WQ0000520_Renewal Application Part 1_20220203

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnWrvnmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0000520
Applicant/Permittee City of Burlington
Applicant/Permittee Address PO Box 1358 Burlington, NC 27216
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
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
Does this need review by the hydrogeologist?*
Regional Office
CO Reviewer
Admin Reviewer
Municipal
City of Burlington Class B Residuals Program
Alamance
Yes No
Fee Amount $395
Complete App Date 02/03/2022
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* Robert Roth
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*
3364034324
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-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.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Permit Number: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
WQ0000520
Has Current Existing permit number
Applicant/Permittee* City of Burlington
Applicant/Permittee Address* PO Box 1358 Burlington, NC 27216
Facility Name* City of Burlington Class B Residuals Program
Please provide comments/notes on your current submittal below.
Part 1 of 3
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.)
City of Burlington Renewal WQ0000520_Partl .pdf 176.11MB
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 1/31/2022

BCity of
URLINGTON
Water Res‘urces
January 3rd 2022
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
RE: Permit Renewal Application, Permit No. WQ0000520
To Whom It May Concern:
The City of Burlington is submitting this application for the renewal of permit number
WQ0000520. In this renewal package the South Burlington and East Burlington Waste Water
Treatment Plants are listed as residual source's. Moving forward the South Burlington Plant's
primary method of disposal will be dewatering and disposal at an offsite composting facility
with land application being the second option. The primary method of disposal at the East
Burlington Plant will continue to be land application with the second option being dewatering
and disposal at an offsite composting facility. Also included in this renewal package are
additional sites and fields to be added, sites and fields that we are deleting and fields we are
combining due to new farming practices. A list will be attached to further show the sites/fields
being added, deleted and combined to help NCDENR staff while reviewing this package.
If you have any questions concerning this renewal package, please contact Shane Fletcher at
[phone] or [e-mail]
Respectfully,
Shane Fletcher
Residuals Management Coordinator
City of Burlington
PO Box 1358
Burlington, NC 27216-1358

Summary of sites and fields that are being added,deleted or combined
All site maps have been updated to reflect the most recent imagery,
as a result all renewed sites are listed as modified
CPLR's are included for every field that has ever been applied to, there are a few fields that
have never had an application of Biosolids.
NC-AM-03 Fields 1,2,3 Deleted
NC-AM-06 Field 9 is being split into A,B,C to accommodate new farming practice.
NC-AM-9 Fields 1,2,3 Deleted
NC-AM-13 Fields 1,2,3 Deleted
NC-AM-14 Field 4 Deleted
NC-AM-14 Field 5 is being split into A,B to accommodate new farming practice.
NC-AM-16 Field 2 is being split into A,B to accommodate new farming practice.
NC-AM-16 Field 4 is being split into A,B to accommodate new farming practice.
NC-AM-17 Fields 1,2,3,4 Deleted
NC-AM-18 Field 1 is being split into A,B,C to accommodate new farming practice.
NC-AM-18 Field 2 is being split into A,B to accommodate new farming practice.
NC-AM-19 Field 1,2,3,4 Adding to permit
NC-AM-72 Fields 1,2 Deleted
NC-AM-98 Fields 1,4 Deleted
NC-AM-116 Field 1 Deleted
NC-AM-116 Field 3 and eastern portion of field 4 combined into field 3 to reflect fencing removed
NC-AM-116 Field 5 and western portion of field 4 combined into field 5 to reflect fencing removed.
NC-AM-116 Fields 6,7,8 combined into field 7 to reflect fencing being removed
NC-AM-116 Fields 10,11,12 combined into field 11 to reflect fencing being removed
NC-AM-118 Field 1 Deleted
NC-AM-120 Field 1 Deleted
NC-AM-121 Field 1 Deleted
NC-AM-123 Field 1 Deleted
NC-AM-127 Field 1 Deleted
NC-AM-128 Field 1 Adding to permit
NC-CS-113 Field 3 is being split into A,B and deleting portion west of property line
NC-CS-113 Field 4 Deleted
NC-CS-113 Field 6A,6B Adding to permit
NC-CS-117 Fields 2,3,4,5 Deleted
NC-CH-001 Fields 1,2 Deleted
NC-CH-39/40 Add northern portion or CH-39-4 to CH-40-1 to reflect fencing being removed
NC-CH-95 Fields 3,4,5,6 Deleted
All Orange County sites are being deleted

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
® If this project is for a modification of an existing permit, submit one copy of the existing permit.
® Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification
New Permit
Major Modification'
Major (land are permitted for > 300 acres)
$1,310
$395
Minor (land are permitted for < 300 acres)
$8 10
$245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1C .0300)
® Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
® For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
® Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
® Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
® Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
® Safety measures; may include safety training program, manuals, signs, etc.
® Spill response plan; including control, containment, remediation, emergency contact information, etc.
® Inspection plan including the following information;
® Names and titles of personnel responsible for conducting the inspections.
® Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
® Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
® Sampling and monitoring plan including the following information;
® Names and titles of personnel responsible for conducting the sampling and monitoring.
® Detailed description of monitoring procedures including parameters to be monitored.
® Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules_Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: http://www.ncwater.org/Rules Policies_and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Burlington
Applicant type: ❑Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Shane Fletcher Title: Residuals Management Coordinator
Applicant's mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216-
Telephone number: [phone] Email Address: sfletcher a,burlingtonnc.gov
2. Consultant's name: License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm: )
Consultant's mailing address:
City: State: Zip:
Telephone number: (_) _- Email Address:
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: Christopher Murray License Number: 1284
Affiliation: ❑ N/A ❑ On Staff ® Retained (Firm: Piedmont Environmental Associates)
Soil Scientist's mailing address: 5401 Thacker Dairy Rd
City: Greensboro State: NC Zip: 27406-
Telephone number: [phone] Email Address:
5. Fee submitted: 395.00 (See Instruction B)
II. 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: WQ0000520
Date of most -recently issued permit: 8/1/2017
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit): 9/10/2018
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: Multiple Plants
City: Burlington State: NC Zip: -
Coordinates: Latitude:
Datum: NAD83
Method of measurement: MAP
2. County where residuals land application program is headquartered: Alamance
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:
Longitude:
Level of accuracy: second
Designation
Name
Affiliation
Certification Number
ORC
Shane Fletcher
City of Burlington
988745
Back -Up ORC
990715
James Blackwell
City of Burlington
Additional Back -Up
ORCs
(if applicable)
Rick Asher
988744
City of Burlington
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: 8456 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
31.97
55.56
270,348
469,851
Five -Year Maximum Adjusted
37.39
60.98
316,182
515,685
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
557.74
Hay
339.95
Pasture
1094.02
Total:
1991.71
Methods
Surface
1991.71
Incorporation or Injection
Total:
1991.71
FORM: RLAP 06-16
Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(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
5407.0
9397.0
6323.6
10313.7
100
2703.5
4698.5
3161.8
5156.8
150
1802.3
3132.3
2107.9
3437.9
200
1351.7
2349.3
1580.9
2578.4
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):
D Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
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/yr)
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 (gallons/hr)
Design Annual Loading
Rate (gallons/yr)
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16
Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
'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, Shane Fletcher Residuals Management Coordinator
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for City or Burlington RLAP
(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.
Signature:
Date: //24./-2.oy7
FORM: RLAP 06-16
Page 5 of 5

City of Burlington Class B Biosolids Land Application
Operations and Maintenance Plan
Operational Functions
The operational function of this program will involve permit compliant Class B Biosolids that
are applied to permitted sites by our hired contractor, Synagro LLC. These Biosolids will be
applied at agronomic rates that will be determined by RYE. These Biosolids will be spread as a
liquid at consistent spread patterns by trained Synagro employees to nonhuman consumption
crops. Signed Landowner Agreements will be in place and all buffers marked by flags before
operations begin.
Safety Measures
Synagro has a safety program in place in which employees participate in weekly, monthly
and yearly safety training that is designed to address various safety programs and practices to
help prevent accidents. All Synagro employees have the authority to stop operations if they
think any aspect of the operation is going to cause environmental or personal injury. The
Residuals Management Coordinator ( ORC ) or his designee can also suspend operations if there
is a condition that warrants such action. The City of Burlington's Water Resources Dept. has an
established Safety Program that involves yearly training and employee interaction. The City of
Burlington's Safety Director also conducts yearly inspections of facilities. The Water Resources
Dept. also has a Safety Committee that meets monthly to address any concerns.
Equipment Maintenance Schedule
Synagro employees will follow the maintenance schedule that is recommended by their
fleet manager.

Spill Response
See Spill Control Plan, this plan is updated as needed and will always be printed on a nonwhite
colored piece of paper.
Sampling
The City of Burlington will collect all permit required Class B Biosolid samples and send
these out to contract laboratories for analysis. Samples will be scheduled and collected by the
Residuals Management Coordinator ( ORC) or a designee at each facility. All records generated
from sampling will be maintained by the Residuals Management Coordinator or Synagro.
• Nutrient and Metals grab samples will be collected at least every 60 days from the East
Burlington. Samples will be collected as needed from the South Plant.
• A TCLP grab samples will be collected once per year from the East Burlington and South
Burlington Plant Digesters.
• East Burlington staff will monitor pH for all lime stabilized Biosolids batches as defined
by PSRP. South Burlington staff will monitor pH if batches are made.
• All soil samples from application sites will be collected by Synagro personnel and sent
to contract laboratories for analysis. This data will be tracked and shared with the
Residuals Management Coordinator for future application purposes.
Inspection Plan
Inspections of the Land Application fields will be conducted by the ORC or his
designee as needed. Prior to an application event the ORC or his designee will;
• Verify that all permit required sampling has been completed.
• Notify NCDWR, Winston Salem Regional Office by phone [phone]) or email 24
hrs. in advance of a newly scheduled application event.
• Calculate PAN and check RYE of each field before operations begin.
• Check that all manned equipment contains a copy of the Spill Control Plan, NCDWR
Permit, and Operations and Maintenance Plan.
• Verify that the Application Field Log is correct and that spreader operators are aware of
any special circumstances at the site.

• Verify that a Landowner Verification form has been completed by the landowner and
lessee.
• Ensure that public access signage information is in place.
• Check that all flagging and buffering adheres to site application maps.
• The ORC will keep a record of all site inspections.
• The ORC or Synagro can stop application if conditions justify.
The ORC or his designee will report by telephone to the Winston Salem Regional Office (336-
776-9800) as soon as possible but no later than 24 hrs. after or the next working day following
the occurrence of the following:
• Any occurrence with the land application program which results in the land application
of significant amounts of waste which are abnormal in quality or characteristics.
• Any failure of the land application program resulting in a release of residuals to
receiving waters.
• Any time that self- monitoring information indicates that the facility has gone out of
compliance with the conditions and limitations of the permit or the parameters on
which the system was designed.
• Any process unit failure, due to known or unknown reasons that render the facility
incapable of adequate residual treatment.
• Any spillage or discharge from a vehicle or piping system during transportation of
residuals.
For any emergency that requires immediate reporting (discharges to surface waters,
imminent failure of a storage structure) outside of the normal business hours must be reported
to NCDENR at 1-800-662-7956, 1-800-858-0368 or 1-919-733-3300
Persons reporting such occurrences by telephone shall also file a written report in letter form
within 5 days following first knowledge of the occurrence. This report must outline the actions
taken to remedy the area affected by the discharge and actions taken to avoid future
reoccurrence.
Persons responsible for inspections of this project are as follows:
Shane Fletcher — Residuals Management Coordinator (ORC) or his designee.
Last reviewed 1/7/2022

BIOSOLIDS SPILL CONTROL PLAN
PROJECT: City of Burlington, NC
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
1. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Operations Manager shall take immediate charge and initiate clean-up activities. Synagro LLC labor and equipment
is to be utilized. In the event additional labor and equipment is required, assistance may be requested from the City of
Burlington, the NC Department of Transportation, and other private contractors as necessary. The Operations Manager
shall also communicate with the public on the scene, answering questions and advising of the clean-up activities.
2. HALT THE SOURCE OF THE SPILL:
Such as a ruptured container or damaged transport unit.
3. 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 advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-up
operation, i.e., local farmers, farm supply centers, nurseries, etc.
4. 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.
5. 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 satisfaction
of the property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original
condition if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs, the Synagro Operations Manager will notify the Synagro Regional office, and
they will then be responsible for notifying other key Synagro personnel. The Operations Manager will also be responsible
for notifying someone on the calling list from the City of Burlington. After contact has been made with someone from
the City, that person will then be responsible for notifying other key city personnel. (See reverse side for contact
numbers.)
7. REPORTING:
Synagro personnel and/or City of Burlington personnel will notify the Winston-Salem regional office of the NCDENR by
telephone immediately, but not more than 24 hours after, or on the next working day following the occurrence. The
Operations Manager shall provide a written report within 48 hours of the spill to the Residuals Management Coordinator
and the Water Resources Director. The report shall list all relative information and actions taken. Synagro and City of
Burlington personnel will file a written report to the Winston-Salem Regional office of the NCDENR within 5 days of the
occurrence.

A. Synagro Project Manager : Barney James
336-408-8974 mobile
C. Residuals Management Coordinator:
(City of Burlington)
D. Plant Chief Operators:
(City of Burlington)
E. Water Resources Director
(City of Burlington)
Assistant Water Resources Director:
(City of Burlington)
Laboratory Services Manager:
(City of Burlington)
F. Local Police/Fire Emergency:
G. Synagro LLC :
Operations Director
Operations Manager
Technical Services Manager
Technical Services Specialist
Shane Fletcher
336-675-5927 mobile [phone] office
Rick Asher (South WWTP)
336-350-0387 mobile [phone] office
Darrin Allred (East WWTP)
336-558-8520 mobile [phone] office
Dennis Thomas (Mackintosh WTP)
336-516-5347 mobile [phone] office
Bob Patterson
336-516-2255 mobile [phone] home 336-222-5130 office
Ben Bani
336-264-1474 mobile [phone] office
Sharon Wagoner
336-516-5904 mobile [phone] office
911
Regional Office
336-998-7150
Todd Larson
336-909-1718 mobile
Steve Matchett
704-400-2186
Nate Roth
336-403-4324 mobile
Ryan Copeland
336-607-4494
H. NCDENR Winston-Salem Regional Office:
NC State Warning Point:
(after hours, holidays, weekends)
336-776-9800
800-858-0368
800-662-7956
919-733-3300
(Revised January 7, 2022

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
® For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
® For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Permits".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
® For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

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South Burlington WWTP
Status Facility Permit Holder
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City of Burlington NC
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SUMMARY FOR FORM: RSC 06-16

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: East Burlington WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, X Local Government, or ❑ Private.
Facility permit issued by: X Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: ).
3. Facility contact person and title: Darrin Allred
Complete mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216 r
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 225 Stone Quarry Rd
City: Burlington State: NC Zip: 27217-
Coordinates: Latitude: 36° 05' 41" Longitude: 79° 22' 39"
Datum: NAD83 Level of accuracy: 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: " - % industrial and % domestic)
El other (explain:
)•
6. Does the facility have an approved pretreatment program: X Yes ❑ No
7. Facility permitted/design flow: 12 MGD and facility average daily flow: 4_2 MGD
8. Average amount of residuals being generated at this facility 2447 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Gravity thickening to lime stabilization to storage
Type and volume of residuals storage (i.e., outside of residuals treatment units): 3 storage/digesters with a volume of
1,138,200 gallons
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
X 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:
X 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 X no.
If yes, list the number(s): 1
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes X 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: ATT and Date of analysis: 2/1/2021
Passed corrosivity test: X yes no. pH: s.u. (2 <pH < 12.5)
Passed ignitability test: X yes ❑ no. Flashpoint: °F (> 140°F)
Passed reactivity test: X yes ❑no. HCN: f i mg/kg (<250) & H2S: mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
Arsenic
5.0
<1.0
Hexachlorobenzene
0.13
<0.5
Barium
100.0
<1.0
Hexachloro-1,3-Butadiene
0.5
<0.5
Benzene
0.5
<0.1
Hexachloroethane
3.0
<0.5
Cadmium
1.0
<0.5
Lead
5.0
<1.0
Carbon Tetrachloride
0.5
<0.1
Lindane
0.4
<0.005
Chlordane
0.03
<0.0005
Mercury
0.2
<0.02
Chlorobenzene
100.0
<0.1
Methoxychlor
10.0
<0.1
Chloroform
6.0
<0.1
Methyl Ethyl Ketone
200.0
<2.0
Chromium
5.0
<1.0
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.5
Pentachlorophenol
100.0
<0.5
o-Cresol
200.0
<0.5
Pyridine
5.0
<0.5
p-Cresol
200.0
<0.5
Selenium
1.0
<0.5
Cresol
200.0
<0.5
Silver
5.0
<1.0
2,4-D
10.0
<1.0
Tetrachloroethylene
0.7
<0.1
1,4-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.1
1,2-Dichloroethane
0.5
<0.1
Trichloroethylene
0.5
<0.1
1,1-Dichloroethylene
0.7
<0.1
2,4,5-Trichlorophenol
400.0
<0.5
2,4-Dinitrotoluene
0.13
<0.05
2,4,6-Trichlorophenol
2.0
<0.5
Endrin
0.02
<0.005
2,4,5-TP (Silvex)
1.0
<1.0
Heptachlor and its Hydroxide
0.008
<0.005
Vinyl Chloride
0.2
<0.2
FORM: RSC 06-16
Page 2 of 5

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: ATT and Date of analysis: 11/1/2021
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
<5.0
Cadmium
85
39
<5.0
Copper
4,300
1,500
120
Lead
840
300
<5.0
Mercury
57
17
<0.20
Molybdenum
75
n/a
<5.0
Nickel
420
420
<5.0
Selenium
100
100
<5.0
Zinc
7,500
2,800
430
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)
❑ > O 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 (nag/kg)
FORM: RSC 06-16
Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 3.32 %.
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: ATT and Date of analysis: 11/1/2021
Parameter
Result
(mg/kg)
Aluminum
19600
Ammonia -Nitrogen
12000
Calcium
141600
Magnesium
3000
Nitrate -Nitrite Nitrogen
12
pH (Standard Unit)
12.0
Phosphorus
17000
Potassium
3200
Sodium
1100
Total Kjeldahl Nitrogen
28000
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.14
[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): X 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 (V) Year PAN
(nig/kg)
Five -Year
Maximum Adjusted PAN
(mg/kg)
Surface
10,812
13,933
Injection/Incorporation
16,812
19,933
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:
FORM: RSC 06-16
Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Laud 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):
O Alternative 1 [15A NCAC 02T.1106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T.1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
O Alternative 4 [15A NCAC 02T.1106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, 0 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.1106(c)(1)] - Fecal Coliform Density Demonstration.
X Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, 0 air drying, 0 anaerobic digestion,
0 composting, or X 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 I1.8. 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.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
® Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
® Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
X Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
® Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
• Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(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.
FORM: RSC 06-16 Page 5 of 5

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Represents Intermitent Operation

DER CONSTRUCTI•
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,• . er Name: BURLINGTON •
RMIT RENEW iv
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Quantitative Justification for Residuals Production Rate
Burlington Eastside WWTP
Between the years of 2018 and 2020, the City of Burlington Eastside WWTP land
applied approximately 1495.61 dry tons of material each year. The currently permitted
4000 dry tons/per year maximum to be produced at this plant, should allow plenty of
room for any increase in plant flow, plant expansions or planned maintenance cleanouts.
Dry tons land applied between 2018 and 2020.
Year Dry Tons
2018 1314.1
2019 1308.23
2020 1864.51

Residuals Sampling Plan
City of Burlington Land Application Program
Eastside WWTP
Nutrients and Metals Analysis
Sampling Point: Sludge Holding Basin
Sampling Frequency: 6/yr
Sample Type: Composite
Lab: American Testing Technologies Inc
Pathogen Reduction: Lime Stabilization
Sampling Point: Sludge Basin
Sampling Frequency: Per Batch
Sample Type: Grab
Lab: In House
Vector Attraction Reduction: Lime Stabilization
Sampling Point: Sludge Basin
Sampling Frequency: Per Batch
Sample Type: Grab
Lab: In House
TCLP
Sampling Point: Sludge Holding Basin
Sampling Frequency: Once per permit cycle
Sample Type: Composite
Lab: American Testing Technologies Inc.

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory lD #: 020421-49
Date of Analysis: 02/26/2021
Metals-TCLP (EPA 1311)
American Testing Technologies, inc.
Certificate of Analysis
Parameter Results Units Regulatory Method
Limits Number
Arsenic <1.0 mg/L 5.0 6010D
Barium <10 mg/L 100.0 6010D
Cadmium <0.5 mg/L 1.0 6010D
Chromium <1.0 mg/L 5.0 6010D
Lead . <1.0 mg/L 5.0 6010D
Mercury <0.02 mg/L 0.2 7470A
Selenium <0.5 mg/L 1.0 6010D
Silver <1.0 mg/L 5.0 6010D
1350 Home Avenue Akron, Ohio 44310
Toll Free: 87 7.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingiechnologies.com
Page 20 of 31

City of Burlington, NC
Ann: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory ID #: 020421-49
Date of Analysis: 02/20/2021
American Testing Technologies, Inc.
Certificate of Analysis
VoIatiles-TCLP (EPA 1311)
Parameter Results Units Regulatory Method
Limits Number
Benzene <0.1 mg/L 0.5 8260D
Carbon tetrachloride <0.1 mg/L 0.5 8260D
Chlorobenzene <0.1 mg/L 100 8260D
Chloroform <0.1 mg/L 6.0 8260D
1',2-Dichloroethane <0.1 mg/L 0.5 8260D
1,1-Dichloroethene <0.1 mg/L 0.7 8260D
Nletby1 ethyl ketone <2.0 mg/L 200 8260D
Tetrachloroethene <0.1 mg/L 0.7 8260D
Trichloroethene <0.1 mg/L 0.5 8260D
Vinyl chloride <0.2 mg/L 0.2 8260D
1350 Home Avenue Akron, Ohio 44310 Page 21 of 31
Toll Free; 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com

American Testing Technologies, Inc.
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory ID #: 020421-49
Date of Analysis: 02/19/2021
Certificate of Analysis
BNA-TCLP (EPA 1311)
Parameter Results Units Regulatory Method
Limits Number
1,4-Dichlorobenzene <0.05 mg/L 7.5 8270C
2,4-Dinit rotoluene <0.05 mg/L 0.13 8270C
Hexachlorobenzene <0.05 mg/L 0.13 8270C
Hexachlorobutadiene <0.05 mg/L 0.5 8270C
Hexachloroethane <0.05 mg/L 3.0 8270C
Nitrobenzene <0.05 mg/L 2.0 8270C
Pyridine <0.05 mg/L 5.0 8270C
9-Cresol • <0.5 mg/L 200 8270C
m,p-Cresol <0.5 mg/L 200 8270C
Pentachlorophenol <0.5 mg/L 100 8270C
2,4,5-Trichlorophenol <0.5 mg/L 400 8270C
2,4,6-Trichlorophenol <0.5 mg/L 2.0 8270C
i350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnoiogies.com
Page 22 of 31

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory ID #: 020421-49
Date of Analysis: 02/17/2021
Pesticides-TCLP (EPA 1311)
Parameter
American Testing Technologies, Inc.
Certificate of Analysis
Results Units Regulatory Method
Limits Number
Chlordane <0.005 mg/L 0.03 8081B
Endrin <0.005 mg/L 0.02 8081B
Heptachlor <0.005 mg/L 0.008 8081B
Heptachlor epoxide <0.005 mg/L 0.008 8081B
Lindane <0.005 mg/L 0.4 8081B
Methoxychlor <0.1 mg/L 10.0 8081B
Toxaphene <0.1 mg/L 0.5 8081B
port reviewed by:
ora Manager
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634,9906 Phone: 330,634.9906 Fax: [phone]
www.AmericanTestingTechnologies.com
Page 23 of 31

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory ID #: 020421-49
Date of Analysis: 02/19/2021
Herbicides-TCLP (EPA 1311)
Parameter
American Testing Technologies, Inc.
Certificate of Analysis
Results Units Regulatory Method
Limits Number
2,4-D <1.0 mg/L 10.0 8151A
2,4,5-TP (Silvex) <1.0 mgfL 1.0 8151A
eport reviewed by:
La:'.rat: Manager
1350 Home Avenue Akron, Ohio 44310
Toll Frog: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnoiogies.com
Page 24 of 31

City of Burlington, NC
Attn: Sharon. Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0753
Client ID #: Land App Dig # 1
Laboratory ID #: 020421-49
American Testing Technologies, Inc.
Certificate of Analysis
Parameter Results Units Method Date of
Number Analysis
Reactive Cyanides <0.5 mg/kg 7.3.3.2 02/12/2021
Reactive Sulfides <25 mg/kg 7.3.4.1 02/12/2021
pH (Lab) 5.83 s.u. 9045D 02/05/2021
Flash point >140 °F 1010A 02/11/2021
eport reviewed by:
Manager
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com
Page 25 of 31

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1350 Home Avenue, Suite G-1 Akron, OH 44310
Website: www.AmericanTestingTechnolagies.com
Toll Free: 877-634-9906 Phone: [phone]
Fax: [phone]
Q
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03/01/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Report No.: 020421-46 50
American Testing Technologies, Inc.
Enclosed are the results of the sample(s) submitted to our laboratory on 02/04/2021.
All analyses vvere performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet
requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation
(EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and
245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via email at
[e-mail]
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330,634.9906 Fax: [phone]
www.AmericanTestingTechnologies.com
Page 1 of 31

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CONTACT PERSON - SHANE FLETCHER
EAST t URLI[NGTON WASTEWATER TREATMENT PLANT
!C of C FOR LAND AP MONTHLY METALS/NUTRIENT SAMPLE
MPILE
SAMPLE LOCATION: if I ,R5 SAMPLE ID: EB W c 2 V
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DATE: La) / TIME: C1
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DELIVERED TO COB LAB B r'/re 2-/' DATE: TIME: $
RECEIVED IN LAB BY:
DATE: 11-1-2I
SHIPPED FROM COB LAB BY:i DATE: TIME:
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COMMENTS:
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TIME:
DATE: 1 '�f - 2- ZLTIME: OS-0 I
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Will the results of this sample be Used for compliance reporting. YES NO

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 11/03/2021
Date Reported: 11/18/2021
Date Collected: 11/01/2021
Time Collected: 0115
Client ID #: EB122021
Laboratory ID #: 110321-143
American Testing Technologies, Inc.
Certificate of Analysis
Parameter
Result
(%)
Result
(mpg)
Analysis Date
Method
Aluminum, Total
19,600
11/15/2021
6010D
Arsenic, Total
<5.0
11/15/2021
6010D
Cadmium, Total
<5.0
11/15/2021
6010D
Calcium, Total
14.1
141,600
11/15/2021
6010D
Chromium, Total
27
11/15/2021
6010D
Copper, Total
120
11/15/2021
6010D
Iron, Total
6,300
11/15/2021
6010D
Lead, Total
<5.0
11/15/2021
6010D
Magnesium, Total
0.3
3,000
11/15/2021
6010D
Manganese, Total
1,100
11/15/2021
6010D
Mercury, Total
<0.20
11/15/2021
7471B
Molybdenum, Total
<5.0
11/15/2021
6010D
Phosphorus, Total
1.7
17,000
11/15/2021
6010D
Nickel, Total
<5.0
11/15/2021
6010D
Potassium, Total
0.32
3,200
11/15/2021
6010D
Selenium, Total
<5.0
11/15/2021
6010D
Sodium, Total
0.11
1,100
11/15/2021
6010D
Sulfur, Total
0.66
6,600
11/15/2021
6010D
Zinc, Total
430
11/15/2021
6010D
Total Kjeldahl Nitrogen
2.80
28,000
11/12/2021
SM-4500
Ammonia Nitrogen
1.20
12,000
11/12/2021
SM-4500
Organic Nitrogen
1.60
16,000
11/12/2021
Calculation
Nitrate+Nitrite- N
12
11/12/2021
SM-4500C
Calcium Carbonate Equivalent
39
390,000
11/11/2021
AOAC 955.01
Total Solids
3.32
33,200
11/05/2021
SM-2540G
Total Volatile Solids
47
470,000
11/05/2021
SM-2540G
Moisture
96.68
11/05/2021
SM-2540G
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com

American Testing Technologies, Inc.
1350°Home Avenue Akron, OH 44310
Webslte: www.AmericanTestingrechnologies.com
Tall Ftee: 877-634-9906 Phone: [phone]
Fax: [phone]
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IjWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® For new or renewed permits, submit a separate certification for each source facility.
® For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
® Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
® For each source facility, attach the following:
® Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Residuals Land Application Permits".
® Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
® Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
® Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
® For each source facility, attach the following:
® Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
® Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

RESIDUALS SOURCE FACILITY SUMMARY
Maximum Dry Tons Per Year
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SUMMARY FOR FORM: RSC 06-16

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: South Burlington WWTP
2. Facility permit holder is: ❑ Federal, ❑ State, X Local Government, or ❑ Private.
Facility permit issued by: X Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: j I).
3. Facility contact person and title: Richard Asher
Complete mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216 ! -
Telephone number: [phone] E-mail address: rasherAburlingtonnc.gov
4. Facility physical address: 2471 Boywood Rd
City: Graham State: NC Zip: 27253
Coordinates: Latitude: 36° 01' 13" Longitude: 79° 22' 23"
Datum: NAD83 Level of accuracy: 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: r i % industrial and ` % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: X Yes ❑ No
7. Facility permitted/design flow: 12 MGD and facility average daily flow: 7.58 MGD
8. Average amount of residuals being generated at this facility 2062 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Thickened DAF solids pumped to 1 of 4 digesters
Type and volume of residuals storage (i.e., outside of residuals treatment units): 4 digesters with combined storage capacity
of 2,357,800 gallons
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
X 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:
X 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 X 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 X 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: ATT and Date of analysis: 2/1/2021
Passed corrosivity test: X yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: X yes ❑ no. Flashpoint: °F (> 140°F)
Passed reactivity test: Xyes ❑no. HCN: mg/kg (<250) & H2S: mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mg/0
Arsenic
5.0
<1.0
Hexachlorobenzene
0.13
<0.05
Barium
100.0
<10
Hexachloro-1,3-Butadiene
0.5
<0.05
Benzene
0.5
<0.1
Hexachloroethane
3.0
<0.05
Cadmium
1.0
<0.5
Lead
5.0
<1.0
Carbon Tetrachloride
0.5
<0.1
Lindane
0.4
<0.005
Chlordane
0.03
<0.005
Mercury
0.2
<0.02
Chlorobenzene
100.0
<0.1
Methoxychlor
10.0
<0.1
Chloroform
6.0
<0.1
Methyl Ethyl Ketone
200.0
<2.0
Chromium
5.0
<1.0
Nitrobenzene
2.0
<0.05
m-Cresol
200.0
<0.5
Pentachlorophenol
100.0
<0.5
o-Cresol
200.0
<0.5
Pyridine
5.0
<0.05
p-Cresol
200.0
<0.5
Selenium
1.0
<0.5
Cresol
200.0
<0.5
Silver
5.0
<1.0
2,4-D
10.0
<1.0
Tetrachloroethylene
0.7
<0.1
1,4-Dichlorobenzene
7.5
<0.05
Toxaphene
0.5
<0.1
1,2-Dichloroethane
0.5
<0.1
Trichloroethylene
0.5
<0.1
1,1-Dichloroethylene
0.7
<0.1
2,4,5-Trichlorophenol
400.0
<0.5
2,4-Dinitrotoluene
0.13
<0.05
2,4,6-Trichlorophenol
2.0
<0.5
Endrin
0.02
<0.005
2,4,5-TP (Silvex)
1.0
<1.0
Heptachlor and its Hydroxide
0.008
<0.005
Vinyl Chloride
0.2
<0.2
FORM: RSC 06-16
Page 2 of 5

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/Laid 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: ATT and Date of analysis: 4/5/2021
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(nag/kg)
Result
(mg/kg)
Arsenic
75
41
<5.0
Cadmium
85
39
<5.0
Copper
4,300
1,500
200
Lead
840
300
<5.0
Mercury
57
17
<0.20
Molybdenum
75
n/a
<5.0
Nickel
420
420
<5
Selenium
100
100
<5.0
Zinc
7,500
2,800
260
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)
FORM: RSC 06-16
Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 2.00 %.
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: ATT and Date of analysis: 4/5/2021
Parameter
Result
(mg/kg)
Aluminum
3300
Ammonia -Nitrogen
34000
Calcium
13700
Magnesium
10000
Nitrate -Nitrite Nitrogen
30
pH (Standard Unit)
6.36
Phosphorus
40000
Potassium
16500
Sodium
9700
Total Kjeldahl Nitrogen
46000
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 2.17
[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): X 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 (1st) Year PAN
(ing/kg)
Five -Year
Maximum Adjusted PAN
(mg/kg)
Surface
20,630
22,971
Injection/Incorporation
37,630
39,971
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:
FORM: RSC 06-16
Page 4 of 5

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.1106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.1106(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.1106(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:
El Alternative 1 [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
X Alternative 2 [15A NCAC 02T.1106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, 0 air drying, ❑ anaerobic digestion,
❑ composting, or X 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.1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
® Alternative 3 [15A NCAC 02T.1107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
® Alternative 4 [15A NCAC 02T.1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
X Alternative 6 [15A NCAC 02T.1107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.1107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.1107(a)(8)] - Drying of Unstabilized Residuals.
® Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
® Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1107(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.
FORM: RSC 06-16 Page 5 of 5

January 13, 2022
Owner Name: BURLINGTON CITY OF
UNDER CONSTRUCTION
PERMIT APPROVED
PERMIT RENEWED
©©
APPLIED FOR PERMIT

Residuals Sampling Plan
City of Burlington Land Application Program
Southside WWTP
Nutrients and Metals Analysis
Sampling Point: Sludge Holding Basin
Sampling Frequency: 6/yr
Sample Type: Composite
Lab: American Testing Technologies Inc
Pathogen Reduction: Lime Stabilization
Sampling Point: Sludge Basin
Sampling Frequency: Per Batch
Sample Type: Grab
Lab: In House
Vector Attraction Reduction: Lime Stabilization
Sampling Point: Sludge Basin
Sampling Frequency: Per Batch
Sample Type: Grab
Lab: In House
TCLP
Sampling Point: Sludge Holding Basin
Sampling Frequency: Once per permit cycle
Sample Type: Composite
Lab: American Testing Technologies Inc.

Quantitative Justification for Residuals Production Rate
Burlington Southside WWTP
Between the years of 2018 and 2020, the City of Burlington Southside WWTP
land applied approximately the following dry tons of material each year listed below. The
varying numbers are a function of weather and varying beneficial reuse outlets. The
currently permitted 4456 dry tons/per year maximum to be produced at this plant, should
allow plenty of room for any increase in plant flow, plant expansions or planned
maintenance cleanouts.
Dry tons land applied between 2018 and 2020.
Year Dry Tons
2018 1705.45
2019 806.78
2020 51.04

•
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W

City of Burlington, NC
Attn: Sharon Wagoner
;1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client ID #: 210201 South Dig #1 Land Ap
Laboratory ID #: 020421-48
Date of Analysis: 02/26/2021
Certificate of Analysis
Metals-TCLP (EPA 1311)
Parameter Results Units Regulatory Method .
Limits Number
1
.krsenie <1.0 mg/L 5.0 6010D
Barium <10 ' mg/L 100.0 6010D
Cadmium <0.5 mg/L 1.0 6010D
Chromium <1.0 I mg/L 5.0 6010D
Lead <1.0 i mg/L 5.0 6010D
Mercury <0.02 I mg/L 0.2 7470A
Selenium <0.5 ' mg/L 1.0 6010D
Silver <1.0 I mg/L 5.0 6010D
La
ort reviewed by:
anager
1350 Home Avenue Akron, Ohio 44310
Toll Free; 577.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnoiogies.com
Page 14 of 31

City of Burluigton,NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client ID #: 210201 South Dig #1 Land Ap
Laboratory ID #: 020421-48
Date of Analysis: 02/20/2021
Certificate of Analysis
Volatiles-TCLE (EPA 1311)
Parameter Results Units Regulatory Method
Limits Number
Benzene <0.1 mg/L 0.5 8260D
Carbon tetrachloride <0.1 mg/L 0.5 8260D
Chlorobenzene <0.1 mg/L 100 8260D
Chloroform <0.1 mg/L 6.0 8260D
1,2-Dichloroethane <0.1 mg/L 0.5 8260D
1,1-Dichloroethene <0.1 mg/L 0.7 8260D
Methyl ethyl ketone <2.0 mg/L 200 8260D
Tetrachloroethene <0.1 mg/L 0.7 8260D
Tricbloroethene <0.1 mg/L 0.5 8260D
Vinyl chloride <0.2 mg/L 0.2 8260D
eport reviewed by:
TIt
I‘ or. "i ry Manager
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com
Page 15 of 31

American Testing Technologies, Inc.
City of Burligton, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client JD #: 210201 South Dig #1 Land Ap
Laboratory ID #: 02042148
Date of Analysis: 02/19/2021
Certificate of Analysis
BNA-TCLP (J A 1311)
Parameter Results Units Regulatory Method
Limits Number
1,4-Dichlorobenzene <0.05 mg/L 7.5 8270C
2,4-Dinitrotoluene <0.05 mg/L 0.13 8270C
Hexachlorobenzene <0.05 mg/L 0.13 8270C
Hexachlorobutadiene <0.05 mg/L 0.5 8270C
Hexachloroethane <0.05 mg/L 3.0 8270C
Nitrobenzene <0.05 mg/L 2.0 8270C
Pyridine <0.05 mg/L 5.0 8270C
o-Cresol <0.5 mg/L 200 8270C
rn,p-Cresol <0.5 mg/L 200 8270C
I?entachlorophenol <0.5 mg/L 100 8270C
3•,4,5-Trichlorophenol <0.5 mg/L 400 8270C
2,4,6-Trichlorophenoi <0.5 mg/L 2.0 8270C
ort reviewed by:
Laboto s\i, anager
1350 Home Avenue Akron, Ohio 44310
Tait Frac: 877.634.9906 Phone: 330,634.9906 Fax: [phone]
www.AmericanTestingTechnologies.com
Page 16 of 31

City of Burlington, NC
'Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client ID #: 210201 South Dig #1 Land Ap
Laboratory ID #: 020421-48
Date of Analysis: 02/17/2021
Certificate of Analysis
Pesticides-TCLP (EPA 1311)
Parameter Results Units Regulatory Method
Limits Number
Chlordane <0.005 mg/L 0.03 8081B
Endrin <0.005 mg/L 0.02 8081B
heptachlor <0.005 mg/L 0.008 8081B
;leptachlor epoxide <0.005 mg/L 0.008 8081B
] indane <0.005 mg/L 0.4 8081B
iylethoxychlor <0.1 mg/L 10.0 8081B
Toxaphene <0.1 mg/L 0.5 8081B
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com
Page 17 of 31

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Date Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client ID #: 210201 South Dig #1 Land Ap
Laboratory ID #: 020421-48
Date of Analysis: 02/19/2021
Certificate of Analysis
Herbicides-TCLP (EPA 1311)
Parameter Results Units Regulatory Method
Limits Number
2,4 D <1.0 mg/L 10.0 8151A
2,4,5 TP (Silvex) <1.0 mg/L 1.0 8151A
port reviewed by:
Manager
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com
Page 18 of 31

City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Pate Received: 02/04/2021
Date Reported: 03/01/2021
Date Collected: 02/01/2021
Time Collected: 0915
Client ID #: 210201 South Dig #1 Land Ap
Laboratory ID #: 020421-48
Certificate of Analysis
Parameter Results Units Method Date of
Number Analysis
Reactive Cyanides <0.5 xng/kg 7.3.3.2 02/12/2021
Reactive Sulfides <25 mg/kg 7.3.4.1 02/12/2021
pH (Lab) 6.03 s.u. 9045D 02/05/2021
Flash point >140 °F 1010A 02/11/2021
ort reviewed by:
Manager
1350 Home Avenue Akron, Ohi6 44310
Toll Free: 877.634.9906 Phone: [phone] Fax: [phone]
www.AmericanTestingTechnologies.com
Page 19 of 31

Serial Number
American Testing Technologies, Inc.
1350 Horne Avenue, Suite G-1 Akron, OH 44310
Website: www.AmericanTestingTechnologies.com
Toll Free: 877-634-9906 Phone: [phone]
Fax: [phone]
OF
STANDARD REPORT
DELIVERY
DATE DUE
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DATE DUE
NUMBER OF COOLERS SUBMITTED
PER SHIPMENT:
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03/01/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Report No.: 020421-46_50
American Testing Technologies, Inc.
Enclosed are the results of the sample(s) submitted to our laboratory on 02/04/2021.
All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet
requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation
(EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020,1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and
245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via email at
[e-mail]
' SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In. no event shall ATT 's
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Freer 877.634.9906 Phone: [phone] Fax; 330.634.9907
www.AmericanTestingTechnologies.com
Page 1 of 31

City of Burlington, NC
j Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
!Date Received: 04/09/2021
Date Reported: 04/27/2021
'Date Collected: 04/05/2021
!Time Collected: 0830
Client ID #: 010521
'Laboratory ID #: 040921-12
American Testing Technologies, Inc.
Certificate of Analysis
Parameter
•
Result
(%)
Result
(mg/kg)
AnalysisDate
Method
fj
npi'
' . Aluminum, Total
3,300.
04/16/2021
6010D
:
Arsenic, Total
<5.0
04/16/2021
j
6010D :irl
Ai .
Cadmium, Total
<5.0
04/16/2021
6010D . •
Calcium, Total
1.4
13,700
04/16/2021
6010D
4
Chromium, Total
50
04/16/2021
'6010D
Copper, Total
200
04/16/2021
6010D I i i
• Iron, Total
11,000
04/16/2021.
6010D '
Lead, Total
<5.0
04/16/2021
6010D liti
Magnesium, Total
1.0
10,000
04/16/2021
6010D hi
Manganese, Total
320
04/16/2021
6010D 1'•
Mercury, Total
<0.20
04/16/2021
7471B 'a i
Molybdenum, Total
<5.0
04/16/2021
6010D 114i
Phosphorus, Total
4.0
40,000
04/16/2021
6010D .:W;
Nickel, Total
<5
04/16/2021
6010D ;!I. '
Potassium, Total
1.7
16,500
04/16/2021
6010D 411
Selenium, Total
<5.0
04/16/2021
6010D '` �'
t 4;
' Sodium,Total
0.97
9,700
04/16/2021
6010D
•
Sulfur, Total
0.8
8,000
04/16/2021
6010D :1I .
. Zinc, Total
260
04/16/2021
6010D Il.,
Total Kjeldahl Nitrogen
4.60
46,000
04/26/2021
SM-4500 :1• ;
Ammonia Nitrogen
3.40
34,000
04/26/2021
SM-4500 ';It
Organic Nitrogen
1.20
12,000
04/26/2021
Calculation ;Ila : '
Nitrate+Nitrite- N
30
04/26/2021
SM-4500C `1 11
Calcium Carbonate Equivalent
40
400,000
04/26/2021
AOAC 955,011;
Total Solids
2.00
20,000
04/12/2021
SM-2540G'j
Total Volatile Solids
57
570,000
04/12/2021
SM-2540G iJ f; I:
Moisture
98,00
04/12/2021
SM-2540G ' ;' i.
1350 Home Avenue . Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: [phone] Fax; 330.634.9907
www.AmericanTestingTechnologies.com
Page 3 of 3

1
04/27/2021
American Testing Technologies, Inc.
•
1City of Burlington, NC
Attn: Sharon Wagoner
11302 Belmont Street
Burlington, NC 27215
Report No.: 040921-11_12
Enclosed are the results of the sample(s) submitted to our laboratory on 04/09/2021.
1All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet
requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation
(I EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and
245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via email at
samy@a,americantestingtechnologies.com
Ty Manager
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall•have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT `s
Tability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone; 330.634.9906 Fax: [phone]
www.AmericanTestingTechnologies.com
Page 1 of 3

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include water
treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
® For modified permits, submit the requested information for only those sites that are new, transferred or affected by the proposed
'13. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
• New (N) • Renewed (R) ♦ Modified (M) • Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
County Board
Notification.doc
iv
✓
✓
✓
Land Owner
Agreement
(If applicable)
w
Setback Waiver
Agreement
An updated
for Residuals
vicinity/setback map in accordance with the "Map Guidance
✓
✓
✓
Land Application Permits"
A soils and
Evaluation Policy"
agronomic evaluation in accordance with the "Soil Scientist
✓
INSTRUCTIONS FOR FORM: LASC 06-16Page
1
of 3

An updated accounting of the land application site's cumulative pollutant
loading rates (CPLRs)
✓
V
Required Item
Status Code
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
✓
V
V
Acknowledgement of field transfer from Land Owner (Fields may not be
permitted to multiple Permittees over the same time period)
✓
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or name
of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each site
must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please note
that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct mapping
unit. If a representative slope is provided, it must be determined accordingly:
® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
® New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Merc (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
® Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the residuals
program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each map portion
must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
® Surface water body classifications information may be found at: http://deq.nc.gov/about/divisions/water-
resources/planning/classification-standards/classifications
® Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq.nc.gov/contact/regional-offices
® General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as "UT
to stream name" as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications.
® Stream Classification Process: One of the options below may be used depending on the known initial project information.
KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16Page 2 of 3
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)

1
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
® Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
® The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr Reservoir
and the North Carolina portion of streams tributary thereto not otherwise named or described
shall carry the classification "B," and all backwaters of Lake Gaston and the North Carolina
portion of streams tributary thereto not otherwise named or described shall carry the classification
"C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16Page
3
of
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Blair Thompson
Kirby, Tony
Kirby, Tony
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Wyatte, Walter B
Wyatte, Walter B
Wyatte, Walter B
Wyatte, Walter B
Drechsel, Shirley
Allred, Jimmy D
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Culberson, Kenneth C
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FORM: LASC 06-16

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FORM: LASC 06-16

PIEDMONT
ASSOCIATES. P.A.
January 18, 2022 Project # 3018
City of Burlington, NC
c/o: Mr. Shane Fletcher,
Residuals Management Coordinator
2741 Boywood Rd.
Graham, NC 27253
RE: Soil Evaluation for Various Properties, City of Burlington Residuals Application
Permit, WQ 0000520
This report is being prepared to satisfy requirements set forth in 15A NCAC 02T .1104
(2) concerning the soil evaluation for the application of residuals.
Soil evaluations were conducted on the proposed application sites for the City of
Burlington, NC project by Piedmont Environmental Associates, P.A. These sites and
application fields are shown in the attached soil/site maps (Attachment 1).
The evaluations consisted of hand auger borings and soil profile descriptions of the soils
within the application sites. Soil profile descriptions are given in Attachment 2. All
documents related to the soil evaluation included in this package were prepared by G.
Christopher Murray, L.S.S. of Piedmont Environmental Associates. All other work was
conducted by The City of Burlington, NC.
For each application field site, representative soil borings were conducted to confirm the
soil series designation provided on the USDA/NRCS soil survey data. It was assumed
that areas unsuitable to slope or a seasonally high-water table are not included in the
application area for any of these fields.
Table 1 lists the dominant soil series mapped for each of the fields in this submittal, as
well as the soil series determined:
Table 1. - Soil Profile Descriptions Data, City of Burlington, Permit WQ 0000520
Field
NRCS Mapped Series Field Identified Series
NC-AM-128 - Field 1 Helena Helena
NC-AM-019 - Field 1 Iredell Iredell
NC-AM-019 - Field 2 Cullen Cullen
NC-AM-019 - Field 3 Enon Iredell
NC-AM-019 - Field 4 Enon Iredell
CS 113 -6A Cullen Cullen
CS 113 - 6B Cullen Cullen
216 S. Swing Rd, Suite 1 . Greensboro, NC 27409 . 336-662-5487

Piedmont Environmental Associates is pleased to be of service in this matter. If you have
questions or require additional information, please feel free to call [phone].
Sincerely,
G. Christopher Murray
NC Licensed Soil Scientist #1284
Piedmont Environmental Associates, PA
List of Attachments:
- Attachment 1 — Soil and Site Maps, City of Burlington Residuals
- Attachment 2 — Soil Profile Descriptions

City of Burlington, WQ 0000520 - Cedar Cliff Rd. (NC-AM-128)
216 S. Swing Rd. Suite 1
Greensboro, NC 27409
piedmontsoil.com
PIEDMONT
AViKONMENTAL
A S S O C ,
I A T E S P.A.
i City of Burlington, Subject Parcels
City of Burlington, Application Fields
Ci of Buriin•ton, Soil Bonin. Locations
Job# 3018
Date: 1/18/22
Client: City of Burlington
County: Alamance
S
inch = 300 feet

PIEDMONT
iV
ASSOCIATES, P, A.
City of Burlington, WQ 0000520 - Barnette Rd. (NC-AM-019)
216 S. Swing Rd. Suite 1
Greensboro, NC 27409
piedmontsoil.com
Job# 3018
Date: 1/18/22
Client: City of Burlington
County: Alamance
City of Burlington, Subject Parcels
City of Burlington, Application Fields
Ci of Burlin.ton, Soil Bonin. Locations

PIEDMONT
9VIRONMENTA1
ASSOCIATES, P.A.
City of Burlington, WQ 0000520 - Stadler Rd. (CS 113)
216 S. Swing Rd. Suite 1
Greensboro, NC 27409
piedmontsoil.com
Job# 3018
Date: 1/18/22
Client: City of Burlington
County: Alamance/Caswell
Legend
City of Burlington, Subject Parcels
City of Burlington, Application Fields
Ci .f : rli •t.n .i :.rin• .. ion
Unit, NC CGIA, Max

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

North Carolina Department of Environmental Quality
Pat McCrory
Governor
Date: 1/24/22
To: Name of Chairman to the Board of County Commissioners: John P. Paisley
Complete mailing address: 10 Northwest Court Square
City: Graham
State: NC Zip: 27253-
Donald R. van der Vaart
Secretary
County where land application sites are located: Alamance
From: Applicant's name: City of Burlington (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: Shane Fletcher
Complete mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216
Telephone number: [phone] E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
will ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals -
generating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: Winston Salem Regional Office
Complete mailing address: 450 West Hanes Mill Road, Suite 300
City: Winston Salem State: NC Zip: 27105-
Telephone number: [phone]
Expected date of application submission: 2/1/22
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] \ Internet: http:llportai ncdenr.orolweblwq
An Equal Opportunity t Aftimratve Action Employer — Made in part with recycled paper FORM: CBN 06-16

Maximum Dry Tons Per Year
Proposed
4000
4456
Current b
4000
4456
Permit Number
00
D
00
cn
O
U
z
N-
00
cr)
o
U
z
R City of Burlington NC East Burlington WWTP Alamance
R City of Burlington NC South Burlington WWTP Alamance

♦ T (Transferred)
TION (See Instruction B):
Current and Proposed
Class
r, rr I « re, 77
H
H 0-
W
WS-V
0 NAD 83 1 ADD Nearest Second • •
rote: Please keen the site information (I.) and waterbody information (II.) of the same field on the same page.
& ch
w -rl
WS-V
Waterbody Subbasin and
Stream Index No.
Scrub Creek, 16-18-(1.5)
Scrub Creek, 16-18-(1.5)
Scrub Creek, 16-18-(1.5)
Scrub Creek, 16-18-(1.5)
Wbiteheat Creek, 16-24
Location Accuracy
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Nearest Second
Location Method Code
0
0 E
V 0
,jA
NAD 83
NAD 83
NAD 83
NAD 83
0
q
z
Site/Field ID Latitude Longitude
0o
00
0
N
i�
�
00
0
Cr
�a
�
00
0
N
79 18'30"
79° 21' 53"
36° 09' 15"
36° 09' 18"
36° 09' 43"
36° 09' 43"
35° 57' 43"
AM19-01
AM19-02
AM19-03
tr
o
1
0\
o
W
N_
0)
0
FORM: LASC 06-16

Site: NC-AM-019; Fields 1-4
0
Feet
4,000 8,000
Legend
[= Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
Site Location
C rorzk Golf
Cour_,
Vicinity Map
1In=6,000ft
Ccai t:gv:I l
iron I Sit i t
is I :t % ne )' �,f("7I
County,Statl bf_North aroIi at?OT Es�I ERE Garmm,
IN9REMENT P USG$,ETI/(�ASA GA��PA USDA
of BpRLYRGTON
t,,
.- G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources Include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce Inconsistencies among fealures represented together on
this map. Neither the City of Budinglon nor the Partnership shell
bo held liable for any errors In this map or supporting data. Pdmarl
public Information sources from which This map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the Information cenlalned within lids map.

Site: NC-AM-128; Field 1
:?74 fr
E CREEK MO
NTAINS
0
Feet
4,000 8,000
Gt,be
Gww
-6- hero.)l
7itl-MN, lfr: ,C
Vicinity Map
1 In = 6,000 ft
Town of Cary, Alamance County, Statiof North Carolina DOTtEsri, HERE,
Gar{nin, INCREMENif.R USGS METI/NASA, NA,'gfrA, USDA
.o
Legend
= Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
City of
URLINGTON
G.I.S.
Disclaimer:
Tills map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. Those resources include public information sources of
different scale, lime, origin, definition and accuracy, which aspects
produce Inconsistencies among features represented together on
Ibis mop. Neither the City of Burlington nor the Partnership shall
be held liable for any errors In this map or supporting dela. Primer)
public information sources from which this map was complied, In
conjunction vfih field surveys where required, must be consulted
Inc the verification of the information contained within this map.

From: UPS
To: Nate Roth
Subject: [ External Email ] UPS Delivery Notification, Tracking Number 1Z51F78W0197822954
Date: Wednesday, January 26, 2022 10:00:36 AM
[EXTERNAL EMAIL]
CAUTION: This email originated from outside the organization. Do not click links or open
attachments unless you validate the sender and know the content is safe.
Hello, your package has been delivered.
Delivery Date: Wednesday, 01/26/2022
Delivery Time: 9:54AM
Left At: INSIDE DELIV
Signed by: FRONTDESK
SYNAGRO - MOCKSVILLE
ALAMANCE COUNTY MANAGER NOTIFICATION
Tracking Number: 1Z51F78W0197822954
JOHN PAISLEY
Ship To: 10 NW COURT SQ
GRAHAM, NC 27253
US
Number of Packages: 1
UPS Next Day Air®
0.5 LBS
20-2360-30-60-4310 50-0055
UPS Service:
Package Weight:
Reference Number:
Download the UPS mobile app
© 2022 United Parcel Service of America, Inc. UPS, the UPS brandmark, and the color brown are
trademarks of United Parcel Service of America, Inc. All rights reserved.
All trademarks. trade names, or service marks that appear in connection with UPS's services are the

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

North Carolina Department of Environmental Quality
Pat McCrory
Governor
Donald R. van der Vaart
Secretary
Date: 1/24/22
To: Name of Chairman to the Board of County Commissioners: Rick McVey
Complete mailing address: 5098 Hodges Dairy Rd.
City: Yanceyville State: NC Zip: 27379-
County where land application sites are located: Caswell
From: Applicant's name: City of Burlington (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: Shane Fletcher
Complete mailing address: PO Box 1358
City: Burlington State: NC Zip: 27216-
Telephone number: [phone] E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
will ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals -
generating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: Winston Salem Regional Office
Complete mailing address: 450 West Hanes Mill Road, Suite 300
City: Winston Salem State: NC Zip: 27105-.
Telephone number: [phone]
Expected date of application submission: 2/1/22
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] \ Internet: httpJ/portaLncdenr.oni/weblwq
An Equal Opportunity \ Affirmative Action Employer— Made In part with recycled paper FORM: CBN 06-16

Maximum Dry Tons Per Year
Proposed
4000
4456
Current b
4000
4456
Permit Number
00
00
oo
c-
N
O
O
U
z
00
C-
00
c+l
N
O
0
U
z
Alamance
Alamance
Facility Name
East Burlington WWTP
South Burlington WWTP
Facility Permit Holder
City of Burlington NC
City of Burlington NC
00
U
0
0

LAND APPLICATION SITE CERTIFICATION
0
U
l4r
h
0
l—I
6)
cn
tZ
6)
z
O
g4) z
0
„4.
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2,995.90 net acres and Total to be certified: 56.62 net acres.
Vl
0
U
0
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0
U
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45.2
N N
a
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0
0
♦ T (Transferred)
q
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Current and Proposed
CIass
D;!)�
J
J
Waterbody Subbasin and
Stream Index No.
Stony Creek, 16-14-(1)
Stony Creek, 16-14-(1)
Location Accuracy
Nearest Second
Nearest Second
Nearest Second
Location Method Code
ADD
Datum
ID Latitude Longitude Locationum
CS113-6A 36° 18' 56" 79° 26' 17" NAD 83
CS113-6B 36° 18' 03" 79° 26' 07" NAD 83
° NAD 83
0
ccs
g.
4;
6)
O
0
O
0
0
0
Y
3
b
0
4)
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4)
0
0
4)
0
z
a)
FORM: LASC 06-16

Site : NC-CS-114; Field 6
t:A5,�IFLL
AI'/ekvIFlNCE—
0
Feet
4,000 8,000
mo Crete
Ire
---Krrrs-t tuipat-firt
882 ft
po9
Vicinity Map
1 In = 6,000 ft
1664.
penson �'
784/8
Stony Creek Mountain &' % '
State of North Carolina DOT, Esri, HERE, Garlpin, INCREMENT P, USGS,
) METI/NASA, NGA'EPA, USDA
41-7
I
1
Legend
0 Subject Farm Boundary
----- Highways & Street Centerlines
GIS Division
Date: 1/10/2022
City of
URLINGTON,,—
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce Inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors In this map or supporting dale. Primary
public Information sources from which this map was compiled, In
conjunction with field surveys where required, must be consulted
for the verification of the Information contained within this map.

Your shipment
1Z51F78W0298810196
Q Delivered On
Wednesday, January 26 at 10:24 A.M. at Porch
Delivered To
YANCEYVILLE, NC US
Get Updates >
Proof of Delivery
View Details
Caswell County CBN Delivery Conformation

SYNAGRO
Please see the required note for each requested redefined compliance boundaries:
NC-AM-19-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the South of this field and shall be located 50 feet
from the well located on the neighboring property.
NC-CS-113-01,02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the west of field 1 and North of field 2 and shall be
located 50 feet from the well.
NC-AM-02-01,04,05: A redefined compliance boundary is requested for this site. The
redefined compliance boundary shall be located to the west of field 1, south of field 4 and
southwest of field 5 and shall be located 50 feet from the well located on the neighboring
property.
NC-AM-05-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the northwest of this field and shall be located 50 feet
from the well.
NC-AM-06-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the west of this field and shall be located 50 feet from
the well.
NC-AM-06-08,9A,9B: A redefined compliance boundary is requested for this site.
The redefined compliance boundary is to the east of field 08, south of field 9A, and north
of 9B shall be located 50 feet from the well.
NC-AM-07-01,02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the south and east of field 1 and southwest of field 2
and shall be located 50 feet from the well.
NC-AM-10-01,02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the west of both fields and shall be located 50 feet from
the well.
NC-AM-14-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the south of this field and shall be located 50 feet from
the well.
NC-AM-15-02,03,04: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the west of fields 2 and 3 and south of field 4 and
shall be located 50 feet from the well.
NC-AM-16-01,03: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the south of field 1 and east of field 3 and shall be
located 50 feet from the wells.
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

SYNAGRO
NC-AM-16-2A,2B,4A,4B: A redefined compliance boundary is requested for this
site. The redefined compliance boundary is to the south of field 2A and 2B and west of
field 4A and centrally located between field 4A and 4B and shall be located 50 feet from
the well(s).
NC-AM-18-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of this field and shall be located 50 feet
from the well(s).
NC-AM-35-06: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is centrally located within this field and shall be located
50 feet from the well(s).
NC-AM-110-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the south of this field and shall be located 50 feet from
the well(s).
NC-AM-73-03: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the northwest of this field and shall be located 50
feet from the well(s).
NC-AM-100-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the west of this field and shall be located 50 feet
from the well(s).
NC-AM-116-07,09,11,13: A redefined compliance boundary is requested for this site.
The redefined compliance boundary is to the west of field 7, southwest of field 9, west of
field 11, northwest of field 13 and shall be located 50 feet from the well(s).
NC-AM-118-09: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is centrally located in this field and shall be located 50
feet from the well(s).
NC-AM-119-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the northeast of this field and shall be located 50 feet
from the well(s).
NC-AM-125-4: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of this field and shall be located 50 feet
from the well(s).
NC-AM-126-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of this field and shall be located 50 feet
from the well(s).
NC-AM-126-05,06,07: A redefined compliance boundary is requested for this site.
The redefined compliance boundary is between fields 5,6 and 7 and shall be located 50
feet from the well(s).
NC-AM-126-08: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the east of this field and shall be located 50 feet from
the well(s).
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

SYNAGRO
NC-CS-36-06,08,09,10,11: A redefined compliance boundary is requested for this
site. The redefined compliance boundary is located to the southwest of field 6, northeast of
field 8, northwest of field 9, east of field 10 and shall be located 50 feet from the well(s).
NC-CH-39-01,04: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is located to the south of field 1, north of field 4 and shall
be located 50 feet from the well(s).
NC-CH-40-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is located to the south of this field and shall be located 50
feet from the well(s).
NC-CH-98-01,02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is located to the north of field 1, south of field 2, and shall
be located 50 feet from the well(s).
NC-CH-251-01: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is located to the west of this field and shall be located 50
feet from the well(s).
NC-CH-251-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the north of this field and shall be located 50 feet
from the well(s).
NC-CH-251-03,05: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of field 3, south of field 5, and shall be
located 50 feet from the well(s).
284 Boger Road, Mocksville, NC 27028 • Phone: [phone] • Fax: [phone]

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. 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.
cxPrepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
NI 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: City of Burlington
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-AM-19-1,2,3,4
Yes
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
IL 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,
IILALTERNATIVES 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;
X A re -defined compliance boundary is needed for field(s) ID: 1
(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

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.
Landownername:
Address:
City:
Phone:
L4J/ L7-62 j14/21i-s L"7Ri 5
.. 1+e7'�
(
Signature:
State: 2V C Zip: ..1 2 .30 L - n%2-1-
E-mail address:
NORTH CAROLINA,
I, the undersigned Notary Public do hereby certify that
COUNTY
Date:
%/,075- 7)1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sealthis the / 1 `�
day of ,,47e.
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
, 20 7 l
Z \ Ag ENE . a.
NOTARY PUBLIC
? .AM -'C GD !WY,, N
01
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
,Lessee/operatorname; ( / tt tJ, .v Jii .A L0 4*.) } rL
Address: 3 L 1 Z inn �P-%ir13 2cj t4A-S RO
City:
Phone: d
Signature:
Permittee's Certification:
State: At ° Zip: % ..)-/
E-mail address:
c.-f .-g,34. 3 Liz
Date: / f'
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
r lE-I �t L tJ
tee..
Signature: Date: / Z %L /mac
FORM: LOA 06-16
Page 3 of 3

Site: NC-AM-019; Fields 1-4
Vicinity Map
1 in = 6,000 ft
0
Feet
4,000 8,000
Legend
Q Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1/1 0/2022
Site Location
Alamance County State of North Carolina DOT Esrl HERE, Garmin,
INCREMENT'P, USGS; METI/NASA, NGA, EPA GSDA
City of
URLINGTON
�.". G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-AM-019; Fields 1-4
BCity of
URLINGTON
G.I.S.
GIS Division
Date: 1 /19/2022
`Note: Acreage calculated in GIS
Legend
QSite Boundary
Q Property Line
Application Area
Unsuitable
X — Fence
V/1
® S.W.A.
® On Site House
III Off Site House
_11 Outbuildings
On Site Well
-0- Off Site Well
• Streams
• — Drains
f
Application Area Map
1 in = 660 fit
Surface Water
Flood Zones:
AE
Disclaimer.
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
Floodway (AE) public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
0.2% Annual Chance Flood Hazard for the verification of the information contained within this map.

Owner Name: MATTE VO4LTERBJR&L|NDAH

Site© NC-AM-019; Fields 1-4
Soil Map
Feet
750 1,500
Legend
Q Approved Application Fields
0 Field Numbers
GIS Division
Date: 1 /10/2022
it"�{' City of
V RLINGTO
V .I.
Disclaimer
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Waypoint..
ANALYTICAL
1/26/2022
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Ref: Analytical Testing
Report Number: 22-017-0001
Project Description: Alamance
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s) on 1/17/2022 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. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
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 May 2012) and NELAC unless otherwise indicated.
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,
Pauric McGroary
Agronomist
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.
Page 1 of 10

Waypoint.
ANALYTICAL
Report Number: 22-017-0001
Client Project Description: Alamance
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Sample Summary Table
Lab No Client Sample ID Matrix Date Collected Date Received Method
Lab ID
56223 19-01 Solids 01/17/2022 6010D
WP MTN
56223 19-01 Solids 01/17/2022 SW-7471B
WP MTN
56224 19-02 Solids 01/17/2022 SW-7471B WP MTN
56224 19-02 Solids 01/17/2022 6010D
WP MTN
56225 19-03 Solids 01/17/2022 SW-7471B WP MTN
56225 19-03 Solids 01/17/2022 6010D
WP MTN
56226 19-04 Solids 01/17/2022 6010D
WP MTN
56226 19-04 Solids 01/17/2022 SW-7471B
WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 2 of 10

46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Waypoint.
ANALYTICAL
Report Number : 22-017-0001
Lab No : 56223
Sample ID : 19-01
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Project Alamance
Information :
REPORT OF ANALYSIS
Report Date : 01/26/2022
Received : 01/17/2022
audit pr Grvwr
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Chromium
Lead
Arsenic
Selenium
Test
48.4
8.00
1.83
<0.500
Results
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Units
0.250 1 01/25/22 00:11 JTR 6010D
0.300 1 01/25/22 00:11 JTR 6010D
0.500 1 01/25/22 00:11 JTR 6010D
0.500 1 01/25/22 00:11 JTR 6010D
MQL
DF Date / Time By Analytical
Analyzed Method
Molybdenum
Copper
Zinc
Cadmium
Nickel
Mercury
0.300
14.3
30.9
0.296
10.8
0.0349
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
0.250
1 01/25/22 00:11 JTR 6010D
0.500 1 01/25/22 00:11 JTR 6010D
1.25 1 01/25/22 00:11 JTR 6010D
0.100 1 01/25/22 00:11 JTR 6010D
0.250 1 01/25/22 00:11 JTR 6010D
0.0158 1 01/19/22 13:20 3W2 SW-74716
Qualifiers/
Definitions
DF Dilution Factor
MQL Method Quantitation Limit
Page 3 of 10

Waypoint.
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Project Alamance
Information :
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number :22-017-0001 REPORT OF ANALYSIS
Report Date : 01/26/2022
Received : 01/17/2022
a.wiz P1 c Grvor�'
Pauric Mc Groary Ph.D., CPA
Agronomist
Lab No : 56224 Matrix: Solids
Sample ID : 19-02 Sampled:
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Copper 2.58 mg/Kg 0.500 1 01/24/22 12:04 EAL 6010D
Zinc 3.40 mg/Kg 1.25 1 01/24/22 12:04 EAL 6010D
Cadmium <0.100 mg/Kg 0.100 1 01/24/22 12:04 EAL 6010D
Nickel 1.29 mg/Kg 0.250 1 01/24/22 12:04 EAL 6010D
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Mercury
0.0261 mg/Kg 0.0148 1 01/19/22 13:21 JW2 SW-7471B
Chromium 5.19 mg/Kg 0.250 1 01/24/22 12:04 EAL 6010D
Lead 2.17 mg/Kg 0.300 1 01/24/22 12:04 EAL 6010D
Arsenic <0.500 mg/Kg 0.500 1 01/24/22 12:04 EAL 6010D
Selenium <0.500 mg/Kg 0.500 1 01/24/22 12:04 EAL 6010D
Molybdenum <0.250 mg/Kg 0.250 1 01/24/22 12:04 EAL 6010D
Qualifiers/
Definitions
DF Dilution Factor MQL Method Quantitation Limit
Page 4 of 10

Waypoint..
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Report Number : 22-017-0001
Lab No : 56225
Sample ID : 19-03
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalyticaLcom
Project Alamance
Information :
REPORT OF ANALYSIS
Report Date : 01/26/2022
Received : 01/17/2022
axvrc (7tear
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test
Results
Units
MQL
DF Date / Time
Analyzed
By Analytical
Method
Chromium
Lead
Arsenic
Selenium
Test
51.9
10.6
2.40
<0.500
Results
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Units
0.250 1 01/22/22 09:24 EAL 6010D
0.300 1 01/22/22 09:24 EAL 6010D
0.500 1 01/22/22 09:24 EAL 6010D
0.500 1 01/24/22 12:09 EAL 6010D
MQL
DF Date / Time
Analyzed
By Analytical
Method
Molybdenum
Copper
Zinc
Cadmium
Nickel
Mercury
0.548
29.4
28.1
1.72
7.76
0.0311
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
0.250 1 01/22/22 09:24 EAL 6010D
0.500 1 01/22/22 09:24 EAL 6010D
1.25 1 01/22/22 09:24 EAL 6010D
0.100 1 01/22/22 09:24 EAL 6010D
0.250 1 01/22/22 09:24 EAL 6010D
0.0148 1 01/19/22 13:22 7W2 SW-7471B
Qualifiers/
Definitions
DF Dilution Factor
MQL Method Quantitation Limit
Page 5 of 10

Waypoint.
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Report Number : 22-017-0001
Lab No : 56226
Sample ID : 19-04
7621 Whitepine Read, Richmond, VA 23237
Main 804-743.9401 ° Fax [phone]
www,waypointanalytical,com
Project Alamance
Information :
REPORT OF ANALYSIS
Report Date : 01/26/2022
Received : 01/17/2022
1'1'c aa/
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test
Results
Units
MQL
DF Date / Time By Analytical
Analyzed Method
Copper
Zinc
Cadmium
Nickel
Test
23.4
30.7
1.47
7.88
Results
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Units
0.500 1 01/22/22 09:29 EAL 6010D
1.25 1 01/22/22 09:29 EAL 6010D
0.100 1 01/22/22 09:29 EAL 6010D
0.250 1 01/22/22 09:29 EAL 6010D
MQL
DF Date / Time By Analytical
Analyzed Method
Mercury
Chromium
Lead
Arsenic
Selenium
Molybdenum
0.0269
79.6
13.9
2.96
<0.500
0.499
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
0.0137 1 01/19/22 13:24 JW2 SW-7471B
0.250 1 01/22/22 09:29 EAL 6010D
0.300 1 01/22/22 09:29 EAL 6010D
0.500 1 01/22/22 09:29 EAL 6010D
0.500 1 01/22/22 09:29 EAL 6010D
0.250 1 01/22/22 09:29 EAL 6010D
Qualifiers/
Definitions
DF Dilution Factor
MQL Method Quantitation Limit
Page 6 of 10

Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Client: Synagro Central LLC/ Technical
Project: Alamance
Lab Report Number: 22-017-0001
Date: 1/25/2022
CASE NARRATIVE
Metals Analysis Method 6010D
Sample 56224 (19-02)
QC Batch No: L595837/L595053
One or more Internal Standards are outside method acceptance criteria. Re -analysis and/or sample dilutions are
required.
Sample 96592
Analyte: Chromium
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges
Analyte: Copper
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Analyte: Nickel
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Analyte: Lead
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Sample 93263
Analyte: Arsenic
QC Batch No: L596091/L595558
The matrix spike and/or the matrix spike duplicate was outside
digestion spike was performed and passed quality control acce
suspected.
quality control acceptance ranges. A dilution test
. No matrix interference is suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A post
ptance ranges. No matrix interference is
Analyte: Chromium
QC Batch No: L596091/L595558
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.
Solids Total Mercury Analysis - CVAA Method 7471A
Sample 96593
Analyte: Mercury
QC Batch No: L595311/L595050
Page 7 of 10

0
'—~ Waypoint
ANALYTICAL
75ZzwhhepinoRoad, Richmond, v4z3237
Main 804/43-940z^Fax 8O427l-6446
wwv^wmypomtana|yhca|.com
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance nongau Apoo`
digon�onspike was pn�onnedand passed qua|�yoon�o|acceptance nangen� Nome��inha�e—interference is
ouopeoo»U.
Page 8 of 10

Waypoint
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 46622
Customer Name: Synagro Central LLC/ Technical
Report Number: 22-017-0001
Shipping Method
O Fed Ex 0 US Postal 0 Lab 0 Other :
O UPS 0 Client 0 Courier Thermometer ID:
Shipping container/cooler uncompromised?
Yes 0 No
Number of coolers/boxes received
Custody seals intact on shipping container/cooler? 0 Yes 0 No 0 Not Present
Custody seals intact on sample bottles? 0 Yes 0 No J Not Present
Chain of Custody (COC) present? 0 Yes 0 No
COC agrees with sample label(s)?
D Yes 0 No
COC properly completed
DYes 0No
Samples in proper containers?
Sample containers intact?
DYes 0No
*Yes O No
Sufficient sample volume for indicated test(s)?
D Yes O No
All samples received within holding time?
D Yes 0 No
Cooler temperature in compliance?
DYes *No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
0 Yes
• No
Water - Sample containers properly preserved
Water - VOA vials free of headspace
0 Yes
0 Yes
O No
O No
• N/A
• N/A
Trip Blanks received with VOAs
0Yes 0No
0 N/A
Soil VOA method 5035 — compliance criteria met 0 Yes 0 No # N/A
High concentration container (48 hr) 7 Low concentration EnCore samplers (48 hr)
High concentration pre -weighed (methanol -14 d) I Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included?
Comments:
0Yes ONo
Signature: iBrandi Watson Date & Time: 01/17/2022 09:08:33 j
Page 9 of 10

0T 30 0T a6ed
n F Sample Infomnatlon 1
©ttecton Information Container Information Please Wnte in Desired Taste
Date Time T Volume SL1 SL2
Number 503 W+tn
of Bodies YPe Metals Se tel pH CCE Ag 1 Others
c
t
1'
(moisture), 1 otai kleidahl Nitrogen. Phosphorus and Potassium
SL2: Banc Test SLI plus Sulfur" Calourr, Magnesium, Sodium, Iron, Aluminum, Manganese, Copper and Zinc � 114f9d/
503 Metals: Arsenic, Cadmium, Chromium, Mercury Molybdenum, Lead. Nickel, and Selenium (Copper and Zinc
included to SL2)
Nitrogen Series: Total Kjeldahl. Ammonium, Nitrate and Organic Matter �t - CCE: Calcium Carbonate Equivalent or Total Neutraltzatpn Value (for Irene treated sludge) 503 ,rt/.Jf „o/F..s. c.n�pct �l z.�.y- t' /t^I q %/
✓/ Q
r
cm
fr
_
y
f
E I
f I_
NI,
tics
m
Zit.
tic
a
i(t

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. L d 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: City of Burlington
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-AM-128-1
Yes
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
n 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event,
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
IILALTERNATIVES 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)
X 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

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 anothermunicipality, 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
Landowner name: J J.11;r ig �/ /� Mil
C l - f: 1
Address: 'ifO.s Ge.d ci' (.� f i 4 / `d'
City: �/}2%iRN'1 State: /V L Zip: of 7 Z 5-3
Phone: q-// IP' I7c $2 96, E-mail address:
f
...,_. �, ' �, r
Signature: c' ;� Date: . ��,`/)
\.
NORTH CAROLINA, I C—N1.Ci C_ f COUNTY
I, the undersigned Notary Public do hereby certify that '1.5 h fP el c. % c.,r) s le,,
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sealthis the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
, 20 d /
MYRA THomP.Rau
NOTARY PUBLIC
Aiamance County
Worth Oaroll.
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
liLessee/operator name: 6/Mir
Address: of p / ,vji c�Lrt t,
City:6.--"z4-aili State: /1/L - Zip: •2?.2�j 3
E-mail address:
Phone: 3 7 rP _ of 03 - 94L/L
Si ature:
Permittee's Certification:
1Cr
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
Signing officialname: S 'cin e (e
Signature: Date: 1 z/ 2 tAt91I
FORM: LOA 06-16
Page 3 of 3

Site: NC-AM-128; Field 1
Vicinity Map
1 in = 6,000 ft
0
Feet
4,000 8,000
Legend
Q Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
Town of Cary, Alamance County, State of North Carolina DO1 Esri, HERE,
Garmin, INCREMENT P, USGS, METI/NASA, NGA, A, USDA
City of
URLINGTON
- GIS.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held table for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-AM-128; Field 1
Application Area Map
BCity of
URLINGTON
r."` G.I.S.
GIS Division
Date: 1 /11 /2022
*Note: Acreage calculated in GIS
Legend
QSite Boundary
Q Property Line
Application Area
Unsuitable
X — Fence
V/I
® S.W.A.
® On Site House
III Off Site House
Outbuildings
On Site Well
-0- Off Site Well
• Streams
— Drains
I I
Surface Water
Flood Zones:
Disclaimer.
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
AE be held liable for any errors in this map or supporting data. Primary
Floodway (AE) public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
0.2% Annual Chance Flood Hazard for the verification of the information contained within this map.

CC)
CO
0 -
January 2O.2022
>0
0
Owner Name: DRECHSELSHIRLEYA
Parcels New ID
^lam="Co un �ysm
5BContours

Site: NC-AM-128; Field 1
Soil Map
1 in = 1 nnn fit
CnC2
C;,D2
VaB
Va D VaC
Val`
Legend
Q Approved Application Fields
0 Field Numbers
GIS Division
Date: 1/10/2022
City of
URLINGTON
G.I.Sr
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must he consulted
for the verification of the information contained within this map.

Waypoint.,
ANALYTICAL
1/24/2022
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
Ref: Analytical Testing
Report Number: 22-017-0003
Project Description: Alamance
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s) on 1/17/2022 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. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
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 May 2012) and NELAC unless otherwise indicated.
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,
Sic
p1c
Pauric McGroary
Agronomist
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.
Page 1 of 6

Waypoint
ANALYTICAL
Report Number: 22-017-0003
Client Project Description: Alamance
76214Vhitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalyticaicom
Sample Summary Table
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
56229 128-1
56229 128-1
Solids
Solids
01/17/2022 SW-7471B WP MTN
01/17/2022 6010D WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 2 of 6

Waypoint.
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Report Number : 22-017-0003
Lab No : 56229
Sample ID : 128-1
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalyticaicom
Project Alamance
Information :
REPORT OFANALYSIS
Report Date : 01/24/2022
Received : 01/17/2022
e
lt1 Growl/
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test
Results
Units
MQL
DF Date / Time
Analyzed
By Analytical
Method
Copper
Zinc
Nickel
Mercury
Selenium
Test
1.86
13.3
1.34
<0.0147
<0.500
Results
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
Units
0.500 1 01/22/22 09:45 EAL 6010D
1.25 1 01/22/22 09:45 EAL 6010D
0.250 1 01/22/22 09:45 EAL 6010D
0.0147 1 01/19/22 13:28 JW2 SW-7471B
0.500 1 01/22/22 09:45 EAL 6010D
MQL
DF Date / Time By Analytical
Analyzed Method
Arsenic
Cadmium
Chromium
Lead
Molybdenum
0.694
<0.100
4.12
4.53
<0.250
mg/Kg
mg/Kg
mg/Kg
mg/Kg
mg/Kg
0.500 1 01/22/22 09:45 EAL 6010D
0.100 1 01/22/22 09:45 EAL 6010D
0.250 1 01/22/22 09:45 EAL 6010D
0.300 1 01/22/22 09:45 EAL 6010D
0,250 1 01/22/22 09:45 EAL 6010D
Qualifiers/
Definitions
DF Dilution Factor
MQL Method Quantitation Limit
Page 3 of 6

Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Client: Synagro Central LLC/ Technical
Project: Alamance
Lab Report Number: 22-017-0003
Date: 1/24/2022
CASE NARRATIVE
Metals Analysis Method 6010D
Sample 96592
Analyte: Chromium
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Analyte: Copper
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Analyte: Nickel
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Analyte: Lead
QC Batch No: L595837/L595053
The matrix spike and/or the matrix spike duplicate was outside
was performed and passed quality control acceptance ranges.
Solids Total Mercury Analysis - CVAA Method 7471A
Sample 96593
Analyte: Mercury
QC Batch No: L595311/L595050
The matrix spike and/or the matrix spike duplicate was outside
digestion spike was performed and passed quality control acce
suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A dilution test
No matrix interference is suspected,
quality control acceptance ranges. A dilution test
No matrix interference is suspected.
quality control acceptance ranges. A post
ptance ranges. No matrix interference is
Page 4 of 6

Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 46622
Customer Name: Synagro Central LLC/ Technical
Report Number: 22-017-0003
Shipping Method
0 Fed Ex 0 US Postal 0 Lab 0 Other :
• UPS 0 Client 0 Courier Thermometer ID:
Shipping container/cooler uncompromised?
D Yes O No
Number of coolers/boxes received 1
Custody seals intact on shipping container/cooler? 0 Yes 0 No 0 Not Present
Custody seals intact on sample bottles? 0 Yes 0 No # Not Present
Chain of Custody (COC) present? # Yes 0 No
COC agrees with sample label(s)?
DYes 0No
COC properly completed
* Yes O No
Samples in proper containers?
Sample containers intact?
* Yes O No
* Yes O No
Sufficient sample volume for indicated test(s)?
D Yes O No
All samples received within holding time?
Yes O No
Cooler temperature in compliance?
DYes 0No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
DYes *No
Water - Sample containers properly preserved
Water - VOA vials free of headspace
0 Yes
0Yes
0 No
0 No
0 N/A
0 N/A
Trip Blanks received with VOAs
DYes ONo
* N/A
Soil VOA method 5035 — compliance criteria met
r High concentration container (48 hr)
0Yes ONo *N/A
Low concentration EnCore samplers (48 hr)
High concentration pre -weighed (methanol -14 d) Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included? 0 Yes 0 No
Comments:
Signature:
Brandi Watson
Date & Time:
01/17/2022 09:15:30
Page 5 of 6

9 30 9 a52a
t

DWR
i-- 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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed 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.
Z 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: City of Burlington
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-CS-113-1,2
No
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals 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

/*-1
I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
X A re -defined compliance boundary is needed for field(s) ID: 1,2
(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

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.
Landownername: r 2ci 6.11,4%, 3744 Or? f
Address: U `
City: E ton
Phone:lt� —
Signature:
54-0A per- tko
5(4s15+5
c� r
NORTH CAROLINA, C. R 5/zA4,{/l
State:
E-mail address: Cd•
Zip: Z7 24
�(Yb hit i m
Date: "2
COUNTY 1
I, the undersigned Notary Public do hereby certify that ; z a be lkh &iy,ry).00s
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sealthis the
day of Januar-
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
(/
I certify that I have read this Agreement and do hereby agree abide by the stipulations and restrictions as specified herein.
'.Lessee/operator name:
Address:
City: Ch../`?
Phone:
Signature:
Permittee's Certification:
1 //
5 rd/c,- 44.
i
State:
/v '
Zip: y
' 9 ," E-mail address:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
Signing official name:
Signature:
cc a
Date: I l 1 1 .7'
FORM: LOA 06-16
Page 3 of 3

- 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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed 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: City of Burlington
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-CS-113-3A
Yes
Fescue
Hay/Pasture
NC-CS-113-3B,5
Yes
Row Crop
Corn/Soybeans
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.
n
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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
,e'%k term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
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)
XA 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

,Lessee/operator name:
LS.17) -
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 anothermunicipality, 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. /t241 .
Landownername: %n.dA. Jiiv�Pit 670.E C;1
Address:
City:
Phone:
ature:
9, H-iH re' Csrck
State: V i
viTon
5 J 51 - 1(I f O-2- E-mail address:
Zip:g36
1-1 p" i'1 COUNTY
I, the undersigned Notary Public do hereby certify that L ,r`+Ck G-~ s rr-N M T(-\5 o s
•
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
Li
9
Date:
WITNESS my hand and official sealthis the
day of
Signature and seal:
ci-,e_\)1/4q D4
20
My commission expires: (A, r
Lessee's/Operator's Certification:
g8 r
o
z:12zcm
- mi®rm
00
-< r
4z rn
5
6,3
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
01/4\ CA) Orl (kal
Address: V a S-k-ack\sLic + \00,ck
City: \Wry
Phone: 3l3a 0 0
Signature:
Permittee's Certification:
State:
1.iti V Zip: L14
E-mail address:
Date:
5/cQ
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
Signing official name:
Signature:
FORM: LOA 06-16
Page 3 of 3

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed 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.
Z 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: City of Burlington
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-CS-113-6A,6B
Yes
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
XA 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

C.,5-t3
I certify that I am adeeded 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 attomey or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address: 6 7 1- % %) Le . D
City: 672,61( State: iv Zip: Z 7 2,4.1
Phone: 3 3 l:_J d4 2(- o2' 40 E-mail address: 5" 0LC 207tD to Ho rM/q �L — A,/
Signature: lr/??%YYl 1 > • C�.. CV Date: /2 / -2 r
NORTH CAROLINA, CCAs6.--16Z,6,
I, the undersigned Notary Public do hereby certify that
COUNTY
�� m, u b. A I I rexi
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sealthis the
day of y / , 20 Z Z
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agrement and do hereby agree to a ide by the stipulations and restrictions as specified herein.
,Lessee/operator name: / /ey /C U 111 #r
Address: 5-11 51 d /+ r d Ai City: /
/©n State: / V,. C Zip: 7� 6/
/
Phone: 336 "",.SG 7 ` 9qJo' ,E-mail address:
Signature: )f E ; f?_ Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
S (4 w L ((€-k-kt•-•`-
Signing official name:
Signature:
Date:
FORM: LOA 06-16 Page 3 of 3

Site: NC-CS-113; Fields 1-2
Vicinity Map
1 in = 6,000 ft
0
ASWE LL
1ANCE�
Feet
4,000 8,000
OVA
Creel,
State of North Carolina DOT, Esri, HERE, Garrr n, INCREMENT P USGS,
METI/NASA, NGA, EPA, USDA
Legend
® Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
City of
URLINGTON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map Neither the City of Burlington nor the Partnership shall
be held liable far any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-CS-113; Fields 3, 5
Vicinity Map
1 in = 6,000 ft
0
CASW'LL
NrE
Feet
4,000 8,000
I41
State of North Carolina DOT, Esri, HERE, Garmin INCREMENT P, USGS,
METI/NASA; NGA, EPA, USDA
Legend
® Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
City of
URLINGTON
'"..- G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-CS-113; Field 6
Vicinity Map
1 in = 6,000 ft
Site Location
State of North Carolina DOT, Esri, HERE, Gar+' ir; INCREMENT P, USGS,
METf/NASA, NGA, EPA, USDA
4,000 8,000
Feet I
Legend
Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 12/28/2021
BCity of
URLINGTON
G.I.S.
Disclaimer.
This map was compiled from the GIS resources of the 8udington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data, Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-CS-113; Fields 1-2
RCity of
URLINGTON
G.I.S.
GIS Division
Date: 1 /11 /2022
*Note: Acreage calculated in GIS
Legend
=Site Boundary
Q Property Line
c4-1Application Area
® Unsuitable
X — Fence
▪ S.W.A.
® On Site House
• Off Site House
Outbuildings
On Site Well
-0- Off Site Well
Application Area Map
1 in = 550 ft
— • Streams
Drains
I I
Surface Water
Flood Zones:
AE
FloodwayAE
( % conjunction with field surveys where required, must be consulted
0.2%Annual Chance Flood Hazard for the verification of the information contained within this map.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Prima
public information sources from which this map was compiled, in

Site: NC-CS-113; Fields 3,
Application Area Map
1 in = 400 ft
City of
URLINGTON
G.I.S.
GIS Division
Date: 1 /11 /2022
*Note! Acreage calculated in GIS
Legend
Site Boundary
Q Property Line
Jr 4 lApplication Area
Unsuitable
X — Fence
V/1
® S.W.A.
On Site House
Off Site House
Outbuildings
On Site Well
-0- Off Site Well
Streams
Drains
Surface Water
Flood Zones:
AE
Floodway (AE)
0.2% Annual Chance Flood Hazard
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public Information sources of
different scale, Time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Site: NC-CS-113; Field 6
Application Area Map
1 in = 550 ft
ET:Zilli=11111Feet
190 380 570 760
City of
URLINGTON
irentf-
G.LS.
GIS Division
Date: 1 /19/2022
*Note: Acreage calculated in GIS
Legend
Site Boundary
0 Property Line
AApplication Area
Unsuitable
X — Fence
V/1
• S.W.A.
On Site House
▪ Off Site House
Outbuildings
On Site Well
-0- Off Site Well
1.1
Streams
— Drains
Surface Water
Flood Zones:
I 1
C CGIA,
n
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map- Neither the City of Burlington nor the Partnership shall
AE be held liable for any errors in this map or supporting data. Primar
AE public information sources from which this map was compiled, in
Floodway (AE) conjunction with field surveys where required, must be consulted
0.2% Annual Chance Flood Hazard for the verification of the information contained within this map.

Site: NC-CS-113; Fields 1-2
Soil Map
1 in = 1,000 ft
Legend
Q Approved Application Fields
0 Field Numbers
GIS Division
Date: 1 /10/2022
City of
URLING TON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained wahin this map.

Site: NC-CS-113; Fields 3,
Soil Map
1 in = 1,000 ft
Legend
Q Approved Application Fields
0 Field Numbers
GIS Division
Date: 1 /10/2022
City of
URLINGTON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, defnition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

3; Field 6
Mt pl
1000+�
CuC2 F C
Legend
Q Approved Application Fields
OField Numbers
GIS Division
Date: 12/28/2021
BCity
URLINGTON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency supped
purposes. These resources include public Information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with held surveys where required, must be consulted
for the verification of the information contained within this map.

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Facility Name:
Acres Permitted:
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Annual Dry Tons Applied:
Elizabeth Kirby
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DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
EN NOT APPLICABLE.
PLACE A "N/A" IN A BLANK OR BOX
00
N
Acres Utilized:
WQ Permit #:
City of Burlington
Facility Name:
Acres Permitted:
CO
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Linda Clemmons
Land Owner:
O
Cation Exchange Capacity (non 503):
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Linda Clemmons
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Signature of Land Applier
DENR FORM FSF (12/2006)

Waypoint.
ANALYTICAL
1/26/2022
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
Ref: Analytical Testing
Report Number: 22-017-0002
Project Description: Caswell
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s) on 1/17/2022 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. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
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 May 2012) and NELAC unless otherwise indicated.
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,
a I1t C
Pauric McGroary
Agronomist
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.
Page 1 of 7

Waypoint.
ANALYTICAL
Report Number: 22-017-0002
Client Project Description: Caswell
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 Fax [phone]
www.waypointanalytical,com
Sample Summary Table
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
56227 1136A Solids 01/17/2022 6010D WP MTN
56227 1136A Solids 01/17/2022 SW-7471B WP MTN
56228 1136B Solids 01/17/2022 6010D WP MTN
56228 1136B Solids 01/17/2022 SW-7471B WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 2 of 7

Waypoint.
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Project Caswell
Information :
7621 hitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www,waypointanalyticaicom
Report Number : 22-017-0002 REPORT OF ANALYSIS
Lab No : 56227
Sample ID : 1136A
Report Date : 01/26/2022
Received : 01/17/2022
AIM c r Gtocvr
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Chromium 41.4 mg/Kg 1.25 5 01/24/22 12:14 EAL 6010D
Lead 15.6 mg/Kg 1.50 5 01/24/22 12:14 EAL 6010D
Arsenic 3.70 mg/Kg 2.50 5 01/24/22 12:14 EAL 6010D
Selenium <2.50 mg/Kg 2.50 5 01/24/22 12:14 EAL 6010D
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Molybdenum
<1.25 mg/Kg 1.25 5 01/24/22 12:14 EAL 6010D
Copper 15.3 mg/Kg 2.50 5 01/24/22 12:14 EAL 6010D
Zinc 24.4 mg/Kg 6.25 5 01/24/22 12:14 EAL 6010D
Cadmium <0.500 mg/Kg 0.500 5 01/24/22 12:14 EAL 6010D
Nickel 6.58 mg/Kg 1.25 5 01/24/22 12:14 EAL 6010D
Mercury 0.0299 mg/Kg 0.0143 1 01/19/22 13:25 7W2 SW-7471B
Qualifiers/
Definitions
DF Dilution Factor MQL Method Quantitation Limit
Page 3 of 7

Waypoint.
ANALYTICAL
46622
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville , NC 27028
Project Caswell
Information :
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Report Number : 22-017-0002 REPORT OF ANALYSIS
Report Date : 01/26/2022
Received : 01/17/2022
rt Pt( (To,a/yr
Pauric Mc Groary Ph.D., ECPA
Agronomist
Lab No : 56228 Matrix: Solids
Sample ID : 1136E Sampled:
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Copper 10.6 mg/Kg 0.500 1 01/22/22 09:40 EAL 6010D
Zinc 14.5 mg/Kg 1.25 1 01/22/22 09:40 EAL 6010D
Cadmium 0.441 mg/Kg 0.100 1 01/22/22 09:40 EAL 6010D
Nickel 5.52 mg/Kg 0.250 1 01/22/22 09:40 EAL 6010D
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Mercury
0.0227 mg/Kg 0.0147 1 01/19/22 13:26 3W2 SW-7471B
Chromium 55.9 mg/Kg 0.250 1 01/22/22 09:40 EAL 6010D
Lead 9.52 mg/Kg 0.300 1 01/22/22 09:40 EAL 6010D
Arsenic 1.28 mg/Kg 0.500 1 01/22/22 09:40 EAL 6010D
Selenium <0.500 mg/Kg 0.500 1 01/22/22 09:40 EAL 6010D
Molybdenum <0.250 mg/Kg 0.250 1 01/22/22 09:40 EAL 6010D
Qualifiers/
Definitions
DF Dilution Factor MQL Method Quantitation Limit
Page 4 of 7

Waypoint.
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Client: Synagro Central LLC/ Technical
Project: Caswell
Lab Report Number: 22-017-0002
Date: 1/24/2022
CASE NARRATIVE
Metals Analysis Method 6010D
Sample 56227 (1136A)
QC Batch No: L595837/L595053
One or more Internal Standards are outside method acceptance criteria. Re -analysis and/or sample dilutions are
required.
Sample 96592
Analyte: Chromium
QC Batch No: L595837/L595053
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: Copper
QC Batch No: L595837/L595053
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: Nickel
QC Batch No: L595837/L595053
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: L595837/L595053
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.
Solids Total Mercury Analysis - CVAA Method 7471A
Sample 96593
Analyte: Mercury
QC Batch No: L595311/L595050
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 5 of 7

Waypoint..
ANALYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 46622
Customer Name: Synagro Central LLC/ Technical
Report Number: 22-017-0002
Shipping Method
O Fed Ex 0 US Postal O Lab 0 Other :
O UPS 0 Client 0 Courier Thermometer ID:
Shipping container/cooler uncompromised?
# Yes O No
Number of coolers/boxes received
Custody seals intact on shipping container/cooler? 0 Yes 0 No 0 Not Present
Custody seals intact on sample bottles? 0 Yes 0 No 0 Not Present
Chain of Custody (COC) present? 0 Yes 0 No
COC agrees with sample label(s)?
# Yes 0 No
COC properly completed
#Yes 0No
Samples in proper containers?
# Yes O No
Sample containers intact?
#Yes 0No
Sufficient sample volume for indicated test(s)?
# Yes 0 No
All samples received within holding time?
# Yes O No
Cooler temperature in compliance?
O Yes # No
Cooler/Samples arrived at the laboratory on ice. 0 Yes 0 No
Samples were considered acceptable as cooling
process had begun.
Water - Sample containers properly preserved
Water - VOA vials free of headspace
O Yes
0 Yes
O No
O No
# N/A
O N/A
Trip Blanks received with VOAs
0 Yes
O No ON/A
Soil VOA method 5035 — compliance criteria met
High concentration container (48 hr)
High concentration pre -weighed (methanol -14 d)
0Yes 0No #N/A
7 Low concentration EnCore samplers (48 hr)
Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included?
Comments:
0Yes #No
Signature: ',Brandi Watson Date & Time: 01/17/2022 09:14:01
Page 6 of 7

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Page 7 of 7

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
NI 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.
(g 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: City of Burlington
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-AM-2-
1,2,3,4,5,6,7.8,9
No
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
X A re -defined compliance boundary is needed for field(s) ID: 1,4,5
(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 anothermunicipality, 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. /7 /
Landownername: KB�'u'id '/ (BOLL f`d A
Address: 7,5?
City: 5e✓Qe..1 /<11ist� State: Are__ /Zi'p: � %3/9
Phone: ��a — :�� ~r337 E-mail address: 4'41 C4/C�t'€SOvv •f .Cl 4 ' t ' V '
Signature: .....y Date: A --
NORTH CAROLINA, RkG1rINC1. r.12—. COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
aq
WITNESS my hand and official sealthis the
dayof ikprtA
Signature and seal:
My commission expires: a' a S - a pR
Lessee's/Operator's Certification:
,20
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operatorname:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
3---/.+9/70/
FORM: LOA 06-16 Page 3 of 3

Site: NC-AM-002; Fields 1-9
Vicinity Map
1 in = 6,000 ft
ALA MAN CE
CHATNAM
Feet
0 4,000 8,000
Site Location
'v
Town of Cary, Alamance County, State of North Carolina DQT, Esri, HERE,
Garmin, INCREMENT P, USGS, METI/NASA,VGA, EPA, USDA
974 ft
CANE CREEK M-0 NTAINS
Snow Ca
Legend
Q Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
City of
URLINGTON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public Information sources of
different scale, lime, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, In
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

1Site: NC-AM-002; Fields 1-9
Application Area Map
1 in = 500 ft
City of
URLINGTONj
G.I.S.
GIS Division
Date: 1 /11 /2022
`Note: Acreage calculated in GIS
Legend
= Site Boundary
Q Property Line
,k 4 (Application Area
Unsuitable
V/1
X — Fence
S.W.A.
El On Site House
1. Off Site House
n Outbuildings
On Site Well
-0- Off Site Well
— ..• Streams
— Drains
Surface Water
Flood Zones:
AE
Floodway (AE)
0,2% Annual Chance Flood Hazard
Disclaimer.
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce Inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the Information contained within this map.

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Site: NC-AM-002; Fields 1-9
Legend
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GIS Division
Date: 1/10/2022
City of
URLINGTON
G.I.S.
Soil Map
1 in = 1,000 ft
Disclaimer:
This map was compiled from the GIS resources oldie Budington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Budington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
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Fert., Animal
Waste, etc)
East Burlington
East Burlington
South Burlington
b
(..)
0.027
1 0.042
6,
o
©
m
Volume applied Volume
(enter one) Solids/ % Applied per
Liquid Solids Acre
Cu. Yds Gallons (Dry Tons/Ac)
6500 4.91 0.102
156000 4.91 2.457
19500 2.5 0.156
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
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0
0
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-
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in
0
0
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Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit lst/2nd Crop
©
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Signature of Land Applier
DENR FORM FSF (12/2006)

Acres Utilized:
City of Burlington
Facility Name:
Acres Permitted:
00
00
Annual Dry Tons Applied:
Kenneth Culberson
Land Owner:
Cation Exchange Capacity (non 503):
Predominant Soil Series:
Kenneth Culberson
N
Name of Crop Type
Receiving Residual
Application
Crop 2 I
I Lime Applied I
lbs/ac
a)
Q
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a,
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N
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0
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E
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
VD
M
N
00
©
o
N
Ammonia m
Nitrogen E
o
N
N
O
00
O
O
O
m
[ E
O
z
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N
0
r
N
m
0
N
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n Rate***
.-.
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South Burlington I
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Q Liquid Solids Acre
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M
rn
o
0
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0.000
0.000
0.000
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Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
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84500
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Signature of Land Applier
DENR FORM FSF (12/2006)

Acres Utilized:
WQ Permit #:
City of Burlington
Facility Name:
Acres Permitted:
Cl
N
Annual Dry Tons Applied:
Kenneth Culberson
Land Owner:
Cation Exchange Capacity (non 503):
Predominant Soil Series:
Kenneth Culberson
z
0
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N
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g Residual
ication
N
O
U
a'
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Q
0.
o
U
0
i
w
N
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0
Q
2
O
O
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O
O
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O
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O
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O
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O
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( lbs/
o
0
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0
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0
0
0
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kn
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
(0_,N
VD
0i
N
a
N
N
o
N
Ammonia
Nitrogen E oi
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o
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H
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v
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u)
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-O
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0.078
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rn
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Cumulative lbs/ac
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applied
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uid
Gallons
110500
0
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Signature of Land Applier
DENR FORM FSF (12/2006)

N NOT APPLICAB:
00
N
0
WQ Permit #:
City of Burlington
Facility Name:
Acres Permitted:
N
00
rn
0
Annual Dry Tons Applied:
Kenneth Culberson
Land Owner:
O
Cation Exchange Capacity (non 503):
CP
Predominant Soil Series:
Kenneth Culberson
O
u
a
0
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a
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00
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( lbs/acre)
N
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0
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0
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0
0
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0
0
0
0
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0
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0
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0
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0
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yN
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zraz E
0
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''
v
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00
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rn
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8C
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East Burlington
'd
u
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N
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v',
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00
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0.000
0.000
0.000
0.000
0
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O
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0.000
0.000
0.000
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Liquid
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o
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Signature of Land Applier
DENR FORM FSF (12/2006)

00
Acres Utilized:
Te
GTr
a
WQ Permit #:
City of Burlington
Facility Name:
00
Acres Permitted:
N
00
Annual Dry Tons Applied:
Kenneth Culberson
Land Owner:
O
Cation Exchange Capacity (non 503):
Predominant Soil Series:
Kenneth Culberson
CL
0
z
a.
U
Name of Crop Type
Receiving Residual
Application
Crop 2
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U
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O
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dcts
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a.
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z
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©
N
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r,
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m
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n Rate***
r1
0
M
0
O
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0
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0
M
0
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Rate**
V,
o
©
©
0
©
0
©
0
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r,
Application
Method*
cn
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O
0
N
r
0
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0
N
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N �" c
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00
©
M
N
r
N
GO
00
r
0
r1
Residual Sources
(NPDES #, WQ#,
Pert., Animal
Waste, etc)
East Burlington
East Burlington
•d
u
N
O
0
o
0
or-
o
0
'd
r,
Volume
Applied per
Acre
(Dry Tons/Ac)
d'
GO
d'
—
rN
00
0
0.000
0.000
0.000
O
O
O
0
0.000
0.000
0.000
O
O
O
0
0.000
O
O
O
O
O
O
O
O
As
rn
N
O
0
No
r1
O
0
VD
O
0
36
'O
0 0
VD
GO
Annual lbs/acre
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit 1 st/2nd Crop
Volume applied
(enter one) Solids/
Liquid
Cu. Yds I Gallons
00SS
32500
o
o
©
©
©
ij UOW
IO2;EQ
N
N
.a
H
0
Signature of Land Applier
DENR FORM FSF (12/2006)

Acres Utilized:
71)
N
0
CY
WQ Permit #:
City of Burlington
Facility Name:
Acres Permitted:
N
7
Annual Dry Tons Applied:
Kenneth Culberson
Land Owner:
Cation Exchange Capacity (non 503):
Predominant Soil Series:
Kenneth Culberson
z
a.
E
cd
z
U
Name of Crop Type
Receiving Residual
Application
N
R.
0
U
I Lime Applied I
lbs/ac
Q
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O
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d)
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w
PAN Applied
( lbs/acre)
cv
0,
Uz
Q
o
O
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0
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0
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0
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0
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0
0
0
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0
0
0
0
0
0
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0
0
0
0
0
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0
0
0
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0
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O
0
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a•
o
CA
o
a
N
-
'-
,
N
,•
o
rn
N
Ammonia °
Nitrogen E
0
r/i
O
O
o
0000
CI
0 •O
00
O
000
CD
cm
-' E
O
N
z
o
0
,n
0
m
©
Mineralizatio
n Rate***
k-.
©
Volatilization
Rate**
v
©
o
kr,
0
0
r`
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0
0
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0
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a
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N
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N
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0.472
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Fert., Animal
Waste, etc)
East Burlington
'O
v000
o
N
000
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0,
v-
Volume
Applied per
Acre
(Dry Tons/Ac)
,D
o,
----
o
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0
O
0.000
0.000
©
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0
O
0.000
0.000
0.000
o
co
0
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0
O
0
O
0.000
0.000
0.000
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©
N
0
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0.0253
0.045
36
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AD
kn
Annual lbs/acre
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit 1st/2nd Crop
•
Volume applied
(enter one) Solids/
Liquid
Cu. Yds I Gallons
o
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a
0
u
a
03
0
cl
E
03
00
N
Signature of Land Applier
DENR FORM FSF (12/2006)

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T ,1.100. 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):
111 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,
IN Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
N. 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: City of Burlington
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
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-AM-5-1,2
No
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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 orgreater, 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.
IL 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;
X A re -defined compliance boundary is needed for field(s) ID: 2
(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)
n ❑ 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 anothermunicipality, contra ctor, 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: Gd1'rl! M ✓d
Address: 0 62 o'k �2'T
City:
5-now— C:t4Ap
Phone:
..
i Sign
State: NG
E-mail address:
Zip: oZlV?
Date: I
NORTH C ARO INA, £LL&4Y & r Cam__ COUNTY
r
I, the undersigned Notary Public do hereby certify that t•(LitY V . —
efore me this da and acknowledged the due exec on of the forgoing instrument.
personally appearedb Y
WITNESS my hand and official sealthis the
day of
Signature and seal:
My commission expires: (7 — - 2 -Q
pvtftnUo-
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
, 20
Lessee/operator name:
Address:
City: State:
Phone: E-mail address:
Signature:
Permittee's Certification:
Zip:
Date:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
r
Signing official name: S V+Q Lote- P` ejE"(' e.
Signature: Date:
7//21719
FORM: LOA 06-16
Page 3 of 3

Site: NC-AM-005; Fields 1-2
Vicinity Map
1 in = 6,000 ft
Feet
0 4,000 8,000
Legend
Q Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
Town ofCary,`Alamance County, State of North Carolina DOT, Esri HERE, ,_
"= INCREMENT ^ METl/NASA, NGA, EPA, USDA
City of
URLINGTON
_ G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspect,.
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable far any errors in this map or supporting data. Prima
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

Application Area Map
1 in = 500 ft
1Site: NC-AM-005; Fields 1-2
Fee
175 350 525 700
BCity of
URLINGTON
G.I.S.
GIS Division
Date: 1 /11 /2022
*Note: Acreage calculated in GIS
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--- Streams
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Surface Water
Flood Zones:
AE
Floodway (AE)
0.2% Annual Chance Flood Hazard
Disclaimer.
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

F & KAREN L
Owner Name: GRIFFIN
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URLINGTON--PA,
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

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Signature of Land Applier
DENR FORM FSF (12/2006)

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Signature of Land Applier
DENR FORM FSF (12/2006)

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed 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: City of Burlington
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
•
Site/Field ID
Lease
Land Use or
Cropping tt
Intended Use of Crops
Intended
Residuals Source
(ptional
(optional)
)
Special note
no-till/over-seed/
pasture)
NC-AM-6-1,2
No
Fescue
Hay/Pasture
,- . The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
X A re -defined compliance boundary is needed for field(s) ID: 2
(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.
tTh,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

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 beha lf 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. 1 certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreementwith anothermunicipality, contractor,or other permitted entity. Furthemiore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Perm ince to land apply residuals to the land application site(s) as specified
herein.
Landowner name: \,10,\Ic-,e..‘" \-\ese-20RW\c1/4.\.e.,t(
Address: S3 -5q, Tv\poa\--(‘
State:
City:
Phone: UND t.%f
Phone: '3-3(9 (01
Sigiature:
il&aA COUNTY
NORTH CAROLINA,
I, the undersigned Notary Public do hereby certify that
Date:
Zip: -z_—ric)ise
e_6 or)
io bec 2Lp-2_ I
et, EV Fl f+ecsektlifAir-
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
\\011111/Ii0
\ca ?•• S 14./l/
day of e \la.q
Signature and seal: vrA4
NOTARY
PUBLIC
My commission expires:)JJj A...-A0-3
--•••
z.-
N CE Cok\,
WITNESS my hand and official sealthis the
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operatorname:
Address:
City: State: Zip:
Phone: E-mail address:
Date:
Signature:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
/27/ .5110 At
FORM: LOA 06-16
Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed 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.
E 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: City of Burlington
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., 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 tt
Intended Use of Crops
Intended
Residuals Source
o
(optional)
Special note
no-till/over-seed/
pasture)
NC-AM-6-8,9A,9B,9C
No
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals 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.
Page 1 of 3
FORM: LOA 06-16

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
X A re -defined compliance boundary is needed for field(s) ID: 8,9A,9B
(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.
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

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 ofthe
deeded landowners, I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
ageementwith anothermunicipality, 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 La ndownerna
Address:
City tpAocc\--1
Phone: 136 VZ-Z" 12-171
Signature:
NORTH CAROLINA
c AVeK`K\ 1!511\1\0-4) e0J
\
State: 0
Zip:
E-mail address: (0"61 e_, oejr
1 F•-tYwen.,
b-vorti-e
I, the undersigned Notary Public do hereby certify that
.12-6 Date: / I
COUNTY
i; 0444. '11\t".a. .1 ilea
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sealthis the
day of j3.QUnOrAr
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
, 20 a -I
....•
•-•
......
....
..... ..
....
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictio - ..n.
//1/11111‘
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Date:
Signature:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified here in.
Signing official name: k1g (AP ke-r
Signature: Date:
FORM: LOA 06-16
Page 3 of 3

Site: NC-AM-006; Fields 1-2, 8-9
Vicinity Map
1 in = 6,000 ft
Feet
0 4,000 8,000
Legend
Q Subject Farm Boundary
Highways & Street Centerlines
GIS Division
Date: 1 /10/2022
Town of Cary,. Alamance County, State of North Carolina DOT, Esri, HERE,,,
Garmin, INCREMENT P, USGS, METI/NASA, NGA, EPA USDA,
City of
URLINGTON
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspect,
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Prima
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.
ry

Site: NC-AM-006; Fields 1-2, 8-9
Application Area Map
1 in = 660 ft
Feet
0 230 460 690 920
�City of
URLINGTON
G.I.S.
GIS Division
Date: 1 /11 /2022
*Note: Acreage calculated in GIS
Legend
(=Site Boundary
Q Property Line
Application Area
Unsuitable
X — Fence
V/1
S.W.A.
On Site House
II Off Site House
Outbuildings
On Site Well
-0- Off Site Well
• Streams
• — Drains
Surface Water
Flood Zones:
AE
6' # Floodway (AE)
0.2% Annual Chance Flood Hazard
I I
Disclaimer.
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Prima
public infomtation sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

0
January 19, 2022
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Site: NC- AM - 006; Fields 1-2, 8-9 Soil Map
1 in = 1,000 ft
Legend
Q Approved Application Fields
0 Field Numbers
GIS Division
Date: 1 /10/2022
City of
URLINGTON
G.I.S.
Disclaimer:
This map was compiled from the GIS resources of the Burlington
Regional GIS Partnership for public planning and agency support
purposes. These resources include public information sources of
different scale, time, origin, definition and accuracy, which aspects
produce inconsistencies among features represented together on
this map. Neither the City of Burlington nor the Partnership shall
be held liable for any errors in this map or supporting data. Primary
public information sources from which this map was compiled, in
conjunction with field surveys where required, must be consulted
for the verification of the information contained within this map.

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Facility Name:
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DENR FORM FSF

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Signature of Land Applier
DENR FORM FSF (12/2006)

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DENR FORM FSF (12/2006)

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 Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16);
Submit the completed and appropriately executed 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: City of Burlington
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-AM-7-1,2
No
Fescue
Hay/Pasture
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 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
t—� term of, and 12 months after termination ofthis Agreement.
IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
X A re -defined compliance boundary is needed for field(s) ID: 1,2
(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)
/"", 0 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