WQ0019960_Application_20160203

Price, Bev
From: Price, Bev
Sent: Saturday, March 05, 2016 10:50 AM
To: Goodrich, David
Subject: RE: _Draft of the City of Marion's Permit WQ0019960
Hey David,
Just a few changes and questions.
1. Remove "storage area" from the description, missed this earlier.
2. Is Condition 11.11. 2T Reference correct? The condition does not seem to match 2T?
3. Attachment A in the current permit says Once per permit cycle for Condition IV.2. (TCLP) not Annually.
4. Just verifying — no buffer waiver for Field F-1, the current permit has one?
5. Is there another map with the buffer waiver notations described in the footnote: "S","B", "T", "C", "V"? I don't
see them on my copies.
Bev Price
Environmental Senior Specialist — Asheville Regional Office
Water Quality Regional Operations Section
NC DEQ— Division of Water Resources
828 296-4500 office
[e-mail]
Asheville Regional Office
2090 U.S. 70 Highway
Swannanoa, NC 28778
-- `'`Nothing Compares-
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Goodrich, David
Sent: Friday, March 04, 2016 2:01 PM
To: Price, Bev <[e-mail]>
Cc: Thornburg, Nathaniel<nathanie[[e-mail]>
Subject: Draft of the City of Marion's Permit WQ0019960
Hello Bev,
Thank you for your staff report. I am attaching the draft of this permit for your review and comment. I have attempted
to include the changes you recommended.
Thank you!

David
David Goodrich
Hydrogeologist II
North Carolina Division of Water Resources
North Carolina Department of Environmental Quality
919 807 6352 office
david.goodrich(aD-ncdenr.gov
512 North Salisbury Street
1617 Mail Service Center
Raleigh, NC 27699-1617
<�Nothing Compares,-,
,
Email correspondence to and from this address is subject to the
!North Carolina Public Records Law and may be disclosed to third parties.
4

��„'' i
M , ' State of North Carolina
Department of Environmental Quality
Division of Water Resources
A. Water Quality Permitting
Regional Staff Report
March 4, 2016,
To: DWR Water Quality Permitting Section Central Office Application No:: WQ0019960
Attn: David Goodrich Regional Login No.:
From: Bev Price
Asheville Regional Office
I. GENERAL SITE VISIT INFORMATION ;
1. Was a site visit conducted? Z Yes or ❑ No
a. Date of site visit: ' 03/01/2016
- 1
b. Site visit conducted by: Bev Price
e. Inspection report attached? . M Yes or.❑ No; ,
d. Person contacted: and their. contact information:;,(828)-652-8843 Larry Carver, Wastewater Superintendent
e. Driving directions: From Asheville: I-40 E to Exit 86. Turn'left on Hwy. 226. The WWTP is approximately
1/2 mile on the right ,
H. PROPOSED FACILITIES FOR NEW AND MODIFICATION APPLICATIONS
1. Facility Classification: (Please attach completed rating sheet to be attached to issued permit)
2. Are the new treatment facilities adequate for the type' -of waste and disposal system? ❑ Yes or ❑ No
If no, explain:
-- 3. Are site conditions (soils, depth to water table, etc) consistent with the submitted reports? ❑ Yes ❑ No ❑ N/A
If no, please explain: =
4. Do the plans and site map represent the actuafsite (property lines, wells, etc.)? ❑ Yes ❑ No ❑ N/A
If no, please explain:
5. Is the proposed residuals management plan adequate? ❑ Yes ❑ No' ❑ N/A
If no, please explain:
6. Are the proposed application rates (e.g.', hydraulic, nutrient) acceptable? ❑ Yes ❑ No ❑ N/A
If no, please explain:
7. Are there any set back.conflicts for proposed treatment, storage and disposal sites? ❑ Yes or ❑ No
If yes, attach a map showing conflict. areas.
8. Is the proposed or existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ N/A
If no, explain and recommend any changes to the groundwater monitoring program:
9. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ❑ N/A
If yes, attach- list of sites with restrictions (Certification B)
FORM: APSRSR 04-10 Page,1 of 4

State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON -DISCHARGE APPLirATmN=4QUEST FORM
February 1, 2016.
To: ROO R® :Lan ►�yd_son
FES - 3 2
From: David Goodrich, Water Quality Permitting Section -Non-Dischrgp�gl�l al Operations
Asheville Regional Office
Permit Number: WQ0019960 Permit Type: Land Application of Residual Solids (503)
Applicant: City of Marion
Owner Type: Municipal
Facility Name: City of Marion RLAP
Signature Authority: Bob Boyette
Address: Post Office Drawer 700, Marion, North Carolina 28752
Fee Category: Non -Discharge Minor
Comments/Other Information:
Project Type: Renewal
Owner in BIMS? Yes
Facility in BIMS? Yes
Title: City Manager
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. ® Return a completed staff report.
❑ Attach an Attachment B for Certification. ❑ 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.
q
RO-WQROS Reviewer: '&'a,
Date:�� Z(g
FORM: WQROSNDARR 09-15 Page 1 of 1

WA
NON-DISi
Div Ion of Wakeir Resources
February 1, 2016
To: AROQI�OS 3Landori=Davison w.
From: David Goodrich, Water Quality Permitting Section - Non-Dis,
Permit Number: WQ0019960.
Applicant: City of Marion
Owner Type: Municipal
Facility Name: City of Marion RLAP
State of.North Carolina
Department of Environmental Quality
9 Division of Water Resources
vs
�UAZITY REGTONlI; OPERATIONS SECTION
:GE APPL QUEST FORM
nor"_ 1W'
3
,20
egd4a! opera2tons
Achm;iilp ^paicnai Office
Permit Type: Land Application of Residual Solids (503)
Signature Authority: Bob Boyette
Address:, Post Office Drawer 700, Marion, North Carolina 28752
Project Type: Renewal
Owner in RIMS? Yes
Facility in BIMS? Yes
Title: City Manager
County: McDowell
Fee Category: Non -Discharge Minor Fee Amount: $0
Comments/Other Information: -
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. ® Return a completed staff report.
❑ Attach an. Attachment B for Certification. ❑ 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.
1A)
13O-WQROS Reviewer: _ Date:
FORM: WQROSNDARR 09-15 Page 1 of 1

Water Resources
ENVIRONMENTAL QUALITY
February 1, 2016
BOB BOYETTE — CITY MANAGER
CITY OF MARION
POST OFFICE DRAWER 700
MARION, NORTH CAROLINA 28752
Dear Mr. Boyette:
PAT MCCRORY
olvrm. r
DONALD R. VAN DER VAART
secrelary
S. JAY ZIMMERMAN
Subject: Acknowledgement of
Application No. WQ0019960
City of Marion
Residuals Management System
McDowell County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on February 1, 2016. Your application package has been assigned the
number listed above, and the primary reviewer is David Goodrich.
Central and Regional Office staff will perform a detailed review 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
David Goodrich at [phone] or [e-mail].
cc:
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
Permit File
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
Direcror

SPILL CONTROL PLAN- Southern Soil Builders, Inc.
City of Marion NC -Permit No. WQ0019960
In the event of a spill, the following should be taken IMMEDITALY.
1. Make sure all personal and bystanders are safe- if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain the
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as much
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, till
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. City of Marion, WWTP- Larry Carver [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 Office,
telephone number [phone], as sopossible, but in no case more than
24 hours or on the next working day following the occurrence or first knowledge
of the occurrence of any of the following:
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any failure of the surface disposal program resulting in a release of
material to surface waters.
C. Any time self -monitoring indicates the facility has gone out of compliance
with its permit limitations.
D. Any process unit failure, due to known or unknown reasons, rendering 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 (e.g., discharges to surface
waters, imminent failure of a storage structure, etc.) outside of normal 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. This report shall
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.

FIELDS:
Fl, F2, F3, F4
JOHN FISHER

Suffers
Propery Lino Proper t Line (50'
Field Boundary o Well Perennial Stream 60')
Perennlal Stream House �� House 400')
Surface Water Well (1 0') �
am Unused Area
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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. }$"
ap C`en e far ¢Yeagr�aphic Ihforrriation�andAriysishl(
1t and the perimeter of the residuals application area. --
Fl@F�r, Jarvlea . Janice: duffer Map W c
Parcels. 1658604330035, 165800433035, 165800525658
McDowell County, NC 0 375 750 1,500 Feet
Produced: November 2015
ati A4_aQ .P1 PARV North Carolina Stateplane, NAD83 Shaffer Soil Services Inc.

FIELDS:
RI & R2
WAYNE RO S S

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, 9
and the perimeter of the residuals application area.
Yhyx t H W 4 r# Field RC TE
.
=E '
2.7 acres
F"
Ai
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r� kx
Field R2 [ t
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R.w Field RI
y 17.2_ acres
4 A r
Buffers ,
x� Property Line ( 50
{; Perennial Stream ? 00')
House (400')
well (100')
Legend �.
Propery Line
-; fir .•�®•- Field Boundary O Well f
Perennial Stream House
Surface Water
*.
K, C', Mj Unused Area
Ross,f Wayne: Buffer Map
Parcel:165700181637 s: l e McDowell County, NC
0 a75 750 1,51.10 Feat s
, , t I r 1 Produced. November Wig
29; anti _R! ASDRO North Carolina Stateplane, NAD83 _ Shaffer Soil Services, Inc.

FIELDS:
Kl & K2
MARIO DELUCA

S Southern
S Soil
$ Builders, Inc.
Monday, January 25, 2016
958 Hoots Road Roaring River, NC 28669
[phone] e 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 the City of Marion
Land Application Permit No. WQ0019960
RECEIVED
Division of Water Resources
F E B - 3 2016
Water Quality Regional Operations
Asheville Regional Off:ce
RECEIVEDf �CDEQ�DV�R
FEB - i 2016
Non -Discharge
permii6ng Unit
The City of Marion is applying for a renewal to its current land application permit WQ00019960.
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,
Zach Key
Southern Soil Builders, Inc.

R
RECE�vDlr"�®EU®%R State of North Carolina
De artment of Environmental FEB - 1 2016 � duality
Division of Water Resources
Division of Water Resources Non -Discharge 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
PerTnAWiNTIONS FOR FORM: RLAP 11-15 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
ht(12:1112ortal. ncdenr-. o�•gweb/wct/aps/luu
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T. I 100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 11-15) Application: (All Application Packages):
❑ Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 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.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An
alternate person may be designated as the signing official if a delegation letter is provided fiom a person who meets the
criteria in 15A NCAC 02T .0106(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
❑ Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
C.
In
Facility Classification
Major (land are permitted for > 300 acres)
New Permit Major Modification'
$1,310
$395
I Minor (Land are permitted for < 300 acres) $810 1 $245 1
__._....
r - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes
not previously permitted. There is no fee for minor modifications to a permit.
Cover Letter (All Application Packages)
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
Environmental Assessments (May be Required — See 15A NCAC 1 C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 11-15 Page I of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
❑ Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
❑ Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102 12). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 11-15 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with. recommendations concerning cover
crops and their ability to accept the proposed application rates.
- J. Hydrogeologie Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104 d (4) and current Division Policy
available at: http://portal.ncdem•.or /web/wq/aps/lau/ olicies. The document shall be signed, sealed and dated by a qualified
professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 021.1104(dU. For Modifications, submit an updated
site map specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the
new units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)ffi and current Division Policy
available at: htt�//portal.ncdem-.or web/wq/aps/lau/policies.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of 15A NCAC 02L .0 107, or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 11-15 Page 3 of 3

' RECEIVEDepartment
State of North Carolina
Department of Environmental Quality
FEB — 1 2016 Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
Non -Discharge
Parmittina Unit FORM: RLAP 11-15
I. APPLICANT INFORMATION:
1. Applicant's name: City of Marion
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
2.
r
4.
ignature authority s name per 15A NCAC 02T .0106: Bob Boyette Title: City Manager
Applicant's mailing address: PO Office Drawer 700
City: Marion State: NC Zip: 28752
Telephone number: [phone] Email Address: [e-mail]
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: Roaring River State: NC Zip: 28669
Telephone number: [phone]
Agronomist's name:
Affiliation: ❑ N/A ❑ On Staff
Agronomist's mailing address: —
City: State:
Telephone number: (_—) _-
Soil Scientist's name:
Email Address: zachkey@southernsoilbuilders com
License Number:
❑ Retained (Firm: )
Zip: -
Email Address:
License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Soil Scientist's mailing address:
City: State: Zip: -
Telephone number: (_) = Email Address:
5. Fee submitted: $0.00 (See Instruction B)
II. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00019960
Date of most -recently issued permit: 7-15-2005
Date of most -recently certified Attachment A (if different than the permit): 7-15-2005
Date of most -recently certified Attachment B (if different than the permit): 7-15-2005
FORM: RLAP 11-15 Page I of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 3982 Highway 226 South
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 35' 39' 09.72" Longitude: 81' 57' 23.81"
Datum: NAD83 Level of accuracy: 0.01
Method 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
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide
the candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training
school and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrozen 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: 290 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
36.484
49.684
10580.36
14408.36
Five -Year Maximum Adjusted
39.23
53.42
11376.73
15492.86
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified
and proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
0
Hay
30.9
Pasture
72.7
Total:
103..6
Methods
Surface
103.6
Incorporation or Injection
0
Total:
103.6
FORM: RLAP 11-15 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
gbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
211.6
288.16
227.53
309.85
100
105.8
144.08
113.76
154.92
150
70.5
96.05
75.84
103.28
200
52.9
72.04
56.88
77.46
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): Z Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
i
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Olt
Land Application Site
Certification.doc
FORM: RLAP 11-15 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irri ation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation:
feet below ground surface. Rules 15A NCAC 02T .0505(n). requires at least one -foot vertical separation between SHWT and
ground surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field / Zone
Design Area
(ft)
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
TotalVista
G
ey§#
, % ",.
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
112
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
It
FORM: RLAP 11-15 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A IdCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper clos 6, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
any act' compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
M es ❑ No, Explain;
(Signature Authority's Name - PLEASE PRINT)
attest that this application for r-ef > f @ fl I n Cr--e,ek- W
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water
Resources may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes
unless specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any
false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: V-
FORM: RLAP 11-15 Page 5 of 5

1
r
I
Operation and Mainteniance Plan
City of Marion, WWTP
Permit No. WQ0019960
In accordance to the requirements set forth by the North Carolina
Department of Environmental and Natural Resources using
NCGS 143-215.1 and 14215.3(a) based on 15A NCAC 02T .110, Southern
Soil Builders, Inc. and the City of Marion 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, br run-offs.
The daily check -off will consist of inspection the following items:
1. Access to the facility will be controlled with a locked gate and
signs to prevent! any unauthorized entry into the complex.
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.
5. All on road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
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 application
event to make sure all regulations as required by the permit are followed.
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 takenjin 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 and
transported as outlined in !the Sampling Plan attached to this O&M Plan.
I
I
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 copy of the
spill control plan attached.
1

City of Marion, WWTP
Permit No. WQ0019960
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the digester.
Samples from the digester will be corMined 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. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The volatile solids will first belattempted to be achieved using option 4 [503.33(b)(1)]; Specific
Oxygen uptake know as a SOUR test. This sample will be taken from the digester.
Fecal Coliform is gather in seven (7) individual samples and tested to meet the requirements of
[503.32(b)(2)]. This requirement is forithe geometric mean fecal coliform density of the samples be less
than two million (2,000,000) MPN per1gram. These samples will be placed in 250ml containers and
placed on ice, in a cooler for transpor# 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 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. This
sample will be taken from the digester:

SPILL CONTROL PLAN- Southern Soil Builders Inc.
City of Marion- Permit No WQ0019960
In the event of a spill, the following should be taken IMMEDITALY.
1. Make sure all personal and bystanders are safe= if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to contain the
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as much
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. I'f the spill occurred on a tillable area, till
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. City of Marion, Larry Carver 828-652-8843
C. NCDENR, Asheville Regional Office 828-296-4500

D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting. The project manager shall detail how the spill occurred and all action
that was taken. A written report shall be given to the Asheville Regional Office as
soon as possible, and within 24 hours of the spill, or next working day.
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
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 11-15
i
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
supportini? documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
httl2:11portal. ncdenr. org/web/wg/ays11au
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15ANCAC 02Ti1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility. i
❑ 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.
Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Permits".
❑ Process flow diagram and/or narrative A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division-certifiedi laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 11-15 1 Page 1 of 1

RESIDL' n�,S SOURCE FACILITY SUMMARY
Applicant's name: City of Marion
Status
Code a
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current n
Proposed
R
City of Marion
Corpening Creek WWTP
McDowell
WQ0019960
290
290
a Status Code for source facility are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution, land application, or disposal (i.e, not applicable to new facility).
SUMMARY FOR FORM: RSC 11-15 Page 1

-DW,Via;.
Divisloh 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 InstructioI n B.):
1. Facility Name: City of Marion, Corpening Creek WWTP
2. Facility permit holder is: 0 Federal, 0 State, 0 Local Government, or Private.
Facility permit issued by: Div. of Water Resources, n Div. of Environmental Health,
or Other ,(explain:: ),
3. Facility contact person and title: Larry Carver
Complete mailing address: PO Drawer 700
City: Marion State: NC
Telephone number: 828 652-8843
Zip: 28752
E-mail address: lcarvernamarionnc.ore
4. Facility physical address: 3982 Highway 226 South
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 35° 39' 09.72" Longitude: 81° 57' 23.81"
Datum: NAD83 Level of accuracy: 0.01
Method of measurement: MAP
5. Purpose of the facility:
El treatment of municipal wastewater, Z treatment of 100% domestic wastewater;
E] treatment of potable water, 0 treatment of 100% industrial wastewater,;
El treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: % industrial and %! domestic)
M other (explain: ).
6. Does the facility have an approved pretreatment program: El Yes EJ No
7. Facility permitted/design flow: 3.0 MGD and facility average daily flow: 1.75 MGD
8. Average amount of residuals being generated at this facility 98.68 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Two 0.780 MG Aeration Basins
Type and volume of residuals storage (i.e., outside of residuals treatment units): 0.75 MG Digester
I
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
M 40 CFR Part 503 or E3 40 CFR Pant 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 Ck Part 257.
2. Specify if residuals are defined under I SA NCAC 02T.1t02(6) as: {
Biological 0 Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrialwastewater (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 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ 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: El yes E no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: ETS and Date of analysis: 3-18-15
Passed corrosivity test: yes El no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: yes 0 no. Flashpoint: 212 T (> 140T)
Passed reactivity test: Z yes Ono. HCN: 0.124 mg/kg (<250) & H2S: 0.249 mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
0.25
Hexachlorobenzene
0.13
ND
Barium
100.0
2.50
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
0.05
Lead
5.0
0.25
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
0.0020
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
0.1
Nitrobenzene
2.0
ND
in -Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol _
200.0
ND
Selenium
1.0
0.25
Cresol
200.0
ND
Silver
5.0
0.1
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin _
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
FORM: RSC 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 dry weight
basis) for the following metal parameters:
Laboratory: Wav oint and Date of analysis: 8-5-15
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/lcg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
4
Cadmium
85
39
2
Copper
4,300
1,500
348
Lead
840
300
42
Mercury
57
17
1.4
Molybdenum
75
n/a
8
Nickel
420
420
24
Selenium
100
100
5
Zinc
7,500
2,800
817
b. For Surface Disposal Unit land ill : Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: ' and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(ing/kg)
> 0 but < 25
30
200
210
E > 25 but < 50
34
220
240
> 50 but < 75
39
260
270
E > 75 but < 100
46
300
320
E > 100 but < 125
53
360
390
> 125
62
450
420
Result (mg/kg)
FORM: RSC 11-15 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 2.27 %.
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: Waypoint and Date of analysis: 8-5-2015
Parameter
Result
(mg/kg)
Aluminum
17100
Ammonia -Nitrogen
13200
Calcium
15800
Magnesium
6880
Nitrate -Nitrite Nitrogen
2
pH (Standard Unit)
7.53
Phosphorus
27400
Potassium
7800
Sodium
3560
Total Kjeldahl Nitrogen
52000
c. Using the results listed in Item 11. 5b. above, calculate the sodium adsorption ration (SAR): 0.89
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): 2 default value, or 0 actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1't) Year PAN
Five -Year
(mg�k�
Maximum Adjusted PAN
(mg/kg)
Surface
18242
19615
Injection/Incorporation
24842
26711
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 11-15 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal Coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
El Alternative 2 [15A NCAC 02T. I 106(b)(3)(B)] - Alkaline Treatment.
El Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Hehninth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T. 1 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Z Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
El Alternative 2 [15A NCAC 02T.I 106(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 II.7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
El Exempt -If Daily Cover Alternative is chosen in Item H.8. below [15A NCAC 02T.1106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Vector Attraction Reduction(_ARM: Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
❑ Alternative 1 [15A NCAC 02T.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [ 15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Z Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T. I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T. 1 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 11-15 Page 5 of 5

Quantitative Justification for Residuals Production Rate
In the following five years the City of Marion has produced the following Dry Tons to be land applied:
2010: 106.98
2011: 166.9
2012: 25.25
2013: 77.04
2014: 117.23
This is a six year average of 98.68 Dry Tons per year, which will allow for any growth or unforeseen
increases in the Waste Water Treatment Plants flow.

City of Marion, WWTP
Permit No. WQ0019960
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the digester.
Samples from the digester 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 sarnples 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. All
samples taken will be taken in the same condition as the residuals are to be land applied.
The volatile solids will first be attempted to be achieved using option 4 [503.33(b)(1)]; Specific
Oxygen uptake know as a SOUR test. This sample will be taken from the digester.
Fecal Coliform is gather in seven (7) individual samples 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 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. This
sample will be taken from the digester.

Page: 1 of 2
Report Number: 15-222-0209
Account Number: 46381
Send To: SOUTHERN SOIL BUILDERS
DENNIS KEY
958 HOOTS ROAD
ROARING RIVER, NC 28669
Lab Number: 63435
Sample Id: MARION
Waypoint "
ANALYTICAL
C L
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project: MARION/NC CERT#257
REPORT OF ANALYSIS
Date Sampled: 8/5/2015 13:30:00
Date Received: 08/10/2015 00:00
Date Reported: 08/18/2015
Total Solids *
2.27
22700
100.0
RD
08/10/2015 15:20
SM-2540G
Moisture *
97.73
100.0
RD
08/10/2015 15:20
SM-2540G
Total Kjeldahl Nitrogen
5.20
52000
10.0
SB
08/11/2015 08:39
SM-4500-NH3C-TKN
Total Phosphorus
2.74
27400
100
KM
08/11/2015 11:32
SW 6010C
Total Potassium
0.78
7800
100
KM
08/11/2015 11:32
SW 6010C
Total Sulfur
0.84
8430
100
KM
08/11/2015 11:32
SW 6010C
Total Calcium
1.58
15800
100
KM
08/11/2015 11:32
SW 6010C
Total Magnesium
0.69
6880
100
KM
08/11/2015 11:32
SW 6010C
Total Sodium
0.36
3560
100
KM
08/11/2015 11:32
SW 6010C
Total Iron
24000
100
KM
08/11/2015 11:32
SW 6010C
Totesa^I Aluminum
17100
I V
KM
08/11/2015 11:32
SW 6010C
Total Manganese
352
5
KM
08/11/2015 11:32
SW 6010C
Total Copper
348
5
KM
08/11/2015 11:32
SW 6010C
Total Zinc
817
5
KM
08/11/2015 11:32
SW 6010C
Ammonia Nitrogen
1.32
13200
10.0
SB
08/17/2015 12:00
SM-4500-NI3C
Organic N
3.88
38800
10.0
08/11/2015 08:39
CALCULATION
Nitrate+Nitrite-N
<2.00
2.00
SB
08/10/2015 08:40
SM-450ONO3F
Total Cadmium
2.0
2.0
KM
08/11/2015 11:32
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 con ,dential use of our clients. and may not be reproduced h7 miho%e cr, par:. nor may any reference be made
to the work. the nesulis. or Gl7e company in any advertising. news release, or other public o't7nDJliCeme!7tS ih7ihCJi obtaining our prior written auti onzat!on.
Debbie Holt

Page: 2 of 2
Report Number: 15-222-0209
Account Number: 46381
Send To: SOUTHERN SOIL BUILDERS
DENNIS KEY
958 HOOTS ROAD
ROARING RIVER, NC 28669
Lab Number: 63435
Sample Id: MARION
o.
Waypoint
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project: MARION/NC CERT#257
REPORT OF ANALYSIS
Date Sampled: 8/5/2015 13:30:00
Date Received: 08/10/2015 00:00
Date Reported: 08/18/2015
Total Chromium
49
5
KM
08/11/2015 11:32
SW 6010C
Total Nickel
24
5
KM
08/11/2015 11:32
SW 6010C
Total Lead
42
5
KM
08/11/2015 11:32
SW 6010C
Total Arsenic
4.0
3.0
KM
08/11/2015 11:32
SW 6010C
Total Mercury
1.4
0.4
KM
08/12/201509:00
SW-7471B
Total Selenium
<5.0
5.0
KM
08/11/2015 11:32
SW 6010C
pH (Standard Units)
7.53
2.00
SB
08/10/2015 08:39
SW-9045D
Total Molybdenum
8
5
KM
08/11/2015 11:32
SW 6010C
Comments:
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
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 reporrs and le.+ter's are Jor the eyc,'usive and confidential use of our clients. and: ��ay not be reprocruced hr whole cr parl. nor may any reference be .made
to the work. the,•esufts. orthe company in any advertisi, iy^. news release, c: other public announcements without obtaining our prior wn-- ten authorization_
Debbie Holt

PAN
Mineralization
as decimal
ITotal dry
tonsiyeaP
jAcres I
Applied on
1 103.6 1
Rate
0.3
TKN
52000
NH3
13200
NO3
2
NO2
0
% Solids
0.027
1 290
PAN Surface
182421rng/kg
36.484 lbsidily top
10580.36libs
total PAN
102.1271!bs
PANIacre
PAN Injection-
248421mgikg
49.684 fbsldpy ton
14408.36
jibs total PAN
139.0768
1 Iles PAN/acre
Dry Tons/1000 gal.
0.11259
1 st year PAN
Surface Ibs.
10580.36
1st year PAN
Injected lbs.
14408.36
lbs./acre
Surface
102.12
Ibs./acre
Injected
-1
39.0/ V�I-
-, 6 0 -,)A I
MR(TKN-NH3)+ +.5(NH3)+NO3+NO2 =mg/kg
mg/kg x.002 =Ibs/dry ton
MR(TKN-NH3) + I(NH3)+NO3+NO2 =mg/kg
mg/kg x.002 =Ibs/dry ton
1000 X 8.34 X %solids X sp. gravity "=dry tons/1 000gal."
2000

SAR
Sodium Absorption Ratio
Na: Sodium (Mg/L) Equivalent weight: 23
Ca: Calcium (Mg/L) Equivalent weight: 20
Mg : Magnesium (Mg/L) Equivalent weight: 12
Na(MgL) Ca M /L . Mg(WI)
80.812 358.66 1 156,176
N am.
Ca (MIS
Mg_ fVlEj
3.513565
'17.933
13, 01467
Milli Equivalent = Mg/L / Equivalent weight The amour
amount of E
SAR= Na Milli Equivalent/[0.5 X (Ca Milli Equivalent + Mg Milli equivalent)]0.5 power
Permitting
SAR = 0.893201 (From Mg/L entered above)
SAR= 0.890438 (From ME entered below)
Na (ME),
Ca (ME)
1
Ma (ME)
1
3.5
17.9
13

PO Box 7565
Asheville, NC 28802
Phone: [phone]
Fax: [phone]
Certificate of Analysis
Project name: Marion WWTP Project number: 150318.503
Collection date:
18-Mar-15
Date received:
18-Mar-15
Sample identification:
CC Sludge #1- Grab
Sample number:
124624
Parameter
Method
Result
RL
Units
Date Analyst
Footnotes
Analyzed
%TS
SM 2540 G
3.1
0.10
%
is-Mar-15 KEK
Mulitple Tube Fermentation Procedure SM 9221-E
102300
5.6 _.._MPN___.
lE?maar u. KEK .
Sample identification:
CC Sludge #2 - Grab
Sample number:
124625
Parameter
Method
Result
RL
Units
Date Analyst
Footnotes
Analyzed
%TS
SM 2540 G
2.7
0.10
%
18-Mar-15 KEK
Mulitple Tube Fermentation Procedure SM 9221-E
62100
4.9
MPN
18-Mar-15 KEK
Sample identification:
CC Sludge #3 Grab
Sample number:
124626
Parameter
Method
Result
RL
Units
Date Analyst
Footnotes
Analyzed
%TS
SM 2540 G
2.6
0.10
- %
1R-Mar--15 KEK
Mulitple Tube Fermentation Procedure SM 9221-E
59800
4.7
MPN
18-Mar-15 KEK
Sample identification:
CC Sludge #4 Grab
Sample number:
124627
Parameter
Method
Result
RL
Units
Date Analyst
Footnotes
Analyzed
%TS
SM 2540 G
2.6
0.10
%
18-Mar-m KEK
Mulitple Tube Fermentation Procedure SM 9221-E
119600
4.7
MPN
18-Mar-15 KEK
Footnotes:
RL = Reporting Limit. Values are reported down to the Reporting Limit only.
Date reviewed: 0 � - i S NC Certification Number: 600
Data reviewed by: Kelley E. Keenan SC Certification Number: 99053
t Signature: NC Drinking Water Certification Number: 37786
This reportshould not be reproduced, exept in its entirety, without the written consent of Environmental Testing Solutions, Inc.
The results in this report relate only to the samples submitted for analysis.

PO Box 7565
® Asheville, NC 28802
Phone: [phone]
Fax: [phone]
Environmental Testing bolutlahs,Inc.:: Cei`iifiCate of Analysis
Project name: ' Marion WWTP -- __ Project number: 150325.502
Collection date: 25jM4roi
Date received:5=M�r?15 _
Sample identification: CC $Qge #5; 4:Grab Sample number: 124741
.1. H ' i%
Method Result RL Units Date Analyst Footnotes
Parameter ; ►„ ,r. aoa
S
5
%TS
SM 2540 G
3.1
0.10
%
25-Mar-ts
KEK
Miilitple Tube Feintentatioli ljjro edure
j 8M 9221-E
71300
5.6
MPN
25;Mar-15
KEK
tmple identification: • ':CC �si3O
gel
i; Grab ..
Sample number:
124742
Parameter i °
+ 'Method
Result
RL
Units
Date
Analyzed
Analyst
Footnotes
%TS t !
SM2540 G.
2.9
KEK
MuliIeTabeFe�rnenW66P1ti "*:,!
SM9221-E:
22620
5.2
MON
25=Mar15
KEK
ample identifioationi :'CCi`
` e #7-Grab:; .
do •
.Sai#ple number:
124743
---
Parameter .
1
. ;:i. ; ..:�_
? aVieiliod
Rest if
RL
, '
Units
Date
Ar aiyzed
Analyst
,Footnotes
?;
%
:
.`
2.7
0.10
25=Mar-15:
KKTS
le Tlibe'F '
'
6T0
49v�N
sMaeMuli is
KEK.
:;{::
T
NC Certification Number: 600
Date review
e Ieeitan : SC Certification Number:: 99053
Data review `b; : r; ::r .'= .. :' r ±—
j NC -Drinking Water Certification Number: 37786
Signature::, `.j - l i': ` l
iS- eJ5bitb dbl -itbt • p. L exe¢t ll5 itJ entirety, without a written consent ofMhonmental'Testing Solutions, Inc.
•:1 • ;; :T[i�re�blts'lrr this Yeport relate only to the samples submitted for analysis.

SOUR CALCULATION SHEET
1.37
1.36
1.52
1.44
1.64
1.49
1.5
1.1315

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling DatelTime:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
04
Dry Solids
grees Celsius
Qrees Celsius
Slope: 0.3
Intercept: 8.0
Correlation Coefficient: 1.0
Oxygen Uptake Rate: 17,47 mg Oxygen/hr
Ambient Specific Oxygen Uptake. Rate: 1.75 mg Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor. 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1.37 mg Oxygenhg/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
0

Time
(minutes)
0
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Na
Biosolids Permit Num
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
. Total Solid's:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
5 0835
.A
5 1010.
er
1000 milliliters
0.99 % Dry Solids
25 degrees Celsius
25 degrees. Celsius
Slope: 0.3
Intercept: 8.2
Correlation Coefficient: 1.0
Oxygen Uptake Rate: 17.20 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 1.74 mg Oxygen/g/hr
Average Temperature: . 25 degrees Celsius
Temperature Correction Pactor. 0.783526166
Temperature Corrected Specific Oxygen Uptake Rater 1.36 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12 .
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By
Analysis DateRime:
Analyzed -By:
Sample Volume:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
14
►2015 0810
Estes
f2015 0950
arter
1000 milliliters
1.04 % Dry Solids
25 degrees Celsius
25 degrees Celsius
Slope: 0.3
Intercept: 7.6
Correlation Coefficient: 1.0
Oxygen Uptake Rate:. 20.21 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 1.94 mg. Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor: 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1.52 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:l
Biosolids Permit Number:'
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
311
16
5
1000 milliliters
1.02 % Dry Solids
25 degrees Celsius
25 dearees Celsius
Slope: 0.3
Intercept: 7.0
Correlation Coefficient: 1.0
Oxygen Uptake Rate: 18.68 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 1.83 mg Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor: 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1.44 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Time
(minutes)
0
1
2
3
4
5
6
7
8
0
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility
Biosolids Permit N
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Amilliliters
% Dry Solids
degrees Celsius
degrees Celsius
0.3
7.6
1.0
Oxygen Uptake Rate: 20.88 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 2.09 mg Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor. 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate:j 1.64 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12 .
13
14
15
Facility
Biosolids Permit N
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
5.
4.
4.
3.
Slope: 0.3
Intercept: 8.2
Correlation Coefficient: 1.0
Dry Solids
grees Celsius
arees Celsius
Oxygen Uptake Rate: 19.23 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 1.90 mg Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor: 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1491mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility
Biosolids Permit N
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Sample Volume:
Total Solids:
Beginning
End
Dissolved Oxygen Level
Slope: 0.3
Intercept: 7.9
Correlation Coefficient: 1.0
Dry Solids
grees Celsius
grees Celsius
Oxygen Uptake Rate: 19.61 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 1.91 mg Oxygen/g/hr
Average Temperature: 25 degrees Celsius
Temperature Correction Factor. 0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1.501 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.

Environmental Testing Solutions
. 351 Depot St,
Asheville, NC 28801-4310
Project:
Work Order:
Reported:
Marion WWTP
5030738
04/10/15 10:34
Sample Data
Sample Number 5030738-01'
Sample Description Marion WWTP CC Sludge Grab collected on
03/18/15 07:49
Parameter
Result
Reporting
Limit
Units
DF
Analyzed
Method
Flag Analyst
Batch
General Chemistry Parameters
Nitrate as N, extractable
1200
157
mg/kg dry
1.00
03/26/15 16:25
EPA 921OA
LDP
B5C0936
Nitrite as N, extractablb
ND
1.37
mEAg dry
1.00
03/26/15' 14:05
sM 45oorro2B-2011
REH
BSC] 000
Total Kjeldahl Nitrogen
51200
844
mt;/kg dry
1.00
04/07/15 16:27
EPA 351.2
LDP
BSD0154
Total Nitrogen (TKN+Nitrate+Nitrite)
52400
844
mg/kg,dry .
1.00
04/07/15 16:27
-
LDP
BSC1002
Total Solids
2.90
6.10
%
1.00
03/23/15 10:30
SM254OG
LCB
115C0810
Total Metals
Mercury
ND
3.2
mg/kg dry
5.00
03/23/15 16:24
EPA 7471E
DER
B5C0749
Aluminum
11900
854
mg/kg dry
50:0
04/01/15 12:20
EPA 6010C
MEC
B5C1001
Arsenic
ND
17.0
mg/kg dry
1.06
03/25/15 11:00
EPA 6010C
MEC
135C0781
Cadmium
ND
6.82
mg/kg dry
1, 00
.03/25/15 11:00
EPA 6010C
MEC
B5C0781
ium
11200
854
mg/kg dry
50.0
04/01/15 12:20
EPA 6010C
MEC
WC1001
Copper
246
6.82
mPIkg dry
1.00
03/25/15 11:00
EPA 6010C
MEC
B5C0781
Lead
32.7
17.0
mg/kg dry
1.00
03/25/15 11:00
EPA 6010C
MEC
B5C0781
Magnesium
4920
1700
nvAg dry
50.6
03/25/15 10:52
EPA 6010C
MEC
B5C0781
Molybdenum
ND
17.0
mg/kgdry
1.00
03/25/IS 0:00
EPA 6010C
MEC
B5C0781
Nickel
13.5
6.82
mg/ks dry
1.00
03l25115 I I :00
EPA 6010C
MEC
B8C0781
Potassium
5330
34.1
mg/kg dry
1.00
03/25/15 11:00
EPA 6010C
MEC
13560781
Selenium
ND
17.0
mg/kg dry
1.00
03/25/15 11:00
EPA 6010C
MEC
B5C0781
Sodium
2960
1700
mg4r9 dry
50.0
03/25/15 10:52
. EPA 601OC
MEC
135C0781
Total Phosphorus as P
19200
683
mg/kg dry'
50.0
04/01/15 12:20
EPA 6010C
MEC
B5C1001
7-inc
574
17.0
mg/kg dry''
1.00
03/25/15 11:00
EPA 6010C
NEC
B5C0781
°O Box 5655. l• Greenville, SC 29606 I.426 Fairforest Way I"Greegviile,-SC 29607' 1 main 864.232..1556.1 fax:864.232,6.140 CE)gei'SalldCallcott.COCTI
"- �-^----- - an employee-ownedcompany
fI0/2015 10:34 This report.tndy not be reproduced,, ercept in frdl,'wirhorri written permission from Pokers d C'allcot, Me.

Certificate of Analysis
Project name:
Marion WWTP
Collection date: 18-Mar-15
Date received: 18-Mar-15
PO Box 7565
Asheville, NC 28802
Phone: [phone]
Fax: [phone]
Project number: 150318.511
Sample identification. CC Sludge - Grab Sample number:
124642
Parameter Method Result RL Units Date Analyst Footnotes
Analyzed
Tota Solids SM 2540 G 2.90 0.10 % 23-Mar-15 LCB 1
Mercury
7471B
<3.2
3.2
mg/kg
23-Mar-15
DER 1
Aluminurri
6010C
11900
854
'mg/kg
1-Apr-15
MEC 1
Arsenic
6010C
<17.0
17.0
M&g
25-Mar-15
MEC 1
Cadmium
6010C
<6.82
6.82
mg/kg
25-Mar-15
MEC 1
Calcium
6010C
11200
854'
.mg/kg
25-Mar-15
NEC 1
Copper
6010C
246
6.82
mg/kg
25-Mar-15
NEC I
Lead
6010C
32.7.
17.0
mg/kg
25-Mar-15
MEC 1
Magnesium
6010C
4920
1700
mg/kg
25-Mar-15
MEC
1
Molybdenum
6010C
<17.0
17.0
mg/kg
25-Mar-15
MEC
1
Nickel
6010C
13.5
6.82
mg/kg
25-Mar-15
MEC
1
Potassium
6010C
5330
34.1'
mg/kg
25-Mar-15
MEC
1
Selenium
6010C
<17.0
17.0
mg/kg'
25-Mar-15
NEC
I
Sodium
6010C
2960
1700
mg/kg
25-Mar-15
NEC
1
Zinc
6010C
574
17.0
mg/kg
25-Mar-15
MEC
1
Nitrate +Nitrite as N
1200
138.37
mg/kg
26-Mar-15
LDP/REH
1, 3
Total Phosphorus
6010C
19200
683
mg/kg
1-Apr-15
MEC
1
Total Kjeldahl Nitrogen
3.51.2
51200
' 844
mg/kg
7-Apr-15
•LDP
1
Total Nitrogen
Calculation
52400
844
mg/kg
7-Apr-15
LDP
1
Ammonia Nitrogen
SM 4500 NH3 D
59
37
mg/kg
19-Apr,15
KEK
Percent Solids
SM 2540 G
2.7
%
18-Mar-15
KW
pH in Liquid
SW 846 9045C
5.5
S.U.
18-Mar-15
KW
4
N-PAV
Calculation
153546
13-Apt-15
KEK
Sodium Absorption Rate
Calculation
33
13-Apr-15
KEK
Reactive Cyanide
335.4
<0.124
0.124
mg/kg
26-Mar45
ECHEM
3
Reactive Sulfide
SM 4500 3 D
<0.249
0.249
mg/kg
26-Mar-15
ECHEM
3
Ignitability.
SW 846 1030
>212
212.0
mm/sec
7-Apr-15
ECHEM
3
Arsenic'- TCLP
6010 C
<0.25
0.25
mg/L
1-Apr-15
MEC
1
Barium - TCLP
6010 C
<2.50
2.50
mg/L
. I-Apr-15
MEC
I
Cadmium -TCLP
6010 C
<0.05
0.05
mg/L
1-Apr-15
NEC
1
Chromium - TCLP.
6010 C
<0.10
0.10
mg/L
1-Apr-15
MEC
I
Lead - TCLP
6010 C
<0.25
0.25
mg/L
1-Apr-is
MEC
I
Selenium - T:CLP..
6010 C
<0.25 ..
0.25
mg/L
1-Apr-15
NEC
1
Silver - TCLP
6010 C..
<0.10
0.10
mg/L
1-Apr-is
MEC
1
Mercury, TCLP
7470A.
<0.0020
0.0020
mg/L
9-Apr-15
DER
1
Full Span TCLP Organics
See attached sheets
1,3
This, report should not be repro. uceSi, �xept m its enttret ,.without . e written consent o Envuonmental Testing So utions, Inc.
'The results:in this report relate only-t6 the samples submitted for analysis.-

i
Cad coat
1r N Y;I:RO N M.'E N TAL
Environmental Testing Solutions Project: Marion.WWTP
351 Depot St, Work Order: 5030738
° Reported: 04/10/15 10:34
g. •. Asheville, NC.28801-4310 . P
Sample Number
Sample Description
Parameter
5030738-02
Marion WWTP CC Sludge Grab collected on 03/18115 07:49
Reporting,
Result Limit units
DF
Analyzed
Method.
Flag Analyst
Batch
TCLP Metals
Mercury
ND,
0.0020
MS/L
10.0
04/09/15 12:11
EPA 7470A
DER
B5D0246
Arsenic
ND.
0.25.
n!6�1-
5.00
04/01/15 14:33
EPA 6010C
MEC
• 115C1046
Barium
ND
2.50
mg/L
5.00
04/01/15 14:33
EPA.6010C
MEC
B5C1046
Cadmium
ND.
0.05
mg1L
5,00
04/01/15 14:33
EPA 6010C
MEC
B5C1046
Chromium
ND
0.10
mg L
5.00
04/01/15 14:33
EPA 601OC
NEC
115C1046
Lead
ND
0.25
mg/L
5.00
04/01/15 14:33
EPA 6010C
MEC .
115C1046
Selenium
ND
0.25
mg/L
5.00
04/01%15 14:33
EPA 6010C
MEC
BSC1046
Silver
ND
0.10
mg/L
5,00.
04/01/15 14:33
EPA 6010C
MEC
11SC1046
TCLP Volatile Organics
Benzene
ND
0:100
mg/L
50.0
03/31/15 20:32
EPA 8260E
ARM
B5D0174
2-Butanone (MEK)
ND
0.200
mg/L
50.0
03/31/15 20:32
EPA 8260B
ARM
115DO174
Carbon tetrachloride
ND
0.100
mSIL
50.0
03/31/15 20:32
EPA 8260E
P ARM
115D0174
Chlorobenzene
ND`
0.1.00 '
Mg/L
50.11
03/31/15 20:32
EPA 8260B
ARM
115DO174
Chloroform
ND-
0.100
mg/L
50.0
03/31/15 20:32
EPA 8260B
ARM
B5D0174
I,!-Dichloroethane
ND
0.100
MIA
50.6
03/31/15 20:32
EPA 8260B
ARM
115DO174
1,4=Dichlorobenzene
ND
0.100
mg/L
50.0
03/31/15 20:32
EPA 8260B
ARM
135DO174
10-Dichl6roethene
ND
0.100
mg/L
50.0
03/31/15 20:32
EPA 8260s
P ARM
135D0174
Tetrachloroethene
ND
0.100
mg/L
50.0
03/31135 20:32
EPA 8260B
P ARM
135DO174
Trichloroethene
ND
0.100
mg/L
50.0
03/31/15 20:32
EPA 8260B
P2 ARM
135DO174
Vinyl.ohloride
ND
0.100
mg/L.
50.0
03/31/15 20:32
EPA 8260B
P2 ARM
135DO174
Surrogates
%REC
%RFC Limits
Flag
1,2-Dichloroethane-D4
88
70-130
Toluene-D8
89
70-130
4-Bromq/luorobencene
91
70-130
TCLP Semi -Volatile Organics
2-Methylphenol (o-Cresol)
ND
0.1100
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
3/4-Methylphenol (m,'p-Cresol)
ND
0.100
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
total Cresol
ND
0.200
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
335D0005
2,4-Dinitrotoluene
ND
0.100
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
Hexachlorobenzene
ND
0.100
mg/L
-10.0
04/06/15 21:24
EPA 8270D
RJM
35D0005
Hexachlorobutadiene
ND
0.100
mg/L
10.0
04/06/15 21:24
EPA827oD
RJM
135D0005
Hexachloroethane
ND
0.100
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
Nitrobenzene
ND
0.100
mg/L
10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
- Pentachlorophenol
ND
• 0.100
mg/L '
10.0
04/06/15 21:24
EPA 8270D
RJM
B51)0005
PO Box 5655 I Greenville SC 2960b. 1426 Fairforest Way
I Greenville; SC 29607
1 crrqin.864.232.1556 I fax 864.232:6140 ;rogersandcaIIcot(;.cOm
.... _..._.- -�.. - ...e ... -.. :..
9
e
- --
- - -
---
- a mplo erownedtompany
ne y .
This report may riot fie reprodueerJ except in frdl, w ihout
written permission from Rogers & Callcolt, Ina
€
04110,12015 10:34

ti
g rs &C t , ott
.-Ro e . . - - - -..Ic ''
Vl V-lRON.M:E.NTAL
Environmental Testing Solutions Project: Marion.WWTP
m
351 Depot St. Work Order: 5030738
Asheville, NC 28801-43.10 Reported: 04/10/15 10:34
Sample Number 5030738-02
Sample Description Marion WWTP CC Sludge Grab collected on 03/18/15 07:49
Result
Reporting
Limit
Units DF
Analyzed
Method
Flag Analyst
Batch
Parameter
TCLP Semi -Volatile Organics
ND
0.100
mg/L 10.0
04/06/15 21:24
EPA 8270D
RJM
I35DO005
Pyridine •.
ND
0.100
mg/L 10.0
04/06/15 21:24
EPA 8270D
RJM
135D0005
2,4,5-Trichlorophenol
ND
0.100
mg/L 10.0
04/06/15 21:24
EPA 8270D
RJM
B51)0005
2,4,6-Tri.oworophenol
%REC
%REC Limits
Flag
Surrogates
Nitrobenzene-D5
` 88
35-114
87
43-116
2-Fhmrobtphenyl
49
21-110
2-Fhrorophen6l
35
10-110
Phenol-D5
2,4,6-7Mbronmphenol
90
10-123
80
33-141
Terphenyl-D7a
TCLP Pesticides
Gamma-BHC (Lindane)
ND
0,00050
m8/L
10.0
04/08/15 20:59
EPA 8081E
RKH
BSDO110
ND
0.0050
mg/L
10.0
04/08/15 20:59
EPA 8081B
RKH
B5D0110
Chlordane
ND
0.00050
mg/L
10.0
04/08/15 20:59
EPA 8081B
RKH
135DO110
Endrin
ND
0.00050
mg/L
10.0
04/08/15 20:59
EPA 8081B
RKH
B5130110
Heptachlor
ND
0.00050
mg/L
10,0
04/08/15 20:59
EPA BOB 1E
RKH
B5D0110
Heptachlor 6pozide
ND
0.0050
mg/L
10.0
04/08/15 20:59
EPA 8081B
RKH
B5DOl 10
Toxaphene"
ND
0.00050
lng/L
10.0
04/08/15 20:59
EPA 8061E
RKH
B5D0110
Methoxychlor
%REC
%REC Limits
Flag
Surrogates
2,4,5,6-Ten•achl0r0-m xylene
86
60-130
Decachlorobtpheni l
84
30-150
FO..l3ox 5655 I. Greenville, SG 29606 1 426 Fairforest Way I Greenville, SC 29607 t rMih 864.232.1556 1 fax [phone]i"40 t"Ogel"SandcalICO1.t.00171
_ - -------�- an employee owned rompariy
04./10./2015 1 U:34 This report may not be reproduced, except in frtfl, w•tthnut written permissiwi,h»nr Rogers 4- Calkntt, Inc.

State of North Carolina
Department of Environmental Quality
DuWRII Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 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:11yortal.ncdenr.or 1Webhvg/aPs/lazy
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 1SA 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 documentation listed
below.
A. Land Application Site Certification (FORM: LASC 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 11-15) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
❑ The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
County Board
✓
Notification. doc
14' J
Land Owner
Agreement
(If applicable)
i
✓
✓
✓
✓
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "MJ) Guidance
for Residuals Land An li _p cation Permits"
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scientist
✓
Evaluation Policy"
INSTRUCTIONS FOR FORM: LASC 11-15 Page 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs)
Required Item Status Code
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Poliev"
Acknowledgement of field transfer from Land Owner (Fields may not I I ,
be permitted to multiple Permittees over the same time period)
m t his item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
❑ Crop Type should include the most likely crop types for the life of the permit (five years).
❑ Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
❑ Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
❑ Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion fiom Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by I1-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: http•//poAal.ncdenr.org/web/wq/ 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 downloaded at:
http://portal.ncdenr.or web/wq/home/ro
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
- _ 3. Open the link _littt)://h2o.enr.state.nc.us/bimsh•epoits/reportsWB.htini. If this link does not work, open
htt/.//portal.ncderu`orweb/wq/ps/csu/classifications and download weekly -updated classification lists for named
waterbodies.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
INSTRUCTIONS FOR FORM: LASC 11-15 Page 2 of 3

1. Select proper basin from
Hydrologically
report,
the List all Waterbodies in Neuse Basin sorted
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 description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in Alamance 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 the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301M.
Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
[] The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
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 Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 11••15 Page 3 of 3

LAND AP. . -RATION SITE CERTIFICATION -
Applicant's name: City of Marion
Land application sites currently certified: 1`17.8 net acres and Total to be certified: 1°036 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 b
Mapping Unit
or Rep. Slope`
R
K1
Mario DeLuca
_ _
16.4 ✓
McDowell
Fescue
Hayesville
HaC
R
K2
Mario DeLuca
30.3
McDowell
Fescue
Hayesville
HaC
R
F1
John Fisher
9.9 ,/
McDowell
Fescue
Braddock
BrB2
R
F2
John Fisher
2.4 ✓
McDowell
Fescue
Braddock
BrB2
R
F3
John Fisher
7.0
McDowell
Fescue
Hayesville
HaC
R
F4
John Fisher
6.7
McDowell
Fescue
Hayesville
HaC
R
RI
Wayne Ross
17.2 v
McDowell
Fescue
Hayesville
HaC
R
R2
Wayne Ross
13.7 `�
McDowell
Fescue
Hayesville
HaC
-status lode Tor land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) ♦ D (Deleted)
b 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)
H. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Datum Location
Location Method Code
Location Accuracy
Waterbod y Subbasin and
Stream Index No.
Current and Proposed
Class
K1
350 34' 43"
810 5 F 48"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 11-32-2-9
C
C
K2
350 34' 43"
810 5`1' 58"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 11-32-2-9
C
C
F1
35.0 35' 39"
810 5.1' 0.4"
NAD 83
ADD
Nearest Second
Magazine Creek 11-327 -9-2
C
C
F2
350 35' 32"
810 50' 60"
NAD 83
ADD
Nearest Second
Magazine Creek 11-32-2-9-2
C
C
F3
350 35' 33"
810 50' 42"
NAD 83
ADD
Nearest Second
Magazine Creek 11-32-2-9-2
C
C
F4
350 35' 31"
810 5.0' 36"
NAD 83
ADD
Nearest Second
Magazine Creek 11-32-2-9-2
C
C
RI
350 34' 40"
810 51' 24"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 11-32-2-91
C
C
R2
350 34' 50"
810 5 F 20"
NAD 83
ADD
Nearest Second
S,Fork Hoppers Creek i 1-32-2-91
C
C
Note: Please keep the site information (1.) and waterbody information (11.) of the same field on the same page.
FORM: LASC 11-15 Page 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 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 we site at:
http://portal.ncdew org/weft/tivc�/a�s/lap
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 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 set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: C i 4 eC Pick P., U n
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
n�
escU
4- ed
U
f es r- V' �
Gil h M� -t&d
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
FORM: LOA 11-15 Pagel of 3

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

` andowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: 0CkV., J
Address:
City:, ._ `y ^ �o�� State: � �— Zip:
V
Phone:
E-mail
Signature: ivv %9 Date:
NORTH CAROLINA, _M C' D U w e I( COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the 15.rti
day of
Signature and seal:
My commission expir .
Lessee's/Operator's Certification:
1EIC",
Q
Al-
kes n_ vbll',
O -vnfk
06
/0gr120LM1111400
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: _
Phone:
Signature:
Permittee's Certification:
State:
E-mail
I certify that I have read this�Agreement and do hereby agree to abide by the
Signing official naike:..)
Signature:
Date:
Date:
Zip:
and restrictions as specified herein.
iC;P
FORM: LOA 11-15 Pase 3 of

, D WR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 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 suti_mit 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 we site at:
http://postal.ncdenr.org/web/wc�/a s/lau
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 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 set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Cjk4 u"o mono."
hereinafter referred to'vas the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
(�
Raa�^
r�
F*,-Se-vz
Igv1.'4'. :Ftv
landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
— mittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
FORM: LOA 11-15 Pagel of3

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.
I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance; boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
1V. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new DroRram:
(Name of the new program)
FORM: LOA 1145 Page 2 of 3

andowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: MeA- ; o z LUC•G
Address: L o., di s LKA -P_
City: 1V b State: JV C. Zip: �s ),G
Phone: ��� �� �''1 �� Y� E-mail address:
Signature:. Date:
NORTH CAROLINA, _ \c- COUNTY
I, the undersigned Notary Public do hereby certify that /d l rnr" o Oe L yr c%
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
r l�
- WITNESS my hand and official seal this the
day of _ �i ti nw i, p 20
77
Signature and seal: _ o„r,nn
My commission expi s: (_I "' Wilkes County
Lessee's/Operator's Certification: '�iiTN'fCIAik
I0\\\\���`
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: - Date:
Permittee's Certification:
I certify that: I have read this Agreement d do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing offci,Xl-naqie:.;—� 6e —� �C C ` Mr i
FORM: LOA 11-15 Page 3 of 3

State of North Uarolma
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
Division of Water Resources
FORM: LOA 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 we site at:
http;//portal.ncdenr. 2m1vteb1wg1aps11au
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 11-15):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 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 set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:_ 6-, U 'a r "0
hereinafter referred to aV the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�- 03
Frs
tI
F- U L1
Fie s e„ e,
-e '
the landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
FORM: LOA 11-15 Pagel of 3

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

indowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: a � n F S � e ,
Address: 399 () a
City: — N c b p U State: N C Zip:
Phone: h S- `'I 39 - N � 3 S" E-mail address:
Signature: �— Date:
NORTH CAROLINA, Pl e b o-•� t I I COUNTY
I, the undersigned Notary Public do hereby certify that —Tu K>` F.51 < r"
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the uuui
� GNE R Y
day of,20
Signature and seal:
My commission expires: y -el • D u
Lessee's/Operator's Certification:
Wnes County _
� 0 rH I c A�?°�``�,,
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as, specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature: _
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify ghat I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing of cia �_ � L�(� i Tf + I cf ✓tgnQ_
FORM: LOA 11-15 Page 3 of 3

:.a State of North Carolina
Department of Environmental Quality RDivision 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 conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
http:llportal. ncdenr. olg/web/wq/aps/1au
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 .1 108(b)(2)[for 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:
s
❑ 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)
The undersigned property owner hereby permits:
Applicant's name: a i IJ of
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 0
the residence or place of public assembly located at the following:
Location address of property:
City: N z &
1,2 U Lc,,\J,S LgnC
State: V C-
feet (i.e., cannot be less than 100 feet) of
Zip: d,Y�G}
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: 5 �� 5,
Signature: 5 ski`' Date:
- l5 -iG
FORM: SWA 11-15 Page 1 of 1

State of North Carolina
pt
Department of Environmental Quality
W 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 conies 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. org/web/w"ls/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 [for 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)
The undersigned property owner hereby permits:
Applicant's name: C +.
Applicable Field ID:
r;0rt
hereinafter referred to as the Permittee, to land apply residuals within 01 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: l 16LI ILo,,,'A.) lane,
City: 't 60
State: ./ C,
zip: d-Y,7.q I
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.
f] 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: /��+ �N n 8 ci
Signature:
Date:
FORM: SWA 11-15 Page 1 of 1

DWR
State of'North Carolina
Department of Environmental Quality
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:
htt /portal. ncdenr. or Aveb/wglaps/lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
sites) 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 1.1-15).
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 WANE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: C I ]
Applicable Field ID
fib AAr; o
41
hereinafter referred to as the Permittee, to land apply residuals within a a d 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: 1 , -w-1 I/ LrJ:,
City: IV,:bv
State:
A/c
Zip: 9 )
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 Permitte11e to land apply residuals to land application site(s) as specified herein.
Property owner name:
Signature:
Date: ) 1 S_ i6
FORM: SWA 11-15 :Page 1 of 1

State of North Carolina
D W It Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PR GRAM)
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 idditional
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.org/web/wq/a s au
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to ,the land pplication
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)12)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 1. -15).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-15) form. Ple se 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 tl ley 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 waiv d 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)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
C -49 e f—
hereinafter referred to as the Permittee, to land apply residuals within d b 0 feet (i.e., cannot be less than 1. 0 feet) of
the residence or place of public assembly ocated at the following:
Location address of nronerty: 13867 V L_af%4k Z, n e.
City: No, 6 State:
y C Zip:
.,) G I
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for th residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement hall 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 3� calendar
days in advance, modifies or cancels this Agreement.
PT
I certify that I am a deeded property owner of above -
property on behalf of other deeded property owners. Fui
hereby grant permission to the Permittee to land apply ri
�! ; a�. l�pr-4,o�
Property owner name:
Signature:
ed property and am authorized to make decisions reg (ding this
'e, I certify that I have read and understand this Agreement and do
to land application site(s) as specified herein.
Date: 1- Is- 16
FORM: SWA 11-15 1 1]age 1 of 1

State of North arolina
Department of Environmentall Quality
,nW,R Division of Water R sources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PR.QGRAM)
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 V dditional
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
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
htt //portal. ncdenr. oil/web/ivglaps/lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land plication
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�(2i�'for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 1 -15).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-15) form. Ple e do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachm nts to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which tl ey 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)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the following:
Location address of property: 19 6 ✓ La��, � t< e_
City:
900 feet (i.e., cannot be less than 1t 0 feet) of
State: NC Zip
4 %1
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for th residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement hall 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 reg� rding 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: yd"� _r_ ­ c'
Signature:
Date: I ` 1
FORM: SWA 11-15 1 age 1 of 1

r�
- ANNUAL LAND APPLICATION FIE _` - 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: City of Marion WQ Permit #: WQ0019960 Field #: F'-nnl s _ Utilized:
Land Owner: James Fisher Annual Dry Tons Applied: 15.0595 Ac
Site #: F-Ol Acres Permitted: 13.7
Operator: James Fisher Predominant Soil Series: Braddock Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 239 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
(enter one) Solids/
%
Q
Liquid
Solids
Cu. Yds Gallons
10-20111
I 78000
4.63
JiAus:l 01 780001
.nnual lbs/acre
rior Years Cumulative lbs/ac
urrent Cumulative lbs/ac
ermitted C. P. L. R.****
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Pert_, Animal
Waste, etc)
1.099
WQ0019960
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Soil
Precip.
y
o_
Cond.
Past 24
q �
� w;
CD
w
rlrs.
o W
N'
Iry'
Wet,
vloist)
inches
o'
d_*y
I n
1 s
, 0.5
, 0.3
TKNT
mg/kg
49000
z�
Owe 0
: a
w
mg/kg
12500
Residuals Applications totals on FORM
FSF supp ( attach FORM
FSF supp to this
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
0.011
0.004
0.779
0.128
0.121
0.005
0.022
0.048
0.007
2.244
0.041
0.022
3.4
1.888
0.577
0.31
0.17
0.289
0.043
10.9i3
0.052
0.026
4.179
2.016
0.698
0.315
0.192
0.337
0.050
13.157
36
34
NA
1338
267
15
NA
374
89
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Crop 1
Crop 2
1
37.816
NA
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
Name of Crop Tvpe
Receiving Residual
Application
Crop 1 Crop 2
Fescue I
P 1 37.816 1 -0.00-6-1 Lime A
37.620 Date
'rmit PAN Limit lst/2nd Crop -
2498
239
[ certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
L
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Appleer DateCompost Mineralization Rates: -0.1, anaerobiall digested -0.2 ,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIEL- .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: City of Marion
Land Owner: James Fisher
Operator: James Fisher
Crop 1 Name: Fescue
WQ Permit #: WQ0019960 Field #: F-02
Annual Dry Tons Applied: 3.7649 Site #: F-02
Predominant Soil Series: Braddock
Crop 1 Max. PAN:
239
Crop 2 Name:
Acres Utilized: 4.3
Acres Permitted: 4.3
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
o Y
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds .Gallons
%
Solids
Volume
A hed er
pp p
Acre
(Dry Tons/AC)
Residual Sources
(NPDES #, WQ#,
Fert_, Animal
Waste, etc)
Soil
Cond.
Dr
(may'
t'
Moist)
Precip.
Past 24
Hrs_
inches
�
K a
cD
a �
o
o
�
�,
w m
*
0
a
TKN
mg/kg
z >
� o
g
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
10-2011
1 19500
1 4.63
0.876
WQ0019960
dry
I 0
s
0.5
0.3
1 49000
1 12500
1 i
30.121
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):
DTALs:
0
19500
As
Cd
Cu
Cr
Pb
Hgr
Mo
Ni
Se
Zn
P
30-1211
0.000
Lime Applied
,nnuallbs/acre
0.009
0.004
0.623
0.102
0.097
0.004
0.018
0.039
0.005
1.795
30.096
Date
lbs/ac
rior Years Cumulative lbs/ac
0.079
0.088 1
1 36
0.15
0.154
34
2.44
3.063
NA
1.263
1.365
1 1338
0.402
0.499
267
0.022
0.026
15 1
0.119
0.137
NA
0.201
0.240
1 374 1
0.029
0.034
89 1
7.601
9.396
2498
urrent Cumulative lbs/ac
ermitted C. P. L. R.****
-rmit PAN Limit 1 st/2nd Crop
1.
239
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
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 Loadinp- Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIE 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: City of Marion
Land Owner: Ia..mes Fis ;er
Operator: James Fisher
Crop 1 Name: Fescue
WQ Permit #: WQ0019960
Annual Dry Tons Applied: 14.2301
Field #: F-03
Site #: F-03
Predominant Soil Series: Hayesville
Crop 1 Max. PAN: 202 Crop 2 Name:
Acres Utilized: 11A.4
Acres Permitted: 11.4
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
O
Q
Volume applied
(enter one) Solids/
Li^uid
q
Cu. Yds Gallons
%
I Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Cond.
(Dry,
Wet,
Moist)
Precip.
Past 24
Nss.
inches
y
�
o W
0.
�
0
?;
CD
N
w
I CD -
x w
TKN
mg/kg
z
o o
w-
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
12-14
136500
2.5
1.248
WQ0019960
dry
1 0
1 s
0.5
0.3
55800
I 2000
949.97
15.162
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
1
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
OTALS:
01
136500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
45.162
0.000
Lime Applied
►nnuallbs/acre
0.050
0.020
0.856
#######
0.124
0.002
0.050
0.035
0.050
2.276
68.390
Date
lbs/ac
rior Years Cumulative lbs/ac
0.042
0.092
36
0.018
0.038
34
2.531
3.387
NA
1.763
#######
1338
0.475
0.599
267
0.019
0.021
15
0.09
0.140
NA
0.219
0.254
374
0.038
0.088
89
9.034
11.310
2498
.urrent Cumulative lbs/ac
ermitted C. P. L. R.****
.rmit PAN Limit 1st/2nd Crop
202
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
:?-y-/J_
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 (12/2006)

ANNUAL LAND APPLICATION FI7 1 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: City of Marion
if Owner: James Fisher
Operator: James Fisher
Crop 1 Name: Fescue
WQ Permit #: WQ0019960 Field #: F-04
Annual Dry Tons Applied: 12.1973 Site #• F-04
Predominant Soil Series: Hayesville
Crop 1 Max. PAN: 202 Crop 2 Name:
Acres Utilized: 8.2
Acres Permitted: 8.2
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
° Y
°
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/AC)
Residual Sources
DES #, W #,
(NP Q
Fert., Animal
Waste, etc)
Soil
Cond.
(DD''
Wet,
Moist)
Precip.
P� 24
Hrs.
inches
➢
C '
o m
o
o
w y
N
* �,
�
w
-
�
TKN
mg/kg
z
o o
3
c; -
mglkg
Nitrate
and
Nitrite
mg/kg
PAN Applie
( lbs/acre)
7R:eCropType
g Residual
ication
Crop 1
Crop 2
Crop 1
Crop 2
12-14
117000
2.5
1.487
1 WQ0019960
dry
0
s
0.5
0.3
55800
2000
949.97
53.817
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
I
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:
01
117000
As
Cd
Cu
Cr
Pb
H
Mo[.042
Ni
Se
Zn
P
53.817
0.000
Lime A lied
umuallbs/acre
0.059
0.024
1.020
#######
0.148
0.002
0.059
0.059
2.712
81.488
Date
lbs/ac
'rior Years Cumulative lbs/ac
0.066
0.125
36
0.035
0.059
34
6.114
7.134
NA
2.109
#######
1338
0.904
1.052
267
0.036
0.038
15
0.165.409
0.224.451
NA
374
0.076
0.135
89
14.495
17.207
2498
:urrent Cumulative lbs/ac
ermitted C. P. L. R.****
ermit PAN Limit 1st/2nd Crop
202
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
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 (1212006)

ANNUAL LAND APPLICATION FE i 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: City of Marion WQ Permit #: WQ0019960 Field #: R-01 Acres Utilized: 19.4
Land Owner: Nancy Ross Annual Dry Tons Applied: '30.4931 Site #: R-Ol Acres Permitted: 19.4
Operator: Nancy Ross Predominant Soil Series: Capacity Hayesville Cation Exchange Ca g p ty (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 202 Crop 2 Name: Crop 2 Max. PAN:
Volume applied Volume Soil C 4
o Residual Sources Precip_ Y o z a Nitrate
(enter one) Solids/ % Applied per (NpDES #, WQ#, Cond_ Past 24 � w -" TKN o � r=ipping
Crop Type
a� r_ PP P Ct PAN Applied
o A' �` °o° ° and (;bs/acre) esidual
L,q�,d Solids ! Acre Fert., Ani*naI Iirs. o n � R Wei c _. * m f I= 'w I Nitrite ication
Cu. Yds Gallons (Dry Tons/Ac) Waste. etc) inches x 0 � � o"
Moist) o mg/kg mg/kg mglkg Crop 1 Crop 2 Crop 1 Crop 2
5-2014 2S2500 2.5 i-000 WQ00I9960 dry 0 s 0.5 0.3 155800 2000 949.97 56.868 NA Fescue
� 0.000
0.000 0.000
0.000 0.000 0.000
0.000 0.060 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):
XA1 0 292500 As Cd Cu Cr Pb Hg MorNi Se Zn P 56.868 0.000 Lime Applied
.nnuallbs/acre 0.063 0.025 1.078 ####### 0.157 0.003 0.063 0.063 2.867 86.146
nor Years Cumulative lbs/ac 0.064 0043 7723 1348 1.203 0.05 1.201 0.102 19.6 Date lbs/ac
urrent Cumulative lbs/ac 0.127 0.068 8.801 ####### 1.360 0.053 1.264 0.165 22.467 10-14 2000
�-rmitted C. P. L. R.**** 36 34 NA 1338 267 15 NA 374 89 2498
-rmit PAN Limit Ist/2nd Crop
202
[ certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting fse
al
formation, including the possibility of fines and imprisonment for knowing violations.,,
l*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 (12/2006)

ANNUAL LAND APPLICATION F. D SUMMARY FORM
F SE 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
Facility Name: City of Marion WHEN NOT APPLICABLE.
WQ Permit #: WQ0019960 Field #: R-02
Land Owner: Nancy Ross l T__ T Acres Utilized: 27 0
Annual ��a, .�� y Tons Applied: i 6.2630 Site #•
Operator: Nancy Ross R-02 Acres Permitted: 22.9
Predominant Soil Series: Hayesville Cation Exchange Capacity Crop 1 Name: Fescue Crop1 Max. PAN- 202 b P h' (non 503):
Crop 2 Name: Crop 2 Max. PAN:
Volume applied Volume Soil C
o Residual Sources Precip. a
(enter one) Solids/ o Cond. PAN A lied Name of Crop Type
Liquid �O Applied per (NPDES #, WQ#, past 24 w z Nitrate
q Solids Acre Fe- (Dry, , � a_ TKN o � and PP
Q ! ! �• -> Animal Hrs. o N. I I D i (lbs/acre} Receiving Residual
? j Nitrite
Yds E C-allr�s I ._ I Waste et-) Wet, Q o I I I Application
fury i onsiAc) > �i
Moist) inches 0 mg/kg mg/kg mg/kg Crop 1 Crop 2 Crop 1 Crop 2
5-2014 156000 2.5 0.710 WQ0019960
i 0 s G.5 1 0.3
0.000 j 55800 2000 949.97 25.694 1 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 v".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): 0.000 0.000
'OTALS: 0 156000 .
As Cd Cu Cr Pb Ha Mo Ni Se Zn P 25.694 0.000 Lime A lied
1ru1uallbs/acre 0.028 0.011 0.487 ####### 0.071 0.001 0.028 0.020 0.028 1.295 38.908
'rior Years Cumulative lbs/ac 0.038 0.037 6.481 0.0278 0.796 0.326 0.715 0.354 0.057 14.75 Date lbs/ac
,urrent Cumulative lbs/ac 0.066 0.048 6.968 ####### 0.867 0.327 0.743 0374 0.085 ]6.045 10-14 2000
'ermitted C. P. L. R.**** 36 34 NA
1338 267 15 NA 374 89 2498
ermit 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 designed to assure that
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
_/;-I-- 1 "j -;) _ `I _�� *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 (12/2006)

ANNUAL LAND APPLICATION Fl
) SUIeMARY FORM
Pa,hA.SE 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: City of Marion
WQ Permit #: WQ0019960
Field #: K-01
T _a r.__._ __ ,._
,�a,.0 ._.W,.er: -U111a Deebo,d
Annual Dry Tons Applied: 12.8749
Site #• K-01
Acres Utilized: 16
Operator: Mario DeLuca
Predominant Soil Series: Hayesville
Cation
Acres Permitted: 16
Exchange
Capacity (non 503):
Crop 1 Name:
Fescue
Crop 1 Max. PAN: 202 Crop
2 Name:
Crop 2 Max. PAN:
Volume applied
o
Volume
Soil C
Residual Sources Precip. a o
z
Nitrate
ate' (enter one) Solids/ %
Applied per
(NpDES #, WQ#, Cond. Past 24 w
;° �' '-'
TKN
FPAN Applied Name of Crop Type
Q iiCtuid �oiids
I l
Acre
ii Fert_, Animal (Dry' fL*s. o !! °-CD
- g
ands/acre} Receiving Residual
Cu. Yds Gallons
(DryTons/Ac)
I Wet, I �_
waste, etc) x O
I` I I w
x
Nitrite Application
12-14 123500 2.5
0.805
Moist) inches
vi/Qv01996v
o mg/kg mg/kg
mg/kg Crop 1 Crop 2 Crop 1 Crop 2
I I 0 s 0.5
0.3 55800 2000
949.971 29.113
M--0.0000.000..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
o.000
0.000 0.000
0.000
0.000 co00
0.000 0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF
oTAI s: 0 123500
As
Cd Cu Cr Pb I H Mo
supp to this form):
Ni Se I Zn
wnuallbs/acre
0.032
0.013 0.552 ####### 0.080 0.001 0.032
P 29.113 0.000 Lime Applied
0.023 0.032 1.468 44.114
rior Years Cumulative lbs/ac
0.161
0.114 17.065 0.94 2.215 0.102 2.442
1.015 0.245 39249
Date lbs/ac
:urrent Cumulative lbs/ac
0.193
0.127 17.617 ####### 2.295 0.103 2.474
1.038 0.277 40.717
ermitted C. P_ L. R.****
36
34 NA 1 1338 267 15 NA
374 89 2498
ermit PAN Limit 1st/2nd Crop
202
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, including the possibility of fines and imprisonment for knowing violations."
0.,, - � *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.LJL: Cumulative Pollutant Loadine Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION W 1 SUMMARY FORM
PLir,.aiSE 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: City of Marion WQ Permit #: WQ0019960 Field #: K-02 Acres Utilized: 35.8
Land -O ner: Anna Deebold Annuai Dry ions Applied: 31.1708 Site #: K-02 Acres Permitted: 35.8
Operator: Mario DeLuca Predominant Soil Series- $
ayesv111e Canon Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 202 Crop 2 Name: Crop-2 Max. PAN•.
Volume applied
(enter one) Solids/
Liyt:id
Volume
Applied per
Solids i Acre
Cu. Yds Gallons (Dry Tons/Ac)
12-14 299000 2.5 i 0.871
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
OTALS:I 0
annual lbs/acre
for Years Cumulative lbs/ac
-urrent Cumulative lbs/ac
ermitted C. P. L. R.****
ermit PAN Limit Ist/2nd (
Residual Sources
(NPDES #, WQ#,
Fert., Animai
Waste, etc)
WQ0019960
Precip.
Cond: Past 24
(Dry, Iirs
Wet, I
inches
V
a
CD
o
O
L).
M _
CD N
A
K
s
0.5
0.3
As
Residuals
Cd
Applications
Cu
totals
Cr
on FORM
Pb
FSF s
H
0.035
0.014
0.598
#######
0.087
0.001
0.159
0.117
17.67
0.997
2.29
0.105
0.194
0.131
18.268
#######
2.377
0.106
R
34
NA
1338
267
15
Z Y
Nitrate
TK1V
o 3
and
CD
m
I Nitrite
mg/kg
mg/kg
mg/kg
55800
2000
1949.97
PAN Applied
(lbs/acre)
Crop 1
31.502
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
upp ( attach FORM FSF supp to this form):
Mo Ni Se I Zn I P 31.502
0.035 0.025 0.035 1.589 47.731
2.452 1.042 0.243 39.914
2.487 1.067 0.278 41.503
NA 374 89 2498
Crop 2
NA
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Name of Crop Type
Receiving Residual
Application
Crop 1 Crop 2
Fescue
Lime Apolied
Date I lbs/ac
202
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, 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 AA, anaerobiall digested -0.2 ,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
Crop 2
NA
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Name of Crop Type
Receiving Residual
Application
Crop 1 Crop 2
Fescue
Lime Apolied
Date I lbs/ac
202
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
ualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
iformation, 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 AA, anaerobiall digested -0.2 ,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

FIELDS:
K 1 & K2
MARIO DELUCA

r
tie
Legend
- - k
Propery Line o Well
-0 "parcel duffer a k
- House
Perennial Stream _� ,' •
C� Surface Water
'� � � '�` k ;• � � r : � y, `';lye ' � �',�.
e
y
v
t�
a •, t• '� - fi ,.fir �e
■el �—�_ ... l fir- •"', ¢ x .� 4 ,♦
Aq-
iii� per � s y
w
y t
..'r a , ,, ,. s ', Apr. ��� 7- ,� -• :',��. _ uy
!u"t' ;i :^ a '�`A 34♦ J �r� •��..� .::� � � rv� i�. £. ip .{.. 1 ��( :.•� `Af. ix. � y1 t•.
'�s d ' t '{r -r � � '� � :: X t,-�. L ��: '� ,7 � ., ,,,y. - ♦ � `� ,r � w.}�1i51
g fir.,.}. ! r. g !! , c"• J s� * 411.
4� , 3g .}� s ` ' a x ' s't''t"} .t `- - " ° z j< +rerR �' @ dµ :}.,, ,, -4�, - ': .rs �.•
� ,,' yy.' A
�,�y,,� '� � # � x 1F�.ffi iw s f�/ ���`••'�� �0:..�. � ✓�.`1F� Ike �' ,♦t> '�i `,
'9S"'Y �'., 1, - �' �^q• �q - . �' �g �> '} - �' . x` � k .,� - d 1` 6 . r�'' fly
�' x'` .,NG n PJ7aC�e"'te fo Gea hic;Info rmetion nd na sis NC; , r
Deluca, Mario! Overview Reap
Parcel: 164700782263
McDowell County, NC 0 375 750 1,500 Feet s
L i I e o I Produced: November 2015
35.5797-81.8691 Shaffer Soil Services, Inc.

FIELDS:
Fl, F2, F3, F4
JOHN FISHED

Legend Buffers _
Proper Lute ." N; AA
Property Line 50 �.
Field Boundary o Well pY (�, .:.
Perennial Stream (100) TL ,
Perennial Stream House House 400'
C� Surface Water ,))
MM Unused �4rea Well 1 0 r
IL;--
t ,v ��
0
an
t %
C 5;
�.. Field F1
r �` `�� � �•� C`�CrPt� ti
ti i(
,,. Field F
6,7 acres ;
` i e
{ „€� S5mm4n"-.. pa T . rce in
ifJ 'h 3
A'1 ` USN V aid`• 9 4 fy�a `
4.
r `�'•
4,, e
,Nu ,OneMak la C e to k,rC eo ra hic,Inform ation,,ar# i Ar alysis;�1YYC
Fisher, Jarriea ,% Janice. Buffer Niap ___-_._
Parcels. 1658004330035, 165800433035, 165800525658 "
McDowell County, NC w�
0 375 750 1,500 Feet
35.5936-89.8462 I 'I ' ' I —�I— ' Produced: November 2015
North Carolina Stateolane. NA�83 _ .. _

FIELDS:
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WAYNE RO S S

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Ross, Wayne: gaffbr Map fiver`✓��,� N
Parcel: 165700181637
McDowell County, NC w e
0 500 1,000 2,000 Feet s
35.5605,-81.8569 nL—+ti .—A ' i Produced: November 2015

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Field Boundary o Well
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g .� ; �I� , ® Unused Area a
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Ross, Wayne: Buffer Map N
Parcel: 165700181637 wE
McDowell County, NC
0 375 750 1,500 Feet s
I 1 } } I } I } I Produced: November 2015
35.5805,-81.8569 North Carolina Stateplane, NA083 Shaffer Soil Services. Inc.