WQ0006018_More Information (Received)_20210527

S)(I )OG R
YOUR PARTNER FOR A CLEANER, GREENER WORLD
May 27th, 2021
N.C. Department of Environment and Natural Resources
Division of Water Resources
Wilmington Regional Office - Water Quality Regional Operations Section
127 Cardinal Drive Ext.
Wilmington..., NC 28405
ATTENTION: Poon-am Giri
REFERENCE: Landowner agreement forms signatures - WQ0006018
Town of Morehead City RLAP
Poonam,
I am addressing Section D of the additional information request for the Town of Morehead C?k
ity
PJLAP. See below.
D. Pro
Documentation:
1. The Landowner Agreement Forms (LOA 06-46) have not been signed by the Permittee.
These forms will need to be properly executed and resubmitted. Please have both the
designated signature authority for the Town of Morehead City and the landowner/lessee
sign the Landowner Agreements. Once notarized, please resubmit new notarized copies
to the Division.
Please find that the Land Owner Agreement forms (LOA 06-16) have been signed by the
signatory authority for Morehead City WWTP. Also, find attached the Land Application Site
Certification (06-16) section of the Morehead City WWTP permit renewal as this will contain all
the required signatures. Let me know if you have any qu,
additional. documentation.
Best regards,
Chris W}
Technical Services Specialist
estions, concerns, or if you need any

State of North Carolina
Department of Environmental. Quality
D ivision 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 bogey 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 nosed, the Applicant shall submit one original and two copies of the application and
sunnorting documentation .
For more information, visit the Water Quality Permitting Section's Non-DischaLge PerinittM* Unit
General — This certifcation 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 .I 100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16)0
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 (FARM: 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 male, as long as the attachments are numbered to coinspond to the section and item to which they
refer.
� For new or renewed permits, submit the requested information for all hand application sites.
� For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed .modification.
B. Land Application Site Information:
� The status of the hand application site with respect 1:o this residuals hand application proicyram must be provided. in table I.
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:
Status Code
Required Item
N R T M
County Board
Noiification.doc
w.
Land Owner
Agreement
(If applicable)
v/
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
for Residuals Land Application Permits"
A sons and agronomic evaluation in accordance with the "Sail scientist
ENialuati"mi Polic)."
The
INSTRUCTIONS FOR FORM: LASC 06-16 Page lof3

An updated accounting of the land application site's cumulative.-_p
ollutant loading rates (C'PLRs)
Code
Status Requrred :Item
N R T M
For previously permitted sites without a sozl series name indicated in the
Attachment B, submit County Soil Survey Map for equivalent} clearly
indicate the location. of the land application site and in accordance with
the sail map requirements in the "Soil Scientist Evaluation Police"
Acknowledgement of field transfer from Land Owner (Fields may not �
be pei-initted to multiple Pennittees 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 requirement.
� Crop Type should include the most likely crop types for the fife 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 ffieficensed 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 sail -mapping unit must be consistent with the predominant soli 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 soli 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 61/o.
� New Sites to be permitted must have slopes determined as dart of the soils report prepared by a licensed soil scientist.
� Acceptable methods for determining location coordinates (Le._, latitude and longitude) and their corresponding codes are as
follows -P
Address Matching (ADD)
• Aerial Photography with Ground Control (AER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township- Section -Range (TSR)
• Conversion from Universal Trans Merc (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Informations. (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
Navigation Quality UPS (GPS)
• Remote Sensing (RS)
• dip Code Centroid {ZIP}
� Use an 8.5 by 1 1-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 neap name and number, the identified location; and be of clear and reproducible quality.
� Surface water body classifications information may -be found at: h
resources/ �la�lning fi /ciass�c�ation-standards/c,lassificatiotls
-.//deq.nc.oFov/about/d1vi'slo-ns/water-
21-
� dp
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 down -loaded at:
htM://dea.nc.Lyov/contact/re..c.-r'lonal-off-ices
General Instructions: There are 17 river basing in North Carolina. Eacb 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
I 1-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 l: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to streafn name" as the waterbodv name.
3. Open the link http://deq.nc.u,ov/about/divisions/water-resources/planning/classification-standards/classifcat'ions.
� S#ream 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.
'Tsourcef' in the description means the beginning of the waterbody segment (most upstream point)_
4. Record all Basins, Scream Index Numbers and Classifications applicable to the project.
0 KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
I . Select the proper county from the List al 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.
"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.
� UNKNOWNBASIN WIRE 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 locafion description.
"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.
El Notes on index number and unnamed streams. -
Unnamed Streams 15A NCAC 02B .0301(i1.
The term
The term
The term
� 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 pou*it of enter) except:
(A) unnamed screams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1,1 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 followm*g 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 enterin Georgia or `Tennessee sliall be classified "C Tr."
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
Little Tennesse River
Basin And Savannah
River drainage area enuring South Carolina shall be classified "B Tr."
Ri-ver'Dram*aae Area
French Broad River
Streams entering Tennessee will be classified "B."
Basin
Wataucra River Basin
Streams entering the State of Tennessee are classified "G."
Z2
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams enterin the State of Tennessee are classified "G."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Streams entering Virginia are classified "C," and such screams enuring South Carolina are
Basin
classified "C."
Luniber River Basin
Streams enterin Sough Carolina are classified "C Stir."
Streams entering Virginia are classified "G" Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
Roanoke River Basin
described snail 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 Virgm'i a are classified "C."
Tar -Pamlico River
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
Basin
canals to Pamlico Sound and it's bays which shall be classified "SC."
Pasquotank River Basin
AH drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3

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Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of d i ionai
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise nosed the Applicant shall submit one on final and two copies of the a plication and
supporting documentation
For -note information, visit the Water Quality PermittingSection's i - i h e n i r' r ni .
General — This document is an agreement between theApplicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water tre atrn ent plant or other type residuals) in. accordance with 1 SA NCA C 42T .1 1 04. D o nod submit
this agreement for review without a corresponding application form (FARM: R-LAP 06-16),,
Unless otherwise noted, the Applicant shall submit one original and two capies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this forin. 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 land -owner 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: Morehead CiRy WWTP
hereinafter referred to as the .Permittee, to land apply residuals from the following facilitY(ies) onto the followhig land
application sites) (i.e., see attached setback maps} in accordance with the stipulations and restrictions as given in this
Agreement:
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s} described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shad 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.
Site/Field ID
Lease
Land Use or
niended Use of Crops
Residuals Source
special note
(no-�ili/over-seed/
(yes/no)
Cropping
Cro �n Patterns
(optional)
�
pasture)
NC-CR-1-1
Y
Row Crop
Animal Feed
NC-CR-1-2
Y
Row Crop
Animal Feed
NC-CR-1-3
Y
Row Crop
Animal Feed
FORM.- LOA 06-16 Page lof3

STIPULATIONS.
I. The landowner or his representative sha11 not enter into any additional residuals application contracts or agreements with another permitted
entity for the sites) 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 I1) 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 hand application site(s) to a new
landawnei. In addition, the current landowner shall give a notice to the new landowner that gives fill 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 method, schedules for typical cropping patterns, a description of the
equipment used by the Perrnittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit friar 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 sa3nples, 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 ally revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Fennittee 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 toenter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of d'etermm'jng
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 ternns 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.
11. RESTRICTIONS:
1. Appropriate measures must be tak-en 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 gazed on the land application site(s) fora 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 shad not be harvested fora 30-day period following a residuals land application event.
4. Food crabs with harvested parts that pouch the residuals/soil mixture and are totally above the land surface shall not be harvested fora 14-month
period fallowing a residuals land. application event.
S. Food crops with harvested parts below the surface of the land shall not be harvested fora 20-month period following a residuals laid 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 haryested parts below the surface of the land shall not b e haryested fora 38-month p eri o d fo I lowing a residuals land application
event when the residuals remain on the land surface for less fih�m four months prior to ixicorporation into the soil.
7. Turf grows on Iand where residuals are applied shall not be harvested fora 12-month period following a residuals Land application event.
Ills ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
1 SA NCAC 02L .0107(d) prohibits wafer supply wells within the compliance boundary. However, 15A NCAC 02T.0 I 05(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 previmisly permitted residuals land application program and t7ransfeiTed
into the new program;
(Name of the new program)
FORM,: LOA 06-16 Page 2 of 3

VICINITY MAP
do
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Mw3
t ;+mq off
V l
Ar
IV
GRAPHIC SCALE
1" = 41000,
43000,
The compliance boundary is established ether 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.
0
ED
1bq1
NC=CRMOI
Fields 1-2

Landowner's Certification:
I certify that 1 am a deeded landowner of the above -referenced land application site(s) and arn authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I arn otherwise authorized, through
Cr
a power of attorney or other le 4z' al delegation, to ��nake decisions regardinn the use of the land applicatian sites) on behalf of the
deeded landowners. I certify tht the above -referenced land application sites) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, Z certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary,�etnent of
p acknowledb
field transfer, and do hereby grant Pei -mission to the Permi
herein. ttee to ]and apply residuals to the land application site(s) as specified
Landowner name: ��1E
1\cs� tor %
ex e, c. Y,
Address: 0\
J S
City: State: Z; _
P.
Phone: ��� `�J����4�j C.��` E-mail address:_�'C*-_J
�g���
w;C Signature-.
a
,41\ Date:
NORTH CAROLINA, Cruvekn COUNTY
I, the undersigned Notary Public do hereby certify that
J& e
h
iVQ M
4
personally appeared before me this day and. acknowledged the dui execution of the forooin� instrument.
WITNESS my hand and official seal this the,
day of
\ 10, ti (,Lq
Signature and seal:
�0 21
__
III corms �ZS C�'Istopher� i i on ex fires�
Lessee's/Operator's Certification:
IN U I A G,
Wake Colinty, ref(;
My Commission Expires AUgLlst 30, 2025
I certify that I have. read this Agreement and do hereby agree to abide b
y the stipulations and restrictions as specified herein.
Lessee/operator name: �� 6 ft4- � f
Address.- �$3 � `�.efri 04
�-f
C I" ty S4c A
State:
Zip:
SL 3f L 0-75 1 y
Phono- L
) - S ignature:
Permittee's Certifican"on:
Date.-
"W
I certify that I have read this -g-ree.ment and do hereby agree to abide �y the stipuia�ions and restrictions as specmed herein.
Sign in (y offt�c �a1riarr��: -_- ��`''i -2ku
e . _� ),e V. f r.Fc�,�"'.,�.�
Sicynature:
�..�. Date-, ..
FORM: Loa 06-16
Page 3 of
3

9
IN
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on
APPLICATION MAP
1
_ . AL ._ 1
LEGEND
APPLICATION AREA
N
PRIVATE ROAD
STREAM
- - DRAIN
kt
x � FENCE
---- PROPERTYLINE
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•
UNSUITABLE AREA
W WATER
S ONSITE HOUSF
� OFFISITE HOUSE
OUTBUILDING
(� WELL
The compliance boundary is established either 250 ft from the residuals alicatiorl area Or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compiianCe boundary and the perimeter of the residuals application area. All
III
locations are approximate,
fry
GRAPHIC SCALE
660'
660' o
C-cR-01
Fields
1-3

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IV
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GRAPHIC SCALE
1" = 800'
00, 0 80or
erect
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.
a
Not,
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Division of Water Resourc-es
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T I 100 — 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 theseinstructions 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 ADP11'eant shall submit one are �nai and two copies of the application and
supporting documentation
For more information, visit the Water Quality Perinitting Section's Non-DischqLge Perm
tting 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 hiclude water treatment plant or other type residuals) i�1 accordance with 15A NCAC 02T I 100. Do not submit
this agreement for review without a corresponding application farm (FORM: RLAP 0646).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FARM: LOA 06-16):
� Submit the completed mid appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please coo
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 sues 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: Morehead Citv WWTP
hereinafter referred to as the Permittee, to land apply residuals from the following facifity(ies) onto the following land
application site(s) (i.e,, see attached setback mays) in accordance with the stipulations and restrictions as given in this
Agreement:
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 sitetsj described above for the disposaY of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shah 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 .
Lease Land Use or Residuals Source Special Hate
Site/Field �D a CroppingPatterns �tended Use of Crops {no-till/over-seed/
(Yes/n) (optional) pasture)
NC-CR-7-2 Y Row Crap Animal Feed
i
i
i
FORM-, LOA 06-16
Page 1 of 3

L STIPLILAT[ONS:
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, 'rhe 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 o#'this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1-617.
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 his provided the landowner or his representative with infomiation 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 Pen-nittee.
7. The Pennittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of and 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 infoniiation 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 s�Lmplcs, and the pennitted application limits.
10. The landowner or his representative will provide the Permittee with infonnatiUn regarding the amount and analysis of other sources of nutrients
(e.g_, fertilizer, unregulated animal wash, etc.) that have been applied to the land application site(s).
1 l . 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, aDd State officials or their representatives to; enter and
inspect any property, promises, or place on or relayed 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 pennit; take necessary leacha-te, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
i. 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 hand 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) fora 30-davperiod following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to pre -vent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested fora 30-day period following a residuals land application event.
4. Food craps with harvested parts that touch the residuals/soil mLYture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
S. Food crops with harvested Paris below the surface of flie land. shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land suz-face for four months or longer prior to incorporation into the soil.
6. Food craps with harvested parts below the surface of the land shall not be harvested fora 38-month period following a residuals land application
went when the residuals remain on the land surface for less than four months prior to incorporation into the soli.
7. Turf grown on land where residuals are applied shall not be harvested fora 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
I SA NCAC 02L .O I07(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0 I U>f 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;
El A re -defined compliance boundary is needed for field(s) M.4
(Pie-ase 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 fields) ID: 'is currently permitted under aaiother
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 preciously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of

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 f am otherwise authorized, trough
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. Furthemiore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to laid apply residuals to the land application sites) as specified
herein.
Landowner name:
Address.-
City:
Phone:.
LD
6xe avj) � X..,)
--
Stake: C11_.*
zip..
E-mail address: G�) r . C`
Signature, A
11�� _W _%_ - --)r
)�_ le.t
NORTH CAROLINA, ( ria�o
i, the undersigned Notary Public do hereby ce�i�'y than
COUNTY
PC 6r-a wTto
Date: 1. wpw�
VQe4ei.;
.%, a b
n 4 h
personall}:, appeared. before me this day and acknowledcred the due execution of the forgoing �nstrur��ent.
WITNESS my hand and afficia.l seal this the � S�
day of
I a w� a�,
T,
Signaturc and seal. -
My commission exp
Christopl,19r'+
NOTAP
Wn _v n 4
Lessee' s/Operatorls Certification: commis,9#011,my
1� -Lpot 10, 20251,
I certify that I have read this Agreement and do herebv agree to abide by the stipulations and restrictions as specified he -rein.
Lessee/operator name: _ 12o Lev 0 , et -S
Address: q 0 3 NeW4ehCity:
is
Phone: � 5L'3� Z 7(5�
Sicynature:
Perm ittee's Certification:
sta-t-ed
46
--Mal a�ress�
Date.
Zip.
I certify that I tea �t�� � here 1 t - - o
ee t u t rat i i ecifjed hereifl.
S 4F
igning o jrL4 name:
4L CL
ler
r
Sr,
Si
.407 anature:
_ Date: .-
.s
FORM: LOA 06-16
Page 3 of 3

=
VICINITY MAP
M
414
i r
7m-
T
-1
GRAPHIC SCALE
1° = 41000,
44
[
45000,
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
4"
NC=CRm07
locations are approximate.
Field 2

APPLICATION MAP
7
Jk
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
W
Y - a
de
W, M
•ems' - - .a.. r�. � � . r •
r'.
F
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 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. All
locations are approximate.
GRAPHIC SCALE
660'
ssa, a
NC-CR-07
Field 2
9

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r ; r
I.
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IL
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po1llR
1
GP
op

Division of 'Water Resource
State of North Carolina
Department of Environmental Quality
Division of Water Resources
I SA 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
0 0
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the a lication and
sunnorting documentation
For more i�tformation, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
Genera! — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for hand 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 dorm (FORM: RLAP 06-16).,
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
� Submit the competed and appropriately executed Land Application Site Certification (FORM-, LASC 06-16) form. Please do
not make any unauthorized contend changes to this fonii. 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 sues 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: Morehead Ci
WWTP
hereinafter referred to as the Permittee, to land apply residuals from the
application site(s) (i.e,, see attached setback maps} in accordance with the
Agreement:
following facifity(ies) onto the following land
stipulations and restrictions as given in this
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals white the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
sham be renewed each time this permitis 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.
SitelField LD
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Craps
Residuals Source
(optional)
Special note
(no-till/oyer-seed/
pasture)
NGON-i-i
N
Row Crap
Animal Feed
NC-ON-1-2
N
Row Crap
Animal Feed
NC-ON-1-3
N
Row Crop
Animal Feed
FORM-. LOA 06-1.6 Page 1 of'.)

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 ]and 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-DWG, 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 Viand application grogram,
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.
$. If the sail pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of Time shall be applied to achieve a Foal soil
pH of at least 6.0, unless an. agronomist provides information indicating that the pHof 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 permuted application limits.
10. The landowner or his representative will provide the Pemi ittee with information regm•ding the amount and analysis of other sources of nutrients
(e.g.,, fertilizer, unregulated animal waste, etc.) that have been applied to the land application sites).
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 prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
evens at appropriate periods.
12. Specific residuals hand 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 Perm.ittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or relaxed 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 antler the terms and conditions of the Permit: take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
i . Appropriate measures must be taken by the Permittee and/or the landowner or has 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 went. Such controls may include the posting of
signs that indicate the activities being conducted at the land applicafion sites).
2. Animals shall not be grazed on the tand 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
eatse
3. Food clops, feed crops, and fiber crops shall not be harvested for a 30-davperiod following a residuals fond 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 fora 14-month
period following a residuals land application event.
5. Food crops with harvested palls below the surface of the land shall not be harvested fora 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.
b. Food crops with harvested parts below the surface of the land shall not be harvested fora 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 fora 12-month period following a residuals land application event.
III,,ALTERNATIVES FORWATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .41Q7(d) prohibits wafer supply wells within the compliance bounda.ty. However, ! 5A 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;
El A re -defined compliance boundary is needed for fields) 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)
Ej The land application field(s) ID: _ _, is currently permitted antler another
*duals land application program; Permit Number WQ: . Ttie 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 aYid 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 T 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. Furthen-nore, 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: tp be r+ P4,, �?t� S
Address:C/
City: C (7'
Phone: Z52 L 75'7 $
State:
-»pail a :
j
i
Zip.
Signature:_Ar Date: 1/21./ 02.1
NORTH CAROUNA, (0.1--rrum
I, the undersigned Notary Public do hereby ;,ertify that
COUNTY
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 �Q�V4lt.6t r
Signature and sea]-.
My comm
12 0
Lessee's/Operator's Certification:
5
t � !
7
f y.
I certify that I have read this Agrle,.ement and do hereby agree to abide by the stipulations and restrictions as specified here __ in. T ~
Lessee/operator name:
Address:
City: - - - _ State: _ Zi P:
Phone: -nmil e
ss-
E'
Signature: �—. - Date:
Pernjittee's Certification:
1 certify that I have r a'd fhs agreement and do hereby afire
Signing off ci
Signature:
4W
to abide by the stipulations and restrictions as specified herein.
79
f
Date:6
FORM: LOA 06-16 Page 3 of 3

Ir�
EE�
4W
a
k4
10,
VICINITY MAP
~to 0A
GRAPHIC SCALE
1" = 41000,
41000,
The compliance boundary is established either 250 ft from the residuals application area or 50 feed 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.
NCmONMOI
Fields 1-3

AE-
APPLICATION MAP
LEGEND
APPLICATION AREA
- - - - - - PRIVATE ROAD
- - STREAM
— — — DRAIN
V. * U - FENCE
-- PROPERTY LINE
a
' —re
P r
2p,
{_
if
_ '
IL
Xt
w
I
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 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. All
locations are approximate.
now,
T
GRAPHIC SCALE
660'
660' 0
NCmON9001
Fields 1-3

SOIL SURVEY
GRAPHIC SCALE
1" = 800'
t
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
�n 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
NCMUNMO 1
locations are approximate.
Fields 1-3

FIELI
CUMULATIVE METAL LOADINGS (LBS/AC) AS OF 2/25/2021
The cumulative metals for this report come from
HISTORY records
(ire. the monthly monitoring process has been completed
far the State and County wherethe Fields are located*1
)
In cases where re a trace metal lab result
was Not Reported rted
to Syna ru or tracking f metal leading was Not Required
the loading on the reportis di pta ed a " I "
Last Date Applied
ZN
05/2212019
0.41538
0.29407
4.71758
91.58634
4.05164
039564
0.67071
3.20290
0.35843
72.93536
Report rt fTl . 2 2 1 3.1 ,46 PM I Page 1 of 1

CUMULATIVE METAL LOADINGS (LBS/AC ) AS OF 2/25/2021
The cumulative metals for
this report come fromHISTORY records
(i.e. the monthly monitoring process has been completed
for the State and County where the Fields are located
In cases where ar
trace metal lab result was Not Reported
to Syna ro or tracking f metal loading was Not Required
the loading on the report is displayed "
FIELDID Last Date Applied
AS
CD
CR
CU
PB
HG
IWO
N1
SE
ZN
NC,- 1- Q --0,_ 04/20/2004
0.21842
0.10926
2.83328
24-11716
1.86108
.11255
0.25998
1.20729,1
IBC--C -0 7 - - 2- 05/22/2019
0.356250.13486
. 1 3
51.45918
1.10260
.129
0,33927
1.73974
0 -51150
05/21/2019
0.54631
0.23893
6.28421
45.18643
2.80018
.'1 4
0,45634
2.92463
0.3548969-51871
Report D t lTi : 2/25/20213:19:27 PM Page 1 of I

CUMULATIVE METAL LOADINGS (LBS/AC ) AS OF 2125/2021
The cumulative metals for this report cote from HISTORY records (Le. the monthly monitoring process has been completed for the State and County where the Fields are located
In cases where re trace metal lab result was Not Reported to Synagro or tracking of metal leading was Not Required the loading on the report is displayed as " l "
FIELDID
Last Date Applied
AS
CD
CR
CU
PB
HG
M0
N1
SE
ZN
NC- -o o 1- - 1-
05 o 2
. 32 2
0.1
0.97384
or 3
0.92686
0.08282
0.28825
0.73795
M2 '1 0/'/y;!{
48.68961
NC- No 1- - off-
05/05/2020
0.36888r
1 12
1.05825
.561 2
0.78586
0.070070.22617
2
0.22841
40.96279
N C-CAN-o 1-- -3-
05/0512020
0.01735r
1 1
0.04047
1.90746
O�03828
0.002060,01691
0.03984
Report D tefTl : 2125/20213:20:09 PIS Page 1 of 1