WQ0002349_Application_20040901

APPLICATION FOR PERMIT RENEWAL.
TOWN OF SPRUCE PINE
PERMIT NO. WQ0002349
Prepared For:
Southern Soil Builders, Inc.
958 Hoots Road
Roaring River, North Carolina 28669
Prepared By:
Branch Residuals & Soils, LLC
2007 Yanceyville St. Box 45
Greensboro, North Carolina. 27405
August 2004

BRANCH RESIDUALS & SOILS9 LLC
2007 YanceyviHe Street Box 45 • Greensboro, NC 27405
PHoNE [phone] FAX [phone]
August 31, 2004
NCDENR -Division of Water Quality
Permits and Engineering Unit
Post Office Box 29535
512 North Salisbury Street
Raleigh, North Carolina 27626-0535
Attention: Mr. Shannon Thornburg
RECEIVED DENRI DWQ
AQUIFER PROTECTION SECTION
SEP 0 1 Z004
Reference: RENEWAL OF PERMIT NO. WQ0002349
Town of Spruce Pine
Residual Solids Management Program
BR&S Job No. 2004-37
Dear Mrs. Thornburg:
Branch Residuals & Soils, LLC is under contract with Southern Soil Builders, Inc. to provide
assistance in the preparation of a land application permit renewal for the Town of Spruce Pine. The
permitted dry tons for this facility has been decreased from 290 dry tons per year to 95 dry tons per
year. The reason for this decrease is the amount of land in the program. The Town of Spruce Pine
will be looking for additional land to utilize these residuals. A permit modification will likely be
made in the next three months to add land. It is estimated that this modification will be
incorporated with the permit review.
Your attention in the review of this application would be greatly appreciated. Please contact us
immediately if you require additional information or have questions in the review of the permit
application.
Sincerely,
Robert T. Branch, L. S. S.
Project Manager
cc: Mr. Dennis Key — Southern Soil Builders, Inc.
Mr. Richard Canipe, Town Manager, Town of Spruce Pine, North Carolina

TABLE OF CONTENTS
Section No. Title
I NON -DEDICATED RESIDUALS LAND APPLICATION PROGRAM
H RESIDUALS SOURCE CERTIFICATION ATTACHMENT WWTP
A Facility vicinity map
B Process flow diagram and narrative
C Justification for residuals production rate
D Residuals sampling plan
_ III LAND APPLICATION SITE CERTIFICATION ATTACHMENT
A Watershed Classification Attachment for Residuals Programs
C Landowner Agreement Attachment
E Vicinity and Buffer Maps
G Cumulative Pollutant Loading Rates and Analysis of Soil Samples to
Include Heavy Metals

NON -DEDICATED RESIDUALS LAND APPLICATION PROGRAM

State of North Carolina
Department of Environment and Natural Resources
- Division of Water Quality
INSTRUCTIONS FOR FORM: NDRLAP 02/02
(NON -DEDICATED RESIDUALS LAND APPLICATION PROGRAMS)
The Division of Water Quality (Division) will not consider this application form to be complete
unless all the instructions are followed. Failure to follow the instructions or to submit all of the
required items will lead to additional application processing and review time.
For more information or for an electronic version of thisform, visit our web site at:
hQ. //h2o. enr . state. nc. us/ndP
INSTRUCTIONS TO THE APPLICANT:
A. Application Form:
✓ This application form must be submitted for any permitting action involving a non -dedicated residuals
land application program.
✓ Non -dedicated residuals land application programs are ones in which all land application sites do not meet the
criteria in 15A NCAC 2H .0203 (11)(a) and (b). Specifically, a residuals land application program cannot be
designated as non -dedicated if any of the following is applicable:
♦ Any land application site certified for the residuals land application program that receives residuals at
rates or frequencies greater than agronomically justifiable.
♦ Any land application site certified for the residuals land application program that is used primarily for
residuals disposal alone (i.e., versus crop production).
♦ Any land application site certified for the residuals land application program that is designated as
dedicated by the Division's Director.
✓ Any changes to this application form will result in the application package being returned.
✓ All forms and guidance documents referred to in this application form may be downloaded from the web site
at http://h2o.enr.state.nc.us/ndpu/.
B. General Information:
✓ The applicant is either the existing Permittee or the entity that is to be responsible for the operation of the
residuals land application program and compliance with the resultant permit. If the applicant is a corporation,
ensure that that applicant's name as listed in Item I. 1. corresponds with the name under which the corporation
is registered with the NC Department of. the Secretary of State.
✓ The signing official must meet the criteria stipulated in 15A NCAC 2H .0206 (b). An alternate person may be
designated as the signing official, provided that a delegation letter from a person who meets the referenced
criteria is submitted. The delegation letter does not have to be resubmitted if the signing official has not
changed since the last permitting action associated with this residuals land application program.
✓ The submitted fee should be in accordance with the Division's most recently -adopted fee schedule. This fee
schedule as well as a detailed explanation of its application may be downloaded from the web site at:
http://h2o.enr.state.nc.us/ndpu/. ' Checks are to be made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
C. Submission of Application Packages:
✓ Submit one original and three copies of the entire application package, including the cover letter, the
completed and appropriately executed application form, as well as all required attachment forms and
supplemental attachments. The instructions (Pages 1 of 5) do not need to be submitted.
✓ To determine which attachment forms and supplemental attachments are required to make a complete
application package, read the instructions of each attachment form carefully. Application packages should be
organized and bound (i.e., stapled, three-ring binder, etc.) in the following order prior to submission:
♦ Cover letter and application fee.
♦ Attachment Order 1: Non -Dedicated Residuals Land Application Programs (Form NDRLAP).
➢ Attachment Order 1-a: Signing official delegation letter.
♦ Attachment Order 2: Residuals Source Certification Attachment (Form RSCA).
♦ Attachment Order 3: Land Application Site Certification Attachment (Form LASCA).
✓ The application package should be sent to the address at the end of this application form. Do not submit this
application package to any Division regional office.
FORM: NDRLAP 02/02 Pagel of 5 Attachment Order 1.

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
NON -DEDICATED RESIDUALS LAND APPLICATION PROGRAMS
(THIS FORMMAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
Application Number: (to be completed by DWQ)
I. GENERAL INFORMATION (See Instruction B.):
1. Applicant's name: Town of Spruce Pine.
2. Signing official's name and title: Mr. Richard Canipe, Town Manager
3. Complete mailing address of applicant: P. O. Box 189
City: Spruce Pine State: NC Zip: 28777
Telephone number: ( 828 ) 765-3000 Facsimile number: ( 828 ) 765-3014
E-mail address: [e-mail]
4. Name and complete mailing address of contact:person and/or consulting firm who prepared application:
Bob Branch — Branch Residuals & Soils, LLC, 2007 Yanceyville St. Box 45
City: Greensboro State: NC Zip: 27405
Telephone number: ( 336 ) 510-0340 Facsimile number: ( 336 ) 510-0341
E-mail address: [e-mail]
5. County where residuals land application program is headquartered: Mitchell
6. County(ies) where residuals source -generating facilities are located: Mitchell
7. County(ies) where land application sites are located: Mitchell
8. Fee submitted: $
H. PERMIT INFORMATION:
1. Application is for: ❑ new, ❑ modified, ® renewed permit (check all that apply).
2. If this application is being submitted to renew or modify an existing permit, provide the following:
the permit number WQ0002349 ,
the most recent issuance date April 29, 2002 , and the expiration date December 31, 2004
Date of most -recently certified Attachment A: April 29, 2002
Date of most -recently certified Attachment B: April 29, 2002
FORM: NDRLAP 02/02 Page 2 of 5 Attachment Order 1

3. Check all that apply to the requested permit modification:
the maximum permitted annual dry tonnage for existing residuals
❑ INCREASE ® DECREASE source -generating facility(ies) certified for this residuals land
application program.
❑ ADD ❑ DELETE residuals source -generating facility(ies) to/from those certified for
this residuals land application program.
❑ INCREASE ❑ DECREASE
❑ ADD ® DELETE
❑ OTHER. Explain:
the net acreage associated with land applications site(s) currently
certified for this residuals land application program.
land application site(s) to/from those certified for this residuals land
application program.
M. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Who will be responsible for the day-to-day management of the residuals, land application program:
❑ Permittee or ® residuals management firm. If a residuals management firm, complete the following:
Firm contact person and title: Mr. Dennis Key- President- Southern Soil Builders, Inc.
958 Hoots Road
City: Roaring River State: NC Zip: 28669
Telephone number: ( 336 ) 957-8909 Facsimile number: ( 336 ) 957-8940
E-mail address: [e-mail]
2. 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..
13532
Back -Up ORC
David Key
Southern Soil Builders, Inc.
23629
Additional Back -Up ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application
program, provide the candidates' names, affiliations, and an estimated time schedule for each candidate's
completion of the required training school and certification test:
FORM: NDRLAP 02/02
Page 3 of 5
Attachment Order 1

3. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitroeen Summary: Determine the maximum plant available nitrogen (PAN)
generated by all residuals source -generating facilities as currently certified and proposed for
certification with this application and list the results in the following table:
Maximum amount of residuals to be certified: 95 dry tons per year.
PAN
First - Year
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
1 37.11
39.01
1 3,525.64
3,706.14
Five Year Maximum Adjusted
1 58.23
60.13
1 5,531.95
5,712.45
b. Land Application Site Use Summary: Summarize information regarding the land application sites as
currently certified and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0.00
Row Crops
0.00
Hay
23.00
Pasture
.0.00
Total:
23.00
Methods
Surface
23.00
Incorporation or Injection
0.00
Total:
23.00
Restrictions
Year -Round
20.00
Seasonal
3r00
Total:
23.00
I
C. Residuals Land Application Summary: Determine the minimum acreage required to land apply the
residuals as currently certified and proposed for certification assuming the scenarios listed in the
followina table:
Assumed
Application Rate
(!bs PAN/ac yr)
Acres Required Using
First -Year PAN Concentration
Acres Required Using
Five -Year Maximum Adjust PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
70
50.37
52.94
79.03
81.61
150
23.50
24.71
36.88
38.08
250
14.10
14.82
22.13
22.85
FORM: NDRLAP 02/02 Page 4 of 5 Attachment Order 1

4. Identify and provide a plan as well as a schedule to resolve any issues that would prevent all of theresiduals
currently certified and proposed for certification to be land applied without exceeding agronomic rates or
violating any of North Carolina's standard permit conditions governing residuals land application programs
(e.g., not enough storage, not enough land, etc.): Currently the Town of Spruce Pines has sufficient land
to spre'ud 5.5 dry tons of biosolids. The Town of Spruce Pine will monitor this situation very carefully to
determine whether additional land. is needed or to take other action as necessary to insure permit compliance.
Applicant's Certification:
I, Mr._ Richard Canipe, Town Manager , attest that this application for Town of Spruce Pine
Land Application Permit Renewal has been reviewed by me and is
accurate and complete to the best of my knowledge. I understand that the Division of Water Quality 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 Quality should a condition of this permit be violated. I also
understand that if all required parts of this application are not completed and that if all required supporting
information and attachments are not included, this application package will be returned to me as incomplete. Note:
In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly
makes any false statement, representation, or certification in any application shall be guilty of a Class 2
misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: - e�---c5—_. Date:�� C
THE COMPLETED APPLICATION PACKAGE,
INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
8/17R004 1:13 PM
By Courier/Special Delivery:
512 NORTH SALISBURY STREET, SUITE 1219
RALEIGH, NORTH CAROLINA 27604 .
TELEPHONE NUMBER: [phone]
*** END OF FORM NDRLAP 02/02 ***
FORM: NDRLAP 02/02 Page 5 of 5 Attachment Order 1

RESIDUALS SOURCE CERTIFICATION ATTACHMENT WWTP

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
RESIDUALS SOURCE CERTIFICATION ATTACHMENT
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality (Division) will not consider this attachment form to be complete
unless all the instructions are followed. Failure to follow the instructions or to submit all of the
required items will lead to additional application processing and review time.
For more information orfor an electronic version of this form, visit our web site at. http✓/h2o.enr state.nc.tts/ndpu/
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding residuals program application
form (Form NDRLAP).
✓ Any changes to this attachment form will result in the application package being returned.
✓ For new residuals programs or renewed residuals programs, submit a separate attachment form for each
residuals source -generating facility to be certified for this residuals program.
✓ For modified residuals programs in which any modification to the certified residuals -source generating facilities
is proposed, submit a separate attachment form for o& those residuals source -generating facilities that are
affected by the proposed modification.
✓ The attachment should be organized prior to submission in the following order (i.e., by facility):
♦ Attachment Order 2: Residuals Source Certification Attachment (Form RSCA).
➢ Attachment Order 2-a: Vicinity map.
➢ Attachment Order 2-b: Process flow diagram and/or narrative.
➢ Attachment Order 2-c: Quantitative justification for residuals production rate.
➢ Attachment Order 2-d: Sampling plan.
➢ Attachment Order 2-e: Laboratory analytical reports and operational data.
✓ All forms and guidance documents referred to in this attachment form may be downloaded from the web site
at http://h2o.enr.state.ncus/ndpu/.
B. Residuals Source -Generating Facility Information:
✓ Attach a vicinity map that shows the location of the facility and meets all of the criteria in the latest version of
the document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs."
✓ Attach a detailed narrative and/or process flow diagram that describes how the residuals are to be generated,
treated, processed, and stored at the facility.
✓ Attach a quantitative justification for the value provided in Item I. 8. Ensure that the amount of residuals listed
is the maximum amount expected to be generated by the facility for the life of the permit. In addition, ensure
that this amount is equivalent to that which is actually to be land applied, distributed, and/or disposed, including
any chemicals, amendments, or other additives that are.added to the residuals during processing.
C. Residuals Quality Information:
✓ Attach a detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In
addition, ensure that the plan details how the facility and/or the residuals are monitored for any applicable
pathogen reduction and vector attraction reduction requirements. Note that all sampling and monitoring must
be completed on the residuals as they are to be land applied, distributed, and/or disposed.
✓ Attach reports for all laboratory analyses used to complete this attachment form. Attach documentation that the
facility complies and/or the residuals comply with any applicable pathogen reduction and vector attraction
reduction requirements. Renewed residuals programs and modified residuals programs are exempt from this
requirement as long as the facility is (i) currently certified for this residuals program; (ii) no changes in the
generation, treatment, processing, and/or storage are proposed; and (iii) a land application/distribution/disposal
event has taken place in the last three years. This exemption will not be allowed unless all three of these criteria
are met.
✓ Item lI. 3. 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.
FORM: RSCA 02/02 Page 1 of 8 Attachment Order 2

Applicant's name: Town of Spruce Pine
Check all that apply: ❑ NEW RESIDUALS PROGRAM ® RENEWED RESIDUALS PROGRAM
❑ INCREASE ® DECREASE the maximum permitted annual dry tonnage for this residuals
source -generating facility certified for this residuals program.
Current: 290 and proposed: 95 dry tons per year.
❑ ADD ❑ DELETE this residuals source -generating facility to/from those certified for
this residuals program.
L
1
2.
3.
4.
❑ OTHER Explain:
RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
Name of facility: Town of Spruce Pine WWTP
Facility permit holder: Tow of Spruce Pine
Facility permit holder is (check one): ❑ federal, ❑ state, ® local government, or ❑ private.
Facility permit number: NCO021423
Facility permit issued by (check one): ® Div. of Water Quality, ❑ Div. of Environmental Health, or
❑ other (explain: ).
If the facility permit is not issued by the Div. of Water Quality, complete the following:
a. Facility contact person and title:
Facility complete mailing address:
City: State: Zip:
Telephone number: ( ) Facsimile number: ( )
E-Mail address:
b. Facility complete location address: _
City:
County:
Latitude:
Purpose of the facility (check one):
State: Zip:
and longitude:
® 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, or
(approximate percentages: % industrial and % domestic)
❑ other (explain:
5. Is the facility required to have an approved pretreatment program: ® yes ❑ no.
If yes, please specify whether or not such a pretreatment has been approved ® yes ❑ no.
6. Facility permitted/design flow: 2.0 MGD and facility average daily flow: 0.4 MGD.
7. Maximum amount of residuals to be certified for this facility: 95 dry tons per year.
FORM: RSCA 02/02 Page 2 of 8 Attachment Order 2

8. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 1- 200,000 gallon digester
Type and volume of residuals storage (i.e., outside of residuals treatment units): None
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under (check one): ® 40 CFR Part 503 or ❑ 40 CFR Part 257.
2. Specify if residuals are intended for (check one):
❑ Land Application/Distribution (Class A or Equivalent).
Complete all items EXCEPT Items H. 4b., 4c., 7b., and 7c.
Z Land Application (Class B or Equivalent).
Complete all items EXCEPT Items II. 4a., 4c., 7a., and 7c.
❑ Surface Disposal.
Complete all items EXCEPT Items II. 4a., 4b., 5., 7a., 7b., and 8.
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non-
hazardous under RCRA:
a. Are the residuals are 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. 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: PAR Labs, Inc. and date of analysis: 4/28/04
Passed corrosivity test: ® yes ❑ no. pH: 6.2 s.u. (2 < pH < 12.5).
Passed ignitability test: ® yes ❑ no. Flashpoint: >200 OF (> 140°17).
Passed reactivity test: ® yes El no. HCN: Non mg/kg (<250) & HZS: Non mg/kg (<25)
TCLP Parameter
Limit
(MI -IL)
Result
(mg/L)
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
Arsenic
5.0
<0.5
Hexachlorobenzene
0.13
<0.013
Barium
100.0
<10.0
Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene
0.5
<0.05
Hexachloroethane
3.0
<0.3
Cadmium
1.0
<0.1
Lead
5.0
<0.5
Carbon Tetrachloride
0.5
<0.05
Lindane
0.4
<0.04
Chlordane
0.03
<0.003
Mercury
0.2
<0.02
Chlorobenzene
1 100.0
<10.0
Methoxychlor
10.0
5:1.0
*** TABLE CONTINUES ON NEXT PAGE ***
FORM: RSCA 02/02 Page 3 of 8 Attachment Order 2

*** TABLE CONTINUED FROM PREVIOUS PAGE ***
TCLP Parameter
Limit
(mg/L)
Result
(mg/L)
TCLP Parameter
Limit
(M91L)
Result
(mg/L)
Chloroform
6.0.
<0.6
Methyl Ethyl Ketone
200.0
<20.0
Chromium
5.0
<0.5
Nitrobenzene
2.0
<0.2
m-Cresol
200.0
<20.0
Pentachlorophenol
100.0
<10.0
o-Cresol
200.0
<20.0
Pyridine
.5.0
<0.5
p-Cresol
200.0
<20.0
Selenium
1.0
<0.1
Cresol
200.0
<60.0
Silver
5.0
<0.5
2,4-D
10.0
<0.013
Tetrachloroethylene
0.7
<0.07 ,
1,4-Dichlorobenzene
7.5
<0.75
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.05
Trichloroethylene
0.5
<0.05
1,1-Dichloroethylene
0.7
<0.07
2,4,5-Trichlorophenol
400.0
<40.0
2,4-Dinitrotoluene
0.13
<1.0
2,4,6-Trichlorophenol
2.0
<0.2
Endrin
0.02
<0.002
2,4,5-TP (Silvex)
1.0
<0.1
Heptachlor and its Hydroxide
0.008
<0.0008
Vinyl Chloride
0.2
<0.02
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 40 CFR Part 503 or 40 CFR Part
257:
a. For Class A or Equivalent: Fill in the following table with the results of the latest analyses (i.e., on a
dry weight basis) for the following metal parameters: laboratory: -
and date of analysis:
Parameter Analysis Required for
Permitting by NC if Residuals are
Regulated Under...
Parameter
Ceiling
Concentration
(mg1kg)
Monthly
Average
Cencentration
(mg1kg)
Result
(mg1kg)
40 CFR Parts 257 and 503
Arsenic
75
41
40 CFR Parts 257 and 503
Cadmium
85
39
40 CFR Parts 257 and 503
Copper
4,300
1,500 '
40 CFR Parts 257 and 503
Lead
840
300
40 CFR Parts 257 and 503
Mercury
57
17
40 CFR Parts 257 and 503
Molybdenum
75
n/a
40 CFR Parts 257 and 503
Nickel
420
420
40 CFR Parts 257 and 503
Selenium
100
100
FORM: RSCA 02/02 Page 4 of 8 Attachment Order 2

b. For Class B or Equivalent: Fill in the following table with the results of the latest analyses (i.e., on a
dry weight basis) for the following metal parameters: laboratory: A & L Agricultural Labs
and date of analysis:
4/16/04
Parameter Analysis Required for
Permitting by NC if Residuals are
Regulated Under...
Parameter
Ceiling.
Concentration
(mg/kg)
Result
(mg/kg)
40 CFR Parts 257 and 503
Arsenic
75
1.61
40 CFR Parts 257 and 503
Cadmium
85
2.40
40 CFR Parts 257 and 503
Copper
4,300
317.00
40 CFR Parts 257 and 503
Lead
840
37.00
40 CFR Parts 257 and 503
Mercury
57.
3.61
40 CFR Parts 257 and 503
Molybdenum
75
11.00
40 CFR Parts 257 and 503
Nickel
420
26.00
40 CFR Parts 257 and 503
Selenium
100
4.92
40 CFR Parts 257 and 503
Zinc
7,500
666.00
c. For Surface Disposal: Fill in the following table with the results of the latest analyses (i.e., on a dry
weight basis) for the following metal parameters: laboratory:
and date of analysis:
Parameter Analysis Required
for Permitting by NC
if Residuals are Regulated Under...
Closest Distance to
Property Lines
(meters)
Arsenic
(mg/kg
Chromium
(mg/kg)
Nickel
(mg/kg)
40 CFR Parts 257 and 503
> 0 but < 25
30
200
210
40 CFR Parts 257 and 503
> 25 but < 50
34
220
240
40 CFR Parts 257 and 503
> 50 but < 75
39
260
270
40 CFR Parts 257 and 503
> 75 but < 100
46
300
320
40 CFR Parts 257 and 503
>_ 100 but < 125
53
360
390
40 CFR Parts 257 and 503
> 125 but < 150
62
450
420
40 CFR Parts 257 and 503
>_ 150
73
600
420
FORM: RSCA 02/02 Page 5 of 8 Attachment Order 2

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 3.72 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the
following nutrient and micronutrient parameters: laboratory: A & L Agricultural Labs
and date of analysis: 4/16/04
Parameter
Result
(mg/kg)
Aluminum
19,800.00
Ammonia -Nitrogen
1,900.00
Calcium
11,100.00
Magnesium
3,600.00
Nitrate -Nitrite Nitrogen
26.00
pH
6.80
Phosphorus
22,300.00
Potassium
5,900.00
Sodium
1,300.00
Total Kjeldahl Nitrogen
60,500.00
c. Using the results listed in Item H. 5b. above, calculate the sodium adsorption ration (SAR): 0.53
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the
residuals: 30 %. This rate is a ® default value or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or
provide technical justification as to why the selected default value is appropriate to be applied to these
residuals: Default value for aerobic digestion.
Calculate the PAN for the residuals (i.e., on a dry weight basis) and list the results in the following table:
Application Method
First Year
Five -Year
PAN
Maximum Adjusted
PAN
(mg/kg)
(mg/kg)
Surface
18,556
29,116
Injection/Incorporation
19,506
30,066
e. Are the residuals are a registered fertilizer with the NC Department of Agriculture and Consumer
Services: ❑ yes ® no. If yes, provide date of registration approval:
the current registration number:
and the fertilizer equivalent:
%, %, and %.
FORM: RSCA 02/02 Page 6 of 8 Attachment Order 2

6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the
residuals and list the results of the latest analyses:
7. Pathogen Reduction Determination: Specify which alternative(s) will be used to meet the pathogen
reduction requirements:
a. For 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 NUN per 4 grams of total dry solids.
AND one of the following (except for residuals regulated under 40 CFR Part 257 that are to be distributed):
❑ Alternative 1 [40 CFR §503.32 (a)(3)] - Time/Temperature Compliance.
❑ Alternative 2 [40 CFR §503.32 (a)(4)] - Alkaline Treatment.
❑ Alternative 3 [40 CFR §503.32 (a)(5)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [40 CFR §503.32 (a)(6)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [40 CFR §503.32 (a)(7)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment, ❑ pasteurization,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation, or ❑ gamma ray irradiation.
❑ Alternative 6 [40 CFR §503.32 (a)(8)] - PFRP-Equivalent Process.
Explain:
b. For Class B or Equivalent:
® Alternative 1 [40 CFR §503.32 (b)(2)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [40 CFR §503.32 (b)(3)] -Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
❑ Alternative 3 [40 CFR §503.32 (b)(4)] - PSRP-Equivalent Process.
Explain:
❑ Not Applicable - Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
c. For Surface Disposal:
❑ Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)] - Soil/Other Material Cover.
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II.7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II.7b. above.
❑ Not Applicable -Regulated under 40 CFR Part 257 with NO Domestic Wastewater Contribution.
FORM: RSCA 02/02 Page 7 of 8 Attachment Order 2

8. Vector Attraction Reduction Determination: Specify which alternative(s) will be used to meet the vector
attraction reduction requirements:
❑ Alternative 1 [40 CFR §503.33 (b)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [40 CFR §503.33 (b)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
® Alternative 3 [40 CFR §503.33 (b)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [40 CFR §503.33 (b)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [40 CFR §503.33 (b)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [40 CFR §503.33 (b)(6)] - Alkaline Stabilization.
❑ Alternative 7 [40 CFR §503.33 (b)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [40 CFR §503.33 (b)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [40 CFR §503.33 (b)(9)] - Injection.
❑ Alternative 10 [40 CFR §503.33 (b)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only [40 CFR §503.33 (b)(11)1- Soil/Other Material Cover.
❑ Alternatives for Animal Processing Residuals Only:
Specify one: ❑ injection, ❑ incorporation, or ❑ lime addition to raise pH to 10.
❑ Not Applicable - Non -Animal Processing Residuals Regulated under 40 CFR Part 257 with NO Domestic
Wastewater Contribution.
*** END OF FORM RSCA 02/02 ***
8/17/2004 9:34 AM
FORM: RSCA 02/02 Page 8 of 8 Attachment Order 2

Facility Vicinity Map

Process Flow Diagram and Narrative

J
WASTEWATER TREATMENT PLANT PROCESS
The Town of Spruce Pine operates a 2.0 MGD facility which utilizes an oxidation ditch type
wastewater treatment plant, processing a municipal wastewater. The treatment scheme includes grit
removal facilities, an oxidation ditch, splitter box, two clarifiers, chlorine contact chamber, sulfate
addition chamber and digester for thickening. After grit removal and oxidation in the oxidation
ditch the influent is directed to one of two clarifiers. Solids are either returned to the oxidation
ditch as return activated sludge or sent to the digester for thickening and final sludge storage.
Liquids from the clarifiers are sent to the chlorine contact chamber for chlorine addition, sulfate
addition chamber for dechlorination and to a weir system prior to -discharge to the North Toe River.
A process schematic for the Town of Spruce Pine WWTP is presented on the following page.

4,Nwasf
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Justification for Residuals Production Rate

JUSTIFICATION FOR WWTP RESIDUALS PRODUCTION RATE
The dry tons permitted for this facility has been decreased from 290 to 95 dry tons based on the
amount of land available for permit renewal. The Town of Spruce Pine will be looking to secure
additional land to add for this project over the next few months to return the production rate to a
more realistic rate. The Town of Spruce Pines will be looking at appropriate avenues to increase
the available land for this program as necessary.

Residuals Sampling Plan

WWTP SAMPLING PLAN
Prior to application, multiple grab residual solid samples are collected from the 200,000 gallon
aerated digester. These samples are composited for nutrient and metal analyses. The composited
sample is mixed to keep the solids suspended and containers filled for this analysis. Individual grab
samples are collected and sent for fecal coliform analysis. Additional samples are collected at this
time and sent to a qualified laboratory for analysis of the 30 day bench test for vector attraction
reduction.
Annually, or when the residual solids are to be land applied, a composite residual solid sample will
be analyzed for: Arsenic, Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc,
Aluminum, Ammonia — Nitrogen, Calcium, Nitrate -Nitrite, Nitrogen, Magnesium, % Total Solids,
pH, Phosphorus, Potassium, TKN, and Sodium. From this information, the Plant Available
Nitrogen (PAN) will be calculated. Annually a composite TCLP sample will be collected to
include:
Arsenic
Hexachlorobenzene
ph for Corrosivity
Barium
Hexachloro-1,3-Butadiene
Benzene
Hexachloroethane
Flash point for ignitability
Cadmium
Lead
Carbon Tetrachloride
Lindane
Sulfides and Cyanides for reactivity
Chlordane
Mercury
1,2-Dichloroedme
Chlorobenzene
Methoxychlor
1,1-Dichloroethylene
Chloroform
Methyl Ethyl Ketone
2,4-Dinitrotoluene
Chromium
Nitrobenzene
Endrin
m-Cresol
Pentachlorophenol
Heptachlor and its Hydroxide
o-Cresol
Pyridine
Trichloroethylene
p-Cresol
Selenium
2,4,5-Trichlorophenol
Cresol
Silver
2,4,6-Trichlorophenol
2,4-D
Tetrachloroethylene
2,4,5-TP (Silvex)
1,4-Dichlorobenzene
Toxaphene
Vinyl Chloride

LAND APPLICATION SITE CERTIFICATION ATTACHMENT

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
LAND APPLICATION SITE CERTIFICATION ATTACHMENT
(THISFORMMAYBE PHOTOCOPIED FOR USE ASAN ORIGINAL)
The Division of Water Quality (Division) will not consider this attachment form to be complete
unless all the instructions are followed. Failure to follow the instructions or to submit all of the
required items will lead to additional application processing and review time.
For more information or for an electronic version of this form, visit our web site at. hup.11h2o.enr.state.nc.us/ndpu/
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for.review without a corresponding residuals program application form (Form
NDRLAP).
✓ Any changes to this attachment form will result in the application package being returned.
✓ For new residuals land application programs or renewed residuals land application programs, submit the requested
information for all land application sites to be certified for this residuals land application program.
✓ For modified residuals land application programs in which any new/transferred land application sites or modification to
the certified land application sites are proposed, submit the requested information for only those land application sites
that are new/transferred or affected by the proposed modification.
✓ All forms and guidance documents referred to in this attachment form may be downloaded from the web site at
http://h2o.enr.state.nc.us/ndpu/.
B. , Land Application Site Information:
Additional copies of Page 2 of 2 of this attachment form may be used if necessary.
✓ The status of the land application site with respect to this residuals land application program must be provided in the table
in Item 1. 1. The status categories and their corresponding codes are as follows:
New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T)
✓ If this is the first time that an application package is being submitted using Form NDRLAP, then a Watershed
Classification Attachment for Residuals Programs (Form RWSCA) must be completed for all existing land application
sites.
✓ For each land application site with a status code of N, attach the following in the order specified:
♦ Attachment Order 3: Land Application Site Certification Attachment (Form LASCA).
➢ Attachment Order 3-a Watershed Classification Attachment for Residuals Programs (Form RWSCA).
➢ Attachment Order 3-b: County Manager Notification Attachment (Form CMNA).
➢ By Land Application Site:
■ Attachment Order 3-c: Landowner Agreement Attachment (Form LOAA).
■ Attachment Order3-d: Buffer Waiver Agreement Attachment (Form BWAA).
■ Attachment Order 3-e. An updated vicinity/buffer map that meets all of the criteria in the latest version of
the document entitled "Guidance for the Preparation of Vicinity/Buffer Maps for North Carolina Residuals
Permitting Programs."
■ Attachment Order 3-f A soils and agronomic evaluation that meets all of the criteria in the latest version of
the document entitled "Guidance for the Preparation of Soils and Agronomic Evaluations for North
Carolina Residuals Permitting Programs."
✓ For each land application site with a status code of R, attach the following in the order specified:
♦ Attachment Order 3: Land Application Site Certification Attachment (Form LASCA).
➢ By Land Application Site:
■ Attachment Order 3-c: Landowner Agreement Attachment (Form LOAA).
■ Attachment Order 3-d: Buffer Waiver Agreement Attachment (Form BWAA).
■ Attachment Order 3-e: An updated vicinity/buffer map (i.e., see above for criteria guidance).
■ Attachment Order 3-g: An updated accounting of the land application site's cumulative pollutant loading
rates (CPLRs) that are required by the permit of the residuals land application program from which the site
is being transferred.
✓ For each land application site with a status code of M contact the appropriate Division's regional office to determine
attachment requirements.
✓ For each land application site with a status code of T attach the following in the order specified:
♦ Attachment Order 3 through 3-f: Everything required for land application sites with a status code of N.
➢ Attachment Order 3-g: An updated accounting of the CPLRs (i.e., see above for criteria guidance).
FORM: LASCA 02/02 Page 1 of 2 Attachment Order 3

C-M
Applicant's name: Town of Spruce Pine
Check all that apply: ❑ NEW RESIDUALS LAND APPLICATION PROGRAM ® RENEW RESIDUALS LAND APPLICATION PROGRAM
❑ ADD ® DELETE this/these land application site(s) to/from those certified for this residuals land application program.
❑ INCREASE ❑ DECREASE the net acreage associated with this/these land application site(s) currently certified for this
residuals land application program.
❑ OTHER Explain:
Land application sites currently certified: 55.0 net acres and proposed for certification:
Approximate percentages: 0 % forested, 100 % agricultural, and 0
I. LAND APPLICATION SITE INFORMATION (See Instruction B.):
1. Complete the following table with the requested information:
0.0 net acres. Total to be certified: 23.0 net acres.
% reclamation sites.
Status
Code
Site/Field ID
Landowner(s)
Leasee(s) or Operators
J
County
Net Acres
Predominant
Soil Series
Soil
CEC
R
H - IA
Coy D. Hollifield
Coy D. Hollifield
Mitchell
5
Dillsboro
8.7
R
H - 1B
Coy D. Hollifield
Coy D. Hollifield
Mitchell
3
Rosman
8.7
R
SP - 1
Penland Bailey Corporation
K.T. Feldspar Corporation
Mitchell
15
Udorthents
9.8
D
U -1
Penland Bailey Corporation
Unimen Corporation
Mitchell
D
U - 2
Penland Bailey Corporation
Unimen Corporation
Mitchell
D
B -1
Mark Byrd
Mitchell
D
P - 1
Tommy Phillips
Mitchell
FORM: LASCA 02/02
*** END OF FORM LASCA 02/02 ***
Page 2 of 2
Attachment Order 3

Watershed Classification Attachment for Residuals Programs

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Updated Landowner Agreement Attachment

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
LANDOWNER AGREEMENT ATTACl3MENT
(MS FORMMAYBE PHOTOCOPIED FOR USEASANORIGINAL)
The Division of Water Quality (Division) will not consider this attachment form to be complete
unless all the instructions are followed. Failure to follow the instructions or to submit all of the
required items will lead to additional processing and review time for the application.
For more information or for an electronic version of thisjonn, visit our web site at: http://h2o.enr.state.nc.uslndpul
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without its corresponding residuals program
application form (Form NDRLAP).
Any changes to this attachment form will result in the application package being returned.
B. Prepare a separate attachment form for each set of land application sites that are owned by a landowner
and operated by a lesseeloperator (Le., H applicable) other than the applicant.
✓ A copy of the completed and appropriately executed attachment form must be provided to the landowner and
the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS
TO PRIVATELY -OWNED LAND APPLICATION SITES
The undersigned landowner or his representative hereby permits:
Applicant's name: Mr. Richard Canipe, Town Manager
Complete mailing address of applicant: Town of Spruce Pine
P. O. Box 189
City: Spruce Pine State: NC Zip: 28777
Telephone number: [phone] Facsimile Number: [phone],
E-mail address: [e-mail]
hereinafter referred to as the Permittee, to land apply residuals from the following residuals source -
generating facility(ies) onto the following land application site(s) (i.e., see attached buffer maps) in
accordance with the stipulations and restrictions as given in this Agreement:
Site/Field ID
Land Use or Cropping
Patterns
Intended Use or Disposition of
Crops
Residuals Source -Generating
Facilities
SP-1
Row Crops
Animal Feed
Town of Spruce Pine WWTP
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied
residuals while the Permittee receives, in consideration, the -use of the land application site(s) described above
for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for
the residuals land application program and shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following
restrictions and stipulations until such time as written notification, given 30 calendar days in advance,
modifies or cancels this Agreement.
FORM: LOAA 02/02 Page 1 of 3 Attachment Order 3-c

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional, waste disposal contracts or agreements with
another municipality, contractor, or other permitted entity for the land application site(s) specified by this Agreement.
The land application of any additional residuals or waste, other than that generated by the residuals source -generating
facilities specified by the Division's residuals land application program permit is prohibited.
2. The existing lessee or operator, if any, of the land application site(s) agrees, by execution of this Agreement, to comply
with all provisions of this Agreement.
3. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) by a third
party, the landowner shall be responsible to ensure that the third party agrees and complies with the terms and conditions
of this Agreement..
4. This Agreement shall be binding on the grantees, the successors, and assigns of the parties hereto with reference to the
subject matter of this Agreement.
5. The landowner or his representative or successors shall adhere to the provisions of this Agreement for a period of 18
months from the date of the most recent residuals land application event.
6.. Notification of cancellation 'of this Agreement shall be immediately forwarded to NCDENR DWQ, Non -Discharge
Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
7. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application
site(s) to a new landowner. The'request shall contain the appropriate forms and agreements. In addition, a notice shall be
given by the current landowner to the new landowner that gives full details of the residuals applied or incorporated at the
land application site(s).
8. The Permittee has provided the landowner or his representative with information and data concerning the residuals land
application program, including an analysis of constituents of the residuals, residuals application methods, schedules for
typical cropping patterns, and a description of the equipment used by the Permittee.
9. The Permittee will provide the landowner or his representative with a copy of the residuals land application program
permit that has been most -recently issued by the Division prior to.commencement of any residuals land application event.
This permit will specify maximum application rates, limitations, and other restrictions prescribed by the laws and
regulations.
10. The land application site(s) shall be adequately limed to a soil pH of at least 6.0 prior to residuals land application. The
only exception is that residuals may be land applied when the land application site has a,pH of less than 6.0, provided that
a sufficient amount of lime is also applied to achieve a final pH of the lime, residuals, and soil mixture of at least 6.0.
11. The Permittee will famish the landowner or his representative with a copy of the results of each soil analysis.
12. Within the limits of the Division's residuals land application program permit, the landowner or his representative and the
Permittee will determine residuals application rates and schedules based on crop patterns and the results of soil samples.
13. The landowner or his representative will furnish the Permittee with information regarding the amount and analysis of
other sources of nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application
site(s).
14. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and
cropping patterns for the land application site(s) prior to each planting season to enable the Permittee to amend this
Agreement and schedule residuals land application events at appropriate periods.
15. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee
and/or the landowner or his representative prior to and during a residuals land application event.
16. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access
to the land application site(s) during active use and for the 12-month period following a residuals land application event.
Such controls may include the posting of signs that indicate the activities being conducted at the land application site(s).
17. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application
event. Land application sites that are to be used for grazing shall have fencing that will be used to prevent access during
-- these periods after such residuals land application events.
18. Crops for direct human consumption shall be harvested in accordance with the conditions of the Division's residuals land
application program permit.
19. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their
representatives to inspect the land application site(s) prior to, during, and after any residuals land application event and to
established monitoring facilities on or near the land application site(s) as required by the residuals land application
program permit.
20. Any duly authorized officer, employee, or representative of the Division may, upon presentation of credentials, enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose
of determining compliance with the Division's residuals land application program permit; may inspect or copy any
records that must be kept under the terms and conditions of this permit; or may obtain samples of groundwater, surface
water, or leachate. '
21. The landowner or his representative authorizes the Permittee, local officials, and State officials or their representatives to
take necessary soil, surface water, and groundwater samples during the term of, and for 12 months after termination of,
this Agreement.

M RESTRICTIONS:
Landowner's. Certification:
® I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to
make decisions regarding the use of the land application site(s) on behalf of other deeded landowners OR that I
am otherwise authorized, through a power of attorney or other legal delegation, to make decisions regarding the
use of the land application site(s) on behalf of the deeded landowners. I certify that the above -referenced land
application site(s) are not included in any waste disposal contract or agreement with another municipality,
contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement, understand the
stipulations and restrictions, and do hereby grant permission to the Permittee to land apply residuals to the land
application site(s) as specified herein.
Landowner
Signature:
C
Date:
NORTrOLINA, Fo QS 9 T4 COUNTY
I, the ersigned Notary Public do hereby certify that -S q ,.,, e S A t- -150"J L j-� 21 Sfyi o rJ
` Zrsonally appeared before me this day and acknowledged the due execution of the forgoing instrument.
, WITNESS my hand and official seal this the L4
""I
J 20 0 L(
tit ST ,
J
and seal:
P��a..e 4:s Jat.y commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as
specified herein
l F,,L- r P
Lessee/operator name: Y".s S ,/3y C A-, ✓ -vV i %tea+ S 0 - r"
Sii--< Date:
Permittee's Certification:
® I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as
specified herein.
Signing official name: Mr. Richard Canipe, Town Manager Q
Signature: J/% G� Date: D -
` *** END OF FORM LOAA 02/02 ***

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
LANDOWNER AGREEMENT ATTACHMENT
(THIS FORMMAYBE PHOTOCOPIED FOR USEASANORIGINAL)
The Division of Water Quality (Division) will not consider this attachment form to be complete
unless all the instructions are followed. Failure to follow the instructions or to submit all of the
required items will lead to additional processing and review time for the application.
For more information or for an electronic version of this form, visit our web site at. http://`h2o.enr state.nc.uslndpul
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without its corresponding residuals program
application form (Form NDRLAP).
✓ Any changes to this attachment form will result in the application package being returned.
B. Prepare a separate attachment form for each set of land application sites that are owned by a landowner
and operated by a lessee/operator (i.e., if applicable) other than the applicant.
✓ A copy of the completed and appropriately executed attachment form must be provided to the landowner and
the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS
TO PRIVATELY -OWNED LAND APPLICATION SITES
The undersigned landowner or his representative hereby permits:
Applicant's name: Mr. Richard Canipe, Town Manager
Complete mailing address of applicant: Town of Spruce Pine
P. D. Box 189
City: Spruce Pine State: NC
Zip:
28777
Telephone number: [phone] Facsimile Number: [phone]
E-mail address: [e-mail]
hereinafter referred to as the Permittee, to land apply residuals from the following residuals source -
generating facility(ies) onto the following land application site(s) (Le., see attached buffer maps) in
accordance with the stipulations and restrictions as given in this Agreement:
Site/Field ID
Land Use or Cropping
Patterns
Intended Use or Disposition of
Crops
Residuals Source -Generating
Facilities
Hl-A
Row Crops
Animal Feed
Town of Spruce Pine WWTP
Hl B
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied
residuals while the Permittee receives, in consideration, the use of the land application site(s) described above
for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for
the residuals land application program and shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following
restrictions and stipulations until such time as written notification, given 30 calendar days in advance,
modifies or cancels this Agreement.
FORM: LOAA 02/02 Page 1 of 3 Attachment Order 3-c

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional waste disposal contracts or agreements with
another municipality, contractor, or other permitted entity for the land application site(s) specified by this Agreement.
The land application of any additional residuals or waste, other than that generated by the residuals source -generating
facilities specified by the Division's residuals land application program permit, is prohibited.
2. The existing lessee or operator, if any, of the land application site(s) agrees, by execution of this Agreement, to comply
with all provisions of this Agreement.
3. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) by a third
party, the landowner shall be responsible to ensure that the third party agrees and complies with the terms and conditions
of this Agreement.
4. This Agreement shall be binding on the grantees, the successors, and assigns of the parties hereto with reference to the
subject matter of this Agreement.
5. The landowner or his representative or successors shall adhere to the provisions of this Agreement for a period of 18
months from the date of the most recent residuals land application event.
6. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWQ, Non -Discharge
Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
7. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application
site(s) to a new landowner. The request shall contain the appropriate forms and agreements. In addition, a notice shall be
given by the current landowner to the new landowner that gives full details of the residuals applied or incorporated at the
land application site(s).
8. The Permittee has provided the landowner or his representative with information and data concerning the residuals land
application program, including an analysis of constituents of the residuals, residuals application methods, schedules for
typical cropping patterns, and a description of the equipment used by the Permittee.
9. The Permittee will provide the landowner or his representative with a copy of the residuals land application program
permit that has been most -recently issued by the Division prior to commencement of any residuals land application event.
This permit will specify maximum application rates, limitations, and other restrictions prescribed by the laws and
regulations.
10. The land application site(s) shall be adequately limed to a soil pH of at least 6.0 prior to residuals land application. The
only exception is that residuals may be land applied when the land application site has a pH of less than 6.0, provided that
a sufficient amount of lime is also applied to achieve a final pH of the lime, residuals, and soil mixture of at least 6.0.
11. The Permittee will furnish the landowner or his representative with a copy of the results of each soil analysis.
12. Within the limits of the Division's residuals land application program permit, the landowner or his representative and the
Permittee will determine residuals application rates and schedules based on crop patterns and the results of soil samples.
13. The landowner or his representative will furnish the Permittee with information regarding the amount and analysis of
other sources of nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application
site(s).
14. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and
cropping patterns for the land application site(s) prior to each planting season to enable the Permittee to amend this
Agreement and schedule residuals land application events at appropriate periods.
15. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee
and/or the landowner or his representative prior to and during a residuals land application event.
16. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access
to the land application site(s) during active use and for the 12-month period following a residuals land application event.
Such controls may include the posting of signs that indicate the activities being conducted at the land application site(s).
17. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application
event. Land application sites that are to be used for grazing shall have fencing that will be used to prevent access during
these periods after such residuals land application events.
18. Crops for direct human consumption shall be harvested in accordance with the conditions of the Division's residuals land
application program permit.
19. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their
representatives to inspect the land application site(s) prior to, during, and after any residuals land application event and to
established monitoring facilities on or near the land application site(s) as required by the residuals land application
program permit.
20. Any duly authorized officer, employee, or representative of the Division may, upon presentation of credentials, enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose
of determining compliance with the Division's residuals land application program permit; may inspect or copy any
records that must be kept under the terms and conditions of this permit; or may obtain samples of groundwater, surface
water, or leachate.
21. The landowner or his representative authorizes the Permittee, local officials, and State officials or their representatives to
take necessary soil, surface water, and groundwater samples during the term of, and for 12 months after termination of,
this Agreement.

!(D
H. RESTRICTIONS:
Landowner's Certification:
® I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to
make decisions regarding the use of the land application site(s) on behalf of other deeded landowners OR that I
am otherwise authorized, through a power of attorney or other legal delegation, to make decisions regarding the
use of the land application site(s) on behalf of the deeded landowners. I certify that the above -referenced land
application site(s) are not included in any waste disposal contract or agreement with another municipality,
contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement, understand the
stipulations and restrictions, and do hereby grant .permission to the Permittee to land apply residuals to the land
application site(s) as specified herein.
/ /< e
Landowner name: C p `! i /L l�
Signature:
NORTH CAROLINA,
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the du`
WITNESS my.hand;and official seal this the
Date:
COUNTY
execution of the forgoing instrument; ...-;
day of 1 Qalt>� , 20 Oy
Signature and seal: ?%Ak d i.-fa n u r', n,,
My commission expires: 0AKGL + a-1
Lessee's/Operator's Certification:
❑ I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as .
specified herein.
Lessee/operator name:
Signature:
Date:
Permittee's Certification:
® I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as
specified herein.
Signing official nammA: Mr. Ltj� Canipe, Town
Signature: ,�. Date:
*** END OF FORM LOAA 02/02 ***

Updated Vicinity and Buffer Maps

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RESIDUALS DATE: Aug-04 & SOILS, LLC: Project No. 2004-37

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RESIDUALS
DATE: Aug-04 ,SOILS' LLC Project No. 2004-37

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REsiw� uALS '
DATE: Aug-04 & SOILS, LLC Project No. 2004-37

Cumulative Pollutant Loading Rates and
Analysis of Soil Samples to Include Heavy Metals

Analysis of Soil Samples to Include Heavy Metals

NCgA,Ai'ronqi�ien'" 'Diihsi6;�430ORitedyCieek"R jftportNo: 02.1b3
Grower: Synderman, Mitch Copies to: Branch Residuals & Soils
PO Box 588
ti Spruce Pine, NC 28777
Branch Residuals & Soils
S oil Test Report
Farm: 2007 Yanceyville St Bx 45
Greensboro, NC 27405
8/11/04 SERVING N.C. CITIZENS FOR OVER 50 YEARS Mitchell County
Agronomist Comments:
The heavy metal report is found on a separate report. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in soils at waste application sites in NC are as
follows: arsenic (Ar)- 5.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 2.8 ppm, nickel (Ni)- 0.6 ppm, & selenium (Se)- 0.1 ppm. Although the above metals here are
not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Soil pH is below the target is both samples and phosphorus level is
low in sample Ul. Note the lime and fertilizer recommendations. See NOTE 12 for additional information.
Brenda R. Cleveland, Agronomist
vi� 4Informations":, !
"±�166
en W t
Sample No. Last Crop
Mo Yr TIA
Crop or Year Lime N R05 KO Ng Cu Zn B Mn See Note
U1
1st Crop: Fes/OG/Tim,E IT 50-70 100-120 20-40 0 0 0 0 12
2nd Crop: Fes/OG/Tim,E 0 50-70 100-120 20-40 0 0 0 0 12
Test Results
Soil Class HM961 W/V CEC BS016 Ac p1l P-I K-I Ca% Mg% Mn-1 Mn-AI (1)Mn-A1(2) Zn-1 Zn-Al Cu-I S-I SS -I NO3-N NIh-N Na
MIN 0.13 1.06 4.3 74.0 1.1 5.2 15 37 50.0 21.0 391 244 244 65 65 118 156 0.1
e
-p "t'li '1-
"oft"ftditi
Sample No. Last Crop
Mo Yr TIA
CroporYear Lime N R05 RO Mg Cu Zn B Mn See Note'
U2
1st Crop: Fes/OG/Tim,E IAT 50-70 0 0-20 0 0 0 0 12
2nd Crop:- Fes/OG/Tim,E 0 50-70 0 0-20 0 0 0 0 12
Test Results
Soil Class HM5vo W/V CEC BS961 Ac pit P-I K-I Ca% Mg% Mn-1 Mn-Al (1) Mn-Al (2) &-.1 Zn-AI Cu-I S-1 SS -I NO3-N AB-N Na
MIN 0.18 1.00 4.3 65.0 1.5 4.7 100 44 46.0 15.0 429 267 267 158 158 230 168 0.1

a i�slon. � - e ree oA .
, e'`
e or . o:onom '
Grower: Buchanan, Dennis
Copies to: Branch Residuals & Soils
PO Box 309
Spruce Pine, NC 28777
ip ®�tBranch
o Testfi
Residuals &Soils
-.. h Farm:
2007 Yanceyville St Bx 45
Greensboro, NC 27405
8/11/04 SERVING N.C. CITIZENS FOR OVER 50 YEARS Mitchell County
Agronomist Comments:
The heavy metal report is found on a separate report. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in soils at waste application sites in NC are as
follows: arsenic (Ar)- 5.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 2.8 ppm, nickel (Ni)- 0.6 ppm, & selenium (Se)- 0.1 ppm. Although the above metals here are
not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Soil pH is below the target. Note the lime and fertilizer
recommendations. Where soil test phosphorus (P) is very high (P-I > 100), crops will not respond to additional P applied.
Brenda R. Cleveland Agronomist
w
Field:Information-
liedLime
}
Recomnazndations= N x
_ . _....._ .. 2. x
Sample No. Last Crop
Mo Yr T/A
Crop or Year Lime N PROS MO Mg Cu
Zn B Mn See Note
SP1
1st Crop: Fes/OG/Tim,E 1.8T 50-70 0 0 0 0
0 0 12
2nd Crop: Fes/OG/rim,E 0 50-70 0 0 0 0
0 0 12
Test Results
Soil Class HM% W/V CEC BS% Ac pH P-I K-1 Ca% Mg% Mn-1 Mn-AI (1) Mn-AI (2) Zn-1 Zn-AI
Cu-I S-I SS -I NO3-N NB-N Na
MIN 0.51 0.96 9.8 81.0 1.9 5.3 606 71 58.0 19.0 194 126 126 1965 1965
1118 64 0.1

7 777 7— 777 R `7 -"'a L 0"M
5E il MA,I,ND. oaomic OW,X ---i- ,
' M7--ek W1;'A
Grower: Hollifield, J.D.
Co . pies to: Branch Residuals & Soils
PO Box 189
Spruce Pine, NC 28777
S
Test Report
Branch Residuals & Soils
Oil Farm:
2007 Yanceyville St Bx 45
Greensboro, NC 27405
8/11/04 SERVING N.C. CITIZENS FOR OVER 50 YEARS Mitchell County
Agronomist Comments:
The heavy metal report is found on a separate report. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in soils at waste application sites in NC are as
follows: arsenic (Ar)- 5.5 ppm, cadmium (Cd)-0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 2.8 ppm, nickel (Ni)- 0.6 ppm, &selenium (Se)- 0.1 ppm.
Although the above metals here are
not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Phosphorus level is low in both samples. Note the lime and
fertilizer recommendations. See NOTE 12 for additional information.
Brenda R. Cleveland, Agronomist
Freld<Information
io
.,Recommendations,' '"""
Sample No. Last Crop
Mo Yr TIA
Crop or Year Lime N R05 RO Mg Cu
Zn B Mn See Note
HA1A
1st Crop: Fes/OG/rim,E .8T 50-70 100-120 0 0 0
0 0 12
2nd Crop: Fes/OG/rim,E 0 50-70 100-120 0 0 0
0 0 12
rest Results
Soil Class HM016 W/V CEC BS% Ac pH P-1 K-I Ca% Mg% Mn-IMn-AI (1)Mn-A1(2) Zn-I Zn-Al
Cu-I S-I SS -I NO-N AH-N Na
MIN 0.76 1.09 8.7 87.0 1.1 6.2 15 168 42-0 30.0 381 238 238 26 96
145 48 0.1
el
lied �Jm" e
'P
co WWIton S Wg
Sample No. Last Crop
Mo Yr TIA
Crop or Year Lime N R05 RO Mg Cu
Zn B. Mn See Note
HAIB
1st Crop: i-es/OG/Tim,E .8T 50-70 120-140 0 0 0
0 0 12
2nd Crop: Fes/OG/Tim,E 0 50-70 120-140 0 0 0
0 0 12
Test Results
Soil Class HM?16 W/V CEC BS016 Ac pH P-I K-I Ca% Mg% Mn-1 Mn-Al (1)Mn-AI (2) Zn-1 Zn-Al
Cu-I S-I SS-1 NC3-N NIL-N Na
MIN 0.81 1.10 8.7 89.0 1.0 6.1 9 156 50.0 30.0 229 147 147 43 43
129 50 0.1

NCDA Agronomic Division...'.;,.' : 4300-Reecky .CreeX.Koad Kaleigh, iNC 646D.. '55 Pg 1 �
Heavy Metal Soil TestR.eport Report #: 02161
..
PO Box 189 .
MEHLICH-3 EXTRACTION Spruce Pine, NC 28777
. Mitchell County.'
Questions concerning these, analyses::should lie Teferres fo tie Agronomic Division; Soil:Testirig.S�etioir
Cd .Ni Pb Se: Cr Al As
Sample Cadmirem Nickel: Lead Selenium Monaitifn Aluminum Arsenic
ID rng/dm3 (ppm)
HA1A 0.10 :;0,30:'::. ::. 0.00 I1,7.0 Kk. 0.30 :.: 6.40
HA 1 B 0.10 0.'40'. ..0.00 0:00 • - 0:30 6.90

Report Number: A&L EASTERN AGRICULTURAL LABORATORIES, INC.
2004-R238-206 7621 Whitepine Road • Richmond, Virginia 23237 - [phone]
Fax No. [phone] AL
Account # 46368
Send To: BRANCH RESIDUALS & SOILS Grower: TOWN OF SPRUCE PINE Samples Submitted By:
LLC - BOX 45 BOB BRANCH
2007 YANCEYVILLE ST
GREENSBORO, NC 27405
Date of Report: 08/31/2004 Page: 1 TOTAL SOIL ANALYSIS REPORT
Date Received: 08/24/2004
Date of Analysis: 08/25/2004
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MEHLICH EXTRACTION
Our reports and letters are for the exclusive and confidential use of our clients, anmay not be reproduced In whole or In part, nor may any reference be made to the
d
work, the results, or the company in any advertising, news release, or other public announcements without obtaining our prior written authorization.
This report applies to the sample(s) tested. samples are retained a
mexIr of thirty days after testing.
A & L EASTERN AGRICULTURAL LABORATORIES, INC.
by: e.o/
C. Norman Jones

Cumulative Pollutant Loading hates

ANNUAL LAND APPLICATION FIELD•SUMMARY FORM
PLEASE MAKE A COPY. -OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
�cility Name: - Town of Spruce Pine Permit #: WQ0002349 Annual Dry Tons Applied: 55.54
vner: Penland -Bailey Co., Inc. Operator.: Penland -Bailey Co., Inc. Cation Exchange Capacity (non 503):
z #:
SP-I Field #; SP-1 Acres Utilized: 15 Acres Permitted:
15
oPer
�Acre
Totals
%
Solids
Dry Tons Per
Acre
Residual
Sources
(Summarize)
t e
Cord.
Dry,
Wet,
Inches
Precip.
Past 24
Hrs.
Appli-
cation
Meth-
od*
Voli-
tila-
zation
Rate**
Miner-
ala- -
zation
Rate
TKN
Ammo-
nia-
Ni-
trogen
Ni-
trate
and
Nitrite
PAN I
PAN 2
Must Select
Crop 1 or Crop
p p
2
rR
Crop 1
Crop 2
03
159000
1000
2.4
0.10008
WWTP
dry
0
s
0.5
30%
61700
1300
0
3.757
#######
fescue
]
03
25000
1666.7
2.4
0.1668
WWTP
dry
0
s
0.5
30%
61700
1300
0
6.26167
#######
fescue
2
03
25000
1666.7
2.4
0.1668
WWTP
dry
0
s
0.5
30%
61700
1300
0
6.261,67
#######
fescue
3
.03
35000
2333.3
2.4
0.23352
WWTP
dry
0
s
0.5
30%
61700
1300
0
8.76634
#######
fescue
4
.03
155000
10333
2.4
1.03416
WWTP
dry
0
s
0.5
30%
61700
1300
0
38.8224
1 #######
fescue
5
.03
150000
10000
2.4
1.0008
WWTP
dry
0
s
0.5
30%
61700
1300
0
37.57
#######
fescue 1
6
•03
65000
4333.3
2.4
0.43368
WWTP
dry
0
s
0.5
30%
61700
1 1300
0
16.2803
#######
fescue
7
-03
50000
3333.3
2.4
0.3336
WWTP
dry
0
s
0.5
30%
61700
1300
0
12.5233
#######
fescue
8
-03
35000
2333.3
2.4
0.23352
WWTP
dry
0
s
0.5
30%
61700
1300
0
8.76634
#######
fescue
9
0
0
0
1 0
10
0
0
0
0
11
0
0
0
0
12
)TAILS:
1 37000
...
As
Cd
Cr
Cu
Pb
H
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
nuallbs/acre
0.01406
0.01258
0
2.8268
0.2812
0.03093
0.0592
0.1776
0.02686
5.3428
186.48
139.009
0
Date
lbs/ac
rrent Cumulative lbs/ac
0.09456 0.51368 0 85.5168 67.5312 0.34093 0.2072 2.9856 0.15346 89.0328
0.0805 0.5011 0 1 82.69 67.25 0.31 0.148 1 2.808 0.1266 83.69 "
36 34 NA1338 1 26715 NA 374 89 2498
250
of Years Cumulative Ibs/ac
rnutted C. P. L. R.***
nut PAN Limit 1 st/2nd Crop
certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
signed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
l *Application Method: S - Surface, IN - Injection, INC - Incorporation
Si,grfature of Land Applier Date **Volitilization Rate: Surface - 0.5, Iniection/Incorporation - 1.0
***C.P.L.R.: Cumulative Pollutant Loadina Rate
i,* The RSSF Data and the Dry Tons Per Acre are to be entered on the MFLSF Form. The FSF and MFLSF are mathematically linked so this information needs to be entered
into the same numbered column on the MFLSF as is entered on the identically numbered FSF row to properly complete the metals equations. ie. FSF row # 1 to MFLSF
DENR FORM FSF (5/2003)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
acility Name:
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Town of Spruce Pine
wner: JD Hollyfield Operator:
to #: H-1 Field #: H-1
Permit #: WQ0002349
JD Hollyfield
Acres Utilized:
Annual Dry Tons Applied: 6.75
Cation Exchange Capacity (non 503):
Acres Permitted: 8
a%
O
S eci
Totals
Per
Acre
Solids
Dry Tons Per
Acre
Residual
Sources
(Summarize)
bite
Cond.
Dry,
Wet,
Moist
Inches
Precip.
Past 24
Hrs.
Appli-
cation
Meth-
od*
Voli-
tila-
nation
Rate**
Miner-
nla-
nation
Rate
TKN
Ammo-
nia-
Ni-
trogen
Ni-
trate
and
Nitrite
PAN 1
PAN 2
Must Select
Crop 1 or Crop
2
r
Crop 1
Crop 2
1-03
30,000
3750
2.4
0.3753
WWTP
dry
0
s
0.5
30%_
61700
1300
0
14.0888
#######
fescue
1
1-03
37,500
4687.5
2.4
0.469125
WWTP
dry
0
s
0.5
30%
61700
1300
0
17.611
#######
fescue
2
0
0
0
0
3
0
0
0
0
4
0
0
0
0
5
0
0
0
0
6
0
0
0
0
7
0
0
0
0
8
0
0
0
1 0
9
0
0
0
0
10
0
0
0
0
11
0
0
0
0
12
OTALS:
8438
As
Cd
Cr
Cu
Pb
H9
Mo
Ni
Se
I Zn
P
PAN 1
PAN 2
Lire Applied
nnual lbs/acre
0.003192
0.00286
0
0.64176
0.06384
0.00702
0.01344
10.04032
0.0061
1.212961
42.336
131.69971
0
Date
lbs/ac
urrent Cumulative lbs/ac
0.037692 0.05796 0 8.02176 0.90384 0.09472 0.12424 0.47932 0.0664 14.058
0.0345 0.0551 0 7.38 0.84 0.0877 0.1108 0.439 0.0603 12.845
36 34 NA 1338 267 15 NA 374 89 2498
;:: 250
12-2003
1
-ior Years Cumulative lbs/ac
;rmitted C. P. L. R.***
;niut PAN Linut l st/2nd Crop
[ certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
-signed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
gnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
Si ature of Land Applier Date **Volitilization Rate: Surface - 0.5, Infection/Incorporation - 1.0
***C.P.L.R.: Cumulative Pollutant Loading Rate
k** The RSSF Data and the Dry Tons Per Acre are to be entered on the MFLSF Form. The FSF and MFLSF are mathematically linked so this information needs to be entered
into the same numbered column on the MFLSF as is entered on the identically numbered FSF row to properly complete the metals equations. ie. FSF row If I to MFLSF
DENR FORM FSF (5/2003)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
aeility Name: Town of Spruce Pine
weer: � Mary Lee Bailey Operator:
to a- U-1
Field #: ' U-1
Permit #: WQ0002349 Annual Dry Tons Applied: 4 .
Mary Lee Bailey Cation Exchange Capacity (non 503):
Acres Utilized: 3.5
Acres Permitted: 3.5
-
< S ecih,
Totals
Per
Acre
%
Solids
Dry Tons Per
Acre
Residual
Sources
(Summarize)
Site
Cond.
Dry,
Wet
Inches
Precip.
Past 24
Hrs.
Appli-
cation
Meth-
od*
Voli-
tila-
zation
Rate**
Miner-
ala-
zation
Rate
TKN
Ammo-
nia-
Ni-
trogen
Ni-
trate
and
Nitrite
PAN-1
PAN 2
Must Select
Crop 1 or Crop
2
a
's
1
Gal.
Cu.Yd.
Report
Totals
in C1.
Crop 1
Crop 2
I-03
15,000
4285.7
2.4
0.428914286
WWTP
Dry
0
s
0.5
30%
61700
1300
0
16.1014
#######
fescue
1
I-03
15000
4285.7
2.4
0.428914286
WWTP
Dry
0
s
0.5
30%
61700
1300
0
16.1014
#######
fescue
2
1-03
10000
2857.11
2.4
0.285942857
WWTP
Dry
0
s
0.5
30%
61700
1300
0
10.7343
#######
fescue
3
0
0
0
0
4
0
0
0
0
151
0
0
0
0
6
0
0
0
0
7
0
0
0
0
8
0
0
-
0
0.
9
0
0
0
0
1101
0
0
0
0
11
0
0
0
0
12
OTALS:
11429
» <
As
Cd
Cr
Cu
Pb
H
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
nnuallbs/acre
0.004332
0.003881
0
0.87096
0.08664
0.00953
0.01824
0.05472
0.00828
1.64616
57.456
42.9372
0
Date
lbs/ac
urrent Cumulative lbs/ac
0.314932 0.10958 0 16.581 11.69484 10.18373 0.23824 0.91162 0.12478 29.3262
0.3106 0.1057 0 15.71 1.6082 0.1742 0.22 0.8569 0.1165 27.68
36 34 NA 1338 267 15 NA 374 89 2498
' 250.7
12-2003
1
rior Years Cumulative lbs/ac
ermitted C. P. L. R.***
ern it PAN Lunit 1 st/2nd Crop
I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
esigned to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
3u_0'y *Application Method: S Surface, IN - Injection, INC - Incorporation
Signat re of Land Applier Date **Volitilization Rate: Surface - 0.5, Iniection/Incorporation - 1.0
***C.P.L.R.: Cumulative Pollutant Loadins Rate
*** The RSSF Data and the Dry Tons Per Acre are to be entered on the MFLSF Form. The FSF and MFLSF are mathematically linked so this information needs to be entered
into the same numbered column on the MFLSF as is entered on the identically numbered FSF row to properly complete the metals equations. ie. FSF row # 1 to MFLSF
DENR FORM FSF (5/2003)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH APPLICATION FIELD.
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Town of Spruce Pine Permit #: WQ0002349
lwner:
.te #:
Mary Lee Bailey Operator: Mary Lee Bailey
U2 Field #: U2 Acres Utilized: 4.5
Annual Dry Tons Applied: 20.0176
Cation Exchange Capacity (non 503):
Acres Permitted: 4.5
� e
a
z> S ecih
Totals
per
Acre
%
Solids
Dry Tons Per
Acre
Residual
Sources
(Summarize)
Site
Cond.
Dry,
Wet,
Inches
Precip.
Past 24
Hrs.
Appli-
cation
Meth-
od*
Voli-
tila-
zation
Rate**
Miner-
ala-
zation
Rate
TKN
Ammo-
pia-
Ni-
trogen
Ni-
trate
and
Nitrite
PAN 1
PAN 2
Must Select
Crop 1 or Crop
p p
2
*
IN Gal.
Cu.Yd.
...
Report
Totals
lll Gal.Moist
Crop 1
Crop 2
1-03
30,000
6666.71
2.4
0.6672
WWTP
Dry
0
s
0.5
30%
61700
1300
0
25.0467
#######
fescue
1
3-03
75000
16667
1 2.4
1.668
WWTP
Dry
0
s
0.5
30%
61700
1300
0
62.6167
#######
fescue
2
4-03
40000
8888.91
2.4
0.8896
WWTP
Dry
0
s
0.5
30%
61700
1300
0
33.3956
#######
fescue
3
8-03
25000
5555.61
2.4
0.556
WWTP
Dry
0
s
0.5
30%
61700
1300
0
20.8722
#######
fescue
4
9-03
25000
5555.61
2.4
0.556
WWTP
Dry
0
s
0.5
1 30%
61700
1300
0
20.8722
#######
fescue
5
,0-03
20000
4444.41
2.4
0.4448
WWTP
Dry
0
s
0.5
30%
61700
1300
0
16.6978
#######
fescue
6
0.
0
0
0
7
0
0
0
0
8.
0
0
0
1 0
9
0
0
0
0
1101
0
0
0
0
11
0
0
0
0
12
'OTALS:
47778
As
Cd
Cr
Cu
Pb
H9
Mo
Ni
Se
Zn
P
PAN 1
PAN 2
Lime Applied
.mluallbs/acre
0.018582
0.01663
0
3.73596
0.37164
0.04088
0.07824
0.23472
0.0355
7.06116
246.4561
179.501
0
Date
lbs/ac
'urrent Cumulative lbs/ac
0.088582 0.12443 0 19.674 2.05544 10.22578 0.09937 1.10752 0.1571 35.2012
0.07 0.1078 0 15.938 1.6838 0.1849 0.02113 0.8728 0.1216. 28.14
36 34 NA 1338 267 15 NA 374 89 2498
... 250
12-2003
i
rior Years Cumulative lbs/ac
ermitted C. P. L. R.***
eniut PAN Limit 1 st/2nd Crop
I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
esigned to assure that qualified personnel properly gathered and evaluated the info rmation.submitted. I am aware that there are
ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/7`/ *Application Method: S - Surface, IN - Injection, INC - Incorporation
S' ature of Land Applier Date **Volitilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
***C.P.L.R.: Cumulative Pollutant LoadinS Rate
*** The RSSF Data and the Dry Tons Per Acre are to be entered on the MFLSF Form. The FSF and MFLSF are mathematically linked so this information needs to be entered
into the same numbered column on the MFLSF as is entered on the identically numbered FSF row to properly complete the metals equations. ie. FSF row # I to MFLSF
DENR FORM FSF (5/2003)