WQ0002712_Modification_20211025

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0002712
Applicant/Permittee City of Lincolnton
Applicant/Permittee Address PO Box 617 Lincolnton, NC 28092
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Municipal
City of Lincolnton RLAP
Lincoln
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
llr�ore
Fee Amount $395
Complete App Date 10/25/2021
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Alex Fox
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
17048813429
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: * Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: * WQ0002712
Has Current Existing permit number
Applicant/Permittee* City of Lincolnton
Applicant/Permittee Address* PO Box 617 Lincolnton, NC 28092
Facility Name* City of Lincolnton RLAP
Please provide comments/notes on your current submittal below.
Major mod to add some new land to the permit and modifying 2 sites.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Sharp Copier_ 20211021_163536.pdf 14.64MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature 09

Submission Date 10/21/2021

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LAND APPLICATION UNIT
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RALEIGH NC 27699-1636
United States

SYNAGRO
OCTOBER 22, 2021
TO: Nathaniel Thomhurg
FROM: Alex Fox, Synagro Central, LLC
RE: City of Lincolnton major modification WQ0002712
We are submitting this major modification request on behalf of the City of Lincolnton. We are
adding 2 new fields to site LT-48 along with one new site LT-55. Also in this modification we
did a house buffer waiver and transferred CA-48-10 from Mike Davis to Randy Leatherman.
Attached is all the information you will need to do this major modification to the City of
Lincolnton's permit. i look forward to working with you all on getting this turned around
quick as possible. Let me know if you have any questions or concerns.
Thank you,
Ur t�
Alex Fox
Technical Services Specialist
704-881-3429
[e-mail]
284 Boger Rcad, Mocksville, NC 27028 + Phone: [phone]. Fax: [phone]

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 -- RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies„ of the application and,
supporting documentation
For more information, visit the Water Quality Permitting Section's Nan -Discharge Permitting Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T ,1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
® Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T. 01�06(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 190 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification �i � �s New Permit � � � Major Modification'
Major (land are permitted for > 300 acres) $1,310 $395
Minor (land are permitted for < 300 acres)� $510$245._
- 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 (Ali Application Packages)
® List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC 1 C .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:
❑ Operational functions, describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
❑ Maintenance schedules; may include equipment calibration, maintenance of signs, etc,
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program,
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g, facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
1.102 12 J. Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I V by 17" plans (electronic format is acceptable - Adobe PDF
only), For Modifications, submit plans specific to the modification(s) only,
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T .1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s),
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable), Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan (AIl 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. Hydrogeologie 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(dL and current Division Policy
available at: http://www.nrwater.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 J 104(d1(21. For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
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)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1.104(dl(51 and current Division Policy
available at: litty://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)
❑ 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(t), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [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

t
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 -- RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City ofLincolnton
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A. NCAC 02T .0106: Robert Pearson Title: Utilities Director
Applicant's mailing address: P.O. Box 617
City: Lincolnton State: N.C. Zip: 28092
Telephone number: 704) 736-8970 Email Address: [e-mail]
2. Consultant's name: Alex Fox License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Firm: Synagro Central, LLC)
Consultant's mailing address: 284_Boger Rd
City: Mocksville State: N_C Zip: 27028
Telephone number: (704 881-3429 Email Address: afox0)svna re o.com
3. Agronomist's name:
License Number:
Affiliation: ❑ NIA ❑ On Staff
❑ Retained (Firm: }
Agronomist's mailing address:
City: State:
Zip: -
Telephone number: (_;) =
Email Address:
4. Soil Scientist's name: Christopher Murray License Number: 1284
Affiliation: ❑ NIA ❑ On Staff
0 Retained (Firm: )
Soil Scientist's mailing address: 216 South Swing Road Suite #1
City: Greensboro State: NC
Zip: 27409
Telephone number: (336) 6 62-54 87
Email Address:
5. Fee submitted: (See Instruction B)
II. PERMIT INFORMATION:
1, Application is for (check all that apply): ❑ new, ® modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0002712
Date of most -recently issued permit: 02/06/20
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page i of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 550 Highway 150 Vilest B -Pass
City: Lincolnton State: N_C Zip: 28092
Coordinates: Latitude: 35' 26' 56" Longitude: 81. 15' 34"
Datum: NAD83 Level of accuracy: Second
Method of measurement: MAP
2. County where residuals land application program is headquartered: Lincoln
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Mike Cox
Synagro Central, LLC
LA 13191
Back -Up ORC
Alex Fox
Synagro Central, LLC
LA 1009594
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 Nitro en 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: 1300 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
14.94
16.24
19,417
21,107
Five -Year Maximum Adjusted
21.06
22.36
27,380
29,070
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
176.8
Hay
253.8
Pasture
304
Total:
734.6
Methods
Surface
734.6
Incorporation or Injection
0
Total:
734.6
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
(bs 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
388.3
422.1
547.6
581.4
100
194.2
211.1
273.8
290.7
150
129.4
140.7
182.5
193.8
200
97.1
105.5
136.9
145.4
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application sites) 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;
El 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.
.I LI-1
Land Application Siite
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irri atg ion system o1a1X.
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: feet
below ground surface. Rules 15A NCAC 02T .0505(a) 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
inlhr
Recommended
Loading Rate
inl r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(.n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field / Zone
Design Area
(fe)
Number of
Nozzles
Maximum Application
Rate ( allonslhr)
Design Annual Loading
Rate (gallons/ r)
Total,
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft2
Nozzle capacity
gpm
Nozzle manufacturer 1 model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0I06):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
I, Robert Pearson Utilities Director
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for City of Lincolnton
(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 § 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: I QZY
FORM: RLAP 06-16 Page 5 of 5

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.
B. Land Application Site Information:
® The status of the ]and 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:
Status Code
Required Item
N
R
T
M
County Board
Notification. doc
ff�F1r
Land Owner
✓
`�
Agreement
(If applicable)
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "MatC,tridancc
for Residuals UmLkNp lication 11crniits"
✓
✓
✓
A soils and agronomic evaluation in accordance with the 11 oii 5cicnti't
1;%,dL1Ai0n ['olive'.
✓
INSTRUCTIONS FOR FORM: LASC 06-16 Page 1 of 3

An updated accounting of the land application site's cumulative
✓
pollutant loading rates CPLRs)
Required Item
Status Code
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soii S�'t!m t Vtaluation I>ulicv
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) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) e Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Mere (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information; (new sites only)
® Use an 8.5 by 11-inch copy of the portion of a 7.5-ininute 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: htt ://de .nc. ovlabou#/divisio:ns/water-
resources/ lanitin /classification-standards/classifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
ti(tp://deq.iic..gov/contac�t/re rional-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://dog.iic.gov/aboLit/divisions/watef-reSOLifces/planning/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the Iocation description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
® KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodics 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).
S. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 1 SA 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

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Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the A licant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Dischar e Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Lan Owner Agreement (FORM: LOA 06-16):
Er Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
Ppplication may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
repare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
WApplicant.
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 rep esentative hereb permits:
Applicant's name: D .A CD 1,
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field 1D
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed!
pasture)
-7- �'h
�!w
M4 Ace
/
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I 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, 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 sites) 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.
I1. 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 021.0105 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;
EfA re -defined compliance boundary is needed for field(s) ID: C h - w z " to } J-4 A-7 -1
(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: 7 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 transfelTed
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:
r1
Address: 1a./
City: State: _
Phone: E-mail
Signature:
Zip: � &0 k
Date: C;� I
NORTH CAROLINA, ,'ri ra �r"1 COUNTY
1, the undersigned Notary Public do hereby certify that R U I1
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 nJo 120
r
Signature and seal: J�A% top
My commission expires: v -i` 20 �rt�
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
1 certify that I have read
Signing officia.a e: E
Signature:
State:
E-mail
Date:
Zip:
Agreement and do hereby agree C�_abide by the stipulations and restrictions as specified herein.
Date:
Z
FORM: LOA 06-16 Page 3 of 3

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
- — — — -
PRIVATE ROAD
W
WATER
— - - —
STREAM
ONSITE HOUSE
-
DRAIN
OFFSITE HOUSE
—
FENCE
❑
OUTBUILDING
PROPERTY LINE
0
WELL
Q
SOIL BORING
The compliance boundary is established either 250 ft from the residuals application area or 5D feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " = 660'
660' 0 660'
I I
N C-CA-48
Field 10

SOIL SURVEY
a
z
GRAPHIC SCALE
1 " = 660'
660' 0 660'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-CA-48
Field 10

TOPOGRAPHIC MAP
GRAPHIC SCALE
1" = 1,000'
1,0o0 0 1,000,
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CA-4 S
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 0-11

GRAPHIC SCALE
1" = 4,000'
4,000' a 4,000'
The compliance boundary is established either 250 fit from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
N C-CA-48
Fields 4 & 10

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
W
WATER
— — — —
STREAM
ONSITE HOUSE
—
DRAIN
OFFSITE HOUSE
x X X
FENCE
❑
OUTBUILDING
PROPERTY LINE
0
WELL
SOIL BORING
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'
6601 o esa'
NC-LT-47
Field 2

SOIL SURVEY
GRAPHIC SCALE
1" = 800'
$04' 4 840'
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-47
Field 2

Brendle
M t 1#',,
TOPOGRAPHIC_ MAP
� � V 7
GRAPHIC SCALE
1" = 1,000'
�,00ao �,aco
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-47
Field 2

0_
��
VICINITY MAP
_
W
.1
,ice
i
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-LT-47
Fields 2A5

F11LE '; CStEI &aa COU91ty
4M) Me"x uv, Tcx
0r! ()at -191 21)21 09.50:00 �. r e-,
State of North Carolina
Department of Environmental Quality
Division of Water Resources
E-W fine TaX $0.00 (CH)
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T.1108(c)
I, &C4 L cw t'Fcrrn, , certify that I am a deeded owner of the property located at:
Address:_ a 3 Parcel No.: 6 —1 1 0-7, 0") a o k
City: Vk It _ State: NC Zip Code: 2yt4'W County:
Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby
agree that the setback distances cited below be granted to the Applicant/Permittee listed on the following
page.
2'For the parcel identified above, I consent to a reduced setback from 50 feet to 0 feet, thereby
allowing the application of Class B residuals as near as 0 feet from my property line.
2 /For the parcel identified above, I consent to a reduced setback from 400 feet to 100 feet,
thereby allowing the application of Class B residuals as near as 100 feet from my residence.
* *THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED* *
Signature: _ � � � ..-� Date: 10 - 1-i - 1.
FORM: NDRMPW-LAS 11 -1S
Page l of

Permittee: _ J�_ o` �v
Po Address: Permit No.:
L-. fAL. In ��
City: �5tate: Al(, Zip Code: a S 9 1- County: �11111'. I1
NORTH CAROLINA, COUNTY
I, 01,' ✓, �4 d , a Notary Public for T% County, North Carolina,
do hereby certify that A ( r' personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 17 r~day of 0 J.�Q'- 2/
�{Itltfrr///
@CoVt�`%
SEAL4�
rrrrrttti
Signature of Notary Public
{{�
My commission expires
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the described properties are located. A copy of the recorded waiver
shall be sent to the following address:
Division of Water Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina27699-1617
FORM: NDRMPW-LAS 11-18 Pace 2 of 2
0

OCTOBER 21, 2021
TO: Nathaniel Thornburg
FROM Alex Fox, Synagro Central, LLC
RE: Lincolnton major modification redefined compliance boundaries.
A redefined compliance boundary is requested for the wells that are centrally located between
Site CA 48-10 and Site LT 47-2.
All of the other new fields do not need a redefined compliance boundary them as there are no
wells close by.
Thank you,
Alex Fox
Technical Services Specialist
704-881-3429
[e-mail]
284 Boger Road, MocksVlle, NC 27028 9 Phone: [phone] Fax: [phone]

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. Lapd Owner Agreement (FORM: LOA 06-16):
IV I Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
[Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representptive herebyy permits:
Applicant's name: _ _-- -- � D L tt e v 1 r
hereinafter referred to as the Permittee, to land apply residuals from the following faeility(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 Ill
Lease
(yesino)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Al
nn
1. 1 - ql� `
q4
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5, The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. fn 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 time 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 time 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 sites) 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 per -nit; 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.
II. 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 021.0105lh1 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
[�ompliance 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,?- _j4e l Q1 ),,k(f�
Address. 7V io Q ads 4, "Ir- 04
City: we- State: /1110- Zip: 02 rlla O
Phone: 16_ AA1l — 0 7,5 C> E-mail address: , x,< - Ls otn%j / tg.t
Signature; ] Date: jP -cQ.2-
NORTH CAROLINA, COUNTY
1, the undersigned Notary Public do hereby certify that U i ; t, �1ac� �� � E 11ffb�-
personally appeared before me this day and acicnowIedged the dueexecutionof the forgoing instrume�.'�
VT
WITNESS my hand and official seal this the Z {
day of Iry 20 l ~ 40P
Signature and seal: l.J i�
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
I certify that I have read this Agreement and do hereby
Signing official
Signature:
Zip:
Date:
by the stipulations and restrictions as specified herein.
Date:
s
FORM: LOA Ob-lb Page 3 of 3

APPLICATION MAP
i c:r-C:nin
APPLICATION AREA
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
W
WATER
GRAPHIC SCALE
— — — —
STREAM
1 �� = 660`
®
ONSITE HOUSE
—
DRAIN
sso' o sso
.
OFFSITE HOUSE
*
FENCE
❑
OUTBUILDING
PROPERTY LINE
WELL
SOIL BORING
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 rs established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-LT-48
Field 13

APPLICATION MAP
,k
LEGEND
APPLICATION AREA UNSUITABLE AREA
- — — — — - PRIVATE ROAD yN WATER
GRAPHIC SCALE
- - -- STREAM 1" = 660'
® ONSITE HOUSE
DRAIN ssT a 660,
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
WELL
+� SOIL BORING The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-LT-48
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate, Field 15

SOIL SURVEY
GRAPHIC SCALE
1" = 660'
660' 0 65c'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-LT-48
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 13

SOIL SURVEY
GRAPHIC SCALE
1 If
= 660'
660' 0 660'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-LT-48
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate, Field 15

TOPOGRAPHIC MAP
12 Th�
N
122,
t C�IvAry
Xlh
. . .
......... .
If
GRAPHIC SCALE
1 1,000'
0 1,000,
The compliance boundary is established either250 ft from the residuals application area or 50 feet within
NC-LT-48
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 13 & 15

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY21-SLO31428
Client; Mike Davis Advisor: Alex Fox
Heavy Metals 284 Bogar Road Synagro
f 7 Boger Rd Mocksviile, NC 27028 284 Ba
g
Soil Report Mehlich-3Extraction Mocksville, NC 27026
Sampled County : Lincoln
Links to Helpful Information
Client ID: 508842 Advisor ID: 501947
sampled: 0412312021 Received: 04/30/2021 completed: 05106/2021 Farm: 1-t-48
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)-4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium
(Cr)-0.2 ppm, lead (Ph)-4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for
plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus (P) is
very high (P-1 a 100), crops will not respond to additional P applied. Tissue testing is advised where soil pH is elevated and is of concern as in samples found hereJagathi
Kamalakanthan, A ronomist, 516I2021
Sample ID: 13
Recommendations: Lime Nutrients (Iblacre)
More
Crop (tonstacre) N P205 K20 Mg S Mn Zn Cu a
Information
Lime History:
1-FescuelOGrass/Tim, M 0.0 121200 0 120 0 0 pH$ 0 0 0
Note: 12 Note'
2 - 0.0
Test Results [units - WN in glcm3; CEC and Na in meg1100 cm3, NO3-N in mgldm33: Soil Class: Mineral
HM% WN CEC BS% Ac pH P4 K-1 Ca% Mg% 5-1 Mn-1 Mn-All Mn-Al2 Zn-1 Zn-AI Cu-1 Na ESP 55-1 NO3-N
0.18 1,10 8.5 97 0.2 6.9 130 11 82 14 305 49 33 74 74 54 0.0
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0,1 Nickel, 0.2 Chromium, 0.3 Lead, 3.6 Selenium, 0.1
Sample ID: 14
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonstacre) N P205 K20 Mg S Mn Zn Cu B
Information
Lime History:
1- Fescue/OGrasslTim, M 0.0 120-200 0 60 0 0 0 0 0 0
Note: 12
2 - 0'0
Test Results [units - WN in gtcm3; CEC and Na in megi100 cm3; NO3-N In mgtdm3]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Cato Mg°/ S-1 Mn-1 Mn-Ali Mn-A32 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N
0,56 1.09 8.8 80 1.7 5.9 242 39 60 18 35 392 252 375 375 436 0.0
North Carolina
Ldi��cn ia»I ! ucJ Cr;ncinv„n
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission,
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxier, Commissioner ofAgriculture

NCDA&CS Agronomic Division Phone: [phone] Wabsito: www.ncagr.gov/agronomi/
Report No. FY21-SL031428
Mike Davis
Page 2 of 3
Heavy Metals {parts per million)- Arsenic, 0.2 Cadmium, 0,0
Nickel, 0.6
Chromium, 0.2
Lead, 6.9
Selenium, 0.1
Sample ID: 15
Lime History:
Recommendations: Lime
Crop (tons/acre) N P2O5 KzO
1-FescuelOGrasslTim, M 0.3 120.200 10 20
2 - 0.0
Nutrients (lblacre)
Mg S Mn
0 0 0
Zn Cu 8
0 0 0
More
Information
Nate- 12
Test Results [units - W1V In glad; CEC and Na In meg1100 cm3; NO3-N in mgldm3]:
HM% WN CEC 138% Ac pH P-1 K-f Ca% Mg%
0.13 0.93 7.0 81 1.3 5.8 58 63 60 17
8.1 Mn-I
415 43
Soil Class: Mineral
Mn-All Mn-Af2 Zn-I Zn-AI Cu-1
43 103 103 174
Na ESP SS-1 NO3-N
0.1 1
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.2
Chromium, 0.4
Lead, 4.1
Selenium, 0.0

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.govlagronomil
Report No. FY21-SLO31428
Mike Davis
page 3 of 3
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crops) indicated, a lime recommendation will be given in units of either
R
boron
ton/acre or Ib11000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 tonlacre (50 Ibi1000 sq ft) at one
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
capper index
ESP
exchangeable sodium percent
Fertilizer
HM %
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on researchlfield studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1
Mn-AI2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-I
M-0
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients. In general, homeowners do not
N
mineral -organic soil class
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr,govlagmncmi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib11000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagcvov/avronomilobpart4.htr tfsf nd information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowners Guide to Fertilizer.
P2O5
phosphate
S•1
sulfur index
Test Results
SS-1
soluble salt index
Wlv
weight per volume
The first seven values [soil class, HM%, WiV, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn•AI
zinc availabt€ity index
remaining 16 [P-1, K-1, Ca%, Mg%, Mn-1, Mn-All, Mn-AI2, Zn-I, Zn-AL Cu-f, S-1, SS-1, Na, ESP, SS -I, NO3-N (not routine)
Zn•I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaaraov/agronomi/uyrst.htm

(2)
7621 Whitepine Road, Richmond, VA 23237
Waypoint,
Main 804-743-9401 ° Fax [phone]
ANALYTICAL www.waypointanalytical.corn
Sample Summary Table
Report Number: 21-117-0006
Client Project Description: William Hefner/LT-55
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
76012 1 Solids 04/27/2021 SW-7471B WP MTN
76013 2 Solids 04/27/2021 SW-7471B WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 1 of 3

Waypointo
ANALYTICAL
46622
Synagro Central LLC/ Technical Project
Mary Brewer
284 Boger Road Information
Mocksville , NC 27028
Report Number : 21-117-0006
Lab No : 76012
Sample ID : 1
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
William Hefner/LT-55
REPORT OFANALYSIS
Report Date : 05/04/2021
Received : 04/27/2021
Yawn W �10- /
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test Results Units MOL DF Date / Time By Analytical
Analyzed Method
Mercury
0.0335 mg/Kg
0.0155 1 05/03/2112:55 DDB SW-74718
Qualifiers/ *
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
g
GGA Outside QC Limits
H
Beyond holding time
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC
Not confirmed
Q
RPD >4011/6 dual column results
T
Sample exhibits toxicity
U
Unconfirmed
Refer to cover letter.
Page 2 of 3

Waypointo
ANALYTICAL
46622
Synagro Central LLC/ Technical Project
Mary Brewer
284 Boger Road Information
Mocksville , NC 27028
Report Number : 21-117-0006
Lab No : 76013
Sample ID : 2
Test
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
William Hefner/LT-55
REPORT OF ANAL. YSIS
Results Units MQL
Report Date : 05/04/2021
Received : 04/27/2021
qq
gaxel.1 P1 t GevT
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
DF Date 1 Time By Analytical
Analyzed Method
Mercury 0.0562 mg/Kg 0.0157 1 05/03/2112:57 DDB SW-7471B
Qualifiers/ *
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
9
GGA Outside QC Limits
H
Beyond holding time
j
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC
Not confirmed
Q
RPD >40% dual column results
T
Sample exhibits toxicity
U
Unconfirmed
Refer to cover letter.
Page 3 of 3

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
— — — — — — PRIVATE ROAD CD WATER
— — — -- STREAM
ONSITE HOUSE
DRAIN
OFFSITE HOUSE
— FENCE ❑
OUTBUILDING
PROPERTY LINE
Q SOIL BORING 0 WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660' 0 660'
N C-LT-48
Field 12

SOIL SURVEY
. � � �}� M � '�JI . • ILA �:
r
GRAPHIC SCALE
I" = 660'
660' 0 660'
The compliance boundary is established either 250 ft from the residua€s appiication 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.
J
NC-LT-48
Field 12

NCOA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY21-SLO31428
Client: Mike Davis Advisor: Alex Fox
Heavy
Metals 284 Boger Road Synagro
Mocksville, NC 27028 284
Boger Rd
" 9 Soil Report Mehlich-3 Extraction Mocksvi€€e, NC 27028
Sampled County: Lincoln
Links to Helpful Information
Client ID, 508842 Advisor ID: 501947
sampled: 04/23/2021 Recelved: 04/3012021 Completed: 05/06/2021 Farm: Lt-48
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeted as Heavy Metals under soil test lab results. Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium
(Cr)- 0.2 ppm, lead (Pb)-4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for
plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus (P) is
very high (P-1 > 100), crops will not respond to additional P applied. Tissue testing is advised where soil pH is elevated and is of concern as in samples found hereJagathi
Kamalakanthan, A ronomist, 5/612021
Sample ID; 13
Recommendations: Lime Nutrients (Iblacre)
More
Crop (tonslacre) N P205 K20 Mg 5 Mn Zn Cu B
Information
Lime History:
1 - FescuelOGrass/Tim, M 0.0 120-200 0 120 0 0 pH$ 0 0 0
Note: 12 Note:
2 - 0.0
Test Results iunits - WN in glcro3; CEC and Na in mog1100 crrt3; NO3-N in mgldntl]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 Kd Ca% Mg% S-1 Mn-I Mn-All Mn•Al2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N
0.18 1.10 8,5 97 0.2 6.9 130 11 82 14 305 49 33 74 74 54 0.6
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.1 Nickel, 0.2 Chromium, 0.3 Lead, 3.6 Selenium, 0.1
Sample ID: 14
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonslacre) N P205 K20 Mg S Mn Zn Cu B
Information
Lime History:
1- FescuelOGfasslTim, M 0.0 120-200 0 60 0 4 0 0 0 0
Note: 12
2 - 0.0
Test Results [units - W1V in glcnf3; CEC and Na in meg1100 cans; NO3-N in mgldrrii]: Soil Class: Mineral
HM% W!V CEC BS% Ac pH P-1 K-1 Ca% Mg1e S-1 Mn-I Mn-Ali Mn-AI2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N
0.56 1.09 8.8 80 1.7 5.9 242 39 60 18 35 392 252 375 375 436 0,0
North Carolina
iahara� innt Fork} G>+nunwi..n
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
Steve TroAer, Commissioner ofAoriculture

NCDA&CS Agronomic Divlslon Phone: [phone] Webslte: WWW.ncagr.gov/agronomi/
Report No. FY21-SL031428
Mike Davis
Page 2 of 3
Heavy Metals (parts per million): Arsenic, 0.2 Cadmium, 0.0
Nickel, 0.6
Chromium, 0.2
Lead, 5.9
Selenium, 0.1
Sample ID: 15
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tonslacre) N P206 K20
Mg S Mn
Zn Cu
B
Information
Lime History:
1-Fescue1OGrass1Tim, M 0.3 120-200 10
20
0 0 0
0 0
0
Note: 12
2 - 0.0
Test Results [units - WIV in glcd; CEC and Na in meg1100 cm3; NO3-N In mgldm3):
Soil Class: Mineral
HM% WIV CEC BS% Ac pH P-1 K-1 Ca% Mg%
8-1 Mn-I
Mn-Ali Mn-AI2 Zn-I
Zn-AI Cu-1
Na ESP SS-1 NO3-N
0.13 0.93 7.0 81 1.3 5.8 58 63 60 17
415 43
43 103
103 174
0.1 1
Heavy Metals (parts per million). Arsenic, 0,2 Cadmium, 0.0
Nickel, 0.2
Chromium, 0.4
Lead, 4.1
Selenium, 0.0

HCDA&CS Agronomic Division Phone: [phone] Wobsite: www.ncagr.gov/agronomi/
Report No. FY21-SL031428
Mike Davis
Page 3of3
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a time recommendation will be given in units of either
B
boron
ton/acre or !b/1000 sq ft. For best results, mix the lime into the top 0 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 tonlacre (50 Ib/1000 sq ft) at ont
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
GEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer.
HM %
percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-All
Mn-availability index for crop 1
Mn-AI2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
Mn-I
manganese index
notations appear on the soil report, refer to $Note Secondary Nutrients and Micronufnents In general, homeowners do not
M-0
N
mineral -organic soil class
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.goviagmnomi/pubs.htm.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncaar.gov/agronomi/o4part4.htmtlt nd information that
P-1
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeowners Guide to Fertilizer.
P205
phosphate
S-1
sulfur index
Test Results
SS-1
soluble salt index
W/V
weight per vdume
The first seven values [soil class, HM%, WN, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
Zn-A!
zinc availability index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-I, Zn-Al, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not rout{net
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncaqr.govlauronomiluvrst.htm

Waypoint.(2)
ANALYTICAL
5/4/2021
Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
Ref: Analytical Testing
Report Number: 21-117-0008
Project Description: Mike Darns/Lt-48
7621 Whitepine Road, Richmond, VA 23237
Main 804.743-9401 0 Fax [phone]
www.waypointanalytical.com
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s) on 4/27/2021 for the analyses presented in the following
report.
The above referenced project has been analyzed per your instructions. The analyses were performed in
accordance with the applicable analytical method. Sub -contracted testing is noted on the Sample Summary Table
if applicable.
The analytical data has been validated using standard quality control measures performed as required by the
analytical method. Quality Assurance, method validations, instrumentation maintenance and calibration for all
parameters (NELAP and non-NELAP) were performed in accordance with guidelines established by the USEPA
(including 40 CFR 136 Method Update Rule May 2012) and NELAC unless otherwise indicated.
Certain parameters (chlorine, pH, dissolved oxygen, sulfite...) are required to be analyzed within 15 minutes of
sampling. Usually, but not always, any field parameter analyzed at the laboratory is outside of this holding time.
Refer to sample analysis time for confirmation of holding time compliance.
The results are shown on the attached Report of Analysis(s). Results for solid matrices are reported on an as -
received basis unless otherwise indicated. This report shall not be reproduced except in full and relates only to
the samples included in this report.
Please do not hesitate to contact me or client services if you have any questions or need additional information.
Sincerely,
Tp.k1i'L M C 1 10"r
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to, at laboratory's option, repeating the
analysis in question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Page 1 of 7

(2)
Waypoint, 7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
Sample Summary Table
Report Number: 21-117-0008
Client Project Description: Mike Darns/Lt-48
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
76015
13
Solids
04/27/2021
SW-7471B
WP MTN
76016
14
Solids
04/27/2021
SW-7471B
WP MTN
76017
15
Solids
04/27/2021
SW-7471B
WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 2 of 7

7621 Whitepine Raad, Richmond, VA23237
Waypoint, Main 804-743-9401 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
46622
Synagro Central LLC/ Technical Project Mike Dams/Lt-48
Mary Brewer Report Date : 05/04/2021
284 Boger Road Information : Received : 04/27/2021
Mocksville , NC 27028
Tame MC Geoor
Report Number ; 21-117-0008 REPORT OFANALYSIS Pauric Mc Groary Ph.D., CPA
Agronomist
Lab No : 76015 Matrix: Solids
Sample ID : 13 Sampled:
Test Results Units MQL DF Date / Time By Analytical
Analyzed Method
Mercury 0.0344 mg/Kg 0.0144 1 05/03/2117:59 DDB SW-7471B
Qualifiers/
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
g
GGA Outside QC Limits
H
Beyond holding time
J
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC
Not confirmed
Q
RPD >4011/6 dual column results
T
Sample exhibits toxicity
u
Unconfirmed
N
Refer to cover letter.
Page 3 of 7

0
Waypoint, 7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
ANALYTICAL www.waypointanalytical.com
46622
Synagro Central LLC/ Technical Project Mike Darns/Lt-48
Mary Brewer Report Date : 05/04/2021
284 Boger Road Information : Received : 04/27/2021
Mocksville , NC 27028
awtc �t T
Report Number : 21-117-0008 REPORT OFAN.4LYSI5 Pauric Mc Groary Ph.D,, CPA
Agronomist
Lab No : 76017 Matrix: Solids
Sample ID : 15 Sampled,
Test Results Units MOL DF Date / Time By Analytical
Analyzed Method
Mercury 0.0762 mg/Kg 0.0157 1 05/03/2113:05 DDB SW-7471B
Qualifiers/
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
g
GGA Outside QC Limits
H
Beyond holding time
]
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC.
Not confirmed
Q
RPD >40% dual column results
T
Sample exhibits toxicity
U
Unconfirmed
N
Refer to cover letter.
Page 5 of 7

WaypiRint.(DAYTICAL
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 'Fax [phone]
www.waypointa nalytica l.corn
Shipment Receipt Form
Customer Number: 46622
Customer Name: Synagro Central LLCI Technical
Report Number: 21-117-0008
Shipping Method
Fed Ex O US Postal C) Lab
is UPS () Client 0 Courier
J Other!
Thermometer ID: I
Shipping container/cooler uncompromised?
0 Yes
0 No
Number of coolers/boxes received
I 1
Custody seals intact on shipping container/cooler?
0 Yes
0 No
Not Present
Custody seals intact on sample bottles?
0 Yes
0 No
0 Not Present
Chain of Custody (COC) present?
0 Yes
0 No
COC agrees with sample label(s)?
40 Yes
0 No
COC properly completed
I♦ Yes
0 No
Samples in proper containers?
ID Yes
0 No
Sample containers intact?
0 Yes
0 No
Sufficient sample volume for indicated test(s)?
• Yes
0 No
All samples received within holding time?
0 Yes
0 No
Cooler temperature in compliance?
n Yes
0 No
Cooler/Samples arrived at the laboratory on ice.
Samples were considered acceptable as cooling
process had begun.
Yes
No
Water - Sample containers properly preserved
;J Yes
No
NIA
Water - VOA vials free of headspace
0 Yes
No
NIA
Trip Blanks received with VOAs
0 Yes
0 No
NIA
Soil VOA method 5035 -- compliance criteria met
0 Yes
0 No
NIA
High concentration container (48 hr) F Low concentration EnCore samplers (48 hr)
High concentration pre -weighed (methanol -14 d) F_ Low conc pre -weighed vials (Sod Bis -14 d)
Special precautions or instructions included? 0 Yes 0 No
Comments:
Signature: Brandi Watson Date & Time: '04/27/2021 09:37:39
Page 6 of 7

0 G
Waypoint.
ANALYTICAL SOIL SAMPLE INFORMATION 14FFT
7621 Whitepine Road
RiOirjond, VA 23237
[phone] 1 Flax [phone]
CUSTOMER INFORMATION GROWER INFORMA710N
f 0q��"'
Send Report to e-mail address
Field ID
_.,.,..,
Please check sera lab In column orovidad If Herbicide or Nematode analysle requested, If Nerbinidn Isere Indicate Hama of Herbicide In Add'i Info hex Wow.
Laq;NUmber ;
Semp181p
Szlit
; s era
11dGEfiuta
; :
Saluph
Addlitonil
hl4indeq
lisi�ndad
Alle"wte
Narrrah
prirfaua
g:
g
9
Cq
6: :
ktn
"Ni
6
iii
LibUuonf
be j"'Inek
SSM
sm
4ilii
uture
NO3-H
Tabu
dru Cads
Cro`Yteld
CroCoda
Crc .Yield
If
c
.
51 M - Oreanle Matter.
Phosohorgus.
Potassium.
CaWune,
k
aanamuin_
nH.
Buffer
❑F
co
M SIM plus eny two of the fcllowfnag Sodium, 5irtfatst-Sulfur, Boron. Zinc, Manganese. Iron, CoPper. Each additlonal cool (a4ove two) cost
9, t3ariky
5, Cangta
iD. C;orrt
Ill. Cctrrst5teybeans Rotation
12. Corn . No Till
13, Corn Silage
20, Getlan
21, Caltgn r No Till
26, Gfoln sorghum
30, pats
32. Pearuis
34. Popcorn
3t . Rapeseed
36. Mice
39, Rye
45, soybeans
46. So*ans- No Titl
51. Sugarcane • Plant
152. Sugarcane - Stubble
52. Tobacco - Surlsy
63. Tobamo •tea rk
64, TobaCaa - Flue Cured
75. Wheat
78. Wheat Silage/Corn Sifege
10i. Alfalfa flay
103, Alfalfa/Cool Season Crass Hay
106. AtfalfalWarm Season Grass Hay
1% Sahlegross Hay
117 Sahiagrass Pasture
121 Common eermuda I toy
122. Common Uiormuda Pasture
423. Common BermudAagume Hay
161. Coastal` Bertn da Hay
1€i2 Caas(al Bermuda Pasture
172 Cool Season Gross, Pasture
173 Coal Season Grass flay
181 Fescue Hay
182. t esc4A0 P89lure
183- FescdetLegume May
184. Fesoueit epurl9e Posture
INDICATE TYPE OF GRASS ANDIOR LEGUME
297. OTHER HAY
258. C)°fHFR PAFrTURC
299. CRP
r1EGETABLE CROPS
-TRUIT a N T t 608
307.
Beans-Uno
381, SpinoCh
400. Apples
Z09
Seam -3nao
382. Squash
dig. Blueberries
320.
Cabimps
393 Sweet. Corn
4X Citrus
322.
ConWoupa
384. Sweof Potalo(ron)
43f1. Grapes
=
Cucumbars
391 Sweet Palaia(bir)
474. Peaches
240
Gorden
386 Tomatoes
474. Pecans
360.
peoDerd
308. Watermelons
490- Strawberries
s
TURFOR. _
512. Dahlogm$a Lawn
513 Bahiograss Sad f 517- nontgrass Green a
521 Rermudagrass Al
622. Bermudagraos k ul
523.. f armlidograss Or
624, Dermudagrass u
628. Sermuaagrass 5
528. Bernludagrass Te
533. Bluegrass Lawn
534. Bluegrass Sod Production
546. Centipede Lawn
647. Centipede Sorf Prodtictiun
561. Fescue AthletlC Vield
563, Fescue Lawn
564, Fescue Sod Production
576. Si Augustine Laura
577. 81. Augustine Sod production
8153. Aysiagrass Lawn
594. Zogefagrass Sod Produclicn
I 4oicia 1onai jests or utner information l
dl to VVpyllraint Anatytiaai, ino iq acceptance of our terms" and i rondffions Ail prices ,era Subject to change
Add1lonnt fees may be charged to Arent, if sample requires addtienal preparalion procedures
Page 7 of 7

Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permittin�g_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. Lano Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
2 H 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 repres ntative hereby permits:
Applicant's name: D
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Fleld ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed!
pasture)
P4 • r'ft
• m4 S • G(1
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

1. 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 NCDFNR-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.
S. 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 thepermitted 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.
11. 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 fallowing 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.
11I.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, [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;
❑ A re -defined compliance boundary is needed for field(s) ID: _
Please include the rationale for the requested re -location
compliance boundary to the application package)
A re -defined compliance boundary is not needed for this site.
of the compliance boundary and attach a map showing the newly proposed
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 nroaram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application sites) 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 Iand application site(s) as specified
herein.
Landowner name: U./ [ r '� ,�►` t G
Address: -?6 7/ 1r A, 5
City: 1Z c d. to /,a fm n State: _A/C_
Phone: 70 73 E-mail address:
Signature: Date:
NORTH CAROLINA, .1ncv r1 COUNTY
1, the undersigned Notary Public do hereby certify that ,' I
Zip: 00oc7
3_ 22-;21
personally appeared before me this day and acknowledged the due execution of the forgoing
r�
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
:.ram 320Lj
Fox
—MO.r
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
I certify that I have read this
Signing offici ame:
Signature:
State:
Email
Date:
Zip:
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date: ��1 Z�
FORM: LOA 06-16 Page 3 of 3

APPLICATION MAP
I C('CAIn
APPLICATION AREA
177-71
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
CD
WATER
��°°�v��
GRAPHIC SCALE
— — — —
STREAM
1 - 660
ONSITE HOUSE
—
DRAIN
660, 0 660,
OFFSITE HOUSE
FENCE
❑
OUTBUILDING
PROPERTY LINE
0
WELL
SOIL BORING
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within A I C-I T_55
in the property boundary, whichever is closest to the application area. The review boundary is established l V L �1
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 1

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— — — — — —
PRIVATE ROAD
W
WATER
— — — —
STREAM
ONSITE HOUSE
—
DRAIN
.
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
WELL
SOIL BORING
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'
sso' o sso'
N C-LT-55
Field 2

SOIL SURVEY
GRAPHIC SCALE
1" = 660'
660' 0 660'
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-55
Field 1

SOIL SURVEY
GRAPHIC SCALE
1 " = 660'
660, 0 660'
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 estab€ished
midway between the compliance boundary and the perimeter of the residuals application area. All
locatlons are approximate.
ME
N C-LT-55
Field 2

TOPOGRAPHIC MAP
1236
H rpo�J f i f
RAJ
7 •
148
- r ��, 69 >�
,lt
1
Soo
2
�
4
d
GRAPHIC SCALE
1" = 1,000`
1,ff00' 0 1,00a
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
N C-LT-55
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1-2

VICINITY MAP
Chapel &.. Indian Creek Tennis CWb
Pee Wee's MountaIng
Bice Trail
jedding
Maxisauto
(service an rapais�rw
Fb h
Z
�� Stev�nsMo[ors4 �-• nowa4 �Ra
� � x'�� ^� 527v1
y PWFm Erl%rprlsesQ PackagingUnlimited
Zeus DogsUl
ttrs
Robert Bosch
pR&D Amusements Tool Corporation v
rso
la Abrasives Inc USA p
vCarolina Mail Speciatists
:c^°�'9Crouse Unites!'
Methodist Church
l;r;nu5,, ii;s r..
C � r ■
Church © I
F� a
t
e
4
C YO,
0h��:, an-Wehbs cnan.
Rd�.` gad
#
c tfi57
R -
s
e�h�j°H Rd Webbs Chapel"
BapOst Church
--
iG
GRAPHIC SCALE
1" = 2,000'
2,00o' 0 2,aao'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-LT-55
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. N1
locations are approximate.
Fields 1 `2

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomc Report No. FY21-SL031429
Client: William Heafner Advisor: Alex Fox
4 X 4 r Heavy Metals 2671 East main St Synagro
il
J J _ Lincolnton, NC 28092 284 Boger Rd
..'; Soil Report Mehlich-3 Extraction Mocks ille, NC 27028
f Sampled County : Lincoln
Links to Helpful Information
ClientlD: 519429 Advisor ID: 501947
Samp#ed: 0412312021 Received: 04/30/2021 completed: 0510612021 Farm: Lt-55
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium
(Cr)- 0.2 ppm, lead (Pb)-4.2 ppm, nickel (Ni)- 0,8 ppm, & selenium (Se)- 0,2 ppm (FY2005-2007). Although the above metals here are not believed to pose a concern for
plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer recommendations. Where soil test phosphorus (P) is
very high (P-1 a 100), crops will not respond to additional P opplied.Tissue testing is advised where soil pH is elevated and is of concern as in samples found here Jagathi
Kamalakanthan, Acironornist, 5/6/2021
Sample ID: 1
Recommendations: Lime Nutrients (Iblacre)
More
Crop (tonslacre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1- FescuelOGrassl7im, M 0.0 120-200 0 0 0 0 pH$ 0 0 0
Note: 12 Nate:
2, 0,0
Test Results [units - WN in glcm3; CEC and Na in meglloo cm3; NO3-N in mgldm37: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-Ali Mn-AI2 Zn-I Zn-AI Cu-1 Na ESP SS-1 NO3-N
0.18 0.95 17.7 98 0.4 7.0 718 94 90 6 40 147 90 303 303 70 0.1 1
Heavy Metals (parts per million): Arsenic, 0.6 Cadmium, 0.0 Nickel, 0,2 Chromium, 0.2 Lead, 5.5 Selenium, 0.0
Sample ID: 2
Recommendations: Lime Nutrients (lb/acre)
More
Crop (tonslacre) N P2O5 K2O Mg S Mn Zn Cu B
Information
Lime History:
1 - FescuelOGrasslTim, M 0.0 120-200 f 30 40 0 0 0 $ $ 0
Note: 12 Note: $
2 - 0.0
Test Results [units - W1V in g1cm3; GEC and Na in meg1100 cm3; NO3-N in mg1dnt3]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-I Mn-I Mn-All Mn-AI2 Zn-I Zn-AI Cu-1 Na ESP SS -I NO3-N
0.13 1.00 6.2 85 0.9 6.2 8 49 54 28 54 288 186 15 15 21 0.0
North Carolina
A�i.1 W
f J,auo Tnnt f mKl G�:rni.,.i„n
Reprogramming of the laboratory -'information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- SteveTroxler, Commissioner&Agriculture

NCDA&CS Agronomic Division Phone: [phone] Website: www.neagr.gov/agronami/
Report No. FY21-SLO31429
William Heafner
Page 2 of 2
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 0.1 Chromium, 0.1
Lead, 2.0 Selenium, 0.1
Understanding the So!] Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lime
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
B
boron
tonlacre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to $ inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 tonlacre (50 Ib11000 sq ft) at on
Ca°/
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
CEC
cation exchange capacity
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Cu-I
copper index
ESP
exchangeable sodium percent
Fertilizer
HM%
percent humic rnatler
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-1
potassium index
Iblacre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
potash
for the crop being grown, not on soil test results. K-1 and P-1 values are based on test results and should be > 50. If they
Mg°%
% CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples.
Mn-Alt
Mn-availability index for crop 1Mn-AI2
Mn-availability index for crop 2
Farmers and other commercial producers should pay special attention to micronutrient levels, If $, pH$, $pH, C or Z
Mn-I
manganese index
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
M-0
mineral -organic soil class
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
N
Na
nitrogen
ncagr-govlagronomilpubs, him.
sodium
H03-N
nitrate nitrogen
ORG
organic soil class
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib11000 sq ft. If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www.ncagr.vov/aaronomi/obpart4.htm#fsf nd information that
P-1
phosphorus index
may help you choose a comparable alternate, For more information, read A Homeowner's Guide to Fertilizer.
P205
phosphate
S-I
sulfur index
Test Results
SS-1
soluble salt index
WN
weight per volume
The first seven values [soil class, HM%. WN, CLC, B$%, Ac and pH] describe the soil and its degree of acidity. The
Zn-Al
zinc availability index
remaining 16 JP -I, K-I, Ca%, Mg%, Mn-1, Mn-Ali, Mn-AI2, Zn-I, Zn-AI, Cu-!, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine)
Zn-I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit www.ncavr.crav/aoronomi/uyrst.hrm

Waypoint(2)
ANALYTICAL
Report Number:
Client Project Description:
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 0 Fax [phone]
www.waypointanalytical.com
Sample Summary Table
21-117-0006
William Hefner/LT-55
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
76012
1
Soiids
04/27/2021
SW-7471B
WP MTN
76013
2
Solids
04/27/2021
SW-74716
WP MTN
WP MTN - Memphis, TN: Waypoint Analytical - TN, Memphis, TN
Page 1 of 3

•
P
�' �� 7621 (2) Whitepine Road, Richmond, VA 23237
Way Main 804-743-9401 ° Pax 804-271-6446
ANALYT]CAL www.waypointanalytical.com
46622
Synagro Central LLC/ Technical Project William Hefner/LT-55
Mary Brewer Report Date : 05/04/2021
284 Boger Road Information : Received : 01/27/2021
Mocksville , NC 27028
Tawi'c m r �f�oT
Report Number : 21-117-0006 REPORT OFANALYSIS Pauric Mc Groary Ph.D., CPA
Agronomist
Lab No : 76012 Matrix: Solids
Sample ID : 1 Sampled:
Test Results Units MOL DF Date / Time By Analytical
Analyzed Method
Mercury 0.0335 mg/Kg 0.0155 1 05/03/2112:55 DDB SW-7471B
Qualifiers/ *
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
g
GGA Outside QC Limits
H
Beyond holding time
J
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC
Not confirmed
Q
RPD >40% dual column results
T
Sample exhibits toxicity
U
Unconfirmed
N
Refer to cover letter.
Page 2 of 3

Waypoint.(2)
ANALYTICAL
46622
Synagro Central LLC/ Technical Project
Mary Brewer
264 Boger Road Information
Mocksville , NC 27028
Report Number : 21-117-0006
Lab No : 76013
Sample ID : 2
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.tom
William Hefner/LT-55
REPORT OFANAL YSIS
Report Date : 05/04/2021
Received : 04/27/2021
1awfc Mt Grpwr
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled:
Test Results Units MOL DF Date / Time By Analytical
Analyzed Method
Mercury 0.0562 mg/Kg 0.0157 1 0510312112:57 DDB SW-7471B
Qualifiers/
Outside QC Limit
B
Analyte detected in blank
Definitions C
GCMS Confirmation Analysis
E
Result above cal range
9
GGA Outside QC Limits
H
Beyond holding time
I
Estimated value
M
Minimum value
NA
Not on Scope of Accreditation
NC
Not confirmed
Q
RPD >40% dual column results
T
Sample exhibits toxicity
U
Unconfirmed
Refer to cover letter.
Page 3 of 3

SYNAGRO, LINCOLNTON PERMIT
WQ 0002712
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Synagro Lincolnton 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.
For each application field site, representative soil borings were conducted to confirm the
soil series designation provided on the USDAINRCS soil survey data. It was assumed
that areas unsuitable to slope or a seasonally high-water table are not included in the
application area for any of these fields.
Table I lists the dominant soil series mapped for each of the fields in this submittal, as
well as the soil series determined:
Table 1. - Soil Profile Descriptions Data, L.incolnton, Permit WQ
0002712
Field NRCS Mapped Series Field Identified Series
LT 55-1 Rion Pacolet
LT 55-2 Cecil Cecil
LT 48-13 Cecil Cecil
LT 48-14 Pacolet Wedowee
LT 48-15 Cecil Cecil

Sincerely,
G. Christopher Murray, L.S.S.
No. 1 284
Synagro, Lincolnton Permit, Various Fields

Soil Profile Descriptions in Field Locations
Project: Uncolnton (WO 0002712)
% Slope: 3%
Site: LT-55
Crop: ForagelPasture
Field: Field 1
Conducted By: GC Murray
PIEDMONT
Coordinates: 35.4264 N
Date: 4/23/2021
ENVIRONMENTAL
-81.2997 W
Soil Series: Pacolet
A S s 0 c 3 A T E 5 P. A.
w
m
a
s
LU
d
(D
`a
C
U y
N
N
&
O
U
O
U
Q
N O
U)U
GI
dl
d C ✓i
NI
U
U
CY.1 U 9 U
O 01 c
a
0
0 Qi O y
j•+
r
`' O V
Ap
0-3
10YR 312
-
moist
sl
mod
med
gr
fr
ns
np
E
3-12
10YR 413
moist
Is
mod
med
gr
fr
ns
np
Bt
12-38
10YR 416
moist
c
mod
med
sbk
fi
s
p
BC
38-48
10YR 316
moist
Sol
wk
med
sbk
fi
s
p
Legend:
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
sct
sandy clay loam
sl
sandy loam
sidd
silty day loam
Structure Grade
Structure Type
wk weak
gr granular
m moderate
pl platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Size
f fine
med medium
Moist Conslstency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type {apparentlperched)

Soil Profile Descriptions in Field Locations
Project: Lincolnton (WQ 0002712)
% Slope: 3%
Site: LT-55
Crop: Forage/Pasture
Field: Field 2
Conducted By: GC Murray
PIEDMONT
Coordinates: 35.4211 N
Date: 4/23/2021
ENVIRONMENTAL
-81,2798 W
Soil Series: Cecil
A 9 S o c I ATE 5, P A.
N
IL w
t a
c
si m
C7
U)
y
p
a O
� f� U
Q
N O (D
N U
0
all *' L T
�
i+ a = 7
U
li
U U C
S
.--'
C
d a 31
« N U N
—ul
Legend:
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Structure Grade
Structure Twe
wk weak
gr granular
m moderate
pl platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
me massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal Hi h Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: Lincolnton (WO 0002712)
% Slope: 3%
Site: LT-18
Crop: ForagelPasture
Field: Field 13
Conducted By: GC Murray
PIEDMONT
Coordinates: 35.5619 N
Date: 4/2312021
ENVIRONMENTAL
-81.4526 W
Soil Series: Cecil
A 5 5 o c, A T @ 5 P A.
�+ N
a
10
i
Wf]
N
u
LU
d. m
L 0 0
C
U
C7
U7
m
•C
C O O
c U U
d
Q
N O
in U
Of
-
G7
N
`1 o H
N Y L W
N
i0-O '�
N
l3
U
CJ C U
Y
O G! R O
T A S S
O
4
O y �O ?i
•0 U
Legend.
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Structure Grade Structure Type
wk weak gr granular
m moderate pl platy
str strong pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Size
f fine
med medium
Moist Consistenev
fr friable
vfr very friable
fi firm
A very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: Lincolnton (WQ 0002712)
% Slope: 3%
Site: LT-48
Crop: Forage/Pasture
Field: Field 15
Conducted By: GC Murray
PIEDMONT
Coordinates: 35.5181 N
Date: 4/23/2021
ENVIRONMENTAL
-81,4441 W
Soil Series: Cecil
r, s s G c I A T F, 5. P w.
w
w
N N
M
n
N
u
LLJ
}
t o o
c
u
N
CS
to
F w
C
C O O
•_ U U
Q
N O
fn V
d
0
L O N
O ` W
NI
61
N G 7 =
U
V
U V C t7
T /1 S C
C
N_
C •� Q
r
U
Legend:
Texture
s
sand
loam
si
silt
sil
sill loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Structure Grade
Structure Type
wk weak
gr granular
m moderate
pl platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Size
f fine
med medium
Moist Consistencv
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal Hiah Water Table:
f3epth {") Type {apparenUperched)

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
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
Formore information, visit the Water Quality Permitting Section's Non-DischaruePermitting Urtit
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 .1I00. 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 documentatio n listed
below.
A. County Board Notification(FORTM: CBN 11-15):
® Submit the completed and appropriately executed County Board Notification (FORM: CBN I 1-15). Please do not make a ny
unauthorized contentchanges to this form. If necessary forclarity 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 theproposed land application sites are not located within these a reas.
® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
https://deq.nc.Rov/about/divisions/water-resources/water-resources-rules/water-supply-watershed-protection-t)ro2ram
M Ifuncertain about whetherthe 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:
httr)s://www.sosnc,jzov/r)Liblications/direct.as]2x
M A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
h ttp : //deq .n c. go v/contact/re oo na l-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 orior to submission of the application to the
Division forreview.
INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of 1

North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
Date: 9/21/2021
To: Name of Chairman to the Board of County Commissioners: Carrol Mitchem
Complete mailing address: 7868 Hallman Mill Road
City: Vale
State: NC Zip: 28168
County where land application sites are located: Lincoln
From: Applicant's name: City of Lincolnton (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: Alex Fox (Synagro LLC)
Complete mailing address: 263 Boger rd
City: Mocksville State: NC Zip: 27028
Telephone number: (704} 881-3429 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 o f Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
will ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals -
generating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: NC DEQ Mooresville
Complete mailing address: 610 East Center Ave Suite 301
City: Mooresville State: NC Zip: 29115
Telephone number. [phone]
Expected date of application submission: 9/27/21
Should you desire to comment on this application, please do so no later than 3 0 calendar days fo Mowing 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 Permitt'ng Unit
1617 Maii Service Center, Raleigh, North Cardina 27699-1617
Phone: [phone] Internet: http:l/porlal.nodenr.oVwebNag
An EqualOppo.tunitylAffirmativeActionFmpldyer—Made in part with recycled paper FORM: CBN06-16

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UPS
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LINCOLN CO BOARD OF COMMISSIONERS
7868 HALLMAN MILL RD
VALE, NC 28168
US
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