WQ0008778_Modification_20220421

Non-Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnMentalQuuuty
Version 2-Revised June 23,2020
Initial Review
Reviewer Thornburg,Nathaniel D
Is this submittal an application?(Excluding additional information.)*
Yes No
Permit Number(IR)* WQ0008778
Applicant/Permittee Town of Farmville
Applicant/Permittee Address 2884 Chinquapin Rd,Farmville NC,27828
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
Owner Type Municipal
Facility Name Town of Farmville Class B Residuals Program
County Pitt
Fee Category Minor Fee Amount $245
Is this a complete application?*
Yes No Complete App Date
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type(if non-application)
Email Notifications
Does this need review by the hydrogeologist?* Yes No
Regional Office
CO Reviewer
Admin Reviewer
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* Chris Wynne
Email Address* Phone Number*
[e-mail] 13369098627
Project Information
Application/Document Type* New(Fee Required) Modification-Minor
Modification-Major(Fee Required) Renewal
Renewal with Major Modification(Fee GW-59, NDMR,NDMLR, NDAR-1,
Required) NDAR-2
Annual Report Residual Annual Report
Additional Information Change of Ownership
Other
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.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:* Wastewater Irrigation High-Rate Infiltration
Other Wastewater Reclaimed Water
Closed-Loop Recycle Residuals
Single-Family Residence Wastewater Other
Irrigation
Permit Number:* WQ0008778
Has Current Existing permit number
Applicant/Permittee* Town of Farmville
Applicant/Permittee Address* 2884 Chinquapin Rd,Farmville NC,27828
Facility Name* Town of Farmville Class B Residuals Program
Please provide comments/notes on your current submittal below.
I'm addressing the pre-review application return.I've check the appropriate box for the major
modification and the check will arrive in the coming days.Thanks.
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.)
Farmville WWTP 2022 modification.pdf 24.91 MB
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
CJ4¢ rtx. rite

Submission Date 4/14/2022

tt a PNKI rr2R A . c r Ft. 9Y o,F_ Ir t ' F,t si
04/11/2022
NCDENR-DWQ
Land Application Permitting and Compliance Unit
Aquifer Protection Section
1636 Mail Service Center
Raleigh,North Carolina 27699-1636
ATTENTION: Mr.Nathaniel Thornburg
REFERENCE: MODIFICATION OF PERMIT NO. W00008778
Town of Farmville
Dear Mr. Thornburg:
Synagro is submitting, on behalf of the Town of Farmville, an application to modify the Town's
residuals land application permit. Listed below are the changes to the existing permit as they
pertain to land application sites:
• Adding 1 application site (NC-PI-6-1)
If you need additional information or have further questions about the submittal, feel free to
contact [phone] or [e-mail]. I look forward to working with you to ensure
that this is an efficient review process.
Sincerely,
Chris Wynne
Technical Services Specialist

State of North Carolina
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.Non-Discharge Permitting Unit
General—This application is for treatment, storage,transport, and/or land application of Class B residuals(may include residuals that
are generated from a water treatment plant or other type facilities)on the proposed or currently approved land application site(s)under
15A NCAC 02T .1100.
Unless otherwise noted,the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM:RLAP 06-16)Application: (All Application Packages):
El 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.
T• he 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 1SA
NCAC 02T.0106(b). --
/1; If this project is for a modification of an existing permit,submit one copy of the existing permit.
0 P• lease submit this application form at least 180 days prior to the expiration date on the existing penult, 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)
// S• ubmit a check, money order or electronic funds transfer made payable to: North Carolina Depaitment of Environmental
Quality(NCDEQ).
Facility Classification New Permit ( Major Modification '
Major(land are permitted for >300 acres) $1,310 $395
Minor(land are peiiiiitted for<300 acres) $810 $245
1 -A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another];adds additional residuals sources;or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter(All Application Packages)
r; List all items included in the application package, as well as a brief description of the requested pei nutting action.
D. Environmental Assessments(May be Required—See I SA NCAC IC .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 arc 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)
�1 For Modification Application,if there are any changes to the existing plan,submit an updated O&M plan.
0 Submit the O&M Plan in accordance with 15A NCAC 02T.1110 and include at a minimum:
0 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.
El Maintenance schedules;may include equipment calibration,maintenance of signs,etc.
0'Safety measures;may include safety training program,manuals, signs,etc.
❑Spill response plan; including control,containment,remediation,emergency contact information, etc.
El Inspection plan including the following information;
0'Names and titles of personnel responsible for conducting the inspections.
0 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.
0 Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
Q Sampling and monitoring plan including the following information;
Q;Names and titles of personnel responsible for conducting the sampling and monitoring.
Q;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
0; Dedicated residuals land application programs are ones in which land application sites meet the criteria in 1SA NCAC 02T
.11021124 Specifically,a residuals land application program is designated as dedicated if any of the following are applicable:
0'Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
0 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.
El 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.
El Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps(All New or Modification Application Packages)
111 Submit three(3)sets of standard size plans and two(2)sets of 11"by 17"plans(electronic format is acceptable-Adobe PDF
only). For Modifications,submit plans specific to the modification(s)only.
Plans must include the following minimum items:
/1 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.
D. 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).
/1 Delineation of the review and compliance boundaries
/á Setbacks as required by 15A NCAC 02T .1108
Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area(when applicable). Clearly label spray
irrigation zones as they will be operated.
Plans must depict a completed design and not be labeled with preliminary phrases(e.g.,FOR REVIEW ONLY,NOT FOR
CONSTRUCTION,etc.)that indicate that they are anything other than final plans. However,the plans may be labeled with
the phrase: FINAL DESIGN-NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

I. Project Evaluation and Receiver Site Management Plan(All New Application Packages or Modifications that include new sites)
f Submit a project evaluation and a receiver site management plan(if applicable)with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report(All New Application Packages or Modifications involving increasing the total design capacity)
Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1104(d)(4) and current Division Policy
available at: http://www.ncwater.or /Rules Policies_and Regplatio_ns/. 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)
0 Submit engineering design documents that have been signed,sealed,and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T.1104(d)(2). For Modifications, submit an updated site map
specific to the modification(s)only.
0 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;
El 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(d)(5)and current Division Policy
available at: hp://www.ncwater.orn/Rules,Policies_and Regulations/.
M. Property Ownership Documentation(All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
�1' Property ownership documentation shall consist of one of the following:
Legal documentation of ownership(i.e.,GIS,deed or article of incorporation),or
►1 Written notarized intent to purchase agreement signed by both parties with a plat or survey map,or
l:1 An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
1.5A NCAC 02L.01010), or
/1 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: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N.SALISBURY STREET
RALEIGH,NORTH CAROLINA 27699-1617 RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone] FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
,„
Department of Environmental Quality
Division of Water Resources
l slon of terResources15A NCAC 02T.1100—RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name:Town of Farmville
Applicant type: 0 Individual 0 Corporation 0 General Partnership 0 Privately-Owned Public Utility
[l Federal 0 State a Municipal ❑County
Signature authority's name per 15A NCAC 02T.0106:David Hodgkins Title:Town Manager
Applicant's mailing address:PO Box 86
City:Farmville State:NC Zip:27828-
Telephone number:[phone] Email Address:dhodgk n am vide-nc cod,;
2. Consultant's name:Christopher Wynne License Number(for P.E.):
Affiliation: l/;On Staff Ej Retained(Firm: )
Consultant's mailing address:284 Boger Rd
City: Mocksville State:NC Zip:27028-
Telephone number:[phone] Email Address: cwynne(isynagro.com
3. Agronomist's name: License Number:
Affiliation:0'N/A 0 On Staff 0 Retained(Finn: )
Agronomist's mailing address:
City: State: Zip:
Telephone number: Email Address:
4. Soil Scientist's name:Eric Thompson License Number: 1238
Affiliation: @ N/A 0 On Staff 0 Retained(Finn: )
Soil Scientist's mailing address:
City: State: Zip: -
Telephone number:[phone] Email Address: [e-mail]
5. Fee submitted: $395.00(See Instruction B)
IL PERMIT INFORMATION:
1. Application is for(check all that apply):0 new, ►l' modified, El renewed permit
2. If this application is being submitted to renew or modify an existing permit,provide the following:
Permit number:WQ0008778
Date of most-recently issued permit: 11/15/2021
Date of most-recently certified Attachment A(if different than the permit):
Date of most-recently certified Attachment 13(if different than the permit):
FORM:RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address:2884 Chinquapin Rd
City: Farmville State:NC Zip:27828-
Coordinates: Latitude: 35°35' 17" Longitude: 77°32'42"
Datum:NAD 84 Level of accuracy: Second
Method of measurement: Map
2. County where residuals land application program is headquartered: Pitt
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 Robert N. Roth. Synagro 1001672
Back-Up ORC John A.Culp Synagro 1000733
Additional Back-Up
ORCs
(if applicable)
If an ORC and at least one Back-Up ORC are not currently designated for this residuals land application program,provide the
candidates'names,affiliations,and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a.Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source-generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 500 dry tons per year.
PAN Pounds of PAN per Dry Ton Pounds of PAN per Year
(Weighted Average)
Surface Incorporation Surface Incorporation
or Injection or Injection
First Year 11.68 13.08 5842 6542
Five-Year Maximum Adjusted 18.16 19.56 9080 9780
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 129.33
Hay 0
Pasture 32.7
Total: 162.03
Methods Surface 162.03
Incorporation or Injection 0
Total: 162.03
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 Acres Required Using Acres Required Using
Application Rate First-Year PAN Concentrations Five-Year Maximum Adjusted PAN
(lbs PAN/ac-yr) Concentrations
Surface Incorporation or Surface Incorporation or
Injection Injection
50 116.8 130.8 181.6 195.6
100 58.4 65.4 90.8 97.8
150 38.9 43.6 60.5 65.2
200 29.2 32.7 45.4 48.9
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): ►1 Non-dedicated ❑Dedicated
If Dedicated,specify the following(check all that apply):
Residuals program contains any land application site(s)that receives residuals at rates or frequencies greater than agronomic
rates,explain;
I: Residuals program contains any land application site(s)that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance,explain;
0 Residuals program contains any land application site(s)that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new,renewed,or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new,renewed,or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification.doc
FORM:RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: 0 Spray 0 Drip
2. Disposal system is:❑I existing Q 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.050 (p)requires at least one-foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
E Yes or E No If Yes,please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil.Scientist Evaluation:
Recommended Recommended
Soil Series Fields within Soil Area Loading Rate Loading Rate
(in/hr) (in/yr)
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
Yes or E 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 Number of Maximum Application Design Annual Loading
(ft2) Nozzles Rate(gallons/hr) Rate(gallons/yr)
Total
Spray Irrigation Design Element Plan Sheet Specification
Number Page Number
Wetted diameter of nozzles ft
Wetted area of nozzles ft2
Nozzle capacity gpm
Nozzle manufacturer/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.0106):
The applicant or any affiliate has not been convicted of an environmental crime,has not abandoned a wastewater facility without proper
closure,does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T.0105.
Yes ❑ No, Explain;
I, David Hodgkins Town Manager
(Signature Authority's Name—PLEASE PRINT) (Title)
attest that this application for Farmville WWTP
(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, andlor criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and§143-215.6B, any person who knowingly makes any false
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.
9
kg1'
Signature: /l/t Date: iirk(l. V2.1 Z&A
FORM:RLAP 06-16 Page 5 of 5

State of North Carolina
ii
i ihrl „„11
Department of Environmental Quality
1,0,
, , ,
Division of Water Resources
1„„„„,,, I,
„ ,
, ii,,,iiii
Iiii,,„,,li„„010 , , ,„, 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-Dischoxgegoaittíng 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 AI 00.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):
2 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.
0 For new or renewed peimits,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:
LI" The status of the land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
•New(N) .Renewed(R) •Modified(M) *Transferred(T) •Deleted(D)
' Attach the following in accordance with each status code:
Status Code
Required Item
N R T m
3 1
.(
County Board
Notification.doc
ís)74; 1
*
Land Owner
Agreement
(If applicable)
/ 17 J ./
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the"Map Guidance / ,( 17 *
for Residuals Land Application Permits"
A soils and agronomic evaluation in accordance with the"Soil Scientist ,f *
its atien Polic,,"
INSTRUCTIONS FOR FORM:LASC 06-16 Page 1 of 3

An updated accounting of the land application site's cumulative
pollutant loading rates(CPLRs)
Status Code
Required Item
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"Soil Scientist Evaluation Policy"
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.
�I Crop Type should include the most likely crop types for the life of the permit(five years).
►1 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.
/L Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil-mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
/ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil),the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey(or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching(ADD) • Digital or Raw Photo Extraction(EXT)
• Aerial Photography with Ground Control(AER) • Geodetic Quality GPS Survey(GEO)
• Cadastral Survey(SUR) • LORAN-C Navigation Device(LOR)
• Conversion from Coordinate Plane(CP) • Navigation Quality GPS(GPS)
• Conversion from Township-Section-Range(TSR) • Remote Sensing(RS)
• Conversion from Universal Trans 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-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number,the identified location,and be of clear and reproducible quality.
Surface water body classifications information may be found at: http:_//deq_nc.gov/about/divisions/water-
resources/planning/classiification-standardsiclassifícations
E. Any questions concerning the waterbody and its classification,please contact the Division's regional offices.
11 A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
pttp://deq.nc.gov/contact/regional-offices
General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions,stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http://deq_nc.gov/about/divisions/waterrresources/planning/classifcation-standards/classifications.
Stream Classification Process: One of the options below may be used depending on the known initial project information.
►1 KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1.Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

2.Locate the name of the identified waterbody(from General Directions)on the list.
3.For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source"in the description means the beginning of the waterbody segment(most upstream point).
4.Record all Basins, Stream Index Numbers and Classifications applicable to the project.
►. KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1.Select the proper county from the List all Waterbodies in county,hydrologically report.
2.Locate the name of the identified waterbody(from General Directions)on the list.
3.For multiple listings of the same waterbody name in the report,select and verify the location description. The term
"source"in the description means the beginning of the waterbody segment(most upstream point).
4.Record all Basins,Stream Index Numbers and Classifications applicable to the project.
It'1 UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1.Use the Clickable basin map to hydrologically sorted list report.
2.Click on the approximate project location to bring up the hydrologically sorted list.
3.Locate the name of the identified waterbody(from General Directions)on the list.
4.For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source"in the description means the beginning of the waterbody segment(most upstream point).
5.Record all Basins, Stream Index Numbers and Classifications applicable to the project.
Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B M301 _
►t 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.
►1 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 Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
Basin And Savannah River drainage area entering South Carolina shall be classified"B Tr."
River Drainage Area
French Broad River Streams entering Tennessee will be classified"B."
Basin
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 Streams entering Virginia are classified "C," and such streams entering South Carolina are
Basin classified"C."
Lumber River Basin Streams entering South Carolina are classified"C Sw."
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
Roanoke River Basin 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 All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
Basin 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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IIIIIII
Á
, 11
?OUR PART NI' FC;01. L AMR. r D
April Oh, 2022
NCDENR-DWQ
Land Application Permitting and Compliance Unit
Aquifer Protection Section
1636 Mail Service Center
Raleigh,North Carolina 27699-1636
ATTENTION: Mr.Nathaniel Thornburg
REFERENCE: Modification OF PERMIT NO. WQ0003919, Landowner agreements
Town of Farmville
Nathaniel,
I am addressing the clarification of the landowner agreements for the requested site. Per Pitt
County NC GIS,parcel 01489 is owned by Ronnie Dawson Dail (see LOA 06-16). Parcel 50572
is owned by Frank Dail Farms Inc., for which Ronnie Dail has signatory authority.
Please let me know if you have any questions or concerns.
Best regards,
Chris
Technical Services Specialist

State of North Carolina
Department of Environmental Quality
% Division of Water Resources
Eliv slon of Water Resources 15A NCAC 02T.1100-LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Dischar e Permitting;Unity
General—This document is an agreement between the Applicant and land owner(s)of residuals receiving sites for land application of
Class B residuals(may include water treatment plant or other type residuals)in accordance with 15A NCAC 02T.1100.Do not submit
this agreement for review without a corresponding application form (FORM:RLAP 06-16).
Unless otherwise noted,the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement(FORM: LOA 06-16):
® Submit the completed and appropriately executed Land Application Site Certification(FORM: LASC 06-16)form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
►� Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Farmville WWTP
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:
Lease Land Use or Residuals Source Special note
Site/Field ID (yes/no) Cropping Patterns Intended Use of Crops (optional) (no-till/over-seed/
pasture)
NC Pl 06 1 Row Crop Animal Feed
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, 1617 Mail
Service Center,Raleigh,NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner.In addition,the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals,residuals application methods,schedules for typical cropping patterns,a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s)ís not maintained at 6.0 or greater,sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0,unless an agronomist provides information indicating that the pH of the soil,residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns,results of
soil samples,and the permitted application limits.
10.The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g.,fertilizer,unregulated animal waste,etc.)that have been applied to the land application site(s).
11.The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s)prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12.Specific residuals land application area boundaries shall be clearly marked on the land application site(s)by the Permittee,the landowner,or
his representative prior to and during a residuals land application event.
13.The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s)as required by the permit; copy any records
that must be kept under the terms and conditions of the permit;take necessary leachate,surface water,groundwater,or soil samples during the
term of,and 12 months after termination of,this Agreement.
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.
IILALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY:(please check one)
15A NCAC 02L.0107(d)prohibits water supply wells within the compliance boundary.However, 15A NCAC 02'1".0105(h)allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly-established compliance boundary.Please mark one of the following;
❑ A re-defined compliance boundary is needed for field(s)ID:
(Please include the rationale for the requested re-location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re-defined compliance boundary is not needed for this site.
IV.ACKNOWLEDGEMENT OF FIELD TRANSFER:(if needed)
❑ The land application field(s)ID: 1 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)
FflPM 1 na nW_la Pn04. nf2

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t ratkt°��r� lftrtt, l um tr (.,lr;tnalría„t lartttteaaaarartr Of tlr,i0 aah04/00ra.lerederPal land ar..talalieattratra tiltdat)mil an aaarthrttimal to rrtaabc ala;t.�tslatranr
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rt laaawor of`atiaar°aaar�or other lr�llrat 4,1a�''lrrlpaa9lrarr#to triage decisions rr"rrl�„a'rr°a,lirrlt tlara tine att"tha;�tot atlr�tlr�t.larrr aalt��9)oft b�€rakf�>1"it►a�
rlr rtltaal lrar°aah�aaerta=rts I 00r°tltY thaat Mc aalatayaaw,rr.finetrear,al land tttaltl%eaatim oilcan are not lrraúhatlal in any yvaxíaa disposal contract or
atllraaetrarttt# WW1 arrrs,aahr'.a°rrararttaarlsaatidy,rrrtatrara;traa°,Or(Abet permitted entity, Furthermore,S certify rant f taarve read tine Avegaaaerat,
ttrtiterrátarral the rtlpatttrtarzsol,r°e.aata�lrttrrzol,afterrraatawaz9 for woter supply wells trulrle the aworraptitirce braundasy„.nebnrawteatgeina:tla or
field ta"uakraater nun do botchy grout pr,.rr"rrtaatOr,n to the aaatttittanra to land imply a°araittuaatts to the land application rtlt��a��alaa�ae,:ttr�l
laarrr,4rr, � �
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t,ow aararlr r,rr�,raa�cl Newry Public do hereby certify that ,,,x,����w���l�u��,w�°�� �;��„���M� � � � �, �
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lat;ra"aaa�aaaa;rlly appeared before ataC this day arid acknowledged tlsaa due eaaeGtats'ora ral"t,lrr�a litrgralaatl ir rrartaa4tat �� �� �
Wl t'l�tll�tl~#my bond mid rrl'l°irir.al narirrl tftiaa tha ,,;,°�,w��tin
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I certify goo l lraaur-t�,artl#lal,a Agrrnnirarsrrt and do hereby aatoanan to tahirle by ate aalprataatia;rtut and z°eaataletla,rzraa tanatrenin°led herein,
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I
APPLICATION
LEGEND
APPLICATION AREA
- — — — — - PRIVATE ROAD
- - STREAM
W9T 1
FENCE
PROPERTY LINE
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 It 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,

GRAPHICSCALE
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.

TOPOGRAPHIC MAP
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GRAPHIC SCALE
1" = 1,000'
1,00a 0 1,000,
I
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C_P I_O 1
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 1'6

VICINITY
i 5,j
��pp j7 N �iF
TI9iPINA4¢duü'
m'fa t a*4H,ri
NNIt r i.
>555
, t
°sr�4ar� r'ea
4,4
( 1,4
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 NC-PI-06
in the property boundary,whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area,All
locations are approximate. Field 1

¡ IAÍi "rl�' 1, 7621 Whitepine Road,Richmond,VA 23237
Main 804-743.9401°Fax [phone]
ANALYTICAL www.waypointanalytical.cam
3/31/2022
Synagro Central LLCI Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
Ref: Analytical Testing
Report Number: 22-082-0001
Project Description: Stacy Dail
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s) on 3/23/2022 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,
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 6

7621 Whhepine Road,Richmond,VA 23237
Main 804-743-9401°Fax [phone]
ANALYTICAL www.waypointanalyticalcom
Sample Summary Table
Report Number: 22-082-0001
Client Project Description: Stacy Dail
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
57240 1 Solids 03/23/2022 6010D WP MTN
WP MTN-Memphis,TN: Waypoint Analytical-TN,Memphis,TN
Page 2 of 6

/n ii„,r ,r rrry ,Jr; 7621 Whitepine Road,Richmond,VA 23237
Main$04-743-9401°Fax 804-271._5446
ANALYTICAL www.waypointanaiytical.corn
46622
Synagro Central LLC/Technical Project Stacy Dail
Mary Brewer Report Date: 03/31/2022
284 Boger Road Information : Received :03/23/2022
Mocksville, NC 27028
Wit Pc Grew /
Report Number:22-082-0001 REPORT OF ANALYSIS Pauric Mc Groary Ph.D.,CPA
Agronomist
Lab No: 57240 Matrix: Solids
Sample ID: 1 Sampled:
Test Results Units MQL DF Date/Time By Analytical
Analyzed Method
Nickel 1.28 mg/Kg 0.250 1 03/30/22 18:26 EAL 6010D
Selenium <0.500 mg/Kg 0.500 1 03/30/22 18:26 EAL 6010D
Test Results Units MQL DF Date/Time By Analytical
Analyzed Method
Arsenic 1.08 mg/Kg 0.500 1 03/30/22 18:26 EAL 6010D
Cadmium 0.115 mg/Kg 0.100 1 03/30/22 18:26 EAL 6010D
Chromium 6.81 mg/Kg 0.25D 1 03/30/22 18:26 EAL 6010D
Lead 10.2 mg/Kg 0.300 1 03/30/22 18:26 EAL 6010D
Qualifiers/ DF Dilution Factor MQL Method Quantitation Limit
Definitions
Page 3 of 6

{ jy1`jl rnnrr,G i f,ilfl ,r+f �r u '"'11101 7621 White pine Road,Richmond,VA 23237
Main 804-743-9401°Fax [phone]
ANALYTICAL www.waypointanalytical.com
Client: Synagro Central LLC/Technical CASE NARRATIVE
Project: Stacy Dail
Lab Report Number: 22-082-0001
Date: 3/31/2022
Metals Analysis Method 6010D
Sample 94776 (EJ-1)
Analyte:Arsenic
QC Batch No: L607997/L607032
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges.A post
digestion spike was performed and passed quality control acceptance ranges. No matrix interference is
suspected.
Sample 94776(EJ-1)
Analyte: Lead
QC Batch No: L607997/L607032
The matrix spike and/or the matrix spike duplicate was outside quality control acceptance ranges.A dilution test
was performed and passed quality control acceptance ranges. No matrix interference is suspected.
Page 4 of 6

9111
✓fa /Jniyp i fy H uraoi/ yii»r/f yvor lfv 7621 Whitephne Road,Richmond,VA 23237
e,r r/lriir✓f % rrr /l it % tGr,r ;.
Main$04-743.9401°Fax [phone]
ANALYTICAL www.waypointanalytical.com
Shipment Receipt Form
Customer Number:46622
Customer Name: Synagro Central LLC/Technical
Report Number: 22-082-0001
Shipping Method
0 Fed Ex O US Postal 0 Lab 0 Other :
UPS 0 Client 0 Courier Thermometer ID:
Shipping container/cooler uncompromised? Yes 0 No
Number of coolers/boxes received P1
Custody seals intact on shipping container/cooler? 0 Yes 0 No 0 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)? 0 Yes O No
COC properly completed 0 Yes O No
Samples in proper containers? * Yes O No
Sample containers intact? Yes 0 No
Sufficient sample volume for indicated test(s)? 0 Yes 0 No
All samples received within holding time? 0 Yes 0 No
Cooler temperature in compliance? 0 Yes 0 No
Cooler/Samples arrived at the laboratory on ice. 0 Yes 0 No
Samples were considered acceptable as cooling
process had begun.
Water-Sample containers properly preserved 0 Yes 0 No 0 N/A
Water-VOA vials free of headspace 0 Yes 0 No © N/A
Trip Blanks received with VOAs 0 Yes 0 No 0 N/A
Soil VOA method 5035—compliance criteria met 0 Yes 0 No 0 N/A
r High concentration container (48 hr) Low concentration EnCore samplers (48 hr)
High concentration pre-weighed (methanol -14 d) Low conc pre-weighed vials (Sod Bis-14 d)
Special precautions or instructions included? 0 Yes 0 No
Comments:
Signature: Brandi Watson Date&Time: 03/23/2022 08:10:54
Page 5 of 6

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„,,„

epine Road,Richmond,VA 23237
7621Main t8(4-743 9401°Fax [phone]
ANALYTICAL www.waypointanalytical.com
3/31/2022
Synagro Central LLC/Technical
Mary Brewer
284 Boger Road
Mocksville, NC, 27028
Ref: Analytical Testing
Report Number: 22-082-0002
Project Description: Stacy Dail
Field PI-06
Dear Mary Brewer:
Waypoint Analytical Virginia, Inc. received sample(s)on 3/23/2022 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,
94.44.0.c ( Glaa /
Pauric McGroary
Agronomist
Laboratory's liability in any claim relating to analyses performed shall be limited to,at laboratory's option, repeating the
analysis ín question at laboratory's expense, or the refund of the charges paid for performance of said analysis.
Page 1 of 6

jtill
1111111111 \
. „ ,,,11111,1,191,
7621 Whitepine Road,Richmond,VA 23237
main 804-743-9401*Fax [phone]
ANALYTICAL wwvv,wavpointanalvticalcom
Sample Summary Table
Report Number: 22-082-0002
Client Project Description: Stacy Dail
Field PI-06
Lab No Client Sample ID Matrix Date Collected Date Received Method Lab ID
57241 1 Solids 03/23/2022 SW-7471B WP MTN
WP MTN-Memphis,TN: Waypoint Analytical-TN,Memphis,TN
Page 2 of 6

911
• 10111114
. i , ' 7621 Whitepine Road,Richmond,VA 23237
,„wir w
Main 804-743-9401°Fax [phone]
ANALYTICAL wwwmaypointanalyticalcom
46622
Synagro Central LLC/Technical Project Stacy Dail
Mary Brewer Report Date: 03/31/2022
284 Boger Road Information: Field PI-06 Received :03/23/2022
Mocksville, NC 27028
414.1ft C
Pauric Mc Groary Ph.D.,CPA
Report Number:22-082-0002 REPORT OF ANALYSIS
Agronomist
Lab No: 57241 Matrix: Solids
Sample ID :1 Sampled:
Test Results Units MQL DF Date I Time By Analytical
Analyzed Method
Mercury 0.0229 mg/Kg 0.0159 1 03/30/22 12:40 ZMT SW-7471B
Qualifiers/ DF Dilution Factor MQL Method Quantitation Limit
Definitions
Page 3 of 6
111001, r, PPODMIRo non MIDA iherorn ammimorrunvomm 1,1 womn%ammo.REM.Viff

1901„,
igim
•
, 111
7821 Whitepine Road,Richmond,VA 23237
Main 804-743-9401 Fax [phone]
ANALYTICAL www.waypobtanalyticalcom
Client: Synagro Central LLC/Technical CASE NARRATIVE
Project: Stacy Dail
Lab Report Number: 22-082-0002
Date: 3/30/2022
Solids Total Mercury Analysis-CVAA Method 7471A
Sample 94781 (LB-1-1)
Analyte: Mercury
QC Batch No: L607937/L607749
The matrix spike, matrix spike duplicate and the post digestion spike were all outside of the quality control
acceptance ranges. Matrix interference is suspected.
Page 4 of 6

}/r olU '• J r 7621 Whitepíne Road,Richmond,VA Z3237
Main 804.743-9401 Fax [phone]
ANALYTICAL www,waypointanalvtical.com
Shipment Receipt Form
Customer Number:46622
Customer Name: Synagro Central LLC/Technical
Report Number: 22-082-0002
Shipping Method
0 Fed Ex 0 US Postal O Lab 0 Other :
CD UPS 0 Client 0 Courier Thermometer ID:
Shipping container/cooler uncompromised? * Yes 0 No
Number of coolers/boxes received [ 1
Custody seals intact on shipping container/cooler? 0 Yes O No 0 Not Present
Custody seals intact on sample bottles? 0 Yes 0 No @ Not Present
Chain of Custody (COC) present? 0 Yes 0 No
COC agrees with sample label(s)? U Yes O No
COC properly completed 0 Yes 0 No
Samples in proper containers? 0 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? C )Yes 0 No
Cooler temperature in compliance? 0 Yes 0 No
Cooler/Samples arrived at the laboratory on ice. O Yes C) No
Samples were considered acceptable as cooling
process had begun.
Water-Sample containers properly preserved 0 Yes 0 No 0 N/A
Water-VOA vials free of headspace 0 Yes 0 No 0 N/A
Trip Blanks received with VOAs 0 Yes 0 No 0 N/A
Soil VOA method 5035—compliance criteria met 0 Yes 0 No 0 N/A
r High concentration container(48 hr) Low concentration EnCore samplers (48 hr)
High concentration pre-weighed (methanol -14 d) Low conc pre-weighed vials (Sod Bis-14 d)
Special precautions or instructions included? 0 Yes 0 No
Comments:
Signature: [Brandi Watson Date &Time: 03/23/2022 08:13:54
Page 5 of 6

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I

SYNAGRO, FARMVILLE P
W00008778
SOIL SCIENTIST CERTIFICATION
This is to certify that a soil profile evaluation was conducted on the proposed application site for
the permit, referenced above, by myself, on behalf of Synagro Central, [LC_ The evaluation
consisted of a hand auger boring and description of the soil on the application site. The boring
was performed by me. All additional work performed for this permit application was conducted
by Synagro Central, LLC.
For the application field site, a representative soil boring was conducted to confirm the soil
series designation provided by USDA/NRCS soil survey data. It was assumed that areas
unsuitable due to slope or seasonal high water table are not included in the application area for
this field.
Table 1. lists the dominant soil series mapped for the field listed, as well as the soil series
determined.
Table 1. Soil Profile Description Data, Proposed Site, WQ0009778
Field NRCS Mapped Series Field Identified Series
PI-06-1 Bladen Bladen
Sincerely,
,, ;/1) ,: ..,,,,,",:ik›,'',,
n ' 01,1
t f ,,r,,c,,,,i q7,1,,'4'
SI SISISS 'S1' 1I I41' IS
r1/ j VI11 r fr,,,'z1:1,114U1'11,A )11. 1 ig
/r1/1
,P1 ':',1
,, ,), 1fr
Eric Thompson, L.C.S. NO. 1238 '''',,S:1111,Z--,,,,,,,11;;;,,,. ;' `,/
Kní /1'
— __

SOH ' 1ESC ',PTION SHEET
project: a y vyk, krt: e., vr,'V\I r") Landowner:
Site: Pr- »Via Field: Sample#: Slope:
,..
Acres (gross): _ Acres(net):
Crop:
SOIL PROFILE DESCRIPTIONS
Hon on Depth Tlxbore Color Structure Mottles
PROFILE A „AP 0 - TS [ 1Pyr 2: 1.4, r
I „ 0
100
- 2
ror dell )
>.4 0 1 ,,, '
Depth to SHVIIT: 11?)
t-i /11 Depth : type of restrictive layer:
or
Soil Series: 14 ft il e 0
Horizon Depth Texture Color Structure Mottles
PROFILE 8 M rom 1 IM14516.4591. .4. ..., ', 1,4 0
011,..
Depth to SHINT: :.1, lift e, 1,31.
Depth 8, type of restrictive layer ,1 ', ;'^' ,,,,,t - 011,;ild', ,
'-'":„,;,'ll-,4-;:fd
SO Series:
144 t ID r 3
Described By: , , ' ,
Date: *14 "51 0/
hegend
Texture Structure Grade Structure Type
a Sand 'I Weak gr Granular abk Angular Blocky
l Loam 2 Moderate pl Platy sbk Subangular Blocky
si Silt 3 Strong pr Prismatic sg Single Grained
o Clay cpr Columnar m Massive
m n s, nir P.m MI mu mememm n mm nu ".....m

State of North Carolina
Department of Environmental Quality
Division of Water Resources
COUNTY BOARD NOTIFICATION
INSTRUCTIONS FOR FORM: CBN 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharge Pertmzittini Unit
General—This notification is intended to provide the county board in which the land application site is proposed to be located with
general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an
opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for
fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review
without a corresponding residuals program application form(FORM: RLAP 11-15).
Unless otherwise noted,the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. County Board Notification(FORM: CBN 11-15):
Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any
unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may
be made,as long as the attachments are numbered to correspond to the section and item to which they refer.
l=1 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:
r Under 15A NCAC 02h 0212, no new permitted sites for land application of residuals are allowed within critical watershed
areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas.
11 For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
https://deq nc.govlabout/divisions/water-resources/water-resources rules%water-supp -waters@fled-protection_prograt
1�1 If uncertain about whether the proposed sites are located within the critical areas,contact the Division or call(919)807-6337.
C. Notification Package Submission:
Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to
the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the
notification package also be sent to the County Manager.
The most current publication of the Directory of State and County Officials may be downloaded at:
https://www.sosnc.gov/publications/direct.aspx
A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
http://deq..ncóov/contact/regional-offices.
The source facility summary shall include: facility name; county where it is located; and the proposed annual dry tonnage
(i.e.,a copy of"Residuals Source Facility Summary" is adequate but not required).
.141 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:
1:1 Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the
Division for review.
INSTRUCTIONS FOR FORM:CBN 06-16 Page 1 of I

North Carolina Department of Environmental Quality
pat McCrory Donald R, van der Vaart
Governor Secretary
</`/Zo z.z
Date:
To: Name of Chairman to the Board of County Commissioners: Mike Fitzpatrick
Complete mailing address: 200 East 4t' Street
City: Greenville State: NC Zip: 27858 ,.<
County where land application sites are located: Pitt
From: Applicant's name: Town of Farmville (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: James Shoulders,Plant ORC
Complete mailing address: 2884 Chinquapin Road
City: Farmville State: NC Zip: 27828-
Telephone number: 252-753-3913 E-mail address: [e-mail]
Subject: Notification of residual land application site proposal
This is to notify you that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to site(s) located in your county. During this review, the Division
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: Washington Regional Office
Complete mailing address: 943 Washington St
City: Washington State: NC Zip: 27889
Telephone number: [phone]
Expected date of application submission: 04/11/2022
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non-Discharge Permitting Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Phone:[phone] Internet:http://portal.ncdenr,orq/twebg
An Equal Oppoi{unity l Affirmative Action Employer—Made in part with recycled paper FORM; CBN 06-16

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24

I
APPLICATION
LEGEND
APPLICATION AREA 7/7
PRIVATE ROAD
STREAM
DRAIN
— FENCE
-- PROPERTY LINE
UNSUITABLE AREA
WATER
ONStTE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660' 0 660'

.
Tracking Number 7022C141.0000184881765 Remove X
Status
.rour item.his been delivered to an agent fur final delivery Eri; Iii'eliivered to Agent for :Delivery
In GREENVILLE,NC 27858 Q.1-4 April 13,2022 at 2,22 turn. April 13.,2022 st,2:22 ore.
GREENVILLE,NC,27S58
USPS Tracking Plus®Available
Got Uritinton
Defivereg to Agent
Text&Email Updates
Tracking History
Aprii 2092,222 pm
Delivered to Agent Soy Foal Oelivery
GREENVILLE.,NC 27852
Your item has been delivered to art agent for final delivery in GREENVILLE,NC 27858 on April 13,2622 at 2:2'2 om.
April 2022,7:5Z urn
OLD tor DefiVerry
GiriEENYILLE,NC 27158