WQ0001863_Regional Office Historical File Pre 2018 (2)

Water Resources
ENVIRONMENTAL QUALITY
April 2, 2018
DAVID E. JOHNSON — UTILITIES DIRECTOR
CITY OF MOUNT HOLLY
POST OFFICE BOX 406
MOUNT HOLLY, NORTH CAROLINA 28120
Dear Mr. Johnson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary ,
LINDA CULPEPPER
Interim Director
BCE
Subject: Attachment B Certification
Permit No. WQ000 1863
City of Mount Holly RLAP
Gaston County
In accordance with your permit modification request received January 30, 2018, and subsequent
additional information received March 18, 2018, March 22, 2018, and March 26, 2018, we are forwarding
herewith a modified Attachment B certified April 2, 2018, to the City of Mount Holly for the subject
residuals program.
This certification is being issued to modify Attachment B by:
1. Addition of three fields in Cleveland County totaling 89.43 acres, those fields being NC-CL-
11-01, NC-CL-11-02 and NC-C1-12-01.
2. Addition of two fields in Lincoln County totaling 30.66 acres, those fields being NC-LT-44-01
and NC-LT-45-01.
3. Removal of four fields in Lincoln County totaling 46.6 acres, those fields being NC-LT-43-01
to -04.
In the past, field NC-LT-44-01 has received both turkey and chicken litter on the field. It is
imperative to stress that all nutrient sources shall be accounted for in the annual report, not only for this
field but for all fields.
This modified Attachment B shall be effective from the date of certification until November 30,
2019 (i.e., expiration date of the current permit), shall void Attachment B of Permit No. WQ0001863 issued
December 1, 2014, and shall be subject to the conditions and limitations as specified therein, as well as
those specified in the above -referenced permit. Please replace the Attachment B of Permit No. WQ0001863
that was issued December 1, 2014 with this modified Attachment B.
Please note that the maps for both the land application sites in the December 1, 2014 permit and
the new land application sites are attached to this letter. In addition, the setback waivers contained in the
December 1, 2014 are contained in this permit attachment revision. Any old maps should be removed from
the December 1, 2014 permit and replaced with the maps provided.
— ''Nothfing Compares.—.."
State of North Carolina Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center 1 Raleigh, North Carolina 27699-1617
919-807-6332

rf
Mr. David E. Johnson
April 2, 2018
Page 2 of 2
If any parts, requirements, and/or limitations contained in this certification or modified Attachment
B are unacceptable, you have the right to request an adjudicatory hearing upon written request within 30
days following receipt of the certification. This request shall be in the form of a written petition, conforming
to Chapter 150B of the North Carolina General Statutes and filed with the Office of Administrative Hearings
at 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such demands are made, this
permit shall be final and binding.
If you need any additional information concerning this matter, please contact Troy Doby at (919)
807-6336 or [e-mail].
Sincerely,
?Linda Culpepper, Interim Director
Division of Water Resources
cc: Gaston County Health Department (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Adam Brigman — Synagro (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

ATTACHMENT B - Approved Land Application Sites
City of Mount Holly
Certification Date: April 2, 2018
Permit Number: WQ0001863 Version: 3.1
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil
Series
Footnotes
NC-CL-11-01
Bowen Family Trust
Andy Bowen
Cleveland
35.347156°
-81.429003°
23.01
CaB2 - Cecil
1
NC-CL-11-02
Bowen Family Trust
Andy Bowen
Cleveland
35.349003°
-81.427939°
15.18
MaB2 - Madison
1
NC-CL-I2-01
Cedar Lake Farm LLC
Charlie Jones
Cleveland
35.353756°
-81.415567°
51.15
HhB - Hulett
2, 16
Total for Cleveland County
89.34
NC-GA-41-01
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.295533°
-81.031617°
3.40
MaB2 - Madison
3
NC-GA-41-06
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.297433°
-81.030931°
8.90
CeB2 - Cecil
3, 14
NC-GA-41-09
Springs, Thomas W., III
Gaston
35.294256°
-81.031553°
4.00
CeB2 - Cecil
3
NC-GA-41-10
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.296292°
-81.026886°
7.90
CeB2 - Cecil
3, 14
NC-GA-41-14
Springs, EdWin Gregory; Springs, Sarah H.
Gaston
35.295128°
-81.028458°
6.80
CeB2 - Cecil
3, 14
NC-GA-44-01
Allen, George Bennett
Gaston
35.399969°
-81.329422°
7.90
WeD - Wedowee
4
NC-GA-45-01
Allen, David; Allen, Sharon
Gaston
35.378547°
-81.286008°
17.00
LdB2 - Lloyd
5, 15
Total for Gaston County
55.90
NC-LT-44-01
Shank, Jenny; Shank, Lee
Lincoln
35.416228°
-81.161897°
15.65
CcB - Cecil
7
NC-LT-45-01
Macomson, Michael Talbott
Lincoln
35.513933°
-81.268894°
15.01
CcB - Cecil
8,
NC-LT-46-01
LTJ Properties LLC
Lincoln
35.409103°
-81.040622°
11.80
CeB2 - Cecil
9
NC-LT-46-02
LTJ Properties LLC
Lincoln
35.411467°
-81.035853°
45.20
CeB2 - Cecil
10
NC-LT-46-03
LTJ Properties LLC
Lincoln
35.407686°
-81.033881°
9.90
• CeB2 - Cecil
9
NC-LT-46-04
LTJ Properties LLC
Lincoln
35.407806°
-81.034253°
19.40
CeB2 - Cecil
10
NC-LT-46-05
LTJ Properties LLC
Lincoln
35.415708°
-81.031 194°
7.90
LdB2 - Lloyd
10
NC-LT-46-06
LTJ Properties LLC
Lincoln
35.413858°
-81.013794°
5.40
PeB2 - Pacolet
11
NC-LT-46-07
LTJ Properties LLC
Lincoln
35.442781°
-81.008003°
7.00
PeB2 - Pacolet
12
NC-LT-46-08
LTJ Properties LLC
Lincoln
35.405769°
-81.041036°
6.60
CeB2 - Cecil
9
NC-LT-46-09
Jones, Tony
Lincoln
35.410469°
-81.026819°
7.30
LdB2 - Lloyd
10
WQ0001863 Version 3.1
Attachment B
Page 1 of 2

ATTACHMENT B — Approved Land Application Sites
City of Mount Holly
Certification Date: April 2, 2018
Permit Number: WQ0001863 Version: 3.1
Total for Lincoln County
151.16
NC-MG-37-01
Connell, Dean Stewart
Mecklenburg
35.296461°
-80.988744°
20.20
CeB2 - Cecil
13
Total for Mecklenburg County
20.20
Total
316.60
1 to 13. See Figure 1 to 13, respectively.
14. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by
Thomas W. Springs, III (of 400 West Catawba Avenue, Mount Holly, NC 28120), regardless of whether a surface or a subsurface application method is used.
15. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by
Glinda Mabe (of 2409 Marshall Allen Trail, Bessemer City, NC 28016), regardless of whether a surface or a subsurface application method is used.
16. The landowner shall provide a stream crossing for application vehicles prior to land application on the other side of the stream.
WQ0001863 Version 3.1 Attachment B Page 2 of 2

APPLICATION MAP
LEGEND
APPLICATION AREA
— PRIVATE ROAD
STREAM
DRAIN
x x x FENCE
PROPERTY LINE
0 SOIL DESCRIPTION
v/t
•
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
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.
660'
GRAPHIC SCALE
1" = 660'
0
Figure 1
NC-CL-11
660'
Fields 1-2

acr
z
—
APPLICATION MAP
y
:
/..-• -*;: *. , ..,
',./ (
INA\ -4.. f...3%.`,97.'As1-- 4 .-- 0 %,"/".s. +',4 • .40 c', , '
(1.6-V-e-i'l.:r,<":,.V- ‘? '1J-,717. • , ‘.; ,.:,:v
b
' • "
: \;:ii 1•,.' :::(.')
"
IN. ' *I' '` I n --„5.1 V . '' ;''• , i.,, '
, ',
'tij..; le - . • a -.,", '4,'M ;,-,
17:7,j,l-iik.,://44.7,1 /-. ,..„.40. /7. , , ' - ' , • W. , . ../.. ,
.,--
, .!;•S` 4 ' e ' "
r D.— ..;;.,1
, .
116
•
..,A•11111:
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
x FENCE
PROPERTY LINE
SOIL DESCRIPTION
•
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
• OFFSITE HOUSE
OUTBUILDING
WELL
GRAPHIC SCALE
1" = 660'
HO` 0
imorziga=resiami
Figure 2
660
fhe 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. Ail
locations are apprmdmate.
NC-CI-12
Field 1

c-r
tn
Legend
-- -- Stream
NM
Drain
x — x - Fence
PropertyLine
v - ApplicationArea
Site: NC-GA-41
OnSiteHouse School
OffSiteHouse(SWAA-1) %
OffSiteHouse
Outbuilding
Church
■
•
•
Application Area Map
OnSiteWell
Unsuitable
Figure 3
1 inch = 660 feet
(all locations approximate)
The compliance boundary Is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
0 160320 640 960 1,280

Legend
Drain
x — x - Fence
111
■ OnSiteHouse
OffSiteHouse
PropertyLine L
ApplicationArea
Site: NC-GA-44
Church
Outbuilding
OnSiteWell
I-O-1 OffSiteWell
Unsuitable
C/A/
Figure 4
Application Area Map
1 inch = 660 feet
(all locations approximate)
The compliance boundary is established at
either 260 feet from the residuals application
area or 50 feet within 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.
Feet
0 160320 640 960 1,280

0LIC
2
Legend
--- Stream ® OnSiteHouse
x —x - Fence ■ OffSiteHouse
PropertyLine ■ OffSiteHouse(SWAA)
ApplicationArea l J Outbuilding
Site: NC-GA-45
IO
WA
Alication Area Ma
OffSiteWell
OffSiteWell
Unsuitable
Figure 5
1 inch = 660 fee!
(all locations approximate)
The compliance boundary Is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
0 160320 640 960 1,280

Legend
-„— StreamPropertyLine
— — Drain OffSiteHouse
x — x - Fence J Outbuilding
ApplicationArea
pp OnSiteWell
Site: NC-LT-43
OffSiteWell
Unsuitable
Figure 6
Application Area Map
1 inch = 660 feet
(all locations approximate)
The compliance boundary Is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
0 230 460 920 1,380
1,840

ztin
APPLICATION MAP
LEGEND
1_•• 4
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
x x x FENCE
PROPERTY LINE
pQ SOIL DESCRIPTION
UNSUITABLE AREA
WATER
• ONSITE HOUSE
• OFFSITE HOUSE
OUTBUILDING
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.
660'
GRAPHIC SCALE
1" = 660'
0
660'
Figure 7
NC-LT-44
Field 1

z
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
— — — DRAIN
x x x FENCE
PROPERTY LINE
Q SOIL DESCRIPTION
UNSUITABLE AREA
WATER
ONSITE HOUSE
GRAPHIC SCALE
1" = 660'
860' 0
OFFSITE HOUSE irnr"imF��
❑ OUTBUILDING
0 WELL Figure 8
,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 appllcation area. All
locations are approximate.
680'
NC-LT-45
Field 1

Legend 1 inch = 660 feet
(all locations approximate)
---- Stream - Al ApplicationArea OnSiteWell The compliance boundary is established at
either 250 feet from the residuals application
SurfaceWater • OnSiteHouse Q SollDescription area or50 feet within the property boundary,
whichever is closest to the application area.
x — x - Fence ! OffSiteHouse r 2 Unsuitable The review boundary is established midway
between the compliance boundary and the
PropertyLine Outbuilding perimeter of the residuals application area.
FSite: NC-LT-46; Fields 1, 3, 8 Figure 9 0 230 460 920 1,380 1,640

Stream
SurfaceWater
X—X- Fence
OnSlteHouse
OliSlteHouse
Outbuilding
1-0-I
V
OffSlteWcll
SoilDescriptlon
Unsuitable
PropertyLine OnSitewell Figure 10
ApplicationArea
Site: NC 'LT 46 Fields 2, 4-.5, 9 0
II l t I i
(all locations approximate)
Tho compliance boundary is established at
either 260 feet from the residuals application
area or 50 feet within 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.
Feet
225 450 900 1,350 1,800

Legend
Stream
V A ApplicationArea
SurfaceWater ■
x — x - Fence
PropertyLine
• OffSiteHouse
Outbuilding
OnSiteWell
OnSiteHouse O SoilDescription
Unsuitable
V//
Site: NC-LT-46; Field 6 Figure 11
1 inch = 660 feet
(all locations approximate)
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
0 230 460 920 1,380 1,840

Legend
Drain J ApplicationArea
•- -- Stream • OnSiteHouse
SurfaceWater ® OffSiteHouse
x — x - Fence Outbuilding
PropertyLine \ OnSiteWell
Site: NC-LT-46; Field 7
O SoilDescription
Unsuitable
Figure 12
1 inch = 660 feet
(all locations approximate)
The compliance boundary is established at
either 250 feet from the residuals application
ansa or 50 feet within the properly 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.
Feet
0 230 460 920 1,380 1,840

DW
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 11-13
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 website at:
http://portal.ncdenr.org/web/wq/a sp /!au
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A' NCAC 02T .1108(b)(2jlfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
•
. ,.
•
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 1SA NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
efLit 1/4Yo Mt. we
— R — y / R.4,W 6 r 01
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the following:
you
Location address of property:
(sw-/)
/00 feet (Le., cannot be less than 100 feet) of
Lens f e0514.71.44 Ave -
City: Al /av//y State: /Vie Zip: SI rs2C3
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name:
Signature:
FORM: SWA 11-13
Date: q / (p
Page 1 of 1

'.
a
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 11-13
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 website at:
ham://aortal. ncdenr. orR.web/wo/ans/lau
General — This document is an agreement between the Applicant and the owner(s) of thp. property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
wr Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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 property from which a waiver is being sought.
[' Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
2/ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
a-pi-.Fr°Ily
Pe- 64- ys - 0I
hereinafter referred to as the Permittee, to land apply residuals within 100
the residence or place of public assembly located at the following:
Location address of property:
City: ges5 e CI ),
feet (Le., cannot be less than 100 feet) of
State:
A/C
Zip: o20g
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement Shan'onlj'
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
�I
day in advance, modifies or cancels this Agreement.
certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regardilig this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: C1,
Signature: 444•L—� 7 / /!,I
Date: /
FORM: SWA 11-13
Page 1 of 1

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
David Johnson — Utility Director
City of Mount Holly
P. O. Box 406
Mount Holly, NC 28120
Dear"Mr. Johnson:
John E. Skvarla, Ill
Secretary
December 1, 2014
Subject: Permit No. WQ0001863
City 'of Mount Holly.503 Residuals
Land Application of Class B Residuals (Non -Dedicated):
Gaston County
In accordance with your permit renewal and major modification request received October 1,
2014, and subsequent additional information received November 24, we are forwarding herewith Permit
No.: WQ0001863 dated December 1, 2014, to City of Mount Holly for the continued operation of the
subject residuals managementprogram.
This permit shall be effective from December 1, 2014 until November 31, 2019, shall void Permit
No. WQ0001863 issued December 31, 2013,.and shall be subject to' the conditions and limitations as
specified therein. Please pay particular attention to themonitoring requirements listed'in Attachments A
and.B forr they may differ from the previous permit .issuance.. Failure to establish an adequate system for
collecting and maintaining the required operational information shall result in future compliance
problems.
Modifications to the subject permit are as follows:
1. Fields NC-GA-44-02 and NC-GA-44-03 are deleted from Attachment B.
2. Fields NC-GA-45 and NC-LT-46-09 are added to Attachment B.
3. Decrease in acreage for NC-MG-37-01 from 20.7 to "20.2 acres.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory-hearing upon written request, within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150E of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, thispermit shall be final and
binding.
Non -Discharge Pehitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: httoi//portal.ncdenr.oroiweb/wq
An Equal Opportunity\Affirmative Action Employer -Made in partwith tei ycled'paper

Mr: David Johnson
December 1, 2014
Page2of2 "
If you need additional information concerning this matter, pleasecontactTroy Doby at (919) 807-
6336 or [e-mail].
Sincerely,
re, Thomas A. Reeder, Director
Division of Water Resources
cc: Gaston County Health Department ([e-mail]) (Electronic Copy)
Mooresville Regional Office, Water Quality. Regional Operations Section (Electronic Copy)
Synagro Central, LLC (jaculp(@,synagro.eom) (Electronic Copy)
Marshall Puryear ([e-mail]) (Electronic Copy)
Eric Thompson ([e-mail]) (Electronic Copy)
Beth Buffington Protectionand Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic. Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT (NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other. applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Mount Holly
Gaston County
FOR THE
continued operation of a residuals management program for the City of Mount Holly and consisting of the
land application of Class B residuals generated by the approved facilities listed in Attachment A to the
approved sites listed in Attachment B with no discharge ;of wastes to surface waters, pursuant to the
application received October 1 2014, and in conformity with other supporting data subsequently filed and
approved by the Department of Environment and Natural Resources and considered a part of this permit.
The use and disposal of residuals. are regulated. under Title.40 Code of Federal Regulations Part 503. This
permit does not exempt the Permittee from complying with the federal regulations.
This permit shall be effective from December 1, 2014 until November 31, 2019, shall void Permit No.
WQ0001863 issued December 31, 2013, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
1. No later than six months prior to the expiration of this permit, the Permittee. shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions :and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T 0105(d) requires an updated site map to be submitted with the permit renewal
application.
II. PERFORMANCE STANDARDS
1. The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Mooresville regional office supervisor, and take any
immediate corrective actions.
WQ00018'63; VerSion,.3.9
Shell Version 140324 Page 1 of12.

2. This permit shall not relieve the Permittee. of their responsibility for damages togroundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative. Pollutant
Loading Rates (CPLRs):
Parameter
Ceiling Concentration
(milligrams per kilogram)
CPLR
(pounds per acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
n/a
Nickel
420
374
Selenium
100
89 .
Zinc
7,500
2,498
The Permittee shall determine compliance_ with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application have not occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC
02T .1106 (a). and (c). Exceptions to this requirement shall be specified in Attachment A.
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 1.5A NCAC 02T
.1107(a). Exceptions to thisrequirement shall be specified in Attachment. A.
WQ0001863 Version. 3.0
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8. Setbacks for Class B land application sites shall be as follows:
Setback Description
Setback by application type
(feet)
Vehicular
Surface
Application
Irrigation
Surface
Application
Injection /
Incorporation
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
part of the project site
400
400
200
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
lessee/operator of the land to be maintained as part
of the project site
0
200
0
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams — intermittent and perennial,
perennial waterbodies, and wetlands)
100
100
50
Surfacewaterdiversions (ephemeral streams,
waterways, ditches)
25
"100
25
Groundwater lowering ditches (where the bottom of
the ditch intersects the SI WT)
25
100
25
Subsurface groundwater lowering system
.0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
more'in vertical height
15
15
15
Building foundations or basements
0
15
0
Water lines .
0
10
0
Swininiing pools
100
100
100
Nitrification fields
-0
20
0
9. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
10. Bulk residuals and other sources of Plant Available Nitrogen. (PAN.) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
•
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science (http://nutrients.soil.nesu.edu/yields/index.php).
A copy shall be kept on file and reprinted everyfive years in accordance with Condition IV.6.
WQ0001863 Version 3.0 Shell Version 140324 Page 3 of 12

c.. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncagr..gov/SWC/tech/documents/9th Guidance Doc 100.109.pdf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards (ftp://ftp-fc.sc.egov.usda.gov/NHQ/practice-standards/standards/590.pdf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards.
12. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (Ibs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied.
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension. Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The.
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee
shall maintain written records of these recommendations and details of their implementation.
14. The compliance boundary for residual land application sites shall be specified in accordance with
15A NCAC 021, .0107(b). These sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application
area. An exceedance of groundwater standards at or beyond the compliance boundary is subject to
reinediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B.
15. Inaccordance with 15A NCAC 02L .0108, the review boundary shall be established midway between
the compliance boundary and the residual land application area. Any exceedance of groundwater
standards at the review boundary shall. require action in accordance with 15A NCAC 02L .0106.
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The, residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge systern to prevent any
contravention, of surface water' or groundwater standards.
WQ0001863 Version 3.0 Shell Version 140324 Page 4 of 12

2. The Mooresville Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall benotified at least
48 hours prior to the initial residuals land application to any new Iand application site. Notification to
the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday,
excluding State Holidays,
3. The Mooresville Regional Office shall be notified via email or -telephone, [phone] at least 24
hours prior to conducting any land application activity. Such notification shall indicate, at a
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply to. additional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to -those fields.
4. The Permittee shall maintain: an approved Operation arid Maintenance Plan (O&M Plan) pursuant to
15A NCAC. 02T .1110. Modifications to the O&M Plan shall be approved by the Division prior to
utilization.af the new plan. The O&M Plan, at the minimum, shall include:;
a) Operational functions;
b) Maintenance schedules;
c) Safety measures;
d) Spill response plan;
e) Inspection plan including the following information'
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, arid
procedures to assure that the selected location(s) and inspection frequency are representative.
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuantto the
noncompliance notification requirements under the monitoring and reporting section of the
permit;
f) Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and Other operating conditions _can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for
any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g, facilities that
land apply multiple times per year but have an annual sampling frequency, may need to
sampleduring winter months when pathogen reduction is most likely to be negatively
affected by cold temperatures).
5 Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee shall designate and employ a certified operator in
responsible charge (ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC. 08G .0201. The ORC or their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition III. 4„
arid shall comply with all other conditions of 15A NCAC 08G. 0204• For More information regarding
classification and designation requirements, please contact the Division of Water Resources'
Technical Assistance & Certification Unit at [phone].
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M Plan shall
be maintained at the land application sites during land application activities.
WQ0001863 Version 3.0 Shell Version 140324 Page 5 of 12

7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles.
8. Residuals shall ,not be stored at any land application site, unless written approval has been requested
and received from the Division.
9. When the Permittee landapplies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites ontoadjacent
properties or into surface waters.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied, or application shall be in accordance with the
crop management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, or an agronomist
and as approved by the Division.
11. Bulk residuals shall not belandapplied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
e. If the land fails to assimilate the bulk residuals or the application causes the contravention of
surface water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporatedwithin
a 24-hour period following a residuals land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
If the slope is greater than.10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of liine are applied to
achieve a final soil p1-I of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will be noted in this permit;
i. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in
a,USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j • If the vertical separation between the; seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
12. The following public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shallbe restricted for 30 days after a residuals land
application event.
g•
WQ0001863 Version 3.0
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13: Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under IIL 12 apply.
14. The following harvesting and, grazing restrictions apply to residual land application sites after each
land application event:
'Harvesting and Grazing Description
Restricted
Duration
Animals shall notbe allowed to graze during:land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
prevent access after each land application event.
30 days
Food crops, feed crops -and fiber crops shall not be harvested for:
30 days,
Turf grown on land where residuals have been applied shall not be harvested for:.
1,2 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e,g„ tobacco, melons, cucumbers, squash, etc.)
shall not be harvested for:
14 months
When the residuals remain on the land surface, for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the: land
surface (e.g., root crops such as potatoes, carrots, radishes, etc) shall not be
harvested for:
20 ,months
When the residuals remain on the land surfacefor less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
surface shall not be harvested for:
38; months
15. The Permittee shall acquire from each landowner or lessee/operator a statement: detailing the volume
of other nutrient sources- (i.e., _manufactured fertilizers,, manures, or other animal waste products) that
have been applied to the' site, and a copy of the most recent Nutrient Management Plan (NMP) for
those operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (MRCS) or other State Agencies. The Permittee shall calculate allowable
nutrient loading rate's based on'the provided itifermation and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified 'Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan.
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LO AA)
between the` Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permitexpiration date,
and shall be renewed during the permit renewal process.
IV. MONITORING AND REPORTING:REQUIREMENTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be, established, and an
acceptable sample reporting schedule shall be followed.
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA), The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)] shall be performed at the frequency specified in
Attachment A, and the Pcrmittee shall .maintain these results for a minimum of five years. Any
WQ0001'863 Version 3.0 Shell Version 140324 Page of 12

exceptions from the requirements in this condition shall be specified in Attachment A.
The TCLP analysisshall include the following parameters (the regulatory level in milligrams per liter
is in. parentheses):
Arsenic" (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1;2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7) '
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide)
(0.008)
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP• (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A,
the Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified, in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following •parameters:
Aluminum
Mercury
Potassium
Ammonia Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium.
Plant Available Nitrogen
(by calculation)"
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at. the frequency specified in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficientto demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
Condition shall be specified in Attachment A.
WQ0001863 Version 3.0.
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5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be ,conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomiipubs.htm). The Permittee shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a perioduf no less than five years, and shall be made. available to the Division upon request. At a
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
PH
6. Laboratory parameter analyses,shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Permittee shall maintain records tracking all residual land application events. At a nainhnum,
these records shall include the following:
a. Source of residuals;
b. Date of land application;
c, Location eland application (ie.., site, gejci; or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);;
e, Method of land application;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, °frozen, etc.);
i. Type of crop or crops to be grown on field;
J.
Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Depai talent of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in gallons per acre, cubicyard per acre, dry tons per acre, or wet
ton per acre;
1. Voluine. of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
m. Volume of soil amendments (e.g., lithe, gYpsurn, etc.) applied in gallons per acre, dry ton per
acre, or wet tons per acre; and
n.„ Annual and Othnitlative totals in dry tons per acre of residuals as ,well as Animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be limited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel,. selenium, and zinc), annual poUnds per acre of PAN, and annual1 pounds per
acre of phosphorus applied to each field.
WQ0001863 Version 3.0
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8. Three copies of an annual report shall be 'submitted on or before March 1st, The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Forms. Instructions for reporting andannual report forms are available at
http://portal.ncdenr.org/web/wq/aps/lau/repotting, or can be obtained by contacting the Land
Application Unit directly. The annual report. shall" be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Noncompliance Notification
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, as soon .as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self-monitoringindicatesthe facility has gone, out of compliance- with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number (800). 662-7956, [phone], or [phone].Persons
reporting such occurrences by telephone shallalso file a written report in letter form within five days
followingfirst knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
V. INSPECTIONS
1. The. Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause therelease of wastes to the
environment, a threat to human health or a public nuisance. The Permittee shall maintain an
inspection log that includes, at a minimum, the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this inspection log
for a period of five years from the date of inspection, and this log shall be made available to the
Division upon request.
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein.
at any reasonable time for the purpose of determining compliance with this permit; may inspect or
copy any records required to be maintained under the terms and conditions of this permit; and may
collect groundwater, surface water or leachate samples.
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VI. GENERAL:. CONDITIONS
1. Failure to comply with the, conditions and limitationscontained herein may subject the Permittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6Ato 143-215.6C;
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit:
3. This permit is effective only withrespect to the nature and volume of residuals described in the
permit application and other supporting documentation.
4.. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, .or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal).. Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B, .0200; erosion and sedimentation control requirements in 15A NCAC Chapter, 4
and under the Division's General Permit NCG010000; any requirements pertaining to .wetlands under
15A NCAC 02B A200 and 02H ,0500; and documentation ofcompliance with Article 21 Part 6 of
Chapter 143 . of the .General Statutes.
5. In the event the residuals program changes Ownership or the Permittee changes their name, a formal
permit modification request shall be. submitted to the Division. This, request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Perniittee of record shall remain fully .responsible for
maintaining and operating, the residuals program. -permitted hereinuntil a permit is issued to the new
owner.
6. This permit is .subject to revocation or unilateral modification upon 60 days -notice from the Division
Director, in whole or partfor the requirements listed in 15A NCAC 02T .0110,
7. Unless the Division Director grants a variance; expansionof the permitted. residuals program
contained herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC
02T .0120(b).
8. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the, annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e)(3).
Permit issued this the lst day of December 2014
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
eeder; Director
ivision of Water Resout_ces
By Authority of the Environmental Management Commission
Permit Number WQ0O01863
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ATTACHMENT ' A - Approved' Residual Sources
City of Mount Haley
Certification Date: December 1, 2014
Permit Number: WQ0001863. Version: 3.0
Owner
Facility Name
County
Permit
Number
Biological
Residuals
Maximum
Dry ear
Per -Year
Monitoring
Frequency for
Non -hazardous
2
CharacteristicsNutrients
Monitoring
Frequency for
Metals and
a,b_
Monitoring
Frequency for
Pathogen &
VectorAttraction
4' s 6
Reductions '
Approved
Mineralization
Rate
City of Mount Holly
Mt. Holly WTP
Gaston
01-36-020
No
130.
Annually
Annually
N/A6
0.40
City of Mount Holly.
Mt. Holly WWTP
Gaston
NC0021156
Yes
730'
Annually
Annually
Annually
0.40
Total
910
1. Maximum Dry Tons per Year is the amount ofresiduals approved for land application iom each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity; and corrosivity) as stipulatedunder permit Condition .1V 2,
3. Testing of metals and nutrients as stipulated under perrnit Condition 1V.3.
4. Analyses of pathogen and vector attraction, reductions as stipulated under permit Condition. IV.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
(short tons per year)
Monitoring frequency
(Established in 40-CFR-503 and 15A NCAC 02T .1111)
<319
1/Year
=>319 — ,< 1,650
1/ Quarter (4 timesper year)
=>1,650 = 16;500
1/60 Days(G-times per year)
=--16,500
lfmonth (12 times per year)
6. Water Treatment Plant residualsare_exempt=from meeting:the pathogen° &, vector attraction reduction requirements in Condition 1V:4, provided they are not mixed. with residuals that have been
generated during the treatment of domestic wastewater, the treatmentof animal processing wastewater,- or the,biological treatment of industrial wastewater. The Water Treaurient.Plant / residuals
must be treated -and processed in a, manner as to not meet the definition of "Biological Residuals" -as defined in 15A NCAC;02T .1 102(6).
If noiancl application events occur during a,required sampling period (e.g. no land application occur (luring an entire year when -annual` monitoring is required), then no
sampling data is. required duringahe period of inactivity.. The annual report shall include.an explanation formissing'sampling data. Those required to,submitthe annual
report to:'EPA may be required to make up the missed sampling, contact. the -EPA for additional information and clarification.
Page .1 of 1

ATTACHMENT B - Approved Land Application Sites
City of Mount Holly
Certification Date: December 1, 2014
Permit Number: WQ0001863 Version: 3.0
Field/ Site
Owner
.Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil Series
Footnotes
NC-GA-41-01
Springs, Edwin G.
Gaston
35° 17' 45"
81° 01' 55"
6,80
Madison sandy clay loam, 2 to 8% slopes,
NC-GA-41-06
Springs, Edwin G.
Gaston
35° 17' 51"
81° 01' 52"
14.30
Cecil
NC-GA-41-09
Springs, 'Moms W.
Gaston
35° 17' 39"
81° 01' 53"
13,50
Cecil
NC-GA-41-10.
Springs, Edwin Gregory
Gaston
35° 17' 48"
81° 01' 37":ii.50
Cecil
NC-GA-41-14
Springs, Edwin Gregory
Gaston
35° 1742"
81° 01' 42"
9.70
Cecil
NC-GA-44-01
Allen, George Bennett
Gaston
35° 23' 59"
81° 19' 48"
6.90
Wedowee sandy loam, 6 to 15% slopes
NC-GA-45-01
Allen, David and Sharon
Gaston
35° 22' 47"
81° 17' 10"
17-.0
Lloyd (LdB2)
NC-LT-43-01
Duckworth, Gary M
Lincoln
35° 25' 30"
80° 59' 50"
11.20
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-02
Duckworth, Gary M
Lincoln
35' 25' 35"
80° 59' 46"
21.00
Cecil sandy clay loam, 2 to 8% slcipes, e
NC-LT-43-03
Duckworth, Gary M
Lincoln
35' 25' 47"
80° 59' 56"
11.00
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-04
Duckworth, Gary M
Lincoln
35° 25' 36"
80° 59' 41"
6.00
Pacolet sandy clay loam, 8 to 15% slopes
NC-LT-46-01
Jones, Tony
Lincoln
35° 24' 32"
81° 02' 27"
11.80
' Cecil sandy clay loam, 2 to 8% slopes,.e
NC-LT-46-02
Jones, Tony
Lincoln
35' 24' 39"
81" 02' 15"
45.20
Cecil sandy clay loam, 2 to 8% slopes, e .
NC-LT-46-03
Jones, Tony
Lincoln
35°24' 22"
81" 02' 51"
9.90
Cecil sandy clay loam, 2 to 8% slopes, c,
NC-LT-46-04
Jones, Tony
Lincoln
350 24' 29"
81° 02' 07"
19,40
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-05
Jones; Tony
Lincoln
35° 24' 56"
81° 01' 52"
7.90
Lloyd (LdB2)
NC-LT-46-06
Jones, Tony
Lincoln
35' 24' 50"
81' 00' 50"
5.40
Pacolet sandy clay loam, 2 to 8% slopes,
NC-LT-46-07
Jones, Tony
Lincoln
35° 26' 35"
81 00' 29"
7.00
Pacolet sandy clay loam, 2 to 8% slopes,
NC-LT-46-08
Jones, Tony
Lincoln
35° 24' 21"
81° 02' 28"
6,60
Cecil sancly clay loam, 2 to 8% slopes,..e
NC-LT-46-09
Jones, Tony
Lincoln
35° 24' 38"
81° 01' 37"
6.60
Lloyd (LdB2)
NC-MG-37-01
Connell, Dean Stewart
Mecklenburg
35° 17' 50"
80° 59' 22"
20.20
Cecil sandy clay loam, 2 to 8% slopes, e
Total
275.60
Page 1 of 1

Jan. 31. 2018 10:58AM
No.0800 P. 1
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
Q
y� II Press TAB to enter Information
Permittee Owner/Officer Name: Dar 1-O /1 nkm
Facility Name:
County:
Mailing Address:
City:
Email Address:
Signature:
& as h-al/7
Ad, 130x 106
H'
av<d,
•O('l 111!11)
11 1
71/10U 2 'I- O 1
State: A/
Ele/ " us
Phone:
Zip:
2Q
tyt.�
Date:
Permit # W6 co0 t 6 3
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type:
Select
‘AL IA/ t P
Facility Grade:
Select
1 V
OPERATO SIBLE CHARGE (ORC} Print Full Name: , ctl.oli,Q, f "
Certificate Type: Select
Email Address;
Certificate Grade: Select
//
Work Phone: 7o z/ ,,2 7 r//�
Certificate#: /Uou 211ff
Signature: G,A Effective Date:
/-2l
"'certify that 1 ag -e to my des anatioti as the Operator In Responsible Charge for the facility noted. 1 understand and will abide by the
rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 086 .0204 and falling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
13ACIWP.OR ... :.:.. .. . .. .. .
Print Full Name: inei i e Wlr7rEf z
Work Phone; 7071 X27 426 /
Certificate Type: Select L. As Certificate Grade: Select Certificate #: 9'9 Z. 71/
Email Address: krjiie,Vvtore,(2 r /tilL/64/S
Signature:
Effective Date:
"1 certify that 1 agree to my designation as a Back-up Operator Ihilespedisible Charge for the facility noted I understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC O8G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System operators Certification Commission."
Mall, fax or email
ORIGINAL to:
Mali or Fax
a COPY to:
WPCSOCC, 1618 Mall Service Center,
Raleigh, NC 27699-1618
Asheville
2090 US Hwy 70
Swannanoa, NC 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington 5q. Mali
Washington, NC 27889
Fax: [phone]
Phone; 252-946-6481
Fax: [phone]
Fayetteville
225 Green St, Suite 714
Fayetteville, NC 28301-5043
Fax [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr,
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]
Email: eaftBdimf �ilC:t�e f:�vv
Mooresville
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax: [phone]
Phone: [phone]
Wlnstan.Salem
45 W. Hanes Mall Rd.
Winston-Salem, NC 27X05
Fax: [phone]
Phone: [phone]
Raleigh
3800 Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone; 919•-791-4200
Revised 4I O16

Water Pollution Control System Operator Designation Form
WPCSOCC
NCAC 15A 8G .0201
Permittee Owner/Officer Name: (-/-t/ J � 1714 Q IAV1,fi (-AD ((i / / Dec VIM( 3-ackS o vi
Mailing Address: P. 0, `4010 I
1 (y2-
City: ��/t.'C I � State: Jv C Zip: Z�IZv - Phone #: T0�(Z7 �{ %
Email addres l Ck 1 cJ 0— a. L4L , us
Signature:
Facility Name: (40(l y LA) W I
County: C-7ccS,n
Date: / 2' g ! — / 7
Permit#: /l/%0O21
SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Facility Type/Grade (CHECK ONLY ONE):
Biological Collection Physical/Chemical Surface Irrigation ("Land Applicatl
Operator in Responsible Charge (ORC)
Print Full Name: 116S CkUL,cfd.
Email: Dot,9 , S ho d zi Mi (4)(//
Certificate Type / Grade / Number: Lund 1>. l ot2oZ4/6 Work Phone #: 7ci'L( "7 % IC/Z 6 %
Signature: /-
;i: .571.6
Date: I 2-`ZY17
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission. -
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Email:
Certificate Type / Grade / Number: Work Phone #:
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail, fax or email the
original to:
Mail or fax a p to the
appropriate Regional Office:
WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618
Email: certadminCancdenr.eov
Asheville
2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sy Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: [phone]
Phone: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Fax: [phone]
Winston-Salem
450 W. Hanes Mall Rd
Winston-Salem 27105
Fax: [phone]
Phone: [phone]
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]
Revised 05-2015

A,VA:
PICDENR
North .daroling Department of FriOxon:toe-tit and Natural Resources
Pat McCrory John E. Skverle, Ili
Governor Secretary
David Johnson — Utility Director
City of Mount Holly
P. O. Box 406
Mount Holly, NC 28120
Decanter 4, 2014
Subject: Permit No. WQ0001863
City of Mount Holly 503 Residuals
Land Application of Class B Residuals (Non -Dedicated)
Gaston County
Dear Mr. Johnson:
In accordance with a. written, request received December 4, 2014 from Drew Culp, we are
forwarding herewith corrected Attachmenta of Permit No. WQ0001863 issued December 1, 2014.
The correction to the subject permit is as follows:
1. Net acreages for fields contained in Attachment B.
Please replace Attachment 13 of Permit No. WQ0001836 issued December I, 2014 with the
enclosed corrected Attachment B.
If yOu need additional information concerning this permit correction please contact Troy Doby at
[phone] or troy.doby@ncdenr,gov.
Sincerely,
Thomas A. Reeder, Director
Division of Water Resources
Enclosure
cc: Gaston County Health Department (Chris.dabbinse,co.nastonlic.us) (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Synagro Central, LLC (laculp@synagro,com) (Electronic Copy)
Marshall Puryear ([e-mail]) (Electronic Copy)
Eric Thompson ([e-mail]) (Electronic Copy)
Beth Buffmgton — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files
Nen-Discharge Permitting Unit
1617 Mail Service Center; Raleigh, North Caroline 27699-1617
Phone: [phone] interneti'httirilOortalinedenr.omAyebfwg
An Equal.Opportunity.‘ Affirmative Action EMployer—, made inpari MO recycled paper

ATTACHMENT B - Approved Land Application Sites
City of Mount Holly
Certification Date: December 1, 2014
Permit Number` WQ0001863 Version: 3.0
Field/,Site
Owner
Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil Series
Footnotes.
:..
NC-GA-41-01
Springs, Edwin G
Gaston
35° 17' 45"
81° 01' 55"
3.40
Madison sandy clay loam, 2::to;8% slopes,
NC-GA=41-06
Springs, Edwin G.
Gaston
35° 17' 51"
81° 01' 52"
8.90
Cecil
;
NC-GA-41-09
Springs, Thomas W.
Gaston
35° 17' 39"
81° 01'53"
4.00
Cecil
NC-GA-41-10
Springs, Edwin Gregory.
Gaston.
35° 17' 48"
81° 01' 37"
7,:90
Cecil
NC-GA-41-14
Springs, °Edwin Gregory
Gaston
35° I7' 42"
81° 01' 42"
6.80
Cecil
NC-GA-44-01,
Allen, George Bennett
Gaston
35° 23' 59"
81° 19' 48"
7.90
Wedowee sandy loam, 6 to 15% slopes
NC-GA-45-01
Allen, David and Sharon
Gaston.
35°'22' 47"'
81° 17' 10"
17.00
:Lloyd (LdB2)
NC-LT-43-01
Duckworth,Gary M
Lincoln
35° 25' 30"
80° 59' 50"
10.60
Cecil sandy clay loam; 2to 8% slopes, e
NC-LT-43-02
Duckworth, Gary M
Lincoln
35° 25' 35"
80° 59' 46"
21.60
Cecil sandy clay loam, 2 to 8% slopes, e:
NC-LT-43-03
Duckworth, Gary, M
.Lincoln:
35° 25' 47"
80° 59' 56"
9.60
Cecil, sandy clay loam, 2 to 8% slopes, e
NC-LT-43-04
Duckworth, Gary
Lincoln.
35°25' 36"
80° 59' 41"
4.80
Pacolet.sandy -clay loam, 8 to 15% slopes
NC-LT-46-01
Jones, Tony
Lincoln
35° 24' 32"
81° 02' 27"
11.80
Cecil sandy clay loam,,2 to 8% slopes, e
NC-LT-46-02
Jones, Tony
'Lincoln
35° 24' 39"
81° 02' 15"
45.20
Cecil sandy clay loam, 2 to:8%slopes, e
NC-LT-46-03
Jones, Tony
Lincoln
35° 24' 22"
81° 02' 51"
9.90
'Cecil sandy clay loam,,2 to.8%slopes, °e
NC-LT-46-04
Jones, Tony
Lincoln
35° 24' 29"
81° 02' 07"
19.40
Cecil sandy day loam, 2 to 8% slopes, e
NC-LT=46-05
Jones, Tony
Lincoln
35° 24' 56"
81° 01' 52"
7.90
Lloyd (Ld132)
NC-LT-46-06
Jones, Tony
Lincoln
35° 24' 50"
81°:00'50"
5.40
Pacolet sandy clay loam, 2-to 8% slopes,
NC-LT-46-07
Jones, Tony
Lincoln
35°.26''35"
81° 00' 29"
7.00
Pacolet sandy clay loam, 2 to 8% slopes,,
NC-LT-46-08
Jones, Tony
Lincoln
35° 24' 21"
81° 02' 28"
6.60.
Cecil sandy clay loam, 2 to 8% slopes; e
NC-LT-46-09
Jones, Tony
Lincoln.
35° 24'38"
81° OF 37"-
7.30
Lloyd (LdB2)
NC-MG-37-01
Connell;, Dean Stewart
Mecklenburg
35° 17' 50"
80° 59' 22"
20.20
Cecil sandy clay loam, 2 to 8% slopes, e
Total
243.20
Page 1:of 1

Jan. 30.2018 6:05A
vi
No.0797 P. 1
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
/�
++ Press TAB to enter Information
D
Permittee Owner/Officer Name: V U n-.0 hson
Mailing Address: f.0, 120X- 06 Phone:
City: Mt-, t c
b
Email Address: OQI/id , 'J'Jr,4-07
Signature:
V i
Facility Name; 6 i 1y 0-P Nlouh 1 ri0
County: V Qs -/-0o
State: !1/ Zip: l ZO
jai,Neili' us
Date:
//lfi/l8
Permit # �t QOQ ( . 6 -
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type:
Select
Ai LAI f P
Facility Grade:
Select
j V
OPERATOR iN RESPONSIBLE CHARGE (ORC)
Print Full Name:
Certificate Type: Select /. r .
Certificate Grade: Select
Email Address: /0,H cr , ,Shot a,JO, ,/%L,/ Ally , it!
Signature:
Work Phone: 70 t,/g2 7 c/26. 7
Certificate#: /000 21/6,
Effective Date: /-2 /t
�I certify that i ag ee to my deslgnation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the
rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and falling to do so can result In
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: ryli'ke rviore.fz_
Certificate Type: Select L A
Work Phone: -7v1( SP27 (126 /
Certificate Grade: Select Certificate #: Z.7L/
EmailAddress: Wit ,rllZoref /�1. 4/.vS
Signature:l/�, �.
Effective Date: / e'f -/?
1/1 certify that i agree to my designation as a Back-up Operator in R pahsible Charge for the facility noted. I understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth In 15A NCAC 08G .0204 and falling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone] Email: [e-mail]
ORIGINAL to: Raleigh, NC 27699-1618
Mail or Fax
a COPY to:
Asheville
2090 US Hwy 70
Swannanoa, NC 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq. Mall
Washington, NC 27889
Fax; 252-946-9215
Phone: [phone]
Fayetteville
225 Green St, Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]
Mooresville
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax: [phone]
Phone:[phone]
Winston-Salem
45 W. Hanes Mall Rd.
Winston-Salem, NC 27105
Fax: [phone]
Phone: [phone]
Raleigh
3800 Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone: [phone]
Revised 4/2016

Water Resources
ENVIRONMENTAL QUALITY
April 2, 2018
DAVID E. JOHNSON — UTILITIES DIRECTOR
CITY OF MOUNT HOLLY
POST OFFICE Box 406
MOUNT HOLLY, NORTH CAROLINA 28120
Dear Mr. Johnson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secre/my
LINDA CULPEPPER
Interim Director
Subject: Attachment B Certification
Permit No. WQ000 1863
City of Mount Holly RLAP
Gaston County
In accordance with your permit modification request received January 30, 2018, and subsequent
additional information received March 18, 2018, March 22, 2018, and March 26, 2018, we are forwarding
herewith a modified Attachment B certified April 2, 2018, to the City of Mount Holly for the subject
residuals program.
This certification is being issued to modify Attachment B by:
1. Addition of three fields in CIeveland County totaling 89.43 acres, those fields being NC-CL-
11-01, NC-CL-11-02 and NC-CI-12-01.
2. Addition of two fields in Lincoln County totaling 30.66 acres, those fields being NC-LT-44-01
and NC-LT-45-01.
3. Removal of four fields in Lincoln County totaling 46.6 acres, those fields being NC-LT-43-01
to -04.
In the past, field NC-LT-44-01 has received both turkey and chicken litter on the field. It is
imperative to stress that all nutrient sources shall be accounted for in the annual report, not only for this
field but for all fields.
This modified Attachment B shall be effective from the date of certification until November 30,
2019 (i.e., expiration date of the current permit), shall void Attachment B of Permit No. WQ0001863 issued
December 1, 2014, and shall be subject to the conditions and limitations as specified therein, as well as
those specified in the above -referenced permit. Please replace the Attachment B of Permit No. WQ0001863
that was issued December 1, 2014 with this modified Attachment B.
Please note that the maps for both the land application sites in the December 1, 2014 permit and
the new land application sites are attached to this letter. In addition, the setback waivers contained in the
December 1, 2014 are contained in this permit attachment revision. Any old maps should be removed from
the December 1, 2014 permit and replaced with the maps provided.
'� .Nothing Compares'::-,
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Mr. David E. Johnson
April2, 2018
Page2of2
If any parts, requirements, and/or limitations contained in this certification or modified Attachment
B are unacceptable, you have the right to request an adjudicatory hearing upon written request within 30
days following receipt of the certification. This request shall be in the form of a written petition, conforming
to Chapter 150B of the North Carolina General Statutes and filed with the Office of Administrative Hearings
at 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless such demands are made, this
permit shall be final and binding.
If you need any additional information concerning this matter, please contact Troy Doby at (919)
807-6336 or [e-mail].
Sincerely,
/(l��fikes7r.er./t
?Linda Culpepper, Interim Director
Division of Water Resources
ce: Gaston County Health Department (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Adarn Brigman — Synagro (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

ATTACHMENT B - Approved Land Application Sites
City of Mount Holly
Certification Date: April 2, 2018
Permit Number: WQ0001863 Version: 3.1
Field/ Site
Owner
Lessee
County
Latitude
Longitude
Net
Acreage
Dominant Soil
Series
Footnotes
NC-CL-11-01
Bowen Family Trust
Andy Bowen
Cleveland
35.347156°
-81.429003°
23.01
. CaB2 - Cecil
1
NC-CL-11-02
Bowen Family Trust
Andy Bowen
Cleveland
35.349003°
-81.427939°
15.18
MaB2 - Madison
1
NC-CL-12-01
Cedar Lake Farm LLC
Charlie Jones
Cleveland
35.353756°
-81.415567°
51.15
HhB - Hulett
2, 16
Total for Cleveland County
89.34
NC-GA-41-01
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.295533°
-81.031617°
3.40
MaB2-Madison
3
NC-GA-41-06
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.297433°
-81.030931°
8.90
CeB2 - Cecil
3, 14
NC-GA-41-09
Springs, Thomas W., III
Gaston
35.294256°
-81.031553°
4.00
CeB2 - Cecil
3
NC-GA-41-10
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.296292°
-81.026886°
7.90
CeB2 - Cecil
3, 14
NC-GA-41-14
Springs, Edwin Gregory; Springs, Sarah H.
Gaston
35.295128°
=81.028458°
6.80
CeB2 - Cecil
3, 14
NC-GA-44-01
Allen, George Bennett
Gaston
35.399969°
-81.329422°
7.90
WeD - Wedowee
4
NC-GA-45-01
Allen, David; Allen, Sharon
Gaston
35.378547°
-81.286008°
17.00
LdB2 - Lloyd
5, 15
Total for Gaston County
55.90
NC-LT-44-01
Shank, Jenny; Shank, Lee
Lincoln
35.416228°
-81.161897°
15.65
CcB - Cecil
7
NC-LT-45-01
Macomson, Michael Talbott
Lincoln
35.513933°
-81.268894°
15.01
CcB - Cecil
8,
NC-LT-46-01
LTJ Properties LLC
Lincoln
35.409103°
-81.040622°
11.80
CeB2 - Cecil
9
NC-LT-46-02
LTJ Properties LLC
Lincoln
35.411467°
-81.035853°
45.20
CeB2 - Cecil
10
NC-LT-46-03
LTJ Properties LLC
Lincoln
35.407686°
-81.033881°
9.90
CeB2 - Cecil
9
NC-LT-46-04
LTJ Properties LLC
Lincoln
35.407806°
-81.034253°
19.40
CeB2 - Cecil
10
NC-LT-46-05
LTJ Properties LLC
Lincoln
35.415708°
-81.031194°
7.90
LdB2 - Lloyd
10
NC-LT-46-06
LTJ Properties LLC
Lincoln
35.413858°
-81.013794°
5.40
PeB2 - Pacolet
11
NC-LT-46-07
LTJ Properties LLC
Lincoln
35.442781°
-81.008003°
7.00
PeB2 - Pacolet
12
NC -LT 46-08
LTJ Properties LLC
Lincoln
35.405769°
-81.041036°
6.60
CeB2 - Cecil
9
NC-LT-46-09
Jones, Tony
Lincoln
35.410469°
-81.026819°
7.30
LdB2 - Lloyd
10
WQ0001863 Version 3.1
Attachment B
Page 1 of 2

ATTACHMENT 11— Approved Land Application Sites
City of Mount }lolly
Certification Date: April 2, 2018
)Permit Number: WQ0001863 Version: 3.1
Total for Lincoln County
151.16
NC-MG-37-01
Connell, Dean Stewart
Mecklenburg
35.296461°
-80.988744°
20.20
CeB2 - Cecil
13
Total for Mecklenburg County
20.20
Total
316.60
to 13. See Figure 1 to 13, respectively.
14. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by
Thomas W. Springs, III (of 400 West Catawba Avenue, Mount Holly, NC 28120), regardless of whether a surface or a subsurface application method is used.
15. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by
Glinda Mabe (of 2409 Marshall Allen Trail, Bessemer City, NC 28016), regardless of whether a surface or a subsurface application method is used.
16. The landowner shall provide a stream crossing for application vehicles prior to land application on the other side of the stream.
WQ0001863 Version 3.1
Attachment B Page 2 of 2

>V V VL
> <
A A A t_
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
x x x FENCE
PROPERTY LINE
Q SOIL DESCRIPTION
•
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
660' 0 660'
OFFSITE HOUSE 1...pmeleamt.immesminatgerei
OUTBUILDING
WELL
GRAPHIC SCALE
1" = 660'
Figure 1
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-CL-11
Fields 1-2

> a
AA At
:c x
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
— STREAM
— — DRAIN
x FENCE
PROPERTY LINE
SOIL DESCRIPTION
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
Q OUTBUILDING
0 WELL
GRAPHIC SCALE
1" 660`
660' a 860'
Figure 2
i he 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-CI.12
Field 1

Legend
See1:10 It ONO
Stream
Drain
x -- x - Fence
PropertyLine
ApplicationArea
Site; - `' 41
OnSiteHouse
OffSiteHouse(SWAA-1)
OfSiteHouse
Outbuilding
Church
Appikation Area Map
School
OnSiteWefl
Unsuitable
Figure 3
1 inch 660 feet
(all locations approximate)
The compliance boundary fG established at
either 250 feat from the residuals application
area or 50 feet within 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.
Feet
0 160320 640 960 1,280

Legend
Drain
x — x - Fence
F-1 PropertyLine
a;[ ApplicationArea
Site: NG-GA-44
OnSiteHouse
OnSiteHouse
Church
Outbuilding
OnSiteWell
1-0-1 OffSiteWell
Unsuitable
Figure 4
Application Area _Map
1 inch = 660 feet
(all locations approximate)
The compliance boundary is established at
either 260 feet from the residuals application
area or 50 feet within 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.
Feet
0 160320 640 960 1,280

Legend
---- Stream
x — x - Fence
PropertyLine
SJ ApplicationArea
Site: NC-GA-45
OnSiteHouse
OffSiteHouse
OffSiteHouse(SWAA)
Outbuilding
cH
Application Area 1111gp
OnSiteWell
OffSiteWell
Unsuitable
Figure 5
1 inch = 660 feet
(all locations approximate)
The compliance boundary ill established at
either 250 feet from tho residuals application
area or 50 feet within the property boundary,
whichever Is closest to the application area.
The review boundary Is established midway
between tho compliance boundary and the
perimeter of the residuals apptication area.
Feet
0 160320 640 960 1,280

Legend
stream
°m° — Drain
x--x- Fence
ApplicationArea
SiCCLTL43
L
PropertyLine
OffSiteHouse
Outbuilding
OnSiteWell
OnSiteWell
Unsuitable
Figure 6
Application Area Map
1 inch 660 feet
(all locations approximate)
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
0 230 460 920 1,380 1,840

>vvvt
AAA t
APPLICATION MAP
LEGEND
APPUCATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
Q SOIL DESCRIPTION
.'/X2
•
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
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
Figure 7
NC-LT-44
Field 1

9'VVt
A A ",
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
0 SOIL DESCRIPTION
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
0 WELL
GRAPHIC SCALE
1" = 660'
600' 0 600'
Figure 8
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-LT-45
Field 1

Legend
----- Stream
ApplicationArea
SurfaceWater r} OnSiteHouse
x --' X - Fence
OffSiteHouse
PropertyLirte ri Outbuilding
Site NC LT46; Fields 1, 3, 8
OnSiteWell
O Soil©escription
Unsuitable
V//
Figure 9
230 460
1 inch 660 feet
(all locations approximate)
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area
The review boundary is established midway
between the compliance boundary and the
perimeter ofthe residuals application area.
Feet
920
1,380 1,840

Lend
1.0.1MIFINO Stream
=1 SurfaceWater
X x Fence
PropertyLine
ApplicationArea
Site: NC-LT-46; Fll
OnSiteHouse
OiSiteliouse
Outbuilding
OnSiteWell
1-0-1 OffSiteWell
C) SoilDescriptlon
Unsuitable
Figure 10
ids 2, 45, 9
0 225 450
1 Inch 660 feeg
locations approxin2age)
The compliance boundary is established at
either 260 feet from the residuals application
area or SO feet within 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.
Feet
900 1,350 1,800

Legend
------ Stream
1 1
ApplicafionArea \ OnSiteWell
SurfaceWater OnSiteHouse
x -- x - Fence
OffSiteHouse
Pro ert Line Outbuilding
Site: NC-LT-46; Field 6
0
SoilDescription
Unsuitable
Figure 11
0
Alica tion Area Ma
1 inch 660 feet
(all locations approximate)
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within 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.
Feet
230 460 920 1,380 1,840

Legend
Drain ApplicationArea O
Stream OnSiteHouse
SurfaceWater OffSiteHouse
Fence
Outbuilding
PropertyLine OnSiteWell
Site: NC-LT-46; Field 7
///
SoilDescription
Unsuitable
Figure 12
Application Area
1 inch 660 feet
(all locations approximate)
The compliance boundary is established at
either250 feet from the residuals application
area or 60 feet within 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.
Feet
0 230 460 920 1,380 1,840

``\
1DeetsIon of Watev Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM; SWA 11-13
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 website al:
http.-/6)ortal.ncdenr.ordweb/wq/aps/lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to he
maintained as part of project site(s) in accordance with 15A' NCAC 02T .1108(b)(2Jjfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form. (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
D Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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 property from which a waiver is being sought.
El Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
•a
.h
AGIREEleIENT TO WAIVE THE SETBACK REQUIEED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
:Cite undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
6: 14 cslc mt • 4911.
hereinafter referred to as the Permittee, to land apply residuals within / ' 0 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 9OCR L.$1-Ave-
City: / State: /Ve Zip:
This Agreement shalt remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
l I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore,1 certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein,
Property owner name:
Signature:
fry J
FORM: SWA 11-13 Page 1 of 1

Divtaloua of Watea• Resounces
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 11-13
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 website at:
ht;/mortal.ncdenr.org'web/wa/aps/lau
•
General — This document is an agreement between the Applicant and the owners) of thp•property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A .NCAC 02T .1108(bl(2)Ifor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 11-13).
A. Setback Waiver Agreement:
. Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 11-13) 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.
E' Prepare a separate agreement for each property from which a waiver is being sought.
[4 Any other setbacks required by 15A NCAC 02T .1I08, other than those referenced above, cannot be waived through
execution of this agreement.
Q� A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
c.. --ally
NC- 64- 4 S — of
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the following:
Location address of property:
boa
feet (Le., cannot be less than 100 feet) of
fri/ Tre
City: Be eo ems' Ci 9 State: Zip: 0*
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
day in advance, modifies or cancels this Agreement.
L 1 certify that 1 am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: GliiJ.,
Signature: ¢/%%t G Date: _�r, J d 1`1
�/�/�
FORM: SWA 11-13
Page 1 of I

Environmental
Quality
State of North Carolina
Division of Water Resources
Water Quality Regional Operations Section
Staff Report
To: ❑ NPDES Unit ® Non -Discharge Unit
Attn: [e-mail]
From: [e-mail]
Mooresville Regional Office
Application No.: WQ0001863
Facility name: City of Mount Holly RLAP
County: Gaston
Note: This form has been adapted from the non -discharge facility staff report to document the review of both non -
discharge and NPDES permit applications and/or renewals. Please complete all sections as they are applicable.
I. GENERAL AND SITE VISIT INFORMATION
1. Was a site visit conducted? ® Yes or n No
a. Date of site visit: Facility Inspection 2-15-18; Land reviewed 2-28-18
b. Site visit conducted by: Maria Schutte
c. Inspection report attached? ❑ Yes or /1 No Sent in separate email.
d. Person contacted: Adam Brigman and their contact information: (704) 650 - 4341 ext.
e. Driving directions: The WWTP facility is located at 201 Broome St, Mt. Holly, NC 28120; however, the field
locations are too complicated to write here.
2. Discharge Point(s): NA -this is a non -discharge permit
Latitude: Longitude:
Latitude: Longitude:
3. Receiving stream or affected surface waters: NA -this is a non -discharge permit
Classification:
River Basin and Sub -basin No.
Describe receiving stream features and pertinent downstream uses:
II. PROPOSED FACILITIES: NEW APPLICATIONS
1. Facility Classification: (Please attach completed rating sheet to be attached to issued permit)
Proposed flow:
Current permitted flow:
2. Are the new treatment facilities adequate for the type of waste and disposal system? n Yes or ❑ No
If no, explain:
3. Are site conditions (soils, depth to water table, etc.) consistent with the submitted reports? ❑ Yes n No ❑ N/A
If no, please explain:
4. Do the plans and site map represent the actual site (property lines, wells, etc.)? ❑ Yes n No ❑ N/A
If no, please explain:
5. Is the proposed residuals management plan adequate? ❑ Yes ❑ No ❑ N/A
If no, please explain:
FORM: WQROSSR 04-14 Page 1 of 5

6. Are the proposed application rates (e.g., hydraulic, nutrient) acceptable? n Yes n No ❑ N/A
If no, please explain:
7. Are there any setback conflicts for proposed treatment, storage and disposal sites? ❑ Yes or ❑ No
If yes, attach a map showing conflict areas.
8. Is the proposed or existing groundwater monitoring program adequate? ❑ Yes ❑ No ❑ N/A
If no, explain and recommend any changes to the groundwater monitoring program:
9. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ❑ N/A
If yes, attach list of sites with restrictions (Certification B)
Describe the residuals handling and utilization scheme:
10. Possible toxic impacts to surface waters:
11. Pretreatment Program (POTWs only):
III. EXISTING FACILITIES: MODIFICATION AND RENEWAL APPLICATIONS
1. Are there appropriately certified Operators in Charge (ORCs) for the facility? // Yes ❑ No ❑ N/A
ORC: Doug Shoutd Certificate #: LA-1000246 Backup ORC: Mike Moretz Certificate #:LA-989274
2. Are the design, maintenance and operation of the treatment facilities adequate for the type of waste and disposal
system? ® Yes or n No
If no, please explain:
Description of existing facilities:
Proposed flow:
Current permitted flow:
Explain anything observed during the site visit that needs to be addressed by the permit, or that may be important
for the permit writer to know (i.e., equipment condition, function, maintenance, a change in facility ownership,
etc.)
3. Are the site conditions (e.g., soils, topography, depth to water table, etc.) maintained appropriately and adequately
assimilating the waste? ® Yes or ❑ No •
If no, please explain: This response refers to the 4 new proposed sites. Soils and depth to water table as
determined by the LSS were not re-examined via additional borings, only by site topography.
4. Has the site changed in any way that may affect the permit (e.g., drainage added, new wells inside the compliance
boundary, new development, etc.)? ❑ Yes or ® No
If yes, please explain:
5. Is the residuals management plan adequate? ® Yes or ❑ No
If no, please explain:
6. Are the existing application rates (e.g., hydraulic, nutrient) still acceptable? a Yes or ❑ No
If no, please explain: Will always have a potential for change, should crop cover change.
7. Is the existing groundwater monitoring program adequate? n Yes ❑ No ® N/A
If no, explain and recommend any changes to the groundwater monitoring program:
8. Are there any setback conflicts for existing treatment, storage and disposal sites? ® Yes or ❑ No
If yes, attach a map showing conflict areas. MRO staff noted a change in proposed buffers (ditch vs stream)
for site NC-CL-11 field 1. See additional information request below.
9. Is the description of the facilities as written in the existing permit correct? ® Yes or ❑ No
If no, please explain:
10. Were monitoring wells properly constructed and located? ❑ Yes ❑ No ® N/A
If no, please explain:
FORM: WQROSSR 04-14 Page 2 of 5

❑ Notice(s) of violation
11. Are the monitoring well coordinates correct in BIMS? ❑ Yes ❑ No ® N/A
If no. please complete the following (expand table if necessary):
Monitoring Well
Latitude
Longitude
o ,
„
0 ,
-
II
o ,
„
- 0 ,
II
o ,
„
- 0 ,
II
o ,
„
- 0 ,
II
o ,
„
0 ,
II
12. Has a review of all self -monitoring data been conducted (e.g., DMR, NDMR, NDAR, GW)? // Yes or ❑ No
Please summarize any findings resulting from this review:
Provide input to help the permit writer evaluate any requests for reduced monitoring, if applicable.
13. Are there any permit changes needed in order to address ongoing BIMS violations? ❑ Yes or ® No
If yes, please explain:
14. Check all that apply:
No compliance issues ❑ Current enforcement action(s) ❑ Currently under JOC
❑ Currently under SOC ❑ Currently under moratorium
Please explain and attach any documents that may help clarify answer/comments (i.e., NOV, NOD, etc.)
If the facility has had compliance problems during the permit cycle, please explain the status. Has the RO been
working with the Permittee? Is a solution underway or in place?
Have all compliance dates/conditions in the existing permit been satisfied? ® Yes ❑ No ❑ N/A
If no, please explain:
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit?
Yes ®No❑N/A
If yes, please explain:
16. Possible toxic impacts to surface waters:
17. Pretreatment Program (POTWs only):
FORM: WQROSSR 04-14 Page 3 of 5

IV. REGIONAL OFFICE RECOMMENDATIONS
1. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes or n No
If yes, please explain:
2. List any items that you would like the NPDES Unit or Non -Discharge Unit Central Office to obtain through an
additional information request:
Item
Reason
Corrected Map and
Acreage for NC-CL-11,
Field 1
A stream buffer setback needs to be applied to the center portion of the field
where the two tree lines connect and along the East tree line. (Revisions were
discussed with Adam Brigman (Synagro) and Doug Shoutd (Mt. Holly) while
on -site.) Also note that the landowner is to provide access across the stream to
the additional land.
O&M plan
Language needs to be updated. Mt. Holly has in-house LA program, so weekly
visitation language is requested to be updated to within 48hrs language in -line
with the 08G rules.
Back ground metals
As per Troy's email
3. List specific permit conditions recommended to be removed from the permit when issued:
Condition
Reason
4. List specific special conditions or compliance schedules recommended to be included in the permit when issued:
Condition
Reason
Highlight language about
additional fertilizer
tracking requirements in
the cover letter.
One of the permittees has a small collection of Turkey, but has been known to
use chicken litter in the past.
5. Recommendation: ® Hold, pending receipt and review of additional information by regional office
❑ Hold, pending review of draft permit by regional office
❑ Issue upon receipt of needed additional information
❑ Issue
n Deny (Please state reasons: )
6. Signature of report preparer: Maria Schutte March 1, 2018
Signature of regional supervisor: 4frt ,ut- 7V,20iL
Date: 03/02/2018
FORM: WQROSSR 04-14
Page 4 of 5

V. ADDITIONAL REGIONAL STAFF REVIEW ITEMS
FORM: WQROSSR 04-14 Page 5 of 5

D
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON -DISCHARGE APPLICATION REVIEW REQUEST FORM
To:
January 30, 2018
QRO.S, Andrew4 till / Corey 73as zlger ;;
From: Troy Doby, Water Quality Permitting Section - Non -Discharge Permitting Unit
RECEIVED/NCDENR/DWR
FEB 1 2018
WQROS
MOORESVILLE REGIONAL OFFICE
Permit Number: WQ0001863 Permit Type: Land Application of Residual Solids (503)
Applicant: City of Mount Holly Project Type: Major Modification
Owner Type: Municipal Owner in BIMS? Yes
Facility Name: City of Mount Holly RLAP Facility in BIMS? Yes
Signature Authority: David E. Johnson Title: Utilities Director
Address: PO Box 406, Mt. Holly, NC 28120 County: Gaston
Fee Category: Non -Discharge Major Fee Amount: $395 - Major Modification
Comments/Other Information:
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:
►1
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: 2,4s �� N/� Date: > & / 2e/ g7
FORM: WQROSNDARR 09-15
Page 1 of 1

Water Resources
ENVIRONMENTAL QUALITY
January 30, 2018
DAVID E. JOHNSON — UTILITIES DIRECTOR
CITY OF MOUNT HOLLY
PO Box 406
MT. HOLLY, NORTH CAROLINA 28120
Dear Mr. Johnson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
RECEIVED/NCDENR/DWR
FEB 1 2018
WQROS
MOORESVILLE REGIONAL OFFICE
Subject: Acknowledgement of
Application No. WQ0001863
City of Mount Holly RLAP
Residuals Management System
Gaston County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on January 30, 2018. Your application package has been assigned the
number listed above, and the primary reviewer is Troy Doby.
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
Troy Doby at [phone] or [e-mail].
cc:
mores r:lelBega,® Off
Permit File WQ0001863
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
unlit y:Regianal Operation: 'ectiio.
� '`Nothia�q Compares - -
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

January 26, 2018
N.C. Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section — Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
ATTENTION: Mr. Nathaniel Thornburg
RECE.I\ISDR\ICOSGIVOR
J AN 2.014
i\lon_Disch rge
Perm►'un9
Unit
REFERENCE: APPLICATION FOR MODIFICATION OF PERMIT #
WQ0001863 CITY OF MOUNT HOLLY
Dear Mr. Thornburg:
On behalf of the City of Mount Holly, Synagro is submitting this application to modify the
referenced residuals land application permit.
Contained in this modification is the addition of 122.4 acres, comprised of four sites. The
required maps are being submitted for all new sites. Forms RLAP and LASC are included,
along with other required forms and documentation. Those sites include:
• C1-11 (40.5 acres)
• CL-12 (51.2 acres)
• LT-44 (15.7 acres)
• LT-45 (15 acres)
Enclosed is a check for $395.00 to cover the fee associated with a permit modification.
This application package should contain all of the information necessary to complete the
requested renewal of the City of Mount Holly's petnnit. However, if you require additional
information or have further questions, please contact me at [phone] or
[e-mail]. Thank you in advance for the timely and efficient review of this
modification application.
Sincerely,
Adam Brigman
Technical Services Specialist
Synagro
CC: David Johnson, Utilities Director, City of Mount Holly
[e-mail]
RECEIVED/NCDENR/OWRR
FEB 12018
WQROS
MOORESVILLE REGIONAL OFFICE
12701 Lancaster Highway, Pineville NC, 28134 • Phone: [phone] • Fax: [phone]

_-p
DWR
° Division of Water Resources
RECEIVEDINCDEQIDWR State of North Carolina
JAN 0 2018 Department of Environmental Quality
Division of Water Resources
15A1t1ACEl 1Ian l0 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIO14SIp10 U10: 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) foim. 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)
El Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
a
Facility Classification
New Permit
Major Modification 1
Major (land are permitted for >_ 300 acres)
$1,310
$395
Minor (land are permitted 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 peinuitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1C .0300)
Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the
residuals treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands
are used for the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16
Page 1 of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
Submit the O&M Plan in accordance with 15A NCAC 02T .1110 and include at a minimum:
EI 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.
Er 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.
Er Inspection plan including the following infounation;
/1 Names and titles of personnel responsible for conducting the inspections.
15 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.
El 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.
El Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event.
The sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are
applicable:
Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed
irrigation facilities or irrigation facilities fed through a fixed supply system.
Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program defmitions.
G. Program Information
[] Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of 11" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
fl 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
111 Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new
sites)
❑ Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover
crops and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.org/Rules Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
• Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer
and/or Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2). For Modifications, submit an updated
site map specific to the modification(s) only.
El The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the
new units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
El Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1104(d)(5) and current Division Policy
available at: http://www.ncwater.org./Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
El Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement running with the land specifically indicating the intended use of the property and meeting the requirements
of 15A NCAC 02L .0107(f), or
E A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well'as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16
Page 3 of 3

D R
„Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Mount Holly
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State 02/ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: (David Johnson Title: Utilties Director
Applicant's mailing address: ;'.::0. Box 406
City: Mt. Holly; State: lVC
Telephone number: [phone]
2. Consultant's name:
Zip:
Email Address: david [e-mail]
License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm: )
Consultant's mailing address:
City:
State: Zip: -
Telephone number: 0 -
3. Agronomist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm:
Email Address:
Agronomist's mailing address: I
City: _ 1 State: I Zip:
Telephone number: ( -i) I Email Address: '
4. Soil Scientist's name: Chris Murray, License Number: 1284
Affiliation: ❑ N/A ❑ On Staff
Retained (Finn: Piedmont Environmental)
Soil Scientist's mailing address:18004 Linville Rd, Ste. C2
City: Oak Ridge State: NiC Zip: 27310-
Telephone number: [phone] Email Address: [e-mail]
5. Fee submitted: (See Instruction B)
H. PERMIT INFORMATION:
RECEIVEDINCDEQIDWR
J AN 3 0 2013
Non -Discharge t
Permitting
1. Application is for (check all that apply): D. new, /1 modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Peimit number: W00001863.
Date of most -recently issued permit: December 1, 2014
Date of most -recently certified Attachment A (if different than the permit): December 1, 2014
Date of most -recently certified Attachment B (if different than the permit): December 1, 2014
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 201 Broome St!
City: !Mount Holly State NC
Zip: 281204
. I
Coordinates: Latitude: 5° i16' 7" Longitude: I81!° 00' 411"
Datum: NAD 83;
Method of measurement: MAP
2. County where residuals land application program is headquartered: ;Gaston
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:
Level of accuracy: Second
Designation
Name
Affiliation
Certification Number
ORC
City of Mount Holly
1000246
Doug _Shoutd
Back -Up ORC
Michael Ben Moretz
City of Mount Holly
989274
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide
the candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training
school and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in
the following table:
Maximum amount of residuals to be certified::9id 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
34.69
45.43
27,058
35,432
Five Year Maximum Adjusted
49_O1
59.75;
38,228
46,602
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
` __ f
Row Crops
115.5
1
Hay
9246
�__ _�
Pasture
257.4
J
Total:
365:5;
1_•
Methods
Surface
365.5
1 i
Incorporation or Injection
r___ !
; - _]
Total:
365.5
______I
FORM: RLAP 06-16
Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac-yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
712.0
960
984.1
1232_l
100
356
492
616
480
150
237.3'
320
328
410.7
200
178
240
246�,
308
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector
reduction practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): Non -dedicated C] Dedicated
If Dedicated, specify the following (check all that apply):
E] Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than
agronomic rates, explain;
❑ Residuals program contains any land application_ site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or
irrigation facilities fed through a fixed supply system, explain; _
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification.doc
FORM: RLAP 06-16
Page 3 of 5

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

Spplicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with
any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
I,
Yes ❑ No, Explain; F-
a UII� E id 1%T LiPts7-D/00-6 PIC
(Signature Authority's Name — PLEASE PRINT)
attest that this application for
(Title)
cL lIv /mac%vl /kice.
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water
Resources may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes
unless specifically granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate
enforcement action, which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any
alse statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine
Lot to exceed $10,000 as well as civil F enalties up to $25,000 per violation.
Signature:
Date:
//7/le�dB
FORM: RLAP 06-16 Page 5 of 5

Pat McCrory
Governor
4 7
NcIDENR
North Carolina Department of Environment and Natural Resources
David Johnson — Utility Director
City of Mount Holly
P. O. Box 406
Mount Holly, NC 28120
Dear Mr. Johnson:
John E. Skvarla, III
Secretary
December 4, 2014
Subject: Permit No. WQ0001863
City of Mount Holly 503 Residuals
Land Application of Class B Residuals (Non -Dedicated)
Gaston County
In accordance with a written request received December 4, 2014 from Drew Culp, we are
forwarding herewith corrected Attachment B of Permit No. WQ0001863 issued December 1, 2014.
The correction to the subject permit is as follows:
1. Net acreages for fields contained in Attachment B.
Please replace Attachment B of Permit No. WQ0001836 issued December 1, 2014 with the
enclosed corrected Attachment B.
If you need additional information concerning this permit correction, please contact Troy Doby at
[phone] or [e-mail].
Sincerely,
1
Thomas A. Reeder, Director
Division of Water Resources
Enclosure
cc: Gaston County Health Department ([e-mail]) (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Synagro Central, LLC ([e-mail]) (Electronic Copy)
Marshall Puryear ([e-mail]) (Electronic Copy)
Eric Thompson ([e-mail]) (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: htlp:llportal.ncdenr.orglwehlwq
An Equal Opportunity 1 Affirmative Acllon Employer— Made in part with recycled paper

cx
NC ERR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
December 1, 2014
David Johnson — Utility Director
City of Mount Holly
P. O. Box 406
Mount Holly, NC 28120
Subject: Permit No. WQ0001863
City of Mount Holly 503 Residuals
Land Application of Class B Residuals (Non -Dedicated)
Gaston County
Dear Mr. Johnson:
In accordance with your permit renewal and major modification request received October 1,
2014, and subsequent additional information received November 24, we are forwarding herewith Permit
No. WQ0001863 dated December 1, 2014, to City of Mount Holly for the continued operation of the
subject residuals management program.
This permit shall be effective from December 1, 2014 until November 31, 2019, shall void Permit
No. WQ0001863 issued December 31, 2013, and shall be subject to the conditions and limitations as
specified therein. Please pay particular attention to the monitoring requirements listed in Attachments A
and B for they may differ from the previous permit issuance. Failure to establish an adequate system for
collecting and maintaining the required operational information shall result in future compliance
problems.
Modifications to the subject permit are as follows:
1. Fields NC-GA-44-02 and NC-GA-44-03 are deleted from Attachment B.
2. Fields NC-GA-45 and NC-LT-46-09 are added to Attachment B.
3. Decrease in acreage for NC-MG-37-01 from 20.7 to 20.2 acres.
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: http://portal.ncdenr.orq/web/wq
An Equal opportunity \ Affirmative Action Employer— Made in part with recycled paper

Mr. David Johnson
December 1, 2014
Page 2 of 2
If you need additional infonnation concerning this matter, please contact Troy Doby at (919) 807-
6336 or [e-mail].
Sincerely,
r, Thomas A. Reeder, Director
Division of Water Resources
cc: Gaston County Health Department ([e-mail]) (Electronic Copy)
Mooresville Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Synagro central, LLC ([e-mail]) (Electronic Copy)
Marshall Puryear ([e-mail]) (Electronic Copy)
Eric Thompson ([e-mail]) (Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AN NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS +: RESIDUALS PERMIT (NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Mount H®lty
Gaston County
FOR THE
continued operation of a residuals management program for the City of Mount Holly and consisting of the
land application of Class B residuals generated by the approved facilities listed in Attachment A to the
approved sites listed in Attachment B with no discharge of wastes to surface waters, pursuant to the
application received October 1, 2014, and in conformity with other supporting data subsequently filed and
approved by the Department of Environment and Natural Resources and considered a part of this permit.
The use and disposal of residuals are regulated under Title 40 Code of Federal Regulations Part 503. This
permit does not exempt the Permittee from complying with the federal regulations.
This permit shall be effective from December 1, 2014 until November 31, 2019, shall void Permit No.
WQ0001863 issued December 31; 2013, and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES
IL
1. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application.
PERFORMANCE STANDARDS
1. The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Mooresville regional office supervisor, and take any
immediate corrective actions.

2. This permit shall not relieve the Peunuittee of their responsibility for damages to groundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the following Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs):
ParameterCeiling
Concentration
(milligrams per kilogram)
CPLR
. , (pounds per acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
n/a
Nickel
420
374
Selenium
100 •
89 .
Zinc
7,500
2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application have not occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC
02T .1106 (a) and (c). Exceptions to this requirement shall be specified in Attachment A.
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to this requirement shall be specified in Attachment A.

8. Setbacks for Class B land application sites shall be as follows:
Setback tescription
Setback by application type
(feet)
Vehicular
Surface
Application
Irrigation
Surface
Application
Injection /
Incorporation
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
part of the project site
•
400 .
400
200
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
lessee/operator of the land to be maintained as part
of the project site
0
200
-
0
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100 -
100
Surface waters (streams — intermittent and perennial,
perennial waterbodies, and wetlands)
100
100
50
Surface water diversions (ephemeral streams,
waterways, ditches)
25
100
25
Groundwater lowering ditches (where the bottom of
the ditch intersects the SHWT)
25
100
25
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
more in vertical height
15
15
15
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
9. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
10. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science (http://nutrients.soil.ncsu.edu/yields/index.php).
A copy shall be kept on file and reprinted every five years in accordance with Condition IV.6.

c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter 1
(http://www.ncagr.gov/SWC/tech/documents/9thGuidance Doc 100109.pdf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards (fip://ftp-fc.sc.egov.usda.gov/NHQ/practice-standards/standards/590.pdf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards.
12. If land application sites are to be over -seeded or double -cropped (e.g., beunuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied.
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee
shall maintain written records of these recommendations and details of their implementation.
14. The compliance boundary for residual land application sites shall be specified in accordance with
15A NCAC 02L .0107(b). These sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application
area. An exceedance of groundwater standards at or beyond the compliance boundary is subject to
remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B.
15. In accordance with 15A NCAC 02L .0108, the review boundary shall be established midway between
the compliance boundary and the residual land application area. Any exceedance of groundwater
standards at the review boundary shall require action in accordance with 15A NCAC 02L .0106.
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The residuals management program shall be properly maintained and operated at all times. The
program shallbe- effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards.

2. The Mooresville Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall be notified at Least
48 hours prior to the initial residuals land application to any new land application site. Notification to
the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday,
excluding State Holidays.
3. The Mooresville Regional Office shall be notified via email or telephone, [phone] at least 24
hours prior to conducting any land application activity. Such notification shall indicate, at a
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply toadditional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields.
4. The Permittee shall maintain an approved Operation and Maintenance Plan (O&M Plan) pursuant to
15A NCAC 02T .1110. Modifications to the O&M Plan shall be approved by the Division prior to
utilization of the new plan. The O&M Plan, at the minimum, shall include:
a) Operational functions;
b) Maintenance schedules;
c) Safety measures;
d) Spill response plan;
e) Inspection plan including the following information:
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, and
procedures to assure that the selected location(s) and inspection frequency are representative
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuant to the
noncompliance notification requirements under the monitoring and reporting section of the
permit;
f) Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for
any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that
land apply multiple times per year but have an annual sampling frequency, may need to
sample during winter months when pathogen reduction is most likely to be negatively
affected by cold temperatures).
5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee shall designate and employ a certified operator in
responsible charge (ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC 08G .0201. The ORC or their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition III. 4.,
and shall comply with all other conditions of 15A NCAC 08G. 0204. For more information regarding
classification and designation requirements, please contact the Division of Water Resources'
Technical Assistance & Certification Unit at [phone].
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M Plan shall
be maintained at the land application sites during land application activities.

7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles.
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division.
9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied, or application shall be in accordance with the
crop management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, or an agronomist
and as approved by the Division.
11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of
surface water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100-year flood elevation, unless the bulk residuals are injected or incorporated within
a 24-hour period following a residuals land application event;
f. During a measurable precipitation event (Le., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a final soil pH of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6.0) will be noted in this permit;
i. If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24 hour period following a residuals land application event. Any field that is in
a USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
g.
12. Thefollowing public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event.

13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under I11.12 apply.
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
Duration
Animals shall not be allowed to graze during land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
prevent access after each land application event.
30 days
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for:
12 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e.g., tobacco, melons, cucumbers, squash, etc.)
shall not be harvested for:
14 months
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the land
surface (e.g., root crops such as potatoes, caiTots, radishes, etc.) shall not be
harvested for:
20 months
When the residuals remain on the land surface for less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
surface shall not be harvested for:
38 months
15. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for
those operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (NRCS) or other State Agencies. The Permittee shall calculate allowable
nutrient loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan.
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LOAA)
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permit .expiration date,
and shall be renewed during the permit renewal process.
IV. MONITORING AND REPORTING REQUIREMENTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed.
2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitability, reactivity, and toxicity
characteristic leaching procedure (TCLP)] shall be performed at the frequency specified in
Attachment A, and the Permittee shall maintain these results for a minimum of five years. Any

exceptions from the requirements in this condition shall be specified in Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):
Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7) .
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)Heptachlor
(and its hydroxide)
(0.008)
Toxaphene (0.5)
Chlorofoun (6.0)
Hexachloro-1,3 butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
2,4,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A,
the Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Pennittee shall maintain the results for a minimum of five years.
The analysis shall include the following parameters:
Aluminum
Mercury
Potassium
Ammonia -Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified. in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficient to demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c), and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
condition shall be specified in Attachment A.

5. An annual representative soils analysis (i.e., Standard. Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomi/pubs.htm). The Permittee shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a period of no less than five years, and shall be made available to the Division upon request. At a
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
• Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied, and shall
be in accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Permittee shall maintain records tracking all residual land application events. At a minimum,
these records shall include the following:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops to be grown on field;
j. Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in gallons per acre, cubic yard per acre, dry tons per acre, or wet
ton per acre;
1. Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
m. Volume of soil amendments (e.g., lime, gypsum, etc.) applied in gallons per acre, dry ton per
acre, or wet tons per acre; and
n. Annual and cumulative totals in dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be limited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.

8. Three copies of an annual report shall be submitted on or before March 1st. The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Points. Instructions for reporting and annual report forms are available at
http://portal.ncdenr.org/web/wq/aps/lau/reporting, or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
9. Noncompliance Notification
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, as soon as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self-monitoringindicates the facility has gone out of compliance with its permit
limitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment. -
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
V. INSPECTIONS
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
environment, a threat to human health or a public nuisance. The Permittee shall maintain an
inspection log that includes, at a minimum, the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this inspection log
for a period of five years from the date of inspection, and this log shall be made available to the
Division upon request.
3. Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premises or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this .permit; may inspect or
copy any records required to be maintained under the terms and conditions of this permit; and may
collect groundwater, surface water or leachate samples.

GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Pernittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C.
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit.
3. This permit is effective only with respect to the. nature and volume of residuals described in the
permit application and other supporting documentation.
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4
and under the Division's General Permit NCG010000;. any requirements pertaining to wetlands under
15A NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of
Chapter 143 of the General Statutes.
5. In the event the residuals program changes ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner.
6. This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110.
7. Unless the Division Director grants a variance, expansion of the permitted residuals program
contained herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC
02T .0120(b).
8. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e)(3).
Permit issued this the 15t day of December 2014
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
ceder, Director
'vision of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0001863

P
t
ed,
ge
Left
• t
111

ATTACHM L. - Approved Residual Sources
City of Mount Holly
Certification Date: Decem I/O14
Permit Number: WQ0001863 Version: 3.0
Owner
4` ..
Facility Name
•
County
Permit
Number
Biological
Residuals
Maximum
Dry Tons
Per Year 1
Monitoring
Frequency for
Non -hazardous 2
CharacteristicsNutrients
Monitoring
Frequency for
Metals and
s
Monitoring
Frequency for
pathogen &
Vector Attraction
Reductions t's'6
Approved
Mineralization
Rate
City of Mount Holly
Mt. Holly WTP
Gaston
01-36-020
No
130
Annually
Annually
N/A6
0.40
City of Mount Holly
Mt. Holly WWTP
Gaston
NC0021156
Yes
780
Annually
Annually
Annually
0.40
Total
910
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility. .
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of -metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IV.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above,
Dry Tons Generated
(short tons per year)
Monitoring Frequency •
(Established in 40 CFR 503 and 15A NCAC 02T .1111)
<319
1/Year
=>319 - <1,650
1/ Quarter (4 times per year)
=='
I,650 - <16,500
1/60 Days (6 times per year)
=>16,500
1/month (12 times per year)
6. Water Treatment Plant residuals are exempt from meeting the pathogen & vector attraction reduction requirements in Condition IV.4, provided they are not mixed with residuals that have been
generated during the treatment of domestic wastewater, the treatment of animal processing wastewater, or the biological treatment of industrial wastewater. The Water Treatment Plant / residuals
must be treated and processed in a manner as to not meet the definition of "Biological Residuals" as defined in 15A NCAC 02'I' .1102(6).
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is required), then no
sampling data is required during the period of inactivity. The annual.report shall include an explanation for missing sampling data. Those required to submit the annual
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification.
Page I of 1

Approved Land Application Sites
olly
Certification Date: December 1, 2014
Permit Number: WQ0001863 Version: 3.0
field/ Site
--\ Owner
Lessee
County
Latitude
Longitude
AcrTe�ge
Dominant Soil Series
Foos
NC-GA-41-01
Springs, \n G.
Gaston -
35° 17'
45"
81° 01' 55"
6.80
Madison sandy clay loam, 2 to 8% slopes ,
NC-GA-41-06
Springs, Edwin .
Gaston
35° 17'
51"
81° 01' 52"
14.30
Cecil .7
NC -GA 41 09
Springs, Thomas W.
�r .�,
Gaston
35° 17'
39"
81° 01' 53"
13.50
Cecil
f
NC-GA-41-10
Springs, Edwin Gregory
,,,,�
Gaston
35° 17'
48"
81° 01' 37"
17.50
NC-GA-4I-14
Springs, Edwin Gregory
Gaston
35° 17'
42"
81° 01' 42"
9.70
,° Cecil
NC-GA-44-01
Allen, George Bennett
Ga'
35° 23'
59"
81° 19' 48"
6.90
W, Wee sandy loam, 6 to 15% slopes
NC-GA-45-01
Allen, David and Sharon
Gaston 4...,__
° 2''
47"
81° 17' 10"
17.0 '
Lloyd (LdB2)
NC-LT-43-01
Duckworth, Gary M
Lincoln
35° 25
59' 50"
J
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-02
Duckworth, Gary M
Lincoln
35° 25'
35"
80° 5 ' -
21.00
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-03
Duckworth, Gary M
Lincoln
35° 25'
47"
8 s 56"0
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-04
Duckworth, Gary M
Lincoln
35° 25'
3
80° 59' 41"
6.00acolet
sandy clay loam, 8 to 15% slopes
NC-LT-46-01
Jones, Tony .
Lincoln
3} 4'
32"
81° 02' 27"
11.80
Ceeil%Indy clay loam, 2 to 8% slopes, e
NC-LT-46-02
Jones, Tony
Lincol
35° 24'
39"
81' 02' 15"
45.20
Cecil sandy ,loam, 2 to 8% slopes, e
NC-LT-46-03
Jones, Tony
"incoln
35° 24'
22"
81" 02' 51"
9.90
Cecil sandy clay ]o 8% slopes, e
NC-LT-46-04
Jones; Tony
,
Lincoln
35° 24'
29"
81° 02' 07"
19.40
Cecil sandy clay loam, 2 to''' , slopes, e
NC-LT-46-05
Jones, Tony
���(LdB2)
Lincoln
° '
3524
56"81°01
52
' "
7.90
Lloyd�`'
LdB2 `\ti
NC-LT-46-06
Jones, Tony
.�
Lincoln
35' 24'
50"
81' 00' 50" '
5.40
Pacolet sandy clay loam, 2 to 8% slopes,
NC-LT-46-07
Jones, Ton. ;'
Lincoln
35° 26'
35"
81° 00' 29"
7.00
Pacolet sandy clay loam, 2 to 8% slopes,
NC-LT-46-08
Job, , ony
Lincoln
35° 24'
21"
81° 02' 28"
6.60
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-09
. Jones, Tony
Lincoln
35° 24'
38"
81° 01' 37"
6.60
Lloyd (LdB2)
NC-MG-3- y
Connell, Dean Stewart
Mecklenburg
35° 17'
50"
80° 59' 22"
20.20
Cecil sandy clay loam, 2 to 8% slopes, e
otal
275.60
Page 1 of 1

Aa - Approved Land Application Sites
City of Mount Holly
Certification Date: ;1°ecemiber 11, 20114
Permit Number: WQ0001863 Version: 3.0
Field/ Site
Owner
Lessee
County
Latitude
Longitude
het
Acreage
Dominant Soil Series
Footnotes
NC-GA-41-01
Springs, Edwin G.
Gaston
35° 17' 45"
81° 01' 55"
3.40
Madison sandyclayt o am, 2 to 8% slopes,
•
NC-GA-41-06
Springs, Edwin G.
Gaston
35° 17' 51"
81° 01' 52"
8.90
Cecil
NC-GA-41-09
Springs, Thomas W.
Gaston
35° 17' 39"
81° 01' 53"
4.00
Cecil
NC-GA-41-10
Springs, Edwin Gregory
Gaston
35° 17' 48"
81° 01' 37"
7.90
Cecil
NC-GA-41-14
Springs, Edwin Gregory
Gaston
35° 17' 42"
81° 01' 42"
6.80
Cecil
NC-GA-44-01
Allen, George Bennett
Gaston
35° 23' 59"
81° 19' 48"
7.90
Wedowee sandy loam, 6 to 15% slopes
NC-GA-45-01
Alien, David and Sharon
Gaston
35° 22' 47"
81° 17' 10"
17.00
Lloyd (LdB2)
NC-LT-43-01
Duckworth, Gary M
Lincoln
35° 25' 30"
80° 59' 50"
10.60
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-02
Duckworth, Gary M
Lincoln
35° 25' 35"
80° 59' 46"
21.60
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-03
Duckworth, Gary M
Lincoln
35° 25' 47"
80° 59' 56"
9.60
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-43-04
Duckworth, Gary M
LincoIn
35° 25' 36"
80° 59' 41"
4.80
Pacolet sandy clay loam, 8 to 15% slopes
NC-LT-46-01
Jones, Tony
Lincoln
35° 24' 32"
81° 02' 27"
11.80
Cecil sandy clay Ioam, 2 to 8% slopes, e
NC-LT-46-02
Jones, Tony
Lincoln
35° 24' 39"
81° 02' 15"
45.20
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-03
Jones, Tony
Lincoln
35° 24' 22"
81° 02' 51"
9.90
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-04
Jones, Tony
Lincoln
35° 24' 29"
81° 02' 07"
19.40
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-05
Jones, Tony
Lincoln
35° 24' 56"
81° 01' 52"
7.90
Lloyd (LdB2)
NC-LT-46-06
Jones, Tony
Lincoln
35° 24' 50"
81° 00' 50"
5.40
Pacolet sandy clay loam, 2-to 8% slopes,
NC-LT-46-07
Jones, Tony
Lincoln
35° 26' 35"
81° 00' 29"
7.00
Pacolet sandy clay loam, 2 to 8% slopes,
NC-LT-46-08
Jones, Tony
Lincoln
35° 24' 21"
81° 02' 28"
6.60
Cecil sandy clay loam, 2 to 8% slopes, e
NC-LT-46-09
Jones, Tony
Lincoln
35° 24' 38"
81° 01' 37"
7.30
Lloyd (LdB2)
NC-MG-37-01
Connell, Dean Stewart
Mecklenburg
35° 17' 50"
80° 59' 22"
20.20
Cecil sandy clay loam, 2 to 8% slopes, e
Total
243.20
Page 1 of 1

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0001863 (City of Mount Holly)
Inspection Plan
Inspections will be conducted on a weekly basis at the land application site during activities of this project. Inspection
frequency is based on the time frame to complete the project and the amount of dry tons to be land applied from the
facility. The inspections will consist of inspecting a field that is currently being applied as well as inspecting random
fields that have been completed. These inspections will consist of:
1. Verifying that the "Pre -Operations Check List" has been completed and signed by both operational and technical
staff.
2. Checking the calculated loads to insure the correct amount of residuals are being land applied.
3. Insuring that all manned equipment has a copy of the spill control plan, the permit, and the operations and
maintenance plan.
4. Insuring that the field has been flagged properly and that all buffers are being adhered to.
5. Insuring that the "Crop and Landowner Verification" form has been filled out.
6. Verifying that the residuals have been adequately sampled to confirm compliance.
The records will be kept in the project files in the respective office for the project. The Permittee or Inspector shall
report by telephone to the NCDENR/DWQ Mooresville Regional Office at 704-663-1699, as soon as possible, but no later
than 24 hours after, or the next working day, following the occurrence or first knowledge of the occurrence of the
following.
• Any occurrence with the distribution program resulting in the land application of significant amounts of
material that is abnormal in quantity or characteristics.
• Any failure of the program that results in a release of material to surface waters.
• Any time that self -monitoring information indicates that the program has gone out of compliance with
the permit.
• Any process unit failure that results in the system not adequately treating the residuals.
• Any spill or discharge from a vehicle or piping system during residuals transportation.
Any release that requires immediate reporting outside of normal business hours shall be called in to DENR at 800-662-
7956, 800-858-0368, or 919-733-3300. These numbers are to be called in the event of a release to surface waters or the
imminent failure of a storage system when the event occurs outside of normal business hours. Within 5 days of the first
notice of an occurrence, a written response in the form of a letter shall be sent to DENR outlining the actions taken or
proposed actions taken to ensure that the problem does not recur.
Persons responsible for inspections on this project are as follows:
Adam Brigman Technical Services Specialist, or his designee.

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0001863 (City of Mount Holly)
Sampling Plan
Sampling for this project consists of sampling the residuals once per permit cycle during the permit renewal
process.
The residuals shall be sampled once
parentheses.)
Arsenic (5.0)
Barium (100.0)
Benzene (0.5)
Cadmium (1.0)
Carbon tetrachloride (0.5)
Chlordane (0.03)
Chlorobenzene (100.0)
Chloroform (6.0)
Chromium (5.0)
m-Cresol (200.0)
o-Cresol (200.0)
p-Cresol (200.0)
Cresol (200.0)
2,4-D (10.0)
per permit cycle for the following: (Regulatory level in milligrams per liter in
1, 4-Dichlorobenzene (7.5 )
1, 2-Dichloroethane (0.5)
1, 1-Dichloroethylene (0.7)
2, 4-Dinitrotoluene (0.13)
Endrin (0.02)
Hexachlorobenzene (0.13
Nitrobenzene (2.0)
Pentachlorophenol (100.0)
Pyridine (5.0)
Selenium (1.0)
Silver (5.0)
Tetrachloroethylene (0.7)
Heptachlor (and its hydroxide) (0.008) Toxaphene (0.5)
Hexachloro-1,3-butadiene (0.5) Trichloroethylene (0.5)
Hexachlorethane (3.0)
Lead (5.0)
Lindane (0.4)
Mercury (0.2)
Methoxychlor (10.0)
Methyl ethyl ketone (200.0)
2,4,5-Trichlorophenol (400.0)
2,4,6-Trichlorophenol (2.0)
2,4,5 TP ( Silvex) (1.0)
Vinyl Chloride (0.2)
The residuals will also be sampled, based on the chart below, for the following constituents
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1 time per year
=>319-<1,650
1 per Quarter (4 times per year)
=>1,650-<16,500
1 every 60 days (6 times per year)
=>16,500
1 every month (12 times per year)
Aluminum
Ammonia -Nitrogen
Arsenic
Cadmium
Calcium
Copper
Lead
Sodium Adsorption Ratio (SAR)
Magnesium
Mercury
Molybdenum
Nickel
Nitrate -Nitrite Nitrogen
Phosphorous
Potassium
pH
Plant Available Nitrogen (calculation)
Selenium
Sodium
Total Solids
Total Kjeldahl Nitrogen
Zinc
In order to meet pathogen and vector requirements, the material will be sampled for fecal coliform density and a 30 day
bench test. The samples will be taken from the digester. Additional samples will be taken for TCLP/RCI and nutrients
and metals analysis. Methods of sampling will follow the conditions of the permit and applicable regulations.
The following people are responsible for sampling:
Adam Brigman, Technical Services Specialist, or his designee.

OPERATIONS AND MAINTENANCE PLAN
SYNAGRO RESIDUALS LAND APPLICATION FOR WQ0001863 (City of Mount Holly)
Operational Functions
The operation function of this project is going to involve removing liquid biosolids from a n aerobic digester that is mixed
and pumped by the City of Mt. Roily. The land application contractor will use a dri-prime pump and a load stand to Toad
tankers out of the digester. The biosolids will be transported to the land application site in the tankers to be off loaded
with a liquid spreader. The material is going to be spread with a liquid applicator that will use a vacuum/pressure pump
to off load the liquid to the spreader then switch to pressure to spread the material in such a way to achieve a consistent
spread pattern. The material is going to be land applied on fields that have grass growing on them that are going to
either be grazed or cut for hay for animal feed some fields may be in row crop production and rates will be determined
by RYE for the crop that is going to be grown for animal consumption.
SAFETY MEASURES
Synagro believes in operating in a safety conscious manner and is has all employees participate in quarterly online safety
course that are designed to help its employees recognize safety issues and take steps to prevent accidents from
occurring. In addition all Synagro employees have the authority to stop operations if they think any aspect of the
operation is going to cause environmental or personal harm.
Maintenance Schedule
Synagro will follow the maintenance schedule as recommended by the Synagro fleet manager for the equipment
necessary to complete the job.

SYNAGR
SPILL CONTROL PLAN
PROJECT: City of Mount Holly Permit No. W00001863
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE IMMEDIATELY TAKEN:
1. MANAGEMENT OF CLEANUP ACTIVITIES: The first Synagro representative (whether IC, operator, or
manager) at the scene will begin procedures to halt the spill and call Synagro and City of Mount Holly staff to help
initiate clean up activities. Upon arrival, the Operations Manager will take immediate action to coordinate all
activity. Synagro labor and equipment are to be utilized. In the event additional labor and equipment are required,
assistance shall be requested from the plant operator. Personal protective equipment (PPE) must be worn by all
persons involved in the cleanup activities. PPE will include safety glasses, safety vests, steel toed boots, and
gloves. The Operations Manager shall also communicate with the public on the scene, answering questions and
advising of the cleanup activities.
2. HALT SOURCE OF SPILL: Such as a ruptured container or damaged transport unit.
3. CONTAIN SPILL: Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers
may be constructed to augment the straw bale containment area. The Operations Manager or the person in charge
on the spill site will advise the clean up personnel where to get the straw, lime, and other items necessary to
complete the clean up operation, i.e. local farmers, farm supply center, nursery, etc.
�. CLEAN UP: Employ front end loaders, vacuum equipment, sludge application vehicles, and/or the local septic
tank service to remove as much of the spilled material as possible. Straw and/or sand should be scattered in the
spill area to soak up the remaining material. The straw and sand soaked material will be collected and removed to
a disposal area approved by representatives of the State regulatory agency.
5. FINAL CLEAN UP: Employ a rotary brush sweeper if needed, and apply lime to the spill area upon the approval
of the clean up efforts by the State regulatory representative. If the event occurs on private property, the clean up
will be completed to the satisfaction of the property owner and State regulatory representatives. The ultimate goal
will be to restore the spill area to its original condition, if possible.
6. NOTIFICATION: As soon as possible after the spill occurs, the Synagro Operations Manager or assistant will
notify the local Synagro office, and they will then be responsible for notifying other key Synagro personnel. The
Operations Manager will also be responsible for notifying someone on the project calling list. The contacted City
of Mount Holly representative will call the Mooresville Regional Office of NCDEQ, unless he/she requests
Synagro to call instead.
7. REPORTING: City of Mount Holly/project personnel and/or regional Synagro personnel will notify the Regional
Office of DEQ by telephone as soon as possible, but not more than 24 hours, or on the next working day following
the occurrence. The Operations Manager shall provide a written report within 48 hours of the spill to the Residuals
Management Coordinator (or appropriate City of Mount Holly personnel). The report shall list all relative
information and actions taken. City of Mount Holly or Synagro regional and project personnel will file a written
report to the appropriate regional office of DEQ within 5 days of the occurrence (decided on a case -by -case basis).
Version Date: 01/2018

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

An updated accounting of the land application site's cumulative
pollutant loading rates (CPLRs)
✓
V
Required Item
Status Code
N
R
T
M
For previously permitted sites without a soil series naive indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
✓
V
V
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same time period)
✓
*: This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
Crop Type should include the most likely crop types for the life of the permit (five years).
Predominant Soils Series Name must be either the name of the soil indicated in Attachment `B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
® New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal Trans Mere (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• 'Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
® Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
® Surface water body classifications information may be found at: http://deq.nc.2ov/about/divisions/water-
resources/planning/class ification-standards/classifications
® Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq.nc.gov/contact/regional-offices
® General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planninciclassifrcation-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 WA 1ER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
® Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16
Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Mt Holly
Land application sites currently certified: 243.2 net acres and Total to be certified: 122.3 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Name b
Mapping Unit
or Rep. Slope°
N
CL-11-01
Bowen Family Trust
Andy Bowen
25.31
Cleveland
Pasture
Cecil
CaB2
N
CL-11-02
Bowen Family Trust
Andy Bowen
15.18
Cleveland
Hay
Madison/Pacolet
MaB2
N
CL-12-01
Cedar Lake Farm LLC
Charlie Jones
51.15
Cleveland
Pasture
Hewitt
HhB
N
LT-44-01
Lee Shank
Lee Shank
15.65
Lincoln
Hay
Cecil
CcB
N
LT-45-01
Mike Macomson
Mike Macomson
15.01
Lincoln
Row Crop
Lloyd/Cecil
CcB
I
I a
i 1
l- (
(
f 1
i-1
-
1
]
r 1`
1
1
r -,
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) + M (Modified)
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. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
♦ T (Transferred) + D (Deleted)
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and
Class
Pro osed
p
CL-11-01
35°20'51" N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
7
CL-11-02
35°20'57" N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
F
CL-12-01
35°21' 12.5" N
81°25' 1.8" W
NAD 83
MAP
Second
Broad / 9-53-6
C
_
LT-44-01
35°24'58.5" N
81°9'42.7" W
NAD 83
MAP
Second
South Fork Catawba River / 11-129-(2.5)
WS-IV
r 1
LT-45-01
35°30'51.8"N
81°16'8.7" W
NAD 83
MAP
Second
Hoyle Creek / 11-129-15-(1.5)
WS - IV
Flo ' ill
[j°_'
NAD 83
ADD
Nearest Second
Ij
L_j
1
° 111 b,
��° ( , ,
, �? i J
NAD 83
ADD
Nearest Second
r
1
[l° irjr ILj"
no fir 1"
NAD 83
ADD
Nearest Second
T -1,,
[_-___1
11
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16
Page 1

SYNAGRO CITY OF MOUNT HOLLY
WQ 0001863
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the City of Mount Holly 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, City of Mount Holly, Various Fields

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

North Carolina Department of Environmental Quality
'at McCrory
Governor
Date: b1/19/18
To: Name of Chairman to the Board of County Commissioners: Eddie Holbrook
Complete mailing address: 311 East Marion Street
City: Shelby'; State: 1Q ZipLi
County where land application sites are located: ;Cleveland
From: Applicants name: City of Mt Holly (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: iDavid Johnso
Complete mailing address: P.O. Box 40
City: Mount Holly State: RC Zip: 28120
Telephone number: (704) 458 f1309, E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
vill ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals-
,;enerating 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 Enviromnental 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: Mooresville Regional Office
Complete mailing address: 610 East Center Avenue, Suite 301!
City: Mooresville State: 1V( Zip: 28115-f
Telephone number (704) 663; 41699,
Expected date of application submission: 01/30/18
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet: http:/lportal.ncdenr.orq/web/wq
An Equal Opportunity 1 Affirmative Action Employer— Made in part with recycled paper FORM: CBN 06-16

ATTACILd1ENT A - Approved Residual Sources
City of Mount Holly
Certification Date: December 1, 2014
Permit Number: WQ0001863 Version: 3.0
Owner
Facility Name
•
County
Permit
Number
Biological
Residuals
Maximum
Dry Tons
per Year t
Monitoring
Frequency for
Non -hazardous
Characteristics 2
Monitoring
Frequency for
Metals and
Nutrients •,
Monitoring
Frequency for
Pathogen &
Vector Attraction
�e a
Reductions "
Approved
Mineralization
Rate
City of Mount Holly
Mt. HoIIy WTP
Gaston
01-36-020
No
130
Annually
Annually
N/A6
0.40
City of Mount Holly
Mt. Holly WWTP
Gaston
NC0021156
Yes
780
Annually
Annually
Annually
0.40
Total
910
•
I. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under permit Condition IV.2.
3. Testing of metals and nutrients as stipulated under permit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IV.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
(short tons per year)
Monitoring Frequency
(Established in 40 CFR 503 and 15A NCAC 02T .1111)
<319
1/Year
=:>319 - <1,650
1/ Quarter (4 times per year)
= 1,650 - <16,500
1/60 Days (6 times per year)
=> 16,500
1/month (12 times per year)
6. Water Treatment Plant residuals are exempt from meeting the pathogen & vector attraction reduction requirements in Condition IV.4, provided they are not mixed with residuals that have been
generated during the treatment of domestic wastewater, the treatment of' animal processing wastewater, or the biological treatment of industrial wastewater. The Water Treatment Plant / residuals
must be treated and processed in a manner as to not meet the definition of -Biological Residuals" as defined in 15A NCAC 02'r .1102(6).
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is required), then no
sampling data is required during the period of inactivity. The annual.report shall include an explanation for missing sampling data. Those required to submit the annual
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification.
Page 1 of 1

LAND - 2LICATION SITE CERTIFICATION
Applicant's name: City of Mt Holly
Land application sites currently certified: 243.2 net acres and Total to be certified: 122.3 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction )3):
Status
Code"
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
-
County
Crop(s)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slope'
N
CL-11-01
Bowen Family Trust
Andy Bowen
25.31
Cleveland
Pasture
Cecil
CaB2
N
CL-11-02
Bowen Family Trust
Andy Bowen
15.18
Cleveland
Hay
Madison/Pacolet
MaB2
N
CL-12-01
Cedar Lake Farm LLC
Charlie Jones
51.15
Cleveland
Pasture
Hewitt
BIB
N
LT-44-01
Lee Shank
Lee Shank
15.65
Lincoln
Hay
Cecil
CcB
N
LT-45-01
Mike Macomson
Mike Macomson
15.01
Lincoln
Row Crop
Lloyd/Cecil
CcB
.
r
(
1 1
Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified) ♦ T (Transferred) • 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)
IL WATERBODY AND CLASSIFICATIONS INFORMATION, (See Instruction C):
Site/Field 1D
Latitude
Longitude
g
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class p
CL-11-01
35°20'51" N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
j
CL-11-02
35°20'57"N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
[
CL-12-01
35°21'12.5" N
81°25'1.8" W
NAD 83
MAP
Second
Broad / 9-53-6
C
;'
LT-44-01
35°24'58.5" N
81°9'42.7" W
NAD 83
MAP
Second
South Fork Catawba River / 11-129-(2.5)
WS-IV
I
LT-45-01
35°30'51.8"N
81°16'8.7" W
NAD 83
MAP
Second
Hoyle Creek / 11-129-15-(1.5)
WS - IV
j 1
°'"°
`" "
NAD 83
ADD
Nearest Second
J
i 1°
E' 'I"
° f'
NAD 83
ADD
Nearest Second
L. Of1"
LT. ' E"
NAD 83
ADD -
Nearest Second
ote: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16
Page 1

Site ID: NC-CL-11
Owners Name: Bowen Family Trust
Address: 135 Eastridge Dr
Lawndale, N.C.
Phone: [phone]
Operator: Andy Bowen
Fields
Total
Acres
Crop(s)
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(Ibs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1
25.3
Fescue
209
CaB2
35°20'52.57"
N
81°25'46.55"
W
2
15.2
Fescue
167
MaB2
35°20'55.58"
N
81°25'39.18"
W
TOTALS 40.5
Notes:
Date: 1/25/18

SYNAR©
VICINITY MAP
. L , F*.aa
. ��s . - ter`"_ �'
`� _ y
, 6,,D ILL
s 0,„V .•
�••
�`i�' ;$
i p �'l w
,, r
4
LL
V
f ;lam 11F 1 !Y :
_
'\
fi.+r'4'_,{.f -f -i ¢ •. ,
•�.�
�.
it
6, !
t �.
1{
Ir
'T -
•
''
_- } a ` ! �' "y._
Q
I C `�+. . lb v
a, ;
t `a
!^mot
•
1
•..Y
1
tl�
E
t
t�•
_' J"
`��
•�tia
'Jy - �•
s' \`�,'' '
..•_
S
ram,/ \."
,s�4J�
�
+ _ 1
:.%"!#=•y
tea. r
z -/ _ __
�"-3. �
%s �
M r ~`` / 5is _ ' 7,
.Ip •(' ), 'AZµ,:
' t LLLvvv... �fl. �`� .Il' ^•`Y
,_"a, C ,.�
_yam s ' r
-'` / - „_R
' S ec..fh .J' / ) --
•. D �. ' f 4` "[. \� a
` P'.,,
V t
_�• . f� �. .. •`a; .
�
s ar
—
�,
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
'he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
Hi 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-C L-1 1
Fields 1-2

Site ID: NC-CL-12
Owners Name: River Taw Farms
Address: 126 Cedar Lake Farm rd
Cherryville, NC 28021
Phone: [phone]
Operator: Travis Jones
Fields
Total
Acres
Crop(s
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(Ibs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1
51.2
Fescue
188
HhB
35°21'11.36"
N
81°25'0.81"
W
TOTALS 51.2
Notes:
Date: 1/25/18

VICINITY
MAP
—�.. _''t*-,a _'mi l f 0 I NNt if �-J `L
ram,-_ r!' i� ,.c�j ` " L _ yJ'' li _�, t ti>" a - f '"[
l'u )_ :, 7/�ru � > f 5 ' � y r s
�ra
_s `. t •�
1 a G
.� t..-L '` ' tjj' iii b 1� i5 • ^ A•in ` `l C7 _ l ��.. rs•O �•
- `F-!_`, t '. I f \ 1+ f 9} F1 '� J _ r y,� Ep . J :�[
:.. - - -.1' ' _. ,_ . ,R ( �.t� i. rltar,,,,,- , "t
-y . ' f w y ,� I A � ;� i N ,'- 0): ..
s. .
] / r; .
Set l a9 7
d1�/
_ `,^,•
`'-.}�2 ~ j`\
n lZ�—l�Vij
> •�1 w °�yq`p --• t 1- '"p.`+
�, �/fit
u
r,,-•_
:./ .— _ t �: tT
-71
4GL{� -
[
.! .. �F`-°tom - 1,.' ..,
-At
t
:,
d 4�Ck, _3e 7 "Wy` —` "el
te-
h �'
..
cr=
A�
1.F v`
te�-�(Afi
a{> yt?, !- . -2
j -
t` J w _ . 3 £ . 1 « r IIIi..
'n e4 `" t-vx' ' / Vi17 ' _ r
. " O K ti ' (� 'am tjylg5' i+
`;-.:••rW. .. .; ... 1'" 1.— [=a :v' .. '-1 . :I..s •- " 1 " f .•' 1... i- � .s ` - _'.'..
�`� f�
f/ .�1
v, "F"A- �p ...
_ f _
La rn ''+} J}' / -*![�
Ate. f N:al
t
. _.-.'iP��.
r*L-f \'i.3�'
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
compliance boundary is established either 250 ft from the residuals application area or 50 feet within
.,.., ie property boundary, whichever is closest to the application area. The review boundary is established
midway between the boundary
N C-C L-12
compliance and the perimeter of the residuals application area. All
locations are approximate.
Field
1

1/26/2018
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Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
COUNTY BOARD NOTIFICATION
INSTRUCTIONS FOR FORM: CBN 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This notification is intended to provide the county board in which the land application site is proposed to be located with
general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an
opportunity to continent 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 foiui may
be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application
sites are located.
B. Critical Watershed Areas Information:
® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed
areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas.
® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
https://deq.nc. gov/about/divisions/water-resources/water-res ources-rules/water-supp ly-watershed-protection-program
If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call [phone].
C. Notification Package Submission:
® Complete and snail the notification letter, source facility summary, land application site summary, and site location maps to
the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the
notification package also be sent to the County Manager.
® The most current publication of the Directory of State and County Officials may be downloaded at:
https://www.sosnc.gov/publications/direct.aspx
A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq.nc. gov/contact/regional-offices.
® The source facility suminary 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
Governor
Date: p1119I18
To: Name of Chairman to the Board of County Commissioners: ill Beam
Complete mailing address: i115 West Main Street
City: Lincoln on State: RC Zip:
County where land application sites are located: Lincoln
From: Applicant's name: City of Mt Holly', (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: David Johnson
Complete mailing address: P.O. Box 406.
City: Mount Holly State: NC Zip: 28120-Pi
Telephone number: (704) 4581.4309 E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
l‘‘
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
rill ensure that all federal and state regulations are enforced. Attached to this foal' is infoiivation regarding residuals-
_;enerating 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 infou cation 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: Mooresville Regional Office
Complete mailing address: 610-East Center Avenue, Suite 301}
City: ooresville 28 State: NC Zip: 115; h
Telephone number: (04i) 663; i1699,
Expected date of application submission: Mooresville
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Internet http://portal.ncdenr.orq/weblwq
An Equal Opportunity 1 Affirmative Action Employer— Made in part with recycled paper FORM: CBN 06-16

ATTACHMENT A - Approved Residual Sources
City of Mount holly
Certification Date: December 1, 2014
Permit Number: WQ0001863 Version: 3.0
Owner
Facility Name
•
County
Permit
Number
Biological
Residuals
Maximum
Dry Tons
Per Year
Frequency for
Non -hazardous
Characteristics 2
Frequency for
Metals and
Nutrients 3,5
Monitoring
Frequency for
Pathogen &
Vector Attraction
Reductions 4' s' 6
Approved
Mineralization
Rate
City of Mount Holly
Mt. Holly WTP
Gaston
01-36-020
No
130
Annually
Annually
N/A6
0.40
City of Mount Holly
Mt. Holly W WTP
Gaston
NC0021156
Yes
780
Annually
Annually
Annually
0.40
Total
910
1. Maximum Dry Tons per Ycar is the amount of residuals approved for la id application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and corrosivity) as stipulated under pennit Condition IV.2.
3. Testing of metals and nutrients as stipulated under pennit Condition IV.3.
4. Analyses of pathogen and vector attraction reductions as stipulated under pennit Condition IV.4.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
(short tons per year)
Monitoring Frequency •
(Established in 40 CFR 503 and 15A NCAC 02T .1111)
<319
1/Year
=:%319 - <1,650
1/ Quarter (4 times per year)
_%'
1,650 - <16,500
1/60 Days (6 titres per year)
_> 16,500
1 /month (12 times per year)
6. Water Treatment Plant residuals are exempt from meeting the pathogen & vector attraction reduction requirements in Condition IV.4, provided they are not mixed with residuals that have been
generated during the treatment of domestic wastewater, the treatment of animal processing wastewater, or the biological treatment of industrial wastewater. The Water Treatment Plant / residuals
must be treated and processed in a manner as to not meet the definition of "Biological Residuals" as defined in 15A NCAC 02'1' .1102(6).
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is required), then no
sampling data is required during the period of inactivity. The annual report shall include an explanation for missing sampling data. Those required to submit the annual
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification.
Page 1 of 1

LAND ArrLICATION SITE CERTIFICATION
Applicant's name: City of Mt Holly
Land application sites currently certified: 243.2 net acres and Total to be certified: 122.3 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)Mappig
Predominant Soil
Series Nameb
Unit
or RepnSlope
N
CL-11-01
Bowen Family Trust
Andy Bowen
25.31
Cleveland
Pasture
Cecil
CaB2
N
CL-11-02
Bowen Family Trust
Andy Bowen
15.18
Cleveland
Hay
Madison/Pacolet
MaB2
N
CL-12-01
Cedar Lake Farm LLC
Charlie Jones
51.15
Cleveland
Pasture
Hewitt
HhB
N
LT-44-01
Lee Shank
Lee Shank
15.65
Lincoln
Hay
Cecil
CcB
N
LT-45-01
Mike Macomson
Mike Macomson
15.01
Lincoln
Row Crop
Lloyd/Cecil
CcB
1
F
1 a
CT
l
j
I
1-7
( 1
I -
r
1
1
L
P
P
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) + M (Modified) ♦ T (Transferred) ♦ 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)
H. WATERBODY 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
Class
Pro osed
p
CL-11-01
35°20'51" N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
1
CL-11-02
35°20'57" N
81°25'42" W
NAD 83
MAP
Second
Broad / 9-53-4-(1)
WS-III
1
CL-12-01
35°21'12.5" N
81°25'1.8" W
NAD 83
MAP
Second
Broad / 9-53-6
C
f I
LT-44-01
35°24'58.5" N
81°9'42.7" W
NAD 83
MAP
Second
South Fork Catawba River / 11-129-(2.5)
WS-IV
LT-45-01
35°30'51.8"N
81°16'8.7" W
NAD 83
MAP
Second
Hoyle Creek / 11-129-15-(1.5)
WS - IV
j
r----1
io['
° i T"
NAD 83
ADD
Nearest Second
t !
1 1
(' 1
7j° []' D"
D° 1''�"
NAD 83
ADD
Nearest Second
, 1
° ' j"
° `' L"
NAD 83
ADD
Nearest Second
( 1
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16
Page 1

Site ID: NC-LT-44
Owners Name: Lee Shank
Address: 2702 Devine rd
Iron Station, NC
Phone:
Operator:
Fields
Total
Acres
704-737-4476 (cell)
Same as above
Crop(s)
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(Ibs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1
15.7
Fescue
209
CeB2
35°24'57.54" N
81°9'44.69" W
TOTALS 15.7
Notes:
Date: 1 /25/18

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000' 0
4,000'
to compliance boundary is established either 250 ft from the residuals application area or 50 feet within
he 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-LT-44
Field 1

Site ID: NC-LT-45
Owners Name: Mike Macomson
Address: 2739 River Rd
Lincolnton, NC
Phone:
Operator:
Fields
Total
Acres
(980)-241-5153
Same as above
Crop(s)
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(Ibs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1
15.0
Row Crop
Crop Rate
CeB2
35°30'51.65" N
81`16'8.95" W
TOTALS 15.0
Notes:
Date: 1/25/18

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ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
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midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C—LT-45
Field 1

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LINCOLNTON, NC 28092
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Site ID: NC-CL-11
Owners Name: Bowen Family Trust
Address: 135 Eastridge Dr
Lawndale, N.C.
Phone: [phone]
Operator: Andy Bowen
Total
Acres
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(Ibs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1 _
25.3
Fescue
209
CaB2
35°20'52.57"
N
81°25'46.55"
W
2
15.2
Fescue
167
MaB2
35°20'55.58"
N
81°25'39.18"
W
TOTALS 40,5
Notes:
Date: 1/25/18
v�l t�raCtl rf,i
g1, t{7 %lt9Dcto

State of North Caroli ' a
Department of Environment and Natural Resour&s
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 11-13
riease 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 website at:
http://portal.nedenr.org/web/wq/aps/lau
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 11-13).
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 11-13):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 11-13) 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.
Z1 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
undersigned landowner or�/his representative hereby permits:
Applicant's name: (. 4 fy o' M -_ l 61 / y
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
C L — I I -" (1— z)
/V0
Huy / pcGs w e.
A-1,mq l Fe e d
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.
's Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
ll 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 11-13
Page 1 of 3

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.
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.
ESTRICTIONS:
Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
I5A 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)
virA re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: • is currently permitted under another
residuals land application program; Permit Number WQ: . The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 11-13 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
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise au
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste d
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have rein _
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgeniu... _ _
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: ,TO 64 1( e.p,1
Address: '/ 7 -pc-i U ci
City:
CW y U 11 E State:
Phone: 46 541 S 93 20 E-mail address:
I1-4A- Date: %7
Signature:
NORTH CAROLINA, C e-kouNa
I, the undersigned Notary Public do hereby certify that
COUNTY
''11A
Zip:
ova
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
ciao
Lessee's/Operator's Certification:
qi(Jod
-2-G22.
20 '7
CLAY FPSACKLY
NOTARY PURUC
WAKE COUNTY, INIt:
My Commiesien EupWA$Mt- 4gr
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: ORS'Ilskt Ad1Sbe0
Address: d 3 S 1-134-Slin jcu,
da City:`� d State: ,/°1' 6' Zip: ,Pci0
Phone: 7051 —4177 -®V 73z,
Signature:
E-mail address:
Date: '" / / 7
Permittee's Certification:
I certify that I have read t
Signing official name:
Signature:
Agreement afid do hereby agree to abide by the stipulations and restrictions as specified herein.
Date:
FORM: LOA 11-13
Page 3 of 3

VICINITY MAP
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:- - _ :/`
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
iumwlinall 1 '
rhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
Hi 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-C L-1 1
Fields 1-2

ICJ ; ti',
>vvv<
> <
n A A A
APPLICATION MAP r
LEGEND
APPLICATION AREA
, PRIVATE ROAD
— — — STREAM
DRAIN
x x FENCE
PROPERTY LINE
SOIL DESCRIPTION
•
•
0
CAS'
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE,
OUTBUILDING
WELL
GRAPHIC SCALE
1" = 660'
660' 0 660'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
... 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-CL-11
Fields 1-2

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"= 1,000'
1,000' 0
1,000'
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet'within
...:he 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-CL-11
Fields 1-2

SOIL SURVEY
GRAPHIC SCALE
1" = 800'
800' 0 800'
'le compliance boundary is established either 250 ft from the residuals application area or 50 feet within
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-CL-11
Fields 1-2

5 --I
SYNAGR
compliance boundary is established either 250 ft from the residual
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Soil Profile Descriptions in Field Locations
0
N
O
2
Project: City of Mount Holly
Site: Andy Bowen (NC-CL-11)
Field: 1
.S:
as
O
O
U
O
m
0
as
A
a)
0
% Slope: 4-5%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1/5/2018
Soil Series: Cecil
a)
in
cu
0
L
d
w
❑
w
N
N
d
w
a.
>--
4-
I18131301FITE6. PA
as
N
0
O
N
d
7.2
U
N
O
A
0-4
2.5YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-41
2.5YR 3/6
-
-
-
-
moist
c
mod
med
gr
fi
s
p
BC
41-48
2.5YR 5/6
-
-
-
-
moist
cl
mod
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
wk weak
m moderate
str strong
gr
PI
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)
>48"

Soil Profile Descriptions in Field Locations
0
N
0
2
Project: City of Mount Holly
Site: Andy Bowen (NC-CL-11)
Field: 2
o
L
O
O
U
a)
w
O
a)
.a
.a
a)
O
% Slope:
Crop:
Conducted By:
Date:
Soil Series:
a)
in
O
5%
Forage/Pasture
GC Murray
1/5/2018
Madison/Pacolet
0
d
w
❑
0
m
3
L
w
N
d
0
.L
I
a
>-
a)
0
R8®ODIRTE6. PR
0
N
A
0-4
10YR 5/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
AB
4-11
7.5YR 5/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
11-32
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-48
2.5YR 4/8
-
-
-
-
moist
cl
wk
med
sbk
fi
ss
sp
Legend:
Texture
s sand
si
sil
c
cl
scl
sl
sicl
loam
silt
silt loam
clay
clay loam
sandy clay loam
sandy loam
silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
PI
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)
>48"

SYNAGRO CITY OF MOUNT HOLLY
WQ 0001863
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the City of Mount Holly 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, City of Mount Holly, Various Fields

Site ID: NC-CL-12
Owners Name: River Taw Farms
Address: 126 Cedar Lake Farm rd
Cherryville, NC 28021
Phone: [phone]
Operator: Travis Jones
Fields
Total
Acres
Cron(s
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(lbs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
1
51.2
Fescue
188
HhB
35°21'11.36"
N
81'25'0.81"
W
TOTALS 51.2
Notes:
Date: 1/25/18
3S 3(ss-?i
41,(/ f

W,,,,,,,63-•
' Div➢sion 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):
NJ 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.
M 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: (L *5 c%-P 1V `ouv 41"r o `1 y
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)
CL- 12 - l01
N©
1-I,/Pa t
4/1trod ieeof
.
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
Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:�---
Address:
city: I1 i i E V State: IV Ci
Zip: �g'--7
Phone: ) 09' -7 1's-7 10 E-mail address: 1t o 1-e G �l
Signature:
Date:
NORTH CAROLINA, C,Ieve,lagd COUNTY
I, the undersigned Notary Public do hereby certify that OCI I l C O I I ear
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of 3u1
Signature and seal:
My commission expires: ''
Oat
9,6r,)cie-614
Lessee's/Operator's Certification:
, 20 (
CLAY FISACKERLY
NOTARY PUBUC
WAKE COUNTY, NC
My Comrnimlon Expires 1-18-2022
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: (1;1 l'1 U- %`� (c -t '
Address: 3 3 ���- F,,c 7/,5
City: /Z �r�/ �i 7/e State: C.;
Zip: ,5 - L%
Phone: 7 O' - ' rr )--F"--t 3 171- E-mail address:
Signature:
Permittee's Certification:
Date: 7- / 7
I certify that I have ad 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

VICINITY MAP
•f' rir_ i
. f
. , -._, t _ - '- ... _..:�-� " t",..:- slB"v' ,�' % ��•3z'i."' iYF r O a; 4 q:y It.;4 = Z+'
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ay f. F r I 4+..
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er
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`� �. ` }. �k� .. t Y = J� irtc/ l3: ✓ Asa 1;;
ry?
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rs k fa..: + �S
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+ 1
:..--2-c� _ a'. 4 r^a'__ a. I:a , ,: __ c. , �. r d l(r,.a.t�
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
t„ 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-CL-12
Field
1

l
Z
›-
>V V V<
AAA t
vwyA L.dileLACV 5r1V4(1
"i6A15-0LICATI®N MAP S
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
SOIL DESCRIPTION
�//
•
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
GRAPHIC SCALE
1"=660'
660' 0
660'
le compliance boundary is established either 250 ft from the residuals application area or 50 feet within
:he 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-CI-12
Field 1

SOIL SURVEY
GRAPHIC SCALE
I"=800'
800' 0 800'
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
....he 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-CL-12
Field 1

0 TOPOGRAPHIC MAP
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1
j t
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(„"�f CCCIII
GRAPHIC SCALE
1"=1,000'
1,000, 0 1,000'
a compliance boundary is established either 250 ft from the residuals application area or 50 feet within
ie property boundary, whichever is closest to the application area. The review boundary is established
between the
A I C-C l -12
I l> L I
midway compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field
1

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) JJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJ
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C

Soil Profile Descriptions in Field Locations
O
TO
i
Project: City of Mount Holly
Site: Rivertaw (NC-CL-12)
Field: 1
O
0
U
cCd
0
O
0
O
a)
0
ns
.0
d
O
% Slope:
Crop:
Conducted By:
Date:
Soil Series:
a)
in
O
a)
❑
0
0
O
a)
3%
Forage/Pasture
GC Murray
1/5/2018
Hewitt
L
d
w
0
v
3
L
w
a.
H
L
0
r
ROMIDI TE®„ PP
A
0-6
10YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
E
6-10
10YR 3/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
10-23
5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
23-28
5YR 4/6
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
C
28-48
5YR 4/4
-
-
-
-
moist
sl
structureless
fr
ns
np
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
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)
>48"

SYNAGRO CITY OF MOUNT HOLLY
WQ 0001863
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on.the proposed application
sites for the City of Mount Holly 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, City of Mount Holly, Various Fields

Site ID: NC-LT-44
Owners Name: Lee Shank
Address: 2702 Devine rd
Iron Station, NC
Phone: [phone] (cell)
Operator: Same as above
Total
Acres
SITE SUMMARY
CITY OF MOUNT HOLLY
Mount Holly, NC
(lbs PAN/ac)
RYE PAN Rate
Predominant
Soil Series
Latitude &
Longitude
1 My
15.7
Fescue
209
CeB2
35°24'57.54" N
81°9'44.69" W
TOTALS 15.7
Notes:
Date: 1/25/18
-V,I61Sp6od

State of North Carolina
DW Department of Environmental Quality
`sue Division of Water Resources
Msion 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):
XI 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 fouu. 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.
j Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: l l ' c}`t -{ ; Nally
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (Le., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
LT—iL-1 — 01
/170
He( y
/ i :rvict'f Pee(I
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, theuse 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
Jha11 be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

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

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.
te-,Sho1\
Landowner name:
'7
Address: ti r- ! U
City: r 0i11\ State: . Zip: g_86,? a,
Phone: G 0 1 ) 'Lll E-mail . d dress: 61140, V P1G
- r
Signature:
NORTH CAROLINA, L r .14 CO I k1 COUNTY
1, the undersigned Notary Public do hereby certify that ee Shan (G
Date:
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the 7
day of Jul ly
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
,20 (
7
CLAY FISA►CKSRLY
NOTARY PUBLIC
WAKE COUNTY, NC
Commigoon Expires 1-18-2022
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreemen and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
FORM: LOA 06-16
Page 3 of 3

• VICINITY MAP
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p�i'J✓t6
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
....he 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-LT-44
Field
1

APPLICATION MAP
IX
>V V V<
A A t
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
x x x FENCE
PROPERTY LINE
SOIL DESCRIPTION
///
UNSUITABLE AREA
WATER
. ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
(� WELL
GRAPHIC SCALE
1" = 660'
660' 0 660'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
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-LT-44
Field 1

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=1,000'
1,000' a 1,00a'
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
die 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-LT-44
Field 1

SOIL SURVEY
Y.a'nBcPti 6-2
-4
Z
GRAPHIC SCALE
I"=800'
800' 0 800'
t'
;
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
.he 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-LT-44
Field 1

WATERSHED MAP
SYNAGR1
�} LLLLLLLLLLL '&
LLLLLLLLL1
_LLLLLLLLL
LLLLLLLLLL
LLLLLLLLL
LLLLLLLLL
L-z�
LLLLLLLL LLLLLLLLL
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LL
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LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL_LLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL.LL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
'.1
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fl
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
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{
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LCt
GRAPHIC SCALE
1" = 7,000' LEGEND
7,0m 0 7,000'
1
WS-I
//�
WS-II
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 of the residuals application area. All
\\�
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L
"`L L L L
1 1 1 1
WS-I
`'
V
perimeter
locations are approximate.

Soil Profile Descriptions in Field Locations
0
N
O
2
Project: City of Mount Holly
Site: Lee Shank Farm (NC-LT-44)
Field: 1
O
O
0
G
m
V
.a
.0
0
CO
C
% Slope:
Crop:
Conducted By:
Date:
Soil Series:
a;
a)
CO
C
3%
Forage/Pasture
GC Murray
1/5/2018
Cecil
N
R
ry
O
5
L
d
w
0
L
W
N
U)
P.
W
a
>-
ci
L
U
a)
N
y
O
V
N
O
Ap
0-5
5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
BA
5-11
5YR 5/6
-
-
-
-
moist
scl
mod
med
gr
fr
ns
np
Bt1
11-41
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Bt2
41-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
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
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Tvoe
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)
>48"

SYNAGRO CITY OF MOUNT HOLLY
WQ 0001863
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the City of Mount Holly 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, City of Mount Holly, Various Fields

Site ID:
Owners Name:
Address:
Phone:
Operator:
Total
Fields Acres
1
15.0
SITE SUMMARY
CITY OF Mt Holly
Mt Holly, NC
NC-LT-45
Mike Macomson
2739 River Rd
Lincolnton, NC
(980)-241-5153
Same
(Ibs PAN/ac)
Crop(s) RYE PAN Rate
Row Crop
Corn: 131 Soybean:
185
Predominant
Soil Series
CeB2
(D.M.S.)
Latitude &
Longitude
35'30'51.65"
TOTALS 15.0
Notes:
81°16'8.95"
w
Date: 01/29/18
~ 6(1. 26 6 / 6 6 /1

W..,,,,,-..F.
1]ivision of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water esources
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):
kr Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
4
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Jy M-1-r dolly
Applicant's name: e
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
(yes/no)
Land Use or
Cropping Patterns
pp' g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
L T- `'i5 - 01
4(0
Row Crops
6, rq,`vl
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
—iall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: / ✓ 1 1 \" C 2 %-1=
5 ;
Address: R / � >h v
1
City: (N)'y nJ C U (•✓ �r%
Phone: b O� 9 > 5-3
Signature:
State: lv ` L
E-mail address: JIJ /A,
Zip:
NORTH CAROLINA, Li (\Co it COUNTY
I, the undersigned Notary Public do hereby certify that
Date: ,7`/
fl' m ryi S -r
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the -4
4-43
day ofU�a�
Signature and seal: �Z . `.20,
Mycommission expires: I g - 2 ° ZZ
P
Lessee's/Operator's Certification:
20 1
CLAY ABSACKERLY
NOTARY PUBLIC
WAKE COUNTY, NC
My Commitstm Expires 148-2022
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: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agree nt and do
Signing official name:
Signature:
State:
Zip:
ereby agree to abide by the stipulations and restrictions as specified herein.
Date:
FORM: LOA 06-16
Page 3 of 3

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GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
.A A 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-LT-45
Field
1

3T
APPLICATION MAP
4k"t
Z
>v v v<
> <
AAAt,
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
x x x FENCE
PROPERTY LINE
0 SOIL DESCRIPTION
7//
•
•
n
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
GRAPHIC SCALE
• 1"=660'
660' 0
660'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
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-LT-45
Field 1

0 TOPOGRAPHIC MAP
>lir
jitp
a ,R
•
! ~`a`_ - •
, •
//\
.ice '
et,„;„..
„...,, , ,
, pii
-
_
„
,
R
' •:
x:! •�q,0.% �,
• , v jj
...
r,„ .
... ,
r
_
'
•
i
lif
S1
' -
a
`{ ,,
„
,...„..._.__. ,./..
11tia
\\
I
\
, eikc
1 r----
GRAPHIC SCALE
1" =1,000'
1,0oo. •0 1,000'
ie compliance boundary is established either 250 ft from the residuals application area or 50 feet within
... 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-LT-45
Field
1

SOIL SURVEY
GRAPHIC SCALE
1"=800'
800' 0
800'
le compliance boundary is established either 250 ft from the residuals application area or 50 feet within
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.

WATERSHED MAP
SYNAG,il:i
_
may. LLLLLLLLLLL
LLLLLLLLL
_LLLLLLLLL
LLLLLLLLLL
LLLLLLLLL
LLLLLLLLL -LL.zt—��
LLLLLLLL LLLLLLLLL"P
LLLLLLL LLLLLLLLLLLI
LLLLLLL LLLLLLLLLLLLI
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLI
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLI
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLI
_
L
1 `1L
I f_il.L
IL.,-*
LL
LLLLLLLLL
LLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
L;L--.L.r±±L
LLLL-L
.L LL
L-
L
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL.LLLLLLLLLL.
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLI
LLLL
L\JLLL,
it
_.—
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
L'
LLLLLLL
_LLLLLL
LLLLLLL
LLL
'�
L L
LLLLLLLLLLLLLLLLLLLLLLLLLLLLL,
LLLL
'LLLLLLLLLL
'LLLLLLLLLLLLLLLLLLLLL
1144
LLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLL
LL LLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLLLLL
LT
L ,"C L;LL
L ILL L
.1_,LL> L, I
LLLL`LLLLLLLLLLLLLLLLLLLL
LLLLLLL
LLLLLLLLLLLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLL
LLa
LL
LL'
LLLLLLLLLLL
LLLLLLLLLLLLL
L
' ►
L
LLLLLLLLLLLL
=LLLLLLLLLLLLL
LLLLLLLLLLLLL
'LLLLLLLLLLLL
LLLLLLLLLLLL
LLLLLLL
LLLL
iLLLLLLLL
LLLLLLLLLL
LLLLLLLLLL
LLLiLLLLLLLLLLLL
LLLL
LLLLILLLLLLLLLLLLLLLLLL
LLLLLLLLLLLLLL
LLLLLL
LLLLLLL
LLLLLLLLL
LLLLLLLLLLLLL_
LLLLLLLLLLLLL_
LLLLLLLLLLLLLL
LLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLL
LLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLL
L
LL
LLLLLLLLLLLL/
LLLLLLLLLLLL
LLLLLLLLLLLLLLL
LL
LLLLL
LLLLLLLLLLLLLLL
LLLLLLLLLLLLLLLL
LLLLLLLL'
LLLLLLLLLLLLLLLLLLLLLLL
II LLLLLLLLLLLLLLLLLLLLL
LLLL
LLLLLLLLLLLLLLLLLLL
_
L
LLLLLLLLL
LLLLLLLLLL
LLLLL
GRAPHIC SCALE
1" = 7,000' LEGEND
7,000' 0 7,000'
r
Ws-1
/A
ws-II
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 of the residuals application area. All
�
\�
W CS_ I l l
`"`
LLLL
I I I I
`'
WS . I V
perimeter
locations are approximate.

Soil Profile Descriptions in Field Locations
c
0
0
2
Project: City of Mount Holly
Site: Mike Macomson (NC-LT-45)
Field: 1
0
a)
.70
O
O
U
0
a
c.)
co
O
% Slope: 4%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1/5/2018
Soil Series: Lloyd/Cecil
ci
a)
❑
v
O
0
0
a)
0
d
w
❑
0
0
4-
C)
L
w
N
L
U
7
L
w
>-
0
0
L
RBI9QOIRTEB. PR
N
tC
Ap
0-4
5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt1
4-19
2.5YR 3/6
-
-
-
-
moist
cl
mod
med
gr
fr
s
p
Bt2
19-41
2.5YR 3/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
41-48
2.5YR 4/8
-
-
-
-
moist
scl
mod
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
wk weak
m moderate
str strong
Structure Type
gr granular
pl platy
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)
>48"

SYNAGRO CITY OF MOUNT HOLLY
WO 0001863
SOIL SCIENTIST CERTIFICATION
111
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the City of Mount Holly 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, City of Mount Holly, Various Fields

NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
OCCUPATIONAL AND ENVIRONMENTAL EPIDEMIOLOGY BRANCH
DRINKING WATER HEALTH RISK EVALUATION
GENERAL
DATE 3l Y161 COUNTY
LABORATORY #
uir
❑ Based on these analytical results, this water should be considered safe for normal usage.
O Chemical analysis did not show any contamination. Water should be resampled if odor
or taste persists.
O The water should not be used for drinking or cooking purposes; avoid prolonged
bathing/showering.
O Based on these analytical results, this water is highly contaminated and should not be
used for drinking, cooking, or bathing/showering.
The laboratory .results are not conclusive, please resample. / h'1t
PLEASE INDICATE ON LAB SKEET THAT IT IS A RESAMPLE AND Vit:OVIbk004 -
PREVIOUS SAMPLE NUMBER(S). NC DEPT. OF ENVIRONMENT .
AND NATURAL RESOURCES
COMMENTS: fOORESVLLLE REGIONAL OFFICE
P(pA i-64� �° ;✓hM !n ldJlJ , P(pg -�Z I a. A r*dll c S '1,kt4
_ (11-6,G41,- )44-chwij
P iaslle -Rvf Y SW„I/w-e a,Le,I l,l- 41- Peil I (,
rj I/ 400dociVe
'9- I
a�1 iine-:oh sP - kA.P-41T of {-c1i 0316-k-i- (JLLvY -R.(y1
Gd h-)vto2It Galt' ,)w I u
For further information, contact Dr. Ken Rudo, Occupational and Environmental Epidemiology
Branch, [phone].
DHHS 3891 (5/99)
Occupational &_ Environmental Epidemiology Branch (Review 2102.)

MADEP VPH
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/20041200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 MA-VPH-98-1 1 01/24/2004 0426
CAS Analytical
Parameter Number Method Result Q PQL Units Run
C5 - C8 Aliphatics MA-VPH-98-1 PD 100 ug/L 1
C9 - C12 Aliphatics MA-VPH-98-1 l D 100 ug/L 1
C9 - C10 Aromatics MA-VPH-98-1 ND 100 ug/L 1
Run 1 Acceptance
Surrogate Q % Recovery Limits
2,5-Dibromotoluene (FID)
2,5-Dibromotoluene (PID)
70 70-130
85 70-130
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit B = Detected in the method blank
ND = Not detected at or above the POL J = Estimated result less than the POL
Where applicable, at soil sample analysis are reported cn a dry weight basis unless flagged with a W
Shealy Environmental Services, Inc
106 Vantage Point Drtve Cayce, SC 29033 [phone] Fax [phone] aswr.shealytab.wm
E = Quantitation of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 40%
Page: 12 of 12
Level 1 Report v2.0

ICP-AES
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/20041200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3030 C 6010B 1 02/02/2004 1135 FTS 01/23/2004 1700 13221
Parameter
CAS Analytical
Number Method Result Q PQL Units Run
Lead
7439-92-1 6010E 0.0030 mg/L 1
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit B = Detected in the method blank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
Where applicable, all sal sample analysis are reported on a drvweioht basis unless flagoed with a'W
E = Quantitabon of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 40%
Shealy Environmental Services, Inc
106 Vantage Pant Drive Cayce, SC 29033 [phone] Fax [phone] www.shealytab.mm
Page: 11 of 12
Level 1 Report v2.0

Volatile Organic Compounds by GC/MS
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/20041200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 5030B 8260B 1 02/02/20041530 RED
Parameter
CAS Analytical
Number Method Result Q PQL Units Run
Benzene 71-43-2 8260B ND 1.0 ug/L 1
Bromodichloromethane 75-27-4 8260B ND 1.0 ug/L 1
Bromoform 75-25-2 8260B ND 1.0 ug/L 1
Bromomethane (Methyl bromide) 74-83-9 8260E ND 2.0 ug/L 1
Carbon tetrachloride " 56-23-5 8260B no 1.0 ug/L 1
Chlorobenzene 108-90-7 8260B ND 1.0 ug/L 1
Chloroethane 75-00-3 8260B ND 2.0 ug/L 1
2-Chloroethylvinylether 110-75-8 8260E ND 10 ug/L 1
Chloroform 67-66-3 8260B ND 1.0 ug/L 1
Chloromethane (Methyl chloride) 74-87-3 8260B ND 2.0 ug/L 1
Dibromochloromethane 124-48-1 8260E ND 1.0 ug/L 1
1,2-Dibromoethane (EDB) 106-93-4 8260E ND 1.0 ug/L 1
1,2-Dichlorobenzene 95-50-1 8260E ND 1.0 ug/L 1
1,3-Dichlorobenzene 541-73-1 8260B ND 1.0 ug/L 1
1,4-Dichlorobenzene 106-46-7 8260B ND 1.0 ug/L 1
Dichlorodifluoromethane 75-71-8 8260B ND 2.0 ug/L 1
1,1-Dichloroethane 75-34-3 8260E ND 1.0 ug/L 1
1,2-Dichloroethane 107-06-2 8260B ND 0.50 ug/L 1
1,1-Dichloroethene 75-35-4 8260B ND 1.0 ug/L 1
trans-1,2-Dichloroethene 156-60-5 8260E ND 1.0 ug/L 1
1,2-Dichloropropane 78-87-5 8260B ND 1.0 ug/L 1
cis-1,3-Dichloropropene 10061-01-5 8260E ND 1.0 ug/L 1
trans-1,3-Dichloropropene 10061-02-6 8260B ND 1.0 ug/L 1
Diisopropyl ether (IPE) 108-20-3 8260B ND 1.0 ug/L 1
Ethylbenzene 100-41-4 8260B ND 1.0 ug/L 1
Methyl tertiary butyl ether (MTBE) 1634-04-4 8260B ND 1.0 ug/L 1
Methylene chloride 75-09-2 8260B ND 1.0 ug/L 1
1,1,2,2-Tetrachloroethane 79-345 8260B ND 1.0 ug/L 1
Tetrachloroethene 127-18-4 8260B ND 1.0 ug/L 1
Toluene 108-88-3 8260B ND 1.0 ug/L 1
1,1,1-Trichloroethane 71-55-6 8260B ND 1.0 ug/L 1
1,1,2-Trichloroethane 79-00-5 8260B ND 1.0 ug/L 1
Trichloroethene 79-01-6 8260B ND 1.0 ug/L 1
Trichlorofluoromethane 75-69-4 8260B ND 2.0 ug/L 1
Vinyl chloride 75-01-4 8260E ND 2.0 ug/L 1
Xylenes (total) 1330-20-7 8260B ND 1.0 ug/L 1
Run 1 Acceptance
Surrogate t] % Recovery Limits
1,2-Dichloroethane-d4 106 70-130
Bromofluorobenzene 83 70-130
Toluene-d8 90 70-130
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
POL = Practical quantitation limit B = Detected in the method dank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
Where applicable, all soil sample analysis are reported on a dry weight basis unless flagged with a "W'
E = Quantitation of compound exceeded the calibration range
P = The RPD between two GC mlumns exceeds 40%
Shealy Environmental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] vnwv.sheaytab.mm
Page: 9 of 12
Leel 1 Repct v20

EDB & DBCP by Microextraction
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01 /22/20041200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst
1 504.1 1 02/05/20041615 MTR
Prep Date Batch
Parameter
CAS Analytical
Number Method Result Q PQL Units Run
1,2-Dibromoethane (EDB)
106-93-4 504.1 I'D 0.019 ug/L 1
' Pt i nr— yosz-49W-
--
Setml
1D'ti
f 7 p0 (52-P3 -- ? 3 zi
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantifation limit B = Detected in the method blank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
Where applicable. at soil sample analysis are reported on a dry weight basis unless flagged with a "W'
Shealy Environmental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 1803) 791-9700 Fax [phone] www.streayiab.c cn
E = 0uantitatico of compound exceeded the calibration ranoe
P = The RPD between two GC columns exceeds 40%
Page: 10 of 12
Level 1 Report v2.0

NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WASTE MANAGEMENT
1646 MAIL SERVICE CENTER RETURNSERVICE REQLIESTE6
401 OBERLIN ROAD, SUITE 150
RALEIGH, NORTH CAROLINA 27699-1646
— 0n
ta Col
1°
e
(13
LIU 01
zerr;
NILES & MARY MILLER
1998 W DAVIDSON AVENUE
GASTONIA NC 28052
L�I�II•.l.11....LL.J.L.ILI
016H26523172
"' 0F"
03/04/2010
Mailed From 27607
11R PnRTA F
T 276 NFE . 1 1O9 Z CC 0a/ 04/ 10
RETURN TO SMND1R
MILLER
TEMPORARZLV AWAY
RMTUR'N TO SENDER
BC: 276.99164699 *1696=02162a-04-41
`!�►I,III>>i;�II�lI.iIIlIl.�►�,,11�II�„I►Illlla.11�l,�I,I,iIll,�l1

MAIL AND COPY DISTRIBUTION INSTRUCTION SHEET
Person Completing Form: Dwayne Peterson
Date: Mar 3, 2010
Project/Item: (example: Dupont letter of 1/1/05)
Miller Well Nitrates (NONCD0002075) Sampling Request Letters
Method of Mailing Original:
❑ Interoffice, Courier or Internal Distribution, as appropriate
❑x Regular US Mail
❑ Overnight Delivery (Service Used (circle one): Fed Ex; UPS; USPS; Other
❑ 2na Day (Service Used (circle one): Fed Ex; UPS: USPS; Other )
❑ Certified Mail
❑ Other
Distribution of Copies:
❑ Mail/distribute copy of letter to all cc's; there are not attachments
❑ Mail/distribute copy of letter to all cc's; with attachments
❑ Mail /distribute copy of letter; include attachments as indicated after recipient's name
❑ No copies to mail or distribute
❑ Provide file copy to requestor
CC Addresses:
Date Completed:
Completed by: SLBB V SH DG SL
SF\slbb\\MAILDISTRIBUTIONSHEETSF.WPD)
March 2006

MAIL AND COPY DISTRIBUTION INSTRUCTION SHEET
Person Completing Form: Dwayne Peterson
Date: Mar 11, 2010
Project/Item: (example: Dupont letter of 1/1/05)
Miller Well Nitrates (NONCD0002075) Sample Request Letter
Method of Mailing Original:
❑ Interoffice, Courier or Internal Distribution, as appropriate
❑x Regular US Mail
❑ Overnight Delivery (Service Used (circle one): Fed Ex; UPS; USPS; Other
❑ 2nd Day (Service Used (circle one): Fed Ex; UPS: USPS; Other .)
❑ Certified Mail
❑ Other
Distribution of Copies:
❑ Mail/distribute copy of letter to all cc's; there are not attachments
❑ Mail/distribute copy of letter to all cc's; with attachments
❑ M• ail /distribute copy of letter; include attachments as indicated after recipient's name
❑x No copies to mail or distribute
❑ P• rovide file copy to requestor
CC Addresses:
Date Completed: :174
Completed by: SLBB SH DG SL
SF\slbb\\MAILDISTRIBUTIONSHEETSF. WPD)
March 2006

Miller Well Nitrates - NONCD0002075
Well Address / Owner Name
.
Sample
Date
Sample
By
#
Well
ID#
PCE
2L= 0.7
MCL= 5
RAL= 12
TCE
2L= 3
MCL= 5
RAL= 300
1,4-Dioxane
2L= 3
MCL=
RAL= 611
Chloroform
2L= 70
MCL= 80
RAL= 100
Nitrate (mg/L)
2L= 10
MCL= 10
RAL= 10
Nitrite (mg/L)
2L= 1
MCL= 1
RAL= 1
HRE
Sent
Comments
1998 W. Davidson Avenue
Azgutsizx
Coun
3G0287
M
ts,;7.e
y
Y
2037 W. Davidson Avenue
%�x'.1vn.
. Peterson
MW-04
Y
1455 Edison Drive
Peterson
MW-11
0
Y
1463 Edison Drive
itta:
Peterson
MW-12
Y
Notes:
All units in ug/I (ppb)
Above MDL Limt =
Above 2L Limit =
Above MCL Limit =
Above RAL =
Chloroform Below 2L =
HRE Sent =
*=Sample collected after filter system
(T) or (t) = Total
dpeterson Page 1 4/8/2010

DATE 41 l°
North Carolina Department of Health and Human serREcEIVED
Division of Public Health
Occupational and Environmental Epidemiology Branch FEB 0 7 2001
Medical Evaluation and Risk Assessment Unit
Drinking Water Health Risk Evaluation
General
NC DEPT. OF ENVIRONMENT
AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
COUNTY
LABORATORY NUMBER 0 `1/Z 1)
( ) Based on these analytical results, this water should be considered safe for normal
usage
( ) Chemical analysis did not show any contamination. Water should be resampled if
odor or taste persists.
(X) The water should not be used for drinking or cooking purposes.
( ) Based on these analytical results, this water is highly contaminated and should not
be used for drinking, cooking or bathing/showering.
( ) The laboratory results are not conclusive, please resample:
PLEASE INDICATE ON LAB SHEET THAT IT IS A RESAMPLE AND
PROVIDE PREVIOUS SAMPLE NUMBER(S)
(X) COMMENTS:
The nitrate drinking water standard is 10 ppm. The nitrate level in your well water is
either above or close to the drinking water standard. Continued consumption, especially
of pregnant woman or infants six months of age and younger, may pose an increased
health risk based on these nitrate levels
r7a$1,95"1 '2 3c7
For further information, contact Dr. Ken Rudo, Medical and Risk Assessment Unit, [phone] or-{919) 715-6430
DHHS (11/99)
OEEB (Rev. 11/00)

North Carolina State Laboratory of Public Health
Department of Health and Human Services
P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047
INORGANIC CHEMICAL ANALYSIS - NITRATE ONLY
Name of System: Miller, Miles & Mary
Address: 1998 Davidson Ave.
Gastonia, NC
County: GASTON
Report To: Gaston Co. Health Dept.
991 West Hudson Boulevard
Gastonia, NC 28053
Courier: 06-34-01
Collected By: JOHN CARPENTER
Location of sampling point: WeII Tap
Remarks:
Zip: 28052
Date: 1/3/01
Source of Water: Ground
Source of Sample:
Type of Sample: Raw
Type of Treatment: None
Type of Analysis: Nitrate
Category: Foster/Thera
Time: 12:30:00 PM
Parameters
Nitrite as N
Nitrate as N
Results Units
Date Analyzed:
<0.10
mg/I
mg/I
1/5/01
1/5/01
EXPLANATION OF RESULTS:
Foster/Therapeutic Homes: Nitrate-N level acceptable if less than or equal to 10 mg/I
Private Well Guidelines: Nitrite-N level should be < 1.0 mg/I and Nitrate-I\L< 10.0 mg/1
Date Received: 1/5/01 Report Date: 1/18/01
Today's Date: 1/18/01 Reference: iRn
rsnin Q..i .L n inw ni.i.n
Reported By:

North Carolina Department of Health and Human Services
Division of Public Health
Epidemiology and Communicable Disease Section
1912 Mail Service Center❑Raleigh, North Carolina 27699-1912
2728 Capital Boulevard❑Courier 56-32-00 0019) 733-3421
J. Steven Cline, D.D.S., M.P.H., Section Chief
MEMORANDUM
TO:
FROM:
SUBJECT:
DATE
1-2--16bi
tjUrJ( �i'Qc�/'k
oti
ED
MAk 1 2004
NC DEPT. OF F,:'r =O itiEf T
AND NATURAL RESOURCES
9OORESVILLE REGIONAL OFFICE
(LqcI?iv/I( eft G
Kenneth Rudo, Ph.D., Toxicologist
Medical Evaluation and Risk Assessment Unit
OccupationallI and Environmental Epidemiology Branch
LJ k01%
Attached is/are the Occupational and Environmental Epidemiology Branch's drinking
water health risk evaluation(s) for the well water sample(s) listed from the above site(s).
Recommendations for continued water use are also provided.
If you have any questions, please call me at [phone].
KR:Ip.
Attachment(s)
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EvenjWhere. EvenjDay. EvenjBody.' An Equal Opportunity/Affirmative Action Employer

NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH
OCCUPATIONAL AND ENVIRONMENTAL EPIDEMIOLOGY BRANCH
DRINKING WATER HEALTH RISK EVALUATION
GENERAL
DATE 3I g 161 ' COUNTY LABORATORY #
Based on these analytical results, this water should be considered safe for normal usage.
❑ Chemical analysis did not show any contamination. Water should be resampled if odor
or taste persists.
❑ The water should not be used for drinking or cooking purposes; avoid prolonged
bathing/showering.
❑ Based on these analytical results, this water is highly contaminated and should not be
used for drinking, cooking, or bathing/showering.
O The laboratory -results are not conclusive, please resample.
PLEASE INDICATE ON LAB SHEET THAT IT IS A RESAMPLE AND PROVIDE
Ems-. u VE
PREVIOUS SAMPLE NUMBER(S).
COMMENTS:
NC pq MAR 1 5 2004 r�
NC A �PPT �� �orL£o. �C:ZuIGIV�
AND NATURAL RESOURCES
OOrIZaiLLE ttr:5arliNAL OFFICE
For further information, contact Dr. Ken Rudo, Occupational and Environmental Epidemiology
Branch, [phone].
DHHS 3891 (5/99)
Occupational & Environmental Epidemiology Branch (Review 2102)

Volatile Organic Compounds by GC/MS
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/2004 1215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 5030E 8260E 1 02/02/20041504 RED
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
Benzene 71-43-2 8260B ND 1.0 ug/L 1
Bromodichloromethane 75-27-4 8260B ND 1.0 ug/L 1
Bromoform 75-25-2 8260B ND 1.0 ug/L 1
Bromomethane (Methyl bromide) 74-83-9 8260E ND 2.0 ug/L 1
Carbon tetrachloride 56-23-5 8260E ND 1.0 ug/L 1
Chlorobenzene 108-90-7 8260E ND 1.0 ug/L 1
Chloroethane 75-00-3 8260B ND 2.0 ug/L 1
2-Chloroethylvinylether 110-75-8 8260E ND 10 ug/L 1
Chloroform 67-66-3 8260B ND 1.0 ug/L 1
Chloromethane (Methyl chloride) 74-87-3 8260B ND 2.0 ug/L 1
Dibromochloromethane 124-48-1 8260B ND 1.0 ug/L 1
1,2-Dibromoethane (EDB) 106-93-4 8260B ND 1.0 ug/L 1
1,2-Dichlorobenzene 95-50-1 8260B ND 1.0 ug/L 1
1,3-Dichlorobenzene 541-73-1 8260B ND 1.0 ug/L 1
1,4-Dichlorobenzene 106-46-7 8260E ND 1.0 ug/L 1
Dichlorodifluoromethane 75-71-8 8260E ND 2.0 ug/L 1
1,1-Dichloroethane 75-34-3 8260E ND 1.0 ug/L 1
1,2-Dichloroethane 107-06-2 8260E ND 0.50 ug/L 1
1,1-Dichloroethene 75-35-4 8260B ND 1.0 ug/L 1
trans-1,2-Dichloroethene 156-60-5 8260B ND 1.0 ug/L 1
1,2-Dichloropropane 78-87-5 8260B ND 1.0 ug/L 1
cis-1,3-Dichloropropene 10061-01-5 8260E ND 1.0 ug/L 1
trans-1,3-Dichloropropene 10061-02-6 8260B ND 1.0 ug/L 1
Diisopropyl ether (IPE) 108-20-3 8260E ND 1.0 ug/L 1
Ethylbenzene 100-41-4 8260B ND 1.0 ug/L 1
Methyl tertiary butyl ether (MTBE) 1634-04-4 8260B ND 1.0 ug/L 1
Methylene chloride 75-09-2 8260B ND 1.0 ug/L 1
1,1,2,2-Tetrachloroethane 79-34-5 8260E ND 1.0 ug/L 1
Tetrachloroethene 127-18-4 8260E ND 1.0 ug/L 1
Toluene 108-88-3 8260B ND 1.0 ug/L 1
1,1,1-Trichloroethane 71-55-6 8260E ND 1.0 ug/L 1
1,1,2-Trichloroethane 79-00-5 8260E ND 1.0 ug/L 1
Trichloroethene 79-01-6 8260E ND 1.0 ug/L 1
Trichlorofluoromethane 75-69-4 8260E ND 2.0 ug/L 1
Vinyl chloride 75-01-4 8260E ND 2.0 ug/L 1
Xylenes (total) 1330-20-7 8260E ND 1.0 ug/L 1
Run 1 Acceptance
Surrogate t] % Recovery Limits
1,2-Dichloroethane-d4 103 70-130
Bromofluorobenzene 81 70-130
Toluene-d8 87 70-130
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit a = Detected in the method blank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
Where applicable. all soil sample analysis are reported on a drvweioht basis unless flagged with a'W'
Shealy Environmental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] vwvw.shealylab.mm
E = Quantitation of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 40%
Page: 5 of 12
Level1 ReportV2.0

EDB & DBCP by Microextraction
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/20041215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst
1 504.1 1 02/05/20041547 MTR
Prep Date Batch
Parameter
1,2-Dibromoethane (EDB)
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
CAS Analytical
Number Method Result Q PQL Units Run
106-93-4 504.1 NJ ' 0.019 ug/L 1
POL = Practical quantitation limit B = Detected in the method blank
ND = Not detected at or above the POL J = Estimated result less than the POL
Where applicable, all sod sample analysis are reported on a dry weight basis unless flagged with a W
Shealy Environmental ^.a vic,=, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] www.shealylab.mrn
E = Ouantitafion of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 40%
Page: 6 of 12
Level 1 Report YL0

ICP-AES
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/20041215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3030 C 6010B 1 02/02/2004 1242 FTS 01/23/2004 1700 13221
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
Lead
7439-92-1 6010B 0.0058
0.0030 mg/L 1
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit B = Detected in the method blank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
When: apolicable. all soil sample analysis are reported on a dry weight basis unless flagged with a'W'
E = Quantitabon of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 40%
Shealy Environmental Services, Inc.
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] wwwshealytab.com
Page: 7 of 12
to 1 Report y20

MADEP VPH
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/2004 1215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 MA-VPH-98-1 1 01/24/2004 0352
CAS Analytical
Parameter Number Method Result Q PQL Units Run
C5.- C8 Aliphatics MA-VPH-98-1 t`D 100 ug/L 1
C9 - C12 Aliphatics MA-VPH-98-1 100 ug/L 1
C9 - C10 Aromatics MA-VPH-98-1 t D 100 ug/L 1
= Run 1 Acceptance
Surrogate Q % Recovery Limits
2,5-Dibromotoluene (FID)
2,5-Dibromotoluene (PID)
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
70 70-130
83 70-130
PQL = Practical quantitation limit B = Detected in the method blank
ND = Not detected at or above the PQL J = Estimated result less than the PQL
Where applicable, all soil sample analysis are reported on a dry weieht basis unless fleeced with a W
Shealy Environmental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] wwwshealytab.mrn
E = Quantitation of compound exceeded the calibration range
P = The RPD between two GC colurrns exceeds 40%
Page: 8 of 12
Level 1 Report v20

Peterson, Dwayne
From:
Sent:
To:
Cc:
Subject:
Attachments:
Bynum, Mike [[e-mail]]
Monday, February 22, 2010 3:39 PM
Peterson, Dwayne
Cloninger, Debby
FW: Municipal Water Service Connections
Michael W Bynum.vcf
There is an 8" water line in W. Davidson Ave in this area. The water availability is listed below. Please contact me if you
have any questions or need additional information.
Michael W. Bynum, PE
Planning and Research Manager
From: Cloninger, Debby
Sent: Monday, February 22, 2010 2:01 PM
To: Bynum, Mike
Subject: RE: Municipal Water Service Connections
Mike,
I have checked each of the addresses below for account information in Cayenta and have listed the findings beside each
individual address. Could you answer if how far the nearest area would be for a connection?
Thank you,
Debby
From: Peterson, Dwayne [mailto:[e-mail]]
Sent: Monday, February 22, 2010 1:27 PM
To: Cloninger, Debby
Subject: Municipal Water Service Connections
Debby,
I am conducting a municipal water service inquiry in Gastonia near the intersection of West Davidson Avenue and Edison
Drive. I would like to know if there are municipal water service connections at the addresses listed below. If there is not
water service in that area, how far is it to the nearest waterline?
This information is critical to my work. Please forward this request to the appropriate party. If you have questions
please contact me.
1998 W. Davidson
2001 W. Davidson
2020 W. Davidson
2030 W. Davidson
2037 W. Davidson
2040 W. Davidson
2044 W. Davidson
2049 W. Davidson
Ave. (No Water or Sewer listed on account) Water Available
Ave. (Water on this account only)
Ave. (No water or sewer listed on account) Water Available —
Ave. (No water or sewer listed on account) Water Available —
Ave. (No water or sewer listed on account) Water Available
Ave. (No water or sewer listed on account) Water Available —
Ave. (No water or sewer, listed on account) Water Available —
Ave. (No water or sewer listed on account) Water Available —
— need tap
need tap
need tap
—need tap
need tap (same lot as 2044 & 2052)
need tap (same lot as 2040 & 2052)
need tap
1

2052 W. Davidson
2061 W. Davidson
1447 Edison Drive
1455 Edison Drive
1463 Edison Drive
1469 Edison Drive
Ave. (No water or sewer listed on account) Water Available — need tap (same lot as '2040 & 2044)
Ave. (No water or sewer listed on account) Extension required —160 ft +/-
(No water or sewer listed on account) Extension required — 287 ft +/-
(No water or sewer listed on account) Extension required — 365 ft +/-
(No water or sewer listed on account) Extension required — 471 ft +/-
(No water or sewer listed on account) Extension required — 550 ft +/-.
Thank you in advance for your assistance in this matter.
Dwayne Peterson
Environmental Specialist
NC Division of Waste Management
Inactive Hazardous Sites Branch
Superfund Section
[phone]
email: [e-mail]
Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties.
2

SITE HEALTH AND SAFETY PLAN
A. General Information
Site Name Miller Well Nitrates ID # NONCD 000 2075
Location 1998 W. Davidson Ave, Gastonia, Gaston County, NC
Proposed Date of Investigation 3/22/10 to 4/22/10
Date of Briefing 3/4/10
Date of Debriefing 4/22/10
Nature of Visit (check one): On -Site Reconnaissance
Off -Site Reconnaissance
Sampling
Sampling Overview
Remediation Overview
X
Health Department Official Contacted Curtis Hopper's voice mail
Date of Contact 3/4/10
Site Investigation Team: All site personnel have read the Site Health and
Safety Plan and are familiar with its provisions.
Personnel Responsibilities Signature
Team 1 Dwayne Peterson
Team 1 Larry Rose
team leader, sampling
sampling
Plan Preparation:
Prepared By: David Lilley, Industrial Hygiene Consultant
Reviewed By: Jack Butler, Superfund Section Chief

Waste Type(s)
Characteristics
B. SITE/WASTE CHARACTERISTICS
X Liquid
Corrosive
Solid Sludge X Gas X Vapor
Ignitable. Radioactive
X Volatile X Toxic Reactive Other
List Known or Suspected Hazards (physical, chemical biological or radioactive)
on Site and their toxicological effects. Also, if known, list chemical amounts
EXPOSURE
HAZARD WARNING PROPERTIES LIMIT
Tetrachloroethene
Utility
Power
Telephone
Gas
Water
Sewer
Call made by:
Odor Threshold = 28 ppm 25 ppm
UNDERGROUND UTILITIES CHECKLIST
Locator/Contact Person
2
Phone # Date of Location

ID # NONCD 000 2075
Facility Description: Size unknown Buildings unknown
Disposal Methods Being Investigated No disposal of material or methods of
disposal have been reported.
Unusual Features on Site (dike integrity, power lines, terrain, etc.):
None known
History of the Site: Unknown
C. HAZARD EVALUATION
The site can be toured and sampled in level D protection. PVC gloves
will be worn while collecting water samples. Chemically resistant knee length
boots will be worn on site if the potential for surface soil contamination
exists.
D. WORK PLAN INSTRUCTION
Map or Sketch Attached? yes
Perimeter Identified? no
Command Post Identified? no
Zones of Contamination Identified? no
Personal Protective Equipment/Level of Protection:
C X D
Modifications Wear goggles, face shield, and PVC gloves while preparing
acid preserved samples, goggles and PVC gloves while collecting acid
preserved samples. Avoid breathing acid vapors.
3

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SLOZ 000 CONON # aI

ID # NONCD 000 2075
Location of Nearest Phone: nearby residences
Hospital (Address and Phone Number)
Gaston Memorial Hospital, 2525 Court 'Drive,. Gastonia, NC [phone]
Emergency Transportation Systems (Phone Numbers)
Fire 911
Ambulance 911
Rescue Squad 911
Emergency•Route to Hospital see next page
PREVAILING WEATHER CONDITIONS AND FORECAST
Air purifying respirator
Cartridges for respirator
X Eye Wash Unit
HNU
OVA
Explosimeter
Radiation Monitor
X Decontamination
Materials
safeform.doc
EQUIPMENT CHECKLIST
X First Aid Kit
X 3 gal. Deionized H2O
X Rain suit'
X Gloves (PE/PVC/nitrile/cloth)
X Boots/Boot Covers
X Coveralls (tyvek/saranex)
X Eye Protection (goggles/shield)
X Hard Hat '
STATE POISON CONTROL CENTER
1-800-848-6946
North Carolina OSHA
1-800-LABOR-NC
5

TO BE COMPLETED BY PROJECT MANAGER
PROJECT MANAGER: Dwayne Peterson PROJECT: Miller Well Nitrates
INVESTIGATION DATE: 3/22/10 to 4/22/10
RECONNAISSANCE SAMPLING VISIT X .REMEDIATION/SAMPLING OVERVIEW .,
Respirator Worn By -Approximate Time in Respirator
Air Monitoring Data
PID: (circle one) Mini Rae, HNU
Serial Number
Calibration Reading
Notes
OVA
Serial Number
Notes
CGI/Oxygen Meter
Serial Number
Calibration Reading
Notes
Radiation Meter
Serial Number
Notes
Were there any injuries? 1V ® if yes, explain:
Signature

HAZARDOUS SUBSTANCE INFORMATION FORM
Chemical Name: Perchloroethylene
I. PHYSICAL/CHEMICAL PROPERTIES
Reference
Chemical Formula C2 C14
1
Natural Physical State at 25oC liquid 2
Vapor Pressure 14 mm Hg at 20oC_ 2
Melting Point -2 oF/oC Boiling Point 250 oF/oC 2
Flash Point (open or closed cup) N/A oC/oF 2
Solubility - H2O 0.01596 2
Other misc with alcohol, ether, chloroform, benzene
1
Physical Features: (odor, color, etc.) colorless liquid with an
odor like ether or chloroform IP=9.32 eV (2) OVA Relative
Response = 7096
II. TOXICOLOGICAL DATA
suspect human
Standards: 25 ppm(3)TLV 100 ppm(4)PEL carcinogen (2)IDLH
Routes of Exposure: Inhalation, Ingestion, Skin and/or Eye Contact
(2)
Acute/Chronic Symptoms: Irritation of eyes, nose, and throat, nausea,
flushed face and neck, vertigo, dizziness, incoordination, headache,
carcinogen (2)
First Aid: Inhalation: artificial respiration; Ingestion: get
medical attention immediately; Eye contact: irrigate immediately;
Skin contact: soap and water wash immediately.

Chemical Name: Perchloroethylene
III. HAZARDOUS CHARACTERISTICS
Reference
A. Combustibility Yes _ No X 2
Toxic by-products
B. Flammability LEL none UEL none 2
C. Reactivity Hazard Incompatible with strong oxidizers,
chemically active metals, such as barium, lithium, and beryllium &
barium; caustic soda; sodium hydroxide, potash (2)
D. Corrosivity Hazard yes/no pH:
Neutralizing agent:
E. Radioactive Hazard Exposure Rate
Background yes/no
Alpha particles yes/no
Beta particles yes/no
Gamma radiation yes/no
IV. REFERENCES
1. The Merck Index, llth Edition, 1989
2. NIOSH Pocket Guide to Chemical Hazards, 1990
3. Threshold Limit Values and Biological Exposure
Indices for 2007 ACGIH.
4. 29 CFR 1910.1000, NC PEL

http://www.mapquest.com/print
APQ-VES
Trip to 2525 Court Dr
Gastonia, NC 28054-2140
5.47 miles - about 11 minutes
Notes
1998 W Davidson Ave, Gastonia, NC 28052-5429
1. Start out going SOUTHEAST on W DAVIDSON AVE
toward CLOVERDALE CIR.
o. 2. Tum RIGHT onto N CHESTER ST / US-321 S /
321) SENATOR DAVID W HOYLE HWY.
3. Turn LEFT onto W LONG AVE / NC-7. Continue to follow Map
NC-7.
4. Merge onto 1-85 N toward CHARLOTTE.
5. Take the NC-279 / NEW HOPE RD exit, EXIT 20, toward
DALLAS.
6. Tum LEFT onto N NEW HOPE RD / NC-279.
7. Turn RIGHT onto COURT DR.
8. 2525 COURT DR is on the RIGHT.
2525 Court Dr, Gastonia, NC 28054-2140
Total Travel Estimate : 5.47 miles - about 11 minutes
Ali rights reserved. Use subject to License/Copyright I Map Legend
go 1.5 mi
go0.5mi
go 1.7 mi
go 0.6 mi
go 0.2 mi
go 0.4 mi
go 0.6 mi
go 0.0 mi
Directions and maps are informational only. We make no warranties on the accuracy of their content, road conditions or route usability or
expeditiousness. You assume all risk of use. MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your
1 of 2 3/4/2010 9:37 AM

CORVEL
WC Authorization I Physician's Report 1 Pharmacy Guide
MAILING ADDRESS: P.O. Box 77880, Charlotte, NC 28271
800-365-5998 www.corvel.com
EMPLOYER: Please complete the top section and give to the injured employee to take with them to their authorized treating physician.
If you already have transitional duty job descriptions available, please attach a copy for the treating physician's review.
Name of Employee: Last:
Date of Injury:
First:
Name of Employer: NCDENR- Division
Employer Signature:
Treating Physician:
EMPLOYEE: Please take this form with you to an authorized treating physician. Please have the physician complete the middle section
and retum this immediately to your employer. The bottom section is for you to show the pharmacist should you need to have any
prescriptions filled as prescribed by your authorized treating physician for this work related injury.
AUTHORIZED PHYSICIAN, PLEASE COMPLETE
Diagnosis:
A post accident drug test (check one) ( ) has been completed ( ) has not been completed
In accordance with this patient's physical capability, check all that apply:
( ) May resume work immediately, no restriction.
( ) May resume work immediately with the following restrictions:
( ) Sedentary work (sitting, occasional walking, standing, lifting less than 10 pounds)
( ) Light work (lifting less than 20 pounds)
( ) Medium work (lifting less than 50 pounds)
( ) Heavy work (lifting less than 100 pounds)
( ) Normal shift
( ) Limited hours: hrs, hrs, hrs per day
() Other:
( ) Repetitiv
Frequency
Left
Right
No Use
Occasional <33% of time
Frequent 34-66% of time
Regular 67-100% of time
( ) Patient may return to work at full duty on (date)
( ) Patient has a return appointment on (date) at (time)
Please indicate any referrals that are required:
Physician's Signature
Date
Physician's Name (type or print)
Physician Offices —Be sure to contact CorVel's Claim Department at 800-365-5998 for authorization for the referral.
PHARMACIST: Process all prescriptions on-line through CorVel's CorCareRx for this patient. Contact CorVel's CorCareRx
Help Desk at [phone] to establish eligibility prior to processing on-line from 8 AM thru 9 PM Eastern. After hours, please
contact [phone].
DO NOT CHARGE THE PATIENT FOR THE PRESCRIPTION.
CHAIN NAME
CHAIN NAME
CHAIN NAME
CHAIN NAME
Bi-Lo Pharmacy
Horizon Pharmacy
Revco drugs
VIX Pharmacy
Bi-Mart
HyVee Drugtown
Rite -Aid drugs
Walgreen's
Brooks Drugs
J & J Pharmacy
RX Discount Pharmacy
Wal-Mart Pharmacy
Brookshire Bothers
Joel & Jerry's
Sack-n-Save
Wegman Pharmacy
Cub Pharmacy
Kash N Katy
Sav-A-Lot
Winn -Dixie
CVS Drugs
Kerr Drugs
Sams Club Pharmacy
Drug Emporium
K-martphcy
Save Mart
Eckerds(all others)
Long's Phcy
Stop N Shop
Franck's Pharmacy
Medicine Shoppe
Super D
Fred Meyer
Medistat Phcy
Super Valu
Fred's Pharmacy
Milner -Rushing Drugs
Super X (HSI)
Giant Pharmacy
Pathmark Pharmacy
Tom Thumb Phcy
Goodings
Perry Drg Str -
Tops Pharmacy
Hannaford Food &
Phar-Mor
Tri Daly Drugs
Revision date: 6/2512009

F1bENR
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Beverly Eaves Perdue Dexter R. Matthews Dee Freeman
Govemor Director Secretary
March 3, 2010
Niles & Mary Miller.
1998 W. Davidson Avenue
Gastonia, NC 28052
RE: Water Supply Well Sampling
1998 W. Davidson Avenue
Gastonia, NC 28052
Dear Mr. & Mrs. Miller:
My name is Dwayne Peterson with North Carolina Department of Environment and Natural Resources,
Division of Waste Management. During the week of March 22nd, 2010, I will be in the Gaston County area
collecting groundwater samples related to groundwater contamination in your area. I would like to sample your
well at the above referenced address during that time. You do not have to be present to have your well sampled
and there is no cost to you. The laboratory results will be forwarded to you as soon as possible,
Please contact me by one of the following ways to confirm whether or not you would like your well
sampled. You can reach me by calling [phone], emailing me at [e-mail] or
respond to this letter stating you do wish or do not wish to have your well sampled. I will be happy to answer
any questions you may have at that time.
Sincerely,
Dwayne Peterson
Environmental Specialist
Inactive Hazardous Sites Branch
Superfund Section
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] \ FAX: [phone] Internet: www.wastenotnc.org
An Equal OpporlunitylAffirmative Action Employer
urally
Carolina

North Carolina Department of Environment
and Natural Resources
Division of Waste Management
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
Grady and Bettie McDonald
2115 Dallas -Stanley Highway
Stanley, North Carolina 28164
Dear Mr. and Mrs. McDonald:
ATA
NCDENR
RE: Sample Results
McDonald Water Supply Well (WSW-15)
2115 Dallas -Stanley Highway
On January 22, 2004, Allied Environmental Services, Inc. personnel, representatives of Mr.
Carroll Rash, sampled your water supply well. The samples were analyzed for volatile organic compounds
(VOCs), Volatile Petroleum Hydrocarbons, and Lead. VOCs include a wide range of manmade
compounds including, but not limited to, gasoline components and chlorinated solvents used as degreasers.
The January 22, 2004 sample detected Lead in the well water.
Laboratory results from these samples indicate the conditions in your well at the time the samples
were collected. I have attached a copy of the laboratory analytical report. The results for the groundwater
sample collected from your well were:
Compound
Ilea
Concentration*
NC Maximum Allowable Concentration
*Concentration in milligrams per liter (mg/L), which is also parts per million (ppm).
Otl:01,5 mg
I have forwarded a copy of the laboratory analytical report to Dr. Ken Rudo, of the Occupational
and Environmental Epidemiology Branch of the Division of Public Health, and requested a Health Risk
Evaluation. The Lead does not appear to be related to the petroleum release at C&S Pit Stop. If you have
any questions regarding this constituent, please contact Mr. Bruce Parrish at [phone], ext. 315, or
Mr. Doc Thompson at the Gaston County Health Department at [phone]. Dr. Ken Rudo can be
reached at [phone].
Sincerely,
Brad C. Newton, P.G.
Hydrogeologist II
Attachments
cc: James Thompson - County Health Departwent
cBru..ce-Parrish =-Groundwater7Seetion,-MRO
919 North Main Street, Mooresville, North Carolina 28115
Phone: [phone] \ FAX: [phone] \ Internet: http://wastenot.enr.state.nc.us/
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER — 50% RECYCLED / 10% POST CONSUMER PAPER

4
Volatile Organic Compounds by GC/MS
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/2004 1200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 5030B 8260B 1 02/02/20041530 RED
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
Benzene 71-43-2 8260B ND 1.0 ug/L 1
Bromodichloromethane 75-27-4 8260B ND 1.0 ug/L 1
Bromoform 75-25-2 8260B I D 1.0 ug/L 1
Bromomethane (Methyl bromide) 74-83-9 8260E ND 2.0 ug/L 1
Carbon tetrachloride 56-23-5 8260B ND 1.0 uo/L 1
Chlorobenzene 108-90-7 8260B ND 1.0 ua/L 1
Chloroethane 75-00-3 8260B ND 2.0 ua/L 1
2-Chloroethylvinylether 110-75-8 8260B ND 10 ug/L 1
Chloroform 67-66-3 8260E ND 1.0 ua/L 1
Chloromethane (Methyl chloride) 74-87-3 8260B ND 2.0 ug/L 1
Dibromochloromethane 124-48-1 8260E ND 1.0 uo/L 1
1,2-Dibromoethane (EDB) 106-93-4 8260B ND 1.0 uo/L 1
1,2-Dichlorobenzene 95-50-1 8260B ND 1.0 uo/L 1
1,3-Dichlorobenzene 541-73-1 8260B ND 1.0 ua/L 1
1,4-Dichlorobenzene 106-46-7 8260B ND 1.0 uo/L 1
Dichlorodifluoromethane 75-71-8 8260B ND 2.0 ug/L 1
1,1-Dichloroethane 75-34-3 8260B ND 1.0 ua/L 1
1,2-Dichloroethane 107-06-2 8260E ND 0.50 ua/L 1
1,1-Dichloroethene 75-35-4 8260B ND 1.0 ua/L 1
trans-1,2-Dichloroethene 156-60-5 8260B ND 1.0 ug/L 1
1,2-Dichloropropane 78-87-5 8260B ND 1.0 uo/L 1
cis-1,3-Dichloropropene 10061-01-5 8260B ND 1.0 ua/L 1
trans-1,3-Dichloropropene 10061-02-6 8260E ND 1.0 uQ/L 1
Diisopropyl ether (IPE) 108-20-3 8260E ND 1.0 ug/L 1
Ethylbenzene 100-41-4 8260E ND 1.0 ua/L 1
Methyl tertiary butyl ether (MTBE) 1634-04-4 8260B ND 1.0 ug/L 1
Methylene chloride 75-09-2 8260B ND 1.0 ua/L 1
1,1,2,2-Tetrachloroethane 79-34-5 8260E ND 1.0 udL 1
Tetrachloroethene 127-18-4 8260E ND 1.0 ua/L 1
Toluene 108-88-3 8260E ND 1.0 ua/L 1
1,1,1-Trichloroethane 71-55-6 8260B ND 1.0 udL 1
1,1,2-Trichloroethane 79-00-5 8260B ND 1.0 ua/L 1
Trichloroethene 79-01-6 8260B ND 1.0 ua/L 1
Trichlorofluoromethane 75-69-4 8260B ND 2.0 uQ/L 1
Vinyl chloride 75-01-4 8260B ND 2.0 ug/L 1
Xylenes (total) 1330-20-7 8260E ND 1.0 ua/L 1
Run 1 Acceptance
Surrooate Q % Recovery Limits
1,2-Dichloroethane-d4 106 70-130
Bromofluorobenzene 83 70-130
Toluene-d8 90 70-130
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quanttation limit B = Detected in the method blank E = Quantitatico of compound exceeded the calibration range
ND = Not detected at or above the PQL J = Estimated result less than the PQL P = The RPD between two GC bourns exceeds 40%
V✓nere aoolitadeall soil same analysis are reported on a dry weicht basis unless flaaoed with a W
Shealy Envinximental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] vmwsheaylab.mrn
Paae: 9 of 12
Lee 1 Feecrt v20

EDB & DBCP by Microextraction
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/2004 1200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method
1
Analytical Method Dilution Analysis Date
504.1 1 02/05/2004 1615
Analyst Prep Date
MTR
Batch
Parameter
1,2-Dibromoethane (EDB)
Footnote(s):. NC Cert. #387/NELAC Cert. E87358
POL = Practical quantita8on limit
ND = Not detected at or above the PQL
Where applicableall soil sample analysis are reported on a
Shealy Environmental Services, Inc
106 Vantage Paint Drive Cayce, SC 7titittri [phone]
CAS
Number
106-93-4
Analytical
Method Result Q
504.1
ND
PQL
0.019
Units Run
ua'L 1
B = Detected in the method blank
J = Estimated result less than the PQL
drvweioht basis unless flagxed with a W
Fax [phone] www.sheaytab.com
E = Quan0tation of a npound exceeded the calibration ranoe
P = The RPD between two GC columns exceeds 40%
Page: 10 of 12
Lee 1 'cchcr. v20

ICP-AES
Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01 /22/2004 1200
Date Received: 01/23/2004
Laboratory ID: FA23007-002
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3030 C 6010B 1 02/02/2004 1135 FTS 01/23/2004 1700 13221
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
7439-92-1 6010E 11TOMMINIMIRTM mg/L 1
Footnote(s): ' NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit
ND = Not detected at or above the PQL
B = Detected in the method Banc E = Ouantitatim ot mmpound exceeded the otbrahon range
J = Estimated result less than the POL P = Tne RPD between two GC columns exceeds 40%
Where aoolioble, ali soil sample analysis are reported on a dry weioht basis unless flagged with a W
Shealy Environmental services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] wwww.shealytab.mm
Page: 11 of 12
Lem 1 Fewer, v2D

Client: Allied Environmental Services, PLLC
Description: WS-15
Date Sampled: 01/22/2004 1200
Date Received: 01/23/2004
Run
1
MADEP VPH
Laboratory ID: FA23007-002
Matrix: Aqueous
Prep Method Analytical Method Dilution Analysis Date Analyst
MA-VPH-98-1 1 01 /24/2004 0426
Parameter
C5 - C8 Aliphatics
C9 - C12 Aliphatics
C9 - C10 Aromatics
Surrogate
2,5-Dibromotoluene (FID)
2,5-Dibromotoluene (PID)
CAS
Number
Prep. Date
Batch
Analytical
Method Result Q PQL
MA-VPH-98-1 ND
MA-VPH-98-1 ND
MA-VPH-98-1 ND
Run 1 Acceptance
Q % Recovery Limits
70 70-130
85
70-130
Footnote(s): • NC Cert. #387/NELAC Cert. E87358
POL = Practical quantization Limn
ND = Not detected at or above the POL a = Detected in the 10d thanmated result less the
POL
Where applicable. all soil sample analysis are reported m a dry welcht basis �ess flaoaed with a W
Shealy Bwirpnmental Services, Inc
106 Vantage Point Drive Cayce, SC 29033 [phone] Fax [phone] www.sheaMab.mm
100
100
100
E = Ouanatation of compound exceeded the calibration lance
P = The RPD between two GC oolunres exceeds 40%
Units • Run
ua'L
ua2
oat
Page: 12 of 12
Lexe 1 r v2 0

• North Carolina Department of Environment
and Natural Resources
Division of Waste Management ,
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
Jewell Brown
2111 Dallas -Stanley Highway
Stanley, North Carolina 28164
Dear Ms. Brown:
ATA
NCDENR
February 24, 2004
RE: Sample Results
Brown Water Supply Well (WSW-14)
2111 Dallas -Stanley Highway
On January 22, 2004, Allied Environmental Services, Inc. personnel, representatives of Mr.
Carroll Rash, sampled your water supply well. The samples were analyzed for volatile organic compounds
(VOCs), Volatile Petroleum Hydrocarbons, and Lead. VOCs include a wide range of manmade
compounds including, but not limited to, gasoline components and chlorinated solvents used as degreasers.
The January 22, 2004 sample detected Lead in the well_water.
Laboratory results from these samples indicate the conditions in your well at the time the samples
were collected. I have attached a copy of the laboratory analytical report. The results for the groundwater
sample collected from your well were:
Compound Concentration*
Lead 1P700.5.8 mg/L
*Concentration in milligrams per liter (mg/L), which is also parts per million (ppm).
NC Maximum Allowable Concentration
0.015 mg/L
I have forwarded a copy of the laboratory analytical report to Dr. Ken Rudo, of the Occupational
and Environmental E.idemiology B anch .f the D.ivision-o. Public Health, and requested a Health Risk
Evaluation. e Lea_d, . e not appear to b related to the retroleum release CAS Iait Stap'. If you have
any questions regarding this constituent, please contact Mr. Bruce Parrish at [phone], ext. 315, or
Mr. Doc Thompson at the Gaston County Health Department at [phone]. Dr. Ken Rudo can be
reached at [phone].
Sincerely,
Brad C. Newton, P.G.
Hydrogeologist II
Attachments
cc: James Thompson - County Health Department
-Brice Parish-- GroundwaterSecton,_MRO .9
919 North Main Street, Mooresville, North Carolina 28115
Phone: [phone] \ FAX: [phone] \ Internet: http://wastenot.enr.state.nc.us/
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER — 50% RECYCLED / 10% POST CONSUMER PAPER

Volatile Organic Compounds by GC/MS
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/2004 1215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 5030B 8260B 1 02/02/20041504 RED
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
Benzene 71-43-2 8260B ND 1.0 ug)L 1
Bromodichloromethane 75-27-4 8260E ND 1.0 uadL 1
Bromoform 75-25-2 8260E ND 1.0 ug/L 1
Bromomethane (Methyl bromide) 74-83-9 8260E ND 2.0 uaiL 1
Carbon tetrachloride 56-23-5 8260B ND 1.0 ua/L 1
Chlorobenzene 108-90-7 8260E ND 1.0 udL 1
Chloroethane 75-00-3 8260B ND 2.0 ug/L 1
2-Chloroethylvinylether 110-75-8 8260B ND 10 1
Chloroform 67-66-3 8260E ND 1.0 uiL 1
Chloromethane (Methyl chloride) 74-87-3 8260B ND 2.0 ua/L 1
Dibromochloromethane 124-48-1 82608 ND 1.0 ug/L 1
1,2-Dibromoethane (EDB) 106-93-4 8260B ND 1.0 uaiL 1
1,2-Dichlorobenzene 95-50-1 8260B ND 1.0 uat 1
1,3-Dichlorobenzene 541-73-1 8260B ND 1.0 ug/L 1
1,4-Dichlorobenzene 106-46-7 8260B ND 1.0 uo/L 1
Dichlorod'tfluoromethane 75-71-8 8260B ND 2.0 ua/L 1
1,1-Dichloroethane 75-34-3 8260B ND 1.0 ug/L 1
1,2-Dichloroethane 107-06-2 8260E ND 0.50 ua/L 1
1,1-Dichloroethene 75-35-4 8260B ND 1.0 ua/L 1
trans-1,2-Dichloroethene 156-60-5 8260B ND 1.0 ug/L 1
1,2-Dichloropropane 78-87-5 8260B ND 1.0 ug!L 1
cis-1,3-Dichloropropene 10061-01-5 8260B ^ ND 1.0 ug/L 1
trans-1,3-Dichloropropene 10061-02-6 8260B ND 1.0 ua/L 1
Diisopropyl ether (IPE) 108-20-3 8260B ND 1.0 ua/L 1
Ethylbenzene 100-41-4 8260E ND 1.0 ua/L 1
Methyl tertiary butyl ether (MTBE) 1634-04-4 8260E KD 1.0 ua/L 1
Methylene chloride 75-09-2 8260B ND 1.0 ua/L 1
1,1,2,2-Tetrachloroethane 79-34-5 8260E ND 1.0 ua/L 1
Tetrachloroethene 127-18-4 8260B ND 1.0 ua/L 1
Toluene 106-88-3 8260B ND 1.0 ug/L 1
1,1,1-Trichloroethane 71-55-6 82608 ND 1.0 ua/L 1
1,1,2-Trichloroethane 79-00-5 8260E ND 1.0 ua/L 1
Trichloroethene 79-01-6 8260B ND 1.0 ug/L 1
Trichlorofluoromethane 75-69-4 8260E ND 2.0 ug/L 1
Vinyl chloride 75-01-4 8260B ND 2.0 ua/L 1
Xylenes (total) 1330-20-7 8260E ND 1.0 ug/L 1
Run 1 Acceptance
Surrogate Q % Recovery Limits
1,2-Dichloroethane-d4 103 70-130
Bromofluorobenzene 81 70-130
Toluene-d8 87 70-130
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quanthation limit 8 = Detecoei in the method blank E = Ouantitation of compound exceeded the calibration ranoe
ND = Not detected at or above the POL J = Estimated result less than the POL P = Tire RPD between two GC miurms exceeds 40%
Where applicable, all soil sample analysis are reported on a dry weight basis unless flagged with a W
Shealy Emtronrnental Services. Inc.
106 Vantage Pc nt Drive Cayce. SC 29033 [phone] Fax [phone] w.wv.shealylab.mm
Page: 5 of 12
Leve 1 Re7an v2 0

EDB & DBCP by Microextraction
Client: Allied Environmental Services, PLLC
Description: WS-14 Laboratory ID: FA23007-0D1
Date Sampled: 01/22/20041215 Matrix: Aqueous
Date Received: 01/23/2004
Run Prep Method 1 Analytical Method Dilution Analysis DateAnalyst
504.1 1 02/05/2004 1547 Prep Date Batth
MIR
Parameter CAS Analytical
1,2-Dibromoethane (EDB) Number. Method Result Q
106 93 4 PQL UnitsRun
504.1 ND
0.019
Footnote(s): * NC Cert. #387/NELAC Cert. E87358
PQL = Practical quantitation limit
ND = Not detected at mor tahae the PQL a = Detected in the method Wank
NDVVh= apdi�We, al sail J = Estimated result less than the P E = Tne R talon of compound exceeded the ta6Wapm
sample analysis are reported on a dry weioht basis unlessP = Tne RPD rarxpe
flapped with a'W' �^''�^ iho GC mlurtns exceeds 40%
Shealy Environmental Services, Inc
106 Vantage Perm Drive Cay0e, SC 29033 [phone] Fax[phone] www. ( ) 7sheaNlab.mm
oat 1
Page: 6 of 12
Leve +.20

ICP-AES
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/2004 1215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 3030 C 6010B 1 02/02/2004 1242 FTS 01/23/2004 1700 13221
Parameter
CAS
Number
Analytical
Method Result Q PQL Units Run
7439-92-1 6010B Mai .04130 rTlg/LI 1
Footnote(s): ' NC Cert. #387/NELAC Cert. E87358
POL = Practical quantitation limit B = Detected in the method Wank
ND = Not detected at or above he POL J = Estimated result less than the POL
Wnere applicable. at soil sample analysis are reported on a drvweioht basis unless flaboed with a W
Shealy Environmental Services, Inc
108 Vantage Point Drive Cayce. SC 29033 [phone] Fax [phone] ywnvsbealylab.cnm
E = Ouantitation of compound exceeded the calibration range
P = The RPD between two GC columns exceeds 401
Pace: 7 of 12
Leve 1 R_eoarr y20

MADEP VPH
Client: Allied Environmental Services, PLLC
Description: WS-14
Date Sampled: 01/22/2004 1215
Date Received: 01/23/2004
Laboratory ID: FA23007-001
Matrix: Aqueous
Run Prep Method Analytical Method Dilution Analysis Date Analyst Prep Date Batch
1 MA-VPH-98-1 1 01/24/2004 0352
CAS Analytical
Parameter Number Method Result Q PQL Units Run
C5 - C8 Aliphatics MA-VPH-98-1 ND 100 uo/L 1
C9 - C12 Aliphatics MA-VPH-98-1 ND 100 ug/L 1
C9 - C10 Aromatics MA-VPH-98-1 ND 100 ug/L 1
Run 1 Acceptance
Surrogate Q ¶' Recovery Limits
2,5-Dibromotoluene (FID)
2,5-Dibromotoluene (PID)
Footnote(s): ' NC Cert. #387/NELAC Cert. E87358
70 70-130
83 70-130
POL = Practical quantifation limit B = Detected in the method blank
ND = Not detected at or above the POL J = Estimated result less than the PQL
Where applicable. all soil sample analysis are reported on a dryweioht basis unless fiaooed with a W
Shealy Environmental Services, Inc
106 Vantage Point Drive Cayce. SC 29033 [phone] Fax [phone] wmvshealytab.ca n
E = Ouanbtation of mrnpound exceeded the calibration ranoe
P = Tne RPD between two GC cdurms exceeds 40%
Page: 8 of 12
Lever 1 Rom v2D

FORMER
KEROSENE
UST LOCATION
VMW-1 0
(NA)
LEG EN D
MW-5
DISPENSER
ISLAND
MW-1 MONITORING WELL LOCATION
VMW-1 DEEP MONITORING WELL LOCATION
— o PRODUCT LINE
—> > >— DITCHES
PROPERTY BOUNDARY
(NA) NOT APPIJCABLE; DEEP WELL
GROUNDWATER FLOW DIRECTION
(50.03') GROUNDWATER ELEVATION (AT LOCATION)
58.00' ESTIMATED GROUNDWATER CONTOUR
57.50'
58.00'
(2) 4,000—GALLON
GASOLINE USTS 58.50'
1
® MW-2
(58.79')
9,250—GALLON
GASOLINE UST
r�
MW-3
(58.55')
L -T�
MW-4
(59.87')
59.00'
SITE
RESIDENCE
DISPENSER
ISLAND
O4LL.A$'/17ANLEY Hr6'f/1Y4Y (H,tw11i4Y 2752
59.50'
80.00'
0
30'
SCALE: 1'= 30'
MASSOCIATES, P.A.
ID -ATLANTIC
Engineering & Environmental Solutions
ESTIMATED WATER TABLE CONTOUR MAP
C & .S PIT STOP SITE
INCIDENT NO. 21536
STANLEY, GASTON COUNTY, NORTH CAROLINA
DRAWN
BY: I/
DRAFT : /'/ ✓W
CHECK
DATE: OCTOBER 2001
JOB NO:
0000C271.03
ENG
CHECK:
CAD NO: 02-027102-03
REFERENCE: APPROVAL: y0-DWG NO: 4

vvaEerSupplyWell (D

NORTH
MOUNT HOLLY, NORTH CAROLINA
35081—C1—TF-024
DMA 4754 I SE —SERIES V842
1993
CONTOUR INTERVAL 20 FEET
NORTH CAROUNA
QUADRANGLE LOCATION
0
2000'
SCALE 1'= 2000'
ID -ATLANTIC
M ASSOCIATES, P.A.
Engineering & Environmental Solutions
TOPOGRAPHIC LOCATION MAP
C & S PIT STOP SITE
INCIDENT NO. 21536
STANLEY, GASTON COUNTY
NORTH CAROLINA
DRAWN
BY:
DATE: OCTOBER 2001
DRAFT
CHECK:
ENG
CHECK:
rJOB
NO:
CAD
02-027104-03
NO:
0000C271.03
APPROVAL: yak
DWG: 1
REFERENCE:

_ > 'TABLET t
_5 WATERLEUEL DATA
,u��v �, �.r i a y i -t�-• f. -S4-�+*�� s
x Z s c# r-(. , � F,- ` r-. y x rM ., � .r• '''C $S S PIT STOP }sl l
_ , tNCNT NO 29536 -
s � LDE� x
STANLEY, GASTONzCOUNT NORTH CAROL1NA
; - . _.= it- _ d'PROJECT NO'.,,C271 O3
J'"c
t
,,
r r
�' z: :. a, ;..
' ..
, f -
7. `.
4
TtEASUR}NG-PO}NT
-.ELEVATION (TOC}'
DEPTH TO FREE
p.ROD.UCT{FT) ;.
;DEPTHTO`WATER
" IFTj : ` .:
PRODUCT :
-THICKNESS'(FT)
VIATER LEVEL
ELEVATIO}d'(FT)
MW- i
98.63
—
DRY
—
—
MW-2
99.09
—
40.30
—
58.79
MW-3
98.60
--
40.05
—
58.55
MW-4
100.00
38.87
43.90
5.03
59.87*
MW-5
87.84
—
30.55
—
57.29
MW-6
100.92
—
40.89
—
60.03
VMW-1
99.08
—
40.75
—
58.33
Notes:
S&ME.
elevation based on calculation (elevation - (depth to water - (free product thickness x 0.75))).
on August 15, 2001.
FT = feet
TOC = Top of Casing
— = Not Applicable
TOCs surveyed by
* Corrected water level
All water levels measured

L..�. 7 ,- , ' , a ..,� 1 TABLE'2.( .0-6 f,of 2} '- -., n ; :.
L� s SUMMARY UP COiMPOUlti(DS? DETECTED IN GROUNDWATERLSAMPLES
`Fl T: i F 'L to p 9 �j.. �•�• �+.,+ �J . n�.� A .i. Y' A hs. 1�
-..L «.a„Y rF i'-,W Rx F.r i `Ya r & S •.11 a7..4Or SITE. z "E mot.' y' #. r ,r 1 -
7 ,e'a. u Z+y� t x -a It+, ti..r. .f x �, �b _ �r. , , q- lag
z Y h'xt2. ',,.�X'" te,'Y• .`v. d' :d- n �,t .-m �1` ck y.�.c�Y 14, `�` �% i� �.a .E�..^5. �' r �r .u.,
4 Z % I ry F--Jt 9 I1 �S M J� Ji (u.t �.'. gy�I. CI DENTNk O . 215364' w%'� tr 'S 1A.� S, X 4 +
m M �� K ` ST NEL � STUN G`O!1 11fTY NORTfFCI�RObWiA- '
4, '' 1 .(..[rL lDR - : i•,. •+Y i .:Y S"'i y 3..`. d. n ,y 1 4 T , '
,:' x:..' A • ...:' ' :Iii;;, :� _a - EGAD - AT A T1C"FR9JECT .NO C2T,,;F:�3�,,,.M.,.�i, .;<. ,. •I.rti
-� - + ;
}
i 3. 2S
4 $ y�.- Ot -..
t. t
uN �t - xx{
yL f
7. 7? i u�'N5., _I..LH
. - COMPOUND
., v s'c{ y t 1. „
aDETEC ' D� �
`_.: i}i91Lj -
- ' . +AMPLE f DJCONCENTRATION L
hi.M.S- w ',"^Sak �-"s tl'�!". y rx� . a 1.: r Ali 1 + •d, r
3 d !_rgIL) 4� 0.� �n F
y
NCGV1[QS
n r
:" xMW Z ..
.:_�I(W-3
-. MW-5 `.
_
�/Milu 1
Benzene
8,200
540
ND
ND
1,800
1
Toluene
5,300
96
ND
ND
ND
1,000
Ethylbenzene
490
28
ND
ND
ND
29
Total Xylenes
3,200
170
ND
ND
140
530
Total BTEX
17,190
834
ND
ND
1,940
NE
Chloroform
ND
ND
ND
ND
ND
0.19
1,2-Dichloroethane
1,300
58
ND
ND
110
0.38
1,3,5-Trimethylbenzene
150
ND
ND
ND
ND
350
1,2,4-Trimethylbenzene
470
38
0.76
ND
37
350
Naphthalene
260
ND
ND
ND
ND
21
MTBE
84
81
ND
ND
25
200
IPE
1,100
92
ND
ND
140
70
Total VOCs
20,554
1,103
0.76
ND
2,252
NE
Total Lead (mg/L)
ND
0.025
0.083
0.043
ND
0.015
Notes:
Micrograms per liter or parts per billion
Milligrams per liter or parts per million
Not Established
Not detected at or above the practical laboratory quantitation limit
Not Sampled
North Carolina Groundwater Quality Standards •
Exceeds applicable NCGWQS
Volatile organic compounds
Benzene, toluene, ethylbenzene, xylenes
Methyl tertiary butyl ether
Isopropyl ether
15, 2001.
µg/L
mg/L
NE
ND
NS
NCGWQS
BOLD
VOCs
BTEX
MTBE
IPE
Samples collected on August

Aix-.w iF
.aY.,Ga> ^4 Y+.�
` SC#I fIA
ia•V, '�S ytirh T- � 7+'`-2 '�, 'k
`N..96! c.- ..
G�i'Ag• of r'
Pi(�. 't'L,
[ 'a {3^"R
� � � w 1
'':,
t Y ' '(.i''-Ys "3Y F A-ks'V
-i•a tF efli S.'f?
.v -ram'�`i'? 'N.(a
y n �;-s' a�.�+ „n
�S r .r�x�r'� �2�1 `v
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kA 1� ,4 .r-�,� "�' L`$�n.�5ic.,7; ' Y '.rC iG iJ ,
.� � Y. " Y
rV ^+ '•.. l ii f- ,3 Y'Y
, ±tit - avi :O t o D )�C�ED t1� fiRol,
. y7 �y"•gSiy '-,�- . 1 3f' ,,:, e,n 'E` `K,f a%+
; Q.• 'i,/.5l ?�/'}l�.. �v i 7.( , d>a'b
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'1'. v's s '*i-'�•
^ wq'4': t, 1w� 1 „`L' ..A ei'
C •er S
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• b •t'9'�.''�y {T�^r.^w'.`�e-ii }' --d'ir '7'"F^�'dPf"'4!gfxt -'' "}* kSiJi'`X�
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.?r='' tPyf1..4,:,' i v fi , i' ., — �`.
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r ><Y •i -'du.
,,, '[�
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ND]_NATE�t
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tNt
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}
-C �� t.`.„ fi
.,4,, `, , js� Aa.'
u-.l h
4
i" f3 .-.T
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I" Ky
y"-' ,Ti'
'
(...rr �e Hi .'4v.+.
' fin
's "" +i4 a5
'
+
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s"" y
.. ,��."i .G££IMvv�,t,..�1Y
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f .!'` "�+f 4
4� Y
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r' -4
r F,:..Y-:�'•'.
i
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r; YaA
k �
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t3.. T 'e'
a`. iv.
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r .vx�' 7v' ,y
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s.�� ,2�,�r
rt Vi 1�
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Yt r �.i:Y 1 F..-<• ...-V`E -f34-m T
,. ND,-,� i�
}L 1, ��f-:+v' aN CF�1C.iF"'i •i,
'",,j.
� }Jh.
�' R..� 3.Y
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_gf."..:, s°•
:' f'
. j':t At�►PLE^
� � i T � rNFN
- ' i .,,.
' ,s- ,,_
"J. f " `�.�++ld 'A'.1`
>,, .. ''' SAT#ONV, .it
J'�yYi.z[ xi.. I' s�. Y .!
>w ' - ^rmt..
a`'r ��.L'} ' z '�" r.,,,4 _, �e'7�
%
JF ,
�+..� -.l!`l -...'
.'" Sij,.„�dA•
't. f. .� `F�
E' ^'ji.
't".
f
- ... y�,
.' `j
c�hrV
�� S
,� � 'L
l
42 ' +? Y�
•:ail:" A
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r x
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T ¢ ^�'r Ali`,.
pp`` .Mtt ki�
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�,
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_
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ii. --4 :�.: ,:t, r:
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i l T.� +$
_
j{��jj��1 ��1y�N
•K3 -.:.' .• ,„ .'9l,y
< - r _.i
{{�� ��(��y
i y Tt�F
-v {
Benzene
ND
ND
ND.
ND
ND
1
Toluene
ND
ND
ND
ND
ND
1,000
Ethylbenzene
ND
ND
ND
ND
ND
29
Total Xylenes
ND
ND
ND
ND
ND
530
Total BTEX
ND
ND
ND
ND
ND
NE
Chloroform
ND
ND
\ 6.92
ND
ND
0.19
1,2-Dichloroethane
ND
ND
ND
ND
ND
0.38
1,3,5-Trimethylbenzene
ND
ND
ND
ND
ND
350
1,2,4-Trimethylbenzene
ND
ND
ND
ND
ND
350
Naphthalene
ND
ND
ND
ND
ND
21
MTBE
ND
ND
ND
ND
ND
200
IPE
ND
ND
ND
ND
ND
70
Total VOCs
ND
ND
6.9
ND
ND
NE
Total Lead
NS
NS
NS
NS NS
0.015
Notes:
Micrograms per liter or parts per billion
Milligrams per liter or parts per million
Not Established
Not detected at or above the practical laboratory quantitation limit
Not Sampled
North Carolina Groundwater Quality Standards
Exceeds applicable NCGWQS
Volatile organic compounds
Benzene, toluene, ethylbenzene, xylenes
Methyl tertiary butyl ether
isopropyl ether
15, 2001.
p.g/L
mg/L
NE
ND
NS
NCGWQS
BOLD
VOCs
BTEX
MTBE
IPE
Samples collected on August

WSW-1
Mr. Bob Rowland
108 Lake Road
704/ 263-2381
13-74-8
Other parcels utilizing WSW-1
Mr. David Mullis
PO Box 4197, Gastonia, NC
Mr. Carroll Nash
2119 Dallas/Stanley Highway
(SUBJECT SITE)
Mr. Jason Rowland
111 Lake Road
13-56-19.03
13-56-19.04
13-56-19.05
WSW-2
Mr. James Mitchell
112 Lake Road
704/ .263-4555
13-56-19.01
WSW-3
Mr. Glenn Rowland
106 Lake Road
704/ 263-2527
14-71-4
WSW-4/4A/4B
Mr. James Welch
2225 Dallas/Stanley Highway
704/ 263-4470
14-71-4.01
WSW-5
Mr. Alberta Jeter
2229 Dallas/Stanley Highway
14-55-30
WSW-6
Ms. Minnie Hamrick
2216 Dallas/Stanley Highway
704/ 263-8327
14-71-7
WSW-6A
Trailer
14-71-8.03
WSW-7
Mr. James Welch
2200 Dallas/Stanley Highway
704/ 263-4470
14-71-6
WSW-8
Ms. Christine Whitley
2116 Dallas/Stanley Highway
704/ 263-2000
14-71-5
WSW-9
Mr. Luther Murphy
2110 Dallas/Stanley Highway
704/ 263-8353
13-74-3

WSW-9A
Mr. Luther Murphy
2110 Dallas/Stanley Highway
704/ 263-8353
13-74-7.01
WSW-10
Mr. Lawrence R. Murphy
2080 Dallas/Stanley Highway
704/ 263-1445
13-74-3
WSW-1 1
Mr. Charles Gardner
2071 Dallas/Stanley Highway
13-74-5.02
WSW-12
Ms. Merle Smith
2083 Dallas/Stanley Highway
13-74-1
WSW-13
Mr. George Matthews
2101 Dallas/Stanley Highway
704/ 263-8033
13-74-1.03
WSW-14
Ms. Jewell Brown
2111 Dallas/Stanley Highway
704/ 263-4844
13-74-1.01
WSW-15
Grady and Bettie McDonald (LF)
2115 Dallas/Stanley Highway
704/ 263-4292
13-74-2
WSW-16
Lovel Sipe
2059 Dallas/Stanley Highway
704/ 263-2398
13-74-5
WSW-17
Mr. Eugene Pressley
2051 Dallas/Stanley Highway
704/ 263-8866
13-74-5.01
WSW-18
Mr. Larry Miller
2041 Dallas/Stanley Highway
704/ 263-1709
13-74-9
WSW-19
Archie and Linnie Foster
102 Graham Street
14-71-17.04
WSW-20
Mr. William McClain
104 Graham Street
704/ 263-8407
14-71-17.02
WSW-21
Ms. Pauline Sherrill
108 Graham Street
14-71-17.03

WSW-22
Locksley Alberga
112 Graham Street
704/ 263-4213
14-71-17.01
WSW-25
209 Shadow Brook Road
14-71-14.66
WSW-26
211 Shadow Brook Road
14-71-14.67
WSW-27
213 Shadow Brook Road
14-71-14.68
Reference: Southeastern Geological Services, Inc. Table February 23, 2000 and Mid -
Atlantic Associates, P.A. Field Activities August 17, 2001.