WQ0031725_Application_20160224

FEB 12 4 2016
MRSECTiON
,WbRMXT,j%,pROGESS,ING UNT
BAXTER HEALTHCARE
CORPORATION RECEr:-:
FEB 2 5 2016
Non -Discharge
Permitting Unit
PERMIT RENEWAL
LAND APPLICATION OF
RESIDUAL SOILDS
PERMIT No. WQ0031725

RECEIVED
Division of Water Resourceli
Gyp 4
AR NON
State of North Carolina
Department of Environmental Quality
Division of Water Resources
TER QUALITY REGIONAL OPERATIONS SECTION
CHARGE APPLICATION REVIEW REQUEST FORM
Water Ounlity Regional operations '
Asheville RegionahR ali_L16
To:R®"' `Q'R®S-Landon avrdso
From: Troy Doby, Water Quality Permitting Section - Non -Discharge Permitting Unit
Permit Number: WQ0031725
Applicant: Baxter Healthcare Corporation
Owner Type: Organization
Facility Name: North Cove Steam Generation Plant
Signature Authority: Michael J. Pisarik
Address: Post Office Box 1390, Marion, North Carolina 28752
Fee Category: Non -Discharge Minor
Comments/Other Information:
Permit Type: Land Application of Residual Solids (503)
Project Type: Renewal
Owner in BIMS? Yes
Facility in BIMS? Yes
Title: Senior Environmental Engineer
County: McDowell
Fee Amount: $0
Attached, you will find all information submitted in support of the above -referenced application for your review,
comment, and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed.
❑ Attach an Attachment B for Certification
® Return a completed staff report. -
❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet; and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-MIQROS Reviewer: iL.l - Date:
FORM: WQROSN DARR 09-15 Page 1 of

F
Z' 4
,� r
.r c�
Wa ter Resources
ENVIRONMENTAL QUALITY
March 11, 2016
MICHAEL J.-PISARIK — SENIOR ENVIRONMENTAL ENGINEER
BARTER HEALTHCARE CORPORATION
POST OFFICE BOX 1390
MARION, NORTH CAROLINA 28752
Dear Mr. Pisarik:
PAT MCCRORY
DONALD R. VAN DER VAART
Sec•reiary
S. JAY ZIMMERMAN
Direclor
Subject: Acknowledgement of
Application No. WQ0031725
North Cove Steam Generation Plant
Residuals Management System
McDowell County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on March 9, 2016. Your application package has been assigned the
number listed above, and the primary reviewer is Troy Doby.
Central and Regional Office staff will perform a detailedreview of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Troy Doby at [phone] or [e-mail].
Sincerely,
�-6-
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: shevilile egonaL+(��ffce; Water„ a11teglod]Opeiratis�isSectaori3
Permit File WQ0031725
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919 807 6464
s `s' ;��
x , 0<.

S Southern
S Soil
B I Builders, Inc.
N
Friday, February 12, 2016
958 Hoots Road Roaring River, NC 28669
[phone] Fax [phone]
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: Permit Renewal for Baxter Healthcare Corporation
Land Application Permit No. WQ0037125
[Watter
CEIVED
f Water Resources
14 2016,
y Regional Operations
e Regional Office
Baxter Healthcare Corporation is applying for a renewal to its current land application permit
WQ0037125.
There no changes in this permit renewal package since the last issuance, except for changes in
acreage of fields, due to updated maps and buffers.
Your attention to this permit application package is greatly appreciated. If you have any
questions or concerns, please feel free to contact me at 336-957-7871 or at
[e-mail]
Sincerely,
ach Key
Southern Soil Builders, Inc.

R
State of North Carolina
, , �' Department o� Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND (APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 11-15 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are su mitted. Adherence to these
instructio s and checking the provided boxes will help produce a quicker review, time and rediice the amount of additional
informati n requested. Failure to submit all of the required items will lead to additional proce$sing and review time for the
permit ap lication. Unless otherwise noted, the Applicant shall submit one original and two conies of the annliratinn and
For more information, visit the Water Quality Permitting
Section's Non -Discharge Permitting Unit website at:
httP: of tril. nedenr. org/iveblhxLlaps/laic
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are general ed from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
1SA T10Aill 111)'r Iron
Unless oth rwise noted, the Applicant shall submit one original and two copies of the application andsupporting documentation listed
below.
A. Resid als Land Application Program (FORM: RLAP 11-15) Application: (All Application Packages):
❑ S bmit the completed and appropriately executed Residuals Land Application Program (FOR RLAP 11-15) form. Please
d not make any unauthorized content changes to this form. If necessary for clarity or due to ispace 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
re er. I
❑ T e Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A, NCAC 02T .0106(b). An
al ernate person may be designated as the signing official if a delegation letter is provided from a person who meets the
criIteria in 15A NCAC 02T .0106(b).
ElIf' his project is for a modification of an existing permit, submit one copy of the lexisting permi �.
❑ Phase submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
o eration of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina department of Environmental
Qoality (NCDEQ).
` - An
adds a
one pr
not pre
C. Cover
❑ Li
D. Envirc
❑ Su
Facility Classification New Permit Mai
✓lajor (land are permitted for > 300 acres) $1 310
dinor (land are permitted for < 300 acres) $810
3jor modification shall be defined as any permit modification that: increases the generating fa
ditional land application areas not previously approved for that particular program [includiri
gram to another]; adds additional residuals sources; or includes the addition of new treat
+iously permitted. There is no fee for minor modifications to a permit.
,etter (All Application Packages)
t all items included in the application package, as well as a brief description of the requested
imental Assessments (May be Required — See 15A NCAC I C .0300)
)mit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Si
>rmation on any mitigating factor(s) from the Environmental Assessment (EA) that im
duals treatment and storage facilities. An EA may also be required for private systems if
used for the construction of the subject facilities.
or Modification 1
$395
$245
i
lity's residuals dry tonnage;
transferring of field(s) from
it or storage units/processes
action.
cent (EIS). Also, include
t the construction of the
public funds and/or lands
INSTRUC' IONS FOR FORM: RLAP 11-15 Pagel of 3

E. Opera tion and Maintenance Plan (New and Renewal Application Packages)
❑ F Modification Application, if there are any changes to the existing plan, submit an updated �&M plan.
El Strait .the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
THE FO
F. Prog
❑ 1
L Operational functions; describe the operation of the program to show what operations ar� 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.
J Safety measures; may include safety training program, manuals, signs, etc.
Spill response plan; including control, containment, remediation, emergency contact infc
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,
selected location(s) and inspection frequency are representative of the residuals manager
Detailed description of inspection procedures including record keeping and actions to
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.
etc,
procedures to assure that the
program.
taken by the inspector in the
Sampling frequency and procedures to assure that representative samples are being colleet4 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.
WING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR
Determination
ONLY.
residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
Specifically, a residuals land application program is designated as dedicated I if any of the following are
L Any land application site certified for the residuals land application program that receives rsiduals at rates or frequencies
greater than agronomic rates.
El 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.
❑ P11 lase contact the Non -Discharge Peimitting Unit if you need any assistance in'determining w ether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Pr vide an explanation of why a dedicated system is required instead of a conventional non-ded cated system.
❑ Pr vide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Su mit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic fo at is acceptable - Adobe PDF
on y). For Modifications, submit plans specific to the modification(s) only.
❑ Ph ns must include the following minimum items: ll
A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s). j
❑ 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 11-15 Page 2 of 3

I. Proje t 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 rec4mendations concerning cover
c ps and their ability to accept the proposed application rates.
J. Hydr geologic Report (All New Application Packages or Modifications involving increasing the dotal design capacity)
-- ❑ Submit a detailed hydrogeologic evaluation in accordance with 15A 1yCAC 02T A I04(dd)( and current Division Policy
a ailable at: htttw.//portal.ncderu.org/web/wa/aps/lau/policies. The document shall be signed, Sealed and dated by a qualified
K.
❑�
0
L. Water
irrigati
❑ Su
av
M. Propei
or irrig
❑ Pr,
wring Design Documents (All New or ,Modification Application Packages with fixed i
-s fed through fixed supply system)
bmit engineering design documents that have been signed, sealed, and dated by a NC
Nor Professional Land Surveyor in accordance with 15A NCAC 021' .1.104(d)(2). For Mc
e map specific to the modification(s) only.
.e design documents must include the following minimum items:
Engineering plans for the facility and equipment except those previously permitted unless
new units or are critical to the understanding of the complete process;
Specifications describing materials to be used, method of construction, and means for ensue
finished product including leaking testing;, and
Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydrar:
curve analysis for each pump, and irrigation design.
Soil mapping units shown on all disposal sites.
Balance (All New Application Packages or Modifications that include new sites utilizit
)n facilities fed through fixed supply systems)
)mit a completed and accurate water balance in accordance with 15A NCAC 021' .1104(d)(
dlableat: http.//poilal.ncdenr.org/weL/wq/aps/eau/policies.
ty Ownership Documentation (All New or Modification Application Packages involving I
rtion components)
iperty 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 i
An easement running with the land specifically indicating the intended use of the property
of 15A NCAC 02L .0107(�, or
A written notarized lease agreement signed by both parties, indicating the intended use of th
survey map.
facilities or irrigation
Professional Engineer
,ns, submit an updated
they are directly tied into the
quality and integrity of the
profile, total dynamic head
fixed irrigation facilities or
and current Division Policy
and/or relocated treatment
or
meeting the requirements
property, as well as a plat or
ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKA% INCLUDING ALL
'PORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLL 1 WING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By Postal Service:
1617 MAIL SERVICE CENTER
IGH, NORTH CAROLINA 27699-1617
NUMBER: [phone]
512 N. SALISBURY STREET
RALEIGH, NORTH C�ROLINA 27604
FAX NUMBER:
49) 807-6496
FOR FORM: RLAP 11-15 1 Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 11-15
I. APPLICANT INFORMATION:
I. Applicant's name: Baxter Healthcare Corporation
Applicant type: ❑ Individual Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
i
Signature authority's name per 15A NCAC 02T .0106: Micheal J Pisarik Title: Sr. Environmental Engine
Applicant's mailing address: PO Box 1390
City: Marion State: NC Zip: 28752
Telephone number: (n8j 756-6QYI Email Address: Michael [e-mail]
2. Consultant's name: Zach Key_ License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: Southern Soil Builders Inc )
Consultant's mailing address: 958 Hoots Road
City: Roarm River State• NC Z' 28669
_ rp.
T lephone number: 336) 957-7871
Email Address: zachkeyasouthernsoilbuilders com
3. Agronomist's name:
License Number:
Affiliation: ❑ N/A ❑ On Staff
❑ Retained (Firm: )
Agronomist's mailing address:
City: State: _
Zip: -
Telephone number: (� _-
Email Address:
4. So il Scientist's name: Karl Shaffer
License Number: 1009
Affiliation: ❑ N/A ❑ On Staff
® Retained (Firm: Shaffer Soil Services)
S iil Scientist's mailing address: 685 Sanford Road
City: Pittsboro State: NC
Zip: 27312
Telephone number: 219 542-5803 Email Address:
5. Fe submitted: $0.00 (See Instruction B)
11. PERMfIT INFORMATION:
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: WQ0031725
of most -recently issued permit: 9-18-2007
of most -recently certified Attachment A (if different than the permit): 4-21-2011
of most -recently certified Attachment B (if different than the permit): 4-21-2011
FORM: RLAP 11-15
Page I of 5

III. RESIQUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 65 Pitts Station Road
City: Marion State: NC Zip: 28152
Coordinates: Latitude: 35° 50' 17.80" Longitude: 81' 59' 54.75"
DI tum: NAD83 Level of accuracy: .01
+hod of measurement: MAP
2. County where residuals land application program is headquartered: McDowell
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Dennis Key
Southern Soil Builders, Inc.
15704
Back -Up ORC
Zach Key
Southern Soil Builders, Inc.
27660
Additional Back -Up
ORCs
j (if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for thisi 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. �_lant Available Nitrozen :Vummary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
§ource-generating facilities as currently certified and proposed for certification with this application and list the results in
�he following table:
Maximum amount of residuals to be certified: 200 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Lijection
Surface
Incorporation
or Injection
First -Year
I
51.244
61.444
10248.8
12288.8
Five -Year Maximum Adjusted
55.10
66.06
11020.2
13213.76
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for certification with this application:
I Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
6.7
Hay
8.7
Pasture
54.2
Total:
69.6
Methods
Surface
62.9
Incorporation or Injection
6.7
Total:
69.6
FORM: RLAP 11-15 Page 2 of 5

c. Residuals Land Applicagn Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
bs PAN/ac-vr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
204.9
245.7
220.4
264.2
100
102.4
122.8
110.2
132.1
150
68.3
81.9
73.4
88.0
200
51.2
61.4
55.1
66.0
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land vector
g
reduction practices not in place, etc.):
7. S ei cify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If gdicated, 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;
i
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. LANDi 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 Sine
Certification. doc
FORM: RLAP 11-15 Page 3 of 5

Note Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. T�e irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Mfilimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation:
feet below ground surface. Rules 1.5A NCAC 02T .0505(p� requires at least one -foot vertical separation between SHWT and
ground surface.
4. A} e there any artificial drainage or water movement structures within 200 feet of any irrigation area?
[II] 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/ r
I
i
i
i
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 1 SA 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
ftzles
=Nmberof
Maximum Applicatio=Dgn
Rate (gallons/hr)ons/
al Loading
r
I
I
I
I
i
i
Total
�k,;!',k
{F 1{
Spray Irrigation Design Element
etetted diamer of nozzles
Plan Sheet
uer
Specification
aimNmhPa Number
$
Wetted area of nozzles
ftz
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
I
FORM: RLAP 11-15
I
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 fagility 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;
(Signature Authority's Name — PLEASE PRINT)
attest that this application for
(Facility Name)
(Title)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water
Resources may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes
unless specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.613, any person who knowingl},l makes any
false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may i clude a fine
rr not to exceed $10,000 as well: as civil penalties up to $25,000 per violation.
M
Signature:�� Da
te:
i
FORM: RLAP 11-15

Operation and Maintenance Plan
Baxter Healthcare; Corporation
Permit No. WQ0031725
i
In accordance to the requirements set forth by the North Carolina
Department of Environmental and Natural Resources using
NCGS 143-215.1 and 143-215.3(a) based on 15A NCAC 02T .110, i outhern
Soil Builders, Inc. and Baxter Healthcare are implementing this Operation
and Maintenance !Plan.
The project manager of the land application event will make sure a daily
check off is performed at the start of each work day. This inspection is to
prevent any spills, leaks, or run-offs. a
The daily check -off will consist of inspection the following items:
i
1. Access to; the facility will be controlled with a locked gate and
signs to prevent any unauthorized entry into the comple'
2. All pumps and hose, will be checked at the start of each day for
leaks or loose fittings.
3. All tanker valves are closed prior to loading and lids are closed
prior to transport.
4. All dump trailers or dump trucks gates are tightly fastened and
do not leak prior to transport. i
5. All on road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
I
6. All equipment is secured at the end of each working day to
prevent any tampering or unauthorized use.
The ORC or back up ORC will inspect the field after each land ap lication
event to make sure all regulations as required by the permit are fo�lowed.
Also the project manager at the end of each working day during a land
application event will make sure that all gates if present are closed.
All samples shall be taken as early as possible before the first application
event of the calendar year to make sure the facility is compliance!
I

The samples will be taken in a matter that is representative of the residuals
and all grab samples will be mixed prior to be placed in to the containers
that will go to the,laboratory. These samples must be collected alnd
transported as outlined in the Sampling Plan attached to this O& Plan.
All records of these laboratory results as well as the annual report and
loading rates will be kept on file for a minimum of five (5) years.
Also, in the unlikely event of a spill or unintended release of residuals,
actions should be immediately taken as outlined in a copyof the
spill control plan attached.
i

Baxter Healthcare Corporation
Permit No. WQ0031725
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the aerobic
digesters and the belt press. These samples will be combined to form individual grab sa i pies to be sE
to a laboratory for analysis. If a land application event is to occur in the early part of a calendar year (i
January or early February) these samples may have to be taken in December so results Can be obtainE
before the land application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform analysis, volatile soli,
reduction, nutrient analysis, and a TCLP test. These tests will be taken by Southern Soil Builders, Inc. P
samples with the exception of: the composite residual sample will be taken to Statesville Analytical. Tl-
composite residual sample will be sent to Waypoint Analytical. All samples taken will be taken in the
same condition as the residuals are to be land applied.
The volatile solids reduction requirement will first be attempted by using option !I [503.33(b)
(1)]; Reduction of volatile solids by at least 38%. The "IN" sample will be taken from the residuals
pumped from the clarifiers and the "OUT" sample from aerobic digester No. 1. If this requirement car
be met, a gallon of residuals will be sampled from the aerobic digester and analyzed for option 3
503.33(b) (3); known as a 30 day bench scale. This test requires less than 15% additional �olatile solid;
reduction during bench -scale aerobic batch digestion for 30 days.
Fecal Coliform are gather in seven (7) individual samples from the aerobic digester and tested
meet the requirements of [503.32(b)(2)]. This requirement is for the geometric mean fec�l coliform
density of the samples be less than two million (2,000,000) MPN per gram. These samples will be place
in 250ml containers and placed on ice, in a cooler for transport to the laboratory before 1600 hours
(4pm) the same day the samples are obtained.
Annually, if land application occurs, a composite residual sample will be collectedi from the be
press and analyzed, prior to a land application event for: Cadmium, Copper, Lead, Mercury,
Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nit .Iogen,
Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information, the Plant
Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sample will
collected in a non -breakable container, at least one quart in size.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in tv io (2) gallon
containers from the aerobic digester. This test will be run annually, unless prior approval i''s granted froi
the division to reduce this requirement to once per permit cycle.
I
I
I
I
I
i

SPILL CONTROL PLAN- Southern Soil Builders, Inc.
Baxter Healthcare Corporation Permit No WQ0031725
In the event of a spill, the following should be taken IMMEDITALY.
i
I
1. Make sure all personal and bystanders are safe- if not contact eme gency
services
2. Halt the source of the spill- overturned truck, leaking valve, rupturec tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain th
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as mucl
of the spilled material as possible. Use straw to soak -up the remaining material.
Dispose of the same in a landfill.
5. Flush the roadways with water if needed. If the spill occurred on a tillable area,
the same into the soil and spread lime if necessary. If a spill occurs on private
property, final clean-up should be to the satisfaction of the owner.
6. Notification. (This should be done as soon as safely possible.)
A. Southern Soil Builders, Inc. Main Office [phone]
B. Baxter Healthcare [phone]

C. NCDEQ-Asheville Regional Office- [phone]
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting:
The Permittee shall report by telephone to the Asheville Regional Offfice,
telephone number [phone], as soon as possible, but in no case more fhc n
24 hours or on the next working day following the occurrence or firs knowledg
of the occurrence of any of the following:
I
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any failure of the surface disposal program resulting in a rele se of
material to surface waters.
C. Any time self -monitoring indicates the facility has gone out of complian e
with its permit limitations.
D. Any process unit failure, due to known or unknown reasons, r' ndering the
facility incapable of adequate residual treatment
E. Any spill or discharge from a vehicle or piping system during residuals
transportation.
Any emergency requiring immediate reporting
p g (e.g., discharges to surface
waters, imminent failure of a storage structure, etc.) outside of normi I business
hours shall be reported to the Division's Emergency Response personnel at
telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter
form within five days following first knowledge of the occurrence. Thi report sh(
outline the actions taken or proposed to be taken to ensure that the problem
does not recur.
8. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed
C. Inspect all seals and replace if necessary.

State of North Carolina
D'I"Ww"R
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERT>FICATION
INSTRUCTIONS FOR FORM: RSC I1-15
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adhere ice to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount o� 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 website at.
htttLL1)2rtal. ncdenr. org/iveb/tivct/aj &Lu.
General — This certificationi provides detailed information of residuals source generating facility and its residuals qua, 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):
i
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attach ents 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 fac:il
❑ Vicinity map - A
❑ Process flow dia;
are to be generate
❑ Quantitative just
Ensure that the a
the permit. In a
and/or disposed,
processing.
❑ Sampling plan -
sampling points,
ensure that the p]
vector attraction
they are to be Ian
C. Residuals Quality Infor
❑ For each source facil
❑ Laboratory analy
❑ Documentation t]
attraction reductic
❑ For new facility
attach analytical i
facilities.
, attach the following:
map that shows the location of the facility and meets all of the criteria in the
-am and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
1, treated, processed, and stored at the facility,
ication for residuals production rate - A quantitative justification for the value provided Item 1. 8.
count of residuals listed is the maximum amount expected to be generated by the facility for the life of
dition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
including any chemicals, amendments, or other additives that are added to the reside als during
k detailed sampling plan for the residuals source -generating facility. Ensure that the p]
ampling frequency, sample type, as well as the Division -certified laboratory to be used.
a details how the facility and/or the residuals are monitored for any applicable pathogen n
:duction requirements. Note that all sampling and monitoring must be completed on the
applied, distributed, and/or disposed.
attach the following:
al reports and operational data - reports for all laboratory analyses used to complete this
t the facility complies and/or the residuals comply with any applicable pathogen reduc
requirements.
at may have not yet been constructed and analytical results of residuals cannot be o
ults of residuals generated from a similar facility along with the description of similar:
i
INSTRUCTIONS FORFO : RSC 11-15
Page 1 of 1
identifies
addition,
ction and
siduals as
and vector
led, please
of the two

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Baxter Healthcare Corporation
Status Facility Permit l• ., Maximum Dry Tons Per Year
Code a y - ran:. Helder Facility Name %-ounty Permit Number
Current' Proposed
R Baxter Healthcare Baxter Healthcare
Co _ ora ' McDowell NC0006564 200 200
I_ - I_ _rp . , thou -�--Corporation --- -I— -- — ----- - ---- - -------- -
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
the- mount-of-residuals-currently-per-n tted-for-distribution,-land-application,-or disposal-(i:e, not applizagbt& Co new faciIit� . -- - -
SUMMARY FOR FORM: RSC 11-15
Page 1

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 11-15
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Baxter Healthcare Corporation
2. Facility permit holder is: ❑ Federal, ❑ State, ❑ 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: Stephen Taylor
Complete mailing address: PO Box 1390
City: Marion State: NC Zip: 28752
Telephone number: [phone] E-mail address: Stephen d—[e-mail]
4. Facility physical address: 65 Pitts Station
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 350 50' 17.80" Longitude: 81° 59' 54.75"
Datum: NAD83 Level of accuracy:.01
Method of measurement: MAP
5. Purpose of the facility:
❑ treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approxhmtelpercentages: 81 % industrial and 19 % domestic)
❑ other (explain: ).
6. Does the facility 1 ave an approved pretreatment program: 0 Yes ❑ No
7. Facility permitted/design flow:12 MGD and facility average daily flow: 0_8 MGD
8. Average amount of residuals being generated at this facility 116.37 dry tons per year.
9. Specify the follov ing regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 2 digesters-307,000 gallon
Type and volume iof residuals storage (i.e., outside of residuals treatment units): 3 sludge dreg beds
I
U. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 OFR 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. I t02(6) as:
Biological ❑ Non -Biological
Note: Biological �esiduals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 11-15 Pagel of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes no.
i
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP)� analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: 1-7-15
Passed corrosivity test: Z yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: E yes ❑ no. Flashpoint: 200 °F (> 140T)
Passed reactivity test: ® yes ❑no. HCN: ND mg/kg (<250) & HZS: ND mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(yng/l)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
!ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
IND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon 'retrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorolenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
6.042
Chromium
5.0
ND
Nitrobenzene
2.0
AND
m-Cresol
o-Crlesol
200.0
200.0
0.536
ND
Pentachlorophenol
Pyridine
100.0
5.0
AND
IND
p-Cresol
200.0
0.536
Selenium
1.0
iND
Cresol
2,41
D
200.0
10.0
0.536
ND
Silver
Tetrachloroethylene
5.0TD
0.7
�D
1,4-Dichlo�obenzene
7.5
ND
Toxaphene
0.5
tV1J
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
�D
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
I
2,4-Dimotoluene
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
i
FORM: RSC 11-15
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 idry weight
basis) for the following metal parameters:
Laboratory: A&L Eastern Labs and Date of analysis: 4-13-15
Parameter
Ceiling
Concentration Limits
(ClassA & ClaSsB)
(mg1kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
12
Cadmium
85
39
2
Copper
4,300
1,500
144
Lead
840
300
15
Mercury
57
17
0.4
Molybdenum
75
n/a
6
Nickel
420
420
37
Selenium
100
100
5
Zinc
7,500
2,800
222
b. For Surface Disposal Unit (lm:drill): Fill in the following table with the results of the latest analyses (i.e., on a weight
basis) for the following metal parameters:
Laboratory:: _ and Date of analysis: _
Distance from Disposal
Unit to Boundary to
Closest Properlty Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
El > 0 but < 25
30
200
210
> 25 but < 50
34
220
240
0 > 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
i
FORM: RSC 11-15 ]'sage 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 11.52 %.
i
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: A&L Eastern Labs and Date of analysis: 4-13-15
Parameter
Result
(mg/k9)
Aluminum
1900
Ammonia -Nitrogen
10200
Calcium
11100
Magnesium
108
Nitrate -Nitrite Nitrogen
2
pH (Standard Unit)
6.94
Phosphorus
18000
Potassium
4490
Sodium
4240
Total Kjeldahl Nitrogen
78600
c. Using the results listed in ;Item II. 5b. above, calculate the sodium adsorption ration (
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local
Extension Office, the Department; of Agriculture and Consumer Services, the Natural Resource Conservati(
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommer
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals:
rate is a (check one): ® default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or prov
justification as to why the selected default value is appropriate to be applied to these residuals: defaull
di estion
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 (lst) Year PAN
Five -Year
(mg�k�
Maximum Adjusted PAN
(mg1kg)
Surface
25622
27550.53
Injection/Incorporation
30722
33034.4
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals
the results of the latest analyses:
FORM: RSC 11-15
R): 2.89
)operative
Service, a
tions shall
integrity
) %. This
technical
provide
Page 4 of 5

i
Pathogen Reduction: Per 15A NCAC 02T.:1106, specify how residuals will meet the pathogen reduction requirements:
a. For DistributionlLand 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.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T. 1 106(b)(3)(D)] - No Prior Testing for Enteric; Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ tbermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
1Z Alternative 1 [15A NCAC 02T.1106(c)(1)] -Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item H. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item H. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item H.B. below [15A NCAC 02T.1106(a)(2)]
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requireents:
Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion). j
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T. 11 07(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T. 1 107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(b)(2)]. I
❑ 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 11-15 ijage 5 of 5

Vicinity Map

Baxter Health Google Maps
https://www.google.com/maps/place/Baxter+Healthcare/@35.83417:- >.0036696,15z/dat...
,Google Maps Baxter Healthcare
Map data ©2016 Google 1000 ft
1 of 1 2/12/2016 12:05 AM

BAXTER NORTHCOVE WASTEWATER TREATMENT PLANT PROCESS
NARRATIVE
The wastewater treatment plant was originally designed to treat a capacity of
600,000 gallons per day. In 1973, due to increased production levels, the wastewater
plants' capacity was doubled to its current 1.2 MOD capacity. Other improvements,
such as the ultraviolet disinfection system, filter press, and solution dump system,.
were made throughout the 1970's, 1980's, and 1990's.
Currently, the existing wastewater treatment plant is permitted at 1.2 MOD
capacity. Wastewater is pumped from the manufacturing plant on the east side of the
North Fork Catawba River to the wastewater plant on the west side of the river by the
influent pumping station. Preliminary physical treatment of the wastewater consists of
three static fine screens for the removal of'any solid materials received at the plant,
such as pieces of plastic IV and PD solution bags, paper or plastic products, cafeteria
scraps, or other large no objects. Each screen is rated at 450 gallons per
minute capacity, for a total capacity of 1350 gallons per minute. The solid materials
are collected in a trough and removed by the operators into a dumpster for ultimate
disposal at the landfill.
I. The influent wastewater flows through the static screens and falls into a flow
equalization basin with a capacity of 1,324,000 gallons. At this point, a minimal
amount of air and mixing energy is added by high speed floating surface aerators to
prevent any solids from settling in the basin.
From the flow equalization basin, the influent is pumped to a flow splitter box
that divides flow between the two (2) aeration basins. The aeration basins are
equipped with eight (8) low speed fixed mechanical aerators, four (4) in each basin.
Total design retention time in the aeration basins is approximately 18 hours.
Nutrients, in the form of granular fertilizer (18-46-0), are also added at this point to
provide the necessary levels of nitrogen and potassium for proper biological activity.
Hydrated lime is also added to maintain the proper wastewater alkalinity levels, as
well as provide some carbon source for the biological process. Both of the additions
are made by hand and require monitoring by plant staff to maintain appropriate levels
for biological growth.
The aeration process is followed.by clarification in four (4) center -feed, suction
header type sludge draw off secondary clarifiers. There are two (2) 32.5-foot
diameter, 8-foot side water depth units rated at 300,000 gallons each, and two (2)
42.5-foot diameter, 10-foot side water depth units rated at 600,000 gallons per day
each, for a total clarification capacity of 1.8 MOD. While modern clarification
equipment is normally designed with deeper side water depths than those found in the
existing clarifiers (normally no less than 12 feet), the existing clarifier performance
has been historically adequate.

Solids captured by the secondary clarifiers are then collected and subsequently
treated in two (2) aerobic digesters with a total volume of approximately 307,000
gallons. Class "B" biosolids are generated by the digestion process, which are then
dewatered by a 2.0 meter belt filter press and disposed of by Foothills Environmental,
Inc, in Lenoir, NC.
The Baxter Wastewater Treatment Facility is.also equipped with three (3) tertiary
upflow sand filters; each rated at 425 gpm each, as a final polishing step prior to
disinfection and discharge. Effluent from the secondary clarifiers and autoclave
cooling water excess is mixed together in a holding pond and applied to the filters, as
well as used to provide water for filter backwash operations.
Disinfection is accomplished with two (2) ultraviolet (UV) disinfection units.
These units destroy bacteria in the effluent by exposure to ultraviolet radiation instead
of oxidation by addition of free chlorine ions (chlorination). This creates a less toxic
discharge into the receiving stream and eliminates the need to monitor chlorine
residual in the effluent. Because the receiving stream is classified as designated trout
waters, the facility does have very stringent chlorine limits. A process diagram of the
wastewater treatment facility is included.

Quanfi6tive Justification for Residuals Production Rate
In the following five years Baxter healthcare Corporation has produced the following Dry Tons to be
land applied:
2011: 100.26
2012: 143.01
2013: 95.2
2014: 108.5
2015: 100.26
This is a six year average of 109.4 Dry Tons per year, which will allow for any growth or unforeseen
increases in the Waste Water Treatment Plants flow.

Baxter Healthcare Corporation
Permit No. WQ0031725
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the aerobic
digesters and the belt press. These samples will be combined to form individual grab samples to be sent
to a laboratory for analysis. If a land application event is to occur in the early part of a calendar year (i.e.
January or early February) these samples may have to be taken in December so results can be obtained
before the land application event, as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform analysis, volatile solids
reduction, nutrient analysis, and a TCLP test. These tests will be taken by Southern Soil Builders, Inc. All
samples with the exception of the composite residual sample will be taken to Statesville Analytical. The
composite residual sample will be sent to Waypoint Analytical. All samples taken will be taken in the
same condition as the residuals are to be land applied.
The volatile solids reduction requirement will first be attempted by using option 1 [503.33(b)
(1)1; Reduction of volatile solids by at least 38%. The "IN" sample will be taken from the residuals
pumped from the clarifiers and the "OUT" sample from aerobic digester No. 1. If this requirement can't
be met, a gallon of residuals will be sampled from the aerobic digester and analyzed for option 3
503.33(b) (3); known as a 30 day bench scale. This test requires less than 15% additional volatile solids
reduction during bench -scale aerobic batch digestion for 30 days.
Fecal Coliform are gather in seven (7) individual samples from the aerobic digester and tested to
meet the requirements of [503.32(b)(2)]. This requirement is for the geometric mean fecal coliform
density of the samples be less than two million (2,000,000) MPN per gram. These samples will be placed
in 250ml containers and placed on ice, in a cooler for transport to the laboratory before 1600 hours
(4pm) the same day the samples are obtained.
Annually, if land application occurs, a composite residual sample will be collected from the belt
press and analyzed, prior to a land application event for: Cadmium, Copper, Lead, Mercury,
Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nitrogen,
Magnesium, %total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information, the Plant
Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sample will
collected in a non -breakable container, at least one quart in size.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the aerobic digester. This test will be run annually, unless prior approval is granted from
the division to reduce this requirement to once per permit cycle.

Page: 1 of 2
Report Number: 15-106-0213
Account Number: 46381
Send To: SOUTHERN SOIL BUILDERS
DENNIS KEY
958 HOOTS ROAD
ROARING RIVER, NC 28669
Lab Number: 61423
Sample Id: BAXTER
9�x A&L Eastern Laboratories, Inc.
�� 7621 Whitepine Road Richmond, Virginia 23237 [phone] Fax [phone]
www,aleastem.com
Proiect : BAXTER
REPORT OF AAOALYSIS
Date Sampled: 4/13/2015 13:35:00
Date Received: 04/16/2015 00:00
Date Reported: 04/21/2015
Total Solids *
11.52
115200
100.0
JM
04/16/2015 16:00
SM-2540G
Moisture'`
88.48
100.0
JM
04/16/201516:00
SM-2540G
Total Kjeldahl Nitrogen
7.86
78600
10.0
JM
04/17/2015 09:24
SM-4500-NH3C-TKN
Total Phosphorus
1.80
18000
100
KM
04/17/2015 00:00
SW 6010C
Total Potassium
0.45
4490
100
KM
04/17/2015 00:00
SW 6010C
Total Sulfur
1.20
12000
100
KM
04/17/2015 00:00
SW 6010C
Total Calcium
1.11
11100
100
KM
04/17/2015 00:00
SW 6010C
Total Magnesium
0.45
4540
100
KM
04/17/2015 00:00
SW 6010C
Total Sodium
0.42
4240
100
KM
04/17/2015 00:00
SW 6010C
Total Iron
9400
100
KM
04/17/2015 00:00
SW 6010C
Total Aluminum
1900
100
KM
04/17/2015 00:00
SW 6010C
Total Manganese
108
5
KM
04/17/2015 00:00
SW 6010C
Total Copper
144
5
KM
04/17/2015 00:00
SW 6010C
Total Zinc
222
5
KM
04/17/2015 00:00
SW 6010C
Ammonia-Nitr6Je
0�720720 f5 07:59
SM-4500-NI3C
Organic N
6.84
68400
10.0
04/17/2015 09:24
CALCULATION
Nitrate+Nitrite-N
<2.00
2.00
JM
04/17/2015 09:25
SM-450ONO3F
Total Cadmium
<2.0
2.0
KM
04/17/2015 00:00
SW 6010C
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
4iOur reports and letters are for the exclusive and confidential use of our clients. and may not be reproduced in whole or part, nor may any reference be n?ade `mg
to the v✓or k, the results. or the company in any advertising, news release, or other public announcements without obtaining our prior written authorization.
Debbie Holt

Page: 2 of 2
Report Number: 15-106-0213�
Account Number: 46381 X
wwwaleastem.com
Send To: SOUTHERN SOIL BUILDERS
DENNIS KEY
958 HOOTS ROAD
ROARING RIVER, NC 28669
A&L Eastern Laboratories, Inc.
7621 Whr epme Road Richmond, Virginia 23237 [phone] Fax [phone]
Project . BAXTER
Lab Number: 61423 REPORT OF ANALYSIS Date Sampled: 4/13/2015 13:35:00
Date Received: 04/16/2015 00:00
Sample Id : BAXTER Date Reported: 04/21/2n1s
Ilu
0
Total Nickel
37
5
Total Lead
15
5
Total Arsenic
12.0
3.0
Total Mercury
<0.4
0.4
Total Selenium
<5.0
5.0
PH (Standard Units) *
6.94
2.00
Total Molybdenum
6
5
Comments:
SULFUR: r:I'D OCRGANIC NI T ROGEN
NOT FOR COMPLIANCE PURPOSES.
QUALIFIER: THE LRB WAS OUT OF
LIMITS FOR "Mn". ALL OTHER QC DATA IS
ACCEPTABLE.
KM
04/17/2015 00:00
SW 6010C
KM
04/17/2015 00:00
SW 6010C
KM
04/17/2015 00:00
SW 6010C
KM
04/17/2015 00:00
SW 6010C
KM
04/20/2015 09:00
SW-7471 B
KM
04/17/2015 00:00
SW 6010C
JM
04/17/2015 09:24
SW-9045D
KM
04/17/2015 00:00
SW 6010C
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Our reports and letters are for the exclusive and confidential use of our clients, and may not be reproduced in whole or part. nor may any reference be .made
to the work. the results. or the company in any advertising. news release, or other public announcements a✓ithout obtaining our prior written authorization.
Debbie Holt

MAW
Mineralization
as decimal
ITotal dry!Acres
tons/year
1
Applied on
1 54.8
Rate
0.3
TKN
78600
NH3
10200
NO3
2
NO2
0
% Solids
0.1152
.134.92
PAN Surface
25622 mglkg 51.244 ibs?dry ton
6913.84 Ibs total PAN
p26J65 1 ibs PANlacre
PAN Injection
3,u 22 mglkg fi r.444 lbsldry ton
8290.024 lbs totai I -AN
151.2773 Ibs PANiacre
Dry Tons/1000 gal. "
0.480384
1st year PAN
lbs./acre
Surface lbs.
Surface
6913.84048
126.1649723
1st year PAN
lbs./acre
iiIje%Yeu IuS.
injected
8290.024 e
151277819
MR(TKN-NH3)+ + .5(NH3)+NO3+NO2 =mg/kg
mg/kg x .002 =ibs/dry ton
MR(TKN-NH3) + l(NH3)+NO3+NO2 =mg/kg
mg/kg x .002 =1bs/dry ton
1000 X 8.34 X %solids X sp. gravity "=dry tons/1000gal."
2000

SAR
Sodium Absorption Ratio
NgN—g/L) Ca(9 /L1 Mg
- Na: Sodium (Mg/L) Equivalent weight: 23
�488.44 1278.72
Ca: Calcium (Mg/L) Equivalent weight: 20
Mg : Magnesium (Mg/L) Equivalent weight: 12
Milli Equivalent = Mg/L / Equivalent weight
SAR= Na Milli Equivalent/[0.5 X (Ca Milli Equivalent +
Mg Milli equivalent)]0.5 power
SAR = 2.896377
(From Ib1g/L entered above.)
523
Na (IUIE�
Ca rM
(IcC (MF
21.23652
63.936
43.58333
I The amour
amount of
Permitting
f
SAR.= 2.895613 (Frorn ME entered below)
Na ME
C. a (ME)M
MEI
21.23
63.93
43.58

Analytical Results
Southern Soil Builders
l58 Hoots Road
Roaring River, NC 28669
Receive Date: 01/07/2015
Reported: 02/03/2015
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method
150107-22-01 % Volatile Solids
Baxter A
150107-22-01 Percent Solids
Baxter A
150107-22-02 % Volatile Solids
Baxter B
150107-22-02 Percent Solids
Baxter B
Respectfully submitted,
" :na Myers
Cert #440,
NCDW Cert #37755,
EPA #NC00909
0.26 % SM2540
0.39 % StV1254OB-1997
0.75 % SM2540G
1.0 % SM2540B-1997
'..
Analyst
01/08/2015 WL
01/08/2015 WL
d1/08/2015 WL
0,1/08/2015 WL
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

Condition of Receipt
Sample Number 150107-22-01 Temp on Arrival:
' s
Parameter Schedule:
Received on Ice
Parameter Schedule:
Received on Ice
Sample Number 150107-22-02 Temp on Arrival:
Parameter Schedule:
Received on Ice
PO Box 228 • Statesville, NC 8'687 ® 704/872/4697
Page 2 of 2

V,IGI1. 11 ` I
STATEzviLLEANALYTICAL
122 Court Street" • P.O. Box.228
Address t
i! 1
!
V i
Statesville, NC 28687
[phone]
intact
- ° L r� P:`
Phone#� i ;,.i
FAX#��
r^��4
r a
..
Chain of
PO #1
Requisitioned by:
(Time
�7
Date)
Custody Record
Customer
Sample ID#
Lab -ID #
Time Sampled't
(Grab y)
Date Sampled
(Grab Only)
-
�
a
E
Matrix
Parameters requested for analysis
su a9a
w
_
ww
S
I
a
Relinquished by:
Time
am, 'M Date
J ( I / �
Sampled by:
e ���
.� �,
'I �'�
Time
`-`
am, pm Date
Trans by.
Y---
r
Ported �. _-
- -- - -
Relinquished by:
Time
am, pm Date.,Holding
d g times met:
Received by:
Time
am, pm Date
Compliance work: /
pqqjLe-Samptjn
--
Time begin
am, pm Date
/ 1_
Non-compliance work:.
Time end
am, pm Date
Lab Comments:
.Composite Sampling
#2:
Time begin
am, pm Date
/ f
Time end
am, pm Date
/ /

VS in 0.75
VS out 0.26
VSFR= 0.882883

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 01/07/2015
Reported: 01/09/2015
For:
Comments:
Sample Number
Parameter
150107-23-01
Fecal Coliforms
150107-23-01
Percent Solids
150107-23-02
Fecal Coliforms
150107-23-02
Percent Solids
150107-23-03
Fecal Coliforms
150107-23-03
Percent Solids
150107-23-04
Fecal Coliforms
150107-23-04
Percent Solids
-.Respectfully
submitted,
0
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
Sample ID Result Unit Method
Baxter 1
2,020
MPN/g
SM9221 CE-2006
Baxter 1
0.99
%
SM254OB-1997
Baxter
2,174
MPN/g
SM92210E-2006
Baxter 2
0.92
%
SM2540B-1997
Baxter 3
2,222
MPN/g
SM92210E-2006
Baxter 3
0.90
%
SM254OB-1997
Baxter 4
4,598
MPN/g
SM92210E-2006
Baxter 4
0.87
%
SM254OB-1997
Analyzed Analyst
011/07/2015 CL
01/07/2015 CL
0�1/07/2015 CL
01 /07/2015 CL
01/07/2015 CL
01/07/2015 CL
01/07/2015 CL
01/07/2015 CL
PO Box 22.8 • Statesville, N(
I
87 •704/872/4697
Page 1 of 1

Vc
-Contact Person -
Customer Lab-113 # Tim
Relinquished
Received by:
Relinquished by:.
Received by:
Tknebeoin-___�__
am, pm
Date
Time and_________anl
pm
Date
.
T]ma b8eoin-_--___am/'
pm.
Date
Tim6 end_
am, pm
Date
1,22 Court Street - P.O. Box 228
Statesville, NC Z8697
Chain of
Requisitioned by:
(ri M e Date)
Record
Sampled.
Onlyl
Date Sampled
A E
Matrix
Parameters requested for analysis
ifl
Time
dU am,(pQM! Date
L2 i
Sampled by:
Date
Transported 13(y
Holding times met:
Time
am, pm Date
Compliance work:
work:
����----- |
Lab Comments:

Analytical Results
Southern soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 01/22/2--015
Reported: 01/23/2015
For: Baxter
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
150122-22-01
Fecal Coliforms
1
200
MPN/g
SM9221
150122-22-01
Percent Solids
1
0.99
%
SM2540B-1997
150122-22-02
Fecal Coliforms
2
400
MPN/g
SM92210E-2006
150122-22-02
Percent Solids
2
1.00
%
SM254OB-1997
150122-22-03
Fecal Coliforms
3
200
MPN/g
SM92210E-2006
150122-22-03
Percent Solids
3
1.06
%
SM:2540B-1997
Respectfully
submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
Analyzed Analyst
01/22/2015 WL
0�1/22/2015 WL
01/22/2015 WL
01/22/2015 WL
01/22/2015 WL
01/22/2015 WL
PO Box 228 • Statesville, NC 2
587 •704/872/4697
Page 1 of 2

w
Condition of Receipt
Temp on
Sample Number 150122-22-01 Arrival: 2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Temp on
Sample Number 150122-22-02 Arrival: 2 7
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate
Received on Ice
Temp on
Sample Number 150122-22-03 Arrival: 2
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
i
Sodium Thiosulfate Received on Ice
PO Box 228 • Statesville, NC 8687 • 704/872/4697
Page 2 of 2

Address: q,
_customer
Lab -ID #
ime
Relinquished
Received by:
--
Relinquished
y:
b
Receivedby:
Time begin
am. pnn
Date
Time end
am,pnn
Date___/___/_�_
�
Composite Sampling
#2:
7lmmbooin
am, pn`
Date
Time end -am,
prn
Date
Requisitioned by:
�d Date Sampled
FA
122 Court Street - P.O. Box 221
Statesville, NC 28687
Chain of
ime Date)
Custody Record
_nx
Parameters requested for analysis
WW
Time 5 0­am,l(bm1 Date
r) �
Time,!�..-/�
�
Time am, pm Date
Holding times met:
Compliance work: �^
�
work:
Lab
' . '
Time am,
pm Date

Analytical Results
Southern Soil Builders
958 Hoots Road
Roaring River, NC 28669
Receive Date: 01/07/2015
Reported: 01/26/2015
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method
150107-24-01
Corrosivity
Baxter
6.7
150107-24-01
Ignitability
Baxter
>200
150107-24-01
Reactivity
Baxter
<0.010
150107-24-01
TCLP
Baxter
See
Attached
Respectfully
submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
SW-846
1010M
SW-846
as Noted
Analyzed Analyst
01/14/2015
PACE
01/21/2015
PACE
01/19/2015
PACE
01/20/2015
i
Pace
PO Box 228 • Statesville, NC
•704/872/4697
Page 1 of 1

ceAnalXical
www.pacelabs.com
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
)ject: SAMPLING 1/7/15
Pace Project No,: 92232417
JaN�C: IOU ,ur-La Lab ID: 92232417001 Collected: 61/07/15 12:10 Received: 01/08/15 1'.•0:48 Matrix: Solid
Results reported on a "dry -weight" basis i
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8270 MSSV TCLP Sep Funnel Analytical Method: EPA 8270 Preparation Method: EPA 3510
Learhate Method/Date: EPA 1311; 01/16/15 14:00
Surrogates
Nitrobenzene-d5 (S)
2-Fluorobiphenyl (S)
46 %
12-102
1
01/20/15 09:01 01/20/1'5 18:01
4165-60-0
Terphenyl-d14 (S)
40 %
60 %
13-107
21-132
1
1
01/20/15 09:01 01/20/15 18:01
01/20/15
321-60-8
Phenol-d6 (S)
15 %
09:01 01/20/15 18:01
1718-51-0
2-Fluorophenol (S)
22 %
10-110
1
01/20/15 09:01 01/20/16 18:01
13127-88-3
2,4,6-Tribromophenol (S)
49 %
10-110
1
01/20/15 09:01 01/20/15 18:01
367-12-4
27-108
1
01/20/15 09:01 01/20/15 18:01
118-79-6
8260 MSV TCLP
Analytical Method: EPA 8260 Leachate
Method/Date:
EPA 1311; 01/12/15 17:19
Benzene
ND ug/L
5.0
1
01/16/15 16:36
71-43-2
2-Butanone (MEK)
42.0 ug/L
10.0
1
01/16/16 16:36
Carbon tetrachloride
ND ug/L
5.0
1
01/16/151 16:36
78-93-3
Chlorobenzene
ND ug/L
5.0
1
01/16/1516:36
56-23-5
Chloroform
ND ug/L
5.0
1
108-90-7
1,4-Dichlorobenzene
ND ug/L
5.0
1
01/16/1 16:36
67-66-3
1,2-Dichloroethane
ND ug/L
5.0
1
01/16/1�
01/16/1916:36
16:36
106-46-7
1, 1 -Dichloroethene
ND ug/L
5.0
1
01/16/15
16:36
107-06-2
Taf—chloroethene
ND ug/L
5.0
1
01/16/15JJi
16:36
75-35-4
loroethene
ND ug/L
5.0
1
01/16/15
16:36
127-18-4
chloride
ND ug/L
5.0
1
01/16/15
16:36
79-01-6
Surrogates
75-01-4
1,2-Dichloroethane-d4 (S)
Toluene-d8 (S)
98 %
70-130
1
01/16/15
16:36
17060-07-0 TP
4-Bromofluorobenzene (S)
95 %
96 %
67-135
1
01/16/15�
16:36
2037-26-5
70-130
1
01/16/15
16:36
460-00-4
Percent Moisture
Analytical Method: ASTM D2974-87
Percent Moisture
99.7 %
0.10
1
01/22/15
16:54
1010 Flashpoint,Closed Cup
Analytical Method: EPA 1010
Flashpoint
>200 deg F
70.0
1
01/21/15
15:00
9045 pH Soil
Analytical Method: EPA 9045
pH at 25 Degrees C
6.7 Std. Units
0.10
1
01/14/15
14:45
733C Reactive Cyanide
Analytical Method: SW-846 7.3.3.2
Cyanide, Reactive
ND mg/L
0.010
1
01/19/15
1:27
734S Reactive Sulfide
Analytical Method: SW-846 7.3.4.2
Sulfide, Reactive
ND mg/L
1.0
1
01/19/15
, 8:30
Date: 01/22/2015 05:14 PM
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
Page 5 of 20

(__Ilake Analytical
Wmpacelabs.com
ANALYTICAL RESULTS
oject: SAMPLING 1/7/15
Pace Project No.: 92232417
aampie: IWIU7-24 Lab ID: 92232417001 Collected: 01/07/15 12:10 Received: 01/08/15 1
Results reported on a "dry -weight" basis
Parameters Results Units Report Limit DF Prepared An.,
8081 GCS Pesticides, TCLP Analytical Method: EPA 8081 Preparation Method: EPA 3510
Leachate Method/Date: EFTA 1311; 01/16/15 14:00
gamma-BHC (Lindane) ND
Pace Analytical Services, Inc.
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Matrix: Solid
CAS No. Qual
Chlordane (Technical)
ug/L
ND ug/L
0.50
1
01/20/15 11:00
01/20/15
22:52
58-89-9
Endrin
ND ug/L
3.0
1
01/20/15 11:00
01/20/15
22:52
57-74-9
Heptachlor epoxide
ND ug/L
0.50
0.50
1
1
01/20/15 11:00
01/20/15 11:00
01/20/11
2252
72-20-8
Methoxychlor
ND ug/L
1000
1
01/20/15 11:00
01/20/115
01/20/16
22:52
22:52
1024-57-3
Toxaphene
Surrogates
ND ug/L
3.0
1
01/20/15 11:00
01/20/15
22;52
72-43-5
8001-35-2
Decachlorobiphenyl (S)
Tetrachloro-m-xylene (S)
33 %
10-138
1
01/20/15 11:00
01/20/1
22:52
2051-24-3
49 %
10-110
1
01/20/15 11:00
01/20/1.
22:52
877-09-8
8151 Chlorinate Herbicide TCLP Analytical Method: EPA 8151 Pre arat' M h - F
p ion et od. Er-mao1c
2,4-D
2,4,5-TP (Silvex)
ND mg/L
0.010 1
01/15/15 14:00
01/16/1100:17
94-75-7
Surrogates
ND mg/L
0.010 1
01/15/15 14:00
01/16/1
00:17
93-72-1
2,4-DCAA(S)
81 %
42-142 1
01/15/15 14:00
01/16/1500:17
19719-28-9
6010 MET ICP, TCLP
Analytical Method: EPA
6010 Preparation Method: EPA
3010
Leachate Method/Date:
EPA 1311; 01/15/15 18:00
nic
am
ND mg/L
0.050 1
01/16/15 15:45
01/17/1
00:35
7440-38-2
=_.,
Cadmium
ND mg/L
0.25 1
01/16/15 15:45
01/17/1
00:35
7440-39-3
Chromium
ND mg/L
0.0050 1
01/16/15 15:45
01/17/1�1
00:35
7440-43-9
Lead
ND mg/L
0.025 1
01/16/15 15:45
01/17/1
7440-47-3
Selenium
ND mg/L
0.025 1
01/16/15 15:45
01/17/15
100:35
00:35
7439-92-1
Silver
ND mg/L
0.10 1
01/16/15 15:45
01/17/15�
00:35
7782-49-2
ND mg/L
0.025 1
01/16/15 15:45
01/17/15�
00:35
7440-22-4
7470 Mercury, TCLP
Analytical Method: EPA 7470 Preparation Method: EPA 7470
Leachate Method/Date: EPA 1311; 01/15/15 18:00
Mercury
ND ug/L
0.20 1
01/16/1514:35
01/16/1517:23
7439-97-6
8270 MSSV TCLP Sep Funnel
Analytical Method: EPA 8270 Preparation Method: EPA 3510
Leachate Method/Date: EPA 1311; 01/16/15 14:00
1,4-Dichlorobenzene
ND ug/L
50.0 1
0.1120115 09:01
01/20/15
16:01
106-46-7
2,4-Dinitrotoluene
Hexachloro-1,3-butadiene
ND ug/L
50.0 1
0.1120115 09:01
01/20/15
18:01
121-14-2
Hexachlorobenzene
ND ug/L
ND ug/L
50.0 1
01/20/15 09:01
01/20/15
1&01
87-68-3
Hexachloroethane
ND ug/L
50.0 1
0.1/20/15 09:01
01/20/15
1801
118-74-1
2-Methylphenol(o-Cresol)
ND ug/L
50.0 1
01/20/15 09:01
01/20/15
18'.01
67-72-1
3&4-Methylphenol(m&p Cresol)
536 ug/L
50.0 1
01/2.0/15 09:01
01/20/15
18101
95-48-7
Nitrobenzene
ND ug/L
50.0 1
01/2.0/15 09:01
01/20/15
18i0l
Pentachlorophenol
ND ug/L
50.0 1
01/2.0115 09:01
01/20/15
8'01
98-95-3
Pyridine
100 1
01/20/15 09:01
01/20/15
801
87-86-5
2,4,5-Trichlorophenol
ND ug/L
50.0 1
01/20/15 09:01
01/20/15
18 01
110-86-1
2,4,6-Trichlorophenol
ND ug/L
ND ug/L
50.0 1
01/20/15 09:01
01/20/15
�18:01
95-95-4
50.0 1
01/20/15 09:01
01/20/15
18 01
88-06-2
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 01/22/2015 05:14 PM without the written consent of Pace Analytical Services, Inc..
Page 4 of 20

Division of Water Resources
State of Nort ! Carolina
Department of Environment il Quality
Division of Water Zesources
LAND APPLICATION SITE CERTI +ICATION
INSTRUCTIONS FOR FORM: J,ASC 11-15
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 o additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless; otherwise noted, the Applicant shall submit one original and two co ies of the aDDI cation and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at.
ham:11 ortal.ncdenr__or' /web/1t lays/lau
General — This certification provides detailed information of receiving sites for land application of Class B residuals ( ay include
water treatment plant or others type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 11-15 or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documer.
below.
A. Land Application Site Certification (FORM: LASC 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 11-15) f
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions,
to the application may be made, as long as the attachments are numbered to correspond to the section and item tc
refer. '
❑ For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits,. submit the requested information for only
proposed modificationthose sites that are new, transferred or afff
B. Land Application Site Information:
❑ The status of the land application site with respect to this residuals land application program must be provided in
status categories and their corresponding codes are as follows:
♦ New (N) ♦ renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
En
County Board
'�
Notification. doc
IY �
I
Land Owner
✓
Agreement
(If applicable)
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
for Residuals Land APpliartiou Permits"
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scientist
Evaluation Policv"
V
ation listed
rm. Please
attachments
which they
:ted by the
able I. The
INSTRUCTIONS FOR FORM: LASC 11-15 11age 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs) I `��
V
Required Item
Status Code
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, i submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
Acknowledgement of field transfer fiom Land Owner (Fields may not
be permitted to; multiple Permittees over the same timeperiod)
* This item may be required for land application site with a status code "M", please contact the Division if you ne
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 existi
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
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series
note that the soil mapping units are variable between Counties, so care should be taken in properly identifyi
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
information on both the soil series name and the slope of the soil), the Applicant may determine the represf
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope rai
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
❑ Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
El Use an 8.5 by I1-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as poss
map portion must be Iabeled with the map name and number, the identified location, and be of clear and reproducit
❑ Surface water body classifications information may be found at: http:// gital.ncdenr.org') eb/wc/ s/csu
❑ 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 down
littp:Hpoi-t-,tt.iicdeni-.oi-g/,A,qb/wq/lioiiie/ro
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies wit
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x I l-inch sheet showing the p
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 trib
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tri
UT to stream name as the waterbody name.
3. Open the link http://h2o.em.state.ne,us/biros/re orts/repe- WB.html. If this Iink does not w
http //portal.ngdenr.ora/web/w/Ws/gsu/classificatious and download weekly -updated classification lists
waterbodies.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project inf
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
I assistant in
permit, or
,pe of each
me. Please
the correct
it provides
ative slope
;of4-8%
entist.
)des are as
where the
ible. Each
le quality.
loaded at:
i assigned
-oject area
1•
taries, see
iutaries as
rk, open
)r named
)rmation.
INSTRUCTIONS FOR FORM: LASC 11-15
rge 2 of 3

1. Select proper basin from the List all Waterbodies in Fig ?Use
—---- Basin sorted
Hydrologically .�
report. Sort hydrologically as this will provide the proper location descriptions if multiple
runs.
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 descriptio i. The term
"source""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 o er coup from the List all Waterbodies in Alamance J
pl� p �' — county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on thei 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 descriptio r. 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:
LJ Any stream which is not named in the schedule of stream classifications carries the same classification as ti at 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 Sty waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are ((conducted.
El The following river basins have different policies for unnamed streams entering other states or for specificreas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah.
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the
River drainage area entering South Carolina shall be classified "B Tr."
>avannah
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Car
classified "C."
lira are
Lumber Riv7BasinStreams
enterin South Carolina are classified "C Sw."
Roanoke Ridescribed
Streams entering Virginia are classified "C." Except that all backwaters of John
Reservoir and the North Carolina portion of streams tributary thereto not otherwise
shall carry the classification "B," and all backwaters of Lake Gaston and tie
Carolina portion of streams tributary thereto not otherwise named or described shall
classification "C and B."
H.Kerr
amed or
North
;airy the
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main
canals to Pamlico Sound and its bays which shall be classified "SC."
drainage
Pas uotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 11-15
P ge 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Baxter Healthcare Corporation
Land application sites currently certified: 140.62 net acres and Total to be certified: 69.6 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
Site/Field
1D
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
-
Crop(s)
Predominant Soil
Series Name
---- - --
Mapping Unit
-or Rep: Slope° -
D
S-01
Trilby Setzer
Derek Teague
19.8
Catawba
D
S-02
Trilby Setzer
Derek Teague
25.00
Catawba
D
T-01
Larry Teague
Derek Teague
26.00
Catawba
D
T-02
Larry Teague
Derek Teague
10.00
Catawba
R
DPI -A
Douglas Poplin
5.5 Aq
Wilkes
Fescue
Fairview
FcB2
R
DP1-B
Douglas Poplin
t2�i 1.6 5
Wilkes
Fescue
Fairview
FcB2
R
DPI-C
Douglas Poplin
Z-�� 3.0 0-1
Wilkes
Fescue
Fairview
FcB2
R
'Status Code
DP1-D
for land application
Douglas Poplin
sites are: ♦ N (New) ♦ R
(Renewedl A tea (M A;-F A�
C�5 9.6 l,�`�
. T .T_ _r
Wilkes
_�.
Fescue
Fairview
FcB2
--�cu)
Soil Series Name (i.e. Appling, Cecil, etc.) 01J kurlececy � � bc�
'Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
DPI -A
Latitude
340 14' 05"
Longitude
g
800 56' 40"
Location
Datum
NAD 83
Location Method Code
MAP
Location Accuracy
Nearest Second
Waterbody Subbasin and
Stream Index No.
Hughes Branch 12-50
Current and Proposed
Class
WS-IV WS-IV
DPI-B
360 14' OS"
800 56' 35"
NAD 83
Map
Nearest Second
Hughes Branch 12-50
WS-IV
WS-IV
DPI-C
350 14' 12"
800 56' 44"
NAD 83
MAP
Nearest Second
Hughes Branch 12-50
Hughes Branch 12-50
WS-IV
WS-IV
DPI-D
36° 14' 12"
800 56' 44"
NAD 83
MAP
Nearest Second
WS-IV
WS-IV
DP2
360 14' 12"
800 56' 52"
NAD 83
MAP
Nearest Second
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Ws- IV
WS-IV
DP3
360 14' 31"
800 56' 28"
NAD 83
MAP
Nearest Second
WS-IV
WS-IV
DP4
360 14' 25"
800 56' 20"
NAD 83
MAP
Nearest Second
WS-IV
WS-IV
DPS
36° 14' 12"
80° "
NAD 93
MAP
Note: Please keep the site
information (I.) and
waterhnAv ;nfn_,f;n„
ITT 1
rH
e'
H —e a wh 1-✓v
S-1
J-1 V
� -j . .. .... -1— vii uic 1JQgc.
FORM: LASC 11-15
Page 1

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Baxter Healthcare
Land application sites currently certified: 140.62 net acres and Total to be certified: 69.6 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Name
Mapping Unit
-or-Rep.- Slope'
R
DP2
Douglas Poplin
0.8 IC
Wilkes
Corn
Fairview
FcB2
R
DP3
Douglas Poplin
�`��14.61Z'�
Wilkes
Fescue/Corn
Fescue
Fescue
Fescue
Fescue
Fairview
FcB2
R
DP4
Douglas Poplin
i� U 8.71 °�
Wilkes
Fairview
FcB2
N
N
DPS
DP6
I Douglas Poplin
Douglas Poplin
�oj1 ,9 �"
�Q�5.5
Wilkes
Wilkes
Fairview
FcB2
Fairview
F3B2
N
DPI
Douglas Poplin
„4y 4.4 k,0Q
Wilkes
Fairview
FcB2
N
N
a Status Code
for land application
sites are- ♦ N (New) • R
[R--il . AA /1,A..A:A..A\
rn
-- -- - - - �- . _ --.,.........y .... k—vuuicu) v i k i rmn3ierrea) e D (Deleted) n Soil Series Name (i.e. Appling, Cecil, etc.)
`Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
U. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Hughes Branch 12-50
Hughes Branch 12-50
Current and Proposed
Class
DP6
360 14' 18"
800 56' 36"
NAD 83
MAP
Nearest Second
WS-IV
WS-IV
DP7
360 14' 25"
800 56' 36"
NAD 83
MAP
Nearest Second
WS-iV
WS-IV
° '
° 'f,NAD
83
ADD
Nearest Second
°11
0 r ItNAD
83
ADD
Nearest Second
° '
° ' it
NAD 83
ADD
Nearest Second
° 'rr°
' ff
NAD 83
ADD
Nearest Second
°
° '11NAD
83
ADD
Nearest Second
° 'it°
' "I
NAD 83
ADD_
Note: Please keep the site
information (I.) and
wsterhnciv infnrmarinn
(TI)
f th f Id
o e same ie on the same page.
FORM: LASC 11-15
Page I

State of North Carolina
Department of
Division of Water
Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AG
FORM: >,OA 11-15
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 appl cation and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit we site at:
kitty://)ortal.nedenr,orghi,eLlij laps/ /last
General — This document is an agreement between the Applicant and -land owner(s) of residuals receiving sites for land ap Dlication of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .11 )0. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting document rtion listed
below.
A. Land Owner Agreement (FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 11-15) fo-m. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, !ttachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity otl er than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/ i
)perator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: �S (Nx' - ar�n,, aOj: u-„
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies), onto the foll wing land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as gi 'en in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special
(no -till)
pasture)
note
over -seed/
De 1
b
aesc.; e
Cl n m��I :rve
1
M
_
Fe s c se
ct : vy,-,\l r
3
00
F sc e lep r,n
Cin;iw -Fec
f 1 0
F•l5c, c,
0n•/''`%I Tutd
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 pr )gram and
shall be renewed each time this permit is renewed.
FORM: LOA 11-15 Pagel of 3

State of Nort l Carolina
Department of Environmen :al Quality
Division of Water Resources
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORME, LOA 11-15
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adher .nee to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount if 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 ap lication and
supportinS documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit we site a
ham:// ortal.ncdenr.or•g/weblivalys/lau
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land pplication 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 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documei station listed
below.
A. Land Owner Agreement (FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 11-15) orm. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lesse /operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: A lq-e" I-}1.�,�:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the fo lowing land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as iven in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Sp'cial
(no-t,
note
I/over-seed/
,asture)
/f
bFesc
ve
p
Te S c,t.
Q n; tr`'s 1 Tz ep
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied resides ils while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the rc siduals.
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.
FORM: LOA 11-15 Page 1 of 3

The undersigned landowner or his) representative and the Permittee agree to abide with the following rests
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agrc
I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with ano
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative n lease or otherwise permit the use of the land application site(s) to a third party, the la
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 Sectic
4. Notification of cancellation of this (Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permittil
Mail Service Center, Raleigh, NC 2%699-1617.
5. The Permittee must request and obtllain a permit modification from the Division prior to a transfer of the land application sit
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals
land application site(s).
6. The Permittee has provided the land wner or his representative with information and data concerning the residuals land applica
including an analysis of constituentsof the residuals, residuals application methods, schedules for typical cropping patterns, a r
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
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 ar
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture i
the specified crop. i
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop pattei
soil samples, and the permitted application limits.
10. The landowner or his representativeI will provide the Permittee with information regarding the amount and analysis of oth(
nutrients (e.g., fertilizer, unregulated i'nimal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule re
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 h
his representative prior to and during I residuals land application event.
13. The landowner or his representative f�ereby authorizes the Permittee, local officials, and State officials or their representatives
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of
compliance with the permit; establish l monitoring facilities on or near the land application site(s) as required by the permit; copy
that must be kept under the terms and ;conditions of the permit; take necessary leachate, surface water, groundwater, or soil samph
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be take
application site(s) during active use ,
posting of signs that indicate the actii
2. Animals shall not be grazed on the la
sites that are to be used for grazing
application events.
3. Food crops, feed crops, and fiber crol
4.
Food crops with harvested parts that
month period following a residuals ]a
5. Food crops with harvested parts belo
application event when the residuals re
6. Food crops with harvested parts belo
application event when the residuals re.
7. Turf grown on land where residuals are
III. ALTERNATIVES FOR WATER SUPPI
15A NCAC 02L .0107(d) prohibits wate
compliance boundary to be placed closer
boundary provided the groundwater standai
❑ A re -defined compliance boundary is of
(Please include the rationale for the r
compliance boundary to the application
�[ A re -defined compliance boundary is nc
IV. ACKNOWLEDGEMENT OF FIELD TI
❑ The land application field(s) ID:
residuals land application program; Perr
agreement, he/she is requesting that the
into the new nroeram:
by the Permittee and/or the landowner or his representative to control public access
1 for the 12-month period following a residuals land application event. Such controls may
es being conducted at the land application site(s).
application site(s) for a 30-day period following a residuals land application event. Land
call have fencing that will be used to prevent access during these periods after such res
shall not be harvested for a 30-day period following a residuals land application event.
nrch the residuals/soil mixture and are totally above the land surface shall not be harvest
I application event.
v the surface, of the land shall not be harvested for a 20-month period following a re:
nain on the land surface for four months or longer prior to incorporation into the soil.
v the surface, of the land shall not be harvested for a 38-month period following a re.,
vain on the land surface for less than four months prior to incorporation into the soil.
applied shall not be harvested for a 12-month period following a residuals land application
,Y WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h)
to the waste disposal area, such that the water supply well is situated outside of the
ds can be met at the newly -established compliance boundary. Please mark one of the folic
eded for field(s) ID:
ted re -location of the compliance boundary and attach a map showing the
needed for this site.
(if needed)
fictions and
:ment.
ier permitted
downer shall
i II) are met.
Unit, 1617
(s) to a new
pplied at the
on program,
,scription of
ny residuals
sieve a final
suitable for
is, results of
sources of
patterns for
iduals land
rdowner, or
enter and
letermining
my records
during the
o the land
include the
application
duals land
I for a 14-
3uals land
luals land
vent.
.)lows the
)mpliance
ring;
proposed
is currently permitted undr another
Number W,Q; . The land owner hereby acknowledge that by si i
;ping this
ld(s) be removed from the previously permitted residuals land application program and tyansferred
FORM: LOA 11-15
(Name of the new program)

�.. I
Landowner's Certification:
I certify that I am a deeded landd,
regarding the use of the land applicE
a power of attorney or other legal
deeded landowners. I certify that t,
agreement with another municipali6
understand the stipulations, restrictl(
field transfer, and do hereby grant
herein. (�
Landowner name: 0 C V ) u �V I
vner of the, above -referenced land application site(s) and am authorized to ma
tion site(s) on behalf of other deeded landowners OR that I am otherwise authori
;legation, to make decisions regarding the use of the land application site(s) on I
e above -referenced land application site(s) are not included in any waste disposa
contractor;, or -other permitted entity. Furthermore, I certify that I have read this
,ns, alternatives for water supply wells inside the compliance boundary, acknowl,
ermission to the Permittee to land apply residuals to the land application site(s)
10 n
Address: S C1 L�l Min.
n.
City: (` d State: C Zip: % (�
Phone: 3 f '1 a S S' _ E-mail address:
I
Signature: )�cwn ,�h 1b�/T— Date:' i - a.o 16
NORTH CAROLINA, (A) i e S COUNTY
— n
I, the undersigned Notary Public do hereby certify that !✓ U tj'�• U- 100 r`
� V
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of Feb rvo,— , 20 1,6
Signature and seal:
My commission
NERV,4r,
e decisions
ed, through
;half of the
contract or
.ement of
specified
Notary NuDi a =_
WIIkna C01 ty
Lessee's/Operator's Certification: j
I
I certify that I have read this Agreen�ent and do hereby agree to abide by the stipulations and restrictions as specified he
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
I certify that I have read this Agreemi
Signing official name:
Signature: l
M
State:
E-mail address:
Date:
Zip:
and do hereby agree to abide by the stipulations and restrictions as specified
(Z_
Date:
FORM: LOA 11-15 T)L— z ,

State of North Carolina
Department of Environmental Quality
R Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 11-15
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 website at.
http://
portal. ncdenr.or h�ivglaps/lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
'Phe undersigned property owner hereby permits:
Applicant's name: 1.� C'X %rr- Pfv\ 00,7C eyrpQ;C%,4,,oh
Applicable Field ID: N 13
hereinafter referred to as the Permittee, to land apply residuals within ) 0 0 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: � S a 4 .n �c '�)) M +n Ad,
City: !\ 0 rn C1J c, State: Pc Zip: 9-9 7
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: (3 f-., vl �o ro9
Signature:
Date: a - )--a— a 0 )
FORM: SWA 11-15 Page 1 of 1

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;ir
Ifr - = Rb. . v : � 'd. Y.6Air . c •,. _ x � _ `tx'G °lL�t_: • $ "Al
� s� A,.s�:.,l:aak

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
-yFa: ilit'-� Na.ne B xter eaitt�care 'W(�-Perm 0031725 Field- _
��-'�Q #�-DP Acres Uti ize : 4.51 -
Land Owner: Douglas Poplin Annual Dry Tons Applied: 16.0711 Site #: DPI -A Acres Permitted: 4.51
Operator: Douglas Poplin Predominant Soil Series: FcB2 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 194 Crop 2 Name: Crop 2 Max. PAN:
-
-- Vloume a tied
pp
-
_
a
Residual Sources
---Soil--
Precip.
>
-
o
-
-
Z
Nitrate
Name of Crop Type
--
° o
°
(enter one) Solids/
%
Applied per
PP P
(NPDES # WQ#,
Cond.
Past 24
6
c�
w
w ..
TKN
o
and
PAN Applied
Receiving Residual
n�
Q �
Liquid
Solids
Acre
Fert., Animal
�iY,
Hrs.
°
o� w
c�
* �.
*
°4 °
w.
Nitrite
(lbs/acre)
Application
Cu. Yds Gallons
(Dry Tons/Ac)
Waste etc )
Wei
Moist)
inches
*
mg/kg
mg/kg
mg/kg
Crop 1
Crop 2
Crop 1
Crop 2
7-2015
1 55.38
11.521
`11.52
1.191
WQ0031725
dry
0
S
0.5
0.3
78600
10200
2
61.048
NA
Fescue
11-2015
110.27
2372
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
121.556
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.00.0
0.000
0.000
0.000
0.000
0.000
0.000 -_
0:000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
'
Residuals Applications totals on FORM FSF supp (attach FORM
FSF supp to this form):
_. ,..
OTALS:
165.65
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
882.605
0.000
Lime Applied
knnuallbs/acre
0.086
0.014
1.026
0.784
0.107
0.003
0.043
0.264
0:036
1.582
128.268
_...
Date
lbs/ac
'rior Years Cumulative lbs/ac
'.urrent
0.041
0.018
0.918
0.506
0.068
0.002
0:032
- 0.19
'0:023
- 2.0I7
-
Cumulative lbs/ac
0.127
0.032
1.944
1.290
0.175 1
0.005
0.075
0.454
0.059
3.599
'ermitted C. P. L. R.****
36
34
1338
NA
267 1
15
NA
374
89
2498
'enmt PAN Limit 1 st/2nd Crop _
_ ..._ 194
`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
*"* Mineralization Rates: Compost -0.1 anaerobiall digested -0.2 Signature of Land Applier Date p � y g
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R-: Cumulative Pollutant Loading Rate
r
DENR FORM FSF (1 3)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE
A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX
WHEN NOT APPLICABLE.
-F acililyName:-$axterHeaifncare- Q-Permit-#:-WQOOr/
Fi`el-d-#.-Dp1 B
c� t ize : 1.2
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 3.0212
Site #: DP1-B
Acres Permitted: 1.25
Operator: Douglas Poplin
Predominant Soil Series: FcB2
Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 194
Crop 2 Name:
Crop 2 Max. PAN:
Volume a lied -
PP
- - -
--Volume -
Residual Sources
-Soil--
Precip.
y
C-
o
--
-
z
Nitrate
Name of CropType
- --
S
(enter one) Solids/
%
Applied per
(NPDES #, WQ#,
Cond.
Past 24
'
w ?:
w .CD
TKN
o
and
PAN Applied
Receiving Residua]
O
Liquid
Solids
Acre
Fert., Animal
(Dry,
Hrs.
o w
* �'
w
w.
°40
o
Nitrite
( lbs/acre)
Application
Q
Cu. Yds Gallons
D Tons/Ac
(Dry )
Waste, etc)
Wet,
Moist)
inches
a o
o
*
o
o
#
c
�
mg/kg
w•
mg/kg
mg/kg
Crop 1
I Crop 2
Crop 1
Crop 2
10-2015
31.14
11.52
2.417
WQ0031725
dry
0
S
0.5
0.3
78600
10200
2
123.853
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
---s eee-
- -
- -- -
- - -- -
-0:000
0:000-
- ---
-
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
'OTALS:
31.141
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
123.8531
0.000
Lime Applied
innuallbs/acre
0.058
0.010
0.696
0.532
0.073
0.002
0.029
0.179
0.024
1.073
87.012
-
Date
lbs/ac
'rior Years Cumulative lbs/ac
0.035
0.015
0.783
0.432
0.058
0.002 -
-- 0.02T--
--0 162
0-019--
--T.7T
-
--- -
:urrent Cumulative lbs/ac
0.093
0.025
1.479
0.964
0.131
0.004
0.056
0.341
0.043
2.793
'ermitted C. P. L. R.****
36
34
1338
NA
267
15
NA
374
89
2498
ermrt PAN Limit 1 s 2nd Crop 194
`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
lam/ *Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*"" Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of Land Applier Date aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1 3)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE
A COPY OF THIS BLANK FORM TO BE COMPLETED
AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
-FaciiityName:saxterltealthcar
WQ'ermit #QpD3j72
Field #: ----
Acres Utilized: 2.3
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 5.8143
Site #: DPI-C
Acres Permitted: 2.3
Operator: Douglas Poplin
Predominant Soil Series: FcB2
Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 194
Crop 2 Name:
Crop 2 Max. PAN:
,..,
Volume a fled
PP
- Volume
Residual Sources
Cond.
Precip.
y
C
o
�
Nitrate
PAN Applied
Name of Crop Type
-
Y
o
(enter one) Solids/
%
Applied per
PP P
(NPDES #, WQ#,
Past 24
cY
�;
M, =
;v
- '
TKN
o El
and
pp
Receiving Residual
y
Q
Liquid
Solids
Acre
Fert., Animal
wry,
Hrs.
6• �'
o� p
�,
* w
=
* w
cl R
R.
Nitrite
(Ibs/acre)
Application
Cu. Yds Gallons
(Dry Tons/Ac)
Waste, etc)
Wei
Moist)
inches0
mg/kg
mg/kg
mg/kg
Crop 1
Crop 2
Crop 1
Crop 2
7-2015
59.93
11.52
2.528
WQ0031725
I d*y
0
S
1 0.5
1 0.3
78600
10200
2
1129.5431
NA
I Fescue
--
eeeI
"Ism
eoe
_-]
_-
--�_-
--_
--
_--�
e e o e
e e e o
_-
--�_-
--�
�-
--�eeee
eeee
. I ... I
I
I
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
'OTALS:
59.931
As
Cd
Cu
Cr
Pb
- Hg
Mo
Ni
Se
Zn
P 1
129.5431
0.000
Lime Applied
knnuallbs/acre
0.061
0.010
0.728
0.556
0.016
0.602
0.030
0.187
0.025.
1.122
91.008
Date
lbs/ac
'rior Years Cumulative lbs/ac
0.61
0.027
1.372
0.757
0.101
0.003
0.047
0.284
0.034
3.015
12-2015
1000
:urrent Cumulative lbs/ac
0.671
0.037
2.100
1.313
0.177
0.005
0.077
0.471
0.059
4.137
'ermitted C. P. L. R.****
36
34
1338
NA
267
15
NA
374
.89
2498
Limit St/2nd Urop
194 1 1 1 1
`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
fua i ie personnelp or erly gathered and evaluated -the n of rmati"-on- s�mifti U. Tam aware tTiat tTiere are significant penalties for sii itfing false
nformation, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (17 ,6)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
--Facility-Name: BaxterHealthcare---------- -- WQ-Permit V ifized: 7.95
Land Owner: Douglas Poplin Annual Dry Tons Applied: 22.1784 Site #: DPI-D Acres Permitted: 7.95
Operator: Douglas Poplin Predominant Soil Series: FcB2 Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 194 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
PP
Volume
Residual Sources
sOd
Precip.
C
-
Nitrate
Name of Crop Type
o
(enter one) Solids/
%
Applied per
DES #, W #,
Q
Cond.
Past 24
�°
T
and
PAN Applied
Receiving Residual
°«3 0
Q
Liquid
Solids
Acre
Fert., Animal
D
( ry°
Hrs.
5 8-
o� �
�
* w
# �-
°
� w.
Nitrite
(lbs/acre)
Application
Waste etc)Wet
�'
w
Cu. Yds Gallons
(Dry Tons/Ac)
Moist)
inches
mglkg
mg/kg
mg/kg
Crop 1
Crop 2
Crop 1
Crop 2
5-2015
59.57
11.52
0.727
WQ0031725
dry
0
S
1 0.5
0.3
78600
10200
2
37.253
NA
Fescue
6-2015
143.38
11.52
1.750
W00031725
dry
0
S
0.5
0.3
78600
10200
2
89.664
NA
Fescue
7-2015
25.65
11.52
0.313
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
16.040
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
n nnn I
n nnn
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
'OTALS: 228.61 01 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 142.93TF 0.000 Lime Applied
�rmuallbs/acre 0.067 0.011 0.804 0.614 0.084 0.002 0.033 0.206 0.028 1.239 100.4401 Date lbs/ac
'rior Years Cumulative lbs/ac 0.027 0.014 0.695 0.376 0.072 0.001 0.024 0.127 0.003 1.413
'.urrent Cumulative lbs/ac 0.094 0.025 1.499 0.990 0.156 0.003 0.057 0.333 0.031 2.652
'ermitted C. P. L. R.**** 36 34 1338 NA 1 267 1 15 1 NA 374 89 2498
'ermit PAN Limit 1st/2nd Crop
_1 194
'I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
ivalified_personneI properly gatliered and -evaluates the-informafibn submitted I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
"doi4' **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of Land Applier Date aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
1J DENR FORM FSF (1, 5)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM' TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility -Name:- Baxter -Healthcare --- - ----- -- -WQ pe i #;-WQ003172 F etd-#' DP2- ---- Acres Uti il'zedc
Land Owner: Douglas Poplin Annual Dry Tons Applied: 9.9364
Operator: Douglas Poplin
Crop 1 Name: Corn
Predominant Soil Series: FcB2
Site #: DP2
Crop 1 Max. PAN: 214 Crop 2 Name:
Acres Permitted: 5.02
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
°
° °
Q
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
"�u
Solids
Volume
A lied er
PP P
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,,
Fert., Animal
Waste, etc)
Soil
Cond.
(DIY,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
>
4 'Cl
o p;
o
;U w
w
cc `�
o
7y
w
w
* °
TKN
mg/kg
Z
o
�.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
ReceivingResidual
Application
Crop 1
Crop 2
Crop 1
Crop 2
10-2014
121.01
9.75
1.979
WQ0031725
dry
0
Ine
1
0.3
111000
7900
18.5
153.790
IOTA
Corn
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach
FORM
FSF supp to this form):
'oTA1
121.01
o
As
Cd
Cu
Cr
Pb
Ha
Mo
Ni
Se
Zn
P
153.7901
0.000
Lime Applied
knnuallbs/acre
0.032
0.07
0.102
36
0.008
0.032
0.040
34
0.467
1.626
2.093
1338
0.293
0.892
1.185
NA
0.047
0.136
0.183
267
0.002
0.003
0.005
15
0.020
0.056
0.076
NA
0.090
0.323
0.422
374
0.020
0.029
0.049
89
1.207
3.484
4.691
2498
58.578
Date
lbs/ac
'rior Years Cumulative lbs/ac
10-2014
2500
.urrent Cumulative lbs/ac
'ermitted C. P. L. R.****
'ermit PAN Limit 1 st/2nd Crop
214
'1 certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
luaiined personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
of Land Applier
-i-or
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R,: Cumulative Pollutant Loading Rate
DENR FORM FSF (1:,-3)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED
AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
-FacilityName:Bax-t,er-Healthcare------
-- Q-Permit#: WQ-p0317Z5
Freet ##: DP3-Grass
Acres Ufi izedc 6983
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 10.8923
Site #: DP3-Grass
Acres Permitted: 6.983
Operator: Douglas Poplin
Predominant Soil Series: FcB2
Cation Exchange Capacity (non 503):
Crop 1 Name:
Fescue
Crop 1 Max. PAN: 194
Crop 2 Name:
Crop 2 Max. PAN:
Volume applied
- -
Volume
--- -- -- - -
Residual Sources
Soil-
-- -
Precip.
-
y
-
o
- --
Z
-- -
Nitrate
- -- - - -- -
-- -
----Type-
Name of Cro P
(enter one) Solids/
%
A lied er
PP P
(NPDES #, WQ#,
Cond.
Past 24
w
7n
w .,
TKN
q
o
and
PAN Applied
Receiving Residual
0
Liquid
Solids
Acre
Fert., Animal'
Hrs.
o w
y
N'
Nitrite
( lbs/acre)
Application
PP
(�
Cu. Yds
Gallons
(Dry Tons/Ac)
Waste, etc)
Wet,�o•�'w
Moist)
inches
a
0
mg/kg
w'
mg/kg
mg/kg
Crop 1
Crop 2
Crop 1
Crop 2
5-2015
57.41
11.52
0.798
WQ0031725
dry
0
S
0.5
1 0.3
78600
10200
2
40.874
NA
Fescue
10-2015
54.86
11.52
0.762
WQ0031725
dry
0
S
0.5
0.3
78600
10200
2
39.058
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
,
0.000
0.000
'OTALS1 112.271 0
\nnual lbs/acre
'rior Years Cumulative lbs/ae
:urgent Cumulative lbs/ac
'ermitted C. P. L. R.****
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
0.037
0.006
0.449
0.343
0.047
0.001
0.019
0.115
0.016
0.693
56.160
0.231
0.082
4.324
2.851
0.371
0:01
--0.1'52
0.83
0:458
9.87-
0.268
0.088
4.773
3.194
0.418
0.011
0.171
0.945
0.474
10.563
36
34
1338
1 NA
267
15
NA
374
89
2498
79.932 1 0.000 Lime Applied
Date I lbs/ac
12- - WOO
'ermit PAN Limit 1st/2nd Crop 194
'I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
/ *Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date
**" Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
***C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (121, ��)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
�'aci[ity-Name: Baxter -Healthcare WQ-Permrt�# 'p(>Q0031725 ie7cT#a:: ])p3-Corn AcresZ7filized: 5.877
Land Owner: Douglas Poplin
Operator: Douglas Poplin
Crop 1 Name: Cron
Annual Dry Tons Applied: 19.2552
Predominant Soil Series: FcB2
Site #: DP3-Corn Acres Permitted: 5.877
Crop 1 Max. PAN: 214 Crop 2 Name:
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
°
;~
Y o(Dry,o'
Q
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/Ac)
-
Residual Sources
(NPDES #, WQ#,
Fert., Animalairs.
Waste, etc )
Soil-
Cond.
Wet,
Moist)
----
Preci .
P
Past 24Receiving
inches
-
o�
�
C
o
�;
w'
�.
0
:
* w
TKN
mg/kg
ZNitrate
o
w
mg/kg
-
Nitrate
mg/kg
-- - -- ----
p Applied
pp
lbs/acre)
- -- --
Name of Crop Type
Residual
Application
Crop 17
Crop 2
Crop 1
Crop 2
3-2015
26.41
11.52
0.436
WQ0031725
dry
0
INC
1
0.3
1 78600
10200
2
26.788
NA
Corn
4-2015
172.06
11.52
2.840
WQ0031725
dry
0
INC
1
0.3
78600
10200
2
174.525
NA
Corn
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
'OTALS:
198.411
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
201.313
0.000
Lime Applied
knnuallbs/acre
0.078
0.231
0.309
36
0.013
0.082
0.095
34
0.942
4.318
5.260
1338
0.719
2.847
3.566
NA
0.098
0.371
0.469
267
0.003
0.01
0.013
15
0.039
0.151
0.190
NA
0.242
0.829
1.071
374
0.033
0.457
0.490
89
1.452
9.852
11.304
2498
117.720
Date
lbs/ac
'rior Years Cumulative lbs/ac
12-2015
1000
;urrent Cumulative lbs/ac
'ermitted C. P. L. R.****
'ermit PAN Limit 1 st/2nd Crop
214
`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
�s f *Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1n6)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name:-l3axtei Healthcare - ` WQ Permit #: WQ0031725 Field #: DP4 Acres Utilized: 6.8
Land Owner: Douglas Poplin Annual Dry Tons Applied: 11.2949 Site #: DP4 Acres Permitted: 6.8
Operator: Douglas Poplin Predominant Soil Series: FcB2
Crop 1 Name: Fescue Crop 1 Max. PAN:
194
Crop 2 Name:.
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
O
y o
Q
Volume applied
PP
enter one Solids/
( )
Liquid
Cu. Yds Gallons
u
/o
Solids
Volume
A lied er
Pp p
Acre
D Tons/Ac
(Dry )
Residual Sources
(NPDES #, WQ#,Past
Fert., Animal
Waste, etc)
Soil
Cond.41
(Dry,
Wet,
Moist)
--
Precip.
24
Hrs.
inches
Y
^o
o
a
L o�'
o
w w
C,
*
a
PJ
aY
w•
* K'
TKN
mg/kg
z
c
o
� °
a E2•
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
8-2015
116.42
1L 2
1 1.661
WQ0031725
dry
0
S
1 0.5
1 0.3
78600
1 10200
2
85.117
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form)-
'OTALS:
116.42r
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
85.117
0.00o
Lime Applied
knnuallbs/acre
0.040
0.168
0.208
36
0.007
0.055
0.062
34
0.478
2.035
3.413
1338
0.365
2.N6
2.391
NA
0.050
0.241
0.291
267
0.001
0.008
0.009
15
0.020
0.104
0.124
NA
0.123
0.679
0.802
374
0.017
0.054
0.071
89
0.737
6.871
7.608
2498
51.796
Date
lbs/ac
'rior Years Cumulative lbs/ac
,urrent Cumulative lbs/ac
'ermitted C. P. L. R.****
'ermit PAN Limit lst/2nd Crop
194
`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
(�-)-ao)c
Signature of Land Applier Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1�} '3)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
Facility Name: Baxter Healthcare
Land Owner: Douglas Poplin
Operator: Douglas Poplin
Crop 1 Name: Fescue
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0031725 Field #: DP5 Acres Utilized: 11.82
Annual Dry Tons Applied: 22.2871 Site #: DP5 Acres Permitted: 11.82
Predominant Soil Series: FcB2
Crop 1 Max. PAN:
194
Crop 2 Name:
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
S.
y
o
i=a
Volume applied
(enter one) Solids/
Liquid
Cu. Yds I Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES # WQ#
>
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
a
10
c� �
a w
o
o
�',
* �.w
p
4
;n �
w
;
N'
Z
TKN
mg/kg
Z Y
� �
o
vac
�,•
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7-2015
56.85
11.52
0.467
WQ0031725
dry
0
S
0.5
0.3
78600
10200
2
23.912
NA
Fescue
8-2015
56.37
11.52
0.463
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
23.710
NA
Fescue
9-2015
88.31
11.52
0.725
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
37.144
NA
Fescue
10-2015
28.19
11.52
0.231
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
11.857
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
229.721
01
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
I P
96.622
0.000
Lime Applied
:Annuallbs/acre
0.045
0.008
0.543
0.415
0.057
0.002
0.023
0.140
0.019
0.837
67.896
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.149
0.048
2.535
1.639
0.224
0.007
0.091
0.589
0.04
5.959
12-2015
1000
-urrent Cumulative lbs/ac
0.194
1 0.056
3.078
2.054
0.281
0.009
0.114
0.729
0.059
6.796
Permitted C. P. L. R.****
36
34
1338
NA
267
15
NA
374
89
2498
Permit PAN Limit 1 st/2nd Crop
194
;`I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified -personnel -properly -gathered- and- evaluated -the-information-submitted. -I-am.aware_tha.t.ther_e are -significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
0-1-
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*xx Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1'` )6)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
d•
Facility Name: Baxter Healthcare WQ Permit #: WQ0031725 Field #: DP .
6 Acres i ize 3.97
Land Owner: Douglas Poplin Annual Dry Tons Applied: 13.1877 Site #: DP6 Acres Permitted: 3.97
--Operator:-Douglas-Poplin-- -- - ---
Cron 1 Name: Fescue
Predominant-Soil-Series:-FeB-2--- -
Crop 1 Max. PAN: 194 Crop 2 Name:
-Cation-Exchange-Capacity-(non-503)- -_-
Crop 2 Max. PAN:
y o
Q
Volume applied
enter one Solids/
( )
Liquid
Cu. Yds Gallons
o
/o
Solids
Volume
A hed per
pp P
Acre
(Dry Tons/Ac)
Residual So-arces
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Y
_
"
o� o
o
_
o
*
�
w =1
r.
-
v
TKN
mg/kg
Z
o
oa o
CD
w
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN A lied
pp
( lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
10-20151
55.46
11.52
1.355
W00031725
dry
0
S
0.5
0.3
78600
10200
2
69.452
NA
Fescue
12-2015
80.47
11.521
1.967
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
100.772
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
135.931
0
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
170.E4
0.000
Lime Applied
Annual lbs/acre
0.080
0..013
0.957
0.731.
0.100
0.003
0.040
0.246
0.033
1.475
119.592
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.201
_
0.069
_
3.628
2.507
0.332
0.008
0.128
0.614
0.04
8.272
Current Cumulative lbs/ac
0.281
0.082
4.585
3.238
0.432
0.011
0.168
0.860
0.073
9.747
Permitted C. P. L. R.****
36
34
1338
NA
1 267
1 15
1 NA
1 374
1 89
2498
Permit PAN Limit lst/2nd Crop
194
tUertify_, der penalty of law, that this document was prepared under my direction or supervision in accordance with a system aesignea to assure that
qualified -personnel -properly -gathered and-evaluated-the-infor-mation-submitted.- 1-am-aware -that there -are -significant penalties -for submitting -false . .
information, including the possibility of fines and imprisonment for knowing violations."
-e--j
Signature of Land Applier
a-1-a",.c
Date
*Application Method: S Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (` `)6)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD A. P PLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Baxter Healthcare
Land Owner: Douglas Poplin
Operator: Douglas Poplin
Crop 1 Name: Fescue
WQ Permit #: WQ0031725 Field #: DP7
Annual Dry Tons Applied: 10.9233 Site #• DP7
Predominant Soil Series: FcB2
Crop 1 Max. PAN: 194 Crop 2 Name:
Acres Utilized: 3.34
Acres Permitted: 3.34
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
° -o
° o
Q
Volume applied
enter one Solids/
( )
Liquid
Cu. Yds G2110nS
o
/o
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES # WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
D
(D,
Wet,
Moist)
Preci .
p
Past 24
Hrs.
inches
Y
cY
w
*
°
%�
w
o
=
w g
CD A,
* K
TKN
mg/kg
Z
�`
o
R.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(Ibs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
8-2015
59.32
11.52
1.723
WQ0031725
dry
0
S
0.5
0.3
78600
10200
2
88.298
NA
Fescue
9-2015
53.27
11.52
1.547
WQ0031725
dry
0
s
0.5
0.3
78600
10200
2
79.293
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
:'OTALS:1
112.591
0 1,
As
Cd
Cu
Cr
Pb
H g
Mo
Ni
Se
Zn
P
167.591
0.0oo
Lime A lied
'nnuallbs/acre
0.078
0.145
0.223
36
0.013
0.047
0.060
34
0.942
2.472
3.414
1338
0.719
1.6
2.319
NA
0.098 '
0.217
0.315
267
0.003
0.007
0.010
15
0.039
0.688
0.127
NA
0.242
0.576
0.818
374 1
0.033
0.037
0.070
89 1
1.452
5.795
7.247
2498
117.720
_.
Date
lbs/ac
?rlor Years Cumulative lbs/ac
�urrent Cumulative lbs/ac
3ermitted C. P. L. R.****
ennrt PAN Limit 1 st/2nd CropF
_. _.
194
•-1 certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed.to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
11; **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1;_ 6)

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ot
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4 !► ' , '1 �,�: ',. USGS Stream
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t {' n'
c�► `.fit
d1 f:
oplin, Douglas: Site Overview N
Parcel Id: 0602427 wE
0 500 1,000 2,000 Feet s
Wilkes County, NC I i i I I i I 1 Produced August 2015
36.2362-80.9418 North Carolina State lane, NA D83 Shaffer Soil Services, Inc.

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
- -MIF-
x.

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
BmaPd
,'oplin, Douglas: Site Evaluation Field Map
Field: DPI-B
Acres: 1.6 p 125 250
Wilkes Countv. NC I I I 1
500 Feet 5
—1 Produced August 2015
Shaffer Soil Services, Inc.

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
_--
a
P9
s

';�°�" �
The Compliance Boundary is established either 250
the property boundary, whichever is The Rev
'+
closer.
,,� ``►' -;
and the perimeter of the residuals application area
t►
e
7
r
D 1
!.D
9.6' acres
Buffers
Perennial Stream (100°)
House 100°)
House 4'00°)
Well (1 0°)
Property Boundary
Field Boundary Q House
USGS Stream o Well
® Unused Area
oplln, Douglas: Site Evaluation Field Map
eld: DP1-D
;res: 9.6
lkes Countv. NC
om the perimeter of the residuals application area or 50 feet within
oundary is established midway between the Compliance Boundary
N
0 125 250 500 Feet wE
I ° ° e 1 ° ° ° 1 Produced AugustP201
North Carolina star olane E_D a Shaffer Soil Services. In

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is establishedmidway between the Compliance Boundary
and the perimeter of the residuals application area.
q f1 4 y+ 4 S {h fIC
.44
e qq
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' t
�J
4 X
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y
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.,� ��; x[" ' c- `• r �� '�('�ti1�'�' ylow
am;
l
44P. 0 '
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tPi` t3,�w
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45
.r m: Buffers
Perennial Stream (1001)
House (1001)
House (4001)
.: Well (100')
Property Boundary
Field Boundary 0 House
The Compliance Boundary is established either 256 feet from the perimeter of the residuals application or 50 feet within �5�� �trea3lnl well
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary I , ® Unused Area
i and the perimeter of the residuals application area -
Poplin,
Douglas: Site Evaluation Field Map
Field: nn
Acres: 14.6
Mikes County, NC
36.24022, 0.94041
0 125 250 500 Feet
1 s o i B p a 1
AN
Wq �aE
Produced August201
Shaffer Soil Services, In(

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
V.
WIII
• �. - i J b
IU
`t
DP4 ,
8.7 acres
+ F
Buffers
Perennial Stream (100')
1.. Mouse 100"
t
i, Hawse 400'�
Well (1 ® )
Property Boundary
Field Boundary Q
House
USGS Stream o Well
® Unused Area
Poplin, Douglas: Site Evaluation Field Map "
Field: DP4 We
Acres: 8.7 0 126 250 500 Feet 5
KiIkes County, NC I I I I I 1 Produced August 2015
36.23854-80.93787 North Carolina Stateplane, NAD83 Shaffer Soil SeNioes, Inc.

Buffers r
Perennial Stream (100')
House 100'
House 4®0°3 b `'
Well (1 0')
Property Boundary
Field Boundary Q House
USGS Stream o Well
® Unused Area
U1 I
Nk;'.
ry s^
15.9 acres
r
M",
f
.' The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
' the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter of the residuals application area.
Poplin, Douglas: Site Evaluation Field Map "
Field: DP5 `"`�'E
Acres; 15.9 0 125 250 500 Feet
s
Wilkes County, NC I i I i , I Produced August 2015

The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary I
and the perimeter of the residuals application area.
i /�- (ram 'i ,r.�� ,Sri+• � \ ` , z "' _ ..
V.
17
DP,
5.5 acres
Poplin, Douglas: Site Evaluation Field Map
Field: DP6
Acres: 5.5 0 125
Buffers
Perennial Stream (100')
House 100')
House 400'
Well (1 0')
Property Boundary
Field Boundary A House
USGS Stream o Well
Na on_ ® unused Area
w�e
250 500 Feet 5
I I L I I Produced August 2015
i Stateplane, NAD83 Shaffer Soil Services, Inc.

t The Compliance Boundary is established either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary R,
and the perimeter of the residuals application area. J R
RT
4.
1/ri/' ' i` rr�„�•r`.��11 � a.�ia� V;+' , - i �- �.., Y� � � .�i� .a;'d'� e, rl

ilk
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EQUALIZATION
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2 5 P,—) 0 5 75
OF

LAN"." WASTE'
TREATMENT
PLANT -EVAWATiON
BAXTER HEALTHCARE.CORPORATION
McDOWELL- COUNTY, NORTH CAROLINA
T T
WATER
I i 150, 000 GALLON FILTER
CLARIFIER CLARIFIER FILTER SLUDGE BASIN WASHWATER
No.3 No.4 r
I:- I - i
rc? KIT
6"C1P�---�-
[ ♦J
/r--6"CIP-J� I CHLORINE AEROBIC
I CONTACT i DIGESTER C ti
I CHAMBERS No.2
K�r r CLARIFIER N La I I 1
Z! �I NQ.2 I�� I I •o\e \, l f �l�I I UV FILTER I _-
. I 4� i� y I I
K\ LLI_-,_ 12"CIP --- --�i F' -r�-_ _----12*aP-�---
I -� ---- z--4"CIP-- ( _
PUMP
BUILDING AEROBIC I III HOLD NGO '
DIGESTER - I I enslN
j. CLARIFIER No.1
III SLUDGE
No.1 I I DRYING BEDS
.. //III •
sJ^
C-��'•�.' - - `��� /� / III
rl�l
LAB & BELT
FILTER PRESS
m
-`� III
BUILDING.
IIE
12" UNFILTERE -
`-` BACKWASH LINE
_ _ L
-
"s

93
Beverly Eaves Perdue
Governor
. A
l
AOJE�
011 A
. .. _ -
North Carolina Department of Environment and
Division of Water Quality
Coleen K Sullins
Director
April 21, 2011
MR. STEPHEN TAYLOR, WASTEWATER SUPERVISOR
BAXTER HEALTHCARE CORPORATION
POST OFFICE BOX 1390
MARION, NORTH CAROLINA 28752
Dear Mr. Taylor:
Natural resources
AFIR 26 26P1 /
Asheville Regional. Office
Freeman
Secretary
Subject: Attachment A and B
Certification
Permit No. WQ0031725
Baxter Healthcare
Corporation
Land Application of Residual
Solids
McDowell County
In accordance with your permit modification application package received on November 4, 2010
as well as'the additional information received on March 2, 2011, we are forwarding herewith a modified
Attachment A and B, certified April 21; 2011, to Baxter Healthcare Corporation for the subject residuals -
land application program.
This certification is being issued to modify Attachment A to increase -the maximum dry tons per
year from 184 to 200 and to modify Attachment B by adding 59.82 acres of land application sites in
Wilkes County.
Please replace the existing Attachment A and B of Permit No. WQ0031725 that was
previously certified on September 18, 2007, with this modified Attachment A and B. Note that only
the vicinity and buffer maps for any new and modified land application sites are attached to this modified
Attachment B. It is the Permittee's responsibility to ensure that a complete permit is created by inserting
this modified Attachment A and B and vicinity and buffer maps into Permit No. WQ0031725, issued on
September 18, 2007, and making sure to retain any vicinity and buffer maps for any existing and
unmodified land application sites.
This modified Attachment A and B shall be effective from the date of certification; shall void
Attachment A and B of Permit No. WQ0031725 that was previously certified on September 18, 2007; and
shall be subject to the conditions and limitations as specified therein and, well as those specified in the
above -referenced permit. As always, remember to take the time to review this modified Attachment A
and B thoroughly, as some of the conditions contained therein may have been changed since the last
certification. Note that this modified Attachment A and B is hereby incorporated by reference into Permit
No. WQ0031725, issued on September 18, 2007.
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 2728 Caaital Boulevard, Raleigh, North Carolina 27604 One
Phone: [phone] FAX 1: 919-715-0588; FAX 2: 919-715-60481 Customer Service: 1-877-623-6748 01'IlclfCllll3:i
Internet: wro ww.ncwateualitV.org
An Fgllfli �-iPportuniiy�. F,iiln8➢v8 kctter,=mA `vpioyer

If any parts, req rents, and/or limitations contained i its certification or modified
Attachment A and B are unacceptable, you have the right to request an adj adicatory hearing upon written
request within 30 days following receipt of the certification. This request shall be in the form of a written
petition, conforming to Chapter 150B of the North Carolina General Statutes and filed with the Office of
Administrative Hearings at 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such
demands are made, .this permit shall be final and binding.
If you need any additional information concerning this matter, please contact Alice M. Wessner
by telephone at 919-715-5208 or via e-mail at [e-mail].
Sincerely,
eorhoeen H. Sullins
cc: Dennis Key, President, Southern Soil Builders, Inc. 958 Hoots Road, Roaring River, NC 28669
McDowell County Health Department
Wilkes County Health Department
she tale e oral C)_lfie_ e 'gfisi ftt- n, ect oi�
Winston Salem Regional Office_— Aquifer Proro 6` 'ion Section
APS Permit File WQ0031725
Notebook File WQ0031725

r-A
ATTACHMENT A - Approved Residual Sources
Baxter Healthcare Corporation
Certification Date: 04/21/20114'
Permit Number: WQ0031725
Version: 1.1
Monitoring
Monitoring
Monitoring
Permit
Biological
Maximum
Frequency for
Frequency for
Frequency for
Approved
Owner
Facility Name
County
Number
Residuals
Dry Tons
t
Non -hazardous
Metals and
Pathogen c&
Mineralization
Rate
Per Year
Characteristics
Nutrients
Vector Attraction
°' 5
Reductions
Baxter Healthcare
Baxter Healthcare
McDowell
NC000656
Yes
200
Annually
See Table Below
See Table Below
0.30
Corporation
Corporation
4
Total
Maximum Dry Tons per Year is the amount of residuals product approved for distribution from the permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2 in the permit issued September 18, 20(
3. Testing of metals and nutrients as stipulated under permit Condition IV.3 in the permit issued September 18, 2007.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA in the permit issued September 18, 2007. Permit application indicated that Fecal Coliform
Density Demonstration will be performed to meet pathogen reduction requirements, 38% Volptile Solids Reduction will be performed to meet vector attraction reductions. However, other
methods listed under 15A NCAC 02T .I 106(b) and . 1107(a) can also be'used to demonstrate compliance with this permit requirement.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
short tons per ear
Monitoring Frequency
Established in 40 CFR 503 and 15A NCAC 02T .1111
<319
1/Year
=>319 - <1,650
1/ Quarter 4 times per year)
—1,650 - <16,500
1/60 Days (6 times per year)
=>16,500
1/month (12 times per year)
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is
required), then no sampling data is required during the period of inactivity: The annual report shall include an explanation for missing sampling data.
Those required to submit the annual report to EPA may be required to make up the missed sampling, contact the EPA for additional information ani
clarification.
Page 1 of 1

ATTACHMENT B - Approved Land Application Sites
Baxter Healthcare Corporation
r
Certification Date: 04/21/2011
.a
Permit Niunber: WQ0031725 Version: 1.1
Field/
Site
Owner
r Lessee
County
Latitude
Longitude
Net Acreage
Dominant Soil Series
S-01
Setzer, Trilby T
Teague, Derek Lee
Catawba
35°37'60"
81004'27"
19.80
CmB2-Cecil
S-02
Setzer, Trilby T
Teague, Derek Lee
Catawba
35037'50"
81004'42"
25.00
HsB2-Hiwassee
T-0I
Teague, Larry Gray
Teague, Derek Lee
Catawba
35°37'19"
81005'37"
26.00
HsB2-Hiwassee
T-02
Teague, Larry Gray
Teague, Derek Lee
Catawba
35037'34"
81 °05'47"
10.00
MgC2-Madison
Total for Catawba County
80.80
DP 1-A
Poplin, Douglas
Wilkes
36014'05"
80056'40"
4.51
FcB2-Fairview
DPI-B
Poplin, Douglas
Wilkes
360 14' 05"
800 56' 35"
1.25
FcB2-Fairview
DPI-C
Poplin, Douglas
Wilkes
36' 14' 12"
80' 56' 44"
2.3
Fc132-Fairview
DPI-D
Poplin, Douglas
Wilkes
36° 14'.12"
800 56' 44"
7.95
FcB2-Fairview
DP2
Poplin, Douglas
Wilkes
360 14' 12"
800 56' 52"
5.02
FcB2-Fairview
DP3
Poplin, Douglas
Wilkes
' 366 14' 31"
800 56' 28"
12.86
FcB2-Fairview
DP4
Poplin, Douglas
Wilkes
360 14' 25"
800 56' 20"
6.8
FcB2-Fairview
DP5
Poplin, Douglas
Wilkes
360 14' 12"
800 56' 28"
11.82
FcB2-Fairview
DP6
Poplin, Douglas
Wilkes
360 14' 18"
800 56' 36"
3.97
FcB2-Fairview
DP7
Poplin, Douglas
Wilkes
36014' 25"
800 56' 36"
3.34
FcB2-Fairview
Total for Wilkes County
59.82
Total
.140.62
Total
Page 1 of 1

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PT MATTON AREA MAP
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C
RECEIVED / DENR / DWQ
Aquifer Profecfion Seciion
MAR 0 A, 2011
WQoo3noa -
(3Ck)(4(r I'+,A 6k�A�2
Owner L o0g 1az
r o be r, ..
Scale: 1" a� 0 ' . Field # )i ) - ll
(J ; i y(es
(I, -^ ��- Total
Acres I -7
Net Acres_ ,
STREAM
APPLICATION AREA — — — — — - PRIVATE ROAD
—y
DRAIN
HOUSE
FORESTED AREA
«'
SURFACE WATER ❑
OUTBUILDING
UNSUITABLE
—A
FENCE
WELL
O
STORAGE AREA
SOIL DESCRIPTION
SUITABLE FOR
INCORPORATION,
PROPERTY LINE
—_ (ev; pU
8.111/ SLOPE
_
Cur pl -te
—_...

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0 p - `I
Loa 00317as
Owner Oc" "s P P�'�-•,
Scale: V = a70Field # .QP Ll_
tit } �° s °"
Total
Acres Net .Acres
STREAM
APPLICATION AREA - -- - - - PRIVATE ROAD
-� DRAIN
®
HOUSE FORESTED AREA
C; SURFACE WATER
❑
OUTBUILDING UNSUITABLE
X--i!---A -- FENCE
0
WELL
STORAGE AREA
Q
SOIL DESCRIPTION SUITABLE FOR
O
INCORPORATION,
®
,_ PROPERTY LINE
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PPLICATION AREA MAP
Owner V 0a e l
_..
Scale: l" = a 70'
Field # Of' -5'
Total Acres 0_ �Net Acres/1
• $a+
—� STREAM
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