WQ0030132_Renewal Application_20210617

Non -Discharge Branch Upload/Submittal Form
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes r No
Permit Number (IR)* WQ0030132
Applicant/Permittee Town of Plymouth
Applicant/Permittee Address PO Box 806, Plymouth, NC 27962
Is the owner in BIMS? a Yes r No Is the facility in BIMS? c' Yes r No
Owner Type Municipal
Facility Name Town of Plymouth RLAP
County Washington
Fee Category Minor Fee Amount $0
Is this a complete
application? *
a Yes r No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review by the hydrogeologist?* r Yes NO
Regional Office
CO Reviewer
Admin Reviewer
Complete App Date 06/17/2021
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by NEB Staff regarding electronic subnittal, confirmation of receipt, and other correspondence.
Name * Drew Matthews
Email Address*
[e-mail]
Project Information
Application/Document Type *
✓ New (Fee Required)
✓ Modification - Major (Fee Required)
✓ Renewal with Major Modification (Fee
Required)
✓ Annual Report
✓ Additional Information
✓ Other
Phone Number*
2528839301
O Modification - Minor
G Renewal
O GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
✓ Residual Annual Report
✓ Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq. nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Permit Number:*
Applicant/Permittee *
✓ Wastewater Irrigation
✓ Other Wastewater
✓ Closed -Loop Recycle
✓ Single -Family Residence Wastewater
Irrigation
Town of Plymouth
✓ High -Rate Infiltration
✓ Reclaimed Water
t: Residuals
✓ Other
WQ0030132
I- s Qirrent Existing permit number
Applicant/Permittee Address* PO Box806, Plymouth, NC 27962
Facility Name * Town of Plymouth RLAP
Please provide comments/notes on your current submittal below.
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 Fomi Engineering Flans, Specifications, Calculations, Rc.)
2021 Town of Plymouth Permit Renewal.pdf 6.5MB
t.pload only 1 RFdocurrent (less than 250 M3). Matiple documents nest be corrbined into one RJFfile unless file is larger than
upload limit.
* fJ By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 6/17/2021

TOWN OF PLYMOUTH
2021 PERMIT RENEWAL
CLASS B PROGRAM
WQ0030132
Submitted by:
Soil Plus
PO Box 1396
Oxford, North Carolina 27565
June 17, 2021
SOIL PLUS

SOIL PLUS
4111111111W-
PO Box 1396
Oxford, NC 27565
[phone]
[e-mail]
www.soilplus.net
June 17, 2021
NCDEQ-DWR
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Mr. Nathaniel Thornburg
Reference:
PERMIT RENEWAL
Town of Plymouth Residual Biosolids "Class B" Program
Permit # WQ0030132
Mr. Thornburg:
Soil Plus, LLC (Soil Plus) is submitting one electronic copy of this permit renewal
application package for the Town of Plymouth (WQ0030132). This package includes:
1. Completed Residual Land Application Program Application (RLAP)
a. Weighted PAN Calculations
b. O&M Plan
2. Completed Residual Source Certification Attachment (RSCA)
a. Field Loading Calculation Sheet
b. Analytical
3. Completed Land Application Site Certification Attachment (LASCA)
a. Land Owner Agreement Form
b. Maps
c. Biosolid Utilization Calculations
d. CPLR Summary
Soil Plus will be responsible for completing this permit renewal for the Town of Plymouth.
If there is any further information required or questions regarding this permit application,
please do not hesitate to contact me for assistance.
Respectfully,
-7-e0
Drew Matthews, Soil Plus
cc: Mike Wright, Town of Plymouth
Jason Smith, Granville Farms

Town of Plymouth
2021 Class B
Permit Renewal
WQ0030132
Plymouth, NC
Residual Land
Application Program
Weighted Source PAN Calculations
O&M Plan
Residual Source
Certification
Field Loading Calculations
Analytical Data
Land Application Site
Certification
Land Owner Agreement Form
Maps
Biosolid Utilization
CPLR Summary

APPENDIX 1
2021 PERMIT RENEWAL
Town of Plymouth (WQ0030132)
RLAP
Weighted PAN Calculations
O&M Plan

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Plymouth]
Applicant type: ❑ Individual [ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Mike Wright Title: Public Works Director
Applicant's mailing address: PO Box 806
City: Plymouth State: NC Zip: 27962-
Telephone number: [phone] Email Address: Am
2. Consultant's name: Drew Matthews License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: Soil Plus, LLC)
Consultant's mailing address: PO Box 1396
City: Oxford State: NC Zip: 27565-
Telephone number: [phone] Email Address: [e-mail]
3. Agronomist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip:
Telephone number: ( ) _- Email Address:
4. Soil Scientist's name: 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 all that apply): ❑ new, ❑ modified, ® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0030132
Date of most -recently issued permit: October 13, 2016
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: Gage Lane
City: Plymouth State: NC Zip: 27962-
Coordinates: Latitude: 35° 53' 36" Longitude: 76° 43' 44"
Datum: NAD 83 Level of accuracy: Sub -Meter
Method of measurement: GIS
2. County where residuals land application program is headquartered: Washington
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
Bryan A. Smith
Granville Farms, Inc.
13265
Back -Up ORC
Jason Smith
Granville Farms, Inc.
13266
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 Nitroj'en 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: 85.1 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
17.07
17.47
1,450
1,487
Five -Year Maximum Adjusted
26.25
26.57
2,234
2,261
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
Row Crops
Hay
16.67
Pasture
16.67
Total:
16.67
Methods
Surface
16.67
Incorporation or Injection
Total:
16.67
FORM: RLAP 06-16
Page 2 of 4

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
29.01
29.74
44.68
45.22
100
14.50
14.87
22.34
22.61
150
9.67
9.91
14.89
15.07
200
7.25
7.43
11.17
11.30
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.): The Town of Plymouth WWTP is also listed as a source on Granville Farms, Inc. Class B Permit
WQ0035595 should additional acreage be needed for land application
7. Specify type of residuals program (See Instruction F): Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
crr
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 4

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 in No, Explain;
I,
Mike Wright Public Works Director
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Town of Plymouth
(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 §143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
47;/'
FORM: RLAP 06-16
Page 4 of 4

TOWN OF PLYMOUTH
OPERATION AND MAINTENANCE PLAN
LAND APPLICATION OF CLASS B RESIDUAL BIOSIOLIDS
WQ#0030132
Revised June 2021

1.0 ANALYTICAL REQUIREMENTS
Prior to the hauling and land application event being schedule the generator must provide analytical results
documenting that all parameters listed in Condition IV. 2 — 4 and at the frequency listed in most recent copy of this
permit. The Town of Plymouth will collect the sample prior to land application and will be done in the following
manner:
Four factors that may ultimately affect the integrity of reported data include: 1) obtaining a representative sample, 2)
preventing contamination of the sample, 3) providing legal documentation of the sampling event, and 4) protecting
the sample from chemical, physical or biological change prior to analysis.
A sample will be collected according to the schedule provided in the most recent copy of the Attachment of this
permit and prior to land application one composite sample should be pulled from a designated location from the
generating source. The Town of Plymouth has identified Meritech, Inc. in Reidsville, NC to be used as the Certified
Laboratory. The composite sample should be analyzed for:
• % Solids,
• Nitrogen Series (TKN, Ammonia, Nitrate, Nitrite, and Organic Nitrogen),
• Phosphorus,
• Potassium,
• Sulfur,
• Calcium,
• Magnesium,
• Sodium,
• Iron,
• Aluminum,
• Manganese,
• Copper,
• Zinc,
• and Remaining 503 Metals (i.e. Arsenic, Cadmium, Chromium, Mercury, Molybdenum, Lead, Nickel,
Selenium)
Approximately 2 quarts of residual should be collected. The sample containers should be clean and sterile. They
should also be labeled so that they are easily identifiable in the lab. The samples should be pulled using the method
listed below:
• Collect one sample from each holding tank(s) from which the material will be land applied using a "swing
sampler"
o The swing sampler must be used with a sterile, plastic 960 ml container
• Combine each sample in a stainless steel bucket
❖ Mix thoroughly using a fiberglass rod
• Collect each sample from the top of the access point at each holding tank. This access point is obtained by
climbing the installed ladder on the side of the holding tank.
Once the sample is pulled, it should be placed in medium size cooler packed with ice. The sample should be collected
with an enough time so that it can be delivered to the laboratory.
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

Once per calendar year a sample should be collected and submitted to Meritech, Inc. in Reidsville, NC. This sample
should be analyzed for:
• Full TCLP
• Ignitability, Corrositivity, and Reactivity
• Requires 5 Liters (In Opac Glass Bottles)
A third should be submitted to Meritech, Inc. for a 30-Day Scale Bench test and Fecal Coliform Density Test. The
30-Day Scale Bench Test also requires 1 quart of "clear" water from the Clarifier for Dilution if necessary. This
sample would be analyzed for:
• 30-Day Scale Bench Test (4 Quarts of Residuals and 1 Quart of Clarifier water)
• Fecal Coliform Density Test (seven pint samples)
The contact information for the labs is:
Mailing Address
Meritech, Inc.
642 Tamco Road
Reidsville, NC 27320
[phone] (phone)
[phone] (fax)
Sampling frequency will be conducted in accordance with the Table listed in the most recent Attachment A of this
permit. The sample will be collected by a representative of Soil Plus, LLC. For further information please contact:
Drew Matthews
PO Box 1396
Oxford, NC 27565
252-883-9301
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

2.0 BIOSOLIDS REMOVAL, TRANSPORT, AND APPLICATION
Biosolids will be transported from the generators to suitable, permitted land application sites. Transport equipment
will be inspected, licensed and appropriately marked, as required, for the purpose of transporting biosolids. Biosolids
will be delivered to the application sites between sunrise to sunset.
Both liquid and dewatered biosolids distribution on the land application sites will be uniform throughout the
application area. To ensure adequate control of the application rate for each site, the equipment used for spreading
the sludge will be calibrated by measuring the amount handled on a known square footage. While the rate of discharge
from the application vehicle is fixed, the speed of the equipment can be adjusted to maintain the flow rate needed to
achieve specific application rates. Spreading operations will be discontinued during periods of inclement weather and
will not be resumed until sufficient drying of the fields has occurred. This allows equipment access without causing
excessive soil compaction or rutting. To prevent adherence of the biosolids, transport vehicles will be equipped with
rear mud flaps, thereby preventing biosolids from being tracked onto roadways. Biosolids adhering to the mud flap
will be scraped off in the field before the truck returns to the roadway. Examples of our application tracking and
summary form/reports can be provided upon request.
3.0 SITE OPERATION
Biosolids will be surface applied at the properly -calculated agronomic rate and in strict accordance with any state and
federal regulations for the land application of the biosolids. Buffer zone distances will be observed in accordance with
applicable state and federal regulations. Buffer zones will be flagged and no biosolids will be applied within those
areas. The most restrictive buffer will apply in combined situations. Operational provisions will be taken to prevent
soil loss through erosion. Provisions will include contour application and avoidance of areas where surface drainage
patterns result in concentrated flow of runoff from rainfall. In accordance with sound, industry standard agronomic
practice, areas which are unseasonably wet (and would produce rutting or damage to the field) will not be utilized for
biosolids application operations during those periods. Operations will be discontinued when soils are saturated and
will not be resumed until the field has sufficient dried. The amount of biosolids applied will not exceed the hydraulic
capacity of the soil at the time of each application. If a subsequent pass across a field is necessary to achieve the
desired application rate, sufficient drying time will be allowed between passes.
4.0 PROJECT CONTROL
To ensure biosolids are continuously applied at the correct application rate and in a manner consistent with the
Operations Plan, a Field Manager (provided by the contracted land application company) will be in direct charge of
the field operations, controlling the amount of biosolids delivered to each field, and conducting daily field inspections.
Field inspections will include ensuring that flags are in place, biosolids are applied uniformly at the designated
application rate, setbacks are observed, trucks are unloading at best location, trucks are not driving over biosolids,
trucks are cleaned before leaving the field and the land application equipment is maintained in working condition.
5.0 TRANSPORTATION SYSTEM ROUTING
Per the specifications, transportation vehicles will be equipped with GPS devices that will guide drivers to the land
application sites. Transportation routes will follow primary highways and avoid residential areas where possible.
Designated routes are followed unless a detour is specified. In the event of a detour route, it shall be taken as specified
by the detour authority. There shall be no unscheduled stops when loaded. Transportation vehicles will be inspected,
licensed and appropriately marked as required with identification numbers for the purpose of this contract. All units
will be equipped with spill guards and full mud flaps. This will prevent the biosolids from adhering to the tires and
undercarriage of the transport vehicle, thereby preventing biosolids from being tracked onto roadways. Biosolids
adhering to the mud flap will be scraped off in the field before the truck returns to the roadway. All federal OSHA
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

and DOT laws and regulations are complied with for the protection of our clients, the community and our drivers.
Examples of vehicle and driver transportation logs and inspection forms can be provided upon request.
6.0 DEWATERED BIOSOLIDS
Dewatered biosolids will be transported in standard end dump trailers. The tankers will be loaded per the generator's
specifications and standard protocols. The aluminum dump trailers used for transportation of dewatered cake
biosolids will be equipped with sealed tailgates and will be completely sealed to prevent leakage. All trucks will be fully
covered and will be fitted with positive lock tailgates.
7.0 LIQUID BIOSOLIDS
Liquid biosolids will be transported using liquid tankers pulled by standard road tractors, or pumper trucks. The
tankers and pumper trucks will be loaded per the generator's specifications and standard protocols. The
tractor/tanker unit will transport its load to a designated staging area inside the buffered area of a permitted land
application site.
8.0 APPLICATION (SPREADING) — DEWATERED BIOSOLIDS
At the staging area each load will be unloaded in a designated area within the land application site. Biosolids will be
loaded into our Side Slinger cake box by a front-end loader. This unit is capable of delivering an accurate, calibrated
application of dewatered biosolids over the application site. The uniform spread pattern ensures that biosolids are
applied at proper agronomic (nutrient) and hydraulic loading rates. The application rates for each site, and its
corresponding crop, will be determined based on the Plant Available Nitrogen (PAN) content of the biosolids, or
other limiting factors. Typical applications will deliver between 75 and 100 percent of a crop's annual PAN
requirement.
9.0 APPLICATION (SPREADING) — LIQUID BIOSOLIDS
At the staging area each load will be transferred into a 4,000 gallon capacity pull behind subsequent land application.
This unit is capable of delivering an accurate, calibrated application of liquid biosolids over the application site. The
uniform spread pattern ensures that biosolids are applied at proper agronomic (nutrient) and hydraulic loading rates.
The application rates for each site, and its corresponding crop, will be determined based on the Plant Available
Nitrogen (PAN) content of the biosolids, or other limiting factors. Typical applications will deliver between 75 and
100 percent of a crop's annual PAN requirement.
10.0 SPILL AND EMERGENCY RESPONSE PROGRAM
In the unlikely event of a spill, the Town of Plymouth will take the following actions immediately.
• Halt Source of Spill. Use of any leaking or damaged unit which is causing the spill will cease immediately. The
unit will be repaired before resuming its use.
• Contain Spill. In the event large quantities of biosolids have been spilled, straw bales will be used where
available and as necessary to either form a barrier or absorb biosolids.
• Clean -Up. Depending on the type and amount of biosolids spilled, a variety of equipment may be used to
remove the biosolids: front-end loader, shovels and brooms and vacuum equipment of a liquid biosolids
applicator. Any biosolids removed from the spill site will be spread on an approved application site, returned
to the WWTP, or disposed of in an approved landfill
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

• Final Clean -Up. Flush roadways with water or sweep as necessary to clean. Allow to dry and incorporate if
spill occurs on non -paved and tillable area. In the event a spill occurs on private property, final clean-up
should be completed immediately to the satisfaction of the owner.
• Management of Clean -Up Efforts. The Operations Manager will take immediate charge and initiate clean-up
activities. The Contract Land Applier along with the Town of Plymouth labor will be used, with additional
labor secured as needed. The Operations Manager will also communicate with the public on the scene,
answering questions and advising of clean-up activities.
• Reporting. All spills will be reported immediately to the Town of Plymouth officials. State and local agencies
will be notified in accordance with their notification requirements. Within 24 hours of the spill, the Operations
Manager will send the Town of Plymouth a written report detailing how the spill occurred and remedial action
taken. This report will be provided using the enclosed Spill Report form.
• Spill Prevention. The Operations Manager will implement the following spill prevention measures:
o Ensure truck drivers watch trailer while loading and do not overload;
o Ensure trailer hatches are closed and latched while transporting;
o Ensure trailer seals are inspected on a daily basis and replaced as necessary; and
o Ensure unloading operations in the field are conducted to minimize any potential runoff or tracking.
The Town of Plymouth require that the Contract Land Applier shall ensure that all employees receive safety and spill
response training as part to their new hire training and thereafter participate in our monthly safety and spill response
training program. In addition to their internal training and protocols, they must also contract with a regional
emergency response firm - HEPACO - available to respond to an incident in the Central and Eastern North Carolina
area within two hours. A copy of our agreement with HEPACO can be provided upon request.
Names and Titles of Inspection Personnel
Andy Smith, Area Supervisor
Jason Smith, Area Supervisor
JT Bryant, Regional Supervisor
Jay Bryant, Project Supervisor
Matt Foster, Project Supervisor
Jeff Bumpass, Field operators
Curtis Riggs, Field operators
Mark Hurley, Field operators
11.0 PREVENTION
The goal of a compliance assurance system is to prevent compliance issues from occurring. Prevention involves:
• Ensuring personnel understand their role in assuring compliance;
• Identifying compliance requirements at the federal, state and local levels;
• Implementing a system where compliance tasks are scheduled, assigned and tracked to completion;
• Developing standard operating procedures where appropriate; and
• Reviewing the compliance task list and standard operating procedures on an ongoing basis and modifying
them as appropriate to account for changes in regulations/requirements and operating methods, and to
address compliance deficiencies.
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

12.0 STANDARD OPERATING PROCEDURES (SOP's)
The Town of Plymouth will direct the Contract Land Applier to develop and implements SOPs to ensure compliance
tasks are completed consistently across the company. The SOP provides standard forms to use, approved biosolids
analytical methods, frequency of monitoring information, etc. Another key SOP relative to preventing compliance
issues from occurring is the use of a "Pre -Operating and Buffer Checklist".
The Pre -Operating and Buffer Checklist ensures federal, state and local regulations and permit requirements are met
prior to initiating biosolids applications at field sites. Compliance items on the Checklist include:
• The field is permitted and suitable for the biosolids/residuals type being applied;
• Pre -application requirements are met;
• Farmer and landowner agreements are current and the crop to be grown has been verified;
• The field is flagged to prevent applications in buffer zones and restricted areas;
• The appropriate application rate and field capacity is calculated; and
• Any special permit or local requirements are met.
• A listing of the buffer zones and restricted areas where biosolids/residuals cannot be applied
• A listing of operating requirements including notification requirements,
• application method requirements, and inclement weather operating requirements
13.0 ASSESMENT
To help ensure compliance requirements are being met and the compliance assurance system is implemented and
working, periodic, consistent, objective and documented assessments of the project/facility's compliance status are
conducted.
14.0 CORRECTIVE ACTION
Once compliance issues have been identified during the course of day to day business and through internal audits and
inspections a system must be in place which ensures that appropriate and timely corrective action is taken, the cause
of the compliance issue is identified and actions are taken to prevent recurrence of the issue.
The Town of Plymouth's goal is to have no instances of non-compliance. However, issues and incidents may occur
and when this happens employees work to correct the incident in a timely and thorough manner. When compliance
issues are identified, the situation is examined to determine the root cause of the problem and the corrective and
preventive action that must be taken. The preventive action must address the root cause with the goal of preventing
a recurrence.
Depending on the nature of the compliance issue, it is assigned to one or more responsible parties to ensure that the
corrective and preventive actions are implemented. A deadline for completion of the task is assigned and the issue is
tracked to completion by regional and corporate compliance personnel.
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

15.0 TRAINING
An effective compliance training program involves:
• Identifying training needs and requirements;
• Assigning personnel to provide training and providing them the resources they need to conduct training;
• Documenting and tracking that mandatory t raining has occurred; and
• An employee's training needs and requirements, as well as their training responsibilities, are based on
his/her position within the company.
Revised 06/21 ©Town of Plymouth Operation and Maintenance Plan

Spill Response/Clean Up
THE FOLLOWING ACTIONS MUST BE TAKEN IN THE EVENT OF A SPILL
Halt the source of the spill: Ruptured line or valve, or damaged tank unit.
Contain spill: Use straw bales to form a barrier. Straw or hay bales can be obtained
from several sources for this purpose. Soil near the site can also be used to form a
barrier for containment.
Clean up: Use application equipment to recover as much of the material as possible.
After the application equipment has recovered as much material as possible, it will
be land applied as per the management plan. A temporary sump pit may be dug in
the containment area and spilled material washed into it to enhance recovery.
Final Clean up: Any unrecoverable material will be washed from road surfaces and
incorporated into an adjacent tillable area.
Notification: As soon as possible after a spill occurs notify:
Town of Plymouth
[phone]
Bryan A. Smith, GFI - President
[phone]
Department of Environmental Quality
Division of Water Resources
Washington Regional Office
[phone]
Fire Department if assistance is required for wash down "911"
Highway Patrol if accident is on a public road "911"
Management of cleanup efforts: The field superintendent will take immediate
charge of the cleanup activities. Additional labor will be requested from the
groundwater recovery site and other departments as needed.
Reporting: Within 24 hours of a spill, the field superintendent will present a written
report detailing the cause of the spill and all actions taken in response to the spill.
The report will be sent to the NCDEQ Regional office having jurisdiction at the
location in which the release occurred.

AVERAGE # of
I
Gallons I Dry Tons
WWTP
IYears Counted I
410,200 42.05 Plymouth WWTP 5

tG
sv
0
0
Source: NCDOT provided County map
Scale: 1 inch equals 2 miles
Drawn by: CSC
Reviewed by:
Date: March -'07
0¢
Creswel I
0
44,
Town of Plymouth WWTP
1200
110
1100
PLYMOUTH
POP. 1.043
11101II1R 1195
l' 1'
An Nelv-i SOIL
IMPLUS
L
40. 1358
13
Pk
1301 * 11
:r ae
LOCATION MAP - WWTP
Washington County, North Carolina
Town of Plymouth Residual Program
Soil Plus Project No. 200701.A11
11251
1218
1125
FIGURE

APPENDIX 2
2021 PERMIT RENEWAL
Town of Plymouth (WQ0030132)
RS CA
Field Loading Calculations
Analytical

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Town of Plymouth
Maximum Dry Tons Per Year
Proposed
tri
co
Current b
tri
co
Permit Number
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County
Washington
E
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Plymouth WWTP
Facility Permit Holder
Town of Plymouth
Status
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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Ilymouth WWTP
2. Facility permit holder is: ❑ Federal, State, Local Government, or Private.
Facility permit issued by: F Div. of Water Resources, Div. of Environmental Health,
or r Other (explain: ).
3. Facility contact person and title: Roland Coburn, W
11
Complete mailing address: PO Box 806
City: Plymouth State: Zip: 279
Telephone number: (E) 793-9773 E-mail address: [e-mail]
4. Facility physical address: Gage Lane
City: Plymouth State: NC Zip: 27962-
Coordinates: Latitude: 53' 36" Longitude: 76' 43' 44"
Datum: =111 Level of accuracy: Sub -Meter
Method of measurement: GIS
5. Purpose of the facility:
▪ treatment of municipal wastewater, 1 treatment of 100% domestic wastewater,
▪ treatment of potable water, treatment of 100% industrial wastewater,
▪ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
▪ other (explain: _ ).
6. Does the facility have an approved pretreatment program: Yes ® No
7. Facility permitted/design flow: 0.8 MGD and facility average daily flow: 0_6 MGD
8. Average amount of residuals being generated at this facility dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 0.8 MG Aeration Basin
Type and volume of residuals storage (i.e., outside of residuals treatment units): (3) Aerobic Digesters Totaling 380,500
Gallons
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
▪ 40 CFR Part 503 or
▪ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
▪ Biological Non -Biological
FORM: RSC 06-16 Page 1 of 5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: E yes E no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: E 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: Meritech, Inc and Date of analysis: EV2020
Passed corrosivity test: • yes I no. pH: 7.4 s.u. (2 < pH < 12.5)
Passed ignitability test: IE yes J no. Flashpoint: - °F (> 140°F)
Passed reactivity test: E yes Eno. HCN: _ mg/kg (<250) & H2S: - mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
<0.100
Hexachlorobenzene
0.13
<0.100
Barium
100.0
0.131
Hexachloro-1,3-Butadiene
0.5
<0.100
Benzene
0.5
<0.0100
Hexachloroethane
3.0
<0.100
Cadmium
1.0
<0.020
Lead
5.0
<0.100
Carbon Tetrachloride
0.5
<0.0100
Lindane
0.4
<0.040
Chlordane
0.03
<0.003
Mercury
0.2
<0.02
Chlorobenzene
100.0
<0.0100
Methoxychlor
10.0
<1.000
Chloroform
6.0
<0.0100
Methyl Ethyl Ketone
200.0
<0.100
Chromium
5.0
<0.050
Nitrobenzene
2.0
<0.100
m-Cresol
200.0
<0.200
Pentachlorophenol
100.0
<0.500
o-Cresol
200.0
<0.100
Pyridine
5.0
<0.100
p-Cresol
200.0
<0.200
Selenium
1.0
<0.100
Cresol
200.0
<0.300
Silver
5.0
<0.050
2,4-D
10.0
<1.000
Tetrachloroethylene
0.7
<0.0100
1,4-Dichlorobenzene
7.5
<0.100
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.0100
Trichloroethylene
0.5
<0.0100
1,1-Dichloroethylene
0.7
<0.0100
2,4,5-Trichlorophenol
400.0
<0.100
2,4-Dinitrotoluene
0.13
<0.100
2,4,6-Trichlorophenol
2.0
<0.100
Endrin
0.02
<0.002
2,4,5-TP (Silvex)
1.0
<0.100
Heptachlor and its Hydroxide
0.008
<0.0008
Vinyl Chloride
0.2
<0.0200
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: Meritech, Inc. and Date of analysis: 3/19/2020
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
<2.14
Cadmium
85
39
0.970
Copper
4,300
1,500
214
Lead
840
300
25.0
Mercury
57
17
0.085
Molybdenum
75
nia
2.24
Nickel
420
420
9.27
Selenium
100
100
<2.14
Zinc
7,500
2,800
564
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
• >0but<25
30
200
210
> 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
111 > 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16
Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: Eli %.
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: `✓leritech, Inc. and Date of analysis: 3/19/2020
Parameter
Result
(mg/kg)
Aluminum
8,380
Ammonia -Nitrogen
<427
Calcium
19,400
Magnesium
4,130
Nitrate -Nitrite Nitrogen
517
pH (Standard Unit)
7.4
Phosphorus
14,000
Potassium
3,040
Sodium
10,200
Total Kjeldahl Nitrogen
26,400
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): �.65
[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): ja default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, ex lain 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 (1st) Year PAN
(mg/kg)
Five -Year
Maximum Adjusted PAN
(mg/kg)
Surface
8,522
13,125
Injection/Incorporation
8,736
13,283
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: None Know
FORM: RSC 06-16
Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
▪ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
MI Alternative 1 [15A NCAC 02T.1106(b)(3)(A)] - Time/Temperature Compliance.
d Alternative 2 [15A NCAC 02T.1106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
El Alternative 4 [15A NCAC 02T.1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
• Alternative 5 [15A NCAC 02T.1106(b13)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, M heat drying, 71 heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
▪ Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
▪ Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, air drying, ❑ anaerobic digestion,
❑ composting, or lime stabilization.
c. For Surface Disposal:
11 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
El Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
El Exempt - If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
El 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:
El Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
El Alternative 2 [15A NCAC 02T.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
LJ Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
LJ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
LJ Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
LJ Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
LJ Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
LJ Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
LI Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(b)(2)].
WI 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

AGMAN
Facility
Sampling Date
Solids
Mineralization Rate
Gallons per DT
Town of Plymouth WWTP
3/19/2020
2.34
0.30
10,248.21
FIELD LOADING ESTIMATES
pH 7.4
Sodium Absorpotion 2.65 <5.0 Safe 5.0 - 10.0 Careful Management
Ratio
NITROGEN APPLICATION
>15.0 Do Not Land Apply
NUTRIENT APPLICATION
TKN (mg/Kg) 26,400
Ammonia Nitrogen (mg/Kg) 427.00
Nitrate -Nitrite (mg/Kg) 517.00
lbs./1,000 gal 5.15
lbs./1,000 gal 0.08
lbs./1,000 gal 0.10
PLANT AVAILABLE NITROGEN SURFACE APPLIED
PAN (mg/Kg) 8,522 lbs./1,000 gal 1.66
PLANT AVAILABLE NITROGEN INJECTED/INCORPORATED APPLIED
PAN (mg/Kg) 8,736
Volatization Rate= 0.5 Surface Application
1.0 Injection/Incorporation
EPA METAL LIMITS
Class A Ceiling
Limits (mg/Kg)
41
39
1,500
300
17
420
100
2,800
Class B Ceiling
Limits (mg/Kg)
75
85
4,300
840
57
420
100
7,500
lbs./1,000 gal 1.70
HEAVY METAL CONCENTRATION
Arsenic (mg/Kg) 2.14
Cadmium (mg/Kg) 0.97
Copper (mg/Kg) 214.00
Lead (mg/Kg) 25.00
Mercury (mg/Kg) 0.09
Nickel (mg/Kg) 9.27
Selenium (mg/Kg) 2.14
Zinc (mg/Kg) 564.00
RESIDUAL NITROGEN CALCULATION
Potassium lbs./1,000 gal 0.59
Phosphorus lbs./1,000 gal 2.73
Calcium lbs./1,000 gal 3.79
Magnesium lbs./1,000 gal 0.81
Manganese lbs./1,000 gal
Sulfur lbs./1,000 gal
Molybdenum lbs./1,000 gal 0.00
HEAVY METAL LOADING
Arsenic lbs./1,000 gal
Cadmium lbs./1,000 gal
Copper lbs./1,000 gal
Lead lbs./1,000 gal
Mercury lbs./1,000 gal
Nickel lbs./1,000 gal
Selenium lbs./1,000 gal
Zinc lbs./1,000 gal
0.00
0.00
0.04
0.00
0.00
0.00
0.00
0.11
1st Year
2nd Year
3rd Year
4th Year
5th Year
Surface Application
Injection/Incorporation Application
Remaining
Remaining
Organic
Organic
PAN PAN
Nitrogen
PAN PAN
Nitrogen
TKN
(mg/kg) (lbs/DT)
(mg/Kg)
TKN
(mg/kg) (lbs/DT)
(mg/Kg)
26,400
8,522
17.04
17,878
26,400
8,736
17.47
17,664
17,878
2,682
5.36
15,196
17,664
2,650
5.30
15,014
15,196
1,140
2.28
14,056
15,014
1,126
2.25
13,888
14,056
527
1.05
13,529
13,888
521
1.04
13,368
13,529
254
0.51
13,275
13,368
251
0.50
13,117
Equations
1 st Yr. PAN (mg/Kg)=(MR x (TKN-NH3))+(VR x NH3)+NOx
2nd Yr PAN (mg/Kg)= 2nd Yr. TKN x (MR/2)
3rd Yr PAN (mg/Kg)= 3rd Yr. TKN x (MR/4)
4th Yr PAN (mg/Kg)= 4th Yr. TKN x (MR/8)
5th Yr PAN (mg/Kg)= 5th Yr. TKN x (MR/16)
Total
13,125 26.25
Total 13,283
26.57

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Report Date: 4/2/2020
Project: Town of Plymouth
Date Sample Rcvd: 3/19/2020
Meritech Work Order # 03192075
Parameters
% Total Solids
Ammonia, Nitrogen
TKN
Nitrate/Nitrite, Nitrogen
Aluminum, total
Arsenic, total
Cadmium, total
Calcium, total
Copper, total
Lead, total
Magnesium, total
Mercury, total
Molybdenum, total
Nickel, total
Phosphorus, total
Potassium, total
Selenium, total
Sodium, total
Zinc, total
pH
Sample: TP031920 Grab
Results
2.34 %
<427 mg/kg
26,400 mg/kg
517 mg/kg
8,380 mg/kg
<2.14 mg/kg
0.970 mg/kg
19,400 mg/kg
214 mg/kg
25.0 mg/kg
4,130 mg/kg
0.085 mg/kg
2.24 mg/kg
9.27 mg/kg
14,000 mg/kg
3,040 mg/kg
<2.14 mg/kg
10,200 mg/kg
564 mg/kg
7.4 S.U.
Analysis Date
3/23/20
3/25/20
3/27/20
3/24/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/24/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/25/20
3/20/20
3/19/20
Reporting Limit Method
0-100 % SM 2540B
427 mg/kg EPA 350.1
20 mg/kg EPA 351.1
31.3 mg/kg EPA 353.2
2.50 mg/kg EPA 200.7
2.14 mg/kg EPA 200.7
0.200 mg/kg EPA 200.7
10.0 mg/kg EPA 200.7
1.00 mg/kg EPA 200.7
0.500 mg/kg EPA 200.7
10.0 mg/kg EPA 200.7
0.02 mg/kg EPA 245.1
0.500 mg/kg EPA 200.7
2.0 mg/kg EPA 200.7
2.00 mg/kg EPA 200.7
20.0 mg/kg EPA 200.7
2.14 mg/kg EPA 200.7
20.0 mg/kg EPA 200.7
0.500 mg/kg EPA 200.7
1.0 - 14.0 S.U. SM 4500-HB
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

NPDES#:
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Project: Town of Plymouth
P.O.#:_
c
O
aS
o 0
= u
N
D
RS
J
pp Ice?
Yes / No
Person Taking Sample (Sign/Print): /j �
Drew Matthews J\ OJ 41
Test(s) Required
Residual Analysis (Al, Ammonia-N, As, Cd, Ca, Cu, Pb,
Mg, Hg, Mb, Ni, Nitrate -Nitrite N, %TS, pH, P, K, Se,
c
N
Z
Y
H
6
Z
L, Fed Ex I Are these results for regulatory purposes? Yes No [: Report results in: mg/L n mg/kg
Client: Soil Plus
Address: PO Box 1396
Oxford, NC 27565
Attention:
How would you like your report sent
Circle all that apply: Email (preferred) , Fax,
°
U
CO
Q n.
,
E a
o 0
U
13 20 2013 Chain of Custody Record (COC)
MERITECH, INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritech-labs.com
Sampling Dates & Times
Time
C
LU
N
co
o
Start
Time f
3
N
,-+
ra
0
3/19/201
Sample Location and/or ID #
TP 031920

Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date:
Project:
Date Sample Rcvd:
Page 1
4/14/2020
Town of Plymouth
3/19/2020
Meritech Work Order # 03192076
Sample: TP031920 Grab
3/19/2020
1311 - TCLP Metals
Parameter
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
Results
<0.100 mg/L
0.131 mg/L
<0.020 mg/L
<0.050 mg/L
<0.100 mg/L
<0.02 mg/L
<0.100 mg/L
<0.050 mg/L
Analysis Date Det. Limit
Reg. Limit Method
3/27/2020 0.100 5.0 EPA 200.7
3/27/2020 0.050 100.0 EPA 200.7
3/27/2020 0.020 1.0 EPA 200.7
3/27/2020 0.050 5.0 EPA 200.7
3/27/2020 0.100 5.0 EPA 200.7
3/24/2020 0.02 0.2 EPA 245.1
3/27/2020 0.100 1.0 EPA 200.7
3/27/2020 0.050 5.0 EPA 200.7
TCLP Organics
Parameter
Volatiles 8260
Semi Vol. 8270
Results
Attached
Attached
Analysis Date
3/26/2020
4/2/2020
Reporting Limit
Method
8260
8270
Other Tests
Parameter
% Total Solids
Cyanide, total
Sulfide
Ignitability
Corrositivity (pH)
Results Analysis Date
2.34 % 3/23/2020
<0.050 mg/kg 3/25/2020
<1.00 mg/kg 3/25/2020
>140 °F 3/25/2020
7.4 S.U. 3/20/2020
Reporting Limit
0-100 %
0.050 mg/kg
1.00 mg/kg
1.0 - 14.0 S.U.
Method
SM 2540B
EPA 335.4
SM4500S2D
EPA 1030
SM 4500 HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date:
Project:
Date Sample Rcvd:
Page 2
4/14/2020
Town of Plymouth
3/19/2020
Meritech Work Order # 03192076 Sample: TP031920 Grab
3/19/2020
1311- TCLP Pesticides & Herbicides
Pesticide - SW-846 8081A
Parameter
Endrin
Chlordane
Toxaphene
Methoxychlor
Heptachlor
Lindane
Herbicides - SW-846 8151A
Parameter
2,4-D
2,4,5-TP (Silvex)
Results
Attached
Attached
Attached
Attached
Attached
Attached
Results
Attached
Attached
Analysis Date Det. Limit Reg. Limit Dilution Factor
Analysis Date Det. Limit Reg. Limit Dilution Factor
I hereby certify that I have reviewed and approve these data. „dimrriiQ 4Na iotit)
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Client:
Project:
Client Sample ID:
Sample Collection:
Meritech Sample ID:
Volatiles: SW-846 8260
Analysis: 03/26/20
Analyst: VWV
Parameter
Benzene
Carbon Tetrachloride
Chlorobenzene
Chloroform
1,2-Dichloroethane
1,1-Dichloroethene
Methyl Ethyl Ketone
Tetrachloroethylene
Trichloroethene
Vinyl Chloride
(TECH, INC.
Environmental Laboratories
Laboratory Certificate #165
Soil Plus
Town of Plymouth
TP 031920
03/19/20
03192076
Semi-Volatiles: SW-846 8270
Analysis: 04/02/20
Analyst: PM
Parameter
1,4-Dichlorobenzene
Hexachlorobenzene
Hexachloro-1,3-butadiene
Hexachloroethane
o-cresol
m&p-cresol
Total cresols
Nitrobenzene
Pentachlorophenol
Pyridine
2,4,5-Trichlorophenol
2,4,6-Tri chlorophenol
2,4-Dinitrotoluene
1311 - TCLP Organics
Result Units
< 0.0100 mg/L
< 0.0100 mg/L
< 0.0100 mg/L
< 0.0100 mg/L
< 0.0100 mg/L
< 0.0100 mg/L
< 0.100 mg/L
< 0.0100 mg/L
< 0.0100 mg/L
< 0.0200 mg/L
Extraction: 03/23/20
Report Date: 04/01/20
Det. Limit Reg. Limit Dilution Factor
0.0100
0.0100
0.0100
0.0100
0.0100
0.0100
0.100
0.0100
0.0100
0.020
0.50
0.50
100
6.0
0.50
0.70
200
0.70
0.50
0.20
Extraction: 03/23/20
Report Date: 04/03/20
Result Units Det. Limit Reg. Limit
<0.100 mg/L 0.100 7.5
<0.100 mg/L 0.100 0.13
<0.100 mg/L 0.100 0.5
<0.100 mg/L 0.100 3.00
<0.100 mg/L 0.100 200
<0.200 mg/L 0.200 200
<0.300 mg/L 0.300 200
<0.100 mg/L 0.100 2.00
<0.500 mg/L 0.500 100
<0.100 mg/L 0.100 5.0
<0.100 mg/L 0.100 400
<0.100 mg/L 0.100 2.00
<0.100 mg/L 0.100 0.13
I hereby certify that I have reviewed and approve these data.
10
10
10
10
10
10
10
10
10
10
Dilution Factor
10
10
10
10
10
10
10
10
10
10
10
10
10
Laboratory Representative
642 Tamco Road * Reidsville, NC 27320
[phone] * [e-mail]

ESE C
A L ATalls
Analytical/Process Consultations
TIC
Toxicity Characteristic Leachate Procedure (TCLP) Analysis for Meritech, Inc., collected 19 March 2020)
03192076
EPA HW Quantitation Results Characteristic
Number Contaminant Limit(mg/L) (me/L) Level(mg/L) EPA Method Analyst
I. TCLP PESTICIDES/HERBICIDES
D-020 Chlordane 0.003 BQL 0.030 8081 MG
D-016 2,4-D 1.000 BQL 10.0 8151 MG
D-012 Endrin 0.002 BQL 0.020 8081 MG
D-031 Heptachlor 0.0008 BQL 0.008 8081 MG
D-013 Lindane 0.040 BQL 0.400 8081 MG
D-014 Methoxychlor 1.000 BQL 10.0 8081 MG
D-015 Toxaphene 0.05 BQL 0.500 8081 MG
D-017 2,4,5-TP(Silvex) 0.100 BQL 1.00 8151 MG
Sample Number 80072-01
Sample Date 03/19/20
Sample Time (hrs) 0830
Sample Matrix Sludge
Date Analyzed 03/31-04/10/2020
mykg milligrams per kiloeram _. pans per million (ppm) BQL = Below Quantitation Limits

NPDES#:
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Project: Town of Plymouth
Turn Around Time*
*RUSH work needs prior approval.
fl415Hrs
Lab Use Only
0 0
Q (-)
Temperature Upon
9. +.� Receipt:
f
Compositor #
Jug #
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Received bi4
Tim .:
[Received by: [fate: Time:
L
Received by Lab ,4111"Time:
On Ice?
(Yes / No
Person Taking Sample (Sign/Print):
Drew Matthews —0 ilAe-hrt
Tests) Required
Full TCLP (Ignitability, Corrositivity, Reactivity) 1 C-
pies must be done in the field prior to preservation. ***
Comments: Please report TCLP results in mg/L
Please email results to [e-mail]
7
CCc ru-
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Client: Soll Plus
Address: PO Box 1396
Oxford, NC 27565
Attention:
How would you like your report
Circle all that apply: Email (preferred),
Are these results for regulatory purposes? Yes I XI No ❑'.
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Relinquished by: Date: Time:
Relinquished by: Date: Time:
O 1
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*** Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN sam
n. C�.
E 2
v
13 20 2013 _ - Chain of Custody Record (COC)
MERITECH, INC.
-s>
ENVIRONMENTAL LABORATORIES
�: 642 Tamco Rd. Phone: [phone]
icyReidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritech-labs.com
Sampling Dates & Times
End
Time
Date
Start
Time
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0
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Sample Location and/or ID #
TP 031920
Method of
Shipment:
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Fed Ex
Hand Delivery
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Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date:
Project:
Date Sample Rcvd:
Page 1
3/30/2020
Town of Plymouth
3/19/2020
Meritech Work Order # 03192067
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (001) Grab
Results Analysis Date Reporting Limit
2.09 % 3/23/20 0-100 %
90,909 col/g dry wt 3/19/20
130 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
Meritech Work Order # 03192068
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (002) Grab
Results Analysis Date Reporting Limit
2.17 % 3/23/20 0-100 %
119,816 col/g dry wt 3/19/20
554 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
Meritech Work Order # 03192069
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (003) Grab
Results Analysis Date Reporting Limit
2.13 % 3/23/20 0-100 %
70,423 col/g dry wt 3/19/20
130 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
Meritech Work Order # 03192070
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (004) Grab
Results Analysis Date Reporting Limit
2.17 % 3/23/20 0-100 %
92,166 col/g dry wt 3/19/20
548 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
Meritech Work Order # 03192071
Parameters
Results
Sample: TP031920 (005) Grab
Analysis Date Reporting Limit
% Total Solids 1.90 % 3/23/20
Fecal Coliform (Sludge) 78,947 col/g dry wt 3/19/20
0-100
130 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date:
Project:
Date Sample Rcvd:
Page 2
3/30/2020
Town of Plymouth
3/19/2020
Meritech Work Order # 03192072
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (006) Grab
Results Analysis Date Reporting Limit
1.98 % 3/23/20 0-100 %
106,061 col/g dry wt 3/19/20
130 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
Meritech Work Order # 03192073
Parameters
% Total Solids
Fecal Coliform (Sludge)
Sample: TP031920 (007) Grab
Results Analysis Date Reporting Limit
2.16 % 3/23/20 0-100 %
115,741 col/g dry wt 3/19/20
551 col/g dry wt
3/19/20
Method
SM 2540B
SM 9222D
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

NPDES#:
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Project: Town of Plymouth
P.O.#:
v
O p
=
Q 0
On Ice?
1�es / No
•
Test(s) Required
Fecal Coliform / % Total Solids G
Fecal Coliform / % Total Solids to,
Fecal Coliform / % Total Solids C9
Fecal Coliform / % Total Solids "1 t
*** Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN samples must be done In the field prior to preservation.***
Comments:
Please email results to [e-mail]
Soil Plus
s: PO Box 1396
Oxford, NC 27565
II that apply: Emai (pr
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I3.20.2013 Chain of Custody Record (COC)
MERITECH, INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritech-Iabs.com
Sampling Dates & Times
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Date
Time I
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3/19/20
Sample Location and/or ID #
TP 031920 (001)
TP 031920 (002)
TP 031920 (003)
TP 031920 (004)

Week 1
Week 2
Week 3
Week 4
Week 5
Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Report Date: 4/22/2020
Project: Town of Plymouth
Date Sample Rcvd: 3/19/2020
Vector Attraction Reduction / Aerobically Digested Sludge (30 Day Test)
Meritech Work Order # 03192074
Total Solids
1.27
Sample: TP 031920 Grab
Volatile Solids
0.750
0.760
0.780
0.760
0.720
3/19/20
% Volatile Solids
0.595
0.606
0.609
0.608
0.610
Mass Balance Equation = -2.59% Volatile Solids Reduction as per EPA Part 503 Biosolids Rule
I hereby certify that I have reviewed and approve these data.
Labo ato Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

JNPDES#:
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Project: Town of Plymouth
P.O.#:
Lab Use Only
.NO ID
z>I O Hd
Temperature Upon
• Receipt:
Compositor #
Jug #
J
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Received by: / )) y ")0 Time: ( C�
Received by: v Date: Time:
Received by Lab , �,�_ 1�, !17).e Time: 1
di JV�1J�j� ,! r %{/ 1
On Ice?
Yes / No
Person Taking Sample (Sign/Print):Drew Matthews jz_D 1» c
Test(s) Required
30 Day Bench Scale Test
KN samples must be done in the field prior to preservation. ***
Comments:
Please email results to samples©soilplus.net
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Client: SOH Plus
Address: PO Box 1396
Oxford, NC 27565
How would yo
Circle all that apply:
Are these results for regulatory purposes? Yes I XI No ❑`.;
Relinquished by.iej Date: 3J/e1/ZGTime:
Relinquished by:
.
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0
<0.5 ppm) of Ammonia, Cyanide, Phenol and TI
20.2013 Chain of Custody Record (COC)
MERITECH, INC.
0,3
ENVIRONMENTAL LABORATORIES
0' 642 Tamco Rd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritech-labs.com
Sampling Dates & Times
Time
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Date
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*** Dechlorination
Sample Location and/or ID #
TP 031920
Method of
Shipment:
N
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Hand Delivery
N
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0
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APPENDIX 3
2021 PERMIT RENEWAL
Town of Plymouth (WQ0030132)
LAS CA
Land Owner Agreement Form
Maps
Biosolid Utilization
CPLR Summary

LAND APPLICATION SITE CERTIFICATION
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LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Mapping Unit
or Rep. Slope'
BoA
CO
1IIII
Series Nameb
Bojac
Bojac
Bojac
1111
Crop(s)
1
Fescue
Fescue
1
1
1
1
1
County
shington
Washington
Washington
11111
6
te
z
O
1
1
1
1
Lessee(s) or Operator(s)
11111111
Landowner(s)
Marjory P. Mizelle
Marjory P. Mizelle
Marjory P. Mizelle
hill
.
9
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1111
(J Co)
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TION (See Instruction C):
II. WATERBODY AND CLASSIFICATIONS INFO
Current and Proposed
Class
11hhhh1I
11111111
Waterbody Subbasin and
Stream Index No.
11111111
Location Accuracy
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Location Method Code
Location
Datum
NAD 83
NAD 83
NAD 83
NAD 83
M
M
M
M
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Longitude
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1
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Site/Field ID
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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Plymouth
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-tiWover-seed/
pasture)
Fields 1-3
No
Fescue Hay
Animal Consumption
Plymouth V V TP
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

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

96,
day of /Ytay ,20 2/ u, �e 1Y'r�c06`ty
10 m
Signature and seal: .,, `d1
. , "'. -,
t < � `4N
.S'� 4 k I
00
1/44
cc,,��„,erGEhC h E F C9@Q
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
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: Marjory P. Mizelle
Address: 8278 Long Ridge Road
City: Plymouth State: NC Zip: 27962
Phone: [phone] E-mail address:
Signature: :79 i "—a`�'L" !/( e , 7 �i� Date: 5 -' 1- ` `� /
NORTH CAROLINA, G ra-AvI. ! le COUNTY
I, the undersigned Notary Public do hereby certify that trla-rj 0 r•y P hi 'Zell
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the /h-
c - ,3a wi
My commission expires: O y— 0,S"- a.0a.3
Lessee's/Operator's Certification:
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: M. e Wri • h PuP:li,e Works Director
Signature:
Date:
FORM: LOA 06-16
Page 3 of 3

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' ". 6;. 4‘;:. i : khk,'+' 4./.-•.'t I. * 4,1:41 ,i,.,,t..—in„)-1s•, ' st. •
^
I*,y7t5:— 'N.:4,44:4+1 414-41W 4: jc•I'•-6'tir t•••k, ,
Buffer
Cemetary
1-1 Field Boundary
Net Area
FJProperty Boundary
Scale: 1 inch = 200 feet
Drawn By: CSC
Reviewed By:
Date: April '14
Manal rcn E. Needs
BUFFER MAP - FIELD 1 & 2
Town of Plymouth Land Application
Class B Permit WQ0030132
Soil Plus Project # 200701.A10
FIGURE
2

W lLAI
LEGEND
Anteana
■ House
Structure
• Well
---► Ditch
Buffer
Cemetary
n Field Boundary
Net Area
F• J Property Boundary
Scale: 1 inch = 200 feet
Drawn By: CSC
Reviewed By:
Date: April'14
SOT prus
[anal run[ Needs
BUFFER MAP - FIELD 3
Town of Plymouth Land Application
Class B Permit WQ0030132
Soil Plus Project # 200701.A10
FIGURE
3

&$a
'CO.' 'CO.' 0 ƒO
ƒ ƒ
¥ i e, e, e, E@ E
- / % % / «
CA / / / $
\ ƒ E
\ u u
m r
•
0 0
/ /
w $ $ $
oc

Cumulative Lbs per Acre
V MV
7 O O
7 l V
G V co
M N N
N M M
M O 0
O V 0
op op7 7 M
O O O
O O 6
0 O N
Ln 1,-)
'Cr C., M
oci o
.-. c,-, N
N cn M
N yr M
7 V'
_ V' 7
O O O
0
N M M CC