WQ0003351_Renewal (Application)_20220331

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0003351
Applicant/Permittee Town of Mocksville
Applicant/Permittee Address 171 Clement Street, MoCksville, NC 27028
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Municipal
Town of Mocksville Class B Residuals Program
Davie
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Yes No
Fee Amount $0
Complete App Date 03/31/2022
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* Brent Collins
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
336-399-3646
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0003351
Has Current Existing permit number
Applicant/Permittee*
Town of Mocksville
Applicant/Permittee Address*
171 Clement Street, Mocksville, NC 27028
Facility Name*
Town of Mocksville Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Town of Mocksville Permit Renewal - WO0003351.pdf 15.48MB
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 3/30/2022

g
Inc.
Permit Renewal Application
For the Town of Mocksville WWTP
WQ0003351
Land Application of Residual Solids
Prepared By:
EMA Resources Inc.
755 Yadkinville Road
Mocksville, NC 27028
336-751-1441

March 30, 2022
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Services Center
Raleigh, NC 27699-1617
RE: Permit Modification — WQ0003351
To Whom it May Concern:
EMA Resources is submitting the included permit renewal for Town of Mocksville's
Land Application Permit - WQ0003351. The fields that are marked as modified (M) in
the LASC form have been re -mapped using ARCGis to reflect the acres more accurately.
The old maps were hand drawn and were not as precise. There are 3 fields that are being
deleted. The plant has been upgraded recently and those upgrades have been referenced
on the RSC form and the plant schematic.
If you have any questions concerning this renewal, please contact Brent Collins —
Director of Technical Services
Respectfully,
Z:�e4;2:�
Brent Collins
Director of Technical Services
brent.collins(cr�,emaresourcesinc.com
[phone]
Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

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

1) RLAP Form

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
L APPLICANT INFORMATION:
1. Applicant's name: Town of Mocksville
Applicant type: ❑ Individual [I Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal [7 State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Ken Gamble Title: Town Manager
Applicant's mailing address: 171 Clement St
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] Email Address: kizamble&a ocksvillenc.gov
2. Consultant's name: Brent Collins License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: EMA Resources Inc.)
Consultant's mailing address: 755 Yadkinville Rd
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] Email Address: brent.collinskemaresourcesinc.com
3. Agronomist's name:
Affiliation: ❑ N/A ❑ On Staff
Agronomist's mailing address:
City: State:
Telephone number: (_) _-_
License Number:
❑ Retained (Firm: )
Zip: -
Email Address:
4. Soil Scientist's name: License Number.
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: �)
Soil Scientist's mailing address:
City: State: Zip: -
Telephone number: (—) L- Email Address:
5. Fee submitted: $0 (See Instruction B)
IL PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified,
® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00003351
Date of most -recently issued permit: 01/08/2018
Date of most -recently certified Attachment A (if different than the permit): 01/08/2021
Date of most -recently certified Attachment B (if different than the permit): 01/08/2018
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 291 Garwood Rd
City: Mocksville State: NC Zip: 27028-
Coordinates: Latitude: 35° 53' 30" Longitude: 80. 30' 06"
Datum: NAD83
Method of measurement: GPS
Level of accuracy: Nearest Second
2. County where residuals land application program is headquartered: Davie
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Roy Whitaker
EMA Resources Inc
13283
Back -Up ORC
Brent Collins
EMA Resources Inc
27651
Additional Back -Up
ORCs
if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 250 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
50.62
56.79
12655
14197
Five -Year Maximum Adjusted
76.79
82.96
19197
20740
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
0
Hay/Pasture
70.93
Total:
70.93
Methods
Surface
70.93
Incorporation or Injection
0
Total:
70.93
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
253.1
283.94
383.94
414.8
100
126.55
141.97
191.97
207.4
150
84.36
94.65
127.98
138.27
200
63.28
70.99
95.99
103.7
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
Residuals program contains any land application site(s) 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.
MAI
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: 17 Spray F1 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/vr
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
W
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Pa a Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft,
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 I5A 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, Ken Gamble Town Manner
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Town of Mocksville
(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 13-215.6A and § 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any applic�,6,.)n. s`n-.- 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',
Signature: Z610� Date:
FORM: RLAP 06-16 Page 5 of 5

la) Current Permit

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
January 8, 2021
LYNN TRIVETTE — INTERIM TOWN MANAGER
TOWN OF MOCKSVILLE
171 CLEMENT STREET
MOCKSVILLE, NORTH CAROLINA 27028
Subject: Permit No. WQ0003351
Town of Mocksville RLAP
Attachment A Certification
Davie County
Dear Ms. Trivette:
In accordance with your permit major modification request received October 21, 2020, we are
forwarding herewith a modified Attachment A certified January 8, 2021, to the Town of Mocksville for the
subject residuals management program.
Modifications to the subject Attachment are as follows: Increasing the permitted annual dry tonnage
for the Dutchman's Creek WWTP (Permit No. NC0021491) from 125 dry tons per year (DT/yr) to 250
DT/yr.
The modified Attachment A shall be effective from the date of certification until December 31,
2022 (i.e., expiration date of the current permit), shall void Attachment A of Permit No. WQ0003351 issued
January 8, 2018, and shall be subject to the conditions and limitations as specified therein, as well as those
specified in the above -referenced permit. Please replace Attachment A of Permit No. WQ0003351 that
was issued January 8, 2018 with the modified Attachment A. Please note that the Permittee shall submit
a renewal application no later than July 4, 2022.
If any parts, requirements or limitations contained in this certification are unacceptable, the
Permittee has the right to request an adjudicatory hearing upon written request within 30 days following
receipt of this permit. This request shall be in the form of a written petition, conforming to Chapter 150B
of the North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Otherwise, this certification shall be final and binding.
If you need any additional information concerning this matter, please contact Erick Saunders at
[phone] or erickson.saunders&ncdenr.gov.
Sincerely,
S. Daniel Smith, Director
Division of Water Resources
D Q
� North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center ! Raleigh, North Carolina 27699-1617
NORTH CAROLINA i
n.wmwm m e�wm���� a.ory 919.707.9000

Ms. Lynn Trivette
January 8, 2021
Page 2 of 2
cc: Davie County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Brent Collins — EMA Resources, Inc. (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)

Water Resources
ENVIRONMENTAL QUALITY
January 8, 2018
MARCUs A. ABERNETHY — TOWN MANAGER
TOWN OF MOCKSVILLE
171 CLEMENT STREET
MOCKSVILLE, NORTH CAROLINA 27028
Dear Mr. Abernethy:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No. WQ0003 3 51
Town of MocksviIle RLAP
Land Application of
Class B Residuals
Davie County
In accordance with your permit major modification and renewal request received October 19, 2017,
and subsequent additional information received November 15, 2017 and December 26, 2017, we are
forwarding herewith Permit No. WQ0003351 dated January 8, 2018, to the Town of Mocksville for the
continued operation of the subject residuals management program.
Modifications to the subject permit are as follows: Addition of seven fields in Davie County totaling
71.4 acres, those fields being MK-05-02, DV-05-01, DV-05-04, DV-05-05, DV-08-01, DV-11-01 and DV-
11-02.
This permit shall be effective from the date of issuance until December 31, 2022, shall void Permit
No. WQ0003351 issued November 17, 2008, and shall be subject to the conditions and limitations as
specified therein. Please pay particular attention to the monitoring requirements listed in Attachment A for
it may differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
Please note the following permit conditions have been removed since the last permit issuance
dated November 17, 2008:
➢ Old Condition I.1. — Condition has been met.
➢ Old Condition IIL5. — New sites can be found, so no need to void the Permit.
➢ Old Condition III.8. — Redundant since covered by Old Condition III.7. and Condition 111.9.
➢ Old Condition III.1 O.h. — Replaced by Condition III.I 1.k.
➢ Old Condition IV.9. — Duration of records detention now part of individual Condition.
---""�'Notl ing Compares'—,
State of North Carolina I Environmental Quality I Water Resources � Water Quality Permitting I Non -Discharge Permitting
I617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Mr. Marcus A. Abernethy
January 8, 2018
Page 2 of 2
Please note the following permit conditions are new since the last permit issuance dated
November 17, 2008:
➢ Condition I.2. — 90 days before implementation of Condition III.3., notification of application
of residuals.
➢ Condition L3. — 180 days before implementation of Condition 1II.13., signage requirement.
➢ Condition II1.3. — Winston-Salem Regional Office to be notified 24 hours prior to land
application of residuals.
➢ Condition III.6. — Similar to Old Condition III.6., but a copy of the Operations & Maintenance
Plan also to be in vehicle.
➢ Condition III.1 Lk. —Bulk residuals not to be applied at rate exceeding agronomic rate.
➢ Condition IV.7.d. — Records tracking residuals to include area (acres) on which residuals
applied.
➢ Condition VIA — Similar to Old Condition VI.6., but 60-day notice required prior to
modification or revocation.
➢ Condition VI.7. — Expansion of facility not permitted without waiver if Permittee exhibits
behavior detrimental to environment.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Troy Doby at (919) 807-
6336 or tro, ncdenr.gov.
Sincerely,
mda Culpepper, Interim Director
Division of Water Resources
cc: Davie County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Roy L. Whitaker — EMA, Inc. (EIectronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
LAND APPLICATION OF CLASS B RESIDUALS PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Town of Mocksville
Davie County
FOR THE
continued operation of a residuals management program for the Town of Mocksville and consisting of the
land application of Class B residuals generated by the approved facility listed in Attachment A to the
approved fields listed in Attachment B with no discharge of wastes to surface waters, pursuant to the
application received October 19, 2017, and subsequent additional information received by the Division of
Water Resources, and in conformity with other supporting data subsequently filed and approved by the
Department of Environmental Quality and considered a part of this permit. The use and disposal of residuals
are regulated under Title 40 Code of Federal Regulations Part 503. This permit does not exempt the
Permittee from complying with the federal regulations.
This permit shall be effective from the date of issuance until December 31, 2022, shall void Permit No.
WQ0003351 issued November 17, 2008, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
1. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02T .0108(b)(2), 02T .0105(d), 02T .0109]
2. The Permittee shall be in full compliance with the regional office notification requirements established
in Condition II1.3 . within 90 days of the effective date of this permit. [ 15A NCAC 02T .0108(b)(2)]
3. The Permittee shall be in full compliance with the signage requirements established in Condition H1.13.
within 180 days of the effective date of this permit. [15A NCAC 02T .0108(b)(2)]
WQ0003 3 5 1 Version 3.0 Shell Version 170401 Page 1 of 12

IL PERFORMANCE STANDARDS
The subject residuals management program shall be effectively maintained and operated at all times so
there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of prolonged
nuisance conditions due to improper operation and maintenance, the Permittee shall immediately cease
land applying residuals, contact the Winston-Salem Regional Office supervisor, and take any
immediate corrective actions. [G.S. 143-215.1]
2. This permit shall not relieve the Permittee of responsibility for damages to groundwater or surface
water resulting from the operation of this residuals management program. [15A NCAC 02B .0200,
02L .0100]
3. Only residuals generated by the facility listed in Attachment A are approved for land application in
accordance with this permit. [G.S. 143-215.1]
4. Only the fields listed in Attachment B are approved for residuals land application. [G.S. 143-215.1]
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs):
Parameter
Ceiling Concentration
(milligrams per kilogram)
CPLR
(pounds per acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
r /a
Nickel
420
374
Selenium
100
89
Zinc
7,500
2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application has not occurred or for which the required data is incomplete,
by determining background concentrations through representative soil sampling.
[15A NCAC 02T. 11051
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC 02T
.1106 (a) and (c). Exceptions to this requirement shall be specified in Attachment A. [15A NCAC 02T
.1106]
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to this requirement shall be specified in Attachment A. [i5A NCAC 02T .1107]
WQ0003351Version 3.0 Shell Version 170401 Page 2 of 12

8. Setbacks for treatment and storage facilities shall be as follows:
Setback Description
Setback
feet
Habitable residence or place of public assembly under separate ownership or not to
be maintained as part of the project site
100
Property lines
50
Private or public water supply
100
Surface waters (streams — intermittent and perennial, perennial waterbodies, and
50
wetlands
Wells with exception to monitoring wells
100
* All treatment and storage facilities were originally permitted prior to September 1, 2006
[15A NCAC 02T .1108]
9. Setbacks for Class B land application sites shall be as follows:
Setback by application type
(feet)
Setback Description
Vehicular
Irrigation
Surface
Surface
Injection 1
Application
Application
Incorporation
Habitable residence or place of public assembly under
separate ownership or not to be maintained as part of
400
400
200
the project site
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
lessee/operator of the land to be maintained as part of
0
200
0
the project site
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams -- intermittent and perennial,
perennial waterbodies, and wetlands
100
100
50
Surface water diversions (ephemeral streams,
25
100
25
waterways, ditches
Groundwater lowering ditches (where the bottom of
25
100
25
the ditch intersects the SHWT
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
15
15
15
more in vertical height
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
[I5A NCAC 02T .1108]
WQ00033 5 1 Version 3.0 Shell Version 170401 Page 3 of 12

10. Land application areas shall be clearly marked on each site prior to and during any residuals application
event. [15A NCAC 02T .0108(b)(1)]
11. BuIk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in exceedance
of agronomic rates. Appropriate agronomic rates shall be calculated using expected nitrogen
requirements based on the determined Realistic Yield Expectations (RYE) using any of the following
methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina State
University Department of Soil Science (h!W- nutrients.soil.ncsu.edu/yieldslindex �hn). A copy
shall be kept on file and reprinted every five years in accordance with Condition IVA
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the Iocal Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter I
(bft://www.neagr.gov/SWC/tecli/documents/9th GuidanceDoe100109.pdD.
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards (ftp //ftp-fc.sc.egov.usda.gov/NHOI ractice-standards/standards/590.addDZ
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
[15A NCAC 02T .1109(b)(1)(k)]
12. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards. [15A NCAC 02T
.0108(b)(1)]
13. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (lbslac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied. [15A
NCAC 02T .0108(b)(1)]
14. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee shall
maintain written records of these recommendations and details of their implementation. [15A NCAC
02T .0108(b)(1)]
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15. These residuals land application sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application area.
An exceedance of groundwater standards at or beyond the compliance boundary is subject to
remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B. [15A NCAC 02L
A 107(a)]
16. The review boundary shall be established midway between the compliance boundary and the residual
land application area. Any exceedance of groundwater standards at the review boundary shall require
action in accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
III. OPERATION AND MAINTENANCE RE UIItEMENTS
The residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards. [15A NCAC 02T .1110]
2. The Winston-Salem Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall be notified at least 48
hours prior to the initial residuals land application to any new land application site. Notification to the
regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding
State Holidays. [15ANCAC 02T .0108(b)(1)]
3. The Winston-Salem Regional Office shall be notified via email or telephone, [phone], at least
24 hours prior to conducting any land application activity. Such notification shall indicate, at a
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply to additional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields. [ 15A NCAC 02T .0108(b)(1)]
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan) Modifications
to the O&M Plan shall be approved by the Division prior to utilization of the new plan. The O&M Plan,
at the minimum, shall include:
a. Operational functions;
b. Maintenance schedules;
c. Safety measures;
d. Spill response plan;
e. Inspection plan including the following information:
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, and
procedures to assure that the selected location(s) and inspection frequency are representative
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be taken
by the inspector in the event that noncompliance is observed pursuant to the noncompliance
notification requirements under the monitoring and reporting section of the permit;
f. Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
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iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for any
foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to
meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply
multiple times per year but have an annual sampling frequency, may need to sample during
winter months when pathogen reduction is most likely to be negatively affected by cold
temperatures).
[15A NCAC 02T .1100]
5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee shall designate and employ a certified operator in responsible
charge (ORC) and one or more certified operators as back-up ORCs in accordance with 15A NCAC
08G .0201. The ORC or his back-up shall visit the facilities in accordance with 15A NCAC 08G. 0204,
or as specified in the most recently approved O&M plan (Le., see Condition III.4.), and shall comply
with all other conditions of 15A NCAC 08G. 0204. For more information regarding classification and
designation requirements, please contact the Division of Water Resources' Protection and Enforcement
Branch at [phone]. [15A NCAC 02T ,0117]
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M Plan shall be
maintained at the land application sites during land application activities. [15A NCAC 02T
.0108(b)(1)]
7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles. [15A NCAC 02T .1110]
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division. [G.S. 143-215.1]
9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters. [G.S. 143-215.1]
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on land
application sites onto which residuals are applied, or application shall be in accordance with the crop
management plan outlined by the local Cooperative Extension Office, the Department of Agriculture
and Consumer Services, the Natural Resource Conservation Service, or an agronomist and as approved
by the Division. [15A NCAC 02T .1109(b)(1)]
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11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under section
4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of surface
water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of the
residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporated within a
24-hour period following a residuals land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 247hour period;
g. If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in a
USDA no -till program shall be exempted from meeting this vegetative cover requirement;
If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
j. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
k. Application exceeds agronomic rates.
[ 15A NCAC 02T .1109]
12. The following public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event.
[15A NCAC 02T .1109(b)(2)]
13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under Condition 111.12.
apply. [15ANCAC 02T.0108(b)(1)]
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14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
Duration
Animals shall not be allowed to graze during land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
30 days
prevent access after each land application event.
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for:
12 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e.g., tobacco, melons, cucumbers, squash, etc.)
14 months
shall not be harvested for:
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the land
surface (e.g., root crops such as potatoes, carrots, radishes, etc.) shall not be
20 months
harvested for:
When the residuals remain on the land surface for less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
38 months
surface shall not be harvested for:
[15A NCAC 02T .1109(b)(3)]
15. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for those
operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (MRCS) or other State Agencies. The Permittee shall calculate allowable nutrient
loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan. [15A NCAC 02T .0108(b)(1), 02T .1104(c)(3)]
16. No residuals shall be land applied unless the submitted Land Owner Agreement between the Permittee
and landowners or lessees/operators of the land application site is in full force and effect. These
agreements shall be considered expired concurrent with the permit expiration date, and shall be renewed
during the permit renewal process. [ 15A NCAC 02T .1104(c)(4)]
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IV. MONITORING AND REPORTING REQUIREMENTS
1. Any Division -required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed. [15A NCAC 02T .0108(c)]
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). Residuals that tests or is classified as a hazardous or toxic waste under 40
CFR Part 261 shall not be used or disposed under this permit. The analyses lcorrosivity, ignitability,
reactivity, and toxicity characteristic leaching procedure (TCLP)] shall be performed at the
frequency specified in Attachment A, and the Permittee shall maintain these results for a minimum of
five years. Any exceptions from the requirements in this condition shall be specified in Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):
Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1, 1 -Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Din itrotol uene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide)
0.008
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A, the
Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
[15A NCAC 13A .0102(b), 02T .1101, 02T .1105]
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3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following parameters:
Aluminum
Mercury
Potassium
Ammonia -Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
[15A NCAC 02T .11011
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the sampling and
monitoring sections of the approved O&M plan. The required data shall be specific to the stabilization
process utilized, and sufficient to demonstrate compliance with the Class B pathogen reduction
requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction requirement in
15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this condition shall
be specified in Attachment A. [15A NCAC 02T .1106, 02T .1107, 02T .1111(c)]
5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B on which a residuals land application event will occur
in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomi/pubs.htTn), The Permittee shall maintain
these results and a description of the sampling methodologies used to determine soil fertility for a period
of no less than five years, and shall be made available to the Division upon request. At a minimum, the
Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
[15A NCAC 02T .0108(c), 15A NCAC 02T .1111(d)]
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505. [15A NCAC 02B .0505]
WQ0003351Version 3.0 Shell Version 170401 Page 10 of 12

7. The Permittee shall maintain records tracking all residual land application events. At a minimum, these
records shall include the following:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops to be grown on field;
j. Nitrogen Application Rate based on RYES (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and reprinted
every five years),
k. Volume of residuals land applied in gallons per acre, cubic yard per acre, dry tons per acre, or wet
ton per acre;
1. Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
in. Volume of soil amendments (e.g., lime, gypsum, etc.) applied in gallons per acre, dry ton per acre,
or wet tons per acre; and
n. Annual and cumulative totals in dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy metal
(e.g., shall include, but shall not be limited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.
[I5A NCAC 02T .0109(a)]
Three copies of an annual report shall be submitted on or before March I". The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting Norms.
Instructions for reporting and annual report forms are available at
http://deg .nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/non-
discharge-permittin -ug nit/reporting-forms, or can be obtained by contacting the Non -Discharge
Permitting Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[15A NCAC 02T . I I I I(a)]
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9. Noncompliance Notification
The Permittee shall report by telephone to the Winston-Salem Regional Office, telephone number (336)
776-9800, as soon as possible, but in no case more than 24 hours or on the next working day following
the occurrence or first knowledge of the occurrence of any of the following:
a. Land application of residuals abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure that the problem does not recur. [15A NCAC 02T .0105(1), 02T .0108(b)(1)]
V. INSPECTIONS
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan. [15A NCAC 02T .0108(b)]
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to identify malfunctions, facility deterioration and
operator errors that could result in discharges to the environment, a threat to human health or a public
nuisance. The Permittee shall maintain an inspection log that includes, at a minimum, the date and time
of inspection, observations made, and any maintenance, repairs, or corrective actions taken. The
Permittee shall maintain this inspection log for a period of five years from the date of inspection, and
this log shall be made available to the Division upon request. [ 15A NCAC 02T .0108(b)]
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or copy
any records required to be maintained under the terms and conditions of this permit; and may collect
groundwater, surface water or leachate samples. [G.S. 143-215.3(a)(2)]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to an
enforcement action by the Division in accordance with North Carolina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143-215.6C]
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit. [15A NCAC 02T .0110]
3. This permit is effective only with respect to the nature and volume of residuals described in the permit
application and other supporting documentation. [G.S. 143-215.1]
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4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under the Division's General Permit NCG010000; any requirements pertaining to wetlands under 15A
NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter
143 of the General Statutes. [ 15A NCAC 02T .0105(c)(6)]
In the event the residuals program changes ownership or the Permittee changes his name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner. [15A NCAC 02T .0104]
6. This permit is subject to revocation or unilateral modification upon 60-day notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
7. Unless the Division Director grants a variance, expansion of the permitted residuals program contained
herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b).
[I5A NCAC 02T .0120]
The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit. [15A NCAC 02T
.0105(e)(3)]
Permit issued this the 8' day of January 2018
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Linda Culpepper, Interim Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0003351
WQ0003351Version 3.0 Shell Version 170401 Page 13 of 12

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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: Town of Mocksville
2. Facility permit holder is: ❑ Federal, ❑ State, ® Local Government, or ❑ Private.
Facility permit issued by: ® Div. of Water Resources, ❑ Div. of Environmental Health,
or [I Other (explain: _).
3. Facility contact person and title: Chip White
Complete mailing address: 771 Sanford Ave
City: Mocksville State: NC Zip: 27028-
Telephone number: [phone] E-mail address: cwhitep_envirolinkinc.com
4. Facility physical address: 291 Garwood Rd
City: Mocksville State: NC Zip: 27028-
Coordinates: Latitude: 35' 53' 30" Longitude: 80. 30' 06"
Datum: NAD83 Level of accuracy: Nearest Second
Method of measurement: GPS
5. Purpose of the facility:
® treatment of municipal wastewater, ❑ treatment of 100% domestic wastewater,
❑ treatment of potable water, ❑ treatment of 100% industrial wastewater,
❑ treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: __E % industrial and % domestic)
❑ other (explain: ).
6. Does the facility have an approved pretreatment program: ® Yes ❑ No
7. Facility permitted/design flow: 1.2 MGD and facility average daily flow: 0.5 MGD
8. Average amount of residuals being generated at this facility 250 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 253,700 & 176,000 gallon digesters
Type and volume of residuals storage (i.e., outside of residuals treatment units): 253,700 & 176,000 gallon digesters
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
® 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
® Biological ❑ Non -Biological
FORM: RSC 06-16 Page 1 of 5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes ® no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes ® no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as well
as those for corrosivity, ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: 01/24/22
Passed corrosivity test: ® yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: ® yes W no. Flashpoint: >200 OF (> 140°F)
Passed reactivity test: W yes Ono. HCN: <0.25 mg/kg (<250) & H2S: <25 mg/kg (<500)
TCLP Parameter
Limit
(mgfi)
Result
(mgfi)
TCLP Parameter
Limit
(mgfi)
Result
(mgfi)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
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: Waypoint Analytical and Date of analysis: 01/24/22
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
<13.3
Cadmium
85
39
<1.11
Copper
4,300
1,500
187
Lead
840
300
17
Mercury
57
17
<0.346
Molybdenum
75
n/a
<7.5
Nickel
420
420
11.9
Selenium
100
100
<17.8
Zinc
7,500
2,800
594
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. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.77 %.
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: WUpoint Analytical and Date of analysis: 01/24/22
Parameter
Result
(mg/kg)
Aluminum
10600
Ammonia -Nitrogen
6170
Calcium
19600
Magnesium
3770
Nitrate -Nitrite Nitrogen
405
pH (Standard Unit)
6.4
Phosphorus
19500
Potassium
6000
Sodium
9780
Total Kjeldahl Nitrogen
78900
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): 2.22
[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): ® 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 (1s) Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg)
(mg/kg)
Surface
25,310
38,395
Injection/Incorporation
28,395
41,480
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

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
❑ A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
❑ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
❑ Alternative 2 [15A NCAC 02T.I 106(b)(3)(13)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T. 1106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 5 [15A NCAC 02T.I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
❑ thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
® Alternative 1 [15A NCAC 02T.1106(c)(1)] -Fecal Coliform Density Demonstration.
❑ Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, I
air drying, ❑ anaerobic digestion,
El composting, or lime stabilization.
c. For Surface Disposal:
❑ Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
® Alternative 1 [15A NCAC 02T.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
® Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
❑ Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
❑ Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
® Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
❑ Alternative 9 [15A NCAC 02T.I 107(a)(9)] - Injection.
❑ Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
❑ Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
❑ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically occur
when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of

2a) Vicinity Map

2b) Process Flow Diagram

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2c) Quantitative Justification

Dutchman's Creek WWTP
Quantitative Justification for Residuals Production Rate
The annual dry ton calculation is based on the percent solids of the analysis and the
maximum removal of 2.OMG per year and projected percent solids of 3%.
Gallons lbs/Gal. %Solids Dry lbs. lbs/ton Dry Tons
2,000,000 x 8.34 x 0.03 = 500,400 - 2000 = 250

2d) Operation and Maintenance Plan

Standard Operating Procedure and Operation
and Maintenance Plan for the Town of Mocksville
- Land Application Program
1. Purpose
a. Ensure the requirements of the Town of Mocksville, NC Non -Discharge
Perm it#WQ0003351 are met.
2. Personnel
a. The following is a list of personnel in order they are to be contacted when
information needs to be shared.
i. EMA Resources inc.
1. Jeff Thompson — Project Manager 336-477-4078
2. Roy Whitaker — Director of Bus.Dvlpmt./Ops. 336-909-1718
3. Brent Collins — Director of Technical Services 336-399-3646
ii. Town of Mocksville, NC
1. Ken Gamble — Town Manager 336-753-6701
2. Chip White — WTP-ORC 336-751-2635 (EnviroLink)
3. Operational Functions
a. The operational function of this project it going to involves transporting the
thickened liquid residuals via tanker trailers to a staging area in the receiver
sites. The liquid residuals will be off-loaded into tractor/pull tank spreader
or pumper truck and land applied in a uniform application. It is going to be
spread at agronomic rates that are determined using the Realistic Yield
Expectations (RYE) as outlined in the permit, the amount of other nutrient
sources the landowner and operator has applied, and the residuals nutrient
and metal sample that is current for that monitoring period. The material is
going to be land applied on fields that have a crop growing on them that
are going to either be grazed or cut for animal feed or row crops for feed
or fiber. Application rates will be reduced by 25% on fields that are primarily
used for grazing in accordance with USDA-NRCS 590. Grazed fields will be
determined by the farmers and EMA project managers.

4. Maintenance Schedule
a. EMA Resources Inc. will follow the maintenance schedule as recommended
by the EMA Resources EHS&T Director for the equipment necessary to
complete the job.
S. Safety Measures
a. The Town of Mocksville and EMA Resources Inc. believe in operating in a
safety conscious manner and all employees participate in safety training that
is designed to help employees recognize safety issues and take steps to
prevent accidents from occurring. In addition, EMA Resources employees
have the authority to stop operations if they think any aspect of the
operation is going to cause environmental or personal harm.
6. Spill Response Plan
a. In the unlikely event of a spill, the following action shall be taken
immediately.
i. Management of Spill Clean-up Activities: The EMA Resources
Project Manager shall take immediate charge and initiate clean-up
activities. EMA Resources labor and equipment is to be utilized. In
the event additional labor and equipment is required, assistance may
be requested from the Town of Mocksville, The NC Department of
Transportation, and other private contractors as necessary.
ii. Halt the Source of the Spill: Such as a ruptured container or
damaged transport unit.
iii. Contain the Spill: Form a barrier. Sufficient quantities of straw shall
be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The
Operations Manager or the person in charge on the spill site will be
advise the clean-up personnel where to get the straw, lime, and other
items necessary to complete the clean-up operation. ie. local farmers,
farm supply centers, nurseries.
iv. Initial Clean -Up: Employ front-end loaders, vacuum equipment,
sludge application vehicles, and/or local septic tank service to
remove as much of the spilled material as possible. Straw and/or
sand should be scattered in the spill area to soak up the remaining

material. The straw and sand soaked material will be collected and
removed to a disposal area approved by representatives of the state
regulatory agency.
v. Final Clean-up: Employ rotary brush sweeper if needed and apply
lime to the spill area upon the approval of the clean-up efforts by the
state regulatory representative. If the event occurs on private
property, the clean-up will be completed to the satisfactory of the
property owner and state regulatory representatives. The ultimate
goal will be restore the spill area to its original condition if possible.
vi. Notification: As soon as possible after the spill occurs, the EMA
Resources Project Manager or designee will notify the Town of
Mocksville and the EMA Resources main office. EMA Resources
office staff is then responsible for notifying other key EMA Resources
personnel.
vii. Reporting_ EMA Resources staff will notify the Winston-Salem
regional office of the NCDENR by telephone [phone] as soon
as possible, but not more than 24 hours after, or on the next working
day following the occurrence. The EMA Project Manager shall
provide a written report with 48 hours of the spill to the EMA
Resources Director of Technical Services and the Town of Mocksville
staff. The report shall list all relative information and actions taken.
With the assistance of EMA Resources personnel, and the Town of
Mocksville personnel, a written report will be filed with the Winston-
Salem regional office within 5 days of the occurrence. For after-hours
reporting, the Division's emergency number shall be called to report
all incidences [phone].
7. Inspection Plan
a. Inspection for the land application of residuals will conducted on a
minimum of a weekly basis at the land application site during land
application activities. The inspection frequency is based on the time frame
that it is going to take to complete the project and the amount of dry tons
to be land applied from this facility. The inspections will consist of
inspecting a current field that is being applied as well as inspecting random
fields that have been completed. Inspections will be conducted by Jeff

Thompson — Project Manager. These inspections will consist of the
following:
i. Verifying the application rates for each field that plan on receiving
material.
ii. Checking the calculated loads to ensure the correct amount of
residuals are being land applied.
iii. Ensure that all manned equipment has a copy of the permit and the
operation and maintenance plan.
iv. Ensure that the field has been flagged properly and that all buffers
are being adhered to.
v. Ensure proper signage has been posted
vi. Verify that the proper number of samples of the residuals have been
taken and that it meets the criteria for land application.
vii. The records will be kept in the EMA Resources project files in the
main office. Copies of all analyses and records will be forwarded to
the Town of Hillsborough and kept on file.
viii. EMA Resources and the Town of Mocksville staff will immediately
inform the other party if any of the following conditions are noted.
1. Any occurrence with the distribution program resulting in the
land application of significant amounts of material that is
abnormal in quantity or characteristics.
2. Any failure of the distribution system that results in the release
to surface waters.
3. Any time that self -monitoring indicates that the facility has
gone out of compliance with the permit.
4. Any process failure that results in the system not adequately
treating the residuals.
5. Any spill or discharge from a vehicle or piping system during
residuals transportation.
6. Any release that requires immediate reporting outside normal
business hours shall be called in by EMA Resources staff to
DENR at [phone]. This number is to be called in the
event of a release to surface waters or imminent failure of a
storage system when the event occurs outside of normal
business hours.

8. Sampling and Monitoring Plan
a. Sampling for this project consists of sampling the residuals prior to land
application occurring in order to ensure that the residuals are suitable for
land application.
b. The samples will be collected from the two storage tanks that holds the
thickened residuals
c. Roy Whitaker, Brent Collins, or other designee will be responsible for sample
collection for nutrient and metal, TCLP, and fecal coliform.
d. Nutrient, metal and TCLP sample aliquots will be collected randomly and
consist of at least 7 individual aliquots mixed together in order to get the
composite sample for these parameters.
e. The residuals will be sampled annually for TCLP including the RCIls.
f. Metal and nutrient parameters will be collected and analyzed based on the
requested dry ton numbers in the permit application.
g. If not Alkaline Stabilized, Residuals will be sampled for fecal coliform to
demonstrate pathogen requirements have been met. Seven separate
samples will be collected and analyzed.
9. Environmental Impacts
a. The environmental impacts for residuals may be affected by this procedure.
b. This procedure helps assure that land application is conducted in a safe and
efficient manner while ensuring compliance with the laws and regulations
and to minimize exposure, negative environmental impacts and public
relation concerns.

2ei) Laboratory Analytical Reports

Waypointo
ANALYTICAL
2/2/2022
EMA Resources Inc
Mr. Brent Collins
755 Yadkinville Rd
Mocksville, NC, 27028
Ref: Analytical Testing
Lab Report Number: 22-025-0021
Client Project Description: Dutchman's Creek
Mocksville, NC
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Dear Mr. Brent Collins:
Waypoint Analytical, LLC. received sample(s) on 1/25/2022 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. Where the laboratory was not responsible for the sampling
stage (refer to the chain of custody) results apply to the sample as received.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2021) and NELAC unless otherwise indicated. Any parameter
for which the laboratory is not officially NELAP accredited is indicated by a '—'symbol. These are not included in
the scope because NELAP accreditation is either not available or has not been applied for. Additional
certifications may be held/are available for parameters, where NELAP accreditation is not required or applicable.
A full list of certifications is available upon request.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Danyale Love
Project Manager
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
TNI
Page 1 of 9

Waypointo
ANALYTICAL
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 Fax [phone]
www.waypointanalytical.com
Certification Summary
Laboratory ID: WP MTN: Waypoint Analytical, LLC., Memphis, TN
State
Program
Lab ID
Expiration Date
Alabama
State Program
40750
02/28/2022
Arkansas
State Program
88-0650
02/07/2022
California
State Program
2904
06/30/2022
Florida
State Program
- NELAP
E871157
06/30/2022
Georgia
State Program
C044
02/18/2023
Georgia
State Program
04015
06/30/2022
Illinois
State Program
- NELAP
200078
10/10/2022
Kentucky
State Program
80215
06/30/2022
Kentucky
State Program
KY90047
12/31/2022
Louisiana
State Program
- NELAP
LA037
12/31/2022
Louisiana
State Program
- NELAP
04015
06/30/2022
Mississippi
State Program
MS
02/11/2023
North Carolina
State Program
415
12/31/2022
Pennsylvania
State Program
- NELAP
68-03195
05/31/2022
South Carolina
State Program
84002
06/30/2022
South Carolina
State Program
84002
06/30/2022
Tennessee
State Program
02027
02/11/2023
Texas
State Program
- NELAP
T104704180
09/30/2022
Virginia
State Program
00106
06/30/2022
Virginia
State Program
- NELAP
460181
09/14/2022
Page 1 of 1 00001/22-025-0021
Page 2 of 9

Waypoint
ANALYTICAL
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Sample Summary Table
Report Number: 22-025-0021
Client Project Description: Dutchman's Creek
Mocksville, NC
Lab No Client Sample ID Matrix Date Collected
91581 Dutchman's Creek Solids 01/24/2022 08:00
Date Received
O1/25/2022
Page 3 of 9

Waypointo
ANALYTICAL
Client: EMA Resources Inc
Project: Dutchman's Creek
Lab Report Number: 22-025-0021
Date: 2/1 /2022
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 fax [phone]
www.waypointanalytical.com
CASE NARRATIVE
Metals Analysis Method 601 OD
Sample 99187
Analyte: Aluminum
QC Batch No: 1-596771/1-596454
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.
Sample 99187
Analyte: Calcium
QC Batch No: 1-597088/1-596454
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.
Sample 99187
Analyte: Copper
QC Batch No: 1-596771/1-596454
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.
Sample 99187
Analyte: Iron
QC Batch No: 1-596771/1-596454
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.
Sample 99187
Analyte: Potassium
QC Batch No: 1-597000/1-596454
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.
Sample 99187
Analyte: Magnesium
QC Batch No: 1-597000/1-596454
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.
Sample 99187
Analyte: Manganese
QC Batch No: 1-596771/1-596454
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.
Sample 99187
Page 4 of 9

Waypointo
ANALYTICAL
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 0 fax [phone]
www.waypointanalytical.com
Analyte: Phosphorus
QC Batch No: 1-597000/1-596454
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.
Sample 99187
Analyte: Lead
QC Batch No: 1-596771/1-596454
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.
Sample 99187
Analyte: Sulfur
QC Batch No: 1-597000/1-596454
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.
Sample 99187
Analyte: Zinc
QC Batch No: 1-596771/1-596454
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.
Page 5 of 9

Waypointo
ANALYTICAL
46245
EMA Resources Inc
Mr. Brent Collins
755 Yadkinville Rd
Mocksville , NC 27028
Report Number : 22-025-0021
Lab No : 91581
Sample ID : Dutchman's Creek
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Project Dutchman's Creek
Information : Mocksville, NC
REPORT OFANALYSIS
Report Date : 02/02/2022
Received : 01/25/2022
Danyale Love
Project Manager
Matrix: Solids
Sampled: 1/24/2022 8:00
Test
Results
Units
MDL
MQL
DF
Date / Time
Analyzed
By
Analytical
Method
Moisture
98.2
%
0.010
1
01/26/22 16:41
FMM
SW-DRYWT
Ammonia Nitrogen
6170
mg/Kg -
dry
889
5560
1
02/01/22 14:00
JPJ
4500NH3C-2011
Nitrate+Nitrite-N
405
mg/Kg -
dry
263
263
1
02/01/22 14:47
ZBD
4500NO3F-2011
Organic N
72720
mg/Kg -
dry
888.9
5556
1
01/31/22 10:00
CALCULATION
pH
6.4
S.U.
1
01/31/2215:39
DRS
9045D
Total Solids
1.77
%
0.010
0.010
1
01/26/22 16:41
FMM
2540G-2011
Total Volatile Solids
72.9
%
0.010
0.010
1
01/26/22 16:41
FMM
2540G-2011
Total Kjeldahl Nitrogen
78900
mg/Kg -
dry
556
13900
1
01/31/22 10:00
JPJ
;M-4500-NH3C-TKl`
Phosphorus
19500
mg/Kg -
dry
153
278
1
01/28/22 05:40
EAL
6010D
Aluminum
10600
mg/Kg -
dry
257
278
1
01/28/22 05:40
EAL
6010D
Arsenic
<13.3
mg/Kg -
dry
13.3
27.8
1
01/28/22 05:40
EAL
6010D
Cadmium
<1.11
mg/Kg -
dry
1.11
5.56
1
01/28/22 05:40
EAL
6010D
Calcium
19600
mg/Kg -
dry
2150
2780
1
01/28/22 05:40
EAL
6010D
Chromium
23.9
mg/Kg -
dry
13.1
13.9
1
01/28/22 05:40
EAL
6010D
Copper
187
mg/Kg -
dry
17.2
27.8
1
01/28/22 05:40
EAL
6010D
Iron
17600
mg/Kg -
dry
473
556
1
01/28/22 05:40
EAL
6010D
Lead
17.0
mg/Kg -
dry
10.0
16.7
1
01/28/22 05:40
EAL
6010D
Magnesium
3770
mg/Kg -
dry
143
278
1
01/28/22 05:40
EAL
6010D
Manganese
989
mg/Kg -
dry
18.1
27.8
1
01/28/22 05:40
EAL
6010D
Mercury
<0.346
mg/Kg -
dry
0.346
0.794
1
01/26/22 17:16
JW2
7471A
Molybdenum
<7.50
mg/Kg -
dry
7.50
13.9
1
01/28/22 05:40
EAL
6010D
Nickel
11.93
mg/Kg -
dry
6.67
13.9
1
01/28/22 05:40
EAL
6010D
Potassium
6000
mg/Kg -
dry
343
556
1
01/28/22 22:03
EAL
6010D
Qualifiers/ DF
Dilution Factor
J
Estimated value
Definitions MQL
Method Quantitation Limit
Page 6 of 9

Waypointo
ANALYTICAL
46245
EMA Resources Inc
Mr. Brent Collins
755 Yadkinville Rd
Mocksville , NC 27028
Report Number : 22-025-0021
Lab No : 91581
Sample ID : Dutchman's Creek
2790 Whitten Road, Memphis, TN 38133
Main 901.213.2400 ° Fax [phone]
www.waypointanalytical.com
Project Dutchman's Creek
Information : Mocksville, NC
REPORT OFANALYSIS
Report Date : 02/02/2022
Received : 01/25/2022
Danyale Love
Project Manager
Matrix: Solids
Sampled: 1/24/2022 8:00
Test
Results
Units
MDL
MQL
DF
Date / Time
Analyzed
By
Analytical
Method
Selenium
<17.8
mg/Kg - dry
17.8
27.8
1
01/28/22 22:03
EAL
6010D
Sodium
9780
mg/Kg - dry
722
1390
1
01/28/22 05:40
EAL
6010D
Zinc
594
mg/Kg - dry
45.0
69.4
1
01/28/22 05:40
EAL
6010D
Sulfur
9830
mg/Kg - dry
288
556
1
01/28/22 05:40
EAL
6010D
Sodium Absorption Ratio
2.24
Ratio
0.01
0.01
1
01/28/22 05:40
CALCULATION
Qualifiers/ DF Dilution Factor
Definitions
J Estimated value
Page 7 of 9

s
WayPAoi nt ..(2) �79p Whitten Road,3.240 Memphis, TN 38133
21.2440
Main 901.213.240fl °Fax [phone]
N A LYT I C A L www.waypointanalytical.com
Shipment Receipt Form
Customer Number: 46245
Customer Name: EMA Resources Inc
Report Number: 22-025-0021
Shipping Method
0 Fed Ex 0 US Postal 0 Lab
0 UPS 0 Client 0 Courier
0 Other:
Thermometer ID:
T137
Shipping container/cooler uncompromised?
* Yes
0 No
Number of coolers/boxes received
F-71
Custody seals intact on shipping container/cooler?
0 Yes
0 No
Not Present
Custody seals intact on sample bottles?
0 Yes
0 No
Not Present
Chain of Custody (COC) present?
# Yes
0 No
COC agrees with sample label(s)?
# Yes
0 No
COC properly completed
# Yes
0 No
Samples in proper containers?
# Yes
0 No
Sample containers intact?
# Yes
0 No
Sufficient sample volume for indicated test(s)?
# Yes
0 No
All samples received within holding time?
# Yes
0 No
Cooler temperature in compliance?
# Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
# Yes
0 No
Water - Sample containers properly preserved
0 Yes
0 No
N/A
Water - VOA vials free of headspace
0 Yes
0 No
N/A
Trip Blanks received with VOAs
0 Yes
0 No
N/A
Soil VOA method 5035 — compliance criteria met
0 Yes
0 No
0 N/A
F_ High concentration container (48 hr)
F_ High concentration pre -weighed (methanol -14 d)
F_ Low concentration EnCore samplers (48 hr)
F_ Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included? 0 Yes * No
Comments:
Signature: IMakayla Weaver Date & Time: 01/25/2022 09:04:46
Page 8 of 9

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Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
I`*
Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Page 1
Report Date: 1/31/2022
Date Sample Rcvd: 1/24/2022
Meritech Work Order # 01242204 Sample: Dutchman's Creek 1 Grab 1/24/22
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.80 % 1/25/22 0-100 % SM 2540B
Fecal Coliform (Sludge) 555,556 col/g dry wt 1/24/22 130 col/g dry wt SM 9222D
Meritech Work Order # 01242205 Sample: Dutchman's Creek 2 Grab 1/24/22
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.77 % 1/25/22 0-100 % SM 2540B
Fecal Coliform (Sludge) 519,774 col/g dry wt 1/24/22 130 col/g dry wt SM 9222D
Meritech Work Order #
01242206 Sample: Dutchman's Creek 3 Grab
1/24/22
Parameters
Result Analysis Date Reporting
Limit
Method
% Total Solids
1.75 % 1/25/22 0-100 %
SM 2540B
Fecal Coliform (Sludge)
548,571 col/g drywt 1/24/22
130 col/g dry wt
SM 9222D
Meritech Work Order #
01242207 Sample: Dutchman's Creek 4 Grab
1/24/22
Parameters
Result Analysis Date Reporting
Limit
Method
% Total Solids
1.77 % 1/25/22 0-100 %
SM 2540B
Fecal Coliform (Sludge)
593,220 col/g dry wt 1/24/22
130 col/g dry wt
SM 9222D
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
r
Page 2
Contact: Brent Collins Report Date: 1/31/2022
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028 Date Sample Rcvd: 1/24/2022
Meritech Work Order # 01242208 Sample: Dutchman's Creek 5 Grab 1/24/22
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.75 % 1/25/22 0-100 % SM 2540B
Fecal Coliform (Sludge) 514,286 col/g dry wt 1/24/22 130 col/g dry wt SM 9222D
Meritech Work Order # 01242209 Sample: Dutchman's Creek 6 Grab 1/24/22
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.74 % 1/25/22 0-100 % SM 2540B
Fecal Coliform (Sludge) 574,713 col/g drywt 1/24/22 130 col/g dry wt SM 9222D
Meritech Work Order # 01242210 Sample: Dutchman's Creek 7 Grab 1/24/22
Parameters Result Analysis Date Reporting Limit Method
% Total Solids 1.81 % 1/25/22 0-100 % SM 2540B
Fecal Coliform (Sludge) 580,110 col/g drywt 1/24/22 130 col/g drywt SM 9222D
I hereby certify that I have reviewed and approve these data. zzz'
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] £ax.[phone]

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Contact: Brent Collins
Client: EMA Resources, Inc
755 Yadkinville Road
Mocksville, NC 27028
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Report Date: 3/16/2022
Date Sample Rcvd: 2/2/2022
Vector Attraction Reduction /Aerobically Digested Sludge 30 Day Test
Meritech Work Order # 02022204 Sample: Mocksville Composite 2/2/22
Total Solids Volatile Solids % Volatile Solids
Week 1 1.32 0.960 0.730
Week 2
1.25
0.890
0.713
Week 3
1.38
1.04
0.755
Week 4
1.23
0.900
0.730
Week 5
1.25
0.910
0.723
Van Kleek Reduction (%): 3.19
I hereby certify that I have reviewed and approve these data.
Pass or Fail
Pass
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

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ace Analytical ' ANALYTICAL REPORT
February 07, 2022
EMA Resources
Sample Delivery Group: L1454549
Samples Received: 01/25/2022
Project Number:
Description: Sludge
Report To: Mr. Brent Collins
755 Yadkinville Road
Mocksville, NC 27028
Entire Report Reviewed By: , �-
Justin Carr
Project Manager
Results relate only to the items tested or calibrated and are reported as rounded values. This test report shall not be
reproduced, except in full, without written approval of the laboratory. Where applicable, sampling conducted by Pace
Analytical National is performed per guidance provided in laboratory standard operating procedures ENV-SOP-MTJL-0067and
ENV-SOP-MTJL-0068. Where sampling conducted by the customer, results relate to the accuracy of the information provided,
and as the samples are received.
N
� T
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1454549 02/07/22 16:05 1 of 21

TABLE OF CONTENTS
Cp: Cover Page
Tc: Table of Contents
2
Ss: Sample Summary
3
Cn: Case Narrative
4
Sr: Sample Results
5
DUTCHMAN'S CREEK L1454549-01
5
Qc: Quality Control Summary
7
Wet Chemistry by Method 9012 B
7
Wet Chemistry by Method 9034-9030B
8
Wet Chemistry by Method 9045D
9
Wet Chemistry by Method D93/1010A
10
Mercury by Method 7470A
11
Metals (ICP) by Method 6010D
12
Volatile Organic Compounds (GC/MS) by Method 8260D
13
Chlorinated Acid Herbicides (GC) by Method 8151A
15
Pesticides (GC) by Method 8081B
16
Semi Volatile Organic Compounds (GC/MS) by Method 8270E
17
GI: Glossary of Terms
19
al: Accreditations & Locations
20
Sc: Sample Chain of Custody
21
ACCOUNT: PROJECT: SDG:
DATE/TIME: PAGE:
EMA Resources L1454549
02/07/22 16:05 2 of 21

SAMPLE SUMMARY
DUTCHMAN'S CREEK L1454549-01 Waste
Collected by
Brent Collins
Collected date/time
01/24/22 08:00
Received date/time
01/25/22 09:15
FP
Method
Batch
Dilution Preparation
Analysis
Analyst
Location
date/time
date/time
F
Preparation by Method 1311
WG1808840
1 01/27/2210:39
01/27/2210:39
JWS
Mt. Juliet, TN
Preparation by Method 1311
WG1809554
1 01/28/2212:49
01/28/2212:49
CJW
Mt. Juliet, TN
Wet Chemistry by Method 9012 B
WG1808566
1 01/30/221127
02/01/22 14:38
LDT
Mt. Juliet, TN
Wet Chemistry by Method 9034-9030B
WG1809680
1 01/31/2216:00
02/01/22 22:00
SAC
Mt. Juliet, TN
Wet Chemistry by Method 9045D
WG1808419
1 01/26/2214:00
01/27/22 09:00
GI
Mt. Juliet, TN
Fn
Wet Chemistry by Method D93/1010A
WG1812928
1 02/04/22 0108
02/04/22 0108
WOS
Mt. Juliet, TN
Mercury by Method 7470A
WG1810317
1 01/30/22 09:32
01/31/22 09:35
MRW
Mt. Juliet, TN
Metals (ICP) by Method 6010D
WG1810384
1 02/01/22 00:24
02/01/22 23:48
CCE
Mt. Juliet, TN
Fr
Volatile Organic Compounds (GC/MS) by Method 8260D
WG1810127
1 01/29/2216:06
01/29/2216:06
JAH
Mt. Juliet, TN
Chlorinated Acid Herbicides (GC) by Method 8151A
WG1811223
1 02/02/22 08:09
02/03/221144
AO
Mt. Juliet, TN
Rc
Pesticides (GC) by Method 8081B
WG1809205
1 02/03/22 06:33
02/03/2215:47
AO
Mt. Juliet, TN
Semi Volatile Organic Compounds (GC/MS) by Method 8270E
WG1809535
1 01/30/2216:30
01/31/22 05:50
JNJ
Mt. Juliet, TN
GI
F
RC
ACCOUNT:
PROJECT:
SDG:
DATE/TIME:
PAGE:
EMA Resources
L1454549
02/07/22 16:05
3 of 21

CASE NARRATIVE
All sample aliquots were received at the correct temperature, in the proper containers, with the FP
appropriate preservatives, and within method specified holding times, unless qualified or notated within
the report. Where applicable, all MDL (LOD) and RDL (LOQ) values reported for environmental samples FC
have been corrected for the dilution factor used in the analysis. All Method and Batch Quality Control
are within established criteria except where addressed in this case narrative, a non-conformance form
or properly qualified within the sample results. By my digital signature below, I affirm to the best of my FS
knowledge, all problems/anomalies observed by the laboratory as having the potential to affect the
quality of the data have been identified by the laboratory, and no information or data have been
knowingly withheld that would affect the quality of the data. 0
Fr
Rc
GI
Justin Carr [Al
Project Manager
RC
Project Narrative
All Reactive Cyanide results reported in the attached report were determined as totals using method 9012 B.
All Reactive Sulfide results reported in the attached report were determined as totals using method 9034-903013.
ACCOUNT: PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources L1454549 02/07/22 16:05 4 of 21

SAMPLE RESULTS - 01
L1454549
DUTCHMAN'S CREEK
Collected date/time: 01/24/22 08:00
Preparation by Method 1311
Result Qualifier Prep
Batch
Analyte
date / time
TCLP Extraction
1/27/202210:39:54 AM
WG1808840
TCLP ZHE Extraction
- 1/28/202212:49:36 PM
WG1809554
Fluid
1 1/27/202210:39:54AM
WG1808840
Initial pH
7.01 1/27/202210:39:54AM
WG1808840
Final pH
4.99 1/27/202210:39:54 AM
WG1808840
Wet Chemistry by Method 9012 B
Result Qualifier RDL
Analyte mg/kg mg/kg
Reactive Cyanide ND 0.250
Wet Chemistry by Method 9034-9030B
Result Qualifier RDL
Analyte mg/kg mg/kg
Reactive Sulfide ND 25.0
Wet Chemistry by Method 9045D
Dilution Analysis Batch
date / time
1 02/01/202214:38 WG1808566
Dilution Analysis Batch
date / time
1 02/01/2022 22:00 WG1809680
Result Qualifier Dilution Analysis Batch
Analyte su date / time
Corrosivity by pH 7.19 T8 1 01/27/2022 09:00 WG1808419
Sample Narrative:
L1454549-01 WG1808419: 7.19 at18C
Wet Chemistry by Method D93/1010A
Result
Analyte Deg. F
Ignitability DNI at200
Mercury by Method 7470A
Qualifier Dilution Analysis Batch
date / time
1 02/04/2022 0108 WG1812928
Result Qualifier RDL Limit
Analyte mg/I mg/I mg/I
Mercury ND 0.0100 0.20
Metals (ICP) by Method 6010D
Result
Qualifier RDL
Limit
Analyte
mg/I
mg/I
mg/I
Arsenic
ND
0.100
5
Barium
ND
0.100
100
Cadmium
ND
0.100
1
Chromium
ND
0.100
5
Lead
ND
0.100
5
Selenium
ND
0.100
1
Silver
ND
0.100
5
Volatile Organic
Compounds (GC/MS) by Method
8260D
Result
Qualifier RDL
Limit
Analyte
mg/I
mg/I
mg/I
Benzene
ND
0.0500
0.50
Carbon tetrachloride
ND
0.0500
0.50
Chlorobenzene
ND
0.0500
100
Chloroform
ND
0.250
6
ACCOUNT:
PROJECT:
EMA Resources
Dilution Analysis Batch
date / time
1 01/31/2022 09:35 WG1810317
Dilution Analysis
Batch
date / time
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
1 02/01/2022 23:48
WG1810384
Dilution Analysis
Batch
date / time
1 01/29/202216:06
WG1810127
1 01/29/202216:06
WG1810127
1 01/29/202216:06
WG1810127
1 01/29/202216:06
WG1810127
SDG:
DATE/TIME: PAGE:
L1454549
02/07/22 16:05 5 of 21
I q,

DUTCHMAN'S
CREEK
SAMPLE RESULTS
- 01
Collected date/time: 01/24/22 08:00
L1454549
Volatile Organic Compounds (GC/MS) by Method 8260D
Result
Qualifier RDL Limit Dilution
Analysis
Analyte
mg/I
mg/I mg/I
date/time
1,2-Dichloroethane
ND
0.0500 0.50 1
01/29/202216:06
1,1-Dichloroethene
ND
0.0500 0.70 1
01/29/202216:06
2-Butanone (MEK)
ND
0.500 200 1
01/29/202216:06
Tetrachloroethene
ND
0.0500 0.70 1
01/29/202216:06
Trichloroethene
ND
0.0500 0.50 1
01/29/202216:06
Vinyl chloride
ND
0.0500 0.20 1
01/29/202216:06
(S) Toluene-dH
90.9
80.0-120
011291202216.06
(S) 4-Bromofluorobenzene
94.6
77.0-126
011291202216.06
(S) 1,2-Dichloroethane-d4
89.8
70.0-130
011291202216.06
Chlorinated Acid Herbicides (GC)
by Method 8151A
Result
Analyte mg/I
2,4,5-TP (Silvex) ND
2,4-D ND
(S) Z4-Dichlorophenyl Acetic Acid 71.2
Pesticides (GC) by Method 8081B
Batch
WG1810127
WG1810127
WG1810127
WG1810127
WG1810127
WG1810127
WG1810127
WG1810127
WG1810127
Qualifier RDL
Limit
Dilution Analysis
Batch
mg/I
mg/I
date / time
0.00200
1
1 02/03/20221144
WG1811223
0.00200
10
1 02/03/20221144
WG1811223
14.0-158
021031202211.44
WG1811223
Result
Qualifier RDL
Limit
Analyte
mg/I
mg/I
mg/I
Chlordane
ND
0.00500
0.03
Endrin
ND
0.00500
0.02
Heptachlor
ND
0.00500
0.0080
Heptachlor epoxide
ND
0.00500
0.0080
Lindane
ND
0.00500
0.40
Methoxychlor
ND
0.00500
10
Toxaphene
ND
0.0100
0.50
(S) Decochlorobiphenyl
93.6
10.0-128
(S) Tetrochloro-m-xylene
93.3
10.0-127
Semi Volatile Organic Compounds
(GC/MS) by Method 8270E
Analyte
1,4-Dichlorobenzene
2,4-Dinitrotoluene
Hexachlorobenzene
Hexachloro-1,3-butadiene
Hexachloroethane
Nitrobenzene
Pyridine
3&4-Methyl Phenol
2-Methylphenol
Pentachlorophenol
2,4,5-Trichlorophenol
2,4,6-Trichlorophenol
(S) 2-Fluorophenol
(S) Phenol-d5
(S) Nitrobenzene-d5
(S) 2-Fluorobiphenyl
(S) Z4, 6-Tribromophenol
(S) p-Terphenyl-d14
ACCOUNT:
EMA Resources
Dilution Analysis
date / time
1 02/03/2022 15:47
1 02/03/2022 15:47
1 02/03/2022 15:47
1 02/03/2022 15:47
1 02/03/2022 15:47
1 02/03/2022 15:47
1 02/03/2022 15:47
0210312022 15.47
0210312022 15.47
Batch
WG1809205
WG1809205
WG1809205
WG1809205
WG1809205
WG1809205
WG1809205
WG1809205
WG1809205
Result
Qualifier RDL
Limit
Dilution Analysis
Batch
mg/I
mg/I
mg/I
date/time
ND
0.100
7.50
1 01/31/2022 0550
WG1809535
ND
0.100
0.13
1 01/31/2022 0550
WG1809535
ND
0.100
0.13
1 01/31/2022 0550
WG1809535
ND
0.100
0.50
1 01/31/2022 0550
WG1809535
ND
0.100
3
1 01/31/2022 0550
WG1809535
ND
0.100
2
1 01/31/2022 0550
WG1809535
ND
0.100
5
1 01/31/2022 0550
WG1809535
ND
0.100
400
1 01/31/2022 05:50
WG1809535
ND
0.100
200
1 01/31/2022 0550
WG1809535
ND
0.100
100
1 01/31/2022 05:50
WG1809535
ND
0.100
400
1 01/31/2022 05:50
WG1809535
ND
0.100
2
1 01/31/2022 05:50
WG1809535
51.5
10.0-120
0113112022 05.50
WG1809535
33.3
10.0-120
0113112022 05.50
WG1809535
80.0
10.0-127
0113112022 05.50
WG1809535
75.9
10.0-130
0113112022 05.50
WG1809535
69.0
10.0-155
0113112022 05.50
WG1809535
82.1
10.0-128
0113112022 05.50
WG1809535
PROJECT:
SDG:
DATE/TIME: PAGE:
L1454549
02/07/22 16:05 6 of 21

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GLOSSARY OF TERMS
Guide to Reading and Understanding Your Laboratory Report
The information below is designed to better explain the various terms used in your report of analytical results from the Laboratory. This is not
intended as a comprehensive explanation, and ifyou have additional questions please contactyour project representative.
Results Disclaimer - Information that may be provided by the customer, and contained within this report, include Permit Limits, Project Name,
Sample ID, Sample Matrix, Sample Preservation, Field Blanks, Field Spikes, Field Duplicates, On -Site Data, Sampling Collection Dates/Times, and
Sampling Location. Results relate to the accuracy of this information provided, and as the samples are received.
Abbreviations and Definitions
u
Fc
Fss]
MDL
Method Detection Limit.
ND
Not detected at the Reporting Limit (or MDL where applicable).
Fn
RDL
Reported Detection Limit.
Rec.
Recovery.
Fr
RPD
Relative Percent Difference.
SDG
Sample Delivery Group.
Surrogate (Surrogate Standard) - Analytes added to every blank, sample, Laboratory Control Sample/Duplicate and
F
(S)
Matrix Spike/Duplicate; used to evaluate analytical efficiency by measuring recovery. Surrogates are not expected to be
detected in all environmental media.
U
Not detected at the Reporting Limit (or MDL where applicable).
Analyte
The name ofthe particular compound or analysis performed. Some Analyses and Methods will have multiple analytes
reported.
Ifthe sample matrix contains an interfering material, the sample preparation volume or weight values differ from the
F
Dilution
standard, or if concentrations of analytes in the sample are higher than the highest limit of concentration that the
laboratory can accurately report, the sample may be diluted for analysis. If a value different than 1 is used in this field, the
result reported has already been corrected for this factor.
Rc
These are the target % recovery ranges or % difference value that the laboratory has historically determined as normal
Limits
for the method and analyte being reported. Successful QC Sample analysis will target all analytes recovered or
duplicated within these ranges.
Original Sample
The non -spiked sample in the prep batch used to determine the Relative Percent Difference (RPD) from a quality control
sample. The Original Sample may not be included within the reported SDG.
This column provides a letter and/or number designation that corresponds to additional information concerning the result
Qualifier
reported. If a Qualifier is present, a definition per Qualifier is provided within the Glossary and Definitions page and
potentially a discussion of possible implications ofthe Qualifier in the Case Narrative if applicable.
The actual analytical final result (corrected for any sample specific characteristics) reported for your sample. Ifthere was
no measurable result returned for a specific analyte, the result in this column may state "ND" (Not Detected) or "BDL"
Result
(Below Detectable Levels). The information in the results column should always be accompanied by either an MDL
(Method Detection Limit) or RDL (Reporting Detection Limit) that defines the lowest value that the laboratory could detect
or report for this analyte.
Uncertainty
(Radiochemistry)
Confidence level of 2 sigma.
A brief discussion about the included sample results, including a discussion of any non -conformances to protocol
Case Narrative (Cn)
observed either at sample receipt by the laboratory from the field or during the analytical process. If present, there will
be a section in the Case Narrative to discuss the meaning of any data qualifiers used in the report.
Quality Control
This section ofthe report includes the results ofthe laboratory quality control analyses required by procedure or
Summary (Qc)
analytical methods to assist in evaluating the validity ofthe results reported for your samples. These analyses are not
being performed on your samples typically, but on laboratory generated material.
This is the document created in the field when your samples were initially collected. This is used to verify the time and
Sample Chain of
date of collection, the person collecting the samples, and the analyses that the laboratory is requested to perform. This
Custody (Sc)
chain of custody also documents all persons (excluding commercial shippers) that have had control or possession ofthe
samples from the time of collection until delivery to the laboratory for analysis.
This section ofyour report will provide the results of all testing performed on your samples. These results are provided
Sample Results (Sr)
by sample ID and are separated by the analyses performed on each sample. The header line of each analysis section for
each sample will provide the name and method number for the analysis reported.
Sample Summary (Ss)
This section ofthe Analytical Report defines the specific analyses performed for each sample ID, including the dates and
times of preparation and/or analysis.
Qualifier
Description
J3
The associated batch QC was outside the established quality control range for precision.
J5
The sample matrix interfered with the ability to make any accurate determination, spike value is high.
J6
The sample matrix interfered with the ability to make any accurate determination, spike value is low.
T8
Sample(s) received past/too close to holding time expiration.
ACCOUNT:
PROJECT: SDG: DATE/TIME: PAGE:
EMA Resources
L1454549 02/07/22 16:05 19 of 21

ACCREDITATIONS & LOCATIONS
Pace Analytical National 12065 Lebanon Rd Mount Juliet, TN 37122
Alabama
40660
Nebraska
N E-OS-15-05
Alaska
17-026
Nevada
TN000032021-1
Arizona
AZ0612
New Hampshire
2975
Arkansas
88-0469
New Jersey—NELAP
TNO02
California
2932
New Mexico
TN00003
Colorado
TN00003
New York
11742
Connecticut
PH-0197
North Carolina
Env375
Florida
E87487
North Carolina'
DW21704 _
Georgia
NELAP
North Carolina 3
41
Georgia'
923
North Dakota
R-140
Idaho
TN00003
Ohio—VAP
CL0069
Illinois
200008
Oklahoma
9915
Indiana
C-TN-01
Oregon
TN200002
Iowa
364
Pennsylvania
68-02979
Kansas
E-10277
Rhode Island
LA000356
Kentucky' 6
KY90010
South Carolina
84004002
Kentucky 2
16
South Dakota
n/a
Louisiana
A130792
Tennessee'"
2006
Louisiana
LA018
Texas
T104704245-20-18
Maine
TN00003
Texas5
LABO152
Maryland
324
Utah
TN000032021-11
Massachusetts
M-TNO03
Vermont
VT2006
Michigan
9958
Virginia
110033
Minnesota
047-999-395
Washington
C847
Mississippi
TN00003
West Virginia
233
Missouri
340
Wisconsin
998093910
Montana
CERT0086
Wyoming
A2 LA
A2LA— ISO 17025
1461.01
AIHA-LAP,LLC EMLAP
100789
A2 LA — ISO 17025 5
1461.02
DOD
1461.01
Canada
1461.01
USDA
P330-15-00234
EPA—Crypto
TN00003
Drinking Water 2 Underground Storage Tanks 3 Aquatic Toxicity "Chemical/Microbiological 5 Mold 6 Wastewater n/a Accreditation not applicable
Not all certifications held by the laboratory are applicable to the results reported in the attached report.
Accreditation is only applicable to the test methods specified on each scope of accreditation held by Pace Analytical.
Rc
ACCOUNT: PROJECT: SDG: DATE/TIME:
EMA Resources L1454549 02/07/22 16:05
PAGE:
20 of 21

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2eii) Residuals Information

Residuals Information Sheet
Generator: Town of Mocksville
Facility:
Dutchman's Creek WWTP
Address:
291 Garwood Rd
Mocksville, NC 27028
Phone:
336-549-8990
Contact:
Chip White
Land Application Contractor: EMA Resources Inc.
755 Yadkinville Rd
Mocksville, NC 27028
Phone: [phone]
Contact: Brent Collins
Please Note: The application of these residuals is only allowed in accordance with subject permit.
(W Q0003351)
All applicable setbacks in accordance with 15A NCAC 02T .1108(b) will be adhered and is the
responsibility of the land application contractor.
Application rates shall be applied at agronomic rates for intended uses.
No residuals shall be applied to any site that is flooded, frozen, or snow covered.
Adequate procedures will be implemented to prevent surface runoff of residuals in any surface waters.
The attached residuals analysis report is a summary of major and micro -nutrients available in the
residuals.
If you have any questions concerning this information, you may contact EMA Resources Inc, at the
number listed above.

3) LASC Form

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-DV-08-01
No
Hay/Pasture
Feed
Dutchman's Creek
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that i have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Roger Spillman
Address: PO Box 738
City: Cooleemee State: NC Zip: 27028
Phone: [phone] E-mail address:
Signature: Date: 3hol2 L
NORTH CA OLINA, vt e- —COUNTY Ko
I, the undersigned Notary Public do hereby certify that ss : 01
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the lafdk
day of of A
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
3/yo /ZG
Davie County, NO
Won Expires Mara 30, 2lYlt3
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
I certify that I have read this
Signing official name:
Signature:
State:
E-mail address:
Date:
Zip:
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date: lu'e_-- Z e_
FORM: LOA 06-16 Page 3 of 3

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-DV-11-(1-2)
No
Hay/Pasture
Feed
Dutchman's Creek
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Gregory Dooley
Address: 692 Godbey Rd
City: Mocksville State: NC Zip: 27028
Phone: d !��a ail address:
Signature: x Date:
NORTH CAROLINA, litljc L COUNTY
3/10122-
I, the undersigned Notary Public do hereby certify that 4rt=64 boot Ov
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the i
day of oeCk 20-27
Signature and seal:
My commission expires
Lessee's/Operator's Certification:
31301
M. Brent Collins
Davie County, NO
Won Expires March 30, 2026
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Ke amble — Town Mana er
Signature: Date:
FORM: LOA 06-16 Page 3 of 3

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There is no cumulative data to report for DV11-02

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
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-NM-01-01
No
Hay/Pasture
Feed
Dutchman's Creek
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: CB Rupard Heirs C/O Clarence Arthur Ruupard
Address: 135 Rupard Trail
City: Mocksville State:
Phone:
Signature:
Zip: 27028
E-mail address:
K Date: 7/
NORTH CAROLINA, Oag; G
COUNTY
1, the undersigned Notary Public do hereby certify that L larm eL f rA%lr Q%.aarcl
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the ek
day of lnorc
Signature and seal:
My commission expires: .31301Z6
Lessee's/Operator's Certification:
20 2L
M. Brent Collins
My CommmiWon Expires March 30, 2026
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip;
I certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Gamble— Town Manama
Signature: Date:'^' �Z
FORM: LOA 06-16 Page 3 of

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
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-NM-01-02
No
Hay/Pasture
Feed
Dutchman's Creek
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that 1 am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners 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 Pennittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: CB Rupard & Sons Inc. _
Address:
City: Mocksville State: NC Zip: 27028
Phone: E-mail address: j J
Signature: ) l4nn., --1 Date: 0 1 1 Z 7,
NORTH CAROLINA, I> W ' f. COUNTY /�
I, the undersigned Notary Public do hereby certify that L larinCt f/r%�+vi 2upord
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the $ tk
day of AlOrC k
Signature and seal: /%% .�!/
My commission expires: 33130124,
Lessee's/Operator's Certification:
M. Brent Collinsa
Davie County, NO
3sion Expires March 3Q, 2MI
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: K amble — Twyn Manager
Signature: Date:
FORM: LOA 06-16 Page 3 of 3

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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 —LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
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-NM-05-01
No
Hay
Feed
Dutchman's Creek
NC-NM-05-02
No
Hay
Feed
Dutchman's Creek
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
HLALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: Town of Mocksville — C/O Ken Gamble
Address: 171 Clement Street
City: Mocksville State: NC Zip: 27028
Phone: [phone] E-mail address: kgamblena.mocksviIlenc.eov
Signature: Date: U3 �ZS (i2
NORTH CAROLINA, `:. V 1'e COUNTY ,,
1, the undersigned Notary Public do hereby certify that VjLny)CA.n Ga" 0--
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of ro Gu-, 20
Signature and seal: `-CJ_f_YAA_U
My commission expires: 11
Lessee's/Operator's Certification:
Z3
NOM
kV CWVAW loe Eq*ft I 1—I- 20 7-3
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: en ble — own Mpoagg
Signature: Date:
FORM: LOA 06-16 Page 3 of 3

— -—���ew�r aq.; •. fir. 6 i
44
�\ � a
y
J.
- t • !A �1t � I r� l •
fhe road between the fields is a private access road. Stay off the road 25' to make sure
:he road is not applied to.
—I
Field Total Acres Applicable Acres
1 4.87 4.12
Source: Esri, M •ar, GeoEye, E rth:
Power Box
■ Off Site Dwelling
— Stream
® Buffer
Field Boundary
2 4.75 4.6 USDA, USGS, P. enoGRID, IGN, nd the Property Boundary
SCALE: 1 440' 'i ,.,��"_.,A Town of Mocksville FIGURE NO.
"=
DATE: 03-07-22 " �MA Land Application Program
DRAWN BY: BC .Resources, Inc. 2
NC-MK-05
Town of Mocksville

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