WQ0006906_Renewal Application_20210311

Initial Review
Reviewer
Thornburg, Nathaniel
Is this submittal an application? (Excluding additional
information.)*
r Yes r No
Permit Number (IR)*
WQ0006906
Applicant/Permittee
Town of Taylorsville
Applicant/Permittee Address
204 Main Avenue Drive
Is the owner in BIMS? r Yes r No
Is the facility in BIMS? r Yes r No
Owner Type
Municipal
Facility Name
Town of Taylorsville RLAP
County
Alexander
Fee Category Minor
Fee Amount $0
Is this a complete
application?*
r Yes r No
Complete App Date 03/11/2021
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by N B Staff
Name * Zach Key
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ .....................................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
3369577871
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WO0006906
Fbs Current Existing perrrit number
Applicant/Permittee*
Town of Taylorsville
Applicant/Permittee Address*
204 Main Avenue Drive
Facility Name *
Town of Taylorsville RLAP
Please provide comments/notes
on your current submittal below.
Land Application Permit WQ0006906
Renewal for the Town of Taylorsville
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Spec'rfications, Calculations, Rc.)
WQ006906 Renewal.pdf 3.07MB
upload only 1 RCF docurrent (less than 250 vB). NLftiple documents nest be corrbined into one RDF file unless file is larger than
upload lirrit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
1�
Submission Date 3/11/2021

PO Box 146 Ronda, NC 28670
336-777-6909
www.usbiosolids.com
Thursday, March 11, 2021
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27064
Reference: Town of Taylorsville
Wastewater Treatment Plant
Permit Renewal
WQ0006906
US Biosolids, Inc. is assisting the Town of Taylorsville, NC in preparing this renewal package for its land
application of residuals on Permit No. WQ0006906 from the Wastewater Treatment Plant.
There have been no changes in the process or the way the residuals are handled since the last issuance
of permit WQ0006906. The only change is the deletion of one field, field number 08-04
Your attention in the review of this permit renewal application is greatly appreciated. Please contact me
with any questions or concerns at [e-mail] or at 336-957-7871.
Sincerely,
Zach Key
US Biosolids, Inc.

State of North Carolina
DW.
KDepartment of Environmental Quality
Division of Water Resources
D10slon of Water Resources 15A NCAC 02T .1100— RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two co ies of the application and
sunporting 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 .I 100.
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: (AIL Application Packages):
Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
El 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.
S. Application Fee (New and Major Modification Application Packages)
Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification'
Major (land are permitted for > 300 acres) $1,310 $395
Minor (land are permitted for < 300 acres) $810 $245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (AIL Application Packages)
List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1 C .0300)
Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS), Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of

E. Operation and Maintenance Plan (New and Renewal Application Packages)
For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑: Submit the O&M Plan in accordance with 15A NCAC 02T. I 110 and include at a minimum:
❑ Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and location of' inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.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
0 Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
0 Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
[] Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1 108
El 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')

1. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .I 104(d)(4) and current Division Policy
available at: http://www.ncwater.oriz/Rules Policies and Regulations . The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
El 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 , l 104 d 2 . For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
[] Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
Submit a completed and accurate water balance in accordance with 15A NCAC 02T .l 104(d)(5) and current Division Policy
available at: http://www.newater.org/Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map,
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06- l6 Page 3 of 3

State of North Carolina
D. Department of Environmental Quality
Division of Water Resources
.W.R
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
1. APPLICANT INFORMATION:
I. Applicant's name: Town of Taylorsville
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: David Odom Title: Town Manager
Applicant's mailing address: 204 Main Avenue Drive
City: NC Zip: 28681
Telephone number: [phone] Email Address: townmana�er�taylorsvillenc.com
2. Consultant's name: Zach Key License Number (for P.E.):
Affiliation: ❑ On Staff [D Retained (Firm: US Biosolids, Inc.)
Consultant's mailing address: PO Box 146
City: Ronda State: NC Zip: 28670-0146
Telephone number: [phone] Email Address: zachkey rr usbiosolids.com
3. Agronomist's name: License Number:
Affiliation: ❑ NIA ❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip: -
Telephone number: (_} �- Email Address:
4. Soil Scientist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Soil Scientist's mailing address:
City: State: Zip: -
Telephone number: (_) Email Address:
5. Fee submitted: 0.00 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check al that apply): ❑ new, 0 modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0006906
Date of most -recently issued permit: 4-6-2016
Date of most -recently certified Attachment A (if different than the permit): 4-6-2016
Date of most -recently certified Attachment B (if different than the permit): 4-6-2016
FORM: RLAP 06-16 Page I of 5

Ili. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 344 Minnigan Lane
City: Taylorsville State: NC Zip: 28681
Coordinates: Latitude: 35' 54' 12" Longitude: 81° I l' 50"
Datum: NAD83
Method of measurement: MAP
Level of accuracy: .01
2. County where residuals land application program is headquartered: Alexander
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
Dennis Key
US Biosolids
15704
Back -Up ORC
Zach Key
US Biosolids
27660
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen 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: 300 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
23.63
27.78
7089
8334
Five -Year Maximum Adjusted
34.54
38.69
10362
11604
b. LandAnplieation Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
0
Hay
14.7
Pasture
69.3
Total:
84
Methods
Surface
84
Incorporation or Injection
0
Total:
84
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Surnnrarv: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(Ibs PANlac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
141.78
166.68
207.24
232.08
100
70.89
83.34
t03.62
116.04
150
104.7
55.56
69.08
77.36
200
35.4
41.67
51.81
58.02
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
El Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
row
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

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

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
Yes [] No, Explain;
[, David Odem Town Manag_er
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Town of Tay lorsville
(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:
, ` "t/ Date: 3 "9f` 2 ej "L
FORM: RLAP 06-16 Page 5 of 5

Operation and Maintenance Plan
Town of Taylorsville
Permit No_ WQ0006906
In accordance to the requirements set forth by the North Carolina
Department of Environmental Quality using
NCGS 143-215.1 and 143-215.3(a) based on 15A NCAC 02T .l 10, The
Town of Taylorsville is implementing this Operation and Maintenance
Plan.
The project manager of the land application event will make sure a
daily check off is performed at the start of each work day. This inspection
is to prevent any spills, leaks, or run-offs.
The daily check -off will consist of inspection the following items:
1. Access to the facility will be controlled with a locked gate and
signs to prevent any unauthorized entry into the complex.
2. All pumps and hose will be checked at the start of each day for
leaks or loose fittings.
3. All tanker valves are closed prior to loading and lids are closed
prior to transport.
4. All dump trailers or dump trucks gates are tightly fastened and
do not leak prior to transport.
5. All on road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
6. All equipment is secured at the end of each working day to
prevent any tampering or unauthorized use.
The ORC or back up ORC will inspect the field after each land application
event to make sure all regulations as required by the permit are followed.
Also the project manager at the end of each working day during a land
application event will make sure that all gates if present are closed.
All samples shall be taken as early as possible before the first application
event of the calendar year to make sure the facility is compliance.
The samples will be taken in a matter that is representative of the residuals
and all grab samples will be mixed prior to be placed in to the containers

that will go to the laboratory. These samples must be collected and
transported as outlined in the Sampling Plan attached to this O&M Plan.
All records of these laboratory results as well as the annual report and
loading rates will be kept on file for a minimum of five (5) years.
Also, in the unlikely event of a spill or unintended release of residuals,
actions should be immediately taken as outlined in a copy of the
spill control plan attached.

City of Taylorsville, WWTP
Permit No. WQ0003281
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the sludge
digesters. These samples will be combined to form individual grab samples to be sent to a laboratory for
analysis. If a land application event is to occur in the early part of a calendar year (i.e. January or early
February) these samples may have to be taken in December so results can be obtained before the land
application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for a nutrient analysis, and a TCLP test.
These tests will be taken by Southern Soil Builders, Inc. All samples with the exception of the composite
residual sample will be taken to Statesville Analytical or any other NC certified laboratory. The
composite residual sample will be sent to Waypoint Analytical or any other NC certified laboratory. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The Pathogen Reduction requirement will be achieved using alternative 2 [15A NCAC
02T.110(c)(2)], or commonly known as lime stabilization. In alkaline stabilization, the addition of
sufficient alkali to raise the pH to at least a 12 at 250C and maintain a pH of equal to or greater than 12
for 2 hours and a pH equal to or greater than 11.5 for 22 more hours.
The Vector Attraction Reduction requirement will be met using alternative 6 [15A NCAC
02T.1107(a)(6)], or commonly known as lime stabilization. In alkaline stabilization, the addition of
sufficient alkali to raise the pH to at least a 12 at 250C and maintain a pH of equal to or greater than 12
for 2 hours and a pH equal to or greater than 11.5 for 22 more hours.
Annually, if land application occurs, a composite residual sample will be collected from the
sludge holding tank and analyzed, prior to a land application event for: Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate
Nitrogen, Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information,
the Plant Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sample
will collected in a non -breakable container, at least one quart in size. From this information, the plant
available nitrogen (PAN), and a sodium absorption Ration (SAR) will be calculated.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the sludge holding tank. This test will be run annually, unless prior approval is granted
from the division to reduce this requirement to once per permit cycle.

SPILL CONTROL PLAN- U.S. Biosolids Inc.
Town of Taylorsville, NC - WQ0006906
In the event of a spill, the following should be taken IMMEDITALY.
1. Make sure all personal and bystanders are safe- if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain the
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as much
of the spilled material as possible. Use straw to soak -up the remaining material.
Dispose of the some in a landfill.
5. Flush the roadways with water if needed. If the spill occurred on a tillable area, till
the same into the soil and spread lime if necessary. If a spill occurs on private
property, final clean-up should be to the satisfaction of the owner.
6. Notification. (This should be done as soon as safely possible.)
A. U.S. Biosolids, Inc. Main Office [phone]
B. Town of Taylorsville, WWTP- [phone]

C. NCDEQ-Mooresville Regional Office [phone]
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting:
The Permittee shall report by telephone to the Mooresville Regional Office,
telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day following the occurrence or first knowledge
of the occurrence of any of the following:
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any failure of the surface disposal 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
wafters, imminent failure of a storage structure, etc.) outside of 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.
B. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed
C. Inspect all seals and replace if necessary.

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the AOplicant 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 Permittiyg 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 . l 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 1 1-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the -M.N.) Guidance for
Res.duals Land. Application Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the 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 l of 1

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Town of Taylorsville
Status Maximum Dry Tons Per Year
Code" Facility Permit Holder Facility Name County Permit Number
Current b Proposed
R Town of Taylorsville Town of Taylorsville Alexander WQ0006906 300 300
I
'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

D.WR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of Taylorsville
2. Facility permit holder is: Q Federal 0 State, MLocal Government, or Q Private.
Facility permit issued by: []' Div. of Water Resources, E] Div. of Environmental Health,
or E] Other (explain
3. Facility contact person and title: Brian Fades
Complete mailing address: 204 Main Avenue Drive
City: Taylorsville
Telephone number: [phone]
4. Facility physical address: 344 Minnigan L_n_._
City: Taylorsville State: NC
Coordinates: Latitude: 35' 54' 12"
State: NC
Zip: 28681
E-mail address: sbel963 ayahoo.com
Datum: NAD83
Method of measurement: MAP
Zip: 28681
Longitude: 81° I 50"
Level of accuracy: .01
5. Purpose of the facility:
El treatment of municipal wastewater, treatment of 100% domestic wastewater,
El treatment of potable water, [] treatment of 100% industrial wastewater,
0 treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages %industrial and %domestic)
El other (explain ).
6. Does the facility have an approved pretreatment program: Yes ❑ No
7. Facility permitted/design flow: 0.83 MGD and facility average daily flow: 0_4 MGD
8. Average amount of residuals being generated at this facility 247 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment:
Type and volume of residuals storage (i.e., outside of residuals treatment units)
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
0 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.] 5A NCAC 02T.1 102(6) as:
0 Biological E 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- t 6 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: [1 yes no.
If yes, list the number(s): 5-'-
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: 0 yes E] no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: 6-1-2020
Passed corrosivity test: E yes Q no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: U yes Q no. Flashpoint: 200 OF (> 140°F)
Passed reactivity test U yes Ejno. HCN: ND mg/kg (<250) & H2S: ND mg/kg (<500)
TCLP Parameter
Limit
(mg/l)
Result
(mg/I)
TCLP Parameter
Limit
(mg/1)
Result
(mg/0
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
mead
5.0
ND
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
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: Waypoint Analytical and Date of analysis: 5-6-2020
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
10.6
Cadmium
85
39
2.13
Copper
4,300
1,500
219
Lead
840
300
13.2
Mercury
57
17
0.477
Molybdenum
75
n/a
5.32
Nickel
420
420
10
Selenium
100
100
10.6
Zinc
7,500
2,800
887
b. For Surface Disposal Unit flaudC1ll}: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mglkg)
Chromium
(mg/kg)
Mickel
(mgikg)
> 0 but < 25
30
200
210
[Q > 25 but < 50
34
220
240
> 50 but < 75
39
260
270
> 75 but < 100
46
300
320
Q > 100 but < 125
53
360
390
125
62
450
420
Result (mg/kg)
--J
FORM: RSC 06-16 Page 3 of

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 4.73 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Waypoint Analytical and Date of analysis: 5-6-2020
Parameter
Result
{mg4p
Aluminum
9260
Ammonia -Nitrogen
4150
Calcium
169000
Magnesium
2700
Nitrate -Nitrite Nitrogen
104
pH (Standard Unit)
12.2
Phosphorus
10000
Potassium
1430
Sodium
1 190
Total Kjeldahl Nitrogen
36600
c. Using the results listed in Item 11. 5b. above, calculate the sodium adsorption ration (SAR): 0.17
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (I") Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mg/kg)
Surface
11815
17270
71njection/Incorporation
13890
19345
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.1 106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of_Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
Alternative 1 [15A NCAC 02T.1 106(b)(3)(A)] - Time/Temperature Compliance.
[] Alternative 2 [15A NCAC 02T.i 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.1 106(b)(3)(C)l - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.1 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Q 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 0 pasteurization.
b. For Laud Application of Class B:
0 Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration,
Alternative 2 [15A NCAC 02T.1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: Q aerobic digestion, Q air drying, 0 anaerobic digestion,
El composting, or lime stabilization.
c. For Surface Disposal:
0 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 7a. above.
Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
Q Exempt - If Daily Cover Alternative is chosen in Item 11.8. below [ 15A NCAC 02T.1 106(a)(2)],
Q Not Applicable - Non -biological Residuals with NO Domestic Wastewater Contribution,
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
Alternative 1 [15A NCAC 02T.1 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.1 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.1 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
0 Alternative 4 [15A NCAC 02T.1 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.1 107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T.1 107(a)(6)] - Alkaline Stabilization.
Alternative 7 [15A NCAC 02T.1 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T.1 107(a)(8)] - Drying of Unstabilized Residuals.
]Q Alternative 9 [15A NCAC 02T.1 107(a)(9)] - Injection.
0 Alternative 10 [15A NCAC 02T.1 107(a)(10)] - Incorporation.
0 Alternative for Surface Disposal Units Only - Soil/Other Material Cover [ 15A NCAC 02T. 1107(b)(2)].
0 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

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Quantitative Justification for Residuals Production Rate
In the following five years the Town of Taylorsville, NC has produced the following Dry Tons to be land
applied:
2016: 172.37 DT
2017: 67.54
2018: 189.22
2019: 92.2
2020: 247.34
This is a five year average of 153.73 Dry Tons per year; less than the 300 Dry Tons per year as is currently
allowed in Permit WQ0006906

City of Taylorsville, WWTP
Permit No. WQ0003281
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the sludge
digesters. These samples will be combined to form individual grab samples to be sent to a laboratory for
analysis. If a land application event is to occur in the early part of a calendar year (i.e. January or early
February) these samples may have to be taken in December so results can be obtained before the land
application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for a nutrient analysis, and a TCLP test.
These tests will be taken by Southern Soil Builders, Inc. All samples with the exception of the composite
residual sample will be taken to Statesville Analytical or any other NC certified laboratory. The
composite residual sample will be sent to Waypoint Analytical or any other NC certified laboratory. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The Pathogen Reduction requirement will be achieved using alternative 2 [15A NCAC
02T.110(c)(2)], or commonly known as lime stabilization. In alkaline stabilization, the addition of
sufficient alkali to raise the pH to at least a 12 at 25°C and maintain a pH of equal to or greater than 12
for 2 hours and a pH equal to or greater than 11.5 for 22 more hours.
The Vector Attraction Reduction requirement will be met using alternative 6 [15A NCAC
02T.1107(a)(6)], or commonly known as lime stabilization. In alkaline stabilization, the addition of
sufficient alkali to raise the pH to at least a 12 at 25°C and maintain a pH of equal to or greater than 12
for 2 hours and a pH equal to or greater than 11.5 for 22 more hours.
Annually, if land application occurs, a composite residual sample will be collected from the
sludge holding tank and analyzed, prior to a land application event for: Cadmium, Copper, Lead,
Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate
Nitrogen, Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information,
the Plant Available Nitrogen (PAN) and a Sodium Absorption Ratio (5AR) will be calculated. This sample
will be collected in a non -breakable container, at least one quart in size. From this information, the
plant available nitrogen (PAN), and a sodium absorption Ration (SAR) will be calculated.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the sludge holding tank. This test will be run annually, unless prior approval is granted
from the division to reduce this requirement to once per permit cycle.

a
762:1 lVhita}�iite Road, Richmond, VA 23237
Waypoint,
Main 804.743-9401. " F,iix 804-271-6446
ANALYTICAL www.waypoititai)alyticii.com
46381
Southern Soil Builders
Dennis Key Project Taylorsville Report Date 05/19/2020
958 Hoots Road Information : Received : 05/11/2020
Roaring River , NC 28664 Me 6'alvr
REPORT Paurt McGroary
Report Number; 20-132-0003 Agronomist
Lab No : 71301 Matrix: Solids
Sample ID : Tayiarsville Sampled: 5/6/2020 11.30
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Moisture 95.3 % 0.010 1 05/12/2016:27 CJR SM-2S40G
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Ammonia Nitrogen
4150
mg/Kg - dry
2130
1
05/18/20 15:00
JPJ
SM-4500-NH3C
Nitrate+Nitrite-N
<104
mg/Kg - dry
104
1
05/18/20 09:14
ZBD
4500NO3F-2011
Organic N
32600
mg/Kg - dry
5320
1
05/18/20 10:00
CALCULATION
pH
12.2
S,u.
1
05/18/20 05:32
JSL
9045D
Total Solids
4.73
%
0.010
1
05/12/20 16:27
CIR
SM-254OG
Total Kjeldahl Nitrogen
36600
mg/Kg - dry
5320
1
05/18/20 10:00
JPJ
>M-4500-NH3C-TKI
Phosphorus
10000
mg/Kg - dry
106
1
05/14/20 21:27
TJS
6010D
Aluminum
9260
mg/Kg - dry
106
1
05/14/20 21:27
TJS
6010D
Arsenic
<10.6
mg/Kg - dry
10.6
1
05/14/20 21:27
TJS
6010D
Calcium
169000
mg/Kg - dry
1060
1
05/14/20 21:27
TJS
6010D
Cadmium
<2.13
mg/Kq - dry
2.13
1
05/14/20 21:27
TJS
6010D
Chromium
16.2
mg/Kg - dry
5.32
1
05/14/20 21,27
TJS
6010D
Copper
219
mg/Kg - dry
10.6
1
05/14/20 21:27
T7S
6010D
Iron
6620
mg/Kg - dry
2.13
1
05/14/20 21:27
TJS
6010D
Lead
13.2
mg/Kg - dry
6.38
1
05/14/20 21:27
TJS
6010D
Magnesium
2700
mg/Kg - dry
106
1
05/14/20 21:27
TJS
6010D
Manganese
124
mg/Kg - dry
10.6
1
05/15/20 14:57
TJS
6010D
Qualifiers/ OF
Dilution Factor
I.
Limit Exceeded
Definitions MQL.
Method Quantitation Limit
Page 3 of 6

Waypoint.(D
,
ANALYTICAL
46381
Southern Soil Builders
Dennis Key
958 Hoots Road
Roaring River , NC 28669
Report Number : 20-132-0003
Lab No : 71301
Sample ID : Taylorsville
7621 Whitepine Road, Richn'iond, VA 23237
Main 804-743.9401 0 Fax [phone]
www.Waypointanalyticat.com
Project Taylorsville
Information
REPORT OFANAkYSIS
Report Date : 05/19/2020
Received : 05/11/2020
? w" in, 640, 0lc,
Pauric McGroary
Agronomist
Matrix: Solids
Sampled: 5/6/ 2020 11:30
Test
Results
Units
MQL
DF
Date / Time
Analyzed
By
Analytical
Method
Mercury
0.477
mg/Kg - dry
0.332
1
05/14/20 11:29
DDB
SW-7471B
Molybdenum
a5.32
mg/Kg - dry
5,32
1
05/14/20 21:27
T35
6010D
Nickel
10.0
mg/Kg - dry
5.32
1
05/14/20 21:27
TJS
60101)
Potassium
1430
mg/Kg - dry
213
1
05/14/20 21:27
T35
6010D
Selenium
a 10.6
mg/Kg - dry
10.6
1
D5/14/20 21:27
TJS
6010D
Sodium
1190
mg/Kg - dry
532
1
05/14/20 21:27
TJS
6010D
Zinc
887
mg/Kg - dry
26.6
1
05/14/20 21:27
TJS
6010D
Sulfur
5830
mg/Kg - dry
213
1
05/14/20 21:27
TJS
6010D
Qualifiers/ DF Dilution Factor
Definitions MQL Method Quantitation Limit
L Limit Exceeded
Page 4 of 6

SAR
Sodium Absorption Ratio
Na : Sodium (MgIL) Equivalent weight: 23
Ca : Calcium (MgIL) Equivalent weight: 20
Mg : Magnesium (MgIL) Equivalent weight: 12
Milli Equivalent = MgIL 1 Equivalent weight
Na M 8I7 MMIL
6a
7993.7 127.71
M9._(MEA
2.447261 399.685 10,6425
SAR= Na Milli Equivaient/[0.5 X (Ca Milli Equivalent + Mg Milli equivalent)]0.5 power
SAR = 0.170856 (From MgIL entered above)
SAR= 0.171047 (From ME entered below)
Na ME Ca (ME) Mg (MEN
2.45 399.69 10.64
The amour
amount of
Permitting I

PAN
Mineralization
as decimal
Total dry
tonslyear
JAcres
I Agjj ed on
Rate
0.3
TKN
36600 1
F NH3
4150
NO3
1
NO2
4
% Solids
0.0473
PAN Surface
11815 mglkg 23.63 lbs/dry ton
0 lbs total PAN
#DIVIO! lbs PAN/acre
PAN Injection
138901 mglkg 27.78 lbs/dry ton
0 lbs total PAN
#DIVIO! jibs PAN/acre
Dry Tons11000 gal.
0.197241
1st year PAN
Surface lbs.
0
1st year PAN
Injected lbs.
0
lbs./acre
Surface
#DIVIO!
lbs./acre
Injected
#DIVI01
MR(TKN-NH3)+ + .5(NH3)+NO3+NO2=rmglkg
mglkg x .002 =Ibsldry ton
MR(TKN-NH3) + l(NH3)+NO3+NO2 =mglkg
mg/kg x .002 =Ibsldry ton
1000 X 8.34 X %solids X sp. gravity_ "=dry tons11000gal."
2000

Analytical Results
U.S. Biosolids Inc
958 Hoots Road
Roaring River, NC 28669
Receive Date: 06/01 /2020
Reported: 06/23/2020
For: Taylorsville
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
200601-14-01
Corrosivity
Taylorsville
See Attached
sw-e46 06/02/2020
PACE
200601-14-01
Ignitabiiity
Taylorsville
See Attached
'o'om 06/02/2020
PACE
200601-14-01
Reactivity
Taylorsville
See Attached
sw•846 06/02/2020
PACE
200601-14-01
TCLP
Taylorsville
See Attached
as Noted 06/02/2020
PACE
Respectfully submitted,
0 -yam. Jlr'bt }
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 42

t eAnalytical a
rwr.gacalais.ean
ANALYTICAL RESULTS
Project: US Bio- Taylorsv4la
Pace Project No.: 92479945
Pace Analytical Services, LLC
9800 Kincay Ava. Suite 100
Hunteravllle, NC 28078
[phone]
Sample: 200601.14 Lab ID: 02419045001 Co4ected: 06101120 13:00 Received: 06102/20 14:05 Matrix: Solid
Results reported on a 'dry weight' basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units Report Limit OF Prepared Analyzed CAS No. Qual
Chlorinated Herb. (GC) 8151A
Analytical Method: EPA8151A Preparation Method: 8151A
Leachate Method/Dale: 1311; 06110/20 20:14 Initial pH: 11,17: Final pH: 5,47
Pace National - Mt. Juliet
2,4,5-TP (Sllvex)
NO mg1L 0.00200
1 06/12/20 07:11 06/12120 16:09 93-72-1
2,4-13
NO mg1L 0.00200
1 06/12/20 07:11 06112120 16:09 94.75.7
Surrogates
2,4-OCAA (S)
75.2 % 14.0.158
1 06/12/20 07:11 06/12120 16:09 19719-25-9
8081 TCLP Pesticides RVE
Analytical Method: EPA 8081 B Preparation Method:
EPA 35100
Leachate Method/Date: EPA 1311; 06103120 15:02
Initial pH: 5.97; Final pH: 5
Pace Analytical Services - Charlotte
gamma-BHC (Lindane)
NO ug1L 0.50
1 06/05/20 10:06 06/11120 18:23 58-89.9
Chlordane (Technical)
NO ug1L 3.0
1 0610512010:06 06/11/2018:23 57-74-9
Endrin
NO ug1L 0.50
1 0610512010:06 0611112018:23 72-20-8
Heptachlor
NO ug1L 0.50
1 0610512010:06 0611112018:23 76-44-8
Haptachlor epoxide
NO ug/L 0.50
1 06105/20 10:06 06/11120 18:23 1024.57-3
Melhoxychlor
ND ug1L 1000
1 06/05120 `10:06 0611112018:23 72-43-5
Toxaphene
ND ug1L 3.0
1 06/05120 10:06 0611112018:23 8001-35-2
Surrogates
Decachlorobiphenyl(S)
110 % 10.138
1 06105/20 10:06 06/11120 18:23 2051.24-3
Tetrachloro-m-xylene (S)
100 % 10.110
1 06/05120 10:06 06/11120 18:23 877.09.8
8082 TCLP PCBs WE
Analytical Method: EPA 8082A Preparation Method: EPA 3510C
Leachate MelhodlDate: EPA 1311; 06103/20 15:02
Initial pH: 5,97; Final pH: 5
Pace Analytical Services - Charlotte
PCB-1016 (Aroclor 1016)
ND ug1L 1000
1 06/05120 10:06 06109/20 23:00 12674-11-2
PCB-1221 (Aroclor 1221)
ND uglL 1000
1 06/C5120 10:06 06/09120 23:00 11104.28-2
PCB-1232 (Aroclor 1232)
NO ug)L 1000
1 06105/20 10:06 06/09120 2100 11141.16-5
PCB-1242 (Aroclor 1242)
NO ug1L 1000
1 06/05/20 10:06 06/09/20 2100 53469.21.9
PCB-1248 (Aroclor 1248)
ND ug1L 1000
1 06/05/20 10:06 06/09120 23:00 12672.29.6
PCB-1254 (Aroclor 1254)
NO ug1L 1000
1 06/05/20 10;06 06/09/20 23:00 11097-69.1
PCB-1260 (Aroclor 1260)
NO ug1L 1000
1 06/05/20 10:06 06/09120 23:00 11096-82-5
Surrogates
Decachlorobiphenyi (5)
93 % 10-132
1 06/05/20 10:06 06/09120 23:00 2051.24.3
6010 MET ICP, TCLP
Analytical Method: EPA 6010D Preparation Method:
EPA 3010A
Leachate MelhodlDate: EPA 1311; 06/04120 16:18
Initial pH; 5.91; Final PH: 2
Pace Analytical Services - Asheville
Arsenic
NO mg1L 0 C50
1 06/06/20 07:40 06109/20 11:03 7440.38.2
Barium
NO mglL 0.25
1 06/06/2007A0 06/09120 11:03 7440-39.3
Cadmium
NO mg1L 0.0050
1 06100/20 07:40 06109/20 11:03 7440.43.9
Chromium
ND mg1L 0.050
1 06106120 07:40 06109120 11:03 7440-47-3
Lead
ND mg1L 0.025
1 06106/20 07:40 06109120 11:03 7439-92-1
Selenium
ND mg1L 0.10
1 06106/20 07:40 06109120 11:03 7782-49-2
Silver
ND mg1L 0.025
1 06/06120 07:40 06109120 11:03 7440-22-4
REPORT OF LABORATORY
ANALYSIS
This report shall not be reproduced, except in full,
Date: 0611912020 05:15 PM
without the written consent of Pace Analytical Services, LLC.
Page 5 of 39
PO Box 228 a Statesville, NC 28687 a 704/872/4697
Page 8 of 42

aceAnalytical
1rwwwwall"M
ANALYTICAL RESULTS
Project: US Bio- Taylorsville
Pace Project No.: 92479945
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Hunlersville. NC 28078
(7041875-9092
Sampla: 200601.14 Lab ID: 92479945001 Collected: 06101/20 1100 Received: 06102)20 14:05 Matrix: Solid
Results reported on a 'dry weight' basis and are adjusted for percent moisture, sample ske and any dilutions.
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
7470 Mercury, TCLP Analytical Method: EPA 7470A Preparation Method: EPA 7470A
Leachate Method/Date: EPA 1311:06104120 16:18 Initial pH: 5.91; Final pH: 2
Pace Analytical Services - Asheville
Mercury ND mg1L 0.00020 1 0610812010:36 0610812017:38 7439-97-6 M1
8270E TCLP RVE
1,4-Dichlorobenzene
2,4-Dinitrotoluene
Hexachloro-1,3-butadiene
Hexachlorobenzens
Hexachloroethane
2-M ethyl phenol(o-C reso I )
3&4-Methylphenol{m&p Cresol)
Nitrobenzene
Pentachlorophenol
Pyridine
2,4, 5-Trioh to roph a nol
2 ,4, 6 -Tri ch t o rop h e nol
Surrogates
Nitrobenzene-d5 (S)
2-Fluoroblphenyt (S)
Terphenyl-d14 (S)
Phenol-d6 (S)
2-Fluorophenol(8)
2,4,6-Tribromophenol (S)
8211011) MSV TCLP
Benzene
2-Butanone (MEK)
Carbon tetrachloride
Chlorobenzene
Chloroform
1,4-Dichlorobenzene
1,2-Dichloroethane
1,1-Dichloreethene
Tetrachloroelhene
Trichloroathene
Vinyl chloride
Surrogates
12-Dichtoroethane-d4 (S)
Toluene-d8 (S)
4-Bromofluorobenzene (S)
Date: 06)1912020 05:15 PM
Analytical Method: EPA 8270E Preparation Method: EPA 3510C
Leachate Method/Date: EPA 1311: 06103/20 15:02 initial pH: 5,97; Final pH: 5
Pace Analytical Services - Charlotte
NO
ug7L
50.0
1
06/05/20 08:57 061051r2i) 1514 106-46-7
NO
uglL
50.0
1
06105120 08:57 GW05120 1514 121-14.2
NO
ug7L
50.0
1
06/05120 08:57 06/05120 15i14 87-68-3
NO
ug7L
50.0
1
06IG5120 08:57 06/05120 15:14 116-74.1
NO
u911-
50.0
1
06105/20 08:57 0670512015:14 67.72-1
NO
ug7L
50.0
1
06105/20 08:57 06/05120 15:14 95-48-7
NO
ug7L
50.0
1
06105/20 08:57 06/05/2015:14 15831-10-4
ND
ug7L
50.0
1
06/05120 08:57 06/05120 15:14 98.95-3
NO
ug7L
100
1
06105120 08:57 06/05120 15:14 87-66-5
NO
ug7L
50.0
1
06105120 08:57 06/05/20 15:14 110-86-1
NO
ug7L
50-0
1
06105/20 08:57 06/05120 15:14 95-95-4
NO
ug7L
50.0
1
06105120 08:57 0610512G 15:14 88.06.2
80
%
12402
1
06105/20 08:57 06/05/20 15:14 4165.60-0
65
%
13407
1
06105120 08:57 0610612015:14 321-60-8
94
%
21.132
1
06105/20 08:57 06/05120 15:14 1718-51.0
42
%
10-110
1
06105120 08:57 06/05120 15:14 13127-88.3
55
%
10.11 D
1
06/05120 08:57 06105120 15:14 367-12-4
67
%
27.108
1
06/05120 08:57 06105/20 15:14 118-79-6
Analytical Method: EPA 826GO Leachate MethodlDate: EPA 1311: 06115/20 12:27
Pace Analytical Services - Charlotte
ND
uglL
100
20
0611612013:31 71.43-2
NO
uglL
200
20
0611612013:31 78-93-3 V1
NO
uglL
100
20
06M612013:31 56.23.5
NO
ug7L
100
20
0611612013:31 108-90.7
NO
ug7L
100
20
06/16/20 13:31 67-66.3
NO
uglL
100
20
06/16/2013-31 106-46-7
NO
uglL
100
20
0611612013:31 107-06.2
NO
ugli,
100
20
06/1612013:31 75-35.4
NO
ug1
100
20
0611612013:31 127-18-4
NO
ugll-
100
20
0611612013:31 79-01-6 M1
NO
uglL
100
20
0611612013:31 75-01-4
105
%
70.130
20
06116120 13:31 17060.07-0
101
%
67-135
20
0611612013:31 2037-26-5
102
%
70-1130
20
0611612013:31 460.00-4
REPORT
OF LABORATORY
ANALYSIS
This report shall not be reproduced,
except in lull,
without the written consent of Pace Analytical Services, LLC, Page 6 cf 39
PO Box 228 a Statesville, NC 28687 a 704/872/4697
Page 9 of 42

aceAnalXical a
WWPO W6scom
ANALYTICAL RESULTS
Project: US Bio- Taylorsville
Pace Project No.: 92479945
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersvilla, NC 28078
(704)B75-9092
Sample: 200601.14 Lab ID: 92479945001 Collected: 06/01120 13:00 Received: 06102/20 14:05 Matrix: Solid
Results reported on a 'dry weight' pasts and are adjusted for percent moisture, sample site and any dilutions.
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. 4ual
Percent Moisture
Analytical Method: ASTM D2974-87
Pace Analytical Services - Charlotte
Percent Moisture
95.0 `ya 0.10 1
06/02120 17:30
1010 Flashpolnt,Closed Cup
Analytical Method: EPA 1010A
Pace Analytical Services - Asheville
Ftashpoint
>200 deg F 70.0 1
06/15120 10:50
9045 pH $oil
Analytical Method: EPA 9045D
Pace Analytical Services - Ashevifle
pH at 25 Degrees C
12.2 Std. Units 0.10 1
06/15120 13:38 E,H3
9095 Paint Filter Liquid Test Analytical Method: EPA 9095E
Pace Analytical Services - Asheville
Free Liquids Fail 1.0 1 06112120 18,10
733C 9 Reactive Cyanide Analytical Method: EPA9014 Preparation Method: SW-846 7.3.3.2
Pace Analytical Services - Greensburg
Cyanide, Reactive N❑ mglkg 25.0 1 06/04120 18:00 06/05/20 13:23
7343 Reactive Sulfide Analytical Method: SM 4500S2F-2011 Preparation Method: SW-846 7.3.4.2
Pace Analytical Services - Greensburg
Sulfide, Reactive ND mglkg 250 1 06104/20 18:00 06/04120 18:35
Sample: 200601.14 LabID: 92479945002 Collected: 06/01/20 09:00 Received: 06/04120 11:52 Matrix: Water
Parameters
Results Units Report Limit DF Prepared Analyzed CAS No. 4ual
8082 GCS PCB RVE
Analytical Method: EPA8082A Preparation Method: EPA 3510C
Pace Analytical Services - Charlotte
PCB-1016 (Aroclor 1016)
ND ug1L 5.0 1 06/17/20 11:63 06/19/20 03:44 12674-11-2
PCB-1221 (Aroclor 1221)
ND ug1L 5.0 1 06/17/20 11:53 06119120 03:44 1(1104.28-2
PCB-1232 (Aroclor 1232)
ND ugiL 5,0 1 06/17120 11:53 06119/20 0144 11141.16-5
PCB-1242 (Aroclor 12421
ND ugiL 5.0 1 06/17/20 11:53 06/19120 03:44 53469.21.9
PCB-1248 (Aroclor 1248)
ND ugiL 5.0 1 06117/20 11:53 06/19120 03:44 12672-29-6
PCB-1254 (Aroclor 1254)
ND ugiL 5.0 1 06117120 11:53 06119120 03A4 11097-69-1
PCB-1260 (Aroclor 1260)
ND ugiL 5.0 1 06/17120 11:53 06119120 0144 11096.82.5
Surrogates
Deaachlorobiphenyt (S)
73 % 10.130 1 06/17120 11:53 06119120 03:44 2051-7-4-3
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in tutl.
Date: 06/19/2020 05:15 PM
without the written consent of Pace Analytical Services, LLC. Page 7 of 39
PO Box 228 • Statesville, NC 28687 a 704/872/4697
Page 10 of 42

State of North Carolina
WR
Department of Environmental Quality
Division of Water Resources
Dirlslon 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 .1 100. Do not subm it 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) 0 Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
County Board
Notification. doc
l
Land Owner
Agreement
(If applicable)
L
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map..Gu_idance
✓
✓
✓
for_Residuals Land_ Application_P.erm ts-
A soils and agronomic evaluation in accordance with the "Soil. Scst.
✓
Evaluation Police"
INSTRUCTIONS FOR FORM: LASC 06-16 Page I of 3

* This item may be required for land application site with a status code "1N"
determining attachment requirements.
An updated accounting of the land application site's cumulative
pollutant loadiniz rates CPLRs
Status Code
Required Item N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil ma re uirements in the "Sail Scientist Evaluation F'1_i_c
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same time eriod)
please contact the Division if you need assistant in
❑ 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 G - 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 I 1-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: htt ://de .nc. ov/about/divisions/water-
resou rces/p tannin /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://deg.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 I 1-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 l: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deg..nc.pov/about/divisions/water-resources/planni g/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
I. 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

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 .03010).
❑ 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 drains a 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: Town of Ta lorsville
Land application sites currently certified: 97.1 net acres and Total to be certified: 84.0 net acres
1. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status
Site/Field
Landowner(s) Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Series Name s
Mapping Unit
Code'
ID
or Rep. Slope
R
08-01
Owen Icenhour
193
Alexander
Fescue
Cecil
CeB2
R
08-02
Owen Icenhout „
]03
Alexander
Fescue
Cecil
CeB2
D
08-04
Matthew Shannon
13.1
Alexander
Fescue
Cecil
CeB2
R
CH-01
Clyde Hendren
23.4
Alexander
Fescue
Pacolet
PcB2
R
CH-02
Clyde Hendren
93
Alexander
Fescue
Cecil
CeB2
R
CP-01
Carol Price
7.0
Alexander
Fescue
Fairview
FeB2
R
PH-01
Phillip Hoover
14.7
Alexander
Fescue
PacoleT
PcB2
N
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. fora 2-8%
slope Cecil in Anson County the mapping
unit is CeB2)
IL WATERBODY
AND CLASSIFICATIONS INFORMATION (See Instruction
C):
Site/Field 1D
Latitude
Longitude
Lon g
Location
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class
Datum
08-01
35,8728080
-81.1031470
NAD 83
ADD
Nearest Second
1 1-73-(0.5) Elk Shoal Creek
WS-CV WS-1V
08-02
35.8769140
-81.100089a
NAD 83
ADD
Nearest Second
1 1-73-(0.5) Elk Shoal Creek
WS-IV WS-IV
08-04
3.5.8723310
-81.0997860
NAD 83
ADD
Nearest Second
1 1-73-(0.5) Elk Shoal Creek
WS-1V
WS-iV
CH-01
35.903900°
-81.1503940
NAD 83
ADD
Nearest Second
1 1-69-7-(0.7) Glade Creek
WS-1V
WS-lV
CH-02
35.9033920
-81,1471190
NAD 83
ADD
Nearest Second
l 1-69-7-(0.7) Glade Creek
WS-IV
WS-IV
CP-01
35.9046310
-81.1531390
NAD 83
ADD
Nearest Second
I 1-69-7-(0.7) Glade Creek
WS-I V
WS-iV
PH-01
35.8999170
-81.1505420
NAD 83
ADD
Nearest Second
1 1-69-7-(0.7) Glade Creek
WS-1V
WS-IV
NAD 83
ADD
Nearest Second
Note: Please keep the site information (I.) and Waterbody information (11.) of the same field on the same page.
FORM: LASC 06-16 Page 1

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LANDOWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the 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 document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town ofTaylorsville
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)
CH-01
No
Fescue
Pasture
CH-02
No
Fescue
Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR.. Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals. residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns. results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to: enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit. copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
It. 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 he 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 a20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
Ill. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 021'.0105 h allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) iD:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: _ I 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:
Address: 1390 Boston Road
City: Taylorsville State: NC _ Zip: 28681
Phone: [phone] > E-mail address:
Signature: �.izc�/9�r.,� _ Date:
NORTH CAROLINA, A14:900"j +4" _ COUNTY
3-8-a02
1, the undersigned Notary Public do hereby certify that �trn�r+r n
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 ^,tc.L
Signature and seal:
My commission expires: _
Lessee's/Operator's Certification:
i-i '91"ao?,I
G k
'LQ 20
t�ntaly Public
Wllkt3s _ounty
r�
O
rC Nqo.
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 l have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: David Odom
Signature: _ �.�.��' Date:
FOR M• t.nA M-I( ❑.,.,., Z s•I

MLJ
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LANDOWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the 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 Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Taylorsville
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
(yeslno)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilllover-seed)
pasture)
CP-01
No
Fescue
Pasture
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

1. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Shauld the landowner or his representative lease or otherwise permit the use of the land application-site(s) to a third party, the landowner shall
he responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program.
including an analysis of constituents of the residuals, residuals application methods. schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g.. fertilizer, unregulated animal waste. etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to, enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit: take necessary leachatc. 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 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) 11):
(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 ficld(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: Carol Price
Address: 912 Boston Road
City: Ta lorsville State: NC Zip: 28681
Phone: [phone] E-mail address:
Signature: Date:
NORTH CAROLINA, A ItY"J I-(- COUNTY
I, the undersigned Notary Public do hereby certify that CA . 1 &_:C t -
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the ���`��� PCHIERk"111,
day of oar[ 20
Notary public
Signature and seal: - W/I =
ny
My commission expires:
rtiCARC
Lessee's/Operator's Certification:
I certify that i have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature:
Permittee's Certification:
Date:
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: David
Signature:
Date: 3 -~ jr— 2 6 2—
FORM: LOA 06-16 Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicantshall 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 document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town ofTaylorsville
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
(Y )
Land Use or
Cropping Patterns
PP� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilllover-seed)
pasture)
08-01
No
Fescue
Pasture
08-02
No
Fescue
Pasture
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

1. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617,
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. if the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at [east 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 sitc(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) priorto 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 -
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops. feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC_02T .0105(h) 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 ofthe 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:
Address: 716 Stikeleather Rd.
City: Hiddenite State: NC Zip:
Phone: [phone] E-mail address:
Signature: 0,� oz/w Date:
NORTH CAROLINA, P I>c)g •..c r COUNTY
I, the undersigned Notary Public do hereby certify that 00w► Zcc.► �Ov/
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the R r� ``\01u tll h''`j'r`/
day of � 20 -
Signature and seal: Notary Pub0c
WilkesCou"TV
My commission expire
may.
Lessee's/Operator's Certification:
certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
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: rlDavid Odom
Signature: _ J,_r� ti -- Date:
FORM: LOA 06-16 Page 3 of 3

DW
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 -- LANDOWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the 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 Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Ta lorsville
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)
PH-01
No
Fescue
Hay
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 I of 3

1. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details ofthe 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 ofthe
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 shal I be applied to achieve a final soil
pH of at ]cast 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 ofthe land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY. (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. [-However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ 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: Pl� ti U 16 V t r
Address: 3 `l C«ro :nw L
City: o j.r State: �C zip:
Phone: 6 a' H $'� E-mail address:
Signature: Date:
NORTH CAROLINA, J4 l---roe. (f COUNTY
I, the undersigned Notary Public do hereby certify that &- l itR u�►`~�
personalty appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNFSS my hand and official seal this the
day of — t-' S n.
Signature and seal:
My commission expires: _ ��'th-3_0-A
Lessee's/Operator's Certification:
Wilkes County
�AR3ti
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: Z0z
FORM: LOA 06-16 Page 3 of')

I'hc Compliunce lloundan is esuthfislted other 1511 lect from the penmeter of the residual~ appliralwn area or 50 01 N Am
Ow prrrperl% honndan. %%hichcwr is eloxr the Hevteu lian un.lat5 Cstahlished mil%%a% herkiecn the C twinplianec iicnrndan
and ncc peruncter N rr,c rc•SWURII, application area
�i
i f j
Field 1
14.7 acres

l tic C'omphnnce 11rnmJnn is e51nhlrshed either 250 leer buret the perimeter ul the residuals applicutonn area ur 50 feet %iihin
Ihr pntpem hounJnn. +0hrchewt is closer I he kcucu ItounJnn t, cxlshlmhcd mtditay ltctuccn Il1c Compliance Nauudin
and the perimeter ul Iltc residuals uppiicatmn are,,
in
44 A
s i
F �
� ;�tv t ; y'•' �
I !�. iNI-
4.1
i
i
• �"WA. ,?
1�
F+eld 08-01
1 19 3 acres
t
r
�r 4k
Icenhour, Owen Buffer Map
Parcel 0013847
Alexander County. NC
0
L.
35 8158 •87 0994
Mt * -A,
Buffers
' Property Line (50'
4 Perennial Stream 60')
House (400 )
r
Well (100')
s. d
pery Line
d Boundary s+ Well
ennial Stream House
face Water
sed Area
Vf 7510 ' SJO Beet
A. l_ L +
North Csrolns 5lateplaee- NA083

I he CumpfumCC liur+ndtrn is c%tahlished either 251) Iiel Kim the perimeter ur tlrc residual. applicatrun ;irea or 511 lcel w rtlun �—
ihe property hhulydan. whPehc%er is clwwrthe lies Pew Iluundan is a tnhlrshed multi+a} hemeen the Cumphivice 1lfuundan
and the perimeter ul the re•rduuls upplPcauun area.
-WOE
C 4L
pi
r ...E -
1
Field 2 ' 4
9.3 acres
w
Fiel 1
234 Gres
4
a
T
Buffers
Property Line (50' )
Perennial Stream (100')
Surface Water (100')
f---1 House (100')
0 House (400')
Legend
Propery Line
Field Boundary a Well
Perennial Stream House
Surface Water -*441 ptnet
® Unused Area
Board-011.
Land Application: Hendren, Clyde Leveme
PIN 3769308303
Alexander County, NC 0 250 500
l_ + P
35 9026 -81 1484 ruorth a+ w rP• lur NADB3 i
1,000 Feet
J

f I hr C ontpllance flounlh•In is .slnhllsllcl[ c,fhcr 25(1 levi from the verlmewr of the ri-sid ,i. ;jpp11c;,1„ )It area or 5111 feel ++Rhin
the prollem huundlln ++luchever Is clmcr I Iw lie%Icl+ "O"Ildun 11% 01"NiSlled 111itNa1' hemecll 01C ( tiI71pliance 11mmdarj -
and the penmcter of the remilMik :Iphlicuuan arcs '
I
If„•�•h,11 ks� ' ,1
Price, Carob B«ffier Map
Parcel 0009501
1 � 1
x`
Z
7 0 acres J
u eIb
Property LI �-,e (50
Perennial Stream (100 '
Intermittent Strearn (2�-)
House(101
Hcuse 40(, }
Well ! -,DO
' 1
lM unused Area I{
0 Well
serer r-,+al 5I eg117 HduSe 1
x Soil Bore
{

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 APPLIf- ABL
E.
Facility Name: Town ofTaylorsville WQ Permit #: W0006906 Field #:
CP 01 Acres Utilized: 7
Land Owner: Carol Price Annual Dry Tons Applied: 14.1027 Site #
CP Ol Acres Permitted: 7
Operator: Carol Price Predominant Soil Series: k' e$2 C-
ation Exchange Capacity (non 503):
Crop 1 Name: Fescue CronI Max PAN 194
- Crop 2 Name: Crop 2 Max. PAN:
Volume applied
tenter one) Solids/
Liquid
Solids
Cu. Yds I Gallons
I0-2020 71500 F4,73
r0TALS:1 01 71 S00
annual Ibs/acre
3rior Years Cumulative lbs/ac
:urrent Cumulative Ibs/ac
'ermitted C. P. L. R.****
Volume Residual Sources
JOt1
Precip.
Applied per (NPDES #. WQ#,
Cord.
Past 24
Acre Fert., Animal
(Dry'
Hrs.
Waste, etc)
{Dry Tons[Ac)
Wet,
Moist)
inches
2.015 WQ006906
dry
0
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
o.000
Residuals App
As
Cd
I Cu
0,043
0.009
0.883
U.041
0.022
2.618
0.084
0.031
3.501
36
34
1338
�>T3T6
Nitrate
o 3
and
Nitrite
mgA9
mg/kgs
0
4150
104
ications totals on FORM FSF supp ( attach FORM
N
FSF
supp to this form):
Cr
Pb
Hg
I Mo
Ni
I Se
I Zn
I P
0.065
0.053
0.002
0.021
OL40
0.043
3.575
40.300
0.229
0.189
0.007
D.059
0.106
0.061
$.051
0.294
0.242
O.U09
0.080
0.146
O.104
11.626
NA
267
15
PAN Applied
( 16s/acre)
Crop 1
48.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
48.006
Crop 2
NA
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Name of Crop Type
Receiving Residual
Application
Crop 1 Crop 2
Fescue
0.000 Lime Applied
Date ]bs/ac
U
'errnit PAN Limit ]st/2nd Crop
A 374 89 2498
11
i 194 certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. 1 am aware that there are significant penalties for submitting false
aformation, including the possibility of tines and imprisonment for knowing violations."
c�
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Appher 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

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 APPLICAB
Field #: 006906 W
Facility Name: Town of Taylorsville WQ Permit #•' Q PH 01 LE. Acres Utilized: 14_7
Land Owner: Phillip Hoover Annual Dry Tons Applied: 38.4620
Site #: PH 01 Acres Permitted: 14.7
Operator: Phillip Hoover Predominant Soil Series: PcB2
Cation Exchange Capacity (non 503):
Crop I Name: Fescue CronI Max PAN 144
Crop 2 Name: Crop 2 Max. PAN:
Volume applied
(enter one) Solids/
Liquid
Solids
Cu. Yds Gallons
7-2020 1 195000 4.73
-01'ALS:1 01 195000
Nnnual lbs/acre
Volume
Residual Sources
Applied per
(NPDES #_ WQ#,
Acre
Fert., Animal
(Dry TonslAc)
Waste. etc)
2.616
WQ006906
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Soil Precip.
> o
Cond. Past 24
yLE
� "
TKN
(Dry'}1rs.
_�
aWet.-
Vloist) inches
0
mglkg
mg
dry 0
s 0.5
0.3
36600
4150
Nitrate
and
Nitrite
mglkg
104
PAN Applied
( Ibs/acre)
Crop I
62.345
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Crop 2
NA
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Name of Crop Type
Receiving Residual
Application
Crop 1 Crop 2
Fescue
Lime Applied
0.069 0.002 0.028 0.052 0.055 4.641 52.,20 Date ]bslac
'rior Years Cumulative IbS/ac 0.317 0.043 5.702 0.545 0.379 0.014 0.113 0.258 6.896 104 136
:urrent Cumulative Ibs/ac 0.372 0.054 6.848 0.630 0.448 0.016 0.141 0.310 0.951 108,977 0
'ermitted C. P. L. R.**** 36 34 1338 NA 267 15
NA 374 84 249$
'ermit PAN Limit Istl2nd Crop
I94
J certify, under penalty of taw, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
aformation, including the possibility of fines and i.,,nr;SOt:ne nt c�..t'r-Owing- _jig violations." •r• • .nuvv�'t
*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 LoadinE Rate
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
As Cd I Cu Cr Pb HMo Ni Se I Zn P
0.055 0 011 1 I46 0 085
62.345
0.000

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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE
Facility Name: Town ofTaylorsville WQ Permit#: Field #: W 006906
Q CH 02 Acres Utilized: 9,3
Land Owner: Clyde Hendren Annual Dry Tons Applied: 23.0772 Site #: CH 02 Acres Permitted: 9.3
Operator: Clyde Hendren Predominant Soil Series: CeI32 Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop 1 Max. PAN 209 Crop 2 Name: Crop 2 Max. PAN:
L
Volume applied
Volume
v c
(enter one ) Solids/
o
/a
Applied per
Q o
Liquid
Solids
Acre
Cu. Yds Gallons
(Dry Tons/Ac)
5-2020
117000
4.73
2.481
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
I
Residual SourcesL(Dry,
Precip.
(NPDES 4, WQ#t.d.
Past 24
K
Fert.. Animal
Hrs.
0
Waste, etc)
,
,
t)WQ006906
inches
0
Residuals Applications totals on FORM
'OTA1.S: 0 117000As Cd Cu Cr Pb H
knnual lbs/acre 0.053 0.011 1.087 0.080 0.065 0.00
'rior Years Cumulative ]bslac 0 0 0 0 0 0
'urrent Cumulative lbs/ac 0.053 0.011 1.087 0.080 0.065 0.00
'ermitted C. P. L. R.**** 36 34 1338 NA 267 15
ermit PAN Limit lst/2nd Crop
n
-
FSF
b
o
w
N"
0
TKN
mg/kg
voo o
a
mglkg
Nitrate
and
Nitrite
mglk9
Name of Crop Type
PAN Applied
Receiving Residual
(Ibs/acre)
Application
Crop 1
Crop 2 Crop 1
Crop 2
0.5
0.3
36600
4150
104
59.127
NA Fescue
0.000
0.000
0.000
0.000
0.000
0.000
o.00o
0.000
o.000
(.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
2
supp ( attach
Mo
0.026
FORM
Ni I
0.050
0.600
0.000
FSF supp to this form):
Se I
Zn
P
59.127 0.000 Lime Applied
0.053
0
0.053
89
4.401
0
4.401
2498
49.620 Date I
lbs/ac
2
0
0.026
0
0
0.050
NA
374
209
I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
tformation, including the possibiiitv of £rues and i.m,prlsonment for knowing vioiatlons.,,
SignaturVof Land Applier
.L" 4•=0.
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

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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE,
Facility Name: Town ofTaylorsville WQ Permit #• WQ006906 Field #: CH O1 Acres Utilized- 23.4
Land Owner: Clyde Hendren Annual Dry Tons Applied: 35.8979 Site #: CH O1 Acres Permitted: 23.4
Operator: Clyde Hendren Predominant Soil Series: PcB2 Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop 1 Max. PAN: 194 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
Volume
_
O
v o
(enter one) Solids/
o
/a
Applied per
O
Liquid
Solids
Acre
Cu, Yds Gallons
(Dry TonslAc)
5-2020
182000
4.73
1.534
RM000,000000000
0.000
0.000
Residual Sources
Soil
Precip.
>
o
(NPDES #_ WQ#,
Cond.
Past 24
Fert., Animal
(Dry'
Hrs.
_K
o W
u
� N
`°
�
Waste, etc)
Wet.
Moist)
inches
3
WQ006906
dry
0
s
0.5
0..
Residuals Applications totals on FORM FSF
supp ( attach F
-0TALS: 0 1820(00
As
Cd
I Cu
Cr
I Pb
Hg
MO
Ni
annual ]bs/acre
0.033
0.007
0.672
0.050
0.040
0.001
0.016
0.03
'rior Years Cumulative lbs/ac
0.043
10 022
3,014
0.279
0.2
0.008
0,057
0.13
:urrent Cumulative lbs/ac
0.076
0.029
3.686
0.329
0.240
0.009
0.073
0.16
'errnitted C. P. L_ IZ.****
36
34
1338
NA
267
15
NA
374
'ermit PAN Limit Ist/2nd Crop
'I certifyunder enal f I
th
y
-
3
TKN
mg/kg
z
o E
M Q
rnglkg
Nitrate
and
Nitrite
nglkg
PAN Applied
( Ibs/acre)
Name of Crop Type
Receiving Residual
Applications
Crop 1
Crop 2
Crap 1
Crop 2
3
36600
4150
104
36.554
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
ORM FSF supp to this form):
Se Zn P 36.554 0.000
1 0.033 2.721 30.680
4 2.238 37.609
5 2.271 40.330
89 2498
t94
Lime Applied
Date
lbs/ac
0
, p ty o aw, at 4. S document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. 1 am aware that there are significant penalties for submitting false
reformation, including the possihilify of finny$ and it prisorim,acrii for KnOwlil VFolat10115.�4
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
��'�� **Volatilization Rate: Surface -0.5, Injection/Incorporation - LO
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

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: Town ofTaylorsville WQ Permit#: WQ006906 Field #
• 08 Ol Acres Utilized: 19,3
Land Owner: Owen Icenhour Annual Dry Tons Applied: 135.8004 Site #:
08 01 Acres Permitted: 19.3
Operator: Owen Icenhour Predominant Soil Series: CeB2
Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop 1 Max. PAN: 216 Crop 2 Name: Crop 2 Max. PAN:
o _ Volume applied
Volume
Residual Sources
Soil
Precip.
(enter one) Solids/ o/a
Applied per
(NPDES #. WQ#.
Cond.
past 24
t7 0 Liquid Solids
Acre
Fert.• Anima]
(Dry
Hrs,
Cu. Yds Gallons
,1)ry �ronslAc)
Waste. etc )
Wet,
Moist)
inches
5-2020 227500 4.73
2.325
WQ006906
dry
0
7-2020 234000 4.73
2.391
WQ006906
dry
0
10-2020 227000 4.73
2.320
WQ006906
dry
0
0.000
0.000
0.000
0.000
o.000
0.000
0.000
o.000
0.000
Residuals Applications totals on FO
TOTALS: D 688500
AS
Cd Cu
Cr
Pb
annual lbs/acre
0.149
0.030 3,082
0.228
0.186
3rior Years Cumulative lbs/ac
0.33
0.218 35?58
1.793
2.821
-urrent Cumulative Ibs/ac
0.479
0.248 38.340
2.021
3.007
'ermitted C. P_ L. R.****
36
34 ]338
NA
267
'ermit PAN Limit Ist/2nd Crop
`I certify, under penalty of law that th' d
K -o
s
C
o
z
0.5
_
a
in
N'
0.3
TKN
mglkg
36600
z 3
CD o
�'
mglkg
4150
Nitrate
and
Nitrite
mg/kg
104
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop ]
55.400
Crop 2
NA
Cr41Crop
Fes
2
0.5
0.3
36600
4150
104
56.983
NA
Fess
0.5
0.3
36600
4150
104
55.278
NA
Fes
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.a00
0.000
0.000
0.000
0.000
RM FSF
H
0.007
supp ( attach
Mo
0.000
0.000
FORM FSF supp to this form):
Ni Se Zn P
167.661 0.000
Lime Applied
0.075 0.141 0.149 12.482 140.720
0.459 j92 4.186 128.705
0.534 4.335 141.187
NA 89 2498
216
Date
Ibs/ac
0.182
0.189
0
15
, �s ocument was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
-n-formatiot:, including the possibility of fines and imprisonment for knowing violations.,,
*Application Method: S - Surface, IN - Injection, INC - Incorporation
W 02 i **Volatilization Rat S f
JV e4 ur ace - 0.5, Injection/incorporation - 1.0
Signature of Land Appiier Date Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
**a`*C.P.L.R.: Cumulative Pollutant Loading Rate