WQ0000672_Renewal Application_20170213

State of North Carolina
Department of Environmental Quality
Division of Water.Resources
WR___ WATER QUALITY REGIONAL OPERATIONS SECTION
v y NON -DISCHARGE APPLICATION REVIEW REQUEST FORM
Divislon of Water Resources
February 13, 2017 RECEIVED
To: ' R®f Wi
DEQ/DWR
From: Troy Doby, Water Quality Permitting Section- Non -Discharge Permitting_Unit FEB -2 0 2017
WQROSNp
Permit Number: WQ0000672 Permit Type: Land`AI� o esRigua1PS"o� Rids (�3�
Applicant: City of Lumberton Project Type: Renewal with Major Modification
Owner Type: Municipal Owner in BIMS? Yes
Facility Name: City of Lumberton RLAP Facility in BIMS? Yes
Signature Authority: Wayne Horne Title: City Manager
Address: Post Office Box 1388, Lumberton, North Carolina 28359 County: Robeson
Fee Category: Non -Discharge Major Fee Amount: $395 - Major Modification
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.
❑ Attach an Attachment B for Certification.
Z Return a completed staff report.
❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer:.
FORM. WQROSNDARR 09-15
Date: 3 i
Page 1 of 1

ROY COOPER
Governor
;sa
MICHAEL S. REGAN
Secretary
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY Director
February 16, 2017
WAYNE HORNE — CITY MANAGER
CITY OF LUMBERTON
POST OFFICE BOX 1388
LUMBERTON, NORTH CAROLINA 283 59
Subject: Acknowledgement of
Application No. WQ0000672
City of Lumberton RLAP
Residuals Management System
Robeson County
Dear Mr. Horne:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on February 6, 2017. Your"application package has been assigned the
number listed above, and the, primary reviewer is Troy Doby.
Central and Regional Office staff will perform a detailed review of the provided application,rand
may contact you with a request. for, additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Troy Doby at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: Fayetteville Regonal_Office, Water Qualitiy Regional`Operations Sectio
Permit File WQ0000672
<:�7'Nothing Compares! ..
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
919-807-6332

FEB _ � 241Z
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January 30, 2017
N.C. Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section — Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
ATTENTION: Mr. Nathaniel Thornburg
REFERENCE: APPLICATION FOR RENEWAL OF PERMIT # WQ0000672
CITY OF LUMBERTON
Dear Mr. Thornburg:
On behalf of the City of Lumberton, Synagro is submitting this application to renew the
referenced residuals land application permit.
Each field is listed, on form "LASC", as deleted, renewed, or modified. The sites are as
listed below. The acreage changes occur due to more accurate mapping techniques. Forms
RLAP, LASC, and RSC are included, along with other required forms and documentation.
The following sites are listed as "renewed" with no changes:
NC-RO-16- 1,2,3,4,5,6,7,8
NC-RO-17
NC-RO-20- 6,7,8,14
NC-RO-28
NC-RO-39
The following sites are to be listed as "deleted":
- 20,21
NC-RO-19
NC-RO-22 E8 , 6 ti011
NC-RO-27 F �s�hat9e
NC-RO-37
NC-RO-3 8
The following site are listed as "modified":
NC-RO-16- 16,17,18,19
NC-RO-18
NC-RO-20- 3,4,5
NC-RO-21
Enclosed is a check for $395.00 to cover the fee associated with a permit renewal.
This application package should contain all of the information necessary to complete the
requested renewal of the City of Lumberton's permit. However, if you require additional
information or have further questions, please contact me at [phone] or
i` [e-mail]. Thank you in advance for the timely and efficient review of this
renewal application.
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

--.� Sincerely,
Chad M. Hayes
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

State of North Carolina
nw Department of Environmental Quality
_ Division of Water Resources
- Dlviston of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permjgji Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T. 1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An
alternate person -may be designated as the signing official if a delegation letter is provided from a person who meets the
criteria in 15A NCAC 02T .0106(b).
If this project is for a modification of an existing permit, submit one copy of the existing permit.
(;. Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
C.
In
Facility Classification
New Permit
Major Modification 1
Major (land are permitted for >_ 300 acres)
_F
$1,310
$395
Minor (land are permitted for < 300 acres)
$810
$245
1- A major modification shall be defined as an permit modification that: increases the generating facility's residuals
J Y P g g ty 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 1C .0300)
Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities. plc��Al�\AI�
REG�.IV�.DI 11J V`�
INSTRUCTIONS FOR FORM: RLAP 06-16
FEB - 6 zM7
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PPMitfin9
Page 1 of 3

E. Operation and Maintenance PIan (New and Renewal Application Packages)
91, For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
Submit the O&M Plan in accordance with 15A NCAC 02T .I 110 and include at a minimum:
Operational functions; describe the operation of the program to show what operations are necessary for the program to
�£ function and by whom the functions are to be conducted.
Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
Safety measures; may include safety training program, manuals, signs, etc.
Spill response plan; including control, containment, remediation, emergency contact information, etc.
Inspection plan including the following information;
Names and titles of personnel responsible for conducting the inspections:
Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the
event that noncompliance is observed.
Sampling and monitoring plan including the following information;
Names and titles of personnel responsible for conducting the sampling and monitoring.
Detailed description of monitoring procedures including parameters to be monitored.
Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
Q Dedicated residuals land application programs are ones'in which land application sites meet the criteria in 15A NCAC 02T
+; .110202). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
Lj- 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.
0 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.
Q Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
�] Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
[( Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
Plans must include the following minimum items:
A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
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
r] Setbacks as required by 15A NCAC 02T .1108
0 Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
0; A map showing the entii6 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
i
irrigation zones as they will be operated.
Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the .plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
[( Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their ability to accept the proposed application rates.
Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
— Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.orgIRules Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated
site map specific to the modifications) only.
0 The design documents must include the following minimum items:
II 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;
II Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
_r 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)
0 Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: hgp://www.nowater.org/Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
Property ownership documentation shall consist of one of the following:
U Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
ff [] Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of 15A NCAC 02L .0107(f), or
.n 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]
R50'eNCIDS001
zoo?
FEB _ 6
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INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
s on o er esources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Ci` of�luoiberton
Applicant type: $ 7' Individual( Corporation "s General Partnership [( Privately -Owned Public Utility
Federal State Municipal10 County
Signature authority's name per 15A NCAC 02T .0106 Jim'SWalteis Title: e�uty D�rector.Pubhc ,W_G s
Applicant's mailing address:'P&Boxt'1388
City: �:uniberton State: PTO Zip 280 i:' . ]
Telephone number: g� 6f 855 Email Address: dins
2. 2. Consultant's name: License Number (for P.E.): _ .1
Affiliation: M On Staff Retained (Firm:
Consultant's mailing address:lT: i
City: State: t''._.- Zip:
Telephone number: ( f :... , Email Address:i
3. Agronomist's name: i.-_:,.'��.:License Number•
{4 i Affiliation:]` N/A 0 On Staff Retained
Agronomist's mailing address: .2 Bo ei"R'ii
City: Mocicsvillel State: NQ Zip: 27028
Telephone number: ffl�_) 998: 7.150' Email Address: iripiy`ii`r.@sync,'gro.com
4. Soil Scientist's name: License Number:
Affiliation: 0 N/A [( On Staff [] Retained (Firm:: - i)
Soil Scientist's mailing address:: _
City: ) State: _ ..: :.._ Zip:....
Telephone number: (`! ` i Email Address: _ ', I
5. Fee submitted: 395:00 (See Instruction B)
II. PERMIT INFORMATION:
RECEIVEDINCDEWWR
1. 'Application is for (check all that apply): 0 new, [] modified, renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number:V000006 72
Date of most -recently issued permit:lVlay_] 2=2008
Date of most -recently certified Attachment A (if different than the
C�Date of most -recently certified Attachment B (if different than the permit): Apri130 ! 0r
-
FEB - 6 ZOV
{Von -Discharge
Permitting !Unit
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 700`I 51aVey"tte Sty
City: State:: Zip: 28358 a i
Coordinates: Latitude: 4°6 &'1I Longitude: 78.�9� 330
Datum: NAD'84' Level of accuracy: Second
Method of measurement:lVIAP
2. County where residuals land application program is headquartered: Robeson
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
Creighton Alan Browi3
Synae LLC
1001685 /Al V�}L
Back -Up ORC
Howard Grady?Eloyd
:' =
280,4Q
Additional Back -Up
ORCs
Jon:iL'ockleat
i h j
14775
(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:
I. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in
l` f� the following table:
Maximum amount of residuals to be certified: 1500 dry tons per year.
PAN
Pounds of PAN per Dry Ton
Pounds of PAN per Year
(Weighted Average)
Surface
Incorporation
Surface
Incorporation
or Injection
or Injection
First -Year
43 42
43.43
65,136
65,151`
Five -Year Maximum Adjusted
6172
61;732579
92;594
b. Land Application Site Use Summary:. Summarize information regarding the land application sites as currently certified
and proposed for certification with this -application:
Category
Use -
Acres
Comments
Crops
Forest or Plantation
Row Crops
Hay
Pasture
Total:
791 ..
Methods
Surface
Incorporation or Injection
Total:
77
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summarv: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
(lbs PAWac yr)
Concentrations
Surface
Incorporation or
Surface
Incorporation or
Injection
Injection
50
;1302 7;
1303 0
Dr5--EZ
18519
100
651_4
6515i
925:8
925 9;
150
4342
434 3�
6172
6173
200
320
3258;
4629,
463;0
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North_ Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.): _' - ii -, i
7. Specify type of residuals program (See Instruction F): 0 Non -dedicated 0 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.
Yam; J
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.
H
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
01- DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: Spray 0 Drip
2. Disposal system is: 0, existing [I proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) 'per Soil Scientist's Evaluation:
feet below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHVVt and
ground surface.
4. Are there any' artificial drainage or water movement structures within 200 feet of any irrigation area?
Yes or U No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Recommended
Recommended
Soil Series
Fields within Soil Area
Loading Rate
Loading Rate
(in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
Uj Yes or[]No If No, explain why 15ANCAC 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 I Zone,
Design Area
(ft 2
Number of
Nozzles
Maximum Application
Rate (gallons/hr).
Design Annual Loading
Rate (gallons/yr)
r7
Total
Spray Irrigation Design Element
I
Plan Sheet
Specification
Number
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
fe
Nozzle capacity
J gplu
Nozzle manufacturer / model
71
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

ipplicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
M- Yes El No, Explain;
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for C ►Z !X eb-VT _ %A k-A tS a VZ N C,
(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
11se statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a .fine
to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: c Date:
.. s
FORM: RLAP 06-16 Page 5 of 5

OPERATIONS AND MAINTENANCE PLAN
1 SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0011244 (City of Lumberton NC WWTP)
Operational Functions
The operational function of this project involves land application of residuals for the City of Lumberton's
wastewater treatment facility. This material will be loaded onto tractor trailers or "spreader trucks" and
hauled to land application sites. Tractor trailers will be off loaded to liquid applicators and spread in a
uniform manner. The residuals will be spread at agronomic rates, as determined by a recently analyzed
nutrients and metals sample. The material will be land applied with a liquid applicator that will use
pressure to achieve a consistent spread pattern. The fields applied will have a crop, either established or
planted soon after application, which is to be utilized for animal consumption.
Safety Measures
Synagro believes in operating in a safety -conscious manner and has all employees participate in
quarterly online safety courses. These courses are designed to help employees recognize safety issues
and take steps to prevent accidents from occurring. In addition, all Synagro employees have the
authority to stop operations if they think any aspect of the operation could cause environmental or
personal harm.
Maintenance Schedule
Synagro will follow the maintenance schedule specified by their fleet management section for the
equipment necessary to complete the job.

SPILL RESPONSE PLAN
'ROJECT: City of Lumberton Permit W00000672
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
I. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Synagro Operations Manager shall take immediate charge and initiate clean-up activities. Synagro labor and
equipment is to be utilized. In the event additional labor and equipment is required, assistance may be requested from the
City of Lumberton NC or the NC Department of Transportation, and other private contractors as necessary.
2. HALT THE SOURCE OF THE SPILL:
Such as a ruptured container or damaged transport unit.
3. CONTAIN THE SPILL:
Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The Synagro Operations Manager or the person in charge on the
spill site will advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-
up operation, i.e., local farmers, farm supply centers, nurseries, etc.
4. CLEAN-UP:
:mploy front-end loaders, vacuum equipment, sludge application vehicles, and/or local -septic tank service to remove as
such of the spilled material as possible. Straw and/or sand should be scattered in the spill area to soak up the remaining
material. The straw- and sand -soaked material will be collected and removed to a disposal area approved by
representatives of the state regulatory agency.
5. FINAL CLEAN-UP:
Employ rotary brush sweeper if needed, and apply lime to the spill area upon the approval of the clean-up efforts by the
state regulatory representative. If the event occurs on private property, the clean-up will be completed to the satisfaction
of the property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original
condition if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs, the Synagro Operations Manager or assistant will notify the Synagro Central
office, and they will then be responsible for notifying other key Synagro personnel.
7. REPORTING:
Synagro Central personnel will notify the Fayetteville Regional office at (910)-433-3300 for the City of Lumberton as
soon as possible, but not more than 24 hours after, or on the next working day following the occurrence. The Operations
Manager shall provide a written report within 48 hours of the spill to the Technical Services Director. The report shall list
all relative information and actions taken. Synagro Central personnel will file a written report to the Fayetteville Regional
office of the NCDEQ within 5 days of the occurrence. For after hours reporting the Division's emergency number shall be
r illed to report all incidences (1-800-858-0368) or (910-433-3300).

OPERATIONS AND MAINTENANCE'PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0000672 (City of Lumberton)
Inspection Plan
Inspections will be conducted on a weekly basis at the land application site during activities of this project. Inspection
frequency is based on the time frame to complete the project and the amount of dry tons to be land applied from the
facility. The inspections will consist of inspecting a field that is currently being applied as well as inspecting random
fields that have been completed. These inspections will consist of:
1. Verifying that the "Pre -Operations Check List has been completed and signed by both operational and technical
staff.
2. Checking the calculated loads to insure the correct amount of residuals are being land applied.
3. Insuring that all manned equipment has a copy of the spill control plan, the permit, and the operations and
maintenance plan.
4. Insuring that the field has been flagged properly and that all buffers are being adhered to.
S. Insuring that the "Crop and Landowner Verification" form has been filled out. -
6. Verifying that the residuals have been adequately sampled to confirm compliance.
The records will be kept in the project files in the respective office for the project. The Permittee or Inspector shall
report by telephone to the NCDEQ/DWQ Fayetteville Regional Office at 910-433-3300, as soon as possible, but no later
than 24 hours after, or the next working day, following the occurrence or first knowledge of the occurrence of the
following.
• Any occurrence with the distribution program resulting in the land application of significant amounts of
material that is abnormal in quantity or characteristics.
• Any failure of the program that results in a release of material to surface waters.
( (�' • Any time that self -monitoring information indicates that the program has gone out of compliance with
the permit.
• Any process unit failure that results in the system not adequately treating the residuals.
• Any spill or discharge from a vehicle or piping system during residuals transportation.
Any release that requires immediate reporting outside of normal business hours shall be called in to NCDEQ at 800-858-
0368, or 910-433-3300. These numbers are to be called in the event of a release to surface waters or the imminent failure
of a storage system when the event occurs outside of normal business hours. Within 5 days of the first notice of on
occurrence, a written response in the form of a letter shall be sent to NCDEQ outlining the actions taken or proposed
actions taken to ensure that the problem.does not recur.
Persons responsible for inspections on this project are as follows:
- Chad M. Hayes, Technical Services Specialist, or his designee.
Y ��

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0000672 (City of Lumberton)
Sampling Plan
Sampling for this project consists of sampling the residuals just before land application is to occur. Based on
the dry tonnage of this plant, there will be four samples for each parameter per year.
The residuals shall be sampled annually for the following: (Regulatory level in milligrams per liter in parentheses.)
Arsenic (5.0)
1, 4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1, 2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2, 4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide) (0.008) Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachlorethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5 TP ( Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl Chloride (0.2)
Cresol (200.0) Methoxychlor (10.0)
2,4-D (10.0) Methyl ethyl ketone (200.0)
The residuals will also be sampled, based on the chart below, for the following constituents
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1 time per year
=>319-<1,650
1 per Quarter (4 times per year)
=>1,650-<16,500
1 every 60 days (6 times per year)
=>16,500
1 every month (12 times per year)
Aluminum
Ammonia -Nitrogen
Arsenic
Cadmium
Calcium
Copper
Lead
Sodium Adsorption Ratio (SAR)
Magnesium
Mercury
Molybdenum
Nickel
Nitrate -Nitrite Nitrogen
Phosphorous
Potassium
pH
Plant Available Nitrogen (calculation)
Selenium
Sodium
Total Solids
Total Kjeldahl Nitrogen
Zinc
All samples will be taken from the covered storage pad or the adjacent drying beds. Additional samples will be taken for
TCLP/RCI and nutrients and metals analysis. Methods of sampling will follow the conditions of the permit and applicable
regulations.
The following people are responsible for sampling:
Chad M. Hayes, Technical Services Specialist, or his designee.

OF WA TF9
State of North Carolina
y Department of Environment and Natural Resources
Division of Water Quality
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 08-11
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 or for an electronic version of this form, visit the Land Application Unit (LAU) web site at:
http://portal.ncdenr.org/web/wgla s/lau
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 08-11, FORM: DCAR 08-11, or FORM: SDR 08-11).
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 08-11):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 08-11) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
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 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 08-11 Page 1 of 1

RESID'u�S SOURCE FACILITY SUMMARY
Applicant's name: City of Lumberton
Status Facility Permit Holder Facility Name County Permit Number Maximum Dry Tons Per Year
Code' Current'' Proposed
R City of Lumberton Lumberton WWTP Robeson WQ0000672 1500 1500
'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 08-11 Page 1

QF W ATFR
O� pG State of North Carolina
r Department of Environment and Natural Resources
>_ Division of Water Quality
p RESIDUALS SOURCE CERTIFICATION
FORM: RSC 08-11
L RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: City of Lumberton WWTP
2. Facility permit holder is: Federal, a State, Local Government, or g Private.
Facility permit issued by: Div. of Water Quality, Div. of Environmental Health,
or Other (explain:
3. Facility contact person and title: Jon W Locklear, Supervisor/ORC
Complete mailing address: Post Office Box 1388
City: Lumberton - State: NC Zip: 28359
Telephone number:[phone] E-mail address:
4. Facility physical address: 700 Lafayette St
City: Lumberton State: NC Zip: 28358
Coordinates: Latitude: 34a360 170 Longitude: 780590 300
Datum: NAD84 Level of accuracy: Second
Method of measurement: MAP -
5. Purpose of the facility:
treatment of municipal wastewater, treatment of 100% domestic wastewater,
treatment of potable water, treatment of 100% industrial wastewater,
II treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: i % industrial and % domestic)
Ej other (explain: = ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 20 MGD and facility average daily flow: 6 MGD
8. Average amount of residuals being generated at this facility 907.4 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 4 Aeration Tanks total capacity 14 million gallons
Type and volume of residuals storage (i.e., outside of residuals treatment units):Aerobic Digestors and Holding Tanks
Totally roughly 3.0 Million gallons
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part503 or 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
�' Biological Non -Biological
FORM: RSC 08-11 Page 1 of 5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
1 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: Ej yes no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: yes 21 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: Summit Environmental Technologies. Inc. and Date(s) of analysis: 2/09/2016
Passed corrosivity test: yes no. pH: 6.49 s.u. (2 < pH < 12.5)
Passed ignitability test: yes no. Flashpoint: >140 T (> 140T)
Passed reactivity test: W yes Uno. HCN: ND mg/kg (<250) & H2S: ND mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(Mg/1)
Result
(mg/l)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
FORM: RSC 08-11 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: Waypoint Analytical and Date of analysis: 08/12/2016
Parameter
Ceiling
Concentration Limits
(ClassA & C1assB)
(mg/kg)l
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
6.0
Cadmium
85
39
<2.0
Copper
4,300
1,500
363
Lead
840
300
20
Mercury
57
17
<0.4
Molybdenum
75
n/a
5
Nickel
420
420
31
Selenium
100
100
<5.0
Zinc
7,500
2,800
448
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: = and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(m9/k9)
Nickel
(mg/kg)
g > 0 but <25
30
200
210
> 25 but < 50
34
220
240
�1 > 50 but < 75
39
260
270
> 75 but < 100
46
300
320 -
> 100 but < 125
53
360
390
> 125
62
450
420
Result (mg/kg)
FORM: RSC 08-11 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 0.98 %.
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
micromitrient parameters:
Laboratory: Waypoint Analytical. and Date of analysis: 08/12/2016
Parameter-
Result
(mg/k9)
Aluminum
39900
Ammonia -Nitrogen
<I0.0
Calcium
13400
Magnesium
1860
Nitrate -Nitrite Nitrogen
7640
pH (Standard Unit)
6.11
Phosphorus
21000
Potassium
2770
Sodium
6780
Total Kjeldahl Nitrogen
46900
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.12
[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): default value, or actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to.why the selected default value is appropriate to be applied to these residuals: This is a default value for
water treatment plant alum 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 (I") Year PAN
Five -Year
Maximum Adjusted PAN
(m91k9)
(mg/kg)
Surface
21,712
30,860
Injection/Incorporation
21,717
30,865
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: No
FORM: RSC 08-11 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
EJ 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. 1 106(b)(3)(A)] - Time/Temperature Compliance.
Alternative 2 [15A NCAC 02T. I 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T. 1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, Q' heat drying, 1 heat treatment,
9 thermophilic aerobic digestion, beta ray irradiation,
gamma ray irradiation, or pasteurization.
b. For Land Application of Class B:
0 Alternative 1 [15A NCAC 02T. I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.1106(c)(2)] -Process to Significantly Reduce Pathogens (PSRP).
Specify one: aerobic digestion, E2 air drying, U anaerobic digestion,
Ljj composting, or lime stabilization.
c. For Surface Disposal:
[1, Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II.7a. above.
Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II.7b. above.
Exempt -If Daily Cover Alternative is chosen in Item I1.8. below [15A NCAC 02T.1106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
W Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
'3 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).
Alternative 4 [15A NCAC 02T.1107(a)(4)] -Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. 1 107(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 08-11 Page 5 of 5

VICINITY MAP
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Quantitative Justification for Residuals -Production Rate
Lumberton WWTP
Between the years of 2011 and 2014, the City of Lumberton land applied
approximately 6.9 million gallons -or 907.44 dry tons of material each year. Based on the
calculations shown below, the Lumberton WWTP would produce approximately 750.6
dry tons/year if operating at the 6.0 million gallon average daily flow. The proposed 1500
dry tons/per year maximum to be produced at this plant, should allow plenty of room for
any increase in plant flow or plant expansions.
Calculations:
Based on rule -of -thumb that average daily flow is approximate to annual volume of
residuals produced
(6.0 x 10^6 gal/yr) x- (3% solids) 8.34 lbs/gal) = 750.6 dt/yr
(2,000lbs/ton) -
Dry tons land applied between 2011 and 2015.
Year Dry Tons
2015 919.67
2014 958.48
2013 1038.24
2012 916.7
2011 704.13
Avg. 907.44

Residuals Sampling Plan
Synagro Residuals Land Application for WQ0000612
City of, Lumberton NC WWTP
Nutrients' and Metals Analysis
• Sampling Point Basin
• Sampling Frequency: 4/yr
• Sample Type; Composite
• Lab:, Waypoint Analytical
Pathogen Reduction (Fecal Coliform Density Demonstration)
• Sampling Point: Basin
• Sampling Frequency: 4/yr
• Sample Type: Grab
• Lab: Cameron.Testing Services, Inc.
Vector Attraction Reduction (30-Day Bench)
• Sampling Point: Basin
• Sampling Frequency: 4/yr J
Sample Type: Composite
Lab: Cameron Testing Services, Inc.
TCLP
• Sampling Point: Basin
• Sampling Frequency: Annually
• Sample Type; Composite
• Lab: Summit Environmental Technologies, Inc
t

SSMAKA4ummit Environmental Technologies, Inc.
1 1 3310Win St,
El`uVIRONPdENTALTECHNOLOGIPsiRUr, Cuyahoga Falls, Ohio44223
/trtas'lrtdcr l f �75=;a�,e�tde' TEL: [phone] FAX: [phone]
Website: http:/hvivw.settek.com
February 13, 2016
Nate Roth
Synagro
284 Boger Rd.
Mocksville, NC 27028
TEL: [phone]
FAX: [phone]
RE: Lumberton WWTP
Dear Nate Roth:
Order No.: 16020218
Summit Environmental Technologies, Inc. received 1 sample(s) on 2/3/2016 for the
analyses presented iri the following report.
There were no problems with the analytical events associated with this report unless noted
in the Case Narrative.
Quality control data is within'laboratory defined or method specified acceptance limits
except where noted.
If you have any questions regarding these tests results, please feel free to call the
laboratory.
Sincerely,
Bachar Najm
Project Manager
3310 Win St.
Cuyahoga Falls, Ohio 44223
A2LA 0724:01, Alabama 41600, Arizona AZ0788, Arkansas 88-0735, California 07256CA, Colorado, Connecticut PH-0105, Delaware, Florida NELAC
E87688, Georgia E87688 and 943, Idaho OH00923, Illinois 200061 and Reg.5, Indiana C-OH-13, Kansas E-10347, Kentucky (Underground Storage Tank)
3, Kentucky 90146, Louisiana 04061 and LA12004, Maine 2012015, Maryland 339, Massachusetts M-OPH923, Minnesota 409711, Montana CERT0099,
New Hampshire 2996, New Jersey OH006, New York .11777, North Carolina 39705 and 631. Ohio Drinking Water 4170, Ohio VAP CL0052, Oklahoma.
9940, Oregon 0112O0001, Rhode Island LA000317, South Carolina 92016001, Tennessee TN04018, Texas T104704466-11-5, Region 8 8TMS-L, •
USDA/APHIS P330-11-00244, Utah OH009232011-1, Vermont VT-87688, Virginia 00440 and 1581, Washington C891, West Virginia 248 and 9957C
and E87688, Wisconsin 399013010
Page 1 of 8

Summit Environmental Technologies, Inc.
3310 Win St.
Summrr Case Narrative
FPWIRONPdIENTALTECHNOLOnleS,iPJC. Cuyahoga Falls, Ohio44223 WO#: 16020218
An_*1y tir_'aY iP a drafl?fifm TEL: [phone] FAX: [phone]
Website: httn:/hviviv.settek.com Date: 2/13/2016
CLIENT: Synagro
Project: Lumberton WWTP
This report in its entirety consists of the documents listed below. All documents contain the Summit
Environmental Technologies, Inc., Work Order Number assigned to this report.
Paginated Report including Cover. Letter, Case Narrative; Analytical Results, Applicable Quality
Control Summary Reports, and copies of the Chain of Custody Documents are supplied with this
sample set.
Concentrations reported with a J-Flag in the Qualifier Field are values below the Limit of Quantitation
(LOQ) but greater than the established Method Detection Limit (MDL).
Method numbers, unless specified as SM (Standard Methods) or ASTM, are EPA methods.
Estimated uncertainty values are available upon request.
Analysis performed by DBM, VRM, or SFG were performed at Summit Labs 2704 Eatonton Highway
Haddock, GA 31033
All results for Solid Samples are reported on an "as received" or "wet weight" basis unless indicated as
"dry weight" using the "-dry" designation on the reporting units.
Summit Environmental Technologies, Inc., holds the accreditations/certifications listed at the bottom of
the cover letter that may or may not pertain to this report.
The information contained in this analytical report is the sole property of Summit Environmental
Technologies, Inc. and that of the customer. It cannot be reproduced in any form without the consent of
Summit Environmental Technologies, Inc. or the customer for which this report was issued. The results
contained in this report are only representative of the samples received. Conditions can vary at different
times and at different sampling conditions. Summit Environmental Technologies, Inc. is not responsible
for use or interpretation of the data included herein.
This report is believed to meet all of the requirements of NELAC or the accrediting / certifying agency.
Any comments or problems with the analytical events associated with this report are noted below.
Original
Page 2 of 8

Summit Environmental Technologies, In Qualifiers and Acronyms
�} SUMI"lor 3310 Win 5
�P"JIr�rJNPdpNYfiLT€ 9 ra5L�GI_s,ata�:. Cuyahoga Falls, Ohio442; WO#: 16020218
-TEL: [phone] FAX.- (330) 253-446
Website: hnp:/Avww.settek.co Date: 2/13/2016
These commonly used Qualifiers and Acronyms may or may not be present in this report.
Qualifiers
U The compound was analyzed for but was not detected.
J The reported value is greater than the Method Detection Limit but less than the Reporting Limit.
H The hold time for sample preparation and/or analysis was exceeded.
D The result is reported from a dilution.
E The result exceeded the linear range of the calibiation or is estimated due to interference.
MC The result is below the Minimum Compound Limit.
* The result exceeds the Regulatory Limit or Maximum Contamination Limit.
in Manual integration was used to determine the area response.
N The result is presumptive based on a Mass Spectral library search assuming a 1:1 response.
P The second column confirmation exceeded 25% difference.
C The result has been confirmed by GC/MS.
X The result was not confirmed when GC/MS Analysis was performed.
B/MM+ The analyte was detected in the associated blank.
G The ICB or CCB contained reportable amounts of aiialyte.
QC-/+ The CCV recovery failed low (-) or high (+).
R/QDR The RPD was outside of accepted recovery limits.
QL-/+ The LCS or LCSD recovery failed low (-) or high (+).
QLR The LCS/LCSD RPD was outside of accepted recovery limits.
QM-/+ The MS or MSD recovery failed low (-) or high (+).
QMR The MS/MSD RPD was outside of accepted recovery limits.
QV-/+ The ICV recovery failed low (-) or high (+).
S The spike result was outside of accepted recovery limits.
Z Deviation; A deviation from the method was performed; Please refer to the Case Narrative for
additional information
Acronyms
ND
Not Detected
RL
Reporting Limit
QC
Quality Control
MDL
Method Detection Limit
MB
Method Blank
LOD
Level of Detection
LCS
Laboratory Control Sample
LOQ
Level of Quantitation
LCSD
Laboratory Control Sample Duplicate
PQL
Practical Quantitation Limit
QCS
Quality Control Sample
CRQL
Contract Required Quantitation Limit
DUP
Duplicate
PL
Permit Limit
MS
Matrix Spike
RegLvl
Regulatory Limit
MSD
Matrix Spike Duplicate
MCL
Maximum Contamination Limit
RPD
Relative Percent Different
MinCL
Minimum Compound Limit
ICV
Initial Calibration Verification
RA
Reanalysis
ICB
Initial Calibration Blank
RE
Reextraction
CCV
Continuing Calibration Verification
TIC
Tentatively Identified Compound
CCB
Continuing Calibration Blank
RT
Retention Time
RLC
Reporting Limit Check
CF
Calibration.Factor .
DF
Dilution Factor
RF
Response Factor
This list of Qualifiers and Acronyms reflects the most commonly utilized Qualifiers and Acronyms for reporting.
Please refer to the Analytical Notes in the Case Narrative for any Qualifiers or Acronyms that do not appear in this
list or for additional information regarding the use of these Qualifiers on reported data.
Original
Page 3 of 8

Summit Environmental Technologies, Inc.
rnsummilr 3310 Win St.
PSirIRQP1h1�7l�ALS'.9��1 l� ,lc$�OPBB.. Cuyahoga Falls, Ohio 44223
An31r UM? TEL: [phone] FAX. • [phone]
Website: hQ.-11wivw"settekcom
Workorder
Sample. Summary
WO#: 16020218
13-Feb-16
CLIENT: Synagro
Project: Lumberton WWTP
Lab SampleID Client Sample ID Tag No Date Collected Date Received Matrix
16020218-001 Lumberton WWTP 1/25/2016 9:40:00 AM 2/3/2016 12:00:00 PM Solid
Page 4 of 8

Summit Environmental Technologies, Inc.
SUMMIT3310 Win St. Analytical Report
FWF,OMMENTALTEI HOLOWES RUG. -Cuyahoga Falls, Ohio44223 (base report)
Ai',4f ;C P TEL: [phone] FAX. [phone] WO#: 16020218
Website: http:/fwivw.settek.com Date Reported: 2/13/2016
CLIENT: Synagro Tag Number:
Matrix: SOLID Collection Date: 1/25/2016 9:40:00 AM
Lab ID: 16020218-001A
Project: Lumberton WWTP
Client Sample,ID Lumberton WWTP
Analyses Result RL Qual Units DF Date Analyzed
RCI SW9045D Analyst: DHC
PH (SW9045D)
pH 6.49 S.u.@19.3C 1 2/9/2016 2:20:00 PM
Qualifiers•
Value exceeds Maximum Contaminant Level,
E
Value above quantitation range
H
Holding times for preparation or analysis, exceeded
M
Manual Integration used to determine area response
` !I MC
Value is below Minimum Compound Limit.
N
Tentatively identified compounds
f ND
Not Detected at the Reporting Limit
0
RSD is greater than RSDlimit
P
Second column confirmation exceeds
PL
Permit Limit Original
R
RPD outside accepted recovery limits
RL
Reporting Detection Limit
U
Samples with CaleVal <MDL
J
Analyte detected below quantitation limits Page 5 of 8

- Summit Environmental Technologies, Inc. WO#: 16020218-
3310 Win St.
j FFbVIRDRIhtf 117AL=HC tdLtic, 7@t Cuyahoga Falls, Ohio 44223 Date Reported: 2/13/2016
Y rtnilrtia3•tsF �rrajurit TEL: [phone] FAX. [phone] Company: Synagro
Wehsite: htto:/hvwiv.settek.com Address: 284 Boger Rd.
Mocksville NC 27028
Received: 2/3/2016
Project#: Lumberton WW
TCLP Metals Analysis (6010)
Client ID#.
Lab ID# Collected Analyte
Rep Lmt Result Units
Matrix
Method
DF
RegLvl
Run
Analyst
Lumberton WWTP
001
1/25/2016 TCLP Arsenic(As)
0.500 ND mg/L
Solid
EPA 6010 C
1
5.00
2/5/2016
WK
Lumberton WWTP
001
1/25/2016 TCLP Badum(Ba)
5.00 ND mg/L
Solid
EPA 6010 C
1
100
2/5/2016
V1/K
Lumberton WWTP
001
1/25/2016 TCLP Cadmium(Cd)
0.100 ND mg/L
Solid
EPA 6010 C
1
1.00
2/5/2016
WK
Lumberton WWTP
001
1/25/2016 TCLP Chromium(Cr)
0.200 ND mg/L
Solid
EPA 6010 C
1
5.00
2/5/2016
WK
Lumberton WWTP
001
1/25/2016 TCLP Lead(Pb)
0.500 ND mg/L
Solid
EPA 6010 C
1
5.00
2/5/2016
WK
Lumberton WWTP
001
1/25/2016 TCLP Selenium(Se)
0.500 ND mg/L
Solid
EPA 6010 C
1
1.00
2/5/2016
WK
Lumberton WWTP
001
1/25/2016 TCLP Silver(Ag)
0.500 ND mg/L
Solid
EPA 6010 C
1
5.00
2/5/2016
WK
TCLP Mercury Analysis (1311/7470)•
Client ID#
Lab ID# Collected Analyte
Rep Lmt Result Units
Matrix
Method
DF
RegLvl
Run
Analyst
Lumberton WWTP
001
1/25/2016 TCLP Mercury
0.00200 ND mg/L
Solid
EPA 7470 A
1
0.200
2/11/2016
MFW
ff }
1(� r
SVOC
SW-846: 8081-TCLP Pesticides
Client ID#
Lab EW Collected Analyte
Rep Lmt Result Units
Matrix
Method
DF
RegLvl
Run
Analyst
Lumberton WWTP
001
1/25/2016 Chlordane, total
0.0250
ND mg/L
Solid
EPA 8081 B
1 '
0.0300 2/8/2016
JBN
Lumberton WWTP
001
1/25/2016 Toxaphene
0.0500
ND mg/L
Solid
EPA 8081 B
1
0.500
2/8/2016
JBN
Lumberton WWTP
001
1/25/2016 Endrin
0.00250
ND mg/L
Solid
EPA 8081 B
1
0.0200
2/8/2016
JBN
Lumberton WWTP
001
1/25/2016 gamma-BHC
0.00250
ND mg/L
Solid
EPA 8081 B
1
0.400
2/8/20:16
JBN
Lumberton WWTP
001
1/25/2016 Heptachlor
0.00250
ND mg/L
Solid
EPA 8081 B
1
0.00800
2/8/2016
JBN
Lumberton WWTP
' 001
1/25/2016 Heptachlor epoxide
0.00250
ND mg/L
Solid
EPA 8081 B
1
0.00800
2/8/2016
JBN
Lumberton WWTP
001
1/25/2016 Methoxychlor
0.00250
ND mg/L
Solid
EPA 8081 B
1
10.0
2/8/2016
JBN
VOC by GC/MS (8260)-TCLP
Client ID#
Lab ID# Collected Analyte
Rep Lmt Result Units
Matrix
Method
DF
RegLvl
Run
Analyst
Lumberton WWTP
001
1/25/2016 1,1-Dichloroethene
0.100
ND mg/L
Solid
EPA 8260 B
1
0.700
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 1,2-Dichloroethane
0.100
ND mg/L
Solid
EPA 8260 B
1
0.500
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 MEK
2.00
ND mg/L
Solid
EPA 8260 B
1
200
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Benzene
0.100
ND mg/L
Solid
EPA 8260 B
1
0.500
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Carbon tetrachloride
0.100
ND mg/L
Solid
EPA 8260 B
-1
0.500
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Chlorobenzene
0.100
ND mg/L
Solid
EPA 8260 B
1
100-
215/201.6
MES
Lumberton WWTP.
001
1/25/2016 Chloroform
0.100
ND mg/L
Solid
EPA 8260 B
1
6.00
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Tetrachloroethene
0.100
ND mg/L
Solid
EPA 8260 B
1
0.700
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Trichloroethene
0.100
ND mg/L
Solid
EPA 8260 B
1
0.500
2/5/2016
MES
Lumberton WWTP
001
1/25/2016 Vinyl chloride
0.200
ND mg/L
Solid
EPA 8260 B
1
0.200
2/5/2016
MES
Page 6 of 8

Summit Environmental Technologies, Inc.
WO#: _ 16020218.
fflSUIAMINt 3310 Win St.
ENVIRONIVIEWALMC NOLOGJES,VIC Cuyahoga Falls, Ohio44223 Date Reported: 2/13/2016
AFY3Ijytica TEL: [phone] FAX.- [phone] Company: Synagro
Website: htto:/Avwiv.settelccom Address: 284 Boger Rd.
Mocksville NC 27028
Received: 2/3/2016 -
Project#: Lumberton WW
SVOC 8270 TCLP BNA List
Client ID#
Lab ID# Collected Analyte
Rep Lmt Result Units
Matrix
Method
DF
RegLvl
Run
Analyst
Lumberton WWTP
001
1/25/2016 1,4-Dichlorobenzene
0.200
ND mg/L
Solid
EPA 8270 C
2
7.50
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 2,4,5-Trichlorophenol
0.500
ND mg/L
Solid
EPA 8270 C
2
400
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 2,4,6-Trichlorophenol
0.500
ND mg/L
Solid
EPA 8270 C
2
2.00
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 2,4-Dinitrotoluene
0.200
ND mg/L
Solid
EPA 8270 C
2
0.130
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Cresols, Total
10.0
ND mg/L
Solid
EPA 8270 C
2
200
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Hexachloro-1,3-
0.200
ND mg/L
Solid
EPA 8270 C
2
0.500
2/9/2016
MO
butadiene
Lumberton WWTP
001
1/25/2016 Hexachlorobenzene
0.200
ND mg/L
Solid
EPA 8270 C
2
0.130
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Hexachloroethane
0.200
ND mg/L
Solid
EPA 8270 C
2
3.00
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Nitrobenzene
0.200
0.398 mg/L
Solid
EPA 8270 C
2
2.00
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Pentachlorophenol
0.500
ND mg/L
Solid
EPA 8270 C
2
100
2/9/2016
MO
Lumberton WWTP
001
1/25/2016 Pyridine
0.500
ND mg/L
Solid
EPA 8270 C
2
5.00
2/9/2016
MO
SVOC SW-846: 8321 Herbicides-TCLP
Client ID# Lab ID# Collected Analyte Rep Lmt Result Units Matrix, Method DF RegLvl Run Analyst
Lumberton WWTP 001 1/25/2016 2,4-D
Lumberton WWTP 001 1/25/2016 2,4,5-TP
5.00 ND mg/L Solid EPA 8321 A 1 10.0 2/9/2016 BJH
0.500 ND mg/L Solid EPA 8321 A 1 1.00 2/9/2016 BJH
Page 7 of 8

Summit Environmental Technologies, Inc.
WO , 16020218 S
-
• 3310 Win St.
EiN SIRONPAFt4TALTEtH,td6Lonir-s, at-c Cuyahoga Falls, Ohio 44223 Date Reported: 2/13/2016
Ftir21y1 cal c WomfoFif.. TEL: [phone] FAX.•'(330).253-4489 Company: Synagro
Website: http://www.settekcom Address: 284 Boger Rd.
Mocksville NC 27028
Received: 2/3/2016
Project#: Lumberton WW
Client ID#
Lab ID# Collected A:nalyte
Result Units
Matrix
Method
DF
RL ' Run
Analyst
Lumberton WWfP
001 1/25/2016 Flashpoint (140T)•
>140 °F
Solid
EPA 1010
1
2/11/2016
TAH
Lumberton WWfP
001 1/25/2016 Cyanide, Reactive
ND mg/Kg
Solid
EPA 9014
1
0.500 2/9/2016.
MS
Lumberton WWfP
001 1/25/2016 Sulfide, Reactive
ND mg/Kg
Solid
EPA 9034
1
25.0 2/9/2016
INS
Page 8 of 8 '

Sununu Environmental Technologies, Inc.
;a
�3 Lo witi street _ nalysis Request/Chain of Custody
Cuyahoga Falls,,Ohio 442Z Tel: 330.253:8211 Fax: 330.253.448g Far'Sumtnit.Envirge- ntal Technologies. Inc. use only
P8$C 'OP Sl?T Nn
Company Name (Please Print)
Project Name
�inslytliesl:Parameters and Metht�ds'
AI
omp/ yl Ad es� �
Frojoct-Address
AXI
Client Phond No
Repo��
,.
Client Fax No. --Please Fax Res I ❑
PO#
Client Emai all ResvIN V
kuote No
Contact n t J-�
Yt—
Sam led
Check if Ohio VAP samples ✓
B
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Sample Idenpfcatlon
hate
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Cdllected
Collected
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Coofor RoOdpt Form
Clio A.. (a�
Initlefs of person (�peo3f n0cooierand aampbs:
Order Number
Data ReaNed; i 3 Time Received: Dab
Number of Coolommo....
coobr(s) opened and
''.
sarnpbs Ina
Shtppar; !( lmS DHL -Alrbome
WA
US Poste, Wavc4n Pftp other.
Packaging: Peanuts
Paper Foam None other
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Custody Son[$ Intact
N
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C-O-C In plastic
y N
N
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WA
present / absent I melted
SempleTemperature fit Gun ;bj§g CF [D b'C
NIA
{see pags2forsoann reausfr }Went aerial ek1 M
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Y N
•WA
im t por:sanipte for Rsdfotogicaf T"Unp. tf sample ie HOT, the Radiologfka
y CIMM must be nomw
C-O.0 Riled out prglertl'
'
ZY�
Sar+plea in sOparate bags
N
NIA
Sampb corrtskrars ItrtIItr
. N
1N
WA
'if no, list broken sample(ay.
WA
Sample fabel(a) complete 00, date, eta,)
Qy N
l s
Labe c) agree with c-a-c
u"t
t� N
WA
Correct oontafners ubed.
J
WA
Sufficient ssmpfe recehmd
N
WA
Samples recetM within holding tineCRYN
Y N
NIA
Bubbles absent from 40 mLvials"
y N
"Sampbs with bubbles c6mm are accsptable. Indicate bubble she M >Brrim
Was dWM Contacted about samplas
y N
Will dientsend new samptes
y N
Cied contact
Dato/Tirna:
Legged in by .
Comments
Page I of 2

j1�
Page: 1 of 2
Report Number: 16-224-0206
Account Number: 46525
Send To: Synagro Central LLC/ Lumberton
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Lab Number: 58905
Sample Id : Lumberton WWTP
'Waypointn
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project: Lumberton WWTP Plant
NC Cert #257
REPORT OFANALYSIS • Date Sampled: 8/9/2016 15:20:00
Date Received: 08/1112016 00:00
Date Reported: 08/18/2016
Total Solids
0.98
9800
100.0
RD
08/11/2016 14:50
SM-2540G
Moisture`
99.02
100.0
RD
08/11/201614:50
SM-2540G.
Total Kjeldahl Nitrogen
4.69
46900
10.0
SB
08/12/2016 08:50
SM-4500-NHSC-TKN
Total Phosphorus
2.10
21000
100
KM
08/12/2016 14:14
SW 6010C
Total Potassium
0.28
2770
100
KM
08/12/2016 14:14
SW 6010C
Total Sulfur
0.92
9170
100
KM
08/12/201614:14
SW 6010C
Total Calcium
1.34
13400
100
KM
08/12/2016 14:1.4
SW 6010C
Total Magnesium
0.19
1860-
100
KM
08/12/2016 14:14
SW 6010C
Total Sodium
0.68
6780
100
KM
08/12/2016 14:14 ..
SW 6010C
Total Iron
20900
100
KM
08/12/2016 14:14
SW 6010C
Total Aluminum
39900
100•
KM
08/12/2016 14:14
SW 6010'C
Total Manganese
189.
5
KM
08/12/2016 14:14
SW 6010C
Total Copper
363
5
KM
08/12/2016 14:14
SW 6010C
Total Zinc
448
5
KM
08/12/2016 14:14
SW 6010C
Ammonia Nitrogen
<10.0
10.0
SB
08/12/2016 08:50
SM-4500-NH3C
Organic N
46900
10.0
08/12/2016 08:50
CALCULATION
Nitrate+Nitrite-N
7640
2.00
SB
08/12/2016 08:50
SM-450ONO3F
All values are on a dry. weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Our reports and letters are for the exclusive and confidential use of our clients, and may not be reproduced in whole orpart, nor may any reference be made
to the work, the results, or the company in any advertising, news release, or otherpublic announcements without obtaining our prior written authorization.
Debbie Holt
Laboratory Supervisor

Page: 2 of 2
Report Number: 16-224-0206
Account Number: 46525
•
Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Send To: Synagro Central LLC/ Lumberton
Project: Lumberton WWTP Plant
Mary Brewer
284 Boger Road
NC Cert #257
Mocksville , NC 27028
REPORT OFANALYSIS
Date Sampled: 8/9/2016 15:20:00
Lab Number: 58905
Date Received: 08/11/2016 00:00
Sample Id : Lumberton WWTP
Date Reported: 08/18/2016
RESULT
RESULT
QUANTITATIONANALYSIS
PARAMETER
.
.•
•�
Total Cadmium
<2.0
2.0
KM
08/12/2016 14:14
SW 6010C
Total Chromium
184
5
KM
08/12/2016 14:14
SW 6010C
Total Nickel
31
5
KM
08/12/2016 14:14
SW 6010C
Total Lead
20
5
KM
08/12/2016 14:14
SW 6010C
Total Arsenic
6.0
3.0
KM
08/12/2016 14:14
SW 6010C
Total Mercury
<0.4
0.4
KKM
08/16/201614:55
SW-7471 B
Total Selenium
<5.0
5.0
KM
08/12/2016 14:14
SW 6010C
pH (Standard Units) * 6.11
SJB
08/12/2016 08:50
SW-9045D
Total Molybdenum
5.
5
KM
08/12/2016 14:14
SW 6010C
Comments:
SULFUR AND ORGANIC NITROGEN NOT FOR COMPLIANCE PURPOSES.
QUALIFIER: THE MATRIX SPIKE WAS OUT OF LIMITS FOR "Al", "Fe", AND "S". ALL OTHER QC DATA IS ACCEPTABLE.
All values are on a dry weight basis except as noted by asterisk. Detection limit on all N series is on a wet basis.
Our reports and letters are for the exclusive and confidential use of our clients, and may not be reproduced in whole or part, nor may any reference be made
to the work, the results, or the company in any advertising, news release, or other public announcements without obtaining our prior written authorization.
Debbie Holt
Laboratory Supervisor

• I
-Cameron, Tetbng .$erWces:.Inc. ! Laboratory ReRo>I't
AcoENR#s0.4
I
NG PHks.#37799
U.b EPA#NC01918
�Ciient
Synagro1S
1 �12 00
I'ro�e�t f
Lumberton
Yes
Sample Information
samplea
W Varner � Date � � 08109/16 ; Rec2i�ed
G..Cameron
bate 08IQ911.5
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§ludae Gr I Fed. C0106rm-S <1 020OW l;Fi1
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1.4000 WKO/1e 9222D - MF
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91600
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a
iasmb
-7 ;103000 dFulb
103000
i
Geomea� <102000
`t
161200
-1 3tud0e .Gr; TS
0.01 0.9fiS 6 2540 G TS
�—
-2 1:05% %
0.01
i
-3 0.896°Io °%
a.o1
-4 0.948% pk
wo1
-fi 0.917% °A
bo1
I
=7 0.974°/a %
o:vi
Repoit .
Review
(24A
- ----- - — -
Lab .Dliector
�a — --
Date
I
i
'219 S: Steele Sir.
419-208-4240
Sanford NC' 27330
ehris gQ Merbdtdst 6g com

sanfdidi NO..27330
Cameron Testing Services,. Inc..
NC' W.WjGW.'W,#.654. NC PHHS,Cert.# $7.799 'US: EPA. NC011916-
- Chain of tut dy.
Rags. of
Phone :,91ST208:44240
R "E4r
nagro
CT
synag*ro.'Co ' i
-T
e,-.LPM
MIR F? LPMA..';
.13
-z 3"1 Mrear Marshall Pu y
J.�-';T4 Boger Rd. 46,r r
HIM"q
MocksvilleN 2704 MOM
3-36=1bb-8617
K
,
Nam
SIQn-eiture:
R
z
u
V"
Mi,
E E:�
SaMPI
0. 1:11 =� ;, j
I h d i -
CD
-F 7 7v
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1 5. I /•��.1 1'
_7K., low
Ri V II ,�I I � ;Ir
Ad .0heir9bg, will', ply
Rush wbek Will r6quire.-Prior approval.. A . itional.

If sewage sludge is > 20°C, SOUR =
If sewage sludge is < 20°C, SOUR =
Version 11/1/11
City of Lumberton
Environmental, Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: Digester # A7 , ,; 7/27/16;cotl;t 11,1;3am kcl
Total Solids
Sample volume used for total solids test:
LVeight_ofdish
Weight of dish + dried solids:
Weight of dried solids:
Total Solids:
SOUR
" 1 r2'S
Al
us
9956
Time
(Minutes)
Temperature
Dissolved
Oxyyygernc((mg/L)
oC
O
.2
3
4
c_
5
6
g
, 27OOJ
- 3t99 t
10
.10. .�: .... ti27,>00�>
11
12
13i'
14
15
mL
9
9
9/L
Oxygen Consumption Rate 0.22 mg/L/minute
SOUR 1.33 (mg/g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperature During Test
°C
26.8125
'z,,sto'LsS4 7 (mg/g)/hr
(mg/g)/hr
SOUR passes if result is <_ 1.5.(mg/g)hr

.�at.mp►c �
City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
Date / Time Collected: . 2 1 . I CO 1/V
Analyst Initial: JQ KCL_.
Sample Location:
..
M,M
=WV1_
®EMOM
®m®
=0114+�
®LqMe
mmm
t!
o
used -I- r;s 4
Tar AL c-oLjbS
,-Res 0 14s
cli6w
Calculations:
0.214
� ( � � � y� icy
��_- 12. `-i5 / _`TI 02 mg/Llmin
Initial -DO 15-min-DO— 15-or_#-of-0Z.readings Oxygen-Consumpfion.Rate
ADigested Sludge Samples
—X . 60 /
02 mg/Umin Hr
0.2 I'-(
For Mixed Liquor Samples
X 60 /
02 mg/Umin Hr
Total Solids (mg/L)
MLVSS (mg/L)
I.Z9
Sv 0-1� = O
SOUR mg/g/hr
SOUR mg/g/hr
Interpretation of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
> 20 mg 02 / g-MLVSS / Hr
Loading
12 - 20 mg 02 / g-MLVSS / Hr
Normal
This range will usually produce good solids settlirig an dCOD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg 021 g-MLVSS / Hr
I Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for reading the oxvgen.
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add an aeration stone to the beaker and aerate for 5 minutes.
While the sample is being aerated Calibrate the DO Meter.
After 5 minutes Pour the aerated sample into a 300ml Boo bottle with a stir bar and place the bottle onto a stir plate. While
mixing, place the BOD probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
minutes or until there is no more DO remaining. When all the readings have been recorded, clean bottles, probe's and equipment
properly. Proceed with the calculations above to complete test.
Vector Attraction Reduction Requirements: pasted are the typical Alternatives we use for Sludge Disposal)
Alternative 1: The mass of volatile solids in the sewage sludge shall be reduces by a minimum of 38%.
Alternative 3: If Alternative 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously .digested sludge anaerobically in the laboratory in a bench -scale unit for 30 additional days at 20°C. Volatile Solids must
be reduced by less than 159/6 to demonstrate compliance.
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less than 1.5 mg of oxygen
per hour per gram of total solids (dry weight basis) at a temperture of 20'C.
\ Alternative 6: The pH of sewage sludge shall be rasied to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for two hours and then at 11.5 or higher for an additional'22 hours.
7/13/16 T.Smith

Sample #
City of Lumberton
Total Solids Analysis Worksheet '
SM 2640 B. 1997
FOR PROCESS CONTROL ONLY
Checked by: � Sample Day & Date: we -CA .,-I-?:] -I G
W
Time IN oven:? •Z I G,) i V • Nam Date & Time Started:—[ •`ICo t ILI Q,rn
R
Time OUT of oven: % ' ` (D (�� cZ m Date & Time Completed: � . `Z 8 -1( g 2q CLM
g = Grams, Wt = Weight
Analyst: W-CL
Dish #
Volume
(MIS)
Tare Wt.
fig)
Tare +
Sample Wt.
(g)
Wet Wt.
(g)
Dried Wt.
.(..
Differen_ ce
(g)
Total Solids �
i
Average TS
(mg/1)
Use if Dup's are run
121.2t19
t-4►=4
5
121.
-2429
Cl Wo
10.15
111
22
11 ! It 4
2599 _
.34
% Solids Calculation:
Total Solids Calculation:
` Dried Wt, (g)
--_ Wet Wt. (g)
X 100
= %Total solids
Dried Wt. (g) x 1000
Total spuds man
Volume (MIS)
Section below is to show your work.
.►�r�si�aa.r�rrs�r�rsi—a.---
►-----sue►—ter------------------
10
qq�
23.0154-
25
2 CR
X 100
_ ".OS 1
2y : 785E
25
X 100
=
_
X 100
=
_
1. Initially use 50m1.s for Known and Unknowns samples and 25mis for regular samples.
2. The sample volume must yeild at least 2.5 mg of residue.
3. To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Value: Known Value Obtained: Limit Range.
Revised 3/14116 T. Smith

City of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: M"t, # 1 '7/28(16 colf`at a�n lCcl
"Sample # 2'
Total Solids
Sample volume used for total, solids test
-- Vlfeight of -dish.=
Weight of dish + dried solids:
Weight of dried solids:
Total Solids:
mL n
9
9
9
g1L
SOUR
0.28
11.092
Time
inutes)
Temperature
Dissolved
Oxygen (mg/L)
aC . -
1
= y27�00 4 . y
AZ.'3Y87T v'.
2-
3
; r N
4
s 2700 `
q
-
6r.,w.:'.v'Y26'QO
8
10
z?:..`., ., `2 7 31k
.12
14
W , .i !1-6�U0,.. , ,__'M
15
Oxygen Consumption Rate 0.17 mg/Lfminute
SOUR 0.94 (mg/g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperature During Test
oC
26.375 .
If sewage sludge is > 20'C, SOUR
(mg/g)/hr
If sewage sludge is < 20°C,'SOURONy (mg/g)/fir
SOUR passes if result is < 1.5 (mg/g)hr
Version 1111/11
0

City of Lumberton Sannplc 4 2
Specific Oxygen Uptake Rate (SOUR)
Date'/Time Collected: ThuYS` z - 1C0
Analyst Initial: ko KCL
Sample Location: n #
owl�
Calculations: I
0,J c,-. A bbr�s .
! - OZ mg/L/min
Initial DO 15 min DO 15 or # of 02 readings Oxygen Consumption Rate
For Digested Sludge Samples
x 60 ! = SOUR mg/g/hr
02 mg/Umin Hr Total Solids (mg/L)
For Mixed Liquor Samples
X 60 / = SOUR mg/g/hr
02 mg/Umin Hr MLVSS (mg/L)
Interpretation of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
> 20 mg 021 g-MLVSS / He
Loading
12 - 20 mg 02 / g-MLVSS / Hr
Normal
This range will usually produce good solids settling an dCOD removal.
This may indicate that there are too many solids (MLSS) or there has
a 12 mg 02 /,g-MLVSS / He
Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in. the TSSNSS SOP.
Other than the solids test, the procedure Is the same for reading the oxvden.
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add ah aeration stone to the beaker and aerate for 5 minutes.
While, the sample is being aerated Calibrate the DO. Meter.
After 5 minutes Pour the aerated sample into a 300ml DOD bottle with a stir bar and place the bottle onto a stir plate. While
mixing, place the DOD probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
minutes or until there is no more DO remaining. When all the readings have been recorded, clean bottles, probes and equipment
properly. Proceed with the calculations above to complete test
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 1: The mass of volatile solids in the sewage sludge shall be reduces by a minimum of 38%.
Alternative 3: If Alternative 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobically in the laboratory in a bench -scale unit for 30 additional days at 20oC. Volatile Solids must
be reduced by less than 15% to demonstrate compliance.
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated In an aerobic process shall be equal to or less than 1.5 mg of oxygen
per hour per gram of total solids (dry weight basis) at a temperture of 20°C.
Alternative 6; The pH of sewage sludge shall be rasied to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for two hours and then at 11.5 or higher for an additional 22 hours.
7/13116 T.Smith

Sample # 2
City of Lumberton
Total Solids Analysis Worksheet
SM 2540 B. 1997
FOR PROCESS CONTROL ONLY
Checked by: ' It.,S Sample Day & Date: ► r 111Ys --7''2-'S8 •»
Time IN oven: R �• 1� • «9 l -(XV am Date & Time Started: ! - • 1�0 •Q� Qf1n
Time OUT of oven:V I -?9 •I b G • I G Q.M Date & Time Completed: T —7 -?9 - I(D G •.1Co o-m
_g = Grams, Wt = Weight — Analyst:
ar
R
% Solids Calculation:
'D,- 1<•Dried Wt. (g) x 100
SaMpleWet Wt. (g)
Section below is to show your work.
• 2 7-73 x 100
214.gg38
x 100
X 100
x 100
= %Total Solids
1. Initially use 50mis for Known and Unknowns samples and 25mis for regular samples.
2, The sample volume must yeiid at least 2.5 mg of residue.
3. To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Valuer
Known Value Obtained:
Total Solids Calculation:
•t -4. Dried Wt. (g) x 1000
Volume (MIS)
= Total Solids mq/l
.22-73 x k,MO _
2S --—
Limit Range:
Revised 8/14/16 T. Smith

City of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: ;D;�gester. `# '( 7/29116 toll at 8 28m kcl
Sample #
Total Solids
Sample volume used for total solids test,
Weight -of -dish.
Weight of dish + dried solids:
Weight of dried solids:.
Total Solids:
25 mL
---
127..19' g
0,27 g .
10.892 g/L
SOUR
Time
(Minutes)
Temperature
Dissolved
Oxygen (mg/L)
oC
-0
9
10382
12
13
' 2b00r
z u
3` 34
14
15
Oxygen Consumption Rate 0.17 mg/L/minute
SOUR 0.92 (mg%g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperature During Test
°C
25.6875
If sewage sludge is > 20°C, SOUR = rr o.;o�,< (mg/g)/hr
If sewage sludge is < 20°C, SOUR = o's3 (mg/g)/hr
r ,
SOUR passes if result is 51.5 (mg/g)hr
Version 11/1/11
1

City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
Date / Time Collected: • 2Q -0 F ° L m
Analyst Initial:
Sample Location:
®MM
mom
MOM
®
6
me
O •
M
Moslem
®EMS
=460
m
L�
®mom
®m
MM='.
®RSIM
Ko / 1<C L
Calculations:
Sampic #-3
.3.Oc7 / 15 = 0• 17 02 mg/L/min
Initial DO 15 min DO 15 or # of 02 readings Oxygen Consumption Rate
For Digested'Sludge Samples
X 60 /
02 mg/L/min Hr Total Solids (moll-)
For Mixed Liquor Samples.
X . 60 /
02'mg/1-/miri Hr MLVSS (mg/L)
SOUR mg/g/hr
SOUR mg/g/hr
Interpretation .of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
> 20 mg OZ / g-MLVSS / Hr
Loading
12 - 20 mg OZ / g-MLVSS / Hr
Normal
This range will usually produce good solids settling an dCOD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg OZ / g-MLVSS / Hr
Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mla of the sample to be tested.
Run Total Suspended and Volatile Solids on sample., Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for readinia the,oxvoen.
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add an aeration stone to the beaker and aerate for 5 minutes.
While the sample is being aerated Calibrate the DO Meter.
After 5 minutes Pour the aerated sample into a 300m( Boo bottle with a stir bar and place the bottle onto a stir plate, While
mixing, place the BOD probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
minutes or until there is no more DO remaining. When all the readings have been recorded, clean bottles, probes and equipment
properly. Proceed with the calculations above to complete test.
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 1: The mass of volatile solids in the sewage sludge shall be reduces by a minimum of 38%.
Alternative 3: If Alternative 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobically in the laboratory in a bench -scale unit for 30 additional days at 20°C. Volatile Solids must
be reduced by less than 15% to demonstrate compliance.
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less than 1.5 mg of oxygen
per hour per gram of total solids (dry weight basis) at a temperture of 20'C.
Alternative 6: The pH of sewage sludge shall be rasied to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for two hours and then at 11.5 or higher for an additional 22 hours.
7/13/16 T.Smith

Sam' pie #
City of Lumbertod
Total Solids Analysis Worksheet
SM 2540 B. 1997
FOR PROCESS CONTROL ONLY
-Checked by: Sample Day & Date:
Time I N.oven: qjS cily-O Date & time Started: 7 -"2-q - I U q I&tern
Time OUT of oven: 116 '(0 1-1 q 7 . e� Date & Time Completed: MC-36' R I - I Cat
g = Grams— Wt = Weight Analyst:
­ -
Di
Dish #
Volume
(MIS)
Tare Wt
(g)
Tdre +
Sample Wt.
Wet Wt
(g)
Dried Wt.
(g)
Difference
(g)
Total S61ids
(M g/1)
Average S.
- T
(mg1l),
Use if Dup's are run
t52
2 5 351117.
19 1 (o
.2 23
10 q
% Solids Calculation: Total Solids Calculation:
Z.4 Dried Wt. (g). -13; 4 Dried Wt. (g) x 1000
sayq,lewet Wt. (g) X 100. %Total Solids Volume (MIS) Total Solids mq1I
-- — — — — - — - — - — — — - — - — - — — — - — — — — — - — — — — — — - — — — — — - — — — — — — — - — — — — —
Section below is to show your work,
@
.2'00 723 .2723 YOMD
x I
-7
'25. W13 .0 25
X 100
1. Initially use-kmls for Known and Unknowns samples and 25mls for regular sarriplep.
2. The sample volume must-yeild at least 2.5 mg of residue.
3. To get the, Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Value: Known Value Obtained:
Limit Range:
Reviqed 311411A T Smith.

City of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: :Digester # 1 8/1,/1'6 colt afi8 50am _kcl
Sample # 4
Total Solids
Sample volume used for total solids test
VV eight of dis-I
Weight of dish + dried solids:
Weight of dried solids:
Total Solids:
SOUR
0,26
10.524
Time
(Minutes)
Temperature
Dissolved
Oxygen (mg/L)
oC
0
rl 26,k00
6�36 r.
A
4.+r`
9
10
r rly� ` 25,300 r „
�412
12-
3 86
13
t: `:.:, _". 25' 0I.0 Om
14
` , 25s00 ;f
3'54k
15
`� �, 25 0'0
F 3 44 _,.z: =•
Oxygen Consumption Rate
SOUR
SOUR Temperature Correction
mL
V
0,14 mg/L/minute
0.81 (mg/g)/hr
Average Sewage Sludge
Temperature During Test
UC
25.375
If sewage sludge is > 20°C, SOUR = :;_w,...oks� ,.� (mg/g)/hr
t If sewage sludge is <20°C, SOUR = z ,;x4, ,,o5s 4_:LLr,.w,,,+(mg/g)/hr
SOUR passes if result is S 1.5 (mg/g)hr
Version 1111/11

City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
`r�M
Date / Time Collected: • ' I L0 @ 095-0 A►'-t.
Analyst Initial: / H H / «�
Sample Location:
.•
Paw-
�0
®m�-
®
�,
=am_
-'�
om
�y
Calculations:
Initial DO 15 min DO
Forbigested'Sludge"Samples .
x 60
OZ mg/L/min Hr
For Mixed Liquor Samples
x 60
OZ mg/L/rrtin Hr
15 or # of OZ readings
Total Solids (mgll-)
MLVSS (mg/L)
4
Oz mg/L.lmin
Oxygen Consumption Rate
SOUR mg/g/Fir
SOUR mg/glhr
Interpretation of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
> 20 mg O2 / g-MLVSS / Hr
Loading
12 - 26 mg Oz / g-MLVSS I Hr
Normal
This range will usually produce good solids settling an dCOD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg OZ / g-MLVSS / Hr
Low
lbeen a toxic occurrence,
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for reading the oxygen. . _ ..... „_
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add an aeration stone to the. beaker and aerate for 5 minutes.
While the sample is being aerated Calibrate the DO Meter.
After 5 minutes Pour the aerated sample into a 300ml BOD bottle. with a stir bar and place the battle onto a stir plate. While
mixing, place the SOD probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every, (1) minute for 15
minutes or until there is no more DO remaining. When all the readings have been recorded, clean bottles, probes and equipment
properly. Proceed with the calculations above to complete test.
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 1: The mass of volatile solids In the sewage sludge shall be reduces by.a minimum of 38%.
Alternative 3: If Alternative 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobicaily in the laboratory in a bench -scale unit for 30 additional days at 20°C. Volatile Solids must
be reduced by less than 156/6 to demonstrate compliance.
Alternative 4:'The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less than 1.5 mg of oxygen
r� per hour per gram of total solids (dry weight basis) at a temperture of 20°C.
i� Alternative 6: The pH of sewage sludge shall be rasied to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for lwo hours and then at 11.5 or higher For an additional 22 hours.
7/13/16 T.Smith

City of Lumberton
Total Solids Analysis Worksheet
SM 2540 B. 1997
FOR PROCESS CONTROL ONLY
Sample #
u n l�rnowc
12erar�
Checked by: � S Sample Day & Date: nn • � 1 CO
Time IN overt. C1r-n_ Date & Time Started: M (8 • 1Co 01'
.? --7 n,-n
Time OUT of oven: M • 1�0 �"' :^' y' S' nm Date & Time Completed.T •2.1Co E� q : c)":� C]ry-,
g = Grams, Wt = Weight Analyst:
Dish #
Volume
(MIS)
Tare Wt.
(g)
Tare +' '
Sample Wt.
(g)
Sample Wet
Wt.
(g)
Dried Wt.
(g)
Dried Wt.
Difference
(g)
Total Solids
(Mg/0
AvWdde TS
(mg/1)
Use If Dup's are run
O
111 y121
-:.
-t2` G
111 �7
.2co31
10.5
SCLMPIC #
� 0.5
I
o
% Solids Calculation: Total Solids Calculation: wp •258
Dried Wt. Diff (g) Dried Wt. Diff (g) x 1000
X 100 = %Total Solids = Total Solids mall
Sample Wet Wt. (g) Volume (MIS)
----------------►•..r------:—.r---io•ar—.ri��•���-�.•���-�-��•r..�-.rarl�r�a.r�s.r�r.a�e��-r^..
Section below is to show yourwork.
io , 2CO3t = 2C93 l x , CEO _
2H1-12- o X 100 C0 ►o
25
X 100
X 100 = _
X 100 =
•
O 123 x 1, OW)PM I-tq . 22&3 = 21Aq .g
1. Initially use 5omis for Known and Unknowns samples and 25mis for regular samples.
2. The sample volume must yeild at least 2.5 mg of residue.
I To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
r
Known Certified Valuer "" Known Value Obtained: — Limit Range:
U n Krx�)wln ;

City- of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: ;Digester # 1. `- 8/2/16 colt at 9 48 am 'kcl
Sample # 5.
Total Solids
Sample volume used for total solids test: 25; mL
_ Weight of dish: '' 94 qXg
Weight of dish + dried solids:. g
Weight of dried solids: 0.27 g
Total Solids: 10�62- g/L
SOUR
Time,
(Minutes)
Temperature
Dissolved
Oxygen (mg/L)
aC .
2,
3
': z 25 OO�r...
4.
5
0
7
sf y i-kc -� r s
t } }. $ ti..
11
12
13
i
14
A"",
15
Oxygen Consumption Rate 0.12 mg/L/minute
SOUR 0.67 (mg/g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperature During Test
PC
25
If sewage sludge is > 20°C; SOUR =y rY.lo:'S2..„s;= ;a. (rung/g)/hr
(m /hr
If sewage sludge is < 20°C, SOUR = ';, _. _, 0:47?_;;t_! g /g)
,- SOUR passes if result is:5 1.5 (mg/g)hr
Version 11/1/11

City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
-T
Date / Time Collected: 8 - ?— • `w @ q -- wi� Cm
Analyst Initial: i —0 / H H V-C-
Sample Location:
©
• •
m
•M
M
t C-
Calculations:
Scamplc
#'
1 = OZ mg/L/min
Initial DO 15 min DO 15 or ## of 02 readings Oxygen Consumption Rate
For Digested 'Sludge Samples
X 60 / = SOUR mglg/hr
OZ mg/Umin Hr Total Solids (mg/L)
For Mixed Liquor Samples
X 60 / = SOUR mg/g/hr
02 mg/Umin Hr MLVSS (mg/L)
Interpretation of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
20 mg 021 g-MLVSS / Hr
Loading
12 - 20 mg 02 / g-MLVSS / Hr
Normal
This range will usually produce good solids settling an dCOD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg 021 g-MLVSS / Hr
I Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for reading the oxygen.
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample Into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add an aeration stone to the beaker and aerate for 5 minutes.
While the sample is tieing aerated Calibrate the DO Meter.
After 5 minutes Pour the aerated sample into a 300ml BOD bottle with a stir bar and place the bottle onto a stir plate. While
mixing, place the BOO probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
minutes or until there is no more Do remaining. When all the readings have been recorded, clean bottles, probes and equipment
properly. Proceed with the calculations above to complete test.
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 1: The mass of volatile solids in the sewage sludge shall be reduces by a minimum of 369A:
Alternative 3: If Alternative 1 cannot be met for anaeroblcally digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobicaily in the laboratory in a bench -scale unit for 30 additional days at 200C. Volatile Solids must
be reduced by less than 15% to demonstrate compliahce.
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less than 1.5 mg of oxygen
per hour per gram of total solids (dry weight basis) at a temperture of VC, .
Alternative 6: The pH of sewage sludge shall be rasied to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for two hours'and then at 11.5 or higher for an additional 22 hours.
7/13/16 T.Smith

City of Lumberton
(' Total Solids Analysis Worksheet
SM 2540 B. 1997
FOR PROCESS CONTROL ONLY
Sample #
U13. *I
Checked by: Sample Day & Date: _ __ t ues 18- L.- I V
Time I N oven: T • (-0 10 - Q3 Date & Time Started: T 9 •2• I `O 10- 00om
Time OUT of oven: -T• l c9 115'j) Date &Time Completed: • �(0 �{ �1 afY
-g = Grams Wt = Weight Analyst: I«
Dish #
Volume
(mis)
Tare Wt.
(g)
Tare +
Sample Wt.
(g)
Sample Wet
Wt.
(g)
Dried Wt.
(g)
Dried Wt.
Difference
(g)
Total Solids
(mg/1)
Average TS
(mg/1)
Use if Dup's are run
1C�CHIM
2-5:3D4
08. 199 O
.`Z-65
10.Co
% Solids Calculation: Total Solids Calculation:
Dried Wt. Diff Dried Wt. Diff x 1000 (g) X 100 = %Total Solids (g) =Total Solids mpA
Sample Wet Wt. (g) Volume (m!s)
Section below is to show your work.
�� 2Co5�i X 100 = �c� . 2Ca55 x 1,000 =
25.31-ILV •O 2c,� 101G
X 100 = _
X 100 -
X 100 =
1. Initially use 50mis for• Known and Unknowns samples and 25mis for regular samples.
2. The sample volume must yeild at least 2.5 mg of residue.
3. To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Value: Known Value Obtained: Limit Range:
Revised 3/14/16 T. Smith

r---
�' City of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: 0111ges"tear=.#;1'
Total Solids
Sample volume used for total solids test:
Weight_of_dish _
Weight of dish + dried solids:
Weight of dried solids:
Total Solids,
SOUR
�r
0.25
10.096
Time
(Minutes)
Temperature
Dissolved
Oxygen (mg/L)
oC
3
5
r; „,
7
25 00 .z,,:.:.�
F ..,.`7 33,
10
12
�a
13
r _ uk;5:00 t'._
14
15
mL
9
9
g/L
Oxygen Consumption Rate 0.09 mg/L/minute
SOUR 0.53 (mg/g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperature During Test
0C.
24.9315
If sewage sludge is > 20°C, SOUR = ., , oa2 _' (mg/g)/hr
^,Y Y� , 3
If sewage sludge is < 20 C, SOUR = �;;,,;;_.,;o�,e;,;,;�,;:(mg/g)/hr
SOUR passes if result is <_ 1.5 (mg/g)hr
Version 11/1/11

Date / Time Collected:
Analyst Initial:
Sample Location:
mom
®E
M6�
=I
M.©
®o
1mno
s t�
City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
v�l _
I -1T / H i-i / vcL
t
Calculations:
/ = 02 mg/11-1min
Initial DO 15 min DO 15 or# of OZ readings Oxygen Consumption Rate
For Digested Sludge Samples
x 60 /
02 mg/L/min Hr Total Solids (mg/L)
For Mixed Liquor Samples
x 60 !
02 mg/Umin Hr
MLVSS (mg/L)
SOUR mg/g/hr
SOUR mg/g/hr
Interpretation of SOUR Test Results for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
20 mg OZ / g-MLVSS / Hr
Loading
12 - 20 mg 02l g-MLVSS / Hr
Normal
This range will usually produce good solids settling an clCOD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg 02 / g-MLVSS / Hr
I Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples:
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for reading the oxygen.
JR Procedure for Digested Sludge for Disposal:
:ct at least 500mis of the sample to be tested.
Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
an aeration stone to the beaker and aerate for 5 minutes.
e the sample Is being aerated Calibrate the DO Meter:
5 minutes Pour the aerated sample into a 300ml BOO bottle with a stir bar and place the bottle onto a stir plate. While
ng, place the BOD probe into the bottle and start to measure the DO.
t until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
ites or until there.is no more DO remaining. When all the readings have been recorded, clean bottles, probes and equipment
ierly. Proceed with the calculations above•to complete test.
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 4: The mass ofvolatile solids in the sewage sludge shall be reduces. by a minimum of 38%.
Altetnative 3: If Altemadve 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobically in the laboratory in a bench -scale unit for 3o additional days at 20°C. Volatile Solids must
be reduced by less than 15% to demonstrate compliance.
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less,than 1.5 mg of oxygen
f per hour per gram of total solids (dry weight basis) at a temperture of 20°C.
F, Alternative 6: The pH of sewage sludge shall be rasied to 12 or higher by alkal( addition and, without the addition of more alkali shall remain at
12 or higher for two hours and then at 11.5 or higher for an additional 22 hours.
7/13/16 T.Smith

Sample #
City of Lumberton
Total Solids Analysis Worksheet 9
SM 2640 B. 1997
FOR PROCESS CONTROL ONLY
Checked by: Sample Day & Date:.. V V eic. O ' • ��
Time IN oven w - 1 G9 QYn Date & Time Started: W S 3 • KD -. T 2A am
Time OUT of oven: @ 1 `D i(7r,��, Date & Time Completed: q •lco
�rams,_N/f = Wight_._ Analyst: YICL
Dish #
Volume
(MIS)
Tare Wt.'
(g)
Tare +
Sample, Wt.
(g)
Sample Wet
Wt.
(g).
Dried Wt.
(g)
Dried.Wt.
Difference
(g)
Total Solids
{mgll)
Average TS
(mg/1)
Use if Dup's are run
OCP
25
03 _
1
.4$ (7
12:3 : 36t
o •116_- A
Q .
% Solids Calculation- Total Solids Calculation:
Dried Wt. Diff (g) X 100 %Total Solids Dried Wt. Diff (g) x 1000
�`- - = =Total Solids mall
Sample Wet Wt. (g) Volume (MIS)
- - - - - - - - - ---------- -ten-.--- ------- -ems-:-----------------sar- -a
Section below is to show your work. -
OCo o x = ` o o� o . z52 ( DOD
xoo Q c� .2 �r _
X 100 =
X 100 =
X 100 = .
1. Initially use 50m-Is for Known and Unknowns samples and 25mis for regular samples.
2. The sample volume must yeild at least 2.5 mg of residue.
3. To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Val
Known Value Obtained: Limit -Range:
RP.VISP.rt 3114/1:F T Smith

City of Lumberton
Environmental Laboratory
Specific Oxygen Uptake Rate (SOUR) Worksheet
Date & Analyst: -Rige$te,# 1 8T4116 co11 at 10 50 am' `TL,
Sample # 7
Total Solids
Sample volume used for total solids test:
1L11eight_ofd1sh:
Weight of dish + dried solids:
Weight of dried solids:
Total Solids:
mL
9
9
g/L
SOUR
Time
(Minutes)
Temperature
Dissolved
Oxygen, (mg/L)
QC
0
,
2'LL,
3
5
6
7
Sfi^ s i aj r
r
8
24 00,,y
60
7 52
10
12
r 23 00
j " v
7i:"38
13
23 `00
7 "28v
14
15
Oxygen Consumption Rate 0..07 mg/L/minute
SOUR 0.38 (mg/g)/hr
SOUR Temperature Correction
Average Sewage Sludge
Temperaturo During Test
°C
23.5625
If sewage sludge is > 20°C, SOUR = _2�>�' (mg/g)/hr
If sewage sludge is < 20°C, SOUR = $,.,,,.%0;_30_`,,..__ y (mg/g)/hr
SOUR passes if result is 51.6 (mg/g)hr
Version 11/1/11

City of Lumberton
Specific Oxygen Uptake Rate (SOUR)
Date /Time Collected: 1 ; 1 t] A V-A
Analyst Initial: Z S
Sample- Location:
Time
(Min)
D.O.
(mg/l)
Temp
(°c)
lriitial DO
_9 J 9
_24
1
9. dgl
2
2
-6,5S
e
3
7. 12
2
4
'7. �5
2
5
Z
6
T -1
.214
7
7. i0
z
6
-%. (QO
2
g
tit°
7. 5Z
2 3
12
7.3g
Z3
13
'7 V .
Z 3
14
T• Z.Z
Z
15
"7.15�
23
Calculations:
.__ -__ - _'1_ = 02 mg/L/min
Initial DO 15 min DO 15 or # of 02 readings Oxygen Consumption Rate
For Digested Sludge Samples
X 60 / = SOUR mg/g/hr
02 mg/Umin Hr Total Solids (mg/L)
For Mixed Liquor Samples
X .60 1 = SOUR mg/g/hr
02 mg/Umin Hr MLVSS (mg/L)
Interpretation of SOUR Test Results -for ML Samples
High
This may indicate that there are not enough solids (MLSS) for the COD
> 20 mg 02 / g-MLVSS /.Hr
Loading
12 - 20 mg 02 / g-MLVSS / Hr
Normal
This range will usually produce good solids settling an c1COD removal.
This may indicate that there are too many solids (MLSS) or there has
< 12 mg 02 / g-MLVSS / Hr
Low
been a toxic occurrence.
SOUR Procedure for Mixed Liquor Samples;
Collect at least 500mis of the sample to be tested.
Run Total Suspended and Volatile Solids on sample: Use 5mis of sample and follow the steps in the TSSNSS SOP.
Other than the solids test, the procedure is the same for reading the oxvicen,
SOUR Procedure for Digested Sludge for Disposal:
Collect at least 500mis of the sample to be tested.
Run Total Solids on sample: Use at least 25mis of sample and follow the steps in the TS SOP.
Pour the remaining sample into a 1 liter beaker with a stir bar, place the beaker on a stir plate on a moderate mixing speed then
add an aeration stone to the beaker and aerate For 5 minutes.
While the sample is being aerated Calibrate the DO Meter.
After 5 minutes Pour the aerated sample Into a 300ml BOD bottle with a stir bar and place the bottle onto a stir plate. While
mixing, place the BOO probe into the bottle and start to measure the DO.
Wait until meter reading has stabilized (no more than 30 sec) and start recording the DO and Temp every (1) minute for 15
minutes or until there Is no more DO remaining, When all the readings have been recorded, clean bottles, probes and equipment
properly. Proceed with the calculations above to complete test.
Vector Attraction Reduction Requirements: (listed are the typical Alternatives we use for Sludge Disposal)
Alternative 1: the mass of volatile solids in the sewage sludge shall be reduces by a minimum of 38%.
Alternative 3: If Alternative 1 cannot be met for anaerobically digested sludge, demonstration can be made by digesting a portion of the
previously digested sludge anaerobically in the laboratory in a bench -scale -unit for 30 additional days at 20°C. Volatile Solids must
be reduced by less than 15%e to demonstrate compliance,
Alternative 4: The specific oxygen rate (SOUR) for sewage sludge treated in an aerobic process shall be equal to or less than 1.5 mg of oxygen
per hour per gram of total solids (dry weightbasis) at a temperture of 20°C.
Alternative 6: The pH of sewage sludge shall be rasled to 12 or higher by alkali addition and, without the addition of more alkali shall remain at
12 or higher for two hours and then at 11.5 or higher for an additional 22 hours.
7/13/16 T.Smith

City of Lumberton
Total Solids Analysis Worksheet
SM 2540 B. 1997
FOR PROCESS CONTROL ONLY
Sample #
I"�, ; 5 #
Checked by: Sample Day & Date: ! h u r S (( (n
Time IN oven: ( (00 AM Date & Time Started: / q I 1 -0510 A ,M
Time OUT of oven: n�E A wig 151 ho - -0, Date & Time Completed:
_g = Grams., V1/_t =-Wejght
Dish #
Volume
(MIS)
Tare Wt.
fig)
Tare +
Sample Wt.
(g)
Sample Wet
Wt.
(g)
Dried Wt.
M
Dried. Wt.
Difference
(g)
Total Solids
(mg/l)
Average TS
(mg/1)
Use if Dup s are run
1(�
25�
izo. -?,j25q
S35'
g
D.203 a
% Solids Calculation: Total Solids Calculation:
Dried Wt. Diff (g) X 100 = %Total Solids Dried Wt. Diff (g) x 1000 Total solids mg�l
Sample Wet Wt. (g) Volume (MIS)
Section below is to show your work.
0- 2h.*�4- X 100 — •Da-�
'?5- � -
X 100 =
X 100 =
X 100 —
1. Initially use 50mis for Known and Unknowns samples and 25mis for regular samples.
2. The sample volume must yeild at least 2.5 mg of residue.
3. To get the Wet Weight; subtract the Tare Weight from the Tare + Sample Weight
Known Certified Value: Known Value Obtained:
O .2-6a ` jC Iy
Ps— _
Limit Range:
1f) . Co
RPvicariWIA0RT .mith

o�oF wATF,�Q
State of North Carolina
G Department of Environment and Natural Resources
j'— Division of Water Quality
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 08-11
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 or for an electronic version of this form, visit the Land Application Unit (LAU) web site at:
hgp:/1portal. ncdenr. org/web/wg1aps/lay
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 08-11 or FORM: SDR 08-11).
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 08-11):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 08-11) 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.
�. 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 (Ml) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
County Manager
Notification
ar
j=.
Land Owner
✓
✓
✓
Agreement
(If applicable)
✓
✓
✓
✓
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
for Residuals Land Application Permits"
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scientist
Evaluation Policy"
✓
An updated accounting of the land application site's cumulative
✓
✓
pollutant loading rates (CPLRs)
INSTRUCTIONS FOR FORM: LASC 08-11 Page 1 of 3

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 Policy"
Acknowledgement of field transfer from Permittee relinquishing field
✓
Acknowledgement of field transfer from Land Owner (Fields may not
✓
be permitted to multiple Permittees over the same timeperiod)
* This item may be required for land application site with a status code "M", please contact the Division if you 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)
t ` • Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: hM://portal.nedenr.ora/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:
hU://portal.ncdenr.org 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 hqp://h2o.enr.state.nc.us/bims/reports/reportsWB.html. If this link does not work, open
hfp://portal.rlcdenr.org/web/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
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
2. Locate the name of the identified waterbody (from General Directions) on the list.
INSTRUCTIONS FOR FORM: LASC 08-11 Page 2 of 3

3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the 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 .0301(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
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 08-11 Page 3 of 3

LAND Ar �LICATION SITE CERTIFICATION
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
L LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code"
Site/Field ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Name
Mapping Unit
or Rep. Slope`
D
NC-RO-19-01
Jennings Hayes
Same
20.7
Robeson
D
NC-RO-19-05
Jennings Hayes
Same
7.4
Robeson
D
NC-RO-19-08
Jennings Hayes
Same
12.7
Robeson
D
NC-RO-19-09
Jennings Hayes
Same
11.9
Robeson
D
NC-RO-19-10
Jennings Hayes
Same
18.6
Robeson
D
NC-RO-19-11
Jennings Hayes
Same
13.3
Robeson
D
NC-RO-19-12
Jennings Hayes
Same
30.2
Robeson
D
NC-RO-19-13AI
Jennings Hayes
Same
22.0
Robeson
a Status Code for land application sites ate: ♦ 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)
U. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Proposed
Current and Class
NAD 83
ADD
Nearest Second
1
Lj F"'
NAD 83
ADD
Nearest Second
F11"
NAD 83
ADD
Nearest Second
I I
NAD 83
ADD
Nearest Second
'
NAD 83
ADD
Nearest Second
—�
0
[71° ' 11"
El- D F j"
NAD 83
ADD
Nearest Second
�'
!
El- ' D,
[j' [-1"
NAD 83
ADD
Nearest Second
.;
E]° []' L j"°
E]' ❑"
NAD 83
ADD
Nearest Second
Note: Please keep the site information (I.) and•waterbody information (II.) of the same field on the same page.
FORM: LASC 08-11 Page 1

LAND ArrLICATION SITE CERTIFICATION
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres:
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code"Series
Site/Field ID
Landowner() s
s or O s
Lessee() Operator(s)
Net Acres
' County
Crop(s)
Predominant Soil
Nameb
Mapping Unit
or Rep. Slope
D
.. NC-RO-19-13B
Jennings Hayes
Same
28.3.
Robeson
D
NC-RO-19-15
Jennings Hayes
Same
17.2
Robeson
D
NC-RO-19-20
Jennings Hayes
Same
111.8
Robeson
D
NC-RO-19-21
Jennings Hayes
Same
18.6
Robeson
D
NC-RO-19-22
Jennings Hayes
Same
50.6
Robeson
D
NC-RO-19-23
Jennings Hayes
Same
26.0
Robeson
D
NC-RO-19-25
Roland Pittman
Jennings Hayes,.
29.4
Robeson
D
NC-RO-19-29
Alfred M Pittman
Jennings Hayes
2.6
Robeson
'Status Code for 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)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location'Method Code
Location Accuracy
_
Waterbody Subbasin and
Stream Index No.
Current and Proposed, Class
°
NAD 83
ADD
Nearest Second
EI° E ET"
�° E1' D,
NAD 83
ADD
Nearest Second
0
0° 0.' IT
7° ❑' j"
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
[' D,"
11° F' D,
NAD 83
ADD
Nearest Second
0
.
NAD 83
ADD
Nearest Second
0
0
D ❑r r
El- 0, D,
NAD 83
ADD
Nearest Second
0
.
LE° [' 7"
E. [1' 01"
NAD 83
ADD
Nearest Second
Note: Please keep the site information (I.) and waterbody information (H.) of the same field on the same page.
FORM: LASC 08-11 Page 2

41— \l
LAND LICATION SITE CERTIFICATION
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 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
Crops)
Predominant Soil
Series Name b
Mapping Unit
or Rep. Slope'
D
NC-RO-19-30
Alfred M Pitmman
Same
12.2
Robeson
D
NC-RO-19-34
Jennings Hayes
Same
28.1
Robeson
D
NC-RO-19-35
Jennings Hayes
Same
23.6
Robeson
D
NC-RO-19-36
Jennings Hayes
Same
12.6
Robeson
D
NC-RO-19-37
Jennings Hayes
Same
11.6
Robeson
D
NC-RO-19-38
Jennings Hayes
Same
20.8
Robeson
D
NC-RO-22-01
F K Biggs
Dexter Locklear
8.9
Robeson
D
NC-RO-22-02
F K Biggs
Dexter Locklear
44.9
Robeson
'Status Code for 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
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and ClassProposed
.
El' "
no
NAD 83
ADD
Nearest Second
0
E. [1' D"
110 [I' Lj"
NAD 83
ADD
Nearest Second
0
0
E]° ' 7"
° C'
NAD 83
ADD
Nearest Second
��
0
° []' []11
° [J„
NAD 83
ADD
Nearest Second
0
[]° 1, ElI"
U° jj' "
NAD 83
ADD
Nearest Second
C]° l 'I' F111
[]"
NAD 83
ADD
Nearest Second
(--
�r�
° L(' ❑"
U° Cj' —1"
NAD 83
ADD
Nearest Second
0
C. [1' D,
E° El' D"
NAD 83
ADD
Nearest Second
L�
FORM: LASC 08-11 Page 3

' � 1
LAND arrLICATION SITE CERTIFICATION
Note:_ Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code"
Site/Field ID
Landowner(s)
Lessees) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slope`
D
NC-RO-22-03
F K Biggs
Dexter Locklear
26.0
Robeson
D
NC-RO-27-01
F K Biggs
Chris McClean
22.7
Robeson
D
NC-RO-27-02
F K Biggs
Chris McClean
16.4
Robeson
D
NC-RO-27-06
F K Biggs
Chris McClean
35.9
Robeson
D
NC-RO-27-07
F K Biggs
Chris McClean
35.2
Robeson
D
NC-RO-37-01
Michael McCarthy
Danny Smith
3.1
Robeson
D
NC-RO-37-02
Michael McCarthy
Danny Smith
8.4
Robeson
D
NC-RO-37-03
Danny Smith
Danny Smith
8.9
Robeson
Status Code for 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
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Class Proposed
El'"
[]° E]'
NAD 83
ADD
Nearest Second
r170 r7' Q"
° F'1' 17"
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
0�
u
[]° [3' El"
[]° 7' E]"
NAD 83
ADD
Nearest Second
El° D' 11,"
01° El' u"
NAD 83
ADD
Nearest Second
° _'' "O
"
NAD 83
ADD
Nearest Second
LJ° �'
D° 0' D,
NAD 83
ADD
Nearest Second
E. Ell 17"
�° �' �"
NAD 83
ADD
Nearest Second
FORM: LASC 08-11
Page 4

LAND APPLICATION SITE CERTIFICATION -
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 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 Nameb
Mapping Unit
or Rep. Slope`
D
NC-RO-37-04
Phillip B Culbreth
Danny Smith
15.1
Robeson
D
NC-RO-37-05
Phillip B Culbreth
Danny Smith
4.1
Robeson
D
NC-RO-37-06
Phillip B Culbreth
Danny Smith
4.4
Robeson
D
NC-RO-16-20
Thomas Maynor
Ozell Baker
8.6
Robeson
D
NC-RO-16-21
Thomas Maynor
Ozell Baker
25.0
Robeson
D
NC-RO-38-01
Leroy Harris
Ray Locklear
11.6
Robeson
Hay
Norfolk
NoA
D
NC-RO-38-02
Leroy Harris
Ray Locklear
19.4
Robeson
Hay
Norfolk
NoA
R
NC-RO-16-01
Ozell Baker
Same
16.9
Robeson
Pasture
Rains Sandy
Ra
R
NC-RO-16-02
Ozell Baker
Same
3.6
Robeson
Pasture
Goldsboro
GoA
R
NC-RO-16-03
Ozell Baker
Same
3.4
Robeson
Pasture
Goldsboro
GoA
'Status Code for 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)
11. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
P
Class
[]'
[]° F]' [7�"
NAD 83
ADD
Nearest Second'
t
E]'
E]° []' E]"
NAD 83
ADD
Nearest Second
®' Ell
[]° E]' Ej"
NAD 83
ADD
Nearest Second
0
r]° L j' []"°
[7]' "
NAD 83
ADD
Nearest Second
[]° n' [j'
[]° El' []"
NAD 83
ADD
Nearest Second
0
rl° [1' D,
D° [T D,
NAD 83
ADD
Nearest Second
u
0
E]° D' El"
E]° [) Ell
NAD 83
ADD
Nearest Second
i
FORM: LASC 08-11 Page 5

LAND rri'LICATION SITE CERTIFICATION
Applicant's name:' City of Lumberton
Land application sites currently certified: 169$.6 net acres and Total to be certified: 791.7 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 Nameb
Mapping Unit
or Rep. Slope`
R
NC-RO-16-04
Ozell Baker
Same
3.6
Robeson
Pasture
Rains sandy
RA
R
NC-RO-16-05
Ozell Baker
Same
8.7
Robeson
Hay
Rains Sandy
RA
R
NC-RO-16-06 .
Ozell Baker
Same.
14.8
Robeson
Hay
Norfolk
NoA
R
NC-RO-16-07
Ozell Baker
same
17.5
Robeson
Row Crop
Norfolk
NOA
R
NC-RO-16-08
Ozell Baker
Same
7.6
Robeson
Pasture
Wagram
WaB
M
NC-RO-16-16
Campen Farms
Ozell Baker
5.0
Robeson
Hay
Wagram
WaB
M
NC-RO-16-17
Campen Farms
Ozell Baker
6.0
Robeson
Hay
Wagram
WaB
M
NC-RO-16-18
Campen Farms
Ozell Baker
12.3
Robeson
Hay
Wagram
WaB
'Status Code for 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)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
g
Location
Datum
Location Method Code
Location AccuracyProposed'
Waterbody Subbasin and
Stream Index No.
Current and Class
®° ❑' [ j"
EO Lj' []"
NAD 83
ADD
Nearest Second
ff l,'° 11, "
DO ` '
NAD 83
ADD
Nearest Second
El' 0"
u° 71' r-11"
NAD 83
ADD
Nearest Second
0°
[]'
NAD 83
ADD
Nearest Second
I
Cj° El'
[]° E]' 0"
NAD 83
ADD
Nearest Second
NAD 83
.ADD
Nearest Second
L
rq° []' F]"
[]°
NAD 83
ADD
Nearest Second
��
° �j' �"
❑° []' 7jj"
NAD 83
ADD
Nearest Second
FORM: LASC 08-11 Page 6

LAND ArkLICATION SITE CERTIFICATION
Applicant's name: City of Roxboro
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
III. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status
Code'
Site/Field ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Series Name b
Mapping Unit
or Rep. Slope'
M
NC-RO-16-19
Campen Farms
Ozell Baker
1.6
Robeson
Hay
Wagram
WaB
R
NC-RO-17-01
City of Lumberton
Delois Allen
36.4
Robeson
Row Crop
Johns Sandy
Jo
R
NC-RO-17-02
City of Lumberton
Delois Allen
25.4
Robeson
Row Crop
Lumbee sandy
Lu
R
NC-RO-17-03
City of Lumberton
Delois Allen
28
Robeson
Row Crop
Lumbeesandyloam
Lu
R
NC-RO-17-04
City of Lumberton
Delois Allen
47.7
Robeson
Row Crop
Johns Sandy
JO
Loam
M
NC-RO-18-01
McLean, David Knox
same
16.6
Robeson
Row Crop
Wagrsand.loamy
WaB
M
NC-RO-18-02
McLean, David Knox
same
49.3
Robeson
Row Crop
oordfolk loamy
san
NoA
M
NC-RO-20-03
R G Hammonds
same
24.9
Robeson
Pasture
Wakulla sand
WkB
'Status Code for 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)
IV. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
p
Class
D"
Lj° i'i'
NAD 83
ADD
Nearest Second
0
[° El' F""°
[1' ,r7"
NAD 83
ADD
Nearest Second
[]"
F1° F' []"
NAD 83
ADD
Nearest Second
[]°
NAD 83
ADD
Nearest Second
[I° D, D,
n' El"
NAD 83
ADD
Nearest Second
0
°
o ®' []"
NAD 83
ADD
Nearest Second
0
°' �"°
Lj' �"
NAD 83
ADD
Nearest Second
I
FORM: LASC 08-11 Page 7

LAND Arr'LICATION SITE CERTIFICATION
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status
Code"
Site/Field ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Series Name
Mapping Unit
or Rep. Slope'
M
NC-RO-20-04
R G Hammonds
Same
31.2
Robeson
Hay
Wakulla sand
WkB
M
NC-RO-20-05
R G Hammonds
Same
33.6
Robeson
Hay
Goldsboro loamy
GoA
sand
R
NC-RO-20-06
R G Hammonds
Same
6.7
Robeson
Row Crop
Norfolk loamy sand
NoA
R
NC-RO-20-07
R G Hammonds
Same
13
Robeson
Row Crop
Goldsboro loam y
GoA
sand
R
NC-RO-20-08
R G Hammonds
Same
73 2
Robeson
Row Crop
Goldsboro loamy
GoA
sand
R
NC-RO-20-14
Taylco c/o Keith
R G Hammonds
10.6
Robeson
Row Crop
GoldsboroloamyGoA
Taylor
M
NC-RO-21-01
Fannie Oxendine
Lacy Cummings
36.1
Robeson
Row Crop
Norfolk loamy sand
NoA
M
NC-RO-21-02A
Fannie Oxendine
Lacy Cummings
38.4
Robeson
Row Crop
Norfolk loamy sand
NoA
"Status Code for 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)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field 1D
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbod y Subbasin and
Stream Index No.
Current and Proposed
Class
ff. M'°
�
NAD 83
ADD
Nearest Second
° ' �,_j"'
�"
NAD 83
ADD
Nearest Second
D° 7' 11"
1]0 F]' D"
NAD 83
ADD
Nearest Second
�.
El- []' "
E° DI
NAD 83
ADD
Nearest Second
i°
�j' C"
NAD 83
ADD
Nearest Second
0
❑° L' D
NAD 83
ADD
Nearest Second
C
L7° []' �"°
�i' �"
NAD 83
ADD
Nearest Second
-j
NAD 83
ADD
Nearest Second
'
1—
FORM: LASC 08-11 page 8

LAND r ''LICATION SITE CERTIFICATION
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status
Code"
Site/Field ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Series Name
Mapping Unit
or Rep. Slope`
M
NC-RO-21-02B
Fannie Oxendine
Lacy Cummings
5.1
Robeson
Row Crop
Wagram loamy sand
WaB
M
NC-RO-21-03
Fannie Oxendine
Lacy Cummings
3.4
Robeson
Row Crop
Wagram loamy sandl
WaB
M
NC-RO-21-04
Fannie Oxendine
Lacy Cummings
11.3
Robeson
Row Cron
lWagrarn loamv sand
WaR
M
NC-RO-21-05
Fannie Oxendine
Lacy Cummings
15.1
Robeson
Row Crop
Goldsborodloamy
GoA
R
NC-RO-28-01
Robert Baskerville
Carrell Locklear
11.6
Robeson
Row Crop
Dunbar sandy loam
Dn
R
NC-RO-28-02
Robert Baskerville
Carrell Locklear
56.9
Robeson
Row Crop
Rains Sandy Loam
Ra
R
NC-RO-28-03
Robert Baskerville
Carrell Locklear
10.4
Robeson
Row Crop
Goldsboro Sandy
o
GoA
R
NC-RO-39-OIA
Barbara Bullard
Patrick Bullard
5.3
Robeson
Pasture
Goldsboro Loamy
GoA
R
NC-RO-39-OIB
Barbara Bullard
Patrick Bullard
2.6
Robeson
Pasture
Goldsboro Loamy
GoA
R
NC-RO-39-02
Barbara Bullard
Patrick Bullard
1.4
Robeson
Pasture
Goldsboro Loamy
Sand
GoA
R
NC-RO-39-03
Quindale Bullard
Patrick Bullard
5.1
Robeson
Pasture
Rains Sandy Loam
Ra
R
NC-RO-39-04
Quindale Bullard
Patrick Bullard
14.8
Robeson
Hay
Lynchburg Sandy
Ly
'Status Code for 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
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
p
Class
° L' �"
[]° 7' jr�"
NAD 83
ADD
Nearest Second
i l
10 Q11„
El- L1, [ J"
NAD 83
ADD
Nearest Second
U° [1' E"
Do P [-]"
NAD 83
ADD
Nearest Second
0' 11"
[° 7' E]"
NAD 83
ADD
Nearest Second
FORM: LASC 08-11 Page 9

LAND=s -'LIGATION SITE CERTIFICATION
Applicant's name: City of Lumberton
Land application sites currently certified: 1695.6 net acres and Total to be certified: 791.7 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Code
aSeries
Site/Field ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Mapping Unit
Name
or Rep. Slope'
R
NC-RO-39-05
Barbara Bullard
Patrick Bullard
3.8
Robeson
Hay
Lynchburg Sandy
L y
Loam
R
NC-RO-39-06
Barbara Bullard
Patrick Bullard
2.9
Robeson
Hay
Wagram Loamy
WaB
Sand
R
NC-RO-39-07
Lyndon Bullard
Same
3.7
Robeson
Hay
Goldsboro Loamy
GoA
R
NC-RO-39-08
Lyndon Bullard
Same
7.4
Robeson
Hay
Norfolk Loamy Sand
NoA
R
NC-RO-39-09
Tracy Bullard
Same
62.5
Robeson
Hay
Wagram Loamy
WaB
a
Otatus t,uue ror iana appucauon sites are: ♦ iv (New) ♦ R (Renewed) ♦ M (Modified) ♦ T ( ransterred) ♦ 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/FieId ID
Latitude
Longitude
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Pro osed
p
Class
7° ET r7"
71,° 7' �"
NAD 83
ADD
Nearest Second
D° El' 11"
� ° 7' 0"
NAD 83
ADD
Nearest Second
9
1 L' "
IT E]' F"
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
7- D 101
17° r]' D"
NAD 83
ADD
Nearest Second
'
°r It
° !_
NAD 83
ADD
Nearest Second
0
Lio ❑' O"
1° 0' C j,
NAD 83
ADD
Nearest Second
L�°'
�"
�° �' ❑"
NAD 83
ADD
Nearest Second
FORM: LASC 08-11
Page 10

Site ID:
NC-RO-16
Owners:
Ozzell Baker (fields 1-8)
Operator:
Same
Address:
2996 Evergreen Ch Rd
Pembroke, NC 28372
Phone:
910-521-2714 ;
Estimated
Applicable
Fields
Acres Cron(s1
SITE SUMMARY
City of Lumberton
WQ0000672
Campen Farms (fields 16-19)
Ozell Baker
302 East Third Av.
Red Springs, NC 28377
910-740-4240
Robeson Co. Predominant Latitude &
RYE Soil Series Longitude
-PAN/aC_/vr_ Imnn nnitl (r) M C1
1
16.9
coastal
194
Rains
3.4.42.24 N
bermuda rass
(Ra)
79.07.40 W
2
3.6
fescue
184
Goldsboro
34.42.14 N
(GoA)
79.07.37 W
3
3.4
coastal
299
Goldsboro .
34.42.20 N
-
bermuda rass
(GoA)
79.07.33 W
4
3.6
coastal
194
Rains
34.42.17 N
bermuda rass
(Ra)
79.07.30 W
5
8.7
coastal
194
Rains
34.42.25 N
bermuda rass
(Ra)'
79.07.23 W
6
14.8
fescue
161
Norfolk
- 34.42.17 N.
(NoA)
79.07.18 W
7
17.5
:corn
soybeans(fs/dc)
131
164/137
Nor -folk
34.42.21 N
wheat
125
(NoA)
79.07.12 W
8
7.6
coastal
264
Wagram
34.42.23 N
bernuda rass
(WaB)
79.07.03 W
16
5.0
. coastal
264
Wagram
34.42.53 N
bermuda rass
(WaB)
.79.06.08 W
17
6.0
coastal
264
Wagram
34.42.57 N
bermuda rass
(WaB)
79.06.03 W
18
12.3
coastal
264
Wagram
34.42.47 N
bermuda rass
(WaB)
79.05.58 W
19
1.6
coastal
264
Wagram
34.42.37' N
bermudagrass
(WaB)
79.06.01 W
I UTALzi 7U7.0
Notes:
Fields 1-8 owned by Ozzell Baker.
Fields 16-19 owned by Campen Farms.
Date: 1/30117

is
Division of CWaterr Resource_,
State of North Carolina
Depan°t m eua of iEnnAronmenntal Quality
Dmslonn of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed .
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM.: LASC 06-16) form. PIease
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
[� 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: 4z�.,o 14-y 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
Wno
(Y )
Land Use or
Cropping Patterns
pp� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Ot- i -- z �,
;,,, �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.
`js Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or ,his representative and the Permittee agree to abide with the foll®wing restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

1. , 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.eequired 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.
k RESTRICTIONS:
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application sites) 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 I4-
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.
IMALTERNIATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .oiv(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: /t/Lf -`go -- / 6 -- 3, q f 5, &-
(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)
-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)

l�
Lando�vner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation,- to make decisions regarding the use of the land application sites) on behalf of the
deeded Iandowners. 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 tbat I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells'inside the compliance boundary, acknowledgement of
Meld transfer,. and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address: 2,. '�4ZFAAa9&
City C� State: �% C; Zip: Z-5.32 2,
a
Pf ne: � � %� E-mail address: r
Signature: ����� Date: 2—
NORTH CAROLINA, � r -o be-50 A
COUNTY
I,, the undersigned Notary Public do hereby certify that Ze% '�Y
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the &!y ee74-h
day of SO- M b e l , 2016
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
.�b ?61 q
GUILFORD COUNTY
STATE OF NORTH CAROLINA
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:
lPetmittee's Certification:
I certify that I have read this
Signing official
Signat
State:
E-mail address:
Date:
Zip:
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date: I — 3a

6WR
blvisslon of Wateir'4motevicess
State OfNori•th Carolina
Department of IEnnvirrom melntal Quality
Divisi rtn of �t , &terr Resoaure�es
1 SA NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in .order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of .the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Awnlicant 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 PermiWqg Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class S 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: RLAI' 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
(2f Submit the completed and appropriately executed Land Application Site .'Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
[ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OFRESIDUALS TO PRIVATELY OWNED LAND
The undersigned landoi
Applicant'smame: 10
hereinafter referred to
application site(s) (i.e.,
Agreement:
or his
permits:
v't
as the Permittee, to land apply residuals from the following facility(ies) onto the following land
see attached setback maps) in accordance with the stipulations and restrictions as given in this
Site/Field ID
Lease
es/no
(Y )
Land Use or
Cropping Patterns
Pp� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
(3'1 � 16,1; 15
A
1m,0 —reed
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.
s Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
snail be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to .abide with 'the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

i
I(. �STIPULATI'0 S.
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 sites) 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.
1. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
t regarding the use of the land application site(s) on behalf of other deeded Landowners OR that Yam 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: JAI -I) 0-5 �� rh-lop e'Al
Address:
f c� -zip: 2✓�3 % 7
CitY: _ � 7 � i� S State:
Phone:.- �L% � E-mail address:
Signature: Date: L�
NORdH CAROLINA, 1 A t; 5 �2 y COUNTY
I, the undersigned Notary. Public do hereby certify that )la.L.n S (r P'tn—
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the -rw eA44Q
fl .uunun,..•
day of
G
Signature and seal:'.
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and- do
Lessee/operator name:
Address:
City:
Phone:
Signature:
Fermittee's Certification:
E�
State:
,20 1 1
M.
�SOTAR YID'•
.� Mo.M;i� rM
en:
=0�.0
�'r0,9
1oti,�
"rrrni;iru`•
to abide by the stipulations and restrictions as specified herein.
Zip:
E-mail address:
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official
Signature:
VefA._
Date: l - 3 0 — / ?
Q

NC-RO_16, Fields 1 _8 (all lnrafinns Annrnximafa) 1 inch = 7,500 fee

VICINITY MAP
L '5
' - z - -.
a;
a' a
i
I .1
_ ` .
• -Its ..
GRAPHIC SCALE
1" = 4,000'
4,0001 0 4,000'
r I
I
_ `The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RO-16
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 16-19

t .
-
J��.
'� �,,�9��4/®®�®�C1��������'11��,;i•I1nr ' 0
3
i��111��1
�( b�L� � r- +,ter f �`i�%" �� ��.,A�'`���'"��� _ �. ' �•�1r� ��
INV"
Nj
r
0
i r I
A7. �' !W,`�
WN
I f" "I ,,
1`41 1 3� 11�SvA�
g
AW
1 R
A':.�;�`�9
r �GGr. ` ,.*�*,, ,�Y;t��'p 1� '�j ri,• ;r1�,��a �L��;, �"1 �j� ,, .„, t
gp
"OWN''.
41
�cn ��, "i' � . , a • •' , � � - � N�.
S ® y 11' �� 1 '� 0 • s' I U

SIN.Xy
Flo

NC-RO-16; Fields 1 (all locations approximate)
1 inch = 595 feet

TOPOGRAPHIC MAP
c ]{
- AV
e
r
1•i 9--
a( i 4•
d
�� „&yy�����y{ y1p.:i__ j iS ,.�{A yp �.. ih�.�yl�, ll�.d• 1 '
-
7 I 6°�.
!t�
4- •�lyr 'v. r 1 e Y �
ip-
e8 �F.F } _ � Fi�'I '-, i" Ira•, : .-•
it {I � ep.n.,. 2ryJ, `.. i� Ir,3 ��e ^�. ..._ b r ..;� �>�r8n ]•.
' +t' �.� � lit t v ! t• { JJ�Ti
�i`�"*''t �5'
..
Y1 _ � �" a ].
a - � 'f9 � �
1�� JI!•� !
{ ¢�'hCs �}i.
-
v}� _ n )
• - a >1._ �' � ., d 7 i R �f1, f4 :_-dp c �.-'nli_' �t'+'-
1 ' � ' � J� f � — 1_ ` .. �� �3 �'Q: `gib if ; 7 ' 'a'L—• �3I�
r t
µx_
t
� 1. r�•��� � 1` - G �_ �.- � � E•t �t tll
L`:t� J -
f •1
j'.•r .� �qf 1
ti � � t �1 L� .I n • n !Y�& , S� J Ba .. _may �� _ 8 _
,icy
,Icl i f=! �.� .i:'.�k=. • ' E
' kln ,ram a y;, F -'��.. _,� , „ .•- -
51
va� i y 71
GRAPHIC SCALE
=1'000'
1,0001. 0 1,0001
- ttttt�t •. ttt� tttttt� t
_ -"The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RO-16
in the property boundary. whichever is, closest to the application area. The, review boundary is established
.
midway between the compliance boundary -and the perimeter of the residuals application area. All
locations are approximate.
FIeIdS .16-19

- .�i•t 1.1; ;:. t!.I + -L .fi+.,,, 4♦ a„"'� LA.3 .�A({1`8�J •a,
A+ ,t' 4 ,p 4r! s� ,� a 4sy- < ♦ in. ]�' .. 7 T `.��a�i' „"7 i
OAk
Zt
t. I x'•'1 7+ ` ram; �:N, iii ,r ero p t I p
! �^k f ' wt �" T a`ir �'.' � • w • �.'AN{� ':4L w.' 7 ♦ ° � ' �' Y fi
F , rtt
ell-
" I w t�.ry` af-.��"t. �� #y � � ✓' ,'„ . • +• h id'•'�,. � ' Q .. rr ,-+�i JT •�r � l�i
`' K`r�'''" '`rt.'a..+yf..;-3�" ,, m, dy.�.o + t� r. ; � w •. � �,+i..� y � ♦ -i,' { I ,
rS''`ri#`l ,,Y:P'i f.d * 4 r *ta •a' k `�>•, rf: �4. ► .., z { s
J a S,, r+.,'",� �:Rr � y`-. 4�t; ► ► . ±,°_
[}��8 a' +� +� %' Y t'�•w • ,.i' a � "a. j .� T:�,., .,%i' a rs ,;.
r ar.�'i� �sy � 7`�` � •YJf t � t'� '` .T-,T r �s' �a r e ".
•, r . ,,,, z .s r
lP•.f ���yq��aB _ .i+.' ,,��r,. ,.,..-+ �. � --soh *. `+�?•A�'r r �'�.j �,�,� * jr?rw.
.1„`c�,•f�
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S�1
��''+ t�.`' . ^ 1` Y. �rq,; }}�� `.:. .ta"'3"5,`': 'ti'i'.- ':�"-.. r _' �.�'' fn 4`y�{ag•. fl�*�- c•T-',.'y'" .in >✓��'i lIIi... � S'f'c .9pVti-< % 4�_.�u i i _ _ �:r`

CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF 1/31/2017
The Cumulative metals for this report come from LTD Period Table records (i.e. a Monthly Report has been produced and the loadings have been archived to History
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field -ID
Last Applied
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
NC-RO-00016-0-0001
07/2016
0.0215-
0.0107
0.6958
1.3376
0.0701'
NR
0.0269
0.1132
0.0269
1.9202
NC-RO-00016-0-0002
0712016
0,0323
0.0161
1.5594
2.8426:
0.1267
0.0017
0.0490
0.2435
0.0404
4.0194
NC-RO-00016-0-0003
07/2016
0.0483
0.0241
2.0577
3.8063
0.1781
0.0016
0.0688
0.3250
0.0604
5.4052
NC-RO-00016-0-0004
07/2016
0.0357
0.0178
1.6221
2.9772
0.1358
0.0015
0.0525
0.2547
0.0446
4.2183
NC-RO-00016-0-0005
07/2016
0.0298
0.0149
1.2138
2.2575
0.1074
0.0008
0.0414
0.1925
0.0372
3.2108
NC-RO-00016-0-0006
0712016
0.0418
0.0208
2.1822
3.9444
0.1708
' 0.0028
0.0662
0.3386
0.0622
5.5636
NC-RO-00016-0-0007'
12/2015
0.0322 -
0.0195
2.1077
3.5687
0.1552
0.0039
0.0546
0.2959
0.0488
4.4247
NC-RO-00016-0-0008
0712016
0.0503
0.0251
1.6233
3.1208
0.1635
NR
0.0629
0.2642
0.0629
4.4799
Page: 1 of 1 1/31/2017 -

SITE SUMMARY
City of Lumberton
WQ0000672
Site ID:
NC-RO-17
Owner:
City of Lumberton (Airport)
Address:
163 Airport Blvd.
Lumberton, NC 28358
Phone:
910-618-4243
Operator:
Delois Allen
Address:
688 Deep Branch Road
Lumberton, NC 28360
Phone:
910-738-4030
Cell: 910-618-:4243
Estimated
Robeson Co. Predominant Latitude &
Applicable
RYE Soil Series Longitude
Fields
Arrp-c; Crnnfiq)
PANIqr- Ivr Imnn iinif) 1r) M -Q1
1
36.4
soybeans(dc)
147
Johns
34.36.39 N
wheat
106
(Jo)
79.03.15 W
2
25.4
soybeans(dc)
147
.
Lumbee
34.35.57 N
wheat
97
(Lu)
79.04.29 W
3
28.0
soybeans(dc)
147
Lumbee
34.36.04 N
wheat
97
(Lu)
79.04.17 W
4
47.7
soybeans(d�)
147
Johns
34.36.27 N
wheat
106
(Jo)
79.03.35 W
TOTALS 137.5
Notes:
Date: .1130/17

_'.7
",Nvlslon off l iatev le3es�eeaee�
State of North Carolina.
Departtniennt of lEnrvkonmental Quality
' pDnvnsnoln of dater Resources
15A NCAC 02T .11100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. )Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting_ documentation
For more information, visit the Water Quality Permitting, Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owners) of residuals receiving sites for land application of
Class B residuals (may include water treatment. plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding -application_ form (FORM: RLAP,06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and'appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
[� A copy of the completed and appropriately 'executed agreement must be provided to the landowner and the lessee/operator.
f AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: at�� &- (K L
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)
C_ a 1 s
w C.
Ak1, 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 fog the disposal of the residuals.
.his Agreement shall remain in effect for the length of the Division's permit for the 'residuals land application program and
shall be renewed -each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

L 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 11) 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 Iand 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.
f. 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.AILTERNATIVES FOR WATER SUPPLY WELLS MSIIDE 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)
R1 A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF F19LID 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 moaram:
(Name of the new program)

Landowner's Certification:.
t certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded Iandowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify.that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: - (i_1 -k4 O T' uly-o- r.)Q-r• ovs� Wt
Address: K 03 i 1' 1)D <-k
City: 1k1-,.6e ru > State ,C__ Zip: ii Jr
Phone: 9 10 , in i S ' Lt K E-mail address: o l P_ed-p tcQ 0 o. L' DYr.
Signature: �l Qc C�� Por�;P l7A-�,001D gate:
NORTH CAROLINA, pke-5pP COUNTY
1, the undersigned Notary Public do hereby certify that A P, 10; 5 Alle 1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hared and official seal this the �W+�al� �A-A
day of Spmhem bev , 20 p
Signature and seal:
My commission expires:
Lessee's/Operator's (Certification:
l 0-.Iq I ROBERT N. ROTH
AU1rA ev MI Irl1 In
GUILFORD COUNTY
STATE OF NORTH CAROLINA
I certify that I have readthisAgreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator namr.D C, [ 0 lS �" e
Address: _6 ee ()
City: Lu"P r&r✓ State: Zip: clg l7
Phone:910 f _24 q a E-mail address: l D A4,0,--,, Cc
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing
Date: I - x 0 - j

RO-17 4611 locations approximate)
1 inch = 7-500 feet

Appllcatl®n Area Map
ji
' ., f,. =?jam h J'k ^" �`1�1ir �"'T } ' • � I. 4' Ypy `-r �,. f `'� ,,
t y �
1' x , ••is ,� ,, It 3 �.. i
1N
Pt
Legend 1 inch = 660 feet
(all locations approximate)
' — _ — Drain Outbuilding
The compliance boundary is established at either 250 feet from the
(.. Stream O SoilDescription residuals application area or 50 feet within the property boundary,
whichever is closest to the application area. The review boundary
PropertyLine ® Unsuitable is established midway between the compliance boundary and the
perimeter of the residuals application area, j
ApplicationArea
Feet
R® 1 7; Fields 9, 4
0 230 460 920 1,380 1,840

Legend. 9 inch = 660 feet
(all locations approximate)
�— Drain Outbuilding
The compliance ;boundary is established.at.either 250 feet from the
Stream O SoilDescriptidn " residuals application area or 50 feet within the property boundary,
whichever is closest to the application area. The review boundary
PropertyLine ® Unsuitable is established midway between the compliance boundary and the
perimeter of the residuals application area.
ApplicationArea ;
Feet
'—�®Q°��'9- �`���d� 2.,3 0. 230 460 920 1,380 1,B40

'��i14 j��'DJ' a �i�! m�� e ,t ,"• p� ' ;S1 t7 5...
` i i'Yt p��rr ' �•� � , i 'p "�,�I1I fie, ''®�.�=. " y �9t' ve',.
�� 7 l' Y� .�'� t -.•,o qe\ .. P _- �V:i __ � •'•� _ , �e'x, �� �'I -' i +"far, \
`'� R �°' \, � yy 'etl ��q� gi,:,.s�`v � '"E daiq��'",% ••:.i
PS .% eye r ���� � l �• b�1._� � ;T�� � � _ �- `�` `` -_• � _y �y�-, r=-'` _`,?��` yy'n
�fr � r t4 P1= •i .
� �'_ - �'�:- �� � •�� f+� +gyp I ;� ,s•� alf`�� �`�' d
0 Topographic Map
tit 7T
Ob
11� Q d
4�.
i-�... ,
PF
PI
+ IF
4P > f
.r� ,�^�•' �•e^ �� p fie`' �'` ' �'' `�,a
al
40
. - .�y.. '7 � 'O '', \� %J�r:..K�',•. �n I, $f'�YT J� �—._ s '£¢T
lit
' , �f p� tii, �La _ � � _ •
t �.t t��4f]�l � ,.d"• �s''�"���''`a._-_�)�W,y ` Y � p�7 b,�,tt �.
0!0�'_RO-17 (all locations approximate) 1 inch = 1,000 feet

C
a .r may' a Pa
II,,1i JO �' t rs;1''•.: a �al ► _ „ ,r�y� -ry PO
.40
rt t }) KaA`r s 'i
�i��-"ri�f1i�±
VAIJ
,,,,�a.. � ' � ••�;� • ,J°r •: ,� � ` tom.
c��yr/ � ,(,�,y� j ; KaA __ ,r ,�,+� '•�. '��,•`, �� `; ,. r�'` T�f ' � Bp
,➢!-
LuJO
YjO
6( ��:� �•r ,�,—� c � '! L(/ � .°d.� ��f1(.�. 1 ,r`I 3 3 x - y� .II. ifr r+• +S` r 7a
I.j• 'I i {l�r �) 1'^i., d7♦ I .r',•f���'-}r ,11u t Vl _,' .
B � I >'; r ry � f •,
`"i , �� s. �. f. sue: • Jo
POBg�p, y, ,li g; , r�►l" Sl 1
JO
MW
:' � � �Tarp46 ,� �� fM. .1•� '+.. 4 I_'rP, .; � ;� •q '� -=p
&.fir
y /f P* � .i.. t� �qt !�; � - S J . ,. 1� ; I ( � �'' 7 *i r` � " •J. '�+` S 4 t+�• i ,.. r�yw ;. +'' • �+ z t kit+f Pa • �1
tyai '� ♦ '� I " i / Irl '- 1 w'��1
I1IoB, NoA
CON, N:mk
RO-17 (all locations approximate) 1 inch = 1,000 feet j
I

CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF
1/31/2017
The Cumulative metals for this report come from LTD Period Table records (i.e. a Monthly Report has been produced and the loadings have been
archived to History
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as
"NR"
Date
Field ID
Last Applied As Cd Cr Cu Pb
Hg Mo
Ni
Se
Zn
NC-RO-0001770-0001.
07/2014 0.0903 0.0401 5.7449 11.1753 1.8702'
0.0198. 0.6236
1.0518
0.0779
8.7448
NC-RO-00017-0-0002
0512016 0.0972 0.0463 5.3849 14.6188 1.4080
0.0266 0.3179
1.5206
0.0916
11.8083
NC-RO-00017-0-0003
04/2016 0.0322 0.0184 1.8826 2.3298 0.1124
0.0034 0.0485
0.2603
0.0344
3.2803
NC=RO-00017-0-0004
07/2014 0.1568 0.0731 7.9555 28.4206 1.7495
0.0165 0.4605
1.6976
.0.1083
16.4300
Page: 1 of 1 1/31/2017

SITE SUMMARY
City of Lumberton
WQ0000672
Site. ID:
NC-RO-18
Owner:
David Knox McLean
Addresses: 919 McLean Road
Lumberton, NC 28358
Phone:
910-671-8822 (mb: 910-374-5719)
Operator:
(same)
Estimated
Robeson Co. Predominant Latitude &
Applicable
RYE, Soil Series Longitude
Fields
Acres Crnn/s1
PAM/Mr hir n ee C,A
1
16.6
row crops
*90
Wagram
34.37.49 N
WaB
78.51.19 W
2
'49.3
row crops
*131
Norfolk
34.36.54.1\1-
NoA
78.51.17 W
TOTALS 65.9
Notes: *Application rate based on corn. Rates for other crops will be used as needed
Date: 1 /31 /17

D
State of North Carolina
Department of IEnnvnronnnmenntal Quality
Division of Water Resources
®vision of WateQ' 1SA NCAG 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist M 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 Auplicant shall 'suhmit one original anal two conies of the aupHgation and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-DischgLge Permdtiug Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). .
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
(J Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made,. as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
l AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PPJVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: ,�,� '���4
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:
Sitetl;ie➢d ID
Please
Lease
(Y )
Land Use or
Cropping Patterns
Pp� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
C
r F
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.
is Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
: i'all be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide With the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

L 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
JJ term of, and 12 months after termination of, this Agreement.
Ir ~ !
t ' 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: WO-40 J �
(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 nroeram:
(Name of the new program)

Landowner's Certiffication:
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 sites) on behalf of other'deeded landowners OR that I am otherwise authorized, through
f 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 sites) 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: AILty / "t
Address:
City: Zip: �V, 3
Phone �i� J E-mail address:
Signature: __ /� Date:
NORTH CAROLINA, k06 s& COUNTY
1, the undersigned Notary Public do hereby certify that �0cy CeJ C- Lr,-,
personally appeared before me .this day and acknowledged the due execution of the forgoing instrument.
WITNESS my, hand and official seal this the _/� j /u e ew
day of20_ t�`��-nM
Signature and seal: OTA
My commission expires: (Qllrlu_e `"
Lessee's/Operator's Certification:
ICo��,,,.
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:
Feemittee's Certification:
I certify that I have read this Agreement and do hereby agree -to abide by the stipulations and restrictions as specified herein.
Signing official ri t : X 4---7 =AZ d /Z o7 c`
Date: l ^ SIP

State of North Carolina
Department of lEnnvnn-oirflmenttal Quality
Divisions of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06.16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. finless otherwise noted, the Applicant shall subunit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned ]an owner o his representative h by per its:
Applicant's name: ►� p
hereinafter referred to as the Permittee, to land ap y 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 1)<D
]Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
t0 -- ( -
Cx-v
lu -,,4J
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.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
s,call be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

L 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 Peiznittee 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.
r I. 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.
IMA)LTIERNATIV ES FOR WATER SUPPLY WELLS INSIDD E THE COMPLIANCE BOUNDARY: (please cheep 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: _AC- KQ - 16 - a
(Please include the rationale for the requested relocation 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. ACXNCWLIEIDGEM1ENT 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 fields) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)

Landowner'§ 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.
T .nrin�.mnr r..lm P•i'\�'�.1 f��� 1 \i �v��b ,V'V - - -- ----
Address:.
City: 1.
Phone:
-State: !�� Zip:
E-mail
Date: 1-9-0 - l q
NORTH CAROLINA, /\d� e COUNTY II/�
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 T� �lw
��
day of ^&_un.0 220 t `�,��v
.��G� � �p•�SSI ON� .��j'%
Signature and seal:
My commission expires: - ��_—
p cPUBLIC,,;Z
Doti ,
Lessee's/Operator's Certification: '��/•'r08ER 3� .•'�`
I certify that I have read this Agreeme t and do hereby agree to abide b the stipulations and restrictions as speciiec� herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: C, Date:
Fermittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official i ►A i-` o?tn
Signature: -- n -r Date:

�m
�lvl�sl®m �ff ��terr "l�es+aeeu�c�
.State of North ��ur��i>rTr�
Departn4 a nt of IE>tnvnlronmrnenttd Quajj ty
DivisIlou of i�N&tteir Resources
15A NCAC 02T .1100 - LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are subnnitted, 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 applicatlon and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other_type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP.06-16):
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM; LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that"are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
f AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVAT ELYY OWNED LAND
The undersigned
Applicant's name:
hereinafter
application
Agreement:
referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilt/over-seed/
pasture)
C16
li}
/
1Vi6�t s� l
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.
ids Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
hall be renewed each 'time this permit is renewed.
The" undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such tithe 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 11) 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 Iand 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).
1I. 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 Perrittee; 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.
. 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.
I&ALTERNATIVES FOR WATER SUPPLE' 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(hl allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
® A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package) -
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER.: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
-- agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new nroeram:
(Name of the new program)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attomey 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.Iand 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
Meld transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
Phone:
Signature:
E-mail
_ Date:_��
NORTH CAROLINA, 10 d" 5 eyly— . COUNTY
1, the undersigned Notary Public do hereby certify that jai V1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS.my hand and official seal this the Tw •ej� S i
day of J 4.4c�
' (QSignature and seas:
My commission expires: _
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby
Lessee/operator name:
Address:
City:
Phone:
Signature: Av�
Petmittee's Certification:
C,
to abide by the stipulations and restrictions'As
State: zip:
address:
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official na 1ZvA Ye4 L U!
Signature: Date:

DWR
State of North Carolina
Department of Environmental Quality
DI -Amon of Water Resources
- . 'Division of dater Remources 15A NICAC 02T .1100 — LAND OWNER AGREEMENT
FORD)[: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, ties Ai➢iilicant shall subixeit 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
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: RLAF 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. PIease
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
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 TFE)F )LAND APIPLICATIONI OF RESIDUALS TO PPIVATIELY OWNED LAND
The undersigned
Applicant's name:
permits:
hereinafter referred to as the Permtttee, 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 I®
Lease
es/no
(.1' )
Land Use or
Cropping Patterns
Pp� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
404 �i-
e5
ow CVV
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.
its Agreement shall remain in effect for the length of the (Division's permit for the residuals land application program and
suall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the 1Permittee 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.

11 _ 4
lL 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 Pernittee 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.
L 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. AnimaIs 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 Iand 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.
IMALTERI?IATIVES 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 ne4wlrC A)y-estaablished compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) .ID: / �l- 1 !?— -"-
(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-def ned compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF F19LID TRANSFER- (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WE): 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)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and ,am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded Iandowners 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:�2-
Address: -qf ?I'P,��
City: ��� State: Zip: pe— 7J.�
Phone: 671 a _Z 7 In 2- a- E-mail address: y
Signature: 4 Date: /�, l�^/
NORTH CAROLINA, K �� a 5 fir-- 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 hp 4,
day of d
Signature and seal:
1
My commission expires: _
Lessee's/Operator's Certification:
I certify that I have read this A
Lessee/operator name:
Address:
City:
and do hereby agree to abide by the stipulations and restrictions
State:
Zip:
Phone: E-mail address:
Signature:
IPetmittee's Certification:
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official ju e-
Date: / -�TO 17

State of I° orth Carolina
Department of Environmental Quality -
IPDivision of Water Resoukees
-®lVlSIOB Of Wate lT tkeRMUMEeS 15A NCAC 02T A100 — LAND OWNER AGREEMENT
.FORM: LOA 06-16
Please rase 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 toadditional processing and review time for the
permit application. Unless other v w noted, the Applicant shall subnxnit one original and two copies of the application and -
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is -an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 0646) 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 lap wner or
Applicant's name: r cfs L"4, er� —
hereinafter referred to as the Permittee, to land apply residuals front the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(Y )
Land Use or
Cropping
Cro in Patterns
-
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilt/over-seed/
pasture)
es
- L0 Cmw
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.
As Agreement shall remain in effect for the length of the (Division's permit for the residuals land application program and
buall be renewed each.time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

I STIPULATIONS:
L. 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.
1. RESTRJCTIONS:
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;
KA re -defined compliance boundary is needed for field(s) ID: fiC-00 i 06 --)—
(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-defned 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)

v
Landowner's Certiflcation:
C)
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.
Zip: 2�36 C
NORTH CAROLINA, "02 — COUNTY
I, the undersigned Notary Public do hereby certify that pb 1/1 1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
V11TNESS my hand and official seal this the T(
day of J ctL.t-
D
Signature and seal:
My commission expires: _
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to
Lessee/operator name:
Address:
City:
Phone:
Signatu
iPekmittee's Certification:
State:
E-mail' address:
" tON,.�,
;a
c),. PUBLI
C Gp�w�,,• ��:
0�G� T�QER 3� •��'�`��
Cov,,,.
by the stipulations and restrictions as�'sns V6Uft1ed�herein.
Zip:
Date: Z—7, � —/7
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official
Date: - ?G f 2

NNo VICINITY MAP
a V at t
'
r 2105
104 _
21C4
`
I ' 1101
Lun-jFed-
2100 - � f'�J-- .
��•.
GRAPHIC SCALE
V = 4,000'
4,000' 0 4,000'
compliance boundary is established either 250-ft from the residuals application area or 50'feet within
N C—RO-18
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary. and the perimeter of the residuals application area. All
locations are approximate.
Fields 1-2

OMM!I'!�� j �7���� ���I `('� f�Xx
.COA�>� wr
--� chim—=

tw'e.
�
C
0

TOPOGRAPHIC MAP
71,
fit
IIIIII
jLL
,gyp I
rrd.kl--lli�
�i
�fAli
It
-
�
i {� i� �� 1'1 y_•�yr '� �. I ;..
Sri
GRAPHIC SCALE
1" = 800'
800' 0 800'
t t
1 compliance boundary is established either 250 ft from the residuals application area or 50 feet within
V A I C_D O_ 1 O
R O
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
Field 1

J(D
TOPOGRAPHIC MAP
�'4-
�� lip �' II. •1r
+
OSEP fHI
.^'�_17
sY ME MJ•j
_ .�_-
r♦r _��+ •' � �. f _ ��f-� 1, :If'
. S• -
F � '�i-Y .r l 'f
I t
i
-
,z-
—410
GRAPHIC SCALE
V = 800'
800, 0 800'
compliance boundary is established either 250 ft from the residuals application area or 50 feet within
�l A I C_RO_ 1 O
I I U
in the
property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 2

GaA +
Aw
x(GoA
74
cv
-�dt�oeTrait Rd!-'- i�^�,,,. ri w ftF . 4 �>! i • G /i+ •r , _ r Y '1 i f, .! �.lr �4TsRw•w t x ,r+. _+i�
tt
,fir SCf�i? P. r, v�-`._.yy_ � p • d Z 5 • �
Q Y� Q'aLtil P u„ `! f ! , ^\ �"` /+,' >.. .t' • .Jffi i
4 4t r f k. l ♦ t ♦ r / �: 3 ! ! �/ � .�Z * " ill
-_ �1 � } _ � _ ...0 R ;may +t►a+ws,x� ���,._ "+ `�IJy " : + f }1
10 '+
Skk ,may, ,4 .y. ! f •. �A � 4��`_l i.
GoA �� s,.'G �{� 'Efa9 ..«.-,r, �--� � � �r ,,.�.,:-r. 1;,r,,, { :,.` ' �'t• ra
r..

'(6)
®id
j T --} 1
4 r.
1 PP 4 i-• r 4N v,. H y 1 ,,1 •' `NCO
• ��,� �ul+ •1''- �� �j1 J. ate-- �,- ,` �-s, _ _ t?rr,�} ` • .'
•Y:. I,Y. _ r�J� 'r y .a Pm,` r -�D- iinn 11�
7• lot � yj•1 � p ^tip/.
4.
jo
it
Ir
�y�
' � 'spa � ��'• ,p° � �� �� +�y L�`, �. r .. '�''•�
• � , _x fc�` may. T— . v+'. �r 1.

SITE SUMMARY
City of Lumberton
W00000672
Site ID:
NC-RO-20
Owner:
R. G. Hammonds
Address:
' 1218 Hammonds Road
Lumberton, NC 28360
Phone:
910-734-2991
Operator:
same
Estimated
Applicable
Fields
Acres Cron(s)
Robeson Co.
Predominant
Latitude &
RYE
Soil Series
Longitude
PAN/ac/vr
(man units
(D.M.S)
3
24.9
common
147
Wakulla
34.47.19 N
-
bermudagrass
(WkB)
79.05.11 W
4
31.2
coastal
196
Wakulla
34.46.45 N
bermudagrass
(WkB)
79.05.11 W
5
33.6
- coastal
230
Goldsboro
34.42.36 N
bermudagrass
(GoA)
79.03.01 W
corn
.131
Norfolk
34.43.30 N
6
6.7
soybeans(fs/dc)
164/137
wheat
125
(NoA)
79.02.29 W
corn
148
Goldsboro
34.43.26 N
7
13.0
soybeans(fs/dc)
176/149
wheat
136
(GoA)
79.02.22 W
corn
148
Goldsboro
34.43.44 N
8
73.2
soybeans(fs/dc)
176/149
wheat
136
(GoA)
79.02.00 W
corn
148
Goldsboro
34.43.38 N
14
10.6
soybeans(fs/dc)
17-6/149
79 02.10 W
- wheat
136
(GoA)
TOTALS 193.2
Notes:
Date: 1 /30/17

Mate of North Carolina.
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06.16
Please use the following instructions as a checklist in order to ensure all required items are submitted: Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall submit one original and two conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation. listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application' Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
[� A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
i
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned la tive hereby permits: downer or his represe a
``
Applicant's name:
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)
Ain- q- 3 i-1..5
N o
Uk �
,� r ��
- 0-00- (o " 1 q
!AW
cv G
N ' ,
I�C-12c3 -ao -
es
Gam.%rk�f
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
rmittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
_Ais Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

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 Iandowner 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 Pemuttee, 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.
_'I. 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 Iand application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when -the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE .COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please marls one of the following;
[d A re -defined compliance boundary is needed -for field(s) ID: _LLC_
(Please include the rationale for the requested re -location of the
compliance boundary to the application package)
attach a map showing the newly proposed
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The Iand application fields) 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)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s)' on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use .of the land application' sites) on behalf of the
deeded landowners.. ' I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or. other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside. the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to. land apply residuals to the land application site(s) as specified
herein. k G
Landown
Address:
City: d� L� E� �� - �° -State: „9 Zip: 24 0
Phone:. ydo_' RE -mail address:
Signature: 1 Ea�aRn.`�^r T"" Date:
0
NORTH CAROLINA, �6� X!46 COUNTY
I, the undersigned Notary Public do hereby certify that 1QG ULLWW&IJ
personally appeared before me this day. and acknowledged the due execution of the forgoing instrument.
rr'
WITNESS my hand and official seal this the N
day of M6 u eta )6 �
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail, address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. ,
Signing official name:
Signature:
.,,w— Date ! ,l6 — L2

'VICINITY MAP
•
.li0 L3.,i�`
5
z
l
iIL 11.t
• IFn I4FJJF r �-
GRAPHIC SCALE
1 = 4,000'
4,00o, 0 4;000'
�.a compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C_RO_20
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 3-4

VICINITY MAP
Nair
ii it
EE
qs ;a, ..
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000,
e compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RO-20
in the property boundary, whichever is closest to the application area. The review boundary is established.
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 5

VICINITYMAP
(Y�
.
SYNA_GI\O
A Ruie;NaliManagement Company
z.,
71
r itile
GROAN i
uls
R4_ _ SITE 3
LOCATION
SITE Ll
LOCATION
RD d-
S
rr S
LOC I
%
S
LOCATION
t
.
.
A:
JtYPY OWNER

a
- 'At, - 41
Ix I - RE
N -70
IK
Mll

r �ii ! �
D,."2 bt'Q "..i'
i � gip iEr ♦(s ♦ / i Ir �O � 4 y' �;. U -
-�
Iw
,�r�•�.,�'? 'v,+.:-� �;
WW���.i�y�+ P T �\ 1 �,•r'- t - _ .'
Wd
r � � \\ ®I� `;4�' i���kab �� � � � �f �-,� . .ram : � a .�: • .
?,iPF
�
p 1jD 1 i li�Y46 °
•K'
�° .:-�'P4`Y � ,.i1 d� y' � ' : - fi ✓�6.'•f may' ,y'p',S,f �� ��,� ,y'6 4 e�s.`
t
In, °
41
^ 1 }1

_ ,�' +_ { \� Re. �.�� `fA ' �t:L. fir,:•,.
,� 1• ! ���N`�J`! y J Lw XZI
WO? �
,_pia/�� .A! 'A•� �� 5 �1,;, � � �.. L \ �
i
1 * f �!/q/ aim -•, it''.,y` i+, ' it
1��, . ��. ' • # ` � J ` AAA,/
f'14
` �. • 'ter , tv^yi4,.' iww, , 4a""` i,: � z'i.+ j`'� '`�

Legend
-- Drain �ApplicationArea
Pond M. OnSiteHouse
P.ropertyLine ■ OffSiteklouse"
IC-RO-20 Fields 6=8, 14
1 inch = 660 teet
(all locations approximate)
Well The compliance boundary is established at
either 250 feet from the residuals application
Unsuitable area or 50 feet within the property_ boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
Feet
.0 230 460 920 1,380 1,840

10 TOPOGRAPHIC MAP
24,
" �i� I. " I d`6 t '�1a r,�• �" Via.
Q7
,
t t'* �, i' i i - �6 1 j t f '•;, y, �1 ter.
Y
1 `
r.�q.` 1I+
��� S`a a
+�q ++ �� F I�� 5�� .l `..�r'n�0v. ¢WI• `s_. .
Fi
y'ddyl� �°
t. ' f,, h eE� � •�i �•o, �,t 9 �y�,�y�
..� .yL d,,�'_�'�� �'•t�'�tma
�i ,.4_{� i ..
'�`�t_
F -s° �� "S.SSJfY •1(�
4 � �y7F I`! •�'�4 .'
'v G� 'T� G �•1' �Ll �'i" � .1 t � �O ^r '� V 1 '� td"mil .; .^�TL.'4, ••
`3 '+mv.2"EP
� •!
lir �1o:•`y ��'1Fyp�
�IC� `e1` ..� I� � „yam �� [
�y 'iu' r
'7-i 2'9��q, �yJ �:.. � .i r � �d+� fIA t`'pS� g~0�•�
• ���,
ly r 'A FFII::EEErrr S� l .d-' f ._ iy bJJ
'ri��
r - s
" �4� ••q4., "y'., `_�#�-'�. bk Toy •� � ,j y * !�r -tra��'�-- iL1 a., wee. ��
N.
NN
`f...L, i ^4 � o {„• � _ ''.tom _ _ 1 • � "`� . .. � � `. �, �R�i
GRAPHIC SCALE
T'=1,000'
1,000' 0 1,000'
rr rr '
,-ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RO'20
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 3-4

10 TOPOGRAPHIC MAP
77
4-' 1
-- lA r l'•, ���'i. 5
,rk ..8..� r
`. rt AI
715,
';i
ir
01,
GRAPHIC SCALE
1"=1,000'
1,0001 0 1,000'
r- I
e compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-DR O.20
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 5

V C=ROD20; Fields 6-8. 14 (all locations approximate) 1 inch = 1,000 feet

ES)
SOIL SURVEY
GRAPHIC SCALE
1" = 800'
800, 0 800,
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-RO-20
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 3

1�
o N ��
� � ' 4 i
- 1 k . .' • -* � -.. \ ''� f�-_ ,a. .`Ref
Pm
fyyLMV
ip,a;
�"
ve
�i•- •_ .. � , 4 �1 Cif•,' � ""'`� L� �`� ,"' 4�-� ��' �`. -C�' � ..r�����i� � .r"��`�� _d ,�:
wa
JT
r� ',T44
o
do
Wkl
.-. v�• ilG-� i •,` wyi•... �dlt .y:R,,; ��y '�,—may`
oAY
��%7. Y:..! 1� �.!-'_Nr.'•�: _raga _� .y3.,. r_-� of �Y �F

q�A
LL
Rim
IC-RO-20; Fields 6-8L 14 (all locations approximate) 1 inch = 1,000 feet

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF
1/3112017-
The Cumulative metals for this report come from LTD Period Table records (i.e. a Monthly Report has been produced and the loadings have been archived to History
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as
"NR"
Date
Field ID Last Applied As Cd Cr Cu Pb
Hg Mo Ni
Se
Zn
NC-RO-00020-0-0006 11/2011 0.0491 0.0098 0.8848 2.5766 0.1728
0.0052 0.0491 0.2681
0:0098
4.3018
NC-RO-00020-0-0007 11/2013 0.0564 0.0124 1.1.799 3.0269 0.2064
0.0058 . 0.0564 0.3251
' 0.0160'
4.9365
NC-RO-00020-0-0008 11/2013 0.0596 0.0166 1.7436 3.4457 0.2457
0.0055 0.0596 0.3967
0.0308
5.2620
-NC-RO-00020-0-0014 .11/2013 0.0234 0.0093 1.0473 1.4371 0.1080,
0.0018 0.0234 0.1.925
0.0234
1.9726
Page: 1 of 1 1/31/2017

SITE SUMMARY
City of Lumberton
WQ0000672
Site ID:
NC-RO-21
Owners:
Fannie Oxendine
Address:
' ' PO Box 1100
Pembroke, NC 28372
Phone:
910-740-7616
Operator:
Lacy Cummings
Address:
'75 Genes Road
Pembroke, NC 28372
Phone:
910-521-4950 (home) 910-827-1211 (cell)
Estimated Robeson Co
Applicable RYE
Fields
Acres Crnn(sl PAN/ar-lvr
Predominant Latitude &
Soil Series Longitude
(man iinifl In 11A C1
1
36.1
corn
soybeans(fs/dc)
131
164/137
'Norfolk
34.42.26 N
wheat
125
(NoA)
79.05.34 W
2-A
38.4
corn
soybeans(fs/dc)
131
164/137
Norfolk
34.42.23 N
wheat
125
(NoA)
79.05.20 W
2-B
5.1
coastal
264
Wagram
34.42.13 N
bermuda rass
(WaB)
79.05.20 W
3
3.4
coastal
264
Wagram
34.42.18 N . .
bermuda rass
(WaB)
79.05.40 W
4
11.3
coastal
264
Wagram
.34.42.10 N
bermuda rass
(WaB)
79.05.32 W
5
15.1
corn
ybeans(fs/dc)
F
148
176/149
Goldsboro
34.42.38 N
wheat
136
(GoA)
79.05.27 W
TOTALS 109.4
Notes:
Date: 1 /30/17

State of North Carolina
Department of (Environmental Quality
Division of Water Resources
Dlvlsiora of Water Resources 15A NCAC 02T .1100 - LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use .the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all'of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General - This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORMt LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
�] Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
jr(] A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
I�
r
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned Iandowner or his representative hereby permits:
c
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the fo lowing 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-tilllover-seed/
pasture)
ej
—Po3 4
#U, Aj E'ee_�_
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
�ermittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
"his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide, with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

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 H) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWI?, 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 toa 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.
,_I. RESTRICTIONS:
L 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 fora. 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 he
E9 A re -defined compliance boundary is needed for field(s)1D: Al eS 0- a I - 1, 0.A. aA , 45
(Please include the rationale for the requested re -location of the compliance bou dary find fittach 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)
(,- Cl The land application field(s) ID: . is currently permitted under another.
s' 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)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
�A 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:
name:l4
/ Address: J�* tl<
,.,-City: �G f'l/l ��04f Stater Zip:
Phone: 0 - 2 VO / E-mail address:
ignatur
NORTH CAROLINA, (1 Soh COUNTY /
I, the undersigned Notary Public do hereby certify that Li/I /l / Z ���/�dC1 / /? -e_
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
- - - - - - WITNESS my hand and official seal this the
O�
day of , 20 ,
OF NX, �C Tq
Signature and seal: �►
My commission expires: oZ0 0
i
$O ,
Lessee's/Operators Certification:r�
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: 76'
City: J�, State: zip: 2 5r% 2—
Phone: 16 -92 7- / 2.1) E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: I AVA Y M c =Ho R 0
Signature: 7777k 2 Yt ` Date: t - -T o - .1 T!

VICINITY MAP
-'2'r�
GRAPHIC SCALE
1 11= 4,000' .
4,000' 0 4,000'
a; compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RO-21
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance_ boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1-5

s
�J/1o%%/�/oJ
//J/
.:} >�r � ' .. �, r ,�` / , �.o�F/ "`, I /< � / ., / /! t � ,�'�� r 5 .e �` • � � fA + r r � "r_'jt
/v r ` ` •,�
.�'i /�-•./l!/��� L^•+'a// i•' a �� /yir(,/il,-i��/. �ry
A♦` l� - `n Q`5 J C
�.' 1. /P '� x•�
eV Y�yy„� 14
' 'i :r i rf `Y / !. L � � tr .' /Y i t s y//e l' n pJ � , f AYJ •> � - y e r, ,,. .
3t���r4�.;,1p"r°
/�RR.�i/' Imo'./�`t4rf :F, � ,,, ,,'/' +r�,/s �4 y��iy '° e`- J��Y ° i° � �� _• .1�,, ' � ;�
' x _ r
FROM
/v
i:•/`��:,6./��n`,ri'`/ �CFh�/�/�/ /,�jf/f /,/i%t � �I�!/r �/���%'I' /,,' ,
;/�,r'�°�� `` ;•%/'%/ 1:���j�.<� �e` �!d/�</ �ir/ �� � /�l�t �I/` j�i'r !`ef'� ,y. �
�((///''[[////i 0
' • • _L/.f I. /'R/`✓f l", ,/Ii/'/,`t.Ff'4h���

TOPOGRAPHIC MAP
t aymp-A
td4;
r �.
t'; tdd 1ldP $d �-wzr,� r,l �` , G,�z/ • ��i,1 J 1 i � `�' �i
�j- • i -- i ?; .T-,vim, l�
...
A, 777 t a-
Y 1
1l �. >
I Jjfj p
dl V it
_e
r4 - t = �_ 4 l
, •1E4 ,y -
�q
`d t =4 > _'k
1
v .:... i �� ,r,, m. '�.,�. r`,i� �".inFl„1, Teri 1,� �.� 1 l ��iY. , �EEk°a 4� J �� ' fl • 4 �
+tw1 �Wtl.. ' � f - .�
++4�d•il.�!�
S dl ii - Ir�i;a •-• J _
�� Y q -� 'ate -p��>r 'F,1$$�" � r t : ,- •' � ' �.. E � `
77
s�.`I , rn .;arj
- ��4i..-yam=Y' f -• _ �� � I r ' P P '
GRAPHIC SCALE
1.=1,000'
1,000' 0-1,000'
1
e compliance boundary is established either 250 ft from the residuals application area or 50 feet within
In the property boundary, .whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
FIG'IdS 1'5

,yv'ni
�
y.., S5
14
01,
211L,
_ szti
�> . - ,� J..i l f {� ' , �,,,,•�U4tl � p, 1 ��'i �Y,
'J�'t � � ��p�"' �. mar.,; �` {• �y4

CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF
1/3112017
The Cumulative metals
for this report come from LTD Period Table records (i.e. a Monthly Report has been produced and the loadings have been archived
to History
In cases where a trace
metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report.is displayed as "NIT'
Date
Field ID
Last Applied As Cd Cr Cu Pb
Ha Mo
. Ni
Se
Zn
NC-RO-00021-0-0001
11%2016 0.1843 0.0628 7.0185 16.3325 0.9849
0.0253 0.3348
1.9155
0.1398
18.2091
NC-RO-00021-0-0002-A
11/2016 0.1809. 0.0608 660638 13.8835 0.8209
0.0195 0.2748
1.5094
0.1304
16.3844
NC-RO-00021-0-0002-B
09/2012 0.2224 0.0430 5.7163 21.5087 4.5066
0.0220 1.2126
2.0510
0.1198
21.2584
NC-RO-00021-0-0003
02/2008 0.1851 0.0355 4.0887 19.3510. 3.3971
0.0187 0.8594
1.6764
0.0802
16.5719
NC-RO-00021-0-0004
01/1997 0.0500 NR 1.2200 3.2800 1.1400
0.0100 0.3100
0.41.00
o.0300
3.7000
NGRO-00021-0-0005
04/2016, 0.1308 0.0357 5.4302 12.6844 1.8167
0.0150' 0.5730
1.6142
0.1086
12.8868
Page: 1 of 1 1/31/2017,

Site ID:
NC-RO-28
Owner:
Robert Baskerville, Jr.
Address:
384 Beard's Creek Dr.
Arapahoe, NC 28510
Phone:
252-514-5869
Operator:
Carnell Locklear
Address:
3009 Daniel McLeod Rd.
Red Springs, NC 28377
Phone:
910-258=4046
Estimated
Applicable
Fields
Acres Crop(s)
SITE SUMMARY
-.,City of Lumberton.
WQ0000672
Robeson Co: Predominant Latitude &
RYE Soil Series Longitude
PAN/ac./vr. (man unitl (D_M_S)
corn
122
Dunbar
34.43.49. N
1
11.6
soybeans(fs/dc)
161/134
wheat
102
(Dn)
79.06.11 W
corn
135.
Rains
34.43.58 N
2
56.9
soybeans(fs/dc)
170/143
wheat
.
106
(Ra)
79.06.60 W
3
10.4
corn
soybeans(fs/dc)
148
176/149
Goldsboro
34.43.41 N
(GbA)
79.05.41 W
wheat
136
TOTALS 78.9
Notes:
Date: 1/30/17 "

D WR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
Divislon of Water Resources
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and.land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding -application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned land wner or his representative hereby permits: i
Applicant's name:
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)
At
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.
:'his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
-hall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

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 landapplication 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 neat 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.
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;
j A re -defined compliance boundary is needed for field(s) ID: h - Q O� _-
(Please include the rationale for the requested re -location of the complian�o3ndary 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)
j� El The land application field(s) ID: is currently permitted under another.
i 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)

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application. site(s) and am authorized to make decisions
regarding the use of the land application sites) 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 sites) 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. I
i; a d caner namei
• M A. State:
P: ene: '2 `) �17��' r7 �% Email address: igl r o+lC'
Date:
NORTH CAROLINA, CRAVEN COUNTY
Zip: ll�,5'ld
'(0 Pry I AX_a jo?n Al 6yb—
I, the undersigned Notary Public do hereby certify that .'Robert D . Baskervi 11_ , Jr.
personally appeared before me this day and acknowledged the due execution of the forgoing instru�ac :�a�rsQ�
WITNESS my hand and official seal this the 29 0°° ,G°°°°°°
o °° (°m
dayof September o ��° ° OT J
, 2016 - 4 '��. 4
on°
°
Signature and seajes"'
s ,
My commission a:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name: C C,rh t � ( L a v k-' 'e—
M
Address: � � � , � . ��a n � •2 � / l R L p �
s
Csa 1, CIS State C Zip:
Phone: J Z d E-mail address: Q D c k'rx t-e
Signature: Date:
Petinittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official na t + � • la TG!
Signature: w Date:

Vicinity Map
" N
Dr'
,w,
m state Rd 1006
W reat arsh hu h R
o� eR
d
fate Rd
a
m
d'f o h
23 'Qa
�y
Off,
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T
T..
Q R O
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D Via.
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Stat
CD
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Rd 15
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o
-
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ate
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o
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fa
a
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•
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r , u t
r
t
VC-R0'28
:,.- .
_, (all locafon�approximate)
inch = 7,500 fief

Application Area Map
1 inch = 660 feet
Legend
(all locations approximate)
Stream
ApplicationArea
SoilDescription The compliance boundary is established at
either 250 feet from the residuals application'
Drain
■
OffSiteHouse
area or 50 feet within the property bbundad
Unsuitable whichever is closest to the application area.
Pond
Outbuilding
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
PropertyLine
%
Well
Feet'
0 230 460 920 1,380 1,840
..-RO-28
1PEff___E --

1
To po' graphic Map
"� 1 . � r m m ®• t '� 11 d j ����sw�""6t. _ � `�`� •'^ tct+ ea , '� N� 1
Alt -
VA
AA
li' `y i1 �-,,,,� � - � :` -bra ., F `'•°'(, ^-� �� �a � � �. ' Yr
"� �� . 4 •'� m. F90C"" it • ,.F- , `� e•� 1 1� �.✓' 1 ) ea q.� •yl !
ws�� 1 � •4 {,t � , '� .oF�.r . •� ', rcma y/,I +�` 555 +tOS t' r' °; `�° 4 ;
f j"�"-.n ! '� � ,t•�a , ...a� —sz+. r. t �'NNN� b°o6� •� �h +�'y Q �'J•, > i
+ °�� �.r ,•, ' j.. kill
f � r` ��ii'� °�� �r IjC�; s� .t f7jP �".• � _
•�
Arc
�a�'�i d Qom`' "� ��+'�+ i S � � �s� l.. ���` e � a.°ta i jl,° �! ",� •
4.e� ���'rlar�; �4t �� '� . �eT°$ ,tr.. �, .;�" �`T—•�.,t-..�, � J �� ,Q�}�
S "i. f�•. y° 1= f....� YYt b�� ., ...�/ tl �R
•.�: ®� ���E�•°' �� + ��„ 1%, ,,;. --_.� 3 `„�' R : = ti.l ;. * °,s„,�� t A l) �d � �',- -mac-'""' ! `°i' j
- „ .' 1 c ffp \'. ,1 / � x �f �"'^�.--tea, i ^ •.: .
jf. 1
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fv �/4• 1: 0� 1\F }PS\t
.y '•' J'
J/ - .. I��4 i 'sJ�l. 1 9�q y�•.l +9{.�y,i�.9y�af( {�tl1;1 ?•1j dT' � � ��J ��,t/ � � i
•-.` 3� ✓3$T y.. `2 .y t �'idm.�.sa ^1� �`''O �yA'•�tS, �V it
rN
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! �+ i • 1 9 f
Lt �*'' +"�`��.-.,} r+ra.'s _ ?>f <, •'\��do !� .��, fI �><.-' ....a:,..l. � �3�.,�A � 'c�T ' �Tb
- l O- V 1
/alI Innafin nc annrnvimnfol ,F „a' - 1

rC-R0-28' (all locations approximate)
I inch1,00o.feet

CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF 1/31/2017
The Cumulative metals for this report come from LTD Period Table records (I e. a Monthly Report has been produced and the loadings have been archived to History
In cases where a,trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Field ID
NC-RO-00028-0-0001
N C-RO-00028-0-0002
Page: 1 of 1
Date
Last Applied As Cd, Cr Cu Pb Hg Mo Ni Se Zn
04%2015 0.0154 0.01.03 1.0427 1.7189 0.0774 0.0020 0.0258 0.1393 0.0258 - 1'.9718
09/2016 0.0695 0.0302 3.5819 4.5693 0.2623 0.0050 0.0839 0.5871 0.0623 5.2331
1 /31 /2017 -

SITE SUMMARY
City of Lumberton.
WQ0000672
,Site ID:
NC=R0=39
Owners:.
See -Notes below .
Operator:
Patrick Bullard
Address:
Post Office Box 1-262
Pembroke,. NC 28372
Phone:
010-316-6467 -`
Estimated' , ..
:Robeson Co. Predominant' : Latitude &
Applicable'
-RYE. Soil Series ', Longitude.
•Flelds'
Acres rmn/cl"
PANh.• hir in ee C-\
IA'
5.3
Hybrid
'bermuda
299
..Goldsboro'
34.36.1.1 N
rass
(GOA)
.79.1309 W
1 B
2.6
Hybrid
299
Goldsboro-,,,34.36.07
N
bermuda rass
(GoA)
79.13.07 W
2
1.4
Hybrid..
299
Goldsboro
34.36.08 N
bermuda rass
(GoA)
79.1`8.04 W
3
5.1
Hybrid . -
194
Rains ,
34.36.01 N
bermudagrass
(Ra)-.
-79.13.14- W
4
4.8
Hybrid ,
237
;' Lynchburg ,
34.36.01 N -
'bermudagrass
(Ly)
79.13.08 W
5
3.8
'Hybrid
237
Lynchburg .
'34.36.01- N
bermuda rass
(Ly) -
79.13.02. W
6
2.9
Hybrid '
264
'Wagram
34.36.03 N
bermuda rass-
-
(WaB)
79:12.58 W
7
3.7
Hybrid
"299
Goldsboro
34.41.12 N
"bermuda rass
(GoA)
79.02.01 W.
8
7.4
Hybrid '°
299
Norfolk
34.41.13 N
bermuda rass
(NoA)
79.01.55 W
9 .
62.5 -
Hybrid
264
= . Wagram
34.24.26 N
bermudagrass
.
(WaB)
. 79.04.25 W

D- "
Sitaate of North Carolina
Department of Environmental tall Quality
Division of Water Resources
'Division of watei desoumes ISA NCAC 02T .i1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions asa. checklist in order to ensnare 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 c612ies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (]FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® Prepare a separate agreement for each set of land application sites, that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR T1FlIE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned land wner or his
,M " , ,
Applicant's name:
permits:
;I
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 snaps) in accordance with the stipulations and restrictions as given in this
.Agreement:
Site/Field 11D
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�� P3 - 19,1 A
Cyr}- 3
,es
l
c/k&l
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
ermittee receives, in consideration, the use of the land application sites) described above for the disposal of the residuals, .
'his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stilmiations until such time as written notification, given 30 calendar days ina,advance, modifies or cancels this Agreement.

L 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 1I) 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 Divisionprior 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 Pennittee, 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.
Ei. 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 applicationevent.
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.
HLALTERNATIFIES FOR WATER SUPPLE! WELLS INSIDE THE COMPLIANCE BOUNDARY: DARY: (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:.. jVC." &0(7 �'
(Please include the rationale for the requested re -location of the compliance boundnd y and attar amp 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 nroaram:
(Name of the new program)

Land6wner'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:
Address: `" 7 (O lA JV* AW
City: `t T State: I� _ Zip:�ej
Phone: U — fir'' E-mail address:
Signature: Date:
NORTH CAROLINA, P_ S 6?-� COUNTY
I, the undersigned Notary Public do hereby certify that )CyA AVeC_
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the 1�0�
day of 1M C tj .0 U n
Signature and seal:
My commission expires: _
Lessee's/Operator's Certification:
I certify that I have read thiAAg
Lessee/oper for name:
AddressA_ ��
'Ad, I? w
City:
Phone:
Signatu
lPei•snittee's Certification'
t 'p :T"rl
.�A !p
�=
0 -low
VLIP
�n0eER 51': a.1:.`•
hereby agree to abide by the stipulations and restrictions as specified herein.
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and, restrictions as specified herein.
Signing official
Signature:
Date: l — .'J 4 l

i�F��'�i •°L ua t
State of North Carolina
Depar$mmnnt of IEnnvIronmenatal Quality
Division of Water Resources
Division of WateP 6 esources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
C'
FORD: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall subunit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class 13 residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOSS, 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Q 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 lap^wner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permttine, 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)
'
pQ
`S
// �
rAe, iu. r z
iM SA C ((i
o
A tt , rii�—S
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
rmittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
its Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permitine 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.

1. 9TIIPULATII®NIS:
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.
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.
1D.ALTIERNA'TiIV1ES 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: /VC, i - ?Q - 3 'L
(Please include the rationale for the requested relocation of the compliance bou dary 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, lie/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)

Landowner's Certifications:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
I/- , . regarding the use of the land application site(s) on behalf of other deeded Iandowners 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 -
Address 3971
City: State: b l.®� Zip:
Phone: A110 E-mail address:
Signature: ,. Dater `� ��
r tt
NORTH CAROLINA, kdh 6-5COUNTY
I, the undersigned Notary Public do hereby certify that 6-U-W A.. Luar k
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this they
day of koo be-- 20r?
Signature and seal: ( . U/LzuX U,fllt
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read th•. Agreeme t an do
Lessee/opera r na e: �t
Address:
City: " `t✓ -
Phone: 1 ' 9�
Signature:
Ferpnittee's Certification:
_e�M`Ss�u/yF i,
} 40IANY-P..
UBL •.:Z
OocAe 31 T., %
B .q
agree to abide by the stipulations and restrictions as specified herein.
State: / V
Ismail address:
Date:
e
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as. specified herein.
Signing official
Signature:
Date:

O
State of Forth Carolina
Department of Environmental Quality
Division of titer Resources
fXVIsloun of Wafer l esoume!B 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit, application. Unless otherwise noted, the Annlicant shall subanit 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
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 .1I00. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. )Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
�rt AGREEMENT FOR TEIE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(Y )
band Use or
Cropping Patterns
PP� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilVover-seed/
pasture)
/V o
Cv
Air
,( re-6
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
P-rmittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
is Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

S
1E. STIPULATIONS:
I, The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this. Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis. .
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, 'or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as.required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
I. 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 fora 12-month period following a residuals land application event.
IMALTERNlATIV ES FOR WATER SUPPLY WELLS INSIDE THE COMPLUANICIE 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;
)Q A re -defined compliance boundary is needed for field(s)1D: jtf t 90 -2q
(Please include the rationale for the requested re -location of the compliance blundary 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.
i residuals land application program; Permit Number WQ: The land owner herebyacknowledge 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 broeram:
(Name of the new program)

Landow' ner's Certifications:
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 applioatiori sites) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land -apply residuals to the land application site(s) as specified
herein. _ I
Landowner name: .J.�
Address: l
City: State 1 4 Zip: 2 (0 C.
Phone:
Signature:
E-mail address:
Date: (�o Ol
NORTVCAROLINA, �10-e-5 ' COUNTY I
_, the undersigned Notary Public do hereby certify that �pJdt! �cts�
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the /G/G":� • 7
day of �t�A, �s� , 20 J
Signature and seal:
My commission expires: ����►
Lessee's/Operator's Certification: I - .
Za�R
ROBERT N.
GUILFORD COUNTY -
STATE OF NORTH CAROLINA
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:
lPetniittee's Certification:
State:
E-mail address -
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the•stipulations and restrictions as specified herein.
Signing official name.
Signature:
Date: / - 30 - /

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. .f�Ivtl5lou� mall ��teQ L3e�aneaue�
State of North Carolina
Department of Environmental Quality
Division of Water Resources
IlSA NCAC 02T .11100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all. required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall subunit one original and two copies of the application and.
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge fermdtjng Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORD: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
[] Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
I' AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner'or his representative hereby permits:
Applicant's name:
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 snaps) 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)
.,00'- 39 q
d Al,7k F.,----
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
�'ermittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
i'his Agreement shall remain in effect for the length of the Division's permit for the residuals Hand application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.

L 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 Il) 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.
{ l- 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. AnimaIs 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)<.ALT1El[ NATIIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY. (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACXNOWLEIIDCIEM ENT OF FIELD TRANSFER: (if needed)
t ❑ 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)

Landowner's Certification:
I certify that I am- a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OX 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:
Addres
City:
Phone:
0 j
Signature:
State: Zip: �13�� ..
-J 191 `T A ' E-mail address:
Date:
NORTH CAROLINA, _ r�i4 Seri . COUNTY 1, the undersigned Notary Public do hereby certify that 2t( V 6 jt&,V-
L.
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
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WITNESS my hand and official seal this the �(:� � M ,
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day of �-
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Signature and seal: -
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My commission expires: � - —�� '•�'
e�BER 3�, .
Lessee's/Operator's Certification: r'rrlriitfttt``
I certify that I have read thih Agreement aid 11 hereby agree to abide by the stipulations and restrictions as specified herein.
Address- ru
City:
Phone: I
Signature:
1Permittee's Certification:
State:
13I� `� �K•'9 E-mail address:
Date:
I certify that i have read this Agreement and do hereby agree to abide by the stipulations and restrictions as. specified herein.
Signing official name: V
Signature: ---1 Date: I ^ -7- 0 ^1 7

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CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF 1/31/2017
The Cumulative metals for this report come from LTD Period Table records (i.e. a Monthly Report has been produced and the loadings have been archived to History
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field ID
Last Applied
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
NC-RO-00039-0-0007
05/2013
0.0145
0.0072
0.4899
1.0742
0.0653
0.0025 �
0.0217
0.1197
0.0181
1.4662
NC-RO-00039-0-0008
05/2013
0.0290 ,
0.0145
0.9799
2.1485
0.1306
0.0050
0.0435
0.2395
0.0362
2.9325
NC-RO-00039-0-0009
06/2015
0.0544
0.0326
3.1434
5.1464
0.2634
0.0093
0.0870
0.5283
0.0815
6.7881
Page: 1 of 1 1/31/2017