WQ0020239_Renewal Application_20210622

Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional
information.)*
r Yes r No
Permit Number (IR)*
WQ0020239
Applicant/Permittee
Town of Hertford
Applicant/Permittee Address
PO Box 32 Hertford, NC 27944
Is the owner in BIMS? r Yes r No
Is the facility in BIMS? r Yes r No
Owner Type
Individual
Facility Name
Town of Hertford RLAP
County
Perquimans
Fee Category Minor
Fee Amount $0
Is this a complete
application?*
r Yes r No
Complete App Date 06/22/2021
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 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 N B Staff regarding electibnittal, confirmation of receipt, other
.......................................................... electronic surece, aner correspondence.
_ -
Name * Drew Matthews
Email Address*
[e-mail]
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*
2528839301
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:*
WQ0020239
Has Current Existing pernit number
Applicant/Permittee *
Town of Hertford
Applicant/Permittee Address*
PO Box32 Hertford, NC 27944
Facility Name *
Town of Hertford 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 Form Engineering Rans, Spec'rfications, Calculations, Rc.)
2021 Hertford RLAP Permit Renewal.pdf 19.17MB
upload only 1 RCF docurrent (less than 250 M3). Matiple documents nest be corrbined into one RDF file unless file is larger than
upload limit.
* 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
Ot,w Wa&�,a,1V
Submission Date 6/22/2021

TOWN OF HERTFORD
2021 PERMIT RENEWAL
CLASS B PROGRAM
WQ0020239
Submitted by:
Soil Plus
PO Box 1396
Oxford, North Carolina 27565
June 22, 2021
SOIL PLUS

SOIL PLUS
June 22, 2021
NCDEQ-DWR
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attention: Mr. Nathaniel Thornburg
Reference: PERMIT RENEWAL
Town of Hertford Residual Biosolids "Class B" Program
Permit # WQ0020239
Mr. Thornburg:
Soil Plus, LLC (Soil Plus) is submitting one electronic copy of this permit renewal
application package for the Town of Hertford (WQ0020239). This package includes:
1. Completed Residual Land Application Program Application (RLAP)
• Weighted PAN Calculations
• O&M Plan
2. Completed Residual Source Certification Attachments (RSCA)
• Field Loading Calculation Sheet
• Analytical
3. Completed Land Application Site Certification Attachment (LASCA)
• RENEW Site 1 and Site 2
• DELETE Site 3
Soil Plus will be responsible for completing this permit renewal for the Town of Hertford.
If there is any further information required or questions regarding this permit application,
please do not hesitate to contact me for assistance.
Respectfully,
Drew Matthews, Soil Plus
cc: Pamela Hurdle, Town of Hertford
J. Bryan Smith, Atlantic OBX
PO Box 1396
Oxford, NC 27565
[phone]
dmatthewsgsoilplus. ne t
www.soilplus.net

Town of Hertford
2021 Class B
Permit Renewal
WQ0020239
Hertford, 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 Forms
Maps
Biosolid Utilization
CPLR Summary

APPENDIX 1
2021 PERMIT RENEWAL
Town of Hertford (WQ0020239)
Weighted PAN Calculations
O&M Plan

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

E. Operation and Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plan in accordance with 15A NCAC 02T .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
.110202). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I V by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

L Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules_ Policies_ and_Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .I 104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
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 .I 104(d)(5) and current Division Policy
available at: hLtp://www.ncwater.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 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
L APPLICANT INFORMATION:
1. Applicant's name: Town of Hertford
Applicant type: ❑ Individual Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Pamela Hurdle Title: Town Manager
Applicant's mailing address: PO Box 32
City: Hertford State: NC Zip: 27944-
Telephone number: [phone] Email Address: manager(c�townofhertfordnc.com
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: dmatthewsksoilplus.net
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)
IL 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: W00020239
Date of most -recently issued permit: October 7, 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: 142 Meades Circle
City: Hertford State: NC Zip: 27944-
Coordinates: Latitude: 36' 12' 0_5" Longitude: 76. 28' 51.2"
Datum: NAD 83
Method of measurement: GIS
Level of accuracy: Sub -Meter
2. County where residuals land application program is headquartered: Perquimans
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
J. Bryan Smith
Atlantic OBX, Inc.
13598
Back -Up ORC
Brad Grainger
Atlantic OBX, Inc.
985517
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: 210 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
22.96
23.22
4,822
4,875
Five -Year Maximum Adjusted
32.91
33.10
6,911
6,950
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
182.62
Hay
26.93
Pasture
Total:
209.55
Methods
Surface
209.55
Incorporation or Injection
Total:
209.55
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
96.44
97.51
138.21
139.0
100
48.22
48.75
69.11
69.50
150
32.15
32.50
46.07
46.33
200
24.11
24.38
34.55
34.75
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
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.
IR
Land Application Siite
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: 17 Spray F1 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/vr
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field / Zone
Design Area
W
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Pa a Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
It,
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;
I, Pamela Hurdle Town M
(Signature Authority's Name —PLEASE PRINT) (Title)
attest that this application for Town of Hertford
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature
Date: 6 Aa/a (Dal
FORM: RLAP 06-16 Page 5 of 5

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TOWN OF HERTFORD WWTP
OPERATION AND MAINTENANCE PLAN
LAND APPLICATION OF CLASS B RESIDUAL BIOSIOLIDS
WQ#0020239
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 Hertford 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
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 Hertford sludge samples will be sent to a 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 digester(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 platform at the top of the steps to the sludge storage tank.
Revised 06/21 OTown of Hertford Operation and Maintenance Plan

Once the sample is pulled, it should be placed in medium size cooler packed with ice. The sample should be
collected with enough time so that it can be delivered to the laboratory in accordance with sample holding times.
Once per calendar year a sample should be collected and submitted to the approved laboratory. This sample should
be analyzed for:
• Full TCLP
• Ignitability, Corrosivity, and Reactivity
• Requires 5 Liters (In Opac Glass Bottles)
A third should be submitted 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)
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 town personnel. For further information please contact:
Charles Jones
Chief Operator
Town of Hertford WWTP
PO Box 32
Hertford NC 27944
Revised 06/21 OTown of Hertford 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 sufficiently 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
Revised 06/21 OTown of Hertford Operation and Maintenance Plan

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 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 LIQUID BIOSOLIDS
Liquid biosolids will be transported using 6,500 gallon capacity liquid tankers, pulled by standard road tractors. The
tankers 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.
7.0 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.
8.0 SPILL AND EMERGENCY RESPONSE PROGRAM
In the unlikely event of a spill, the Town of Hertford 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.
• 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 Hertford 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 Hertford 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 Hertford 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.
Revised 06/21 OTown of Hertford Operation and Maintenance Plan

The Town of Hertford 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.
9.0 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.
10.0 STANDARD OPERATING PROCEDURES (SOP's)
The Town of Hertford 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
11.0 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.
12.0 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.
Revised 06/21 OTown of Hertford Operation and Maintenance Plan

The Town of Hertford'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.
13.0 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 OTown of Hertford 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 Hertford
[phone]
J. Bryan Smith, Atlantic OBX Inc.
[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.

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HERTFORD WWTP
Quantitative Justification
YEAR
GALLONS
DRY TONS
2016
3421-000
44.07
2017
2241-000
21.76
2018
0
0
2019
2731-000
26.07
2020
1891-000
30.97
AVERAGE
3421-667
24.57

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Town of
PER
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County WTP - Winfall
Albermarle
Perquimans County WTP - Bethel Legend
NC Sources
Road
County Boundary
CI Municipal Boundary
1 0.5 0 1 Water Body
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Scale: 1 inch = 1 miles SOURCE LOCATION MAP
Figure
Drawn by: CSC S D IL PLUS Atlantic OBX, Inc.
Reviewed by: Hertford, North Carolina 7
Date: May'17 Soil Plus Project # 201007.B20

APPENDIX 2
2021 PERMIT RENEWAL
Town of Hertford (WQ0020239)
RS CA
Field Loading Calculations
Analytical

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

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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
l?ivision of hater Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
L RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: tertford WWTP
2. Facility permit holder is: ❑ Federal, 0 State, 0 Local Government, or 0 Private.
Facility permit issued by: IL Div. of Water Resources, Div. of Environmental Health,
or L Other (explain: _).
3. Facility contact person and title: Jeremy. ORC
Complete mailing address: PO Box 32
City: � State: Zip: 27944-
Telephone number: 52) 426-3099 E-mail address: ww1l townofhertfordnc.com
4. Facility physical address: 142 Meades Circle
City: Hertford State: NC Zip: 27944-
Coordinates: Latitude: b° 12' 0_5" Longitude: 76' 28' 51.2"
Datum: � Level of accuracy: Sub -Meter
Method of measurement: GIS
5. Purpose of the facility:
treatment of municipal wastewater, treatment of 100% domestic wastewater,
treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
other (explain: _ ).
6. Does the facility have an approved pretreatment program: Yes ® No
7. Facility permitted/design flow: 0 MGD and facility average daily flow: 0_5 MGD
8. Average amount of residuals being generated at this facility 0 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 Oxidation Ditch
Type and volume of residuals storage (i.e., outside of residuals treatment units): F5 MG Aerobic Digester
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
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: 0 yes ® no.
If yes, list the number(s): _
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: P yes 0 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Meritech, Inc. and Date of analysis: 9/10/2020
Passed corrosivity test: []I yes r no. pH: 6.5 s.u. (2 < pH < 12.5)
Passed ignitability test: d yes p no. Flashpoint: = OF (> 140°F)
Passed reactivity test: Eyes Mno. HCN: <0.050 mg/kg (<250) & H2S: - mg/kg (<500)
TCLP Parameter
Limit
(mgfi)
Result
(mgfi)
TCLP Parameter
Limit
(mg17)
Result
(mg17)
Arsenic
5.0
<0.100
Hexachlorobenzene
0.13
<0.100
Barium
100.0
0.137
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-Trichloropheno1
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: h4eritech, Inc. and Date of analysis: 9/10/2020
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mglkg)
Monthly Average
Concentration Limits
(Class A Only)
(mglkg)
Result
(mglkg)
Arsenic
75
41
<1.27
Cadmium
85
39
0.992
Copper
4,300
1,500
369
Lead
840
300
37.2
Mercury
57
17
0.560
Molybdenum
75
n/a
0.636
Nickel
420
420
11.3
Selenium
100
100
<1.27
Zinc
7,500
2,800
1,130
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)
W > 0 but < 25
30
200
210
19 > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
> 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: a %.
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: 14eritech, Inc. and Date of analysis: 9/10/2020
Parameter
Result
(mg1kg)
Aluminum
15,600
Ammonia -Nitrogen
<254
Calcium
33,800
Magnesium
2,890
Nitrate -Nitrite Nitrogen
2,190
pH (Standard Unit)
6.3
Phosphorus
30,300
Potassium
2,770
Sodium
6,230
Total Kjeldahl Nitrogen
30,800
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR):
[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): JW 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: ia
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (11) Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mg/kg)
Surface
11,481
16,454
Injection/Incorporation
11,608
16,548
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 Kno
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:
C1 A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
id 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):
14 Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
EJ Alternative 2 [15A NCAC 02T.I 106(b)(3)(13)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T. 1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
E] Alternative 4 [15A NCAC 02T. 1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, A 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.I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, I
air drying, ❑ anaerobic digestion,
El composting, or lime stabilization.
c. For Surface Disposal:
rl Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
J Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
J Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
J 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.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
El Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
E] Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
El Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
E] Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
E] Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
E] Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
El Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
El Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
id 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

kvAGMAN
FIELD LOADING ESTIMATES
Facility Hertford WW P
Sampling Date 9/10/2020
Solids 3.93
Mineralization Rate 0.30
Gallonsper DT 6,101.99
pH 6.3
Sodium Absorpotion 1.73 <5.0 Safe 5.0 - 10.0 Careful Management >15.0 Do Not Land Apply
Ratio
NITROGEN APPLICATION
TKN (mg/Kg) 30,800 lbs./1,000 gal 10.10
Ammonia Nitrogen (mg/Kg) 254.00 lbs./1,000 gal 0.08
Nitrate -Nitrite (mg/Kg) 2,190.00 lbs./1,000 gal 0.72
PLANT AVAILABLE NITROGEN SURFACE APPLIED
PAN (mg/Kg) 11,481 lbs./1,000 gal 3.76
PLANT AVAILABLE NITROGEN INJECTED/INCORPORATED APPLIED
PAN (mg/Kg) 11,608 lbs./1,000 gal 3.80
Volatization Rate= 0.5 Surface Application
1.0 Injection/Incorporation
EPA METAL LIMITS
Class A Ceiling
Class B Ceiling
Limits (mg/Kg)
Limits (mg/Kg)
41
75
39
85
1,500
4,300
300
840
17
57
420
420
100
100
2,800
7,500
1st Year
2nd Year
3rd Year
4th Year
5th Year
HEAVY METAL CONCENTRATION
NUTRIENT APPLICATION
Potassium lbs./1,000 gal 0.91
Phosphorus lbs./1,000 gal 9.93
Calcium lbs./1,000 gal 11.08
Magnesium lbs./1,000 gal 0.95
Manganese lbs./1,000 gal
Sulfur lbs./1,000 gal
Molybdenum lbs./1,000 gal 0.00
HEAVY METAL LOADING
Arsenic (mg/Kg)
1.27
Arsenic lbs./1,000 gal
0.00
Cadmium (mg/Kg)
0.99
Cadmium lbs./1,000 gal
0.00
Copper (mg/Kg)
369.00
Copper lbs./1,000 gal
0.12
Lead (mg/Kg)
37.20
Lead lbs./1,000 gal
0.01
Mercury (mg/Kg)
0.56
Mercury lbs./1,000 gal
0.00
Nickel (mg/Kg)
11.30
Nickel lbs./1,000 gal
0.00
Selenium (mg/Kg)
1.27
Selenium lbs./1,000 gal
0.00
Zinc (mg/Kg)
1130.00
Zinc lbs./1,000 gal
0.37
RESIDUAL NITROGEN CALCULATION
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)
30,800
11,481 22.96
19,319
30,800
11,608 23.22
19,192
19,319
2,898 5.80
16,421
19,192
2,879 5.76
16,313
16,421
1,232 2.46
15,190
16,313
1,224 2.45
15,090
15,190
570 1.14
14,620
15,090
566 1.13
14,524
14,620
274 0.55
14,346
14,524
272 0.54
14,252
Equations
1st 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 16,454 32.91
Total 16,548 33.10

Contact: Drew Matthews
Client: Soil Plus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Report Date: 9/23/2020
Project: Town of Hertford
Date Sample Rcvd: 9/10/2020
Meritech Work Order #
091020115 Sample. Hertford Grab
9/10/20
Parameters
Results
Analysis Date
Reporting Limit
Method
% Total Solids
3.93 %
9/11/20
0-100 %
SM 2540B
Ammonia, Nitrogen
<254 mg/kg
9/16/20
254 mg/kg
EPA 350.1
TKN
30,800 mg/kg
9/15/20
20 mg/kg
EPA 351A
Nitrate/Nitrite, Nitrogen
2,190 mg/kg
9/15/20
31.3 mg/kg
EPA 353.2
Aluminum, total
15,600 mg/kg
9/22/20
2.50 mg/kg
EPA 200.7
Arsenic, total
<1.27 mg/kg
9/22/20
1.27 mg/kg
EPA 200.7
Cadmium, total
0.992 mg/kg
9/22/20
0.200 mg/kg
EPA 200.7
Calcium, total
33,800 mg/kg
9/22/20
10.0 mg/kg
EPA 200.7
Copper, total
369 mg/kg
9/22/20
1.00 mg/kg
EPA 200.7
Lead, total
37.2 mg/kg
9/22/20
0.500 mg/kg
EPA 200.7
Magnesium, total
2,890 mg/kg
9/22/20
10.0 mg/kg
EPA 200.7
Mercury, total
0.560 mg/kg
9/15/20
0.02 mg/kg
EPA 245.1
Molybdenum, total
0.636 mg/kg
9/22/20
0.500 mg/kg
EPA 200.7
Nickel, total
11.3 mg/kg
9/22/20
2.0 mg/kg
EPA 200.7
Phosphorus, total
30,300 mg/kg
9/22/20
2.00 mg/kg
EPA 200.7
Potassium, total
2,770 mg/kg
9/22/20
20.0 mg/kg
EPA 200.7
Selenium, total
<1.27 mg/kg
9/22/20
1.27 mg/kg
EPA 200.7
Sodium, total
6,230 mg/kg
9/22/20
20.0 mg/kg
EPA 200.7
Zinc, total
1,130 mg/kg
9/22/20
0.500 mg/kg
EPA 200.7
pH
6.3 S.U.
9/11/20
1.0 - 14.0 S.U.
SM 4500-HB
I hereby certify thatl have reviewed and approve these data.
Laboratory Representative
642 Tarnco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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Contact: Drew Matthews
Client: Soil PIus
P.O. Box 1396
Oxford, NC 27565
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Page 1
Report Date: 9/23/2020
Project: Town of Hertford
Date Sample Rcvd: 9/10/2020
Meritech Work Order #
091020116 Sample: Hertford Grab
9/10/2020
1311
- TCLP Metals
Parameter
Results
Analysis Date
Det. Limit
Reg. Limit
Method
Arsenic
<0.100 mg/L
9/22/2020
0.100
5.0
EPA 200.7
Barium
0.137 mg/L
9/22/2020
0.050
100.0
EPA 200.7
Cadmium
<0.020 mg/L
9/22/2020
0.020
1.0
EPA 200.7
Chromium
<0.050 mg/L
9/22/2020
0.050
5.0
EPA 200.7
Lead
<0.100 mg/L
9/22/2020
0.100
5.0
EPA 200.7
Mercury
<0.02 mg/L
9/22/2020
0.02
0.2
EPA 245.1
Selenium
<0.100 mg/L
9/22/2020
0.100
1.0
EPA 200.7
Silver
<0.050 mg/L
9/22/2020
0.050
5.0
EPA 200.7
TCLP Organics
Parameter
Results
Analysis Date
Reporting Limit
Method
Volatiles 8260
Attached
9/16/2020
-
8260
Semi Vol. 8270
Attached
9/21/2020
-
8270
Other Tests
Parameter
Results
Analysis Date
Reporting Limit
Method
% Total Solids
1.90 %
9/15/2020
0-100 %
SM 2540B
Cyanide, total
<0.050 mg/kg
9/16/2020
0.050 mg/kg
EPA 335.4
Sulfide
<1.00 mg/kg
9/16/2020
1.00 mg/kg
SM4500S21)
Ignitability
>140 °F
9/14/2020
-
EPA 1030
Corrositivity (pH)
6.5 S.U.
9/15/2020
1.0 - 14.0 S.U.
SM 4500 HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Page 2
Contact: Drew Matthews Report Date: 9/23/2020
Client: Soil Plus
P.O. Box 1396 Project: Town of Hertford
Oxford, NC 27565 Date Sample Rcvd: 9/10/2020
Meritech Work Order # 091020116 Sample: Hertford Grab 9/10/2020
1311- TCLP Pesticides & Herbicides
Pesticide - SW-846 8081A
Parameter
Results Analysis Date Det. Limit Reg, Limit Dilution Factor
Endrin
Attached - - -
Chlordane
Attached - - -
Toxaphene
Attached - - -
Methoxychlor
Attached - - -
Heptachlor
Attached - - -
Lindane
Attached - - -
Herbicides - SW-846 8151A
Parameter
2,4-D
2,4,5-TP (Silvex)
Results Analysis Date Det. Limit Reg. Limit Dilution Factor
Attached
Attached
I hereby certify that I have reviewed and approve these data. ML
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tei.[phone] fax.[phone]

MERITECH, INC.
Environmental Laboratories
Laboratory Certificate #165
Client:
Project:
Client Sample ID:
Sample Collection:
Meritech Sample ID:
Soil Plus
Town of Hertford
Hertford
09/ 10/20
091020116
1311 - TCLP Oraanics
Volatiles: SW-846 8260
Analysis: 09/ 16/20
Extraction:
09/ 14/20
Analyst: VWV
Report Date:
09/17/20
Parameter
Result
Units
Det. Limit
Reg- Limit
Dilution Factor
Benzene
< 0.0100
mg/L
0.0100
0.50
10
Carbon Tetrachloride
< 0.0100
mg/L
0.0100
0.50
10
Chlorobenzene
< 0.0100
mg/L
0.0100
100
10
Chloroform
< 0.0100
mg/L
0.0100
6.0
I0
1,2-Dichloroethane
< 0.010Q
m&L
0.0100
0.50
10
1.1-Dichloroethene
< 0.0100
m&L
0.0100
0.70
10
Methyl Ethyl Ketone
< 6.I00
mg/L
0.100
200
10
Tetrachloroethytene
< 0.0100
mg/L
0.0100
0.70
10
Trichloroethene
< 0.0100
mg/L
0.0100
0.50
10
Vinyl Chloride
<0.0200
mg/L
0.020
0.20
10
Semi-Volatiles: SW-846 8270
Analysis: 09/21/20
Extraction:
09/14/20
Analyst: PM
Report Date:
09/22/20
Parameter
Result
Units
Det. Limit
Reg. Limit
Dilution Factor
1,4-Dichlorobenzene
<0.100
mg/L
0.100
7.5
IQ
Hexachlorobenzene
<0.100
mg/L
0.100
0.13
10
Hexachloro-1,3-butadiene
<0.100
mg/L
0.100
0.5
10
Hexachloroethane
<0.100
mg/L
0.100
3.00
10
o-cresol
<0.100
mg/L
0.100
200
10
m&p-cresol
<0.200
mg/L
0.200
200
10
Total cresols
<0.300
mg/L
0.300
200
10
Nitrobenzene
<0.100
mg/L
0_ I00
2.00
10
Pentachlorophenol
<0.500
mg/L,
0.500
100
10
Pyridine
<0.100
mg/L
0.100
5.0
10
2,4,5-Trichlorophenol
<0.100
mg/L
0.100
400
10
2,4,6-Trichlorophenol
<0.100
mg/L
0.100
2.00
10
2,4-Dinitrotoluene
<0.100
mg/L
0.100
0.13
10
I hereby certify that I have reviewed and approve these data. aZ4LGt/ ��-
Laboratory Representative
642 Tamco Road * Reidsville, NC 27324
[phone] * [e-mail]

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Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Page 1
Contact: Drew Matthews Report Date: 9/21/2020
Client: Soil Plus
P.O. Box 1396 Project: Town of Hertford
Oxford, NC 27565 Date Sample Rcvd: 9/10/2020
Meritech Work Order # 091020118 Sample: Hertford (001) Grab 9/10/20
Parameters Results Analysis Date Reporting Limit Method
% Total Solids 4.50 % 9/11/20 0-100 % SM 2540B
Fecal Coliform (Sludge) <202 col/g dry wt 9/10/20 202 col/g dry wt SM 9222D
Meritech Work Order # 091020119 Sample: Hertford (002) Grab 9/10/20
Parameters
% Total Solids
Fecal Coliform (Sludge)
Results Analysis Date Reporting Limit Method
4.80 % 9/11/20 0-100 % SM 2540B
<189 col/g dry wt 9/10/20 189 col/g dry wt SM 9222D
Meritech Work Order # 091020120 Sample: Hertford (003) Grab
Parameters Results Analysis Date Reporting Limit
% Total Solids 4.47 % 9/11/20 0-100 %
Fecal Coliform (Sludge) <203 col/g dry wt 9/10/20 203 col/g dry wt
Meritech Work Order # 091020121 Sample: Hertford (004) Grab
9/10/20
Method
SM 2540B
SM 9222D
9/10/20
Parameters Results Analysis Date Reporting Limit Method
% Total Solids
4.49 %
9/11/20
0-100 %
SM 2540B
Fecal Coliform (Sludge)
202 col/g drywt
9/10/20
130 col/g dry wt
SM 9222D
642 Tamco Road, Reidsville, North Carolina 27320
teI.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Drew Matthews
Client: Soil Plus
Page 2
Report Date: 9/21/2020
P.O. Box 1396 Project: Town of Hertford
Oxford, NC 27565 Date Sample Rcvd: 9/10/2020
Meritech Work Order # 091020122 Sample: Hertford (005) Grab
9/10/20
Parameters
Results
Analysts Date
Reporting Limit
Method
% Total Solids
4.45 %
9/11/20
0-100 %
SM 2540B
Fecal Coliform (Sludge)
<204 col/g dry wt
9/10/20
204 col/g dry wt
SM 9222D
Meritech Work Order # 091020123 Sample: Hertford (006) Grab
9/10/20
Parameters
Results
Analysis Date
Reporting Limit
Method
% Total Solids
4.50 %
9/11/20
0-100 %
SM 2540B
Fecal Coliform (Sludge)
<202 col/g dry wt
9/10/20
202 col/g dry wt
SM 9222D
Meritech Work Order # 091020124 Sample: Hertford (007) Grab
Parameters
Results
Analysis Date
Reporting Limit
% Total Solids
4.50 %
9/11/20
0-100 %
Fecal Coliform (Sludge)
202 col/g dry wt
9/10/20
130 col/g dry wt
9/10/20
Method
SM 2540B
SM 9222D
I hereby certify that I have reviewed and approve these dates
Laboratory epres tatfve
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
0
Contact: Drew Matthews Report Date: 10/16/2020
Client: Soil Plus
P.O. Box 1396 Project: Town of Hertford
Oxford, NC 27565 Date Sample Rcvd: 9/10/2020
Vector Attraction Reduction Aerobically Digested Sludge 30 Day Test
Meritech Work Order # 091020117 Sample. Hertford Grab 9/10/20
Total Solids Volatile Solids % Volatile Solids
Week 1 2.13 1.07 0.504
Week 2 2.70 1.35 0.501
Week 3 2.25 115 0.512
Week 4 2.13 1.02 0.480
Week 5 2.01 1.02 0.507
Mass Balance Equation = -0.65% Volatile Solids Reduction as per EPA Part 503 Biosolids Rule
1 hereby certify that 1 have reviewed and approve these data.
- iv, )
,Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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APPENDIX 3
2021 PERMIT RENEWAL
Town of Hertford (WQ0020239)
LAS CA
Land Owner Agreement Forms
Maps
Biosolid Utilization
CPLR Summary

State of North Carolina
DW Department of Environmental Quality
AM"' V--'q R
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class 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 Hertford
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(Y )
Land Use or
Cropping Patterns
PP� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
01/Fields 1-3
No
Row Crop/Small Grains
Animal Consumption
Hertford WWTP
No -Till
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page] of 3

I. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. . Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map 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

Lanc+owner's• Certification:
l 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 iandowners _QR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners, r 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: Edward Lee Nixon
Address: 446 Ballahack Road
City: Hertford State: NC 27W
Zip:
Phone: 2(�}r, E-mails: Q Signature: Gp s� 1t U _ Date:
NORTH CAROUNA, C r r COLNTY
I, the undersigned Notary Public do hereby certify that t i E 1� Of)
personallY aweared before me this day and acknowledged the due execution of the forgoing instrument.
WI7NE,55 my hand and official seal this the l' s�
day of l Q
Signature and seal:
MY commission expires:
Lessee'sloperatur's Certification:
20
BW% M Ftarrt
Curritudc County, Ne
My Commisa M Expires February 22, 2025
I certify that I have read this Agreement and do hereby agree is abidr In the stipulations and restrictions as specified herein
Lesseeloperator 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: Pamela Hurdle, Town Manager
Signature: _ 7 "tl + �^ �e� `�F� kd),-
Date: a s a b a 1
J
FORM: LOA 06-16
Page 3 of 3

N
WE
j[SS
11 Gro
Legend
■ House
Structure
• Well
b G
°ro �`��� — —► Ditch
5
XX Fence
- Stream
Buffer
Field Boundary
Net Area
500 250 0 500
Feet Pond
Scale: 1 inch = 500 feet = BUFFER MAP - SITE 3 FIELD 1 FIGURE
Drawn by: CSC IL i U Pasquotank County, North Carolina
Reviewed by: Town of Hertford Residual Program 7
Date: March'15 Soil Plus Project No. 200802.A11

L I " I
fflu
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 Hertford
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
p
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
02/Fields 1 & 6
No
Row Crop/Small Grains
Animal Consumption
Hertford WWTP
No -Till
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

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-D WR, 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 Pennittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits. -
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
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- 4 6 Page 2 of 3

Landowtter'•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 ain otherwise authorized, through
a power of attorney or other legal delegation, to maize 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
herein. site(s) as specified
Landowner name: J. Wallace Hobbs Jr.
Address: 544 Snug Harbor Road
City: Hertford
State: NC
Zip: 27944
Phone2Hr5Fi
SignatDate:ti
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the � a
th-
day of
Signature and seal:
My commission expires: 0 ihh 911R. 01\ V
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
10
NOTARY PUBLIC
Currituck County, NC
MY Commission Expires February 22, 2025
Date:
Zip:
n.
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: Pamela Hurdle, Town Manager
Signature: 't
Date;
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 Applicant shall submit one original and two conies of the application and
stwortina 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 Hertford
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(y )
Land Use or
Cropping Patterns
PP� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
02/Fields 2-5
No
Row Crop/Small Grains
Animal Consumption
Hertford WWTP
No -Till
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

I. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. . Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map 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 sites) 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: John Wallace Hobbs III
Address: 498 Snug Harbor Road
City: Hertford State: NC 27944
-7 r { k 1 Zip:
Phone: � 33 C �f -mail address: N I I�t�Y] O'Laa c d
Signature: �+ d ),�
Date:
NOR CAROLINA, COUNTY `
I, the undersigned Notary Public do hereby certify that ❑V\n
Personally appeased before me this day and acknow ltdgged the due execution of the forgoing instr uncnL
WITNESS my hand and official seal this the lTi_
day of Ix 1 to
Signature and seal:
My commission expires: _
Lessee's/Operator's Certification:
M
L�J
20_ 'eX1
Bmoke M Harris
Cw hd County, NC
My Coalmbft Expkm February 22, 2o25
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Pamela Hurdle, Town Manager
Signature: PwevjA i t„ou (� �aa 1 a o a+
Date:
FORM: LOA 06-16 Page 3 of 3

.o
ia
Scale: 1 inch = 500 feet
Drawn by: CSC
Reviewed by:
Date: Aprit'15
32N29,Gross Acres
26.93 Net Acres
J; :} 0 500 500 250
F
,OIL PLL
941IMP
Legend
House
Well
Structure
r Ditch
X X Fence
Stream
Buffer
Field Boundary
Net Area
Pond
p* poll
= Property Boundary
BUFFER MAP - SITE 2 FIELD 1
Perquimans County, North Carolina
Town of Hertford Residual Program
Soil Plus Project No. 200802.A11
FIGURE I
1!

S
449�%Net Acres
53.82 Net Acres
33.40 Gross Acres
2
27.02 Net Acres
Gross Acre
4 j
9.84 Net Acres Legend
1-1
House
Well
Structure
r Ditch
X X Fence
Stream
Buffer
Field Boundary
Net Area
Pond
500 250 0 500
lb Feet Property Boundary
Scale: 1 inch = 500 feet = BUFFER MAP - SITE 2 FIELD 2 - 4 FIGURE
Drawn by: CSC OIL P ` Perquimans County, North Carolina
Reviewed by: Town of Hertford Residual Program 5
Date: April'15 Soil Plus Project No. 200802.A11

3
49L88 Net Acres
6
53.82 N
14.95 Net Acres
f2.34 Gross
4
9.84 Net Acres
�L Legend
House
Well
Structure
r Ditch
X X Fence
Stream
Buffer
Field Boundary
;•�'k! Net Area
r.
Pond
500 250 0 500
Property Boundary
Feet
Scale: 1 inch = 500 feet = BUFFER MAP - SITE 2 FIELD 5 & 6 FIGURE
Drawn by: CSC OIL P ` Perquimans County, North Carolina
Reviewed by: Town of Hertford Residual Program 6
FDate: April'15 Soil Plus Project No. 200802.A11
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