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WQ0003902_Regional Office Historical File Pre 2018
State of North Carolina Department of Environmental Quality I)- - WR_ Division of Water Resources WATER QUALITY REGIONAL OPERATIONS SECTION Division of Water Resources NON -DISCHARGE APPLICATION REVIEW REQUEST FORM r , - E- February 10, 2020 To: Iw1�R® W-11I QRfJS Andrew '.�ti� r�l o r ,y 'ri tiger WQROS From: Ranveer Katyal, Water Quality Permitting Section - Non -Discharge Branch MOORESVILLE REGIONAL OFFICE Permit Number: WQ0003902 Applicant: City of Newton Owner Type: Municipal Facility Name: City of Newton RLAP Signature Authority: Todd Clark Address: PO Box 550, Newton, NC 28658 Fee Category: Non -Discharge Major Comments/Other Information: kT%i'ismai Permit Type: Land Application of Residual Solids (503) Project Type: Major Modification Owner in BIMS? Yes Facility in BIMS? Yes Title: City Manager County: Catawba Fee Amount: $395 - Major Modification Attached, you will find all information submitted in support of the above -referenced application for your review, comment, and/or action. Within 45 calendar days, please take the following actions: ® Return this form completed. ® Return a completed staff report. ❑ Attach an Attachment B for Certification. ❑ Issue an Attachment B Certification. When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and return it to the appropriate Central Office Water Quality Permitting Section contact person listed above. RO-WQROS Reviewer: Date: FORM: WQROSNDARR 09-15 Page 1 of 1 6 s ROY COOPER Governor MICHAEL S. REGAN Secretary S. DANIEL SMITH Director TODD CLARK — CITY MANAGER CITY OF NEWTON PO Box 550 NEWTON, NORTH CAROLINA 28658 Dear Mr. Clark: NORTH CAROLINA Environmental Quality February 10, 2020 Subject: Acknowledgement of Application No. WQ0003902 City of Newton RLAP Residuals Management System Catawba County The Water Quality Permitting Section acknowledges receipt of your permit application and supporting documentation received on February 4, 2020. Your application package has been assigned the number listed above, and the primary reviewer is Ranveer Katyal. Central and Regional Office staff will perform a detailed review of the provided application, and may contact you with a request for additional information. To ensure maximum efficiency in processing permit applications, the Division of Water Resources requests your assistance in providing a timely and complete response to any additional information requests. Please note that processing standard review permit applications may take as long as 60 to 90 days after receipt of a complete application. If you have any questions, please contact Ranveer Katyal at (919) 707-3661 or ranveer.katyal@ncdenr.gov. cc: �lv�foorses;aen>e��ceran�><v;� Permit File W00003902 Sincerely, Nathaniel D. Thornburg, Supervisor Division of Water Resources Now , l o h a �Pi Upinmenf of Emimn ..' ..lily North Carolina Department of Environmental Quality I Division of Water Resources 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh. North Carolina 27699-1617 919.707.9000 - T.4011 Jft' LUx All 1A lll� 1 zm�1� aui a RECEIVEDNCDENRAYWR FEB 12 2020 WQROS MOORESVILLE REGIONAL OFFICE January 21, 2020 N.C. Department of Environment and Natural Resources Water Quality Section Non -Discharge Permitting Unit — Aquifer Protection Unit 1636 Mail Service Center Raleigh, NC 27699-1636 ATTENTION: Mr. Nathaniel Thornburg REFERENCE: RENEWAL OF CITY OF Newton LAND APPLICATION PERMIT WQ0003902 Dear Mr. Thornburg: Synagro Central LLC is submitting a request to modify a land application program for residuals generated by the City of Newton Wastewater Treatment Plant. One original and two copies of this application to renew the referenced residuals are included. We are adding 5 brand ._ new sites along with Lt-119 is adding one more field to that site. The new sites are CA-25, CA- 27, CA-28, CA-29, and CA-47. As of right now there 541.1 acres remain in the program. We are adding 167.32 acres to bring us to a total of 708.42. This application package contains the information necessary to complete the certification of this permit. However, if you require any additional information or have further questions about the information presented herein, please contact me at afox@synagro.com or at my phone number (336)-703-8681 I look forward to working with you to ensure a timely and efficient review of this application. Sine rely, Alex Fox Technical Services Specialist Synagro Central, LLC State of North Carolina ]Department of Environmental Quality Division of Water Resources ` ®ivision of Water Resources ISA NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under 15A NCAC 02T .1100. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages): Submit.the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer. The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b). If this project is for a modification of an existing permit, submit one copy of the existing permit. ❑ Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units. B. Application Fee (New and Major Modification Application Packages) Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental Quality (NCDEQ). Facility Classification New Permit Major Modification 1 Major (land are permitted for > 300 acres) $1,310 $395 Minor (land are pennitted for < 300 acres) $810 $245 1 - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage; adds additional land application areas not previously approved for that particular program [including transferring of field(s) from one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not previously permitted. There is no fee for minor modifications to a permit. C. Cover Letter (All Application Packages) List all items included in the application package, as well as a brief description of the requested permitting action. D. Environmental Assessments (May be Required — See 15A NCAC 1C .0300) ❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for the construction of the subject facilities. INSTRUCTIONS FOR FORM: RLAP 06-16 Page 1 of 3 E. Operation and Maintenance Plan (New and Renewal Application Packages) ❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan. ❑ Submit the O&M Plan in accordance with 15A NCAC 02T .I 110 and include at a minimum: Operational functions; describe the operation of the program to show what operations are necessary for the program to function and by whom the functions are to be conducted. ❑ Maintenance schedules; may include equipment calibration, maintenance of signs, etc. �] Safety measures; may include safety training program, manuals, signs, etc. ❑ Spill response plan; including control, containment, remediation, emergency contact information, etc. ❑ Inspection plan including the following information; ❑ Names and titles of personnel responsible for conducting the inspections. ❑ Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the selected location(s) and inspection frequency are representative of the residuals management program. Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event that noncompliance is observed. [] Sampling and monitoring plan including the following information; ❑ Names and titles of personnel responsible for conducting the sampling and monitoring. ❑ Detailed description of monitoring procedures including parameters to be monitored. ❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature, flow; and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most likely to be negatively affected by cold temperatures. THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY. F. Program Determination ❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T i, .110202). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable: Any land application site certified for the residuals land application program that receives residuals at rates or frequencies greater than agronomic rates. ❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal, and agricultural crop production is of secondary importance. ❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation facilities or irrigation facilities fed through a fixed supply system. ❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program falls under the dedicated program definitions. G. Program Information ❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system. ❑ Provide an explanation of the dedicated system and its operation. H. Detailed Site Maps (All New or Modification Application Packages) Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF only). For Modifications, submit plans specific to the modification(s) only. Plans must include the following minimum items: A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site relief and showing all facility related structures and fences within the land application area. The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s). ® Delineation of the review and compliance boundaries Setbacks as required by 15A NCAC 02T .1108 ® Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s). ❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray irrigation zones as they will be operated. ❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3 I. K. L. M Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites) Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops and their ability to accept the proposed application rates. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity) ❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy available at: hn://www.ncwater.orgIRules Policies and Regulations/. The document shall be signed, sealed and dated by a qualified professional. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation facilities fed through fixed supply system) Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated site map specific to the modification(s) only. ❑ The design documents must include the following minimum items: ❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new units or are critical to the understanding of the complete process; ❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the finished product including leaking testing; and ❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head curve analysis for each pump, and irrigation design. Soil mapping units shown on all disposal sites. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or irrigation facilities fed through fixed supply systems) ❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy available at: hn://www.ncwater.org/Rules Policies and Regulations. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment or irrigation components) Property ownership documentation shall consist of one of the following: Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or Z Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or ❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements of 15A NCAC 02L .0107(f) or ® A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or survey map. ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS: NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES WATER QUALITY PERMITTING SECTION NON -DISCHARGE PERMITTING UNIT By U.S. Postal Service: 1617 MAIL SERVICE CENTER RALEIGH, NORTH CAROLINA 27699-1617 TELEPHONE NUMBER: (919) 807-6464 By Courier/Special Delivery: 512 N. SALISBURY STREET RALEIGH, NORTH CAROLINA 27604 FAX NUMBER: (919) 807-6496 INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of') State of North Carolina DW Department of Environmental Quality Division of Water Resources Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM FORM: RLAP 06-16 I. APPLICANT INFORMATION: 1. Applicant's name: City of Newton Applicant type: 0 Individual [] Corporation ❑ General Partnership ❑ Privately -Owned Public Utility 0 Federal El State N Municipal ❑ County Signature authority's name per 15A NCAC 02T .0106: Todd Clark Title: City Manager Applicant's mailing address: P.O. Box 550 City: Newton State: NC Zip: 28658 Telephone number: (828) 695-4259 Email Address: telark@newtonnc.gov 2. Consultant's name: Alex Fox License Number (for P.E.): Affiliation: On Staff Retained (Firm: Synagro Central LLC.) Consultant's mailing address: 284 Boger Rd City: Mocksville State: NC Zip: 27028 Telephone number: 336) 703-8681 3. Agronomist's name: ' i Affiliation: [] N/A [] On Staff Agronomist's mailing address Email Address: afox@syna rg o.com License Number: ® Retained (Firm: Piedmont Environmental) City: State: NC Zip: Telephone number:) I_i-: I Email Address: 4. Soil Scientist's name: Chris Murray License Number: 1284 Affiliation: 0 N/A ❑ On Staff Z Retained (Firm: !) Soil Scientist's mailing address:: 216 S. Swing Rd. Suite 1 City: Greensboro State: NC Zip: 27028 Telephone number: (336) 662-5487 Email Address: ch-ris@piedmontsoil.com 5. Fee submitted: I (See Instruction B) II. PERMIT INFORMATION: 1. Application is for (check all that apply): ❑ new, m modified, 0 renewed permit 2. If this application is being submitted to renew or modify an existing permit, provide the following: Permit number: WQ0003902 Date of most -recently issued permit: June 1, 2015 Date of most -recently certified Attachment A (if different than the permit): i Date of most -recently certified Attachment B (if different than the permit): I I FORM: RLAP 06-16 Page 1 of 5 III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION: 1. Residuals Processing Facility's physical address: 1407 McKgy Farm Rd. City: Newton State: NC Zip: 28658 Coordinates: Latitude: 35' 37' 40" Longitude: 81' 14' 03" Datum: NAD83 Level of accuracy: Man Method of measurement: Second 2. County where residuals land application program is headquartered: Catawba 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 Mike Cox Synagro 13191 Back -Up ORC Robert Roth Synagro 1001672 Additional Back -Up ORCs (if applicable) _ __ _J J 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: Alex Fox Spring 2020 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: 3438 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 13.00 19.52 44686 67102 Five -Year Maximum Adjusted 17.20 23.72 59147 81562 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 27.5 Hay 21.4 _ _] Pasture 492.2 Total: 541.1 Methods Surface 541.1 Incorporation or Injection 0 Total: 541.1 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 qbs PAN/ac yr) Acres Required Using First -Year PAN Concentrations Acres Required Using Five -Year Maximum Adjusted PAN Concentrations Surface Incorporation or Inj ection Surface Incorporation or Injection 50 893.7 1342 1182.9 1631.2 100 446.9 671 591.5 815.6 150 297.9 447.3 394.3 543.7. 200 223.4 335.5 295.7 407.8 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 ofNorth Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction practices not in place, etc.): e 7. Specify type of -residuals program (See Instruction F): Non -dedicated Ll 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; i 0 Residuals program contains any land application_site(s) that is used primarily for residuals disposal, and agricultural crop production is of secondary importance, explain; ❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation facilities fed through a fixed supply system, explain; IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source) Complete and submit the following Residuals Source Certification and all associated documentation. Residuals Source Certification V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site) Complete and submit the following Land Applications Site Certification and all associated documentation. Land Application Siite Certification. doc FORM: RLAP 06-16 Page 3 of 5 Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only. J• TI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM 1. The irrigation system is: 0 Spray ❑ Drip 2. Disposal system is: 0 existing ❑ proposed. 3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: i 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: Recommended Recommended Soil Series Fields within Soil Area Loading Rate Loading Rate in/hr in/ r 6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist? ( ❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met: 7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system): Field / Zone Design Area fe) Number of Nozzles Maximum Application Rate ( allons/hr) Design Annual Loading Rate (gallons/ r) - - - 7-7. --- -1 i _-i Total j _wl Spray Irrigation Design Element Plan Sheet FSpecification Number Page Number Wetted diameter of nozzles Vvj ft Wetted area of nozzles ftz _ Nozzle capacity _ gpm Nozzle manufacturer / model L Elevation of highest nozzle ft FORM: RLAP 06-16 Page 4 of 5 A pplicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106): d -.ie 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 (Signature Authority's Name — PLEASE PRINT) (I attest that this application for v6 ��� &VI 00 (Facility Name) A (Title) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically granted in the permit. Further, any discharge of residuals to -surface waters or the land will result in an immediate enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed and that if all required supporting information and attachments are not included, this application package will be returned to me as incomplete. Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false -`atement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to ,ceed $10,000 as well as civil penalties up to $25,000 per violation. Signature: Date: �v FORM: RLAP 06-16 Page 5 of 5 State of North Carolina Division of Water Resources Department of ]Environmental Quality Division of Water Resources LAND APPLICATION SITE CERTIFICATION INSTRUCTIONS FOR FORM: LASC 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supportinj4 documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land Application Site Certification (FORM: LASC 06-16): ® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer. ❑ For new or renewed permits, submit the requested information for all land application sites. ® For modified permits, submit the requested information for 2nly those sites that are new, transferred or affected by the proposed modification. Land Application Site Information: ® The status of the land application site with respect to this residuals land application program must be provided in table I. The status categories and their corresponding codes are as follows: o New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D) ® Attach the following in accordance with each status code: Status Code Required Item N R T M H -1/ County Board Notification. doc Land Owner Agreement (If applicable) ✓ ✓ ✓ ✓ Setback Waiver Agreement An updated vicinity/setback map in accordance with the "Map Guidance for Residuals Land Application Peimits" ✓ ✓ ✓ A soils and agronomic evaluation in accordance with the "Soil Scientist Evaluation Policy" ✓ INSTRUCTIONS FOR FORM: LASC 06-16 Page 1 of 3 An updated accounting of the land application site's cumulative ✓ pollutant loading rates CPLRs tatus Code qNR Required Item T M For previously permitted sites without a soil series name indicated in the Attachment B, submit County Soil Survey Map (or equivalent) clearly ✓ indicate the location of the land application site and in accordance with the soil map requirements in the "Soil Scientist Evaluation Polic " Acknowledgement of field transfer from Land Owner (Fields may not be permitted to multiple Permittees over the same timeperiod) * This item may be required for land application site with a status code "M", please contact the Division if you need assistant in determining attachment requirements. ® Crop Type should include the most likely crop types for the life of the permit (five years). ® Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or name of the soil series as provided by the licensed soil scientist. ® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct . mapping unit. If a representative slope is provided, it must be determined accordingly: ® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8% would have a representative slope of 6%. ® New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist. ® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as follows: • Address Matching (ADD) • Digital or Raw Photo Extraction (EXT) • Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO) • Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR) • Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS) • Conversion from Township -Section -Range (TSR) • Remote Sensing (RS) • Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP) • Map Interpretation by Digital or Manual Extraction (MAP) C. Waterbody and Classifications Information: (new sites only) ® Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality. ® Surface water body classifications information may be found at: http:Hdeg.nc.gov/about/divisions/water- resources/planning/classification-standards/classifications ® Any questions concerning the waterbody and its classification, please contact the Division's regional offices. ® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at: http://deq.nc. eov/contact/regional-offices ® General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned subbasins, location descriptions, stream index numbers and established classifications. 1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area should be submitted with the permit application regardless of whether a Stream classification was completed). 2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as "UT to stream name" as the waterbody name. 3. Open the link http:Hdeq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications. ® Stream Classification Process: One of the options below may be used depending on the known initial project information. ® KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED 1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide the proper location descriptions if multiple runs. INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3 2. Locate the name of the identified waterbody (from General Directions) on the list. 3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term "source" in the description means the beginning of the waterbody segment (most upstream point). 4. Record all Basins, Stream Index Numbers and Classifications applicable to the project. ❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED 1. Select the proper county from the List all Waterbodies in county, hydrologically report. 2. Locate the name of the identified waterbody (from General Directions) on the list. 3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term "source" in the description means the beginning of the waterbody segment (most upstream point). 4. Record all Basins, Stream Index Numbers and Classifications applicable to the project. ❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED 1. Use the Clickable basin map to hydrologically sorted list report. 2. Click on the approximate project location to bring up the hydrologically sorted list. 3. Locate the name of the identified waterbody (from General Directions) on the list. 4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term "source" in the description means the beginning of the waterbody segment (most upstream point). 5. Record all Basins, Stream Index Numbers and Classifications applicable to the project. ❑ Notes on index number and unnamed streams: Unnamed Streams 15A NCAC 02B .0301(i). ❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned to the stream segment to which it is tributary (at the point of entry) except: (A) unnamed streams specifically described in the schedule of classifications; (B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or (C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted. ❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the basin: Unnamed 'Tributaries Entering Other States or for Specific Basin Areas Hiwassee River Basin Streams entering Georgia or Tennessee shall be classified "C Tr." Little Tennesse River Basin And Savannah River Drainage Area Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah River drainage area entering South Carolina shall be classified "B Tr." French Broad River Basin Streams entering Tennessee will be classified "B." Watauga River Basin Streams entering the State of Tennessee are classified "C." Broad River Basin Streams entering South Carolina are classified "C." New River Basin Streams entering the State of Tennessee are classified "C." Catawba River Basin Streams entering South Carolina are classified "C." Yadkin -Pee Dee River Basin Streams entering Virginia are classified "C," and such streams entering South Carolina are classified "C." Lumber River Basin Streams entering South Carolina are classified "C Sw." Roanoke River Basin Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or described shall carry the classification "B," and all backwaters of Lake Gaston and the North Carolina portion of streams tributary thereto not otherwise named or described shall carry the classification "C and B." Chowan River Basin Streams entering Virginia are classified "C." Tar -Pamlico River Basin All drainage canals not noted in the schedule are classified "C Sw." except the main drainage canals to Pamlico Sound and its bays which shall be classified "SC." Pas uotank River Basin All drainage canals not noted in the schedule are classified "C." INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3 LAND A JCATION SITE CERTIFICATION Applicant's name: City of Newton Land application sites currently certified: 541.1 net acres and Total to be certified: 708.4 net acres. I. LAND APPLICATION SITE INFORMATION (See Instruction B): Status Code' Site/Field ID Landowners �� Lessees or Operator(s) (� Net Acres Count y s Crop(s) p() Predominant Soil Series Nameb Mapping Unit or Rep. Slope° N CA-25-1 Gary`D'ellin 40.8 Catawba Fescue, Corn, Wheat Popular forest N CA-27-1 7a:s�dn i 7.5 Catawba Fescue pasture/Hay Fairview N CA-27-2 son Litt1 22.8 Catawba Fescue pasture/Hay Fairview N CA-27-3 'a� son Littl 11.7 Catawba Fescue pasture/Hay Clifford N CA-28-1 harry Browrry 4.9 Catawba Fescue pasture/Hay Clifford N CA-29-1 enrieth Arrowwoo ' 20.7 Catawba Fescue pasture/Hay Clifford N CA-47-6 Sh n S Rhone j Randy Leatherman 9.6 Catawba Corn, Beans, Wheat _ Lloyd N CA-47-7 Sl on S :Rhori y Randy Leatherman 6.6 Catawba Corn, Beans, Wheat Lloyd N CA-47-8 � t p ie'Bblick Morgax Randy Leatherman � Catawba Corn, Beans, Wheat LE7 N LT-119-5 Gordy G n L3�9 incoln escue Hay loy_d FORM: LASC 06-16 Page 1 T, A l'4D H, � T ,IC A TIFON SITE CERTIFICATION a Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) o T (Transferred) s D (Deleted) b Soil Series Name (i.e. Appling, Cecil, etc.) 'Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2) II. WATERSODY AND CLASSIFICATIONS INFORMATION (See Instruction C): Site/Field ID Latitude Longitude Location Datum Location Method Code Location Accuracy Waterbody Subbasin and Stream Index No. Current and Proposed Class CA-25-1 350 40' .959" 810 2' .351" NAD 83 MAP Nearest Second Terrapin Creek 11-81-(-1) WS-IV WS-IV CA-27-1 3_Sj° 45' S1.83" 81° 9' S6.62" NAD 83 MAP Nearest Second Lyle Creel 11-76-(3.5) WS-IV WS-IV CA-27-2 350 45' 46.96" 81° 9' 45.28" NAD 83 MAP Nearest Second Lyle Creel 11-76-(3.5) WS-IV WS-IV CA-27-3 350 45' 46.53" 81° 10' 2.35" NAD 83 MAP Nearest Second Lyle Creel 11-76-(3.5) WS-IV WS-IV CA-28-1 350 45' 22.45" 81° 6' 31.92" NAD 83 MAP Nearest Second Catawba River ll-(74) WS-IV;CA WS-IV;CA CA-29-1 350 48' 24.72" 810 11' NAD 83 MAP Nearest Second Bakers Cree , 11-76-3 C C CA-47-6 350 38' 12" 810 23' 4" NAD 83 MAP Nearest Second Jacob Fork 11-129-2-(9.5) WS-III WS-III CA-47-7 350 38' 10" 810 22' 51" NAD 83 MAP Nearest Second Jacob Fork 11-129-2-(9.5) WS-III WS-III I`--1 CA-47-8i 35.�7.4 81.30.42� NAD 83 MAP Nearest Second Jacob Fork 11-129-2-(9.5) WS-III WS-III LT 1 L9°=51°=51 t35 32 46, 1 1828 NAD 83 MAP Nearest Second Pott Creek 11-129-3(0 I S-1 1 WS-I' Note: Please keep the site information (I.) and waterbody information (H.) of the same field on the same page. FORM: LASC 06-16 Page 2 State of North Carolina Department of Environmental Quality Division of Water Resources �Dwater c COUNTY BOARD NOTIFICATION of Water Resources TIFICATION. INSTRUCTIONS FOR FORM: CBN 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This notification is intended to provide the county board in which the land application site is proposed to be located with general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review without a corresponding residuals program application form (FORM: RLAP 11-15). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. County Board Notification (FORM: CBN 11-15): ® Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may be made, as long as the attachments are numbered to correspond to the section and item to which they refer. ® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application sites are located. B. Critical Watershed Areas Information: ® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas. ® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at: htt )s:Hdea.ne.aov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection-pro Aram ® If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call (919) 807-6337. C. Notification Package Submission: ® Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the notification package also be sent to the County Manager. ® The most current publication of the Directory of State and County Officials may be downloaded at: ht!ps://www.sosnc.,szoy/publications/direct.mpx ® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at: hqp://deg.nc..gov/contact/regional-offices. Z The source facility summary shall include: facility naive; county where it is located; and the proposed annual dry tonnage (i.e., a copy of "Residuals Source Facility Summary" is adequate but not required). ® The land application site summary shall include: field ID; acreage; county where it is located; latitude and longitude (i.e., a copy of "Land Application Site Certification" is adequate but not required). D. Proof of Submission: ® Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the Division for review. INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of 1 , North Carolina Department of Environmental Quality at McCrory Donald R. van der Vaart Governor Secretary Date: 01/21/2020 To: Name of Chairman to the Board of County Commissioners: Randall Isenhower Complete mailing address: 1537 Little Hill Road City: Newton State: NC Zip: 28658 County where land application sites are located: Catawba From: Applicant's name: City of Newton (on behalf of the Division of Water Resources in accordance with Session Law 2013-340) Contact person and title: Eric Jones Waste Water Superintendent Complete mailing address: 1407 McKa�Rd City: Newton State: NC Zip: 28658 Telephone number: (828)-217-4457 E-mail address: ejones@newtonnc.gov Subject: Notification of residual land application site proposal This is to notify you that the Applicant listed above will be submitting an application to the Division of Water. 1�.esources for the land application of residual solids to site(s) located in your county. During this review, the Division ill ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals- 6enerating sources and locations of the proposed land application sites. Please forward this letter and its associated attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and Planning Department) if applicable. More information of the land application sites included in this application will be available at the following Division of Water Resources Regional Office: Name of appropriate regional office: NC DEO Mooresville Complete mailing address: 610 East Center Ave Suite 301 City: Mooresville State: NC Zip: 28115 Telephone number: (704) 663-1699 Expected date of application submission: 1/24/20 Should you desire to comment on this application, please do so no later than 30 calendar days following the expected application submission date. If you have any questions or comments about this notification, or if you would like more information, please contact the appropriate regional office at the telephone number provided above. Thank you in advance for your attention to this matter. Enclosures: Source Facility Summary Land Application Site Summary Maps Non -Discharge Permitting Unit 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Phone: 919-807-64641Internet: http://portal.ncdenr.org/web/wo An Equal Opportunity(Affirmative Action Employer— Made in part with recycled paper FORM: CBN 06-16 State of North Carolina Department of Environmental Quality f,_ r f,.> Division of Water Resources ' Division of Water IItesources COUNTY BOARD NOTIFICATION INSTRUCTIONS FOR FORM: CBN 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This notification is intended to provide the county board in which the land application site is proposed to be located with general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review without a corresponding residuals program application form (FORM: RLAP 11-15). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. County Board Notification (FORM: CBN 11-15): ® Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may be made, as long as the attachments are numbered to correspond to the section and item to which they refer. ® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application sites are located. B. Critical Watershed Areas Information: ® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas. ® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at: httt)s:Hdeo.nc. v-ov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection-program ® If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call (919) 807-6337. C. Notification Package Submission: ® Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the notification package also be sent to the County Manager. ® The most current publication of the Directory of State and County Officials may be downloaded at: https://www.sosne.goy/publications/direct.aspx ® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at: hqp:Hdeq.nc.gov/contact/regional-offices. ® The source facility summary shall include: facility name; county where it is located; and the proposed annual dry tonnage (i.e., a copy of "Residuals Source Facility Summary" is adequate but not required). ® The land application site summary shall include: field ID; acreage; county where it is located; latitude and longitude (i.e., a copy of "Land Application Site Certification" is adequate but not required). D. Proof of Submission: ® Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the Division for review. INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of 1 North Carolina Department of Environmental Quality at McCrory Donald R. van der Vaart Governor Secretary Date: 01/21/2020 To: Name of Chairman to the Board of County Commissioners: Caroll Mitchem Complete mailing address: 7868 Hallman Mill Rd City: Vale State: NC Zip: 28168 County where land application sites are located: Lincoln From: Applicant's name: City of Newton (on behalf of the Division of Water Resources in accordance with Session Law 2013-340) Contact person and title: Eric Jones Waste Water Superintendent Complete mailing address: 1407 McKay Rd City: Newton State: NC Zip: 28658 Telephone number: (828)-217-4457 E-mail address: ejones@newtonnc.gov Subject: Notification of residual land application site proposal This is to notify you that the Applicant listed above will be submitting an application to the Division of Water Resources for the land application of residual solids to site(s) located in your county. During this review, the Division ,ill ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals- senerating sources and locations of the proposed land application sites. Please forward this letter and its associated attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and Planning Department) if applicable. More information of the land application sites included in this application will be available at the following Division of Water Resources Regional Office: Name of appropriate regional office: NC DEQ Mooresville Complete mailing address: 610 East Center Ave Suite 301 City: Mooresville State: NC Zip: 28115 Telephone number: (104) 663-1699 Expected date of application submission: 1/24/20 Should you desire to comment on this application, please do so no later than 30 calendar days following the expected application submission date. If you have any questions or comments about this notification, or if you would like more information, please contact the appropriate regional office at the telephone number provided above. Thank you in advance for your attention to this matter. Enclosures: Source Facility Summary Land Application Site Summary Maps Non -Discharge Permitting Unit 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Phone: 919-807-64641 Internet: http://pogal.ncdenr.or4/web/wq An Equal Opportunity 1 Affirmative Action Employer — Made in part with recycled paper FORM: CBN 06-16 Alex Fox rom: UPS Quantum View <pkginfo@ups.com> Sent: Thursday, January 23, 2020 10:37 AM To: Alex Fox Subject: UPS Delivery Notification, Tracking Number 1Z51 F78W0196074701 Your package has been delivered. Delivery Date: Thursday, 01/23/2020 Delivery Time: 10:34 AM x -- Set Delivery Instructions At the request of SYNAGRO - MOCKSVILLE this notice alerts you that the status of the shipment listed below has changed. Shipment Detail Tracking Number: 1ZSIF78WO196074701 CAROLL MITCHEM Ship To: 7868 HALLMAN MILL RD VALE, NC 28168 US UPS Service: UPS NEXT DAY AIR Number of Packages: 1 Package Weight: 0.5 LBS Delivery Location: GARAGE Reference Number 1: 20-2360-30-60-4310 50-0055 1 IN. Download the UPS mobile aop © 2020 United Parcel Service of America, Inc. UPS, the UPS brandmark, and the color brown are trademarks of United Parcel Service of America, Inc. All rights reserved. All trademarks, trade names, or service marks that appear in connection with UPS's services are the property of their respective owners. Please do not reply directly to this email. UPS will not receive any reply message. Review the UPS Privacy Notice For Questions, Visit Our Help and Support Center Alex Fox -rom: UPS Quantum View <pkginfo@ups.com> Sent: Thursday, January 23, 2020 9:31 AM To: Alex Fox Subject: UPS Delivery Notification, Tracking Number 1Z51 F78W0199626896 Your package has been delivered. Delivery Date: Thursday, 01/23/2020 Delivery Time: 0922 AM Set Delivery Instructions At the request of SYNAGRO - MOCKSVILLE this notice alerts you that the status of the shipment listed below has changed. Message from SYNAGRO - MOCKSVILLE of SYNAGRO - MOCKSVILLE: CATAWBA COUNTY NOTIFICATION Shipment Detail Tracking Number: 1ZSIE78WO199626896 RANDALL ISENHOWER Ship To: 1537 LITTLE HILL RD NEWTON, NC 28658 US UPS Service: UPS NEXT DAY AIR Number of Packages: 1 Package Weight: 0.5 LBS 1 Delivery Location: FRONT DOOR Reference Number 1: 20-2360-30-60-4310 50-0055 x Download the UPS mobile app ll © 2020 United Parcel Service of America, Inc. UPS, the UPS brandmark, and the color brown are trademarks of United Parcel Service of America, Inc. All rights reserved. All trademarks, trade names, or service marks that appear in connection with UPS's services are the property of their respective owners. Please do not reply directly to this email. UPS will not receive any reply message. Review the UPS privacy Notice For Questions, Visit Our Help and Support Center 191 State of North Carolina (Department of Environmental Quality Division of Water Resources Division of Water 15A NCAC 02T .1100 — LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Lan 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. VA 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/hermits: Applicant's name: m' o Z0 ,11 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) /► }J ,�6 The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the "ermittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals. r his 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 Landowner's Certification: I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement, understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified herein. i I . % a j ., 1 Lands Addri City: Phony Signa r I, the undersigned Notary Public do hereby certify that 2X G X (initials: )personally appeared before me this day, and, being duly sworn, stated that in his/her presence C 0f U -D(c.1 'j flLj Y signed the attached document and acknowledged the due execution of the foregoing instrument. WITNESS my hand and official seal this the 1Z61 day of 'Dete..i ht f , 20�_ loll Signature and seal: 6/ice% . My. commission expires: Lessee's/Operator's Certification: n%.FUGM 11. -=h % 0 l Li I NOTARY PI I GU&FORC COUKI-y- STATE OF NORTH CAROLINA 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: I certify that I have read this Agreement and do hereby Signing official name: Signature: Zip: Date: to abide by the stipulations and restrictions as specified herein. Date: FORM: LOA 06-16 Page 3 of 3 r SITE SUMMARY City of Newton, Clark Creek WWTP Newton, NC Site ID: CA-25 Name: Gary Dellinger Address: 495 Hopewell Church Rd Catawba, NC Phone: 704-201-4079 Operator: Address: Phone: Estimated Applicable Fields Acres Crop(s) Predominant Latitude & Soil Series Longitude 1 40.8 Fescue, Corn, Wheat Popular Forest 35.7088 N -81.103 W TOTALS 40.8 Notes: Date: 11 /4119 J/� � / ,.;"�'.. / '.� �tFj � 1. �////6// //� f f/f%%/ice r ir% ' r ^ ��l, � ! ,;y r 1•.. i ., }.�,f.'�..1 �r����� �l JJl rl �,%/r ��/ /i/.f/%r' /���� J .1.:.. ,r 'A.4�`/f � � 1 .•'t�,- t "j / n op. Is Rn64 ! % r w t r��-• ! JL v� , cc a `f� 1�ip �. ils , • a I � �..\�}i si, U-01P �i ._ I�L��• �..i #�, 4"' '(V fl. f]! y�r r1 p�c F; , f`pp''•��'�-�'C�C�""... �eWr 41 :i � ' is. �\ ��,. :.7. P.OE Sly t ;f •+r l y -. Jml • 1� " � r;y -{ # � �' \ .� �¢,¢ —t r C� �s. til s ,f. ,�I ` F � ,:' � ,�' •.,r ILI , . S._ �i •F p1 ,rr v ��"'� a � ��i� � � 1 * i f90 s� kt t .,+ y4 �G C iY aM ,fin ' f4 414 t Apple Wey, R� f '� ;,'�,� r `� t���1}. �N e� 1 ft°�i• .iti �tsF\ - 5': r mod- ,�. Qf r L ' d' `«! • d��i r Y; - j��j�h L, ? _ � �� � � •i' k � " jfir +-_• *�l. ,rF.J�P `v'v I' ' � �,'• �jr V)�1 �� �'laG� � •�� r»�, a � �` -• •. `+ ,�,� Z' "" �`�• 1. ?.Y: +"� 3 �i�:Ffi'it _ ..� } ,.. .f_�"f' r. _ •�1..• 10 TOPOGRAPHIC MAP A } 4 {`111t X �p ,. -z 1" �{,, �'�„ 7 4 Y;, h i ✓y�i'e - aI � w.i �. 4-. -laQJi VV -ie 41 "' YIL 1,9C'n fit. Y TR. -, -✓ Y'' i*rviir .,t� rr r ,rye *'s, ` ° �f �����ryyk�i� �� 4. Qi � ���" 't"e.. .i, FS t: „_„a__; ,y -_ ■ lS 1 t- Ijl '" L flu '*,s i���F_ 183 ���� -i."', �•i °'X�.�kf ; ✓ +r'� � ^'_ ~ �L� »ice �� c GRAPHIC SCALE 1"=1,000' 1,000' 0 1,000, i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-25 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 1 $ VICINITY MAP t �� �Y rY�'. _rY•. ti).� 3 rt"SL-3 �iY �✓ !' a",��.^R"il >` +:��� ,.1.•� ��i� � ,y ���. �i'� 3y' 1. '\,i, •17�.., °• . 1 A v `s � �y ; � � �`1 � « J" �1 F '',��• 'I •.� n r i I ` — 1 L. .(/`•S86 � 1 - a t • , } \I , �., ,, I K I''t.< J�� r �, 1, Pctt� ,,,i��(.�F ,,` 3 i : ' ::lam.. ,• �._ ^, �r f: �; � a ;;'� �- •7 • ,i -� t r �! �� � r� ",�. � � � �i `�--�.' .� �� ^:.' , i:� r'' rt i�,'s1t , ltf (((� GRAPHIC SCALE 1" = 43000' 4,0001 0 4,000' I , the compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C—CA-25 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Fields 1-2 NCDA&CS Age' is Division Phone: (919) 733-2655 Website: www.n lov/agronomi/ ReportNo. F IL006843 i n'ro Client: Gary Dellinger Advisor: Alex Fox Heavy Metals 965 Hopewell Church Rd P Catawba, NC 28609 S na ro Y g 284 Boger Rd Soil Rep®r$ Mehlich-3 Extraction r; Sampled County: Catawba Mocksville, NC 27028 Fviierv3' Links to Helpful Information Client ID: 493739 Advisor ID: 501947 Sampled: 09/16/2019 Received: 09/27/2019 Completed: 10/02/2019 Farm: NC-CA-25 Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Jagathi Kamalakanthan 10/2/2019 Sample ID: 1 Recommendations: Lime Nutrients (lb/acre) More Crop (tonslacre) N P205 K20 Mg S Mn Zn Cu B Information Lime History: 1 -Corn, grain 2.0 120 - 160 140 50 0 0 0 6 0 0 Note: 3 2 - 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg1dm3]: Soil Class: Mineral HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-1 Na ESP SS-1 NO3-N 0.22 1.03 4.7 38 2.9 4.7 3 42 19 15 54 125 92 22 22 47 0.0 Heavy Metals (parts per million): Arsenic, 0.3 Cadmium, 0.0 Nickel, 0.3 Chromium, 0.3 Lead, 3.1 Selenium, 0.0 Sample ID: 2 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information Lime History: 1 -Corn, grain 0.4 120 - 160 130 10 0 0 0 0 0 0 Note: 3 2 - 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-I Zn-AI Cu-1 Na ' ESP SS-1 NO3-N 0.60 0.99 8.4 80 1.7 5.8 5 73 63 13 72 1266 777 49 49 64 0.1 1 Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.3 Chromium, 0.2 Lead, 3.8 Selenium, 0.1 o th Carolina �'c+l+ac����rusr. Fuacl ���rarn�6sktesw Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner ofA.ariculture SYNAGRO, NEWTON CLASS B PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WWTP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton WUVTP Project, Various Fields Soil Profile Descriptions in Field Locations Project: Uncolnton Permit (WQ 0002712) % Slope: 2% Site: Dillinger Farms Crop: Forage/Pasture Field: Dillinger Farms Field 1 Conducted By: GC Murray Coordinates: 36.7088 N Date: 9/16/2019 -81.1030 W Soil Series: Poplar Forest -C O O V = O O r U U O s K O co 01 T n S S m � o � c O .O N Q U) m m S S U O U K M rV s w U) °� N 5 X PIEDMONT ENVIRONMENTAL ASSOCIATES, P. A. w �Q w R N ya, .� 0 Y) F- N I I C U1 a) i i O N O 7 7 N V N �• L O IC m in �n S n n Ap 0-4 7.5YR 4/4 - - - - moist sl mod med gr fr ns np AB 4-11 1 OR 4/8 - - - - moist sl mod med sbk fi s p Bt 11-31 1 OR 4/8 - - - - moist c wk med sbk fi s p BC 31-42 1OR 4/8 - - - - moist scl wk med sbk fi s p C 42-48 1 1 OR 4/8 1 - - - - moist sl I wk med sbk fr ss sp Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr very friable fi firm vfi very firm State of North Carolina Department of Environmental Quality a,�,;� Division of Water Resources Dlvlsion of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting, Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class. B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land weer Agreement (FORM: LOA 06-16): ubmit 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 e application may be made, as long as the attachments are numbered to correspond to the section and item to which they efer. pare a separate agreement for each set of land application sites that are owned or operated by an entity other than the pplicant. 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: D .✓ �So Gl 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 es/no (Y ) Land Use or Cropping Patterns PP� g� Intended Use of Crops Residuals Source (optional) Special note (no-till/over-seed/ pasture) ✓� I u ,/''' � �i'�dho+ F'-'�ti 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 Iand application site(s) described above for the disposal of the residuals. Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and JxLaxx 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 I 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. Landown Address: city: State: /®` , Zip: T. � Phone: W. �4 2 ° �� E-mail address: Signature: Date: NORTH CAROLINA, l le,� �� COUNTY 1, the undersigned Notary Public do hereby certify that _ T4AQ j 4 ® personally appeared before me this day and acknowledged the due execution of the forgoing instrument. ,�4o���A �® WITNESS my hand and official seal this the �� day of ✓I/c�✓Y.�, �� Signature and seal: f� �►� My commission expires: O L 2 Ze Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/operator name: Address: City: Phone: Signature: Permittee's Certification: State: E-mail address: I certify that I have read this Agreement and do hereby Signing official name: Signature: Zip: Date: to abide by the stipulations and restrictions as specified herein. Date: ❑r FORM: LOA 06-16 b,,-- *2 ,.P12 State of North Carolina Department of Environment and Natural Resources Division of Water Resources Division of Water Resources LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for .review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land Owner Agreement (FORM: LOA 06-16): ® Submit the completed and appropriately executed Residuals Source 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 he undersigned lando ner r his repretative hereby Applicant's name: ,J4 Qisen��� 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) Ab P. L 41-tP ( 1.� eZ, 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. his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and call 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 Pagel of 3 I. STIPULATIONS: 1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted entity for the site(s) specified by this Agreement. 2. Should the landowner or his representative lease or otherwise permit the use of the land application sites) to a third party, the landowner shall be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement. 3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met. 4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636 Mail Service Center, Raleigh, NC 27699-1636. 5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land application site(s). 6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program, including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the equipment used by the Permittee. 7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land application event and a copy of the results of each soil analysis. 8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the specified crop. 9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of soil samples, and the permitted application limits. 10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s). 11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application events at appropriate periods. 12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or his representative prior to and during a residuals land application event. 13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the term of, and 12 months after termination of, this Agreement. u. 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 pl Aiance boundary to the application package)) re -defined compliance boundary is not needed for this site. TV. 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 nroaram: (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: � Address: % .s� �°` P�Ci 9 to"A e- 9 City: � l tT � /h a it State: Zip: �. Phone: �°��� Q� 3 6 E-mail address: Signature: �� Date: L, 2L NORTH CAROLINA, �k av 0 q COUNTY 1, the undersigned Notary Public do hereby certify that✓% C �.�° �re personally appeared before me this day and acknowledged the due execution of the forgoing instrument. 01111" 511 IV WITNESS my hand and official seal this the 2 day of b Signature and seal: My commission expires: V Ce�. 2,Z 4 a�q Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/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: Signature: Date: FORM: LOA 06-16 Page 3 of 3 rjl ,, ��®q�����t�• ��' TV 1 9Q y :f' l/ i �f ),✓ / �d ✓� lr �✓•' ✓y�-7��s9�v�ed' ,',r-� ����. ��,,„�j1' - � 1 �'+, , i- A � .a �. ^' l✓�;'�%lir _ �...>> .ram ,'df �.�.%� ' / <i° t�� k' F 1 .�' / �t ✓® /./✓.j ��Ja �n� z��� r �� �� r _r �%v� .�-'tir. 'T s 4 ��.. : ��!7 �� v—srg�-.r����T �J /�i•F 1y �,r. y�% �! ���l�r3�'le C�,y� 5 pf �d..tr a Y• %%d„'�� •%v'-ml// 3 'y, + 9.�''-9�� � �r'•'a ' e9 1-4 9 1 j ��(Ij�O- F.y�7j�j`�y�"3,£s�j _ � 1��%y�!�,%r''''�ry' r-.'' r�� z "�%sj77� �l'r� !!•.�, , ,� _ CY�/{ ' 3 t e" �� �x�-�3w ��li�'[�/y/�y! J��.11// /_' f•� J'' �/y Y rI� F � ;a7./ �.. iy M� � tr` Lam--_ 9,�? ,/ � . ' + / ,//'9J>✓r " %�� �`- ° d�' I .� If - ;,KZ T rigR 41, rn FIT TnE (( er9end Rtl� q� L'�a.•y.af� ip'. �, ~ ~' -+`< - s s ex ,ISO, - _ RV RZ" I >� tiY �i{^��ID. D ''9•'®—ZJ lD S y �Gets►atoae y, rP In ,4+ 1.hk" •j='l'`Yt .cam '.,� �:y.. A �,.. r 'i.Q[1tM1 .M y- r,� � '.•art ,.. • 's +� '-, S,� y. r ;� `�'r'R , " y C^ LT •�_ ar .r F� t Cf -n:r �*., Loi' 'r m°�, FmTw.�, f 1 fF as 3 Q*� ` l� `� x+ '4�}y Y • q1 k "� =� ."�> - ' ,; a �+ ��'�, , �� t Iz . �' -„ '. ' � 'tCi � 11f a2 +� y ...e' ,; t � � �;.-�. � • ra{�'_ L�1, �p 7' w "f�t.. � i4;Ar N'- , 1�:1�,�� rs D, Go Qi #01 €all 46 f , aE3i 1 a� 4r IT, fi 7M r Y d ✓r F3E3+ �r l�� iJo�.7�'y Cf% t. � x - +� Ib Ai� �:.-,y, p!$,: -.. ....._.n4ln.eq� .,...,jT�9C,• � i�il, e_„� VICINITY MAP GRAPHIC SCALE 1" = 4,000' 4,000' 0 41000' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. NC-CA-27 _ Field 1-3 TOPOGRAPHIC MAP GRAPHIC SCALE 1"=660' 660' 0 660' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-27 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Fields 1-3 NCDA&CS / )mic Division Phone: (919) 733-2656 Website: www.'n ov/agronomi/ Report No, FY2( 17112 Client: Jason Little Advisor: Alex Fox Heavy Metals 5104 River Bend Rd Synagro Claremont, NC 28610 284 Boger Rd Mehlich-3 Extraction , Soil Report Mocksville, NC 27028 �• , ,¢..; Sampled County: Catawba Links to Helpful Information Client ID: 504791 Advisor ID: 501947 Sampled: 11/14/2019 Received: 11/26/2019 completed: 12/02/2019 Farm: CA-27 Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Jagathi Kamalakanthan 12/2/2019 Sample ID: 1 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B Information Lime History: 1-Fescue/OGrass/Tim, M 0.5 120-200 60 0 0 0 0 0 0 0 Note: 12 2- 0.0 Test Results [units - W[V in g/cm3; CEC and Na in meq/100 ems; NO3-N in mg/dm3]: Soil Class: Mineral HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-I Zn-AI Cu-I Na ESP SS-1 NO3-N 0.32 0.92 5.9 78 1.3 5.6 33 230 32 26 204 142 102 68 68 55 0.1 2 Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.2 Lead, 5.3 Selenium, 0.2 Sample ID: 2 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B Information Lime History: 1 -Fescue/OGrass/Tim, M 1.6 120-200 130 50 0 0 0 $ 0 0 Note: 12 Note: 2- 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N 0.41 0.95 4.3 44 2.4 4.9 6 47 23 16 160 112 84 17 17 65 0.1 2 Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.3 Lead, 3.7 Selenium, 0.1 North Carolina robirco Trust.; Fund Comubt;1on Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner of Agriculture NCDA&CS J 1 )mic Division Phone: (919) 733-2655 Website: www.n =Gov/agronomi/ Report No. FY2(- 17112 Jason Little Page 2 of 3 Sample ID: 3 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O6 K2O Mg S Mn Zn Cu B Information Lime History: 1- Fescue/OGrass/Tim, M 1.2 120-200 40 0 0 0 0 0 0 0 Note: 12 2 - 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-I Zn-Al Cu-I Na ESP SS-1 NO3-N 0.92 0.93 8.4 73 2.3 5.4 40 185 46 16 , 55 260 173 86 86 72 0.1 1 Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.1 Nickel, 0.4 Chromium, 0.2 Lead, 5.6 Selenium, 0.1 NCDA&CS j Dmic Division Phone: (919) 733-2655 Website: www.n lov/agronomi/ Report No. FY21 17112 Jason Little Page 3 of 3 Understanding the Soil Report: explanation of measurements, abbreviations and units Recommendations Lime If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting. For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at time, even if the report recommends more. You can apply the rest in similar increments every six months until the full r is applied. If MG is recommended and lime is needed, use dolomitric lime. Fertilizer Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear only on reports for greenhouse soil or problem samples. Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients_ In general, homeowners do not need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit ncagr.gov/agronomi/pubs.htm. Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find the exact fertilizer grade recommended on the report, visit www.ncaar..gov/agronomi/obParN.htm ind information that may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizes Test Results Report Abbreviations Ac exchangeable acidity B boron BS% % CEC occupied by basic cations Ca% % CEC occupied by calcium CEC cation exchange capacity Cu-I copper index ESP exchangeable sodium percent HM% percent humic matter K-I potassium index K20 potash Mg% % CEC occupied by magnesium MIN mineral soil class Mn manganese Mn-All Mn-availability index for crop 1 Mn-AI2 Mn-availability index for crop 2 Mn-I manganese index M-O mineral -organic soil class N Na NO3-N ORG pH P-1 P205 S-1 SS-1 W/V The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The Zn-AI remaining 16 [P-I, K-I, Ca%, Mg%, Mn-1, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routinel) Zn-1 available)] indicate levels of plant nutrients or other fertility measurement. Visit ww ncear.pov/egronomi/uvrst.htm nitrogen sodium nitrate nitrogen organic soil class current soil pH phosphorus index phosphate sulfur index soluble salt index weight per volume zinc availability index zinc index SYNAGRO, NEWTON CLASS 8 PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WV\/TP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton WVVfP Project, Various Fields Soil Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 4% Site: Jason Littles Crop: Forage/Pasture Field: Field 1 Conducted By: GC Murray Coordinates: 35.7648 N Date: 11/14/2019 -81.1660 W Soil Series: Fairview O In O O U O O U U O X d •� N r, TO /1 Si m C U � N U) O Q U) U a) m m X O N X S S N S � PIEDMONT ENVIRONMENTAL ASSOCIATES, P. A. w Q LU U N a y Ue U) T d O �+ X to U w p Ap 0-6 10YR 4/4 - - - - moist sl mod med gr fr ns np Bt 6-32 2.5 YR 4/6 - - - - moist c mod med sbk fi s p BC 32-40 2.5 YR 416 - - - - moist cl mod med sbk fi s p C 40-48 10R 5/6 - - - - moist scl wk med sbk fi ss sp Legend: Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consisten sg single grained fr friable ma massive vfr veryfriable fi firm vfi veryfirm Soil Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 4% Site: Jason Littles Crop: Forage/Pasture Field: Field 2 Conducted By: GC Murray Coordinates: 35.7633 N Date: 11/14/2019 -81.1629 W Soil Series: Fairview � N O O v c O O r U U O t x d N T e1% S S m cc as 3 O C Q m S N U) S O V x N °? S PIEDMONT ENVIRONMENTAL A s s n e i Arms, P. A. w LU o w N (L w C9 U) N i O d U c Y «� 3 7 3 N V N !C rn in in S n n Ap 0-5 7.5YR 414 - - - - moist sl mod med gr fr ns np AB 5-11 7.5YR 4/6 - - - - moist scl mod med gr fr ns np Bt 11-37 2.5 YR 4/6 - - - - moist c mod med sbk fi s p BC 37-43 2.5 YR 4/6 - - - - moist cl mod med sbk fi s p C 43-48 1 OR 5/6 - - - - moist scl wk med sbk fi ss sp Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Structure Grade Structure Type wk weak gr granular m moderate pl platy str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky sg single grained ma massive Structure Size f fine med medium Moist Consistencv fr friable vfr very friable fi firm vfi very firm Seasonal High Water Table: Depth (") Type (apparent/perched) Soil Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 5% Site: Jason Littles Crop: Forage/Pasture Field: Field 3 Conducted By: GC Murray - Coordinates: 35.7623 N Date: 11/14/2019 -81.1675 W Soil Series: Clifford c O O v O O O s X d N r+ ►. N T n S S m o � � c Ci w O N � O Q W V a) d d K d 0 X S S N S d PIEDMONT ENVIRONMENTAL A 3 s O C 1 A r■ s, P. A. w N(L a) (� W U N O w ►3+ V c C� i N V N O � rn rn n S n Legend. Texture Structure Grade Structure Type Structure Size s sand wk weak gr granular f fine I loam m moderate pl platy med medium si silt str strong pr prismatic sil silt loam cpr columnar c clay abk angular blocky cl clay loam sbk subangular blocky Moist Consistency scl sandy clay loam sg single grained fr friable sl sandy loam ma massive vfr very friable sicl silty clay loam fi firm vfi very firm Seasonal High Water Table: Depth (") Type (apparent/perched) I W-1 DIVISIon of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant, and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land Owner Agreement (FORM: LOA 06-16): �bmit 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 Zfer. 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 lando ej his repres tative hereby permi s: Applicant's name: 44 s"1 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 es/no (Y ) Land Use or Cropping Patterns PP� g Intended Use of Crops Residuals Source (optional) Special note (no-till/over-seed/ pasture) The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals. is Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and „tall 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 Pale 1 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. A ..01 Landowner name: z 7 e4_4 W-11— Address: ,p Q' city: � � State: 'AlZip: O �Axne: .C. V% 2� S E-mail address:-00 aa J� Signature: Date: 1 J �I NORTH CAROLINA, COUNTY I, the undersigned Notary Public do hereby certify that )Le, rrV 1(pv.•i� personally appeared before me this day and acknowledged the ^due execution of the forgoing instrument. ,����11®ttf1 WITNESS my hand and official seal this the �1 ,�� I �s day of �(� 6��- , 20 7 �` Signature and seal: My commission expires: C'C. 2 z 0 Z q Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/operator name: Address: City: Phone: Signature: Permittee's Certification: State: E-mail Date: Zip: I certify that I have read this Agreement and do herebyagree to abide by the stipulations and restrictions as specified herein. Signing official name: �. J4 C(l FORM: LOA 06-16 Page 3 of 3 APPLICATION MAP r- z Ln I �:(_1=t\Ir) APPLICATION AREA UNSUITABLE AREA — — — — — — PRIVATE ROAD OW WATER — — — — STREAM . ONSITE HOUSE — DRAIN . OFFSITE HOUSE X X X FENCE OUTBUILDING PROPERTY LINE WELL The compliance boundary is established either 250 ft from the residuals application area or 50 feet within -in-the property boundary, whichever is closest to the application area. The review boundary -is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. GRAPHIC SCALE 1 " = 660' 660' 0 660' N C-CA-28 Field 1 132 CfD L r x •J , t•z, A sqs' .. �.ir� _t Tm9 <•' •-.�Y Y!. , ,•A ) , � � -tit a� a a ,. . � r � eil Vs . • C • - , f•' � „ : ''•• ' � " ' �'fi r 1}' •l� h" *�• �r;#� `y =�`u i uaj� +tY. f``� !V✓�� `'�`. „ry..r•. ,,•� ,-,.',�� •M ��^':�' t .. d*� r ,.F �f{4 t •A �. CR3 �' if• ' I .,^ '^iiF'u'R`E+''y*x +�7 �; �'t, {9 "� A �4 �, - � �✓�,f "�`�..rt t}'� 3 - '• �i. � -- �r _�,� 4 ,��F � f., ����f�,� ��� ''� Yr'�p`a` �•` �'5..� 'y ir'�o D2 `yj I. 0. FdE2 1 x k P ITVµ rt� 'M. c Tm6 i n J tTmEI 4k, c �CaA 1 ? yyt_ic CiC` L Trot 7mQ '�'aaw_'-,`-.F:..�-r..+•+�+.:r-.•..•••� +-ar—^ .;+, 4.i;+.+1'..a+i-.-r._ +'+,.."d^"• b+-^'y-•--""-1',.', 1.T-,r....--�-.�.-. 4 TOPOGRAPHIC 1MAP y Y0 _f _�•-�_''' �a-.- ter,. � _ � � e=' ,�` ` � ,F { � � . P� _ I � -1 ~::.e; P� ti� r"•. ai �ef`s xi Win. ;2 �:c ` rr " % f, -- i`<• 4^ Ar `4 3L 2_ � i f } _ i �L l! /J� •+ " -i '. i i E ten. r �.. tofq� 9� �,� ,.. r r � _..,-ti•ti i •r �+•�� y_ 114 �� `� � "' • � � ,�' -ter,.-h- �`-.•:, �� G} � �a! � L •v f j i Y ^^y c s t F'i 13 ,�, r t �R - , Y `c..� ,r 1 R grn 1.• v'n k �# 4 ,i S tTTL kk (� � e' �iL9�-wq�"Y4 "(:k j// �, f >!s v��'4 ! l'`tw I yy �• Li k', f �r ! '.�1 L f '• j.J' F' � "�' S fi��t{ 5 l '^a+e��;- 4 ������ J4 �' i. � nr��—ram. �•. �tq, � t �., ��, �` M j2 � k A Y -x '�t`^Y �r�ati 1. ♦ � � t a ? j ��,� .. St �e /'$ ,.ice I GRAPHIC SCALE V = 660' 660' 0 660' t The complianceboundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-28 in the property boundary; whichever is closest -to -the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 1 VICINITY MAP kV, "a Of ON I ,lot k t X, GRAPHIC SCALE 1 4,000' 4,000- 0 4,000' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within -the -property N C--CA-28 in bduhdary, whichOver is closest -to the application area. 'The review -boundary is established - midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 1 NCDA&CS ) )mic Division Phone: (919) 733-2655 Website: www.n ov/agronomi/ Report No. FY2( 17111 at£,3i,.F�.u�: Client: Larry A Brown Advisor: Alex Fox Heavy Metals 4459 Lookout Dam Rd Synagro Catawba, NC 28609 284 Boger Rd Soil Ike„®rt Mehlich-3 Extraction Mocksville, NC 27028 �(,,;#i< �,�• , ~ Sampled County: Catawba NilF.") Links to Halgful Information i Client ID: 448081 Advisor ID: 501947 Sampled: 11118/2019 Received: 11/26/2019 completed: 12/02/2019 Farm: CA-28 Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Jagathi Kamalakanthan 12/2/2019 Sample ID: 1 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information Lime History: 1 - Fescue/OGrass/Tim, M 0.0 120-200 130 50 0 0 0 0 0 0 Note: 12 2 - 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-I Zn-AI Cu-I Na ESP SS -I NO3-N 0.32• 0.93 7.1 86 1.0 6.3 5 - 44 50 32 181 53 44 26 26 44 0.1 1 Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.0 Nickel, 0.5 Chromium, 0.1 Lead, 2.5 Selenium, 0.1 North. Carol Ina 1 I'fob.,c•cir Tfust Fun ti Cojnnihl ,,km Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner of Aariculture NCDA&CS A omit Division Phone: (919) 733-2655 Website: www.n Iov/agronomi/" Report No. FY2 17111 Larry A Brown Page 2 of 2 Understanding the Soil Report: explanation of measurements, abbreviations and units Recommendations Lime If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either ton/acre or lb/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting. For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at time, even if the report recommends more. You can apply the rest in similar increments every six months until the full r is applied. If MG is recommended and lime is needed, use dolomitric lime. Fertilizer Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear only oh reports for greenhouse soil or problem samples. Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients_ In general, homeowners do not need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit ncagr.gov/agronomi/pubs.htm. Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find the exact fertilizer grade recommended on the report, visit www.ncacrr.aov/agronomi1bbDart4.hfml ind information that may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizes Test Results The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-Al, Cu-I, S-1, SS -I, Na, ESP, SS -I, NO3-N (not routinel available)] indicate levels of plant nutrients or other fertility measurement. Visit•ncagr.00v/agronomi/uvrst.htm Report Abbreviations Ac exchangeable acidity B boron BS% % CEC occupied by basic cations Ca% % CEC occupied by calcium CEC cation exchange capacity cu-I copper index ESP exchangeable sodium percent HM% percent humic matter K-1 potassium index K20 potash Mg% % CEC occupied by magnesium MIN mineral soil class Mn manganese Mn-All Mn-availability index for crop 1 Mn-AI2 Mn-availability index for crop.2 Mn-1 manganese index M-O mineral -organic soil class N nitrogen Na sodium NO3-N nitrate nitrogen ORG organic soil class pH current soil pH P-1 phosphorus index P205 phosphate S-1 sulfur index SS-1 soluble salt index WN weight per volume Zn-AI zinc availability index Zn-I zinc index SYNAGRO, NEWTON CLASS E PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WWfP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton WWTP Project, Various Fields Soil Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 3% Site: Larry Brown Farm Crop: Forage/Pasture Field: Davis Farm Field 1 Conducted By: GC Murray Coordinates: 35.7567 N Date: 11/14/2019 -81.1091 W Soil Series: Clifford -O O O v O O c U U O t L 2 L Cz O T f% S S d U) Q ! S N d w S ti O U K . N r 3 N S PIEDMONT ENVIRONMENTAL 6 5 i O C 1 A T!:, P. A. W W v N'(' rO+ C7 U) f— T d d O c 7 N V N L L L (jS Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr very friable fi firm vfi very firm State of North Carolina Department of Environmental Quality sion of Water Resources Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. 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 efer. Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the pplicant. 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 repr ntative hereby permits: Applicant's name: 1 17 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) 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. tis Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and snall 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 Pagel 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: "-IVAI L Address: 1/j ry 0 @ City: C� [.F'j�J State: %y" �__ _ Zip: Phone: '-7a17 all E-mail address: Signature �, Date: NORTH CAROLINA, f% kWj/ COUNTY I, the undersigned Notary Public do hereby certify that If4-A 1•G r �` � 40,0 woo f personally appeared before me this day and acknowledged the due 'execution of the forgoing instrument. WITNESS my hand and official seal this the31 l - day of A✓Z*,Lee- 120 Signature and seal: L✓ C7 My commission expires: So N 6, Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/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: FORM: LOA 06-16 Page 3 of 3 M go &Mmv Wm _ C2,C C2r ° x- ® rvR 'r d k{`'VV�t a tl F,dE2 FoE3 > PS QOtt d^ dRL CsgC2J' B t� w V I� it i Rlver88Rd Rdy of r , 1p, s i ti CfB , Y �c71 ,r 0 TOPOGRAPHIC MAP 0j GRAPHIC SCALE 1 " = 800' 800' 0 800' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C--CA-29 in the property boundary, whichever is closest to the application area, The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 1 VICINITY MAP t � � ti +� ���s41, . n d � ' + r w ;f gt C ] • ,� ��, •` m<.... �,,f � ,. �.s�v s, i �� e -i � �" � �'1` U � "-a-�� { '� �L `- ��J ��,� �� .� L�'�F�.��s'ff,' , � ���, c +' t ]"f ,1 L e 1� ! )�✓n5 "ass + t,,, •�. ' � .I J t -� � s§ J" r_ w, a 2��Y y � , y I�ti � ,. ' i ♦:J i..� } 6.-a✓.Y N� 2` a r'� � r•'i •,� '. -.,�^�k".WN,fir �.�'t' `cr' ',.?�'' -' - '-•,.. J tti t; . qi� SY �:�ia . � 'S\ �'� a � ��"� � J i��%`�'•2' A� J r-•�� 7 ] , �i 'q� ,' ! ��� .Il� �� -t- 9�sb i 4 � ..J +,�� r y- _ �v .�+ � +� ♦ � $�� r.,, � �TM s '` .:. l� l � J �� �.dt' —•'4, � p ,y�.J.`.„�: ��"--� + •�:'�i}.�F ' �L r ,���; r,a, ti '��, _ _ti �1s�kj , ti+ ., � y �\ � 1�. �� , t . _/r i �* a ;�� ,�'�.�.!; r ✓- V , " a 3 gat 'Y t` �* „r�..'H`.... �., . tom- . ���'r���sss � .`•y, t 1 � of 1 � ]s"`�V .. 4 •x$.� f '�r�s�•.``e � ��- y: i�� :. C ` m + r �• � v r0 � t r ,J r } `,,,� � _ .-�4� �.i�i � � .�. rWO�\ ` rsVl' 1,�_„�,"`�•—f +, ,`. f.+. C ; ` s r.6 �, _._Ilr' i .:j,.✓Mn� �,.. r t ..`�,�11 '1 •L � P J � � "''`��.'t�r/ { 11r_: tik \\, 4^a, i P® 1 },�. ;J � p{�ast '�� `�` !� ' ` J \�-1�7%/�`�+:` �'�. J�.,it t•s,E�iE1i`` f� _.� 1 �.', ; 4 J ` t . � � x ;: •*-- -�I ;� ter 1 + - } �' � `% ' J t _ s �EYo- , r r '' .. . � C 5 ffi t5r � rj y.��'��%�� �t� r �• T- .!'`�fl, n x: ° � z j 17 + GRAPHIC SCALE V = 4,000' 4,000' 0 4,000' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C'CA-29 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 1 NCDA&CS i omic Division Phone: (919) 733-2655 Website:.www.n jov/agronoml/ Report No. FY2 17109 Client: Kenneth Arrowood Advisor: Alex Fox Heavy Metals 4391 Hall Dairy Rd. Synagro Claremont, NC 28610 284 Boger Rd �a Soil Report Mehlich-3 Extraction Mocksville, NC 27028 ., ' Sampled County: Catawba Links to Helpful Information Client ID: 153187 Advisor ID: 501947 Sampled: 11/14/2019 Received: 11/26/2019 completed: 12/02/2019 Farm: LA-29. Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (CO- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Jagathi Kamalakanthan 12/2/2019 Sample ID: 1 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B Information Lime History: 1-Fescue/OGrass/Tim, M 0.8 120-200 50 0 0 0 0 0 0 0 Note: 12 2 - 0.0 Test Results [units - WN in g/cm3; CEC and Na in meg1100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% W/V CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn4 Mn-All Mn-AI2 Zn-I Zn-Al Cu-I Na ESP SS-1 NO3-N 0.66 0.99 6.0 71 1.7 5.5 37 110 37 25 141 108 82 83 83 74 0.1 2 Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.1 Nickel, 0.3 Chromium, 0.2 Lead, 4:8' Selenium, 0A orl . Carolina, { MoLxgca c Tfu%t } ul�ti i :�a,titii@{sledu Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner of Agriculture NCDA&CS j _ =Dmic Division Phone: (919) 733-2655 Website: www.n Iovlagronomi/ Report No. . FY2 '17109 Kenneth Arrowood Page 2 of 2 Understanding the Soil Report: explanation of measurements, abbreviations and units Recommendations Lime If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either tonlacre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting. For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at time, even if the report recommends more. You can apply the rest in similar increments every six months until the full r is applied. If MG is recommended and lime is needed, use dolomitric lime. Fertilizer Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies for the crop being grown, not on soil test results. K-I and P-1 values are based on test results and should be > 50. If they are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear only on reports for greenhouse soil or problem samples. Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients_ In general, homeowners do not need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit ncagr.gov/agronomi/pubs.htm. Recommendations forsmall areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft. If you cannot find the exact fertilizer grade recommended on the report, visit www.ncagr.aov/acrronomi/obnart4.htmtsFind information that may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizei Test Results The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not rou available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaar.aov/aaronomi/uyrsi Report Abbreviations Ac exchangeable acidity B boron BS% % CEC occupied by basic cations Ca% % CEC occupied by calcium CEC cation exchange capacity Cu-I copper index ESP exchangeable sodium percent HM% percent humic matter K-I potassium index K20 potash Mg% % CEC occupied by magnesium MIN mineral soil class Mn manganese Mn-AI1 Mn-availability index for crop 1 Mn-AI2 Mn-availability index for crop 2 Mn-I manganese index M-O mineral -organic soil class N nitrogen Na sodium NO3-N nitrate nitrogen ORG organic soil class pH current soil pH P-1 phosphorus index P205 phosphate S-1 sulfur index SS -I soluble salt index W/V weight per volume Zn-AI zinc availability index Zn-I zinc index SYNAGR®,.NEWTON CLASS E PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WWTP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton WWTP Project, Various Fields Soil. Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 3% Site: Ken Arrowood Crop: Forage/Pasture Field: Field 1 Conducted By: GC Murray Coordinates: 35.8072 N Date: 11/14/2019 -81.1914 W Soil Series: Clifford .0 O O U U U O X d N F, A)s S CD w C •gyp N Q m d w w S S v O X ° N �O L y S m K d O ci n PIEDMONT ENVIRONMENTAL ASSOCIATES, P. A. w NIL H L L N a V U) O N Q: V� (� �n rn S in n Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr very friable fi firm vfi very firm State of North Carolina Department of ]Environment and Natural Resources Division of Water Resources ` Divislon of Water Resources LAND OWNER AGREEMENT ( FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land Owner Agreement (FORM: LOA 06-16): ® Submit the completed and appropriately executed Residuals Source 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 'he undersigned landownE or is represent tive�heereby Applicant's name: � 0 t /V{ d✓, 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) G 7 ` 1f5 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. 'his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and hall 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 Pagel of 3 I. STIPULATIONS: 1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted entity for the site(s) specified by this Agreement. 2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement. 3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met. 4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636 Mail Service Center, Raleigh, NC 27699-1636. 5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land application site(s). 6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program, including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the equipment used by the Permittee. 7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land application event and a copy of the results of each soil analysis. 8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the specified crop. 9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of soil samples, and the permitted application limits. 10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s). 11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application events at appropriate periods. 12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or his representative prior to and during a residuals land application event. 13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the term of, and 12 months after termination of, this Agreement. [. 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. IH.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one) 15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following; ❑ A re -defined compliance boundary is needed for field(s) ID: (Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance boundary to the application package) G].r1Cre-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: /_0 cq anz&4 Address: qV City: t4 & State: /VC zip: x? (f I6I Date: / -,�/ �'? 0 personally appeared before me this day and acknowledged the due execution of the forgoing • a WITNESS my hand and official seal this the Signature and seal: My commission expires: l�(7, d2u-02�( Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/operator name: Address: City: 14 r State: �� Zip: 2�O�a Phone: �'�� �i" /g30� - �y 7 3 E-mail address: Signature: Kew Date: Permittee's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Signing official name: l & �K- ,07 Signature:Z�W/ Date: FORM: LOA 06-16 Page 3 of 3 State of North Carolina Department of Environmental Quality Division of Water Resources Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Land Owner Agreement (FORM: LOA 06-16): P"OSO'ubmit 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. 041"Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the �pplicant. 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 reprentative hereby permits: Applicant's name: J +! ✓Vei./klq 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 es/no (y ) Land Use or Cropping Patterns pp� g Intended Use of Crops Residuals Source (optional) Special note (no-till/over-seed/ pasture) The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals. his Agreement shall remain in effect for the length of the Division's permit for. the residuals land application program and all 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 Pagel 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. ,, " !%' 1Landowner name: -�'`�( 1� r (�'t+L — Address: _ i > l city: � _.�` k State: Oc_,° Zip: AC8 70`1 Phone: d Q< L , 5 _ ,,�A E-mail address: Mi o � A f� { (1:1-V\ U Signature: NORTH CAROLINA, POVk -L&P COUNTY I, the undersigned Notary Public do hereby certify that J C p �G 1,'e, i�Q eK personally appeared before me this day and acknowledged the due execution of the forgoing instrument. `�®®®%W 11 a81®I% WITNESS my hand and official seal this the c7}� ® day of ov � 20 *S Signature and seal: �✓ C� ® �: My commission expires: oci L n -1 q e�� v Lessee's/Operator's Certification: I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein. Lessee/operator name: Address: 3 5 Z 1, l City: _ V4 L State: Zip: Phone: —7(7,q r6-30 ^-.e. Iq _7 E-mail address: 1-7 Z9-16 T Signature: ) Date: Permittee's Certification: I certify that I have read this Agreement and do hereby agree to Signing official name: Signature: by the stipulations and restrictions as specified herein. Date: FORM: LOA 06-16 Page 3 of 3 + Lcc �GaD LcCt .�Xa + ,LcD' 4r PaE3 CAD 5 u 1? ------ +� r S�1 17 �, v\`3 .� ' t L�iG2 + F•dE•2 . , L. ,�, ��^ 1 ,• + ;+ . L , a ate , f4. N1P> N4 +rD LdG2 ` ;fir,---,:�__ °' s �• �" , •, PCIE ?�""�ai.�'F �_ 1Q ..(�-'°e�F3 ,_L''�'��- •�Y'.�Fk��� _-ram. . VICINITY MAP GRAPHIC SCALE 1" = 4,000' 4,000' 0 4,000' The compliance boundary is established either 250 ft from the residuals application area or 50 feet within in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. N C-CA-47 OXII MOO, TOPOGRAPHIC MAP _ i . i `� N ky - } � �+��`S �F• � SIY, � �, R,J���Nf€� ��, •/ ��.� /F y �� ��;�-"� �� , 3 'Y 3 t •n` d�+f f ram) �-d�� �'- �'r �'�R.y�'�r b �,•;� (� � t' S � � •.� �{l � [° _ A. 70 r, ,�y F a ,y- x4, �p -•- e " ?RA t x 't 46 � s1 1,00 GRAPHIC SCALE 1" = 800' I t The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-47 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Fields 6-7 SYNAGRO, NEWTON CLASS S PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WWTP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton WWTP Project, Various Fields Soil Profile Descriptions in Field Locations Project: Lincolnton Permit (WQ 0002712) % Slope: 2% Site: Randy Leatherman Farm Crop: Forage/Pasture Field: Leatherman Farm Field 6 Conducted By: GC Murray Coordinates: 35.6371 N Date: 9/16/2019 -81.3838 W Soil Series: Lloyd O O v O O c U U o x as N � O M O ^ NMI S (D � d 0 -a c O a d IT. N co d M;N O U X - M 4, U) S c x PIEDDIONT ENVIRONMENTAL A S S C C I A T■ S. P. A. w LLI N ya. d 0 U) C y d d ` O d ++ L) v v N Y V p f6 rn rn en5 n n Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Structure Grade Structure Type Structure Size wk weak gr granular f fine m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr very friable fi firm vfi very firm Seasonal High Water. Table: Depth (") Type (apparent/perched) Soil Profile Descriptions in Field Locations Project: Lincolnton Permit (WQ 0002712) % Slope: 2% Site: Randy Leatherman Farm Crop: Forage/Pasture Field: Leatherman Farm Field 7. Conducted By: GC Murray Coordinates: 35.6358 N Date: 9/16/2019 -81.3809 W Soil Series: Lloyd O O U O O c U U o x 2 T n 5 5 a� � o U) C O N .a Q in a� ai 55 55 U O U x 01 rY °' L N 5 X 11 PIEDPIO SIT ENVIRONMENTAL A S s O C 1 AT 3 i, P. A. w Q w U C9 co y � � t .0 N d d i OCD = U c B 7 7 U U N L L L O ni 'en (a ni Legend. Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Structure Grade Structure Type Structure Size wk weak gr granular f fine m moderate _ pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr veryfriable fi firm vfi very firm Seasonal High Water Table: Depth (") Type (apparent/perched) Soil Profile Descriptions in Field Locations Project: Lincolnton Permit (WQ 0002712) % Slope: 2% Site: Randy Leatherman Farm Crop: Forage/Pasture Field: Leatherman Farm Field 8/9 Conducted By: GC Murray Coordinates: 35.6272 N Date: 9/16/2019 -81.3427 W Soil Series: Lloyd to N ai L L V O O O O U U O SG N N .�. L f+ T rl S S m U R a) 0 G Q m r S N U) m 5 O U x O (D cc U) L In S K � PIEDMONT ENVIRONMENTAL A 5 9 0 C 1 A T E s. P. A. w w N iL C9 U) I— An 1 1 1 r y d O In c U U) L L Q (jf Ad A • • �� vaa�® • • ��®mom Legend: Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr veryfriable fi firm vfi very firm NCDA&CS Agronomic Division Phone: (919) 733-2655 Website: www.neagr.gov/agronomi/ Report No. FY20-SL006841 Client: Randy Leatherman Advisor: Alex Fox n� . , i �, Heavy Metals 3322 Dansbury Ln Synagro '' Y. Vale, NC 28168 284 Boger Rd Soil Report Mehlich-3 Extraction Mocksville, NC 27028 Sampled County : Lincoln '�"f�•n'�' Links to Helpful Information Client ID: 502961 Advisor ID: 501947 Sampled: 09/16/2019 Received: 09/27/2019 completed: 10/02/2019 Farm: NC-Lt-47 Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Note elevated lead (Pb) in sample 6. Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus P is very high P-1 > 100), crops will not respond to additional P applied. Ja athi Kamalakanthan 10/2/2019 Sample ID: 2 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B Information Lime History: 1 -Corn, grain 1.0 120 - 160 0 0 0 0 0 0 0 0 Note: 3 2 - 0.0 Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N 0.76 0.93 7.5 74 2.0 5.4 199 92 53 15 49 121 90 313 313 432 0.1 1 Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0 Nickel, 0.6 Chromium, 0.2 Lead, 2.9 Selenium, 0.0 Sample ID: 4 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B Information Lime History: 1 -Corn, grain 1.1 120 - 160 0 30 0 0 0 0 0 0 Note: 3 2 - 0.0 Test Results [units - W/V in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS -I NO3-N 0.66 1.05 7.8 72 2.2 5.4 93 55 51 18 42 150 107 563 563 251 0.1 1 Heavy Metals (parts per million): _ Arsenic, 0.3 Cadmium, 0.0 Nickel, 0.8 Chromium, 0.4 Lead, 4.6 Selenium, 0.0 orLh Carolina i2. lydyl.+ar��rTri `(:t�;nrlolisslc�lu Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner ofAcgricuiture NCDA&CS comic. Division Phone: (919) M-2655 Website: www.i . ; gov/agronomil Report No. FY, )06841 Randy Leatherman Page 3 of 4 Sample ID: 8 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P206 K20 Mg S Mn Zn Cu B Information Lime History: 1 -Corn, grain 0.0 120 -160 0 50 0 20 0 0 0 0 Note: 3 2 - 0.0 Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-AI2 Zn-1 Zn-AI Cu-1 Na ESP SS-1 NO3-N 0.41 1.24 6:3 82 1.2 6.1 95 44 61 17 22 316 205 156 156 283 0.0 Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0:0 Nickel; 0.5" Chromium,-, 0.3. Lead; 4.5 Selenium; .0.1 State of North Carolina Department of ]Environmental Quality Division of Water Resources -I'Divlsion of Water Resources 15A NCAC 02T .1100 —LAND OWNER AGREEMENT FORM: LOA 06-16 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional information requested. Failure to submit all of the required items will lead to additional processing and review time for the permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit. General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16). Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed below. A. Lay 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 efer. Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the ,,Applicant, 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 . __ undersigned landowner qr his represerative hereby permits: Applicant's name: P_ d y si Ne,- -a, 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 es/no (Y ) Land Use or Cropping Patterns pp g' Intended Use of Crops Residuals Source (optional) Special note (no-till/over-seed/ pasture) All 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. Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and 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 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 sites) are not included in any waste disposal contract or agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement, understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified herein. % Landowner name: ��{ t°,V Address: � � � i �3 6 � � isel - f � City: _Lam C., li, t. a State: MC, Zip: 7101 Z Phone: �� • 3 P E-mail address: ff Signature: Ake, /M Date: Iffik NORTH CAROLINA, .&, j1n B1a ( n COUNTY I, the undersigned Notary Public do hereby certify that personally appeared before me this day and acknowledged the due execution of the forgoing instrument. WITNESS my hand and official seal this the l s k day of By / C`s Signature and seal: / �✓ My commission expires: 0L T. e Lessee's/Operator's Certification: pou% 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 off Signature: FORM: LOA 06-16 Page 3 of 3 ®. r a gU"t'`s .� t x;}`1 -felt ............ 11'_'.� cYa a Y .Y ''� .r ► ► AMC' 4��'P'+- i / �i" � :. ► Q, p i' ► 1 _`. _.� - C `\ � . ...a,. 5►' x9 F, ;TAT � ; � .,`� _ ry � s�� ®ems x F "r � ..M Jy i. ♦ `,. '�i - ! Y ` rf`�,� I��F/a �i�4t #�w, Y _.�jii.''1 3 . r '� w � { � `��(y'C^�, J���i ♦ ► �I�I�I�/I®��® T s r cl a"�3�1�� r � < ''YC,.o�`` � dry.. ��" ►+%>✓ y. ,�,_, �', s � ►�� gyp, ��� rsr � ►� t +w a •. 3 y $t E M 1 � � 1 . 1 • 1 1 A -all 0 • IM TOPOGRAPHIC MAP I z U1 l � t� � 'R. } ��r ;- e'' ���*,,,•o-r r t' q � �r K ':te I���.lw .�m ice_ a, r GRAPHIC SCALE 1" = 660' 660' 0 660' f The compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC—LT-1 19 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Field 5 VICINITY MAP r•n1 , i •. I I 4!; i t• i 1 �= f GRAPHIC SCALE 1" = 2,000' 2,000- 0 2,000' I The compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC-LT-1 19 in the property boundary, whichever is closest to the application area. The review boundary is established midway between the compliance boundary and the perimeter of the residuals application area. All locations Field 1-5 are approximate. SYNAGRO, NEWTON CLASS B PERMIT WQ 0003902 SOIL SCIENTIST CERTIFICATION This is to certify that soil profile evaluations were conducted on the proposed application sites for the Newton WWTP project by Piedmont Environmental Associates, P.A. on behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and descriptions of the soils on the application sites. All hand auger borings included in this package were either performed by me or under my direct supervision. All other work performed for this permit application was conducted by Synagro Central, LLC. G. Christopher Murray, L.S.S. No. 1284 Synagro, Newton VN TP Project, Various Fields Soil Profile Descriptions in Field Locations Project: Newton Permit (WQ 0003902) % Slope: 3% Site: Gordy Goins Farm Crop: Forage/Pasture Field: Goins Farm Field 1 Conducted By: GC Murray Coordinates: 35.5467 N Date: 11/14/2019 -81.3074 W Soil Series: Lloyd Vl y = O O v O O r U U O K m N t, a. T+ T O a S m W O N G Q m m S S O U x01 N co rn 3 N SCD i K PIEDMONT ENVIRONMENTAL A S S O C I A r n s. P. A. w w N a y 0 N H N t0. rU a0. O d) o U U L) L)l N Y c� rn rn in S rn A -� : � = - � vaa�® • • ��®mil Legend. - Texture s sand I loam si silt sil silt loam c clay cl clay loam scl sandy clay loam sl sandy loam sicl silty clay loam Seasonal High Water Table: Structure Grade Structure Type Structure Size Depth (") Type (apparent/perched) wk weak gr granular f fine - - m moderate pl platy med medium str strong pr prismatic cpr columnar abk angular blocky sbk subangular blocky Moist Consistency sg single grained fr friable ma massive vfr veryfriable fi firm vfi very firm NCDA&CS comic Division Phone: (919) 733-2655 Website: www.i _gov/agronomi/ Report No. FY, )17108 S�ucrLur• Client: Gordy Goins Advisor: b' •i °� 19 t<<,. Heavy Metals 2924 Blackburn Bride Rd / 1489 Ed g Craig Lane �v Mehlich-3 Extraction .. .. Soil Report vale, NC 28168 NNSE; - Links to Helpful Information Sampled County: Lincoln Client ID: 284170 Advisor ID: Sampled: 11/14/2019 Received: 11/26/2019 completed: 12/02/2019 Farm: Lt-119 Agronomist's Comments: This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium (Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Jagathi Kamalakanthan 12/2/2019 Sample ID: 1 Recommendations: Lime Nutrients (lb/acre) More Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information Lime History: 1 -Fescue/OGrass/Tim, M 0.0 120-200 130 70 0 0 0 $ 0 0 Note: 12 Note: 2 - 0.0 Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-'Al2 Zn-I Zn-Al Cu-I Na ESP SS-1 NO3-N 0.32 1.06 5.1 79 1.1 5.9 5 33 51 25 43 1642 1002 24 24 52 0.1 2 Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 1.0 Chromium, 0.1 -Lead, 3.4 Selenium, 0.1 ,:North: Carolina, i �`��Ya' •J Reprogramming of the laboratory -information -management system that makes this report possible is being funded through a grant from the North Carolina Tobacco Trust Fund Commission. Thank you for using agronomic services to manage nutrients and safeguard environmental quality. - Steve Troxler, Commissioner ofAariculture ROY COOPER Governor MICHAEL S. REGAN Secretary LINDA CULPEPPER Director E. TODD CLARK — CITY MANAGER CITY OF NEWTON PO Box 550 NEWTON, NORTH CAROLINA 28658 Dear Mr. Clark: NORTH CAROLINA Environmental Quality December 9, 2019 REiCEIVEDINGDE'NWI)WR GEC 1 0 ? 19 WGRGS {LaOORESVILLE REGIONAL QEFIG.i , Subject: Acknowledgement of Application No. WQ0003902 City of Newton RLAP Residuals Management System Catawba County The Water Quality Permitting Section acknowledges receipt of your permit application and supporting documentation received on December 3, 2019. Your application package has been assigned the number listed above, and the primary reviewer is Ranveer Katyal. Central and Regional Office staff will perform a detailed review of the provided application, and may contact you with a request for additional information. To ensure maximum efficiency in processing permit applications, the Division of Water Resources requests your assistance in providing a timely and complete response to any additional information requests. Please note that processing standard review permit applications may take as long as 60 to 90 days after receipt of a complete application. If you have any questions, please contact Ranveer Katyal at (919) 707-3661 or ranveer.katyal@ncdenr.gov. Sincerely, Nathaniel D. Thornburg, Supervisor Division of Water Resources cc: more us iII4'e�Regczual OO fife , ' ater Q+ ualitsy ' egil Op'ge'>giois lion Permit File WQ0003902 �« (g-5)�9s �t37v D nora7n envoi. irtn OeOarVnenl 01 fmimnmaninl Ouelily North Carolina Department of Environmental Quality I Division of Water Resources 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617 919.707.9000 Mooresville, NC 610 E Center Ave to Newton, NC 1 lMckc1 rections - MapQ... Page 1 of 2 YOUR TRIP TO: MZC 1407 McKay Rd 46 MIN I 28.7 MI 1Gk Est. fuel cost: $1.86 Trip time based on traffic conditions as of 8:24 AM on October 26, 2017. Current Traffic: Moderate __ ----------- _-------------- --- --------------- ______--------- --- ...... ____•-.__._-_._.. 1. Start out going west on E Center Ave toward Cedar St. ------------ _...... ___------------------- _...... ___________...... _------- __-___-___---_Q.b9-totaVrrtiles 2. Turn left onto S Main SYNC-152. S Main St is just past S Church St. If you are on W Center Ave and reach N Broad St you've gone a little too far. ....____Then-0:08-miles________------------ _------------- _------------ _---------- _----------------------------- g..67-total-m les 3. Take the tat right onto W McLelland Ave. If you mach E Catawba Ave you've gone about 0.2 miles too far. .__. __-:Then-0:96-mges------ _________________...... ____------------------------ _------- _---------- ___ --- ______q•.63-to4aV+niles 4. Turn left onto E Plaza Dr/NC-150. Continue to follow NC-150. ----••--Then•14.52-miles_--- _------ ______________•_._------------------------------- _---------- _------------ .464-5-totatmile& 5. Turn right onto N Highway 16/NC-16 Bus. Continue to follow N Highway 16. N Highway 16 is 0.1 miles past Bud Rd. ...••----Then-l-&7-mNes.... ....... .......... ............. ..................................................... 17.7-2•totaiamles T 6. Turn slight right onto NC-161S NC 16 Hwy. __--Then-6,77-mfles----------------------------------------------------------- _-.----- _._.-___.___-------- 24.49-total�mBes 7. Turn left onto Smyre Farm Rd. Smyre Farm Rd is 0.2 miles past S Park Dr. if you are on S NC 16 Hwy and reach Crestview Dr you've gone about 0.6 miles too far. .------- -Then-3,24-miles--------------- --- ------------------------------------------- _____------- _---------- 27-.7-0-total-mHes t 8. Turn left onto S US 321 Hwy/US-321 Bus S. -------- Then-0:20-miles______---- _------ _------- _---------------------------------------- __________.._._..___-2744-totalmiles a 9. Take the 1st right onto McKay Rd. - If you are on US-321 Bus S and reach Rome Jones Rd you've gone a little too far. .__..-__Then-0,82-fite&----------- _------------ ____________________________________------- _------------------- 2&.7-2-tatalmiles j¢ 10. 1407 McKay Rd, Catawba, NC, 28668-9485, 1407 MCKAY RD is on the left. Your destination is 0.5 miles past Little Coulters Church Rd. If you reach Evergreen Dr you've gone about 0.2 miles too far. Use of directions and maps Is subject to our Terms of Use. We don't guarantee accuracy, route conditions ar usability. You assume all risk of use Y,'t+--/A... --rJYlr1,—+n— n- l A;� +/fA,C /nn/m nnrc017; I I al') R 1 11;_7`-%dQ/A ini)r,i')nil Mooresville, NC 610 E Center Ave to Newton, NC 1407 McKay Rd Directions - MapQ... Page 2 of 2 610 E Center Ave Book a hotel tonight and Car trouble mid -trip? save with some great deals! 0 MapQuest Roadside Assistance is here: (1-877-577-5766) (i-888-461-3625) h++,.o•/%,nznz mor�miac+ �nm/�iran+inne/lie+/1/nc/nnrth_rarnlina/mnnracvilla/7R1 1 S_75dS2/F. 1 n/1)01�/1)nl7