WQ0001863_Regional Office Historical File Pre 2018 (5)

COMPLETE•
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C. Date of Delivery
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1. Artiole Addressed to:
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2. Article Number-....-__.
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PS Form_ 3811, February 2004 Domestic Return Receipt �o2595 i' ,�59_o,.i
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September 15, 2014
kD Alex Patton
Lincoln County Chairman, Board of Commissioners
115 West Main_: Street
Lincolnton, NC 28092
ATTN: Mr. Patton
Ln
REFERENCE: Modification of Permit No.-WQ0001863
City of Mount Holly -
Land Application 'of Residual Solids -Permit
Dear Mr. Patton,
Synagro: is submitting, on behalf of the City'of Mount Holly, an application to the State of
.:North Carolina's: Department of Environment and Natural Resources to modify the City's
residuals land application permit. Listed below are the requested modifications to the existing
permit as:they pertain to land application sites. in your county.
• Adding acreage. to site NC7.LT=46 (approx. 9.6 acres
This letter and state form (CBN 11-13) are being sent to:you in accordance with the rules and
regulations mandated by the North Carolina Department of Environment and Natural
Resources. The enclosed form should contain :all of the information that is necessaryto
inform you of the requested modification. However, if you require additional information or
-:have further questions about the included information, please contact me immediately.My
contact information is included below:.
Kind regards,
Drew Culp
Technical. Services Specialist
Synagro Central, LLC
.(704)-574-5291.
laculpt�synagro.com
Enclosures: CBN 11-13 form, site summary, vicinity map, and list of sources of material
12701 Lancaster Hwy Pineville, NC 28134
Phone: [phone] Fax: [phone]

SITE SUMMARY
City of Mt Holly
Mt. -Holly. NC
1
11.8
Fescue
..
209
Cecil
(CeB2)
:35 24 32 N
81 02:27 W
2 -.-
45.2 -- .
Fescue.
209
Cecil
(CeB2)
35 2442 N
81 02 06 W
3
9.9
Fescue
-
209
Cecil::
(CeB2)
35:24 22 N
81 02 51 W.,:
4
19.4
Fescue
Cecil.
(CeB2)
35.24.29 N
81 02 07 W
5 '
7.9
Fescue-
176
Lloyd
(LdC2)
35 24 56 .
N
81 01::52 W
6:
5.4
Fescue
188
Pacolet
(PeB2)
35 24 50 N .
Al 00 50 W .
7
7.0
Fescue
188
Pacolet
(PeB2)
35-26-35 N
f.81 00 29 W.-
8
6.6
Fescue
209.
Cecil.
(CeB2)
35.24 21 N
81 02 28 W
9
2.3
Fescue
158
Pacolet
(PeC2)
1. 35 26 44 N .
81 00:31 W

10.
7.3
Fescue
216
Lloyd
(LdB2
35 24 38 N
81 01.37 W

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State of North Carolina
Department of Environment and Natural Resources
Division of Water. Resources
v1slon of Water Resources
LAND OWNERAGREEMENT
FORM: LOA 1143
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 website at:
h
portal, ncdenr.or /wg eb/wq/aps/lau
General — This document is an agreement between the Applicant and land owner(s):of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do:not
submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
Unless otherwise noted, the Applicantshall submit one original and two copies of the application -and supporting documentation listed
below.
A. - Land Owner Agreement (FORM: LOA 11. 3):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) 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: c. % i-v vtC /1' W ni . 11-0//y
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:
Lease:::: Land Use or :....... Residuals Source; Special note -
Site/Field ID Intended Use of Crops (no-till/over-seed
(yes/no) Cropping Patterns_ (optioriaq pasture)
A�on��9l Fig ,
60-1/- Po
landowner or his representative receives, in consideration, full use of the. nutrient value of the applied residuals while the
nittee receives, in consideration; the use of the land application site(s) described above for the -disposal of the residuals.
Tfi s 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 11-13 Page 1 of 3

I. STIPULATIONS::.
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified -by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of.this Agreement.
5 ;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 Permitted 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 providethe_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 theland application sites) 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 Permitted 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. Th& 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 Ieachate, surface water, groundwater; or soil samples during the
term of, and 12 months after termination of, this Agreement. qs
-.
kr.'RESTRICTIONS:
1. Appropriate measures must betaken by the Permitted 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 fora 14-
month period following a residuals land application event.
so
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 l2=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: i 01r 0 (o s l o; I W-)
(Please include the rationale for the requestedre-location of the complianceboundaryand-attach a .map. showing the newly proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV ,kCKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
] The land: application fields) ID:::.:: . ....... is currently permitted under: another
., residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s)_ be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 11-13 PaoP o of

State of North Carolina
DRepartment of Environment and Natural Resources
Division of Water Resources
_ .. ....:=':a•:>;.
ulslon of Water Resources. LAND OWNER AGREEMENT
FORM: LOA 11=13
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
supoorting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
htfp://portal.ncdenr.br lwg eb/wq/aps/lau
General - This document is an agreement between the Applicant and land owner(s) bf 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: REAP 11-13).
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 11713):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) 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:
t✓ i fy . of Myun f %o /ly
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:... :.:.. .
Lease::::.:: Land Use or Residuals Source
Special note .
Site/F.Wd ID (yes/no) Cropping Patterns: Intended Use of Crops (optional) (no-till/over-seed/
:: pasture)
Fe a
MAY /P.+.s e:. 4. tsC N+%. Wl
i landowner or his representative receives; in consideration, full use of the:nutrient value of the applied residuals while the
--1-nittee receives, in consideration; the use of the land -application sites) 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 11-13 Pagel 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.
~ 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;
q
Ej�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 tothe application package)
❑ A re -defined compliance boundary is not: needed for this site.
,V. 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: ofthe new program)
FORM: LOA I I -II Nap nfI

Landowner's. Certification:
I certify that I .am a deeded landowner of the above -referenced land application site(s) and am authorized to. make decisions.
regarding the use of the land application site(s) on behalf of:other deeded landowners OR. that I am otherwise authorized, through
a power of attorney or other legal delegation; to. make decisions regarding the use of the land application sites) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included.in any waste disposal contract or
agreement with. another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,.
understand the stipulations, restrictions,:alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the. Perm_ ittee to land apply residuals to the land: application site(s) as specified
herein:
Landowner name:
r �
Address: ZZ IA.), ale. E�
City: State: I V Zip: 2i �? 2 0 .::..
Phone: E-mail address: N4) 5r
Signature: i ... `.. Date:'
NORTH CAROLINA, 67,9-im j COUNTY
I, the undersigned Notary Public do hereby certify that %0m&3o��i.�
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal -this the f 6�
day of ew, be , 20... 1
" Signature and seal:
0 JOHN A. CULP
My commission expires: i/ — i 3 ` 1
AT" PUBUC
MecMenhn County
NoRh Carofina
Lessee's/Operator's Certification: My Comw4aden Expires 04/13/2019
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:
:Zi City: State: p:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
. ....... .......
I certify that I have read this Agreement and do hereby agree io abide by the stipulations and restrictions as specified herein.
•Y1- A . s I ._. . . —
Signing off,
icia ai
Signature:
j
FORM: LOA 11-13
Page 3 of 3

State of North_ Carolina
Department of Environment and Natural Resources
C:-- Division of -Water Resources .
Division of Water Resources SETBACK WAIVER AGREEMENT (FUR RESIDUALS PROGRAM)
FORM: SWA 11-13
- _... -. ...... _.. ...... ......
Please use the following instructions as -a checklist in order to ensure all required items are submitted: Adherence to these
instructions, and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application,; : Unless otherwise noted, the Applicant shall submit one original and two conies- of the _application and -
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website.at.­
htW:l
/ZjortaLncdenr.or/wg eb/tivq/a sp /lau
General - This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application.
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b) 2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13)..
A: Setback Waiver Agreement:
❑ :Submit the completed and appropriately executed Setback Waiver. Agreement (FORM: SWA 11-13) 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 properly from which a waiver :is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced' above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
-The undersigned property owner hereby -permits:
Applicants name: L 1 l l y Uy .
Applicable Field ID:: R44,1.f ti
wq­
hereinafter referred to as the Permittee, to land apply residuals within feet (i.e., cannot be less than 100 feet) of
the residence or place:of public assembly located at the following: rope ""
Location address of P � ��� l^�'J Y#✓e-
property- .::...
City: /�� %�%C'� State: Al .. Zip: 5 I ✓20
This Agreement shall, remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and: shall be renewed each time this permit is renewed. In addition, this Agreement: shall only
remain in effect for as long as the undersigned property owner owns the property described herein..
The undersigned property owner agrees to abide by this Agreement until such time'as Written notification; given 30 calendar
days in advance, modifies or cancels this Agreement:-
[v�I certify that I am a deeded property owner of above -referenced property and .am authorized to make. decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I ;have read and understand: this Agreement and do
hereby grant permission to the Permittee to land -apply residuals to land application site(s) as specified herein.

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State of North Carolina
Department of Environment and Natural Resources:
Division of Water Resources
dlslon of Water Resources. LAND OWNER AGREEMENT
FORM: LOA 1143
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 notedahe Applicant shall submit one original and two copies of the application and
supborting documentation
For. more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
hh4://portal.ncdenr,org/iveb laps/lay
General = This. document is an agreement between the Applicant and land owner(s)of.f residuals receiving sites for land application of
Class B residuals .(may include water treatment plant or other type residuals) in- accordance with 15A NC AC 02T .1100. Do not
submit this agreement: for. review without a corresponding application form (FORM: . AP 11-13).
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: L A = :
Z. Submit the completedand appropriately executed Residuals Source Certification (FORM: LASC 11-13) form: Please do not
make any unauthorized. content changes to this form. If necessary for clarity, or due to space restrictions, attachments toahe.
application may be made, as, long as the attachments are numbered to correspond to the section and item to which they refer.
1 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:
E
... AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
Ci lfo16y
hereinafter referred to as the Permittee, to land apply residuals from the following facility(leg).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:
S note
te
Lease:- Land Use or Residuals Source
Site/Field ID (yes/no) Cropping Patterns (optional)
Intended Use of Crops (no-till/over-seed/
.:pasture)
No
landowner or his representative receives, in consideration, full use of the -nutrient value of the applied residuals while :the
nittee 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,-.1.0 A 1 1-11 Page 1 of 3

I. STIPULATIONS:.
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified. by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions: of this Agreement.
it .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 theland 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 patternsifor
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 necessaryleachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
_.. RESTRICTIONS:
1. Appropriate measures must betaken by the Perrnittee::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 aresiduals 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 or 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months. prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12=month period following a residuals land application event.
I.H.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: G .
(Please include the rationale for the requested re -location of the compliance boundary and attach a map . showing the newly . proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed) ...
❑ The land application field(s) ID::..: is currently permitted under:another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the fields) be removed from the --previously permitted residuals land application program and transferred
into the new program;
(Name of.the new'program)
-FORM: LOA 11-13 pa op o of I

SITE SUMMARY
City of Mt Holly
-
Mt: Holly. NC
Site I'D:
NC=GA-44
Owners Name:
George -Bennett Allen
Address:.
2552 Lincolnton H
Cherryville, NC 28021
Phone:
704-435-5345 (home),
704=691-9497 (cell)
Operator:... ..
Same ... .
_> Estimated
Gaston Co.
- Predominant
Applicable -
Annual PAN . .
Soil Series
Latitude and
Fields Acres
Crop(s)LB/AC/YR
Lon itude
escue
e:
35 23 59 N .
.
81 1948W.
TOTALS : 6.8
Notes.:
Date:
.09/22/14

y
Applicati
c_ NC-GA-44

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Soil Map
Site Nr..r..A.Ad

-
State of North Carolina
Department of Environment and -Natural Resources
Division of Water. Resources
dslon of Water Resources. .. LAND OWNER AGREEMENT
FORM: LOA 11=13
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 l o 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 aoolication and
suyoorting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
lino:/portal.ncdenr. org/web/wg/aps/lau
General — This document is an agreement. between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals .(may include water treatment plant or other _type residuals) in accordance with 15A NCAC 02T .1100. Do not, .
submit this agreement for review without a corresponding application: form (FORM: RLAP 11=13).
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 11713)i - - -
® Submit the completed.and appropriately executed Residuals Source Certification (FORM: LASC 11-13) orm. Pease 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: ► fy.:: v Dun. -=: . o y -----
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)
S ecial note
P
(no-till/over-seed/
' : pasture)
9/lCA
landowner or his representative receives; in consideration, full use of the.nutrient value of the applied residuals while.the
.nittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
... ........
'this Agreement shallremain in effect for the length of the Division's permit for the residuals land applicationprogram 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 11-11 Paae 1 of3

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 Permitted 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 Permitted 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 lofficials or their representatives to; enter and
inspect any property; premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance. with the permit;, establish, monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
RESTRICTIONS:
.a.
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 Arid 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;
0 A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
[� A re -defined compliance boundary is not needed for this site.
IV, ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
The land application field(s) ID: -.is currently permitted under another
residuals land application program;,Permit Number WO- The land owner hereby acknowledge -that by signing this
Agreement, he/she is -requesting that the fields be removed from the reviousl permitted residuals land application program and transferred
1p' 9 g O.. previously P PP P g
into the new program;
(Name of the new program)
'FORM: LOA 11-13 PaLye 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 aegal 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 she(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,
�
E.
Landowner name: � Il A V r 9 ::
Address:
City: - .e ms IV'j, � �� State: -ems C_­ Zip:
Phone::: 7a 4 — / / t ..- �j33,�� E-mail address:
Signature: v1 Date;
NORT 7CAROLINA'- 6/}S'&A/ - ' : : COUNTY
_. 1, the undersigned Notary Public d'hereby certify that �}vld Alley
ersonall appeared before: me this dayand acknowledged the due execution of the forgoing instrument.
P ....... Y PP
S
WITNESS my -hand and official seal; this the --
day. of J'Al V 20-
Signature and seal:
My.commission expires: .
- .0 3 o JOHN A. CULP .
PUBLIC
Mecklenbu►g County
.
Lessee's/Operator's Certification: Ply Comm eslon NikhCaiolina
Expires 04/13/2019
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
essee operator Name:
Address:: .
:City State: Zips
Phone: E-mail address:
Signature: Date: .
Permittee's :Certification:
I certify that I ave read this A eement and do hereby agree to abide. by the stipulations and restrictions as specified herein.
Signing official in
Signature: Date B d
FORM: LOA 11-13
. I Nae. I of l

State of North Carolina
Department of Environment and Natural Resources
,-- - -' Division of Water Resources
Division of Water Resources. SETBACK WAIVER.AGREEMENT (FOR RESIDUALS PROGRAM)
FORM:- SWA 11-13
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 bones 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 oriuinal and two copies of the application and .:
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
http /portal ncdenr. org1weblwglaos/lay.
pp.General - This document is an agreement between the Applicant and the owner(s) of thR property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of. public assembly not owned by the permittee or not to be
maintained as part of project. site(s) in accordance :with 15A NCAC 02T .1108(b)(2)[for habitable residences or place of. public
assembly only]. Do. not submit this agreement;for review Without a corresponding application form (FORM:: RLAP 11-13). .
A.- Setback Waiver Agreement:
2 Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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 property from which a waiver-.is.being sought.
Any other setbacks required by 15A NCAC 02T .1108, other than _those referenced above, cannot be waived through. .
execution of this agreement.
A copy of the completed and executed agreement must be provided to the property owner. .
° AGREEMENT TO WAIVE THE SETBACK- REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
- i The undersigned piroperty owner hereby permits:
Applicant's name:
y-
Applicable Field ID NL` ` (A - q S o I .
hereinafter referred to as the Permittee to land apply residuals within feet (i
.e., cannot be. ess than 100 feet). of :.. ,
the residence or place of public assembly located at the following:
Location. address of property: eAJ
5 e� �t+i1. State: �VG Zip: Oa/6
City: - Se G."
This Agreement shall remain in effect for the length of the Division of Water Quality's (Divisfion) permit for the residuals.;
land application program and: shall be renewed each time this perinit :is. renewed. In addition, this Agreement: shialh only
�.ti,.. Y
remain in effect for as long as .the undersigned property owner owns the property described herein.
- The undersigned: property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
d7I
in advance, modifies or. cancels this Agreement:
certify. that I am a deeded property owner. of above -referenced property and .am authorized to make decisions regarding this,:
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to- land. apply residuals to land application site(s) asspecified herein.
Property owner name:
Signature: Date: 7 :� JAI
FORM: SWA 11-13
Page 1 of I

SITE SUMMARY
t
City of Mt Holly
Mt. Holly, NC_
Site ID:
- NC-GA-45
Owners Name:
op
David Allen
Address:
110 Helton.:Rd.
Cherryville,- NC 28021
Phone: .
...
_.: 704-616-9333 (cell)
p.
Operator.
Same.:_: .
-
Estimated
-- ---
Gaston Co.: predominant
Applicable--
Annual PAN Soil Series
Latitude and
Fields :
-Acres
Crop(s) (LB/AC/YR)
Longitude
1
17.0 -
Fescue::
216 :.:
Lloyd (LdB2)
35 22 47 N _ . .
81 17 10 W
TOTALS
Notes: .
Date:
09/23/14

0
z
V)
Legend.
- Stream ■ OnSiteHouse 'G, OnsiteWell
S x — x - Fence ■ OffSiteHouse l OffSiteWell
PropertyLine ■ OffSiteHouse(SWAA) Unsuitable
ApplicationArea Outbuilding.
Site - NC-GA-d.5
1 inch = 660 feet
(all locations approximate)
The compliance boundary Is established at
either 260 feet from the residuals application
area or 60 feet within the property boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
Feet
0 160320 640 960 1,280

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XV� SYNAGRO
SOIL DESCRIPTION SHEET
A Residuals Management Company
Project::
Landowner:
6,skl
Site: r ' Field: Sample #:
Slope:
Acres (gross):
Acres net : ... Crop::s
::
Apr
SOIL PROFILE DESCRIPTIONS
Horizon Depth Texture Color
Structure Mottles
PROFILE A
AD�-
Depth to SHWT:
- .... .
Depth & type of restrictive layer:
Soil Series: "�A
Horizon Depth Texture Color
Structure Mottles
PROFILE B
Depth to SHWT:
Depth & type:of restrictive layer: -
Soil Series:
Notes:
&✓ .�`��?.�.11-7
t
Date:101,
Described By:
Legend
Texture
Structure'Grade Structure Type
s Sand
1 : Weak .. gr Granular
abk. Angular Blocky
I Loam
2 Moderate' pl Platy
sbk' Subangular Blocky
si Silt
3 Strong -or Prismatic
sg Single Grained
c .: Clay
.. cpr Columnar m Massive

Page 1. of:1:
I ,
I
Report Number: 14-:.: A �L:`
262-0579
as Laboratories
Account Number: 00015 ,
7621 Whitepine Road Richmond, Virginia 23237 [phone] Fax [phone]
® .... . .......
www.aleastern.com
Send To: SYNAGRO CENTRAL/MT HOLLY Grower: Submitted By: DREW CULP
WAYNE BRADY DAVID ALLEN PERMITTING
Farm ID:
12701 LANCASTER HWY NGGA-45
PINEVILLE NC 28134 MT:HOLLY50-1701
SOIL ANALYSIS REPORT Analytical Method(s):
Mehlich 3
.Date Received:: 09/19/2014 :::: Date Of Analysis: 09/2212014::. Date Of Resort: 09/22/2014
Ot gamc Matter
Phosphorus
Potassium
Magnesium
Calcium
Sodium
pH ;"
ActdRy
C E G'
Samp D"ID:
P
N'Lab
umber
:.:
, ENR
/o. Rate
Mehlich 3
Reserve
K =:
Mg ; Ca
:,
Sod
-Buffer
H
Ibs/A
PPm . Rate "
_ppm :Rate
ppm ;Rate
:ppm Rate
ppm Rate
ppm
---Kate:
_ : PH
Index
meq/100g
meq/100g
1
13300
5.4 H : 149
22
... L
.: " "
48 VL
189 : H
762 M
6.1
6.84
0.9
6.4
NC=18
NC=25
:Percent -Base Saturation
Nitrate
Sulfiir
Zinc .
Manganese'
Iron.
Copper -
Boron
Solupte Salts
chioMde `
Aluminum""
Sample -ID
FIe1d ID
K
Mg
Ca
Na
H
NON
S
Zn .:
Mn
Fe
"
Cu „
B
SS
Cl'
Air.
;:'
TPPmi
Rate
;PPrn;PPm
...Rate
PP m' : Rate
...
PPm "Rate
PPm Rate
ppm -Rate
`ms/cm 'Rate
ppim Rate'
,. PPrn,
1
1.9
24.6
59.5
13.7
Values on this: report represent the plant available nutrients in the Explanation of symbols: % (percent), ppm (parts per million), Ibs/A • This report applies to sample(s) tested. Samples are retained a
soil. Rating after each value: VL (Very Low), L (Low), M (Medium), (pounds per acre), ms/cm (milli -mhos per centimeter), megl100g maximum of thirty days after testing. c
H (High), VH (Very High). ENR - Estimated Nitrogen, Re lease: (milli -equivalent per 100 grams). Conversions: ppm x 2 = Ibs/A, Soluble by: Pox;- m 60wr
C.E.C: -.Cation Exchange Capacity. ' • _Salts msfcm x 640 ppm.
Analysis prepared by: A&L Eastem Laboratories, Inc.
Pauric McGroary

ulslon of Water Resources . .
State of North Carolina
Department of Environment, and Natural Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 11-13
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.4he Applicant shall .submit one original and two conies of the.aaplication and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
lztfo://portal. ncdenr.or Iivg eb1w--q/aps/lap
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) h accordance with 15A NCAC 02T .1100. Do :not
submit this agreement: for: review without_a corresponding application: foram (FORM: RLAP 11-13).
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 1143)::
® Submit the completed and appropriately executed Residuals Source Certification (FORM:, LASC 11-13) form. Please do not
make: any unauthorized content changes to this form. If ;necessary for clarityor 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.
y
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 Permtttee, to land apply residuals from -the:: following facility(ies)-onto.:the following land.
application site(s) (i.e., see attached_ _ setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease:
(yes/no)
Land Use or
Cropping Patterns"
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�p ...
7 Y ffS V9e,.:.
L I
jr
-r- . oilfinkiJw/
.
landowner or his representative receives, in consideration, full use of the -nutrient value of the applied residuals while;the
nittee receives, in consideration, the use of the land -application site(s) described above for the disposal of the residuals.
`Phis 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- I.0 A 1 1-11 Paae 1 of 3

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.
1. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC - 27699-163 6.
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 anddata 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 Permitted.
- 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 ormodificationsto 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 Permitted, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permitted, 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.: ...
AESTRICTIONS:
�`-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 appl,ication.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 compli- nce:boundary. Please -mark one of the following; .
A re -defined compliance boundary is needed.for fields ID:
(Please include the rationale for the requested: re=location of the compliance boundary and: attach a map showing the newly proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
- The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ:.. -. The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 11-13 Page 2 of 3

r
La' fidowner'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 orother 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::-: L .
Address: S �: ! /� s� %� JOB
City: State: Zip:
Phone: o ✓ E-mail address:
Signature:Date:...
NORTH CAROL"A,: L / 0`1 C d /ire = . = - COUNTY
I, the undersigned Notary Public do hereby certify that �6tra/ /i%= Pue 6 &j0A
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 „ UAG , 20 /
Signature and seal:
My commission expires:
JOHN A. CULP
NOTAFMOUBLIG
Mecklenburg County.
North Carolina
Lessee's/Operator's Certification c My Commission Expires 01/13t2o=9
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: Stater Zip:_.
Phone: E-mail address:
Signature: Date:
Permittee's: Certification:
I certify th t I have read th' Agreement and do hereby agree to. abide by the stipulations :and restrictions as specified herein.
Signing: offic 1 am
Jl V a�[}'
Signature: ?VIU 1 � `� Date: P7414
i`
FORM: LOA 11-13 Page 3 of 3

SITE SUMMARY
y�
- City of Mt Holly
Mt. Holly. NC -
Site ID:
NC-LT-43
Owners Name:-
-Gary Duckworth
Address:
857 S. HWY1.6 .:
Stan ley,,NC-28164--
Phone:
704-996-0849 (cell)
704=827-9205 (home)
Aerator: - :
_:.: : -.. .... .
Same -_
stimate: :-
Lincoln Co: Predominant
Applicable
Annual PAN Latitude and
Soil: Series -
mesas Acres crops) (Lk31AG1YK) Lo:ngnude
1: 11.2 Fescue 209 Cecil (CeB2) 35 25 30 N
80 59 50 W
2 21.0 Fescue 2.09. Cecil (.CeB2)
80 59 46 W ::
35 25 47 N
3 11.0 Fescue 209 Cecil CeB2
805956W
4 6.0 Fescue 188 Pacolet (PaB) 35 25 36 N:.:.
80 59 41 W-....

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EPUTON
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0

:7,W
rlslon of .Water Resources.
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 11-13
Please use the following in 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.auulication and
supporting documentation .
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
hy://wb/wlap/aupgs
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 11-13).
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-11-13):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) form, Please do not
make: any unauthorized. content changes to this form,:: If necessary for clarity: or due to space restrictions, attachments to the:
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer..
® Prepare a separate agreement for each set of land application- sites that are owned or_ operated by an entity -other than the
Applicant.
® A- copy of the completed and appropriately executed agreement must be provided to the landowner: and the lessee/operator.
i
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: C.i of Moeen.::f�o�/y
hereinafter: _referred to as the Permittee, to land apply residuals from the following facility(ies). onto the following land.
application sites) (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)
1T=y6 of-o
No
llnarn•�/_ �-t�a/
..
^.
c. WIN*4611
landowner. or his representative receives, in consideration, full use of the.nutrient value of the applied. residuals while the
,nittee 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'si permit for the residuals land application program and
shall be renewed each timethis 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.
Fnrz.na- r n A 1 1-11 page I 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 arid data concerning the residuals land application program,
includingan analysis of constituents of the residuals, residuals application methods, schedules. for typical dropping 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: Of related to the land, application site(s) at any reasonable time for the purpose of. determining
...... PrP... g.
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that muss t be kept under the terms, d 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.
. 'tESTRICTIONS:. .:::..
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(4) 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 supplywell is. situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance:boundary. Please: inark one of the following; .:
VA re -defined compliance boundary is neededfor field(s) ID:
(Please include the rationale for the requested- re -location of the, compliance boundary and: attach a map showing the newly proposed
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed) ....
The land, application field(s),ID:. is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program) --
FORM: LOA 11-13 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 Iand 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: tje 5
Address: I IUmmae PrQSprra.
City: P. Vel—r- State: : N c, Zip: d �(o 3 %
Phone: 73 4 ` % 3-1600 E-mail address:
Signature: Date: ......6(o - i 3 - 14
t
NORTH CAROLINA, L I t _0 I_ COUNTY-
•
1, the undersigned Notary Public do -hereby certify that a jae;<
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 U�¢. , 20
Signature and seal:
My commission expires: 611,13 .a of JOHN A. CULP
Mecklenburg County .
North .Carolina
Lessee's/Operator's.Certiiication: Fty1MINIOnEvires.0013/201J
I certify that I have read this Agreement and do hereby agree to abide by the: stipulations and restrictions as; specified herein:
Lessee/operator name;
Address:
City: State: Zip:.
Phone: E-mail address:
Signature: Date:
ermittee's'Certification: -
I certify that I ha. a read this Agree ent and do hereby agree to, abide by the stipulations and restrictions as specified herein.
Signing official nam j 0.��Q
Signature:�ll✓ Date:/ b I-/ l
FORM: LOA 11-13 Page 3 of -

1
11:8 :_
Fescue
209 =
- -----
Cecil (CeB2)'
... .
35 24 32 N
81 2 27 W
2
45.2
Fescue
209
-
Cecil:(CeB2)
35 24 42 N
81 2 6.W : .
3
9..9
Fescue
-.209-
Cecil.(CeB2)
35 24 22 N
81 2 51 W
4
19.4 :
Fescue
209
Cecil (CeB2)
35 24 2-9 N
81 2 1 W
5
7.9
Fescue
.
21.6
Lloyd_(LdB2)
- --
35 24 56 N
.: 81152W._.
6
5.4
Fescue
188
Pacolet (PaB)
35 24 50 N .
81 050W
7:
7.0
Fescue
188
Pacolet (PaB) :
35 26 35 N .
81029W...
8
6.6
Fescue
209
Cecii (CeB2)
35 24 21 N
81 2 28 W
9
7.3
Fescue
216.
Lloyd (LdB2)
35 24 38 N.
81:1 37 W

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SYNAG 0
SOIL DESCRIPTION SHEET
A Residuals Management Company
Project:
/� �
Landowner:
ea Y :5 ;..o-;! .
SiteField:
Samp'le #:
Slope:
Acres (gross): Acres_ (net).:
Crop:
SOIL PROFILE
bESCRIPTIONS
Horizon iDepth Texture-
Color
Structure Mottles
PROFILE A
% i V 4- .
f B
- --- ---
- -------
Depth to S T: >!J40
Depth & type of restrictive layer:
Soil Series: -_ ..LLo ` 6, ...... -.
.
Horizon Depth Texture
Color.
Structure Mottles
PROFILE B
Depth to SHWT:
Depth& type:of restrictive layer:
Soil :Series:
Notes: 14 A
es c C
7777
p.Described
By::..
Date: mea rc
f
Legend
_ Texture
StructureGrade
Structure Type
s Sand
1 Weak
gr Granular
abk: Angular Blocky
I Loam
2 Moderate
pl Platy
sbk Subangular Blocky
Si Silt :
3 Strong
pr Prismatic
sg Single Grained
C. Clay
cpr Columnar m :::::Massive

Page 1 of.! �.��"
f
Report Number: 14-262-0578
- AFLv Eastern Laboratories
ACCOLInt Number: 00015 " 7621 Whitepine Road Richmond, Virginia 23237 [phone] Fax (804) 2 l-W6
www.aleastern.com
Send To: SYNAGRO CENTRAL/MT HOLLY Grower: Submitted By: DREW CULP
WAYNE BRADY TONY JONES PERMITTING Farm ID':
12701 LANCASTER HWY NC-LT--46
_.
PINEVILLE NC 28134 MT. HOLLY 50-1701
- SOIL ANALYSIS REPORT
Analytical Method(s):
Mehlich 3
Date Received:: 09/19/2014 Date :Of Analys-is::09/22/2014 :: Date Of Report: 09/22/2014 -
Organic Matter
Phosphorus
Potassium
Magnesium
Calcium
Sodtum
pH
Acidity..
C;E.C'
Sample ID"
Field'ID
-.'Lab
Number .
%. Rate, _ENR
Mehlich3
Reserve
Mg•.
Ca
Na. -
Soil
Buffer
H ,
Ibs/A
__...... . .
Ppm Rate
....._ ._.
ppm :Rate
ppm Rate
=ppm Rate
'ppm ;Rate
ppm - "Rate
PH
,.....
Index
OOg
ame41, .
m eg1100g'
09
13299
4:0 M 121
63
H
80 L
225.. VH
750" M
6.7
0.3
6.1
NC=52
NC=41
Percent Base,
Saturatton '''.
Nitrate
`•. Sulfur
Zinc
Manganese,;
' , .Iron
Copper
Boron
soluble Gaits`.
ChloNde _'
Aluminum ;
Sam p16,10
Field.l0.
K
Mg
Ca
Na
H`
NO3N
S
Zn
Mn
Fe :
=Cu
B
SS
CI
Al
"/° " .
"/o
"/o
%
%-'
ppm.:` Rate''ppm
Rate
ppm Rate
ppm ;Rate
Rate
PPm Rate;
PPm "Rate ms/cm Rate.
PPm 'Rate
Ppm
09
3.4
30.7
61.5
4.5
Values on this report represent the plantavailable nutnehts in the Explanation of symbols: % (percent), ppm (parts per million), Ibs/A This report applies to samples) tested. Samples are retained a
soil. Rating after each value: VL (Very Low), L (Low), M (Medium), (pounds per acre), ms/cm (milli -mhos per centimeter), meq/100g maximum of thirty days after testing. by: �Ay/ic m. 6e
FI (High), VH (Very High). ENR -Estimated Nitrogen Release. (milli -equivalent per 100 grams). Conversions: ppm x 2 = Ibs/A, Soluble - Analysis prepared by: A&L Eastem Laboratories, Inc.
C.E.C'. — Cation Exchange Capacity. Salts ms/cm x 640 = ppm.
Pauric McGroary

State of North Carolina
DW Department of Environment and Natural Resources
.Division of Water Resources
ulslon of.Water Resources- - LAND OWNER AGREEMENT
FORM: LOAam
11=13
_... -.
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 website at.,
ho.Ilportal. ncdenr. brjz/web/wg/aps/lau
General — This. document is an agreement:between the Applicant and land owner(s):of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with BA NCAC 02T .1100. Do :not
submit this agreement for review without a corresponding application form (FORM: RLAP.1143).
Unless otherwise noted, the Applicant shall submit one original and two copies of theapplication and supporting documentation listed
below. -
........
A.:. Land Owner Agreement (FORM: LOA 11-13):.
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) 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 Vermittee, 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
Agceement:
...
Site/Field ID
. . .
Lease:'':
(yes/no)'.
Land Use or
.Cropping Patterns:
- .
Intended Use of Crops
.....
Residuals Source:
(optional)
pec�a note
Special t
(no-till/over-seed/
:. pasture)
landowner or his representative receives, in consideration, full use of the: nutrient value of the applied residuals while the
pp' .: ( )
�nittee receives in consideration the use of the land a lication 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, given30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 11-13
Pale 1 of 3

d. 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 oc 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 _ plan_ ting season to enable: the Permittee to amend :this Agreement and schedule residuals land
application events at appropriate periods.
I2. 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 properly; 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; fake necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
i RESTRICTIONS: -
I. Appropriate measures must betaken 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.
s.
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 t0incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when -the residuals remain 'on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply, wells within the compliance boundary. However,. 15A NCAC 02T .0105(h) allows the.
compliance boundary to be placed closer to the waste disposal area, such that, the :water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance, boundary. Please mark one of the following;......
A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance, boundary and attach a map showing the newly ,proposed.
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
W. 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 11-13 PaoP o of I

Landowner's Certification:
I: certify that I am a. deeded landowner of the above -referenced land application site(s) and am authorized 'to make decisions
regarding the use -of the land application sites) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding :the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application 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: Dk,L4 A�
Address: I D � ,
az Z� s F/-�rY
City: C State: %�lS Zip:
Phone: D % E-mail address:
Signature: Date: °??f
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that ` AAA qtAtwiconytGl
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
rd . . .
WITNESS my -hand and ofcial seal this the Z 3 —
day of J•ql4
Signature and seal: L g C
My commission expires: o y /i 3 ig J" A.-Ci"
Lessee's/Operator's. Certification: �°�
My eioe ice ; OM =019
I certify. that I have read this Agreement and do hereby agree to abide by the'stipulations and restrictions as -specified herein.
Lessee/operator. name: ..
Address:
... City: State:
Zip:
Phone: E-mail address -
nature: Si -
g - Date:
Permittee's Certification:
I certify that I ha a read this Agre ment and do hereby agree to abide by the stipulations and restrictions as specified herein. .
Signing official na e: _�c►
Signature: �,' V�,. �/�" Dater B�� i

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
}.Vlslon of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 1143
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 belp::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 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 website at.
http://portal.nc enr.or wee W a s au
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
submitthis agreement for review without,a corresponding application- form (FORM: RLAP 11-13).
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 11=13):: -
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) form. Please do not
make any unauthorized, content changes to this form.: If necessary for clarity. or: due to space restrictions, attachments to the
I
pplication may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned :or operated by an entity other than the
Applicant.. ....
A copy, of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operatorI.
-AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO, PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
Cify.:
hereinafter -referred to as the- Perntittee, 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/noy
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source::
(optional)
Special note -
(no-tilUover-seed/
pasture)
landowner or his representative receives; in consideration, full use of the.nutrient value of the applied. residuals while the
mittee 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- i.nA 11-II _. Page I of

I: STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be -immediately forwarded: to NCDENR-DWR, Non -Discharge Permitting Unit, 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
landapplication 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 croppingpatterns, 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 tire permitted application, limits.
10. The landowner or his representative will provide the Permittee -with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that. have been applied to the.land application site(s). -
11. The landowner or his representative will inform the Pernittee of any revisions onmodifications to the intended use and cropping patterns for
the anapplication site(s) prior to each planting season to enable the Permittee to amend -this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13.:The landowner: or. his representative hereby: authorizes the Permittee;:local officials, and State: officials or their representatives: to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and-12 months after termination of, this Agreement.
"i'. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee. and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs: that indicate the activities being conducted at the land application site(s).
2. Animals shall not lie 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 fora 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
boun_ dary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID:(�'
....(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed.
compliance boundary to the application package)
❑ A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
'❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WO: 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 ofthenew:program)
FORM: LOA 11-13 PaEe 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. ,, ff
Landowner name: /45�' V-F A�,P D f A—z_LE
Address::.—
City: C G 40—I /- C State: i' Zip: .
Phone O q —, / 2- — F70 2 E-mail address: CG�
Signature: �Dater
NORTH CAROLINA; COUNTY -
I, the undersigned Notary Public do hereby certify that Howar Ali eNN6/1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my.hand:and official sealahis the 2 3v+d
day of lei
Signature and:seal:
My commission expires:
Lessee's/Operator's. Certification:
,20
JOHN A. CUL.P
NOTARY PUBI I.
Weddenbu% county
NOM carolhie
. YyODlpMigionbpkesfl4/13/2015
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 thaMhave rea
Signing:offici a e:
Signature:
3
State:
E-mail address: - - -
Zip:
this Agreement and do hereby agree to abide .by the stipulations and restrictions as. specified herein... .
Z
FORM: LOA 11-13 Page 3 of 3

SITE SUMMARY . :..
City of Mt Holly .
Mt. Holly. NC.
ite :.
NC-M.G-37-------
Owners Name:
Dean:and Dale Connell :-
Address:
-10812 Rozzelles Ferry Rd.
Charlotte, NC 28214
Phone:
704-737-9796.-(Dean) .......
7047512-8902 (Dale) : ._:..
Operator:
-(SAME)/Nathan Thommason
704-634-6311 (Nathan)
Estimated
Mecklenburg Co. predominant
Applicable -
..
-Annual PAN = :; -Soil Series
Latitude and
Fields - ....
-. Acres
Crop(s) (LB/AC/YR)
Longitude
1.
20..2
Fescue
209.
Cecil (CeB2)
5517 50 N
-, ._
80 59 22 W .
TOTALS
20.2
Notes:
-
-- .
.
....... Date:. ........
09/22/14

Topographic Map
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Vicinity Map
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d
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ake Rd Q �t� �Svoe Bend Beach R
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Site: ■ C G-37 Int-mflnnc onnrnvimmfmN i ink - 7 rmn foe+

Soil Map
I La.. I - -MG- /

.. CITY OF MOUNT HOLLY
WQ#0001863
SOIL SCIENTIST: CERTIFICATION
This is to certify that soil and site evaluations (listed below) were conducted on the
proposed application sites for the=City of Mount Holly by Synagro Central, LLC.
The evaluations consisted of hand auger borings and descriptions of the soils on
the application sites; collection of soil fertility samples using standard soil
sampling methods; location of property 1_nes, residences, -wells, and surface water
.features; identification of required buffer areas, and generation of application area
maps. All hand auger borings included in this package were either performed by
me or under my direct supervision:
0 5� e.
5� r
:Qn Th
_ .. Eric rm nompson;
No.1238
1238
NC-GA-45 field 1
NC-LT-46: field 9

SYNAG O
- SOIL DESCRIPTION SHEET
A Residuals Manag—ni C-Pany
Project:
dat_&7 ...
Landowner:
Site: a Field: 4-.
Sample;#
Slope:
Acres (gross): Acres (net):
Crop:
C La& Y
SOIL PROFILE.
DESCRIPTIONS:
Horizon Depth Texture
C
Structure. Mottles
PROFILE A:.
®�7polo
Depth to SHWT;
Depth & type of restrictive layer: %o
Soil Series: '-r::..:
Horizon Depth Texture
Color
Structure Mottles.
PROFILE B
Depth to SHWT:....
Depth & type of restrictive layer;
Soil Series:
w.
Notes:
Date:
Described By; .
Legend
Texture .
Structure:Orade
Structure Type
s Sand
1 Weak
gr Granular
-
abk Angular Blocky
I Loam_
2= Moderate
pl Platy
sbk Subangular Blocky
si Silt.
3 Strong
pr. Prismatic
sg Single Grained
c.... .Clay
- _
cpr, Columnar m Massive

1 J/
SYNAGRO
SOIL DESCRIPTION
SHEET
AResid-Is Ma-g—ntc—pany
Project:
��� i
Landowner:
'' '0 V5
Site::.fir- 1-14 Field:
Sample:#::
Slope:
ross
Acres net :
CroP�Acres(9
SOIL FILE:
DESCRIPTIONS:
Horizon Depth Texture
Color'
Structure _ Mottles
PROFILE A
ppr
..
,,...
Depth to SHWT:.
-Depth & type of 'restrictive layer:. >YP
,.
Soil Series: Leo
_
Horizon- -:Depth Texture
Color
Structure Mottles
PROFILE B
Depth to SHWT: - - --
Depth & type of restrictive layer:
:..
Soil Series:
Notes:
Described By:. -
Date:
Legend
Texture
Structure Grade
= Structure Type
s Sand
1 Weak'
gr' :Granular
'abk Angular Blocky
Loam
2 Moderate
pl Pfaty.....
sbk Subangular Block y
si Silt
3 Strong
pr - Prismatic
sg Single Grained
c Clay
cpr Columnar m - Massive

w�
lr� -
NCDEWR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvadai.III -
Governor , Director Secretary
December. 31, 2013
Mr. James Friday - Utility Director jAN 0 9 2014 .
City of Mt. Holly
400 Bast Central Avenue
Mount Holly, North Carolina 28120
Subject: Attachment B Certification
Permit No. WQ0001863
City of Mount Holly 503 Residuals
Land Application Program..
Gaston County
Dear Mr. Friday:
t of Mt- Nally
In, accordance with a permit modification request received from the �Fvvnr eFHell on October
21, 2013, and subsequent additional information received December 23, 2013; we are forwarding
herewith a modified Attachment: B, -certified December 31, 2013, to the City of Mt. Holly for the subject
residuals land application program:
This certification is being. issued to modify Attachment B by modifying Site NC-LT-46-2 from
44.6 acres to 45.2 acres; by modifying Site NC-LT464 from 8.2 acres to.19.4 acres; and by adding new
land application sites NC-LT-46-01 (11.8 acres), NC7.LT-46-03 (9.9 acres), NC-LT-46-05-(7.9 acres),
NC=LT-46-06 (5.4 acres), NC -LT 46-07 (TO acres), and NC=LT-46-08 (6.6 acres).:New Site NC-LT-46
08 is composed of a portion of Site NC-GA-42-05,.which was removed firorn the permit by way of the. .
Attachment B: (modified) certification issued on July26, 2013. All of fihese changes together result in an
increase of 60.4 acres,:changing the total acreage from 247.8 acres to.308:2 acres...
Please replace the existing Attachment B of Permit No. WQ0001863 that was previously certified
on July 26, 2013, with this modified Attachment B, and attach accompanying Figures 1 through 5. Note
that it is the Permittee's responsibility to, ensure that a complete permit is created by inserting .this:
modified Attachment B and the accompanying five Figures: into Permit No. WQ0001863, issued on
September: 23; :2011.Iss
This modified Attachment B shall be effective from the date of certification; shall void -
Attachment B. of Permit No. WQ0001863 that was previously certified on July 26, 2013; and shall be
subject to the. conditions and: limitations as specified -therein and well as -those specified in the above
referenced permit.
1f any parts, requirements; and/or limitations : contained in this certification. or modified
Attachment B are unacceptable; you have the right to request an adjudicatory hearing upon written
request within 30 days: following receipt of the certification. This request shall be in the form of a written
WATER QUALITY PERMITTING SECTION - : --
1636 Mall Service Center, Raleigh, North Carolina 27699.1636
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
PI.horie: 919.807-64641 FAX: 91 g-807-6496
Internet: hila'lfoortal ncdenrorglweblwafans
An Equal Oppa luoity 1 AfTrmalive Action Employer

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
. . ....DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
....... RALEIGH
LAND. APPLICATION OF -CLASS B RESIDUAL SOLIDS PERMIT -(NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General:Statutes of North Carolina as
. _..... ..
amended, and otherapplicable haws Rules,: and Regulations
PERMISSION IS HEREBY GRANTED TO: .
The City of Mount Holly
Gaston: County
FOR THE
continued operation of a residuals management program for the City of Mount Holly and consisting of the
land application of Class B residuals generated :by the approved facilities listed in Attachment A to the::. -
__ approved sites listed. in Attachment B with no discharge of wastes to surface -waters, pursuant to the
application:received August 4, 2011, and in conformity with other supporting data subsequentlyfled:and
approved by the Department of Environment and Natural Resources and considered a part of this .permit.
.The use and disposal of residuals are regulated under Title 40 Code of Federal Regulations Part 503. This
permit does not exempt the Permittee from: complying with the federal regulations.
This permit shall be effective from the date of issuance.until November 30,-2015, shall void Permit No.
WQ0001863 issued . December, 2005 and:: shall be subject to the following specified conditions and-
limitations:
...... .
I. SCHEDULES
1. At the::time of permit issuance, Field NC-LT-43704 had been recently cleated. The Mooresville
egiona ice shall be notified via email or telephone, (704) 663-�1699, at least 48 hours prior to
. .
con ucting initial land: application on this f eld so that .staff :can verify that - a cover- crop has been.. -
established.
2. Noaater than six months prior: to the expiration of this permit, the Permittee shall request renewal of
this permit on official :Division forms,_ Upon receipt of the request, the Division will review the::
adequacy of the facilities described therein, and if warrantek will renew the permit for such period of
time, and under such conditions and limitations as it mayappropriate.deein Please note. Rule 15A
....
NCAC- 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application.
.. . _....
_. .
3. The. permittee shall be in:: full : compliance. with, the regional . office notification requirements
established in Condition II1:3. within 90 days of Permit issuance.
4. The permittee shall be in full compliance_ with the signage, requirements established in Condition .
11I.13.. within 180 days of permit issuance.
WQO06180 Version 1l Shell Version 101116 Page 1 of 12

H.
J.....
PERFORMANCE STANDARDS
L The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of f nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals : to the site contact the Mooresville regional office's Aquifer Protection Section
supervisor, and take any immediate corrective actions necessary.
.2. This permit shall not. relieve the Permittee of their responsibility for damages to . groundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with his permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs):
Parameter
..
Ceiling Concentration
(milligrams per kilogram)
CPLR
..
(pounds per acre)
Arsenic
- 75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
n/a
Nickel
420
374
Selenium ...
.100 ..
89 .
Zinc
7,500
2,498
The Permittee shall determine. compliance with the CPLRs using one of the following methods:..
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For ..land where residuals application have not : occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen -reduction requirements in 15A NCAC
02T .1106 (a) and (c). Exceptions to this -requirement shall be -specified- in Attachment A.
7.. Biological residuals. (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to this requirement shall be specified in Attachment A.
WQ0001863 Version 2.1 Shell Version 101116
Page 2 of 12

S. Setbacks for land application sites shall be'as follows:
Setback by application type
(feet)
Setback Description
Vehicular
Irrigation
-Surface
Surface
Inl action /
Application
Application.
Incorporation
Habitable residence or place of public assembly
under separate ownership or not to. be maintained as
400
400
200
art of the project sitesw
Habitable residence or places of public -assembly
owned by the Permitteei the owner of the land, -or the
lesseetoperator of the land to be maintained as part
0
200
0
of the project site
Property lines
50
150
50
Public right of way.
50
SO
50
Private or public water supply
100
100
100
Surface waters (streams- intermittent and perennial,
erennial waterbodies, and wetlands
_. 100
100
Sa
Surface water diversions (ephemeral streams,
waterwa s, ditches
25 ..
100 ...
25
Groundwater lowering ditches (where the bottom of
the ditch intersects the SHWT) . .: = :.. .som
25
100
25
Subsurface groundwater lowering 'system.
0
100
0
Wells with exception tomonitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments :or cuts of two feet or
_.
more in vertical hei ht
15
15
15
Building foundations or basements::::.::
0
15
0
Water lines
0 .
10
0 .
Swimming pools
100
100
-100.
Nitrification fields
0
20
0

10. Bulk:residuals and other sourices of Plant Available Nitrogen (PAN) shall not be, applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen req*dinents based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
a
a. Division's prenapproved. site specific historical data for specific crop or soil types by calculating
the mean of the beat three yieldsof. the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science (h=://www.soil.ncsu.edu/prou ms/Mp/ eld . A
copy shall be kept on file and reprinted: every five years. in accordance with Condition IV.7.
c. If the RYE cannot be determined using methods (a) or (b) abovel the Permittee may use the RYE
and: appropriate nutrient application rates .repotted in any of the following documents:
i. Crop management plan as,eutlined by the local. Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste - Utilkation Plan as outlined by the Senate. Bill - 1217 Interagency Group - Guidance:
Document- ChapteT I ao://www.enr.state.nc.us/DSWC/DaM/Bgjdance docs.htmD.
iii. Certified Nutrient Management. Plan as outlined by the Natural Resources Conservation
Services (MRCS). These plAns must meet the USDA­NRCS 590:14utrient Managemen t
Standards -//fLip-fc.se.egov.usda.ggy/NHO�/�ractice-standards/standards/590.pdf).
d. If the RYE and appro"pAate nutrient application rates cannot 66. determined, the Permittee shall
contact the Division to determine necessary action.
11. When 'residuals are land applied -to grazed pasture hay crop
realistic nitrogen rate shall be. reduced by
25% in accordance with the USDA -MRCS. 590 Nutrient Management Standards.
q
12. If land application sites :are to be over -seeded or double -cropped (e.g., berniuda grass in the summer
r
and rye: grass in the winter with both crops to receive residuals), then the second crop: can receive an
application of PAN at a rate not to:exceed 50 pounds per acre per year (lbs/ac/yr): This practice may.
be allowed as long as the second crop is:to-be harvested -or grazed. Ifthe second crop istobeplahted
for erosion control only. and is to be tilled into the soil, then no additional PAN shall be applied.
13. Prior to land application of residuals: containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall - obtain and implement - recommendations. from a . t least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services: the Natural
Resource Conservation Service; a North Carolina. Licensed Soil Scientist; or an agronomist. The
recommendations. shall address the pdium : sodiumrate;
.- ­ .- .
: application. rate 9 -.soil amendments (eig., gypsum, etc.), or a
mechanism for maintaining site integrity .and conditions conducive to crop growth. The Permittee
shall maintain written records of these recommendations and details of their implementation.-
:14: The compliance boundary residual land application sites shall 'be specified in accordance with 15A
NCAC 02L .0 1 07(b). These. sites were individually permitted on or. after December 30, 1983
.
therefore, the complianceboundary, is establislidd:at dither 250 febtfiom the residual land application
area, or 50 feet. within the property: boundary, whichever is closest to the residual land application -
area. An exceedance of groundwat6i -standards at or beyond the compliance boundary is subject to
remediation action according to 15A -NCAC. :02L .0106(d)(2) as.well. as enforcement: actions in
accordance with North C - arolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B.
15. In accordance with 15ANCAC 02L .0108,'the-review boundary shall. be established midway between
the compliance boundary: and the residual land application area. Any exceedance of groundwater
standards atthoxeView boundary shall require action in accordance with 15A NCAC 02L .0106.
W00001863 Vetsion1l:: She'll 'Version 101116 Page 4 of 12

M. OPERATION AND MAINTENANCE REQUIREMENTS
s p
. . .. .....
1. The residuals.management programshall be properly maintained and .operated at All times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water: or groundwater standards.
2. The Mooresville: Regional Office;' telephone number [phone], and the - appropriate local- -
government official(i.e., county manager, -city manager, or health director) shall be notified at least
48. hours prior to the initial ;residuals land application to any new laud application site. Notification to
-
the Aquifer Protection, Section's regional supervisor shall be made from 8-00.a.m. until 5:00 p.m. on
Monday through Friday, excluding State Holidays.
3. The Mooresville Regional Office shall be notified Via email or telephone, (704) 6634699 -at-least 24
hours prior to conducting any land application activity. Such notification shall. indicate, at a.
minimum, the anticipated application times, field IDs, and location of land application activities. If -it:
becomes necessary to apply- to additional fields due to :unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields.
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M'Plan) pursuant to
15A NCAC.02T . 1110.- Modifications to the O&M Plan shall be approved by the Division prior to
a
utilization of the new .plan: The O&M Plan, at the minimum, shall include:
4) OperatioriaL fdrictibris;
b) Maintenance schedules,
c) Safety measures;
d) Spill response plan;
e) Inspection plan including the following information: ...
i. Names and titles of personne1responsible for conductingthe inspections; . .. ...
U. Frequency and location of ':inspections, including those to be conducted- by the ORC, and.
procedures to assure that: the selected location(s) and inspectionfrequency are representative
of the residuals management program;
in. Detailed. description of inspection: procedures including record keeping and actions to be -
-taken by the inspector in the event that ..noncompliance. is observed pursuant to the:
noncompliance notification requirements under the monitoring: and reporting sect" of the
ion
permit;
f) Sampling and monitoring planincludingthe following information:
i. Names and titles of personnel responsiblefor conducting the sampling and monitoring-
U.- Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling1requency and procedures to assure that: representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affectthe quality of - the
residuals gathered: during a particular sampling event. The:sa-mpling 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
afficted:by cold temperatures)..
WQ0001863 Version 2.1
Shell Version 101116
Page 5 of 12

f;
5. Upon' the Water Pollution :Control System Operators Certification Commission's (WPCSOCC)
classification of the facility,.. the Permittee shall designate and employ a certified operator in
1 responsible charge:(ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC 08G .0201. The ORC or their back-up. shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition III.
4.), and shall, comply with all other. conditions of 15A NCAC 08G. 0204.. For more information
regarding classification and designation requirements, please contact the Division of Water Quality's
Technical Assistance & Certification Unit at [phone].
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M Plan shall
be maintained at the land application:sites during land application activities.
7. When the Permittee transports or land applies bulk residuals, the :spill control provisions shall be
maintained in all residuals transport and application vehicles;
S. Residuals shall not be stored at any land application.site, unless written approval has been requested
and received from the Division.
9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind . .
erosion and surface runoff from conveying residuals from the land: application sites onto: adjacent
properties or into surface waters.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be. maintained on
land: application sites onto: which residuals are applied in accordance with the crop management plan
outlined by the_ local. Cooperative Extension Office; the Department of Agriculture and Consumer -
Services, the Natural Resource Conservation Service, or an. agronomist and as approved by the
Division. .......
H . Bulk residuals shall not be land applied under the following conditions:
a., If the residualsare likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its: designated critical habitat;
b. If the application causes prolonged nuisance conditions; =.
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of
surface water or groundwater standards;
d. If the land.is flooded, frozen.or snow=covered, or is otherwise in a condition, such that runoff of
..... the residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporated within
a 24=hour period following a residuals: _land application event;
f ..During a measurable precipitation event (i.e., .greater than 0.01. inch per hour), or within 24.hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
-
g•
If the s16 64 , greater than 10%:for: surface applied Iiquid residuals, or if the, slope is greater than _
18% for injected or incorporated bulk liquid residuals; ..... .
h: If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a.final soil pH of at least:6.0, or if an agronomist provides information indicating that the -
pH of thesoil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will -be noted in this -permit;
i. If the land does not have an established vegetative _cover unless the residuals are incorporated or
injected within:a 24-hour period following a residuals -land application event;
j. If the :vertical separation between the seasonal high water table and the depth of -residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
WQ0001863 Version 2.1 : Shell Version 101116 Page 6 of 12

L . Application exceeds. agronomic rates.
12. The following public access restrictions apply to residual -land application sites:
a. Public access to public contact sites (e.g., golf courses, parks,.ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access: to non-public contact sites shall be restricted for 30 days after a residuals land
application event.
13. Public access controls shall include the. posting of signs with a minimum area of. 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information;' imiuding the Permittee or applicator's telephone_ number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site duffing a -land
application event,: and for as long as the -public access restrictions required under 1II.12 apply.
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and.Grazing Description
Restricted
Duration:
Animal§.shall not be allowed.to graze during land application activities and
restricted period. ;Sites that are to be used for grazing shall have fencing to
30 days
prevent access aftervach land application event.
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for.
12 months
Food crops: with harvested parts that touch the residual/soil mixture and are.
totally above the land surface (e.g., tobacco, melons_, cucumbers, squash, etc.)
14 months
shall not be harveste. 0or.
Whenthe residuals remain -on the land surface for four months or longer prior to
incorporation into the soil,' crops with harvested parts below the land
20 months
surface (e.g.; root crops such as potatoes, carrots, radishes,. etc.) shall not be
harvested for:
When:the residuals remain:on the land surface for less than four months:prior to
incorporation into. the soil, food crop_ s with harvested parts.below the land
38 months
surface shall not be harvested for:
15. The Perinittee shall acquire from each landowner or lesseeloperator a statement detailing the volume
of other nutrient -sources (i.e., manufactured fertilizers, manures, or other animal. waste products) that -
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for .
those operations where a NMP is required by the US Department of Agriculture — National. Resources
Conservation Service (NRCS) _ or other State Agencies. The Pennrttee. shall calculate allowable
nutrient loading rates based on the provided information and use appropriate reductions.
For the. purpose of this permit condition; a Crop Management Plan (CMP), Waste' Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan.::. .
....... .. .
16. No residuals shall be- land applied: lied: unless the submitted Land Owner Agreement Attachment LOAA PP- ( )
!p'
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be: considered expired concurrent with the permit expiration date,::
and shall be renewed during the permit renewal process.
WQ0001863 Version 2.1 Shell Version 101116 Page 7 of 12

- IV. MONITORING AND REPORTING REQUIREMENTS
1. Any Division :required monitoring :(including groundwater; plant tissue,: soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed.
2. Residuals shall-be_analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)]shall be performed At the frequency specified in
Attachment A. and the Permittee shall.maintain these results for a minimum::of five years. Any::
exceptions from the requirements in this condition shall be specified in Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):. ..
Arsenic (5.0) ::::
1,4-Dichlorobenzene (7.5)
Nitrobenzene.(2.Q)
Barium-(100.0)
.1,2-Dichloroethane (0.5) .
Pentachlorophenol (100.0) .
...... Benzene (0.5)
1, 1 -Dichloroethylene (0.7)
Pyridine (5.0).
Cadmium (1.0)
.......
2,4-Dinitrotoluene (0.13)
Selenium 1:0.....,
( )
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)_
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene:(100.0)
...
Heptachlor (and its hydroxide)
0.008
Toxaphene (0.5)
.Chloroform (6.0).::::
Hexachloro-1,37butadiene (0.5)
.... Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane .(3.0)
2,4,5-Trichlorophenol (400.0.).
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenoi (2.0)
o-Cresol (200:0) '
Lindane (0.4)
2,4,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2}: .::
Vinyl .chloride (0.2)
Cresol 200.0 ( ) ..
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)

3. An analysis shall be conducted on residuals from each source generating facility at the: frequency
specified in Attachment A,:: and the Pertnittee shall maintain the results fora minimum- of fiveyears.
The anaiysis shall include the klowing 'parameters:
'Aluminum
Mercury
Potassium
Ammonia -Nitrogen
:Molybdenum.
-Selenium
Arsenic
Nickel
sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
...... Copper
:PH
zinc ......
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
4. Residuals shall: be monitored for compliance with pathogen and vector attraction -reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the: sampling
and- monitoring sections of the approved O&M plan. The required data shall be . specific to the
stabilization process utilized, and:sufficient to demonstrate compliance with- the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c); and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shag be met. Any exceptions from the requirementsI . in I this
condition shall be specified in Attachment A.
5. An annual representative soils analysis (i.e., Standard Soil . Fertility Analysis) shall . b I e conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be:in accordance with the.."Guidance on Soil:
Sampling" located in the Sampling Instructions section of the NC.Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomi/`Pubs.htm). The Permittee :shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a period of 'no less than five years and shall be made available to the Di i i- .. - :
ivision upon request. At a:
minimum, the Standard Soil Fertility Analysis shall include the followi
ng parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (*by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
:6: Laboratory parameter analyses shall be performed on the residuals as they
are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Perinittee shall maintain records .tracking all residual .land application events. At a :minimum,..
these records shall -include the following:
a. Source of residuals;
b. Date of land Application;
c., Location of land application (i.e., site, field, or zone number as listed in Attachment B);.
d. Approximate areas applied to (acres);
e.: Method of land application;
woo-ob 1:863 Version 2.1 Shell V'ers'ion 101116 ... PA& 9 of 12

f. Weather conditions (e.g., sunny, cloudy, raining,; etc.);
}, PP�g UnitPredominant Soil Mapping CbB2);
g• (e.g.,
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops :to be grown on field,:
j. Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in: gallons per acre,:oubicyard per acre; dry tons per acre, or wet
ton per acre;
1. Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre; or
wet tons per acre;
in.. Volume of soil amendments (e.g., lime, gypsum, etc.) applied. in gallons per acre,: dry ton per
acre, or wet tons per acre; and
n. Annual and cumulative totalsin dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be limited to, arsenic,: cadmium, copper, lead,. mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.
8. Three copies of an annual.report shall be submitted on or before March 15 . The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Forms. Instructions for reporting - and annual report forms': are available at
http://portal.ncdenr.or web/wg/aps/lau/re�orting, or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleig
h, North Carolina 27699-1617
9. Noncompliance Notifteation .
The Permittee shall report bytelephone to the -Mooresville Regional Office, _telephone number (704)
663-1699, as soon as vossible, abut in no case more than 24 hours or on:the next working day
following the occurrence or first knowledge of the occurrence of any. of the following:.. -.
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b-. Any failure of the land application program:resulting in a release of material to surface waters.
c_ Any time ;self -monitoring indicates the facility has gone out of compliance with its permit
........ .......
limitations.
d. Any process unit at ure, due:to : - . own or unknown reasons, rendering the facility incapable of
adequate residual treatment. -
e. Any spill or discharge froma vehicle or piping system during'residuals transportation.
`1JQ0001863 Version-2.f Shell Version 101116 Page 10 of 12

Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent:failure of
a storage structure, etc.)- outside normal business hours shall be reported to the Division's Emergency
Response personnel -at telephone number (800) 662-795.6, [phone], or (919)-733-3300.Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline_ the actions taken or proposed to
be takentoensure that the problem does not recur.
V. INSPECTIONS
I. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
environment, a threat to human health or a public nuisance. The Permittee shall maintain an
inspection log that :includes, at a minimum,. the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Permittee shall maintainthis inspection log
for a period of five years from :the date of inspection, and this log: shall -be made available to the
Division upon request.
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the. land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or .
copy any records required to be maintained under the terms and conditions: of :this permit; and may
collect. groundwater; surface. water or leachate samples.
VI.: GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to
an enforcement action by the Division_ in accordance with North Carolina: General Statutes 143-
215.6A to 143-215.6C.
2. This permit shall become .voidable if the residuals land application ' events are not carried out in
accordance with the.conditions of this permit.
3. This permit is effective only with respect to the .nature and volume of residuals described in the
permit application and other supporting documentation.
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules,. regulations, or ordinances, which maybe imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules.
in 15A NCAC 02B ..0200; erosion and sedimentation control: requirements in. 15A NCAC Chapter 4
-and under the Division's General Permit NCG010000; anyrequirementspertaining to wetlands under
15A NCAC 02B .0200 and-02H .0500; and .documentation of compliance with Article 2T Part 6 of
Chapter 143 of the General Statutes.. .. .
-
5: In the event the residualsprogram changes ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fiilly responsible for
ihaintaining and operating the residuals program _permitted herein until a permit is issued. to .the new
owner:
. WQ0001863 Version 2.i Shell Version 101116 Page 11 of I l

ATTACHMENT A - Approved Residual Sources
City of Mount Holly
Maximum
ring
reque cyf r
Frequency
Approved
.. Owner .:
Facility'Name
County
Permit
Biological
Dry Tons:
Frequency for
Freq� ueney for
P thogen &
M neralizat on
-
-
Number
Residuals
,
Per Xear:.
Non -hazardous
Characteristicsz
Metals and
Nutrieuts:3'S
Vector Attraction:
Rate:
a �,e-:
Redactions `'
Cityormt.alolly
Mt. IIolly WTP
Gaston .:
01-36-020
No .
130 .:
:Annually
Annually
Annually
0.40
. Holl y _ _
-Cityof:Mt
Mt. Holly W WTP :
(Equalization Basm Uul ,
Gaston
NCO021156
.:: Yes
.: 280
Annually
Annually
Annually
0.40
City of Mi. Hol ly .
Mt. Holly W WTP
Gaston
NC0021156 :
Yes
500
Annually
4 X'Year
4 X Year
0.30
Total ..
910: .:
..... ......
1. Maximum Dry Tons per Year is the amount of residuals approved forUnd application from each:perrnitted facility.
2. Analyses to demonstrate that residuals are n6h-hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV:2.
.3.:.Testing of.metals mid nutrients as stipulated under: permit Condition IV.3.. , , :. .
4_ Analyses of pathogen and vector attraction reductions as stipulated under:pertnit Condition 1V.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
1)ry Tons Generated
(short tons per ear
Monitoring: Frequency::
(Established in 40 CFR S03 and 15A NCAC OtT .1111
!/Year
=>319 - <1,650
1/ varier (4 tunes per ear
=>1,650:- <16,500 :::
1/60 Days (6 times: per ear)
_?16,500
1/month l2 times per ear
6. Water Treatment. Plant residuals. are exempt from meeting. the vector attraction reduction requirements in Condition IVA, provided they are not mixed with residuals -that have beers generated'
during the treatment of domestic wastewater, the treatment of animal. processing wastewater, or.the biological treatment of industrial wastewater. Water Treatment Plant residuals must be
treated and processed in a manner as to not inset the definition of `Biological Residuals" as defined in 15A NCAC 02T .1102(6).
7. 31re.Division understands that .the equalization basin is cleaned once every five to seven years. The entire:280, dry tons:per year of residuals that accumulate in the: basin (i.e., 56 dry tons per year
during a tive:year permit.cycle) may removed and land applied during a single calendar. year, with' no subsequent.land application events during the remainder of the. permit cycle.. Residual.
sample(s) and verification:of compliance with the: pathogen reduction and vector attractibrisequirements of the.residuals shall be taken/performed separately from those: taken for/performed on:::.
the residuals generated by the activated sludge: process in the year(s) that land- application occurs. -The Permittee shall take care to take representativesanrple(s) ofahe. accumulated residuals to:.
account for any variability in location and depth within the basin.
If no, land application events :occur,duriug a required sampling period (e.g,.no land application.occur during an entire: year when annual: monitoring is
required), then no sampling data is required during the .period of inactivity.. The annual :report shall include: an explanation for' missing. sampling ,data.
Those required to submit the annaal. report to EPA may be required to make. up the missed sampling, contact the EPA for additional: information and
clarification:
Page I of 1

ATTACHMENT B -.Approved Land Application Sites
City of Mt. Holly .
Certification Date:: December 31, 2013
Permit Number: WQ0001863 Version: -1.3
Field/ Site
Owner
Lessee
County
:.Latitude
Longitude
Net Acreage :.
Dominant
Soil Series
Footnote
NC-GA-41-01
E. Gregory Springs
Gaston
3501T45"
81*01'55"
6.80
Madison
NC-GA-41-06
E. Gregory Springs
Gaston
35017151"
81001152"
14.30 .
Cecil
NC-GA-41-09
E. Gregory Springs
-Gaston
3501739"
81001'53"
13.50
Cecil
NC-G,A-41-10
E. Gee gor Springs, Y„
Gaston
35°17'48"
81001137"
17.50
Cecil
NC7GA-41-14
E.. Gregory Springs
Gaston
35017142"
81001'42"
9.70
Cecil
IV C-GA-44-01
George B. Allen
g
Gaston
35023'59"
81019'48"
.6.90
Wedowee
NC-GA-44-02
R-Anell Housing Group
George B: Allen
Gaston
35023452"
81019'31"
18.90 '
Appling
NC-GA-44-03
R-Anell HousingGroup...
P:::...
George B: Allen
g
Gaston
35 23 41 '�
�. "
81 19 35
37.50 :
Cecil
NC-LT-43-01
Gary Duckworth
Lincoln
35025'30"
80°5950"
• 11.20
Cecil
NC-LT-43-02
Gary Duckworth
Lincoln
35°25'35"
80°59--46"
'21.00
Cecil
NC-LT-43-03
Gary Duckworth'
Lincoln
35025'47"
80059.1561-'
11.00
Cecil
NC-LT-43-04
Gary Duckworth
Lincoln
3502536"
80059'41"
6.00
Pacolet
NC-LT-46-01
Tony. Jones
Lincoln
35024'32"
81002127"
11.80
Cecil
NC=LT: 46-02
Tony Jones
Lincoln
35-24-42"
81002'06"
45.20
Cecil
NC-LT-46-03
Tony Jones
Lincoln
:35°24'22"
81002'51"
9.90
Cecil
NC-LT-46-04
Tony Jones
Lincoln
35024'29"
8100T67"
' 19.40
Cecil
NC-LT-46-05
Tony Jones
Lincoln
3502456"
81001,52"'
7.90
Lloyd
NC=LT-46-06
Tony Jones
Lincoln
35024'50"
81000,50"
5.40:
Pacolet
NC-LT-46-07
Tony Jones
Lincoln
3502635"
81000'29"
7.00
Pacolet
NC-LT-46-08
Tony Jones
Lincoln
35024'21"
81002128"
6.60
Cecil
NC-MG-37-01
Dean Connell
Mecklenburg
35017'50"
, 80°5922"'
20.70
Cecil
-Total
308.20
_'r� lof 1