WQ0001800_Application_20200319

Application For Modification of
Permit NO. WQ0001800
R���IVED�t�CD���WR
MAR 1 9 20�.�
Land Application of Town of Yadkinville, NC
Residuals
Prepared by:
Alex Fox
Synagro Central, LLC
Mocksville, INC 27028
P 336-703-8681 F 336-998-8450
January 30, 2020
rt;_l5charge
�arm,i�n Unit

March 4, 2020
N.C. Department of Environment and Natural Resources
Water Quality Section
Non -Discharge Permitting Unit — Aquifer Protection Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
ATTENTION: Mr. Nathaniel Thornburg
REFERENCE: Yadkinville Modification
Dear Mr. Thornburg:
RECEIVED/NCDEOIDWR
MAR 1 9 2020
Non -Discharge
Permitting Unit
Synagro Central LLC is submitting a modification to the Town of Yadkinville Class B Permit.
on March 4th. We are adding a new site YK-42 fields 1,2,4,5 with a total of 64.4 acres to be
added.
This application package contains the information necessary to complete the certification of
this permit. However, if you require any additional information or have further questions about
the information presented herein, please contact me at [e-mail] or at my phone
number (336)-703-8681 I look forward to working with you to ensure a timely and efficient
process of this renewal
S i kce �ely,
Alex Fox
Technical Services Specialist
Synagro Central, LLC

REG���E
1 202� State of North Carolina
�v�AR Department of Environmental Quality
DWRNon-O�S��aUntt
Division of Water Resources
�L, t16
`-Divislon of Water Resources 15A 1 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
sunaortine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting 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.
Z 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(bl.
® 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).
Facility Classification New Permit Major Modification 1
FMajor (land are permitted for > 300 acres) $1,310 $395
Minor (land are permitted for < 300 acres) F- $810 $245
1 - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
Z List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC I .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
Safety measures; may include safety training program, manuals, signs, etc.
Spill response plan; including control, containment, remediation, emergency contact information, etc.
Inspection plan including the following information;
Names and titles of personnel responsible for conducting the inspections.
Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
Detailed description of monitoring procedures including parameters to be monitored.
® Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
Plans must include the following minimum items:
A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
---perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
® Delineation of the review and compliance boundaries
® Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 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.
J. 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: hnp://www.ncwater.orglRules 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 A 104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
El Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
El Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at:.h=://www.ncwater.ory/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:
® Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
® Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

DWR
Division of Water Resources 15A NCAC 02T .1100 —
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Yadkinville
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership 0 Privately -Owned Public Utility
❑ Federal ❑ State Municipal
❑ County
Signature authority's name per 15A NCAC 02T .0106: Jacob Swain
Title: Director of Public Works
Applicant's mailing address: PO Box 816
City: iYadkinville State: NG Zip: 27055
Telephone number: 336 469-:0063. Email Address: [e-mail]
2. Consultant's name: 'Alex Fok License Number (for P.E.):
_� _
Affiliation: ❑ On Staff 0 Retained (Firm: Syna rg o LLC)
R � 1VED
Consultant's mailing address: 284 Boger rd
lv1gR 1 202J
City: Mockesville State: NC Zip: 27028-
,jSCilaTge
Telephone number: 336) 703-8681 Email Address: [e-mail]
Non-D,,
permi`L ng Un►t
3. Agronomist's name:
License Number:
Affiliation: ❑ N/A ❑ On Staff
❑ Retained (Firm: )
Agronomist's mailing address:
City: State:
Zip: -
Telephone number: (_) --
Email Address:
4. Soil Scientist's name: Chris Murray
License Number: 1284
Affiliation: Z N/A ❑ On Staff
❑ Retained (Firm: ;)
Soil Scientist's mailing address: 216
S. Swing Rd. Suite 1
City: Greensboro, State: NC
Zip: 27409
Telephone number: 336 U&5.4.87
Email Address: chris a niedmontsoil.coni
5. Fee submitted: (See Instruction B)
IL PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, 9 modified, 0 renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00001800
Date of most -recently issued permit: 02/04/2019
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit): 7/10/2009
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 1620 Fred Hinshaw
City: Yadkinville State: NC Zip: 27055-
Coordinates: Latitude: 36' 08' 01." Longitude: 80' 37' 32"
Datum: NAD83 Level of accuracy: second
Method of measurement: MAP
2. County where residuals land application program is headquartered: Yadkin
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:
4.
Designation
Name
Affiliation
Certification Number
ORC
Nate Roth
Synagro LLC
1001672
Back -Up ORC
Michael Boone
Synagro LLC
987521
Additional Back -Up
ORCs
if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrot2en Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 280 (250 WWTP, 30 WTP) dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
32.58
36.70
9,123
10,275
Five -Year Maximum Adjusted
50.76
54.88
14,213,
15,366
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
8.5
Hay
96.3
Pasture
82.3
Total:
187.1
Methods
Surface
187.1
Incorporation or Injection
Total:
187.1
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
Obs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
182.5,
205.5
284.1
307.3
100
91.2
102.8
142.1
153.1,
150
68.5
94.8
102.4
200
45.6,
51.4
711
76.8
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): 0 Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
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.
E-1
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.
J. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
(in/hr).
Recommended
Loading Rate
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505 n is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field Zone
Design Area
(ft2)
Number of
Nozzles
Maximum Application
Rate ( allons/hr)
Design Annual Loading
Rate allons/ r)
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
fit
Wetted area of nozzles
ftZ
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
1be 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 ❑ No, Explain;
I, Jo-G4�0C:w+ ?"M1L S-erLiLGS
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
Yceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: _ �J D
FORM: RLAP 06-16 Page 5 of 5

L
n
E

a� wA rE�
State of North Carolina
Department of Environment and Natural Resources
j f Division of Water Quality
a 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:
ham: //portal. ncdenr. org/web/wq/arcs/lau
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 (M) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Status Code
Required Item
N
R_
T
M
County Manager
Notification
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 Pagel of 3

Status Code
Required Item
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 PoLe "
Acknowledgement of field transfer from Permittee relin uisMi field
✓
Acknowledgement of field transfer from Land Owner (Fields may not
✓
be permitted to multiple Permittees over the same time eriod
* 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)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Merc (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
® 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: http://portal.ncdenr.o web/w4/ys/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:
htip:Hportal.nedenr.orL,-,'web/wg/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 l: 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 http://h2o.enr.state.nc.us/bims/re2orts/reportsWB.html. If this link does not work, open
http://portal.nedenr.om/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
INSTRUCTIONS FOR FORM: LASC 08-11 Page 2 of 3

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.
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 teml
"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 entcria& 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."
Pas 'uotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 08-11 Page 3 of 3

LAND A-t eLICATION SITE CERTIFICATION
Applicant's name: Town of Yadkinville
Land application sites currently certified: 122.8 net acres and Total to be certified: 187.1net 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°
N
Yk-42-1
Phil Brown
16.7
Yadkin
Fescue
Clifford
2-7%
N
Yk-42-2
Peggy York
Phil Brown
7.6
Yadkin
Fescue
Fairview
2-7%
N
Yk-42-4
James Sumerlin
Phil Brown
22.1
Yadkin
Fescue
Fairview
2-7%
N
Yk-42-5
Mark Russel, David Porterfield
Phil Brown
18.0
Yadkin
Fescue
Clifford
2-7%
a 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.)
GMapping 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 Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Class Proposed
Yk-42-1
360 13' 2.80"
800 35' 6.25"
NAD 83
ADD
Nearest Second
12-83-2-0.3
1
Yk-42-2
360 12' 50"
800 34' 55"
NAD 83
ADD
Nearest Second
12-83-2-0.3
C
Aff
Yk-42-4
36° 14' 9.1"
80035' 22.14"
NAD 83
ADD
Nearest Second
12-68
C
Yk-42-5
360 14' 15.8"
80" 35' 15.55"
NAD 83
ADD
Nearest Second
12-68
C
�tl
FORM: LASC 08-11 Page 1

rIL
Ll

APPLICATION MAP
LEGEND
APPLICATION AREA
�n n�
F01
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
�
WATER
— — — —
STREAM
ONSITE HOUSE
—
DRAIN
OFFSITE HOUSE
—
FENCE
OUTBUILDING
PROPERTY LINE
SOIL BORING
0
WELL
The 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.
GRAPHIC SCALE
1" = 660'
660' 0 660,
NC-YK-42
Fields 1-2

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
W
WATER
- - - -
STREAM
ONSITE HOUSE
-
DRAIN
OFFSITE HOUSE
Xc X
FENCE
❑
OUTBUILDING
PROPERTY LINE
Q
SOIL BORING
0
WELL
The 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.
GRAPHIC SCALE
V=660'
660' 0 660'
N C-YK-42
Fields 4-5

r '{CgC2, - ' .
s _ g E)?-.
4 CUB
) �q
Z.
a x- J.
GRAPHIC SCALE
1" = 660'
660' 0 660'
The 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.
NC-YK-42
Fields 1-2

SOIL SURVEY
GRAPHIC SCALE
1 " = 660'
660' 0 660'
The 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.
NC-YK-42
Fields 4-5

L f
TOPOGRAPHIC MAP
GRAPHIC SCALE
1" = 1,000'
1,000, 0 1,000,
l '
The 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.
I
N C-YK-42
Fields 1-2

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=1,000'
1,000, 0 1,000-
The 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.
N C-YK-42
Fields 4-5

Q
z
V
VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
The 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
N C-YK-42
locations are approximate.
Fields 1-2,4-5

SYNAGRO, YADKINVILLE CLASS B PERMIT
WQ 0001800
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Yadkinville project by Piedmont Environmental Associates, P.A. on behalf
of Synagro Central, LLC. The evaluations consisted of hand auger borings and
descriptions of the soils on the application sites. All hand auger borings included in this
package were either performed by me or under my direct supervision. All other work
performed for this permit application was conducted by Synagro Central, LLC.
G. Christopher Murray, L.S.S.
No. 1284
Synagro, Yadkinville VVWTP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project: Synagro Yadkinville (WQ 0001800)
% Slope: 4%
Site: Phil Brown
Crop: Forage/Pasture
PIEDMONT
Field: YK-42-1
Conducted By: GC Murray
Coordinates: 36.2198 N
Date: 1/9/2020
ENVIRONMENTAL
-80.5833 W
Soil Series: Clifford
ASS o e I ATE S P. A.
w
N
LU
IL
W
O
_
us
O
=
v ;�
N CN
fn
H N
=
O
O
.n
a
O
cn �'
N
w
C w
N
�+
—,
w O
41
c�
T P1 S
1-5
Eno - -
aaa�o
• •®©e
Legend.
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Seasonal High Water Table:
Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched)
wk weak gr granular f fine -
m moderate pl platy med medium
str strong pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky Moist Consistency
sg single grained fr friable
ma massive vfr very friable
fi firm
vfi very firm

Soil Profile Descriptions in Field Locations
Project: Synagro Yadkinville (WQ 0001800) % Slope: 4%
Site: Phil Brown Crop: Forage/Pasture
Field: YK-42-2 Conducted By: GC Murray
Coordinates: 36.2148 N Date: 1/9/2020
-80.5812 W Soil Series: Fairview
N
N
L
O
O
v
O
O
N
rO,
s
0
m
m
�
r
3
Q
a>
S
N
to
m
S
O
U
K
N
M
c
S
�
PIEDMONT
ENVIRONMENTAL
ASS CC I ATE S, P. A.
w
w c
N
C9 U) I-- N
C VJ
d O
N
r3. i O V lN4
rn rn rn S n n
Ap
0-3
10YR 4/3
-
-
-
-
moist
sl
wk
med
gr
fr
ns
np
Bt
3-29
1 OR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
29-37
1 OR 4/6
-
-
-
-
moist
scl
mod
med
sbk
fi
s
p
C
37-48
1 OR 5/4
-
-
-
-
moist
sl
structureless
fr
ns
np
Legend:
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Structure Grade
Structure Type
wk weak
gr
granular
m moderate
pl
platy
str strong
pr
prismatic
cpr
columnar
abk
angular blocky
sbk
subangular blocky
sg
single grained
ma
massive
Structure Size
f fine
med medium
Moist Consistencv
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparentiperched)

Soil Profile Descriptions in Field Locations
Project: Synagro Yadkinville (WQ 0001800)
% Slope: 3%
Site: Phil Brown
Crop: Forage/Pasture
Field: YK-42-4
Conducted By: GC Murray
PIEDMONT
Coordinates: 36.2358 N
Date: 1/9/2020
P
ENVIRONMENTAL
-80.5886 W
Soil Series: Fairview
ASSOCIATES, P. A.
m
C
N
w
LJJ
N
C.1
W
d �
O
O
C
ti
d C N
U
U)
r
C
V
O
C C U
O
U
.Q
Q
N O
a) U CDy
N
O N
o
m
m
m K
p G) fC
O
O
O y 'o
i
v
S
r n S
S
S
S fY S 1-
rn
rn
rn n n
Ap
1 0-3
10YR 4/3
-
-
-
-
moist
sl
wk
med
gr
fr
ns
np
Bt
3-29
1 OR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
29-37
1 OR 4/6
-
-
-
-
moist
scl
mod
med
sbk
fi
s
p
C
37-48
1 OR 4/8
-
-
-
-
moist
sl
structureless
fr
ns
np
Legend:
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sid
silty clay loam
Seasonal High Water Table:
Structure Grade Structure Structure T . e Structure Size Depth (") Type (apparent/perched)
wk weak gr granular f fine - -
m moderate pl platy med medium
str strong pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky Moist Consistences
sg single grained fr friable
ma massive vfr very friable
fi firm
vfi very firm

Soil Profile Descriptions in Field Locations
Project: Synagro Yadkinville (WQ 0001800)
% Slope: 3%
Site: Phil Brown
Crop: Forage/Pasture
PIEDMONT
Field: YK-42-5
Conducted By: GC Murray
Coordinates: 36.2373 N
Date: 1/9/2020
P
ENVIRONMENTAL
-80.5870 W
Soil Series: Clifford
ASSOCIATES, P. A.
U
w
0
N
LV V
N
s p
p
C
C� +�
=o N
!g�
C7
U)
F- N
v
o
L)
o
U
.Q
a
N V y
Cn
C co
o w.
N r=+ K
G7
Gi
01 x +3+
Ni
V
V
�1O
1
O
O
O
i
VNr
I
n S
S
S
S rV S
n
in
— w
Legend. -
Texture
Structure Grade
Structure Structure Tjge
Structure Size
s sand
wk weak
gr
granular
f fine
I loam
m moderate
pl
platy
med medium
Si silt
str strong
pr
prismatic
sil silt loam
cpr
columnar
c clay
abk
angular blocky
cl clay loam
sbk
subangular blocky
Moist Consistency
scl sandy clay loam
sg
single grained
fr friable
sl sandy loam
ma
massive
vfr veryfriable
sicl silty clay loam
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

State of North Carolina
Department of Environment and Natural Resources
- Division of Water Resources
r LAND OWNER AGREEMENT
'Division 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):
L?"S-ubmit the completed and appropriately executed Residuals Source 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
plicant.
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
ae undersigned landowner or his reprrn
tative hereby permits:
Applicant's name: l � c/r] d �c.�. trZ V., &-
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)
j
fr.�
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
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.
FORM: LOA 06-16 Page 1 of 3

Landowner's Certification:
V
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:
City: &r7A State: / Zip:
Phone: 3- L4 of q E-mail address:
j� Signature: Date:
NORTH CAROLINA, k L6 �_ COUNTY
I, the undersigned Notary Public do hereby certify that D • %%1Hl/f/�
personally appeared before me this day and acknowledged the due execution of the forgoing instrument,-.'-*
AN
WITNESS my hand and official seal this the 4,� Y
day of L• 20 d
Signature and seal
My commission expires: 0 L� ZZ
Lessee's/Operator's Certification:
I certify that I have read this rAgreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name: _ j, my
Address: 6 q 5,7 j)w, t.
J�
City: Eo.6 � f3 ey- _ — State: , e zip
Phone: C > ��j 5 S' E-mail address:
Signature: _ Date:
Permittee's Certification:
a 710 &
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: J_q _ f pin, S ,�„�;.-•
Signature: Date:1-1olo
FORM: LOA 06-16 Page 3 of 3

DWR .
Mvlslon of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
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-Dischar a Permitten 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 caner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source 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
,pplication 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
plicant.
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
.ie undersigned landowner or his representative hereb%� permits:/
Applicant's name: �,�n �c c� k M4&
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)
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 Iand application program and
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.
FORM: LOA 06-16 Page 1 of 3

Landowner's Certification:
j
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.
r-
Landowner name: , j I _
Address:
d -*i1,. L
City: tom- State: Zip:
Phone: Q� ��, E-mail address:
��— tt rr I- _
Date: 2- �1
I, the undersigned Notary Public do hereby certify that hr✓�� %r
personally appeared before me this day and acknowledged the due execution of the forgoing instrument,
VVTI'NESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
Mh
Lk-- 120
l.✓ �r1-s��
SN
�� W FOx,,i'�i
r (�
• �Pv
I certify that I have read this ph
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name: �" h f /�ev to LV
Address: 16g 3 7 11&,Y Y L `-
city: APA.
State: i � �� Zip:
a `7 0 i
Phone: E-mail address:
Signature: Lam+—= 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:
Signature: Date: 3 p
FORM: LOA 06-16 Paee 3 of 3

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Divlslon of Water Resources
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. Lan wner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source 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.
repare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
A icant.
[� 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
he undersigned landowner
or his representative hereby permits:
Applicant's name: I''
o c✓ (
A o 4 l Kl,?
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)
Y
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
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.
FORM: LOA 06-16 Page 1 of 3

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:i%/r
Address: -7 /-fLcJ
City: s c S ` 9t ,4 �.
Phone: 3 SV 5
7
State: Jlt C % 6
Zip:
E-mail address: -Ph: j 4,0-cl4AW O fP- 6i6o 4q"
Signature: s[r �y Date:
NORTH CAROLINA,A COUNT44,1140
�Yy
I, the undersigned Notary Public do hereby certify that C h+ 1 1 J 1� !'O -V t\
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the O4,k
A
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
Z, ;20 2
120
```votI IW IF.*,err
X �r
V ®
err
�TagrftBOCO
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: � q 3 �7
City: y 0 ep-
State: All d
Phone: ;� X /, , )- �e}v [ 5- E-mail address:
. a
Signature: Date:
Permittee's Certification:
Zip:
2-—16 —/,
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: je - e p)]
Signature: � Date: D
FORM: LOA 06-16 Page 3 of 3

Dtvlsion of Wafter Resources
State of North Carolina
Department of Environmental Quality
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 checldng 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 laud 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. L�andd Owner Agreement (FORM: LOA 06-16):
L` 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
r er.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
A 5cant.
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
.i. ne undersigned Iandowner or his represent ive 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 )
Land Use or
Cropping Patterns
PP� g'
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�yf L�
� —1 1
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.
a Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
—Al 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

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: ed
Address: t)p 1 �•A •,�
City:zip: r3 `mod I�
Phone: E-mail address:
X Signature: _ Date:
NORTH CAROLINA, -6 C �l� COUNTY
1, the undersigned Notary Public do hereby certify that 1 ' h '1 _ S!A5j
personally appeared before me this day and acknowledged the due execution of the forgoing
WITNESS my hand and official seal this the 1,0
day of
Signature and seal:
r
W
,zo 1qL
My commission expires: OC-4n �, 2. 'Ali
t
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: 0 14,0 j' r
Address: ' %
City: e-yv State:
zip:'
Phone: 331 It,?, E-mail address:
Signature:`�y _ Date:12
. 142
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: e"
Signature: Date:
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
.AD1vlsion 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 oriiiinal and two co ies 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. Lan er 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 theapplication may be made, as long as the attachments are numbered to correspond to the section and item to which they
r
Prepare a separate agreement for each set of land application sites that are owned or operated b an entity other than e
A-plShicant.
p Y tY ih
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
ine undersigned landowner or his representative hereb permits:
Applicant's name: p �<< •1(
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 M Lease Land Use or
(yes/no) /Cropping Patterns
Intended Use of Crops Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permtttee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
it be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permttee 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 I of 3

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: 0- 42 e- f '
Address:
LJ
City: a---, gel-- cY- State: _ � � � zip:
Phone: 334 .— q 9 S� u- 3 3.3 6 E-mail address:
a 76 /W
Signature: Date: ^- l &
U
NORTH CAROLINA, kj'!l COUNTY
I, the undersigned Notary Public do hereby certify that TI &O% S summ-er � n
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the toy``
day of
Signature and seal: Ix W
My commission expires: (DCA-
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do
Lessee/operator name: _1 i /Ic
, 20 l
AL -"
iy agree to abide by the stipulations and restrictions as specified herein.
)'-J LJ
Address: Rj % l7 4y 67
City: [��v�� State: zip:
Phone: -73& , — T'7-s-'y E-mail address:
Signature: Date: 2 -46 J
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:
Signature: Date:
Ci
FORM: LOA 06-16 Page 3 of 3

NCDA&CS Agn iic Division Phone: [phone] Website: www.n gov/agronomi/
Report No. F SL022011
Heavy Metals
Client: Alex Fox
Synagro
Advisor: Alex Fox
Synagro
284 Boger Rd
g
284 Boger R
oge d
�
A.
��. Soil Report Mehlich-3 Extraction
-� Links to Helpful Information
Mocksville, NC27028
Sampled County: Yadkin
Client ID: 501947
Mocksville, NC27028
Advisor ID: 501947
Sampled: Received: 01 /15/2020 Completed: 01 /21 /2020 Farm: Phil Brown
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results.
Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium
(Cd)- 0.1 ppm, chromium
(Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Note elevated lead (Pb) in samples 2, 3 and 4. Although the above
metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer
recommendations. Tissue testing is suggested where the soil pH is high as in samples found here. Ja athi Kamalakanthan 1/17/2020
Sample ID: 1
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20 Mg S Mn Zn
Cu B
Information
Lime History:
1 -Fescue/OGrass/Tim, M 0.0 120-200 30
40 0 0 pH$ 0
0 0
Note: 12 Note:
2- 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]:
Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-1 Zn-AI
Cu-I Na ESP SS-1 NO3-N
0.27 1.08 7.0 93 0.5 6.7 48 49 78 11
97 117 77 111 111
267 0.1 1
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.1
Nickel, 0.3 Chromium, 0.3 Lead,
4.5 Selenium, 0.1
Sample ID: 2
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20 Mg S Mn Zn
Cu B
Information
Lime History:
1-FescuelOGrass/Tim, M 0.0 120-200 70
10 0 0 pH$ 0
0 0
Note: 12 Note:
2- 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]:
Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-AI2 Zn-I Zn-AI
Cu-I Na ESP SS-1 NO3-N
0.32 0.99 10.0 96 0.4 6.9 30 76 63 29
41 127 79 298 298
100 0.1 1
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.1
Nickel, 0.4 Chromium, 0.2 Lead,
10.8 Selenium, 0.1
North Carolina
Tait CCOTrustFuiiiComirilisslort
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Trox/er, Commissioner of Agriculture

NCDA&CS Agr/ iic Division Phone: [phone] Website: www.r govlagronomi/
Report No.
F SL022011
Alex Fox
Page 2 of 3
Sample ID: 3
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim, M 0.3 120-200 130
110
0 0
0
0
0 0
Note: 12
2- 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-1
Zn-AI
Cu-1 Na ESP SS-1 NO3-N
0.36 0.96 6.5 82 1.2 5.8 5 17 54 26
36 62
54
134
134
73 0.1
2
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.1
Nickel, 0.4
Chromium, 0.2
Lead,
7.1 Selenium, 0.1
Sample ID: 4
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre) N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1 -Fescue/OGrass/Tim, M 0.0 120-200 60
100
0 0
pH$
0
0 0
Note: 12 Note:
2- 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mgldm3]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-AI2
Zn-1
Zn-AI
Cu-1 Na ESP
SS-1 NO3-N
0.36 1.03 7.5 91, 0.6 6.7 32 18 65 25
51 91
61
260
260
85 0.1
1
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.1
Nickel, 0.4
Chromium, 0.5
Lead,
8.1 Selenium, 0.0

NCDA&CS Agra iic Division Phone: [phone] Website: www.n gov/agronomi/ Report No. F 'SL022011
Alex Fox
Understanding the Soil Report: explanation of measurements, abbreviations and units
Page 3 of 3
Recommendations Report Abbreviations
Lime
Ac
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at on
Ca%
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
ESP
Fertilizer
HM%
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of I K-1
Ib/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear
only on reports for greenhouse soil or problem samples.
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients_ In general, homeowners do not
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
ncagr.gov/agronomi/pubs.htm.
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
the exact fertilizer grade recommended on the report, visit www.ncaar.aov/aaronomi/obpart4.htrrrind information that
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
Test Results
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS-1, NO3-N (not routinel
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaor.gov/agronomi/uvrst.htm
K20
Mg%
MIN
exchangeable acidity
boron
% CEC occupied by basic cations
% CEC occupied by calcium
cation exchange capacity
copper index
exchangeable sodium percent
percent humic matter
potassium index
potash
% CEC occupied by magnesium
mineral soil class
Mn
manganese
Mn-All
Mn-availability index for crop 1
Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
M-0
mineral -organic soil class
N
nitrogen
Na
sodium
NO3-N
nitrate nitrogen
ORG
organic soil class
pH
current soil pH
P-1
phosphorus index
P205
phosphate
S-1
sulfur index
SS-1
soluble salt index
WN
weight per volume
Zn-AI
zinc availability index
Zn-I
zinc index

0
r IL

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Divlsion of Water Resources COUNTY BOARD NOTIFICATION
INSTRUCTIONS FOR FORM: CBN 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 notification is intended to provide the county board in which the land application site is proposed to be located with
general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an
opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for
fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review
without a corresponding residuals program application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. County Board Notification (FORM: CBN 11-15):
® Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any
unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may
be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application
sites are located.
B. Critical Watershed Areas Information:
® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed
areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas.
® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
https://deq.nc._ov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection-pro rgram
❑ If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call [phone].
C. Notification Package Submission:
® Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to
the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the
notification package also be sent to the County Manager.
® The most current publication of the Directory of State and County Officials may be downloaded at:
https://www.s2s .gov_/publicationsldirect.aspx
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
httg://deq.nc.gov/contact/regional-offices.
® The source facility summary shall include: facility name; county where it is located; and the proposed annual dry tonnage
(i.e., a copy of "Residuals Source Facility Summary" is adequate but not required).
® The land application site summary shall include: field ID; acreage; county where it is located; latitude and longitude (i.e., a
copy of "Land Application Site Certification" is adequate but not required).
D. Proof of Submission:
® Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the
Division for review.
INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of 1

North Carolina Department of Environmental Quality
-at McCrory Donald R. van der Vaart
Governor Secretary
Date: 03/3/20
Name of Chairman to the Board of County Commissioners: Kevin Austin
Complete mailing address: 2100 Hoots Rd
City: Yadkinville State: NC Zip: 27055
County where land application sites are located: Yadkin
From: Applicant's name: Town of Yadkinville (on behalf of the Division of Water Resources in accordance with
Session Law 2013-340)
Contact person and title: Alex Fox TSS
Complete mailing address: 284 Boger Rd Mocksville
City: Mocksville
Telephone number: [phone]
State: NC Zip: 27028
E-mail address: afox e,syna rg o.com
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
will ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals-
anerating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: Winston Regional Office
Complete mailing address: 450 West Hanes Mill Rd Suite 300
City:. Winston-Salem
Telephone number: [phone]
State: NC Zip: 27105
Expected date of application submission: 03/05/2020
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: http://ioortal.nodenr.ora/weblwa
An Equal Opportunity 1 Affirmative Action Employer— Made in part with reoyc!ed paper
FORM: CBN 06-16

Alex Fox
rom: UPS Quantum View <[e-mail]>
Sent: Wednesday, March 4, 2020 10:27 AM
To: Alex Fox
Subject: UPS Delivery Notification, Tracking Number 1Z51 F78W0107170783
Your package has been delivered,
Delivery Date: Wednesday, 03/04/2020
Delivery Time: 10:20 AM
At the request of SYNAGRO - MOCKSVILLE this notice alerts you that the status of the shipment listed
below has changed.
Shipment Detail
Tracking Number:
1Z51F78W0107170783
KEVIN AUSTIN
KEVIN AUSTIN
Ship To:
2100 HOOTS RD
YADKINVILLE, NC 27055
US
UPS Service:
UPS NEXT DAY AIR
Number of Packages:
1
Weight:
0.5 LBS
Delivery Location:
GARAGE
ABSHER
Reference Number 1:
20-2360-30-60-4310 50-0055
Download the UPS mobile aoo
1

© 2020 United Parcel Service of America, Inc. UPS, the UPS brandmark, and the color brown are
trademarks of United Parcel Service of America, Inc. All rights reserved.
All trademarks, trade names, or service marks that appear in connection with UPS's services are the
property of their respective owners.
Please do not reply directly to this email. UPS will not receive any reply message.
Review the UPS Privacy Notice
For Questions, Visit Our Help and Support Center
01

C7
:�