WQ0010583_Renewal Application_20211101

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0010583
Applicant/Permittee Davie County
Applicant/Permittee Address 123 S. Main St. Mocksville NC 27028
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
County
Davie County Class B Residuals Program
Davie
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
llr�ore
Fee Amount $0
Complete App Date 11/01/2021
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Brent Collins
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
336-399-3646
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0010583
Has Current Existing permit number
Applicant/Permittee*
Davie County
Applicant/Permittee Address*
123 S. Main St. Mocksville NC 27028
Facility Name*
Davie County Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
WO0010583 - Permit Renewal.pdf 16.78MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature

Submission Date 11/1/2021

November 1", 2021
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Services Center
Raleigh, NC 27699-1617
RE: Permit Modification — WQ0010583
To Whom it May Concern:
EMA Resources is submitting the included permit renewal for the Davie County permit -
WQ00105836. The fields that are marked as modified (M) in the LASC form have been
re -mapped using ARCGis to more accurately reflect the acres. The old maps were hand
drawn and were not as precise. Those are the only modifications in this renewal.
If you have any questions concerning this renewal, please contact Brent Collins —
Director of Technical Services
Respectfully,
zl�z 4;510�1.
Brent Collins
Director of Technical Services
brent.collins(cr�,emaresourcesinc.com
[phone]
Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

g
Inc.
Permit Renewal Application
For
Davie County
WQ0010583
Land Application of Residuals
Prepared By:
EMA Resources Inc.
755 Yadkinville Road
Mocksville, NC 27028
336-751-1441
November 1st, 2021
Phone [phone] — Fax [phone]
755 Yadkinville Road — Mocksville, NC 27028

Table of Contents
1) RLAP Form
a) Current Permit
2) RSC Form
a) Vicinity Map
b) Process Flow Diagram
c) Quantitative Justification
d) Operation and Maintenance Plan — Including Sampling Plan
e) Residuals Quality Information
i) Laboratory Analytical Reports
ii) Residuals Information Sheet
3) LASC Form
a) Per Site Information
b) Landowner Agreement
c) Vicinity M a p
d) Aerial/Application Map
e) Current Cumulative Loadings

1) RLAP Form

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
L APPLICANT INFORMATION:
1. Applicant's name: Davie County
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ® County
Signature authority's name per 15A NCAC 02T .0106: Johnny Lambert Title: Utilities Director
Applicant's mailing address: 123 South Main St
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] Email Address: jlambertkdaviecountync. og_v
2. Consultant's name: Brent Collins License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: EMA Resources Inc.)
Consultant's mailing address: 755 Yadkinville Rd
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] Email Address: brent.collinskemaresourcesinc.com
3. Agronomist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip: -
Telephone number: (_) _- Email Address:
4. Soil Scientist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained
Soil Scientist's mailing address: 7231B Summerfield Rd
City: State: Zip: -
Telephone number: Email Address:
5. Fee submitted: $0 (See Instruction B)
IL PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WO00105836
Date of most -recently issued permit: 05/19/2017
Date of most -recently certified Attachment A (if different than the permit): 07/02/2021
Date of most -recently certified Attachment B (if different than the permit): 07/02/2021
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 175 Hwy 801 South
City: Cooleemee State: NC Zip: 27014
Coordinates: Latitude: 35' 48' 15" Longitude: 80' 33' 40"
Datum: NAD83
Method of measurement: GP
Level of accuracy: nearest second
2. County where residuals land application program is headquartered: Davie
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Roy Whitaker
EMA Resources Inc.
13283
Back -Up ORC
Brent Collins
EMA Resources Inc.
27651
Additional Back -Up
ORCs
if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 2817 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
5.022
7.432
14147
20936
Five -Year Maximum Adjusted
6.432
8.842
18119
24908
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
36.78
Hay/Pasture
207.37
Total:
244.15
Methods
Surface
244.15
Incorporation or Injection
0
Total:
244.15
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summarv: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
282.94
418.72
362.38
498.16
100
141.47
209.36
181.19
249.08
150
94.313
139.57
120.79
166.05
200
70.735
104.68
90.59
124.54
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) thatreceives residuals atrates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505(p) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field /Zone
Design Area
(ft2)
Number of
Nozzles
Maximum Application
Rate ( allons/hr)
Design Annual Loading
Rate (gallons/ r)
Total
AM
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Pa a Number
Wetted diameter of nozzles
It
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
It
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
I, Johnny Lambert — Utilities Director
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Davie County
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
�7o��e ZRW79e
Signature: Johnny Lam ert (Nov 1, 202107:34 EDT) Date:
Nov 1, 2021
FORM: RLAP 06-16 Page 5 of 5

la) Current Permit

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
JOHNNY LAMBERT — UTILITIES DIRECTOR
DAVIE COUNTY
123 SOUTH MAIN STREET
MOCKSVILLE, NORTH CAROLINA 27028
Dear Mr. Lambert:
NORTH CAROLINA
Environmental Quality
July 2, 2021
Subject: Permit No. WQ0010583
Davie County RLAP
Attachments A and B
Certification
Davie County
In accordance with your permit major modification request received June 15, 2021, we
are forwarding herewith modified Attachments A and B certified July 2, 2021, to Davie County for the
subject residuals management program.
Modifications to the subject Attachments are as follows: Increased the maximum amount of
residuals approved for land application from 315 dry tons per year to 2,817 dry tons per year in Attachment
A; the total acreage increased from 298.25 acres to 363.14 acres as a result of adding Fields NC-DV-008-
09, NC-DV-009-01, NC-DV-009-02, and NC-RO-001-01 to Attachment B.
The modified Attachments A and B shall be effective from the date of certification until April 30,
2022 (i.e., expiration date of the current permit), shall void Attachment A of Permit No. WQ0010583 issued
May 19, 2017 and Attachment B that was previously certified on December 21, 2018, and shall be subject
to the conditions and limitations as specified therein, as well as those specified in the above -referenced
permit. Please replace Attachment A of Permit No. WQ0010583 that was issued May 19, 2017 and
Attachment B that was certified on December 21, 2018 with the modified Attachments A and B. Please
note that the Permittee shall submit a renewal application no later than November 1, 2021.
Please note that only the maps for new land application sites are attached to this letter. It is the
Permittee's responsibility to ensure that a complete permit is created by inserting these documents into the
previously issued permit.
If any parts, requirements or limitations contained in this certification are unacceptable, the
Permittee has the right to request an adjudicatory hearing upon written request within 30 days following
receipt of this permit. This request shall be in the form of a written petition, conforming to Chapter 150B
of the North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Otherwise, this certification shall be final and binding.
D ��� North Carolina Department of Environmental Quality 1 Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
NORTH CARDLINA
Dgwhneoof Imn.—'out;'\/— 919,707,9000

Mr. Johnny Lambert
July 2, 2021
Page 2 of 2
If you need any additional information concerning this matter, please contact Vivien Zhong at (919)
707-3627 or vivien.zhongkncdenr.gov.
Sincerely,
S. Daniel Smith, Director
Division of Water Resources
cc: Davie County Health Department (Electronic Copy)
Rowan County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Brent Collins — EMA Resources Inc. (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Davie County
Davie County
FOR THE
continued operation of a residuals management program for Davie County and consisting of the land
application of Class B residuals generated by the approved facility listed in Attachment A to the approved
fields listed in Attachment B with no discharge of wastes to surface waters, pursuant to the application
received March 13, 2017, and subsequent additional information received by the Division of Water
Resources, and in conformity with other supporting data subsequently filed and approved by the
Department of Environmental Quality 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 April 30, 2022, shall void Permit No.
WQ0010583 issued January 21, 2008, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
No later 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 warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
(15A NCAC 02T .0108(b)(2), 02T .0105(d), 02T .0109]
2. The Permittee shall be in full compliance with the regional office notification requirements established
in Condition 111.3. within 90 days of the effective date of this permit. [ 15A NCAC 02T .0108(b)(2)]
3. The Permittee shall be in full compliance with the signage requirements established in Condition IlI.13.
within 180 days of the effective date of this permit. [15A NCAC 02T .0108(b)(2)]
WQ0010583 Version 3.0 Shell Version 160210 Page 1 of 12

II. PERFORMANCE STANDARDS
1. 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 prolonged
nuisance conditions due to improper operation and maintenance, the Permittee shall immediately cease
land applying residuals to the site, contact the Winston-Salem Regional Office supervisor, and take any
immediate corrective actions. [G.S. 143-215.1]
2. This permit shall not relieve the Permittee of responsibility for damages to groundwater or surface
water resulting from the operation of this residuals management program. [15A NCAC 02B .0200,
02L .0100]
3. Only residuals generated by the facility listed in Attachment A are approved for land application in
accordance with this permit. [G.S. 143-215.1]
4. Only the Melds listed in Attachment B are approved for residuals land application. [G.S. 143-215.1]
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
f 00
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 has not occurred or for which the required data is incomplete,
by determining background concentrations through representative soil sampling.
[15A NCAC 02T .1105]
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. [15A NCAC 02T
.1106]
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 distributed 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. [ 15A NCAC 02T . 11071
WQ0010583 Version 3.0 Shell Version 160210 Page 2 of 12

8, Setbacks for Class B land application sites shall be as follows:
Setback by application type
(feet)
Setback Description
Vehicular
Irrigation
Injection /
Surface
Surface
Incorporation
Application
Application
Habitable residence or place of public assembly under
separate ownership or not to be maintained as part of
400
400
200
the project site
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
0
200
0
lessee/operator of the land to be maintained as part of
the project site
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams — intermittent and perennial,
100
100
50
perennial waterbodies, and wetlands
Surface water diversions (ephemeral streams,
25
100
25
waterways, ditches)
Groundwater lowering ditches (where the bottom of
25
100
25
the ditch intersects the SHWT
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
15
15
15
more in vertical height
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
[I5A NCAC 02T .1109]
9. Land application areas shall be clearly marked on each site prior to and during any residuals application
event. [15A NCAC 02T .0108(b)(1)]
WQ0010583 Version 3.0 SheIl Version 160210 Page 3 of 12

10. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in exceedance
of agronomic rates. Appropriate agronomic rates shall be calculated using expected nitrogen
requirements based on the determined Realistic Yield Expectations (RYE) using any of the following
methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of 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 (http;//nutrients.soil. ncsu.edu/yields/index.phn). A copy
shall be kept on file and reprinted every five years in accordance with Condition IVA
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined 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 Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncagr.gov/SWC/tech/documents/9th Guidance Doc 100109.pdf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards(ftp://ftp-fc.se.egov.usda.gov/NHO/practice-standards/standards/590.R&.
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
[ 15A NCAC 02T. I 109(b)(1)(k)]
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards. [15A NCAC 02T
.0108(b)(1)]
12. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
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 (ibs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied. [15A
NCAC 02T .0108(b)(1)j
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 at 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 sodium application rate, soil amendments (e.g., 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. [ 15A NCAC
02T .0108(b)(1)]
14. These residuals land application sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land area. An
exceedance of groundwater standards at or beyond the compliance boundary is subject to remediation
action according to 15A NCAC 02L .0106(dx2) as well as enforcement actions in accordance with
North Carolina General Statute 143-215.6A through 143-215.6C. Any approved relocation of the
COMPLIANCE BOUNDARY will be noted in Attachment B. [15A NCAC 02L .0107(a)]
WQ0010583 Version 3.0 Shell Version 160210 Page 4 of 12

15. The review boundary shall be established midway between the compliance boundary and the residual
land application area. Any exceedance of groundwater standards at the review boundary shall require
action in accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
M. OPERATION AND MAINTENANCE REQUIREMENTS
The residuals management program shall 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. [ 15A NCAC 02T . 1110]
2. The Winston-Salem 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 land application site. Notification to the
regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding
State Holidays. [15A NCAC 02T .0108(b)(1)]
3. The Winston-Salem Regional Office shall be notified via email or telephone, [phone], 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. [15A NCAC 02T .0108(b)(l)]
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan) Modifications
to the O&M Plan shall be approved by the Division prior to utilization of the new plan. The O&M Plan,
at the minimum, shall include:
a. Operational functions;
b. Maintenance schedules;
c. Safety measures;
d. Spill response plan;
e. Inspection plan including the following information:
L Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, and
procedures to assure that the selected location(s) and inspection frequency are representative
of the residuals management program;
iii. 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 section of the permit;
f. Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for any
foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to
meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply
multiple times per year but have an annual sampling frequency, may need to sample during
winter months when pathogen reduction is most likely to be negatively affected by cold
temperatures).
[ 15A NCAC 02T . 1100]
WQ0010583 Version 3.0 Shell Version 160210 Page 5 of 12

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 responsible
charge (ORC) and one or more certified operators as back-up ORCs in accordance with l5A NCAC
08G .0201. The ORC or his 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 IIIA.), 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 Resources' Protection and Enforcement
Branch at [phone]. [ 15A NCAC 02T .0117]
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. [15A NCAC 02T
.0108(b)(1))
When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles. [15A NCAC 02T .1 I 101
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division. [G.S. 143-215.11
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. [G.S. 143-215.1]
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on land
application sites onto which residuals are applied, or application shall be 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. [15A NCAC 02T .1109(b)(1)]
11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are 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 I00-year flood elevation, unless the bulk residuals are injected or incorporated within a
24-hour period following a residuals land application event;
£ 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 slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. 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. Any field that is in a
USDA no -till program shall be exempted from meeting this vegetative cover requirement;
i. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
j. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
k. Application exceeds agronomic rates.
WQ0010583 Version 3.0 Shell Version 160210 Page 6 of 12

[ 15A NCAC 02T .1109]
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.
[ 15A NCAC 02T .1109(b)(2)]
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, including 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 during a land
application event, and for as long as the public access restrictions required under Condition I11.12.
apply. (15A NCAC 02T .0108(bx])]
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
Duration
Animals 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 after each 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 harvested for:
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food 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 crops with harvested parts below the land
3 8 months
surface shall not be harvested for:
[15A NCAC 02T. I 109(b)(3)]
15. The Permittee shall acquire from each landowner or lessee/operator 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 (MRCS) or other State Agencies. The Permittee 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 (CLAMP) shall also be considered a Nutrient
Management Plan. [15A NCAC 02T .0108(b)(l), 02T .1104(c)(3)]
WQ0010583 Version 3.0 Shell Version 160210 Page 7 of 12

16. No residuals shall be land applied unless the submitted Land Owner Agreement 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. [ 15A NCAC 02T .1104(c)(4)]
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. [ 15A NCAC 02T .0108(c)]
Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). Residuals that tests or is classified as a hazardous or toxic waste under 40
CFR Part 261 shall not be used or disposed under this permit. The analyses [corrosivity, ignitahility,
reactivity, and toxicity characteristic leaching procedure (TCLP)J 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-Dichiorobenzene (7.5)
Nitrobenzene (2.0)
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)
0.00$
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (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-Trichlorophenol (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)
Once the residuals have been monitored for two years at the frequency specified in Attachment A, the
Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
[15A NCAC 13A .0102(b), 02T .1101, 02T .1105]
WQ0010583 Version 3.0 Shell Version 160210 Page 8 of 12

3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following 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)
[15A NCAC 02T .1101]
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) shall be met. Any exceptions from the requirements in this condition shall
be specified in Attachment A. [15A NCAC 02T .1106, 02T .1107, 02T .1111(c)]
An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be 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(hqp://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 Division upon request. At a minimum, the
Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
[15A NCAC 02T .0108(c), 15A NCAC 02T .1111(d)]
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. [15A NCAC 02B .0505]
WQ0010583 Version 3.0 Shell Version 160210 Page 9 of 12

7. The Permittee 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;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
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, cubic yard 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 totals in 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.
[15A NCAC 02T .0109(a)]
8. Three copies of an annual report shall be submitted on or before March 111. The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual ReportingF.
Instructions for reporting and annual report forms are available at
http://den.ne.gov/about/divisions/water-resources/water-resources permits/wastewater-branch/non-
discharste-permitting-unit/reportinng _fortes, or can be obtained by contacting the Non -Discharge
Permitting Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[ 15A NCAC 02T A 111(a)]
WQ0010583 Version 3.0 Shell Version 160210 Page 10 of 12

V.
9. Noncompliance Notification
The Permittee shall report by telephone to the Winston-Salem Regional Office, telephone number (336)
776-9800, as soon as possible, but 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. Land application of residuals 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 failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
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 [phone], [phone], or [phone].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
betaken to ensure that the problem does not recur. [15A NCAC 02T .0105(1), 02T .0108(b)(1)]
1. 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. [15A NCAC 02T .0108(b)]
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to identify malfunctions, facility deterioration and
operator errors that could result in discharges 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 maintain this 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. [15A NCAC 02T .0108(b)]
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. [G.S. 143-215.3(a)(2)]
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. [G.S. 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. [15A NCAC 02T A 110]
3. This permit is effective only with respect to the nature and volume of residuals described in the permit
application and other supporting documentation. [G.S. 143-215.1]
WQOO10583 Version 3.0 Shell Version 160210 Page 11 of 12

4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be 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; any requirements pertaining to wetlands under 15A
NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter
143 of the General Statutes. [ 15A NCAC 02T .0105(c)(6)]
In the event the residuals program changes ownership or the Permittee changes his 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 fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner. [15A NCAC 02T .0104]
6. This permit is subject to revocation or unilateral modification upon 60-day notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
7. Unless the Division Director grants a variance, expansion of the permitted residuals program contained
herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b).
[15A NCAC 02T .0120]
8. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [I 5A NCAC 02T
.0105(e)(3 )]
Permit issued this the 19' day of May 2017
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
-rS. ]ay Zimmerman, P.G., Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0010583
WQ0010583 Version 3.0 Shell Version 160210 Page 12 of 12

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2) RSC Form

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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Cooleemee WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, ® Local Government, or ❑ Private.
Facility permit issued by: ❑ Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: _).
3. Facility contact person and title: Tim Smith - ORC
Complete mailing address: 123 South Main St
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] E-mail address: tlsmith&daviecountync.gov
4. Facility physical address: 175 Hwy 801 S.
City: Cooleemee State: NC Zip: 27028-
Coordinates: Latitude: 35' 48' 15" Longitude: 80. 33' 40"
Datum: NAD83 Level of accuracy: nearest second
Method of measurement: GPS
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: __E % industrial and % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ® Yes ❑ No
7. Facility permitted/design flow: 1_5 MGD and facility average daily flow: 0_5 MGD
8. Average amount of residuals being generated at this facility 315 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Aerobic Digester — 150,000 gallons
Type and volume of residuals storage (i.e., outside of residuals treatment units): 1.5 MG concrete basin and 3MG concrete
basin
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
® Biological ❑ Non -Biological
FORM: RSC 06-16 Page 1 of
5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as well
as those for corrosivity, ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: 04/26/2021
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes W no. Flashpoint: >170 OF (> 140°F)
Passed reactivity test: W yes Ono. HCN: <0.25 mg/kg (<250) & H2S: <25 mg/kg (<500)
TCLP Parameter
Limit
(mgfi)
Result
(mgfi)
TCLP Parameter
Limit
(mgfi)
Result
(mgfi)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
0.25
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not violate
the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Waypoint Analytical and Date of analysis: 6/10/21
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mglkg)
Monthly Average
Concentration Limits
(Class A Only)
(mglkg)
Result
(mglkg)
Arsenic
75
41
6.12
Cadmium
85
39
2.24
Copper
4,300
11500
103
Lead
840
300
31.8
Mercury
57
17
.388
Molybdenum
75
n/a
3.44
Nickel
420
420
25.9
Selenium
100
100
<2.11
Zinc
7,500
2,800
390
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
❑ > 50 but < 75
39
260
270
❑ > 75 but < 100
46
300
320
❑ > 100 but < 125
53
360
390
❑ > 125
62
450
420
Result (mg/kg)
5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 19.3 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:

Laboratory: Waypoint Analytical and Date of analysis: 6/10/21
Parameter
Result
(mg/kg)
Aluminum
48900
Ammonia -Nitrogen
2410
Calcium
4030
Magnesium
3050
Nitrate -Nitrite Nitrogen
127
pH (Standard Unit)
7.1
Phosphorus
4390
Potassium
2140
Sodium
655
Total Kjeldahl Nitrogen
6340
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): 0.74
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from 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, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity and
conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This rate
is a (check one): M default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (ls) Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mg/kg)
Surface
2511
3216
Injection/Incorporation
3716
4421
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T. 1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T. 1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).

Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
® Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
❑ composting, or ❑ lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
® Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
❑ Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
❑ Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically occur
when these residuals are applied and left on the land surface.

2a) Vicinity Map

2b) Process Flow Diagram

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'GREY ENGINEERING, INC
Civil Design and Surveying
P.O. Box 9 Mocksville, N.C. 27028
greyengineering.com [phone]
DRAWN BY: G. BULLARD PROJ. NU.: 102.101.X
DESIGN BY: G- BULLARD DATE: 09/21/07
_ 6" SLUDGE_
—E WASTING
F—\ i
8" SLUDGE
co
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��
4 SLUDGE
6" SCUM
00
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V)
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Ow
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8" SLUDGE
¢w
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in
12" SLUDGE
RECIRCULATION
TO SOUTH
YADKIN
24" RIVER
LEGEND
INFLUENT/MIX LIQUOR
SLUDGE
EFFLUENT
— — WASTING/SCUM
`r FROM NORTH
INTERCEPTOR
DAVIE COUNTY
COOLEEMEE WWTP PROCESS SCHEMATIC SHEET
2
OF 3

2c) Quantitative Justification

Davie County
Quantitative Justification for Residuals Production Rate
Davie County is working with FEMA to address damage to the holding
basin's wall. They are currently permitted for 315 dry tons a year. Based on
EMA Resource's survey of the basin, there are approximately 2502 dry tons
of material at 15% solids. We are requesting an increase from 315 to 2817
dry tons to take care of the cleanout. Once this has been accomplished their
dry ton numbers can return to 315.
The annual dry ton calculation is based on the percent solids of the analysis
and the removal of 950,000 gallons per year.
Gallons lbs/Gal. %Solids Dry lbs. lbs/ton Da Tons
4,000,000x 8.34 x 0.15 = 5,004,000 / 2000 = 2502 New
315 Old
2817 Total

2d) Operation and Maintenance Plan

Standard Operating Procedure and Operation and
Maintenance Plan for the Davie County — Land
Application Program
1. Purpose
a. Ensure the requirements of the Davie County Non -Discharge Permit#
WQ0010583 are met.
2. Personnel
a. The following is a list of personnel in o rder they are to be contacted when
information needs to be shared.
i. EMA Resources inc.
1. Jeff Thompson - Project Manager 336-477-4078
2. Roy Whitaker- Director of Bus.Dvlpmt./Ops. 336-909-1718
3. Brent Collins - Director of Technical Services 336-399-3646
ii. Davie County
1. David Bone - County Manager 336-753-6001
2. Johnny Lambert- Utilities Director 336-749-6313
3. Tim Smith-ORC Cooleemee WWTP 336-477-5096
3. Operational Functions
a. . The operational function of this project it going to involve mixing the
lagoon with a tractor powered Houle pump to achieve a well -mixed and consistent
material that is suitable for land application. It is going to be spread at agronomic
rates that are determined using the Realistic Yield Expectations (RYE) as outlined in
the permit, the amount of other nutrient sources the landowner and operator has
applied, and the residuals nutrient and metal sample that is current for that
monitoring period. It is going to be spread with a liquid applicator that will use
pressure to spread the material in such a way as to achieve a consistent spread pattern.
The material is going to be land applied on fields that have a crop growing on them
that are going to either be grazed or cut for animal feed. Application rates will be
reduced by25% on fields that are primarily used for grazing in accordance with
USDA NRCS 590. Grazed fields will be determined by the farmers and EMA project
managers.
4. Maintenance Schedule
a. EMA Resources Inc. will follow the maintenance schedule as recommended by the
EMA Resources Operations Manager (Mike Collins) for the equipment necessary to
complete the job.

5. Safety Measures
a. Davie County and EMA Resources Inc. believe in operating in a safety conscious
manner and all employees participate in safety training that is designed to help
employees recognize safety issues and take steps to
prevent accidents from occurring. In addition, EMA Resources employees have the
authority to stop operations if they think any aspect of the operation is going to cause
environmental or personal harm.
6. Spill Response Plan
a. In the unlikely event of a spill, the following action shall be taken immediately.
i. Management of Spill Clean-up Activities: The EMA Resources Project
Manager shall take immediate charge and initiate clean-up activities.EMA
Resources labor and equipment is to be utilized. In the event additional labor
and equipment is required, assistance may be requested from Davie County,
The NC Department of Transportation, and other private contractors, as
necessary.
ii. Halt the Source of the Spill: Such as a ruptured container or damaged transport
unit.
In. Contain the Spill: Form a barrier. Sufficient quantities of straw shall be used
for such purposes. Earthen barriers may be constructed to augment the straw bale
containment area of the spill. The Operations Manager or the person in charge
on the spill site will be advise the clean-up personnel where to get the straw,
lime, and other items necessary to complete the clean-up operation. le. local
farmers, farm supply centers, nurseries.
iv. Initial Clean -Up: Employ front-end loaders, vacuum equipment, sludge
application vehicles, and/or local septic tank service to remove as much of
the spilled material as possible. Straw and/or sand should be scattered in the
spill area to soak up the remaining material. The straw and sand -soaked
material will be collected and removed to a disposal area approved by
representatives of the state regulatory agency.
v. Final Clean -Up: Employ rotary brush sweeper if needed and apply lime to
the spill area upon the approval of the clean-up efforts by the state regulatory
representative. If the event occurs on private property, the clean-up will be
completed to the, satisfactory of the property owner and state regulatory
representatives. The ultimate goal will berestoring the spill area to its original
condition if possible.
vi. Notification: As soon as possible after the spill occurs, the EMA Resources
Project Manager or designee will notify the Davie County and the EMA
Resources main office. EMA Resources office staff are then responsible for
notifying other key EMA Resources personnel.
vii. Reporting:, EMA Resources staff will notify the Winston Salem regional office

of the NCDENR by telephone [phone] as soon as possible, but not
more than 24 hours after, or on the next working day following the occurrence.
The EMA Project Manager shall provide awritten report with 48 hours of the
spill to the EMA Resources Director of Technical Services and Davie County
staff. The report shall list all relative information and actions taken. With the
assistance of EMA Resources personnel, and the Davie County personnel,
a written report will be filed with the Winston Salem regional office within
5 days of the occurrence. For after-hours reporting, the Division's emergency
number shall be called to report all incidences (800) 662- 7956.
7. Inspection Plan
a. Inspection for the land application of residuals will conducted on a minimum
of a weekly basis at the land application site during land application activities. The
inspection frequency is based on the time frame that it is going to take to complete the
project and the number of dry tons to be land applied from this facility. The
inspections will consist of inspecting a current field that is being applied as well as
inspecting random fields that have been completed. Inspections will be conducted by Jeff
Thompson - Project Manager. These inspections will consist of the following:
i. Verifying the application rates for each field that plan on receiving
material.
ii. Checking the calculated loads to ensure the correct amount of residuals
are being land applied.
In. Ensure that all manned equipment has a copy of the permit and the
operation and maintenance plan.
iv. Ensure that the field has been flagged properly and that all buffers are being
adhered to.
v. Verify that the proper number of samples of the residuals have beentaken and
that it meets the criteria for land application.
vi. The records will be kept in the EMA Resources project files in the mainoffice.
Copies of all analyses and records will be forwarded to DavieCounty and
kept on file.
vii. EMA Resources and Davie County staff will immediately inform the other
part if any of the following conditions are noted.
1. Any occurrence with the distribution program resulting in the land
application of significant amounts of material that is abnormal in
quantity or characteristics.
2. Any failure of the distribution system that results in the release to
surface waters.
3. Any time that self -monitoring indicates that the facility has gone out
of compliance with the permit.
4. Any process failure that results in the system not adequately treating the

residuals.
5. Any spill or discharge from a vehicle or piping system during
residuals transportation.
6. Any release that requires immediate reporting outside normal business
hours shall be called in by EMA Resources staff to DENR at (800) 66
2-7956. This number is to be called in the event of a release to surface
waters or imminent failure of a storage system when the event occurs
outside of normalbusiness hours.
8. Sampling and Monitoring Plan
a. Sampling for this project consists of sampling the residuals prior to land application
occurring to ensure that the residuals are suitable for land application.
b. The samples will be collected from the storage lagoon that holds the residuals.
c. Jeff Thompson, Brent Collins, or other designee will be responsible for sample
collection for nutrient and metal, TCLP, and fecal coliform.
d. Nutrient, metal and TCLP sample aliquots will be collected randomly and consist
of at least 7 individual aliquots mixed together in order to get the composite sample
for these parameters.
e. The residuals will be sampled annually for TCLP including the RClls.
f. Metal and nutrient parameters will be collected and analyzed based on the requested
dry ton numbers in the permit application.
g. Residuals will be sampled for fecal coliform to demonstrate pathogen requirements have
been met. Seven separate samples will be collected and analyzed.
9. Environmental Impacts
a. The environmental impacts for residuals may be affected by this procedure.
b. This procedure helps assure that land application is conducted in a safe and efficient
manner while ensuring compliance with the laws and regulations and to minimize
exposure, negative environmental impacts, and public relation concerns.

2ei) Laboratory Analytical Reports

Waypointo
ANALYTICAL
8/18/2021
EMA Resources Inc
Mr. Brent Collins
755 Yadkinville Rd
Mocksville, NC, 27028
Ref: Analytical Testing
Lab Report Number: 21-223-0035
Client Project Description: Cooleemee, NC
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Dear Mr. Brent Collins:
Waypoint Analytical, LLC. received sample(s) on 8/11/2021 for the analyses presented in the following report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Where the laboratory was not responsible for the sampling
stage (refer to the chain of custody) results apply to the sample as received.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule August 2017) and NELAC unless otherwise indicated. Any
parameter for which the laboratory is not officially NELAP accredited is indicated by a '—'symbol. These are not
included in the scope because NELAP accreditation is either not available or has not been applied for. Additional
certifications may be held/are available for parameters, where NELAP accreditation is not required or applicable.
A full list of certifications is available upon request.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Danyale Love
Project Manager
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Ijp,
Page 1 of 8

Waypointo
ANALYTICAL
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 Fax [phone]
www.waypointanalytical.com
Certification Summary
Laboratory ID: WP MTN: Waypoint Analytical, LLC., Memphis, TN
State
Program
Lab ID
Expiration Date
Alabama
State Program
40750
02/28/2022
Arkansas
State Program
88-0650
02/07/2022
California
State Program
2904
06/30/2022
Florida
State Program
- NELAP
E871157
06/30/2022
Georgia
State Program
C044
02/18/2023
Georgia
State Program
04015
06/30/2021
Illinois
State Program
- NELAP
200078
10/10/2022
Kentucky
State Program
80215
06/30/2022
Kentucky
State Program
KY90047
12/31/2021
Louisiana
State Program
- NELAP
LA037
12/31/2021
Louisiana
State Program
- NELAP
04015
06/30/2022
Mississippi
State Program
MS
02/11/2023
North Carolina
State Program
415
12/31/2021
Oklahoma
State Program
9311
08/31/2021
Pennsylvania
State Program
- NELAP
68-03195
05/31/2022
South Carolina
State Program
84002
06/30/2022
South Carolina
State Program
84002
06/30/2022
Tennessee
State Program
02027
02/11/2023
Tennessee
A21LA ISO 17025:2017
4313.01
10/31/2021
Texas
State Program
- NELAP
T104704180
09/30/2021
Virginia
State Program
00106
06/30/2022
Virginia
State Program
- NELAP
460181
09/14/2021
Page 1 of 1 00001/21-223-0035
Page 2 of 8

Waypoint
ANALYTICAL
Report Number: 21-223-0035
Client Project Description: Cooleemee, NC
Lab No Client Sample ID
89374 Cooleemee
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Sample Summary Table
Matrix Date Collected Date Received
Solids 08/10/202107:00 08/11/2021
Page 3 of 8

Waypointo
ANALYTICAL
Client: EMA Resources Inc
Project: Cooleemee, NC
Lab Report Number: 21-223-0035
Date: 8/18/2021
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Metals Analysis Method 601 OD
Analyte: Aluminum
QC Batch No: 1-569164/1-568958
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Iron
QC Batch No: 1-569164/1-568958
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Potassium
QC Batch No: 1-569164/1-568958
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Analyte: Lead
QC Batch No: 1-569164/1-568958
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges. A post
digestion spike was performed and passed quality control acceptance ranges. No matrix interference is
suspected.
Page 4 of 8

waypANALYTICAL
46245
EMA Resources Inc
Mr. Brent Collins
755 Yadkinville Rd
Mocksville , NC 27028
Report Number : 21-223-0035
Lab No : 89374
Sample ID : Cooleemee
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Project Cooleemee, NC
Information :
REPORT OFANALYSIS
Report Date : 08/18/2021
Received : 08/11/2021
Danyale Love
Project Manager
Matrix: Solids
Sampled: 8/ 10/ 2021 7:00
Test
Results
Units
MDL
MQL
DF
Date / Time
Analyzed
By
Analytical
Method
Moisture
95.7
%
0.010
1
08/16/21 17:09
FMM
SW-DRYWT
Ammonia Nitrogen
6210
mg/Kg -
dry
372
2330
1
08/17/21 09:00
JPJ
4500NH3C-2011
Nitrate+Nitrite-N
1900
mg/Kg -
dry
106
106
1
08/13/21 11:38
ZBD
4500NO3F-2011
Organic N
10090
mg/Kg -
dry
2326
1
08/17/21 09:00
CALCULATION
pH
6.9
S.U.
1
08/17/2115:07
DRS
9045D
Total Solids
4.35
%
0.010
0.010
1
08/16/21 17:09
FMM
2540G-2011
Total Volatile Solids
27.2
%
0.010
0.010
1
08/16/21 17:09
FMM
2540G-2011
Total Kjeldahl Nitrogen
16300
mg/Kg -
dry
1160
1
08/18/21 13:56
CLP
4500NORGD-2011
Phosphorus
274
mg/Kg -
dry
64.2
116
1
08/14/21 02:20
DADS
6010D
Aluminum
4470
mg/Kg -
dry
107
116
1
08/14/21 02:20
DADS
6010D
Arsenic
<5.58
mg/Kg -
dry
5.58
11.6
1
08/14/21 02:20
DADS
6010D
Cadmium
<0.465
mg/Kg -
dry
0.465
2.33
1
08/14/21 02:20
DADS
6010D
Calcium
<900
mg/Kg -
dry
900
1160
1
08/14/21 02:20
DADS
6010D
Chromium
<5.49
mg/Kg -
dry
5.49
5.81
1
08/14/21 02:20
DADS
6010D
Copper
<7.21
mg/Kg -
dry
7.21
11.6
1
08/14/21 02:20
DADS
6010D
Iron
7260
mg/Kg -
dry
198
233
1
08/14/21 02:20
DADS
6010D
Lead
<4.19
mg/Kg -
dry
4.19
6.98
1
08/14/21 02:20
DADS
6010D
Magnesium
344
mg/Kg -
dry
60.0
116
1
08/14/21 02:20
DADS
6010D
Manganese
33.7
mg/Kg -
dry
7.56
11.6
1
08/14/21 02:20
DADS
6010D
Mercury
0.814
mg/Kg -
dry
0.159
0.365
1
08/18/21 11:20
TJS
7471A
Molybdenum
<3.14
mg/Kg -
dry
3.14
5.81
1
08/14/21 02:20
DADS
6010D
Nickel
<2.79
mg/Kg -
dry
2.79
5.81
1
08/14/21 02:20
DADS
6010D
Potassium
577
mg/Kg -
dry
144
233
1
08/14/21 02:20
DADS
6010D
Qualifiers/ DF
Dilution Factor
J
Estimated value
Definitions L
Limit Exceeded
MQL
Method Quantitation Limit
Page 5 of 8

WayP�'��'
2790 Whitten
Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
ANALYTICAL
www.waypointanalyiical.com
46245
EMA Resources Inc
Project
Cooleemee, NC
Mr. Brent Collins
Report Date : 08/18/2021
755 Yadkinville Rd
Information :
Received : 08/11/2021
Mocksville , NC 27028
Danyale Love
Report Number : 21-223-0035
REPORT OFANALYSIS
Project Manager
Lab No : 89374
Matrix: Solids
Sample ID : Cooleemee
Sampled: 8/10/2021 7:00
Test
Results
Units
MDL
MQL DF Date / Time By Analytical
Analyzed Method
Selenium
<7.44
mg/Kg - dry
7.44
11.6 1 08/14/21 02:20 DADS 6010D
Sodium
1370
mg/Kg - dry
302
581 1 08/14/21 02:20 DADS 6010D
Zinc
22.13
mg/Kg - dry
18.8
29.1 1 08/14/21 02:20 DADS 6010D
Sulfur
330
mg/Kg - dry
120
233 1 08/14/21 02:20 DADS 6010D
Sodium Absorption Ratio
3.27
Ratio
0.01
0.01 1 08/14/21 02:20 CALCULATION
Qualifiers/ DF Dilution Factor
Definitions
J Estimated value
Page 6 of 8

s
WayPAoi nt ..(2) �79p Whitten Road,3.240 Memphis, TN 38133
21.2440
Main 901.213.240fl °Fax [phone]
N A LYT I C A L www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 46245
Customer Name: EMA Resources Inc
Report Number: 21-223-0035
Shipping Method
0 Fed Ex 0 US Postal 0 Lab
0 UPS 0 Client 0 Courier
0 Other:
Thermometer ID:
T102
Shipping container/cooler uncompromised?
(* Yes
0 No
Number of coolers/boxes received
F-71
Custody seals intact on shipping container/cooler?
0 Yes
0 No
# Not Present
Custody seals intact on sample bottles?
0 Yes
0 No
0 Not Present
Chain of Custody (COC) present?
Yes
0 No
COC agrees with sample label(s)?
Yes
0 No
COC properly completed
Yes
0 No
Samples in proper containers?
Yes
0 No
Sample containers intact?
Yes
0 No
Sufficient sample volume for indicated test(s)?
Yes
0 No
All samples received within holding time?
Yes
0 No
Cooler temperature in compliance?
Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Yes
0 No
Water - Sample containers properly preserved
0 Yes
0 No
0 N/A
Water - VOA vials free of headspace
0 Yes
0 No
0 N/A
Trip Blanks received with VOAs
0 Yes
0 No
0 N/A
Soil VOA method 5035 — compliance criteria met
0 Yes
0 No
# N/A
F_ High concentration container (48 hr)
F_ High concentration pre -weighed (methanol -14 d)
F_ Low concentration EnCore samplers (48 hr)
F_ Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included? 0 Yes * No
Comments:
Signature: IMakayla Weaver Date & Time: 08/11/2021 09:16:01
Page 7 of 8

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Aw
Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Page 1
Report Date: 8/19/2021
Date Sample Rcvd: 8/10/2021
Meritech Work Order #
08102104 Sample: Cooleemee 1 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
5.23 % 8/12/21
0-100 %
SM 2540B
Fecal Coliform (Sludge)
26,769 cal/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
Meritech Work Order #
08102105 Sample: Cooleemee 2 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
2.5 % 8/12/21
0-100 %
SM 2540E
Fecal Coliform (Sludge)
25,000 col/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
Meritech Work Order #
08102106 Sample: Cooleemee 3 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
7.00 % 8/12/21
0-100 %
SM 2540B
Fecal Coliform (Sludge)
38,571 col/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
Meritech Work Order #
08102107 Sample: Cooleemee 4 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
4.83 % 8/12/21
0-100 %
SM 2540B
Fecal Coliform (Sludge)
51,760 col/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
642 Taxnco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
s
Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
MocksviIle, NC 27028
Page 2
Report Date: 8/19/2021
Date Sample Rcvd: 8/10/2021
Meritech Work Order #
Parameters
% Total Solids
Fecal Coliform (Sludge)
08102108 Sample: Cooleemee 5 Grab
Result Analysis Date
5.24 % 8/12/21
66,794 col/g dry wt 8/10/21
Reporting Limit
0-100 %
130 col/g dry wt
8/10/21
Method
SM 2540B
SM 9222D
Meritech Work Order #
08102109 Sample: Cooleemee 6 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
3.74 % 8/12/21
0-100 %
SM 2540B
Fecal Coliform (SIudge)
26,738 col/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
Meritech Work Order #
08102110 Sample: Cooleemee 7 Grab
8/10/21
Parameters
Result Analysis Date
Reporting Limit
Method
% Total Solids
5.00 % 8/12/21
0-100 %
SM 2540B
Fecal Coliform (Sludge)
18,000 col/g dry wt 8/10/21
130 col/g dry wt
SM 9222D
I hereby certify that I have reviewed and approve these data.
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Report Date: 9/23/2021
Date Sample Rcvd: 8/10/2021
Vector Attraction Reduction / Aerobically Digested Sludge (30 Day Test)
Meritech Work Order # 08102103 Sample: CooIeemee Composite 8/10/21
Total Solids Volatile Solids % Volatile Solids
Week 1 1.54 0.410 0.264
Week 2
1.31
0.360
0.277
Week 3
1.00
0.300
0.297
Week 4
1.11
0.300
0.270
Weep 5
1.08
0.290
0.266
Van Kleek Reduction (%): -1.08
I hereby certify that I have reviewed and approve these data.
Pass or Fail
Pass
� &LaLe k
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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ace Analytical ' ANALYTICAL REPORT
May 07, 2021
EMA Resources
Sample Delivery Group: L1344243
Samples Received: 04/27/2021
Project Number: COOLEEMEE
Description: Sludge
Report To: Mr. Brent Collins
755 Yadkinville Road
Mocksville, NC 27028
Entire Report Reviewed By: Jw C4V1--
Justin Carr
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be
reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace
Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067and
ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided,
and as the samples are received.
N
� T
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources COOLEEMEE L1344243 05/07/21 13:39 1 of 21

TABLE OF CONTENTS
Cp: Cover Page
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
COOLEEMEE L1344243-01
5
Qc: Quality Control Summary
7
Wet Chemistry by Method 9012 B
7
Wet Chemistry by Method 9034-9030B
8
Wet Chemistry by Method 9045D
9
Wet Chemistry by Method D93/1010A
10
Mercury by Method 7470A
11
Metals (ICP) by Method 6010D
12
Volatile Organic Compounds (GC/MS) by Method 8260D
14
Chlorinated Acid Herbicides (GC) by Method 8151A
15
Pesticides (GC) by Method 8081B
16
Semi Volatile Organic Compounds (GC/MS) by Method 8270E
17
GI: Glossary of Terms
19
al: Accreditations & Locations
20
Sc: Sample Chain of Custody
21
ACCOUNT: PROJECT: SDG:
DATE/TIME: PAGE:
EMA Resources COOLEEMEE L1344243
05/07/21 13:39 2 of 21

SAMPLE SUMMARY
COOLEEMEE L1344243-01 Waste
Collected by
Brent Collins
Collected date/time
04/26/2107:00
Received date/time
04/27/2109:15
FP
Method
Batch
Dilution Preparation
Analysis
Analyst
Location
date/time
date/time
F
Preparation by Method 1311
WG1662761
1 05/02/21 09:54
05/02/21 09:54
TM
Mt. Juliet, TN
Preparation by Method 1311
WG1663076
1 05/03/2115:33
05/03/2115:33
IDW
Mt. Juliet, TN
Wet Chemistry by Method 9012 B
WG1665185
1 05/06/21 09:54
05/06/21 22:31
JER
Mt. Juliet, TN
Wet Chemistry by Method 9034-9030B
WG1661388
1 04/29/21 22:00
04/29/2122:00
LDT
Mt. Juliet, TN
Wet Chemistry by Method 9045D
WG1662996
1 05/04/2117:58
05/04/21 2121
SAC
Mt. Juliet, TN
Fn
Wet Chemistry by Method D93/1010A
WG1663446
1 05/05/21 22:00
05/05/21 22:00
CO
Mt. Juliet, TN
Mercury by Method 7470A
WG1663247
1 05/03/21 09:51
05/03/2117:55
SD
Mt. Juliet, TN
Metals (ICP) by Method 6010D
WG1663404
1 05/03/2112:44
05/05/2103:08
EL
Mt. Juliet, TN
Fr
Volatile Organic Compounds (GC/MS) by Method 8260D
WG1663986
1 05/05/2115:09
05/05/2115:09
JAH
Mt. Juliet, TN
Chlorinated Acid Herbicides (GC) by Method 8151A
WG1663776
1 05/04/21 22:52
05/05/2115:00
MT-1
Mt. Juliet, TN
Rc
Pesticides (GC) by Method 8081B
WG1663712
1 05/04/21 07:31
05/05/21 09:46
HMH
Mt. Juliet, TN
Semi Volatile Organic Compounds (GC/MS) by Method 8270E
WG1663508
1 05/03/2122:45
05/04/2116:30
SHG
Mt. Juliet, TN
GI
F
RC
ACCOUNT:
PROJECT:
SDG:
DATE/TIME:
PAGE:
EMA Resources
COOLEEMEE
L1344243
05/07/21 13:39
3 of 21

CASE NARRATIVE
All sample aliquots were received at the correct temperature, in the proper containers, with the FP
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples FC
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my FS
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data. 0
Fr
Rc
GI
Justin Carr [Al
Project Manager
RC
Project Narrative
All Reactive Cyanide results reported in the attached report were determined as totals using method 901213.
All Reactive Sulfide results reported in the attached report were determined as totals using method 9034/903013.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources COOLEEMEE L1344243 05/07/21 13:39 4 of 21

SAMPLE RESULTS - 01
L1344243
COOLEEMEE
Collected date/time: 04/26/21 07:00
Preparation by Method 1311
Result Qualifier
Prep
Batch
Analyte
date / time
TCLP Extraction
5/2/2021 9:54:21 AM
WG1662761
TCLP ZHE Extraction -
5/3/2021 3:33:25 PM
WG1663076
Fluid 1
5/2/2021 9:54:21 AM
WG1662761
Initial pH 6.51
5/2/2021 9:54:21 AM
WG1662761
Final pH 4.87
5/2/2021 9:54:21 AM
WG1662761
Wet Chemistry by Method 9012 B
Result Qualifier RDL Dilution Analysis Batch
Analyte mg/kg mg/kg date / time
Reactive Cyanide ND 0.250 1 05/06/2021 22:31 WG1665185
Wet Chemistry by Method 9034-9030B
Result Qualifier RDL
Analyte mg/kg mg/kg
Reactive Sulfide ND 25.0
Wet Chemistry by Method 9045D
Dilution Analysis Batch
date / time
1 04/29/202122:00 WG1661388
Result Qualifier Dilution Analysis Batch
Analyte su date / time
Corrosivity by pH 7.04 T8 1 05/04/2021 2121 WG1662996
Sample Narrative:
L1344243-01 WG1662996: 7.04 at24.7C
Wet Chemistry by Method D93/1010A
Result
Analyte Deg. F
Ignitability DNI at170
Mercury by Method 7470A
Qualifier Dilution Analysis Batch
date / time
1 05/05/202122:00 WG1663446
Result Qualifier RDL Limit
Analyte mg/I mg/I mg/I
Mercury ND 0.0100 0.20
Metals (ICP) by Method 6010D
Result
Qualifier RDL Limit
Analyte
mg/I
mg/I mg/I
Arsenic
ND
0.100 5
Barium
0.250
0.100 100
Cadmium
ND
0.100 1
Chromium
ND
0.100 5
Lead
ND
0.100 5
Selenium
ND
0.100 1
Silver
ND
0.100 5
Volatile Organic
Compounds (GC/MS) by Method 8260D
Result
Qualifier RDL Limit
Analyte
mg/I
mg/I mg/I
Benzene
ND
0.0500 0.50
Carbon tetrachloride
ND
0.0500 0.50
Chlorobenzene
ND
0.0500 100
Chloroform
ND
0.250 6
ACCOUNT:
PROJECT:
EMA Resources
COOLEEMEE
Dilution Analysis Batch
date / time
1 05/03/202117:55 WG1663247
Dilution Analysis
Batch
date / time
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
1 05/05/202103:08
WG1663404
Dilution Analysis
Batch
date / time
1 05/05/202115:09
WG1663986
1 05/05/202115:09
WG1663986
1 05/05/202115:09
WG1663986
1 05/05/202115:09
WG1663986
SDG:
DATE/TIME: PAGE:
L1344243
05/07/21 13:39 5 of 21

COOLEEMEE SAMPLE RESULTS
Collected date/time: 04/26/21 07:00 L1344243
Volatile Organic Compounds (GC/MS) by Method 8260D
- 01
Result
Qualifier RDL Limit Dilution
Analysis
Batch
Analyte
mg/I
mg/I mg/I
date/time
1,2-Dichloroethane
ND
0.0500 0.50 1
05/05/202115:09
WG1663986
1,1-Dichloroethene
ND
0.0500 0.70 1
05/05/202115:09
WG1663986
2-Butanone (MEK)
ND
0.500 200 1
05/05/202115:09
WG1663986
Tetrachloroethene
ND
C3 0.0500 0.70 1
05/05/202115:09
WG1663986
Trichloroethene
ND
0.0500 0.50 1
05/05/202115:09
WG1663986
Vinyl chloride
ND
0.0500 0.20 1
05/05/202115:09
WG1663986
(S) Toluene-dH
102
80.0-120
051051202115.09
WG1663986
(S) 4-Bromofluorobenzene
102
77.0-126
051051202115.09
WG1663986
(S) 1,2-Dichloroethane-d4
112
70.0-130
051051202115.09
WG1663986
Chlorinated Acid Herbicides (GC) by Method 8151A
Result
Analyte mg/I
2,4,5-TP (Silvex) ND
2,4-D ND
(S)2,4-DichlorophenylAcetic Acid 73.6
Pesticides (GC) by Method 8081B
Qualifier
RDL
mg/I
0.00200
0.00200
14.0-158
Limit
mg/I
1
10
Dilution Analysis
date/time
1 05/05/202115:00
1 05/05/202115:00
051051202115.00
Batch
WG1663776
WG1663776
WG1663776
Result
Qualifier
RDL
Limit
Dilution Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
Chlordane
ND
0.00500
0.03
1 05/05/202109:46
WG1663712
Endrin
ND
0.00500
0.02
1 05/05/20210946
WG1663712
Heptachlor
ND
0.00500
0.0080
1 05/05/20210946
WG1663712
Lindane
ND
0.00500
0.40
1 05/05/20210946
WG1663712
Methoxychlor
ND
0.00500
10
1 05/05/20210946
WG1663712
Toxaphene
ND
0.0100
0.50
1 05/05/20210946
WG1663712
(S) Decochlorobiphenyl
63.5
10.0-128
051051202109.46
WG1663712
(S) Tetrochloro-m-xylene
65.8
10.0-127
051051202109.46
WG1663712
Semi Volatile Organic Compounds
(GC/MS) by Method 8270E
Result
Qualifier
RDL
Limit
Dilution Analysis
Batch
Analyte
mg/I
mg/I
mg/I
date/time
1,4-Dichlorobenzene
ND
0.100
7.50
1 05/04/202116:30
WG1663508
2,4-Dinitrotoluene
ND
0.100
0.13
1 05/04/202116:30
WG1663508
Hexachlorobenzene
ND
0.100
0.13
1 05/04/202116:30
WG1663508
Hexachloro-1,3-butadiene
ND
0.100
0.50
1 05/04/202116:30
WG1663508
Hexachloroethane
ND
0.100
3
1 05/04/202116:30
WG1663508
Nitrobenzene
ND
0.100
2
1 05/04/202116:30
WG1663508
Pyridine
ND
J4
0.100
5
1 05/04/202116:30
WG1663508
3&4-Methyl Phenol
ND
0.100
400
1 05/04/202116:30
WG1663508
2-Methylphenol
ND
0.100
200
1 05/04/202116:30
WG1663508
Pentachlorophenol
ND
0.100
100
1 05/04/202116:30
WG1663508
2,4,5-Trichlorophenol
ND
0.100
400
1 05/04/202116:30
WG1663508
2,4,6-Trichlorophenol
ND
0.100
2
1 05/04/202116:30
WG1663508
(S) 2-Fluorophenol
51.0
10.0-120
051041202116.30
WG1663508
(S) Phenol-d5
33.6
10.0-120
051041202116.30
WG1663508
(S) Nitrobenzene-d5
88.0
10.0-127
051041202116.30
WG1663508
(S) 2-Fluorobiphenyl
85.5
10.0-130
051041202116.30
WG1663508
(S)2,4,6-Tribromophenol
78.5
10.0-155
051041202116.30
WG1663508
(S) p-Terphenyl-d14
84.6
10.0-128
051041202116.30
WG1663508
ACCOUNT:
PROJECT:
SDG:
DATE/TIME: PAGE:
EMA Resources
COOLEEMEE
L1344243
05/07/21 13:39 6 of 21

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GLOSSARY OF TERMS
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and ifyou have additional questions please contactyour project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On -Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
u
Fc
Fss]
MDL
Method Detection Limit.
ND
Not detected at the Reporting Limit (or MDL where applicable).
Fn
RDL
Reported Detection Limit.
Rec.
Recovery.
Fr
RPD
Relative Percent Difference.
SDG
Sample Delivery Group.
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
F
(S)
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U
Not detected at the Reporting Limit (or MDL where applicable).
Analyte
The name ofthe particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
Ifthe sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
F
Dilution
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
Rc
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample
The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications ofthe Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. Ifthere was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty
(Radiochemistry)
Confidence level of 2 sigma.
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn)
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
This section ofthe report includes the results ofthe laboratory quality control analyses required by procedure or
Summary (Qc)
analytical methods to assist in evaluating the validity ofthe results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc)
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession ofthe
samples from the time of collection until delivery to the laboratory for analysis.
This section ofyour report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr)
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)
This section ofthe Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier
Description
C3
The reported concentration is an estimate. The continuing calibration standard associated with this data responded low.
Method sensitivity check is acceptable.
J3
The associated batch QC was outside the established quality control range for precision.
J4
The associated batch QC was outside the established quality control range for accuracy.
J6
The sample matrix interfered with the ability to make any accurate determination, spike value is low.
T8
Sample(s) received past/too close to holding time expiration.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources COOLEEMEE L1344243 05/07/21 13:39 19 of 21

ACCREDITATIONS & LOCATIONS
Pace Analytical National 12065 Lebanon Rd Mount Juliet, TN 37122
Alabama
40660
Nebraska
N E-OS-15-05
Alaska
17-026
Nevada
TN000032021-1
Arizona
AZ0612
New Hampshire
2975
Arkansas
88-0469
New Jersey—NELAP
TNO02
California
2932
New Mexico
TN00003
Colorado
TN00003
New York
11742
Connecticut
PH-0197
North Carolina
Env375
Florida
E87487
North Carolina'
DW21704 _
Georgia
NELAP
North Carolina 3
41
Georgia'
923
North Dakota
R-140
Idaho
TN00003
Ohio—VAP
CL0069
Illinois
200008
Oklahoma
9915
Indiana
C-TN-01
Oregon
TN200002
Iowa
364
Pennsylvania
68-02979
Kansas
E-10277
Rhode Island
LA000356
Kentucky' 6
KY90010
South Carolina
84004002
Kentucky 2
16
South Dakota
n/a
Louisiana
A130792
Tennessee'"
2006
Louisiana
LA018
Texas
T104704245-20-18
Maine
TN00003
Texas5
LABO152
Maryland
324
Utah
TN000032021-11
Massachusetts
M-TNO03
Vermont
VT2006
Michigan
9958
Virginia
110033
Minnesota
047-999-395
Washington
C847
Mississippi
TN00003
West Virginia
233
Missouri
340
Wisconsin
998093910
Montana
CERT0086
Wyoming
A2 LA
A2LA— ISO 17025
1461.01
AIHA-LAP,LLC EMLAP
100789
A2 LA — ISO 17025 5
1461.02
DOD
1461.01
Canada
1461.01
USDA
P330-15-00234
EPA—Crypto
TN00003
Drinking Water 2 Underground Storage Tanks 3 Aquatic Toxicity "Chemical/Microbiological 5 Mold 6 Wastewater n/a Accreditation not applicable
Not all certifications held by the laboratory are applicable to the results reported in the attached report.
Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace Analytical.
Rc
ACCOUNT: PROJECT: SDG: DATE/TIME:
EMA Resources COOLEEMEE L1344243 05/07/21 13:39
PAGE:
20 of 21

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2eii) Residuals Information Sheet

Residuals Information Sheet
Generator: Davie County
Facility: Cooleemee WWTP
Address: 175 Hwy 801 S
Cooleemee, NC 27028
Phone: [phone]
Contact: Tim Smith
Land Application Contractor: EMA Resources Inc.
755 Yadkinville Rd
Mocksville, NC 27028
Phone: [phone]
Contact: Brent Collins
Please Note: The application of these residuals is only allowed in accordance with subject permit.
(WQ0002376)
All applicable setbacks in accordance with 15A NCAC 02T .1108(b) will be adhered and is the
responsibility of the land application contractor.
Application rates shall be applied at agronomic rates for intended uses.
No residuals shall be applied to any site that is flooded, frozen, or snow covered.
Adequate procedures will be implemented to prevent surface runoff of residuals in any surface waters.
The attached residuals analysis report is a summary of major and micro -nutrients available in the
residuals.
If you have any questions concerning this information, you may contact EMA Resources Inc, at the
number listed above.

3) LASC Form

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3b) Landowner Agreement

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
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: Davie County Land Application Program
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-DV-008-(04,07,08,09)
No
Fescue Pasture/Hay
Feed/Food/Fiber
NC-DV-008-(05-06)
No
Row Crop
Feed/Food/Fiber
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
H. 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.
HLALTERNATIVES 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.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that 1 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 a 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 specked
herein.
Landowner name,: r�A-0 -r
Address: T' 0 fJC]K 739
City: Coo er�»e-e State: AX Zip: 271DI
Phone: 33(v - 9/r5"- 6060 E-mail address:
ti
Signature: X pate: S%! A? 1
NORTH CAROLMA, COUNTY
I, the undersigned Notary Public do hereby certify that K 05, I I I MO l
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
sf
WITNESS my hand and official seal this the a
day of
Signature and seal: /7)
My commission expires: 3A30��(0
Lessee's/Operator's Certification:
,20Z1
M.BMCONN
0� * EVku Imh 3k =
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and! do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official"e: Ann ! 0"brr� ot;l;�;[s t);rec4-*
Signature:
Date: G • c;- ' 2,9L I T
FORM: LOA 06-16 Page 3 of 3

3c) Vicinity Map

3d) Aerial/Application Map

W.
t � ��,�" t � s • �4 y. ,� ..
p0t, C I
Well
Fai ■
i�i ■ Off Site Dwelling
alga _
A Structure
"a•, _ _ _ Stream
i'-•. Pond
a a
® Buffer
' Field Boundary
Field Total Acres Applicable Acres
4 26.58 19.49 Source: Esri, M ar, GeoE�ye, E rths'tar Property Boundary
USDA, USGS, AeroGRdD, IGN, nd the
SCALE: ,.,�` ..,�\ FIGURE NO.
" = ' i E.I.MA
DATE 1 440 10-31-21 rDavie County Land Application Program
DRAWN BY: BC .Resources, Inc. 2
PROJECT NO: NC-DV-008
WQ0010583 Roger Spillman

pxw'(Z)(6-9)-800n0\sde"\R4unoo alne4\eled SIJ\SIJyblsluawroo4\6sioNsiesn\:o

3e) Current Cumulative Loadings

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 18 Acres Permitted: 18 Site #: NC-DVO08 Field #:
379.04
CeB2
4
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
WINE
Com-
posite
Date
Monosson
NEWEEMEM
0
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
1 C
11
12
DT/Ac./
App.
Event
21.06
Arsenic
0.258
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.258
Cadmium
0.094
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.094
Copper
4.338
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4.338
Chromiuni
2.514
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
2.514
Lead
1.339
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.339
Mercury
0.016
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.016
Molyb-
0.145
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.145
denum
Nickel
1.091
0.000
0.000
1 0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
1 0.000
0.000
1.091
Selenium
0.089
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.089
Zinc
16.425
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
16.425
Total
Phos-
184.889
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
184.889
horus
1
1
1
1
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/27/2021
Date
DENR FORM MFLSF (12/2006)

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ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 18 Acres Permitted: 18 Site #: NC-DVO08 Field #:
78.73
M rC2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
1.23
3.14
Arsenic
0.014
0.035
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.049
Cadmium
0.005
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.008
Copper
0.251
0.045
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.296
Chromiuni
0.164
0.035
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.198
Lead
0.075
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.101
Mercury
0.001
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.006
Molyb-
0.009
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.029
denum
Nickel
0.075
0.018
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.093
Selenium
0.010
0.047
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.056
Zinc
0.844
0.139
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.983
Total
Phos-
8.561
1.723
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
10.284
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/27/2021
Date
DENR FORM MFLSF (12/2006)

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ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 20 Acres Permitted: 20 Site #: NC-DVO08 Field #:
252.46
M rB2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
12.62
Arsenic
0.145
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.145
Cadmium
0.055
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.055
Copper
2.575
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
2.575
Chromiuni
1.679
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.679
Lead
0.767
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.767
Mercury
0.009
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.009
Molyb-
0.092
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.092
denum
Nickel
0.770
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.770
Selenium
0.098
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.098
Zinc
8.659
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
8.659
Total
Phos-
87.856
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
87.856
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/27/2021
Date
DENR FORM MFLSF (12/2006)

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9b

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 44.5 Acres Permitted: 44.5 Site #: NC-DVO08 Field #:
469.83
MrB2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
11
4/26/21
21
6/10/21
3 J
4
5
61
7
8
L9J
10 J
11 J
12
% Solidsj
4.89
15.2
Arsenic
4.9
6.12
Cadmium
0.408
2.24
Copper
8.73
103
Chromiurn
9.63
59.7
Lead
3.67
31.8
Mercury
0.134
0.388
Molyb-
denum
2.76
3.44
Nickel
3.16
25.9
Selenium
6.53
2.11
Zinc
36.1
390
Total
Phos-
horus
394
4390
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
11
21
1 31
4
J
6
7
8
9
1�
11j
12
DT/Ac./
y
App.
Event
1.67
8.89
14
Arsenic
1 0.016
0.109
0.000
1 0.000
0.000
0.000
1 0.000
0.000
1 0.000
0.000
0.000
1 0.000
0.125
Cadmium
0.001
0.040
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.041
Copper
0.029
1.831
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.860
Chromium
0.032
1.061
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.093
Lead
0.012
0.565
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.578
Mercury
0.000
0.007
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.007
Molyb-
0.009
0.061
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.070
denum
Nickel
0.011
0.460
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.471
Selenium
0.022
0.038
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.059
Zinc
0.121
6.933
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
7.053
Total
Phos-
1.316
78.037
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
79.353
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1 /27/2021
Date
DENR FORM MFLSF (12/2006)

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ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 18.2 Acres Permitted: 18.2 Site #: NC-DVO08 Field #:
47.21
M rB2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
2.59
Arsenic
0.043
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.043
Cadmium
0.008
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.008
Copper
1.541
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.541
Chromiuni
0.297
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.297
Lead
0.296
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.296
Mercury
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.006
Molyb-
0.025
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.025
denum
Nickel
0.148
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.148
Selenium
0.040
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.040
Zinc
5.759
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
5.759
Total
Phos-
59.143
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
59.143
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2020
Date
DENR FORM MFLSF (12/2006)

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9b

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Roger Spillman Owner: Roger Spillman Predominant Soil Series:
Acres Used: 23.67 Acres Permitted: 23.67 Site #: NC-DVO08 Field #:
212.58
MrB2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
8.98
Arsenic
0.103
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.103
Cadmium
0.039
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.039
Copper
1.832
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.832
Chromiuni
1.194
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.194
Lead
0.546
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.546
Mercury
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.006
Molyb-
0.066
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.066
denum
Nickel
0.548
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.548
Selenium
0.070
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.070
Zinc
6.161
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
6.161
Total
Phos-
62.508
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
62.508
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/27/2021
Date
DENR FORM MFLSF (12/2006)

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9b

3b) Landowner Agreement

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
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: Davie County Land Application Program
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-DV-009-(01-02)
No
Fescue Pasture/Hay
Feed/Food/Fiber
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
H. 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.
HLALTERNATIVES 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.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein. I ff'' �
Landowner name: 4S 1✓4, S Ill
Address: 8 n{ r LO n L
City: A(Vcuvi itC_ State: Nc-
zip: 2 702 S'
Phone: E-m 1 address:
Signature: Date: _,r1ZT z I
NORTH CAROLINA,
+Jovi C COUNTY
I, the undersigned Notary Public do hereby certify that 71,A14$ k ".4 k*f" —
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 A
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
313oACo
26 {A
M. Brent Collins
Mraan"bnooresNard,
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein,
Signing official
Signature:
Date: (0� Fr- Zo 21
FORM: LOA 06-16 Page 3 of 3

3c) Vicinity Map

3d) Aerial/Application Map

I
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sk
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WV
--.►_-�, • r�x. }. ,;i, _.._.._ Stream
x — x - Fenceline 6
F s M �r ", •�h.
®Buffer
,fir 1• 4
Field Total Acres Applicable Acres
Field Boundary
1 7.47 6.48 `
Source: Esri, DigitalGlobe, Geo ! Property Boundary
2 16.07 15.75 DS, USDA, USGS,AeroGRl©, I ���
_ o
SCALE: 1 ^ = 440 ' Davie County FIGURE NO. i
DATE: 05-10-21 EMA Land Application Program
DRAWN BY: BC --Resources, Inc. 2
'ROJECT NO: NC-DV-009
LAinnninrwz Thomas Whitaker

3b) Landowner Agreement

3c) Vicinity Map

3d) Aerial/Application Map

pxw,(Z)-Z6pna\sdew\Ajuno3 aine4\ele0 SIJ\SI`J3jblsluawn3o4\6sioNsiesn\:o

3e) Current Cumulative Loadings

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
41.95
Operator: Herbert Dooley Owner: Herbert Dooley Predominant Soil Series: CfB2
Acres Used: 16 Acres Permitted: 16 Site #: NC-DV12 Field #: 1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phoms
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
2.62
Arsenic
0.044
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.044
Cadmium
0.008
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.008
Copper
1.557
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.557
Chromiuni
0.300
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.300
Lead
0.299
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.299
Mercury
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.006
Molyb-
0.025
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.025
denum
Nickel
0.149
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.149
Selenium
0.041
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.041
Zinc
5.821
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
5.821
Total
Phos-
59.782
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
59.782
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2020
Date
DENR FORM MFLSF (12/2006)

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9b

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
48.95
Operator: Herbert Dooley Owner: Herbert Dooley Predominant Soil Series: FeC2
Acres Used: 9 Acres Permitted: 9 Site #: NC -DV 12 Field #: 2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
Date
Total
Phos-
phoms
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
LOJ
11
12
DT/Ac./
App.
Event
5.44
Arsenic
0.091
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.091
Cadmium
0.017
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.017
Copper
3.231
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
3.231
Chromiuni
0.623
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.623
Lead
0.621
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.621
Mercury
0.012
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.012
Molyb-
0.052
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.052
denum
Nickel
0.310
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.310
Selenium
0.084
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.084
Zinc
12.075
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
12.075
Total
Phos-
124.009
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
124.009
horus
1
1
1
1
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2020
Date
DENR FORM MFLSF (12/2006)

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9b

3b) Landowner Agreement

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
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: Davie County Land Application Program
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-RO-001-01
No
Fescue Pasture/Hay
Feed/Food/Fiber
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
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, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
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.
H. 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.
HLALTERNATIVES 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.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded Iandowners. 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: T 'es I_ 7a l or
Address: 3190 ro-r4 t. 44re a V_ b r • _
city: Wood I c a F state: ,JC Zip: A
Phone: 'x
Signature: Ic -,174Date, x le lllal
NORT CAROLINA, Nvt C COUNTY
I, the undersigned Notary Public do hereby certify that . TOM cs
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 J. Ikf_ , 2021
Signature and seal:
31301202 (+NARYPUBUD
My commission expires: _
MYOanmbsM E*= Mlillh 90, 2=
Lessee Is/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessec/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official e:
Signature: (7,11
Date:.,._Zte - L_-areZ
FORM: LOA 06-16 page 3 of 3

3c) Vicinity Map

3d) Aerial/Application Map

Field Total Acres Applicable Acres
1 23.35 18.99
SCALE: - r 1 440'
f *—R
=DATE: 05-11-21DRAWN BY: BCesources, Inc.
t,.
h
�"" ► Structure
h.r
Well
`t��"`0 Off Site Dwelling - Waiver
■ Off Site Dwelling
Stream
® Buffer
E- HERE, OOO Field Boundary
S . E D,• I ���+
Property Boundary
Davie County FIGURE NO.
Land Application Program 2
NC-RO-001
James Taylor

3e) Current Cumulative Loadings

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Davie County Water System Total Dry Tons Applied (Annual):
Permit #: WQ0010583 Cation Exchange Capacity (non 503 only):
Operator: Adam Taylor Owner: James Taylor Predominant Soil Series:
Acres Used: 18.99 Acres Permitted: 18.99 Site #: NC-R001 Field #:
62.04
ApB
1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
WINE
Com-
posite
Date
MENEEMBEEMEM
Total
Phos-
phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3
4
5
6
7
8
9
1 C
11
12
DT/Ac./
App.
Event
3.27
Arsenic
0.036
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.036
Cadmium
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.003
Copper
0.047
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.047
Chromium
0.036
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.036
Lead
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Mercury
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.005
Molyb-
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
denum
Nickel
0.018
0.000
0.000
1 0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
1 0.000
0.000
0.018
Selenium
0.049
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.049
Zinc
0.144
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.144
Total
Phos-
1.790
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.790
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/27/2021
Date
DENR FORM MFLSF (12/2006)

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