCAC 02T .1109]
12. The following public access restrictions apply to residual land application sites:
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.
[15A NCAC 02T .1109(b)(2)]
13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 21. 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 Condition 111.12.
apply. [15A NCAC 02T .0108(b)(1)]
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
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
surface (e.g., root crops such as potatoes, carrots, radishes, etc.) shall not be
20 months
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:
W00037637 Version 1.0 Shell Version 150101 Pase 7 of 12

[15A NCAC 02T .I 109(b)(3)]
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 (NRCS) or other State Agencies. The Permittee 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
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
ManagementPlan. [15A NCAC 02T .0108(b)(1), 02T .l 104(c)(4)]
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LOAA)
between the Permittee and landowners or lesseestoperators 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. [15A NCAC 02T .1104(c)(4)]
IV. MONITORING AND REPORTING REQUIREMENTS
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. [15A NCAC 02T .0108(c)]
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). Residuals that tests or is classified as a hazardous or toxic waste
under 40 CFR Part 261 shall not be used or disposed under this permit. The analyses
[corrosivity, ignitability, reactivity, and toxicity characteristic leaching procedure (TCLP)] 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 Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):
Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pcntachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (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)
WQ0037637 Version 1.0 Shell Version 150101 Page 8 of 12

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.
[15A NCAC 13A .0102(b), 02T .1101, 02T .11051
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:
Aluminum
Mercury
Potassium
Ammonia -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)
[I SA NCAC 02T. 1101]
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 I SA 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 .1111(c)]
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 (Iittp://www.ncagr.gov/agronomi/pubs.htm). 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
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
[I 5A NCAC 02T .1 111(d)]
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. [15A NCAC 02B
.0505]
UMAWAIAz7 Vsrcinn 1 n Rha11 Varcinn ISO 1(11 paaP 0 of 1)

7. The Permittee shall maintain records tracking all residual land application events. At a minimum,
these records shall include the following:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., sunny, 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;
1. 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 limited 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.
[15A NCAC 02T .0109(a)]
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
Forms. Instructions for reporting and annual report forms are available at
bSV:Hportal.ncdenr.or web/wq/aps/lau/reporting, or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[I SA NCAC 02T .111 l (a)]
9. Noncompliance Notification
The Permittee shall report by telephone to the Washington Regional Office, telephone number (252)
975-3716, 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:
a. Land application of residuals abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
WQ0037637 Version 1.0 Shell Version 150101 Page 10 of 12

V.
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
betaken to ensure that the problem does not recur. [15A NCAC 02T .0105(1), 02T .0108(b)(1)]
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan. [15A NCAC 02T
.0108(b)]
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals processing, 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
environment, a threat to human health or a public nuisance. The Permittee 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 Permittee shall maintain this inspection log
for a period of five years from the date of inspection, and this log shall be made available to the
Division upon request. [I SA 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 permit; and may
collect groundwater, surface water or leaehate samples. [G.S.143-215.3(a)(2)]
VL GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit 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]
3. This permit is effective only with respect to the nature and volume of residuals described in the
permit application and other supporting documentation. [G.S. 143-215.1]
.. . , „ at..n umim pnaP 11 of 17

4. The issuance of this permit does not exempt the Permittee 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 Permit NCG010000; 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. [15A NCAC 02T .0105(c)(6)]
5. In the event the residuals program changes ownership or the Permittee changes his 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 Permittee 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 permit 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. [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 Permittee exemplifies any of the criteria in 15A NCAC
02T .0120(b). [1 SA NCAC 02T .0120]
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 because for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 17s' day of April 2015
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
2,417 -1-
- ay merman, Director
ivis' n of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0037637
WQ0037637 Version 1.0 Shell Version 150101 Page 12 of 12

ATTACHMENT A - Approved Residual Sources
Craven Ag Services, Inc.
Certification Date: April 17, 2015
Permit Number: WQ0037637 Version: 1.0
Maximum
Monitoring
Monitoring
Monitoring
Frequency for
Approved
Owner
Facility Name
County
Permit
Number
Biological
Residuals
Dry Ton
Frequency for
Non -hazardous
Frequency for
Metals and
Pathogen &
Mineralization
t
Per Year
2
Characteristics
3
Nutrients
Vector Attraction
Reductions°
Rate
Town of Maysville
Maysville WWTP
Jones
NCO021482
Yes
15
Annually
Annually
Annually
0.3
Total
15
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non-bazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA.
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year wben 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.
WQ0037637 Version 1.0 Attachment A Page 1 of 1

THIS PAGE BLANK

ATTACHMENT B - Approved Land Application Sites
Craven Ag Services, Inc.
Certification Date: April 17, 2015
Permit Number: WQ0037637 Version: 1.0
Field
Owner
Lessee
County
Latitude
Longitude
Net Acreage
Dominant Soil Series
Figures
Surface
Subsurface
2-1
Roach, Winfred Allen & Gloria
Craven
35.32920
77.26960
1.3
1.7
Ba-Bayboro
1
2-2
Roach, Winfred Allen & Gloria
Craven
35.33080
77.26910
3.1
4.0
Se -Seabrook
1
2-3
Roach, Winfred Allen & Gloria
Craven
35.33101'
77.27190
19.2
19.5
Ba-Bayboro
1
2-4
Roach, Winfred Allen & Gloria
Craven
35.3333°
77.27010
27.6
32.4
Ap-Arapahoe
1
2-5
Roach, Winfred Allen & Gloria
Craven
35.33200
77.27420
3.8
5.0
Se -Seabrook
1
3-1
Roach, W Allen & Gloria Arrington
Craven
35.3214
77.2695
5.6
6.6
Se -Seabrook
2
3-2
Roach, W Allen & Gloria Arrington
Craven
35.3236
77.2694
14.6
14.6
To-Torhunta
2
3-3
Roach, W Allen & Gloria Arrington
Craven
35.3244
77.2716
6.1
6.1
To-Torhunta
2
4-1
McKeel, Linda B et al
Roach, Winfred Allen
Craven
35.3277
77.2840
8.0
8.0
Ba-Bayboro
3
4-2
McKeel, Linda B et al
Roach, Winfred Allen
Craven
35.3267
77.2862
10.5
10.5
To-Torhunta
3
4-3
McKeel, Linda B et al
Roach, Winfred Allen
Craven
35.3258
77.2884
5.8
5.8
StA-State
3
4-4
McKeel, Linda B et al
Roach, Winfred Allen
Craven
35.3252
77.2893
3.1
3.1
To-Torhunta
3
4-5
McKeel, Linda B et al
Roach, Winfred Allen
Craven
35.3243
77.2916
5.4
15.2
CnB-Conetoe
3
6-1
Roach, Disclaimer Trust -Winfred
Craven
35.3166
77.2671
12.4
12.4
TaB-Tarboro
5
6-2
Roach, Disclaimer Trust -Winfred
Craven
35.3165
77.2639
17.5
17.5
Portsmouth
4
6-3
Roach, Disclaimer Trust -Winfred
Craven
35.3171
77.2598
4.6
4.6
Ln-Leon
4
6-4
Roach, Disclaimer Trust -Winfred
Craven
35.3151
77.2687
7.1
7.1
Ln-Leon
4
7-1
Roach, Disclaimer Trust -Winfred
Craven
35.3448
77.2940
5.5
5.9
TM-Tomotley
5
7-2
Roach, Disclaimer Trust -Winfred
Craven
35.3499
77.2969
10.6
10.7
Pa-Pantego
5
7-3
Roach, Disclaimer Trust -Winfred
Craven
35.3447
77.2921
11.3
11.3
Tm-Tomotley
5
7-4
Roach, Disclaimer Trust -Winfred
Craven
35.3414
77.2862
20.8
25.4
Tm-Tomotley
5
8-1
Roach, Disclaimer Trust -Winfred
Craven
35.3287
77.2728
13.9
13.9
Ba-Bayboro
6
10-1
Roach, Disclaimer Trust -Winfred
Craven
35.3409
77.2911
2.6
2.6
Se -Seabrook
7
Total
220.4
243.9
WQ0037637 Version 1.0 Attachment B Page 1 of 1

THIS PAGE BLANK

Water Resources
ENVIRONMENTAL OVALITY
June 21, 2017
JOHN W. DUNHAM — PRESIDENT
CRAVEN AG SERVICES, INC.
2115 NC HIGHWAY 55
NEW BERN, NORTH CAROLINA 28562
Dear Mr. Dunham:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZD& ERMAN
Director
Subject: Attachment A Certification
Permit No. WQ0037637
Craven Ag Services RLAP
Craven County
In accordance with your permit modification request received May 17, 2017, we are forwarding
herewith a modified Attachment A certified June 21, 2017, to Craven Ag Services, Inc. for the subject
residuals program.
This certification is being issued to modify Attachment A by: Addition of 0.73 dry tons/year from
Pruitt Health Care (Permit NC0047759).
This modified Attachment A shall be effective from the date of certification until March 31, 2020
(i.e., expiration date of the current permit), shall void Attachment A of Permit No. WQ0037637 issued
April 17, 2015 that was previously certified on November 3, 2015, and shall be subject to the conditions
and limitations as specified therein, as well as those specified in the above -referenced permit. Please replace
the Attachment A of PermitNo. WQ0037637 certified on November 3, 2015 with this modified Attachment
A.
If any parts, requirements, and/or limitations contained in this certification or modified Attachment
A are unacceptable, you have the right to request an adjudicatory hearing upon written request within 30
days following receipt of the certification. This request shall be in the form of a written petition, conforming
to Chapter 150B ofthe North Carolina General Statutes and filed with the Office of Administrative Hearings
at 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such demands are made, this
permit shall be final and binding.
I"Nothtng Compares' -_—
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Mr. John W. Dunham
June 21, 2017
Page 2 of 2
If you need any additional information concerning this matter, please contact Troy Doby at (919)
807-6336 or trov.dob @ncdenr gov.
Sincerely,
�S. Jay Zimmerman, P.G., Director
Division of Water Resources
cc: Craven County Health Department (Electronic Copy)
Washington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Karl Shaffer, LSS — Shaffer Soil Services (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

ATTACHMENT A - Approved Residual Sources
Craven Ag Services, Inc.
Certification Date: June 21, 2017
Permit Number: WQ0037637 Version: 1.2
Owner
Facility Name
County
Permit
Biological
Maximum
Dr Tons
Y
Monitoring
Frequency for
Monitoring
Frequency for
Monitoring
Frequency for
Approved
Number
Residuals
per Year I
Non -hazardous
Metals and
Pathogen &
Mineralization
Characteristics 2
Nutrients 3.5
Vector Attraction
Rate
Reductions
Town of Maysville
Maysville WWTP
Jones
N00021482
Yes
15
Annually
Annually
Annually
0.3
Pruitt Health — Sea Level, LLC
Pruitt Health Care
Craven
NCO047759
Yes
0.73
None required
Annually
Annually
0.3
Town of Bridgeton
Bridgeton WWTP
Craven
NCO074837
Yes
5
Annually
Annually
Annually
0.3
C & P Enterprises
Ocean Bay Villas
Carteret
W00003067
Yes
1
None required
Annually
Annually
0.3
Total
21.73
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA.
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.
WQ0037637 Version 1.2 Attachment A Page 1 of I

THIS PAGE BLANK

Craven Ag Services, Inc.
Operation and Maintenance Plan

CRAVEN AG SERVICES
SLUDGE RESIDUALS HAULING AND APPLICATION
OPERATION AND MAINTENANCE
The residuals land application program shall be effectively maintained and operated at all times
as a non -discharge system to prevent the discharge of any wastes resulting from the operation
of this program.
1.Operational Functions:
a. An operator to be in responsible charge (ORC) shall be appointed to oversee the
hauling and application of the residuals. The ORC shall hold a certificate of the type
classification assigned to the program by the Division of Water Resources (DWR).
b. The operation shall include but may not be limited to the following functions to carry
out the hauling and application of residuals.
-- Have a copy of the permit on hand at all times
-- Removing residuals from the waste water treatment plant (wwtp) with a pump
and loading it into tankers or vac trucks.
-- Hauling the residuals over the highway to the permitted site
-- Identifying an off loading site at the permitted fields
-- Flagging field boarders to mark all buffer zones (see permit for setbacks and
public notices)
-- Off loading the residuals from the tankers or vac trucks to field applicators
-- Determine the loading rate in gallons per acre based on the nitrogen or
phosphorus requirements of the crop to be grown and the amount of nitrogen
and phosphorus that is in 1000 gallons of the residuals. Application events can
occur as necessary to provide the nitrogen or phosphorous requirements but
shall not exceed the hydraulic capacities of the receiver sites. (see permit rules)

-- After determining the gallons per acre calibrate the field applicator
-- Land application is not permitted during wet weather conditions or when the
ground is frozen or when the water table is too close to the surface. (See rules in
permit)
-- Apply the residuals evenly on the permitted fields with a moving field
applicator
-- Keeping a record of gallons hauled to the field
2. Inspections Plan
a. The ORC shall be responsible for overseeing and inspection of the sludge hauling and
application process
-- ORC will be John W. Dunham LA certification Number 13203
-- ORC back up will be Mac K Dunham LA certification number 24992
b. Frequency of inspections: The receiver site shall be inspected prior to application and
will include the following:
-- Determining groundwater distance from the soil surface ( see permit )
-- Determine field access for equipment
-- Check field buffers and see that they are flagged (see permit)
-- Check the weather forecast for rain and also check the site to determine if it is o. k.
for field application. (see Permit) The inspector shall keep an inspection log or summary
including at least the date and time of inspection, observations and any maintenance,
repairs, and corrective actions taken.
-- Prior to each residual land application event the inspector shall inspect the residuals
storage, transport, and application facilities to prevent malfunctions and deterioration ,
operator errors, and discharges that may cause or lead to the release of wastes to the
environment, a threat to human health, or a nuisance.
-- The inspector will be at the WWTP when pumping begins each day to oversee start
up
-- The inspector will accompany the first tanker to the field and will see that the off
loading and application procedures are in place for a safe start up

-- The inspector will be on hand to observe the application process at the beginning of
the day, mid day, and at the end of the day
-- The field technician will be given a site receiver log sheet to keep daily records of the
application process. These logs shall include the truck number, time of day, date,
quantity of material, receiver site, weather conditions, and soils moisture, and the name
of the field technician doing the application.
-- Other record keeping required by the permit such as vector, pathogens, metals,
nutrients, shall be done prior to application process and will be done by the plant
operator or Craven Ag OCR (see permit requirements for monitoring residuals for
metals, hazardous materials, records & reporting)
--Any noncompliance found during the above inspections shall be reported by telephone
to the Washington Office 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:
_ Any occurrence of the land application program which results in the land
application of significant amounts of wastes which are abnormal in quantity or
characteristics
_ Any failure of the land application program resulting in a release of material
to receiving waters
_ Any time that self -monitoring indicates that the facility has gone out of
compliance with the conditions and limitations of the permit or the parameters
on which the system was designed.
Any process unit failure, due to known or unknown reasons, that render the
facility incapable of adequate residual treatment
_ Any spillage or discharge from a vehicle or piping system during loading,
transporting, or off loading sludge
Any emergency that requires immediate reporting outside of business hours
shall call 800-662-7956 and shall also do a written report in letter form within
five days of the occurrence

BUSINESS SAFETY & SPILL PLAN
CRAVEN AG SERVICES, INC.
2115 HWY 55 WEST
NEW BERN, N.C. 28562
252- 633-5334
1. COMPANY SAFETY POLICY: It is the policy of Craven Ag Services, Inc. to
provide a work place free of recognized safety and health hazards. We are
committed to setting proper examples of our employees and contract personnel.
We will do our jobs in the safest manner possible.
2. SITE SAFETY INSPECTIONS: Each worksite is inspected at the start of each day
by all employees who will be working at the site. The site is specifically checked
for objects that may cause one to trip and fall or cause any body injury. Also the
site is checked for any environmental hazards that may be present. Since many of
our jobs are off site from our shop we must check for damage to equipment by
vandals, missing equipment etc. Any defect affecting employee or equipment
safety is taken out of service and corrective measures are initiated immediately
before work begins.
3. EQUIPMENT CHECKS: At the start of each day the operator of each piece of
company equipment checks the unit for fluids, lubricants, and safety defects. All
trucks get a "walk around" inspection for tires, brakes, lights, fluids, belts, hoses,
valves on tankers, safety caps, etc. The cabs of equipment shall be reasonably
clear and free of all debris which may roll under controls and make for a
hazardous situation. All windows shall be kept clean so as to allow proper vision
of the area and all personnel.
4.OPERATING COMPANY VEHICLES: Company vehicles and equipment are to be
used only to carry out business for Craven Ag Services, Inc. No company vehicles
will be used for personal tasks. All operators of company vehicles are expected to
do so in a safety conscious way. Obey the regulations of both state and federal

agencies regarding driver safety. Proper equipment inspections are required each
day in order to maintain the highest level of safety and productivity.
S. REPORTING INJURIES: All on the job injuries must be reported to our office
immediately. Failure to report an injury properly may result in one's lose of
Workman's Compensation Insurance. All appropriate paper work will be prepared
in a timely manner by our office staff . All injuries on the job will be investigated
by management and the injury will be reviewed by management and employees
for preventative action. We will continuously check for trends should they
develop and initiate action to curtail patterns.
6. TRAINING NEW HIRES: All new hires will be provided a copy of our written
safety program and time will be taken to familiarize them with our procedures,
equipment, and expectations. All new hires will get on-the-job training as to how
to operate equipment before he is allowed to work solo.
7. SAFETY MEETINGS: Craven Ag Services, Inc. will hold a monthly safety meeting
program whereby appropriate topics are provided and all employees attend. In
addition, tailgate safety meetings are held on a more frequent basis when a topic
is suggested by conditions, past injuries, or new equipment or procedures.
Documentation of such meetings will be maintained at our company office.
8. PERSONAL PROTECTIVE EXUIPMENT: Each job may require the use of special
protective equipment. Craven Ag Services, Inc. will provide each individual type of
PPE which will meet or exceed the standards established by NIOSH or ANSI for
any specific job. Some examples are:
1. Hard Hats
2. Safety Glasses
3.Safety Boots
4. Protective clothing (coveralls)
5. Dust masks
6. Gloves

9. EMERGENCY ACTION PLAN: In the event of an emergency, we will contact 911
or the appropriate telephone number for the location. We will administer basic
first aid while EMS is in route. Whenever necessary, we may choose to meet the
responding emergency units at an agreed upon place and lead them to the site. It
will be the responsibility of the owner to make any calls to family members if
need be. After the individual is properly cared for, we will initiate an investigation
into the cause of the injury and prepare a written report.
10. HAZARD COMMUNICATION PROGRAM: Craven Ag Services does not handle
any hazards materials at the present time. However, should we be required to do
so each employee will receive training on the hazards of the material and
individual material safety data sheets will be maintained in each foreman`s truck.
11. BLOOD BORNE PATHOGENS: We provide the Hepatitis and tetanus injections
through the Craven County Health Department. We require our employees to
ware the correct gloves, eye protection, and other protective clothing to help
prevent any blood borne infections.
12. HEARING CONSERVATION: Our employees are required to wear hearing
protection when working around open equipment that is running. Example is at
Cherry Point Air station where jets are operating.
13. PORTABLE FIRE EXTENGUISHERS: All of our equipment is equipped with fire
extinguishers and our employees are trained to use them properly.
14. DEFENSIVE DRIVING PLAN: All drivers are expected to obey and comply with
all applicable State, Federal, and Craven Ag. Service requirements. Some are as
follows:
1. Have a valid N.C. CDL if required for the vehicle he operates.
2. DOT physical
3. Current background check
4. DOT required drug testing program
5. Report all tickets and accidents as soon as they occur.

6. Provide vehicle inspection check sheet each day. If a problem is found it
should be reported to the shop foreman and the vehicle is not to be used
until the foreman o.k.'s it.
7. Keep vehicle clean inside and out including having a trash container
inside to through trash. Container is to be emptied before or at full
capacity.
GENERAL SAFETY PROCEDURES
TO CONSIDER WHEN OPERATING EQUIPMENT
1. Keep safety decals free of dirt and grime
2. Replace all damaged, missing or illegible safety decals.
3. Keep safety shields installed
4. When towing equipment: do not exceed recommended mph, Make sure the
SMV, reflective tape or lights are clean and clearly visible; Refer to local, state or
provincial laws and regulations for restrictions on public roads; Make sure the tail
lights are operating properly.
5. If you are assigned a piece of equipment to use and are not comfortable with it
ask someone to help you before you begin operation.
6. Never let anyone ride with you while operating equipment
7. Only Craven Ag Service employees are allowed to operate its equipment or ride
as a co -passenger in trucks or other vehicles.
8. When operating PTO'S be sure everyone is clear of the machine before you
engage it.
9. Do not attempt to work on any equipment while the PTO in engaged.

10. Do not attempt to work on any equipment while it is running. Shut it down
and engage the brakes before beginning inspections or work.
11. Know the speed rating of the PTO and do not operate the equipment above
that speed. Most of our PTO speeds are either 1000 or 540. This is PTO speed not
engine RPM speed. Most engines run around 2000 RPM for a 1000 PTO and about
1800 RPM for 540 PTO.
12. When operating equipment that extends up in the air be sure to watch for
overhead power lines, be sure you are on level ground, don't walk loaders with
the bucket extended up in the air etc.
13. Do not rush. Hurrying can lead to accidents. Haste, carelessness and lack of
training are the primary cause of equipment -related injuries.
14. Do not wear jewelry or loose fitting or hanging clothing because they could
catch on moving parts and cause injury or death.
15. Wear proper safety equipment as required: Hard hat, safety shoes, ear
protectors, reflective vests, dust masks safety glasses, goggles, gloves, etc.
16. Do not jump on or off machines. Keep two hands and one foot or two feet and
one hand in contact with the steps and handholds at all times. Place objects on
machine from ground level before climbing on or have someone hand you the
object once you are on the machine. Always face the machine when climbing on
or off to reduce the chances of slipping and injury.
16. Read all warning decals before starting, operating, maintaining or repairing
machines.
17. If operating machinery with loud noise exposure wear ear protective
equipment.
18. Wear eye protection at all times while working with or on equipment.
19. All operators must be alert, physically fit and free from the influences of
alcohol, drugs and dedications that might affect his eyesight, hearing or reactions.

20. Safety must always be the operator's most important concern. He must
refuse to operate when he knows it is unsafe and consult his supervisor when
safety is in doubt.
21. When climbing up or down on equipment be sure the mounting steps and
handholds are free of oil, grease, foreign objects, ice, snow, and mud to reduce
the possibility of slipping and injury.
22. When any equipment is standing with the engine running, have the
transmission in neutral, apply the parking brakes (on trucks be sure the truck
brakes are on) and lower all raised equipment.
23. Before moving equipment be sure everyone has moved from around it and in
the case of trucks honk the horn.
24. When in doubt about the safety operation of equipment ask for help and the
operators manual.
25. When working around electrical machinery be sure all wires are in good
shape, do not overload extension cords, electrical outlets, etc. Do not operate
electrical equipment in standing water. Get all problems fixed before starting
work.
26. When working around open holes put up no trespassing tape if you are going
to be there for a period of time.
27. When operating pumper trucks: use traffic caution cons where traffic is a
problem. When in public areas use the cons around the truck, working area, hose
crossing walkways, etc.
28. Hydrogen sulfide is formed as a result of the decomposition of organic
material. It is a clear, colorless gas and can be recognized in small concentration
by its rotten egg odor. However, human ability to smell this gas disappears
rapidly as a result of continued exposure and with increased exposure. Liquid
waste systems can produce relative large concentrations of hydrogen sulfide (as
well as carbon Dioxide). Hydrogen sulfide is classified as a toxic chemical. In high
concentration, it will lead to almost instantaneous poisoning and death. Exposure

to smaller concentrations may cause nausea, coughing, headache, dizziness, and
eye irritation. No one should ever enter a liquid waste holding tank without
following these rules for confined space entry:
1. Wash out spreader using wash system and recalculate
2. Remove cleanout doors
3. Blow air in the top hopper using a large fan for at least 30 minutes
4. Use a Hydrogen Sulfide Detector
5. Use a self controlled breathing device
6. Use a life line
No employee of Craven As Services is to inter a waste holding tank.
Do not go into a tank after a downed person, you will be overcome too.
29. When loading & off loading tankers follow these safety steps:
1. Loading: Drive under the loading shoot
a. When you exit the truck be sure you have on all required safety
protection equipment
b. Check all valves on tankers, pumps, and storage units and be sure
they are closed then check all transfer hose and connectors to be
sure they are secure and not leaking
c. Open the top hatch on the tanker and position the loading stand
in the hole
d. Open the valve at the storage unit
e. Open the valve at the pump
f. Start pumping the effluent into the tanker and then move to the
top of the tanker to watch it fill up.

g. When the sludge reaches the full marker cut off the pump and
close the valves
h. Remove the loading stand from the tanker, secure the lid to the
tanker, and proceed to the receiving site.
2.Offloading: Stage the truck and tanker at the offloading site
a. When you exit the truck be sure you have on all required safety
protection equipment
b. Open the top lid to the tanker to allow for ventilation
c. Connect the discharge hose from the applicator to the tanker and
open the valves
d. Turn on the applicator and begin offloading the tanker
e. Observe the load indicator on the applicator and shut off the pump
when the applicator is full
f. Close all valves and disconnect the loading hose
g. When tanker is empty close the top lid and go back for another
load
30. Field application of sludge: The applicator has been calibrated as to travel
speed, gate opening and spread width: Applicator technician shall:
1. Assist the truck driver in offloading the tanker
2. Maintain a constant speed in the field
3. Keep an even spread pattern across the field
4. Stay inside all buffer flags
S. Be sure the applicator valve in completely closed while traveling to and
from the tanker and while offloading the tanker

6. Record each tanker and keep the application log
7. Assure that all applicator parts are functioning correctly
8. Notify the ORC as soon as possible if anything goes wrong
9. Remove all buffer flags from the field when the job is finished
10. If field incorporation is required see that it is done within 6 hours after
application
IN AND AROUND THE SHOP
AND DEWATERING AREA
1. Keep hoses folded up and hung out of the way when not in use.
2. Keep up tools when you finish with them. Don't leave them laying around for
someone to fall over.
3. Keep the inside of shops neat and clean. Waste material should be discarded in
a proper manner. Recycled or trash bean.
4. Tires new and used should be stored properly.
5. When handling tires or other heavy materials use safety measures. Use tire
dollies, get someone to help, use loader or forklift, etc.
6. Always use eye protection when working around equipment, welders, grinders,
torches, hydraulics, steam cleaners, etc.

SPILL CONTROL PLAN
1. Halt the source of the spill: Ruptured lines, valves, hoses, tail gates, tanks, etc.
close the valve
2. Contain the spill: Use straw bales or soil to form a barrier to contain the spill
3. Notification: Contact the office at 252-633-5334 or 252-670-8530 give them
complete details of the spill. (location, extent of spill, equipment needed for clean
up, any injuries, etc.) The office will then contact the proper authorities and begin
clean up procedures ( getting equipment and personnel needed for clean up to
the site etc. )
4. Management of clean up: Control all traffic flow so as to protect citizens from
any type of contact from the spill. Use proper equipment to clean up the site and
then properly dispose of it. After clean up is finished cover the affected area with
lime for RFP procedures.
S. Reporting: Within 24 hours after the spill a written report explaining the cause
of the spill and all actions taken in response to the spill will be prepared and given
the all proper authorities
EQUIPMENT MAINTANCE
1. Craven Ag has a full time mechanic who is responsible for maintained and
repa i rs
2. Regular maintained is done according to manufactures recommendations
3. After each job event all equipment is brought into the shop and checked over
for needed preventive maintained and is prepared for the next job event

RESIDUALS SOURCE CERTIFICATION ATTACHMENT
Town of Maysville WWTP

Residuals Source Facility Summary Page

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

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Craven Ali Services, Inc,
Status A
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
Town of Maysville
Maysville WWTP
Jones
NCO021482
15
15
R
Town of Bridgeton
Bridgeton WWTP
Craven
NCO074837
5
5
R
Pruitt Health -- Sea Level, NC
Pruitt Health Care
Carteret
NCO047759
1
1
N
Town of River Bend
River Bend WWTP
Craven
NCO030406
15
'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

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
1. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of Maysville
2. Facility permit holder is: ❑ Federal, ❑ State, ® Local Government, or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Schumata Brown, Town Manager
Complete mailing address: Post Office Box 265
City: Maysville State: NC Zip: 28555-_
Telephone number: [phone] E-mail address: townmanagerabizec.rr.com
4. Facility physical address: Garment Ave. Ext.
City: Maysville State: NC Zip: 28555-
Coordinates: Latitude: 34.893104" N Longitude:-77.23089" W
Datum: WGS84 Level of accuracy: 1"
Method of measurement: Man
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and _ % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: 0.18 MGD and facility average daily flow: 0.14 MGD
8. Average amount of residuals being generated at this facility 15 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 38,000 gallons aerated digestion
Type and volume of residuals storage (i.e., outside of residuals treatment units): No Additional
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
l . Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
® Biological ❑ Non -Biological
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).
FORM: RSC 06-16 Page] of5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Environmental Chemists and Date of analysis: December 4, 2019
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: > 195 IF (> 140°F)
Passed reactivity test: ® yes []no. HCN: <0.05mg/kg (<250) & H2S: 0.22 mg/kg (<500)
TCLP Parameter
Limit
(mg/l)
Result
(mg/1)
TCLP Parameter
Limit
(mg//)
Result
(mg/1)
Arsenic
5.0
<1.00
Hexachlorobenzene
0.13
<0.05
Barium
100.0
<1.00
Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene
0.5
<0.01
Hexachloroethane
3.0
<0.05
Cadmium
1.0
<1.00
Lead
5.0
<1.00
Carbon Tetrachloride
0.5
<0.01
Lindane
0.4
<0.0005
Chlordane
0.03
<0.02
Mercury
0.2
<0.0002
Chlorobenzene
100.0
<0.01
Methoxychlor
10.0
<0.0005
Chloroform
6.0
<0.01
Methyl Ethyl Ketone
200.0
<0.05
Chromium
5.0
<1.00
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.05
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
<0.05
Pyridine
5.0
<0.05
p-Cresol
200.0
<0.05
Selenium
1.0
<1.00
Cresol
200.0
<0.05
Silver
5.0
<1.00
2,4-D
10.0
<0.003
Tetrachloroethylene
0.7
<0.01
1,4-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.01
Trichloroethylene
0.5
<0.01
],I-Dichloroethylene
0.7
<0.01
2,4,5-Trichlorophenol
400.0
<0.05
2,4-Dinitrotoluene
0.13
<0.05
2,4,6-Trichlorophenol
2.0
<0.05
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
<0.003
Heptachlor and its Hydroxide
0.008
<0.0005
Vinyl Chloride
0.2
<0.01
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Laud 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: Environmental Chemists and Date of analysis: December 4 2019
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mg1kg)
(mg1kg)
(inglkg)
Arsenic
75
41
< 13.80
Cadmium
85
39
< 13.80
Copper
4,300
1,500
403.00
Lead
840
300
18.20
Mercury
57
17
< 1.00
Molybdenum
75
n/a
< 13.80
Nickel
420
420
14.50
Selenium
100
100
< 13.80
Zinc
7,500
2,800
871.00
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
Omelets, check one)
Arsenic
(niglkg)
Chromium
(mglkg)
Nickel
(mglkg)
❑ > 0 but < 25
30
200
210
❑ ? 25 but < 50
34
220
240
❑ >_ 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (ing/kg)
FORM: RSC 06-16 Page 3 of

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.40 %.
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: Environmental Chemists and Date of analysis: December 4, 2019
Parameter
Result
(mg/kg)
Aluminum
5,110.00
Ammon ia-Nitrogen
1,640.00
Calcium
38,900.00
Magnesium
2,910.00
Nitrate -Nitrite Nitrogen
126.00
pH (Standard Unit)
6.74
Phosphorus
19,400.00
Potassium
3,770.00
Sodium
7,570.00
Total Kjeldahl Nitrogen
28,300.00
c. Using the results listed in Item 11. 5b. above, calculate the sodium adsorption ration (SAR): 1.78
[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 (1$`) Year PAN
Five -Year
Maximum Adjusted PAN
(mglkg)
(mglkg)
Surface
8,944
13,748
Injection/Incorporation
9,764
14,568
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Gass A or Equivalent. -
El 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.1106(c)(1)] - Fecal Coliform Density Demonstration.
® Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ® lime stabilization.
c. For Surface Disposal. -
Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
❑ Exempt - If Daily Cover Alternative is chosen in Item 11.8. 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.1 107, specify how residuals will meet the VAR requirements:
❑ Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.1107(a)(2)1- 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
® Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

Process Flow Narrative

Town of Maysville WWTP
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SCALE: 1 " = 1,500 ft Craven Ag Services, Inc,
Land Application Program Site
CHECKED BY: RTB Town of Maysville Vicinity
DRAWN BY:
RTB BRANCH Maysville, NC Map
RESIDU"S
DATE: 3I4f2020 & SOILS, LLC Pm;eatNo• 2019-132

MAYSVILLE WASTEWATER TREATMENT PLANT PROCESS
The Town of Maysville WWTP has a designed flow of 0.18 MGD of municipal influent. The
WWTP is a dual -train package plant. This facility is equipped with 4 tanks
of 8,000-9,000 gallons that are connected and can be easily moved between
each of the tanks. Sludge is aerated and allowed to settle. Decant liquids
are sent back to the head of the plant as return activated sludge. All of
decisions are made based on mixed liquid suspended solids, temperature,
settling time, sludge thickness, aeration, etc. as dictated by the ORC.
Treated effluent is monitored and sent to it's discharge point at the White Oak River.

Justification for Residuals Production Rate

JUSTIFICATION FOR MAYSVILLE WWTP RESIDUALS PRODUCTION RATE
The Town of Maysville Wastewater Treatment Plant is currently operating at 0.14 million gallons
per day (MGD). Based on previous years' production, the dry tons have been set at 15 for annual
production to be delivered to this permit.

Residuals Sampling Plan

WWTP SAMPLING PLAN — TOWN OF MAYSVILLE
Annually, multiple grab residual solid samples are collected from the sludge holding tanks. These
samples are composited for nutrient and metal analyses. The composited sample is mixed and aerated
to keep the solids suspended and containers filled for this analysis. Lime stabilization occurs when the
sludge handling tank reaches capacity. Lime is added to reach proper stabilization requirements for
vector attraction and pathogen reduction. Field measurements of pH and temperature are collected for
each stabilization event to insure pH requirements are met. pH values are later temperature corrected
for reporting purposes. The Town of Maysville may elect to meet pathogen reduction by the collection
of 7 fecal samples. In addition, vector attraction reduction may be met by incorporation/injection into
the soil or collection of samples for the 30-day bench test for aerobic digestion or SOUR tests.
Annually, a composite residual solid sample will be analyzed for: Arsenic, Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -
Nitrite, Nitrogen, Magnesium, % Total Solids, pH, Phosphorus, Potassium, TKN, and Sodium. From
this information, the Plant Available Nitrogen (PAN) and Sodium Adsorption Ratio (SAR) will be
calculated.

Analytical Data From
Town of Maysville WWTP
Nutrient & Metals and TCLP

Environmental Chemists, Inc.
` ` 6602 Windmill Wiiy, Wilmington, NC 28405 a 910.392.0223 Lab a 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 a 252.473.5702 Lab/Fax
Am255-A Wilmington Highway, Jacksonville, NC 285.10 • 910.3475843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS intbu:cmironinentalchemists.coill
Town of Maysville Date of Report: Dec 04, 2019
Post Office Box 265 Customer PO #:
Maysville NC 28555 Customer ID: 17020023
Attention: Report #: 2019-18771
Project ID: Sludge
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
19A7778 Site: Sludge 11/6/2019 2:30 PM Solid/Sludge boomer
Test
Method
Results
Date Analyzed
Chlordane (TCLP)
SW 846 Method 8081 B/3510
<0.02 mg/L
11/20/2019
Endrin (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
11/20/2019
Heptachlor (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
11/20/2019
Heptachlor epoxide (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
11/20/2019
Lindane (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
11/20/2019
Methoxychlor (TCLP)
SW 846 Method 80818/3510
<0.0005 mg/L
11/20/2019
Toxaphene (TCLP)
SW 846 Method 80818/3510
<0.05 mg/L
11/20/2019
1,4-Dichlorobenzene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
2,4,5-Trichlorophenol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
2,4,6-Trichlorophenol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
2,4-Dinitrotoluene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
Cresol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
Hexachloro-1,3-butadiene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
Hexachlorobenzene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
Hexachloroethane (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
11/19/2019
m + p-Cresol (TCLP)
SW 846 method 827013510
<0.050 mg/L
11/19/2019
Nitrobenzene (TCLP)
SW 846 method 827013510
<0.050 mg/L
11 /19/2019
o-Cresol (TCLP)
SW 846 method E1270/3510
<0.050 mg/L
11/19/2019
Pentachlorophenol (TCLP)
SW 846 method 8270/3510
<0.250 mg/L
11/19/2019
Pyridine (TCLP)
SW 846 method 627013510
<0.050 mg/L
11/19/2019
2,4,5-TP (TCLP)
SW846 Method 8151A
<0.003 mg/L
11/20/2019
2,4-D (TCLP)
SW846 Method 8151A
<0.003 mg/L
11/20/2019
1,1-Dichloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
1,2-Dichloroethane (TCLP)
SW846 Method826015030
<0.01 mg/L
11/19/2019
Benzene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
Carbon Tetrachloride (TCLP)
po— «. .,,,,,, ..—
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019

Environmental Chemists, Inc.
envir+ 6602 Windmill 4Vati', Wilmiligton, ii!C 28405 • 910.392.0223 Lab • 910.392. E-12-1 Fax
710 Bowserk)wn Road, Manteo, NC 27954 • 252.473.5702 I_ab/Fax
, 2;5-A Wilmington Ftighway, Jacksonville, NC 28540 • 910.3 }7.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS infix"tr em-irorinlenliilchemists.cont
Town of Maysville
Date of Report: Dec 04, 2019
Post Office Box 265
Customer PO #:
Maysville NC
28555
Customer ID: 17020023
Attention:
Report #: 2019-18771
Project ID: Sludge
Chlorobenzene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
Chloroform (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11 /19/2019
Methyl ethyl ketone (TCLP)
SW846 Method 8260/5030
<0.05 mg/L
11/19/2019
Tetrachloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
Trichloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
Vinyl Chloride (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
11/19/2019
RCI
Cyanide EPA 4
Reporting limit elevated due to matrix interference.
<0.05 mg/kg
11/15/2019
Sulfide
SM 4500 S D
0.22 mg/kg
11/08/2019
Ignitability
SW 846 method 1010
>195 °F
11/15/2019
pH
SW 846 Method 9045D
6.74 units
11/13/2019
Sludge Residuals
Aluminum
EPA 200.7
5110 mg/kg
11/18/2019
Arsenic
EPA 200.7
<13.8 mg/kg
11/18/2019
Cadmium
EPA 200.7
<13.8 mg/kg
11/18/2019
Calcium
EPA 200.7
38900 mg/kg
11/18/2019
Chromium
EPA 200.7
<13.8mg/kg
11/18/2019
Copper
EPA 200.7
403mg/kg
11/18/2019
Lead
EPA 200.7
18.2 mg/kg
11/18/2019
Magnesium
EPA 200.7
2910 mg/kg
11/18/2019
Molybdenum
EPA 200.7
<13.8 mg/kg
11/18/2019
Nickel
EPA 200.7
14.5 mg/kg
11/18/2019
Potassium
EPA200.7
3770mg/kg
11/19/2019
Selenium
EPA 200.7
<13.8 mg/kg
11/18/2019
Sodium
EPA 200.7
7570 mg/kg
11/18/2019
Zinc
EPA 200.7
871 mg/kg
11/18/2019
Total Kjeldahl Nitrogen (TKN)
EPA 351.2
28300 mg/kg
11/18/2019
Nitrate+Nitrite-Nitrogen
EPA 353.2
126 mg/kg
11/18/2019
Total Solids (%)
SM 2540 B
1.40 %
11/11/2019
Report # - 2019-18771

-7 Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28.10a • 910.392.0223 Lab e 910.392.4424 Fax
710 13owscrto:vn Road,
sa !�lanteo, NC 27954 • 252.473.5702 Lab/Fix
255-A Wilmington Highway jacksonville, NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS i nto-a ens i rontnentit lcliemists.com
Town of Maysville Date of Report: Dec 04, 2019
Post Office Box 265 Customer PO #:
Maysville NC 28555 Customer ID: 17020023
Attention: Report #: 2019-18771
Project ID: Sludge
Ammonia Nitrogen SM 4500 NH3 C 1640 mg/kg 11/18/2019
Total Phosphorus SM 4500 P F 19400 mg/kg 11/13/2019
Mercury SW846 7471 B <1.00 mg/kg 11 /11 /2019
TCLP Metals
Arsenic
EPA 200.7
<1.0 mg/L
11/21/2019
Barium
EPA 200.7
<1.0mg/L
11/21/2019
Cadmium
EPA 200.7
<1.0mg/L
11/21/2019
Chromium
EPA 200.7
<1.0 rng/L
11/21/2019
Lead
EPA 200.7
<1.0 mg/L
11/21/2019
Selenium
EPA 200.7
<1.0 mg/L
11/21/2019
Silver
EPA 200.7
<1.0 mg/L
11/21/2019
Mercury
EPA 245.1
<0.0002 mg/L
11/21/2019
Comment:
Sludge residuals reported on a dry weight basis.
Reviewed by:

ENVIRONMENTAL CHEMIS ■ S, INC OFFICE:: Oi392 223iIFAX910-392-442428405
ENVIRONMENTAL
Analytical & Consulting Chemists NCDENR: DWQ CERTIFICATION # 94 NCDHHS: DLS CERTIFICATION # 37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
Client: Town of Maysville VWUTP
PROJECT NAME: Annual Sludge
REPORT NO:
ADDRESS:
CONTACT NAME:
PO NO:
REPORT TO:
PHONE/FAX-
COPY TO:
email:
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RESIDUALS SOURCE CERTIFICATION ATTACHMENT
Town of Bridgeton WWTP

Residuals Source Facility Summary Page

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Divislon of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supportine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permittingnit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .l 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
® For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Permits".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Craven Ag Services, Inc,
Status
Code 9
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
Town of Maysville
Maysville WWTP
Jones
NCO021482
15
15
R
Town of Bridgeton
Bridgeton WWTP
Craven
NCO074837
5
5
R
Pruitt Health — Sea Level, NC
Pruitt Health Care
Carteret
NCO047759
1
1
N
Town of River Bend
River Bend WWTP
Craven
NCO030406
15
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 I

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
1. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of Bridgeton
2. Facility permit holder is: ❑ Federal, ❑ State, ® Local Government, or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Kevin Mullineaux, Utility Director
Complete mailing address: Post Office Box 317
City: Havelock State: NC Zip: 28532-
Telephone number: [phone] E-mail address: hscs-environmental a,ec.rr.com
4. Facility physical address: 200 Pine Street.
City:Bridgeton State: NC Zip: 28519-
Coordinates: Latitude: 35' 7' 43.04" N Longitude 77' 1' 13.78" W
Datum: NAD 1983 State Plane, NC Level of accuracy: 1"
Method of measurement: Man
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and _ % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: 0.075 MGD and facility average daily flow: 0.035 MGD
8. Average amount of residuals being generated at this facility 5 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 30,000 gallons aerated digestion
Type and volume of residuals storage (i.e., outside of residuals treatment units): No Additional
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
l . Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1 102(6) as:
® Biological ❑ Non -Biological
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).
FORM: RSC 06-16 Page] of5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: SGS North America and Date of analysis: December 12, 2019
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: >195 °F (> 140°F)
Passed reactivity test: ® yes ❑no. HCN: <0.05mg/kg (<250) & H2S: 0.22 mg/kg (<500)
TCLP Parameter
Limit
(nag/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/l)
Result
(mg/1)
Arsenic
5.0
<0.10
Hexachlorobenzene
0.13
<0.05
Barium
100.0
<2.0
Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene
0.5
<0.01
Hexachloroethane
3.0
<0.05
Cadmium
1.0
<0.05
Lead
5.0
<0.05
Carbon Tetrachloride
0.5
<0.01
Lindane
0.4
<0.000I
Chlordane
0.03
<0.001
Mercury
0.2
<0.005
Chlorobenzene
100.0
<0.01
Methoxychlor
10.0
<0.0002
Chloroform
6.0
<0.01
Methyl Ethyl Ketone
200.0
<0.05
Chromium
5.0
<0.1
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.05
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
<0.05
Pyridine
5.0
<0.05
p-Cresol
200.0
<0.05
Selenium
1.0
<0.10
Cresol
200.0
<0.15
Silver
5.0
<0.10
2,4-D
10.0
<0.05
Tetrachloroethylene
0.7
<0.01
IA-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.005
1,2-Dichloroethane
0.5
0.0106
Trichloroethylene
0.5
<0.01
],I-Dichloroethylene
0.7
<0.01
2,4,5-Trichlorophenol
400.0
<0.05
2,4-Dinitrotoluene
0.13
<0.05
2,4,6-Trichlorophenol
2.0
<0.05
Endrin
0.02
<0.002
2,4,5-TP (Silvex)
1.0
<0.005
Heptachlor and its Hydroxide
0.008
<0.000I
Vinyl Chloride
0.2
<0.01
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Laud 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: Environment One and Date of analysis: January 28, 2019
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(ing4g)
(mglkg)
(mglkg)
Arsenic
75
41
< 2.50
Cadmium
85
39
1.90
Copper
4,300
1,500
335.00
Lead
840
300
31.00
Mercury
57
17
0.25
Molybdenum
75
n/a
< 5.0
Nickel
420
420
10.00
Selenium
100
100
< 5.0
Zinc
7,500
2,800
1,754.00
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:.
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mglkg)
Chromium
(mg1kg)
Nickel
(mglkg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg1kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.40 %.
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: Environment One and Date of analysis: January 28, 2019
Parameter
Result
(mglkg)
Aluminum
3,391.00
Ammonia -Nitrogen
76.14
Calcium
47,517.00
Magnesium
3,084.00
Nitrate -Nitrite Nitrogen
21.20
pH (Standard Unit)
6.90
Phosphorus
17,650.00
Potassium
5,283.00
Sodium
31,302.00
Total Kjeldahl Nitrogen
45,750.00
Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 1.68
[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 (I") Year PAN
Five -Year
(mg4g)
Maximum Adjusted PAN
(mg/kg)
Surface
13,761
21,992
Injection/Incorporation
r- 13,799
22,030
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distributionn/Lannd 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 sabnonella 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.1106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.1 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helm inth Ova.
❑ Alternative 5 [15A NCAC 02T.1 106(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.1 106(c)(2)] -Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ® lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.]106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107, specify how residuals will meet the VAR requirements:
❑ Alternative 1 [15A NCAC 02T.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.1 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 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.1 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1 107(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.1 107(a)(I0)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

Tow% of Bridgeton W WT
W
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N oeeo n N NRCan, Esri Japan, METI, Esri China (Hong Kong), Esri Korea, Esri
o (Thailand), Mapmylndia, NGCC, O OpenStreetMap contributors, and the
GIS User Community
SCALE: l " = 1,500 ft Craven Ag Services, Inc,
Land Application Program Site
CHECKED BY: RTB Town of Bridgeton Vicinity
DRAWN BY: RTB BRANCH Town
NC Map
RESIDUALS
DATE: 3/4/2020 & SOILS, LLC Pmjecl No. 20 l !l_ 1 32

Process Flow Narrative

BRIDGETON WASTEWATER TREATMENT PLANT PROCESS
The Town of Bridgeton WWTP has a designed flow of 0.075 MGD of domestic influent. The
WWTP has a bar screen and splitter box that directs influent to one of two
aeration basins (one 40,000 gallons and the other 85,000 gallons) in a dual -
train extended -air package plant. Flow from either of these basins can be
directed to one of two secondary clarifiers. Once thickened and having met
treatment, solids are removed from the clarifiers where they are wasted to
one of four aerated, digester tanks (2,000 gallons, 6,000 gallons, 10,000
gallons and 14,000 gallons). Total holding capacity of these plants are
32,000 gallons where solids are allowed to settle with water sent back to the
head of the plant and solids remaining. This process is performed several
times to achieve solids percent solids. Sludge application normally occurs at
24,000 gallons per event which is quarterly to bi-monthly. All of decisions
are made based on mixed liquid suspended solids, temperature, settling time,
sludge thickness, aeration, etc. as dictated by the ORC. Once the desired
volume of solids have been accumulated the land applier is contacted for lime
stabilization and land application
Treated effluent is monitored under NCO074837 and sent to it's discharge point at the Neuse
River.

Justification for Residuals Production Rate

JUSTIFICATION FOR BRIDGETON WWTP RESIDUALS PRODUCTION RATE
The Town of Bridgeton Wastewater Treatment Plant is currently operating at 0.075 million gallon
per day (MGD). Based on previous years' production, the dry tons have been set at 5 for annual
production to be delivered to this permit.

Residuals Sampling Plan

WWTP SAMPLING PLAN — TOWN OF BRIDGETON
Annually, multiple grab residual solid samples are collected from the sludge holding tanks. These
samples are composited for nutrient and metal analyses. The composited sample is mixed and aerated to
keep the solids suspended and containers filled for this analysis. Lime stabilization occurs when the
sludge handling tank reaches capacity. Lime is added to reach proper stabilization requirements for vector
attraction and pathogen reduction. Field measurements of pH and temperature are collected for each
stabilization event to ensure pH requirements are met. pH values are later temperature corrected for
reporting purposes. The Town of Bridgeton may elect to meet pathogen reduction by the collection of 7
fecal samples. In addition, vector attraction reduction may be met by incorporation/injection into the soil
or collection of samples for the 30-day bench test for aerobic digestion or SOUR tests.
Annually, a composite residual solid sample will be analyzed for: Arsenic, Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -
Nitrite, Nitrogen, Magnesium, % Total Solids, pH, Phosphorus, Potassium, TKN, and Sodium. From
this information, the Plant Available Nitrogen (PAN) and Sodium Adsorption Ratio (SAR) will be
calculated. Once a permit cycle, a residuals solid sample will be analyzed for TCLP. TCLP
parameters are listed below:
Arsenic
Cadmium
Chlorobenzene
O-Cresol
Cresol
1,2 Dichloroethane
Endrin
Hexachloroethane
Lindane
Methyl ethyl ketone
Pyridine
Tetrachoroethylene
2,4,5 Tricholophenol
2,4,6 Tricholophenol
Barium
Benzene
Carbon Tetrachloride
Chorodane
Chloroform
Chromium
m-Cresol
p-Cresol
2.4 D
1,4 Dichlorobenzene
1,1 Dichloroehylene
2,4 Dintrotoluene
Hexachlorobenzene
Hepachlor (and it's hydroxide)
Lead
Hexachloro 1,3 butadiene
Mercury
Methoxychlor
Nitrobenzene
Pentachlorophenol
Selenium
Silver
Toxaphene
Trichloroethylene
Vinyl Chloride
2,4,5 TP (Silvex)

Analytical Data From
Town of Bridgeton WWTP
Nutrient & Metals and TCLP

114 OAKMONT DRIVE
GREENVILLE, N.C.27856
TOWN OF BRIDGETON
HYDRO SERVICES & CONSULTING
MR. KEVIN MULLINEAUX
P.O. BOX 317
HAVELOCK ,NC 28532
PARAMETERS
PH (not to be used for reporting)
Aluminum, (dry wt. basis), mg/kg
Arsenic (dry wt. basis), mg/kg
Calcium (dry wt. basis), mg/kg
Cadmium (dry wt. basis), mg/kg
Copper (dry wt. basis), mg/kg
Chromium, T.(dry wt. basis),mg/kg
Lead (dry weight basis), mg/kg
Magnesium (dry wt. basis), mg/kg
Mercury (dry wt. basis), mg/kg
Nickel (dry wt. basis), mg/kg
Potassium (dry wt. basis), mg/kg
Selenium (dry wt. basis), mg/kg
Sodium (dry wt. basis), mg/kg
Zinc (dry wt. basis), mg/kg
Sodium Adsorption Ratio (calc)
Total Solids, %
TKN (dry wt.), mg/kg
Ammonia Nitrogen (dry wt.),mg/kg
Phosphorus, T. (dry wt.), mg/kg
Nitrate -Nitrite (dry wt.), mg/kg
Molybdenum (dry wt. basis), mg/kg
Sludge Analysis Method
Sample Date Analyst Code
6.9
01/02/19
HMIM 4500HB-11
3991
01/15/19
LFJ
EPA200.7
<2.5
01/22/19
MTM
3113B-04
47517
01/15/19
LFJ
EPA200.7
1.9
01/17/19
MTM
3113B-04
335
01/15/19
LFJ
EPA200.7
17
01/15/19
LFJ
EPA200.7
31
01/18/19
MTM
3113B-04
3084
01/15/19
LFJ
EPA260.7
0.25
01/18/19
MTM
EPA7471B
10
01/15/19
LFJ
EPA200.7
5283
01/15/19
LFJ
EPA200.7
<5.0
01/15/19
MTM
3113B-04
31302
01/15/19
LFJ
EPA200.7
1754
01/15/19
LFJ
EPA200.7
37.6
0.20
01/03/19
JMS
254OG-11
c 45750
01/16/19
CLO
351.2 R2-93
c 76.14
01/11/19
DTL
350.1 R2-93
c 17650
01/16/19
DTL
365.4-74
c 21.20
01/11/19
CLO
353.2 R2-93
<5.0
01/15/19
LFJ
EPA200.7
`DrIuXi ag Watea =,g 37715
Wantewstar 2D, 10
PHONE [phone]
CA). '2 52) 756-t0633S
ID#: 440 A
DATE COLLECTED: 01/02/19
DATE REPORTED : 01/28/19
REVIEWED BY:
v

The results set forth herein are provided by SGS North America Inc
Technical Report for
e-Hardctopy 2.0
.4 tttonutted Report
Environment 1, Inc
Town of Bridgeton Hydro Services & Consulting; Havelock, NC
440C
SGS Job Number: FA70914
Sampling Date: 12/12/19
Report to:
Environment 1, Inc
PO Box 7085
Greenville, NC 27835
[e-mail]
TTN: Deedee Woolard
Total number of pages in report: 13
wa.
.
Test results contained within tltis data package meet the requirements Caitlin Brice, M.S.
of the rational Environmental Laboratory Accreditation Program General Manager
an"' r state specific certification programs as applicable.
Client Service contact: Jean Dent -Smith 407-425-6700
Certifications: FL(E83510), LA(03051). KS(E-10327), IL(200063). NC(573), NJ(FL002), NY(12022), SC(96038001)
DoD ELAP(ANAB L2229), AZ(AZ0806), CA(2937), TX(T104704404), PA(68-03573), VA(460177),
AK, AR, IA, KY, MA, MS, ND, NH, NV, OK, OR, UT, WA. WV
This report shall not be reproduced, except in its entirety, without the written approval of SGS.
Test results relate only to samples analyzed.
SGS North America Inc. 4405 Vineland Road • suite C-15 • Orlando, Ft. 32811 • tel: [phone] • fax: [phone]
SUS is the sole aut:iort-N fir authorwin_ :,!!t. ,rn, , iili .,uw:> x, t t..i„�un;wti: Ylr;t:. ;i: trr �nur itiea; about �f�
L'nau:hurized muditicanon ui thi> -spur: is strtc=l;. r:uai'weil !tot% ttr can Nzrve %ou beuer a:: g��
Retiett standard terms at: nui : utttt s».�nm rn :erm.-any'.- un.!ta.a; Filti I'� C'us: ,;n�rCar�,t:e,.•on,
1 of 1
FA7a91

Sections:
Table of Contents
-I-
Section1: Sample Summary...................................................................................................
Section2: Summary of Hits....................................................................................................
Section3: Sample Results........................................................................................................
3.1: FA70914-1: SLUDGE SAMPLE..................................................................................
Section4: Misc. Forms............................................................................................................
4.1: Chain of Custody...........................................................................................................
3
4
5
6
11
12
2of13
SGS
FA70914

SGS North America Inc.
Sample Summary
Environment 1, Inc
Job No: FA70914
Town of Bridgeton Hydro Services & Consulting; Havelock, NC
Project No: 440C
Sample
Collected
Matrix
Client
Plumber
Date Time By
Received Code Type
Sample ID
This report contains results reported as ND = Not detected. The following applies:
Organics ND = Not detected above the MDL
FA70914-1 12/12/19 09:37 KM 12/14/19 SO Sludge SLUDGE SAMPLE
Soil samples reported on a dry weight basis unless otherwise indicated on result page.
_SG3of1
S
FA709'

Summary of Hits Page 1 of 1
Job Number: FA70914
Account: Environment 1, Inc
Project: Town of Bridgeton Hydro Services & Consulting; Havelock, NC
Collected: 12/12/ 19
Lab Sample ID Client Sample ID Result/
Analyte Qual RL MDL Units Method
FA70914-1 SLUDGE SAMPLE
1,2-Dichloroethane 0.0106 0.010 0.0031 mg/1 SW846 8260B
�bl 4 of
FA70!

Orlando, FL
Sample Results
Report of Analysis
Section 3
sfis5 of 13
FAT0914

SGS North America Inc.
Report of Analysis Page 1 of 1
Client Sample ID: SLUDGE SAMPLE
Lab Sample ID: FA70914-1 Date Sampled: 12/12/19
Matrix: SO - Sludge Date Received: 12/14/19
Method: SW846 8260B SW846 1311 Percent Solids: n/a
Project: Town of Bridgeton Hydro Services & Consulting; Havelock, NC
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 5E19799.D 10 12/23/1916:01 SO 12/16/19 14:00 OP78166 V5E899
Run #2
Purge Volume
Run #1 5.0 ml
Run #2
VOA TCLP List
CAS No.
Compound
Result
HW#
MCL RL
71-43-2
Benzene
ND
D018
0.50 0.010
78-93-3
2-Butanone (MEK)
ND
D035
200 0.050
56-23-5
Carbon Tetrachloride
ND
D019
0.50 0.010
108-90-7
Chlorobenzene
ND
D021
100 0.010
67-66-3
Chloroform
ND
D022
6.0 0.010
106-46-7
1,4-Dichlorobenzene
ND
D027
7.5 0.010
107-06-2
1,2-Dichloroethane
0.0106
D028
0.50 0.010
75-35-4
1, 1 -Dichloroethylene
ND
D029
0.70 0.010
127-18-4
Tetrachloroethylene
ND
D039
0.70 0.010
79-01-6
Trichloroethylene
ND
D040
0.50 0.010
75-01-4
Vinyl Chloride
ND
D043
0.20 0.010
CAS No.
Surrogate Recoveries
Run# 1
Run# 2
Limits
1868-53-7
Dibromofluoromethane
101%
83-118%
17060-07-0
1, 2-Dichloroethane-D4
109%
79-125%
2037-26-5
Toluene-D8
105%
85-112%
460-00-4
4-Bromofluorobenzene
111%
83-118%
TCLP Leachate method SW8461311
MDL
Units Q
0.0031
mg/1
0.020
mg/1
0.0036
mg/I
0.0020
mg/1
0.0030
mg/l
0.0026
mg/1
0.0031
mg/1
0.0032
mg/l
0.0022
mg/I
0.0035
mg/1
0.0041
mg/l
ND = Not detected MDL = Method Detection Limit j = Indicates an estimated value
MCL = Maximum Contamination Level (40 CFR 261 7/1/11) B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
SG6of1:
FA7091.

SGS North America Inc.
Report of Analysis
Page 1 of 1
Client Sample ID: SLUDGE SAMPLE
Lab Sample ID: FA70914-1 Date Sampled: 12/12/19
Matrix: SO - Sludge Date Received: 12/14/19
Method: SW846 8270D SW846 3510C Percent Solids: n/a
Project: Town of Bridgeton Hydro Services & Consulting; Havelock, NC
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 X068591.1) 1 12/19/19 20:27 MV 12/19/19 07:47 OP78217 SX2818
Run #2
Initial Volume Final Volume
.un #1 100 ml 1.0 ml
:un #2
ABN TCLP List
TCLP Leachate method SW846 1311
CAS No.
Compound
Result
HW#
MCL RL
MDL
Units Q
95-48-7
2-Methylphenol
ND
D023
200 0.050
0.0056
mg/1
3&4-Methylphenol
ND
D024
200 0.050
0.0098
mg/1
87-86-5
Pentachlorophenol
ND
D037
100 0.25
0.050
mg/l
95-95-4
2,4,5-Trichlorophenol
ND
D041
400 0.050
0.0074
mg/1
88-06-2
2,4,6-Trichlorophenol
ND
D042
2.0 0.050
0.0075
mg/l
106-46-7
1,4-Dichlorobenzene
ND
D027
7.5 0.050
0.0050
mg/1
121-14-2
2,4-Dinitrotoluene
ND
D030
0.13 0.050
0.0081
mg/l
118-74-1
Hexachlorobenzene
ND
D032
0.13 0.050
0.0069
mg/1
87-68-3
Hexachlorobutadiene
ND
D033
0.50 0.050
0.0050
mg/1
67-72-1
Hexachloroethane
ND
D034
3.0 0.050
0.016
mg/1
98-95-3
Nitrobenzene
ND
D036
2.0 0.050
0.0093
mg/l
110-86-1
Pyridine
ND
D038
5.0 0.10
0.020
mg/l
CAS No.
Surrogate Recoveries
Run# 1
Run# 2
Limits
367-12-4
2-Fluorophenol
36%
14-67%
4165-62-2
Phenol-d5
26%
10-50%
118-79-6
2,4,6-Tribromophenol
82%
33-118%
4165-60-0
Nitrobenzene-d5
78%
42-108%
321-60-8
2-Fluorobiphenyl
80%
40-106%
1718-51-0
Terphenyl-d14
84%
39-121%
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
MCL = Maximum Contamination Level (40 CFR 261 7/1/11) B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
�u7 of '13
FA70914

SGS North America Inc.
Report of Analysis
Client Sample ID: SLUDGE SAMPLE
Lab Sample ID: FA70914-1 Date Sampled: 12/12/19
Matrix: SO - Sludge Date Received: 12/14/19
Method: SW846 8151A SW846 3510C Percent Solids: n/a
Project: Town of Bridgeton Hydro Services & Consulting; Havelock, NC
Page 1 of 1
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 CC065678.1) 1 12/23/19 18:37 RS 12/21/19 11:10 OP78260 GCC1573
Run #2
Initial Volume Final Volume
Run #1 10.0 ml 5.0 ml
Run #2
Herbicide TCLP List
TCLP Leachate method SW846 1311
CAS No. Compound
Result
HW#
MCL RL
MDL Units Q
94-75-7 2,4-D a
ND
D016
10 0.050
0.017 mg/l
93-72-1 2,4,5-TP (Silvex) a
ND
D017
1.0 0.0050
0.0013 mg/l
CAS No. Surrogate Recoveries
Rung 1
Run# 2
Limits
19719-28-9 2,4-DCAA
60%
39-135%
(a) Associated BS outside of control limits high, sample
was ND.
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
MCL = Maximum Contamination Level (40 CFR 261 7/l/11) B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
SO
8of13
Fa709U

SGS North America Inc.
Report of Analysis
Client Sample ID: SLUDGE SAMPLE
Lab Sample ID: FA70914-1 Date Sampled: 12/12/19
Matrix: SO -Sludge Date Received: 12/14/19
Method: SW846 8081B SW846 3510C Percent Solids: n/a
Project: Town of Bridgeton Hydro Services &Consulting; Havelock, NC
Page 1 of 1
File ID DF Analyzed By Prep Date Prep Batch Analytical Batch
Run #1 KK96255.D 1 12/23/19 14:09 WH 12/21/19 12:45 OP78259 GKK3070
Run #2
Initial Volume Final Volume
Run #1 100 ml 5.0 ml
Run #2
Pesticide TCLP List
CAS No. Compound
Result HW# MCL RL
TCLP Leachate method SW846 1311
MDL Units Q
58-89-9
gamma-BHC (Lindane) a
ND
D013 '
0.40 0.00010
0.000022
mg/1
12789-03-6
Chlordane b
ND
D020
0.030 0.0010
0.00038
mg/I
72-20-8
Endrin b
ND
D012
0.020 0.00020
0.000021
mg/1
76-44-8
Heptachlor b
ND
D031
0.0080 0.00010
0.000026
ing/1
1024-57-3
Heptachlor epoxide a
ND
D031
0.0080 0.00010
0.000020
mg/1
72-43-5
Methoxychlor c
ND
D014
10 0.00020
0.000050
mg/1
8001-35-2
Toxaphene
ND
D015
0.50 0.0050
0.0021
mg/l
CAS No.
Surrogate Recoveries
Run# 1
Run# 2
Limits
877-09-8 Tetrachloro-m-xylene 125% 42-127%
2051-24 3 Decachlorobiphenyl 115% 27-127%
(a) Associated BS outside of control limits high, sample was ND. Associated CCV outside of control limits high,
sample was ND.
(b) Associated CCV outside of control limits high, sample was ND.
(c) Associated BS outside of control limits high, sample was ND.
ND = Not detected MDL = Method Detection Limit J = Indicates an estimated value
MCL = Maximum Contamination Level (40 CFR 261 7/1/11) B = Indicates analyte found in associated method blank
E = Indicates value exceeds calibration range N = Indicates presumptive evidence of a compound
9 of
�s .
FA709

SGS North America Inc.
Report of Analysis
Client Sample ID: SLUDGE SAMPLE
Lab Sample ID: FA70914-1 Date Sampled: 12/12/19
Matrix: SO - Sludge Date Received: 12/14/19
Percent Solids: n/a
Project: Town of Bridgeton Hydro Services & Consulting; Havelock, NC
Page 1 of 1
Metals Analysis, TCLP Leachate SW846 1311
Analyte
Result
HW#
MCL
RL
Units
DF
Prep
Analyzed
By
Method
Prep Method
Arsenic
< 0.10
D004
5.0
0.10
mg/1
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
Barium
< 2.0
D005
100
2.0
mg/1
1
12/18/19
12/20/19
LM
SW846 601OD 2
SW846 3010A 3
Cadmium
< 0.050
D006
1.0
0.050
mg/l
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
Chromium
< 0.10
D007
5.0
0.10
mg/l
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
Lead
< 0.050
D008
5.0
0.050
mg/1
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
Mercury
< 0.0050
D009
0.20
0.0050
mg/1
1
12/19/19
12/19/19
is
SW846 7470A 1
SW846 7470A 4
Selenium
< 0.10
D010
1.0
0.10
mg/1
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
Silver
< 0.10
D011
5.0
0.10
mg/l
1
12/18/19
12/20/19
LM
SW846 6010D 2
SW846 3010A 3
(1) Instrument QC Batch: MA16416
(2) Instrument QC Batch: MA16420
(3) Prep QC Batch: MP36569
(4) Prep QC Batch: MP36576
RL = Reporting Limit
MCL = Maximum Contamination Level (40 CFR 261 7/1/11)
ass 10 of 1
Fa7o9

Orlando, FL
Section 4
Misc. Forms
Custody Documents and Other Forms
Includes the following where applicable:
• Chain of Custody
0
11 of 13
FA70914

Environfuenl 1, Inc.
P 0. Box 7085,114 Oakmont Dr.
CHAIN OF CUSTODY RECORDFAV;[Oq
11(i 1
Jmcnnllc, NL: POO
environment] inc.com
Phone [phone] • Fax [phone]
CLIENT: 440C Week:1
GOWN OF B1tIDGSTON
MRO SERVICES do CONSULTING
0 BOX N MULLMU�
3AVELOCRNC2A532'
252)723-0101
CGLLC{ TION
DISINFECTION
CHLORINE
W
NOIWH
CiiOFTNE N ATCOLLECTION
pHCHECK PS)
G
G
G
G
'
A
A
A
A
�M�P �
A.NONE D,NAOH
B•HND, E-HCL
C-HSO, F-dINCACETATEMAOH
0•NATHOS DATE
Q
S?
tZ
�n
I
SANPLELOCATIGN
DATE
TIME
Sludge Sample
T !3 7.
3
WASIEYIATER(NPOES)
MNMWATER
D1 1101
SOLID WASTE SECTION
CHAIN OF CUSTODY (SEAL) tMINTAMED
DURI ENTMELIVERY
Y�. N
1
SWPLES COLLECTED EY:
(P�sePrfnQ
ctiY
sPrAPIESP,ECEiVEDINtAeaT l G1 -°C
REuTV MIEDBY(SlG.PA NpER)
h ik
DATEIIVAE
REC SIG) (
DA e1iWE
z Zs)
COIAMM.
u.
REL'NDUI BY( G.)
DA;ElMTt
j21
RE BY(SIG.)
`7
'2/31a
7
) e
1
R UIShTD (S
E
12�i Ii i
RECSVE SY(SI1)
D E/IIAI A
1 ��1 �/ / 7'fly Samrinr mil nla�a fl'C' for COm00eite Sam010 0f a'G� 10f
u PLEASE READ Irb-ti Dons for completing this rm on the reverse side. Grab samp'e in the bloclrs above ter each parameter requaMad. N2 3 % 6 0 6 b
IF
FORM e6
FA70914: Chain of Custody
Page 1 of 2
-GSc 1zof1
FA7091

SGS Sample Receipt Summary
Job Number: FA70914
Date / Time Received: 12/14/2019 9.00:00 AA
Client: ENVIRONMENT 1. INC.
Delivery Method: FED EX
Therm ID: IR 1; Therm CF: -0.8:
Cooler Temps (Raw Measured) °C: Cooler 1: (2.3);
Cooler Temps (Corrected) eC: Cooler 1: (1.5);
Cooler Information _Y or N
1. Custody Seals Present W ❑
2. Custody Seals Intact 2 ❑
3. Temp criteria achieved W ❑
4. Cooler temp verification IR Gun
5. Cooler media Ice (Ban)
Trio Blank Information
1. Trip Blenh present I cooler
2. Trip Blank listed on CDC
3. Type Of TB Received
Y or N NIA
❑ W ❑
❑ , ❑
W or S NIA
❑ ❑ Lei
Project: TOWN OF BRIDGETON
Airbill fats:
# of Coolers: 1
Samlee Information
1. Sample labels present on bottles
2. Samples preserved property
3. Sufficient volumelcontainers recvd for analysis:
4. Condition of sample
5. Sample recvd within HT
8. DatesrrmesnDs on CDC match Sample Label
7. VOCs have headspace
8. Botdea received for un3peciried test*
9. Compositing instructions clear
10. Vos Soil Fits/Jars received past 48hrs?
11. % Solids Jar received?
12. Residual Chlorine Present?
Misc. Information
Number of Encores: 25-Gram 5-Gram Number of 5035 Field Kits:
Test Strip Lot #s: pH 0-3 230315 pH 10-12 219813A
Residual Chlorine Test Strip Lot p:
Comments
Retool Rev. Date 05R4n7 Technician: TRINITYNI Date 12/14/2019 9.00 00 A Reviewer.
I
s
Y
or N
NIA
`i^
rJ
02
❑
9
❑
n t
2
®
❑
F-
❑
9
�
❑
E
❑
9
Number of Lab Filtered Metals:
Other: (Specify)
Date
FA70914: Chain of CustodN
Page 2 of 2
UZI
13 of 1:
FA7091

RESIDUALS SOURCE CERTIFICATION ATTACHMENT
Pruitt Health Sealevel, NC WWTP

Residuals Source Facility Summary Page

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
® For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Pen -nits".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Craven Ag Services, Inc,
Status
Code°
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
Town of Maysville
Maysville WWTP
Jones
NCO021482
15
15
R
Town of Bridgeton
Bridgeton WWTP
Craven
NCO074837
5
5
R
Pruitt Health — Sea Level, NC
Pruitt Health Care
Carteret
NCO047759
1
I
N
Town of River Bend
River Bend WWTP
Craven
NCO030406
15
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

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
1. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Pruitt Health at Sea Level, NC
2. Facility permit holder is: ❑ Federal, ❑ State, ❑ Local Government, or ® Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Anna Bernacchi, Administrator
Complete mailing address: Post Office Box 100
City: Sea Level State: NC Zip: 28577-
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 468 Highway 70 East
City: Sea Level State: NC Zip: 28577-
Coordinates: Latitude: 34" 53' 1.04" N Longitude: 76' 23' 38.58" W
Datum: NAD 1983 NC State Plane Level of accuracy: 1"
Method of measurement: Man
5. Purpose of the facility:
❑ treatment of municipal wastewater, ® treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and _ % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: 0.014 MGD and facility average daily flow: 0.12 MGD
8. Average amount of residuals being generated at this facility 1 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 2,700-gallon aerated digestion sludge holding
Type and volume of residuals storage (i.e., outside of residuals treatment units): No Additional
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1 102(6) as:
® Biological ❑ Non -Biological
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).
FORM: RSC 06-16 Page 1 of 5

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) TCLP is not Required for This Facility
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ❑ no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ❑ no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: NA. and Date of analysis: NA
Passed corrosivity test: ❑ yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ❑ yes ❑ no. Flashpoint: NA IF (> 140°F)
Passed reactivity test: ❑ yes ❑no. HCN: NA mg/kg (<250) & H2S: NA mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
NA
Hexachlorobenzene
0.13
NA
Barium
100.0
NA
Hexachloro-1,3-Butadiene
0.5
NA
Benzene
0.5
NA
Hexachloroethane
3.0
NA
Cadmium
1.0
NA
Lead
5.0
NA
Carbon Tetrachloride
0.5
NA
Lindane
0.4
NA
Chlordane
0.03
NA
Mercury
0.2
NA
Chlorobenzene
100.0
NA
Methoxychlor
10.0
NA
Chloroform
6.0
NA
Methyl Ethyl Ketone
200.0
NA
Chromium
5.0
NA
Nitrobenzene
2.0
NA
m-Cresol
200.0
NA
Pentachlorophenol
100.0
NA
o-Cresol
200.0
NA
Pyridine
5.0
NA
p-Cresol
200.0
NA
Selenium
1.0
NA
Cresol
200.0
NA
Silver
5.0
NA
2,4-D
10.0
NA
Tetrachloroethylene
0.7
NA
1,4-Dichlorobenzene
7.5
NA
Toxaphene
0.5
NA
1,2-Dichloroethane
0.5
NA
Trichloroethylene
0.5
NA
1, 1 -Dichloroethylene
0.7
NA
2,4,5-Trichlorophenol
400.0
NA
2,4-Dinitrotoluene
0.13
NA
2,4,6-Trichlorophenol
2.0
NA
Endrin
0.02
NA
2,4,5-TP (Silvex)
1.0
NA
Heptachlor and its Hydroxide
0.008
NA
Vinyl Chloride
0.2
NA
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For DistrlbutionlLand 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: Environment One and Date of analysis: January 30, 2019
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mglkg)
(mg/kg)
(mglkg)
Arsenic
75
41
< 2.5
Cadmium
85
39
1.10
Copper
4,300
1,500
1,574.00
Lead
840
300
68.00
Mercury
57
17
170
Molybdenum
75
n/a
< 5.0
Nickel
420
420
17.00
Selenium
100
100
< 5.0
Zinc
7,500
2,800
1,557.00
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mglkg)
Chromium
(mglkg)
Nickel
(mglkg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mglkg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.23%.
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: Environment One and Date of analysis: January 30, 2019
Parameter
Result
(mglkg)
Aluminum
3,611.00
Ammonia -Nitrogen
149.90
Calcium
40,417.00
Magnesium
3,074.00
Nitrate -Nitrite Nitrogen
4.96
pH (Standard Unit)
8.10
Phosphorus
14,850.00
Potassium
3,196.00
Sodium
20,410.00
Total Kjeldahl Nitrogen
30,960.00
c. Using the results listed in Item I1. 5b. above, calculate the sodium adsorption ration (SAR): 2.92
[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 (1") Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mglkg)
Surface
9,323
14,875
Injection/Incorporation
9,398
14,950
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Ladd 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.1 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.1 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.1106(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.1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ® lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 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 11.8. below [15A NCAC 02T.1 106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107, 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.1 107(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.1 107(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.1 107(a)(6)] -Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1 107(a)(7)] -Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.1 107(a)(9)] -Injection.
❑ Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only- Soil/Other Material Cover [15A NCAC 02T.]107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

Masont4wirt
S'A
PruittHealth Sea Level WWTA
J
a10 eJY6h.'.-e
In .p
�d BJ ass
ss� ♦5
o„
�S 5`
Sources Esri, HERE, Del_orme, USGS Intermap, INCREMENT P.
NRCan, Esn Japan, METI, Esn China (Hong Kong), Esri Korea, Esri
(Thailand), Mapmylndia, NGCC. O OpenStreetMap contributors. and the
GIs User Community
SCALE: 1 " _ 1,500 ft Craven Ag Services, Inc,
Land Application Program Site
CHECKED BV: RTB PruittHealth Vicinity
DRAWN BV: RTB BRANCH SIDUALS Sea Level, NC Map
RE
DATE: 3/4/2020 & SOILS, LLC Project No. 2019-132

Process Flow Narrative

PRUITT HEALTH AT SEA LEVEL WASTEWATER TREATMENT PLANT PROCESS
The Pruitt Health at Seal Level, NC WWTP has a designed flow of 14,000 GPDof domestic
influent. The WWTP has an aerated equalization basin, bar screen and splitter
box that directs influent to one of two aeration basins (both 6,075 gallons)
in a dual -train extended -air package plant. Flow from either of these basins
can be directed to one of two secondary clarifiers or back to the either one
of the basins. Once thickened and having met treatment, solids are removed
from the clarifiers where they are wasted to an aerated, digester tank. This
tank will hold 2,700 gallons. Solids are allowed to settle with water sent
back to the head of the plant and solids remaining. This process is performed
several times to achieve solids percent solids. All of decisions are made
based on mixed liquid suspended solids, temperature, settling time, sludge
thickness, aeration, etc. as dictated by the ORC. Once the desired volume of
solids have been accumulated the land applier is contacted for lime
stabilization and land application
Treated effluent is monitored under NCO047759 and sent to it's discharge point into Nelson Bay
of the White Oak River Basin. A plant schematic is attached.

Wastewater Treatment Plant Process for Pruitt Health at Sea Level
Equalization Basin
3,750 gal
Dual Aeration
Basins
6,075 gal each
Dual Clarifier
Influent
Equalization
Basin
1,687 gal each yClarifierClarifier
Liquidsnt
Dual Tertiary
Filters
Chlorine
Contact Chamber
Liquid Sodium Bisulfite
De -Chlorination
Influent Pump
Station
Bar Screen
Outfall 001 Discharge
Nelson Bay (White Oak
Solids
Aerobic
Digester
2700 Gal
Application
Site

Justification for Residuals Production Rate

JUSTIFICATION FOR PRUITT HEALTH AT SEA LEVEL WWTP RESIDUALS
PRODUCTION RATE
The Pruitt Health at Sea Level, NC Wastewater Treatment Plant is currently operating at 14,000
gallon per day. Based on previous years' production, the dry tons have been set at 1 for annual
production to be delivered to this permit.

Residuals Sampling Plan

WWTP SAMPLING PLAN — PRUITT HEALTH AT SEA LEVEL
Annually, multiple grab residual solid samples are collected from the sludge digester. These samples are
composited for nutrient and metal analyses. The composited sample is mixed and aerated to keep the
solids suspended and containers filled for this analysis. Lime stabilization occurs when the sludge
handling tank reaches capacity. Lime is added to reach proper stabilization requirements for vector
attraction and pathogen reduction. Field measurements of pH and temperature are collected for each
stabilization event to ensure pH requirements are met. pH values are later temperature corrected for
reporting purposes. The Pruitt Health at Sea Level may elect to meet pathogen reduction by the collection
of 7 fecal samples. In addition, vector attraction reduction may be met by incorporation/injection into the
soil or collection of samples for the 30-day bench test for aerobic digestion or SOUR tests.
Annually, a composite residual solid sample will be analyzed for: Arsenic, Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -
Nitrite, Nitrogen, Magnesium, % Total Solids, pH, Phosphorus, Potassium, TKN, and Sodium. From
this information, the Plant Available Nitrogen (PAN) and Sodium Adsorption Ratio (SAR) will be
calculated. Because this is a domestic only facility no TCLP is required.

Analytical Data From
Pruitt Health Sealevel WWTP
Nutrient & Metals and TCLP

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GREENVILLE, N.C. 27858
PRUITT HEALTH (SEA LEVEL)
ATTNs STACEY RRAFT
P.O. SOX 100
SEA LEVEL ,NC 28577
PARAMETERS
PH, Units
Aluminum, (dry wt. basis), mg/kg
Arsenic (dry wt. basis), mg/kg
Calcium (dry wt. basis), mg/kg
Cadmium (dry wt. basis), mg/kg
Copper (dry wt. basis), mg/kg
Chromium, T.(dry wt. basis),mg/kg
Lead (dry weight basis), mg/kg
Magnesium (dry wt. basis), mg/kg
Mercury (dry wt, basis), mg/kg
Nickel (dry wt. basis), mg/kg
Potassium (dry wt. basis), mg/kg
Selenium (dry wt, basis), mg/kg
Sodium (dry wt. basis), mg/kg
Zinc (dry wt. basis), mg/kg
Total Solids, %
TKN (dry wt.), mg/kg
Ammonia Nitrogen (dry wt.),mg/kg
Phosphorus, T. (dry wt.), mg/kg
Nitrate -Nitrite (dry wt.), mg/kg
Molybdenum (dry wt. basis), mg/kg
Sludge Analysis Method
Sample Date Analyst Code
8.1
01/11/19
I{DS
450OBB-11
3611
01/15/19
LFJ
EPA200.7
<2.5
01/22/19
MTM
311311-04
40417
01/15/19
LFJ
EPA200.7
1.1
01/17/19
MTM
311311-04
1574
01/15/19
LFJ
EPA200.7
10
Ol/1S119
LFJ
EPA200.7
68
01/18/19
MTM
311313-04
3074
0111SI19
LFJ
EPA200.7
2.7
01/18/19
MTM
EPA7471B
17
0111SI19
LFJ
EPA200.7
3196
01/15/19
LFJ
EPA200.7
<5.0
01/15/19
MTM
311313-04
20410
01/15/19
I,FJ
EPA200.7
1557
01/15/19
LFJ
EPA200.7
1.23
01/07/19
JM 1
2540G-11
c 30960
01/18/19
TLH
351.2 112-93
c 10.9
01/24/19
CLO
350.1 112-93
c 14850
01/18/19
BLD
365.4-74
c 4.96
01/15/19
DTL
353.2 112-93
<5.0
01/15/19
LFJ
EPA200.7
Wastewater IDr 10
PHONE (262) r56-6208
FAX [phone]
ID#: 381 A
DATE COLLECTED: 01/07/19
DATE REPORTED : 01/30/19
REVIEWED BY:
a Uncertified data, DWA does not offer non -aqueous certification for this analytical procedure.
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PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for
FORM 05 Grab sample in the blocks above for each parameter requested. N® 366372

RESIDUALS SOURCE CERTIFICATION ATTACHMENT
Town of River Bend WWTP

Residuals Source Facility Summary Page

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 1 1-15) fonn. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
❑ For modified pennits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
® For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Pen -nits".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Craven Ag Services, Inc,
Status
Code a
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current n
Proposed
R
Town of Maysville
Maysville WWTP
Jones
NCO021482
15
15
R
Town of Bridgeton
Bridgeton WWTP
Craven
NCO074837
5
5
R
Pruitt Health — Sea Level, NC
Pruitt Health Care
Carteret
NCO047759
1
1
N
Town of River Bend
River Bend WWTP
Craven
NCO030406
15
° 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

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of River Bend
2. Facility permit holder is: ❑ Federal, ❑ State, ® Local Government, or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Delane Jackson, Town Manager
Complete mailing address: 45 Shoreline Drive
City: River Bend State: NC Zip: 28562-
Telephone number: [phone] E-mail address: manaeerexiverbendnc.org
4. Facility physical address: Gull Point Road.
City: River Bend State: NC Zip: 28562-
Coordinates: Latitude: 34' 41' 16.57" N Longitude: 77' 8' 5.34" W
Datum: NAD 1983 NC State Plane Level of accuracy: 1"
Method of measurement: Man
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and _ % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ❑ Yes ® No
7. Facility permitted/design flow: 0.33 MGD and facility average daily flow: 0.12 MGD
8. Average amount of residuals being generated at this facility 15 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 2-15,000 gallons aerated digestion + 40,000 gallon aerated sludge holding
Type and volume of residuals storage (i.e., outside of residuals treatment units): No Additional
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
l . Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1 102(6) as:
® Biological ❑ Non -Biological
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).
FORM: RSC06-16 Pagel of5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Environmental Chemists and Date of analysis: January 20, 2020
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: >205 OF (> 140°F)
Passed reactivity test: ® yes ❑no. HCN: <0.05mg/kg (<250) & H2S: 0.56 mg/kg (<500)
TCLP Parameter
Limit
(mg/V
Result
(mg/l)
TCLP Parameter
Limit
(mg/1)
Result
(mg/V
Arsenic
5.0
<1.00
Hexachlorobenzene
0.13
<0.05
Barium
100.0
<1.00
Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene
0.5
<0.01
Hexachloroethane
3.0
<0.05
Cadmium
1.0
<1.00
Lead
5.0
<1.00
Carbon Tetrachloride
0.5
<0.01
Lindane
0.4
<0.0005
Chlordane
0.03
<0.02
Mercury
0.2
<0.0002
Chlorobenzene
100.0
<0.01
Methoxychlor
10.0
<0.0005
Chloroform
6.0
<0.01
Methyl Ethyl Ketone
200.0
<0.05
Chromium
5.0
<1.00
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.05
Pentachlorophenol
100.0
<0.25
o-Cresol
200.0
<0.05
Pyridine
5.0
<0.05
p-Cresol
200.0
<0.05
Selenium
1.0
<1.00
Cresol
200.0
<0.05
Silver
5.0
<1.00
2,4-D
10.0
<0.003
Tetrachloroethylene
0.7
<0.01
1,4-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.0I
Trichloroethylene
0.5
<0.01
1, 1 -Dichloroethylene
0.7
<0.0I
2,4,5-Trichlorophenol
400.0
<0.05
2,4-Dinitrotoluene
0.13
<0.05
2,4,6-Trichlorophenol
2.0
<0.05
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
<0.003
Heptachlor and its Hydroxide
0.008
<0.0005
Vinyl Chloride
0.2
<0.01
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1 105.
a. For Distribution/Laud 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: Environmental Chemists and Date of analysis: January 20, 2020
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mg4g)
(mg/kg)
(mg/kg)
Arsenic
75
41
< 9.82
Cadmium
85
39
< 9.82
Copper
4,300
1,500
751.00
Lead
840
300
11.00
Mercury
57
17
< 0.712
Molybdenum
75
n/a
< 9.82
Nickel
420
420
10.60
Selenium
100
100
< 9.82
Zinc
7,500
2,800
765.00
b. For Surface Disposal Unit (landrll): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(nag/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 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)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 2.81 %.
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: Environmental Chemists and Date of analysis: January 20, 2020
Parameter
Result
(mglkg)
Aluminum
4,060.00
Ammonia -Nitrogen
8,670.00
Calcium
37,200.00
Magnesium
2,860.00
Nitrate -Nitrite Nitrogen
1,820.00
pH (Standard Unit)
7.48
Phosphorus
12,900.00
Potassium
3,560.00
Sodium
4,660.00
Total Kjeldahl Nitrogen
58,300.00
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 1.05
[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 (11t) Year PAN
Five -Year
Maximum Adjusted PAN
(mg4g)
(mg/kg)
Surface
21,044
1 29,987
Injection/Incorporation
25,379
1 34,322
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1 106, 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.1 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.1 106(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.1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ® lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.1 106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107, specify how residuals will meet the VAR requirements:
❑ Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.1 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.1 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
® Alternative 6 [15A NCAC 02T.1107(a)(6)] -Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1 107(a)(7)] -Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1 107(a)(8)] - Drying of Unstabilized Residuals.
® Alternative 9 [15A NCAC 02T.1 107(a)(9)] - Injection.
® Alternative 10 [15A NCAC 02T.1 107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.]107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

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SCALE: 1 "= 1,500ft
CHECKED Bl': RTB
RTB BRANCH
DRAWN BY: RESIDUALS
DATE: 3/4/2020 & SOILS, LLC
ToWn of Bridgeton WWT-P,-
d W WT.P_t
Havelock
Craven Ag Services, Inc,
Land Application Program Site
Town of Riverbend Vicinity
Riverbend, NC Map
Project No. 201 rl_ 1 3

Process Flow Narrative

THE TOWN OF RIVER BEND WASTEWATER TREATMENT PLANT PROCESS
Wastewater enters the River Bend WWTP through the main lift station which collects wastewater
from the town's collection system. The operational capacity for this plant is .33 MGD. From the
lift station influent flows over the static screen to remove larger debris. From this point the influent
flows to an aerated equalization basin before going to a splitter box t h a t d i r e c t s i n f l u e n t t o
one of two aeration in a dual -train extended -air package plant. Flow from
either of these basins can be directed to one of two secondary clarifiers or
back to the either one of the basins. Once thickened and having met
treatment, solids are removed from the clarifiers where they are wasted to
one of three an aerated, digester tanks. These tanks total approximately 8,000
gallons. Solids are allowed to settle with water sent back to the head of the
plant and solids remaining. This process is performed several times to
achieve solids percent solids. All of decisions are made based on mixed
liquid suspended solids, temperature, settling time, sludge thickness,
aeration, etc. as dictated by the ORC. Once the desired volume of solids
have been accumulated the land applier is contacted for lime stabilization
and land application
Treated effluent is monitored under NCO030406 and sent to it's discharge point into the Trent
River a tributary of the Neuse River. A plant schematic is attached.

Avg. Inf.Flow:
0.093MGD
Main Lift
.Station
Dechlor.
Room
Town Of River Bend Wastewater Treatment Process Flow Dia ram
Gen#2
Gen#1
Static
Screen
Avg. Effluent
Flow: 0.093
MGD
Blower Room
Flow
Equalizat
ion Bas.
River
Main Digester/ Dosing Tank
Plant #1 WAS:
AVG:150gpd
Plant#2 WAS:
AVG:l00gpd
Chlorine
Room
t
Plant #1
i'7
Plant#2
Plant#lAVG FLOW:
0.080MGD
Plant#2 AVG Flow:
0.013MGD

Justification for Residuals Production Rate

JUSTIFICATION FOR RIVERBEND WWTP RESIDUALS PRODUCTION RATE
The Town of Riverbend, NC Wastewater Treatment Plant's operational capacity is 330,000 gallon
per day. Based on previous years' production, the dry tons have been set at 15 for annual production
to be delivered to this permit.

Residuals Sampling Plan

WWTP SAMPLING PLAN — TOWN OF RIVER BEND
Annually, multiple grab residual solid samples are collected from the sludge digesters. These samples
are composited for nutrient and metal analyses. The composited sample is mixed and aerated to keep the
solids suspended and containers filled for this analysis. Lime stabilization occurs when the sludge
handling tank reaches capacity. Lime is added to reach proper stabilization requirements for vector
attraction and pathogen reduction. Field measurements of pH and temperature are collected for each
stabilization event to ensure pH requirements are met. pH values are later temperature corrected for
reporting purposes. River Bend WWTP may elect to meet pathogen reduction by the collection of 7 fecal
samples. In addition, vector attraction reduction may be met by incorporation/injection into the soil or
collection of samples for the 30-day bench test for aerobic digestion or SOUR tests.
Annually, a composite residual solid sample will be analyzed for: Arsenic, Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -
Nitrite, Nitrogen, Magnesium, % Total Solids, pH, Phosphorus, Potassium, TKN, and Sodium. From
this information, the Plant Available Nitrogen (PAN) and Sodium Adsorption Ratio (SAR) will be
calculated. Once a permit cycle, a residuals solid sample will be analyzed for TCLP. TCLP
parameters are listed below:
Arsenic
Cadmium
Chlorobenzene
O-Cresol
Cresol
1,2 Dichloroethane
Endrin
Hexachloroethane
Lindane
Methyl ethyl ketone
Pyridine
Tetrachoroethylene
2,4,5 Tricholophenol
2,4,6 Tricholophenol
Barium
Benzene
Carbon Tetrachloride
Chorodane
Chloroform
Chromium
m-Cresol
p-Cresol
2.4 D
1,4 Dichlorobenzene
1,1 Dichloroehylene
2,4 Dintrotoluene
Hexachlorobenzene
Hepachlor (and it's hydroxide)
Lead
Hexachloro 1,3 butadiene
Mercury
Methoxychlor
Nitrobenzene
Pentachlorophenol
Selenium
Silver
Toxaphene
Trichloroethylene
Vinyl Chloride
2,4,5 TP (Silvex)

Analytical Data From
Town of River Bend WWTP
Nutrient & Metals and TCLP

?' e
kY enviro .....
r
ANALYTICAL & CONSULTING CHEMISTS
Environmental Chemists, ffneo
6602 Windmill Way, Wilmington, NC 28405 ° 910.392.0223 Lab ° 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 ° 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 ° 910.347.5843 Lab/Fax
info�ii;emironmentalchemists.com
Town of River Bend
Date of Report:
Jan 20, 2020
45 Shoreline Drive
Customer PO #•
New Bern NC 28562
Customer ID:
12110004
Attention: Brandon Mills
Report #:
2019-21213
Project ID: Wastewater
Lab ID Sample ID:
Collect Date/Time Matrix
Sampled by
19-53738 Site: Sludge
12/17/2019 8:20 AM Solid/Sludge
Tom Harper
Test Method Results Date Analyzed
Chlordane (TCLP)
SW 846 Method 8081B/3510
<0.02 mg/L
12/23/2019
Endrin (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
12/23/2019
Heptachlor (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
12/23/2019
Heptachlor epoxide (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
12/23/2019
Lindane (TCLP)
SW 846 Method 80818/3510
<0.0005 mg/L
12/23/2019
Methoxychlor (TCLP)
SW 846 Method 8081B/3510
<0.0005 mg/L
12/23/2019
Toxaphene (TCLP)
SW 846 Method 8081 B1351 0
<0.05 mg/L
12/23/2019
1,4-Dichlorobenzene (TCLP)
SW 846 method 6270/3510
<0.050 mg/L
12/19/2019
2,4,5-Trichlorophenol (TCLP)
SW 846 method 6270/3510
<0.050 mg/L
12/19/2019
2,4,6-Trichlorophenol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
2,4-Dinitrotoluene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
Cresol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
Hexachloro-1,3-butadiene (TCLP)
SW 646 method 8270/3510
<0.050 mg/L
12/19/2019
Hexachlorobenzene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
Hexachloroethane (TCLP)
SW 646 method 8270/3510
<0.050 mg/L
12/19/2019
m + p-Cresol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
Nitrobenzene (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
o-Cresol (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
Pentachlorophenol (TCLP)
SW 846 method 8270/3510
<0.250 mg/L
12/19/2019
Pyridine (TCLP)
SW 846 method 8270/3510
<0.050 mg/L
12/19/2019
2,4,5-TP (TCLP)
SW846 Method 6151A
<0.003 mg/L
12/20/2019
2,4-D (TCLP)
SW646 Method 8151A
<0.003 mg/L
12/20/2019
1,1-Dichloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
1,2-Dichloroethane (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Benzene (TCLP)
SW846 Method 6260/5030
<0.01 mg/L
12/21/2019
Carbon Tetrachloride (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Report #:: 2019-21213 Page 2 of 5

.nnvironmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 ° 910.392.0223 Lab ° 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 ° 252.473.5702 Lab/Fax
s" 255-A Wilmington Highway, Jacksonville, NC 28540 ° 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS info(rJ•emvironnientalchemists.com
Town of River Bend
Date of Report: Jan 20, 2020
45 Shoreline Drive
Customer PO #:
New Bern NC
28562
Customer ID: 12110004
Attention: Brandon Mills
Report #: 2019-21213
Project ID: Wastewater
Chlorobenzene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Chloroform (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Methyl ethyl ketone (TCLP)
SW846 Method 8260/5030
<0.05 mg/L
12/21/2019
Tetrachloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Trichloroethylene (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
Vinyl Chloride (TCLP)
SW846 Method 8260/5030
<0.01 mg/L
12/21/2019
RCI
Cyanide
EPA 335.4
<0.05 mg/kg
12/27/2019
Sulfide
SM 4500 S D
0.56 mg/kg
12/26/2019
Ignitability
SW 846 method 1010
>205 OF
01/10/2020
Sludge Residuals
Aluminum
EPA 200.7
4060 mg/kg
12/30/2019
Arsenic
EPA 200.7
<9.82 mg/kg
12/30/2019
Cadmium
EPA 200.7
<9.82 mg/kg
12/30/2019
Calcium
EPA 200.7
37200 mg/kg
12/30/2019
Chromium
EPA 200.7
12.4 mg/kg
12/30/2019
Copper
EPA 200.7
751 mg/kg
12/30/2019
Lead
EPA 200.7
11.0 mg/kg
12/30/2019
Magnesium
EPA 200.7
2860 mg/kg
12/30/2019
Molybdenum
EPA 200.7
<9.82 mg/kg
12/30/2019
Nickel
EPA 200.7
10.6 mg/kg
12/30/2019
Potassium
EPA 200.7
3560 mg/kg
12/30/2019
Selenium
EPA 200 7
<9.82 mg/kg
12/30/2019
Sodium
EPA 200.7
4660 mg/kg
12/30/2019
Zinc
EPA 200 7
765 mg/kg
12/30/2019
Nitrate+Nitrite-Nitrogen
EPA 353.2
1820 mg/kg
01/04/2020
Total Solids (%)
SM 2540 B
2.81 %
12/18/2019
pH
SM 4500 H B
7.48 units
12/23/2019
Ammonia Nitrogen
SM 4500 NH3 C
8670 mg/kg
12/20/2019
Total Kjeldahl Nitrogen (TKN)
SM 4500 Org B
58300 mg/kg
12/19/2019
Report #:: 2019-21213
Pane 3 of 5

ii2invironment al Chemists, Enc e
envirochem. 6602 Windmill Way, Wilmington, NC 28405 ° 9"10.392.0223 Lab ° 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
sM 255-A Wilmington Highway, Jacksonville, NC 28540 e 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS info(uenvironmentalchemisls.com
Town of River Bend Date of Report: Jan 20, 2020
45 Shoreline Drive Customer PO #:
New Bern NC 28562 Customer ID: 12110004
Attention: Brandon Mills Report #: 2019-21213
Project ID: Wastewater
Total Phosphorus SM 4500 P F 12900 mg/kg 01 /03/2020
Mercury SW8467471B <0.712mg/kg 12/28/2019
TCLP Metals
Arsenic
EPA 200.7
<1.0 mg/L
12/30/2019
Barium
EPA 200.7
<1.0 mg/L
12/26/2019
Cadmium
EPA 200.7
<1.0 mg/L
12/26/2019
Chromium
EPA 200.7
<1.0 mg/L
12/26/2019
Lead
EPA 200.7
<1.0 mg/L
12/26/2019
Selenium
EPA 200.7
<1.0 mg/L
12/30/2019
Silver
EPA 200.7
<1.0 mg/L
12/26/2019
Mercury
EPA 245.1
<0.0002 mg/L
12/28/2019
Lab ID Sample ID:
Collect Date/Time
Matrix Sampled by
19-53756 Site: 1
12/17/2019 8:20 AM
Solid/Sludge Tom Harper
Test
Method
Results Date Analyzed
Total Solids (%) SM 2540 B 2.70 % 12/18/2019
Fecal Density SM 9221C E MPN 24 hr 503 1667 MPN/g 12/18/2019
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
19-53757 Site: 2 12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test Method Results Date Analyzed
Total Solids (%)
Fecal Density
Lab ID Sample ID:
19-53758 Site:3
SM 2540 B
SM 9221C E MPN 24 hr 503
2.65 % 12/18/2019
2944 MPN/g 12/18/2019
Collect Date/Time Matrix Sampled by
12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test Method Results Date Analyzed
Total Solids (%)
Fecal Density
SM 2540 B
SM 9221 C E MPN 24 hr 503
2.70 % 12/18/2019
741 MPN/g 12/18/2019
Report #:: 2019-21213 Page 4 of 5

Elmvlronmenttal CChemIlsts9 Inc.
4
Y
MI
y 6602 Windmill Way, Wilmington, NC 28405 ° 910.392.0223 Lab ° 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
s,e 255-A Wilmington Highway, Jacksonville, NC 28540 ° 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS inli)(ci:,ciivironmentalchemists.com
Town of River Bend
Date of Report: Jan 20, 2020
45 Shoreline Drive
Customer PO #:
New Bern NC
28562 Customer ID: 12110004
Attention: Brandon Mills
Report #: 2019-21213
Project ID: Wastewater
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
19-53759 Site: 4
12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test
Method Results Date Analyzed
Total Solids (%)
SM 2540 B 2.70 % 12/18/2019
Fecal Density
SM 9221C E MPN 24 hr 503 <667 MPN/g 12/18/2019
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
19-53760 Site: 5
12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test
Method Results Date Analyzed
Total Solids (%)
SM 2540 B 2.76 % 12/18/2019
Fecal Density
SM 9221C E MPN 24 hr 503 725 MPN/g 12/18/2019
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
19-53761 Site: 6
12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test
Method Results Date Analyzed
Total Solids (%)
SM 2540 B 2.55 % 12/18/2019
Fecal Density
SM 9221C E MPN 24 hr 503 19216 MPN/g 12/18/2019
Lab ID Sample ID:
Collect Date/Time Matrix Sampled by
19-53762 Site: 7
12/17/2019 8:20 AM Solid/Sludge Tom Harper
Test
Method Results Date Analyzed
Total Solids (%)
SM 2540 B 2.71 % 12/18/2019
Fecal Density
SM 9221C E MPN 24 hr 503 2510 MPN/g 12/18/2019
Comment: Sludge residual results, except pH, reported on a dry weight basis. pH reported on an as received
basis.
Reviewed by:
Report #.: 2019-21213 Paoe 5 of 5

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LAND APPLICATION SITE CERTIFICATION ATTACHMENT

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supportine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include water
treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed pen -nits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the proposed
modification.
B. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
®
County Board
✓
Notification. doc
Land Owner
✓
✓
✓
Agreement
(If applicable)
n
✓
✓
✓
✓
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Man Guidance
for Residuals Land Application Permits'
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scientist
Evaluation Polic%-
✓
INSTRUCTIONS FOR FORM: LASC 06-16Page 1 of

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

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

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LAND APPLICATION SITE CERTIFICATION
B Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
C Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction Q:
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
p
Class
° ' 11°
' ft
NAD 83
ADD
Nearest Second
° ' "
° '
NAD 83
ADD
Nearest Second
° ' rp
° '
NAD 83
ADD
Nearest Second
° ' ff
° ' It
NAD 83
ADD
Nearest Second
° ' It
° ' it
NAD 83
ADD
Nearest Second
° ' "
° ' It
NAD 83
ADD
Nearest Second
° ' if
° ' It
NAD 83
ADD
Nearest Second
° ' It
° ' if
NAD 83
ADD
Nearest Second
Note: Please keep the site information (I.) and waterbody information (11.) of the same field on the same page.
FORM: LASC 06-16 Page 2

Landowner Agreement Attachments

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two conies of the application and
supaorting 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 Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name W. (Winfred) Allen and Gloria (Arrington) Roach
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)
2-1
Yes
Row Crop
Animal Feed
2-2
Yes
Row Crop
Animal Feed
2-3
Yes
Row Crop
Animal Feed
24
Yes
Row Crop
Animal Feed
2-5
Yes
Row Crop
Animal Feed
2-6
Yes
Row Crop
Animal Feed
3-1
Yes
Row Crop
Animal Feed
3-2
Yes
Row Crop
Animal Feed
3-3
Yes
Row Crop
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16Page 1 of

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, 1636 Mail
Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit, take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
I1. 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 nroeram:
FORM: LOA 06-16Page
(Name of the new program)
of

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: neyoet-_
Address: /9 a e / l •- '44
City:
Phone: J y -
Signature:
State: Zip: �7.5
E-mail
Date: 3- l _1 a
NORTH CAROLINA, C (•a V ems-. COUNTY
I, the undersigned Notary Public do hereby certify that P II Pn (�iC G.
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the +�i f Fees H-_ d
day of Olatrc,
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
�- '?y ao�y
20 20
L�
0 DUB
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: ,4-
/
Address: !qG❑ "%^ tQ _
City: Qy
Phone:
Signature
Permittee's Certification:
State: H. C Zip:
E-mail address:
Date: b7 -43 ny- o
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: L/d
Signature: Date: 3 - f 3 - o�
FORM: LOA 06-16Page 3 of

I!U
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two 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 Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Winfred Roach Trust
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)
6-1
Yes
Row Crop
Animal Feed
6-2
Yes
Hay
Animal Feed
6-3
Yes
Row Crop
Animal Feed
64
Yes
Row Crop
Animal Feed
7-1
Yes
Row Crop
Animal Feed
7-2
Yes
Row Crop
Animal Feed
7-3
Yes
Row Crop
Animal Feed
74
Yes
Row Crop
Animal Feed
8-1
Yes
Row Crop
Animal Feed
10-1
Yes
Row Crop
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16Page 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 H) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636 Mail
Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
I1. 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.
I11.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 06-16Page 2 of

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: _/`�w�r•� / �G�'�
Address:
City:. State: Zip: A r-F— 3 U
Phone: E-mail address:
Signature: ��1 44 Date:
NORTH CAROLINA, �GVC/1 COUNTY
I, the undersigned Notary Public do hereby certify that %l/1 �D�G� ���� x- ENn�����T
personally appeared before me this day and acknowledged the due execution of the forgoing
WITNESS my hand and official seal this the +/h i r feen f-k
day of I C i-•
Signature and seal:
My commission expires: / J U;� s y
Lessee's/Operator's Certification:
120
z�..•oSARy
?U=
X
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: /10 ��/ /j44
Address: 7 °U / / /`(C 1
City: State: Zip:ie
Phone: E-mail address:
Signature:
Permittee's Certification:
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 name:
Signature:
FORM: LOA 06-16Page 3 of

Updated Site Vicinity Map

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r
MaP1ecYPlrss ,pro
ti-9 a
Netaavaa
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osN an CAutu
Y"" Field 8-1
Fields 3-1 3-3
Fields 2-1 - 2-5
Nelcon Ro
Fields 6-1 6-4 �Ra�e4syP
a
K100"
Sources. Esri, HERE, DeLorme, USGS, Intermap, INCREMENT P,
NRCan, Esri Japan, METI, Esri China (Hong Kong), Esn Korea. Esri
(Thailand), Mapmylndia, NGCC, © OpenStreetMap contributors, and the
GIS User Community
SCALE: 1 2,�0� ft
Craven A Services, Inc,,
g
Land Application Program
Site
CIIECKED BY: RTB
Allen Roach Fields
Vicinity
DRAWN BY: RTB
BRANCH
�SIDUALS
Si SOILS, LLC
Craven County, NC
Map
DATE: 3/11/2020
Project No.
2019-132

Updated Buffer Maps

Cumulative Pollutant Loading Rates

If Surface Land Application will be performed, an additional 200 feet will need to be buffered around the housess.
This area is hatched under the HOuseBuf400 feature on this map
IN,
:ya`jy✓ S Field 2-5
01
Field 2-3
s, �♦ d _
e
Feld 2-1
Field 8-1
� y I �•a � - �, i , -s
[ ^•�- ,�' �.. �i ice` �': � / ;
The Groundwater Compliance Boundary for these fields are either 250 feet from the residual land application area or 50 feet within the property boundary, whichever is closest to the land application area.
The Groundwater Review Boundary for these fields is midway between the Compliance Boundary and t he land application area.
Scale: 1 inch = 660 feet Branch
Residuals
All locations are approximate and are not survey data. Data provided by: Drawn By: RTB & Soils, LLC
USDA National Agricultural Imagery Program, Checked By: RTB
NC OneMa , and Craven County GIS Date: 3/16/2020
,}'"'
Legend
House
Structure
• Wells
Craven Roads
- - Ditches
- - - Parcel Lines
Stream
® HOuseBUf200
® HouseBuf400
® DitchesBuf25
® ParcelLineBuf50
Pond
® PondBuf33
Subsurface Land Application Fields
® SurfaceWaterBuf33
CravenAg Services, Inc. Buffer
Land Application Program Map
Winfred Allen Roach & Gloria Arrington 1
ctNo: 2019-132

L
0

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Ditches
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The Groundwater Compliance Boundary for these fields are either 250 feet from the residual land application area or 50 feet within the property boundary, whichever is closest to the land application area.
The Groundwater Review Boundary for these fields is midway between the Compliance Boundary and t he land application area.
Scale: 1 inch = 400 feet Branch
Residuals
All locations are approximate and are not survey data. Data provided by: Drawn By: RTB & Soils, LLC
USDA National Agricultural Imagery Program, Checked By: RTB
NC OneMa , and Craven County GIS Date: 3/16/2020
— Stream
® HOuseBUf200
t� HouseBuf400
® DitchesBuf25
® ParcelLineBuf50
Pond
® PondBuf33
Subsurface Land Application Fields
® SurfaceWaterBuf33
CravenAg Services, Inc. Buffer
Land Application Program Map
Winfred Roach Disclaimer Trust 3
r 2019-132

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: W00037637 Field #: 3 Acres Utilized: 6.60
Owner: Allen & Gloria Roach Annual Dry Tons Applied: 2.60 Site #: I Acres Permitted: 5.60
Operator: Allen Roach Predominat Soil Series Se Cation Exchange Capacity (non 503): NA
Crop l Name: Millet Crop 1 Max PAN: 100.00 Crop 2 Name: #N/A Crop 2 Max. PAN #N/A
oC7
Specify
Totals
Per Acre
o
/o Solids
As
Decimal
Volume
Applied per
Acre
DT/AC
Residual Sources
(NPDES #, WQ#,
Fert.. Animal Waste,
etc.)
Site
Cond.
(Dry
Moist )
Precip.
Past 24
Hrst..
Inches
.n
3
� �.
o w
w w CD
* N
o
3
� CD
� w
* o
o
TKN
mg/kg
z Y
a°�o o
g R.
m tk g
Nitrate
and
Nitrite
m lk g
PAN Applied
(lbs/acre)
Must Select
Crop I or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Crop 1
Crop 2
Crop 1
Crop 2
Jul-19
42.000
6,364
1.40
0.37
Maysville WWTP
INC
1.00
0.30
28.300
1.640
126
7.25
X
Jul-19
18.000
2,727
0.20
0.02
Bridgeton WWTP
INC
1.00
0.30
45.750
76
21
0.63
X
TOTALS:
9,091
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.01
0.01
0.00
0.31
0.01
0.00
0.01
1 0.01
0.01
0.73
15.22
7.88
1 0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.01 0.01 NA 0.57 0.02 0.00 NA 0.03 0.02 2.77
0.00 0.00 0.02 0.25 0.00 0.00 0.01 0.02 0.01 2.04
36 34 NA 1 1,338 267 15 NA 374 89 2.498
100.00
Prior Years Cumulative Ibs/acre
Permitted C. P. L. R.****
Permit PAN Limit I 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."
Signature of Land Applier Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 3 Acres Utilized:
Owner: Allen & Gloria Roach Annual Dry Tons Applied: 35.06 Site #: 2 Acres Permitted:
Operator: Allen Roach
Crop 1 Name: Corn (Grain)
Predominat Soil Series
Crop 1 Max PAN: 138.00
To Cation Exchange Capacity (non 503):
Crop 2 Name: Rye (Grain) Crop 2 Max. PAN
14.60
14.60
NA
50.00
o
Specify
Totals
Per Acre
o
/o Solids
As
Decimal
Volume
Applied per
Acre
DT/Ac
Residual Sources
(NPDES #, WQ#.
Fert.. Animal Waste.
etc.)
Site
Cond.
(Dry.
Wet'
Moist)inches
Precip.
Past 24
Hrs.
n
a �.
w_
0
w
* N
* w
o
o
'in
5
z
w
*
o
o
TKN
m>
z a
El
a o
CD ?
mg
Nitrate
andCD
Nitrite
m
PAN Applied
(Ibs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
Gal.
Cro 1[Cro
pp
2
Cro 1
p
Crop 2
Mar-19
18.500
1,267
0.20
0.01
Bridgeton WWTP
INC
1.00
0.30
45.750
76
21
0.29
X
Nov-19
44
3
74.10
2.22
Craven Wood Energy
INC
1.00
0.30
1
0
0
0.00
X
Nov-19
42,000
2,877
1.40
0.17
Maysville WWTP
INC
1.00
0.30
28.300
1.640
126
1
3.28
X
TOTALS:
4.147
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.15
0.01
0.00
0.00
0.01
0.00
0.34
7.16
0.29 1
3.28
Date
lbs/ac
Current Cumulative Ibs/acre
0.00 0.00 NA 0.15 0.01 0.00 NA 0.01 0.00 0.34
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 34 NA 1.338 267 15 NA 374 89 2.498
138.00 1 50
Nov-19
128
Prior Years Cumulative Ibs/acre
Permitted C. P. L. R.****
Permit PAN Limit 1 st/2nd Crop 1
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date ***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 3 Acres Utilized: 6.10
Owner: Allen & Gloria Roach Annual Dry Tons Applied: 0.18 Site #: 3 Acres Permitted: 6.10
Operator: Allen Roach Predominat Soil Series To Cation Exchange Capacity (non 503): NA
Crop 1 Name: Wheat (Grain) Crop 1 Max PAN: 111.00 Crop 2 Name: #N/A Crop 2 Max. PAN #N/A
C7
o
o
Specify
Totals
Per Acre
o
/o Solids
AS
Decimal
Volume
Applied per
Acre
DT'AC
Residual Sources
(NPDES #, WQ#,
Fert.. Animal Waste,
etc.)
Site
Cond.
D
( ry'
Moist )
Precip.
Past 24
Hrs.
Inches
o
K z,
s _.
°t. n w
* °
0
_:
w
iv
o
°
3
z °
- w
�
TKN
m
z D
S
� c
w.
m W k g
Nitrate
and
Nitrite
mgAg
PAN Applied
pp
(]bs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
In Gal.
Crop l
Crop 2
Crop l
Crop 2
Oct-19
21,000
3.443
0.20
0.03
Bridgeton WWTP
INC
1.00
0.30
45,750
76
21
0.79
X
L3443
TOTALS:
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.02
0.00
0.00
0.00
1 0.00
0.00
0.10
1.01
0.79
1 0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.02 0.00 0.00 NA 0.00 0.00 0.10
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 34 NA 1.338 267 15 NA 374 89 2,498
111.00
Prior Years Cumulative lbs/acre
Permitted C. P. L. R.****
Permit PAN Limit I 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."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Date Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: W00037637 Field #: 6 Acres Utilized:
Owner: Roach Trust Annual Dry Tons Applied: #VALUE! Site #: I Acres Permitted: 12.40
Operator: Allen Roach Predominat Soil Series TaB Cation Exchange Capacity (non 503): NA
Crop I Name: #NIA Crop 1 Max PAN: #N/A Crop 2 Name: #N/A Crop 2 Max. PAN #N/A
C7
o
o
Specify
Totals
Per Acre
o Solids
/o
As
Decimal
Volume
Applied per
Acre
DT Ac
Residual Sources
(NPDES #. WQ#.
Fert., Animal Waste,
etc.)
Site
Cond.
(Dry
Wet'
Moist)
Precip.
Past 24
Hrs.
Inches
o
s �.
m
* o
w
* N
_
coTKN
m,/kg
z a
� o
°
mgtkg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Crop 1
Crop 2
Crop l
Crop 2
TOTALS:
0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
LimeApplied
Annuallbs/acre
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.07 0.00 0.00 NA 0.01 0.00 0.33
0.00 0.00 0.00 0.07 0.00 0.00 0.00 0.01 0.00 0.33
36 34 NA 1.338 267 15 NA 374 89 2.498
#N/A
Prior Years Cumulative lbs/acre
Permitted C. P. L. R.****
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."
Signature of Land Applier Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation -1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 6 Acres Utilized:
Owner: Roach Trust Annual Dry Tons Applied: #VALUE! Site #: 2 Acres Permitted:
Operator: Allen Roach Predominat Soil Series Pt Cation Exchange Capacity (non 503):
Crop 1 Name: #N/A Crop 1 Max PAN: #N/A Crop 2 Name: #N/A Crop 2 Max. PAN
17.50
NA
#N/A
o
SpeciN
Totals
Per Acre
u
/o Solids
As
Decimal
Volume
Applied per
Acre
DT/AC
Residual Sources
(NPDES #, WQ#.
Fert.. Animal Waste,
etc.)
Site
Cond.
(Dry'
Wet
Moist)
Precip.
Past 24
Hrs.
Inches
.d
v
� �.
° w
n
w
N
o'
5
;a"
>✓
*
TKN
m tkg
z a
B
oa o
m>
Nitrate
andCD
Nitrite
m /k
PAN Applied
(Ibs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Cro 1
p
[Cr p 2
Cro l
p
Cro 2
p
TOTALS:
0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
0.00
0.00
1 0.00
0.00
0.00
0.00
0.00
1 0.00
1 0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.00 0.00 0.00 NA 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
1 36 34 NA 1.338 267 15 NA 374 1 89 2,498
I I #N/A
Prior Years Cumulative Ibs/acre
Permitted C. P. L. R.****
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
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date ***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 6 Acres Utilized:
Owner: Roach Trust Annual Dry Tons Applied: #VALUE! Site #: 3 Acres Permitted: 4.60
Operator: Allen Roach Predominat Soil Series Ln Cation Exchange Capacity (non 503): NA
Crop 1 Name: #N/A Crop l Max PAN: #N/A Crop 2 Name: #N/A Crop 2 Max. PAN #N/A
oC7
�
Specify
Totals
Per Acre
u
/o Solids
As
Decimal
Volume
Applied per
Acre
DT AC
Residual Sources
(NPDES #, WQ#,
Fert.. Animal Waste.
etc.)
Site
Cond.
(Dry,
Wet'
Moist)
precip.
Past 24
Hrs.
Inches
s �.
w
°
�
* N
o
5
� 0
CD w
* o'
o
TKN
mgtkg
z Y
El
o0 o
g °
mgtkg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(Ibs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Crop 1
Crop 2
Crop ]
Crop 2
TOTALS:
0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1 0.00
0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.49 1 0.02 0.00 NA 0.01 0.01 1.59
0.00 0.00 0.01 0.49 0.02 0.00 0.00 0.01 0.01 1.59
36 34 NA 1 1338 267 15 NA 374 89 1 21498
I #N/A
Prior Years Cumulative Ibs/acre
Permitted C. P. L. R.****
Permit PAN Limit l st/2nd Crop I
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation -1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 6 Acres Utilized:
Owner: Roach Trust Annual Dry Tons Applied: #VALUE! Site #: 4 Acres Permitted:
Operator: Allen Roach Predominat Soil Series Ln Cation Exchange Capacity (non 503):
Crop 1 Name: #N/A Crop 1 Max PAN: #N/A Crop 2 Name: #N/A Crop 2 Max. PAN
7.10
NA
#N/A
0
o
S ci
Totals
Per Acre
u
/o Solids
As
Decimal
Volume
Applied per
Acre
DT AC
Residual Sources
(NPDES #, WQ#,
Fert., Animal Waste,
etc.)
Site
Cond.
(Dry
Wet,
Precip.
Past 24
Hrs.
Inches
o
�.
a °
<
_:
w
* N
o'
o
�'
w
* �,
* 'o'
❑
TKN
m ,l; g
z Y
�o o
> >
w
m
Nitrate
andCD
Nitrite
m
PAN Applied
(lbs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Crop 1
Crop 2
Crop 1
Crop 2
TOTALS:
0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
1 0.00
0.00
1 0.00
0.00
0.00
0.00
0.00
1 0.00
0.00
Date
Ibs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.000.00 0.00 NA 0.00 0.00 0.26
0.00 0.00 0.00 0.00 0.26
0.00 0.00 0.06 E1.33E8L2E67
36 34 NA 15 NA 374 89 2,498
I #N/A
Prior Years Cumulative lbs/acre
Permitted C. P. L. R.****
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."
Signature of Land Applier Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Craven Ag Services WQ Permit #: WQ0037637 Field #: 7 Acres Utilized:
Owner: Roach Trust Annual Dry Tons Applied: #VALUE! Site #: 2 Acres Permitted: 10.60
Operator: Allen Roach Predominat Soil Series Pa Cation Exchange Capacity (non 503): NA
Crop 1 Name: #N/A Crop I Max PAN: #N/A Crop 2 Name: #N/A Crop 2 Max. PAN #N/A
l7
co
o
Svecifv
Totals
Per Acre
o
/o Solids
As
Decimal
Volume
Applied per
Acre
DT Ac
Residual Sources
(NPDES #, WQ#,
Fert.. Animal Waste,
etc.)
Site
Cond.
(Dry'
Wet,
Moist)
Precip.
Past 24
Hrs.
Inches
b
n
_
a w
0
;� _:
w
N
_
�
7�
w
;ge
w
TKN
m .
z a
=7
a o
CD R.
m •/kg
Nitrate
and
Nitrite
m .
PAN Applied
(lbs/acre)
Must Select
Crop 1 or Crop 2
Gal.
Cu.Yd.
Report
Totals
in Gal.
Crop l
Crop 2
Crop I
Crop 2
TOTALS:
0
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
Annuallbs/acre
0.00
0.00
0.00
0.00
1 0.00
0.00
1 0.00
0.00
0.00
0.00
0.00
1 0.00
0.00
Date
lbs/ac
Current Cumulative lbs/acre
0.00 0.00 NA 0.04 0.00 0.00 NA 0.00 0.00 0.08
0.00 0.00 0.00 0.04 0.00 0.00 0.00 0.00 0.00 0.08
36 34 NA 1.338 267 15 NA 374 89 2,498
I #N/A
Prior Years Cumulative lbs/acre
Permitted C. P. L. R.****
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."
Signature of Land Applier
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
***Mineralization Rates: Compost - 0.1, Anaerobically Digested - 0.2,
Aerobically Digested - 0.3, Raw Sludge - 0.4
****C.P.L.R.: Cumulative Pollutant Loading FORM FSF (12/2006)