WQ0001346_Regional Office Historical File Pre 2018 (2)

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
WATER QUALITY REGIONAL OPERATION9SECTION
Division of Water Resources NON -DISCHARGE APPLICATION REVIEW REQUEST FORM
August 2, 2018 11IWNC0ENftMFt
To: MRO er AUG 6 2018
From: Troy Doby, Water Quality Permitting Section - Non -Discharge Branch WOROS
MOORESVILLE REGIONAL OFFICE
Permit Number: WQ0001346
Applicant: City of Monroe
Owner Type: Municipal
Facility Name: City of Monroe RLAP
Signature Authority: Russell G. Colbath, PE
Address: PO Box 69, Monroe, NC 28111
Fee Category: Non -Discharge Major
Comments/Other Information:
Permit Type: Land Application of Residual Solids (503)
Project Type: Renewal with Major Modification
Owner in BIMS? Yes
Facility in BIMS? Yes
Title: Water Resources Director
County: Union
Fee Amount: $395 - Major Modification
Attached, you will find all information submitted in support of the above -referenced application for your review,
comment, and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed. ® Return a completed staff report.
❑ Attach an Attachment B for Certification. ❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS keviewer: 4 -, 'k',�Zd
Date: fe, & _1J
FORM: WQROSNDARR 09-15 Page I of 1

ROY COOPER
Govef nw
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Inrerfm 1?arcrtor
NORTH CAROLINA
EnWrr nmental Quality
August 3, 2018
RUSSELL G. COLBATH, PE — WATER RESOURCES DIRECTOR
CITY OF MONROE
PO Box 69
MONROE, NORTH CAROLINA 28111
Dear Mr. Colbath:
RECEIVED/NCOENR/DWR
AUG 6 2018
WQROS
MOORESVILLE REGIONAL OFFICE
Subject: Acknowledgement of
Application No. WQ0001346
City of Monroe RLAP
Residuals Management System
Union County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on August 2, 2018. Your application package has been assigned the
number listed above, and the primary reviewer is Troy Doby.
Central and Regional Office staff will perform a detailed review of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Troy Doby at [phone] or [e-mail].
cc: ,
Permit File WQ0001346
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
E Q I
North Carolina Department of Environmental Quality I Division of Water Resources I Non -Discharge Branch
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.3654

0 a
MICHAEL S. RECAN NORTH CAPOLINA
secretary Environmental Qudlity
LINDA CULPEPPER
trifeem arector
DATE OF LETTER
RUSSELL G. COLBATH, PE — WATER RESOURCES DIRECTOR
CITY OF MONROE
POST OFFICE BOX 49
M ONROE, NORTH CAROLINA 28111
Subject: Application No. WQ0001346
Additional Information Request
City of Monroe RLAP
Land Application of
Class B Residuals
Union County
Dear Mr. Colbath:
Division of Water Resources' Central and Regional staff has reviewed the application package
received August 2, 2018. However, additional information is required before the review may be completed.
Please address the items below no later than the close of business on DUE DATE.
➢ On the Figure 2 in Appendix VI, there is no acreage information on Fields NC-UN-25-1 and NC-UN-
25-2. Please provide a revised map with this,information.
➢ The sole owner of Fields NC-UN-29-01, -02, and -05 is Diane S. Griffin, the wife of William Irvin
Griffin. While you submitted a Land Owner Agreement (LOA) for William Irvin Griffin, you did not
submit one for Diane S. Griffin. Please submit a notarized LOA from Diane Griffin as well since she
is the sole land owner on these three fields.
➢ The owner of Field NC-UN-30-01 (Parcel ID 02173008) is Margaret Little Appenzeller of 5704 Old
Oak Ridge Road, Greensboro, NC 27410. Please provide a notarized Land Owners Agreement signed
by Margaret Little Appenzeller.
➢ Fields NC-UN-31-03 to -06 were not in the permit issued September 30, 2013 yet you indicated on the
Land Application Site Certification Form that these are being renewed. Are these being transferred
from another permit? Are they new fields? If they are new, were they part of the submission to the
County Board of Commissioners? Please clarify this.
➢ Field NC-UN-034-01 is on separate parcels belonging to Joan Funderburk Whitmore (04069006),
William Calvert Funderburk and Renee Kessel Funderburk (04069010NL), Leonard Theodore
Funderburk (04069010L), and Glenson Fairley Funderburk and Francis B. Funderburk (04069016).
Because these are under separate ownership, these must have 50-foot setbacks at the property boundary.
Please provide maps with appropriate setbacks and recalculate acreage with a revised LASC.
North aroilra epartment or ^nviro-�-H-7r�; tal Quality j Division of Water Resources I Non -Discharge Bran(:n
512 'north Salisbury Street 11617 Mail Service Center ; Raleigh. North Carolina 2?699 1617
919.7 '7.365A

Mr. Russell G. Colbath, PE
DATE OF LETTER
Page 2 of 2
➢ As with NC-UN-034-01 above, Fields NC-UN-034-02 and -03 are on parcels owned by separate
owners and require 50-foot property boundary setbacks. Please provide maps with appropriate
setbacks and recalculate acreage with a revised LASC.
Please be aware that you are responsible for meeting all requirements set forth in North Carolina
rules and regulations. Any oversights that occurred in the review of the subject application package are
still the Applicant's responsibility. In addition, any omissions made in responding to the outstanding items
above, or failure to provide the additional information on or before the above requested date may result in
your application being returned as incomplete. Please reference the subject application number when
providing the requested information. All revised and/or additional documentation shall be signed, sealed
and dated (where needed), with two paper copies and one electronic copy submitted to my attention at
the address below.
If you have any questions regarding this request, please do not hesitate to contact me at (919) 707-
3655 or [e-mail]. Thank you for your cooperation.
Sincerely,
! r
G
Troy Doby, PE, Engineer
Division of Water Resources
cc: Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Rob Willcox — Willcox & Mabe Soil Solutions (Electronic Copy)
Permit Application File WQ0001346

The State gfSoutI, C'aroliima
Office (, Secretary (f Si ne i fal -k ' aminond !;
This is to certify thpt
STEPHEN HOLDEN
was duly appointed and commissioned Notary Publiaiof r:"
South Carolina. The apf.ointment to continue with term
ending February 5th, 2023.
Notary's Signature Secretary of State

RECEIVEFIV77"MR
AUG - 2 2018
Non -Discharge
Permitting Unit
APPLICATION FOR
RESIDUALS LAND APPLICATION PROGRAM
PERMIT RENEWAL AND MODIFICATION
CITY OF MONROE
PERMIT NO. WQ0001346
WMSS Project No. 15-10 RECEIVED/NCDENRIDWR
WQROS
MOORESVILLE REGIONAL OFFIU
Prepared for:
City of Monroe
Post Office Box 69
Monroe, North Carolina 28111
Prepared by:
Willcox & Mabe Soil Solutions, PLLC
7231 B Summerfield Road
Summerfield, North Carolina 27358
Willcox&mate
SOIL SOLUTIONS
July, 2018

July 25, 2018
NCDEQ/DWR
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Non -Discharge Permitting Unit
Willcox&mate
SOIL SOLUTIONS
RECEIVEDNCDF 'DWR
Reference: Application for Residuals Land Application Program
Permit Renewal and Modification
City of Monroe
Permit No. WQ0001346
WMSS, PLLC Project No. 15-10
Non -Discharge Permitting Unit:
AUG 2 2018
Non -Discharge
Permitting Unit
Willcox & Mabe Soil Solutions, PLLC (WMSS) is submitting the enclosed Residuals Land
Application Program Permit Renewal and Modification Application on behalf of the City of
Monroe. The application package includes information for the following:
• renewal of eight land application sites (380.7 net acres),
• change previous Site 18 ownership to: (Site 18-Ben Myers and Site 31-Henry Myers),
previous owner Mr. Harry Myers passed away and left fields to the two sons,
• modification for the addition of four new land application sites and modification to
add acres to an existing permitted field (129.5 net acres),
• delete three land application sites (142.1 net acres),
• renewal of two sources (City of Monroe WWTP-annual volume 2,044 dry tons, and
City of Monroe WTP-annual volume 1,200 dry tons). No changes to permitted annual
volumes, and
• clarification in Attachment A of the Permit to indicate that pathogen and vector
attraction reduction monitoring are not required of the WTP since those residuals are
not "Biological Residuals".
Willcox & Mabe Soil Solutions, PLLC / 7231 B Summerfield Road / Summerfield, NC 27358 / Rob 336.339.9128 or
Martin 336.312.1396 / www.willeoxmabesoil.com

City of Monroe — Permit No.W00001346 July 25, 2018
Permit Renewal and Modification
If there is any further information required or questions regarding this application please do not
hesitate to contact the City of Monroe, Mr. Kyle Ketchum at [phone], Mr. Steve
Holden at [phone], or WMSS, Rob Willcox at [phone] for further assistance.
Sincerely,
Willcox & Mabe Soil Solutions, PLLC
Martin Mabe Rob Willcox, L.S.S.
Agronomist Soil Scientist
cc: City of Monroe
Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewa1\15-10 City of Monroe Residuals Land
Application Program - Renewal July-2018.doc

TABLE OF CONTENTS
Page 1
APPENDIX TITLE
RESIDUALS LAND APPLICATION PROGRAM
APPLICATION FORM
(FORM: RLAP 06-16)
OPERATION AND MAINTENANCE PLAN
COPY OF EXISTING PERMIT NO. WQ0001346
11 RESIDUALS SOURCE CERTIFICATIONS
• CITY OF MONROE WWTP
(FORM: RSC 06-16)
• CITY OF MONROE WTP
(FORM: RSC 06-16)
III LAND APPLICATION SITE CERTIFICATION
(FORM: LASC 06-16)
WATERBODY AND CLASSIFICATION INFORMATION
IV COUNTY BOARD NOTIFICATION
(FORM CBN 06-16)
RENEWAL SITES
ANSON COUNTY SITES
V CALVIN MORRIS (NC-AN-19) (Field 1)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
UNION COUNTY SITES
VI BEN MYERS (NC-UN-18) (Fields 1, 2,7 and S)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
VII WAYNE MCBRIDE (NC-UN-25) (Fields 1 and 3)
EMERSON MCBRIDE (NC-UN-26) (Fields 1, 2, 3, 4, 5 and 6)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES

TABLE OF CONTENTS
Page 2
RENEWAL SITES (Continued)
VIII LELAND WOLFE (NC-UN-27) (Fields 1 and 2)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
IX WILLIAM GRIFFIN (NC-UN-29) (Fields 1, 2,3 and 4)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
X TOM APPENZELLER (NC-UN-30) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
XI HENRY MYERS (NC-UN-31) (Fields 3, 4, 5 and 6)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
UPDATED CUMULATIVE POLLUTANT LOADING RATES
MODIFICATION / NEW SITES
UNION COUNTY SITES
XII BEN MYERS (NC-UN-18) (Field 8 - Addition)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
SOILS AND AGRONOMIC EVALUATION
XHI WILLIAM GRIFFIN (NC-UN-29) (Field 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
SOILS AND AGRONOMIC EVALUATION
XIV DANNY BAKER (NC-UN-32) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
SOILS AND AGRONOMIC EVALUATION

TABLE OF CONTENTS
Page 3
MODIFICATION / NEW SITES (Continued)
UNION COUNTY SITES
XV TED FUNDERBURK (NC-UN-33) (Field 1)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)
SITE MAPS
SOILS AND AGRONOMIC EVALUATION
XVI CALVIN FUNDERBURK (NC-UN-34) (Fields 1, 2 and 3)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)
SITE MAPS
SOILS AND AGRONOMIC EVALUATION

APPENDIX 1
RESIDUALS LAND APPLICATION PROGRAM
APPLICATION FORM
(FORM: RLAP 06-16)
OPERATION AND MAINTENANCE PLAN
COPY OF EXISTING PERMIT

RESIDUALS LAND APPLICATION PROGRAM
APPLICATION FORM
(FORM: RLAP 06-16)

State of North Carolina
RECEIVFDINC�EQIDWR Department of Environmental Quality
DWR AUG _ 2 2018 Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIOWQRgE 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
supportine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
10 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
Major (land are permitted for > 300 acres)
Minor (land are permitted for < 300 acres)
New Permit
$1,310
$810
Major Modification'
$395
$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 (Maybe Required— See 15A NCAC 1 C .0300) N/A
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages) (APPENDIX 1)
® For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan. (NO CHANGES)
Submit the O&M Plan in accordance with 15A NCAC 02T .I 110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
® Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
® Safety measures; may include safety training program, manuals, signs, etc.
® Spill response plan; including control, containment, remediation, emergency contact information, etc.
® Inspection plan including the following information;
® Names and titles of personnel responsible for conducting the inspections.
® Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
® Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination N/A
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I.
J.
K.
L.
[a
Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
0 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.
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.
Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .I 104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
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 .l 104(d)(5) and current Division Policy
available at: http://www.ncwater.org/Rules Policies and Regulations/.
Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Saecial Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

Division of Water Resources
I. APPLICANT INFORMATION:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
1. Applicant's name: City of Monroe
Applicant type: 0 Individual ❑ Corporation ❑ General Partnership
0 Federal 0 State ® Municipal
Signature authority's name per 15A NCAC 02T .0106: Russell G. Colbath, P.E.
Q Privately -Owned Public Utility
0 County
Applicant's mailing address: Post Office Box 69
City: Monroe State: N.C. Zip: 28111
Telephone number: (7Q4j 2824601 Email Address: [e-mail]
2. Consultant's name: Rob Willcox License Number (for P.E.):
Affiliation: [] On Staff ® Retained (Firm: Willcox & Mabe Soil Solutions, PLLC)
Consultant's mailing address: 7231 B Summerfield Road
Title: Water Resources Director
RECEIVFnh I(`nrn �ni ire
City: Summerfield State: N.0
Zip: 27358
Telephone number: [phone]
Email Address: rob@,willcoxmabesoil.com
3. Agronomist's name: Martin Mabe
License Number: N/A
Affiliation: ❑ N/A ❑ On Staff
0 Retained (Firm: Willcox & Mabe Soil Solutions, PLLC)
Agronomist's mailing address: 7231 B Summerfield Road
City: Summerfield State: N.C.
Zip: 27358
Telephone number: 3(� 312-1396
Email Address: [e-mail]
4. Soil Scientist's name: Rob Willcox
License Number: 1098
Affiliation: 0 N/A O On Staff
® Retained (Firm: Willcox & Mabe Soil Solutions, PLLC)
Soil Scientist's mailing address: 7231B Summerfield Road
City: Summerfield State: N.C.
Zip: 27358
Telephone number: (3336) 339-9128
Email Address: robAwillcoxmabesoil.com
5. Fee submitted: 395.00 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified, 0 renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00001346
Date of most -recently issued permit: September 30, 2013
Date of most -recently certified Attachment A (if different than the permit): February 1, 2014
Date of most -recently certified Attachment B (if different than the permit): February 1, 2014
AUG 2 2018
Non-Diserhdrg&
Permitting Unit
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 775 Treeway Drive
City: Monroe State: N.C. Zip: 28110
Coordinates: Latitude: 34' 59' 44.7" Longitude: 80' 29' 27.3"
Datum: NAD83 Level of accuracy: tenth of second
Method of measurement: MAP
2. County where residuals land application program is headquartered: Union
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
Kyle Ketchum
City of Monroe
15703
Back -Up ORC
Stephen Holden
City of Monroe
987966
Additional Back -Up
ORCs
(if applicable)
Robert Kyle Edwards
City of Monroe
987526
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 3,244 dry tons per year. (Analytical — Appendix II)
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
16.60
N/A
53,864
N/A
Five -Year Maximum Adjusted
25.15
N/A
81,586
N/A
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
Hay
11.0
Pasture
499.2
Total:
510.2
Methods
Surface
510.2
Incorporation or Injection
Total:
510.2
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
(!bs PAN/ac yr)
Concentrations
Surface
Incorporation or
Surface
Incorporation or
Injection
Injection
50
1,077
N/A
1,632
N/A
100
539
N/A
816
N/A
150
359
N/A
544
N/A
200
269
N/A
408
N/A
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 ofNorth Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.): N/A
7. Specify type of residuals program (See Instruction F): M 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;
0 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) (APPENDIX In
Complete and submit the following Residuals Source Certification and all associated documentation.
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. (APPENDIX III)
ed-l
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 (N/A)
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing 0 proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: 2?;;LL feet
below ground surface. Rules 15A NCAC 021.0505(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
ftZ
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
I
i
Spray Irrigation Design Element
Plan Sheet
Number
Specification
I Pa a Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
0 Yes No, Explain; IMP
I, Russell G. Colbath P.E. Water Resources Director
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Renewal and Modification of Permit No. WO0001346
(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: ate: / 1, G
FORM: RLAP 06-16 Page 5 of 5

OPERATION AND MAINTENANCE PLAN

Operation and Maintenance Plan
The City of Monroe Land Application Standard Operation and
Maintenance Plan is outlined in the different areas which is in compliance
with 15A NCAC 02T .1110 and in accordance with permit number
WQ0001346.
The program consists of two procedures depending on the source of
the residuals. Residuals come from both the Wastewater Treatment and
Water Treatment facilities. Liquid residuals are loaded by overhead loading
stations into tankers. Storage pads are located at both facilities for holding
cake while waiting to be applied. The loading stations and storage pads are
maintained by plant maintenance and operators which consist of daily visual
plant checks and preventative maintenance by operators and/or EIM
personnel.
This program is run by the Land Residual Coordinator which is
responsible for overseeing the program. This document contains a yearly
work plan that outlines work/tasks required to operate the program
throughout the year. In the absence of the Land Residual Coordinator, the
Wastewater Treatment Plant Superintendent will designate personnel to take
over the required duties.
The field equipment that is used consist of a road tractor, field tractor,
pull tank, spreader, three tankers and a dump trailer that are maintained by
daily visual inspection and annually by fleet maintenance. The Land
Residual Coordinator is responsible for maintaining equipment while doing
land application when equipment is in the field.

Yearly Work Plan
January
➢ WWTP Activities Effecting Land Application
➢ Start preparing annual report for DWQ and EPA
➢ 60 day samples (Fecal Coli forms, 38% reduction, 503 metals) Send samples to A&L
labs. Take fecals to Par labs in Charlotte
➢ Run belt press as personnel and weather permits
➢ Start preparing land application program budget for next Fiscal Year
➢ Go to NCAGR website and retrieve soil samples for annual report
➢ WTP Activities Effecting Land Application )� —�r—
➢ 90 day samples (503 metals only) Send samples �A�&LEIa�bs f/ I_
➢ Haul from WTP to WWTP if needed due to weat l4
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance (grease pull tank, spreader, tractor, ect...)
➢ Take tractor to shop for yearly service
➢ Do monthly inspection of all equipment
➢ Application possibilities — Land application is not done during this month due to weather
conditions, annual report having to be done
February
➢ WWTP Activities Effecting Land Application
➢ Finish preparing annual report for DWQ and EPA
➢ EPA report needs to be sent off by no latter than Feb. 18`h
➢ DWQ report has to be sent off no latter than Feb. 281
➢ Haul cake to field if possible
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Haul from WTP to WWTP if needed due to weather
➢ Haul cake to field if possible
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans - Critical to ensure equipment is ready for spring.
➢ Preventative maintenance on all trailers — Air lines, brakes, tires, lighting, baffles,
stress cracks
➢ General maintenance (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities — Wet weather typical, limited land application available
March
➢ WWTP Activities Effecting Land Application
➢ 60 day samples (Fecal Coli forms, 38% reduction,503 metals) Send to A&L labs.
Take Fecals to Par labs in Charlotte
➢ Haul liquid or cake to fields if possible
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Haul liquid or cake to fields if possible
➢ Haul from WTP to WWTP if needed

➢ Crop Considerations
➢ Fescue, Grassland only available
➢ Equipment Maintenance Plans
➢ General maintenance on all equipment (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities - Wet weather typical, limited land application available
April
➢ WWTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Pull 90 day samples (503's) send samples to A&L labs
➢ Haul cake or liquid to fields
➢ Haul from WTP to WWTP if needed
➢ Crop Considerations
➢ Contact farmers to line up fields for land application
➢ Contact Contractors about liming fields before applications
➢ Equipment Maintenance Plans
➢ General maintenance on all equipment (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to fields
May
➢ WWTP Activities Effecting Land Application
➢ 60 day samples (Fecal Coli forms, 38% reduction, 503 metals) Send samples to A&L
labs. Take fecals to Par labs in Charlotte
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Haul from WTP to WWTP if needed
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance on all equipment (grease pull tank, spreader, tractor, ect... )
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to fields
June
➢ Check budget for availabilities of funds for end of fiscal year
➢ WWTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Haul from WTP to WWTP if needed
➢ Crop Considerations
➢ Fescue, Grasslands
➢ Equipment Maintenance Plans
➢ General maintenance on all equipment (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all quipment
➢ Application possibilities - warmer/dryer, try to maximize application to field
July

➢ Start of new budget year
➢ Setup PO for A&L and Par labs
➢ Setup PO for contract laboratory
➢ Resign contract for trucking and setup PO
➢ Setup PO for Lime Applications to fields
➢ WWTP Activities Effecting Land Application
➢ 60 day samples (Fecal Coli forms, 38% reduction, 503 metals) Send samples to A&L
labs. Take samples to Par labs in Charlotte
➢ Run belt press as much as personnel and weather will permit
➢ Do annual TCLIP samples (send to contract laboratory)
• WTP Activities Effecting Land Application
➢ 90 day samples (503's)
➢ Haul to WTP to WWTP if needed
➢ Do annual TCLIP samples (send to contract laboratory)
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to field
August
➢ WWTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Haul from WTP to WWTP if needed
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance (grease pull tank, spreader, tractor, ect... )
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to field
September
➢ WWTP Activities Effecting Land Application
➢ 60 day samples (Fecal Coli forms, 38% reduction, 503 metals) Send samples to A&L
labs. Take samples to Par labs in Charlotte
➢ Run belt press as much as personnel and weather will permit
➢ Haul cake or liquid to fields
➢ WTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Haul from WTP to WWTP if needed
➢ Crop Considerations
➢ Starting to cut corn, check for open row crop fields
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance (grease pull tank, spreader, tractor, ect... )
➢ Inspection due on F-250 pickup
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to field

October
➢ WWTP Activities Effecting Land Application
➢ Haul cake or liquid to fields
➢ Run belt press as much as personnel and weather will permit
➢ WTP Activities Effecting Land Application
➢ 90 day samples (503's) Send samples to A&L labs
➢ Haul to WWTP if needed
➢ Crop Considerations
➢ Starting to cut soybeans, check for open row crop fields
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ General maintenance (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities - warmer/dryer, try to maximize application to field
November
➢ WWTP Activities Effecting Land Application
➢ 60 day samples (Fecal Coli forms, 38% reduction, 503 metals) Send samples to A&L
labs. Take samples to Par labs in Charlotte
➢ Run belt press as much as personnel and weather will permit
➢ Try to have storage beds empty for wet weather
➢ Try to have digester #5 empty if possible
➢ Pull soil samples on fields that have received land application where no second
application is anticipated during the year
➢ Send samples to NCDA&CS for analysis
➢ Start gathering paper work for annual report
➢ WTP Activities Effecting Land Application
➢ Haul to WWTP if needed
➢ Cake opportunity while waiting for WWTP 60 day samples (�
4—
➢ Crop Considerations zz `lu t
➢ Finish cutting soybeans, check for open row crop fields V
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ Plan for any major repairs during wet weather
➢ General maintenance (grease pull tank, spreader, tractor, ect...)
➢ Do monthly inspection of all equipment
➢ Application possibilities —wetter conditions, application to fields limited due to weather
December
➢ WWTP Activities Effecting Land Application
➢ Run belt press as much as personnel and weather will permit
➢ Pull soil samples on fields that have been applied on during Nov. and Dec.
➢ WTP Activities Effecting Land Application
➢ Target all drying beds (WTP) and thickener empty for the winter
➢ Haul to WWTP if needed
➢ Crop Considerations
➢ Fescue, Grassland
➢ Equipment Maintenance Plans
➢ Plan for any major repairs during wet weather
➢ General maintenance (grease pull tank, spreader, tractor, ect... )
➢ Do monthly inspection of all equipment
➢ Application possibilities - wetter conditions, application to fields is limited due to weather

Spill Control Plan
In the unlikely event of a spill, the following actions shall be immediately taken:
1. Management of cleanup activities: The first City of Monroe representative at the scene
will began procedures to halt the spill and initiate cleanup activities. Upon arrival of the
Land Residual Coordinator or Wastewater Treatment Superintendent will take
immediate action to coordinate all activities. In the event additional labor and
equipment are required, assistance shall be requested from City of Monroe Water
Resources Department. The LRC or WTS will also communicate with the public on the
scene, answer questions and advice of cleanup activities.
2. Contain Spill: Attempt to halt spill from ruptured containers. Form barriers from earthen
materials, straw or foam such as to contain spill. The person in charge on the site will
advise the clean up personnel where to get straw, lime, and other items necessary to
contain the spill.
3. Clean Up: Water Resources department will supply front end loaders, vacuum
equipment, local septic tank services or whatever other equipment needed to remove
as much spilled product as possible. Straw and sand will be used to soak up materials
than removed to a designated site.
4. Final Clean Up: Rotary brush sweeper or street cleaner shall be utilized. Lime will be
applied to the site. If the spill occurs on private property, the cleanup will be completed
to the satisfaction of the property owners and the City of Monroe representatives. The
ultimate goal is to return the spill site to its original condition.
5. Reporting: The LRC or WTS will notify other City of Monroe personnel as needed.
The regional office or DENR will be contacted as soon as possible, but no more than 24
hours after the spill occurrence. The LRC or WTS shall provide a written report within 48
hours of the spill to the WTS. The report will list all relative information and actions
taken. City of Monroe personnel will file a written report to DENR within 5 days of the
occurrence.
Contact information
Land residual Coordinator Mobil — [phone] Office — [phone]
Wastewater Treatment Superintendant Mobil - [phone] Office — [phone]
Water Treatment Superintendent Mobil — [phone] Office — [phone]
Wastewater Treatment Chief Operator Mobil — [phone]-2914 Office — (704)
282-4678
Water Resources Director Mobil — [phone] Office — [phone]
Local Police and Fire Emergency 911

Sampling and Monitoring Plan
The Land Residual Coordinator is responsible for taking all samples. If the
Land Residual Coordinator is unavailable, the Wastewater Plant
Superintendent will designate personnel to perform the sampling. Samples
must be taken in accordance with 40 CFR Part 503.32(a) or (b) and 40 CFR
Part 503.33 so that pathogen and vector attraction specifications are met.
Pollutant concentrations are checked prior to field application events.
Residuals applied shall also be monitored as listed in rules .1105(a),
.1105(d), .1106 and .l 107. The frequency of the monitoring is required as
the following:
Metric tons per 365 day period dry weight basis)
frequency
Greater than zero but less than 290
Equal to or greater than 290 but less than 1500
times per year)
Equal to or greater than
(6 times per year)
Equal to or greater than
times per year)
1500 but less than 15000
15000
Monitoring
once per year
once per quarter (4
once per 60 days
once per month (12

Field Inspections
The Land Residual Coordinator is responsible for flagging the field to make
sure that all buffers are in accordance with state regulations. With the City of
Monroe doing our own program, a certified Land Application person is in
the field during Land Application events. In the absence of the Land
Residual Coordinator, the Wastewater Plant Superintendent will designate
personnel to take their place. A field pre -operating check list is to be
completed prior to any application events. A post operating checklist is to be
completed within 48 hours after application to insure that the field is
maintained in accordance with all rules. The pre -operating and post -
operating checklists are located below.

PREOPERATING & POSTOPERATING onro e
CHECKLIST North Carolina
Verify field is listed in permit
Verify landownership has not changed
Verify PAN loading rate for crop to be grown or 50 lbs. for second crop to be grown
Rain gauge on site and field flagged
Make sure field is signed properly
Date land application is est. to start
Location of application site
Acres to be applied on
Source of residuals WTPL WWTPL WTPC WWTPC WWTPLM
Verify field was left neat and clean
Check for runoff due to rain
Field application was checked: During, after, or both
NAME
DATE
City of Monroe • PO Box 69 • Monroe, NC 28111-0069
Tel: [phone] • Fax: [phone]
www.monroenc.org

COPY OF EXISTING PERMIT NO. WQ0001346

��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder
Governor Director
September 30, 2013
Russell G. Colbath, P.E.— Water Resources Director
City of Monroe
Post Office Box 69
Monroe, North Carolina 28111
Dear Mr. Colbath:
John E. Skvarla, III
Secretary
Subject: Permit No. WQ0001346
City of Monroe
Land Application of Class B / t /
Water Treatment Plant and
Wastewater Treatment Plant
Residuals (Non -Dedicated)
Union County
In accordance with your request for permit major modification and renewal received August 1,
2013, we are forwarding herewith Permit No. WQ0001346 dated September 30, 2013 and effective on
February 1, 2014, to the City of Monroe for the continued operation of the subject residuals management
program. Please note that this renewed permit shall become effective on February 1, 2014 (i.e. the day
after the expiration date of the existing permit), which may differ from the issuance date of this letter.
Modifications to the subject permit are as follows: Fifteen new land application sites are being
added to the program and forty-seven sites are being removed from the program for a net loss of 2,525.8
acres.
This Hermit shall be effective from February 1, 2014 until January 31, 2019, shall void Permit No.
WQ0001346 issued August 23, 2005, and shall be subject to the conditions and limitations as specified
therein. Please pay particular attention to the monitoring requirements listed in Attachment A for they
may differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
Please note that on September 1, 2006, North Carolina Administrative Code Title 15A
Subchapter 02T — Waste not Discharged to Surface Waters was adopted. Accordingly, this pen -nit
incorporates the requirements of these rules; therefore, please take the time to review this permit
thoroughly. The following conditions have been added, modified or deleted from those in the last permit
issuance:
➢ Condition 1. 1. —Describes the requirements for renewal of the permit.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: http://portal.ncdenr.ora/web/wolaps
An Equal Opportunity 1 Affirmative Action Employer

Mr. Russell G. Colbath
September 30, 2013
Page 3 of 3
If you need additional information concerning this matter, please contact David Goodrich at (919)
807-6352 or at [e-mail].
Sincerely,
/rTho as A. Reeder
cc: Anson County Health Department
Stanly County Health Department
Union County Health Department
Mooresville Regional Office, Aquifer Protection Section
Rob Wilcox, L.S.S. — S&ME, Inc., 718 Old Battleground Road, Greensboro, NC 27410
Beth Buffington, Aquifer Protection Section
Permit File WQ0001346
Notebook File WQ0001346

Mr. Russell G. Colbath
September
30, 2013
Page 2 of 3
➢
Condition I.2. —
Requires compliance with notification requirements within 90 days
➢
Condition I.3.
— Requires submission of an Operation & Maintenance Plan (if not already
submitted)
➢
Condition I.4. —
Requires that the posting of signs be performed as per Condition 111.13.
➢
Condition II.7.—Requires
biological residuals to meet a vector attraction reduction
➢
Condition I1.10.
— Sources of PAN may not be applied in excess of agronomic rates
➢
Condition 11.11.
— restricts nitrogen applications on grazed pasture areas
➢
Condition II.13.
— restricts residual applications onto land having a high SAR content
➢
Condition I11.4.
— lists the minimal requirements for an Operation and Maintenance Plan
➢
Condition III.5.
— requires the hiring of an ORC and a backup ORC to manage the program
➢
Condition II1.11
— prohibits the application of bulk residuals under certain conditions
➢
Condition II1.12.
— restricts public access to the land application areas
➢
Condition III.13.
— includes the posting of signs for public access control
➢
Condition IV.3.
— specifies the laboratory analyses of residuals
➢
Condition IVA. — requires residual monitoring for vector attraction and pathogens
➢
Condition IV.8. —
lists the requirements for tracking land application events
➢
Condition IV.9. —
requires the submission of an annual report each year
➢
Condition V.1. —
requires the performance of adequate facility inspection and maintenance
➢
Condition VI.5. —
addresses the procedures used if there is a change i>( ownership
➢
Condition VI.7. —
the permit to may be revoked or unilaterally modified in certain situations
➢
Condition VI.8. —
expansion of the permit program is not allowed under certain conditions
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.

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS B WATER TREATMENT PLANT AND WASTEWATER/
TREATMENT PLANT RESIDUAL SOLIDS PERMIT (NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Monroe
Union County
FOR THE
continued operation of a residuals management program for the City of Monroe and consisting of the land
application of Class B Water Treatment Plant and Wastewater Treatment Plant 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 August 1, 2013, 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 and 257. This permit does not exempt the Permittee from
complying with the federal regulations.
This permit shall be effective from February 1, 2014 until January 31, 2019, shall void Permit No.
WQ0001346 issued August 23, 2005, and shall be subject to the following specified conditions and
limitations:
L 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_
2. The permittee shall be in full compliance with the regional office notification requirements
established in Condition 1II.3. within 90 days of the effective date of this permit.
3. The permittee shall submit the Operation and Maintenance (O&M) plan as required in Condition
I11.4. to the Division within 90 days of the effective date of this permit.
4. 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.
WQ0001346 Version 3.0 Shell Version 130801 Page I of 12

U. PERFORMANCE STANDARDS
1. The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Mooresville regional ofce's Aquifer Protection Section
supervisor, and take any immediate corrective actions.
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
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.
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.
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
.1 107(a). Exceptions to this requirement shall be specified in Attachment A.
WQ0001346 Version 3.0 Shell Version 130801 Page 2 of 12

8. Setbacks for land application sites shall be as follows:
Setback by application type
(feet)
Setback Description
Vehicular
Irrigation
Infection /
Surface
Surface
corporation
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
50
50
Public right of way
50
50
50
Private or public water supply source, waters
classified as SA or SB, and any Class I or Class 11
impounded reservoir used as a source of drinking
100
100
100
water.
Surface waters (streams - intermittent and perennial,
perennial waterbodies, and wetlands), any streams
classified as WS or B, or any other stream, canal,
100
100
50
marsh or coastal waters and any other lake or
impoundment.
Upslope interceptor drains and upslope surface water
diversions.
10
10
10
Surface water diversions (ephemeral streams,
waterways, ditches), downslope interceptor drains,
downslope surface water diversions, downslope
25
25
25
groundwater drainage systems, and downslope
surface drainage ditches.
Groundwater lowering ditches (where the bottom of
the ditch ,intersects the SHWT)
25
100
25
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
more in vertical height
15
15
15
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
*The setback requirement may be reduced to a minimum of 100 feet upon written consent of the
owner and approval from the Aquifer Protection Section of the appropriate Division's regional office
in Attachment B of this permit.
WQ0001346 Version 3.0 Shell Version 130801 PaoP l of 1

Some of the setbacks specified above may not have been included in previous permits for this
residuals land application program. However, any land application sites that are listed in the most
recently -certified Attachment B of this permit, but were approved with different setbacks, shall be
reflagged to comply with these setbacks.
9. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
10. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
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/yields/index.php).
A copy shall be kept on file and reprinted every five years in accordance with Condition W - 8 j.
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 (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards(ftp://ftp-fc.sc.eRov.usda.2ov/NHO/practice-standards/standards/590.Ddf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
I L 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.
12. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied.
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Pennittee
shall maintain written records of these recommendations and details of their implementation.
WQ0001346 Version 3.0 Shell Version 130801 Paee 4 of 12

14. The compliance boundary for residual land application sites shall be specified in accordance with
15A NCAC 02L .0107(b). These sites were individually permitted on or after December 30, 19831
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.
15. In accordance with 15A NCAC 02L .0108, 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.
III. OPERATION AND MAINTENANCE REOUMEMENTS
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.
2. The Mooresville 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 Aquifer Protection Section's regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on
Monday through Friday, excluding State Holidays.
3. The Mooresville 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 lDs, 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.
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan) pursuant to
15A NCAC 02T .1110. 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 location(s) and inspection frequency are representative
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuant to the
noncompliance notification requirements under the monitoring and reporting section of the
permit;
WQ0001346 Version 3.0 Shell Version 130801 Page 5 of I?.

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;
Ili. 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).
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 their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition Hl.
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' Technical Assistance & Certification Unit at [phone].
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.
7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles.
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division.
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.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied 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.
I I. 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;
WQ0001346 Version 3.0 Shell Version 130801 paaP C, nf i)

g. If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
-- h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a final soil pH of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will be noted in this permit;
I. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in
a USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
12. The following public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event.
13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under 1II.12 apply.
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:
WQ0001346 Version 3.0 ShelI Version 130801 Paae 7 of 12

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 NW is required by the US Department of Agriculture - National Resources
Conservation Service (MRCS) 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 (CLAMP) shall also be considered a Nutrient
Management Plan.
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LOAA)
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permit expiration date,
and shall be renewed during the permit renewal process.
N. 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.
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)l shall be performed at the frequency specified in
Attachment A, and the Permittee shall maintain these results for a minimum of five years. Any
exceptions from the requirements in this condition shall be specified in 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)
Pentachlorophenol (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)
Once the residuals have been monitored for two years at the frequency specified in Attachment A, the
Pennittee 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.
WQ0001346 Version 3.0 Shell Version 130801 Page 8 of 12

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)
After the residuals generated by a particular residuals source -generating facility have been monitored
for two years at the frequency specified in the most recently -certified Attachment A of this permit, the
Permittee may submit a request to the Division for a permit modification to reduce the frequency of
this monitoring requirement. In no case, however, shall the frequency of this monitoring be less than
once per year when a residuals land application event of residuals generated by the residuals source -
generating facility occurs during that year.
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficient to demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
condition shall be specified in Attachment A.
5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/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:
Acidi
Exchan eable Sodium Percenta e
Phos horus
uration (by calculation)
K
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
WQ0001346 Version 3.0 Shell Version 130801 p2cp 9 of 1

7. All analytical determinations made pursuant to the monitoring and reporting requirements of this
permit shall be made by a laboratory certified by the Division for the required parameter(s) under
15A NCAC 2H .0800 or 15A NCAC 2H .1100.
8. 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;
in. 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.
9. Three copies of an annual report shall be submitted on or before March I". 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
http://Portal.ncdenr.org/web/wq/gps/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
10_ Noncompliance Notification
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, as soon as osp Bible, 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. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic_
WQ0001346 Version 3.0 Shell. Version 130801 Page 10 of 12

b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
V. INSPECTIONS
1. The Penrttee 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.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
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_
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 pen -nit; 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 leachate samples.
VI. 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.
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit.
3. This permit is effective only with respect to the nature and volume of residuals described in the
permit application and other supporting documentation.
WQ0001346 Version 3.0 Shell Version 130801 Page I I of 12

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 NCGO 10000; 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.
5. In the event the residuals program changes ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted hereon until a permit is issued to the new
owner.
6. The permit may be modified, revoked, and/or reissued to incorporate any conditions, limitations and
monitoring requirements the Division deems necessary in order to protect the environment and public
health adequately.
7. 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.
8. 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).
9. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e) (3).
Permit issued this the 30"' day of September 2013 and effective February 1, 2014.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Tho.iias A. Reeder, Director
Division of -Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0001346
WQ0001346 Version 3.0 Shell Version 130801 Pane 12 of 12

ATTACHMENT A - Approved Residual Sources
CITY OF MONROE
Certification Date: February 1, 2014
Permit Number: WQ0001346 Version: 3.0
Owner
Facilit Name
Y
County
Permit
Biological
Maximum
Dry Tons
Monitoring
Frequency for
Monitoring
Frequency for
Monitoring
Frequency for
Approved
Number
Residuals
Per Year l
Non -hazardous
Metals and
Pathogen &
Mineralization
Characteristics 2
Nutrients 3,5
Vector Attraction
Rate
Reductions 4' 5' 6
City of Monroe
Monroe Water Treatment Plant
Union
01-90-010
No
1,200.00
Annually
See Table Below
See Table Below
0.40
City of Monroe
Monroe Wastewater Treatment Plant
Union
NCO024333
Yes
2,044.00
Annually
See Table Below
See Table Below
0.30
Total
3,244.00
l . Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA. Permit application indicated that a fecal coliform density demonstration will be performed to
meet pathogen reduction requirements, and volatile solids reductions will be performed to meet vector attraction reductions. However, other methods listed under 15A NCAC 02T .1106(b) and
.1 I07(a) can also be used to demonstrate compliance with this permit requirement. For non -biological residuals, see Footnote 6.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
short tons per year
Monitoring Frequency
Established in 40 CFR 503 and 15A NCAC 02T .1111
<319
1 /Year
=>319 - <1,650
1/ Quarter 4 times per ear
=>1,650 - <16,500
1/60 Days 6 times per ear
=>16,500
1/month 12 times per ear
6. Water treatment plant residuals are exempt from meeting the vector attraction reduction requirements in Condition IVA, provided they are not mixed with residuals that have been generated
during the treatment of domestic wastewater, the treatment of animal processing wastewater, or the biological treatment of industrial wastewater. The water treatment plant residuals must be
treated and processed in a manner as to not meet the definition of "Biological Residuals" as defined in 15A NCAC 02T .1102(6).
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.
Page 1 of 1

ATTACHMENT B - Approved Land Application Sites
CITY OF MONROE
Certification Date: February 1, 2014,
Permit Number: WQ0001346 Version: 3.0
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil Series
Footnotes
NC-AN-19-01
Morris, Calvin
Anson
34057'34"
80016'27"
10.8
GoB - Goldston
NC-ST-12-01
Morgan, Thomas
Stanly
35010'36"
80025'54"
7.4
BaB — Badin
NC-ST-12-02
Morgan, Thomas.
Stanly
35010'37"
80025'45"
9.2
MhB — Misenheimer
NC-ST-12-03
Morgan, Thomas
Stanly
35010'44"
80025'38"
15.4
MhB - Misenheimer
NC-ST-12-04
Morgan, Thomas
Stanly
35010'51"
80025'36"
3.0
GoB — Goldston
NC-ST-12-05
Morgan, Thomas
Stanly
35010'46"
80025'26"
11.2
GoB — Goldston
NC-ST-28-01
Dowdey, Paul
Stanly
35011' 10"
80028'31"
10.1
GoB — Goldston
NC-UN-18-01
Myers, Harry
Union
34059'59"
80029'43"
35.5
BdB2 — Badin
NC-UN-18-02
Myers, Harry ,
Union
35000'03"
80030'05"
34.2
GoB — Goldston
NC-UN-18-03
Myers, Harry
Union
35000'56"
80025'51"
2.1
BdB2 — Badin
NC-UN-18-04
Myers, Harry
Union
35000'58"
80028'43"
4.9
BdB2—Badin
NC-UN-18-05
Myers, Harry
Union
35001'09"
80028'34"
14.9
TbB2 — Tatum
NC-UN-18-06
Myers, Harry
Union
35001'12"
80028'21"
6.9
ChA— Chewacla
NC-UN-18-07
Myers, Harry
Union
35000'54"
80°29'26"
5.4
CmB - Cid
NC-UN-18-08
Myers, Harry
Union
35000'46"
80029'25"
3.0
CmB — Cid
NC-UN-23-01
Brooks, Hilton
Union
34056'45"
80027'52"
3.6
GsB — Goldston-Badin
NC-UN-23-02
Brooks, Hilton
Union
34056'46"
80027'37"
5.8
BaB — Badin Chan Sit
NC-UN-23-03
Brooks, Hilton
Union
34056'40"
80027'39"
4.5
BaB — Badin Chan Sit
NC-UN-23-04
Brooks, Hilton
Union
34056'44"
80027'29"
16.4
BaB - Badin Chan Sit
NC-UN-23-05
Brooks, Hilton
Union
34056'49"
80027'21"
11.6
BaB — Badin Chan Sit
NC-UN-23-07
Brooks, Hilton
Union
34056'33"
80027'39"
7.0
GsB — Goldston-Badin
NC-UN-23-08
Brooks, Hilton
Union
34056'40"
80027'13"
19.4
GsB — Goldston-Badin
NC-UN-23-09
Brooks, Hilton
Union
34056'36"
80027'23"
12.2
BaB — Badin Chan Sit
Page 1 of 2

ATTACHMENT B - Approved Land Application Sites
CITY OF MONROE
Certification Date: February 1, 2014
Permit Number: WQ0001346 Version: 3.0
NC-UN-23-10
Brooks, Hilton
Union
34056'30"
80027'19"
5.3
GsB— Goldston-Badin
NC -UN 25-01
McBride, Wayne
Union
34°49'52"
80037'29"
6.5
TaB — Tatum
NC-UN-25-03
McBride, Wayne
Union
34049'57"
80037'24"
14.1
TaB2—Tatum
NC-UN-26-01
McBride, Emerson
Union
34049'49"
80038'01"
15.4
TaB—Tatum
NC-UN-26-02
McBride, Emerson
Union
34049'42"
80037'43"
6.1
TaB2 — Tatum
NC-UN-26-03
McBride, Emerson
Union
34049'33"
80037'56"
10.5
TaB — Tatum
NC-UN-26-4A
McBride, Emerson
Union
34049'30"
80038' 17"
12.1
TaB — Tatum
NC-UN-26-4B
McBride, Emerson
Union
34049'27"
80038'04"
12.7
CmB — Cid
NC-UN-26-05
McBride, Emerson
Union
34049'47"
80038'20"
11.6
TaB2 — Tatum
NC-UN-26-06
McBride, Emerson
Union
34050'07"
80037'39"
25.8
TbB2 — Tatum
NC-UN-27-01
Wolfe, Leland
Union
34052' 10"
80028'43"
13.4
GsB — Goldston
NC-UN-27-02
Wolfe, Leland
Union
34052' 16"
80028'27"
17.0
GsB — Goldston
NC-UN-29-01
Griffin, William
Union
34055'42"
80019'02"
24.5
GoC — Goldston
NC-UN-29-02
Griffin, William
Union
34055'44"
80018'57"
5.7
GoC — Goldston
NC-UN-29-03
Griffin, William
Union
34059'39"
80023'25"
7.4
Bab — Badin
NC-UN-29-04
Griffin, William
Union
34059'45"
80023'34"
7.2
BdB2 - Badin
NC-UN-30-01
Appenzeller, Tom
Union
34059'42"
80023'46"
13.1
BdB2 — Badin
NC-UN-30-02
Appenzeller, Tom
Union
34059'45"
80023' 16"
10.4
BaB - Badin
NC-UN-30-03
Appenzeller, Tom
Union
34059'58"
80023' 16"
11.8
BaB - Badin
NC-UN-30-04
Appenzeller, Tom
Union
35000'07"
80023' 11"
15.2
BaB - Badin
NC-UN-30-05
Appenzeller, Tom
Union
34000'13"
80023'08"
10.8
BaB - Badin
Total
511.1
Page 2 of 2

APPENDIX 11
RESIDUALS SOURCE CERTIFICATIONS
• CITY OF MONROE WWTP
(FORM: RSC 06-16)
• CITY OF MONROE WTP
(FORM: RSC 06-16)

RESIDUALS SOURCE CERTIFICATION
• CITY OF MONROE WWTP
(FORM: RSC 06-16)

1EM
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 .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "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: City of Monroe
Status
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
City of Monroe
Monroe WWTP
Union
NCO024333
2,044
2,044
R
City of Monroe
Monroe WTP
Union
01-90-010
1,200
1,200
8 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

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: City of Monroe WWTP
2. Facility permit holder is: Federal, State, ED Local Government, or IM Private.
Facility permit issued by: Div. of Water Resources, IM Div. of Environmental Health,
or Other (explain: ).
3. Facility contact person and title: Russell G. Colbath, P.E.
Complete mailing address: Post Office Box 69
City: Monroe State: N.C. Zip: 28111-0069
Telephone number: 704) 282-4624 E-mail address: rcolbath n,monroenc.org
4. Facility physical address: 775 Treewgy Drive
City: Monroe State: N.C. Zip: 28110
Coordinates: Latitude: 34' 59' 44.68" Longitude: 80' 29' 27.27"
Datum: NAD 83 Level of accuracy: nearest tenth of second
Method of measurement: MAP
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: 30 % industrial and 70 % domestic)
0 other (explain: ).
6. Does the facility have an approved pretreatment program: Yes ❑ No
7. Facility permitted/design flow: 10.4 MGD and facility average daily now: 6.16 MGD
8. Average amount of residuals being generated at this facility 2,044 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Aerobic Digestion, 5.0 MG
Type and volume of residuals storage (i.e., outside of residuals treatment units): Cake Storage Pad; 3,000 yd3
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
0 40 CFR Part 503 or 0 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 ED 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 Pagel 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)
a. Are the residuals listed in 40 CFR §261.31-§261.33: el 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: Is yes im 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: Shealy Environmental Services, Inc. and Date of analysis: 9/4/17
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: >140 IF (> 140°F)
Passed reactivity test: ® yes Ono. HCN: <50 mg/kg (<250) & H2S: <50 mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
<0.15
Hexachlorobenzene
0.13
<0.040
Barium
100.0
<0.25
Hexachloro-1,3-Butadiene
0.5
<0.040
Benzene
0.5
<0.050
Hexachloroethane
3.0
<0.040
Cadmium
1.0
<0.050
Lead
5.0
<0.10
Carbon Tetrachloride
0.5
<0.050
Lindane
0.4
<0.00040
Chlordane
0.03
<0.0040
Mercury
0.2
<0.00020
Chlorobenzene
100.0
<0.050
Methoxychlor
10.0
<0.0016
Chloroform
6.0
<0.050
Methyl Ethyl Ketone
200.0
<0.10
Chromium
5.0
<0.10
Nitrobenzene
2.0
<0.040
m-Cresol
200.0
<0.040
Pentachlorophenol
100.0
<0.20
o-Cresol
200.0
<0.040
Pyridine
5.0
<0.040
p-Cresol
200.0
<0.040
Selenium
1.0
<0.20
Cresol
200.0
<0.040
Silver
5.0
<0.10
2,4-D
10.0
<0.020
Tetrachloroethylene
0.7
<0.050
1,4-Dichlorobenzene
7.5
<0.040
Toxaphene
0.5
<0.0080
1,2-Dichloroethane
0.5
<0.050
Trichloroethylene
0.5
<0.050
1, 1 -Dichloroethylene
0.7
<0.050
2,4,5-Trichlorophenol
400.0
<0.040
2,4-Dinitrotoluene
0.13
<0.080
2,4,6-Trichlorophenol
2.0
<0.040
Endrin
0.02
<0.00040
2,4,5-TP (Silvex)
1.0
<0.0050
Heptachlor and its Hydroxide
0.008
<0.00040
Vinyl Chloride
0.2
<0.010
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: WWoint Analytical and Date of analysis: 3/30/18
Parameter
Ceiling
Concentration Limits
(ClassA & C1assB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
8.79
Cadmium
85
39
9.63
Copper
4,300
1,500
118.0
Lead
840
300
15.3
Mercury
57
17
0.173
Molybdenum
75
n/a
28.0
Nickel
420
420
36.9
Selenium
100
100
0.50
Zinc
7,500
2,800
587.0
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
(mg/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
0 > 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: 16.42 %.
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 Waypoint Anal ical and Date of analysis: 3/30/18
Parameter
Result
(mg/kg)
Aluminum
6,110
Ammonia -Nitrogen
5,110
Calcium
7,320
Magnesium
1,220
Nitrate -Nitrite Nitrogen
30.3
pH (Standard Unit)
6.6
Phosphorus
11,200
Potassium
1,040
Sodium
669
Total Kjeldahl Nitrogen
34,400
c. Using the results listed in Item 11. 5b. above, calculate the sodium adsorption ration (SAR): 0.77
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): 0 default value, or a 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: RM
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 (11") Year PAN
Five -Year
Maximum Adjusted PAN
(mglkg)
(mg/kg)
Surface
22.74
34.17
Injection/Incorporation
27.85
39.28
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. Pathoeen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribudon/Land Application of Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: El composting, EB heat drying, ❑ heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
0 Alternative I [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, El air drying, in anaerobic digestion,
❑ composting, or lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
® Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.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.1107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T.I 107(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.I 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.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

• CITY OF MONROE WWTP
(FORM: RSC 06-16) (ATTACHMENTS)
o VICINITY MAP
o PROCESS FLOW DIAGRAM AND/OR NARRATIVE
o QUANTITATIVE JUSTIFICATION
o SAMPLING PLAN
o ANALYTICAL

SYNAGKO
VICINITY MAP
A Residuals Managamnt Company
�` n 8
- ` _ •' B
to
�
�'[
■x � •,
ro
J
Te
u� Q
� � e i 9
! -•
u y[ �
rat � P : �-J
�
1
� Fps
Q
\ - • �
p i
k�
TWddy
F B
� G
roppa P
I P r
rr � � . 607 �,! pro
nt■
kL
anew[ ■° /� `S
0
P I 3 O )
F
/
✓
'� / SITE
`-
+$ A-
4 �u
IACATION
; l
P
r ■k
r• a
0
\�7
~
k!
84 T
�` \ p�'•k
f
F e�>r upea
a
r-,A
_
p
•
W
�'
74 `
$=-,.w '
_ 1
r' ►,+
r � ■p
aav` 75 r
'Pay R
� a C � 1
ro
a Ty
\ e
J
e
+^
6 r.Cf Q
BR
Pt
- '-�pp
"0 �
Rttuy� crQp4 pg■aar al ro
'' �' :.@
'�•
B. , � '
1 'i
p ■■
_- o f y .'Lake- `
'� 9qr L
1 pm
` I'. -!.,• ¢e . .Y+ F y Ake
�
• s Hronc Tr■n
601
T■
ro 96 .8
`.
'
Sb
m[eNw
C ' r- J P
t
® e 6 - 100r'Ik0g-
01 a
"`I
s
1
M
Mt
e
iw "
'°pF s '.■. *way � �%
� �
b e� oar ,
'a �
eir `pp •
•. a ro
V ! F
• i i S. i`
I��P' Raf
207
b
a-✓ +�
1 -� e p \ ,p°
\
h�
7d
COUNTY Ut4(nJ OWNER 67-�- 1'44,6 45-
i

775 ay Ln, Monroe, NC �.
M
i
d�
` � T
i � l � i• t
_ / �• NN L
2013 Googie
Gxog(c earth -

DATE 1 Z03Z! AM PLOT SCALE = it: t CAD FILE = H: \DRAWINGS\3515•-3\O &-M\3515-007 by d XREF t.,c =
1.H5 M GiJ
COUNTY FLOW
METER FLOW FILTER BACKWASH RETURN
EQUALIZATION r�
BASIN 1.6
Gb
INFLUENT I,A dn�D
PUMPING CITY FLOW ROTARY AERATION SECONDARY ,
STATIONS METERS SCREENS BASINS CLARIFIERS
AERATION BASINS I"
SPUTTER BOX
CENTRATE M Gb I— — — RAS — _ RAS PUMPING
3,0 m Gb STATIONS
WAS ^tag rn %e
SUPERNATANT
,®m5 manrDIGESTERS/
LIME
I i
4 I AEROBIC
_
r
DIGESTER/
STORAGE
TANK NO 5
AEROBIC
I
DIGESTER/
I
STORAGE
LIME
TANK NO 1
I
LEGEND
TERTIARY
FILTERS
FILTER
BACKWASH CHLORINE
CONTACT
TANKS
® PUMPS
WASTEWATER FLOW
— — — — SOLIDS FLOW
FLOW
MEASUREMENT
CASCADE
AERATION
EFFLUENT TO
RICHARDSON CREEK
CI-2
S02
NPW
�u� fi;11
P-----�
TRUCK LOADING PUMP-- .®l. MG® MONROE WASTEWATER TREATMENT PLANT
LAND APPLICATION MONROE, NORTH CAROLINA
MZENAND SAYER�c a'�w33� �����a�`on EXISTING PLANT
Environmental Engineeral Scientists ��i5G1,ow�t Ott m
RALEIGH, NORTH CARO11,_1NA tp�` �a q PROCESS FLOW SCHEMATIC N eaVa LTI�� 6e. �7.

QUANTITATIVE JUSTIFICATION
City of Monroe
Wastewater Treatment Plant (WWTP)
Non -Discharge Permit No. WQ0001346
Requested Dry Tons for Renewal —2,044
LAND APPLICATION OF CLASS B RESIDUALS
• Previously Permitted Dry Tons — 2,044
• Requested Dry Tons for Renewal — 2,044

Sampling and Monitoring Plan
The Land Residual Coordinator is responsible for taking all samples. If the
Land Residual Coordinator is unavailable, the Wastewater Plant
Superintendent will designate personnel to perform the sampling. Samples
must be taken in accordance with 40 CFR Part 503.32(a) or (b) and 40 CFR
Part 503.33 so that pathogen and vector attraction specifications are met.
Pollutant concentrations are checked prior to field application events.
Residuals applied shall also be monitored as listed in rules .1105(a),
.1105(d), .1106 and .1107. The frequency of the monitoring is required as
the following:
Metric tons per 365 dgy period (dry weight basis) Monitoring
frequency
Greater than zero but less than 290 once per year
Equal to or greater than 290 but less than 1500 once per quarter (4
times per year)
Equal to or greater than 1500 but less than 15000 once per 60 days
(6 times per year)
Equal to or greater than 15000 once per month (12
times per year)

CITY OF MONROE WWTP & WTP
Permit No. WQ0001346
2018 Analytical
3.244 Permitted Dry Tons
PLANT AVAILABE NITROGEN SUMMARY (Weighted Averages)
SOURCE - DT
SURFACE (1st Year)
PAN m
SURFACE (5 Year)
PAN m
SURFACE (1st Year)
PAN lb/dry ton
SURFACE (5 Year)
PAN lb/dry ton
W WTP - 2,044
7,165
10,766
14.33
21.53
WTP- 1,200
1,137
1,809
2.27
3.62
FIRST YEAR
8,302
16.6U
FIVE YEAR 12,575 [� 25.15
Pounds of PAN per Year
FIRST YEAR IF 53,864
FIVE YEAR 11 81,586
PAN/ac-yr
50
100
150
200
FIRST YEAR ACRES FIVE YEAR ACRES
Surface
Surface
1,077
1,632
539
816
359
544
269
408

CITY OF MONROE
LAND APPLICATION PROGRAM
RESIDUALS ANALYSIS
Residual Type: Wastewater Treatment Plant Biosolids
Date Sampled: March 20, 2018
City of Monroe WWTP Permit No. WQ0001346
Mineralization Rate 0.3 16.42 % Solids
6.6 pH
Parameter
%
Mg/Kg Dry Weight
(% a 10,000)
Pounds/Dry Ton
(M a 0.002
Nitrogen (TKN)
3.440
34,400.000
68.800
Phosphorus
1.120
11,200.000
22.400
Potassium
0.104
1,040.000
2.080
PAN (injected)*
1.393
13,927.300
27.855
PAN (surface)*
1.137
11,372.300
22.745
Ammonia Nitrogen
0.511
5,110.000
10.220
Calcium
0.732
7,320.000
14.640
Calcium Carbonate Eq.
---
---
---
Magnesium
---
1,220.000
2.440
Sodium
---
669.000
1.338
Sulfur
---
---
---
Nitrate N / Nitrite N
---
30.300
0.061
Barium
Chloride
---
---
---
---
---
---
SAR
0.77
Iron
---
---
---
Ceiling Concen.
(Mg/Kg)
Aluminum
---
6,110.00
12.220
Arsenic
---
8.790
---
75
Cadmium
---
9.630
0.019
85
Chromium
---
118.000
---
---
Copper
---
332.00
0.664
4,300
Lead
---
15.300
0.031
840
Mercury
---
0.173
---
57
Molybdenum
---
28.000
---
75
Nickel
---
36.90
0.074
420
Selenium
---
0.500
--
100
Zinc
--- 1
587.00 1
1.17411
7,500
Waypoint Analytical 18-080-0227
*Determination of Plant Available Nitrogen (PAN):
Injected Application:
(Mineralization Rate)(TKN-Ammonia N) + Ammonia N + Nitrate N + Nitrite N = % PAN
Surface Application:
(Mineralization Rate)(TKN-Ammonia N) + (0.5)(Ammonia N) + Nitrate N + Nitrite N = % PAN
Note: Constituents N.D. (Not Detected) or < detection limits are listed as detection limits
for calculation purposes.

Page: 1 of 2
Report Number: 18-080-0227
Account Number: 46205
Submitted By: Steve Holden
Send To: City of Monroe
Steve Holden
775 Treeway Dr
Monroe, NC 28110
(2)
Waypoint.,
ANALYTICAL
Project: WWTP Cake
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
REPORT OF ANALYSIS Date Sampled: 3/20/2018 10:30:00
Lab Number: 59300 Date Received: 03/21/2018 00:00
Sample Id : WWTP Cake Date Reported: 03/30/2018
loial Jonas -
16.42
164200
100.0
BW1
03/21/2018 14:00
SM-254OG
Moisture'
83.57
100.0
BW1
03/21/201814:00
SM-2540G
Total Kjeldahl Nitrogen
3.44
34400
50.0
JM
03/22/2018 08:15
SM-4500-NH3C-TKN
Total Phosphorus
1.12
11200
5.00
JTR
03/28/2018 01:46
6010C
Total Potassium
0.10
1040
50.0
BKN
03/29/2018 13:15
6010C
Total Sulfur
0.67
6710
5.00
JTR
03/28/2018 01:46
6010C
Total Calcium
0.73
7320
5.00
JTR
03/28/2018 01:46
6010C
Total Magnesium
0.12
1220
5.00
JTR
03/28/2018 01:46
6010C
Total Sodium
0.07
669
25.0
JTR
03/28/2018 01:46
6010C
Total Iron
149000
50.0
BKN
03/29/201813:15
6010C
Total Aluminum
6110
5.00
JTR
03/28/2018 01:46
6010C
Total Manganese
863
0.500
JTR
03/28/2018 01:46
6010C
Total Copper
332
0.250
JTR
03/28/2018 01:46
6010C
Total Zinc
587
0.500
JTR
03/28/2018 01:46
6010C
Ammonia Nitrogen
0.51
5110
50.0
R D
03/22/2018 08:15
SM-4500-NH3C
Organic N
2.93
29290
50.0
03/22/2018 08:15
CALCULATION
Nitrate+Nitrite-N
30.3
2.39
MMT
03/23/2018 09:07
4500NO3F-2011
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
«
Pam
C
m
Our reports and letters are for the exclusive and confidential use of our clients. and may not be reproduced in whole or part. nor may any reference be made
to the work, the results, or the company in any advertising, news release or otherpublic announcements without obtaining our pnor written authorization.
Pauric McGroary
Agronomist
Paqe 2 of 3

Page: 2 of 2
Report Number: 18-080-0227
Account Number: 46205
Submitted By: Steve Holden
Send To: City of Monroe
Steve Holden
775 Treeway Dr
Monroe, NC 28110
Waypoint.(D
ANALYTICAL
Project: WWTP Cake
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
REPORT OF ANALYSIS Date Sampled: 3/20/2018 10:30:00
Lab Number: 59300 Date Received: 03/21/2018 00:00
Sample Id: WWTP Cake Date Reported: 03/30/2018
WWI �Iaumtum
9.63
0.100
JTR
03/28/2018 01:46
6010C
Total Chromium
118
0.250
JTR
03/28/2018 01:46
6010C
Total Nickel
36.9
0.250
JTR
03/28/2018 01:46
6010C
Total Lead
15.3
0.300
JTR
03/28/2018 01:46
6010C
Total Arsenic
8.79
1.00
JTR
03/28/2018 01:46
6010C
Total Mercury
0.173
0.0133
KKM
03/27/2018 12:42
7471A
Total Selenium
<0.500
0.500
JTR
03/28/2018 01:46
6010C
pH `
6.6
1.0
JM
03/22/2018 08:15
9045D
Total Volatile Solids
53.28 532800
100.0
BW1
03/21/2018 14:00
SM-2540G
Total Molybdenum
28.0
0.250
JTR
03/28/2018 01:46
6010C
Comments:
NC CERT#257
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Our reports and fetters are for the exclusive and confidential use of our clients. and may not be reproduced in whole orpart. nor may any reference be made
Pew;
to the work, the results, or the company in any advertising, news release or other public announcements without obtaining our prior written authorization
Pauric McGroary
Agronomist
Paqe 3 of 3

Page: 1 of 1
Report Number: 18-080-0229
Account Number: 46205
Submitted By: Steve Holden
Send To: City of Monroe
Steve Holden
775 Treeway Dr
Monroe, NC 28110
o
Waypoint.
ANALYTICAL
Project : RAS
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypoititanalytical.com
REPORT OF ANALYSIS Date Sampled: 3/20/2018 10:00:00
Lab Number: 59302 Date Received: 03/21/2018 00:00
Sample Id: RAS Date Reported: 03/23/2018
Mal 00110S 1.45 14800
Moisture ' 98.52
Total Volatile Solids 75.67 756700
Comments:
NC CERT#257
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
100.0
BW1
03/21/201814:00
SM-2540G
100.0
BW1
03/21/201814:00
SM-2540G
100.0
BW1
03/21/201814:00
SM-2540G
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Our reports and letters are for the exclusive and confidential use of out clients. and unay not be reproduced in whole or part not may any reference be made
to the work, the results, or' the corndany in any advertising, news release, or other public announcements without obtaining ourpnor written authorization.
Pauric McGroary
Agronomist

CITY OF MONROE WWTP
%VSR
%VS in 1 0.7567 _ Enter in
%VS out 1 0.53281 decimal form
%VSR= (%VS in - %VS out)
((%VS in - (%VS in x %VS out))
%VSR= 63.33
Waypoint Analytical: Report No.18-080-0227
Waypoint Analytical: Report No.18-080-0229

Willcox & Mahe Soil Solutions, PLLC
Summerfield, North Carolina
RESIDUAL PAN CALCULATION
City of Monroe WWTP
TKN= 34,400 mg/kg
NH3= 5,110 mg/kg
NO3-NO2-N= 30.3 mg/kg
Min Rate= 0.30
PAN= Imin.rate (TKN - NH3) + 0.5 (NH3) + NO3-NO2I
0.30 29,290 2,555 30.30
PAN= 11372.30 mg/kg
Calculate residual nitrogen for years 2,3,4 and 5 following the initial application to determine
the amount of PAN/DT remaining.
2ND YEAR RESIDUAL PAN
PAN= Imin.rate (1st year org. - N 2nd year min. - NI
0.15 29,290 8,787
PAN= 3075.45 mg/kg remaining from 1 st year application
3RD YEAR RESIDUAL PAN
PAN= Imin.rate (2nd year org. - N 3rd year min. - NI
0.08 20,503 3,075
PAN= 1394.20 mg/kg remaining from I st year application
4TH YEAR RESIDUAL PAN
PAN= Imin.rate (3rd year org. - N 4th year min. - NI
0.05 17,428 1,394
PAN= 801.67 mg/kg remaining from 1st year application
5TH YEAR RESIDUAL PAN
PAN= Imin.rate (4th year org. - N 5th year min. - N)
0.03 16,033 802
PAN= 442.78 mg/kg remaining from 1 st year application
Residual PAN from years 2 thru 5 after the initial application = 5714.10 mg/kg
Application
Five Year Maximum
Method
First Year PAN
Adjusted PAN
(mg/kg)
(mg/kg)
Surface
11,372
17,086
Incorporation
13,927
19,641
Application
Five Year Maximum
Method
First Year PAN
Adjusted PAN
I bs/DT
Ibs/DT
Surface
22.74
34.17
Incorporation
27.85
39.28

SAR
SAR Calculation
Na mg/I _
Ca mcaA _
Mg mg/I
200.324
109.8498
1201.944
_
Na Ca
Mg SAR
4.776 60.097
16.694 r 0.771
Na mil eq
Ca mil eq
Mg mil eq
- -
- 4.776 -
60.097 -
16.694
Enter
Enter .% TS
16.42
_
Data,==:>
Na mac /kk
669
- - -
- - - -
-
Ca moa
- - 7320
.- -- ---
m-9/4
1220
-- - - -
Job Name:
Ci of Monroe WWTP
Page 1

iz,
-. F: Z
PROM PT-ACCLI RATE -RELIABLE
LABORATOIRIES, INC
WWW.PARLABS.COM
REPORT OF' ANALYSES
Attn: STEVE HOLDEN
CITY OF MONROE WASTEWATERPLANT PROJECT NAME: MAR 18
PO BOX 69 DATE: 04/05/18
MONROE, NC 28111-
SAMPLE NUMBER-
130984
SAMPLE ID- MONROF WWTP
SAMPLE MATRIX- SO
DATE SAMPLED-
03/13/18
DATE RECEIVED-
03/13/18
SAMPLER- SH
RECEIVED BY- DJ
TIME RECEIVED-
1403
DELIVERED BY- SH
TYPE SAMPLE- Grab
Page 1 of 1
ANALYSIS
ANALYSIS
METHOD DATE TIME BY
RESULT UNITS
FECAL COLIFORM (GEOM. MEAN) SM 9221 E 03/13/18 1500 RE 14,903 MPN/g
- / �""'- =
LABORATORY DIRECTOR-
f
P.O. Box 411483 • Charlotte, NC 28241-1483
Phone: [phone] • Fax: [phone]

AM 2217 Graham Park Drive
PO Box 411483
=" Charlotte, NC 28241-1483
PRO MPT•ACCU RATE• REi_1ABLE
LABCJR.ATORIES, INC NC Cert # 20; SC Cert # 99003001
CITY OF MONROE
MONROE WWTP
1 03/13/18
FECAL COLIFORM, GEOMETRIC MEAN
®s SM 9221 E
130984
1
3,599
16.82%
21,391.37
2
1,519
16.03%
9,472.60
3
2,913
16.07%
18,131.89
4
1,317
16.45%
8,001.01
5
3,259
16.12%
20,217.50
6
2,695
15.70%
17,162.40
7
2,739
17.11 %
16,007.13
Fecal Coliform
i
Geometric Mean= •

�A
L 450RATQMES,1NC.
www.partabs.com
CHAIN OF CUSTODY
Y
PAR Laboratories, Inc
Phone [phone]
Fax [phone]
Shipping: Mailing_
2217 Graham Park Drive PO Box 411483
Charfo<<e, NC 28273 Charlotte, NC 28241-1483
is essent:al that all information be recorded on this Chain of Custody doctinnent :or acceptance by PAR Laboratories. Inc. and The North
Czroiira Daoari--T o: E—im—e -,ai and uaty l Resov,ces_
Ccnpzny Name lbiningf City of Mon-roeComments/ Special Instructions
r Address
PO Box 69
1 City. State $ zip code _
Monroe_ Fi C 28111
Steve Holden ( 704 ) 282-4679 sholden@nionroe11c.01*0
503 BIOSOLIDS
REPORTING
Sample Taken By: 5il�L- �400 F-')
IS THIS FOR STATE or EPA REPORTING? YE_S „ NO
'Sample type: DW __ WW )C GWMW _ HW Soil other
Sample Temp at time of sampfng:/*C Sample Temp upon receipt_ d -L �C
Preserved: Yes — No X Teflon Liner/ Zero Headspace: Yes No N/A X
Client Sample I.D.
Sample Location /Number)
Comp
Grab
Preserv.
Set Up
Date / Time
Collection
Date / Time
Analyes Requested
# I WWT'P
X
NONE
3_ i3, (I'
FECAL COLIFORM
# 2 WWTP
x
Nora
3- 13- Sr
FECAL COLIFORM
# 3 WWTP
X
NONE
g
FECAL COLIFORM
4 WWT'P -
X
NONE
- 13- I
FECAL COLIFORM
P, 5 WwrP
X
NONE
FECAL COLIFORM
# 6 WWTP
X
NONE
3. 3- g
FECAL COLIFORM
# 7 W)V P
X
NONE
3_ 3 _
FECAL COLIFORM
?elinGu' d by: Date/Time Re"by- Da[efTime
6.
3elinquished by: Daterime P.eceived by: j Date/Time
C=Composite G=Grab DW=Drinking Water WW=Wastewater GWMW=Groundwater Monitoring Well HIN=Hazardovs Waste
See Other Side

SHEALY ENVIRONMENTAL SERVICES, INC.
Report of Analysis
City of Monroe
PO Box 69
Monroe, NC 28111
Attention: Steve Holden
Project Name: Land Application
Lot Number:SH23072
Date Completed:09/04/2017
09/07/2017 1:40 PM
Approved and released by:
Project Manager: Lucas Odom
�Snc_
jC /ILABORATORY
ACCREDITATION
BUREAU
ACCREDITEDISOIIE<<7oz5
oea�
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety, without the written approval of Shealy Environmental Services, Inc.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 1 of 13

SHEALY ENVIRONMENTAL SERVICES, INC.
SC DHEC No: 32010001 NELAC No: E87653 NC DENR No: 329 NC Field Parameters No: 5639
Case Narrative
City of Monroe
Lot Number: SH23072
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary following this Case Narrative.
The sample receiving date is documented in the header information associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most current approved NELAC
standards. the Shealy Environmental Services, Inc. ("Shealy") Quality Assurance Management Plan (QAMP), standard operating
procedures (SOPs), and Shealy policies. Any exceptions to the NELAC standards, the QAMP, SOPS or policies are qualified on the
results page or discussed below.
Where applicable, all soil sample analysis are reported on a dry weight basis unless flagged with a "W" qualifier
If you have any questions regarding this report please contact the Shealy Project Manager listed on the cover page.
The pH analysis associated with the sample(s) in this report was/were performed after the method recommended 15 minute holding
time.
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 2 of 13

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
City of Monroe
Lot Number: SH23072
Sample Number Sample ID Matrix Date Sampled Date Received
001 WWTP CAKE Solid 08/23/2017 08/23/2017
002 WTP CAKE Solid 08/23/2017 08/23/2017
(2 samples)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 3 of 13

SHEALY ENVIRONMENTAL SERVICES, INC.
Detection Summary
City of Monroe
Lot Number: SH23072
Sample Sample ID Matrix Parameter Method Result Q Units Page
001 WWTP CAKE Solid Ignitability (Pensky-Martens 1010A >140 ° F 5
002 WTP CAKE Solid Ignitability (Pensky-Martens 1010A >140 ° F 8
(2 detections)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 4 of 13

�.ncn. vap vmvnvc
Descriptton: WWTP CAKE
Date Sampled:08/23/2017
Date Received:08123/2017
Matrix: Solid
% Solids: 20.5 08/23/2017 2254
Inorganic
non-metals
Run Prep Method
Analytical Method
Dilution
Analysis Date Analyst Prep Date Batch
1
(Ignitability) 1010A
1
08/31/2017 0000 KWP 50509
1
(pH) 9045D
1
08/25/2017 2044 HRJ 50080
1
(Reactive Cya) 7.3.3
1
08/31/2017 1428 HKL 08/27/2017 1104
1
(Reactive Sul) 7.3.4
1
08/28/2017 1440 AMM1 08/27/2017 1104
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Ignitability (Pensky-Martens Closed -Cup)
1010A
>140
140
- F
1
pH
9046D
7.5
su
1
Reactive Cyanide
7.3.3
ND
50
mg/kg
1
Reactive Sulfide
7.3.4
ND
50
mg/kg
1
TCLP Volatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/5030B 8260B 10 08/31/2017 0158 ECP 50383 08/27/2017 1645
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
Benzene
71-43-2
8260B
ND
0.050
mg/L
1
2-Butanone (MEK)
78-93-3
8260B
ND
0.10
mg/L
1
Carbon tetrachloride
56-23-5
8260B
ND
0.050
mg/L
1
Chlorobenzene
108-90-7
8260B
ND
0.050
mg/L
1
Chloroform
67-66-3
8260B
ND
0.050
mg/L
1
1,2-Dichloroethane
107-06-2
8260E
ND
0.050
mg/L
1
1, 1 -Dichloroethene
75-35-4
8260E
ND
0.050
mg/L
1
Tetrachloroethene
127-18-4
8260E
ND
0.050
mg/L
1
Trichloroethene
79-01-6
8260B
ND
0.050
mg/L
1
Vinyl chloride
75-01-4
8260B
ND
0.010
mg/L
1
Run 1
Acceptance
Surrogate
Q % Recovery
Limits
1,2-Dichloroethane-d4
93
70-130
Bromofluorobenzene
95
70-130
Toluene-d8
94
70-130
TCLP Semivolatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8270D 1 08/29/2017 1701 CMP2 08/25/2017 1913 50035 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
1,4-Dichlorobenzene
106-46-7
8270D
ND
0.040
mg/L
1
2,4-Dinitrotoluene
121-14-2
8270D
ND
0.080
mg/L
1
Hexachlorobenzene
118-74-1
8270D
ND
0.040
mg/L
1
Hexachlorobutadiene
87-68-3
8270D
ND
0.040
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 5 of 13

Description: WWTP CAKE
Matrix: Solid
Date Sampled:08/23/2017
% Solids: 20.5 08/23/2017 2254
Date Received:08/23/2017
TCLP Semivolatiles
Run Prep Method
Analytical Method Dilution Analysis Date Analyst
Prep Date
Batch Leachate Date
1 1311/3520C
8270D 1 08/29/2017 1701 CMP2
08/25/2017 1913 50035 08/24/2017 2219
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Hexachloroethane
67-72-1 8270D
ND
0.040
mg/L
1
2-Methylphenol
95-48-7 8270D
ND
0.040
mg/L
1
3+4-Methylphenol
106-44-5 8270D
ND
0.040
mg/L
1
Nitrobenzene
98-95-3 8270D
ND
0.040
mg/L
1
Pentachlorophenol
87-86-5 8270D
ND
0.20
mg/L
1
Pyridine
110-86-1 8270D
ND
0.040
mg/L
1
2,4,5-Trichlorophenol
95-95-4 8270D
ND
0.040
mg/L
1
2,4,6-Trichlorophenol
88-06-2 8270D
ND
0.040
mg/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
2-Fluorobiphenyl
49 37-129
2-Fluorophenol
25 24-127
Nitrobenzene-d5
51 38-127
Phenol-d5
40 28-128
Terphenyl-d14
53 10-148
2,4,6-Tribromophenol
42 41-144
TCLP Herbicides
Run Prep Method
Analytical Method Dilution Analysis Date Analyst
Prep Date
Batch Leachate Date
1 131118151A
8151A 1 09/01/2017 1551 DAL1
08/29/2017 1852 50244 08/24/2017 2219
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
2,4-D
94-75-7 8151A
ND
0.020
mg/L
1
2,4,5-TP (Silvex)
93-72-1 8151A
ND
0.0050
mg/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
DCAA
79 62-117
TCLP Pesticides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8081E 1 08/31/20171435 PMS 08/29/20171632 50249 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
gamma-BHC (Lindane)
58-89-9
80818
ND
0.00040
mg/L
1
Chlordane
57-74-9
8081 B
ND
0.0040
mg/L
1
Endrin
72-20-8
8081 B
ND
0.00040
mg/L
1
Heptachlor
76-44-8
8081 B
ND
0.00040
mg/L
1
Heptachlor epoxide
1024-57-3
8081E
ND
0.00040
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 6 of 13

Description: WWTP CAKE
Date Sampled:08/23/2017
Date Received:08/23/2017
Matrix: Solid
% Solids: 20.5 08/23/2017 2254
TCLP Pesticides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311 /3520C 8081 B 1 08/31 /2017 1435 PMS 08/29/2017 1632 50249 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method Result Q LOQ
Units Run
Methoxychlor
72-43-5
8081B ND 0.0016
mg/L 1
Toxaphene
8001-35-2
8081E ND 0.0080
mg/L 1
Run 1 Acceptance
Surrogate Q % Recovery Limits
Decachlorobiphenyl 67 20-131
Tetra chloro-m-xylene 68 26-132
TCLP Metals
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3010A 601OD 10 08/28/2017 1757 CJZ 08/25/2017 1930 50043 08/24/2017 2219
1 1311/7470A 7470A 1 08/25/2017 2323 SLS 08/25/2017 2014 50053 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
Arsenic
7440-38-2
601OD
ND
0.15
mg/L
1
Barium
7440-39-3
601OD
ND
0.25
mg/L
1
Cadmium
7440-43-9
601OD
ND
0.050
mg/L
1
Chromium
7440-47-3
601OD
ND
0.10
mg/L
1
Lead
7439-92-1
601OD
ND
0.10
mg/L
1
Mercury
7439-97-6
7470A
ND
0.00020
mg/L
1
Selenium
7782-49-2
601OD
ND
0.20
mg/L
1
Silver
7440-22-4
601OD
ND
0.10
mg/L
1
LOQ = Limit of 0uantitation 8 = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 7 of 13

RESIDUALS SOURCE CERTIFICATION
• CITY OF MONROE WTP
(FORM: RSC 06-16)

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 .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR I1-15, 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: City of Monroe
Status
Code
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current b
Proposed
R
City of Monroe
Monroe W WTP
Union
NCO024333
2,044
2,044
R
City of Monroe
Monroe WTP
Union
01-90-010
1,200
1,200
s 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

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: City of Monroe WTP
2. Facility permit holder is: ❑ Federal, ❑ State, 0 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: Russell G. Colbath, P.E.
Complete mailing address: Post Office Box 69
City: Monroe State: N.C. Zip: 28111-0069
Telephone number: [phone] E-mail address: rcolbath(&monroenc.org
4. Facility physical address: 2119 Old Camden Road
City: Monroe State: N.C. Zip: 28110
Coordinates: Latitude: 35' 02' 03.40" Longitude: 80. 28' 32.80"
Datum: NAD 83 Level of accuracy: nearest tenth of second
Method of measurement: MAP
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: gM ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 11.2 MGD and facility average daily flow: 6.44 MGD
8. Average amount of residuals being generated at this facility 1,200 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Treatment of Potable Water
Type and volume of residuals storage (i.e., outside of residuals treatment units): Cake Storage: 170 yd3
I1. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
El 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:
03 Biological N 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)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes 0 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: 0 yes 0 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: Shealy Environmental Services, Inc. and Date of analysis: 9/4/17
Passed corrosivity test: 0 yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: >140 OF (> 140°F)
Passed reactivity test: [0 yes ❑no. HCN: <50 mg/kg (<250) & H2S: <50 mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
<0.15
Hexachlorobenzene
0.13
<0.040
Barium
100.0
<0.25
Hexachloro-1,3-Butadiene
0.5
<0.040
Benzene
0.5
<0.050
Hexachloroethane
3.0
<0.040
Cadmium
1.0
<0.050
Lead
5.0
<0.10
Carbon Tetrachloride
0.5
<0.050
Lindane
0.4
<0.00040
Chlordane
0.03
<0.0040
Mercury
0.2
<0.00020
Chlorobenzene
100.0
<0.050
Methoxychlor
10.0
<0.0016
Chloroform
6.0
<0.050
Methyl Ethyl Ketone
200.0
<0.10
Chromium
5.0
<0.10
Nitrobenzene
2.0
<0.040
m-Cresol
200.0
<0.040
Pentachlorophenol
100.0
<0.20
o-Cresol
200.0
<0.040
Pyridine
5.0
<0.040
p-Cresol
200.0
<0.040
Selenium
1.0
<0.20
Cresol
200.0
<0.040
Silver
5.0
<0.10
2,4-D
10.0
<0.020
Tetrachloroethylene
0.7
<0.050
114-Dichlorobenzene
7.5
<0.040
Toxaphene
0.5
<0.0080
1,2-Dichloroethane
0.5
<0.050
Trichloroethylene
0.5
<0.050
1, 1 -Dichloroethylene
0.7
<0.050
2,4,5-Trichlorophenol
400.0
<0.040
2,4-Dinitrotoluene
0.13
<0.080
2,4,6-Trichlorophenol
2.0
<0.040
Endrin
0.02
<0.00040
2,4,5-TP (Silvex)
1.0
<0.0050
Heptachlor and its Hydroxide
0.008
<0.00040
Vinyl Chloride
0.2
<0.010
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 .l 105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Waypoint Analytical and Date of analysis: 4/3/18
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
4.25
Cadmium
85
39
33.5
Copper
4,300
1,500
374
Lead
840
300
21.8
Mercury
57
17
0.0249
Molybdenum
75
n/a
43.5
Nickel
420
420
21.2
Selenium
100
100
0.5
Zinc
7,500
2,800
97
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
(mg/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: 17.99 %.
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: WWoint Analytical and Date of analysis: 4/3/18
Parameter
Result
(mg/kg)
Aluminum
4,980
Ammonia -Nitrogen
1,390
Calcium
1,680
Magnesium
490
Nitrate -Nitrite Nitrogen
16.4
pH (Standard Unit)
5.0
Phosphorus
2,970
Potassium
393
Sodium
544
Total Kjeldahl Nitrogen
13,200
c. Using the results listed in Item 11. 5b. above, calculate the sodium adsorption ration (SAR): 1.27
[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: 20 %. This
rate is a (check one): 0 default value, or in 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 (V) Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mg/kg)
Surface
3,073
4,891
Injection/Incorporation
3,768
5,586
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: En
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 Distribudon/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
® A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.I 106(bx3)(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. 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: N/A —Water Treatment Residual
❑ Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.1106(c)(2)] -Process to Significantly Reduce Pathogens (PSRP).
Specify one: 0 aerobic digestion, I
air drying, n anaerobic digestion,
EM composting, or lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 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.1107, specify how residuals will meet the VAR requirements:
N/A — Water Treatment Residual
❑ Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.1107(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.1107(a)(10)] -Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(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

• CITY OF MONROE WTP
(FORM: RSC 06-16) (ATTACHMENTS)
o VICINITY MAP
o PROCESS FLOW DIAGRAM AND/OR NARRATIVE
o QUANTITATIVE JUSTIFICATION
o SAMPLING PLAN
o ANALYTICAL

1;r
SYNAGRO
VICINITY MAP
A Residuals Managernenr Company
.�
FiI IbMnNar•
enr • 1qy
� G„au !°
° i r•�, `` 78
�
r
I Si I C
\\ 4
.x
` �'°r � 7 I y°xri j
` ;` f�'q, '4 S 4 •A
��5 278
a '<t
NI
v°°'� 1 d 4rreN ed°e"
: ♦ � °O /1 \
� iv
4
�
once m n \F IIk .•�
5
\ ) ('!� 1p / MEmr,r 't rl IeY'� °° A,
1
b� �
Yb b ro /
1
Polk
Mtn I ar
i
fit
44
\)
h
a J `
% 99 "Y x
�t b P • .-� �
' f
•P 4
J d _<_
M ro
0
es
,
SITE
°,Hmadm
4
r
LOCATION
Leka' �,
� �.r •
Qr
�♦ Yl
M r
°
timpn
200
f• `9 _. %7 ax+o, 4
� h m
papYal" im r
4 - � �
F t�i if I @ )
"p � I
•�f
qp• a e rxpo
a 3
x0
'�
°'4
� /
1 1 epask
� +i t pyppM F
— i4 B G
o•
rr
W1
YM
ay
�y $ ..m
Dam.. .
•�J x t""0 Wn �n a--''
rr+
x�• ,d° - 75 r
v
J
a0
qO ROy C _isi
w n 1
T
/tie-
p
. r
i�
eOek
-•,a ,
r'
r
-
�13
tEde
- 0•°
ry xeul y,wr cr•°J• ..mowm m �
!
�; I F
'#i I
a
�
M �•
� eur m c
h� F
'
�/ $ � � -
6 ♦ _ °�'tr° � Y B �
� I 4° . R a $ C
A �k • 9r°nc �
�
Y° � bre a M
�'.� ,J4u i •
,a I � p.,�m m
L
!°� /
9
m -^� � a -
�
/ � �,\ •, b � ��
"•
off., w.r �'. i'- e
8 J J °•
44ti
r- .. -j.
g
a
6 ,�, M•M Jcr n
R. I�
•
:er'kl»dv �
e° � M ! �
@ 3/b O F 6 � tCe.l+aa a
i ♦ - -\� 0 0
$
• u�aav
_ � F
a<r .�
i► i 4$ 8
`rr•J �e �
"J 1) $ rry� `I
$ I x4
..
.�
p,p .+
S` a � � '-a .'
�•rer
� 1• ♦ •
eS p4•,aa
- � r
� wles � w a Dupe
r t
=
_ �
p !/ . pYAAaole we
I��Y4,e�p�'s � p M Y
` �
ray � B g
522 F4,e f
% • 1 i ...
_ 1� 4 c 1p - l R '
�prlY ,p @ .,
J
,�. ,�!^
m
.�•
rw°l'_..M-
.psi
A
COUNTY OWNER f �Y d= lam 'Q %Jr/

qk,
ri
0 2013 Google (',.00gic ear ti,

John Glenn Water Treatment Plant (11.0 MGD)
NPDES PERMIT # NCO080381
Monroe, NC
Process Schematic
NPDES SYSTEM COLOR CODED GREEN
O — Manhole
SI e_SlM_age}� goon Supernatant, Trac Vac Discharge antl sin Floor Drains to Clarifier jA
Y_._._._. _._. _. _._._. ._._._�
i
E
Filter Backwash and fop Basin Drains (Wat o Sludge Storage Lagoon �t
Storage Laaoop 6
2.25 MG 4
Qec�nLLim s
(2) fad 200 m e
Solider Bo
- _.-
6 x
Rapid Mixer#2 ^�7�--
Chemical Feed Legend- -
, I
5 8JU 3 5
Potassium Permanganate
—>O
Pump Station #2
Powdered Activated Carbon
—� O
Ammonia rank and Buiidin�
Sodium Hydroxide
-� g
Chlorine
Ferric Chloride
-y
5
Polymer
Polyphosphate
� 6
7)_
g -• g�
Fluoride
—> 8
To Distribution System
Ammonia
9,
—�
Sulfur Dioxide
10
Ladle rwitty
Monthly flow
For July 2008- June 2013
Averaae 0.73 mod
Max.89 mad
Min 0.40 mod
Stewarts Cr
Stewarts

QUANTITATIVE JUSTIFICATION
City of Monroe
Water Treatment Plant (WTP)
Non -Discharge Permit No. WQ0001346
Requested Dry Tons for Renewal —1,200
LAND APPLICATION OF CLASS B RESIDUALS
• Previously Permitted Dry Tons — 1,200
• Requested Dry Tons for Renewal —1,200

Sampling and Monitoring Plan
The Land Residual Coordinator is responsible for taking all samples. If the
Land Residual Coordinator is unavailable, the Wastewater Plant
Superintendent will designate personnel to perform the sampling. Samples
must be taken in accordance with 40 CFR Part 503.32(a) or (b) and 40 CFR
Part 503.33 so that pathogen and vector attraction specifications are met.
Pollutant concentrations are checked prior to field application events.
Residuals applied shall also be monitored as listed in rules .1105(a),
.1105(d), .1106 and .1107. The frequency of the monitoring is required as
the following:
Metric tons per 365 day period (dry weight basis)
frequency
Greater than zero but less than 290
Equal to or greater than 290 but less than 1500
times per year)
Equal to or greater than
(6 times per year)
Equal to or greater than
times per year)
1500 but less than 15000
15000
Monitoring
once per year
once per quarter (4
once per 60 days
once per month (12

CITY OF MONROE WWTP & WTP
Permit No. WQ0001346
2018 Analytical
3.244 Permitted Dry Tons
PLANT AVAILABE NITROGEN SUMMARY (Weighted Averages)
SOURCE - DT
SURFACE (1st Year)
PAN m
SURFACE (5 Year)
PAN m
SURFACE (1st Year)
PAN lb/dryton
SURFACE (5 Year)
PAN Ib/d ton
WWTP - 2,044
7,165
10,766
14.33
21.53
WTP- 1,200
1,137
1,809
2.27
3.62
FIRST YEAR
$ O2
16.60
J
FIVE YEAR 11 1 12,575 l 25.15
Pounds of PAN per Year
FIRST YEAR 1 53,864
FIVE YEAR F 81,586
PAN/ac-yr
50
100
150
200
FIRST YEAR ACRES FIVE YEAR ACRES
Surface
Surface
1,077
1,632
539
816
359
544
269
408

CITY OF MONROE
LAND APPLICATION PROGRAM
RESIDUALS ANALYSIS
Residual Type: Water Treatment Plant Residuals
Date Sampled: March 20, 2018
City of Monroe WTP Permit No. WQ0001346
Mineralization Rate 0.2 17.99 % Solids
5.0 pH
Parameter
%
Mg/Kg Dry Weight
(% IL 10,000)
Pounds/Dry Ton
(M a 0.002
Nitrogen (TKN)
1.320
13,200.000
26.400
Phosphorus
0.297
2,970.000
5.940
Potassium
0.039
393.000
0.786
PAN (injected)*
0.377
3,768.400
7.537
PAN (surface)*
0.307
3,073.400
6.147
Ammonia Nitrogen
0.139
1,390.000
2.780
Calcium
0.168
1,680.000
3.360
Calcium Carbonate Eq.
---
---
---
Magnesium
---
490.000
0.980
Sodium
---
544.000
1.088
Sulfur
---
---
---
Nitrate N / Nitrite N
---
16.400
0.033 11
Barium
-
---
---
SAR
Chloride
---
---
---
1.27
Iron
---
---
---
Ceiling Concen.
Aluminum
--
4,980.00
9.960
(M )
Arsenic
---
4.250
---
75
Cadmium
---
33.500
0.067
85
Chromium
---
199.000
---
---
Copper
---
374.00
0.748
4,300
Lead
---
21.800
0.044
840
Mercury
---
0.025
---
57
Molybdenum
---
43.500
---
75
Nickel
---
21.20
0.042
420
Selenium
---
0.500
---
100
Zinc
---
97.00
7,500
�0.94
Waypoint Analytical 18-080-0228
*Determination of Plant Available Nitrogen (PAN):
Injected Application:
(Mineralization Rate)(TKN-Ammonia N) + Ammonia N + Nitrate N + Nitrite N = % PAN
Surface Application:
(Mineralization Rate)(TKN-Ammonia N) + (0.5)(Ammonia N) + Nitrate N + Nitrite N = % PAN
Note: Constituents N.D. (Not Detected) or < detection limits are listed as detection limits
for calculation purposes.

Page: 1 of 2
Report Number: 18-080-0228
Account Number: 46205
Submitted By: Steve Holden
Send To: City of Monroe
Steve Holden
775 Treeway Dr
Monroe, NC 28110
Lab Number: 59301
Sample Id : WTP Ferric Cake
Waypoint..,
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project : WTP Ferric Cake
REPORT OF ANALYSIS Date Sampled: 3/20/2018 10:15:00
Date Received: 03/21/2018 00:00
Date Reported: 04/03/2018
Total Solids "
17.99
179900
100.0
BW 1
03/21/2018 14:00
SM-2540G
Moisture "
82.00
100.0
BW 1
03/21/2018 14:00
SM-254OG
Total Kjeldahl Nitrogen
1.32
13200
50.0
JM
03/22/2018 08:15
SM-4500-NH3C-TKN
Total Phosphorus
0.30
2970
5.00
JTR
03/28/2018 01:51
6010C
Total Potassium
0.04
393
5.00
JTR
03/28/2018 01:51
6010C
Total Sulfur
0.27
2670
5.00
JTR
03/28/2018 01:51
6010C
Total Calcium
0.17
1680
5.00
JTR
03/28/2018 01:51
6010C
Total Magnesium
0.05
490
5.00
JTR
03/28/2018 01:51
6010C
Total Sodium
0.05
544
25.0
JTR
03/28/2018 01:51
6010C
Total Iron
284000
100
BKN
03/30/201818:20
6010C
Total Aluminum
4980
5.00
JTR
03/28/2018 01:51
6010C
Total Manganese
310
0.500
JTR
03/28/2018 01:51
6010C
Total Copper
374
0.250
JTR
03/28/2018 01:51
6010C
Total Zinc
97.0
0.500
JTR
03/28/2018 01:51
6010C
Ammonia Nitrogen
0.14
1390
50.0
R D
03/22/2018 08:15
SM-4500-NI3C
Organic N
1.18
11810
50.0
03/22/2018 08:15
CALCULATION
Nitrate+Nitrite-N
16.4
2.24
MMT
03/23/2018 09:08
4500NO3F-2011
All values are on a dry weight basis except as noted
by asterisk. Detection limit on all N series is on a wet basis.
Our reports and letters are for the exclusive and confidential use of our clients. and
may not be reproduced
in whole or part. nor may any
reference he made
to the wail, the results, or the company in any adverlising. news release. or other public announcements without obtaining our prior written authonzalion.
Pauric McGroary
Agronomist
Paae 2 of 4

Page: 2 of 2
Report Number: 18-080-0228
Account Number: 46205
Submitted By: Steve Holden
Send To: City of Monroe
Steve Holden
775 Treeway Dr
Monroe, NC 28110
WayPOint,(D
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project: WTP Ferric Cake
REPORT OF ANALYSIS Date Sampled: 3/20/2018 10:15:00
Lab Number: 59301 Date Received: 03/21/2018 00:00
Sample Id : WTP Ferric Cake Date Reported: 04/03/2018
WWI %laumium
33.5
0.100
JTR
03/28/2018 01:51
6010C
Total Chromium
199
0.250
JTR
03/28/2018 01:51
6010C
Total Nickel
21.2
0.250
JTR
03/28/2018 01:51
6010C
Total Lead
21.8
0.300
JTR
03/28/2018 01:51
6010C
Total Arsenic
4.25
1.00
JTR
03/28/2018 01:51
6010C
Total Mercury
0.0249
0.0133
KKM
03/27/2018 12:43
7471A
Total Selenium
<0.500
0.500
JTR
03/28/2018 01:51
6010C
pH "
5.0
1.0
JM
03/22/2018 08:15
9045D
Total Volatile Solids
35.33 353300
100.0
BW1
03/21/2018 14:00
SM-2540G
Total Molybdenum
43.5
0.250
JTR
03/28/2018 01:51
6010C
Comments:
NC CERT#257
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Ouneports and letters are for the exclusive and confidential use or our clients. and may not he reproduced in whole or parr. nor may any reference be made Plfte' Xc-14wr
to the work, the results or the company in any advertising, news release, or other public announcements without obtaining our prior wntten authorization
Pauric McGroary
Agronomist
Paqe 3 of 4

Willcox & Mahe Soil Solutions, PLLC
Summerfield, North Carolina
RESIDUAL PAN CALCULATION
City of Monroe WTP
TKN= 13,200 mg/kg
NH3= 1,390 mg/kg
NO3-NO2-N= 16.4 mg/kg
Min Rate= 0.20
PAN= Imin.rate (TKN - NH3) + 0.5 (NH3) + NO3-NO21
0.20 11,810 695 16.40
PAN= 3073.40 mg/kg
Calculate residual nitrogen for years 2,3,4 and 5 following the initial application to determine
the amount of PAN/DT remaining.
2ND YEAR RESIDUAL PAN
PAN= Imin.rate (I st year org. - N 2nd year min. - NJ
0.10 11,810 2,362
PAN= 944.80 mg/kg remaining from 1st year application
3RD YEAR RESIDUAL PAN
PAN= Imin.rate (2nd year org. - N 3rd year min. - NJ
0.05 9,448 945
PAN= 453.50 mg/kg remaining from 1 st year application
4TH YEAR RESIDUAL PAN
PAN= Imin.rate (3rd year org. - N 4th year min. - NJ
0.03 8,503 454
PAN= 268.32 mg/kg remaining from 1 st year application
5TH YEAR RESIDUAL PAN
PAN= Imin.rate (4th year org. - N 5th year min. - NJ
0.02 8,050 268
PAN= 150.80 mg/kg remaining from 1 st year application
Residual PAN from years 2 thru 5 after the initial application = 1817.43 mg/kg
Application
Five Year Maximum
Method
First Year PAN
Adjusted PAN
(mg/kg)
(mg/kg)
Surface
3,073
4,891
Incorporation
3,768
5,586
Application
Five Year Maximum
Method
First Year PAN
Adjusted PAN
Ibs/DT
lbs/DT
Surface
6.15
9.78
Incorporation
7.54
11.17

SAR - WTP
SAR Calculation
Na Ca Mg SAR
Nam /I
-Cq�ll --
Mg mg/l
88.151
97.8656
202,232
---4.255—
15.112---.
7.346 1.270
Na mil eq
Ca mil eq
Mg mil eq
—
4.255
15.112
7.346
Enter
Enter.% TS
17.99
Data-==>-
Nam /k
_____544
Ca mg/kg
1680
490
Job Name:
CityofMonroe WTP
Page 1

SHEALY ENVIRONMENTAL SERVICES, INC.
Detection Summary
City of Monroe
Lot Number: SH23072
Sample Sample ID Matrix Parameter Method Result Q Units Page
001 WWTP CAKE Solid Ignitability (Pensky-Martens 1010A >140 ° F 5
002 WTP CAKE Solid Ignitability (Pensky-Martens 1010A >140 ° F 8
(2 detections)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
i
Page 4 of 13

SHEALY ENVIRONMENTAL SERVICES, INC.
Sample Summary
City of Monroe
Lot Number: SH23072
Sample Number Sample ID Matrix Date Sampled Date Received
001 WWTP CAKE Solid 08/23/2017 08/23/2017
002 WTP CAKE Solid 08/23/2017 08/23/2017
(2 samples)
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 3 of 13

L;uent t;ity OT Monroe
Description: WTP CAKE
Date Sampled:08/23/2017
Date Received:08/23/2017
Lauorarvey tu.ancaurc-uuc
Matrix: Solid
% Solids: 19.7 08/23/2017 2254
Inoraanic non-metals
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 (Ignitability) 1010A 1 08/31/2017 0000 KWP 50509
1 (pH) 9045D 1 08/25/2017 2044 HRJ 50080
1 (Reactive Cya) 7.3.3 1 08/31/2017 1431 HKL 08/27/2017 1104
1 (Reactive Sul) 7.3.4 1 08/28/2017 1440 AMM1 08/27/2017 1104
CAS Analytical
Parameter
Number Method
Result Q
LOQ
Units
Run
Ignitability (Pensky-Martens Closed -Cup)
1010A
>140
140
° F
1
pH
9045D
6.23
su
1
Reactive Cyanide
7.3.3
ND
50
mg/kg
1
Reactive Sulfide
7.3.4
ND
50
mg/kg
1
TCLP Volatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311 /5030B 8260B 10 08/31/2017 0220 ECP 50383 08/27/2017 1645
CAS Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
Benzene
71-43-2
8260B
ND
0.050
mg/L
1
2-Butanone (MEK)
78-93-3
8260B
ND
0.10
mg/L
1
Carbon tetrachloride
56-23-5
8260B
ND
0.050
mg/L
1
Chlorobenzene
108-90-7
8260E
ND
0.050
mg/L
1
Chloroform
67-66-3
8260B
ND
0.050
mg/L
1
1,2-Dichloroethane
107-06-2
8260B
ND
0.050
mg/L
1
1,1-Dichloroethene
75-35-4
8260B
ND
0.050
mg/L
1
Tetrachloroethene
127-18-4
8260B
ND
0.050
mg/L
1
Trichloroethene
79-01-6
8260B
ND
0.050
mg/L
1
Vinyl chloride
75-01-4
8260B
ND
0.010
mg/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
1,2-Dichloroethane-d4
93 70-130
Bromofluorobenzene
95 70-130
Toluene-d8
94 70-130
TCLP Semivolatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8270D 1 08/29/2017 1636 CMP2 08/25/2017 1913 50035 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
1,4-Dichlorobenzene
106-46-7
8270D
ND
0.040
mg/L
1
2,4-Dinitrotoluene
121-14-2
8270D
ND
0.080
mg/L
1
Hexachlorobenzene
118-74-1
8270D
ND
0.040
mg/L
1
Hexachlorobutadiene
87-68-3
8270D
ND
0.040
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 8 of 13

uiienu trrty of monroe
Description: WTP CAKE
Date Sampled:08/23/2017
Date Received:08/23/2017
Laboratory IL1:JHzsUrZ-UUZ
Matrix: Solid
% Solids: 19.7 08/23/2017 2254
TCLP Semivolatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8270D 1 08/29/2017 1636 CMP2 08/25/2017 1913 50035 08/24/2017 2219
Parameter
CAS
Number
Analytical
Method
Result Q
LOQ
Units
Run
Hexachloroethane
67-72-1
8270D
ND
0.040
mg/L
1
2-Methylphenol
95-48-7
8270D
ND
0.040
mg/L
1
3+4-Methylphenol
106-44-5
8270D
ND
0,040
mg/L
1
Nitrobenzene
98-95-3
8270D
ND
0.040
mg/L
1
Pentachlorophenol
87-86-5
8270D
ND
0.20
mg/L
1
Pyridine
110-86-1
8270D
ND
0.040
mg/L
1
2,4,5-Trichlorophenol
95-95-4
8270D
ND
0.040
mg/L
1
2,4,6-Trichlorophenol
88-06-2
8270D
ND
0.040
mg/L
1
Surrogate
2-Fluorobiphenyl
2-Fluorophenol
Nitrobenzene-d5
Phenol-d5
Terphenyl-d14
2,4,6-Tribromophenol
—07
Run 1
% Recovery
48
28
54
36
54
47
Acceptance
Limits
37-129
24-127
38-127
28-128
10-148
41-144
TCLP Herbicides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311 /8151 A 8151 A 1 09/01 /2017 1614 DAL1 08/29/2017 1852 50244 08/24/2017 2219
CAS Analytical
Parameter Number Method Result Q LOQ Units Run
2,4-D 94-75-7 8151A ND 0.020 mg/L 1
2,4,5-TP (Silvex) 93-72-1 8151A ND 0.0050 mg/L 1
Run 1 Acceptance
Surrogate Q % Recovery Limits
DCAA 76 62-117
TCLP Pesticides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8081B 1 08/31/2017 1451 PMS 08/29/2017 1632 50249 08/24/2017 2219
CAS
Analytical
Parameter
Number
Method
Result Q
LOQ
Units
Run
gamma-BHC (Lindane)
58-89-9
8081 B
ND
0.00040
mg/L
1
Chlordane
57-74-9
8081B
ND
0.0040
mg/L
1
Endrin
72-20-8
8081 B
ND
0.00040
mg/L
1
Heptachlor
76-44-8
8081 B
ND
0.00040
mg/L
1
Heptachlor epoxide
1024-57-3
8081 B
ND
0.00040
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40%
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 9 of 13

unent:wty of monroe
Laboratory lu:styzaurz-uuz
Description: WTP CAKE
Matrix: Solid
Date Sampled:08/23/2017
% Solids: 19.7 08/23/2017 2254
Date Received:08/23/2017
TCLP Pesticides
Run Prep Method
Analytical Method
Dilution Analysis Date Analyst
Prep Date
Batch Leachate Date
1 1311 /3520C
8081 B
1 08/31 /2017 1451 PMS
08/29/2017 1632 50249 08/24/2017 2219
CAS Analytical
Parameter
Number Method
Result Q
LCIQ
Units
Run
Methoxychlor
72-43-5 8081 B
ND
0.0016
mg/L
1
Toxaphene
8001-35-2 8081B
ND
0.0080
mg/L
1
Run 1 Acceptance
Surrogate
Q % Recovery Limits
Decachlorobiphenyl
77 20-131
Tetrachloro-m-xylene
77 26-132
TCLP Metals
Run Prep Method
Analytical Method
Dilution Analysis Date Analyst
Prep Date
Batch Leachate Date
1 1311/3010A
6010D
10 08/28/2017 1802 CJZ
08/25/2017 1930
50043 08/24/2017 2219
1 1311/7470A
7470A
1 08/25/2017 2325 SLS
08/25/2017 2014
50053 08/24/2017 2219
CAS Analytical
Parameter
Number Method
Result Q
LCQ
Units
Run
Arsenic
7440-38-2 6010D
ND
0.15
mg/L
1
Barium
7440-39-3 6010D
ND
0.25
mg/L
1
Cadmium
7440-43-9 6010D
ND
0.050
mg/L
1
Chromium
7440-47-3 6010D
ND
0.10
mg/L
1
Lead
7439-92-1 6010D
ND
0.10
mg/L
1
Mercury
7439-97-6 7470A
ND
0.00020
mg/L
1
Selenium
7782-49-2 6010D
ND
0.20
mg/L
1
Silver
7440-22-4 6010D
ND
0,10
mg/L
1
LOQ = Limit of Quantitation B = Detected in the method blank E = Quantitation of compound exceeded the calibration range
ND = Not detected at or above the LOQ N = Recovery is out of criteria P = The RPD between two GC columns exceeds 40 %
H = Out of holding time W = Reported on wet weight basis
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 10 of 13

Chain of Custody
�:J
Miscellaneous Documents
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 11 of 13

rn C
m
< m
m l<
rn
v�
toCD
<
CD
oM
ro N
NCD N
co
w
m
0
0
-n
N
X
OD
W
W
CWA /NPOES SHEALY ENVIRONMENTAL SERVICES, INC.
SHED Chain of CustodyRecord 106 Vantage Point Drlva - We-,t Cclumbia. SC Z-j1 /2 26776
'�► Telephone No. (80a) 791-9700 Fax No. (8W) 791.9111 Number
www-r,hanlylab.corn
4ue:C nema ra CPn!4cr --- 7r(y,ra t.rq Ab ,' Fsx Na. ! E rreU —QV-
lfa
E M ry ei
G+Q
�� 5rin,ule:t±:.Siyrp.'.rry
t�_� jJ lYe7ydN 'J_
Page
{J �s� Cxi� r Maha:a (P!taa'r Se: d .g\k7B al.�s,:e a r:riSrl:Yf.) - —
___L_�.7IV !�'V [� i �•rtmr' PL-•rr r-AU F'31'�•t�dfdl3 (.I. ei. pit 7r.rrp., 00) am hr rgowead i� :'h9Ck Dax24.
A•rkc' 1z . - .
�• P.7_ fw:. g , N) R Tire ulGL,racerr 07 F
& s'� AfaMx r1yP.sw7raomx T w ))�11% V V f �? f SLJ2 3072
jwu ir'�imvr:t,ura.rY;...�aRr i�3{r � r �, wl�r ! r• �1��r f-f
�. SE'r7pf!tb lDtsic�pGa•; W�3 Tir;r!.
M1.arp - T y T� �4 f1�: rr L� 15.•f' �/�L�' /,.
,t9,'•rtr.faruhf*�nghrrtgytm=?tMiC0.p6AC-i y_ 2F.4di. 1 f J F Yr 7f� 4 �G _• l
I � i
nicL
k.
I
Fl, B,
Fxvl
Fhb)
_.. _. Ftw
I �
F I Its
--
_ i
Fckt r
Taw .+rru,eclirrX FicgtintY(reru(•4eylyrow :u4�,t9a'frxr4[OsVlufl^i1T.) �7crab ^tL�p52: OG ArAnrwrr:nr.: (Srsciffl rlCe9lbk0Wald
lder�r4'�++�r —
MIT-4 ❑ •Rasa (SOM C q!•"Irn M cwvmnf 2w4y gp r�nn•Fia zro ❑ as,nnable L Skr Inisr 7'dsof �l l nknc rn
! rtstlny -- 1JsIe am I AacArred aaw Vwg
rirrr'7�"IT.�,i�aY LA9fd irm^ Y. an41•.�!rr
'y. ReR'N mvod
4.fin!i,rF,e»•rarib': 1 Oa^a T• 4.l:kmnh: RraahEoby % oafs me
14rotc: m sarnpWs a ldir. ed fcr six weeks from ret:,a)pt csra USE ONLY
urkw Ovr arim�gooricins are made. _ -- KS��ueu un i.•6 (Gr(A.) r r.7)� Nb lbv PE:k 1 ,7etwe x ?im'y, l _ •�: I IEVf,)7. !'"d't(X,+N
DISTRIBUMN: VMTEA YELLOW-Wy^x, h) Cvtorx':rr: wirh Fnrr%rA^iq;, AirYK-Fid%Wr.+Kar# Coy !1rn!.Ta�e No. rrter F-A�zL9r [11L+tn� �!p 5•Vi•ii�
CAI
Tm
N
0
'M
V+
Z
0

1-11 1 SHEALY ENVIRONMENTAL SERVICES, INC.
tiherh Lnvrrnnmrntnl Serv:r-.c.'.nc
MA-.iment Number: NEW I SC-,.W
Part I tS t
F$cc i;r Gal,: C^.,2Kr2n17
k'.x.uw Ili:.e :57:72on'r^.
aauapk: Receilit Checklist (SRC)
Client:[ � A •i p� LY} r rr-- Cooler inspected by!date Fi:U ,"� 2 3 17 1,�,; ti:S� �a.3 c 7- _
Mcans of receipt: w-SI:SI
❑ Client ❑ UPS ❑ FedF% n Otlux ~�
Yes ❑ 2+0
_ 1. W ene custcxly st: ttls prescInt an the cooler?
Yes ❑
"_ If cuswdy souls wc-rc present, were they intact and unbroken?
pH strip Ill:
Cl strip iD:
C:oolcr ID,'Original temlteratirrr.
ripon reQcee tlDerived (corrected) tcmperuttirc Capon receipt:
C.
Method: olemperature Blank ❑ Aguin,l. Rul llcs IR Gun Ill: IR Gun Correction Factor. C_-3
Method of coolant: it Wet Tc;e n Blue lac u Dry lee o Noiu:
Yes - No a N
r. Iftemperature of any cooler exceeded 6.0aC, was I'rgject Managet Notified?
i'M tvas Notified by: phonc i email ! face-to-face (cirole.. cane).
Yes 7
No D
NA Xj
4. Is the commercial can,rier'� pwking sliR attached to ilusi form?
5. 1'4'`crn pro cr custody procedures (relinquishc received) followed?
6. Wcre sampl;: IDs listed on the (:(?(:?
7. Were -,ample Tf).ti Iislal on all sample containers?
8. Wac collection date R. limes listed on the COO?
9. Was collection date & time listed on all sample coriwiner3?
Yes -
No
Yes
No
Ycs
No -
7cs
No u
JC5,91,
No ❑
Yes
no ❑
Itl. F)i(I ;ill container label information (11), date, time) agree w'iili the COO
No u
1 cs�
11. Were nest; to he performed listed on die C'0177
12. Did all samples aurive in the prupercontainens foreach test andior in good ctrrirlili:m
Yes,rf'
Ro 0
(unbroken, lids on, etc.)?
Yeses
BTU ❑
No ❑
13. WF,.•i rrdcyuaic scan le volume available?
14. Were all samples received %rithin','a tfie liollittg lime, or 48 hours; whichever comes first?
1 S. A'l = any samples containers missin&xcess (circle one) .samples Not listed on C OC.?
Ycs
Yes ❑
N443`
No ❑
N
Yes e
_
16. '%Vcre bubbles present }"pea -size" ('/,"or 6mm in dia,7leter) in any V0A vials?
Ycs. C
No u
No u
NA,r�—
17. tit°erne all DRO. mctaWnutrient samples rccLivcd at a pl I of < 2?
1 H. Were all cyanAe.. samples received at a pH : 12 anti sulfide samples receivcd at a pH > 97
Yes =
NA
Yes 71
Nu C
NA,,,, -
•A
19. Were all applicable NH3 PLNlcyanideiphenoifBNA (c o.Snipt) xmnplm fire of residual
chlorine?
No:
NA-: 7.20.
Yes a
Wcre collection temperatwts documented on the (X)(: tar NC samples?
Yes G
No :
NA
21. Were client remarks,'requem, (i.e. rCyueslcd dilutions, Mtilti9SD designations, etc...}
Correct! ` transcribed from the COC litho the coinmarrt soolion in LIMS?
yet; r Nn
.22. Was the quote nwnlxr used lakcn from the container labci.-'
_
Sample Preservation (Must be completed for any sample(s) incorrectly preseived or with hcsidspaoe.)
Sample(s)
wcry: wrouived incorrectly preserved and were adjusted accordingly in
sample receiving with
(H?SO4, HNO,, HCI, NarOl1) usin1 SR. tl
Samples) _
Were Received with bubbles'-6 mm in diamcler.
Samples(s)
---- wem rr:ecived ,.vith 'I'R(. > 0.5 inWL (If #21 is No) ,lent were
adiusted accordingly in sample reeeiying with stadium thiosulfate (Na2S20,) wilh Shealy ID:
SC Drinking Afaler Prgicct Sample(g) pi I verilicd to be -- 2 by Date,.
sample(s)
_
Nollr=ivcd at a pi l of < 2 and were aditatod accordingly wing Skit _
Sample labels applied b
(r DWe:__B •,Z3 -j 7
Comments:
Shealy Environmental Services, Inc.
106 Vantage Point Drive West Columbia, SC 29172 [phone] Fax [phone] www.shealylab.com
Page 13 of 13

APPENDIX III
LAND APPLICATION SITE CERTIFICATION
(FORM: LASC 06-16)
WATERBODY AND CLASSIFICATION INFORMATION

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall submit one original and two 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 receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
WIWI
County Board
Notifkation. doc
L"
Land Owner
Agreement
(If applicable)
✓
✓
✓
✓
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 Policy"
INSTRUCTIONS FOR FORM: LASC 06-16 Page 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs
Status Code
Required Item
N
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 Policy"
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted 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) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
® Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
® Surface water body classifications information may be found at: http://deg.nc.gov/about/divisions/water-
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 hM:Hdeg.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 06-16 Page 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 06-16 Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Monroe
Land application sites currently certified: 511.1 net acres and Total to be certified: 510.2 net acres.
1. LAND APPLICATION SITE INFORMATION (See Instruction B): (Renewed Sites)
Status
Code'
Site/Field ID
Landowner(s)
s) or O s
Operator(s)
Lessee(s) ()
Net Acres
County
Cro s)
Crop(s)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slope
R
NC-AN-19-01
Morris, Calvin
11.6
Anson
Fescue
Goldston
GoB
R
NC-UN-18-01
Myers, Ben
44.6
Union
Fescue
Badin
BdB2
R
NC-UN-18-02
Myers, Ben
27.6
Union
Fescue
Badin
BdB2
R
NC-UN-18-07
Myers, Ben
5.7
Union
Fescue
Cid
CmB
R
NC-UN-18-08
Myers, Ben
3.0 (+)
Union
Fescue
Cid
CmB
R
NC-UN-25-01
McBride, Wayne
Union
Fescue
Tatum
TaB
R
NC-UN-25-03
McBride, Wayne
14.6
Union
Fescue
Tatum
TaB2
R
NC-UN-26-01
McBride, Emerson
16.4
Union
Fescue
Tatum
TaB
R
NC-UN-26-02
McBride, Emerson
6.5
Union
Fescue
Tatum
TaB2
R
NC-UN-26-03
McBride, Emerson
11.3
Union
Fescue
Tatum
TaB
R
NC-UN-26-04
McBride, Emerson
25.6
Union
Fescue
Cid
CmB
R
NC-UN-26-05
McBride, Emerson
11.0
Union
Fescue
Tatum
TaB2
R
NC-UN-26-06
McBride, Emerson
26.5
Union
Fescue
Tatum
TbB2
R
NC-UN-27-01
Wolfe, Leland
15.5
Union
Fescue
Goldston
GsB
R
NC-UN-27-02
Wolfe, Leland
18.4
Union
Fescue
Goldston
GsB
R
NC-UN-29-01
Griffin, William
24.5
Union
Fescue
Goldston
GoC
R
NC-UN-29-02
Griffin, William
5.7
Union
Fescue
Goldston
GoC
R
NC-UN-29-03
Griffin, William
7.2
Union
Fescue
Badin
BaB
R
NC-UN-29-04
Griffin, William
2.9
Union
Fescue
Badin
BdB2
R
NC-UN-30-01
Appenzeller, Tom
13.1
Union
Fescue
Badin
BdB2
R
NC-UN-30-02
Appenzeller, Tom
11.9
Union
Fescue
Badin
BaB
R
NC-UN-30-03
Appenzeller, Tom
11.8
Union
Fescue
Badin
BaB
R
NC-UN-30-04
Appenzeller, Tom
15.2
Union
Fescue
Badin
BaB
R
NC-UN-30-05
Appenzeller, Tom
10.8
Union
Fescue
Badin
BaB
R
NC-UN-31-03
Myers, Henry
2.5
Union
Fescue
Badin
BdB2
R
NC-UN-31-04
Myers, Henry
4.7
Union
Fescue
Badin
BdB2
R
NC-UN-31-05
Myers, Henry
17.6
Union
Fescue
Tatum
TbB2
R
NC-UN-31-06
Myers, Henry
7.8
Union
Fescue
Chewacla
ChA
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified)* T (Transferred) ♦ D (Deleted)
Soil Series Name (i.e. Appling, Cecil, etc.)
`Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
+ - NC-UN-18-08 is included as a modification site to increase net acres from 3.0 previously permitted acres to 16.0 net acres with modification
FORM: LASC 06-16 Page 1

LAND APPLICATION SITE CERTIFICATION
11. WATERBODV AND CLASSIFICATIONS INFORMATION (See Instruction Q: (Renewed Sites)
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
P
Class
NC-AN-19-01
340 57' 34"
800 16' 27"
NAD 83
MAP
Nearest Second
N/A
NC-UN-18-01
340 59' 59"
800 29' 43"
NAD 83
MAP
Nearest Second
N/A
NC-UN-18-02
350 00' 03"
800 30' 05"
NAD 83
MAP
Nearest Second
N/A
NC-UN-18-07
350 00' 54"
800 29' 26"
NAD 83
MAP
Nearest Second
N/A
NC-UN-18-08
350 00' 46"
800 29' 25"
NAD 83
MAP
Nearest Second
N/A
NC-UN-25-01
340 49' 52"
800 37' 29"
NAD 83
MAP
Nearest Second
N/A
NC-UN-25-03
340 49' 57"
800 37' 24"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-01
340 49' 49"
800 38' 01"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-02
340 49' 42"
800 37' 43"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-03
340 49' 33"
800 37' 56"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-04
340 49' 28"
800 38' 10"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-05
340 49' 47"
800 38' 20"
NAD 83
MAP
Nearest Second
N/A
NC-UN-26-06
340 50' 07"
800 37' 39"
NAD 83
MAP
Nearest Second
N/A
NC-UN-27-01
340 52' 10"
800 28' 43"
NAD 83
MAP
Nearest Second
N/A
NC-UN-27-02
340 52' 16"
800 28' 27"
NAD 83
MAP
Nearest Second
N/A
NC-UN-29-01
340 55' 42"
800 19' 02"
NAD 83
MAP
Nearest Second
N/A
NC-UN-29-02
340 55' 44"
800 18' 57"
NAD 83
MAP
Nearest Second
N/A
NC-UN-29-03
340 59' 39"
800 23' 25"
NAD 83
MAP
Nearest Second
N/A
NC-UN-29-04
340 59' 45"
800 23' 34"
NAD 83
MAP
Nearest Second
N/A
NC-UN-30-01
340 59' 42"
800 23' 46"
NAD 83
MAP
Nearest Second
N/A
NC-UN-30-02
340 59' 45"
800 23' 16"
NAD 83
MAP
Nearest Second
N/A
NC-UN-30-03
340 59' 58"
800 23' 16"
NAD 83
MAP
Nearest Second
N/A
NC-UN-30-04
350 00' 07"
800 23' 11"
NAD 83
MAP
Nearest Second
N/A
NC-UN-30-05
340 00' 13"
800 23' 08"
NAD 83
MAP
Nearest Second
N/A
NC-UN-31-03
350 00' 56"
800 25' 51"
NAD 83
MAP
Nearest Second
N/A
NC-UN-31-04
350 00' 58"
800 28' 43"
NAD 83
MAP
Nearest Second
N/A
NC-UN-31-05
350 01' 09"
800 28' 34"
NAD 83
MAP
Nearest Second
N/A
NC-UN-31-06
350 01' 12"
80028' 21"
NAD 83
MAP
Nearest Second
N/A
FORM: LASC 06-16 Page 2

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Monroe
Land application sites currently certified: 511.1 net acres and Total to be certified: 510.2 net acres.
III. LAND APPLICATION SITE INFORMATION (See Instruction B): (New Sites / Modified Sites)
Predominant Soil
Status
Code
Site/Field ID
Landowners
�)
Lessees or Operator(s)
O
Net Acres
Count Y
s
Crop(s)
P�)
Series Nameb
Mapping Unit
or Rep. Slope°
M
NC-UN-18-08
Myers, Ben
16.0 (+)
Union
Fescue
Cid
CmB
N
NC-UN-29-05
Griffin, William
2.2
Union
Fescue
Cid
CmB
N
NC-UN-32-01
Baker, Danny
23.5
Union
Fescue
Goldston
GsB
N
NC-UN-32-02
Baker, Danny
15.5
Union
Fescue
Badin
BdB2
N
NC-UN-32-03
Baker, Danny
10.0
Union
Fescue
Goldston
GsB
N
NC-UN-32-04
Baker, Danny
3.2
Union
Fescue
Goldston
GsB
N
NC-UN-32-05
Baker, Danny
19.3
Union
Fescue
Cid
CmB
N
NC-UN-33-01
Funderburk, Ted
5.0
Union
Fescue
Tarrus
TbB2
Funderburk, Glenson,
Funderburk, Ted,
N
NC-UN-34-01
Funderburk, Calvin,
Funderburk, Calvin
19.6
Union
Fescue
Badin
BaB
Joan FunderburkWitmore
Funderburk, Glenson,
Funderburk, Tedd,
N
NC-UN-34-02
Funderburk, Calvin,
Funderburk, Calvin
10.4
Union
Fescue
Tarrus
TbB2
Funderburk, Scott
Funderburk, Glenson,
N
NC-UN-34-03
Funderburk, Ted,
Funderburk, Calvin
7.8
Union
Fescue
Secrest
ScA
Judy King Britt
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) ♦ D (Deleted)
Soil Series Name (i.e. Appling, Cecil, etc.)
'Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
+ - NC-UN-18-08 is included as a modification site to increase net acres from 3.0 previously permitted acres to 16.0 net acres with modification
FORM: LASC 06-16 Page 3

LAND APPLICATION SITE CERTIFICATION
IV. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C): (NeW Sites / Modified Sites)
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class
NC-UN-18-08
350 00' 46.3"
800 29' 24.4"
NAD 83
MAP
nearest 10d' of second
UT to Richardson Creek; 13-17-36- (5)
C
C
NC-UN-29-05
340 55' 51.3"
800 19' 0.4"
NAD 83
MAP
nearest 101 of second
UT to Canes Creek; 13-1740 (1)
WS-V
WS-V
NC-UN-32-01
340 58' 52"
800 20' 13"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-1740-13
C
C
NC-UN-32-02
340 58' 48"
800 20' 22"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-1740-13
C
C
NC-UN-32-03
340 58' 40"
800 20' 13"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-1740-13
C
C
NC-UN-32-04
340 58' 36"
800 20' 17"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-1740-13
C
C
NC-UN-32-05
340 58' 22"
800 20' 2 1 "
NAD 83
MAP
nearest second
UT to Beaverdam Creek; 13-1740-11
WS-V
WS-V
NC-UN-33-01
340 52' 45"
800 28' 51'
NAD 83
MAP
nearest second
UT to Lick Branch; 13-1740-13
WS-V
WS-V
NC-UN-34-01
340 52' 36"
800 29' 05"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-17-40-13
WS-V
WS-V
NC-UN-34-02
340 52' 43"
800 29' 00"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-17-40-13
WS-V
WS-V
NC-UN-34-03
340 52' 44"
800 29' 12"
NAD 83
MAP
nearest second
UT to Lick Branch; 13-17-40-13
WS-V
WS-V
FORM: LASC 06-16 Page 4

LAND APPLICATION SITE CERTIFICATION
V. LAND APPLICATION SITE INFORMATION (See Instruction B): (Deleted Sites)
Status
Code'
Site/Field ID
Landowners
Lessees or Operator(s)
Net Acres
County Coun
s
Crop(s)
p�
Predominant Soil
Series Name b
Mapping Unit
or Rep. Slope`
D
NC-ST-12-01
Morgan, Thomas
7.4
Stanly
Fescue
D
NC-ST-12-02
Morgan, Thomas
9.2
Stanly
Fescue
D
NC-ST-12-03
Morgan, Thomas
15.4
Stanly
Fescue
D
NC-ST-12-04
Morgan, Thomas
3.0
Stanly
Fescue
D
NC-ST-12-05
Morgan, Thomas
11.2
Stanly
Fescue
D
NC-ST-28-01
Dowdey, Paul
10.1
Stanly
Fescue
D
NC-UN-23-01
Brooks, Hilton
3.6
Union
Fescue
D
NC-UN-23-02
Brooks, Hilton
5.8
Union
Fescue
D
NC-UN-23-03
Brooks, Hilton
4.5
Union
Fescue
D
NC-UN-23-04
Brooks, Hilton
16.4
Union
Fescue
D
NC-UN-23-05
Brooks, Hilton
11.6
Union
Fescue
D
NC-UN-23-07
Brooks, Hilton
7.0
Union
Fescue
D
NC-UN-23-08
Brooks, Hilton
19.4
Union
Fescue
D
NC-UN-23-09
Brooks, Hilton
12.2
Union
Fescue
D
NC-UN-23-10
Brooks, Hilton
5.3
Union
Fescue
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) ♦ D (Deleted)
D Soil Series Name (i.e. Appling, Cecil, etc.)
`Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
FORM: LASC 06-16 Page 5

LAND APPLICATION SITE CERTIFICATION
Vl. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction Q: (Deleted Sites)
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
P
Class
NC-ST-12-01
350 10' 36
800 25' 54"
NAD 83
MAP
nearest second
NC-ST-12-02
350 10' 37"
80025' 45
NAD 83
MAP
nearest second
NC-ST-12-03
350 10' 44"
800 25' 38"
NAD 83
MAP
nearest second
NC-ST-12-04
350 10' 51"
800 25' 36"
NAD 83
MAP
nearest second
NC-ST-12-05
350 10' 46"
800 25' 26"
NAD 83
MAP
nearest second
NC-ST-28-01
350 1 V 10"
800 28' 3 1 "
NAD 83
MAP
nearest second
NC-UN-23-01
34" 56' 45"
800 27' 52"
NAD 83
MAP
nearest second
NC-UN-23-02
340 56' 46"
800 27' 37"
NAD 83
MAP
nearest second
NC-UN-23-03
340 56' 40"
800 27' 39"
NAD 83
MAP
nearest second
NC-UN-23-04
340 56' 44"
800 27' 29"
NAD 83
MAP
nearest second
NC-UN-23-05
340 56' 49"
800 27' 2 1 "
NAD 83
MAP
nearest second
NC-UN-23-07
340 56' 33"
800 27' 39"
NAD 83
MAP
nearest second
NC-UN-23-08
340 56' 40"
800 27' 13"
NAD 83
MAP
nearest second
NC-UN-23-09
340 56' 36"
800 27' 23"
NAD 83
MAP
nearest second
NC-UN-23-10
340 56' 30"
800 27' 19"
NAD 83
MAP
nearest second
FORM: LASC 06-16 Page 6

APPENDIX IV
COUNTY BOARD NOTIFICATION
(FORM CBN 06-16)
G

iii Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can rdfurn the card to you.
■ Attach this .qhcard to back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
UN lD+•r CCAtiT y 6w�
0�*Nlzoe, Af C . 22It 2
,a,A/ /yI2. rl?AAII(' f}IM15
A. Sign ture
❑ Agent
X (�l ❑ Addressee
e 'v d by�finted Na/me)/ C. Date of Delivery
B. R
�r
D. is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type ❑ Priority Mail Express®
II I'lll'I I'll I'I I II II II II'lllll' Ilili I I II II III ❑Adult Signature ❑ Registered MailT"
pKtlult Signature Restricted Delivery ❑ Registered Mail Restricted
irt
ifled Mail® Delivery
ertifled Mall Restricted Delivery ❑ Return Receipt for
9590 9402 1658 6053 9653 09 ❑ Collect on Delivery Merchandise
_ ❑ Collect on Delivery Restricted Delivery El Signature Coni'irmationTM'
o ninon _ [I Signature Confirmation
2 _ 7 015 3 4 3 0Y 0 0 0 0 7264 0943 2estricted Delivery Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ;
TFordeliVEy
stal Service"
IFIED MAIL° RECEIPT
Mail Only
information, visit our website at www.usps.com".
...Il
ru
iti
ED
0
a
0
0
m
m
C3
17-

I . W
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
COUNTY BOARD NOTIFICATION
INSTRUCTIONS FOR FORM: CBN 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 notification is intended to provide the county board in which the land application site is proposed to be located with
general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an
opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for
fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review
without a corresponding residuals program application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. County Board Notification (FORM: CBN 11-15):
® Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any
unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may
be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application
sites are located.
B. Critical Watershed Areas Information:
® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed
areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas.
❑ For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
https://deg.nc,gov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection program
❑ If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call [phone].
C. Notification Package Submission:
® Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to
the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the
notification package also be sent to the County Manager.
® The most current publication of the Directory of State and County Officials may be downloaded at:
hMs://www.sosnc.jzov/publications/direct.gw—x
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http:Hdeg.nc.gov/contact/regional-offices.
® The source facility summary shall include: facility name; county where it is located; and the proposed annual dry tonnage
(i.e., a copy of "Residuals Source Facility Summary" is adequate but not required).
® The land application site summary shall include: field ID; acreage; county where it is located; latitude and longitude (i.e., a
copy of "Land Application Site Certification" is adequate but not required).
D. Proof of Submission:
® Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the
Division for review.
INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of 1

North Carolina Department of Environmental Quality
Pat McCrory Donald R, van der Vaart
Governor Secretary
Date: June 28, 2018
To: Name of Chairman to the Board of County Commissioners: Frank Aikmus
Complete mailing address: 500 N. Main Street, Room 921
City: Monroe
State: N.C. Zip: 28112
County where land application sites are located: Union
From: Applicant's name: City of Monroe (on behalf of the Division of Water Resources in accordance with Session Law
2013-340)
Contact person and title: Russell G. Colbath, P.E.
Complete mailing address: Post Office 69
City: Monroe State: N.C. Zip: 28111
Telephone number: [phone] E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
will ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals -
generating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: Mooresville Regional Office
Complete mailing address: 610 East Center Avenue, Suite 301
City: Mooresville
Telephone number: [phone]
State: N.C. Zip: 28115
Expected date of application submission: July 27, 2018
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: 919$07-64641 Internet: http://Dortal.nodenr.org/web/wq
An Equal Opportunity 1 Affirmative Action Employer - Made in part with recycled paper
FORM: CBN 06-16

COPIES OF MAPS FOR NEW/MODIFIED SITES ARE INCLUDED IN
SECTIONS XII - XVI

APPENDIX V
Renewal Site
CALVIN MORRIS (NC-AN-19) (Field 1)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

CALVIN MORRIS (NC-AN-19) (Field 1)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

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 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: City Of Monroe
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
Land Use or
Intended Use of Crops
Residuals Source
Special note
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-AN-19-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 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.
H. 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
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
showing the newly proposed
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am
a power of attorney or other legal delegation, to make decisions regarding the use of the land apr
deeded landowners. I certify that the above -referenced land application site(s) are not included
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certif
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance bou._
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land applicati,
herein.
Landowner name: Calvin Morris
Address: 554 Hasty Road
City: Peachland State: North Carolina zip: 28133
Phone: [phone] E-mail address: c/
Signature: - Date:' �— d
NORTH CAROLINA, COUNTY j
I, the undersigned Notary Public do hereby certify that (�✓A LO/h7 0t?R / 5
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of Ate 0- , 20
Signature and seal:
My commission expires
Lessee's/Operator's Certification:
rf•
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing of
Signature:
Date: ✓ ' 2 y' / 9
Page 3 of 3
FORM: LOA 06-16

CALVIN MORRIS (NC-AN-19) (Field 1)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

CALVIN MORRIS (NC-AN-19) (Field 1)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City fo Monroe WQ Permit #: WQ0001346 Field #: 1 Acres Utilized: 10.8
Land Owner: Calvin Morris Annual Dry Tons Applied: 0.0000 Site #: NC-AN-19 Acres Permitted: 10.8
Operator: Same Predominant Soil Series: GoB-Golston Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (past.) Crop 1 Max. PAN: 126 Crop 2 Name: Fescue (past.) Crop 2 Max. PAN:
50
-°
a
°
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%u
Solids
Volume
Applied per
Acre
D Tons/Ac
(Dry )
Residual Sources
(NPDES #, WQ#,
Fen., Animal
Waste, etc)
Soil
Cond.
(Dry'
Wet'
Moist)
Precip.
Past 24
Hrs.
inches
Y
4 v
L?
0. w
*°
°
o
w
°
�
;n
N
°
°
TKNo
m /k
9 9
z Y
;'
°
�-'•
m /k
9 9
Nitrate
and
Nitrite
m /k
9 9
PAN Applied
Ibs/acre
( )
Name of Crop Type
Receiving Residual
Application
Crop 1
P
Crop 2
P
Crop 1
P
Crop 2
P
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
0
0
:::::::::::
As
Cd
Cu
Cr
Pb
H.g
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
. .
Date
Ibs/ac
Prior Years Cumulative lbs/ac
1.312
0.214
15.106
23.123
2.92
0.091
2.392
4.427
0.501
84.153
Current Cumulative lbs/ac
1.312
0.214
15.106
23.123
2.920
0.091
2.392
4.427
0.501
84.153
Permitted C. P. L. R.****
36
1 34
1 1338
1 X
1 267
15
X
374
89
2498
Permit PAN Limit l st/2nd Crop
. .....
126.......50
"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
**Volatilization Rate: Surface - 0.5, Injection/incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
D :OR" (1e -....)

APPENDIX VI
Renewal Site
BEN MYERS (NC-UN-18) (Fields 1, 2,7 and 8)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

BEN MYERS (NC-UN-18) (Fields 1, 2,7 and 8)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

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 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 .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
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:
Special note
Site/Field ID
Lease
Land Use or
Intended Use of Crops
Residuals Source
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-18-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-7
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-8
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The ndowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Perr U tee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. 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: Ben Myers )
Address: ,� ao f] I -MS Poach RC�.
City: Monroe State: North Carolina Zip: 28110
Phone:
Signature:
lay -
Date: J—%2�—%e
NORTH CAROLINA, L{A%I IP /-J COUNTY
I, the undersigned Notary Public do hereby certify that �3Pnl k?) 5
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
i .,,,rA­
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
I�Pe2rJ�R� CPO
20 / r
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Ru 11 G. Colbath P.E. Water Re es Director f�
Signature: Date: �' 7
FORM: LOA 06-16 Page 3 of 3

BEN MYERS (NC-UN-18) (Fields 1, 2,7 and 8)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

BEN MYERS (NC-UN-18) (Fields 1, 2, 7 and 8)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 1 Acres Utilized: 35.5
Land Owner: Harry Myers
Operator: Same
Crop 1 Name: Fescue (Past.)
Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 35.5
Predominant Soil Series: BdB2-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Croa 2 Max. PAN:
°
o
Ca
Volume applied
pP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
A lied er
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,w'
Moist
Precip.
Past 24
Hrs.
inches
D
�
5 c,'
o w
o
o
;n �;
� r
* N'
7y
w
N
o
�
TKN
mg/kg
9
z a
q
o �
�; 0
o
m /k
9 9
Nitrate
and
Nitrite
m /k
9 9
PAN Applied
( lbs/acre)
Name of Crop Type
ReceivingResidual
Application
PP
Crop 1
P
Crop 2
P
Crop 1
P
Crop 2
P
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
.........
......
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS.1
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.956
0.113
14.297
14.812
1.935
0.034
0.726
2.358
0.123
46.226
Current Cumulative lbs/ac
0.956
0.113
14.297
14.812
1.935
0.034
0.726
2.358
0.123
46.226
Permitted C. P. L. R.****
36
34
1 1338
X
1 267
1 15
X 1
374
1 89
2498
Permit PAN Limit l st/2nd Crop
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
r\CAID CnDRA CCC M7/OIll1L.`\

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 2 Acres Utilized: 34.2
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 34.2
Operator: Same Predominant Soil Series: GoB-Golston Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 135 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
°
° °
0
Volume applied
(enter one) Solids/
Liquid
q
Cu. Yds Gallons
oho
Solids
Volume
A lied er
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
a
5 b
Er �'
°n w
* °
o
;e _
* w'
�
;n
w
g °=
* w
o
* �
TKN
mg/kg
z >
q
o �
M °
' w.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
4.527
0.362
21.72
17.44
4.983
1.437
3.297
4.238
2.229
58.325
Current Cumulative lbs/ac
4.527
0.362
21.720
17.440
4.983
1.437
3.297
4.238
2.229
58.325
Permitted C. P. L. R.****
36
34
1 1338
X
1 267
1 15
X
1 374
1 89
2498
Permit PAN Limit lst/2nd Cro P
135 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
ncKiD cnORA cor i�ninnnc�

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 7 Acres Utilized: 5.4
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #• NC-UN18 Acres Permitted: 5.4
Operator: Same Predominant Soil Series: CmB-Cid Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 141 Crop 2 Name: Fescue (Past.) Cron 2 Max. PAN:
50
o
N s~
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dn,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
v>
3 b
o i?'
a
* o
o
C
o
;e �;
�, _
�; -
* N'
w
c
o
4
;e �,
w -,
�; E
* -
+ w
* 0
TKN
mg/kg
Z a
q
o
as o
CD o
o
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
pp
lbs/acre
( )
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
....... ...........
TOTALS:
01
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.401
0.083
9.468
2.968
0.649
0.014
0.704
1.142
0.143
19.281
Current Cumulative lbs/ac
0.401
0.083
9.468
2.968
0.649
0.014
0.704
1.142
0.143
19.281
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit lst/2nd Crop
141 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nCkJn rr%nRA rnr /An/nnn/f�

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 8 Acres Utilized: 3
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 3
Operator: Same Predominant Soil Series: CmB-Cid Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 141 Crop 2 Name: Fescue (Past.) Cron 2 Max. PAN:
50
S.
y
N Q
C)
Volume applied
(enter one) Solids/
Li Liquid
4
Cu. Yds Gallons
oho
Solids
Volume
A hed er
PP P
Acre
D Tons/Ac
try >
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Y
K b
co
o w
a _.
*
C
R.
�, _
�, --
N'
„ _�
°
o
;v �
w -,
'✓
* o
o
TKN
mg/kg
D
Z
q
o o
o �,
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
of
0
:::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.539
0.11
11.492
2.886
0.929
0.023
0.984
0.655
0.168
23.183
Current Cumulative lbs/ac
0.539
0.110
11.492
2.886
0.929
0.023
0.984
0.655
0.168
23.183
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit 1 st/2nd Crop
P
141 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nCAI[3 rnoRs ror i+n1nnnn1

Hermit Kenewai and Moditication
APPENDIX VII
Renewal Site
WAYNE MCBRIDE (NC-UN-25) (Fields 1 and 3)
EMERSON MCBRIDE (NC-UN-26) (Fields 1, 2, 3, 4, 5 and 6)
LANDOWNER AGREEMENTS
(FORM: LOA 06-16)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

WAYNE MCBRIDE (NC-UN-25) (Fields 1 and 3)
EMERSON MCBRIDE (NC-UN-26) (Fields 1, 2, 3, 4, 5 and 6)
LANDOWNER AGREEMENTS
(FORM: LOA 06-16)

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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease
Land Use or
Residuals Source
Special note
Site/Field ID
(yes/no)
Cropping Patterns
Intended Use of Crops
(optional)
(no-till/over-seed/
pasture)
NC-UN-25-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-25-3
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWI;, 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.
IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Wayne McBride
Address: 3303 Trinity Church Road
City: Monroe State: North Carolina Zip: 28112
Phone: [phone] E-mail address:
Signature: C Pr I'4�� Date: 3'1
NORTH CAROLINA, UC,V/ZJCOUNTY
I, the undersigned Notary Public do hereby certify that tJAH W Me tRx d �
I
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the L
day of MIR Ze b� 120
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
(?y C�0,=)3
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
Signing official name:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
2,Zld
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
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:
Special note
Site/Field ID
Lease
Land Use or
Intended Use of Crops
Residuals Source
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-26-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-26-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-26-3
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-264A
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-26-4B
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-26-5
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-26-6
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. 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: Emerson McBride
Address: 7210 Rocky River Road
City: Monroe State: North Carolina zip: 28112
Phone: [phone] / !7 �E-mail address:
Signature: if , Llil n f�/�cy--p Date
NORTH CAROLINA, LA a ) 0 A.-) COUNTY
I, the undersigned Notary Public do hereby certify that C`,,i 2soej >Mc 0
personally appeared before me this day and acknowledged the due execution of the forgoing
WITNESS my hand and official seal this the I Z+k'
day of 20
Signature and seal:
64,
My commission expires: rfBe..,4,e e►f a!, 3
Lessee's/Operator's Certification:
d1L,
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: 1
FORM: LOA 06-16 Page 3 of 3

WAYNE MCBRIDE (NC-UN-25) (Fields 1 and 3)
EMERSON MCBRIDE (NC-UN-26) (Fields 1, 2, 3, 4, 5 and 6)
UPDATED SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

b�' ..�tk �t r �•ir[! y�`� + +? !k!',Initl,r-,Lw
E A k A f`.f t '9i1n » r �•
71
• .% ? ;� ..
?}
t
IT
Ax
wr. `} s .•} . h? �'` i of 1 .Gt,w• �1 - . . - r z '�,� -
�N_ !r' T�'�� -.�„ 1 f RK^gAi,-.• A�. '�C+tir �l S,,'.^
(+.` A'� �. ` .yvT N' .��; a �.' +c� rt a iw r alp: s 'r 't P :F� F4' r'•�►. .. _ °� e:
�a .r � �•:.; ` b-. r ..�'' �' r� �rs,�'.'rc• �! �' a '� � f ? �'. Via+' � �: , - � A _
•
tk.
,K!a 2
Y "..ice
.x ?A'dr, i Me �_)�' x. e; ,n i a 4:r �•+r. I 4 s�'_! "L i.
`.roc,.- ::i . '• "'`' s.. •,`` `. _s >' Field NC-UN-26-1
Field NC-UN-26-5
Field NC-UN-25-1
M a`
Field NC-UN-26-3
Field NC-UN-25-3
• Well
00
♦ Structure
N
y
m
■ Dwelling
O
to LIDW
m
o
W
Y W
■ Gate
0
o
o
O
_
U
— Drain
— • - — Streams
o
z
`n
- Lakes
O
0
LU
O
® Buffer
J
d
Z tr)
z
Field Boundary
�t�t7
Property Boundary
Q
O
a
C7
w
W U)
z
0
E
w 06 J
1 O
UO
o
�cf)
■ �herl'
� Pia
Q
i
Cn
O
UJ
Q F-
J
FIELD TOTAL ACRES BUFFERED ACRES NET ACRES
W LL
w z
E
Field NC-UN-26-2 NC-UN-26-1 25.2 8.8 16.4
0
NC-UN-26-2 7.2 0.7 6.5
N
com
z
m
a
NC-UN-26-3 15.2 3.9 11.3
U �
a
NC-UN-26-4 37.0 11.4 25.6
U
z
■
Z
NC-UN-26-5 13.0 2.0 11.0
z
a
NC-UN-26-6 36.4 9.9 26.5
W
v
REVIEW BOUNDARY shall be established around each land application site
0
midway between the Compliance Boundary and the perimeter of the
o
residuals land application area.
COMPLIANCE BOUNDARY: The Compliance Boundary for each land application site
t2
is established at either 250 feet from the residuals land application area or 50 feet
within the property boundary, whichever is closest to the residual land application area.
FIGURE NO
m
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FCR INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN
LEGAL, OR ANY OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY WMSS ASSUMES NO RESPONSIBILITY FOR ANY DECISION MADE
OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION

WAYNE MCBRIDE (NC-UN-25) (Fields 1 and 3)
EMERSON MCBRIDE (NC-UN-26) (Fields 1, 2, 3, 4, 5 and 6)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Wayne McBride
Operator: Same
Crop 1 Name: Fescue (Past.)
WQ Permit #: WQ0001346 Field #:
Annual Dry Tons Applied: 0.0000 Site #•
Predominant Soil Series: TaB-Tatum
Crop 1 Max. PAN: 137
Acres Utilized: 6.5
NC-UN25 Acres Permitted: 6.5
Cation Exchange Capacity (non 503): N/A
Crop 2 Name: Fescue (Past.)
Crop 2 Max. PAN: 50
°
°
°
Volume applied
enter one Solids/
( )
Li Liquid
9
Cu. Yds Gallons
o
/o
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
3 L+
� �'
o m
a o•
°
o
w
� --
N'
* ?
7�
w
*
0
TKN
mg/kg
z Y
o �
o
o w
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of CropType
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
.......
.... ..
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
01
o
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
:.
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.877
0.108
15.517
12.319
1.482
0.04
1.706
2.09
0.093
36.501
Current Cumulative lbs/ac
0.877
0.108
15.517
12.319
1.482
0.040
1.706
2.090
0.093
36.501
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit 1 st/2nd Cro P
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
r1FNR Fr1RhA FCF !17/7nnrn

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 3 Acres Utilized: 14.1
Land Owner: Wayne McBride Annual Dry Tons Applied: 0.0000 Site #: NC-UN25 Acres Permitted: 14.1
Operator: Same Predominant Soil Series: TaB-Tatum Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 137 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
�.
o(enter
Ca
Volume applied
one) Solids/
Liquid
Cu. Yds Gallons
oho
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
D
( rY.
Wet,
Moist
Precip.
Past 24
Hrs.
inches
y
ao
s
o w
n o•
o
C
o
;U �;
c
N'CD
* ?:
0
;n
w
O
TKN
mg/kgm
z y
a8 o
o
/k
9 9
Nitrate
and
Nitrite
m /k
9 9
PAN Applied
(lbs/acre)
Name of CropType
YP
Receiving Residual
Application
Crop 1
P
Crop 2
P
Crop 1
P
Crop 2
P
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
.........
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
................
..
TOTALS:
01
o
::.::.:::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
...
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.966
0.138
15.546
13.857
1.449
0.036
1.773
2.214
0.223
38.911
Current Cumulative lbs/ac
0.966
0.138
15.546
13.857
1.449
0.036
1.773
2.214
0.223
38.911
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit 1 st/2nd Crop
P
77
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nr:niQ POPRA 9:cF: r1,)i,)nnai

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Emerson McBride
Operator: Same
Crop 1 Name: Fescue
WQ Permit #: WQ0001346 Field #: 1
Annual Dry Tons Applied: 0.0000 Site #• NC-UN26
Predominant Soil Series: TaB-Tatum
Crop 1 Max. PAN: 137 Crop 2 Name:
Acres Utilized: 15.4
Acres Permitted: 15.4
Cation Exchange Capacity (non 503): N/A
Fescue Crop 2 Max. PAN:
50
O '�
ce o
0
Volume applied
PP
enter one Solids/
( )
Liquid
Cu. Yds Gallons
o
/o
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
D
( ry°
Wet
Moist)
Precip.
Past 24
Hrs.
inches
y
�
�_ b
"
o� w
o
j° �'
w ^.
fD
o'
�
70 �,
F m
* w
7
TKN
mg/kg
z �
,'
"'
o°n
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
PP
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
. ........
.......
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
01
o
::::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000-T
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
.
Date
]bs/ac
Prior Years Cumulative lbs/ac
0.824
0.13
15.14
11.455
1.632
0.027
1.489
2.161
0.19
41.095
Current Cumulative lbs/ac
0.824
0.130
15.140
11.455
1.632
0.027
1.489
2.161
0.190
41.095
Permitted C. P. L. R.****
36
1 34
1 1338
X
1 267
1 15
X
1 374
1 89
2498
Permit PAN Limit Ist/2nd Crop
P
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
IICAID CnDRA CCC M9/9/1(1R\

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 2 Acres Utilized: 6.1
Land Owner: Emerson McBride Annual Dry Tons Applied: 0.0000 Site #: NC-UN26 Acres Permitted: 6.1
Operator: Same Predominant Soil Series: TaB2-Tatum Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue Crop 1 Max. PAN: 137 Crop 2 Name: Fescue Crop 2 Max. PAN:
50
r✓ =
°
o
Ca
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
A Led er
PP P
Acre
o Tons/Ac
(Dry )
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet'
Moist)
Precip.
Past 24
Hrs.
inches
�o
o
�'
o w
o•
°
o
�, 2
�, N'
��
°
o
�
70 °
w
N
*�
TKN
mg/kg
z Yg
o B
CD 0
o �,
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
g
Application
PP
Crop 1
Crop 2
Crop I
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
o
o
::::::::::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
0.000
0.000
Lime A lied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
;:
....................
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.733
0.112
14.664
10.19
1.729
0.027
1.349
2.21
0.184
43.454
Current Cumulative lbs/ac
0.733
0.112
14.664
10.190
1.729
0.027
1.349
2.210
0.184
43.454
Permitted C. P. L. R.****
36
1 34
1 1338
X
267
15
X
374
89
2498
Permit PAN Limit lst/2nd Crop
P
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
1'1CA1D CnDPA CCC tiojo nnx

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Emerson McBride
Operator: Same
Crop I Name: Fescue
WQ Permit #: WQ0001346 Field #: 3
Annual Dry Tons Applied: 0.0000 Site #• NC-UN26
Acres Utilized: 10.5
Acres Permitted: 10.5
Predominant Soil Series: TaB-Tatum Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN: 137
Crop 2 Name: Fescue Crop 2 Max. PAN: 50
�,
°
° a
°
Q
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds G211ons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Preci P•
Past 24
Hrs.
inches
a
3
'c
� �
°o F
°
<
o
�;
X _
� -
*
0
4
7y
w w
�'
* w
TKN
mg/kg
z a
:,
o
�, �
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
lbs/acre )
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
0
0
::::::::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
]bs/ac
Prior Years Cumulative lbs/ac
0.905
0.147
18.364
16.728
1.951
0.033
1.734
2.679
0.229
49.905
Current Cumulative lbs/ac
0.905
0.147
18.364
16.728
1.951
0.033
1.734
2.679
0.229
49.905
Permitted C. P. L. R.****
36
1 34
1 1338
X
1 267
1 15
X
1 374
89
2498
Permit PAN Limit I st/2nd Crop
' .
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
r1GA1D Cr1DRA CCC P1,)mnnnN

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City Of Monroe WQ Permit #: WQ0001346 Field #: 4A Acres Utilized: 12.1
Land Owner: Emerson McBride Annual Dry Tons Applied: 0.0000 Site #: NC-UN26 Acres Permitted: 12.1
Operator: Same
Crop 1 Name: Fescue
Predominant Soil Series: TaB-Tatum
Crop 1 Max. PAN: 137 Crop 2 Name:
Cation Exchange Capacity (non 503): N/A
Fescue Crop 2 Max. PAN:
50
Q
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
�jo
Solids
Volume
Applied r
pP per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
D
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
D
3 v
c w
°
�;
Z.
*
°�
7d
w
* w
* o
7
TKN
mg/kg
>
c
w'
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
lbs/acre
( )
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp (attach FORM
FSF supp to this form):
TOTALS:
0
0
::::::::::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Sle
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.00.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.925
0.142
19.107
12.202
2.025
0.033
1.79
2.64
0.2Current
Cumulative lbs/ac
0.925
0.142
19.107
12.202
2.025
0.033
1.790
2.640
0.2Permitted
C. P. L. R.****
36
34
1338
X
267
15
X
374
8
Permit PAN Limit lst/2nd Crop
P
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
r1GAIR Gr1RRA GQF /1,)/9nna\

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 4B Acres Utilized: 12.7
Land Owner: Emerson McBride Annual Dry Tons Applied: 0.0000 Site #: NC-UN26 Acres Permitted: 12.7
Operator: Same
Crop 1 Name: Fescue
Predominant Soil Series: CmB-CID
Crop 1 Max. PAN: 141 Crop 2 Name:
Cation Exchange Capacity (non 503): N/A
Fescue Crop 2 Max. PAN:
50
°
c� o
Q
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)inches
Soil
Cond.
D
( ry°
Wet,
Moist)
Precip.
Past 24
Hrs.
Y
3 "c$
�» _
"
o� m
* °
;�
=
?
* w
* 0
�
TKN
m /k
9 9
z a
0 �.
m /k
9 9
Nitrate
and
Nitrite
m /k
9 9
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
p
Crop 2
p
Crop 1
p
Crop 2
p
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.0oo
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.71
0.123
13.697
10.755
1.697
0.03
1.278
2.159
0.172
42.207
Current Cumulative lbs/ac
0.710
0.123
13.697
10.755
1.697
0.030
1.278
2.159
0.172
42.207
Permitted C. P. L. R.****
36
34
1 1338
1 X
267
15
X
374
89
2498
Permit PAN Limit l st/2nd Crop
..
M 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nCAID CrNDRA CCC momnnR\

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 5 Acres Utilized: 11.6
Land Owner: Emerson McBride Annual Dry Tons Applied: 0.0000 Site #: NC-UN26 Acres Permitted: 11.6
Operator: Same
Crop 1 Name: Fescue (hay)
Predominant Soil Series: TaB2-Tatum
Crop 1 Max. PAN: 137 Crop 2 Name:
Cation Exchange Capacity (non 503): N/A
Fescue (hay) Crop 2 Max. PAN:
50
o
•, o
Q
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
4 °
�'
oa w
* $
<
o
w
�, -
o'
w
TKN
mg/kg
z Y
o
� °
7 w
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
Ibs/acre
( )
Name of CropType
YP
Receiving Residual
Application
Crop I
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
0
0
:::::::::.:::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
.
Date
lbs/ac
Prior Years Cumulative lbs/ac
1.023
0.146
17.911
14.626
1.683
0.046
1.901
2.743
0.32
48.638
Current Cumulative lbs/ac
1.023
0.146
17.911
14.626
1.683
0.046
1.901
2.743
0.320
48.638
Permitted C. P. L. R.****
36
1 34
1 1338
X
1 267
1 15
X
1 374
1 89
1 2498
Permit PAN Limit lst/2nd Crop
.. .... . _:;
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nCAID CnDRA CQC /40/7nnr-%

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 6 Acres Utilized: 14
Land Owner: Emerson McBride Annual Dry Tons Applied: 0.0000
Operator: Same
Crop 1 Name: Fescue (hay)
Site #: NC-UN26 Acres Permitted: 25.8
Predominant Soil Series: TaB2-Tatum
Crop 1 Max. PAN: 137 Crop 2 Name:
Cation Exchange Capacity (non 503): N/A
Fescue (hay) Crop 2 Max. PAN:
50
o
Q
Volume applied
PP
(enter one) Solids/
Li Liquid
4
Cu. Yds G8110nS
%
Solids
Volume
Applied per
PP P
Acre
(Dry TonslAc)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
a
n '
°
Er �'
o f
n
o
w
�, _
�, '"
N'
o'
R
° '�
* -
TKN
mg/kg
z a
q
o °
° ?
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
ReceivingResidual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
...................
TOTALS:
o
o
.:::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.412
0.068
11.865
4.041
0.952
0.013
0.993
1.22
0.144
20.364
Current Cumulative lbs/ac
0.412
0.068
11.865
4.041
0.952
0.013
0.993
1.220
0.144
20.364
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit Ist/2nd Crop
137 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
ncnio crone cec /4n1nnn0%

Hermit Henewai ano moomcation
APPENDIX Vill
Renewal Site
LELAND WOLFE (NC-UN-27) (Fields 1 and 2)
LANDOWNER AGREEMENT / SETBACK WAIVER AGREEMENT
(FORM: LOA 06-16)
(FORM: SWA 06-16)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

LELAND WOLFE (NC-UN-27) (Fields 1 and 2)
LANDOWNER AGREEMENT / SETBACK WAIVER AGREEMENT
(FORM: LOA 06-16)
(FORM: SWA 06-16)

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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-DischaLge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
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:
Special note
Site/Field ID
Lease
Land Use or
Intended Use of Crops
Residuals Source
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-27-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-27-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. 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: Leland Wolfe
Address: 1805 Jack Davis Road
City: Monroe State: North Carolina Zip: 281
Phone:
Signature:
E-mail address:
NORTH CAROLINA, jI ✓ ) d2&2 COUNTY
Date:
I, the undersigned Notary Public do hereby certify that L-AgyA AA0I pe:i
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of 040R_ a 14 120
Signature and seal:
My commission expires: �, j )5t L3 Amid C' y 070 Zt 3 l
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
Signing official name:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date: 72
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .l 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: 1. f & A,-'& IJO L F
Applicable Field ID: A✓C - u,✓ - o? ? - a
hereinafter referred to as the Permittee, to land apply residuals within O Q feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: / 9a? __-)1 e,r _i�,A6t� / -P
City: IM 63 011 Stater Zip:
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to lano apply residuals to land application site(s) as specified herein.
Property owner name:
Signature: 0F0� ' 2 2J4 Date: 3 �,I
FORM: SWA 06-16 Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 PermittinjZ Unit
General - This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02'r .I 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: f
Applicable Field fD: _,,;1C - aws l " )% - a
hereinafter referred to as the Permittee, to land apply residuals within i O C7 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: / J A�� �,o�i ,6,4d
City: YA(9p--lii-OL__ State: 42 L Zip: 2 1 i ?
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner e: `✓�Q il/� /� - lJ 1�
Signature: d /-
Date:
/7
FORM: SWA 06-16 Page I of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .l 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: 4,f44.%0 AOLiL
Applicable Field ID: AAC —ZJA) - of 1 -
hereinafter referred to as the Permittee, to land apply residuals within f' D C-) feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following: p Q
Location address of property: 7 ..r2ek br4JIC /.S eA
City: yv%OoQ d f State: Ne, Zip: I / 7—
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
da s in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: ---_VO C Pk LIW A,yr
Signature:
Date: 311111$
-ITT
FORM: SWA 06-16 Page 1 of 1

LELAND WOLFE (NC-UN-27) (Fields 1 and 2)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

LELAND WOLFE (NC-UN-27) (Fields 1 and 2)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
Facility Name: City of Monroe
Land Owner: Leland Wolfe
Operator: Same
Crop 1 Name: Fescue (Past.)
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0001346 Field #: I
Annual Dry Tons Applied: 0.0000 Site #: NC-UN27
Acres Utilized: 13.4
Acres Permitted: 13.4
Predominant Soil Series: GsB-Goldston Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN: 135
Crop 2 Name: Fescue (Past.)
Crop 2 Max. PAN: 50
o
Ca
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
��u
Solids
Volume
Applied r
PP per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Y
4 b
0
o w
n o•
c
X iv
�, y
* N'
* K
w
* N'
* w
TKN
mg/kg
z Y
q
o c
ao
°
:v'
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
lbs/acre
( )
Name of Crop Type
Receiving Residual
Application
PP
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000 1
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
...................
TOTALS:
o
o
::::::::::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.36
0.065
9.695
3.174
0.876
0.012
0.711
1.154
0.134
20.539
Current Cumulative lbs/ac
0.360
1 0.065
9.695
3.174
0.876
0.012
0.711
1.154
0.134
20.539
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit Istl2nd Crop
'<
135 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nEKID Cr%DRA ccc i+or�nnc�

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Leland Wolfe
Operator: Same
WQ Permit #: WQ0001346 Field #: 2
Annual Dry Tons Applied: 0.0000 Site #: NC-UN27
Acres Utilized: 17
Acres Permitted: 17.0
Predominant Soil Series: GsB-Golston Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 135 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
,-
°
°
0
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(N Q
PDES #, W #,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry'
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
y
o w
0. -•
+.o
?»
-
; N'
00
w
'v
* -
* w
*-
a
TKN
mg/kg
a
aro o
co o
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
Ibs/acre
( )
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
01
0
::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.388
0.092
11.358
3.63
0.898
0.015
0.862
1.313
0.163
24.465
Current Cumulative lbs/ac
0.388
0.092
11.358
3.630
0.898
0.015
0.862
1.313
0.163
24.465
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit lst/2nd Crop135
50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nCnio rnPRA reG 141M AN

APPENDIX IX
Renewal Site
WILLIAM GRIFFIN (NC-UN-29) (Fields 1, 2,3 and 4)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

WILLIAM GRIFFIN (NC-UN-29) (Fields 1, 2,3 and 4)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

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 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 .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease
Land Use or
Residuals Source
Special note
Site/Field ID
Intended Use of Crops
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-29-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-29-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-29-3
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-294
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: William Griffin
Address: 6705 Austin Grove Church Road
city: Marshville State: North Carolina Zip: 28103
Phone: [phone] E-mail address:
Signature: Date:
NORTH CAROLINA, lilit/>!9� COUNTY
3 - /y ao%
I, the undersigned Notary Public do hereby certify that _�Vl/_I ,A" &/J=C/�
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
Signature and seal:
rw
20 ;S3, '.
My commission expires: �' %�BtlLl AR`I �Jai 3
Lessee's/Operator's Certification:'
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: R_11U4G. Colbath P.E. W
Signature:
Date: ; • 7k / g
FORM: LOA 06-16 Page 3 of

WILLIAM GRIFFIN (NC-UN-29) (Fields 1, 2,3 and 4)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

Oil)

0

WILLIAM GRIFFIN (NC-UN-29) (Fields 1, 2,3 and 4)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: William Griffin
Operator: Same
Crop 1 Name: Fescue (Past.)
WQ Permit #: WQ0001346 Field #: 1
Annual Dry Tons Applied: 0.0000 Site #: NC-UN29
Acres Utilized: 24.5
Acres Permitted: 24.5
Predominant Soil Series: GoC-Golston Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN: 116 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
o
Q
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
past 24
Hrs.
inches
�
t?
0
o w
a
* o
°
c
?
�, -
* N'
* w
w
N
* -
*
* '"
TKN
mg/kg
z >
o
M 0
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
...................
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
SerZn
P
0.000
0.000
Lime A lied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.279
0.045
6.325
2.271
0.507
0.006
0.515
0.706
0.084Current
Cumulative lbs/ac
0.279
0.045
6.325
2.271
0.507
0.006
0.515
0.706
0.084Permitted
C. P. L. R.****
36
34
1338
X
267
15
X
374
89
Permit PAN Limit l st/2nd Crop
.:. < .
116 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
f1FNR Popp FCF /1w9nnsi

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 2 Acres Utilized: 5.7
Land Owner: William Griffin Annual Dry Tons Applied: 0.0000 Site #: NC-UN29 Acres Permitted: 5.7
Operator: Same Predominant Soil Series: GoC-Goldston Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 116 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
o
0
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
oho
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NpDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
past 24
Hrs.
inches
a
9• �.
o w
a _.
* o
°
C
o
w ?=
c� _
* N'
*
w
+ -
*
* r
TKN
mg/kg
z a
B B
M o
?
w
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
PP
(►bs/acre)
Name of CropType
YP
Receiving Residual
g
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
...................
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
Ibs/ac
Prior Years Cumulative lbs/ac
0.505
0.08
11.462
3.141
0.92
0.013
0.997
0.984
0.122
16.324
Current Cumulative lbs/ac
0.505
0.080
11.462
3.141
0.920
0.013
0.997
0.984
0.122
16.324
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
1 374
1 89
2498
Permit PAN Limit l st/2nd Crop
»:::; .:.: ':.: ..
116 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nr=mp Fr1RIU FCF mg/9nrim

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 3 Acres Utilized: 7.4
Land Owner: William Griffin Annual Dry Tons Applied: 0.0000 Site #: NC-UN29 Acres Permitted: 7.4'
Operator: Same Predominant Soil Series: BaB-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
°
°
Q
Volume applied
(enter one) Solids/
Liquid
9
Cu. Yds Gallons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
Y
4 b
.
T o,
°a w
�o
°
c
�
W _
� -
* w'
�*.
0
4
z �
m -,
0
* N
*p
0
TKN
mg/kg
z a
-: '
o �
0
o �.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
..............
TOTALS:
01
As
Cd
Cu
I Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.00o
o.000
Lime A lied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.448
0.081
11.671
4.502
0.787
0.015
1.021
1.324
0.692
18.109
Current Cumulative lbs/ac
0.448
0.081
11.671
4.502
0.787
0.015
1.021
1.324
0.692
18.109
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit 1 st/2nd Crop
.' ;: ..... .:
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
nPKIP GnRnn GeG n,)i,)nnrN

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: William Griffin
Operator: Same
WQ Permit #: WQ0001346 Field #: 4
Annual Dry Tons Applied: 0.0000 Site #: NC-UN29
Predominant Soil Series: BdB2-Badin
Acres Utilized: 7.2
Acres Permitted: 7.2
Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
y s;
•- o
c�
0
Volume applied
enter one Solids/
( )
Liquid
Cu. Yds Gallons
o
/o
Solids
Volume
Applied per
Acre
D Tons/Ac
ry )
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
D
( rY.
Wet
Moist)
Precip.
Past 24
Hrs.
inches
o
o� w
* °
o
�'
°
70 =
w -,
w
* w
* o'
TKN
mg/kg
Z 3
;'
�o c
w.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
PP
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop I
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
...................
TOTALS:
01
01.
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.301
0.05
8.058
2.932
0.571
0.01
0.667
0.961
0.111
14.257
Current Cumulative lbs/ac
0.301
0.050
8.058
2.932
0.571
0.010
0.667
0.961
0.111
14.257
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit Ist/2nd Cro
. .. ... . ....
.. . .
I.I
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
r\CMD CnDRA Cer /111') AN

APPENDIX X
Renewal Site
TOM APPENZELLER (NC-UN-30) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

TOM APPENZELLER (NC-UN-30) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

DWR
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 .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: City of Monroe
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
Land Use or
Intended Use of Crops
Residuals Source
Special note
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-30-1
NC-UN-30-2
NC-UN-30-3
NC-UN-30-4
NC-UN-30-5
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Tom Appenzeller
Address: 830 Cloverleaf Road
City: Marshville State: North Carolina zip: 28103
Phone: [phone] E-mail address: (�
Signature: Cz, , Date:
NORTH CAROLINA, L! A//U COUNTY
I, the undersigned Notary Public do hereby certify that 725M l]nnS,� �-
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of Msizckj 120 le i
t
r r�
Signature and seal:�
My commission expires: 4A2y
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16 Page 3 of 3

TOM APPENZELLER (NC-UN-30) (Fields 1, 2, 3, 4 and 5)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

TOM APPENZELLER (NC-UN-30) (Fields 1, 2, 3, 4 and 5)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 1 Acres Utilized: 13.1
Land Owner: Tom Appenzeller Annual Dry Tons Applied: 0.0000 Site #: UN-UN30 Acres Permitted: 13.1
Operator: William Griffin
Crop 1 Name: Fescue (Past.)
Predominant Soil Series: BM-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
o .,
Q
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
oho
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
D
( ry'
Wet
Moist)
Precip.
Past 24
Hrs.
inches
�A
b
°n. w
o
°
o
w'
o
w
�, w
* N
0
TKN
mg/kg
z Y
o io
w c
g w•
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
pp
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
0
0
::::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime App lied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.424
0.07
11.262
3.98
0.934
0.016
0.906
1.402
0.155
24.476
Current Cumulative lbs/ac
0.424
0.070
11.262
3.980
0.934
0.016
0.906
1.402
0.155
24.476
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit l st/2nd Crop
122 50
"1 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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Tom Appenzeller
Operator: Same
Crop 1 Name: Fescue (Past.)
WQ Permit #: WQ0001346 Field #: 2 Acres Utilized: 10.4
Annual Dry Tons Applied: 0.0000 Site #: NC-UN30 Acres Permitted: 10.4
Predominant Soil Series: BaB-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Max. PAN
122
Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
o
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Cond.
We '
Moist)
Precip.
Past 24
Hrs.
inches
:» �
a w•
_
* N
o'
?
TKN
mglkg
z >
o
as o
w•
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
01
0
As
Cd
Cu
Cr
Pb
Hg
Mo
I Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0. 000
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit lstl2nd Crop
122
50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Tom Appenzeller
Operator: Thomas Morgan
WQ Permit #: WQ0001346 Field #: 3
Annual Dry Tons Applied: 0.0000 Site #: NC-UN30
Predominant Soil Series: BaB-Badin
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN:
122
Acres Utilized: 11.8
Acres Permitted: 11.8
Cation Exchange Capacity (non 503): N/A
Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
°
°
Q
Volume applied
PP,
enter one Solids/
( )
Liquid
Cu. Yds Gallons
o
/o
Solids
Volume
Applied per
PP P
Acre
_(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry'
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
y
cu
o w
a
�
w =
N'
o'
°
`'� CD
:
-
* "
TKN
mg/kg
a
o
°Q °
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
g
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
...............
...
TOTALS:
01
o
.:.:.::: v
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000I-V
Date
lbs/ac
Prior Years Cumulative Ibs/ac
Current Cumulative lbs/ac
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit 1 st/2nd Crop
20 5
50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 4 Acres Utilized: 15.2
Land Owner: Tom Appenzeller Annual Dry Tons Applied: 0.0000 Site #: NC-UN30 Acres Permitted: 15.2
Operator: Same Predominant Soil Series: BaB-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
`o s
Q°
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, W #,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry'
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
a
o w
a o.
°
o
Ei
* N'
* w
T
* w
N
p
TKN
mg/kg
z Y
:,'
o
°o
w.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop I
Crop 2
Crop I
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
j 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
01
0
::: ::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
ww
.
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.253
0.038
5.715
2.44
0.471
0.008
0.529
0.763
0.087
11.055
Current Cumulative lbs/ac
0.253
0.038
5.715
2.440
0.471
0.008
0.529
0.763
0.087
11.055
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit Ist/2nd Crop
77
122
50..
-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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 5 Acres Utilized: 10.8
Land Owner: Tom Appenzeller Annual Dry Tons Applied: 0.0000 Site #: NC-UN30 Acres Permitted: 10.8
Operator: Same Predominant Soil Series: BaB-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
s
°
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
oho
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry'
Wt
vest)
Precip.
Past 24
Hrs.
inches
3 �
cc d
a w
o
%`�
m w
* N
TKN
mg/kg
z Y
o
w o
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( Ibs/acre)
Name of Crop Type
ReceivingResidual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
...................
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
6.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
:::
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.344
0.074
9.417
3.483
0.72
0.015
0.797
1.239
0.132
20.332
Current Cumulative lbs/ac
0.344
0.074
9.417
3.483
0.720
0.015
0.797
1.239
0.132
20.332
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
1 89
2498
Permit PAN Limit 1st/2nd Crop
` :
122
50
"1 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
**Volatilization Rate: Surface - 0.5, Injection/incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

APPENDIX XI
Renewal Site
HENRY MYERS (NC-UN-31) (Fields 3, 4, 5 and 6)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

HENRY MYERS (NC-UN-31) (Fields 3, 4, 5 and 6)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

DWR
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 .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: City Of Monroe
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease
Land Use or
Residuals Source
Special note
Site/Field ID
Intended Use of Crops
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-18-3
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-4
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-5
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-6
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page] of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Henry Myers
Address: 30,0 4 Aw,-" cc1t '
City: Monroe State: North Carolina
Zip: 28110
Phone: [phone] E-mail address:
Signature: Date: 2_
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that d�YIZA,11?d 114fge lRS
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
120 %.
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: R G. Colbath P.E. Water Resources Director
Signature: SDate:
FORM: LOA 06-16 Page 3 of 3

HENRY MYERS (NC-UN-31) (Fields 3, 4, 5 and 6)
SITE MAPS
(Vicinity Map)
(Buffer/Setback Map)

Ip
0
N
r m
W L6 >
a 1 v W
0 0
U
06
X
O
Q
CM
Q �
Ir
U
N
■
Ce W
•
W LL
w ZO
OTAL ACRES BUFFERED ACRES NET ACRES
E r
°?
U- a
m z E
5.0 2.5 2.5
X �
o m
Access Road
d
a
7.5 2.8 4.7
ZW U
Z
• Well
a
21.9 4.3 17.6
= Z
O
00
3
12.6 4.8 7.8
♦ Structure
E
2
■ Dwelling
tM
ished around each land application site
C
■ Gate
■ •
undary and the perimeter of the
o
— - Drain
pliance Boundary for each land application site
the residuals land application area or 50 feet
o
—•--- streams
ever is closest to the residual land application area.
® Buffer
FIGURE NO
m
QField Boundary
INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN
A
r , :
WMSS ASSUMES NO RESPONSIBILITY FOR ANY DECISION MADE
1
, Property Boundary

r

HENRY MYERS (NC-UN-31) (Fields 3, 4, 5 and 6)
UPDATED CUMULATIVE POLLUTANT LOADING RATES

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe
Land Owner: Harry Myers
Operator: Same
WQ Permit #: WQ0001346 Field #: 3
Annual Dry Tons Applied: 0.0000 Site #: NC-UN18
Acres Utilized: 2.1
Acres Permitted: 2.1
Predominant Soil Series: BdB2-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop I Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN: 50
o
c
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
oho
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
We ,
Moist)
Precip.
Past 24
Hrs.
inches
Y
b
�°
a w
c
2
_
o'
�
m w
o
]
TKN
mg/kg
Z Y
o o
`; w•
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
...................
TOTALS:
01
o
: :::::.::::
As
Cd
Cu
I Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
::
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.71
0.076
11.201
9.399
1.338
0.24
1.141
1.919
1.38
34.469
2-17
2150
Current Cumulative lbs/ac
0.710
0.076
11.201
9.399
1.338
0.240
1.141
1.919
1.380
34.469
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
1 89
2498
Permit PAN Limit l st/2nd Crop
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
mcniD Gnane sec tiimnonN

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 4 Acres Utilized: 4.9
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 4.9
Operator: Same Predominant Soil Series: BdB2-Badin Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
Volume applied
(enter one) Solids/
Liquid
9
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
a
b
�'
n w
o
o
?:
-
*
4
m w
w
0
TKN
mg/kg
z a
o B
sv
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 17
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
....
.......
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
..............
..
TOTALS:
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
0.000
Lime A lied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
::
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.77
0.077
12.803
10.477
1.496
0.027
1.306
2.149
0.195
39.706
2-17
1904
Current Cumulative lbs/ac
0.770
0.077
12.803
10.477
1.496
0.027
1.306
2.149
0.195
39.706
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit lst/2nd Cro P
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
nFniQ Gnann GCG n)nnnR�

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 5 Acres Utilized: 14.9
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 14.9
Operator: Same Predominant Soil Series: TbB2-Tatum Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 122 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
50
°
° °
,8 °
Q
Volume applied
PP
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/AC)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
a
n "
F
0
n
o
°
o
w m
.. =
�,
* w'
0
�
w
0
TKN
mg/kg
z a
o o
w
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(Ibs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
...................
TOTALS:
01
0
::::::::::::
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.000
1 0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
lbs/ac
Prior Years Cumulative lbs/ac
1.254
0.151
18.282
20.757
2.123
0.045
2.211
1.7
0.314
48.776
Current Cumulative Ibs/ac
1.254
0.151
18.282
20.757
2.123
0.045
2.211
1.700
0.314
48.776
Permitted C. P. L. R.****
1 36
34
1 1338
X
1 267
1 15
X
1 374
1 89
2498
Permit PAN Limit lst/2nd Crop
P
122 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
MCKID rnDRA rcr i�oionna�

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Monroe WQ Permit #: WQ0001346 Field #: 6 Acres Utilized: 6.9
Land Owner: Harry Myers Annual Dry Tons Applied: 0.0000 Site #: NC-UN18 Acres Permitted: 6.9
Operator: Same Predominant Soil Series: ChA-Chewacla Cation Exchange Capacity (non 503): N/A
Crop 1 Name: Fescue (Past.) Crop 1 Max. PAN: 149 Crop 2 Name: Fescue (Past.) Crop 2 Max. PAN:
-3
°
° °
Ca
Volume applied
PP
(enter one) Solids/
Li Liquid
q
Cu. Yds Gallons
oho
Solids
Volume
Applied per
P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet
Moist)
Precip.
Past 24
Hrs.
inches
Y
b
S F'
0 m
o
;n ��-
_
;
o"
o
70
w
*
* o
o
TKN
mg/kg
Z a
'
o
as o
w'
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(Ibs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
...
.......
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
.........
TOTALS:
01
o
:::::::::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
1 0.000
0.000
Lime Applied
Annuallbs/acre
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Date
Ibs/ac
Prior Years Cumulative lbs/ac
1.057
0.13
15.027
16.05
1.945
0.036
1.759
2.674
0.27
51.171
Current Cumulative lbs/ac
1.057
0.130
15.027
16.050
1.945
0.036
1.759
2.674
0.270
51.171
Permitted C. P. L. R.****
36
34
1338
X
267
15
X
374
89
2498
Permit PAN Limit lst/2nd Crop
P
149 50
"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
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate

APPENDIX XII
Modification / New Site
BEN MYERS (NC-UN-18) (Field 8-Addition)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)
SOILS AND AGRONOMIC EVALUATION

BEN MYERS (NC-UN-18) (Field 8-Addition)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

DWR
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 .l 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: CItX Of Monroe
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:
Special note
Site/Field ID
Lease
Land Use or
Intended Use of Crops
Residuals Source
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-18-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-7
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-18-8
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The `tndowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Pernottee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Ben Mvers
Address: -? oZD a- f1l /-M 5 P4'..'6 Rd
City: Monroe State: North Carolina Zip: 28110
Phone: 7 OO�jV - P?q/ 7�"i -mai 1 address:
Signature: / Date: Z- - i e
NORTH CAROLINA, �ZIA)I !9 A COUNTY
I, the undersigned Notary Public do hereby certify that '�3 PA.� S
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
�ti
WITNESS my hand and official seal this the 77,
day of %Z 1' t _ 120 /
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
424 ova
tip
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
ater
FORM: LOA 06-16 Page 3 of 3

BEN MYERS (NC-UN-18) (Field 8-Addition)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)

_ co
.
r cy
o
r� t\ > m
4
t y
Q
O Lu
w
r QLu
0
r,o
CD Lu
�1
_ -
,
f .i<' I f �i L)
o
, n
,
r� Z
J
J
7 �+ S ibfl•` ,,;' �r�. - 0 m w
'� • �/ er �� 0 V "^ Field NC
-UN-18-7 f t - ..•
• t
U)
• \ ( ��:ti `\_ - = Field NC-UN-1
8-8 • - `�J b �� J z
24 `�� 'J - �'_ ~ 1 ,1. r-;� J �• .b: > r \\' Jjl' - f' _Sl�l••;�-�: _ -•�• ':b —
Mom/ _I
• -1 `!.r ', - q0 PN5
to ,� u _
/ i ✓
0
j �. � \, . � S9a P- 51 � � / �"�� %` •••� .-l� - - ll.r � f -� t `'-� ,
- -• y1V
t. Field NC-UN-18-2 _ �
Field NCUN 18 f J
✓ , - t a _}
\f
1 �
tz
V ,f
�.-ri Z
r
-.•t • • � /_ .,tom-•^'' ` ! - � N � U
r y� LL S S
4�
+ liil ' ) `
c
Cem t O w
�,.pq-tn �' a A - ' .�/�J r.._ ^ �(' �' ae` `�•
vr? 1.: �. .,c 1 %. co COL i
,a/ t. •' • • ^ i I ...� - � • L •; -. ._! -r dt' ■ �' - /�_ _ I • ___ _ ;t /� ! �: h i llp r o Z
Z m co O
Lu
, ... ®
••�' � � sw '4 � J�.`. � t � Z = O
%� Tan ' .. ) z
.• . f 4
N
-:1�. 1 �t•r. � � ♦ � '. t f : {x S.,b., twr /� � "� -'� �� \ xiµ _ s �. • r • � ���
,
• I
No �^ • �.
t , • t5
_ , M mow/•+• , }y i 1 ^�, � I \ � � t�
•i6f��1 7 FIGURE NO
REFERENCE: �! :` T I s"L,da[ y�j If"'copy'i
S + �YIDg `i• �.:
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY IT IS NOT MEANT FOR DESIGN 1 ,
{ , 4
LEGAL, OR ANY OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY WMSS ASSUMES NO RESPONSIBILITY FOR ANY DECISION MADE I �.��� • !! �.
OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION !�• _ _; !-t+"Yr A�• f ' " F---Trit`© 20j 3 p afior al;Ge
• -
SAO

r
I

BEN MYERS (NC-UN-18) (Field 8-Addition)
SOILS AND AGRONOMIC EVALUATION

CITY OF MONROE
BEN MYERS SITE (NC-UN-18) — FIELD &ADDITION
SOILS AND AGRONOMIC EVALUATION
The Ben Myers Site NC-UN-18 — Field 8-Addition is located on the east side of Helms
Pond Road in Union County, N.C. The surrounding area is primarily predominantly rural.
Field 8-Addition is currently in row crop production and is planned to be established with
Fescue for hay production and /or pasture, the same as the original portion of Field 8 that is
currently permitted. The topography over the fields ranges from 2 to 6 %. Buffer
requirements as required by 15A NCAC 02T.1108 for setbacks will need to be adhered to
and will reduce the useable acreage in these fields. Refer to "Buffer Maps" for specific
buffer/setback requirements and acreage totals.
A field investigation was conducted by a WMSS agronomist and soil scientist on May 23,
2018. Preliminary soils information for this site was obtained from the United States
Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS) Web
Soil Survey (WSS). A WMSS licensed soil scientist advanced hand auger borings on the
proposed fields to characterize the proposed application sites (hand auger boring locations
are indicated on Figure 3 — NRCS Soils Map). Soil profile descriptions were performed
within the proposed fields and indicated the fields as suitable according to the criteria
outlined in 15A NCAC 02T .1104(c) (2). The predominant soil series associated with Field
8-Addition is most similar to the Cid series (Fine, mixed, semi active, thermic Aquic
Hapludults). Soil profile description sheets are contained within this section of the
application indicating the predominant soil series identified within Fields 8-Addition.
Both the soils and the crops should be able to assimilate the proposed loadings of liquids,
solids, nitrogen, phosphorus, heavy metals, and salts known to be in the biosolids. This
assessment is based on the residual analysis provided, the planned application rate, proper
crop management guidelines and adherence to permit requirements. Soil pH for mineral
soils should be maintained above 6.0 and at levels to ensure optimal crop production.
Nitrogen is considered the most limiting characteristic of these residuals, however soil tests
should be reviewed annually to identify any changes in the nutrient status of the soil.
Management practices should be evaluated prior to each application to account for changes
in the proposed land use objectives. Crop management guidelines that will be of importance
for this site will be:
• timing of application events with plant nutritional needs and periods of plant
dormancy,
• split application to prevent hydraulic overloading or nutrient leaching,
• performance of proper stabilization methods to fit crop and soil needs,
• maintenance of proper vegetative cover on more sloping areas with runoff
potential, and
• proper coordination between application events and crop harvesting.

City of Monroe Ben Myers Site NC-UN-18 — Field 8-Addition
WMSS Project No. 15-10
The results of the soil analysis for these fields, included in this report, indicate no gross
deficiencies in the fertility of these fields. By using standard agricultural practices for the
management of forage and crop production, the operator should see significant benefits from
the application of biosolids. In turn, these well -maintained fields should provide good
assimilation of the plant available nutrients contained in the biosolids and afford an
environmentally safe means of solids disposal and nutrient recycling. >r
t
Martin Mabe
Agronomist
,PP
: 4
Rob Willcox, L.S.S.
Soil Scientist
'Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewal\Land Application Site Info\Site 18 - Ben
,, Myers\15-10 Soil Scientist - Agronomist Report Monroe -Ben Myers.doc

WILLCOX & MABE SOIL SOLUTIONS, PLLC
SITE/SOIL EVALUATION
Project No. / 5 — /Q Phone No.
Location �!ZT of I*A424F, Pin
Date: S Z'?
County: &/N/o/ -1 Property Size
Proposed Facility: /36,v Myf& s' Water Supply:
Described By: /C a/S WL.LL DVC
Weather: $fu "Al h14111k1 Antecedent Moisture
On -Site Well ❑ Evaluation: Auger Boring
Community ❑ Pit ❑
Public ❑ Cut ❑
Mew S'>" Surface Water: /J1 A
FACTORS
PROFILE
#�
PROFILE
( Conti
PROFILE
PROFILE
Landscape Position %
po
Horizon Depth I
— (P
Color Munsell
U 2 .51 L
Texture
S,
Structure
Consistence
S
Boundary
Horizon Depth II
61_ Z
260 _ 0
Color — Munsell
2, G
' S ell
Texture
Mottles
Structure
I
Consistence
5 S 5 �►�
><
/'+`
Boundary
Horizon Depth III
2 _
_ 3S --
Color — Munsell
Texture
, C
Mottles
74C _ Z. S 7
Structure
Consistence
SS S
S
Boundary
Horizon Depth IV
Color — Munsell
6161
Texture
j
Mottles
C 611,
Structure
Consistence
S '
1?
/a
Boundary
Soil Wetness
Restrictive Horizon
Saprolite
LTAR
Classification
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
CV
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
Is
loamy sand
sl
sandy loam
I
loam
si
silt
A
silt loam
sicl
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fr
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
m
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
pl
platy
pr
prismatic

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SL037472
P��cui:rueu.�` Heavy Metals Client: Willcox & Mabe Soil Solutions Advisor:
1205 W Bessemer Ave Ste 202
A Soil Report Mehlich-3 Extraction Greensboro, NC 27408
4
Sampled County : Union
Links to Helpful Information Sampled: 05/23/2018
_ Received: 06/15/2018
Farm: Ben Myers NC - UN -18 Completed: 06/26/2018 Client ID: 462496 Advisor ID:
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test
extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)-
4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and
note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus (P) is very high (P-1 > 100), crops will not respond to additional P
applied. Tissue testing is advised where soil pH is elevated and is of concern as in samples found here. Ja athi Kamalakanthan 6/26/2018
Sample ID: 01
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1 - Fescue/OGrasslTim, M 0.0 120-200 0 30 0 0 pH$ 0 0 0
Note: 12 Note:
2- Fescue/OGrasslTim, M 0.0 120-200 0 30 0 0 pH$ 0 0 0
Note: 12 Note:
Test Results [units - W/V in g/cnr3; CEC and Na in meq/100 crnr ; NO3-N in mg/drrr3]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.27 1.02 12.1 100 0.0 7.4 191 59 73 25 31 180 104 104 310 310 374 0.1 1
Heavy Metals (parts per million): Arsenic, 0.3 Cadmium, 0.1 Nickel, 0.4 Chromium, 0.2 Lead, 6.2 Selenium, 0.2
North Carolina
4. 'a
R t
[A -
Tobacco Trust Fund Commission
Reprogramming of the laboratory -information -management system that makes this report possible is
beinq funded throuqh a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxler, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SLO37472
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at onE
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-Al2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-n- I
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
N
mineral -organic soil class
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.gov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations forsmall areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagr�o_y/agronomi/obpart4.html ind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
WN
weight per volume
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
zinc availability index
remaining 16 [P-1, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-1, Zn-Al, Cu-I, S-1, SS -I, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncagrpov/agronomi/uyrst.htm

Waypoint
ANALYTICAL
6/25/2018
Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield, NC, 27358
Ref: Analytical Testing
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number: 18-166-0200
Project Description: Ben Myers
Waypoint Analytical Virginia, Inc. received sample(s) on 6/15/2018 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Arizona AZ0629 New Jersey VA011 Pennsylvania 68-03109 Virginia 460014
Florida E871087 North Carolina 257 South Carolina 93007
♦t, L p`r+
a

Waypointo
ANALYTICAL
Client: Willcox & Mabe Soil Solutions, PLLC
Project: Ben Myers
Lab Report Number: 18-166-0200
Date: 6/25/2018
7621 Whitepine Road, Richmond, VA 23237
Main 804.743-9401 0 Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Solids Total Mercury Analysis - CVAA Method SW-7471 B
Sample 61187 (01)
Analyte: Hg
QC Batch No: E64698/E64582
MS and/or MSD spike recovery failed. Analyte concentration >25X the MQL. Dilution test exceeded method
limits. Matrix interference is suspected.
QC Batch No: E64698/E64582
MS and/or MSD spike recovery failed. Analyte concentration < 25X the MQL. Post Digestion Spike exceeded
method limits. Matrix interference is suspected.

Report Number
18-166-0200
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Ben Myers
Lab Number: 61187
Sample Id : 01
Analysis
Waypointo
ANALYTICAL
REPORT OF ANALYSIS
Result
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Quantitation
Limit Method
Mercury, mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
Date and Time
Test Started Analyst
SW-7471 B 06/22/2018 12:45 MMT
t w« mC 1�r
Pauric McGroary

(2)waypoint 7621 ain 80 -7 Road, Richmond, 27 -6446
Main 804-743-9401 1Fax [phone]
ANALYTICAL www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 08361
Customer Name: Willcox & Mabe Soil Solutions, PLLC
Report Number: 18-166-0200
Shipping Method
0 Fed Ex US Postal U Lab
0 UPS Client 0 Courier
Other
Thermometer ID:
Shipping container/cooler uncompromised?
Yes
i No
Number of coolers received
F 1
Custody seals intact on shipping container/cooler?
n Yes
0 No
Not Required
Custody seals intact on sample bottles?
Yes
0 No
Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
0 Yes
0 No
COC properly completed
0 Yes
0 No
Samples in proper containers?
0 Yes
0 No
Sample containers intact?
0 Yes
0 No
Sufficient sample volume for indicated test(s)?
0 Yes
0 No
All samples received within holding time?
0 Yes
0 No
Cooler temperature in compliance?
is Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Yes
No
Water - Sample containers properly preserved
40 Yes
No
N/A
Water - VOA vials free of headspace
0 Yes
0 No
N/A
Trip Blanks received with VOAs
0 Yes
No
N/A
Soil VOA method 5035 — compliance criteria met
n Yes
No
N/A
High concentration container (48 hr) Low concentration EnCore samplers (48 hr)
High concentration pre -weighed (methanol -14 d) F Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included? r- Yes 0 No
Comments
Signature: (Brandi Watson I Date & Time: 06/15/2018 12:42:32 I

Waypoint 0
ANALYTICAL
��I IIIII NIII III IIIII IIII IIB
10406
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfieid NC
27358
Comments: City of Monroe
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 *Fax [phone]
www.waypointanalocal.com
Grower Information
Grower Name: Ben Myers
Address:
Farm: NC-UN-19
Field:
Additional
Email:
n
..,
Z.
ey
-t
4
3
a
w
Additional
Intended
Intended
Alternate
Alternate
Prev
Sample ID
1M1fS2Ni
B
Cu
FeMnNa
S
Zn
S3M
p w
tz trl
F
p
4
$
Tests
Crop
Crop
Crop
Crop
Cre -
�
Code
viela-
Cqg
'% Yiel6
1
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
1 L❑ 10][11010101
Mercury
un�
I/I

APPENDIX XI11
Modification / New Site
WILLIAM GRIFFIN (NC-UN-29) (Field 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)
SOILS AND AGRONOMIC EVALUATION

WILLIAM GRIFFIN (NC-UN-29) (Field 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

State of North Carolina
DWI
Department of Environment and Natural Resources RDivision 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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
IGeneral — 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: City Of Monroe
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:
Special note
Site/Field ID
Lease
Land Use or
Intended Use of Crops
Residuals Source
(no-till/over-seed/
(yes/no)
Cropping Patterns
(optional)
pasture)
NC-UN-29-1
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-29-2
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-29-3
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
NC-UN-29-4
No
Fescue
Cattle/Feed
WWTP & WTP
Pasture
biosolids
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: William Griffin
Address: 6705 Austin Grove Church Road
City: Marshville State: North Carolina
Zip: 28103
Phone: [phone] E-mail address:
Signature: t �/ 4JA&,Date:
NORTH CAROLINA, jQ,4 0_A,1 COUNTY
I, the undersigned Notary Public do hereby certify that 1i_J1,41 rf1-f1
/
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
, 20
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
o
,v
I certify that I have read this Agreement and do hereby agree to abide by the stipulations
and restrictions as specified herein.
Lessee/operator name:
Address:
City: State:
Zip:
Phone: E-mail address:
Signature:
Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
P.E.
Date: 7- 2t;�'A!�
FORM: LOA 06-16 Page 3 of 3

WILLIAM GRIFFIN (NC-UN-29) (Field 5)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)

'v� 1 = �•
f
s J
FIELD NC-UN-29-5
Y 1 i \�
C-UN-29-2
FIELD N
:orsgg_
r
FIELD NC -UN 29-1
Jr�
j
�. J
17,
t _ ✓� - V,
' Cem e
IFIGURENO
rSturdi,.ants Cros"
vREFERENCE:GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FORINFORMATIONAL
PURPOSES ONLY IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NOGUARANTEES ABOUT ITS ACCURACY WMSS PLLCASSUMES NO RESPONSIBILITY FOR ANY ///.��ADECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. '� ',�� FieldCopyTight02013 NatioSCALE: 1 �� = 2,000 WILLIAM GRIFFIN FIELDS DATE: 05-04-18 W��ICAX$ciilc� NC-UN-29 FIELDS 1-2 & 5
DRAWN BY: MEM
PROJECT NO: SOIL SOLUTIONS USGS TOPOGRAPHY MAP
f, 15-18 Ph: 02 UNION COUNTY, NORTH CAROLINA

i- y ,elf .0��
r r '• � `
can (A
J _ I
v. T
FIELD NC-UN-29-4
FIELD NC-UN-29-3 •'�_.
t
At1-
s�ltsoMarshville
st. �
l 1
• tob��.
t:SSO
REFERENCE: r 1•`_ - . ♦__-_..-_ ,� {w•
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL y }
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY /--
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. 3- ' Field Boundary
Copright© 2013 Natio
SCALE 1 „ = 2,000 , FIGURE NO
WILLIAM GRIFFIN FIELDS
DATE 05-16-18 WI�ICOX&mc� NC-UN-29 FIELDS 3-4 3
DRAWN BY MEM
PROJECT NO SOIL SOL it T I O N S USGS TOPOGRAPHY MAP
15-18 Ph: 02 UNION COUNTY. NORTH CAROLINA

WILLIAM GRIFFIN (NC-UN-29) (Field 5)
SOILS AND AGRONOMIC EVALUATION

CITY OF MONROE
WILLIAM GRIFFIN SITE (NC-UN-29) — FIELD 5
SOILS AND AGRONOMIC EVALUATION
The William Griffin Site NC-UN-29 — Field 5 is located on the northeast side of the
intersection of Lunsford Road and White Store Road, in Union County, N.C. The
surrounding area is primarily predominantly rural.
Field 5 is currently established with Fescue for hay production and /or pasture. The
topography over the field ranges from 2 to 6 %. Buffer requirements as required by 15A
NCAC 02T.1108 for setbacks will need to be adhered to and will reduce the useable acreage
in these fields. Refer to "Buffer Maps" for specific buffer/setback requirements and acreage
totals.
A field investigation was conducted by a WMSS agronomist and soil scientist on May 4,
2018. Preliminary soils information for this site was obtained from the United States
Department of Agriculture (USDA) Natural Resources Conservation Service (MRCS) Web
Soil Survey (WSS). A WMSS licensed soil scientist advanced hand auger borings on the
proposed fields to characterize the proposed application sites (hand auger boring locations
are indicated on Figure 3 — NRCS Soils Map). Soil profile descriptions were performed
within the proposed fields and indicated the fields as suitable according to the criteria
outlined in 15A NCAC 02T .1104(c) (2). The predominant soil series associated with Field
5 is most similar to the Cid series (Fine, mixed, semi active, thermic Aquic Hapludults).
Soil profile description sheets are contained within this section of the application indicating
the predominant soil series identified within Field 5.
Both the soils and the crops should be able to assimilate the proposed loadings of liquids,
solids, nitrogen, phosphorus, heavy metals, and salts known to be in the biosolids. This
assessment is based on the residual analysis provided, the planned application rate, proper
crop management guidelines and adherence to permit requirements. Soil pH for mineral
soils should be maintained above 6.0 and at levels to ensure optimal crop production.
Nitrogen is considered the most limiting characteristic of these residuals, however soil tests
should be reviewed annually to identify any changes in the nutrient status of the soil.
Management practices should be evaluated prior to each application to account for changes
in the proposed land use objectives. Crop management guidelines that will be of importance
for this site will be:
• timing of application events with plant nutritional needs and periods of plant
dormancy,
• split application to prevent hydraulic overloading or nutrient leaching,
• performance of proper stabilization methods to fit crop and soil needs,
• maintenance of proper vegetative cover on more sloping areas with runoff
potential, and
• proper coordination between application events and crop harvesting.

City of Monroe William Griffin Site NC-UN-29 — Field 5
WMSS Proiect No. 15-10
The results of the soil analysis for these fields, included in this report, indicate no gross
deficiencies in the fertility of these fields. By using standard agricultural practices for the
management of forage and crop production, the operator should see significant benefits from
the application of biosolids. In turn, these well -maintained fields should provide good
assimilation of the plant available nutrients contained in the biosolids and afford an
environmentally safe means of solids disposal and nutrient recycling.��
i�L�, " .
Martin Mabe
Agronomist
Rob Willcox, L.S.S.
Soil Scientist
Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewal\Land Application Site Info\Site 29 - William
Griffin\15-10 Soil Scientist - Agronomist Report Monroe -William Griffin.doc
2

WILLCOX & MABE SOIL SOLUTIONS, PLLC
SITE/SOIL EVALUATION
Project No. /s - /b Phone No.
Location of N~ Pin
County:
Date:
ba-
ProSize
Proposed Facility: ALL/i}M 6RtftIA/Water Supply: On -Site Well ❑ Evaluation:
Ale -- UAJ - 2'J - 5 Community ❑
Described By: �g �Glco Public El
Weather: Sct� �,�/�►2 kA Antecedent Moisture Iko,,S r Surface Water:
Auger Boring
Pit ❑
Cut ❑
FACTORS
PROFILE
PROFILE
CvA
PROFILE
PROFILE
Landscape Position %
_ 2 _ %d
Horizon Depth I
—
Color Munsell
S Z
Texture
1-5,11
Structure
r
Consistence
S
Boundary
Horizon Depth II
f
2S - Z
Color — Munsell
Texture
5, C_ t
Mottles
Structure
;
C S ,t
Consistence
IC J
Boundary
Horizon Depth III
( _
Color — Munsell
G
Texture
`
Mottles
-7
Structure
Consistence
<1
r
Boundary
Horizon Depth IV
Color — Munsell
2. &
Texture
,
Mottles
7 t
Structure
N/
Consistence
-/OtIle
Boundary
Soil Wetness
2 '' S H
Restrictive Horizon
Saprolite
LTAR
Classification
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
Cv
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
Is
loamy sand
sl
sandy loam
I
loam
si
silt
A
silt loam
Sid
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fir
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
m
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
pl
platy
pr
prismatic

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SL037470
P Heavy Metals Client: Willcox & Mabe Soil Solutions Advisor:
1205 W Bessemer Ave Ste 202
Soil Report Mehlich-3 Extraction Greensboro, NC 27408
/ A
O •-
5
�ti Links to Helpful Information Sampled: 05/23/2018 Sampled County: Union
Received: 06/15/2018
Farm: William Griffin NC-UN-29 Completed: 06/26/2018 Client ID: 462496 Advisor ID:
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test
extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)-
4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and
note where elevated above background levels. Note any lime and fertilizer recommendations. Ja athi Kamalakanthan 6/26/2018
Sample ID: 05
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim, M 1.6 120-200 50 80 0 0 0 0 0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 50 80 0 0 0 0 0 0
Note: 12
Test Results [units - W/V in g/cnn ; CEC and Na in meq/100 cnr3; NO3-N in mg/dnr3]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-1 NO3-N
0.36 1.08 5.0 52 2.4 4.8 36 27 34 16 34 114 85 85 31 31 29 0.1 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.2 Lead, 5.9 Selenium, 0.2
North Carolina
\
Tobacco Trust Fund Commission
Reprogramming of the laboratory-information-manag6enent system that makes this report possible is
being funded through a qrant fromihe t4orth Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- 7 Steve Troxler, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SL037470
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at onE
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1
Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
M-0
mineral -organic soil class
notations appear on the soil report, refer to $Note: SecondaNutrients and Micronutrients. In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncaqr.gov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit WwW._ncayrgov_/a rg onomi/obpart4.htmisfind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
WIV
weight per volume
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
Zn-I
zinc availability index
zinc index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-Al2, Zn-1, Zn-AI, Cud, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routinel
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncacu.gov/aaronomi/uvrst.htm

(D
WayPAoi nt .
NALYTICAL
6/25/2018
Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield, NC, 27358
7621 Whitepine Road, Richmond, VA 23237
Main 904-743-9401 ° Fax [phone]
www.waypointanalytical.com
Ref: Analytical Testing
Report Number: 18-166-0201A
Project Description: William Griffin
Waypoint Analytical Virginia, Inc. received sample(s) on 6/15/2018 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
g.,;. ir 6 -i
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Arizona AZO629 New Jersey VA011 Pennsylvania 68-03109 Virginia 460014
Florida E871087 North Carolina 257 South Carolina 93007
♦°,a atry�o+
1�
• c

Waypoint
ANALYTICAL
Client: Willcox & Mabe Soil Solutions,
PLLC Project: William Griffin
Lab Report Number: 18-166-0201A
Date: 6/25/2018
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Solids Total Mercury Analysis - CVAA Method SW-7471B
Sample 61187
Analyte: Hg
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration >25X the MQL. Dilution test exceeded method
limits. Matrix interference is suspected.
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration < 25X the MQL. Post Digestion Spike exceeded
method limits. Matrix interference is suspected.

Report Number
18-166-0201
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project: William Griffin
Lab Number: 61188
Sample Id : 05
D
Waypoint-(
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Analysis Result Limit
Mercury, mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Purchase Order:
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled
Method
SW-7471 B
Date and Time
Test Started Analyst
06/22/201812:55 MMT
Pauric McGroary

(DiWaypont.
7621 -7 Road, Richmond,
V7
-6446
Main 804-743-9401 1Fax [phone]
ain 80
ANALYTICAL
www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 08361
Customer Name: Willcox & Mabe Soil Solutions, PLLC
Report Number: 18-166-0201
Shipping Method
O Fed Ex ! US Postal Lab
Other
0 UPS Client Courier
Thermometer ID:
Shipping container/cooler uncompromised?
4D Yes
No
Number of coolers received
F 1
Custody seals intact on shipping container/cooler?
J Yes
No
Not Required
Custody seals intact on sample bottles?
',D Yes
(D No
0 Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
40 Yes
O No
COC properly completed
0 Yes
0 No
Samples in proper containers?
0 Yes
No
Sample containers intact?
• Yes
C No
Sufficient sample volume for indicated test(s)?
40 Yes
0 No
All samples received within holding time?
0 Yes
O No
Cooler temperature in compliance?
I& Yes
No
Cooler/Samples arrived at the laboratory on ice.
Yes
No
Samples were considered acceptable as cooling
process had begun.
Water - Sample containers properly preserved
Yes
No
n N/A
Water - VOA vials free of headspace
0 Yes
O No
N/A
Trip Blanks received with VOAs
O Yes
O No
N/A
Soil VOA method 5035 — compliance criteria met 0 Yes
0 No
N/A
High concentration container (48 hr)
F_ Low concentration EnCore samplers (48 hr)
High concentration pre -weighed (methanol -14 d)
Low conc pre -weighed
vials (Sod Bis -14 d)
Special precautions or instructions included?
Yes
0 No
Comments. -
Signature: Brandi Watson
Date & Time: 06/15/2018 12_43:44

. p
Waypoint
ANALYTICAL
Ihlll III I�1 IVII ICI IIN IIII
10239
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfield . NC
27358
Comments: City of Monroe
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytic.al.com
Grower Information f
Grower Name: 5 W/ J'ir,*% Gr't �-PIn
Address:
09
Farm: NC-IJN 0
Field:
Additional
Email:
Intended Intended Alternat Alternat
A additional Prev
tiample 11l �Sll1[S2)1 R C'u Fc Nil] Na S 7.n S31[ p H U Crop Crop Crop Crop
i H i4l 8 1 etits Code l ield I Code field C ro[
of I IF- IJjCI
M1fercu
Ilf

APPENDIX XIV
Modification / New Site
DANNY BAKER (NC-UN-32) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)
SOILS AND AGRONOMIC EVALUATION

DANNY BAKER (NC-UN-32) (Fields 1, 2, 3, 4 and 5)
LANDOWNER AGREEMENT
(FORM: LOA 06-16)

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 copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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: C/T�1 OF 40AJ&
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)
NC-11N-32- 1
AJo
,�ESGctE
/VC- u&- 32-2-
lUo
FESLuE
A!C- uAr • 32- 3
Al
JES'GuE
AfC-uN- 32- 4
N&
re-5cuF
NC-uAJ - 32 - S
/U d
ices cu E
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3
f

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
i
Address:
City: State: _ Ale— Zip: �4)2
Phone: E-mail address:
Signature: Date: 3 A 4,
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that //� ZAr-9
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
4 �-A-
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
, 20 V 5
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Rus bath P.E. Water Resources Director�r-
Signature: Date:
FORM: LOA 06- l 6 Page 3 of 3

DANNY BAKER (NC-UN-32) (Fields 1, 2, 3, 4 and 5)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)

_
N
• •..•. ,..4,.�sy- _ fY� _ t ° 99
Set•
8
r
Sewage
Field NC-UN-32-2
.. N�1�7
7)k, _. -
©� Field NC-UN-32-4 Field NC-UN-32-3 - �`��� '� •, ���
d
Field NC-UN-32-5
�r
/`--- � � -• ;' , icy - �` 1. � �,, ! � `b
k
L X. .
REFERENCE:
- -- - •1 ` .3 -,., \ GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
4 � ; PURPOSES ONLY IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
Field Boundary GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.
SCALE'. 1 " - 2,000 FIGURE NO
...., DANNY BAKER FARM
DATE05-24-18 ��hX&�� NC-UN-32 FIELDS 1-5 2
DRAWN BY MEM
PROJECT NO SO I L SOLU T I O N S USGS TOPOGRAPHY MAP
15-10 Ph:OZ UNION COUNTY, NORTH CAROLINA

N

DANNY BAKER (NC-UN-32) (Fields 1, 2, 3, 4 and 5)
SOILS AND AGRONOMIC EVALUATION

CITY OF MONROE
DANNY BAKER SITE (NC-UN-32) — FIELDS 1-5
SOILS AND AGRONOMIC EVALUATION
The Danny Baker Site NC-UN-32 — Fields 1-5 are located on the north and south side of
Hasty Road in Union County, N.C. The surrounding area is primarily predominantly rural.
Fields 1-5 are currently established with Fescue for hay production and /or pasture. The
topography over the field ranges from 2 to 6 %. Buffer requirements as required by 15A
NCAC 02T.1108 for setbacks will need to be adhered to and will reduce the useable acreage
in these fields. Refer to "Buffer Maps" for specific buffer/setback requirements and acreage
totals.
A field investigation was conducted by a WMSS agronomist and soil scientist on May 22,
2018. Preliminary soils information for this site was obtained from the United States
Department of Agriculture (USDA) Natural Resources Conservation Service (MRCS) Web
Soil Survey (WSS). A WMSS licensed soil scientist advanced hand auger borings on the
proposed fields to characterize the proposed application sites (hand auger boring locations
are indicated on Figure 3 — NRCS Soils Map). Soil profile descriptions were performed
within the proposed fields and indicated the fields as suitable according to the criteria
outlined in 15A NCAC 02T .1104(c) (2). The predominant soil series associated with Field
1, 3 and 4 is most similar to the Goldston series (Loamy -skeletal, siliceous, semiactive,
thermic, shallow Typic Dystrudepts, Field 2 is most similar to the Badin series (Fine, mixed,
semiactive, thermic, Typic Hapludults) and Field 5 is most similar to the Cid series (Fine,
mixed, semi active, thermic Aquic Hapludults). Soil profile description sheets are contained
within this section of the application indicating the predominant soil series identified within
Field 5.
Both the soils and the crops should be able to assimilate the proposed loadings of liquids,
solids, nitrogen, phosphorus, heavy metals, and salts known to be in the biosolids. This
assessment is based on the residual analysis provided, the planned application rate, proper
crop management guidelines and adherence to permit requirements. Soil pH for mineral
soils should be maintained above 6.0 and at levels to ensure optimal crop production.
Nitrogen is considered the most limiting characteristic of these residuals, however soil tests
should be reviewed annually to identify any changes in the nutrient status of the soil.
Management practices should be evaluated prior to each application to account for changes
in the proposed land use objectives. Crop management guidelines that will be of importance
for this site will be:
• timing of application events with plant nutritional needs and periods of plant
dormancy,
• split application to prevent hydraulic overloading or nutrient leaching,
• performance of proper stabilization methods to fit crop and soil needs,
• maintenance of proper vegetative cover on more sloping areas with runoff
potential, and
• proper coordination between application events and crop harvesting.

City of Monroe William Griffin Site NC-UN-32 — Fields 1- 5
WMSS Proiect No. 15-10
The results of the soil analysis for these fields, included in this report, indicate no gross
deficiencies in the fertility of these fields. By using standard agricultural practices for the
management of forage and crop production, the operator should see significant benefits from
the application of biosolids. In turn, these well -maintained fields should provide good
assimilation of the plant available nutrients contained in the biosolids and afford an
environmentally safe means of solids disposal and nutrient recycling.
Martin Mabe Rob Willcox, L.S.S.
Agronomist Soil Scientist
Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewal\Land Application Site Info\Site 32 - Danny
Baker\15-10 Soil Scientist - Agronomist Report Monroe -Danny Baker.doc

WILLCOX & MABE SOIL SOLUTIONS, PLLC ?n r loF 2
SITE/SOIL EVALUATION
Project No. /S — /0 Phone No.
Location G'! F /YpygyEPin
Date:
County: IIAJ16" Property Size
Proposed Facility: / /V/✓ ZE2 Water Supply: On -Site Well El Evaluation:
- — 0V— 3 / — S Community ❑
Described By: TO,6 VcLCD<< Public ❑
Weather: ' /i/A A4 Antecedent Moisture // ((JI C T Surface Water:
Auger Boring K
Pit
Cut ❑
FACTORS
PROFILE
#
PROFILE
Z
PROFILE
PROFILE
#
Landscape Position %
_ Z_4 26,
/0
Horizon Depth I
_
-
S
-
Color Munsell
S
S
2
Q 1�715
Texture
,
Structure
Z41C/
r
r
,.
Consistence
/? s
^
Boundary
Horizon Depth II
Al
(1- /Q
_
_
Color - Munsell
149w,-
LJZ !o
(o
Texture
,
S, G
Mottles
Structure
klrblt M,45
11/f t
die TRof r, ✓
At/) A&1 S'' v,P
Consistence
IC%
S F,
SS
s-s- S �.
_/s
Boundary
Cr
,
0-,-
Horizon Depth III
/ . 3
r7 _
. Z
/ S -
Color - Munsell
/z (o/�'
S b
Texture
;
c( S ��
S i /
Mottles
—
_
—
Structure
ry
r C
, ,/
S
Consistence
SS 5
S
S5 1
S
kle w
M. !
Boundary
Horizon Depth IVAR_
2
_
Color - Munsell
Z $(
Texture
G(
Mottles
_ 2. S R ilk
Structure
sby- ✓t-,S.
Consistence
SS SIP
c 9, S s
2 - f
Boundary
M-S�
Soil Wetness
y (
36
if
Restrictive Horizon
/1_ Cr
_ cr
3w'_ C,-
Saprolite
LTAR
Classification
W
N
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
Cv
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
Is
loamy sand
sl
sandy loam
I
loam
si
silt
sil
silt loam
sic]
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fir
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
in
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
p1
platy
pr
prismatic

WILLCOX & MABE SOIL SOLUTIONS, PLLC
SITE/SOIL EVALUATION
Project No. 15-16 Phone No. Date: 5/,?,? &
Location efiry OF County: IjAlloN Property Size
Proposed Facility: L,C Water Supply: On -Site Well ❑ Evaluation: Auger Boring
Described By:
Weather:
NC -(-ail%- 32- !-s Community ❑ Pit
Gihz l"o x Public ❑ Cut
N
Antecedent Moisture /Y1oI s 7- Surface Water: �
FACTORS
PROFILE
PROFILE
f
PROFILE
PROFILE
Landscape Position %
_
Horizon Depth I
Color Munsell
S
Texture
Structure
Consistence
S IL2 P,
Boundary
Horizon Depth II
_ 12
z715 _ 2
Color — Munsell
(r 4
Texture
Mottles
—
_ 41 2
Structure
,r
ke
Consistence
/13 fip
s '
Boundary
Horizon Depth III
/ —
Color — Munsell
C-
Texture
S
Mottles
7
Structure
Consistence
_W102 k, Ph,
Boundary
Horizon Depth IV
/ — Z S
Color — Munsell
S G
Texture
Mottles
-&>14 1ZG/11
Structure
a C
Consistence
5 '
2
Boundary
Soil Wetness
5#AI7- I
Restrictive Horizon
_ Cr-
Saprolite
LTAR
Classification
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
Cv
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
Is
loamy sand
sl
sandy loam
I
loam
si
silt
sil
silt loam
sicl
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fr
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
in
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
pl
platy
pr
prismatic

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SL037469
a�"M.rc"E1„ Heavy Metals Client: Danny Baker Advisor: Willcox & Mabe Soil Solutions
4P f�
Pender Packing Co, Inc. 1205 W Bessemer Ave Ste 202
z Soil Report Mehlich-3 Extraction 921 Scott Rd / 4520 Hwy 133 Greensboro, NC 27408
�'
o Rocky Point, NC 28457
Links to Helpful Information Sampled: 05/23/2018
Sampled County: Union
Received: 06/15/2018
Farm: Danny Baker NC-UN-32 Completed: 06/26/2018 Client ID: 259432 Advisor ID: 462496
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test
extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)-
4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and
note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus (P) is very high (P-I > 100), crops will not respond to additional P
applied. Tissue testing is advised where soil pH is elevated and is of concern as in samples found here. Ja athi Kamalakanthan 6/26/2018
Sample ID: 01
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1- Fescue/OGrass/Tim, M 1.8 120-200 0 0 0 0 0 0 0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 0 0 0 0 0 0 0 0
Note: 12
Test Results [units - W/V in glcrnr ; CEC and Na in meq/100 crrr3; NO3-N in mg/dm3]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N
0.56 1.01 8.5 61 3.3 5.3 64 110 37 18 90 450 287 287 77 77 139 0.3 4
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.4 Chromium, 0.2 Lead, 2.7 Selenium, 0.1
Sample ID: 02
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1- Fescue/OGrass/Tim, M 0.5 120-200 0 0 0 0 0 0 0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 0 0 0 0 0 0 0 0
Note: 12
Test Results [units - W/V in glcnr ; CEC and Na in megl100 crt3; NO3-N in mg/clnr ]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.56 1.02 7.6 75 1.9 5.8 63 114 47 20 40 512 324 324 63 63 156 0.2 3
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.4 Chromium, 0.1 Lead, 2.4 Selenium, 0.2
North Carolina
[A -
Tobacco Trust Fund Commission
Reprogramming of the laboratory -information -management system that makes this report possible is
beinq funded throuqh a qrant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
Steve Troxler, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SL037469
Danny Baker
Page 2 of 3
Sample ID: 03
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1- Fescue/OGrass/Tim, M 0.3 120-200 0
0
0 0
0
0
0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 0
0
0 0
0
0
0 0
Note: 12
Test Results [units - WIV in g/crrP; CEC and Na in meq/100 crrr3; NO3-N in mg/drrP]:
Soil Class:
Mineral
HM% WIV CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn-AI
Cu-I Na ESP
SS-1 NO3-N
1.02 0.91 12.3 82 2.2 5.9 318 279 54 16
48 922
570 570
302
302
384 0.1 1
Heavy Metals (parts per million): Arsenic, 0.3 Cadmium, 0.0
Nickel, 0.7
Chromium, 0.1
Lead,
5.8 Selenium,
0.1
Sample ID: 04
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tonslacre) N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1- Fescue/OGrass/Tim, M 1.5 120-200 0
0
0 0
0
0
0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 0
0
0 0
0
0
0 0
Note: 12
Test Results [units - W/V in g/crrP; CEC and Na in meq/100 crrr3; NO3-N in mgldm3]:
Soil Class:
Mineral
HM% WIV CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn-AI
Cu-I Na ESP
SS-1 NO3-N
0.71 0.98 7.2 63 2.7 5.3 69 85 45 11
42 249
166 166
58
58
85 0.1 1
Heavy Metals (parts per million): Arsenic, 0.3 Cadmium, 0.0
Nickel, 0.4
Chromium, 0.1
Lead,
4.6 Selenium,
0.2
Sample ID: 05
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1- Fescue/OGrass/Tim, M 0.0 120-200 60
0
0 0
0
0
0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 60
0
0 0
0
0
0 0
Note: 12
Test Results [units - WIV in g/cmP; CEC and Na in meq/100 crrr3; NO3-N in mg/do]:
Soil Class:
Mineral
HM% WIV CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn-AI
Cu-I Na ESP
SS-1 NO3-N
0.51 1.05 10.4 85 1.5 6.4 34 80 60 22
90 1835
1112 1112
74
74
120 0.3 3
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.3
Chromium, 0.1
Lead,
2.6 Selenium,
0.3

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SLO37469
Danny Baker
Page 3 of 3
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at on
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-AI2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-I
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients. In general, homeowners do not
M-0
N
mineral -organic soil class
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
nitrogen
sodium
ncaqr.qov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagrgoy_/a rq onomi/obpart4.htm_Wind information that
P-I
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
W/V
weight per volume
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
zinc availability index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-Al2, Zn-I, Zn-AI, Cud, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncac]rc]ov/agronomi/uyrst.htm

-- Waypoint,
ANALYTICAL
6/25/2018
Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield, NC, 27358
Ref: Analytical Testing
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number: 18-166-0203
Project Description: Danny Baker
Waypoint Analytical Virginia, Inc. received sample(s) on 6/15/2018 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
P'i. OW 6-7�
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Arizona AZ0629 New Jersey VA011 Pennsylvania 68-03109 Virginia 460014
Florida E871087 North Carolina 257 South Carolina 93007
s

Waypointo
ANALYTICAL
Client: Willcox & Mabe Soil Solutions, PLLC
Project: Danny Baker
Lab Report Number: 18-166-0203
Date: 6/25/2018
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Solids Total Mercury Analysis - CVAA Method SW-7471 B
Sample 61187
Analyte: Hg
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration >25X the MQL. Dilution test exceeded method
limits. Matrix interference is suspected.
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration < 25X the MQL. Post Digestion Spike exceeded
method limits. Matrix interference is suspected.

Report Number
18-166-0203
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Danny Baker
Lab Number: 61192
Sample Id : 01
Analysis
Waypoint(D
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Result Limit
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Method
Mercury, mg/Kg <0.400 0.400 SW-7471 B
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
Pcwfir- In loorlr
Date and Time
Test Started Analyst
06/22/201813:09 MMT
Pauric McGroary

Report Number
18-166-0203
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Danny Baker
Lab Number: 61193
Sample Id : 02
Analysis
Mercury, mg/Kg
Method Reference:
Waypoint(D
ANALYTICAL
REPORT OF ANALYSIS
Result
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Quantitation
Limit Method
<0.400 0.400 SW-7471 B
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
Date and Time
Test Started Analyst
06/22/201813:11 MMT
Pauric McGroary

Report Number
18-166-0203
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Danny Baker
Lab Number: 61194
Sample Id : 03
Waypoi t..
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Analysis Result Limit
Mercury, mg/Kg <0.400 0A00
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Purchase Order
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled
Method
SW-7471 B
pwir, m` 1�G
Date and Time
Test Started Analyst
06/22/201813:14 MMT
Pauric McGroary

Report Number
18-166-0203
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Danny Baker
Lab Number: 61195
Sample Id : 04
Analysis
Waypoi nt .0
ANALYTICAL
REPORT OF ANALYSIS
Result
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Quantitation
Limit Method
Mercury , mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
SW-7471 B
pofir' #1 C 100rf
Date and Time
Test Started Analyst
06/22/201813:16 MMT
Pauric McGroary

Report Number
18-166-0203
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Danny Baker
Lab Number: 61196
Sample Id : 05
Waypoi nt
(D
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Analysis Result Limit
Mercury , mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Date and Time
Method Test Started Analyst
SW-7471 B 06/22/2018 13:18 MMT
pofie. #1 C 104JIr"
Pauric McGroary

Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 08361
Customer Name: Willcox & Mabe Soil Solutions, PLLC
Report Number: 18-166-0203
Shipping Method
0 Fed Ex 0 US Postal 0 Lab
C-1 UPS 0 Client Courier
Other
Thermometer ID: I
Shipping container/cooler uncompromised?
Yes
No
Number of coolers received
1
Custody seals intact on shipping container/cooler?
0 Yes
0 No Not Required
Custody seals intact on sample bottles?
n Yes
0 No Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
0 Yes
0 No
COC properly completed
0 Yes
0 No
Samples in proper containers? 0 Yes 0 No
Sample containers intact? 0 Yes No
Sufficient sample volume for indicated test(s)? 0 Yes 0 No
All samples received within holding time?
Cooler temperature in compliance?
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Water - Sample containers properly preserved
Water - VOA vials free of headspace
Trip Blanks received with VOAs
Soil VOA method 5035 — compliance criteria met
High concentration container (48 hr)
High concentration pre -weighed (methanol -14 d
Special precautions or instructions included?
Comments:
0 Yes 0 No
Yes 0 No
�i Yes No
Yes 0 No N/A
i Yes 0 No N/A
0 Yes ) No N/A
0 Yes ;J No N/A
Low concentration EnCore samplers (48 hr)
Low conc pre -weighed vials (Sod Bis -14 d)
Yes 0 No
Signature: jBrandi Watson I Date & Time: 06/15/2018 12:46:04

Waypo�nt0
Ar�n�vTlca�
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfield NC
27358
Comments: City of Monroe
A
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401°Fax [phone]
www.waypointanalytical.com
1/1
Grower Information
Grower Name: Danny Baker
Address:
Farm: NC-UN-32
Field:
Additional
Email:
5

APPENDIX XV
Modification / New Site
TED FUNDERBURK (NC-UN-33) (Field 1)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(NRCS Soil Survey Map)
(Buffer/Setback Map)
SOILS AND AGRONOMIC EVALUATION

TED FUNDERBURK (NC-UN-33) (Field 1)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)

State of North Carolina
IDWRDepartment 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 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 lancjpwner or his representbive her9by permits:
Applicant's
��
hereinafter referred to as the Permittee, to land apply residuals from the following facility(i6s) 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)
NC. uk - 33 - !
/v u
FE5Cu F
4477ZZ `6CD
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to�ermittee to land apply residuals to the land application site(s) as specified
herein. � // / ____7 I , .
Landowner
Address:
City: ���C+-3 State:
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that Lef�/� lir� %heoaloY� �7l Y�C/>o�-�u
personally appeared before me this day and acknowledged the due execution of the forgoing instruiji
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
20
b
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date:
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Dkision of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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. Faihure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwisenoted. 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
----maintained as part of project sites) in accordance with 15A NCAC 02T .1108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-14
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought
❑ Any other setbacks required by 15A NCAC 02T .1108 other than those referenced above, cannot be waived through
execution of this agreement
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T 11 08(b)(Zx6abitable residences)
The undersigned Dronerty awnpr i.p., h-
Applicant's
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (Le., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: off - ,F C
City: 1V QY1&C State: IV • �- Zip: _�i CP Id
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
7days ' advance, modifies or cancels this Agreement.
certify that I am a deeded property owner of above -referenced and am a
property on behalf of other deeded �°�Y authorized to make decisions regarding this
property
prol�h' owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: JO'P d jn ► f 1 i�
Date: � / A
FORM: SWA 06-16
Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
_maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108 other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
Iheunden
Applicant's
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (Le., cannot be less than 100 feet) of
the residence or place of public assembly locateWof
Location address of property:
City: StatZip:
Thi*Agreementsball remain in effect for thision of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
da s in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding
g g this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name:
Signature:
Date:
FORM: SWA 06-16 Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Divislon of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 uiformation, visit the Water Quality Permitting Section's Non -Discharge Perm! n Unit
General - This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
_maintained as part of project sites) in accordance with 15A NCAC 02T .l 108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLA.P 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought
❑ Any other setbacks required by 15A NCAC 02T 1108 other than those referenced above, cannot be waived through
execution of this agreement
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(babitabie residences)
The undersigned p owner hereby
Applicant's nam /1Z
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet i.
the residence or place of public assembly located at the following: (e'' cannot be less than 100 feet) of
Location address of property. 1'En Jlr
city: --M o t\c-oE State: K'- Zip: - c9 46 l 1 a
This Agreement shall remain in effect for the length of the Division of Water Resources'
lead application (Division) permit for the residuals
pp program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement,
[� I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission too�the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: l,\ r:s-\t, D he,, + (�-1 zcc b _z ky,
f
Signature:����
FORM: SWA 06-16
Page I of I

State of North Carolina
DWK
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .l 108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RI.AP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner herebypyrmits:
Applicant's name:
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be Jess than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: - 1'1 4 0- . -Q ;��t- CIA r 1j
City: State: NC Zip: 22 1l '
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
f I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: 1 ► 1 C- "r=
Signature:
FORM: SWA 06-16
Date: q - Gy - t o
Page I of I

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General - This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The unders
Applicant's
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 1 11� 8 1 "l/ b(,Ll1A_ C kc._ r,_k Rd,
City: / V t O 0 r J -e- State: N � C . Zip: --7$ / / -2-
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
Ej-f-certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: -vim f- vo VL �- s-t-�I I I ki q T
Signature:X . _
Date: 4 '-.2-L~ -/ F
FORM: SWA 06-16 Page 1 of 1

TED FUNDERBURK (NC-UN-33) (Field 1)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)
I
I

I

_ •_ r • j J n.6i? i �
l_` !`\ . -_ -. • �:r is
o
t � ,
we
y nu
rwer , , �� ,•
o
. r "
JI j �615Smy
�., 4
FIELD NC-UN-33-1 71q
• .his �/ �� ` J \\\ r
t Kl—
REFERENCE:
CIS DATA LAYERS WERE OBTAINED FROM ESRL INC. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL. OR ANY OTHER USES. THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE ORANYACTIONS TAKEN BYTHE USER BASED UPON THIS INFORMATION �i ` Field Boundary
Copyright 2013 Nationale
SCALE 1 = 2,000 TED FUNDERBURK FARM FIGURE NO
iDATE 05-30-18 �Ih & � NC-UN-33 FIELD 1 2
DRAWN BY MEM
PROJECTNO SOIL SOLU TIONS USGS TOPOGRAPHY MAP
15-10 Ph:02 UNION COUNTY, NORTH CAROLINA

BdB2
-
t
w
'c fi�By
?
^�
P
A
SOILS LEGEND ,
CmB - Cid channery silt loam, 1-5%slope
TaB - Tarrus gravelly silt loam, 2-8% slope
Tb132 - Tarrus gravelly silty clay loam, 2-8%slope
REFERENCE:
Hand Auger Boring
2
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
f
PURPOSES ONLY IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES. THERE ARE NO
Field Boundary
0
GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION. Q
NRCS Soils Boundary
SCALE
1 = aoo
TED FUNDERBURK FARM
FIGURE '
Dnre 05-30-18
�IhX$ciil�
NC-UN-33 FIELD 1
3
DRAWN BY MEM
SOIL SOLUTIONS
NRCS SOILS MAP
PROJECT NO
15-10 Ph:02
UNION COUNTY. NORTH CAROLINA

REVIEW BOUNDARY shall be established around each land application site
midway between the Compliance Boundary and the perimeter of the
residuals land application area.
COMPLIANCE BOUNDARY: The Compliance Boundary for each land application site
is established at either 250 feet from the residuals land application area or 50 feet
within the property boundary, whichever is closest to the residual land application area.
FIELD TOTAL ACRES BUFFERED ACRES NET ACRES
NC-UN-33-1 9.6 4,6 5.0
N
A
�
T,��t;"!►�Xr
easy 4k v Ii �? a:. r. �` r •� t �; - 1! w%i. f._ `. " i
67
■l �'- -dd ��5�a,. •+�If-� s7" � s . jis,�� `-T .�. a� # - ;�'; .'� y��
�:fii� � ,, �rr`�R� � � .il�' i f .;� A ti•ff��, f f.
s�►.�B'•
All
�y t
::. ---may.
� +� , ` 4� �¢ ate Tuop• a erp'�rxgi�, �it� ..
FIELD NC-UN-33-1• ■,, 4„�,,-: •
.� q
f r!
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC PLEASE NOTE THIS MAP IS FOR INFORMATIONAL •
PURPOSES ONLY IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION
SCALE 1 = 400
TED FUNDERBUI
DATE 05-30-18 �p NC-UN-33 FIE
DRAWN BY ME M WI11COX`Q, ' r-'"abe
PROJECT NO SO' . SOLUTIONS BUFFER MAP
15-10 Ph:02 UNION COUNTY. NORTH
• Well
Structure
■ Dwelling m
Access Road

TED FUNDERBURK (NC-UN-33) (Field 1)
SOILS AND AGRONOMIC EVALUATION
1

CITY OF MONROE
TED FUNDERBURK SITE (NC-UN-33) — FIELD 1
SOILS AND AGRONOMIC EVALUATION
The Ted Funderburk Site NC-UN-33 — Field 1 is located on the north and south side of Mt.
Pleasant Church Road in Union County, N.C. The surrounding area is primarily
predominantly rural.
IField 1 is currently established with Fescue for hay production and /or pasture. The
topography over the field ranges from 2 to 6 %. Buffer requirements as required by 15A
NCAC 02T.1108 for setbacks will need to be adhered to and will reduce the useable acreage
in these fields. Refer to "Buffer Maps" for specific buffer/setback requirements and acreage
totals.
' A field investigation was conducted by a WMSS agronomist and soil scientist on May 22,
2018. Preliminary soils information for this site was obtained from the United States
Department of Agriculture (USDA) Natural Resources Conservation Service (MRCS) Web
Soil Survey (WSS). A WMSS licensed soil scientist advanced hand auger borings on the
proposed fields to characterize the proposed application sites (hand auger boring locations
are indicated on Figure 3 — NRCS Soils Map). Soil profile descriptions were performed
within the proposed fields and indicated the fields as suitable according to the criteria
outlined in 15A NCAC 02T .1104(c) (2). The predominant soil series associated with Field
' 1 is most similar to the Tarrus series (Fine, kaolinitic, thermic Kanhapludults). Soil profile
description sheets are contained within this section of the application indicating the
predominant soil series identified within Field 1.
Both the soils and the crops should be able to assimilate the proposed loadings of liquids,
solids, nitrogen, phosphorus, heavy metals, and salts known to be in the biosolids. This
' assessment is based on the residual analysis provided, the planned application rate, proper
crop management guidelines and adherence to permit requirements. Soil pH for mineral
soils should be maintained above 6.0 and at levels to ensure optimal crop production.
' Nitrogen is considered the most limiting characteristic of these residuals, however soil tests
should be reviewed annually to identify any changes in the nutrient status of the soil.
Management practices should be evaluated prior to each application to account for changes
in the proposed land use objectives. Crop management guidelines that will be of importance
for this site will be:
• timing of application events with plant nutritional needs and periods of plant
dormancy,
• split application to prevent hydraulic overloading or nutrient leaching,
• performance of proper stabilization methods to fit crop and soil needs,
• maintenance of proper vegetative cover on more sloping areas with runoff
potential, and
• proper coordination between application events and crop harvesting.

City of Monroe Ted Funderburk Site NC-UN-33 — Field 1
WMSS Project No. 15-10
The results of the soil analysis for these fields, included in this report, indicate no gross
deficiencies in the fertility of these fields. By using standard agricultural practices for the
management of forage and crop production, the operator should see significant benefits from
the application of biosolids. In turn, these well -maintained fields should provide good
assimilation of the plant available nutrients contained in the biosolids and afford an
environmentally safe means of solids disposal and nutrient recycling.
SOIL SC,
WILLCO
Al� P�&IJZ'�4
Martin Mabe Rob Willcox, L.S.S.
' Agronomist Soil Scientist
' Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewal\Land Application Site Info\Site 33 -Ted
Funderburk\15-10 Soil Scientist - Agronomist Report Monroe -Ted Funderburk.doc
I
H

WILLCOX & MABE SOIL SOLUTIONS, PLLC
SITE/SOIL EVALUATION
1
I
Project No.
Location
/5 -16 Phone No.
/T4 Gf MdiN�Df Pin
Proposed Facility: 66,0 Water Suppl,
h"-494133_0 /
Described By: /_U/j 0"ueo+e
Weather: Ski ' Lj/,jj Antecedent Moisture
County:
Date: _ s— 2 2 !�
Z/r(/D/ ,- Property Size
On -Site Well ❑ Evaluation:
Community ❑
Public ❑
i)")'Ol'T Surface Water:
Auger Boring
Pit ❑
Cut /a/if- ❑
FACTORS
PROFILE
PROFILE
PROFILE
PROFILE
Landscape Position %
Z_ %
Horizon Depth I
Color Munsell
Texture
Structure
a t'
Consistence
Boundary
Horizon Depth II
Color — Munsell
$
Texture
Mottles
—
Structure
S
Consistence
'
Boundary
Horizon Depth III
Color — Munsell
2 S
Texture
/ C
Mottles
Structure
Consistence
S S
Boundary
Horizon Depth IV
Color — Munsell
Texture
/
Mottles
Structure
Consistence
Boundary
Soil Wetness
7 ��
Restrictive Horizon
!Cr rr _ C
Saprolite
LTAR
Classification
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
Cv
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
Is
loamy sand
sl
sandy loam
I
loam
si
silt
A
silt loam
sicl
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fr
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
m
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
pl
platy
pr
prismatic

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SL037470
Pv�,�t.ukt o4 Heavy Metals Client: Willcox & Mabe Soil Solutions Advisor:
_ _ — 1• 1205 W Bessemer Ave Ste 202
i
Soil Report Mehlich-3 Extraction Greensboro, NC 27408
Links to Helpful Information Sam led: 05/23/2018 Sampled County : Union
p
Received: 06/15/2018
Farm: Ted Funderburk NC -UN 33 Completed: 06/26/2018 Client ID: 462496
Advisor ID:
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results.
Using Mehlich 3 as a soil test
extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)-
4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant
growth, continue to monitor these and
note where elevated above background levels. Note any lime and fertilizer recommendations. Ja athi Kamalakanthan 6/26/2018
Sample ID: 01
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn
Cu B
Information
Lime History:
1 - Fescue/OGrass[Tim, M 1.6 120-200 50 80 0 0 0 0
0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 50 80 0 0 0 0
0 0
Note: 12
Test Results [units - W/V in g/crr>3; CEC and Na in meq/100 cnt ; NO3-N in mg/drrti3]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI
Cu-I Na ESP SS-1 NO3-N
0.36 1.08 5.0 52 2.4 4.8 36 27 34 16 34 114 85 85 31 31
29 0.1 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.2 Lead,
5.9 Selenium, 0.2
North Carolina
�a \
Tobacco Trust Fund Commission
Reprogramming of the laboratory -information -management system that makes this report possible is
beinq funded through a qrant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
Steve Troxler, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SL037470
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at onE
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-Al2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-n- I
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
N
mineral -organic soil class
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
nitrogen
sodium
ncagr.gov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagr gov/agronomi/obpart4.htrr>t sfind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
W/V
weight per volume
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
zinc availability index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-Al2, Zn-I, Zn-Al, Cu-I, S-I, SS-1, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaprCloy/agronomi/uyrst.htm

waypoint(D
ANALYTICAL
6/25/2018
Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield, NC, 27358
Ref: Analytical Testing
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number: 18-166-0201
Project Description: Ted Funderburk
Waypoint Analytical Virginia, Inc. received sample(s) on 6/15/2018 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
? , - A 7-
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Arizona AZ0629 New Jersey VA011 Pennsylvania 68-03109 Virginia 460014
Florida E871087 North Carolina 257 South Carolina 93007
O

Waypointo
ANALYTICAL
Client: Willcox & Mabe Soil Solutions, PLLC
Project: Ted Funderburk
Lab Report Number: 18-166-0201
Date: 6/25/2018
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Solids Total Mercury Analysis - CVAA Method SW-7471B
Sample 61187
Analyte: Hg
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration >25X the MQL. Dilution test exceeded method
limits. Matrix interference is suspected.
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration < 25X the MQL. Post Digestion Spike exceeded
method limits. Matrix interference is suspected.
I

Report Number
18-166-0201
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Ted Funderburk
Lab Number: 61188
Sample Id : 01
Waypoint.,(D
ANALYTICAL
REPORT OFANALYSIS
Quantitation
Analysis Result Limit
Mercury, mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled
Method
SW-7471 B
Pcwfi4 #1 C 1011rf
Date and Time
Test Started Analyst
06/22/201812:55 MMT
Pauric McGroary

Ij
1
Waypdlent(D
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 08361
Customer Name: Willcox & Mabe Soil Solutions, PLLC
Report Number: 18-166-0201
Shipping Method
0 Fed Ex 0 US Postal 0 Lab
0 UPS 0 Client 0 Courier
Other
Thermometer ID:
Shipping container/cooler uncompromised?
Yes
No
Number of coolers received
F 1
Custody seals intact on shipping container/cooler?
Yes
0 No
Not Required
Custody seals intact on sample bottles?
Yes
0 No
Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
9 Yes
0 No
COC properly completed
0 Yes
0 No
Samples in proper containers?
0 Yes
0 No
Sample containers intact?
0 Yes
0 No
Sufficient sample volume for indicated test(s)?
` Yes
0 No
All samples received within holding time?
0 Yes
0 No
Cooler temperature in compliance?
Yes
17) No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
j Yes
No
Water - Sample containers properly preserved
0 Yes
0 No
N/A
Water - VOA vials free of headspace
CJ Yes
0 No
N/A
Trip Blanks received with VOAs
�� Yes
No
0 N/A
Soil VOA method 5035 — compliance criteria met
Yes
No
N/A
High concentration container (48 hr)
High concentration pre -weighed (methanol -14 d)
Low concentration EnCore samplers (48 hr)
Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included?
Comments:
Yes 0 No
Signature: jBrandi Watson Date & Time: 06/15/2018 12:43:44

Waypoint
ANALYTICAL
111111111111111111111111111 IN III
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfield NC
273S8
Comments: City of Monroe
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Grower Information
Grower Name: Ted Funderburk
Address:
Farm: NC-UN-33
Field:
Additional
Email:
0
Qd
v
u
o
Additional
Intended
Intended
Alternat
,Alternat
Prey
Sample ID
SI N1
S2N1
B
Cu
Fe
NI
Na
S
7.n
S3N1
cn
U
A
e
Tests
Crop
Crop
Crop
Crop
Crop
H
;G
Code
field
Code
Vieltl
I01 _1Lj Lj_LjJL-1LU�LLU1_LJ I L-1I L-j1 �--�.1L—jLLLL-i LjjU Mercun
In

AD-13 (March 2010) SOIL SAMPLE INFORMATION - HEAVY METALS
SAMPLE TYPE
Heavy Metals Test ($25 per sample) NCDA&CS Agronomic Division Soil Testing Section
for regulated sites only — Mailing Address: 1040 Mail Service Center, Raleigh NC 27699-1040
not applicable for homeowners ! Physical Address (UPS/FedEx): 4300 Reedy Creek Road, Raleigh NC 27607
Submit samples April 1—Dec 15 only. Phone: [phone] Web Address: www.ncagr.gov/agronomi
SAMPLE INFORMATION PAYMENT GROWER INFORMATION (please print)
FOR OFFICE USE ONLY
REPORT #
DATE REC'D
INITIAL
CONSULTANT/OTHER RECIPIENT
FARM ID
FEE TOTAL 25.00
LAST NAME FIRST NAME
LAST NAME FIRST NAME
Ted Funderburk
AMT PAID
Funderburk Ted
Willcox & Mabe Soil Solutions, PLLC
NC-UN-33
METHOD OF PAYMENT
( ) CASH
ADDRESS
--------------------------------
ADDRESS
7231 B Summerfield Road
---------------------------
SAMPLE DATE
May 23, 2018
( X CHECK
(payable to NCDA&CS)
( ) MONEY ORDER
COUNTY (where collected)
CITY STATE ZIP
CITY STATE ZIP
Summerfield
Union
( ) ESCROW (provide
NC 2735�
PHONE
PHONE
account name below)
(___) ___ _
----
(336_) 339 _ 9128
NUMBER OF SAMPLES
CK# 1300
_
E-MAIL ADDRESS LX Do Not notify me when report is [e-mail]
AIL ADDRESS ❑ Do Not notify me when report is available.
1
LAB NUMBER
(Leave blank)
SAMPLE
IDENTIFICATION
LIME APPLIED WITHIN
PAST 12 MONTHS
Tons/Acre Month Year
You must specify a crop CODE to receive a recommendation (see reverse side of form)
FIRST CROP
CODE
SECOND CROP
CODE
1
01
Fescue
055
Fescue
055
2
3
4
5
6
7
8
9
10
11
12
Thank you for using agronomic services to niancrge nutrient.~ and safeguard environmental quality. — Steve Troxler, Commissioner of'Agriculture

1
I
Waypoint
ANALYTICAL
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfield NC
27358
Comments: City of Monroe
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Grower Information
Grower Name: Ted Funderburk
Address:
Farm: NC-UN-33
Field:
Additional
Email:
.°'
a �
'9
�:
m
�
o
"Additional
Intended
Intended
Alternate
Alternate
Prev
Sample ID
p
S1 M
S2M
B
Cu
FeMnNa
S
Zn
S3M
,., A
H
�j
�'
Tests
Crop
Crop
Crop
Crop
Crop
rn
H
Code
Yield
Code
Yield
O1 __
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
Mercury
-
---
I —

APPENDIX XVI
Modification / New Site
CALVIN FUNDERBURK (NC-UN-34) (Fields 1, 2 and 3)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: S WA 06-16)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)
SOILS AND AGRONOMIC EVALUATION

CALVIN FUNDERBURK (NC-UN-34) (Fields 1, 2 and 3)
LANDOWNER AGREEMENTS/SETBACK WAIVER AGREEMENTS
(FORM: LOA 06-16)
(FORM: SWA 06-16)
1

DWR
Division of Water Resources
��cn1 f or✓ 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 .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:
_ r
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC- CAN-,34-
64zc ke o
A/C- uN- 34- - 2
iUo
F.j cut
44rn4r-
NC-uiv- 34 - 3
My
),�.s euE
6+rra- 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.

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

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: Irf"uf tii✓� '�a�'.
Address:
City: 46✓4>-e State: Zip: 2 51 2-
Phone: `U,-t 7/, 'j � Y(o 5 — E-mail
`Y -- L 3- 2,&I '
NORTH CAROLINA,
COUNTY
I, the undersigned Notary Public do hereby certify that &112i fv
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of Pre t L 20
Signature and seal: i
z.
My commission expires:
Lessee's/Operator's Certification:
/I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
-Lessee/operator name: a�F-CN2fer h"
Address: l 71 Y 1�c .z�f/Q4 s�.w�
City: State: Zip:�'�/
Phone: ��, `f -�-'i7 227 E-mail address: lZ).+L
Signature: %;�/C�,.� 4Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing off
ISignature:
' FORM: LOA 06-16 Page 3 of 3

DWR
S<- tt
a
State of North Carolina
�� DF 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 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 .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed 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:
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)
NC 4)N-34 -2
/U
�Escuta
1-4.077Zer fEtO
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.

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement-
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuaWsoil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .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
c9mpliance boundary to the application package)
A re -defined compliance boundary is not needed for this site_
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
boundary and attach a map showing the newly proposed
❑ 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 oroeram:
(Name of the new program)

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: /5L l,%,-, y zi/2 Ecl �oPr r d
Address: / Z/� 1'4' 0,«f �`�4S�fvf �'�u✓!.� v�
City: k4 e ^1f o e State:
Phone:
Signatu
Zip: Z Z11 2--
E-mail address: ?`2,1n �2,Lj"Zr' . eyr✓1
Date:
NORTH CAROLINA, 0 A.)) tv --) COUNTY
I, the undersigned Notary Public do hereby certify that _:5,,7-//�!V�V
�NtipS2 �urLh
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the L'
day of
120
4,w
3ignaLure anu seai: w
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
`/Lessee/operator name: C<6`4� F, ieLy f�"h
Address: !7/s4,Y,f
City: % 24,-V 1 a State: /v, ( Zip: 2 S-112—
Phone: 7015� - Z7�/c, 7 E-mail address: (" �"11.✓� +/�,��e/-,FG,i(r/�7�a.1 . [ .�
Signature: _ _ G �ne� ..G Date: i 15 � 5?�
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
P.E. W
Date: 7' 2 L1 • t., V
FORM: LOA 06-16 Page 3 of 3

1
DWR
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:
hereinafter
application
Agreement:
referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
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)
Ale-U,V,34
SI aE
elt-Me Fr4-o
NC-1W, 34-Z
AJ,0
s�esc4E
e mk �Eo
A16-UN-34-3
AL,
A�rcifE
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 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.
U. 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.
IMALTERNATIVES 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
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
boundary and attach a map showing the newly proposed
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: ,��Q�� �✓ ����� if
Address: P--7`40" 91 wl . 10L h A SA IV T_ l A, IPA �
City: State: AV C_ Zip: II Z—
Phone: E-mail address: "i;Gr�i n L13 �A i/ czL'o.�t
Signature LZ2 Date: S�
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that U&,,A215 /N£ODORL c(.rJ�r2.gtJ2K
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
^ it
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
20 '
e�
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: (!�' -(;z f"' 64& 6 r4.&
Address:
City: PIC) lae State: A!/Ic Zip: ��r((��2
Phone: �I U y" l D 71 E-mail address: c� 6. fft'D (C%I a/Qr I� �i> rc
Signature:f�,�-� a' Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: &;sseW. CO
Signature:
Date:
FORM: LOA 06-16 Page 3 of 3

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 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 .I 100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-14
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:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., 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)
/�
No
r
Aesct�F
//J�
6MJ- /7eEP
rvc- 041, 4-2-
N&
scuff
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.

1. STIPULATIONS:
L 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 time shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
11. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuaWsoil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .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
compliance boundary to the application package)
and attach a map showing the newly proposed
❑ 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)

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: M ��t�r /1L[—�{� �� dr �j ��E O'I --
Address: % /'-/ %i®� .c; P'6��c� us✓f ��t�.r �'. 2 c ���
City:_ cj /V D e State: )V1 l Zip: Srl/ 2—
Phone: 7/1 y y^% —/�� Z E-mail address:' a,l alarc
Signature: `�� � Date: Y2 y ZolS�
NORTH CAROLINA, 411L/'%.;/ COUNTY
I, the undersigned Notary Public do hereby certify that 01 LL. I A r— C A L tJ, tit r—,u .✓ -b Qt 2 u R F�,
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:/
Lessee's/Operator's Certification:
, 20 1
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
`/Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: R G. Colba P.E. Water Resources Director
Signature: Date: "
FORM: LOA 06-16 Page 3 of 3

"Ifir.
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA W16
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 ApDlicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Qualify Permitting Section's Non -Discharge Permitting Una
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. N 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: 677i 0 jr 1110WA E-
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
SitdField ID
Lease
(yestuo)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilltover-seed/
pasture)
,dUti- 34 -- /
Ale)
iEsCur
Am - AE- "
The landowner or his representative receives, in consideration, fall 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.

. STIPULATIONS:
1- The landowner or his mpresentarive 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 sites) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the berms and conditions of this Agreement
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application sites).
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 PcnniUee 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 sites).
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 Permitter, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terns and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement
IL 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 sit(s) during active use and for the 12-month period following a residuals landapplication event Such controls may include the
posting of signs that indicatte the activities being conducted at the land application sites).
2. Animals shall not be grazed on the land application sites) 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, feted 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
IILALTERNAM%S 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, helshe is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of ft new program)

L.andowner'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, aclmowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landown
Address:
City: -M a 1 /i rgJ State: IV C --- Zip:
Phone: q- 9Y 10 52 E-mail address:
Signature:
Date: 4U — /, / 9'
NORTH CAROLINA, 144 f 142/2 COUNTY
I, the undersigned Notary Public do hereby certify that T A N ,y F
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the 1
day of — u rJ
Signature and seal: —
My commission expires: ay- 3
L.essee's/Operator's Certification:
tr
/I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
J Lessee/operator name: _ _ (�/ "V%u 144 �+ �-i� ✓/�v �',�� �r lL
Address: 1 z !e a ",IL
City: / M U lvl \ 2 P State: /V: Li Zip: � 11
Phone: (�Sj=? Za E-mail address: 2�""&4z al-4- Z I—IZ14, /. ey`�j i
Signature:�C Date: /
T /'lefts �Cv�
��CtM.r u
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: ;�>' 2-111-1

o �
A +g �, of3�'� a
ffi w d ^oaZ :oc o °��.�' � •boa
zu
01
o�C yad � •moo o• v � �N � � �� '� .=: � a
y 'O i R7
A O W
as a .°''fl
'p H
• cr
4 0 h ON I:: j3 O Cn ' G
,a I �, ' 't7 � O � :'0 •�
• � �gg'
a..9
Q .+.13
... a w
1.3
.b L
09
400
w 'ti7 O Cy y >,,O ctl +3 C40
r.
y L
a
b a
d
a �C
a�
O
U
n
C
L
o
U
a o

(=Mojd MOO ag;3o OWN)
d Mau atp o;u!
pau4s=4 Pne tuejSojd uopolidde PalP!saj pa111mr2d (lsnolnajd atp wog panoauaa aq (s)plag atp TM Sttgsanbaj sI aqs fag `;aawaaaSe
snp StnuSls ,Cq ;etp aSPalMoatiae dgamq aauMo Pllel o%L ' 'OM jag =M I!u=d =wejSaW uogsogdde Puel sfmPl=
jagloue mpun p2ppmd Spmum s! -C[I (s)pla3 uo=lldde Pal oqt ❑
(Mmu A Z133SNVNI GTMA AO J.N31w1t3 G3'IMON}IOV -Al
joi palsa au ;ou sl kmpunoq aauslldwoo PaugaP-m N ❑
(aftioed uowatidda oq; of Ampunoq aoasgdwoo
pasodojd Clmau atp Suln+ags dsw s qot i;e Pue kmpunoq aane,tdatat atp 3o not
mool-aj pa;sanbaa aq; aql aleuogw aq; apniotn amid)
:QI (s)PIa3 jo3 popaau si kmpunoq ooamildwoo paugop-w V ❑
:2aiMoilo3 aq; 3o aao iljem amid ,Saeptmoq aauelldtuoo patls►Igev;o-,CImou otp;e ma oq use spaspusys ja;empunoa alp papinoid faUpunoq
aoue!idwoo mp jo apts;no pa;etgts s! Aam fqddtts ja;eM otp ;etp guns `ease issods►p awm mp of msolo paosid oq of kmpunoq oouegdwoo
atp smoke (4)Solo' JZO :)VDN ` 51 `ianamoH *Amq moq aouegdwoo aq; ultptm s112M [4ddns jaTem suglgojd (P)LOIO- -IZO OVDN VgI
(auo ilaaga amgd)=AHVGf4aOg 813NVrTjWOZ) 3> U:I(HSNI STI3M A'Iddf1S Ha LVM HOA S3AI.LVNH3.L'IV'II1
•;uana uo!m!ldde Fuel slenplsai s Su!mo[lo3 Poly ipuow-ZI a jol PaV2ASeq aq;ou llegs pa!idde = slenp!= amgm pus[ uo nmoa _jm L 'L
'llos atp o;ul uoneaodjoout o; JO!Jd stpuow mo; ustp ssa[ jo; aotgans pus[ atp uo ulautaj slsnp!sw otp uagM;uana uoneotidde
puei sienplsaj s Su!molio3 Popad gluom-8£ a jo.3 PalsaAjeq oq ;ou llugs Puvl otp 3o anjim lip Molaq n and pa;sa&wq tplm scion poo3 '9
•Iios aql olut uonejodjoou[ of loud raSaol jo stpuom anol j% omglm puss aig uo uteu=j s[enptsw atp uagm;nana uoyeagdde
puei sisnp►saa a Smmoflo3 Pound tpuout-OZ B jo3 paysan oq lou llegs puel aql 3o aotgms atp molaq swt d pm=Amq qpm scion pood "S
-ivana uogeagdde puvl sismtsat a Su►mollo3 pound tpuow
-y I E 103 palsaAnq aq iou lfegs ads Punt atp anoge f4pn ; aje pus ampgw Ilos/sisnpisw otp gano; gem sated Pa;sanjsq gilts sdom poo3 •iy
-;ulna uoneogdde pus[ sienp►= E 2uuMollo3 Pound rCsp-O£ 8 lo3 pa;.sanjeq aqIOU i►egs sdon jagg pus °sdom pmj `sdaa pool '£
s;uma uonaogdde
puef sienplsaj inns jags sp%md asatp Sulmp swans ;uanajd of porn aq tilts legs Sulaual "ieq [legs Swna jo3 posn aq of ate wM sous
uonto!Idde purl 7uana uor dde Punt sleRPlsm B SulMotlo3 poltad keP'O£ a jo3 Est uogm!ld& Fuel mp uo p=w2 aq;ou [legs slewluV "Z
aoneolidde puss aq; >ve payonpttoa Staaq sanunas aq; a .put wsuSls jo Supsod
atp apnfoul 4mu sioj;uoo ganS -juana uoptldP�f Steep= s SmMollo3 PopW gin�-ZI agi jo3 pue asn anq:re $temp (s)2m uoneogdde
Pal ail o; ssaoae otignd Iognoo of an aasatdW stq jo jaunmopuel atp jo/pus =UW=d 21P Cq uaj% aq ;snw smnmw o1updojddV '1
:SNOLL31ais" 'I1
-;uawaajgv sup 10 uoneuluual jags stpum ZI PUB 10 ULM
atp Suunp saldwes I!os jo `ja;empunw8 ]ajeM aasyas `a;etiaeal 6lessaoau a7ie; �nujatl atp3o saon!puoo pue sum; otp japun idmi aq ysnw wEp
spjooat (ae ,Cdoa !1?wjad atp Aq pannllaj se (s)mis uopeagdde pull otp jeau ao uo sa!3II!nj Suuoi!uow gslige;sa Naiad otp tptun aotjegdwoo
Sululmja;ap 3o osodjnd atp jo3 awn olgeuosm ,Cue le (s)oats uogeagdde puel otp o; polgw jo uo aaeid jo `sostwajd `)Citodotd ,Cue padsm
pue as;ua :o; sanne;t>asajdat Harp jo sis►atgo a S pug `sieiatBo ieooi mjad aq; sazuoglne .Cgajaq amne;u2s2idw slq jo jauMopusl QtLL '£ I
-jtnna uoneolldde PSI slettpisaj a Smmp pus o; loud anns;uosajdw stq
ao `jaumopuel atp `aa;;Iwjad aql -Cq (s):;ls uoneogddu ptml oql uo p24mw ,(Imlo aq llegs s2pupmoq elm uolmqdde Puul qmp!= og!=dS 'Z I
spouad awudojdde;e s;nano nonsagdde
PQeI slenplsaj ainpagos Pus ;ljawaajSV slip pnatue o; aa;llauad aq; aigeaa o; uoseas Sm;usid gsea o; joud (s)2as uoneagdde Peel otp
ao3 stuausd Studdojo Pas asn Papua;ul atp og suoneagtPow jo suolsu►at ,Cue 3o =U!m ad atp tujo;w IPm annsutasajdaj stq jo jaumopuei ag.L -I l
Ee is uonw!lddu Pit atp of pagdde uoaq anBq letp (o;a `a;SBM [eutlue paXlnSajun `rxntpja; ` S a) .un
3o saomos aatpo 3o sls,Cieue pug ;unowe otp 8uquttSaj uoneatjoJW tp!M aaAtwtad atp apinojd 1[!M anne;aa=CIW St
g jo JOaMoPUUl ag L -01
•simul uonsatidde pmnujad atp pue `saidutes pos
3o s1[nsaz `suja ed dnto uo paseq salnpatlns [we sa;ej uonsogdde slenptsaj uo aajSs AIA+ aapnujad atp pm ann�nasajdaj s!q jo jaumoPuml OU '6
'dojo pog!=& atp
jo3 algetms si ajtt nw awg pug sisnpisaj Ilos otp jo Hd otp imp Sunsotpm uonewjo3m sap!nojd;snuouojSe ue ssaltm `O 9 legal le;o Hd t!os
[Bug s anatt a o; Palm aq i" awq 3o s;ttnowe ;tralog;ns jo p 9 ie patjte;utew ion st (epos aonea. peel atp jo Hd Ilos ag; 3l '8
-s►s,C[eue ilos gm*jo sgttsaa oq;3o OW B pue;uana uoneogdde puei
sisnp►saj ,Cue 30 ;uawaouatuwoo o; loud ;luuad siettpisaj atp 30 Sdoo B glln+ anise;tiasajdaa sni jo mumopusi atp apinojd Illm aaAl ad atLL 'L
d aq; kq pasn;uawdtnbo oq;
3o uondtjosap 8 `suz2ed Stnddojo tm!ddl joj solnpagos ` "potp w uomm!ldda si mp!sw ` -pmp!= mp 3o siaanlnsaoa 3o stsAlsus ue Sugxtlaal
`wvAwd uoneogdde puel slenp!= otp SuW=uoo step pus uogmwojut q4m anise;uasajdaj siq jo raunmoptmi otp Paputold seq aaAtuuad atlt •9
mp ;e pagdde slenp!= atp Jo gnzaap Ana saA►S ;Btp jaontopael man aq; o; canon E an19 [Isis JOUM Espl!s uone MumIddPam[
man B (n s s uouvo! dde im a o s of joud uomu w uomo �� ittauna a� `�nIppo ul rauMopaei
E )ail 1 P I g; 3 ja3saw3 (I ail oj3 giPow lluLtad a ttt%go pue mnbw ;snw aa4llumd ag,L S
-9£91-669LZ 3N `g Rlirl mWwD aa!AjaS ITT
9£91 `uafl Sutgnwad aSjegoslQ-uoN `2IM4-llr3a3N of Pai+jo3 Ata►paww! aq ilgp 3wtuaatBV s!tp;o uo�laaneo jo uot;eog!loN
xaw ate (ll UOgaaS japmt) saonau a a;cs atp3o Ile [ntm;uautaajSV stgi3o stjotstnojd a>g o; ajatiPs Ilegs anus;uaMAW s!q ao aaaMopusi ag,y £
-;umu=12V Sup jo suoWpuw Pug smi aq1 glue sogdmoo pae saarSe And pmA aq; wT artisan o; alq►suodsm aq
Begs jaamopael aT °k>ted pntp a o; (s)2as uoneolldde past axp3o leis atp;ntcrad as!Mjatpo jo aseai antmuosaWw stq jo jattMoput�i atp PinogS 'Z
z s!gl ,Cq pagloads (s)2ps otp jo; Aqua
Pal3!aataad jatpous tplM s;taamaafde jo spe4uw uogsatldde sleRP!saj IeQOR!PPe Aug o;m salon ;ou liege aAlM daj snI jo saumoP�l ag L " [
:SNOLLVIMCU.LS '1

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.
Landown
Address:
City: Z22 /✓ l / -e State: / 6 Zip: �-;) c1 /l
Phone: �% E-mail address4
a/7
�/o-!r�— cJ36 7
Signa
ture: Date:2, ��
NORTH CAROLINA, 0 Al1`6 N' COUNTY
I, the undersigned Notary Public do hereby certify that _ 14 q y i{ i ,B 2 I T
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
Signature and seal:
N
My commission expires:
Lessee's/Operator's Certification: i
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
JLessee/operator name: �.%� I%iii wy
Address: 17 f y In 21ze, f /-2/8�a S e7z✓,� CZ "Lc
City: M 0 a State: /✓, Zip: 21& 2--
Phone: /U N
Signature: u/t
Permittee's Certification:
E-mail address: 3 l
Date:
Iv' 414 n,t- Fu • t6Lt tc "11.yr�t�ls
L DAL
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature: �� --� > Date: 7 -

State of North Carolina
M-W DWDepartment of Environmental Quality KDivision of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108 other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: 4/ !%, : v� GAL✓ %i/ f�f.✓o{c�' (7G v !�
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: i i!Y ytnis"'t 6'ia S�, n/tl' ,�� i` Z:,-ee e'
City: State: 4V t1 Zip: / Z—
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
da s in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property oar name:
Signature:
Date:

Zip: 1 1
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
[� I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein. C
Property owner name: vll r:sko
gn �Q�� tom.
Si ature: b Q
State of North Carolina
DW
Department of Environmental Quality
AEWF' M MRDivision of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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
supportin2 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)ffor habitable residences or place of public
assembly only). Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned prop3�pty owner hereby
Applicant's
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: �'> 1lr ll1*Pi�ctsa��.t Ch
city: L�A o vt vc_ State: k�C-
Date: 9 - ; N - 1p
FORM: SWA 06-16 Page 1 of i

State of North Carolina
DW
Department of Environmental Quality
,,RDivision of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with I5A NCAC 02T .1 108(b)(2)(for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .l 108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned proper pwner hereby permits
Applicant's
Applicable Field ID:
hereinafter referred to as the Permtttee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: MW _ M " 0" Pl P%i4e-14- C `j &<f
City: /V 2 doC State: i'{/�/. (. Zip: _ j 00
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
7days ' advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding
g g this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: e 0� N i ff ), I
Signature:
Date: `/ -O�V / f
FORM: SWA 06-16 Page 1 of 1

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 Rater Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: to ����=� U/✓c ur f�
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 1 '71 � l3^; z t 64 f 10,dam
City: _ .,i�� State: zl,— l Zip: 2 417
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: '
i ✓� ��� ' �
Signature: ..� � �� �.y_�s ,� ��� Date: 1 Z S "%

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
[� A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: 1,�� //. .0 /� 1� �,�r/ T-z--y '&L A 4110k
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 1h_ t? feet (Le., cannot be less than 100 feet) of
the residence or place of p b assembly located at the following:
Location address of property:
City: State: ,�i[ Zip: 122_Z,
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner
Signature: 1 , _..0 '/!/�_
Date: _✓—

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 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 Permilift Unit
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 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.
[r Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
[fi A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: L✓ : 1 (,',e n4 CU/,,, .✓ �u.✓� f�; �J �e� l�
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within %z, L) feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at thee following:
Location address of property: %Yr1-( l?? , .v % /` I c" f-,-4 l ��47
City: All, i t, State: /v' Zip:
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name
Signature:
Fez, %-I o f ze ' CJ'Dti'/rIG
e:

CALVIN FUNDERBURK (NC-UN-34) (Fields 1, 2 and 3)
SITE MAPS
(Vicinity Map)
(USGS Topography Map)
(MRCS Soil Survey Map)
(Buffer/Setback Map)

p
f
J.
. FIELD NC-UN-34-3 } FIELD NC-UN-34-2 j lF'7
FIELD NC-UN-34-1
12'', .
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL
PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN, LEGAL, OR ANY OTHER USES THERE ARE NO
GUARANTEES ABOUT ITS ACCURACY WMSS, PLLC ASSUMES NO RESPONSIBILITY FOR ANY ®Field Boundary
DECISION MADE OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION Copyright:© 2013 Natio y
SCALE 1 .= 2,000 FIGURE NO
_ ...•, CALVIN FUNDERBURK
DATE 06-15-18 �II�X ril� NC-UN-34 FIELDS 1-3 2
DRAWN BY MEM
PROJECT NO Sol L SOLUTI O N S USGS TOPOGRAPHY MAP
c 15-10 Ph:02 UNION COUNTY, NORTH CAROLINA

C.\arcgis\2015\15-10 Monrce\Calvin Funderburk\Maps\NRCS.mxd

­4
NS F
7r
-7-
.0t
'k
zv
4
FIELD NC-UN-34-3
40
•
46L
FIELD NC-UN-34-1
N,
FIELD TOTAL ACRES BUFFERED ACRES NET ACRES
NC-UN-34-1 27.3 7.7 19.6
NC-UN-34-2 12.1 1.7 10.4
NC-UN-34-3 15.1 7.3 7.8
d11W
REVIEW BOUNDARY shall be established around each land application site
midway between the Compliance Boundary and the perimeter of the
residuals land application area.
COMPLIANCE BOUNDARY: The Compliance Boundary for each land application site
is established at either 250 feet from the residuals land application area or 50 feet
within the property boundary, whichever is closest to the residual land application area.
REFERENCE:
GIS DATA LAYERS WERE OBTAINED FROM ESRI, INC. PLEASE NOTE THIS MAP IS FOR INFORMATIONAL PURPOSES ONLY. IT IS NOT MEANT FOR DESIGN,
LEGAL, OR ANY OTHER USES. THERE ARE NO GUARANTEES ABOUT ITS ACCURACY WMSS ASSUMES NO RESPONSIBILITY FOR ANY DECISION MADE
OR ANY ACTIONS TAKEN BY THE USER BASED UPON THIS INFORMATION.
A
A
- FIELD NCUN-34-2
f
AA
ti
too A:
-- 'V7'f'�
CA
A
CO
C4
Lo
(D
C3
>-
z LLJ
: :
M
LU
y LU
U
LU �
L)
•.c
C:)
C)
z
LLI
W
z
W
LP')
L
CL
L)
0 . C)
z
z
EE
LU
L6
LJ
<
L)
U>
0
(Y
I alz
0
LU
ED
06
A� 0 10
0
U)
ban
00
w
'V�
LLJ —J!
Z ILL
• Well
D -Rt
LL M
A Structure
I
z z
0 Dwelling
U
z
0 Gate
Access Road
------ streams
lakes
Buffer
FIGURE NO
Field Boundary
Property Boundary
4
z
—.1
0
Q-
<
0
W Z
u-
LL
CD z
0
z
0
z
:D

CALVIN FUNDERBURK (NC-UN-34) (Fields 1, 2 and 3)
SOILS AND AGRONOMIC EVALUATION

CITY OF MONROE
CALVIN FUNDERBURK SITE (NC-UN-34) — FIELDS 1-3
SOILS AND AGRONOMIC EVALUATION
The Calvin Funderburk Site NC-UN-34 — Fields 1-3 are located on the south side of Mt.
Pleasant Church Road in Union County, N.C. The surrounding area is primarily
predominantly rural.
Fields 1-3 are currently established with Fescue for hay production and /or pasture. The
topography over the field ranges from 2 to 6 %. Buffer requirements as required by 15A
NCAC 02T.1108 for setbacks will need to be adhered to and will reduce the useable acreage
in these fields. Refer to `Buffer Maps" for specific buffer/setback requirements and acreage
totals.
A field investigation was conducted by a WMSS agronomist and soil scientist on May 22,
2018. Preliminary soils information for this site was obtained from the United States
Department of Agriculture (USDA) Natural Resources Conservation Service (MRCS) Web
Soil Survey (WSS). A WMSS licensed soil scientist advanced hand auger borings on the
proposed fields to characterize the proposed application sites (hand auger boring locations
are indicated on Figure 3 — NRCS Soils Map). Soil profile descriptions were performed
within the proposed fields and indicated the fields as suitable according to the criteria
outlined in 15A NCAC 02T .1104(c) (2). The predominant soil series associated with Field
1 is most similar to the Badin series (Fine, mixed, semiactive, thermic, Typic Hapludults),
Field 2 is most similar to the Tarrus series (Fine, kaolinitic, thermic Kanhapludults), and
Field 3 is most similar to the Secrest series (Fine -silty, siliceous, subactive, thermic, Aeric
Epiaquults). Soil profile description sheets are contained within this section of the
application indicating the predominant soil series identified within Fields 1-3.
Both the soils and the crops should be able to assimilate the proposed loadings of liquids,
solids, nitrogen, phosphorus, heavy metals, and salts known to be in the biosolids. This
assessment is based on the residual analysis provided, the planned application rate, proper
crop management guidelines and adherence to permit requirements. Soil pH for mineral
soils should be maintained above 6.0 and at levels to ensure optimal crop production.
Nitrogen is considered the most limiting characteristic of these residuals, however soil tests
should be reviewed annually to identify any changes in the nutrient status of the soil.
Management practices should be evaluated prior to each application to account for changes
in the proposed land use objectives. Crop management guidelines that will be of importance
for this site will be:
• timing of application events with plant nutritional needs and periods of plant
dormancy,
• split application to prevent hydraulic overloading or nutrient leaching,
• performance of proper stabilization methods to fit crop and soil needs,
• maintenance of proper vegetative cover on more sloping areas with runoff
potential, and
• proper coordination between application events and crop harvesting.

City of Monroe Calvin Funderburk Site NC-UN-34 — Fields 1-3
WMSS Project No. 15-10
The results of the soil analysis for these fields, included in this report, indicate no gross
deficiencies in the fertility of these fields. By using standard agricultural practices for the
management of forage and crop production, the operator should see significant benefits from
the application of biosolids. In turn, these well -maintained fields should provide good
assimilation of the plant available nutrients contained in the biosolids and afford an
environmentally safe means of solids disposal and nutrient recycling..om_.•„,
/gyp souITT. W
&4A�_ 1Lva
Martin Mabe Rob Willcox, L.S.S.
Agronomist Soil Scientist
Shared\WMSS Projects\2015\15-10 City of Monroe\2018 Permit Renewal\Land Application Site Info\Site 34 - Calvin
Funderburk\15-10 Soil Scientist - Agronomist Report Monroe -Calvin Funderburk.doc

WILLCOX & MABE SOIL SOLUTIONS, PLLC
SITE/SOIL EVALUATION
Project No.
Location
/5 -ld Phone No.
_CIZLl OF /6v/20F Pin County:
Proposed Facility: LAI V4,,U �yy0&&tt 4L Water Supply:
AVC -U/u- 34-401 fAra03
Described By: Z e ljlu'a Y
Weather: Svtrlw' (A )A2r1 Antecedent Moisture
r-
Date:
UN/Or✓
On -Site Well
Community
Public
MOi-ST
S) 2 2-11
Property Size
❑ Evaluation:
El
EJ
Surface Water:
Auger Boring
Pit ❑
Cut ❑
FACTORS
PROFILE
PROFILE
PROFILE
PROMtjr�f
Landscape Positron %
_ 4 D
L - 2 _ B
l
.2 - 2 - 20
Horizon Depth I
-
--S
Color Munsell
�, �� j
. S z (0 6
Texture
5
Structure
/
l
Consistence
rp
Boundary
Horizon Depth II
, (
S _
Color - Munsell
S w tL (o L
7.7
?/
`
Texture
C
.0
Mottles
Structure
w cbk
q
Consistence
3, D
1
y_C S
S S
Boundary
Horizon Depth III
_
_2
f
Color - Munsell
$
,S
ri
Texture
C
C/
Mottles
S
2. SAW
S
Structure
IAIS HUI&
kv M )
Consistence
S A9 jP,
SS S 1
s
- S s
!Q
Boundary
Horizon Depth IV
_ 30
Color - Munsell
f
Texture
Mottles
Structure
Consistence
SS S
_IaVIL S
Boundary
Soil Wetness
7 , C)1
7 ►1
-SigW l
Restrictive Horizon
3 ' 1 - C r
1' - C /
Saprolite
LTAR
Classification
LEGEND
LANDSCAPE POSITION
R
Ridge Interfluve
S
Shoulder
L
Linear Slope
FS
Foot Slope
N
Nose Slope
H
Head Slope
Cc
Concave Slope
Cv
Convex Slope
T
Terrace
P
Flood Plain
TEXTURE
s
sand
PIS
loamy sand
sl
sandy loam
I
loam
Si
silt
sil
silt loam
sicl
silty clay loam
cl
clay loam
scl
sandy clay loam
sc
sandy clay
sic
silty clay
c
clay
CONSISTENCE WET
Ns
non -sticky
Ss
slightly sticky
S
sticky
Vs
very sticky
Np
non -plastic
Sp
slightly plastic
P
plastic
Vp
very plastic
MOIST
vfr
Very friable
fr
friable
fi
firm
vfi
Very firm
STRUCTURE
sg
single grain
m
massive
cr
crumb
gr
granular
sbk
subangular blocky
abk
angular blocky
PI
platy
pr
prismatic

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY18-SL037471
Heavy Metals Client:
Willcox & Mabe Soil Solutions Advisor:
1205 W Bessemer Ave Ste 202
A Mehlich-3 Extraction
Soil Report
Greensboro, NC 27408
P A
Links to Helpful Information Sampled: 05/23/2018
Sampled County: Union
Received: 06/15/2018
Farm: Calvin Funderburk NC -UN -34 Completed: 06/26/2018
Client ID: 462496 Advisor ID:
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test
extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)-
4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and
note where elevated above background levels. Note any lime and fertilizer recommendations. Ja athi Kamalakanthan 6/26/2018
Sample ID: 01
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5
K2O Mg S Mn Zn Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim, M 0.5 120-200 80
90 0 20 0 0 0 0
Note: 12
2 - Fescue/OGrass/Tim, M 0.0 120-200 80
90 0 20 0 0 0 0
Note: 12
Test Results [units - WN in g/crrr3; CEC and Na in meg1100 cm3; NO3-N in mg/dnt3]:
Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.22 1.11 9.9 83 1.6 5.7 24 25 58 24
22 39 40 40 40 40 46 0.2 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.2 Chromium, 0.1 Lead, 2.6 Selenium, 0.2
Sample ID: 02
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P2O5
K2O Mg S Mn Zn Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim, M 0.5 120-200 30
30 0 0 0 0 0 0
Note: 12
2- Fescue/OGrass/Tim, M 0.0 120-200 30
30 0 0 0 0 0 0
Note: 12
Test Results [units - WN in g/cmP; CEC and Na in meg1100 crrr3; NO3-N in mg/dm3]:
Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.51 1.02 6.6 79 1.4 5.7 47 60 56 18
26 187 129 129 102 102 42 0.1 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.2 Chromium, 0.1 Lead, 3.6 Selenium, 0.1
North Carolina
Tobacco Trust Fund Commission
Reprogramming of the laboratory -information -management system that makes this report possible is
being funded through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxler, Commissioner of Agriculture

NCDABCS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SL037471
Page 2 of 3
Sample ID: 03
Lime History:
Recommendations: Lime
Crop (tons/acre) N P2O5
1 - Fescue/OGrass/Tim, M 1.8 120-200 30
2- Fescue/OGrass/Tim, M 0.0 120-200 30
K2O
80
80
Nutrients (lb/acre)
Mg S
0 0
0 0
Mn
0
0
Zn Cu
0 0
0 0
B
0
0
More
Information
Note: 12
Note: 12
Test Results [units - W/V in g/crrP; CEC and Na in meq/100 crrr3; NO3-N in mg/drrr ]:
Soil Class:
Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn-AI Cu-1
Na ESP SS-1 NO3-N
0.36 1.02 5.3 51 2.6 4.7 45 31 32 16
35 114
85 85
38
38 30
0.1 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.2
Chromium, 0.2
Lead, 5.2
Selenium, 0.1

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY18-SLO37471
Page 3 of 3
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at onE
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-Al2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-n- I
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
N
mineral -organic soil class
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
nitrogen
sodium
ncaqr.qov/aqronomi/pubs.htm.
NOs-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagrgo_v/agronomi/obpart4.html sfind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowne►'s Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
W/V
weight per volume
0 o
The first seven values [soil class, HM /o, W/V, CEC, BS /o, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
zinc availability index
remaining 16 [P-1, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-Al2, Zn-I, Zn-AI, Cu-I, S-1, SS -I, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncagr.gov/agronomi/uvrst.htm

Waypointo
ANALYTICAL
6/25/2018
Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield, NC, 27358
Ref: Analytical Testing
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number: 18-166-0202
Project Description: Calvin Funderburk
Waypoint Analytical Virginia, Inc. received sample(s) on 6/15/2018 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
?". P c-7�
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Arizona AZ0629 New Jersey VA011 Pennsylvania 68-03109 Virginia 460014
Florida E871087 North Carolina 257 South Carolina 93007

Waypointo
ANALYTICAL
Client: Willcox & Mabe Soil Solutions, PLLC
Project: Calvin Funderburk
Lab Report Number: 18-166-0202
Date: 6/25/2018
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Solids Total Mercury Analysis - CVAA Method SW-7471 B
Sample 61187
Analyte: Hg
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration >25X the MQL. Dilution test exceeded method
limits. Matrix interference is suspected.
QC Batch No: E64698
MS and/or MSD spike recovery failed. Analyte concentration < 25X the MQL. Post Digestion Spike exceeded
method limits. Matrix interference is suspected.

Report Number
18-166-0202
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Calvin Funderburk
Lab Number: 61189
Sample Id : 01
Analysis
Mercury, mg/Kg
Method Reference:
Waypointo.
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Result Limit
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Method
<0.400 0.400 SW-7471 B
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
polic. #11 10JIr"
Date and Time
Test Started Analyst
06/22/201812:57 MMT
Pauric McGroary

Report Number
18-166-0202
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Calvin Funderburk
Lab Number: 61190
Sample Id : 02
Waypoint-(D
ANALYTICAL
REPORT OF ANALYSIS
Quantitation
Analysis Result Limit
Mercury, mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled
Method
SW-7471 B
pofif' mC 101
Date and Time
Test Started Analyst
06/22/201812:59 MMT
Pauric McGroary

Report Number
18-166-0202
Account Number
08361
Send To: Willcox & Mabe Soil Solutions, PLLC
7231 B. Summerfield Rd
Summerfield , NC 27358
Project : Calvin Funderburk
Waypointo
ANALYTICAL
REPORT OF ANALYSIS
Lab Number: 61191
Sample Id : 03
Quantitation
Analysis Result Limit
Mercury, mg/Kg <0.400 0.400
Method Reference:
USEPA, SW-846, Test Methods for Evaluating Solid Wastes, Physical/Chemical Methods, 3rd Ed. Current Revision
Comments:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Purchase Order :
Report Date : 06/25/2018
Date Received : 06/15/2018
Date Sampled :
Date and Time
Method Test Started Analyst
SW-7471 B 06/22/2018 13:02 MMT
polif, #1 C 10,111rf
Pauric McGroary

Waypoint
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Cooler Receipt Form
Customer Number: 08361
Customer Name: Willcox & Mabe Soil Solutions, PLLC
Report Number: 18-166-0202
Shipping Method
0 Fed Ex 0 US Postal ,J Lab
UPS 0 Client 0 Courier
Other
Thermometer ID:
Shipping container/cooler uncompromised?
0 Yes
No
Number of coolers received
r 1
Custody seals intact on shipping container/cooler?
0 Yes
0 No
0 Not Required
Custody seals intact on sample bottles?
Yes
0 No
0 Not Required
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
0 Yes
0 No
COC properly completed
0 Yes
0 No
Samples in proper containers?
0 Yes
0 No
Sample containers intact?
0 Yes
0 No
Sufficient sample volume for indicated test(s)?
0 Yes
0 No
All samples received within holding time?
0 Yes
0 No
Cooler temperature in compliance?
0 Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
J Yes
0 No
Water - Sample containers properly preserved
0 Yes
No
N/A
Water - VOA vials free of headspace
Yes
No
N/A
Trip Blanks received with VOAs
Soil VOA method 5035 — compliance criteria met
High concentration container (48 hr)
High concentration pre -weighed (methanol -14 d
Special precautions or instructions included?
Comments: i
�) Yes No N/A
J Yes No N/A
F Low concentration EnCore samplers (48 hr)
Low conc pre -weighed vials (Sod Bis -14 d)
", Yes 0 No
Signature: Orandi Watson I Date & Time: 6/15/2018 12:44:50 1

Waypoint0
ANALYTKAL
Customer Information
Customer No: 08361
Customer: Willcox & Mabe Soil Solutions, PLLC
Address: 7231 B. Summerfield Rd
Summerfield NC
273S8
Comments: City of Monroe
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalocal.cam
Grower Information
Grower Name: Calvin Funderburk
Address:
Farm: NC-UN-34
Field:
Additional
Email: