WQ0000672_Permit Application_20130401

Barber, Jim
From: I Mcdaniel, Chonticha
Sent: ': ;; Tuesday, April 23, 2013 1:11 PM
To: Barber, Jim
Subject: FW: More Information for Lumberton NC
Attachments: .:. LASC Attachment.docx
`� i i .:;.
VJ
Chonticha McDahiel,: • .;!
Environmental Engineer,
North Carolina Uepartm6 t of Environment and Natural Resources-
, ..; .. ,,..:,.-.
Division of Water Qualyitw*ifer.Protection Section
1636 Mail Service Cente',r::'.
Raleigh, NC 27699-1636. i
Phone: (919) 807,-6337. Fax: [phone]
http://Portal.ncdenr'.org/Web/wq ,
DISCLAIMER: Fm'ail co respondence to and from this address is subject fo the North Carolina Public Records Law and may
be disclosed to third' parties.unless the content is exempt by statute or other regulation.
From: Stephens; Edward[mailto:[e-mail]]
Sent: Wednesday, April'03,! 2013 8:03 AM
To: Mcdaniel,i Chonticha
Subject: RE:I More Information for Lumberton NC
Updated LAST Attachment
Thank you. -
Edward
From: Mcdaniel,; Chonticha [mailto:[e-mail]]
Sent: Tuesday, April,02, 2013 9:12 AM
To: Stephens; Edward j
Subject; RE:More Information for Lumberton NC
Stephens,
On the LASC form;.field 1�0_, 14 still has R.G Hammonds listed as landowner, please change it to Taylco c/o Keith Taylor.
Chonticha McDaniel;' ;!
Environmental Engineer`; ! I'
North Carolina Department of Environment and Natural Resources
Division of Water.Quality/Aquifer Protection Section
1636 Mail Sergi lice Cente
Raleigh, lr
1 1 ,. , 1 {l
NC 27699-16361 I�; i I.
Phone: [phone] Fax[phone]
I : I' 1 .1.1 1•., .I 1!

Status Code
Site/Field
ID
Landowners
Lesse(s) or
Operator(s)
Net
Acres
County
Crop(s)
Predominant Soil
Series
Name
Mapping
Unit
M
NC-RO-20-7
R.G. Hammonds
Same
13.0
Robeson
Row Crops
Goldsboro
GoA
M
NC-RO-20-8
R.G. Hammonds
Same
73.2
Robeson
Row Crops
Wagram
WaB
N
NC-RO-20-14
Tayloo
c/o Keith Taylor
R.G. Hammonds
10.6
Robeson
Row Crops
Goldsboro
GoA
N
NC-RO-37-1
Michael McCarthy
Danny Smith
3.1
Robeson
Coastal Bermuda
Lakeland
LaB
N
NC-RO-37-2
Michael McCarthy
Danny Smith
8.4
Robeson
Coastal Bermuda
Kalmia
KaA
N
NC-RO-37-3
Danny Smith
Same
8.9
Robeson
Row Crops
Norfolk
NoB
N
" NC-RO-37-4
Phillip/Beatrice Culbreth
Danny Smith
15.1
Robeson
Row Crops
Norfolk
NoA
N
NC-RO-37-5
Phillip/Beatrice Culbreth
Danny Smith
4.1
Robeson
Row Crops
Norfolk
NoA
N
NGRO-37-6
Phillip/Beatrice Culbreth
Danny Smith
4.4
Robeson
Coastal Bermuda
Norfolk
NoA
N
NC-RO-16-1
Ozzell Baker
Same
16.9
Robeson
Coastal Bermuda
Rains
Ra
N
NC-RO-16-2
Ozzell Baker
Same
3.6
Robeson
Fescue
Goldsboro
GoA
N
NC-RO-16-3
Ozzell Baker
Same
3.4
Robeson
Coastal Bermuda
Goldsboro
GoA
N
NC-RO-16-4
Ozzell Baker
Same
3.6
Robeson
Coastal Bermuda
Rains
Ra
N
NC-RO-16-5
Ozzell Baker
Same
8J
Robeson
Coastal Bermuda
Rains
Ra
N
NC40-16-6
Ozzell Baker
Same
14.8
Robeson
Fescue
Norfolk
NoA
N
NC-RO-16-7
Ozzell Baker
Same
17.5
Robeson
Row Crops
Norfolk
NoA

Status Code
Sit6/Field
ID
Landowners
Lesse(s) or
Operator(s)
Net
Acres
County
Crop(s)
Predominant Soil
Series
Name
Mapping
Unit
N
NC-RO-16-8
Ozzell Baker
Same
7.6
Robeson
Coastal Bermuda
Wagram
WaB
N
NC-RO-38-1
Leroy Harris
Chad Harris
11.6
Robeson
Coastal Bermuda
Norfolk
NoA
N
NC-RO-38-2
Leroy Harris
Chad Harris
19.4
Robeson
Coastal Bermuda
Norfolk
NoA
N
NC-RO-28-1
Robert Baskerville Jr.
Carnell Locklear
11.6-
Robeson
Row Crops
Dunbar
Dn
N
NC-RO-28-2
Robert Baskerville Jr.
Carnell Locklean
56.9
Robeson
Row Crops
Rains
Ra
N
NC-RO-28-3
Robert Baskerville Jr.
Carnell Locklear
10.4
Robeson
Row Crops
Goldsboro
GoA
N
NC-RO-17-2
City of Lumberton
Pete Allen
25.4
Robeson
Row Crops
Lumbee
Lu
N
NC-RO-17-3
City of Lumberton
Pete Allen
28.0
Robeson
Row Crops
Lumbee
Lu
M
NC-RO-11-4
City of Lumberton
Pete Allen
47.7
Robeson
Row Crops
Johns
Jo
N
NC-RO-39-7
Lyndon Bullard
Lyndon Bullard
3.7
Robeson
Coastal Bermuda
Goldsboro
GoA
N
NC-RO-39-8
Lyndon Bullard
Lyndon Bullard
7.4
Robeson
Coastal Bermuda '
J
Norfolk
NoA
N
NC-RO--39-9
Patrick Bullard
Same
62.5
Robeson
Coastal Bermuda
Wagram
WaB
N
NC-RO-39-IA
Lindbergh Bullard
Patrick Bullard
5.3
Robeson
Coastal Bermuda
Goldsboro
GoA
N
NC-RO-39-1B
Lindbergh Bullard
Patrick Bullard
2.6
Robeson
Coastal Bermuda
Goldsboro
GoA
N
NC-RO-39-2
Lindbergh Bullard
Patrick Bullard
1.4
Robeson
Coastal Bermuda
Goldsboro
GoA
N
NC-RO-39-3
Quindale Bullard
Patrick Bullard
5.1
Robeson
Coastal Bermuda
Rains
Ra
N
NC-RO-39-4
Quindale Bullard
Patrick Bullard
14.8
Robeson
Coastal Bermuda
Lynchburg
Ly
N
NC-RO-39-5
Rhonda Kay Chong
Patrick Bullard
3.8
Robeson
Coastal Bermuda
Lynchburg
Ly
N.
NC-RO-39-6
Rhonda Kay Chong
Patrick Bullard
2.9
Robeson
Coastal Bermuda
Wagram
Wa

Site/Field ID
Latitude
Longitude
Location
Datum
Location
Method
Code
Location .
Accuracy
Waterbody Subbasin and Steam
Index No.
Current and
Proposed Class
NC-RO-20-7
34043'30"
79002'2F
NAD83
MAP
Nearest Second
LBR51-14-12
QSw
NC-RO-20-8
34043'48"
79002'03"
NAD83
MAP
Nearest Second
LBR51-14-12
C;Sw
NC-RO-20-14
34043'38"
79002'l0"
NAD83
MAP
Nearest Second
LBR51-14-12
C;Sw
NC-RO-37-1
34037'26"
79009'08"
NAD83
MAP
Nearest Second
L13R51-14-8-(2.5)
WS-IV;Sw
NC-RO-37-2
34037'17"
79009'01"
NAD83
MAP
Nearest Second
LBR51-14-8-(2.5)
WS-IV;Sw
NC-RO-37-3
34037'56"
79006'49"
NAD83
MAP
Nearest Second
LBR51-14-9-(1.5)
WS-IV;Sw
NC-RO-37-4
34037'50"
79006'42"
NAD83
MAP
Nearest Second
LBR51-14-9-(1.5)
WS-IV;Sw
NC-RO-37-5
34037'55"
79006'37"
NAD83
MAP
Nearest Second
LBR51-14-9-(1.5)
WS-IV;Sw
NC-RO-37-6
34037'45"
79006'37"
NAD83
MAP
Nearest Second
LBR51-14-9-(1.5)
WS-IV;Sw
NC-RO-16-1
34042'24"
79007'40"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-2
34043'14"
79007'37"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-3
34042'20"
79007'33"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-4
34042'17"
79007'30"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-5
34042'25"
79007'23"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-6
34042'17"
79007'18"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-16-7
34042'21"
79007'12"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw

Site/Field ID
Latitude
Longitude
Location
Datum
Location
Method
Code
Location
Accuracy
Waterbody Subbasin and Steam
Index No.
Current and
Proposed Class
NC-RO-16-8
34042'23"
79007'03"
NAD83
MAP
Nearest Second
LBR52-14-10-8-4-(0.5)
WS-IV;Sw
NC-RO-38-1
34045'41"
79008'14"
NAD83
MAP
Nearest Second
LBR52-14-10-8-3-(2)
WS-IV;Sw
NC-RO-38-2
34045'23"
79008'14"
NAD83
MAP
Nearest Second
LBR52-14-10-8-3-(2)
WS-IV;Sw
NC-RO-28-1
34043'49"
7900611"
NAD83
MAP
Nearest Second
LBR52-14-10-(1)
C;Sw
NC-RO-28-2
34043'58"
79006'60"
NAD83
MAP
Nearest Second
LBR52-14-10-(1)
QSw
NC-RO-28-3
34043'41"
79005'41"
NAD83
MAP
Nearest Second
LBR52-14-10-(1)
QSw
NC-RO-17-2
34035'57"
79004'29"
NAD83
MAP
Nearest Second
LBR51-14-17
QSw
NC-RO-17-3
34036'04"
79004'17"
NAD83
MAP
Nearest Second
LBR51-14-17
QSw
NC-RO-17-4.
34036'27"
79003'35"
NAD83
MAP
Nearest Second
LBR51-14-17
C;Sw
NC-RO-39-7
34041'12"
79002'01"
NAD83
MAP
Nearest Second
LBR51-14-12-4
C;Sw
NC-RO-39-8 _
34041'13"
79001'55"
NAD83
MAP
Nearest Second
LBR51-14-12
C;Sw
NC-RO-39-9
34024'26"
79004'25"
NAD83
MAP
Nearest Second
LBR54-14-30-8
QSw
NC-RO-39-1A
34036,11"
79013'09"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
C;Sw
NC-RO-39-1B
34036'07"
79013'07"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
C;Sw
NC-RO-39-2
34036'08"
79013'04"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
C;Sw
NC-RO-39-3
34036'01"
79013'14"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
QSw
NC-RO-39-4
34036'01"
79013'08"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
QSw
NC-RO-39-5
34036'01"
79013'02"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
C;Sw
NC-RO-39-6
34036'03"
79012'58"
NAD83
MAP
Nearest Second
LBR54-14-30-3-1
QSw

i
State of North Carolina
Cl
Please use the followin -s-
instructions and check
information requested.`
permit application. Uu
sunnortine documentation
De artmen nment and Natural Resources
RECEIVEDInE�S6
Division of Water Quality
MAR I. 3 Z013 LAND OWNER AGREEMENT
FORM: LOA 08-11
rder to ensure all required items are submitted. Adherence to these
produce a quicker review time and reduce the amount of additional
iired items will lead to additional processing and review time for the:
For more information or for an electronic version of this form, visit the Land Application Unit (LA U) web site at:
http:/Mortal. ncdenr. org, `webiwgiapsilau
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 08-11).
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 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.
❑ 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 orhisrepresentative hereby permits:
Applicant's name: ' i asc L►�-t✓
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., 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
o tional
(optional) )
Special note
(no-till/over-seed/
pasture)
JUL F,0 —2Z
Al
i
n�
I,J w1� t�fit'
��-tZo -zu - g-►
-
G_M _
c-
r
PIT
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.
iThis 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
F 3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section R) are met
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWQ, Land Application Unit, 1636 Mail Service
Center, Raleigh, NC 27699-1636.
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 withthe permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement
�IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee andlor.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 residualstsoil 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.
IMALTERNATIVES 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: NC - Rn®' 7
(Please include the rationale for the requested re -location of the compliante 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
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 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, acimowledgement of
field transfer, and do heremiby grant pert ion to, the. Permittee to land apply residuals to the land application site(s) as specified
,
herein. � /.'
Landowner name: tf2ik U V
4w t State: J V zip: �-b � �b
Phone: 't Q _'°� 1 E-mail address: .
Signature: Date:
NORTH CAROL.INA,, :0-1 Q✓c> COUNTY
I, the undersigned Notary Public do hereby certify that (initials-A4=1 personally —
appeared before me this -day, and, being duly sworn, stated that in his/her presence_ Nia rJ! signed
the attached document and aclaiowledged the due execution of the foregoing instrument. —
WITNESS my hand and official eal this the day of ►/�4rMe 20 It
Signature and seal:
. MC
-� 'My commission expires: 0 t KUM
ZMECOUNM
- MMOF NORTH CARMJNA
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-
Lesseeloperator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
. r
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 naive: �r�^_� Al !t '1�tf5
Signature: „�.�� ' Date:

I� ■f t 666 iiJ ;�,•
MAR 2 8 2013
March 11, 2013
N.C. Department of Environment and Natural Resources
Division of Water Quality
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
ATTENTION: Ms. Chonticha McDaniel
REGEIVEDIDENRIDWO
MAR 18 2013
Aquifer Protection Section
REFERENCE: REQUEST FOR ADDITIONAL INFORMATION REGARDING
APPLICATION FOR MODIFICATION OF PERMIT # WQ0000672:
CITY OF LUMBERTON
Dear Ms. McDaniel:
This letter is in response to the request for additional information letter dated February 26, 2013
regarding the current permit modification application for the City of Lumberton, permit
#WQ0000672.- . 11
1. A field designated NC-RO-21-6; owned and operated by Lacy Cummings has been
withdrawn from the permit modification application and information regarding it has been
removed. Fields. 1-5 listed on the site summary remain unchanged. A new site summary
listing fields'l-5 is included, please discard the version listing field 6 and any maps related
to it.
2. A field designated NC-RO-20-7, operated by Ronald Hammonds. At the time the permit
modification application was submitted to NC DENR DWQ the Robeson County GIS
system showed that the field in question was owned entirely by Ronald Hammonds. A
subsequent review of the Robeson County GIS system by Mr. Jim Barber of the Fayetteville.
Regional Office revealed that a portion of field 7 was owned by Taylco Inc. The owner of
Taylco, Mr. G. Kenneth Taylor has agreed to participate as a land owner and has signed the
Land Owner Agreement Form (LOA 8-11). Updated maps showing the property boundaries
and required setbacks are included with this letter as well as the LOA signed by Mr. Taylor.
Please discard the map of field 7 included with the permit modification application and
insert the attached version. An updated site summary for NC-RO-20 is also included.
3. Fields NC-RO-20-11, 12 and 13 are owned and operated by Ronald Hammonds. Mr.
Hammonds has decided that he does not want to include fields 11, 12 and 13 in the
Lumberton permit at this time. This decision was made after the permit modification
application was prepared and submitted. Updated maps are included that show fields
currently under consideration, but not 11, 12 and 13. Please insert them in the permit
modification application binder where appropriate.

This letter is believed to supply all additional information requested. In the event more
information or a clarification of information already submitted is required, please contact me via
e-mail using [e-mail] or by phone at 336-403-4324.
Sincerely,
Edward Stephens
Technical Services Manager
Cc: T. Wayne Horne, City Manager; City of Lumberton
I

SITE SUMMARY
City of Lumberton
WQ0000672
Site, ID:
NC-RO-21 .
Owners:
Fannie Oxendine
Lacy Cummings .
Address:
7632 NC Highway 711
75 Genes Road
Pembroke, NC 28372
Pembroke, NC 28372
Phone:
91'0-521-4757
Operator:
. Lacy Cummings -
Address:
75 Genes Road
Pembroke, NC 28372
Phone:
910-521-4950 (home) 910-827-1211 (cell)
Estimated
Robeson Co. Predominant ' Latitude &
Total -Applicable,
RYE Soil Series Longitude
Fipick
Ar_rPs Acres Cron(sl.
PAN/ac:/vr_ (man unit) (D.M.S)
corn
131
Norfolk
34.42.26 N
1
47.6
39.7
soybeans(fs/dc)
164/137
(NoA)
79.05.34 W
wheat
125
corn
131
Norfolk
34.42.23 N
2-A
51.8
' 45.9
soybeans(fs/dc)-
164/137
(NoA)
79.05.20 Wwheat
125 .
2-13
5.1
5.1
coastal
264
Wagram
34.42.13.N
bermuda rass
WaB)
79.05.20 W
3
4.8
4.0
coastal"
264
Wagram
34A2.18.N
bermuda rass
'
Wa6
79.05.40 W
4
20.2
13.0
coastal
264
Wagram
34.42.10 N
bermuda rass
.(Wa'B)
79.05.32 W
corn
148
Goldsboro
34.42.38 N
5
'59.9
52.1 -
soybeans(fs/dc)
176/149
(GoA)
79.05.27 W
wheat
136
TOTALS 189.4 159.8
Notes:
Fannie Oxendine owns fields 1-5, which are currently permitted.
Date: 3/11 /13

State of North Carolina
RECEIVDIDE�p Department of Environment and Natural Resources'
r --~ Q Division of Water Quality
> MAR 2013 LAND OWNER AGREEMENT
Aquifer PCOf@ctjp sggAFORM: LOA 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/wg1aps/lau
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 08-11).
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 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.
❑ 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: o
Applicant's name: i. Ij ' Un-
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 Patterns
Cropping Patte
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over=seed/
pasture)
cor, 6a"."s
1 eeJ .
w7e_ iJWt�
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives; in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and:
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative, and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 08-11 Pagel of 3

L STIPULATIONS:
1. The landowner .4 his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the �ite(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-DWQ, Land Application Unit,1636 Mail Service
Center, Raleigh, NC 27699-1636.
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-
11. 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.
IMALTERNATIVES 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(r) 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
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: aa
City: Lt rh 66&rvAV State: / V G Zip: 02 g 5 (� D ,
Phone: f O q 3 �b -mail address: lQNSTQ % R R Z • n't .
� 20
Signature: 01 Date -
NORTH CAROLINA, %o 655c COUNTY
I, the undersigned Notary Public do hereby certify that -Y PI E , 4 l 199
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
fi
day of ! 1 ql c 20 IS
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
/0 /,�7
I certify that I have read thi eement and
Lessee/operator name:
Address:./21
City:
Phone: �ia3�1 �,�q !
hereby agree to abide by the stipulations and restrictions as specified herein.
A
State: _✓�
E-mail
Zip: 9U 6v
Signature: LV�Mvirr' t� — Date: • 3I i3
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: 0 �7
Signature: a Date:
RECEIVEDIDENRI M
MAR 18 2013
Aquifer Protection Section