WQ0003902_Application_20200204

Permit Number WQ0003902
Program Category
Non -discharge
Permit Type
Land Application of Residual Solids (603)
Primary Reviewer
ranveer.katyal
Coastal SWRule
Permitted Flow
Facility
Facility Name
City of Newton Residuals Land Application Program
Location Address
PO Box 550
Newton
Owner
NC 28658
Central Files: APS _ SWP
2/10/2020
Permit Tracking Slip
Status Project Type
In review Major modification
Version Permit Classification
H Individual
Permit Contact Affiliation
James Dusty Wentz
Director Public Works
PO Box 550
Newton NC 28658
Major/Minor Region
Major Mooresville
County
Catawba
Facility Contact Affiliation
Owner Name Owner Type
City of Newton Government - Municipal
Owner Affiliation
E Todd Clark
City Manager
PO Box 550
Dates/Events Newton NC 28658
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/30/1983 2/4/2020
Regulated Activities Requested /Received Events
Wastewater treatment and disposal Region comments on draft requested
Region comments on draft received
RO staff report received
RO staff report requested 2/10/20
Outfal l
Waterbody Name Streamindex Number Current Class Subbasin

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
TODD CLARK — CITY MANAGER
CITY OF NEWTON
PO Box 550
NEWTON, NORTH CAROLINA 28658
Dear Mr. Clark:
NORTH CAROLINA
Environmental Quality
February 10, 2020
Subject: Acknowledgement of
Application No. WQ0003902
City of Newton RLAP
Residuals Management System
Catawba County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on February 4, 2020. Your application package has been assigned the
number listed above, and the primary reviewer is Ranveer Katyal.
Central and Regional Office staff will perform a detailed review of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Ranveer Katyal at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: Mooresville Regional Office, Water Quality Regional Operations Section
Permit File WQ0003902
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1617 Mail Service Center I Raleigh. North Carolina 27699-1617
Depll-1, Envirun .1 DuNI_Iel� 919.707.9000

State of North Carolina
Department of Environmental Quality
Division of Water Resources
DWR NON -DISCHARGE BRANCH
Division of Water Resources BUDGET OFFICE PAYMENT INFORMATION FORM
February 10, 2020
To: Antoine Pope, Budget Office
From: Kendall N. Williams, Water Quality Permitting Section — Non -Discharge Branch
Permit Number: WQ0003902
Applicant: City of Newton
Fee Category: Non -Discharge Minor
Batch Number: PR-20150113-02
Check Number: 860009641
Check Date: 11/27/2019
Payer: Synagro Technologies, Inc.
Attach payment here:
Permit Type: Land Application of Residual Solids (503)
Project Type: Renewal with Major Modification
Application Fee: $395 - Major Modification
Payment Amount: 3$ 95-00
Method: Check
Payment Received Date: 02/04/2020
Reference #:
FORM: NDPU-BOPI 09-15 Page 1 of 1

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water 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 on inal an icatiori and
sunnortins documentation
NCe DE/D R
For more information, visit the Water Quality Permitting Section's Non -Discharge ermi�tn Unit
0 4 FEB 2P20�
General — This document is an agreement between the Applicant and land owner(s) o residuals receiving sites or and applica ion of
Class B residuals (may include water treatment plant or other type residuals) in a rdance vv(h 1� C 02T� o not
unurge
submit this agreement for review without a corresponding application form (FOR : RLAP
Unless otherwise noted, the Applicant shall submit one original and two copies of the a
below.
A. Land Owner 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.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
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)
Gq-z r - i
gyres
V
ak,A,1/ <1
jr.
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 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: W t 1 S on - Wad l 1 c k4-aA m. L L G
Address:
City: }�f E-}Q_s&L State: zip: ,10811V
Phone: 3w. ci(9 . �v �J E-mail address: Fb r 4- LAne- s �Zz_-Q
& S, . ed U.
Signatures:. Z r1 - Date: _ �Zoz Z�
or W; ISo d 1 is KC ahm) LL
NORTH CAROLINA, C ftl PIW 6 ft COUNTY
1, the undersigned Notary Public do hereby certify that �v1 tRh A 0 (?, A ✓� amP_ �0i(UAP- 0.V4 aV+f`&
Vj xv, \ G
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the �� `��I1 i I I I I I///"
dayof �O.�uar� ,20 2— SW
Signature and seal:
4e `t W s PUBLIC'
My commission expires: S_ t 3— Z. 0 Z 4 ��? 4
Lessee's/Operator's Certification:
/COU1\�A
I certifv that I have read this Agreement and doherebyagree
lt/o► abide by the stipulations and restrictions as specified herein.
Lessee/operator name: 4r/J ��✓ t f` _
Address:. 7"(0 1
City: , �.//.,, State: Y ' �' zip:
Phone: , q'60- 772'— E-mail address: rDwL,�lm 2e� 1�4��: r •���
Signature:Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing offi
Signature:
FORM: LOA 06-16 Page 3 of 3

PART 2: CERTIFICATION
By my signature below I hereby certify, under penalty of law, that this document and all attachments were
prepared under my direction or supervision in accordance with a system designed to assure that qualified
personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations.
I am also aware that the contents of this document shall become an enforceable part of the NPDES MS4
Permit, and that both the Division and the Environmental Protection Agency have NPDES MS4 Permit
compliance and enforcement authority.
® I am a principal executive officer or ranking elected official.74
C E IVED
❑ lam a duly authorized representative and have attached the autho zation maNeWrRir� principal
executive officer or ranking elected official which specifies me a : L, FEB 2070
❑ A specific individual having overall responsibility for stc rMwater matters.
Non -Discharge
❑ A specific position having overall responsibility for store iwater tters.
Fe'rm ittine Unit
Signature:
Name:
E . Todd Clark
Title:
City Manager
Signed this 27`h day of January, 2020.
NCS000397 SWMP
City of Newton
January 27, 2020
Page 2

Ors,,O C /
SYNAGRO
Application For Renewal of
Permit INII, WQ0003902
Land Application of City of Newton., NC
7
Residuals VVED
NCDEQ/D-;lv,R
FEB 2020
Prepared b�*:
Aiex �Ox
Snagro Central, LLC
�SA Sap V er Road
i
hucks,'�IEO-:NC 2-!028
P 336-998-115"0, � 336-998-8450

January 21, 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: RENEWAL OF CITY OF Newton LAND APPLICATION PERMIT
WQ0003902
Dear Mr. Thornburg:
Synagro Central I1C is submitting a request to modify a land application program for
residuals generated by the City of Newton Wastewater Treatment Plant. One original and two
copies of this application to renew the referenced residuals are included. We are adding 5 brand
new sites along with Lt-119 is adding one more field to that site. The new sites are CA-25, CA-
27, CA-28, CA-29, and CA-47. As of right now there 541.1 acres remain in the program. We are
adding 167.32 acres to bring us to a total of 708.42.
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)-703-868t I look forward to working with you to ensure a timely and efficient
review of this application.
Sinc rely,
Alex Fox
Technical Services Specialist
Synagro Central, LLC

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge 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.
The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b}_
If this project is for a modification of an existing permit, submit one copy of the existing permit.
❑ Please -submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
1 Facility Classification New Permit Major Modification'__I
fMajor (land are permitted for > 300 acres) F_ $1,310 $395
Minor (land are permitted for < 300 acres) $810 $245
' - 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)
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 1C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Pagel 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.
n 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 Linder the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
® Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
® Plans must include the following minimum items:
Z 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).
Z Delineation of the review and compliance boundaries
Z 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: http://www.ncwater.orz!Rules_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 .I 104(d)(2l. For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: hUp://www.ncwater.orglRules Policies and _RRe ulations/.
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
Bv U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Deliver%:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Newton
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State 2 Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Todd Clark Title: City Manager
Applicant's mailing address: P.O. Box 550
City: Newton State: NC Zip: 28658
Telephone number: [phone] Email Address: telark&ewtonnc.gov
2. Consultant's name: Alex Fox License Number (for P.E.):
Affiliation: ❑ On Staff 0 Retained (Firm: Synagro Central LLC.)
Consultant's mailing address: 284 Boger Rd
City: Mocksville State: NC Zip: 27028
Telephone number: [phone] Email Address: afox@,ssynagro.com
3. Agronomist's name: _— License Number:
Affiliation: ❑ N/A ❑ On Staff ® Retained (Firm: Piedmont Environmental)
Agronomist's mailing address
City: State: NC Zip:
Telephone number: (_) = Email Address:
4. Soil Scientist's name: Chris Murray License Number: 1284
Affiliation: ❑ N/A ❑ On Staff E Retained (Firm: )
Soil Scientist's mailing address:: 216 S. Swing Rd. Suite 1
City: Greensboro State: NC Zip: 27028
Telephone number: [phone] Email Address: [e-mail]
5. Fee submitted: (See Instruction B)
Il. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: E00003902
Date of most -recently issued permit: June 1- 2015
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page 1 of 5

II1. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 1407 McKay Farm Rd.
City: Newton State: NC Zip: 28658
Coordinates: Latitude: 35' 37' 40" Longitude: 81' 14' 03"
Datum: NAD83 Level of accuracy: Map
Method of measurement: Second
2. County where residuals land application program is headquartered: Catawba
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Mike Cox
Synagro
13191
Back -Up ORC
Robert Roth
Synagro
1001672
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: Alex Fox Spring, 2020
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitroten 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: 3438 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
13.00
19.52
44686
67102
Five -Year Maximum Adjusted
17.20
23.72
59147
81562
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
27.5
Hay
21.4
Pasture
492.2
Total:
541.1
Methods
Surface
541.1
Incorporation or Injection
0
Total:
541.1
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
(lhs PANIac 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
893.7
1342
1182.9
1631.2
100
446.9
671
591.5
815.6
150
297.9
447.3
394.3
543.7
200
223.4
335.5
295.7
407.8
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 ofNorth 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): n 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.
H
Land Application Siite
Certification.doc
FORM: RLAP 06-16
Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505(n) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended Recommended
Loading Rate Loading Rate
(in/hr) in/vr
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
[l 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
ft
Wetted area of nozzles
ft2
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):
fhe 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.
Z Yes ❑ No; Explain;
(Signature Authority's Name — PL(E�ASE PRINT)IL
attest that this application for 1tr W''��
(Facility Name)
A
(Title)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and §143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: /30
/,0,7—
FORM: RLAP 06-16 Page 5 of 5

0
9

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Divlslon of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two conies of the application and
sunuortine documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
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 06-16 or FORM: SDR 06-16).
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 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ For new or renewed permits, submit the requested information for all land application sites.
® For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
County Board
✓
Notification. doc
Land Owner
Agreement
(If applicable)
Im✓
✓
✓
✓
Setback Waiver
Agreernt
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"
✓
INSTRUCTIONS FOR FORM: LASC 06-16 Page 1 of 3

An updated accounting of the land application site's cumulative
7
�
I
pollutant loading rates(CPLRs)
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 Policy"
Acknowledgement of field transfer from Land Owner (Fields may not
be ermitted to multiple Permittees over the same timeperiod)
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
® New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Mere (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: hfp://den.nc.gov/about/divisions/water-
resources/planning /classification-standards/classifications
® Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq.nc.gov/contact/reQional-offices
® General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deq.nc.aov/about/divisions/water-resources/Tlanninglclassification-standards/classifications.
® Stream Classification Process: One of the options below may be used depending on the known initial project information.
® KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple tuns.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

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 term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams enterine. 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."
Wata a River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall cant' 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 06-16 Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Newton
Land application sites currently certified: 541.1 net acres and Total to be certified: 708.4 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
Site/Field
ID
Landowners
�)
Lessees or Operator(s)
�)
Net Acres
CountyCrop(s)
s
pi)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slope
N
CA-25-1
Crary Dellinger
40.8
Catawba
Fescue, Corn, Wheat
Popular forest
N
CA-27-1
Jason Little
7.5
Catawba
Fescue pasture/Hay
Fairview
N
CA-27-2
Jason Little
22.8
Catawba
Fescue pasturc/Hay
Fairview
N
CA-27-3
;lason Little,
11.7
Catawba
Fescue pasture/Hay
Clifford
N
CA-28-1
Larry_ Brown
4.9
Catawba
Fescue pasture/Hay
I Clifford
N
CA-29-1
I{ennethArrowwood
20.7
Catawba
Fescue pasture/Hay
Clifford
N
CA-47-6
Sharon S Rhoney
Randy Leatherman
9.6
Catawba
Corn, Beans, Wheat
Lloyd
N
CA-47-7
Sharon S Rhoney
Randy Leatherman
6.6
Catawba
Corn, Beans, Wheat
Lloyd
N
CA-47-8
Stephanie Bolick Morgan,
Randy Leatherman
28J
Catawba
Corn, Beans, Wheat
Lloyd
N
LT-119-5
[Gordy Goias
13.9
bneoln;
Fescue Hay,
�doy4
FORM: LASC 06-16 Page 1

LAND APPLICATION SITE CERTIFICATION
status uoae for Lana application sites are: ♦ N (New) ♦ K (Kenewed) ♦ M (Mori ttcd) i 1('Iransterred) ♦ D (Deleted)
t Soil Series Name (i.e. Appling, Cecil, etc.)
'Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
II. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Class Proposed
CA-25-1
350 40' .959"
810 2' .351"
NAD 83
MAP
Nearest Second
Terrapin Creek 11-81-(-1)
WS-IV
WS-IV
CA-27-1
35° 45' 51.83"
810 9' 56.62"
NAD 83
MAP
Nearest Second
Lyle Creel 11-76-(3.5)
WS-IV
WS-IV
CA-27-2
35° 45' 46.96"
81° 9' 45.28"
NAD 83
MAP
Nearest Second
Lyle Creel 11-76-(3.5)
WS-IV
WS-IV
CA-27-3
350 45' 46.53"
810 10' 2.35"
NAD 83
MAP
Nearest Second
Lyle Creel 11-76-(3.5)
WS-IV
WS-IV
CA-28-1
350 45' 22.45"
810 6' 31.92"
NAD 83
MAP
Nearest Second
Catawba River 11-(74)
WS-IV;CA
WS-IV;CA
CA-29-1
35' 48' 24.72"
810 11'
NAD 83
MAP
Nearest Second
fakers Creek 11-76-3
C
C
CA-47-6
350 38' 12"
810 23' 4"
NAD 83
MAP
Nearest Second
Jacob Fork 11-129-2-(9.5)
WS-III
WS-III
CA-47-7
35' 38' 10"
810 22' 5 1 "
NAD 83
MAP
Nearest Second
Jacob Fork 11-129-2-(9.5)
WS-III
WS-III
CA-47-8;
35.37.42
81.30.42
NAD 83
MAP
Nearest Second
Jacob Fork 11-129-2-(9.5)
WS-III
WS-III
LT- 119-5i
35.32.46'
81.18.2&
NAD 83
MAP
Nearest Second
Ntt Creek 11-129-3(0.7)'
WS-IV
'WS-IV
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16 Page 2

11

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
Dh4slon 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 PermWbig 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:
hgps•//deq nc Gov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection-program
® 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:
hops://www.sosnc. eov/publications/direct.as px
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
hn://deq.nc.gov/contact/reE!ional-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 l of 1

North Carolina Department of Environmental Quality
Pat McCrory Donald R,, van der Vaart
Governor Secretary
Date: 01 /21 /2020
To: Name of Chairman to the Board of County Commissioners: Randall Isenhower
Complete mailing address: 1537 Little Hill Road
City: Newton State: ITC Zip: 28658
County where land application sites are located: Catawba
From: Applicant's name: City of Newton (on behalf of the Division of Water Resources in accordance with Session Law
2013-340)
Contact person and title: Eric Jones Waste Water Superintendent
Complete mailing address: 1407 McKay Rd
City: Newton State: NC Zip: 28658
Telephone number: (82$)-217-4457 E-mail address: ejones u�7.newtoanc.gov
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 -
generating 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: NC DEQ Mooresville
Complete mailing address: 610 East Center Ave Suite 301
City: Mooresville State: NC Zip: 28115
Telephone number: [phone]
Expected date of application submission: 1/24/20
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: 919M7-64641 Internet: htiy9portal.ncdenr.org/web/m
An Equal Opportunity 1 Affirmative Action Employer— Made in part with recycled paper FORM: CBN 06-16

State of North Carolina
DW.
RDepartment of Environmental Quality
Division of Water Resources
Division 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:
hops://deg.nc.eov/about/divisions/water-resources/water-resources-rules/water-supph•-watershed-protection-prob am
® 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:
bttps://www.sosnc.p,ov/publications/direct.aspx
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
htip://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 pjior 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
Pat McCrory Donald R. van der Vaart
Governor Secretary
Date: 01/21/2020
To: Name of Chairman to the Board of County Commissioners: Caroll Mitchem
Complete mailing address: 7868 Hallman Mill Rd
City: Vale
State: NC Zip: 28168
County where land application sites are located: Lincoln
From: Applicant's name: City of Newton (on behalf of the Division of Water Resources in accordance with Session Law
2013-340)
Contact person and title: Eric Jones Waste Water Superintendent
Complete mailing address: 1407 McKay Rd
City: Newton State: NC Zip: 28658
Telephone number: (828. -21] 7-4457 E-mail address: e}onesQnewtonnc.gov
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 -
generating 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: NC DEQ Mooresville
Complete mailing address: 610 East Center Ave Suite 301
City: Mooresville
State: NC Zip: 28115
Telephone number: [phone]
Expected date of application submission: 1/24/20
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 Penritting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: httn://Portal.ncdenr.org/webtwq
An Equal Opportunity 1 Affirmative Action Employer— Made in part with recycled paper
FORM: CBN 06-16

Alex Fox
From: UPS Quantum View <[e-mail]>
Sent: Thursday, January 23, 2020 10:37 AM
To: Alex Fox
Subject: UPS Delivery Notification, Tracking Number 1Z51 F78W0196074701
Your package has been delivered.
Delivery Date: Thursday, 01/23/2020
Delivery Time: 10:34 AM
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At the request of SYNAGRO - MOCKSVILLE this notice alerts you that the status of the shipment listed
below has changed.
Shipment Detail
Tracking Number:
Ship To:
UPS Service:
Number of Packages:
Package Weight:
Delivery Location:
Reference Number 1:
1ZSIF78WO196074701
CAROLL MITCHEM
7868 HALLMAN MILL RD
VALE, NC 28168
US
UPS NEXT DAY AIR
1
0.5 LBS
GARAGE
20-2360-30-60-4310 50-0055
1

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Alex Fox
From: UPS Quantum View <[e-mail]>
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To: Alex Fox
Subject: UPS Delivery Notification, Tracking Number 1751F78W0199626896
Your package has been delivered.
Delivery Date: Thursday, 01/23/2020
Delivery Time: 09:22 AM
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At the request of SYNAGRO - MOCKSVILLE this notice alerts you that the status of the shipment listed
below has changed.
Message from SYNAGRO - MOCKSVILLE of SYNAGRO - MOCKSVILLE:
CATAWBA COUNTY NOTIFICATION
Shipment Detail
Tracking Number: 1Z51F78W0199626896
RANDALL ISENHOWER
Ship To: 1537 LITTLE HILL RD
NEWTON, NC 28658
US
UPS Service: UPS NEXT DAY AIR
Number of Packages: 1
Package Weight: 0.5 LBS
1

Delivery Location: FRONT DOOR
Reference Number 1: 20-2360-30-60-4310 50-0055
101
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trademarks of United Parcel Service of America, Inc. All rights reserved.
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11

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 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 Sections 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 Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
r fer.
repare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
VA copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby/hermits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
/� " . ' `
., /
%•✓ CID
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

SITE SUMMARY
City of Newton, Clark Creek WWTP
Newton, NC
Site ID:
CA-25
Name:
Gary Dellinger
Address:
495 Hopewell Church Rd
Catawba, NC
Phone:
704-201-4079
Operator:
Address:
Phone:
Estimated
Applicable
Fields Acres Crop(s)
Predominant Latitude &
Soil Series Longitude
1
40.8
Fescue, Corn, Wheat
Popular Forest
35.7088 N
-81.103 W
TOTALS 40.8
Notes:
Date: 11 /4/19

APPLICATION MAP
I pr_pnln
APPLICATION AREA
UNSUITABLE AREA
— —�— —�—
PRIVATE ROAD
W
WATER
GRAPHIC SCALE
STREAM
'I" = 660'
ONSITE HOUSE
DRAIN
660' 0 660'
OFFSITE HOUSE
X
FENCE
OUTBUILDING
PROPERTY LINE
WELL
SOIL BORING
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-CA-25
Field 1

SOIL SURVEY
GRAPHIC SCALE
V = 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-CA-25
Field 2

Q
z
V)
TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=1,000'
1,000- a 1,000'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-25
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 1

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
locations are approximate.
`4 n J, A r s ~�
n„
N C-CA-25
Fields 1-2

NCDA&CS Agr nic Division Phone: [phone] Website: www.n gov/agronomi/
Report No. F-SL006843
Client: Gary Dellinger
Advisor: Alex Fox
Heavy Metals
f 4'
965 Hopewell Church Rd
Catawba, NC 28609
Synagro
284 Boger Rd
f r�$ Mehlich-3 Extraction
Soil Report
Mocks ille, NC
Sampled County: Catawba
k"t6ir•�""� Links to Helpful Information
Client ID: 493739
Advisor ID: 501947
Sampled: 09/16/2019 Received: 09/27/2019 Completed: 10/02/2019 Farm: NC-CA-25
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). 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. Jagathi Kamalakanthan
10/2/2019
Sample ID: 1
Recommendations: Lime
Nutrients (Ib/acre)
More
Crop (tons/acre) N P2O5
K2O Mg S Mn Zn
Cu B
Information
Lime History:
1 -Corn, grain 2.0 120 - 160 140
50 0 0 0 6
0 0
Note: 3
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% WfV CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI
Cu-I Na ESP SS-1 NO3-N
0.22 1.03 4.7 38 2.9 4.7 3 42 19 15
54 125 92 22 22
47 0.0
Heavy Metals (parts per million): Arsenic, 0.3 Cadmium, 0.0
Nickel, 0.3 Chromium, 0.3 Lead,
3.1 Selenium, 0.0
Sample ID: 2
Recommendations: Lime
Nutrients (lb/acre)
I More
Crop (tons/acre) N P2O5
K2O Mg S Mn Zn
Cu B
Information
Lime History:
1 -Corn, grain 0.4 120 - 160 130
10 0 0 0 0
0 0
Note: 3
2 - 0.0
Test Results [units - WIV 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-1 Mn-All Mn-Al2 Zn-I Zn-AI
Cu-1 Na ESP SS-1 NO3-N
0.60 0.99 8.4 80 1.7 5.8 5 73 63 13
72 1266 777 49 49
64 0.1 1
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.3 Chromium, 0.2 Lead,
3.8 Selenium, 0.1
. North Carolina
1
ToWc(oTrusl Fund tveninBskm
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 Troxler, Commissioner of Agriculture

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton VVVVTP 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, Newton WWTP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project: Lincolnton Permit (WQ 0002712) % Slope: 2%
Site: Dillinger Farms Crop: Forage/Pasture
Field: Dillinger Farms Field 1 Conducted By: GC Murray
Coordinates: 35.7088 N Date: 9/16/2019
-81.1030 W Soil Series: Poplar Forest
N
N
O
O
U
O
O
T /'1
S
S
d
U
�
d
�
r
.0 N
Q in
d m
w
S S
O
U
x
IV
la
S
x
PIEDMONT
ENVIRONMENTAL
A i i O C 1 A T■ :. P. A.
W
CI LV U
N }
O y
m :r
V V V •' 'rU�+
� � 7 N V N
L o
rn rn 1 - S n
Ap
0-4
7.5YR 4/4
-
-
-
-
moist
sl
I mod
med
gr
fr
ns
np
AB
4-11
1 OR 4/8
-
-
-
-
moist
sl
mod
med
sbk
fi
s
Bt
11-31
1 OR 4/8
-
I
-
-
-
moist
c
wk
med
sbk
fi
s
p
BC
31-42
1 OR 4/8
-
-
-
-
moist
scl
wk
med
sbk
fi
s
C
42-48
1 OR 4/8
-
-
-
-
moist
sl
wk
med
sbk
fr
I ss
sp
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 Tyoe
Structure Size
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
Seasonal High Water Table;
Depth (") Type (apparent/perched)

r7
LJ

State of North Carolina
WDepartment of Environmental Quality
r, - Division of Water Resources
�r 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
D[vision 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 note the A licant 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 caner Agreement (FORM: LOA 06-16):
ubmit 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 e application may be made, as long as the attachments are numbered to correspond to the section and item to which they
fer.
P pare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
pplicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lesseeloperator.
AGREEMENT FOR TIM LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: l..Jt O Jet.✓ �ot)
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)
(Y )
Land Use or
Cropping Patterns
pp g
y !
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.
its Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
stiall 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 sites) as specified
herein.
Landowner name:
r
;"/4 5
Phone: 5�_6/ T 4 .7!5 E-mail address:
Signature: Date:.
NORTH CAROLINA, CAf 1 A COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument����, ­]( W
WITNESS my hand and official seal this the
$ }�
day of
Signature and seal:
4"-- �1-�
My commission expires: OL r 2 Z, p2C) f y
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
I certify that I have read this Agreement and do hereby
Signing official name:
Signature:
Zip:
Date:
to abide by the stipulations and restrictions as specified herein.
Date:
0
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Dlvislon 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 orip_inal and two conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Dischatye 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 .I100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed 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
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned land ner r his repres tative hereby permits:
Applicant's name: i 0T "., a,�,
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 Land Use or
(yes/no) Cropping Patterns
A,%
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�{
t7'
11
r ( 1 �cG-
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
11. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(hl allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary-. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
olnpliance boundary to the application package)
A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: . is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 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•�!:A,{rF.R'"
Address: g e 7 2 a Pa 9 td i e 9 T
City: / Q M Q !il # i! State: _ f [i _ _ Zip: __9
Phone: ��� �� E-mail address:
Signature: &A441 Date:
NORTH CAROLINA, its he 61 COUNTY
I, the undersigned Notary Public do hereby certify that ti V,
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
�`% rr�i
JAX IV
WITNESS my hand and official seal this the 20 J��
day of Alt,vs-fw 6-e e_— _ 20�„�
Signature and seal: QQ�x��1x]V J*
My commission expires: V ZZ oZ
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16 Page 3 of 3

l
WeN 011
APPLICATION MAP
APPLICATION AREA
UNSUITABLE AREA
ROAD
WATER
—--n—n�— PRIVATE
— STREAM
ONSITE HOUSE
— DRAIN
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
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'

SOIL SURVEY
GRAPHIC SCALE
1" = 660'
660' 0 660'
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.
N C-CA-27
Fields 1-3

U
z
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.
N C-CA-27
Fields 1-3

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
locations are approximate.

TOPOGRAPHIC MAP
•; k.'-..,,Far �.,� 1
�' ,.�''�'- �,.•.. �.,�.,,� i i ..ems ■ � :,�• ---
� t � "w�,�r ��■~ail.. '"'- '�1
-1` ' f
IT
•�
■ ! `" �I
s '
,� � I y~� ✓r ,� J ■ � 4 f I
I t Yf
^ i w
7e * • t �r� i � � �
GRAPHIC SCALE
1" = 660'
660' 0 660'
1 1
� is ■.w I
1
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-27
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-3

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY20-ZiL017112
Client: Jason Little
Advisor: Alex Fox
a`y''r11 Heavy Metals 5104 River Bend Rd
Claremont, NC 28610
Synagro
284 Boger Rd
- SoilMehlich-3 Extraction
Report
Mocksville, NC 27028
Sampled County: Catawba
�k'�"J•r' Links to Helpful Information
Client ID: 504791
Advisor ID: 501947
Sampled: 11/14/2019 Received: 11/26/2019 Completed: 12/02/2019 Farm: CA-27
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). 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. Jagathi Kamalakanthan
12/2/2019
Sample ID: 1
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonslacre) N P205 K20 Mg S Mn Zn
Cu B
Information
Lime History:
1-Fescue/OGrass/Tim, M 0.5 120-200 60 0 0 0 0 0
0 0
Note: 12
2- 0.0
I
Test Results [units - WN in g1cm3; 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-I Zn-AI
Cu-1 Na ESP SS-1 NO3-N
0.32 0.92 5.9 78 1.3 5.6 33 230 32 26 204 142 102 68 68
55 0.1 2
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.2 Lead,
5.3 Selenium, 0.2
Sample ID: 2
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonslacre) N P205 K20 Mg S Mn Zn
Cu B
Information
Lime History:
1 -Fescue/OGrass/Tim, M 1.6 120-200 130 50 0 0 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-AI2 Zn-I Zn-AI
Cu-1 Na ESP SS-1 NO3-N
0.41 0.95 4.3 44 2.4 4.9 6 47 23 16 160 112 84 17 17
65 0.1 2
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.3 Lead,
3.7 Selenium, 0.1
Nonh Carolina
[Tohicco Trust Fund tW, n1kss14vn
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 Troxler, Commissioner ofAciriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr,gov/29ronomi/ Report No. FY20-aL017112
Jason Little Page 2 of 3
Sample ID: 3
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tonslacre) N P206
K20
Mg S
Mn Zn Cu
B
Information
Lime History.
1-Fescue/OGrass/Tim, M 1.2 120-200 40
0
0 0
0 0 0
0
Note: 12
2 - 0.0
Test Results [units - W/V 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-I Zn-AI Cu-I
Na ESP SS-1 NO3-N
0.92 0.93 8.4 73 2.3 5.4 40 185 46 16
55 260
173
86 86 72
0.1 1
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.1
Nickel, 0.4
Chromium, 0.2
Lead, 5.6
Selenium, 0.1

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY20-aL017112
Jason Little Page 3 of 3
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Lime
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
ton/acre or lb/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 tonfacre (50 Ib/1000 sq ft) at
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full i
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Fertilizer
Recommendations for field crops or otherlarge areas are listed separately for each nutrient to be added (in units of
lb/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-1 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 forsmall 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.ncagr.c/ov/agronomi/obtart4.ht ind information that
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizei
Test Results
Report Abbreviations
Ac
B
BS%
Ca%
CEC
Cu-I
ESP
HM%
K-1
K20
Mg%
MIN
Mn
Mn-All
Mn-AI2
Mn-1
M-O
N
Na
N 03-N
ORG
pH
P-1
P205
S-1
SS-1
W/V
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The Zn-AI
remaining 16 [P-1, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-Al2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine) Zn-I
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncacraov/aaronomi/uvrsthtm
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
manganese
Mn-availability index for crop 1
Mn-availability index for crop 2
manganese index
mineral -organic soil class
nitrogen
sodium
nitrate nitrogen
organic soil class
current soil pH
phosphorus index
phosphate
sulfur index
soluble salt index
weight per volume
zinc availability index
zinc index

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton WVVTP 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, Newton V1MifP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project: Newton Permit (WQ 0003902) % Slope: 4%
Site: Jason Littles Crop: Forage/Pasture
Field: Field 1 Conducted By: GC Murray
Coordinates: 35.7648 N Date: 11/14/2019
-81.1660 W Soil Series: Fairview
O O
v
c
O O
c
U U
o
m
N
T n
S S
P! EDNONT
ENVIRONMENTAL
A i 3 0 G 1 A r! f, P.A.
m
0
.r+
w
N
w
}
d
N
N O
of ci x
-0
S S No
y
U)
S
i
u' L
n
L
in
L
n
N
S
Ap
0-6
10YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
6-32
2.5 YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-40
2.5 YR 4/6
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
40-48
10R 516
-
-
-
f -
moist
scl
wk
med
sbk
fi
ss
sp
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
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
Seasonal High Water Table:
Structure Size Depth (") Type (apparent/perched)
f fine - -
med medium
Moist Consistencv
fr friable
vfr veryfriable
fi firm
vfi very firm

Soil Profile Descriptions in Field Locations
Project:
Newton Permit (WQ OD03902)
% Slope:
4%
Site:
Jason Littles
Crop:
Forage/Pasture
Field:
Field 2
Conducted By:
GC Murray
Coordinates:
35.7633 N
Date:
11/14/2019
-81.1629 W
Soil Series:
Fairview
N
N
t
O
O
V
O
O
U
U
O t
x
m
0 °;
S
s0
PIEDMONT
ENVIRONMENTAL
Ass 6 Q I Arm z. P. A.
o
C V
w
w
N
w
u
C
O
0 0
Is; sr,,
`
o
s
O L
k
L
L
L
A
0
.r
o
s
Ap
1 0-5
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
AB
5-11
7.5YR 4/6
-
-
-
-
moist
scl
mod
med
gr
fr
ns
np
Bt
11-37
2.5 YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
37-43
2.5 YR 4/6
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
43-48
10R 5/6
-
-
-
-
moist
scl
wk
med
sbk
fi
ss
sp
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
Seasonal High Water Table:
Structure Size Depth (") Type (apparent/perched)
f fine -
med medium
Moist Consistency
fr friable
vfr veryfriable
fi firm
vfi veryfirm

Soil Profile Descriptions in Field Locations
Project:
Newton Permit (WQ 0003902)
% Slope:
5%
Site:
Jason Littles
Crop:
Forage/Pasture
Field:
Field 3
Conducted By:
GC Murray
Coordinates:
35.7623 N
Date:
11/1412019
-81.1675 W
Soil Series:
Clifford
y
N
O
O
v
=
O
O
C
U
U
O L
�(
d
rC r�i
S
S
PIEDMONT
ENS' - 3 MENTAL
ASSOCIATE!, P.A.
Q
C C)
CO
0
.+
�
wLU
N
f/i
C
H
i
a
d
)
•C
G N
m m K
S S N
w
S
K 3
L
rn
7
L
ran+
7
L
rn
O
U
S
���
aaa�rm
• •
��®©a
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
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
Seasonal High Water Table:
Structure Size Depth (") Type (apparent/perched)
f fine -
med medium
Moist Consistencv
fr friable
vfr very friable
fi firm
vfi very firm

0

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 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 oriErinal and two copies of the a lication 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 wner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
fer.
0111p"repare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
A licant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landor&/
r or his repres tative hereby permits:
Applicant's name: 1-1
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 ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilUover-seed!
pasture)
Z �
/
,�/
/ t f
��j� l r'tes�C�
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
'shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 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. A n
Landowner name: ZX OLIM ff-,-e-6 `"�
Address:
City: 10
/Fr, -
State: Zip:$��
y(omene: • 2 rqS E-mail address:
Signature: 4— Date: 1 0 • 3 �' y
NORTH CAROLINA, —COUNTY
I, the undersigned Notary Public do hereby certify that )__e, rry � (y,✓r}
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the �����.0 W
day of UC� ie
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
l./
Z z, av2
120.
l
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
I certify that I have read this Agreement and do herebyagree to abide
Signing official name: ,, Jr. ly G(OI( (2_(ar'
Signature:
Zip:
Date:
the stipulations and restrictions as specified herein.
Date: _ %fjaf oaoAd
FORM: LOA 06-16 Page 3 of 3

w
Ir r)
1--4
Lf
APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
WATER
— — — — — — PRIVATE ROAD
— — — STREAM
ONSITE HOUSE
— — DRAIN
■
OFFSITE HOUSE
—-- FENCE
OUTBUILDING
PROPERTY LINE
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-CA-28
Field 1

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.
N C-CA-28
Field 1

TOPOGRAPHIC
r
■
30
^mow
ti
tf
III
t�.
GRAPHIC SCALE
1"=660'
660' 0 660'
1 '
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.
Hwy+
NC-CA-28
Field 1

0
U)
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
[ a
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,

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.govlagronomi/ Report No. FY20-61-017111
awe= Client: Larry A Brown Advisor: Alex Fox
.Wj I
r'F Heavy Metals 4459 Lookout Dam Rd Synagro
Catawba, NC 28609 284 Boger Rd
Soil Report Mehlich-3 Extraction Mocksville, NC 27028
Sampled County: Catawba
Links to Helpful Information
Client ID- 448081 Advisor ID: 501947
Sampled; 11/18/2D19 Received: 11/26/2019 Completed: 12/02/2019 Farm: CA-28
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). 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. Jagathi Kamalakanthan
12/2/2019
Sample ID: 1
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonslacre) N P2O6 K2O Mg S Mn Zn Cu B
Information
Lime History:
1-Fescue/OGrass/Tim, M 0.0 120-200 130 50 0 0 0 0 0 0
Note: 12
2 - 0.0
Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dn�]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.32 0.93 7.1 86 1.0 6.3 5 44 50 32 181 53 44 26 26 44 0.1 1
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.0 Nickel, D:5 Chromium, 0.1 Lead, 2.5 Selenium, 0.1
Noah Carolina
ie�harctr vusf f uroJ C(4m5i6skua
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 Troxier• Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY20-6L017111
Larry A Brown Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations Report Abbreviations
Lime
Ac
exchangeable acidity
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
boron
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%
% CEC occupied by basic cations
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%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or otherlarge areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
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
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1
Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
M-O
mineral -organic soil class
notations appear on the soil report, refer to Note: Secondary Nutrients and Micronutrients_ In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.gov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations forsma/l areas, such as home lawnslgardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncapr.pov/agronomi/obpart4.htmsCind information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowners Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
WN
weight per volume
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
2n-AI
zinc availability index
remaining16 P-I K-I Ca% M % Mn-1, Mn-All, Mn-Al2 Zn-I Zn-AI, Cu-I, S-I SS-1, Na ESP SS-1,NO3-N (not routinel
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www•ncagrgov/agronomi/uyrst.htm

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton WVVfP 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, Newton WVVfP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project: Newton Permit (WQ 0003902) % Slope: 3%
Site: Larry Brown Farm Crop: Forage/Pasture
Field: Davis Farm Field 1 Conducted By: GC Murray
Coordinates: 35.7567 N Date: 11/14/2019
-81.1091 W Soil Series: Clifford
UI
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PIEDMONT
ENVIROMMENTAL
A i s O C 1 A T! s. P. A.
W
WUi v
N iL
0
Legend.
Texture
Structure Grade
Structure Type
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 very friable
sicl silty clay loam
fi firm
vfi veryfirm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

LJ
E
0

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Al
Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
sup[wrting documentation
For more information, visit the Water Quality Permitting Section's Nan-Dischar e 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 .I100. 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. Lano Owner Agreement (FORM. LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form_ If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
efer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
/pplicant.
ram"/A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his repre ntative hereby permits:
Applicant's name: � f .D J�C. ,1,0
hereinafter referred to as the Permittee, to land apply residuals from
application site(s) (i.e., see attached setback maps) in accordance with
Agreement:
the following facility(ies) onto the following land
the stipulations and restrictions as given in this
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
L`
�•'N� l
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
! this Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel 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:
Address:
City: C�-�ii l- 12r 4� r State: _IVIL
Phone: 0 E-mail address:
Signature,- I Date:
NORTH CAROLINA, w 7 s%.VUj h COUNTY
I, the undersigned Notary Public do hereby certify that K,Alld rI� �/"ro �✓voC:
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of D✓4'" -ee
Signature and seal: & L✓
My commission expires: OC-4
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
I certify that I have read this
Signing official name: --d
Signature:
State:
E-mail
Date:
Zip:
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date:
FORM: LOA 06-16 Page 3 of 3

T
Z
y
V)
1
APPLICATION MAP
LEGEND
AREA
UNSUITABLE AREA
APPLICATION
��W�
WATER
- — — — — - PRIVATE ROAD
- STREAM
ONSITE HOUSE
DRAIN .
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
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'
N C-CA-29
Field 1

z
V)
SOIL SURVEY
GRAPHIC SCALE
1"=660'
sso' o sso'
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-CA-29
Field 1

1-�
TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=800'
600, 0 600,
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-CA-29
Field 1

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
locations are approximate.

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomc Report No. FY20-5L017109
aut,crc'a, Client: Kenneth Arrowood Advisor: Alex Fox
'r. Heavy Metals 4391 Hall Dairy Rd. Synagro
Claremont, NC 28610 284 Boger Rd
Soil Report Mehlich-3 Extraction Mocksville, NC27028
Sampled County: Catawba
Links to Helpful Information
Client ID: 153187 Advisor ID: 501947
Sampled: 11/14/2019 Received: 11126/2019 Completed: 1210212019 Farm: LA-29
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). 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. Jagathi Kamalakanthan
12/212019
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 0.8 120-200 50 0 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-AI2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.66 0.99 6.0 71 1.7 5.5 37 110 37 25 141 108 82 83 83 74 0.1 2
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.1 Nickel, 0.3 Chromium, 0.2 Lead, 4.8 Selenium, 0.1
North Carolina
�. , J
k63cact Tfust f wd C(misrisclom
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 Troxier, Commissioner of Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY20-aL017109
Kenneth Arrowood Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations I Report Abbreviations
Lime
Ac
exchangeable acidity
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
boron
ton/acre or lb/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
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 onf
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-1
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-I
potassium index
Ib/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
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
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only an reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
M-0
mineral -organic soil class
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients. In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
neagr.gov/agronomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawnslgardens, are listed in units of Ib/1000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncacrr.pov/apronomi/obhart4.htr, stand information that
P-I
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
WN
weight per volume
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-AI
zinc availability index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-1, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www•ncagr.uov/agronomi/uvrst.htm

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton WWTP 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, Newton VVVVTP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project:
Newton Permit (WQ 0003902)
% Slope: 3%
Site:
Ken Arrowood
Crop: Forage/Pasture
PIEDMONT
Field:
Field 1
Conducted By: GC Murray
Coordinates:
35.8072 N
Date: 11/14/2019
ENVIRONMENTAL
P
-81.1914 W
Soil Series: Clifford
Ass 6 c i A T e s. P.A.
(n
c
1
�'
LL
0
14
rn
h
Vi
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V
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O
C
O
N
p
m
d
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Q
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++
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2
Ap
1 0-2
1 7.5YR 4/41
1
1-1
-
moist
I sl
I mod
I med
I gr
fr
ns
np
AB
2-10
7.5YR 4/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
10-38
2.5 YR 4/611
moist
cl
mod
med
sbk
fi
s
p
BC
38-48
2.5 YR 4/611
moist
scl
mod
med
sbk
fi
s
p
Legend.
Seasonal High Water Table:
Texture
Structure Grade
Structure Type
Structure Size
Depth ("} Type (apparent/perched)
s sand
wk weak
gr
granular
f fine
-
I loam
m moderate
pi
platy
med medium
si silt
str strong
pr
prismatic
sil silt loam
cpr
columnar
�+�`•r.� xK 7 `
c clay
abk
angular blocky
cl clay loam
sbk
subangular blocky
Moist Consistency
%; z ''•
scl sandy clay loam
sg
single grained
fr friable
sl sandy loam
ma
massive
vfr very friable
Sid silty clay loam
fi firm
vfi very firm
��

0
0

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Dlvlslon 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. Land Owner 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.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landown r or jis represen 2�tiveheereby
Applicant's name:✓
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application sitc(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
N .'47 - & 7
Ye S
Z;, . Cm
,--. (
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months alter termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a. residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105 h allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
©.ri re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: _ is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 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:
Address: b 4�j
City: 4- State: NC Zip: 4 �h
NORTH CAROLINA, TAW 4"
I, the undersigned Notary Public do hereby certify that
Date: / 9- o.
5
personally appeared before me this day and acknowledged the due execution of the forgoing instrument
WITNESS my hand and official seal this the arA O
X
day of / 20,20
Signature and seal:
My commission expires: �G� .21 2,6VY _ yNou 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:
Address: dL4, /,4 _
City: State: rI ,Zip:
Phone: -70�/ - �3`� - V'Y 7.3 E-mail address:
Signature: �r _ Date: 1VrZ20
Permittee's Certification:
I certify that I have read this Agreement and do hereby -agreee to abide by the stipulations and restrictions as specified herein.
Signing official name: - t �AJ_ 6kr-k-
Signature: _ _ - Date: .20
FORM: LOA 06-16 Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 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 e 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):
2"'Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
pplicant.
copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: _ ,/ }�y �,e .✓1r)
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)
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittce receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 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: raw J� ^� Q �C9K"}T3{�
i Address::-.T.�' ll I V-\fVAC: �r 1'\Y lAn0, L)eXA
J
City4kkQ.,%t rN ir State: _OC-,,, Zip: _r�� -X.
Phone: e t 1 E-mail address:l(Y�ti((�CkVyln��fl_�`�ii�%®(Mg
_T \r
Signature: `• . �!'-`Date: + . _
NORTH CAROLINA, _ la v COUNTY
I, the undersigned Notary Public do hereby certify that +.di t ��p l%� i,�►rL
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this they}�
day of eY �,- .120
Signature and seal: `-�
My commission expires: c2k,�- '21vL eta Y
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address: Is Z Z.
City: _ �!. �L 7 r State: /VC— Zip:
Phone: �� r "� . } E-mail address:
Signature: �.. _Date: 3�
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 off
Signature:
FORM: LOA 06-16 Page 3 of 3

APPLICATION MAP
'A - -
VV 11 r � •
l7
6% ti.' 1,
LEGEND
APPLICATION AREA UNSUITABLE AREA
— — — — — — PRIVATE ROAD CD WATER GRAPHIC SCALE
STREAM ® ONSITE HOUSE
1" = 660'
sso' o sso'
DRAIN OFFSITE HOUSE
FENCE ❑ OUTBUILDING
PROPERTY LINE 0 WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-47
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 6-7

R

SOIL SURVEY
} � R •sr i
1 i
`1
7
r" S
.g wsRti � R� fr
GRAPHIC SCALE
1"=660'
660, o sso,
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-47
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 6-7

SOIL SURVEY
GRAPHIC SCALE
1 " = 660'
sso' o sso'
�i ■� ti i
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
NC-CA-47
locations are approximate. 1 Field 8

VICINITY MAP
A`4
ca�
4�
77
'53
GRAPHIC SCALE
V = 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
locations are approximate.

TOPOGRAPHIC MAP
1.0
GRAPHIC SCALE
V=800'
800, 0 800,
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-47
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 6-7

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton WWTP 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, Newton VVWTP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project:
Lincolnton Permit (WQ 0002712)
% Slope:
2%
Site:
Randy Leatherman Farm
Crop:
Forage/Pasture
Field:
Leatherman Farm Field 6
Conducted By:
GC Murray
Coordinates:
35.6371 N
Date:
9/16/2019
-81.3838 W
Soil Series:
Lloyd
y
N
O
O
V
O
O
c
U
U
o
x
m
«+
NL.
++
T n
S
S
PIEDMONT
ENVIRONMENTAL
ASSOCIATES. P.A.
w
Q W lL V
NIL
�:
r N
= U N
7 v c Mtn
N O c
Q co U m O `� L O
m v x +M.
O O y O O ; O
S S N S rn rn en S
aaa�o
• • ME
"Mr,
®©o
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 (apparent/perched)

Soil Profile Descriptions in Field Locations
Project:
Lincolnton Permit (WQ 0002712)
% Slope:
2%
Site:
Randy Leatherman Farm
Crop:
Forage/Pasture
Field:
Leatherman Farm Field 7
Conducted By:
GC Murray
Coordinates:
35.6358 N
Date:
9/16/2019
-81.3809 W
Soil Series:
Lloyd
�
N
s
O
O
c
U
U
c
O L
K
d
N_ +,
0
M
O
T Y9
S I
S
PIEDMONT
ENVIRONMENTAL
A s s O C I A r m s. P. A.
0 N 0.
0 lA F— y
Q co m v m O
m m x
O O p x L ` N
S S M S d in m n s
�■
WRIT
aaa■E•�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
Structure Grade
Structure Toe
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 (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: Lincolnton Permit (WQ 0002712) % Slope: 2%
Site: Randy Leatherman Farm Crop: Forage/Pasture
Field: Leatherman Farm Field 8/9 Conducted By: GC Murray
Coordinates: 35.6272 N Date: 9/16/2019
-81.3427 W Soil Series: Lloyd
M
N
O O
U
O
O
c
U U
O
25 d
.N ar
C ++
00 n
S 0
m
d
tca
a
�
C
L)
U)
N
O
Q (n
U
d G7
x
L
O
N
+y+ w
K
S S
N
S
PIEDMONT
ENVIRONMENTAL
ASSOCIATE:, P.A.
w
w 0
N
U) H N
L O N
7 3 7 N Ul
i V {�
:n �n •n S n
•
��
vaa�®
� •
��®mom
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
Structure Grade
Structure Tyne
Structure Size
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 veryfriable
fi firm
A veryfirm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

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NCDA&CS dy,onomic Division Phone: [phone] Website: www.nL..9r.gov/agronomi/
Report No. FY20-6L006841
Randy Leatherman
Page 3 of 4
Sample ID: 8
Recommendations: Lime
Nutrients (tblacre)
More
Crop (tons/acre) N P2O5
K2O
Mg S Mn
Zn
Cu B Information
Lime History:
1 -Corn, grain 0.0 120 - 160 0
50
0 20 0
0
0 0 Note: 3
2 - 0.0
Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NOS-N in mg/dm3]:
Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-1 K-I Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2 Zn-I
Zn-AI
Cu-I Na ESP SS-1 NO3-N
0.41 1.24 6.3 82 1.2 6.1 95 44 61 17
22 316
205 156
156
283 0.0
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0
Nickel, 0.5
Chromium, 0.3
Lead,
4.5 Selenium, 0.1

�J
0

State of North Carolina
D� W.
Department of Environmental Quality
Division of Water Resources
ADivision of Water Resources
J 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Laild Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
Pfer.
repare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
t. pplican
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
_e undersigned landownerjr his represeative hereby permits:
Applicant's name: Jr M —A-a
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/F'ield ID
Lease
e
(y s/no)
:LaudUse or
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 Iand 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
1 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

Landowiaer'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: &*r Ay ._d
Address: � � � � )4,+ Ln
City: GLitt, t.,-L k a . �' (, State: ✓ zip:
Phone: a ��ti 3 �_'�'f _ E-mail address:
Signature: ,( [9�� _ Date:
NORTH CAROLINA, _ j�njg ItA COUNTY i
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the s _
day of a _ 120
Signature and seal:
My commission expires: 0G
Lessee's/Operator's Certification:
�o t
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State: Zip:
E-mail
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing off
Signature:
FORM: LOA 06-16 Page 3 of 3

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
ca)
WATER
- - - - - -
PRIVATE ROAD
-
STREAM
ONSITE HOUSE
-
DRAIN
OFFSITE HOUSE
FENCE
OUTBUILDING
--
PROPERTY LINE
(
WELL
(�
SOIL BORING
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.
<�.
v
ti
GRAPHIC SCALE
1"=660'
660' 0 660'
1
NC-LT-119
Field 5

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=660'
660' 0 660'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC-LT-1 19
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All -
locations are approximate. Field 5

14�
VICINITY MAP
1 aW
,y
r�
4
N
a
GRAPHIC SCALE
1" = 2,000'
2,000' 0 2,000'
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.

SYNAGRO, NEWTON CLASS B PERMIT
WQ 0003902
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Newton WVTFP 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, Newton WV\fTP Project, Various Fields

Soil Profile Descriptions in Field Locations
Project:
Newton Permit (WQ 0003902)
% Slope:
3%
Site:
Gordy Goins Farm
Crop:
Forage/Pasture
Field:
Goins Farm Field 1
Conducted By:
GC Murray
Coordinates:
35.5467 N
Date:
11/14/2019
-81.3074 W
Soil Series:
Lloyd
N
N
t
O
O
v
O
O
f)
tU
O Z
k
G7
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES. P.A.
w
w
C U (:i 0 H N
7 d C � i C
N O
Q N V � •O.. � i� O
Oi
+�'+ 7 y
L AlL L
S S fY S rn n n S
M • •
N���©0
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 Typ
wk weak
gr
granular
M moderate
pi
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 (apparent/perched)

NCDA&CS Agronomic Division Phone: [phone] Website: www.rit,-,Ir.gov/agronomi/ Report No. FY20--;oL017108
f,5 k;'L-R,.Q Client; Gordy Goins Advisor:
` lx Heavy Metals 2924 Blackburn Bridge Rd / 1489 Ed
Craig Lane
Soil Report Mehlich-3 Extraction Vale, NC 28168
Links to Helpful Information Sampled County: Lincoln
Client ID: 284170 Advisor ID:
Sampled: 11/14/2019 Received: 11/26/2019 Completed: 12/02/2019 Farm: Lt-119
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). 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. Jagathi Kamalakanthan
12/2/2019
Sample ID: 1
Recommendations: Lime Nutrients (Ib/acre)
More
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1 -Fescue/OGrass/Tim, M 0.0 120-200 130 70 0 0 0 $ 0 0
Note: 12 Note:
2 - 0.0
Test Results [units - WIV 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-Al2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N
0.32 1.06 5.1 79 1.1 5.9 5 33 51 25 43 1642 1002 24 24 52 0.1 2
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 1.0 Chromium, 0.1 Lead, 3.4 Selenium, 0.1
North Carolina
T&acco Trust fund Cthmuesslrna
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 Troxler, Commissioner ofAcI iculture

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