WQ0014452_Renewal Application_20220225

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnWrvnmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0014452
Applicant/Permittee Town of Bladenboro
Applicant/Permittee Address PO Box 455 Bladenboro, NC 28320
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
Owner Type Municipal
Facility Name Town of Bladenboro
County Bladen
Fee Category Minor Fee Amount $0
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review by the hydrogeologist?*
Regional Office
CO Reviewer
Admin Reviewer
Yes No
Complete App Date 02/25/2022
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
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name*
Matthew Carter
Email Address* Phone Number*
[e-mail] 336-705-9886
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Permit Number: *
Applicant/Permittee *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Town of Bladenboro
WQ0014452
Has Current Existing permit number
Applicant/Permittee Address* PO Box 455 Bladenboro, NC 28320
Facility Name* Town of Bladenboro Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
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 Plans, Specifications, Calculations, Etc.)
Town of Bladenboro Renewal 2022.pdf 19.93MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature

Submission Date 2/25/2022

SYNAGRO
APPLICATION FOR RENEWAL OF
PERMIT NO. WQ0014452
Land Application of Town of Bladenboro,
NC Residuals
ORIGINAL COPY
Prepared by:
SYNAGRO CENTRAL, LLC
284 Boger Road
Mocksville, NC 27028
P 336.790.160
Feb 22, 2022

SYNAGRO
Feb 22nd, 2022
N.C. Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section —Class B Residuals Permit (DEDICATED)
1617 Mail Service Center
Raleigh, NC 27699-1617
ATTENTION: Mr. Nathaniel Thornburg
REFERENCE: APPLICATION FOR PERMIT RENEWAL
TOWN OF BLADENBORO RLAP WQ0014452
BLADEN COUNTY
Dear Mr. Thornburg:
On behalf of the Town of Bladenboro, Synagro is submitting this application to renew the
referenced residuals land application permit.
There is no few included with this renewal. This application package should contain all
information necessary to complete the requested renewal of the Town of Bladenboro
permit. However, if you require additional information or have further questions, please
contact me at (336)-705-9886 or [e-mail]. Thank you in advance for the
timely and efficient review of this renewal application.
Sincerely,
Matthew D. Carter
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

State of North Carolina
DW RDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T.1100—RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 &SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharge Permitting Unit
General—This application is for treatment, storage,transport,and/or land application of Class B residuals(may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s)under
15A NCAC 02T.1100.
Unless otherwise noted,the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16)Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program(FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions,attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T.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)
D 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) $1,310 $395
Minor(land are permitted for<300 acres) $810 $245
-A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s)from
one program to another];adds additional residuals sources;or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter(All Application Packages)
® List all items included in the application package,as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required—See 15A NCAC 1 C .0300)
❑ Submit a copy of the Findings of No Significant Impact(FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s)from the Environmental Assessment(EA)that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 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 l5A NCAC 02T.1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
®Maintenance schedules;may include equipment calibration,maintenance of signs,etc.
® Safety measures;may include safety training program,manuals,signs,etc.
® Spill response plan;including control, containment,remediation, emergency contact information, etc.
® Inspection plan including the following information;
®Names and titles of personnel responsible for conducting the inspections.
• Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s)and inspection frequency are representative of the residuals management program.
®Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
® Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
® SampIing frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow,and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M)ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically,a residuals land application program is designated as dedicated if any of the following are applicable:
❑Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non-Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non-dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps(All New or Modification Application Packages)
❑ Submit three (3)sets of standard size plans and two(2)sets of 11"by 17"plans(electronic format is acceptable-Adobe PDF
only). For Modifications,submit plans specific to the modification(s)only.
❑ Plans must include the following minimum items:
❑A general location map,a vicinity map and a topographic map with contours not exceeding 10 feet or 25%of the total site
relief and showing all facility related structures and fences within the land application area.
O The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial),springs, lakes,ponds,and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T.1108
❑ Site property boundaries within 500 feet of all waste treatment,storage,and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases(e.g.,FOR REVIEW ONLY,NOT FOR
CONSTRUCTION,etc.)that indicate that they are anything other than final plans. However,the plans may be labeled with
the phrase: FINAL DESIGN-NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan(All New Application Packages or Modifications that include new sites)
❑ Submit a project evaluation and a receiver site management plan(if applicable)with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report(All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules_Policies_and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed,sealed,and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T.1104(d)(2). For Modifications, submit an updated site map
specific to the modification(s)only.
❑ The design documents must include the following minimum items:
❑Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used,method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump,and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: http://www.ncwater.org/Rules_Policies_and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
O 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
O An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 021,.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: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N.SALISBURY STREET
RALEIGH,NORTH CAROLINA 27699-1617 RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone] FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T.1100—RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Bladenboro
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately-Owned Public Utility
❑ Federal ❑ State ®Municipal El County
Signature authority's name per 15A NCAC 02T .0106: I Oiyan D Lowry Title: Town Manager
Applicant's mailing address: PO Box 455
City: Bladenboro State:NC Zip:28320-;
Telephone number: [phone] Email Address: [e-mail]
Consultant's name: Matthew Carter License Number(for P.E.):
Affiliation: ® On Staff El Retained(Firm: )
Consultant's mailing address: 284 Boger Rd
City: Mocksville State:NC Zip: 27028-
Telephone number: [phone] Email Address: mcarter ,synagro.com
2. Agronomist's name: License Number:
Affiliation: ❑N/A ❑ On Staff ❑ Retained(Firm:
Agronomist's mailing address:
City:—_ _ State: Zip:
Telephone number: Email Address:
3. Soil Scientist's name: G. Christopher Murray License Number: 1284
Affiliation: ❑N/A ❑ On Staff ®Retained(Firm:Piedmont Environmental Associates,P.A)
Soil Scientist's mailing address: 216 S Swing Rd, Suite 1
City: Greensboro State:NC Zip:27409-
Telephone number: (336)-662-5487) Email Address: [e-mail]
4. Fee submitted: (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: W00014452
Date of most-recently issued permit: 09/12/20 17
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:
I. Residuals Processing Facility's physical address: 258 West Bladen Street
City: Bladenboro State:NC Zip: 28320-:
Coordinates: Latitude: 34°32' 18" Longitude: 78°48'5"
Datum:NAD 84 Level of accuracy: Second
Method of measurement: Map
2. County where residuals land application program is headquartered: Bladen
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 Robert N. Roth Synagro 1001672
Back-Up ORC John A. Culp Synagro 1000733
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: 50 dry tons per year.
PAN Pounds of PAN per Dry Ton Pounds of PAN per Year
(Weighted Average)
Surface Incorporation Surface Incorporation
or Injection or Injection
First-Year
34.59 43.58 17234 17324
Five-Year Maximum Adjusted 50.98 59.98 21734 21734
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 0
Row Crops 69.3
Hay 0
Pasture 0
Total: 0
Methods Surface 69.3
Incorporation or Injection 0
Total: 69.3
FORM:RLAP 06-16 Page 2 of 5

c.Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed Acres Required Using Acres Required Using
Application Rate First-Year PAN Concentrations Five-Year Maximum Adjusted PAN
(lbs PANIac yr) Concentrations
Surface Incorporation or Surface Incorporation or
Injection Injection
50 34.6 43.6 51.0 60
100 17.3 21.8 25.5 30
150 11.5 14.5 17 20
200 8.6 10.9 12.7 15
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent Iand 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.
Land Application Siite
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑existing ❑proposed.
3. Minimum depth to mean seasonal high water table(SHWT)within irrigation sites(s)per Soil Scientist's Evaluation: feet
below ground surface.Rules 15A NCAC 02T.0505(p)requires at least one-foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑Yes or ❑No If Yes,please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Recommended Recommended
Soil Series Fields within Soil Area Loading Rate Loading Rate
(in/hr) (in/yr)
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 Number of Maximum Application Design Annual Loading
(ft2) Nozzles Rate(gallons/hr) Rate(gallons/yr)
Total i
I
Spray Irrigation Design Element Plan Sheet Specification
Number Page Number
Wetted diameter of nozzles ft
Wetted area of nozzles ft2 _
Nozzle capacity gpm
Nozzle manufacturer/model 1
Elevation of highest nozzle j 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, Oryan D Lowry Town Manager
(Signature Authority's Name—PLEASE PRINT) (Title)
attest that this application for Bladenboro WWTP
(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§I43-215.6B,any person who knowingly makes any false
statement,representation, or certification in any application shall be guilty of a Class 2 misdemeanor,which may include a fine not to
exceed$10,000 as well as civil penalties up to$25,000 per violation.
Signature: Date: / wd4
FORM: RLAP 06-16 Page 5 of 5

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0014452
Town of Bladenboro
Inspection Plan
Inspections will be conducted on a weekly basis at the land application site during activities of this project. Inspection
frequency is based on the time frame to complete the project and the amount of dry tons to be land applied from the
facility. The inspections will consist of inspecting a field that is currently being applied as well as inspecting random
fields that have been completed. These inspections will consist of:
1. Verifying that the"Pre-Operations Check List" has been completed and signed by both operational and technical
staff.
2. Checking the calculated loads to insure the correct amount of residuals are being land applied.
3. Insuring that all manned equipment has a copy of the spill control plan,the permit,and the operations and
maintenance plan.
4. Insuring that the field has been flagged properly and that all buffers are being adhered to.
5. Insuring that the"Crop and Landowner Verification"form has been filled out.
6. Verifying that the residuals have been adequately sampled to confirm compliance.
The records will be kept in the project files in the respective office for the project. The Permittee or Inspector shall
report by telephone to the NCDENR/DWQ Fayetteville Regional Office at 910-433-3300,as soon as possible,but no later
than 24 hours after,or the next working day,following the occurrence or first knowledge of the occurrence of the
following.
• Any occurrence with the distribution program resulting in the land application of significant amounts of
material that is abnormal in quantity or characteristics.
• Any failure of the program that results in a release of material to surface waters.
• Any time that self-monitoring information indicates that the program has gone out of compliance with
the permit.
• Any process unit failure that results in the system not adequately treating the residuals.
• Any spill or discharge from a vehicle or piping system during residuals transportation.
Any release that requires immediate reporting outside of normal business hours shall be called in to DENR at 800-662-
7956,or 800-585-0368.These numbers are to be called in the event of a release to surface waters or the imminent failure
of a storage system when the event occurs outside of normal business hours. Within 5 days of the first notice of on
occurrence, a written response in the form of a letter shall be sent to DENR outlining the actions taken or proposed
actions taken to ensure that the problem does not recur.
Persons responsible for inspections on this project are as follows:
Nate Roth,Technical Services Manager,or his designee.

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0014452
Town of Bladenboro
Sampling Plan
Sampling for this project consists of sampling the residuals just before land application is to occur. The plant
will be sampled on an annual basis as required by permitted dry tonnage.
The residuals shall be sampled annually for the following: (Regulatory level in milligrams per liter in parentheses.)
Arsenic(5.0) 1,4-Dichlorobenzene(7.5) Nitrobenzene(2.0)
Barium (100.0) 1, 2-Dichloroethane(0.5) Pentachlorophenol(100.0)
Benzene(0.5) 1, 1-Dichloroethylene(0.7) Pyridine(5.0)
Cadmium (1.0) 2,4-Dinitrotoluene(0.13) Selenium (1.0)
Carbon tetrachloride(0.5) Endrin (0.02) Silver(5.0)
Chlordane(0.03) Hexachlorobenzene(0.13 Tetrachloroethylene(0.7)
Chlorobenzene (100.0) Heptachlor(and its hydroxide)(0.008)Toxaphene(0.5)
Chloroform(6.0) Hexachloro-1,3-butadiene (0.5) Trichloroethylene(0.5)
Chromium(5.0) Hexachlorethane(3.0) 2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0) Lead (5.0) 2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0) Lindane(0.4) 2,4,5 TP(Silvex) (1.0)
p-Cresol (200.0) Mercury(0.2) Vinyl Chloride(0.2)
Cresol (200.0) Methoxychlor(10.0)
2,4-D(10.0) Methyl ethyl ketone(200.0)
The residuals will also be sampled,based on the chart below,for the following constituents
Dry Tons Generated Monitoring Frequency
(short tons per year) (Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319 1 time per year
=>319-<1,650 1 per Quarter(4 times per year)
=>1,650-<16,500 1 every 60 days(6 times per year)
=>16,500 1 every month(12 times per year)
Aluminum Magnesium pH
Ammonia-Nitrogen Mercury Plant Available Nitrogen (calculation)
Arsenic Molybdenum Selenium
Cadmium Nickel Sodium
Calcium Nitrate-Nitrite Nitrogen %Total Solids
Copper Phosphorous Total Kjeldahl Nitrogen
Lead Potassium Zinc
Sodium Adsorption Ratio(SAR)
All samples will be taken from the basin located on site.Additional samples will be taken for TCLP/RCI and nutrients and
metals analysis. Methods of sampling will follow the conditions of the permit and applicable regulations.
The following people are responsible for sampling:
Nate Roth,Technical Services Manager,or his designee.

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0014452
Town of Bladenboro
Operational Functions
The operational function of this project involves land application of residuals for the Town of
Bladenboro's wastewater treatment facility. Material will be loaded onto tractor trailers or"spreader
trucks" and hauled to land application sites. Tractor trailers will be off loaded to liquid applicators and
spread in a uniform manner. The residuals will be spread at agronomic rates, as determined by a
recently analyzed nutrients and metals sample. The material will be land applied with a liquid applicator
that will use pressure to achieve a consistent spread pattern. The fields applied will have a crop, either
established or planted soon after application, which is to be utilized for animal consumption.
Safety Measures
Synagro believes in operating in a safety-conscious manner and has all employees participate in
quarterly online safety courses. These courses are designed to help employees recognize safety issues
and take steps to prevent accidents from occurring. In addition, all Synagro employees have the
authority to stop operations if they think any aspect of the operation could cause environmental or
personal harm.
Maintenance Schedule
Synagro will follow the maintenance schedule specified by their fleet management section for the
equipment necessary to complete the job.

SPILL RESPONSE PLAN
PROJECT: WQ0014452 Town of Bladenboro
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
1. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Synagro Operations Manager shall take immediate charge and initiate clean-up activities. Synagro labor and
equipment is to be utilized. In the event additional labor and equipment is required, assistance may be requested from the
PWC of Fayetteville or the NC Department of Transportation, and other private contractors as necessary.
2. HALT THE SOURCE OF THE SPILL:
Such as a ruptured container or damaged transport unit.
3. CONTAIN THE SPILL:
Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The Synagro Operations Manager or the person in charge on the
spill site will advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-
up operation,i.e., local farmers, farm supply centers,nurseries,etc.
4. CLEAN-UP:
Employ front-end loaders, vacuum equipment, sludge application vehicles, and/or local septic tank service to remove as
much of the spilled material as possible. Straw andlor sand should be scattered in the spill area to soak up the remaining
material. The straw- and sand-soaked material will be collected and removed to a disposal area approved by
representatives of the state regulatory agency.
5. FINAL CLEAN-UP:
Employ rotary brush sweeper if needed, and apply lime to the spill area upon the approval of the clean-up efforts by the
state regulatory representative. If the event occurs on private property,the clean-up will be completed to the satisfaction
of the property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original
condition if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs,the Synagro Operations Manager or assistant will notify the Synagro Central
office, and they will then be responsible for notifying other key Synagro personnel.
7. REPORTING:
Synagro Central personnel will notify the Fayetteville Regional office at(910)433-3300 for the Town of BIadenboro as
soon as possible,but not more than 24 hours after, or on the next working day following the occurrence. The Operations
Manager shall provide a written report within 48 hours of the spill to the Technical Services Manager. The report shall
list all relative information and actions taken. Synagro Central personnel will file a written report to the Fayetteville
Regional office of the NCDEQ within 5 days of the occurrence. For after hours reporting the Division's emergency
number shall be called to report all incidences(1-800-858-0368) or(919-733-3300).

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application,distribution,or disposal in accordance with 15A NCAC 02T.1100. Do not submit this certification for review without
a corresponding application form(FORM: RLAP 11-15,FORM: DCAR 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. PIease 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-I6 Page 1 of 1

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Mate of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE-GENERATING FACILITY INFORMATION(See Instruction B.):
1. Facility Name: Bladenboro WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, IZ Local Government,or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other(explain: ).
3. Facility contact person and title: Daniel Ward,Plant ORC
Complete mailing address: PO Box 455
City: Bladenboro State:NC Zip: 28320-
Telephone number: [phone] E-mail address:[e-mail]
4. Facility physical address: 258 West Bladen Street
City: Bladenboro State:NC Zip:28320-1 I
Coordinates: Latitude:34°32' 18" Longitude78°48'5"
Datum:NAD 83 Level of accuracy: Second
Method of measurement: Map
5. Purpose of the facility:
Al 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: j {%industrial and %domestic)
111 (explain: ' I).
6. Does the facility have an approved pretreatment program: ® Yes ❑ No
7. Facility permitted/design flow: 0.5 MGD and facility average daily flow: 0.125 MGD
8. Average amount of residuals being generated at this facility 13.46 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Aerobically digested liquid, 1-miIlion gallon tank
Type and volume of residuals storage (i.e., outside of residuals treatment units): Aerobically digested liquid, 1-million
gallon tank
II. RESIDUALS QUALITY INFORMATION(See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503,otherwise,the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6)as:
® Biological ❑ Non-Biological
FORM: RSC 06-16 Page 1 of 5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons,activated sludge systems,extended aeration systems,and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non-hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100%non-municipal,domestic wastewater only)
a. Are the residuals listed in 40 CFR§261.31-§261.33: ❑ yes E no. 1
If yes,list the number(s): 1
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity,ignitability, and reactivity:
Laboratory: : Pace Analytical Services,LLC and Date of analysis: 05/11/2021
Passed corrosivity test: ® yes LI no. pH: s.u. (2<pH< 12.5)
Passed ignitability test: ® yes ❑ no. Flashpoint: 140°F(> 140°F)
Passed reactivity test: ®yes Duo. HCN:ND mg/kg(<250)&H2S:ND mg/kg(<500)
TCLP Parameter Limit Result TCLP Parameter Limit Result
(mg/1) (mg/1) (mg/1) (mg/1)
Arsenic 5.0 ND Hexachlorobenzene 0.13 ND
Barium 100.0 0.051 Hexachloro-1,3-Butadiene 0.5 ND
Benzene 0.5 ND Hexachloroethane 3.0 ND
Cadmium 1.0 ND Lead 5.0 ND
Carbon Tetrachloride 0.5 ND Lindane 0.4 ND
Chlordane 0.03 ND Mercury 0.2 ND
Chlorobenzene 100.0 ND Methoxychlor 10.0 ND
Chloroform 6.0 ND Methyl Ethyl Ketone 200.0 ND
Chromium 5.0 ND Nitrobenzene 2.0 ND
m-Cresol 200.0 ND Pentachlorophenol 100.0 ND
o-Cresol 200.0 ND Pyridine 5.0 ND
p-Cresol 200.0 ND Selenium 1.0 ND
Cresol 200.0 ND Silver 5.0 ND
2,4-D 10.0 ND Tetrachloroethylene 0.7 ND
1,4-Dichlorobenzene 7.5 ND Toxaphene 0.5 ND
1,2-Dichloroethane 0.5 ND Trichloroethylene 0.5 ND
1,1-Dichloroethylene 0.7 ND 2,4,5-Trichlorophenol 400.0 ND
2,4-Dinitrotoluene 0.13 ND 2,4,6-Trichlorophenol 2.0 ND
Endrin 0.02 ND 2,4,5-TP(Silvex) 1.0 ND
Heptachlor and its Hydroxide 0.008 ND Vinyl Chloride 0.2 ND
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T.1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis)for the following metal parameters:
Laboratory: Pace Analytical Services,LLC and Date of analysis: 05/11/2021
Parameter Ceiling Monthly Average Result
Concentration Limits Concentration Limits
(ClassA & ClassB) (Class A Only)
(mg/kg) (mg/kg) (nag/kg)
Arsenic 75 41 11
Cadmium 85 39 3.4
Copper 4,300 1,500 700
Lead 840 300 48
Mercury 57 17 ND
Molybdenum 75 n/a ND
Nickel 420 420 38
Selenium 100 100 ND
Zinc 7,500 2,800 1200
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: ! J
Distance from Disposal Arsenic Chromium Nickel
Unit to Boundary to
Closest Property Line
(meters, check one) (mg/kg) (mg/kg) (mg/kg)
❑ >0 but<25 30 200 210
❑ >25 but<50 34 220 240
❑ >50 but<75 39 260 270
❑ >75 but< 100 46 300 320
❑ > 100 but< 125 53 360 390
❑ > 125 62 450 420
Result(mg/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 0.924%.
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: : Pace Analytical Services,LLC and Date of analysis: 05/11/202I
Parameter Result
(mg/1cg)
Aluminum 22000
Ammonia-Nitrogen 9000
Calcium 25000
Magnesium 3500
Nitrate-Nitrite Nitrogen 194
pH(Standard Unit) 6.9
Phosphorus 25000
Potassium 6500
Sodium 2900
Total Kjeldahl Nitrogen 51000
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.44
[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): El default value, or El actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals(i.e.,on a dry weight basis) and fill the results in the following table:
Application Method First(V) Year PAN Five-Year
Maximum Adjusted PAN
(mg/1cg) (mg/kg)
Surface 13710 17234
Injection/Incorporation 13710 21734
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: A
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings(except for non-biological residuals):
❑ Alternative 1 [15A NCAC 02T.1106(b)(3)(A)]-Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1106(b)(3)(B)] -Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1106(b)(3)(C)]-Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ 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, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or LI pasteurization.
b. For Land Application of Class B:
® Alternative 1 [15A NCAC 02T.1106(c)(1)]-Fecal Coliform Density Demonstration.
® Alternative 2 [15A NCAC 02T.1106(c)(2)] -Process to Significantly Reduce Pathogens(PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, E. anaerobic digestion,
❑ composting, or ® lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
L. Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b.above.
LI Exempt-If Daily Cover Alternative is chosen in Item 11.8.below[15A NCAC 02T.1106(a)(2)].
❑ Not Applicable-Non-Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction(VAR): Per 15A NCAC 02T.1 107,specify how residuals will meet the VAR requirements:
• Alternative 1 [15A NCAC 02T.1 I07(a)(l)]-38%Volatile Solids Reduction(Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.1107(a)(2)]-40-Day Bench Scale Test(Anaerobic Digestion).
® Alternative 3 [l5A NCAC 02T.1107(a)(3)] -30-Day Bench Scale Test(Aerobic Digestion).
® Alternative 4 [15A NCAC 02T.1107(a)(4)] -Specific Oxygen Uptake Rate Test(Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
® Alternative 6 [15A NCAC 02T.1107(a)(6)] -Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1107(a)(7)] -Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1107(a)(8)] -Drying of Unstabilized Residuals.
f.:,.. Alternative 9 [15A NCAC 02T.1107(a)(9)]-Injection.
® Alternative 10 [15A NCAC 02T.1107(a)(10)] -Incorporation.
❑ Alternative for Surface Disposal Units Only-Soil/Other Material Cover[I5A NCAC 02T.1107(b)(2)].
❑ Not Applicable-Non-Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

VICINITY MAP SYNAGRO
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TOWN OF BLADENBORO PERMIT RENEWAL
QUANTITATIVE JUSTIFICATION FOR RESIDUALS PRODUCTION RATE
The following is a record of the annual land application volume for the Town of
Bladenboro wastewater treatment plant:
Year Dry Tons Land Applied
2018 0
2019 27.96
2020 0
2021 12.42
The proposed permitted volume (50 dry tons per year) is greater than the anticipated need
for the coming years. Over the 4 years shown above the average number of dry tons land
applied were 10.095, which is well within reason of the permitted dry tonnage. Looking
forward the volume of material is expected to increase due to returning industries.

Residuals Sampling Plan
Synagro Residuals Land Application WQ0014452
Town of Bladenboro NC WWTP
Nutrients and Metals Analysis
• Sampling Point: Basin
• Sampling Frequency: 1/yr
• Sample Type: Composite
• Lab: Waypoint Analytical
Pathogen Reduction (Fecal Coliform Density Demonstration)
• Sampling Point: Basin
• Sampling Frequency: 1/yr
• Sample Type: Grab
• Lab: Meritech Inc. Environmental Lab
Vector Attraction Reduction (38% VSR)
• Sampling Point: Digester
• Sampling Frequency: 1/yr
• Sample Type: Composite
• Lab: In house
TCLP
• Sampling Point: Basin
• Sampling Frequency: Annually
• Sample Type: Composite
• Lab: Summit Environmental Technologies, Inc

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aceAnalytical
Report of Analysis
Synagro
12701 Lancaster Hwy
Pineville, NC 28134
Attention: Nate Roth
Project Name: Bladenboro
Lot Number:WD22023
Date Completed:05/11/2021
.0:> -. 0V—et__
05/11/2021 11:04 AM
Approved and released by:
Project Manager II: Lucas Odom
P«p
4,111 A4B
ANSI Mani AccreeaVoe hard
. < IA ACCREDITED
TESTING EAHOFATONY
The electronic signature above is the equivalent of a handwritten signature.
This report shall not be reproduced, except in its entirety,without the written approval of Pace Analytical Services, LLC.
Pace Analytical Services, LLC(formerly Shealy Environmental Services, Inc.)
106 Vantage Point Drive West Columbia, SC 29172
Tel: [phone] Fax: [phone] www.pacelabs.com
PaRc 1 of 10

PACE ANALYTICAL SERVICES, LLC
SC OHEC No:32010001 NELAC No:E87653 NC DENR No:329 NC Field Parameters No:5639
Case Narrative
Synagro
Lot Number: WD22023
This Report of Analysis contains the analytical result(s) for the sample(s) listed on the Sample Summary
following this Case Narrative. The sample receiving date is documented in the header information
associated with each sample.
All results listed in this report relate only to the samples that are contained within this report.
Sample receipt, sample analysis, and data review have been performed in accordance with the most
current approved The NELAC Institute (TNI) standards, the Pace Analytical Services, LLC ("Pace")
Laboratory Quality Manual, standard operating procedures (SOPs), and Pace policies. Any exceptions to
the TNI standards, the Laboratory Quality Manual, SOPs or policies are qualified on the results page or
discussed below.
Where applicable, all soil sample results (including LOQ and DL if requested) are corrected for dry weight
unless flagged with a "W" qualifier.
If you have any questions regarding this report please contact the Pace Project Manager listed on the
cover page.
The pH analysis associated with the sample(s) in this report was/were performed after the method
recommended 15 minute holding time.
Metals by ICP
Due to low % solid the initial amount of sample -002 was 3 times the standard procedure amount per
PM's request. The LOQ has been adjusted accordingly.
TCLP VOCs
The following sample was analyzed outside of analytical holding time: WD22023-001. This sample was
over-looked when loading based off of holding-times.
Pace Analytical Services,LLC(formerly Shealy Environmetal Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172(803)791-9700 Fax[phone] www.pacefabs.com
Pace 2 of 10

Client:Synagro Laboratory IL):W D22023-001
Description:Bladenboro WWTP Matrix: Solid
Date Sampled:04/20/2021 1030 %Solids: 1.33 04/24/2021 1436
Date Received:04/22/2021
Inorganic non-metals
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
2 (%Solids)SM 2540G 1 04/24/2021 1436 AAB 90126
1 {Flashpoint() 1010B 1 04/26/2021 1239 KMC 90241
1 (Reactive Cya)7.3.3 1 04/26/2021 1758 KFE 04/23/2021 2131
1 (Reactive Sul)7.3.4 1 04/27/2021 2225 GDC 04/23/2021 2131
1 (Soil pH meas)9045D 1 04/26/2021 2209 NBW 90278
CAS Analytical
Parameter Number Method Result 0 LOQ DL Units Run
%Solids SM 2540G 1,33 % 2
Flashpoint(Pensky-Martens Closed-Cup) 1010E >140 140 0 ° F 1
Reactive Cyanide 7.3.3 ND 50 50 mg/kg 1
Reactive Sulfide 7.3.4 ND 50 50 mg/kg 1
Soil pH measured in water @ 18.8°C 9045D 6.9 su 1
TCLP Volatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/503013 8260D 10 05/09/2021 1645 TML 91772 05/05/20212224
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Benzene 71-43-2 8260D ND H 0.050 0.0040 mg/L 1
2-Butanone(MEK) 78-93-3 8260D ND H 0.10 0.020 mg/L 1
Carbon tetrachloride 56-23-5 8260D ND H 0.050 0.0040 mg/L 1
Chlorobenzene 108-90-7 8260D ND H 0.050 0.0040 mg/L 1
Chloroform 67-66-3 8260D ND H 0.050 0.0040 mg/L 1
1,2-Dichloroethane 107-06-2 8260D ND H 0.050 0.0040 mg/L 1
1,1-Dichloroethene 75-35-4 8260D ND H 0.050 0.0040 mg/L 1
Tetrachloroethene 127-18-4 8260D ND H 0.050 0.0040 mg/L 1
Trichloroethene 79-01-6 8260D ND H 0.050 0.0040 mg/L 1
Vinyl chloride 75-01-4 8260D ND H 0.010 0.0040 mg/L 1
Run 1 Acceptance
Surrogate Q %Recovery Limits
Bromofluorobenzene H 101 70-130
1,2-Dichloroethane-d4 H 106 70-130
Toluene-d8 H 108 70-130
TCLP Semivolatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8270E 1 05/09/2021 0449 SCD 05/06/2021 1712 91446 05/03/2021 1721
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
1,4-Dichlorobenzene 106-46-7 8270E ND 0.040 0.0050 mg/L 1
2,4-Dinitrotoluene 121-14-2 8270E ND 0.080 0.0050 mg/L 1
LOQ=Limit of Quantitallon B=Detected in the method blank E=Quantitation of compound exceeded the calibration range DL=Detection Limit Q=Surrogate failure
ND=Not detected at or above the DL N=Recovery is out of criteria P=The RPD between two GO columns exceeds 40% J=Estimated result<LOQ and>DL L=LCS/LCSD failure
H=Out of holding time W=Reported on wet weight basis S=MS1MSD failure
Pace Analytical Services,LLG (formerly Shealy Environmental Services,Inc)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 3 of 10

client:Synagro Laboratory rU:WD22023-001
Description:Bladenboro WWTP Matrix:Solid
Date Sampled:04/20/2021 1030 %Solids: 1,33 04/24/2021 1436
Date Received:04/22/2021
TCLP Semivolatiles
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date match Leachate Date
1 1311/3520C 8270E 1 05/09/2021 0449 SCD 05/06/2021 1712 91446 05/03/2021 1721
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Hexachlorobenzene 118-74-1 8270E ND 0.040 0.0050 mg/L 1
Hexachlorobutadiene 87-68-3 8270E ND 0.040 0.0050 mg/L 1
Hexachloroethane 67-72-1 8270E ND 0.040 0.010 mg/L 1
2-Methylphenol 95-48-7 8270E ND 0.040 0.010 mg/L 1
3+4-Methylphenol 106-44-5 8270E ND 0.040 0.015 mg/L 1
Nitrobenzene 98-95-3 8270E ND 0.040 0.015 mg/L 1
Pentachlorophenol 87-86-5 8270E ND 0.20 0.020 mg/L 1
Pyridine 110-86-1 8270E ND 0.040 0.0050 mg/L 1
2,4,5-Trichlorophenol 95-95-4 8270E ND 0.040 0.0050 mg/L t
2,4,6-Trichlorophenol 88-06-2 8270E ND 0.040 0.0050 mg/L 1
Run 1 Acceptance
Surrogate 0 % Recovery Limits
2-Fluorobiphenyi 84 37-129
2-Fluorophenol 50 24-127
Nitrobenzene-d5 79 38-127
Phenol-d5 73 28-128
Terphenyl-d14 78 10-148
2,4,6-Tribromophenol 66 41-144
TCLP Herbicides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/8151 A 8151A 1 05/06/2021 2107 JPB 05/06/2021 0041 91294 05/03/2021 1721
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
2,4-D 94-75-7 8151A ND 0.020 0.0050 mg/L 1
2,4,5-TP (Silvex) 93-72-1 8151A ND 0.0050 0.0013 mg/L 1
Run 1 Acceptance
Surrogate O % Recovery Limits
DCAA 81 50-112
TCLP Pesticides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8081B 1 05/07/2021 1633 DAL1 05/06/2021 1537 91422 05/03/2021 1721
CAS Analytical
Parameter Number Method Result 0 LOQ DL Units Run
gamma-BHC(Lindane) 58-89-9 8081B ND 0.00040 0.00017 mg/L 1
Chlordane 57-74-9 80818 ND 0.0040 0.0015 mg/L 1
Endrin 72-20-8 8081B ND 0.00040 0.00015 mg/L 1 •
LOQ=Limit of Quantitation B=Detected in the method blank E=Quantitalion of compound exceeded the calibration range DL-Detection Limit Q-Surrogate failure
ND=Not detected at or above the DL N=Recovery is out of criteria P-The RPD between two GC columns exceeds 40% .1=Estimated result<LOQ and>DL L=LCSILCSD failure
H=Out of holding time W=Reported on wet weight basis S=MS/MSD failure
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 4 of 10

Client:Synagro Laboratory ID:WD22v23-001
Description:Bladenboro WWTP Matrix:Solid
Date Sampled:04/20/2021 1030 %Solids: 1.33 04/24/2021 1436
Date Received:04/22/2021 •
TCLP Pesticides
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3520C 8081B 1 05/07/2021 1633 DAL1 05/06/2021 1537 91422 05/03/2021 1721
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Heptachlor 76-44-8 8081B ND 0.00040 0.00015 mg/L 1
Heptachlor epoxide 1024-57-3 8081B ND 0.00040 0.00016 mg/L 1
Methoxychlor 72-43-5 8081B ND 0.0016 0,00021 mg/L 1
Toxaphene 8001-35-2 8081B ND 0.0080 0.0030 mg/L 1
Run 1 Acceptance
Surrogate Q %Recovery Limits
Decachlarobiphenyl 82 20-131
Tetrachloro-m-xylene 97 26-132
TCLP Metals
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch Leachate Date
1 1311/3010A 6010D 1 05/05/2021 0733 KSH2 05/04/2021 2321 91152 05/03/2021 1721
1 1311/7470A 7470A 1 05/05/2021 1404 CMS2 05/05/2021 1100 91210 05/03/2021 1721
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Arsenic 7440-38-2 6010D ND 0.15 0.025 mg/L 1
Barium 7440-39-3 6010D 0.051 J 0.25 0.031 mg/L 1
Cadmium 7440-43-9 6010D ND 0.050 0.0060 mg/L 1
Chromium 7440-47-3 6010D ND 0.10 0.013 mg/L 1
Lead 7439-92-1 6010D ND 0.10 0.047 mg/L 1
Mercury 7439-97-6 7470A ND 0.0020 0.00091 mg/L 1
Selenium 7782-49-2 6010D ND 0.20 0.085 mg/L 1
Silver 7440-22-4 6010D ND 0.10 0.021 mg/L 1
LOQ=Limit of Quantitation S=Detected In the method blank E=Quantitation of compound exceeded the calibration range DL=Detection Limit Q=Surrogate failure
ND=Not detected at or above the DL N=Recovery is out of criteria P=The RPD between two GO columns exceeds 40% J=Estimated result<LOQ and>DL L=LCS/LCSD failure
H=Out of holding time W=Reported on wet weight basis S=MS/MSD failure
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 5 of 10

Ulient:Synagro Laboratory Ill:WD22023-002
Description:Bladenboro WWTP Matrix:Solid
Date Sampled:04/20/2021 1030 %Solids: 0.924 04/24/2021 1436
Date Received:04/22/2021
Inorganic non-metals
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
2 (%Solids)SM 2540G 1 04/24/2021 1436 AAR 90126
1 350.1 (Ammonia-N)350.1 2 04/26/2021 1408 DRD 90225
3 (Nitrate-N)9056A 1 04/30/2021 1202 AMR 90829
1 (Nitrite-N )9056A 1 04/28/2021 1221 AMR 90631
1 (Phosphorus)365.1 10 04/26/2021 1446 DMA 04/24/2021 1139 90119
1 (Soil pH meas)9045D 1 04/26/2021 2210 NBW 90278
1 351.4 (TKN)351.2 1 04/26/2021 1318 DMA 04/24/2021 1116 90116
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
%Solids SM 2540G 0.924 % 2
Ammonia-N(gas diffusion) 350.1 9000 S 220 110 mg/kg 1
Nitrate-N (soluble) 9056A 160 54 11 mg/kg 3
Nitrite-N(soluble) 9056A 34 22 11 mg/kg 1
Phosphorus 7723-14-0 365.1 25000 S 5400 1100 mg/kg 1
Soil pH measured in water @ 18.7°C 9045E) 6.9 su 1
TKN 351.2 51000 2700 2700 mg/kg I
CVAA
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 7471B 7471B 1 04/30/2021 1520 CMS2 04/30/2021 1104 90505
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Mercury 7439-97-6 7471B ND 7.9 1.9 mg/kg 1
lCP-AES
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3050B 6010D 1 04/23/2021 1943 KSH2 04/23/2021 0253 89959
2 3050B 6010D 1 04/23/2021 1206 KSH2 04/23/2021 0253 89959
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Aluminum 7429-90-5 6010D 22000 720 270 mg/kg 1
Arsenic 7440-38-2 6010D 11 J 27 9.0 mg/kg 1
Cadmium 7440-43-9 6010D 3.4 J 9.0 2.3 mg/kg 1
Calcium 7440-70-2 6010D 25000 9000 1100 mg/kg I
Chromium 7440-47-3 6010D 57 18 4.5 mg/kg 1
Copper 7440-50-8 6010D 700 18 8.1 mg/kg 1
Iron 7439-89-6 6010D 34000 180 82 mg/kg 2
Lead 7439-92-1 6010D 48 18 8.1 mg/kg 1
Magnesium 7439-95-4 6010D 3500 J 9000 1100 mg/kg 1
Manganese 7439-96-5 6010D 250 27 11 mg/kg 1
Molybdenum 7439-98-7 6010D ND 72 18 mg/kg 1
LOQ=Limit of Quantitatlon 8=Detected in the method blank E-Quantilation of compound exceeded the calibration range DL=Detection Limit 0=Surrogate failure
ND=Not detected at or above the DL N=Recovery is oul of criteria P=The RPD between two GC columns exceeds 40% J=Estimated result<LOQ and s DL L=LCS/LCSD failure
H=Out of holding time W=Reported on wet weight basis S=MS/MSD failure
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 (803}791-9700 Fax[phone] www.pacelabs.com
Puna A of 111

(.;Bent:Synagro Laboratory ID:WD22023-002
Description:Bladenboro WWTP Matrix:Solid
Date Sampled:04120/2021 1030 %Solids: 0.924 04/24/2021 1436
Date Received:0 412 212 0 2 1
ICP-AES
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3050B 6010D 1 04/23/2021 1943 KSH2 04/23/2021 0253 89959
2 3050B 6010D 1 04/23/2021 1206 KSH2 04/23/2021 0253 89959
CAS Analytical
Parameter Number Method Result Q LOQ DL Units Run
Nickel 7440-02-0 6010D 38 J 72 19 mg/kg 1
Potassium 7440-09-7 6010D 6500 J 9000 1100 mg/kg 1
Selenium 7782-49-2 6010D ND 36 15 mg/kg 1
Sodium 7440-23-5 6010D 2900 J 9000 1100 mg/kg 1
Zinc 7440-66-6 6010D 1200 90 22 mg/kg 1
LOQ=Limit of Quantitatlon 9=Detected in the method blank E=Quantitation of compound exceeded the calibration range DL=Detection Limit Q=Surrogate failure
ND=Not detected at or above the DL N=Recovery is out of criteria P=The RPD between Iwo GC columns exceeds 40% J—Estimated result<LOQ and>DL L=LCS/LCSD failure
H=Out of holding time W=Reported on wet weight basis S=MSIMSD failure
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 7 of 10

Chain of Custody
and
Miscellaneous Documents
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 8 of 10

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PACE ANALYTICAL SERVICES, LLC
,
l Samples Receipt Checklist(SRC)(MEGQ1gC-z5) Revised:9/29/202o
2ek ytee,3f Issuing Authority:Pace ENV• WCOL Page 1 of 1
i Sample Receipt Checklist (SRC)
I cliet; $YNACRO Coale;inspected MPH
. 1)4? 212D21Lot c Wl?32Jt123
tv4ranX ol`raceipt face Clionl d L1PS Pellet _Oth, .: -----Ij Y; No 1.Were custody seals present on the cooler'?
um .
1'cxs 1�Iu NA . lF cttstotly seals Were present,were the vita t and i Inirolcarl?
pl•i strip ID: NA Cilorine Strip Ifl; NA Tested by:"
Original temperuture upon receipt/Derived(Cnrneebeti)temperature upon receipt %Solid Snap..Cup ID: 21.443
i 4 9 I f-0.9 3c NA. i NA nc NA f b1A ac NA 111A aC
4ethod;❑Temperature Blank [,1Against Bottles ill.Gun]lt. `� IR Gun Correction Factor: 0 "C:
Method of rolar.t: ❑✓ Wet Ice 0 Ice Pac.kr; Li Dry ice 0 None
cs No �� 3. If temperature miry cooler excesxla�d 6.0'C',was i'rajcst Manttper lVuti ell'?
I'M was Notified by;phone/email/face-le-face(circle on — -T
1►'I Ycl ❑No (1NA 4. Is d cornmnrciat courier's packing slip artncicd to this form?
�Yes 1JNe 5. Were proper custody procedures(relinquished/receiiived)follttwcd? }
Yesl,J Ain C., Were sample IDs listed on the COC.?'Cs q No 7. Were sample tDs listed.on all samlr:e.crrntaincrs'1
i j Yes LJ No S. MIS eel)onion date&time Hated on the cOo
iEl Yes UNo 9. Was collection dare&time'listed un all sample containers/
)1-1 Ye. [TTNo 10.Did all container label intiorniatlon(ID,dim;,time)agt•cc with Ih4 COC?
I,' �f No I I I. Were:tcsis to be performed listed on the COC?
M Yes EI No 12.Did ail samples arrive hi the proper cnrainerS for tacit last and/or in good coidi:'on
1 _ (unbroken,lids on,etc.)? u
1 Ye [ No 13, Was aalma:Late sample volum available? --'
✓ Iles Q No 14. :Vere all samples received within the holdin2 time or+IS hours,whichever comes first?
i '4'.es lil No IS.Wore any sxmpies curttaincrs mirysirt exe s( ircle era)samples Not listed on COC2
�Yt� n No ON.4 .
' 16, For VOA and RSK.. 75 samples,wt..ro bubbles present> pea-size"(Vi'or 6tttin in diarnek r')
� �
to an ofthe VOA #iuis?
' 1es U Nu' ✓ NA 17-Werc'all DROimeaddnutrient samples reaciycd at a pH of.2? —_
_j Yes. iJ Ni JNA 18.Were!!!cyanide sun Tics received at a pH'• 12 and sulfide samples received at a pH>9?
0'4s EINe J✓ NA 19. Were all applicable NH ICK.I`loyunideiphcnoUG2S.li4i083(<Q.Smg%L)!Jam pies free of
i� residual chlorine?
in
❑ 20, Were clientnenrksirc<luests(.e.t0tluesteddilutionsi +Itt;..,)
Yes ID ENA MS/MSDdesib+nntions,
i I correctly trartscrltted from the COC into Ilat comment section in L114M5?
1 Y6 iQ No _ 121, Was the uote ntttnber tiytod.on the container label s,Quote li Nn .
j Sum pie Preservation '�
pi (Must be tsolupietrd for any sample(s)incorrectly ores,rvetl or with Irertdsitace-)
' Satnp;e(s) NA -- were neceivod incorrectly preserved and were adj,tsted•
ac, rdingLy
I satltpia receiving with NA rnL ofctrele tiro:ii2SO4,HNO3,MCI,NaOFI using SR it ll'A _
Time f preset ytllion NA . if more than one preservative is needed,please nom in the comments below,
Sarnple(s)NA _
. _ , _ _were received with bubbles>6 loin in diameter,
'ampllrt s)!� i• were received with'I RC r 0.5 mgfl.(tfii€9 15 no)and were
! adilm1c1:1 accordingly in sample receiving with scdiuirt thlosultrate(Na2S,O))with Shealy in; NA
' S,� R bat trtiiz labels Rppiied by: hS1:Ft — Date: 0,t1220.021
i
1 Como-ti•nts:.
Pace Analytical Services,LLC (formerly Shealy Environmental Services,Inc.)
106 Vantage Point Drive West Columbia,SC 29172 [phone] Fax[phone] www.pacelabs.com
Page 10 of 10

Cameron Testing Services, Inc. Laboratory Report NC DENR#654
NC RHHS#37799
US EPA#NC01918
Client Synagro CIS Prof._ 2104-165 DW Celt#37799
Project; Bladenboro ' Regulatory Yes
Sample information
•
Sampled N. Roth € Date 04/20/21 Received J. Cameron Data 1 04/20/21
Analyses and Results
. . ° sa s T °: Std.Methods
Lab ID Sample ID 1c o L° Analyte Result a a, E ra
2 U C7 - z ix ,a cz Reference •
2104-165 -01 SiudgE cr Fee.Coliform-S <31800 CFUrg 31800 04/20/21 RL 9222D-MF
-02 <32400 cFurg 32400
-03 <27500 CFUrg 27500
-04 <176000 CFurg 176000
-05 <68800 CFUrg 68800
-06 <172000 CFUlg 172000
-07 <174000 CFUlg 174000
Geomean <72200
2104-165 01 -01 Sludge Gr TS(%) 3.14% o.01 04/20/21 RL 2540 G-TS
-02 3.09% 001
-03 3.63% 0.01
-04 0.570% 0.01
-05 1.45% 0.01
-06 0.583% 0'01
-07 0.576% 0.01
Report
Review 1' /l
Lab Director Date
219 S.Steele Str. 919-208-4240
Sanford NC 27330 Chris@camerontesting-corn

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

An updated accounting of the land application site's cumulative ✓
pollutant loading rates(CPLRs)
Required Item Status Code
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly ✓ f f
indicate the location of the land application site and in accordance with
the soil map requirements in the"Soil Scientist Evaluation Policy"
Acknowledgement of field transfer from Land Owner (Fields may not ✓
be permitted to multiple Permittees over the same time period)
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit(five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil-mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided,it must be determined accordingly:
® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
® New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching(ADD) • Digital or Raw Photo Extraction(EXT)
• Aerial Photography with Ground Control(AER) • Geodetic Quality GPS Survey(GEO)
• Cadastral Survey(SUR) • LORAN-C Navigation Device(LOR)
• Conversion from Coordinate Plane(CP) • Navigation Quality GPS(GPS)
• Conversion from Township-Section-Range(TSR) • Remote Sensing(RS)
• Conversion from Universal Trans Mere(UTM) • Zip Code Centroid(ZIP)
• Map Interpretation by Digital or Manual Extraction(MAP)
C. Waterbody and Classifications Information: (new sites only)
® Use an 8,5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number,the identified location,and be of clear and reproducible quality.
• Surface water body classifications information may be found at: http://deq.nc.gov/about/divisions/water-
resources/planning/classification-standards/classifications
▪Any questions concerning the waterbody and its classification,please contact the Division's regional offices.
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq.nc.gov/contact/regional-offices
® General Instructions: 'There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
I. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table I: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications.
® Stream Classification Process: One of the options below maybe used depending on the known initial project information.
® KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
I.Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

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

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a.

State of North Carolina
4 r` i Department of Environmental Quality
• '�`
O" Division of Water Resources
Division of Water Resources15A 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):
Ki 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.
[Xj Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
2 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: ,\ o -4f LC(O
hereinafter referred to as the Permittee, to land apply residuals front the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Lease Land Use or Residuals Source Special note
Site/Field ID (yes/no) Cropping Patterns Intended Use of Crops (optional) (no-till/over-seed/
pasture)
N -8L 03~ I N Qbw ciirf AEA kCP.,)
L-13L,03- 3 N} eww Crop
W w cipe
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives,in consideration,the use of the land application site(s)described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification,given 30 calendar days in advance,modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

1. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s)specified by this Agreement.
2. 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).
1.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 ieachate,surface water,groundwater,or soil samples during the
term of,and 12 months after termination of,this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s)during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s)for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops,feed crops,and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY:(please check one)
15A NCAC 02L.0107(d)prohibits water supply wells within the compliance boundary.However,15A NCAC 02T.0105(h)allows the compliance
boundary to be placed closer to the waste disposal area,such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly-established compliance boundary.Please mark one of the following;
D 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)
r4rA re-defined compliance boundary is not needed for this site.
IV.ACKNOWLEDGEMENT OF FIELD TRANSFER:(if needed)
❑ The land application field(s)ID: , is currently permitted under another
residuals land application program;Permit Number WQ: . The land owner hereby acknowledge that by signing this
agreement,he/she is requesting that the field(s)be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above-referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s)on behalf of other deeded landowners OR that I am otherwise authorized,through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above-referenced land application site(s)are not included in any waste disposal contract or
agreement with another municipality,contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations,restrictions, alternatives for water supply wells inside the compliance boundary,acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: I UMV% dr 'Bladenboro
Address: Ili ! - Ve v S4
A.d
City: D! y\bovo State: AZ Zip: 0223 o_O
Phone: ld " g&3—36 5S E-mail address: 6�O ratca.Ca_b_I e c_.. rr. corv. -
Signature: Date: ( ' 44,o' o7 Q
NORTH CAROLINA,_ (kien COUNTY
I,the undersigned Notary Public do hereby certify that Op jA.•s. L-OLI r 9
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the Ot„.wve. S on
day of Feh '[AA.. I/ i Jr +h ,20 2.Z — —
Signature and seal: [(
My commission expires: 2 3 p .(p
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State:_ Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: �ci)t 44307 ,11 . .7
Signature: Date: 1 4. 4,
FORM: LOA 06-16 Page 3 of 3

0) VICINITY MAP
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r - I NC 131 1—_ r-til_
1 inch = 4,000 feet
NC-BL-03 feet
0 1,300 2,600 5,200 7,800 10,400
Fields 1-4
All locations are approximate.

APPLICATION MAP
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LEGEND The compliance boundary is established at
either 250 feet from the residuals application
JAPPLICATION AREA PROPERTY LINE
area or 50 feet within the property boundary,
—------ STREAM /,// UNSUITABLE AREA
whichever is closest to the application area.
•—•—• DRAIN • OFFSITE HOUSE
The review boundary is established midway
PUBLIC ROAD • MONITORING WELL
between the compliance boundary and the
PRIVATE ROAD O SOIL DESCRIPTION
perimeter of the residuals application area.
1 inch = 660 feet All locations are approximate.
Feet NC-BL-03
0 .5 430 860 1,290 1,720
Fields 1-4

0 TOPOGRAPHIC MAP
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0 215 430 860 1,290 1,720
Fields 1-4
All locations are approximate.

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, _. . -..# '.,4 :! 2`- . , . . . ., .a , .,:•1 1
. i, .., .
. J 1 . y
ir DuA
•
. e... � .
Dr1 y 4. llo
J F 044-iits r
f 1111 i r
�1 \:. , / .1 •
�)A 11. �' K' rig
RaA tiji,
ii
N C-BL-03 1 inch = 660 feet
Fields 1-4 U 215 130 800 1,290 1,720
All locations are approximate.