WQ0000543_FP AttB_20120608

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Charles Wakild, P. E.
Director
June 8, 2012
PHILLIP HEGWER, CITY MANAGER
CITY OF SANFORD
PO Box 3729
SANFORD, NORTH CAROLINA 2733 1-3 729
Dear Mr. Hegwer:
Dee Freeman
Secretary
Permit No. Attachment B Certification
WQ0000543
City of Sanford
Land Application of Class B /
Residuals ( Non -Dedicated)
Lee County
In accordance with your permit major modification application package received on March 6,
2012, and the additional information received May 10, 2012, we are forwarding herewith a modified
Attachment B, certified June 8, 2012, to the City of Sanford for the subject residuals land application
program.
This certification is being issued to modify Attachment B by:
• Transferring NC -CH -10 Fields 1 and 4 from the Town of Siler City's Land Application
program (WQ0003226) to the City of Sanford consisting of 32.2 acres.
• Updating the ownership information for NC -CH -17 Fields 1 and 4 to change the
ownership from Robert C. Hancock to Bobby and Elaine Branch as well as modifying the
application area for Field 1 from 57.3 acres to 38..7 acres and the application are for Field
4 from 68.7 to 38.4 acres.
• Adding NC -CH -60 Fields 1 through 13 and NC -CH -66 Fields 1 through 5 consisting of
441.5 acres.
• Deleting NC -CH -13 Fields 1 and 2, NC -CH -17 Fields 2 and 3, NC -LE -1 Fields 2 through
10, NC -LE -7 Fields 2 through 7, 9 and 11, NC -LE -8 Field 1, NC -MO -10 Fields 1
through 6 and 8 through 16, NC -MR -2 Fields 1 through 3 consisting of 601.2 acres.
Please note that on August 5, 2009, Session Law 2009406, entitled "An Act to Extend Certain
Government Approvals Affecting the Development of Real Property Within the State," was enacted by
the General Assembly and signed into law. The Act, known as the Permit Extension Act of 2009, extends
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-4636
location: 512 N. Salisbury St., Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] NorthCaroXina
Internet; htt :! ork i,nodenro Iweblw las ��'tura���
An Equal Opportunity 1 Affirmative Action Employer lZ L

Mr. Hegwer
June 8, 2012
Page 2 of 2
the expiration date of certain government approvals and permits. In addition, Session Law 2010-177
extended the Act by another year. Permit No. WQ0000543 falls within the scope of this Act and is
therefore being extended until February 28, 2014. A renewal application must still be submitted six
months in advance of the extended expiration date.
Please replace the existing Attachment B of Permit No. WQ0000543 that was previously
certified on August 12, 2011, with this modified Attachment B. Note that only the vicinity and buffer
maps for any new and modified land application sites are attached to this modified Attachment B. It is
the Permittee's responsibility to ensure that a complete permit is created by inserting this modified
Attachment B and vicinity and buffer maps into Permit No. WQ0000543, issued on March 14, 2005, and
making sure to retain any vicinity and buffer maps for any existing and unmodified land application sites.
This modified Attachment B shall be effective from the date of certification; shall void
Attachment B of Permit No. WQ0000543 that was previously certified on August 12, 2012; and shall be
subject to the conditions and limitations as specified therein and well as those specified in the above -
referenced permit. As always, remember to take the time to review this modified Attachment B
thoroughly, as some of the conditions contained therein may have been changed since the last
certification. Note that this modified Attachment B is hereby incorporated by reference into Permit No.
WQ0000543, issued on March 14, 2005.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Alice M. Wessner at
[phone] or [e-mail].
Sincerely,
i�— Charles Wakild, P. E.
cc: Chatham County Health Department
Lee County Health Department
Montgomery County Health Department
Moore County Health Department
Fayetteville Regional Office, Aquifer Protection. Section
Raleigh Regional Office, Aquifer. Protection Section
Matt Haynes, Technical Services Manager, Synagro, 284 Boger Road, Mocksville, NC 27028
Technical Assistance and Certification Unit
Permit File WQ0000543
'Notebook File WQ0000543Y

ATTACHMENT B - Approved Land Application Sites
City of Sanford - City of Sanford Residuals Land Application Program
Certification Date: June 8, 2012
Permit Number: WQ0000543 Version: 2.4
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net Acreage
Dominant Soil Series
Footnotes
NC -CH -10-1
Purvis, W.N.
Teague, Ronald
Chatham
35°41'09"
7925'07"
23.6
Georgeville
1
NC -CH -10-4
Purvis, W.H.
Teague, Ronald
Chatham
35041'00"
79024157"
8.6
Georgeville
1
NC -CH -17-01
Hancock, Robert G
Teague, Ronald
Chatham
35039'30"
79022'47"
38.7
Georgeville
2
NC -CH -17-04
Hancock, Robert G
Teague, Ronald
Chatham
35040'05"
7902218"
38.4
Tatum
NC -CH -27-01
Jones, Jae
Teague, Ronald
Chatham
35040'27"
79"24'17"
10.90
Georgeville
NC -CH -27-02
Jones, Joe
Teague, Ronald
Chatham
3540'26"
79°23146"
47.40
Georgeville
NC -CH -27-03
Jones, Joe
Teague, Ronald
Chatham
35040'48"
7923'40"
23.50
Georgeville
NC -CH -27-04
Jones, Joe
Teague, Ronald
Chatham
35°40'51"
79'24'02"
27.30
Georgeville
NC -CH -27-05
Janes, Joe
Teague, Ronald
Chatham
35040'54"
79024'23"
90.10
Georgeville
NC -CH -60-1
Moore Bertis
Moore Todd
Chatham
35038'55"
79030'08"
35.2
Badin
NC -CH -60-2
Moore, Bertis
Moore, Todd
Chatham
35028'26"
7929'59"
45.6
Herndon
1
NC -CH -60-3
Moore, Bertis
Moore, Todd
Chatham
35038'38"
79°23'29"
37.4
Lignum
1
NC -CH -60-4
Moore, Bertis
Moore, Todd
Chatham
35038'22"
79°23'31"
41.6
Cid
NC -CH -60-5
Moore, Bertis
Moore, Todd
Chatham
3528'26"
79023'18"
5.7
Cid
NC -CH -60-6
Moore, Todd and
Moore, Luanne
Moore, Todd
Chatham
35038'12"
79°23'29"
19.9
Lignum
NC -CH -60-7
Moore, Bertis
Moore, Todd
Chatham
35°38'32"
79°23`08"
18.1
Nanford-Badin
NC -CH -60-8
Moore, Bertis
Moore, Todd
Chatham
35°40'35"
7922'17"
28.1
Georgeville
NC -CH -60-9
Moore, Bertis
I Moore, Todd
Chatham
35040'25"
79022'16"
18.6
Georgeville
NC -CH -60-10
Moore, Todd
Moore, Todd
Chatham
35°40'23"
79122127"
10.0
Georgeville
NC -CH -60-11
Moore, Bertis
Moore, Todd
Chatham
35037'59"
79°22'27"
16.0
Nanford-Badin
NC -CH -60-12
Moore, Bertis
Moore,Todd
Chatham
35037'42"
79022'24"
13.7
Cid
NC -CH -60-13
Moore, Todd
Moore, Todd
Chatham
W38'07"
79°25'15"
23.0
Cid
NC -CH -62-03
Brooks, James B
Teague, Ronald
Chatham
35°29'23"
79°25'19"
7.50
Georgeville
NC -CH -62-04
Brooks, James B
Teague, Ronald
Chatham
35029'29"
79"25'19"
12.40
Georgeville
Page I of 4

ATTACHMENT B - Approved Land Application Sites
City of Sanford - City of Sanford Residuals Land Application Program
Certification Date: June 8, 2012
Permit Number: WQ0000543 Version: 2.4
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net Acreage
Dominant Soil Series
Footnotes
NC -CH -62-05
Brooks, James B
Teague, Ronald
Chatham
35029'32"
79°25'18"
4.30
Georgeville
NC -CH -62-06
Brooks, James B
Teague, Ronald
Chatham
35029135"
7925'25"
24.20
Gaston
Stinson, Benner
Stinson, Benner
NC -CH -66-1
H/Stinson, Margaret
HlStinson,
Chatham
35`22'49"
79'24'40"
28.9
Badin
S.
Mar aret S.
Stinson, Benner
Stinson, Benner
NC -CH -06-2
H./Stinson, Margaret
H./Stinson,
Chatham
35032'45"
79024'57°'
17.9
Nanford-Badin
S.
Margaret S.
Stinson, Benner
Stinson, Benner
NC -CH -66-3
H./Stinson, Margaret
H./Stinson,
Chatham
3532153"
79°25'00"
14.0
Nanford-Badin
S.
Margaret S.
Stinson, Benner
Stinson, Benner
NC -CH -66-4
H./Stinson, Margaret
H./Stinson,
Chatham
35033101"
79025'03"
22.0
Nanford-Badin
S.
Margaret S.
Stinson, Benner
Stinson, Benner
NC -CH -06-5
H./Stinson, Margaret
H./Stinson,
Chatham
35033113"
79024'54"
13.6
Nanford-Badin
S.
Margaret S.
NC -CH -70-01
Fitts, William R
Chatham
35041'42"
7924'28"
28.80
Georgeville
3
NC -CH -70-02
Fitts, William R
Chatham
35041'43"
79°24'28"
5.10
Enon
3
NC -CH -70-03
Fitts, William R
Chatham
35041'51"
79025'01"
17.00
Poindexter
3
NC -CH -70-04
Fitts, William R
Chatham
35°41'54"
79°25'09"
10.90
Zion
3
NC -CH -70-05
Fitts, William R
Chatham
3542'08"
79°25'04"
10.10
Enon
3
NC -CH -70-06
Fitts, William R
Chatham
35°42'13"
7902515"
3.70
Zion
3
NC -CH -70-07
Fitts, William R
Chatham
35041'54"
79025'17"
25.00
Zion
3
NC -CH -101-01
Oscar GvarinlJamie
Teague, Ronald
Chatham
3536'12"
79'24'05'
6.60
Badin
Dubeibe
NC -CH -101-02
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'04"
79024'02"
5.20
Badin
Dubeibe
NC -CH -101-03
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'10"
79°32'57"
19.50
Badin
Dubeibe
NC -CH -101-04
Oscar GvarinlJamie
Dubeibe
Teague, Ronald
Chatham
3536'10"
79023'51"
9.70
Lignum
NC -CH -101-05
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'14"
79023'52"
2.80
Lignum
Dubeibe
Page 2 of 4

ATTACHMENT B - Approved Land Application Sites
City of Sanford - City of Sanford Residuals Land Application Program
Certification Date: June 8, 2012
Permit Number: WQ0000543 Version: 2.4
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net Acreage
Dominant Soil Series
Footnotes
NC -CH -101-06
Oscar Gvarin/Jamie
Teague, Ronald
Chatham
3536'17"
79023145"
9.60
Badin
Dubeibe
NC -CH -101-07
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'22"
7923'36"
27.10
Lignum
Dubeibe
NC -CH -101-08
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'24"
79023'22"
10.50
Lignum
Dubeibe
NC -CH -101-09
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'30"
79°23'16"
13.10
Georgeville
Dubeibe
NC -CH -101-10
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'32"
79023'24"
14.30
Badin
Dubeibe
NC -CH -101-11
Oscar Gvarin/Jamie
Teague, Ronald
Chatham
35036'36"
79023128"
2.90
Lignum
Dubeibe
NC -CH -101-12
Oscar GvarinlJamie
Teague, Ronald
Chatham
35636'44"
7923'20"
9.50
Badin
Dubeibe
NC -CH -101-13
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'39"
792318"
12.50
Badin
Dubeibe
NC -CH -101-14
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'38"
79`23'12"
8.40
Lignum
Dubeibe
NC -CH -101-15
Oscar GvarinlJamie
Teague, Ronald
Chatham
35036'39"
79023'06"
10.50
Cid
Dubeibe
Tota! for County
Chatham
949
NC -MR -03-01
Coffer, Bertram W
Teague, Ronald
Moore
35029'56"
79020'36"
63.70
Tetotum
NC -MR -03-02
Coffer, Bertram W
Teague, Ronald
Moore
35°29'57"
7920'37"
35.90
Tetotum
NC -MR -03-03
Coffer, Bertram W
Teague, Ronald
Moore
35029'52"
79020'24"
21.70
Tetotum
NC -MR -03-04
Coffer, Bertram W
Teague, Ronald
Moore
35029'46"
79020'44"
8.50
Masada
NC -MR -03-05
Coffer, Bertram W
Teague, Ronald
Moore
35029'46"
79°21'11"
7.60
Masada
Total for County
Moore
137.4
Total
id
1086.4
1. A re -defined compliance boundary has been approved for this land application site. This re -defined compliance boundary is located 100 feet from the water supply well on the
property. Note that the 100 -foot setback between wells and the land application area shall still be met_
2. A. reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by
Robert C. Hancock (i.e., indicated by the label "SWAA" on the approved setback map), regardless of whether a surface or a subsurface application method is used_
3. A buffer distance of no Less than 25 feet shall be maintained between the application areas and all rock exposures on this site.
Page 3 of 4

ATTACHMENT B - Approved Land Application Sites
City of Sanford - City of Sanford Residuals Land Application Program
Page 4 of 4
Certification Date: ,lune S, 2012
Permit Number: WQ0000543 Version: 2.4

SY AG
r N
APPLICATION ARE A MAP A ?ejUvah Mamrgeraeo Corapany
Owner 660' Field 9
e15 6ve-ell-A . Sege: 11 F
__._.> STREAM
DRAIN
Tot -al Acres (See su=j. m L Net Acres eS {se'✓ sug-ffn 1 Y
CDAPPLICATION APIA— IA _ PRIVA'T'E ROAD
I
a ROUSE FORESTED AREA
SURFACE WATER ❑ OUTBUILDING � UNSUITABLE
VENCE 0 WELL
STORAGE AREA Q SOIL DESCRIPTION � SUITABLE FOR
INCORPORATION,
PROPERTYLJNE 8-12% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 50 feet within the property boundary,
whichever Is closer to the applicationarea . The reviewboundaryts
established midway between the compliance boundary and the
perimeter of the residuals application area.

i� SYNAG O
APPLICATION AREA MAP ARerirwirMaxpvientCompany
Owner &O d?r /e Scale: " ^ 660' Field #
0/IZa m'grew r
. . _ > STREAM
— >
DRAIN
CiD
SURFACE NATE:
HOUSE FORESTED AREA
FENCE
OuTmiILmNG UNSUITABLE
(:D
STORAGE ARUA
a
PROPERTYLINE
Total Acres see summ Net Acres {see summary)
CIDAPPLICATION
AREA - - - .__ - _ PRIVATE ROAD
HOUSE FORESTED AREA
❑
OuTmiILmNG UNSUITABLE
5
0
WELL
a
SOIL DESCRIPTION SUITABLE FOR
INCORPORATION,
8-52% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 50 feet within the property boundary,
whichever Is closer to the application area. The review boundary is
established midway between the compliance boundary and the
Perimeter of the residuals application area.
0

SYNAGRO .
APPLICATION AREA MAP A Residuals 111 anrrgemew Coxpdny
Owner IVOAI kale: 1." = 660' Field # _�
To Baa
Acres (see sumu.agn= Net Acres (see q=--ga.rO
_ >
STREAM
APPLICA'T'ION AREA - - -- --- -- - PRIVATE ROAD
>
DRAIN
HOUSE FORESTED AREA
OSURFACE
WATER ❑
OUTBTJILDING UNSUITABLE
FENCE 0WELL
O
STORAGE AREA d
SOIL DESCRIPTION SUITABLE FOR
INCORPORATION,
PROFRRTYLENE
8-12% SLOPE
The compliance boundary is establishe d at either 250 feet from
the residuals application area or 50 feet within the property boundary,
whichever is closer to the application area. The review boundaryis
established midway between the compliance boundary and the
perimeter o€the residuals applicatioh area.

'R Reradmals kanagelent Company
Owner BI -W-5 lr)e k'e (lle-ta Z
Scale: 1" = 660' Field # /
_
'Fatal
Acres (seesu= -1 Net Acres ( see sura 4:2-11)
_ >
STREAM CID
APPLICATION AREA — — "`-' — -- - PRIVATE ROAD
DRAIN
HOUSE FORESTED AREA
CDSURFACE
WATER ❑
OUTBUILDING UNSUITABLE
FEN � CE
WE LL
STORAGE AREA a
SOIL DESCRIPTION SUITABLE FOR
INCORPORATION,
FROPERTYLINE
8-12% SLOPE
The compliance boundary is established at alther 250 feet from
the residuals application area or 5o feet within the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the compliance boundary and the

��) �6'
S-YNAGI
'A Reri4eals Mmagr..Reni Company
owner _ B��EI.5
/YIwe-.�/�� C'!� C}�
-- Scale: 1" = 660' Fie.1d #
T oW
Acres ('see summary) Net Acres (see sunnnary)
.. _..-. >
STREAM CID
APPLICATION .AREA --- -- -- ..._. — 4 PRIVATE ROAD
-- >
DRAIN
HOUSE FORESTED AREA
CDSURFACE
WATER ❑
OUTBUILDING UNSUITABLE
FENCE
WELL
CD
STORAGE AREA Q
SOIL DESCRIPTION SUITA:BLL' FOR
� XNCORPORATION,
PROPERTY LINE
8-12% SLOPE
The compliance boundary Is established at elther Mfeet from
the residuals application area or 50 feet within the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the compliance boundary and the

��P"P''P !c .� l P�/►ti •11'.'9 �i•11
Np
,lpSMAC
A .Rariduah Managen4ent Cmrspany
Owner B(W-15 161,44R F- (Ne-& -/,O Scale: 1t► � 660' Field # �
- > STREAM
}
DRAIN
Ci:)
SURFACE"WAVE.
- - '--- - -- PRIVATE. ROAD
�1
FENCE
STORAGE AREA
FORESTED AREA
PROPERZ'YLINE
Total Acres (see sumrn
' Net Acres (see sgmmgay)
Ci:)
APPLICATION AREA
- - '--- - -- PRIVATE. ROAD
$OUSE
FORESTED AREA
❑
OUTBUILDING
UNSUITABLE
' 0
WELL
a
SOIL DESCRIPTION
SUITABLE FOR
INCORPORATION,
842% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 50 feet within the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the cmmnHan,o r+..,... ,--

O
ml SYNA❑R
APPLICATION AREA MAP ;� Rasidurslr Mana��ten� co�d��y
Owner 7001ve-
GuA,vye lnoaQ5
— > STREAM
C�)
CD
SURFACE WATER
FENCE
STORAGE AREA
PROPERTY LINE
Scale: 1":—= � 660' Field # ep
Total
Acres �s�e suu�Rary)
Ne Acres {see sur�ur�arv)
CIDAPPLICATION
AREA —
— — w — _ PRIVATE ROAD
HOUSE
FORESTED AREA
❑
OUTBUMI)ING
UNSUITABLE
' 0
WELL
Q
SOIL DESCRIPTION
SUITABLE FOR
INCORPORATION,
8.12% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or So feet within the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the compliance boundary and the

mp
NAGR
APPLICATION N . REA M.IP A .Refidualr Managed -t Company
Owner &,e7-5 "&V2 /,�/C�-C'�-�a_ Scale: P 660' Field #
%D 1Db Ind d,2 rF
> STREAM
-- >
DRAIN
Ci:)
WATEi
SURFACE
"
FENCE
` 0
STORAGE AREA
PROPERTY LINE
T otal
Acres (see strmiug - Net Acres Csee su��a� v i
APPLICATION AREA --- — — ` — _ PRIVA'T'E ROAD
HOUSE FORESTED AREA
OUTBUU DING UNSUITABLE
` 0
WELL
SOIL DESCRIPTION LLU I SUITABLE FOR
INC ORP ORA'T'ION,
8-12% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 5o feet with In the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the corn pliance boundary and the

Owner
scale: Z't = 660' FieZd r01
Total
Acres (See Su-jllna y- Net .mer es .(see Summ q, y
>
STREAMCi)
APPLICATION AREA — ._._. _ —._ - PRNATE ROAD
- -->
DRAIN
}
HOUSE FORESTED AREA
0
OSURFACE
WATER ❑
OUTBUILDING UNSUITABLE
YENCE
WELL
(D
STORAGE AREA
0
SOIL DESCRx XON SUITABLE FOR
Il'
INCORPORATION,
PROPERTYLINE
8-12% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 5o feet within the property boundary,
whichever is closer to the appllcat4on area. The review boundary is
established midway between the compliance boundary and the

SYNAGR
APPLICATTON A 1VIAP A Residunir Managerient Company
--> STREAM
Tota.i. Acres (See StNnm-?xNet A4.cre$ fsee SaCi naM
1� APPLICATION AREA ..._. — — .—...._.. _ PRIVATE ROAD
HOUSE FORESTED AREA.
SURFACE WATER
❑
OUTBUMI)MG UNSUITABLE
FENCE
0
WELL
STORAGE AREA
SOIL DESCRIPTION SUITABLE FOR
� INCORPORATION,
PROPERTYL ;'
8-12% SLOPE
The compliance boundary is established at either 250 feet from
the residuals application area or 50 feet within the property boundary,
whichever is closer to the application area. The review boundary Is
established midway between the compliance boundary and the

kq� M IMM 11
SYNAGR
A Reradua1t Ajawcsgenzea Company
Owner &171?c''e6kKlw-eV44) scale: err 660' Field.
—�
> STREAM
CD
���7V►1
SURFACE WATER
FENCE
STORAGE AREA
PROPERTY LINE
Total
Acres fsee summarO
Nd Acres .(see summarv)
APPLICATION AREA -~
-- - - _ � PRI'VAT'E ROAD
HOUSE
FORESTED AREA
❑
OUTBUILDING
UNSUITABLE
' 0
7VELL
a
SOIL DESCRIFTIpN
SUITABLE FOR
� INCORPORATION,
5-12% SLOPE
The compliance boundary is established at either 250 feet from
t3he residuals appliaatiun area or 50 feet within the property boundary,
whichever is closer to the application area. The review boundary is
established midway between the compliance boundary and the
perimeter of the residuals application area.

W.b 28 12 08:42a 13obb�j and Elizabeth Drano 919-774-,1463
Nov. 18. 2013 8:28AM No, 2157 P. 2
State of arth Carolina
Department of Environment and Natural Resources
Division of Water Quality
SETBACK . ' R AGj=NFN ' ATTACHMENT
For Land Application of kesiduA Solids (FORM: SWAA 070807)
(TR S.PO)WMWRE,P110T OCOPIED FOR USE.49"ORIOD L)
Tits ]Division of Wates- Quality (Division) will not accept this attachwortt Won fill ilia iamtnletiottg sere
folk wed. Fboare to submit all required stems wlll lead to addit[nteal pr6eming and revlew time,
Far panni gort Calton' visit our web site
I1+1.9'1'iILYJt;"P ONS TO TIM ltlPll (CANT.
A. AttechmeatForin:
.r Do not subsoil title attacltttt"t corm f4Y tsview 'vithot11 its 0rrr3parnd1ra9 resitittals pro,grant
appheation foam (VORt4t NDULAP).
ARY duftes to this attaa ismemt tbrrn Will i t Adt In Ilte appticatio,ra packago baiug returned.
ji. 2repikre a acparata: littachancmt Corm for epch property fivra whiolt a{ waiver front ISA. NCAC 2r
_1108(h)(2)(tor lialsitalilai residertecs or Mace of)PaTAte titssembly) is Wig g sought.
✓ Any odw sabacks nquiiied by 15A NCAC ZT .1108, alter than those i-Screarpad ftbova,,rparmo be ;valved
titrtriagh exeoutioli ofthis aitAcbnttat fora.
A topy ofthe completed read apprViiatoly executed attaobwentfnammust be provided to thepwpctiy owner.
AGREEMENT TO WAM TA9 StTOA.CK D EQ7liINSID 11Y 15,E tdt.AC 1� .1106#J�}(1)(ha3s1ta3DIa rosldsrasees)
Tice Undersigned preg arty osv'netrhereby peimitst
Apgiiceax's Harare: '1"Dtvg man%rd
t:ompleremedingaddreas ofappllcfial: _ P.O. Box 3m ---
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City_ _ ftlhrg , state" _ IAC 23p: 2'7331-3729
Taleltho,rt member: (U9 .)_77s -83x _ i�acai,tiilezi►r►�bcr c. .) -aa37
B-aaa 11 addrmss:
koralnn[#ortfcrrcdtoas#ltopermtttec,Inland appiyrasidulalstrttitin HiQ hat (i,e., caxtnat be less
than 100 teat) ofthe resith:atce er plaice of pu blic aswembly lometed at the roltowhip-,
I,oaatlonart4dreasorptnp�y. A114 i�iMEW h,fli _Ok&Aeo MiG_ ligj>.cir1
City; . _�,14{�` R°C -- — State: Zip:
This Agretinent slab rtinartra In ei%aE for the length of Ike Division Of waster Qdhllty's (1)tv1110n) permit for
the rcatduaTr 113114 app]100011 prugraim rand shall be Ytaclved each bane Hair pormit is roneived. In addition,
#lilt Agreetneut shall only rewstin in etPeet for as long as tiro undersigned property owo& mens the property
cleserlbed herelwj.
Tito ttnderslgncd propFerty owner agvitts to abide by this Agreement unillsuch Rate as 1YriEteitaa4tTiTcsttloat,
given 30 enis3tdnr days Tn a4vanea:, snudities or cancels this Agreatnaitt.
I t&dfy fila&[ I atm a dreded pmpeity owner of above-rcfcrcaccd propcoy aix3 ilm autborucd to make, c decisions
rcgaardiug tills property an tta: 414 of Okhtr ticed5d property owners. &rllattmoro, I certify that Y l,arre rend and
amdtrstand titin Age "inent and do bmby grant pennlsslon to the I'amitleo to land apply residuals to Tand
application sita(s) as specified l/teerchf/ut_J/��
PraFWY OVA01 r34triR: �11d��G Jai' G: d�-cam• � .�.. _. -
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IFO M: SWAJk 070807 Pogo t of I A#taclunent Order 3,d
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