WQ0037135_Owner (Affiliation Change)_20200507

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANCE
Division of Water Resources INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION
This form is for ownership changes or name changes of a non -discharge system permit. Please note that "Permittee"
references the existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitling Unit website
A. Non -Discharge Permit Ownership/Name Change (FORM: NDPONC 06-16) Application (All Applications):
❑ Submit an original completed and appropriately executed Non -Discharge Permit OwnershipfName Change (FORM: NDPONC
06-16) application.
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b}.
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0.106 b . Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0I06(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit.
C. Property Ownership Documentation (All Applications):
Per 15A NCAC 02T.0504( f), I SA NCAC 021' .0604(e), 15A NCAC 02'f .0704_ffl, 15A NCAC 02T .0804, 15A NCAC 02T
.1004 d , 15A NCAC 02T. 1104(d)(7}, 15A NCAC 02T ,1 104 e 5 , 15A NCAC 02U .0201(c) or 15A NCAC 02U .0202(fl,
the Applicant shall demonstrate they are the owner of all property containing the non -discharge system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(l}, provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (All Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to
be sold):
Home/Property Owners' Associations
❑ Per 15A NCAC 02T_01 15(c), submit an original properly executed Operational Agreement_(FORM: HO_A_).
❑ Per 15A NCAC 02T .01 15 c , submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws.
Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Operation and Maintenance Agreement (All Applications for Single -Family Wastewater Irrigation Systems):
❑ Per 15A NCAC 02T .0604(h), submit an original of a notarized Operation and Maintenance Agreement (FORM: SFRWWIS
O&M) that has been signed and dated by all deeded property owners.
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE BRANCH
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources FORM: NDPONC 06-16
1. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: Southern Soil Builders, INC.
2. Signature authority's name: Dennis Key per 15A NCAC 02T .0106(b) Title: President
3. Permittee's mailing address: 958 Hoots Road
City: Roaring River State: NC Zip: 28669-9148
4. Permittee's contact information: Phone number: [phone] Email Address: [e-mail]
5. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Permittee or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
11. FACILITY INFORMATION:
1. Facility name: U.S Biosolids, Inc.
2. Facility's physical address: 958 Hoots Road
City: Roaring River State: NC Zip: 28669-9148 County: Wilkes
III. PERMIT INFORMATION:
1. Existing permit number: WQ0037135 and most recent issuance date: May 7, 2019
2. Existing permit type: Land Application of Residual Solids (503)
3. Reason for the permit application: Name Change
4. Has the facility been constructed? ® Yes or ❑ No
1V. APPLICANT INFORMATION:
1. Applicant's name: U.S. Biosolids, Inc.
2. Signature authority's name: Zach Key per 15A NCAC 02T .0I06(b) Title: President
3. Applicant's mailing address: 958 Hoots Road
City: Roaring River State: NC Zip: 28669-9148
4. Applicant's contact information: Phone number: [phone] Email Address: zachke usbiosolids.com
5. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.613? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0I05(e)(2}? ❑ Yes or ® No
FORM: NDPONC 06-16 Page I of 2

Existing Permittee's Certification per 15A NCAC 02T .0106 b :
ktrYl SO-t
ignature Authority's name & title from Application Item 1.2.)
(Facility nam from Application Item 11.1.)
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that 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 the existing permit be violated. I also understand that if all required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete. I further certify that the existing Permittee 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 per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: n Date: C ao
Applicant's Certification per 15A NCAC 02T .0106(b):
I, LCAC �` IX attest that this application for
(Signature Authority's name & title from Application Item IV.2.)
v. S. e l v So i; dS , -Tn(.
(Facility name from Application Item H.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that 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. 1 also understand that if all required parts of this application
package 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. I further certify that 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 per 15A
NCAC 02T .0105 e .
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: 9Date: J ~ C OR
FORM: NDPONC 06-16 Page 2 of 2

State of North Carolina
Department of the Secretary of State
ARTICLES OF INCORPORATION
SOS1D: 1904887
Date Filed: 10/14/2019 1:47:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C2019 284 00220
Pursuant to §55-2-02 of the General Statutes of North Carolina, the undersigned does hereby submit these Articles of
Incorporation for the purpose of forming a business corporation.
1. The name of the corporation is: U.S. Biosolids, Inc.
2. The number of shares the corporation is authorized to issue is: 1000
3. These shares shall be: (check either a or b)
a. ❑� All of one class, designated as common stock; or
b. Divided into classes or series within a class as provided in the attached schedule,
with the information required by N.C.G.S. Section 55-6-01.
4. The name of the initial registered agent is: Zachery Key
5. The North Carolina street address and county of the initial registered office of the corporation is:
Number and Street 1151 Wagon Ridge Road
City Roaring River State NC
Zip Code 28669
County Wilkes
6. The mailing address, if different from the street address, of the initial registered office is:
Number and Street
City State NC Zip Code
7. Principal office information: (must select either a or b.)
a.❑ The corporation has a principal office.
The principal office telephone number: 336-467-3550
The street address and county of the principal office of the corporation is:
Number and Street 1151 Wagon Ridge Road
City Roaring River
State NC Zip Code 28669
County
County Wilkes
The mailing address, if different from the street address, of the principal office of the corporation is:
Number and Street
City
State Zip Code
b. The corporation does not have a principal office.
County
BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form B-01)

Any other provisions, which the corporation elects to include, i.e., the purpose of the corporation, are attached.
The name and address of each incorporator is as follows:
Name
Zachery Key
Address
1151 Wagon Ridge Road, Roaring River, INC 28669
10. (Optional): Listing of Company Officers (See instructions on why this is important)
Name
Address
Title
Zachery Key
1151 Wagon Ridge Road, Roaring River, INC 28668
President
Heather Key
1151 Wagon Ridge Road, Roaring River, INC 28668
Secretary/Treasurer
Privacy Redaction
11. (Optional): Please provide a business e-mail address.
The Secretary of State's Office will e-mail the business automatically at the address provided at no charge when a
document is filed. The e-mail provided will not be viewable on the website. For more information on why this
service is being offered, please see the instructions for this document.
12. These articles will be effective upon filing, unless a future date is specified:
This the day of October20 19
U.S. Biosolids, Inc.
Signature
Zachery Key, Incorporator
Type or Print Name and Title
NOTES:
1. Filing fee is $125. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form B-01)