WQ0016247_More Information Received_20221003

Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.) *
Yes No
If not an application what is the submittal type?* Annual Report
Residual Annual Report
Additional Information
Other
Permit Number (IR) * WQ0016247
Applicant/Permittee Synagro Central, LLC
Email Notifications
.............................................................................................
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer

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* Robert Roth
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*
13364034324
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
Perm it Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number: *
WQ0016247
Has Current Existing permit number
Applicant/Permittee Address*
284 Boger Rd. Mocksville NC 27028
Facility Name*
Synagro Western Piedmont Class B Residuals Program
Please provide comments/notes on your current submittal below.
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.)
WO0016247 Add Info 9_22_22.pdf 192.72MB
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
R RA;0
Submission Date 9/23/2022

SYNAGRO
September 20, 2022
NCDENR-DEQ
Division of Water Resources
Land Application Permitting and Compliance Unit
Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
ATTENTION: Mr. Erick Saunders
REFERENCE: Application No. WQ0016247
Additional Information Request
Synagro Western Piedmont RLAP
Statewide
Dear Mr. Saunders:
As a response to the additional information request received August 23rd, please see below for
responses to each item. Additionally, any supporting documents will be attached to this letter
in PDF format:
D. Operations and Maintenance Plan:
1. As requested, the previously submitted spill control provision has been updated to
include contact information for each regional office included in the program.
E. Residuals Source Certification Form:
1. It is noted that the most recent forms are to be used for any future submittals.
2. As requested in this letter and required by permit, professional recommendations will
be sourced prior to any application of material that carries a sodium absorption rate
above 10.
F. Land Application Site Certification Form:
1. CPLRs for fields NC-CH-72-03, NC-LT-54-RP-01 and RP-02 are provided. All other
requested fields have never received material and will not carry any amount of CPLR.
2. All setback waivers have been signed and recorded at the appropriate register of deeds
as requested except for items a, d and f. See notes below. Signed buffer waivers,
amended maps, and an adjusted LASC are provided.
a. A setback waiver for parcel 4774595828 was unable to be obtained however a
setback waiver for the neighboring property at parcel 4775603282 was obtained.
d. A setback waiver was unable to be obtained. The application map was amended
to reflect the added buffer.
284 Boger Road, Mocksville, NC 27028 • Phone: [phone]

SYNAGRO
f. The requested setback waiver was unable to be obtained. The application map
has been amended to reflect the added buffer.
3. The remaining soil analytics for field NC-CD-03-04 and full soil analysis for NC-CH-
81-1,2 are now included with this letter.
4. Since the submittal of this application package this farm has been sold and will no longer
be accepting Class B material. The amended LASC form now does not include this site.
5. Maps for fields NC-CH-73-02,07,08, and 09 were inadvertently included in this package
please disregard these maps. Only fields CH-73-03,04,05,06 are to be transferred. Field
CH-73-10 will remain as a "renew" field. An updated vicinity map for this site is
included.
6. Field NC-CL-08-14 has been removed from all associated maps as it is not to be
permitted. Updated maps are attached to this letter.
7. The maps for site NC-CL-08 have been updated to reflect the recent change in
neighboring parcel lines. Amended maps and updated LASC form are attached.
8. The requested waivers are now attached to this letter. Due to the executed buffer
waivers, the previously shown property line between fields 1 and 4 has also been
removed. Updated maps and an updated LASC are attached.
9. Updated maps for site NC-RC-49 are now included.
10. All soils now match the provided soil scientist certification sheet for those fields. It has
been understood that the soil scientist's field observations dictate the predominant soil
series for which ever field in question. Soils work for field NC-CH-73-03 was done
because of altering the previously permitted field and the soil scientist recommendation
was to modify the previous predominant series to his most recent observations. The
certification sheet for these fields is attached to this letter.
11. All requested map changes have been made. An updated application map and an updated
LASC form are attached to reflect changes. Due to scale and prevailing buffers some
requested setbacks aren't as clearly shown as others on fields NC-CH-81-1 and NC-CH-
81-2.
12. The structure in question was recently dismantled. Additionally, there is no water well
there yielding no need for updated mapping.
13. All requested maps are now included with this letter.
14. An updated LASC and soil profile description is attached. The correct soil type for field
LT-57-02 is Pacolet.
15. A clearer map of site NC-PO-09 is now included which better depicts property line
boundaries. Apparently, imagery for this area in Polk County is limited.
284 Boger Road, Mocksville, NC 27028 • Phone: [phone]

SYNAGRO
16. After review with the landowner, the debris pile in question will be removed in the near
future prior to land application. Also, the concrete pad will likely be used at a later date
and will remain in the field. All soils near these items are suitable for land application
with no needed setbacks.
17. An updated soil scientist description is now attached. The attached LASC has been
updated to match coordinates provided in these descriptions. Also updated maps
depicting the soil boring locations are also provided.
18. Map updates have been made. Those maps and an updated LASC form are attached.
G. Landowner Agreement Form
1. A new LOA signed by Mary D. Icenhour is now provided for site AL-15. Vinsen Lamar
Icenhour is deceased and Mary D. Icenhour is now the sole owner of the property.
2. As requested, a new LOA is provided for field NC-CA-06-03.
3. A Properly signed LOA for fields CA-53-03 and LT-53-01 is now attached to this letter.
4. Fields NC-CD-03-6,7 will no longer be renewed. Please disregard the previously
submitted maps. The updated LASC form now identifies these fields as "Delete".
5. An updated LOA is now provided for fields IR-41-1,2.
6. All requested LOAs are attached and properly notarized.
7. As requested, a new LOA for site NC-RC-50 is attached which now acknowledges
transfer from another RLAP program. Additionally the most recent CPLRs are included
for each field.
8. Upon further inspection it was determined that all requested fields required redefined
compliance boundaries. It was assumed that the requested redefined compliance
boundary for field NC-PO-02-02 was meant for field NC-PO-07-02. Updated LOAs and
associated location notes are included as attachments to this letter.
If you require additional information or have further questions, please contact me at
[phone] or [e-mail]. Thank you in advance for the timely and efficient
review of this modification application.
Sincerely,
284 Boger Road, Mocksville, NC 27028 • Phone: [phone]

DWR
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 land application site with respect to this residuals land application program must be provided in table I. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
KI
✓
County Board
Notification. doc
cy1
Land Owner
Agreement
✓
✓
✓
*
(If applicable)
in
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
✓
✓
✓
for Residuals Land Application Permits"
A soils and agronomic evaluation in accordance with the "Soil Scientist
✓
Evaluation Policy"
INSTRUCTIONS FOR FORM: LASC 06-16
Page 1 of 3

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

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
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."
River Drainage Area
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pasquotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16
Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Synagro Western Piedmont
Land application sites currently certified: 2,864.35 net acres and Total to be certified: TBD net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Codes
Site/Field ID
Landowner(s)
Lessee(s) Operator(s) or O s
Net Acres
County
Crop(s)
P�)
Predominant Soil
Series Nameb
Mapping Unit
or Rep. Slopes
D
CD-02-1
Hanes Farms
Shane Wilson
13.3
Caldwell
D
CD-02-2
Hanes Farms
Shane Wilson
11.2
Caldwell
D
CD-02-3
Troy Wilson
Shane Wilson
15.7
Caldwell
D
CD-02-4
Jennie Wilson
Shane Wilson
6.4
Caldwell
D
CD-02-5
Dykes Wilson
11.0
Caldwell
D
HA-47-01
James Pope
19 2
Harnett
D
HA-47-02
James Pope
9 9
Harnett
D
HA-47-03
James Pope
11.0
Harnett
D
HA-47-04
James Pope
4 3
Harnett
D
RC-49-02
Bennett Farms, LLC
10.7
Rockingham
D
RC-49-03
Bennett Farms, LLC
7 4
Rockingham
D
RC-49-04
Bennett Farms, LLC
10.7
Rockingham
D
RC-49-05
Bennett Farms, LLC
8 7
Rockingham
D
RC-49-06
Bennett Farms, LLC
5,
Rockingham
D
CD-15-1
rm Prestwood
14.E
Caldwell
D
IR-35-1
Sammy Deal
22 5
Iredell
D
IR-35-2
Sammy Deal
6.3
Iredell
D
IR-35-3
Sammy Deal
35.2
Iredell
D
IR-35-4
Sammy Deal
35.2
Iredell
FORM: LASC 06-16
Page 1

LAND APPLICATION SITE CERTIFICATION
D
PO-06-1
Robert Holbert
8.1
Polk
D
PO-06-2
Robert Holbert
16 2
Polk
D
PO-06-3
Dale Edwards
7 2
Polk
D
PO-07-1
Ethan Edwards
10.6
Polk
R
A1-13-01A
Arlene Millsaps
Danny Millsaps
15.1
Alexander
Hay
Pacolet
R
A1-13-01B
Arlene Millsaps
Danny Millsaps
14.7
Alexander
Hay
Clifford
R
A1-13-2
Danny Ray Millsaps
15.6
Alexander
Hay
Cecil
R
AL-13-04
Danny Ray Millsaps
8.5
Alexander
Pasture
Fairview
R
A1-13-05
Danny Ray Millsaps
15.9
Alexander
Pasture
Clifford
R
A1-13-06
Danny Ray Millsaps
19 2
Alexander
Pasture
Clifford
R
A1-15-01
Mary D. Isenhour
17.1
Alexander
Row Crop
Fairview
R
Al-15-02
Mary. D. Isenhour
26 8
Alexander
Row Crop
Fairview
R
A1-15-03
Mary. D. Isenhour
10 2
Alexander
Row Crop
Fairview
R
Al-16-01
Kevin Daniels
18.3
Alexander
Row Crop
Clifford
R
A1-16-2
Kevin Daniels
18.3
Alexander
Row Crop
Fairview
R
CA-06-01
Dennis Lutz
16.8
Catawba
Hay
Cecil
CaB2
R
CA-06-02
Dennis Lutz
13.3
Catawba
Hay
Lloyd
R
CA-06-03
RFE Farms Inc
19.6
Catawba
Hay
Pacolet
JAB
R
CA-53-3
Howard Goodson
13.3
Catawba
Hay
Cecil
R
CD-03-2
Patrick Starnes
17.8
Caldwell
Row Crop
Fairview
R
Patrick Starnes
8.5
Caldwell
Row Crop
Wooline
.III
D
CD-03-6
Patrick Starnes
4.2
Caldwell
Row Crop
Fairview
1
D
CD-03-7
Patrick Starnes
3.5
Caldwell
Row Crop
Fairview
R
CH-60-01
Bertis E Johnson & Luanne
Moore Johnson Trustee
48.90
Chatham
Hay
Hemdon
HrB
FORM: LASC 06-16
Page 2

LAND APPLICATION SITE CERTIFICATION
R
CH-60-02
Bertis E Johnson & Luanne
Moore Johnson Trustee
Me
Chatham
Pasture
Badin-Tarrus
BdB
R
CH-60-03
Bertis E Moore & Luanne
Moore Johnson Trustee
35.82
Chatham
Hay
Cid-Lignum
CmB
R
CH-60-04
Bertis E Moore & Luanne
Moore Johnson Trustee
41.11
Chatham
Hay
Cid-Lignum
CmB
R
CH-60-06
22.29
Chatham
Pasture
Cid-Lignum
CmB
Luanne Moore Johnson
R
CH-60-07
Bertis E Moore & Luanne
Moore Johnson Trustee
20.00
Chatham
Hay
Nanford-Badin
NaB
R
CH-60-11
Bertis E Moore Trustee &
Luanne M Johnson & Todd S
16.71
Chatham
Hay
Nanford-Badin
NaB
R
CH-60-12
Bertis E Moore Trustee &
Luanne M Johnson & Todd S
15.64
Chatham
Hay
Cid-Lignum
CmB
R
CH-72-1
Angel & Teresa Toro
48.22
Chatham
Pasture
Cid-Lignum
CmB
R
CH-72-2
Angel & Teresa Toro
67.29
Chatham
rsturI
Cid-Lignum
CmB
R
CH-72-3
Angel & Teresa Toro
13.45
Chatham
Hay
Cid-Lignum
CmB
R
CH-73-10
James Douglas Ellis
38.5
Chatham
Pasture
Georgeville
GeC2
R
CH-78-01
Winding Creek Holdings,
LLC
66.4
Chatham
Pasture
Cid-Lignum
R
CH-78-02
Richmond Road Holdings,
LLC
40.7
Chatham
Pasture
Cid-Lignum
R
CH-78-03
Spring Hill Holdings, LLC
57.6
Chatham
Pasture
Cid-Lignum
R
CH-78-05
Otter Rock Development,
LLC
65.5
Chatham
Pasture
Georgeville
R
CH-101-1
Jaime Dario Dubeibe & Erika
Illian Fong
6.6
Chatham
Pasture
Badin
BdB
R
CH-101-2
Jaime Dario Dubeibe & Erika
Illian Fong
5.2
Chatham
Pasture
Badin
BdB
R
CH-101-3
Jaime Dario Dubeibe & Erika
Illian Fong
20.5
Chatham
Pasture
Badin
BdB
FORM: LASC 06-16
Page 3

LAND APPLICATION SITE CERTIFICATION
R
CH-101-4
Jaime Dario Dubeibe & Erika
Illian Fong
9.7
Chatham
Hay
Lignum
CaB
R
CH-101-5
Jaime Dario Dubeibe & Erika
IllianFong
4.5
Chatham
Hay
Lignum
CaB
R
CH-101-6
Jaime Dario Dubeibe & Erika
IllianFong
10.1
Chatham
Hay
Badin
BdB
R
CH-101-7
Jaime Dario Dubeibe & Erika
Illian Fong
27.5
Chatham
Hay
Lignum
CaB
R
CH-101-8
Jaime Dario Dubeibe & Erika
Illian Fong
10.5
Chatham
Hay
Lignum
CaB
R
CH-101-9
Jaime Dario Dubeibe & Erika
IllianFong
13.1
Chatham
Georgeville
GaB
R
CH-101-10
Jaime Dario Dubeibe & Erika
IllianFong
14.3
Chatham
Pasture
Badin
BdB
R
CH-101-11
Jaime Dario Dubeibe & Erika
Illian Fong
2.9
Chatham
Pasture
Lignum
CaB
R
CH-101-12
Jaime Dario Dubeibe & Erika
Illian Fong
9.5
Chatham
Pasture
Badin
BdB
R
CH-101-13
Jaime Dario Dubeibe & Erika
Illian Fong
12.5
Chatham
Pasture
Badin
BdB
R
CH-101-14
Jaime Dario Dubeibe & Erika
IllianFong
8.4
Chatham
Pasture
Lignum
CaB
R
CH-101-15
Jaime Dario Dubeibe & Erika
Illian Fong
10.5
Chatham
Pasture
Cid
CkC
R
CL-21-1
Luke Beam
38.0
Cleveland
Hay
Pacolet
R
CL-08-10
Beam, Jacqueline Davenport
Luke Beam
5.8
Cleveland
Pasture
Pacolet
PaC2
R
CL-08-11
Beam, Jacqueline Davenport
Luke Beam
11.3
Cleveland
Pasture
Pacolet-Bethlehem
PbB2
R/M
CL-08-13
Beam, Jacqueline Davenport
Luke Beam
15.3
Cleveland
Pasture
Pacolet
PaC2
R
CL-21-5
Beam, Jacqueline Davenport
Luke Beam
10.5
Cleveland
Pasture
Cecil
CeB2
R
CL-21-6
Luke Beam
118
Cleveland
Hay
Cecil
CeB2
R
CL-21-7
Beam, Jacqueline Davenport
Luke Beam
12.0
Cleveland
Hay
Cecil
CeB2
R
CL-21-8
Beam, Jacqueline Davenport
Luke Beam
4.0
Cleveland
Hay
Pacolet
PaC2
R
CL-21-9
Beam, Jacqueline Davenport
Luke Beam
2.2
Cleveland
Hay
Cecil
CeB2
R
CL-52-1
Edward parker
30.5
Cleveland
Hay
Pacolet
FORM: LASC 06-16
Page 4

LAND APPLICATION SITE CERTIFICATION
R
CL-52-2
Edward Parker
30.6
Cleveland
Hay
Pacolet
R
CL-52-3
Edward Parker
42.3
Cleveland
Hay
Pacolet
R
CL-52-4
Ron Parker
21.1
Cleveland
Hay
Cecil
R
CL-52-1
Edward parker
30.5
Cleveland
Hay
Pacolet
R
IR-20-1
Dennis Philips
11.1
Iredell
Pasture
Appling
R
IR-20-2
Dennis Phillips
11.5
Iredell
Pasture
Cecil
RIM
IR-20-3
Dennis Philips
10.3
Iredell
Pasture
Cecil
R
IR-20-4A
Dennis Phillips
42.3
Iredell
Pasture
Cecil
R
IR-20-4B
Dennis Phillips
14.1
Iredell
Pasture
Cecil
R
IR-20-6
Dennis Phillips
15.0
Iredell
Pasture
Helena
R
IR-20-7
Dennis Phillips
15.2
Iredell
Pasture
Helena
R
IR-20-8
Dennis Phillips
10.3
Iredell
Pasture
Appling
R
IR-20-9
Dennis Phillips
11.4
Iredell
Pasture
Cecil
R
IR-20-11
Dennis Phillips
32.9
Iredell
Pasture
Cecil
R
IR-20-12
Dennis Phillips
2.7
Iredell
Pasture
Cecil
R
IR-23-02
Lorane Porter Trust
Shane Porter
38.1
Iredell
Hay
Cecil
R
IR-23-03
Lorane Porter Trust
Shane Porter
27.4
Iredell
Hay
Cecil
R
IR-23-04
JW Page Family Trust
Shane Porter
14.8
Iredell
Pasture
Cecil
R
IR-23-05
JW Page Family Trust
Shane Porter
19.6
Iredell
Pasture
Cecil
R
IR-36-1
Chris Cartner
52.6
Iredell
Row Crop
Pacolet
R
IR-36-2
Chris Cartner
19.4
Iredell
Row Crop
Wedowee
R
IR-36-3
Chris Cartner
21.9
Iredell
Row Crop
Tomlin
R
IR-36-4
Chris Cartner
41.5
Iredell
Row Crop
Tomlin
R
IR-36-5
Chris Cartner
23.8
Iredell
Row Crop
Tomlin
R
IR-37-1
Morris Fox
Andy Fox
46.2
Iredell
Clifford
R
IR-37-2
Josh Sloan
Andy Fox
18.2
Iredell
Hay
Fairview
R
IR-37-3
Josh Sloan
Andy Fox
26.3
Iredell
Hay
Fairview
R
IR-37-4
Aaron Fox
Andy Fox
12.5
Iredell
Hay
Clifford
R
IR-38-1
Daniel Lackey
26.5
Iredell
Row Crop
Tomlin
FORM: LASC 06-16
Page 5

LAND APPLICATION SITE CERTIFICATION
R
IR-39-1
Ronald Clodfelter
28.0
Iredell
Hay
Cecil
R
LT-23-01
Michael Heafner, Marie
Michael
24.0
Lincoln
Pasture
Cecil
R
LT-23-02
Michael Heafner
27.7
Lincoln
Hay
Cecil
R
LT-32-1A
Doug Huss
14.1
Lincoln
Hay
Cecil
R
LT-32-1B
Doug Huss
14.3
Lincoln
Hay
Cecil
R
LT-32-2
Doug Huss
19.2
Lincoln
Hay
Cecil
R
LT-32-3
Doug Huss
4.5
Lincoln'
Hay
Cecil
R
LT-32-4
Doug Huss
5.9
Lincoln
Hay
Cecil
R
LT-23-1
Lawrence Heafner, Marie
Michael
24.0
Lincoln
Pasture
Cecil
R
LT-23-2
Lawrence Heafner, Marie
Michael
27.7
Lincoln
Pasture
Cecil
R
LT-35-1
Ottman Jarrett
35.4
Lincoln
Pasture
Cecil
R
LT-50-1
Gary Mille'
MIIMIIPasture
a.
R
LT-50-2
Gary Millet
Lincoln
Pasture
R
LT-53-1
Howard Goodson
34.3
Lincoln
Hay
Pacolet
R
PO-07-2
Roy Lee
Ethan Edwards
Folk
Hay
Pacolet
R
RA-05-1
Allen Livengood
Rowan
Hay
Enon
1777
R
RA-05-2
Allen Livengood
44.8
Rowan
Hay
Mecklenburg
R
RA-05-3
Allen Livengood
18.5
Rowan
Pasture
Dorian
R
RA-53-1
Mark Tevepaugh
26.5
Rowan
Hay
Cecil
R
RA-53-2
Mark Tevepaugh
19.1
Rowan
Hay
Pacolet
R
RC-49-01
Elizabeth Ann Purgason
21.2
Rockingham
Pasture
Clifford
R
ST-01-1
Donald Misenheimer
5.9
Stanley
Pasture
Tanis
R
ST-01-2
Donald Misenheimer
7.0
Stanley
Pasture
Geogreville
R
ST-01-3
Donald Misenheimer
10.6
Stanley
Pasture
Tan -us
R
ST-01-4
Donald Misenheimer
17.6
Stanley
Pasture
Tans
R
ST-01-5
Donald Misenheimer
17.3
Stanley
Hay
Badin
R
ST-01-6
Donald Misenheimer
22.3
Stanley
Hay
Badin
FORM: LASC 06-16
Page 6

LAND APPLICATION SITE CERTIFICATION
R
ST-01-7
Donald Misenheimer
26.2
Stanley
Hay
Tanis
R
ST-02-1
Sylvester Little
130
Stanley
Row Crop
Badin
R/M
ST-02-2
Sylvester Little
5.3
Stanley
Row Crop
Badin
R
ST-03-1A
Robert Ridenhour
1.
Stanley
Pasture
Badin
R
ST-03-1B
Robert Ridenhour
1.
Stanley
Pasture
Misenheimer
R
ST-03-2
Robert Ridenhour
PI
Stanley
Pasture
Badin
R
ST-03-3
Robert Ridenhour
25.4
Stanley
Pasture
Badin
R
ST-03-4
Robert Ridenhour
8.4
Stanley
Hay
Goldston
R
ST-03-5
Robert Ridenhour
12.4
Stanley
Hay
Goldston
R
ST-03-6
Robert Ridenhour
4.0
Stanley
Hay
Goldston
R
ST-03-7
Robert Ridenhour
18.1
Stanley
Pasture
Badin
R
ST-04-1
Henry Anderson
26.8
Stanley
Pasture
Badin
R
ST-04-2
Lynette Anderson
12.8
Stanley
Pasture
Goldston
R
ST-04-3
Henry Anderson
6.9
Stanley
Row Crop
Badin
R
ST-04-4
Lynette Anderson
8.9
Stanley
Row Crop
Badin
R
ST-04-5
Lynette Anderson
6.7
Stanley
Row Crop
Goldston
T
LT-19-1
Chuck Waters
41.8
Lincoln
Pasture
Llyod
LdB2
T
LT-19-2
Chuck Waters
12.7
Lincoln
Hay
Llyod
LdB2
T
LT-19-3
Chuck Waters
13.2
Lincoln
Pasture
Riverview Loam
RvA
T
LT-06-2
Mike Macomson
29.4
Lincoln
Pasture
Cecil
CeB2
T
LT-45-1
Mike Macomson
15.01
Lincoln
Pasture
Cecil
CeB
T/M
LT-54-RP1
Selwyia Perkins
Richard Perkins
13.7
Lincoln
Pasture
Madison
MdB2
T/M
LT-54-RP2
Selwyia Perkins
Richard Perkins
7.2
Lincoln
Hay
Cecil
CeB2
T/M
LT-58-DP1
Kenneth Preston
12.0
Lincoln
Pasture
Cecil
CeB2
T
LT-107-1
Jason Huitt
10.7
Lincoln
Hay
Cecil
CeB2
T
LT-107-2
Jason Huitt
12.0
Lincoln
Hay
Cecil
CeB2
T
LT-107-3
Calvin Wehunt
17.0
Lincoln
Row Crop
Cecil
CeB2
T
LT-107-4
Calvin Wehunt
10.9
Lincoln
Row Crop
Rion
RnB
T
LT-107-5
Calvin Wehunt
17.8
Lincoln
Row Crop
Cecil
CeB2
FORM: LASC 06-16
Page 7

LAND APPLICATION SITE CERTIFICATION
T
LT-107-6
Calvin Wehunt
9.5
Lincoln
Row Crop
Cecil
CeB2
T
LT-120-2
Wayne Gilbert
27.6
Lincoln
Row Crop
Cecil
CeB2
T
LT-120-3
Wayne Gilbert
IA
Lincoln
Row Crop
Cecil
CeB2
T/M
NC-CH-73-3
James D Ellis
12.57
Chatham
Hay
Nanford-Badin
NaB
T
NC-CH-73-4
James D Ellis
23.48
Chatham
Pasture
Georgeville
GeC2
T
NC-CH-73-5
James D Ellis
19.28
Chatham
Pasture
Georgeville
GeC2
T/M
NC-CH-73-6
James D Ellis
52.57
Chatham
Pasture
Georgeville
GeC2
N
PO-09-1
Scott Champion
11.0
Polk
Hay
Cecil
CeB2
N
PO-09-2
Luke Schlabach
9.3
Polk
Pasture
Cecil
CeB2
N
LT-57-1
Thomas Baxster
41.2
Lincoln'
Hay
Cecil
CeB2
N
LT-57-2
Thomas Baxster
8.9
Lincoln
Hay
Pacolet
PaB
N
LT-57-3
Thomas Baxster
14.8
Lincoln
Pasture
Cecil
CeB2
N
CA-06-4
Dennis Lutz/Neil Properties
7.7
Catawba
Pasture
Llyod
LdB2
N
CA-06-5
Dennis Lutz
44.0
Catawba
Pasture
Llyod
LdB2
N
CD-03-4
Patrick Starnes
11.2
Caldwell
Hay
Woolwine
Woolwine
N
CD-04-1
Steve Fox
18.7
Caldwell
Pasture
Fairview
Fairview
N
IR-41-1
Curtis Johnson
9.2
Iredell
Hay
Cecil
CeB2
N
IR-41-2
Curtis Johnson
13.0
Iredell
Hay
Cecil
CeB2
N
BU-01-1
Reagan Hudson
14.8
Burke
Pasture
Fairview
Fairview
N
BU-01-2
Reagan Hudson
49.2
Burke
Pasture
Fairview
Fairview
N
Al-17-30
David Mecimore
15.3
Alexander
Hay
Clifford
Clifford
N
CA-37-1
Chris Sigmon
39.0
Catawba
Pasture
Clifford
Clifford
N
CA-38-1
John Mauser
Jimmy Gibson
131.9
Catawba
Pasture
Llyod
LdB2
N
CA-38-2
John Mauser
Jimmy Gibson
145.3
Catawba
Pasture
Llyod
LdB2
N
LT-52-5
Ron Parker
45.5
Lincoln
Hay
Cecil
CeB2
N
LT-52-6
Ron Parker
35.2
Lincoln
Hay
Cecil
CeB2
N
DV-47-1
David Lee Johnson
28.8
Davie
Pasture
Clifford
Clifford
N
RA-62-1
Nancy Myers
David Lee Johnson
40.1
Rowan
Pasture
Enon
Enon
FORM: LASC 06-16
Page 8

LAND APPLICATION SITE CERTIFICATION
N
RA-62-2
Ioel Steel
kavid Lee Johnson
33.3
Rowan
Pasture2
T
RC-50-01
Douglas Merritt
Barry Knight
14.4
Rockingham
Pasture
Clifford
CgB2
T
Douglas Merritt
Barry Kight
13.1
Rockingham
Pasture
Clifford
CgB2
N
CH-81-1
Doyle Cox
72.0
Chatham
Cid-Lignum
CmB
N
CH-81-2
Doyle Cox
21.4
Chatham
Pasture
Nanford-Badin
NaB
N
CH-44-12
Allen Phillips
8.7
Chatham
Pasture
Nanford-Badin
NaB
N
CH-44-13
Allen Phillips
25.5
Chatham
Pasture
Badin-Tarrus
BdB
N
CH-44-14
Allen Phillips
6.3
Chatham
Hay
Georgeville
GaB
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
P
Class
AL-17-30
35.881
81.131
NAD83
MAP
Nearest Second
Jumping Run 11-69-7-1
WS-IV
WS-IV
BU-01-1
35.638
81.486
NAD83
MAP
Nearest Second
Douglas Creek 11-129-2-12
WS-III
WS-III
BU-01-2
35.636
81.488
NAD83
MAP
Nearest Second
Douglas Creek 11-129-2-12
WS-III
WS-III
CA-06-4
35.616
81.280
NAD83
MAP
Nearest Second
South Fork Catawba River 11-129-
WS-V
WS-V
CA-06-5
35.614
81.275
NAD83
MAP
Nearest Second
South Fork Catawba River 11-129-
WS-V
WS-V
CA-37-1
35.812
81.194
NAD83
MAP
Nearest Second
Naked Creek 11-66
C
C
CA-38-1
35.604
81.296
NAD83
MAP
Nearest Second
South Fork Catawba River 11-129-
WS-V
WS-V
CA-38-2
35.600
81.286
NAD83
MAP
Nearest Second
South Fork Catawba River 11-129-
WS-V
WS-V
CD-03-4
35.852
81.345
NAD83
MAP
Nearest Second
Isaac Creek 11-59-(1)
WS-IV
WS-IV
CD-04-1
35.873
81.337
NAD83
MAP
Nearest Second
Isaac Creek 11-59-(1)
WS-IV
WS-IV
DV-47-1
35.524
81.415
NAD83
MAP
Nearest Second
Little Creek 12-108-15
C
C
35.730
NAD83
MAP
Nearest Second
WS-IV
WS-IV
FORM: LASC 06-16
Page 9

LAND APPLICATION SITE CERTIFICATION
IR-41-2
35.711
80.853
NAD83
MAP
Nearest Second
I-L Creek
C
C
LT-52-5
35.490
81.490
NAD83
MAP
Nearest Second
Little Creek 9-53-1.3
WS-IH
WS-III
LT-52-6
35.488
81.488
NAD83
MAP
Nearest Second
Little Creek 9-53-1.3
WS-IH
WS-III
LT-57-1
35.448
81.410
NAD83
MAP
Nearest Second
Indian Creek 11-129-8
WS-II
WS-II
LT-57-2
35.451
81.412
NAD83
MAP
Nearest Second
Indian Creek 11-129-8
WS-II
WS-II
LT-57-3
35.455
81.408
NAD83
MAP
Nearest Second
Indian Creek 11-129-8
WS-II
WS-II
PO-09-1
1.204
$1,977
NAD83
MAP
Nearest Second
Buck Creek 9-55-2-1
C
C
PO-09-2
liii
MI
NAD83
MAP
Nearest Second
Buck Creek 9-55-2-1
C
C
RA-62-1
35.7685
80.726
NAD83
MAP
Nearest Second
Beaver Dam Branch 12-108-17-2
WS-IV
WS-IV
RA-62-2
35.82529
80.66393
NAD83
MAP
Nearest Second
Fourth
Creek 12-108-20
,
C
CH-81-1
15° 34' 48.9"
791° 20' 54"
NAD 83
ADD
Nearest Second
Indian Creek
WS-IV
WS-IV
CH-81-2
35° 34' 31.98"
j9° 20' 39.9"
NAD 83
ADD
Nearest Second
Indian Creek
WS-IV
WS-IV
CH-44-12
15° 44' 50.22"
19° 22' 57.32"
NAD 83
ADD
Nearest Second
Varnell Creek
C
C
CH-44-13
35° 44' 46.41"
79° 23' 10.65"
NAD 83
ADD
Nearest Second
Varnell Creek
C
C
CH-44-14
35° 45' 26.24"
77° 22' 21.8"
NAD 83
ADD
Nearest Second
Varnell Creek
C
C
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16
Page 10

SPILL RESPONSE PLAN
PROJECT: SYNAGRO WESTERN PIEDMONT PERMIT W00016247
IN THE UNLIKELY EVENT OF A SPILL, THE FOLLOWING ACTIONS SHALL BE TAKEN
IMMEDIATELY:
1. MANAGEMENT OF SPILL CLEAN-UP ACTIVITIES:
The Synagro Operations Manager shall take immediate charge and initiate clean-up activities. Synagro labor and
equipment is to be utilized. In the event additional labor and equipment is required, assistance may be requested from the
NC Department of Transportation, and other private contractors as necessary.
2. HALT THE SOURCE OF THE SPILL:
Such as a ruptured container or damaged transport unit.
3. CONTAIN THE SPILL:
Form a barrier. Sufficient quantities of straw shall be used for such purposes. Earthen barriers may be constructed to
augment the straw bale containment area of the spill. The Synagro Operations Manager or the person in charge on the
spill site will advise the clean-up personnel where to get the straw, lime, and other items necessary to complete the clean-
up operation, i.e., local farmers, farm supply centers, nurseries, etc.
4. CLEAN-UP:
Employ front-end loaders, vacuum equipment, sludge application vehicles, and/or local septic tank service to remove as
much of the spilled material as possible. Straw and/or sand should be scattered in the spill area to soak up the remaining
material. The straw- and sand -soaked material will be collected and removed to a disposal area approved by
representatives of the state regulatory agency.
5. FINAL CLEAN-UP:
Employ rotary brush sweeper if needed and apply lime to the spill area upon the approval of the clean-up efforts by the
state regulatory representative. If the event occurs on private property, the clean-up will be completed to the satisfaction
of the property owner and state regulatory representatives. The ultimate goal will be to restore the spill area to its original
condition if possible.
6. NOTIFICATION:
As soon as possible after the spill occurs, the Synagro Operations Manager or assistant will notify the Synagro Central
office, and they will then be responsible for notifying other key Synagro personnel. The Synagro Mocksville office can be
reached at 336-790-1610. Using the provided extensions, calls are forwarded to the appropriate staff.
7. REPORTING:
Depending on field location, Synagro Central personnel will notify either the Mooresville Regional office at (704) 663-
1699, Raleigh Regional Office at 919-791-4200 or Asheville Regional Office at 828-296-4500 as soon as possible, but not
more than 24 hours after, or on the next working day following the occurrence. The Operations Manager shall provide a
written report within 48 hours of the spill to the Technical Services Director. The report shall list all relative information
and actions taken. Synagro Central personnel will file a written report to the Mooresville Regional office of the NCDENR
within 5 days of the occurrence. For after hours reporting the Division's emergency number shall be called to report all
incidences (1-800-858-0368) or (919-733-3300).

CUMULATIVE METAL LOADINGS (LBS/AC) AS OF 12/31/2022
FIELDID
The cumulative metals for this report come from HISTORY records (i.e. the monthly monitoring process has been completed for the State and County where the Fields are located)
In cases where a trace metal lab result was Not Reported to Synagro or tracking of metal loading was Not Required the loading on the report is displayed as "NR"
Last Date Applied AS CD CR CU PB HG MO NI SE ZN
NC-CH-00072-0-0001- 06/16/2022 0.21306 0.04576 0.95777 7.31086 0.57666 0.03790 0.25977 0.55019 0.21471 21.92596
NC-CH-00072-0-0002- 07/19/2019 0.07185 0.01710 0.60601 2.93529 0.23828 0.00490 0.05659 0.27815 0.05843 8.73408
NC-CH-00072-0-0003- 05/26/2022 0.01557 0.00404 0.10383 1.15365 0.07210 0.00170 0.08652 0.11248 0.02682 2.62454
Report Date/Time: 9/20/2022 12:21:29 PM Page 1 of 1

CUMULATIVE METAL LOADINGS (LBS/AC) AS OF 12/31/2022
FIELDID
The cumulative metals for this report come from HISTORY records (i.e. the monthly monitoring process has been completed for the State and County where the Fields are located)
In cases where a trace metal lab result was Not Reported to Synagro or tracking of metal loading was Not Required the loading on the report is displayed as "NR"
Last Date Applied AS CD CR CU PB HG MO NI SE ZN
NC-LT-00054-0-ORP1- 06/15/2022 0.27578 0.01307 0.42508 3.13376 0.16635 0.00906 0.10818 0.18102 0.11968 8.68451
NC-LT-00054-0-ORP2- 06/09/2022 0.21945 0.01324 0.46797 3.31802 0.18376 0.00880 0.11038 0.19462 0.11924 9.17388
Report Date/Time: 8/25/2022 11:41:11 AM Page 1 of 1

Type: CRP
Recorded: 09/20/2022 at 02:08:29 PM
Fee Amt: $26.00 Page 1 of 2
Iredell County, NO
Maureen P. Purcell Register of Deeds
6K2947 PG1754-1755
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
Oft U
I, i f_ r4111 ,tyG , certify that I am a deeded owner of the property located at:
Address: t ( rift ; ) f s 6.-AM,Q t) 40 Parcel No.: Lk I 1 sTro l '-(
City: S�' 'e (f i [C State: NC Zip Code: �2S' County: 1�e1/
Furthermore, 1 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/Perinittee listed on the following
page.
For the parcel identified above, 1 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.
or 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:
n
Ailt
FORM: NDRMPW-LAS i1-18
Date: q. /6 27
Page 1 of 2
Pale t omit.
R.O.'1'.C. :JNS ©PO p 1

Permittee: Synagro Western Piedmont RLAP
Address: 284 Boger Rd. Mocksville, NC 27028 Permit No.: W00016247
City:Mocksville State: NC Zip Code:27028 County: Davie
NORTH CAROLINA, Try...L ( COUNTY
I, 4te)••••• Vi. , a Notary Public for —rjcfe- (-f County, North Carolina,
do hereby certify that •Nk.. 14, `•e4i-try, personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 16 day of -4 ,1 7•
„,
����N" p.LEX.001111 I� WI • 1 ��
SEAL �� �0 cif , �+/ -., 7
���C la G
Signature of Notary Public
My commission expires 0
c - iv' 2.0211,
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the describedproperties 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 Carolina 27699-1617
FORM: NDRMPW-LAS 11-18 Page 2 of 2

Type: CRP
Recorded: 09/20/2022 at 02:08:29 PM
Fee Amt: $26.00 Page 1 of 2
Iredell County, NO
Maureen P. Purcell Register of Deeds
BK2947 PG1756-1757
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS 13 RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
g, certify that I am a deeded owner of the property located at:
Address: Z/ I,3 flqi6 ( I R` t Parcel No.: ill 1' (0 03 z6
city: `-,�.c.`f6-S vvt(C
State: NC Zip Code: 9-661 County: /Reda/
Furthermore, 1 certify that 1 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.
For the parcel identified above, 1 consent to a reduced setback from 50 feet to 0 feet, thereby
allowing the application of Class B residuals as near as a feet from any property line.
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.
C*THIS WAIVER SHALL BE. TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
Signature:
FORM: NDRMPW-LAS 11-18
Date: 9
Page 1 of 2
R.0.T.C.
Page Count:
r1NS DPQ ° .i

Permittee: Synagro Western Piedmont RLAP
Address: 284 Boger Rd. Mocksville, NC 27028 Permit No.: WQ0016247
City:Mocksville State: NC Zip Code:27028 County: Davie
NORTH CAROLINA,TA, k COUNTY
r
I,
, a Notary Public for
County, North Carolina,
do hereby certify that U,t l I. 3c/ („NA- personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the VS}~day of
ee�ttl$111fig,!
SEAL ,4 fi`'. O #41,0f
411 MP
dir• MP
101
w
v��'1, 0Mb
�i c01) ll Mitt ►r
Lt
"LZ
,•
Signature of NotaryPublic
My commission expires ©L `e(,oall
Once notarized, this form shall be recorded at the Register ofDeeds in the county or
counties in which the described properties are located. A copy ofthe recorded waiver
shall be sent to the following address:
Division ofWater Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina27699-1617
FORM: NDRMPW-LAS 11-18
Page 2of2

Type: CRP
Recorded: 09/20/2022 at 02:08:29 PM
Fee Amt: $26.00 Page 1 of 2
Iredell County, NC
Maureen P.7Purcell Register of Deeds
BK2947 PG1758-1i! 59
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
17 vg 1
7/ , certify that I am a deeded owner of the property located at:
Address: 9 57 Parcel No.: L[tlevo "NC DC\
City:
State: NC Zip Code:
County: to et. if
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.
r;r the parcel identified above, 1 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.
or 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: ,--e v V `-`r✓ Date:
111.1,61
FORM: NDRMPW-LAS 11-18
Page 1 of 2
Pagc €lt L:
LJNS EJPQ PS!

Permittee: Synagro Western Piedmont RLAP
Address: 284 Boger Rd. Mocksville, NC 27028 Permit No.: W00016247
City:Mocksville State: NC Zip Code:27028 County: Davie
NORTH CAROLINA, li k [ COUNTY
do hereby certify that
nn , a Notary Public for
'JA4r/ 1_ w+t
Tzeie
County, North Carolina,
personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 1 Z tLday of �tp�r,„ L�,� 7x-
SEAL •
�.�`°°�'sx w F01. •
•
}
r
0_
'nisi etti0-
Signature of Notary Public
My commission expires
D 1,4 z z, 0202i
Once notarized, this form shall be recorded at the Register ofDeeds in the county or
counties in which the described properties are located. A copy ofthe recorded waiver
shall be sent to the following address:
Division of Water Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDRMPW-LAS 1 I -I 8 Page 2 of 2

APPLICATION
MAP
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WATER GRAPHIC SCALE
11"=660'
ONSITE HOUSE
660' 0 660'
DRAIN
OFFSITE HOUSE
FENCE
x x x
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.
N C-I
R-20
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1-3

0APPLICATION
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SCALE
660'
660'
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x x x
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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.
N C-I
R-20
Field
4

Doc IIIIIII IIIIII iii iii!I IIIII IIIII IIIII IIIII iiiii iiiii iiiii IIIII i
ID: 014422800002 T IIIIIIIIIIIIIIIII
Fee Recorded: 06/18/2020 atp01:1CR
6P
Rowan,ntNO$26.00 Page 1 of 2 50 PM
J. E. Brindle Register of Deeds
BK1350PG593
State of North Carolina
Department of Environmental Quality
Division of Water Resources
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, O'crAitie S ;64./aet / o,»,041 , certify that I am a deeded owner of the property located at:
Address: ( Pr- L mot.
Parcel No.: 21 l 0 Zs"
City: eel t ✓t t L State: NC Zip Code: Z 70 ( 3 County: 1O".1
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.
NIor 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.
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 propertyline.
**THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
Signature: 3 ..,#
FORM: NDRMPW-LAS 11-18
Date: S.-1:1'oti%"
Page 1 of 2

Permittee: Synagro Western Piedmont RLAP
Address: 284 Boger Rd. Mocksville, NC 27028 Permit No.: W00016247
City:Mocksville
State: NC Zip Code:27028 County: Davie
NORTH CAROLINA, 1`ouG•n COUNTY
I, At ✓ h✓ k , a Notary Public for %c k l ( County, North Carolina,
do hereby certify that 1-t r r� S+t.n.�- 1 ,,,_ personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the i&� day of
SEAL
t_ Za4 .
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 Carolina 27699-1617
FORM: NDRMPW-LAS 11-18 Page 2 of 2

ei) APPLICATION
MAP
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— — — — — — PRIVATE ROAD
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GRAPHIC SCALE
ONSITE HOUSE 1 = 660
DRAIN 660' 0 660'
OFFSITE HOUSE
FENCE
x x x
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.
I V
N C_RA_05
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1-2

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MAP
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WATER GRAPHIC SCALE
i " = 660'
ONSITE HOUSE
660' 0 660'
DRAIN
OFFSITE HOUSE
FENCE
x x x
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.
N C-RA-05
Fields
2-3

cc
L9
0
z
>-
0
SOIL SURVEY
GRAPHIC SCALE
1"=800'
800' 0 800'
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-RA-05
Fields 1-3

CS) TOPOGRAPHIC
MAP
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1,000' 0 1,000'
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-RA-05
Fields
1-3

VICINITY
MAP
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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-RA-05
Fields
1-3

cc
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AAA P
x x x
APPLICATION MAP
LEGEND
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- PROPERTY LINE
///
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WATER
• ONSITE HOUSE
• OFFSITE HOUSE
❑ OUTBUILDING
0 WELL
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-ST-02
Fields 1-2

cc
L9
0
z
>-
0
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.
N C-ST-02
Fields 1-2

SYNAGRO1
TOPOGRAPHIC MAP
_,
,,
.
'
''
.. ,
O- 2
GRAPHIC SCALE
1"=800'
800' 0 800'
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-ST-02
Fields 1-2

Ave
4,000'
VICINITY MAP
III
1
I
r
i
GRAPHIC SCALE
1" = 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-ST-02
Fields 1-2

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY22-SL033959
i'. 4 Client: Patrick Starnes Advisor: Alex Fox
.. ,o , r, Heavy Metals PO Box 414 Synagro
'aV Granite Falls, NC 28630 284 Boger
#f SO i l Report Mehlich-3 Extraction Mocksville,
Sampled County : Caldwell
Links to Helpful Information
Rd
NC 27028
Client ID: 494622 Advisor ID: 501947
Sampled: Received: 05/13/2022 Completed: 05/18/2022 Farm: CD-03
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium
(Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Note elevated lead (Pb) in both the sample areas. 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-I > 100), crops will not respond to additional P applied. Jagathi Kamalakanthan, Agronomist, 5/18/2022
Sample ID: 4
Lime History:
Recommendations: Lime Nutrients (lb/acre)
More
Information
Note: 3
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
1 -Corn, grain 1.3 120 - 160 0 0 0 0 0 0 0 0
2 - 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn-I Mn-AI1 Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS -I NO3-N
0.66 0.92 8.5 73 2.3 5.2 135 99 50 17 64 137 99 154 154 125 0.1 1
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 0.4 Chromium, 0.3 Lead, 7.0 Selenium, 0.0
Sample ID: 5
Lime History:
Recommendations: Lime Nutrients (lb/acre)
More
Information
Note: 3
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
1 -Corn, grain 1.6 120 - 160 0 0 0 0 0 0 0 0
2 - 0.0
Test Results [units - WN in g/cm3; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]: Soil Class: Mineral
HM% W/V CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn-I Mn-AI1 Mn-Al2 Zn-I Zn-AI Cu-I Na ESP SS -I NO3-N
0.71 0.93 7.2 64 2.6 5.1 140 93 38 19 69 98 76 131 131 122 0.1 1
Heavy Metals (parts per million): Arsenic, 0.0 Cadmium, 0.0 Nickel, 0.3 Chromium, 0.3 Lead, 6.8 Selenium, 0.0
North Carolina
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxler, Commissioner of Agriculture
Totau i. (rusk Find Co risk n

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomi/ Report No. FY22-SL033959
Patrick Starnes Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Lime
Report Abbreviations
Ac exchangeable acidity
B boron
BS% % CEC occupied by basic cations
Ca% % CEC occupied by calcium
CEC cation exchange capacity
at-1 copper index
ESP exchangeable sodium percent
HM% percent humic matter
K-I potassium index
K20 potash
Mg% % CEC occupied by magnesium
MIN mineral soil class
Mn manganese
Mn-AI1 Mn availability index for crop 1
Mn-Al2 Mn-availability index for crop 2
Mn-I manganese index
M-o mineral -organic soil class
N nitrogen
Na sodium
NO3-N nitrate nitrogen
ORG organic soil class
pH current soil pH
P-I phosphorus index
P205 phosphate
S-I sulfur index
SS -I soluble salt index
W/V weight per volume
Zn-AI zinc availability index
Zn-I zinc index
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
ton/acre or Ib/1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
For no -till or established plantings where this is not possible, apply no more than 1 to 1.5 ton/acre (50 Ib/1000 sq ft) at one
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
is applied. If MG is recommended and lime is needed, use dolomitric lime.
Fertilizer
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
for the crop being grown, not on soil test results. K-I and P-I values are based on test results and should be > 50. If they
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear
only on reports for greenhouse soil or problem samples.
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
ncagr.gov/agronomi/pubs.htm.
Recommendations for small areas, such as home lawns/gardens, are listed in units of Ib/1000 sq ft . If you cannot find
the exact fertilizer grade recommended on the report, visit www.ncagr.gov/agronomi/obpart4.htmisfind information that
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
Test Results
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-AI1, Mn-Al2, Zn-I, Zn-AI, Cu-I, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routinely
indicate levels fertility Visit www.ncagr.gov/agronomi/uyrst.htm
available)] of plant nutrients or other measurement.

Page 1 of 1
Report No: 22-089-9513
Account No: 46622
Advisor: Synagro Central LLC/ Technical
Mary Brewer
284 Boger Road
Mocksville NC 27028
Waypol nt.m
ANALYTICAL
Client: Doyle Cox
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
Farm:
Date Received: 03/30/2022
Date of Report: 09/20/2022
Lab No Field ID
Sample ID
Soil Class
HM%
W/V pH
Ac
P-I
K-I
S-I
Mn-I
Mn-All Mn-Al2
Zn-I
Zn-Al
Cu-!
CEC BS%
Ca%
Mg%
ESP
Na
22863
CH-81-1
MIN
1.8
6.5
0.6
16
28
19
144
96
0
100
100
45
8.2 92
64
25
1.3
0.1
Crop Recommendations:
Rec Uom
Lime (t/acre)
N
P205
K20
S
Mn
Zn
Cu
B
Mg
Last Crop
1- Fescue Hay
lb/acre
0.0
150
102
82
20
0
0
0
0
0
22865
CH-81-2
MIN
1.9
5.9
1.2
9
26
23
81
67
0
93
93
35
7.0 83
56
24
1.8
0.1
Crop Recommendations:
Rec Uom
Lime (t/acre)
N
P205
K20
S
Mn
Zn
Cu
B
Mg
Last Crop
1- Fescue Hay
lb/acre
0.5
150
122
86
20
0
0
0
0
0
Comment:
Test result units = CEC and Na in meq/100cm3; NO3 N in mg/dm3; WA/ in g/cm3
North Carolina Division of Water Quality Certification #257, Analysis and fertility recommendations shown on this report are performed in accordance within NCDA guidelines, Analysis prepared by: Waypoint Analytical Virginia, Inc.

SYNAGR©
VICINITY MAP
• Glow
•
a 000 Church Rd
",4:9
42,
Pa
i-
•
g 4
y
i
[
N
Joe Brown Rd
Mt Vem90$0,.9$ Rd
-2,
c�
N
,
a •
1,4
,I,
y
'4
%.,
31,
^?��
r
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In*-
Imo
/
+
1135,
Rd
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,
,1136,
116651 }
11391 ilEl
aonlee r d
111
111411
aosWv.dt 111361
al.
p0;rieme
04
V•
An
N. 1
ti
rwo
Church nd E
1717.51
r
Bear Creek
111411
HMI
111361 V
,11391
111451
GRAPHIC SCALE
1"=5,000'
5,000' 0 5,000'
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-C H -73
Fields 3-6, 10

APPLICATION
MAP
SYNAGR
o 0 )
-,�►
// /
•
1J 4
•
►
A
►
.
.
lb
t
t
iv
ir
,
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r
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4 11 �/
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4
V 4
I IV
LEGEND
,v v v<
APPLICATION AREA
j//
UNSUITABLE AREA
AAA is
— — — — — — PRIVATE ROAD © WATER GRAPHIC SCALE
1"=660'
- - - STREAM ONSITE HOUSE
660' 0 660'
DRAIN ■ OFFSITE HOUSE
x FENCE OUTBUILDING
x x
- PROPERTY LINE (O 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.
N C-C
L-08
Fields
10,11
,13

rx
0
z
>-
0
800'
SOIL SURVEY
GRAPHIC SCALE
1"=800'
0
800'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-08
Fields 10,11,13

6)
TOPOGRAPHIC
MAP
SYNAGR1
13
-
A
-
4
4
r
.
11
►.. .
...•ar
10
.} • �.
i • ►
4
•
GRAPHIC SCALE
1"=800'
800' 0 800'
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_C L_08
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1 0,11 ,13

SYNAGR©1
VICINITY MAP
ro
115331
ig
Q
x
4
EL
s
r r It i CD`
'7761 O
1 004
I
i
r
f
p
•
®a E.
•
fa
b
ci
Ce
CY
ral
don 0 152i r'ya
WI
fj`/f 11
o. n
7I l 1 G ,
.r
2 crttir.-
.jib) .. r in. f,A
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_C L_08
Fields 1 0,11 13

10 APPLICATION
MAP
SYNAGR
f
Aty444/
� 4. - •
4/
1 ,
%►
,.
ov-4
e.
CD
/,
�,
;„/
.. ., i
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o ,,
PAO • �.-
A.
A'
O
,
- - 3 •
' •;•-/
•
LEGEND
>v v v<
APPLICATION AREA
j//
UNSUITABLE AREA
AAA P
- - - - - - PRIVATE ROAD © WATER
— — — STREAM ONSITE HOUSE GRAPHIC SCALE
1" = 660'
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING 660o sso
x x x
PROPERTY LINE 0 WELL
Q 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.
N C-C
L-52
Fields
1-2,4

cc
L9
0
z
>-
0
SOIL SURVEY
800'
GRAPHIC SCALE
1" = 800'
0
800'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-52
Fields 1-4

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=800'
800' 0 800'
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-C L-52
Fields 1-4

0) APPLICATION
MAP
/ \
4',
F
v
/4 ®
A.
411) •,1 la:i.
B
�•
Awl
B#7�
rim,
I
wa
4-411.4-
w,"
/
AP.'
19111
Oli
ir1
it
AL
ftec
#
43virt
1,,rro
rii,I.
";
ilt
/ Nir
LEGEND
>v v v<
APPLICATION AREA
,
j//
UNSUITABLE AREA
AAAP
- - - - - - PRIVATE ROAD © WATER
— — — — STREAM ONSITE HOUSE GRAPHIC SCALE
1" = 660'
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING 660o seo
x x x
PROPERTY LINE 0 WELL
Q 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.
N C-RC-49
Field
1

cc
L9
0
z
>-
0
SOIL SURVEY
660'
GRAPHIC SCALE
1"=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-RC-49
Field 1

TOPOGRAPHIC
MAP
SYNAGR
• (
,..----.
4 1 1
! .\
-'..1. '"
• % _v: it __ i
r
) %
i r-1
. s ' • I A
, \,. ._
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_. _
....z..•
II
.i:
i.,0 \..: ,
,..............._.,
�_
(...
.... 1
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'-
/
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./..._...„ .,..._.
\
...... ,-,....„.1
(
r....-
....... %,„.,...,,,,...,1
/ ,..". / /,` /..5'...
( l'e.. \
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( 1 ' 1 ()CIA,....
, .
,,
.,,,,
t�/ \
1, ,
1
1
)
_._ _
\ i-i '` 1 \ \ r --)
GRAPHIC SCALE
1"=800'
800' 0 800'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-RC-49
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 1

VICINITY MAP
If Restaurants Op hotels 12 Things to do 0 Museums ei Transit +n Pharmacies
Precision Body Works9
New Hope Church q tree
Ps hau
Hp
c4
0
�o-
Sorrell Waterproofing
9
Green Act Horse Farm 9
f
" 9sharon K Hopper
Fine Gardening
EARL PGTTS9
SLokesdale ivlarketpiece
223 Exxon / 220 GrIII 9
Y gweh Yra� l 1. NewnaMAd
Quail Acres Mobile Park9
Ry Automatic Transmission
9
Kerf Burled9
a Ie+tier
win Of
TJM;Enterprises, Inc
'1f
�� ` 9 HnwonG pc
2,000'
GRAPHIC SCALE
1" = 2,000'
0 2,000'
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.
NC-RC-49
Field 1

SYNAGRO WESTERN PIEDMONT RLAP
WQ0016247
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application sites
for the permit, referenced above, by myself, on behalf of Synagro Central, LLC. Additionally,
similar evaluations were made on existing sites with new acreage being added. The evaluations
consisted of hand auger borings and descriptions of the soils on the proposed application sites
and new application areas on existing sites. All borings were performed by me. All additional
work performed for this permit application was conducted by Synagro Central, LLC.
For each application field site, a representative soil boring was conducted to confirm the soil
series designation provided by USDA/NRCS soil survey data. For those areas determined to be
different from soil survey data, notes on the "SOIL DESCRIPTION SHEET" include additional
information. 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 fields listed, as well as the soil series
determined.
Table 1. Soil Profile Description Data, Proposed Sites and Additions to Existing Sites (marked
with "*'), WQ0016247
Field NRCS Mapped Series
CH-44-12 Cid/Lignum
CH-44-13 Badin
CH-44-14 Georgeville
CH-73-3* Cid/Lignum
CH-73-6* Georgeville
CH-81-1 Cid/Lignum
CH-81-2 Nanford
RC-50-1 Clifford
RC-50-2 Clifford
Sincerely,
Eric Thompson, L.S.S. NO. 1238
Field Identified Series
Nanford
Badin
Georgeville
Nanford
Georgeville
Cid
Nanford
Clifford
Clifford

APPLICATION
MAP
CC
is<
.. MIR
Z
INIIIIIIIIIN
/
e.
''� /ice
/
/
vvv
%;.. ,20 �'
/.., - • 044....
, . . • ,:. e . „,
3r4.,
.,/ A 0 ,
` •��••/
.1,
/
iiii
LEGEND
>v v v<
n A A t
APPLICATION AREA
j//
UNSUITABLE AREA
— — — — — — PRIVATE ROAD
— — — — STREAM
©
WATER
GRAPHIC SCALE
ONSITE HOUSE 1 — 660
DRAIN 660' 0 660'
OFFSITE HOUSE
FENCE
x x x
OUTBUILDING
PROPERTY LINE
0 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.
I V
N C_C
H _ A
�l `F`F
A
Fields
12-13

cc
LD
0
z
>-
0
SOIL SURVEY
GRAPHIC SCALE
1"=800'
800' 0 800'
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-CH-44
Fields 12-13

SYNAGRO1
TOPOGRAPHIC
MAP
't J
(. N.....,
i
----:\\
-----,
a I
lir ___.-
`� /
�r'
;
., .;..."."
J
,r
s ! 1
�,
/
i
0
, Ar
. .„__,
_ . . ,
1
A ., 4_,...../.._., .040
•___ .._
.,.
APP.' =.:.•+..../. ---•,
) c.-.)
, ...________, ,.,
___....,..yr-7
,-\ /-\\---- ....
i _ ,
ti.
_, .
1
, .
. „
„,....„ ,
„_____?://-_.- /./ r__
(..7- ! t____ (.. _______-_\__,
11,,..) ,
_. ) ---„,.._____,
(......,
i
,,
..
..., f
____...
. \,
.,/(d'-'\N\
-----r-----7
_ .
...
_____
..
y o/
_
.. _
/---------______
GRAPHIC SCALE
1" = 800'
800' 0 800'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
A I C_C H A A
in the property boundary, whichever is closest to the application area. The review boundary is established
_
V fl `F`F
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 12-13

Smith Hudson Rd
Harris Carpet
11324 I
•
RepeapletTowings 9 GpagQ Hudson Rd
asset! Rd
VICINITY MAP
Growing Wild Nursery
Silk Hope Transmissions9
HickoryMaurt
Baptist Chur
2,000'
GRAPHIC SCALE
1" = 2,000'
0 2,000'
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.
NC-CH-44
Fields 12-14

APPLICATION MAP
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
All locations are approximate.
0 Pond
Legend Stream
Chatham Roads Property Boundary
0 Soil 0 Onsite
• Offsite
A A A Application Area Well
Residential/ Property Line Buffer & Unsuitable Area
0 0.075 0.15
0.3 Miles
NC-CH-81
Field-1 &2

le) APPLICATION
MAP
SYNAGR
44,11
re
1,
•.
"�
I
) ' •
.1►.
•�•►E�s�1
4
►
•
O
dt
4.
:,,►
iggik‘
■
kA' •
'
LEGEND
>v v v<
APPLICATION AREA
j//
UNSUITABLE AREA
Ann P
- - - - - - PRIVATE ROAD © WATER
— — — — STREAM ONSITE HOUSE GRAPHIC
SCALE
1" = 660'
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING 660
o sso
x x x
PROPERTY LINE 0 WELL
Q 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.
N
C-LT-52
Fields
5-6

cc
LD
0
z
>-
Ln
SOIL SURVEY
GRAPHIC SCALE
1" = 800'
800' 0 800'
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-52
Fields 5-6

TOPOGRAPHIC MAP
1,000'
GRAPHIC SCALE
1"= 1,000'
0
1,000'
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.
NC-LT-52
Fields 5-6

0 t
Q
4,000'
VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
0 4,000'
V .I
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-52
Fields 5-6

SYNAGRO, WESTERN PIEDMONT PERMIT
WQ 0016247
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Synagro Western Piedmont 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 USDA/NRCS 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 1 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 Desc. Data, W. Piedmont, Permit. WQ 0016247
Field NRCS Mapped Series Field Identified Series
IR 41-1 Cecil Cecil
IR 41-2 Cecil Cecil
BU 1-1 Fairview Fairview
BU 1-2 Fairview Fairview
AL 17-30 Clifford Clifford
AL 18-1 Clifford Clifford
AL 18-2 Clifford Clifford
DV 47-1 Clifford Clifford
RA 62-1 Enon Enon
RA 62-2 Lloyd Lloyd

Sincerely,
G. Christopher Murray, L.S.S. No. 1284
Synagro, Western Piedmont Permit, Various Fields

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: IR 41
Field: Field 1
Coordinates: 35.72933 N
-80.95722 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
2.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: IR 41
Field: Field 2
Coordinates: 35.71961 N
-80.85387 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
2.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: BU 1
Field: Field 1
Coordinates: 35.63879 N
-81.48682 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
2.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-26
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
26-33
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
33-48
2.5YR 4/8
-
-
-
-
moist
I
structureless, massive
fr
ss
sp
Legend:
Texture
s sand
si
sil
c
cl
s c I
s1
sicl
loam
silt
silt loam
clay
clay loam
sandy clay loam
sandy loam
silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: BU 1
Field: Field 2
Coordinates: 35.63401 N
-81.48853 W
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Fairview
Mottle Size
Moisture Status
L
X
H
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
N
0
a)
a
4-
0
a
Ap
0-2
2.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
2-23
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
23-30
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
30-48
2.5YR 4/8
-
-
-
-
moist
I
structureless, massive
fr
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: AL 17
Field: Field 30
Coordinates: 35.88018 N
-81.13216 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: AL 18
Field: Field 1
Coordinates: 35.84738 N
-81.07233 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
si
sil
c
cl
scl
sl
sicl
loam
silt
silt loam
clay
clay loam
sandy clay loam
sandy loam
silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: AL 18
Field: Field 2
Coordinates: 35.86662 N
-81.06839 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 5/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: DV 47
Field: Field 1
Coordinates: 35.87997 N
-80.69913 W
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Clifford
Mottle Size
Moisture Status
L
X
H
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
N
0
a)
a
4-
0
a
Ap
0-3
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-48
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
0
L
0
x
Project: W. Piedmont (WQ 0016247)
Site: RA 62
Field: Field 1
Coordinates: 35.7685 N
-80.726 W
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 3/2/2022
Soil Series: Enon
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-24
10YR 5/8
-
-
-
-
moist
c
mod
med
sbk
vfi
vs
vp
C
24-42
10YR 6/8
-
-
-
-
moist
I
Structureless
fr
ns
np
R
42
-
Legend:
Texture
s sand
Structure Grade
wk weak
I loam m moderate
si silt str strong
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope:
Site: RA 62
Field: Field 2
Coordinates: 35.82529 N
-80.66393 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop:
Conducted By:
Date:
Soil Series:
Mottle Size
d
a)
0
a
O
0
a)
3%
Forage/Pasture
GC Murray
3/2/2022
Lloyd
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt1
4-24
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Bt2
24-42
2.5YR 4/6
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
si
sil
c
cl
scl
sl
sicl
loam
silt
silt loam
clay
clay loam
sandy clay loam
sandy loam
silty clay loam
Structure Grade
wk
m
str
weak
moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

APPLICATION MAP
0 0.0475 0.095
0.19 Miles
1 1 1 1 1 1 1 1
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
All locations are approximate.
LEGEND
— Property Boundary . Onsite House
Offsite House A A Application Area
A Well/Pond
Unsuitable Area
0 Soil Bore
— Stream/Ditch
NC-PO-9-1 &2

SYNAGRO, WESTERN PIEDMONT PERMIT
WQ 0016247
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Synagro Western Piedmont 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 USDA/NRCS 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 1 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 Desc. Data, W. Piedmont, Permit. WQ 0016247
Field NRCS Mapped Series Field Identified Series
P09-1 Cecil Cecil
P09-2 Cecil Cecil
LT57-1 Cecil Cecil
LT57-2 Pacolet Pacolet
LT57-3 Cecil Cecil
CA-06-F4 Lloyd Lloyd
CA-06-F5 Lloyd Lloyd
CD03-4 Woolwine Woolwine
CD03-5 Fairview Fairview
CD04-1 Fairview Fairview
AL17-6 Hibriten Hibriten
AL17-5 Fairview Fairview
AL17-8 Fairview Fairview
AL17-9 Fairview Fairview
AL17-7 Fairview Fairview
AL17-2 Fairview Fairview

AL17-1 Fairview Fairview
AL17-4 Woolwine Fairview
AL17-10 Fairview Fairview
AL17-12 Fairview Fairview
AL17-14 Fairview Fairview
AL17-13 Evard Fairview
AL17-15 Fairview Fairview
AL17-11 Fairview Fairview
AL17-22 Fairview Fairview
AL17-17 Hibriten Hibriten
YK26-3 Danripple Clifford
YK26-2 Clifford Clifford
YK26-4 Poplar Forest Poplar Forest
YK26-5 Poplar Forest Poplar Forest
IR32-7 Clifford Clifford
IR32-6 Fairview Fairview
NC-IR-40-01 Clifford Clifford
CA37-1 Clifford Clifford
NC-AL-17-16 Fairview Fairview
NC-AL-17-18 Fairview Clifford
NC-AL-17-19 Fairview Fairview
NC-AL-17-20 Fairview Fairview
NC-AL-17-23 Yadkin Yadkin
NC-AL-17-24 Fairview Fairview
CA-38-01 Lloyd Lloyd
CA-38-02 Lloyd Lloyd
Sincerely,
G. Christopher Murray, L.S.S. No. 1284
Synagro, Western Piedmont Permit, Various Fields

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Scott Champion, P09
Field: Field 1
Coordinates: 35.2047 N
-81.9779 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
2.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Scott Champion, P09
Field: Field 2
Coordinates: 35.2021947 N
-81.97447 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
AB
0-16
5YR 4/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
16-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Thomas Baxter, LT57
Field: Field 1
Coordinates: 34.44804 N
81.41058 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
10YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-29
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
29-48
10R 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Thomas Baxter, LT57
Field: Field 2
Coordinates: 35.45130 N
81.41308 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1/31/2022 Soil
Series: Pacolet
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-11
10YR 4/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
11-35
10YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
35-48
2.5YR 4/6
-
-
-
-
moist
cl
mod
med
sbk
fi
s
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Thomas Baxter, LT57
Field: Field 3
Coordinates: 35.45543 N
81.40776 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Cecil
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
A/B
0-17
10YR 4/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
17-48
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Dennis Lutz, CA-06
Field: Field 4
Coordinates: 35.61733 N
81.28165 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Lloyd
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-6
2.5YR 3/4
-
-
-
-
moist
I
mod
med
gr
fr
ns
np
Bt
6-48
2.5YR 3/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
str strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Dennis Lutz, CA-06
Field: Field 5
Coordinates: 35.61417 N
81.27681 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Lloyd
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-5
2.5YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-48
2.5YR 3/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Patrick Starnes, CD03
Field: Field 4
Coordinates: 35.85273 N
81.34594 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Woolwine
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
N
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
A
0-8
2.5YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
AB
8-15
5YR 5/8
-
-
-
-
moist
scl
mod
med
gr
fr
ns
np
Bt
15-32
5YR 5/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-35
5YR 5/8
-
-
-
-
moist
scl
mod
med
sbk
fr
ss
sp
Legend:
Texture
s sand
si
sil
c
cl
scl
sl
sicl
loam
silt
silt loam
clay
clay loam
sandy clay loam
sandy loam
silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type Structure Size
granular f fine
platy med medium
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Patrick Starnes, CD03
Field: Field 5
Coordinates: 35.85478 N
81.38944 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
Ap
0-3
2.5YR 3/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-29
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
29-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, CD04
Field: Field 1
Coordinates: 35.87380 N
81.337020 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
Ap
0-4
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-25
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
25-42
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 6
Coordinates: 25.86634 N
81.33050 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Hibriten
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
AB
0-13
10YR 5/6
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
13-24
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
CR
24+
-
-
-
-
-
massive rock controled stucture
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 5
Coordinates: 35.86095 N
84.32400 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-5
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-37
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
37-48
10R 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 8
Coordinates: 35.88400 N
81.32363 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
Ap
0-4
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-29
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
29-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 9
Coordinates: 35.88109 N
81.32300 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-9
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
6-24
10R 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
24-42
10R 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
C
42+
1OR 5/6
-
-
-
-
moist
massive, stucturaless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 7
Coordinates: 35.86674 N
81.32058 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-9
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
9-32
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 2
Coordinates: 35.85334 N
81.32445 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
AB
0-11
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
11-28
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
28-43
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
C
44+
-
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 1
Coordinates: 35.83066 N
8130962 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
AB
0-13
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
13-34
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
34-44
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
C
44+
-
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 1
Coordinates: 35.83066 N
8130962 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-5
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-31
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
31-42
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
42-48
2.5YR 4/9
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 10
Coordinates: 35.87326 N
81.28620 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
A
0-3
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-23
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
23-32
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
32-42
2.5YR 4/6
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 12
Coordinates: 35.88019 N
81.28158 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-32
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 001
Site: Casey Richey, AL17
Field: Field 14
Coordinates: 35.88454 N
81.27917 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
6247) % Slope:
Crop:
Conducted By:
Date:
Soil Series:
Mottle Abundance
Mottle Size
d
a)
0
a
O
0
a)
3%
Forage/Pasture
GC Murray
1 /31 /2022
Fairview
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
A
0-3
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-28
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
28-41
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
ss
sp
C
41-48
2.5YR 4/6
-
-
-
-
moist
sl
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 13
Coordinates: 35.88614 N
81.27571 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-38
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
38-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 15
Coordinates: 35.89025 N
81.27577 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-32
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-43
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
43-48
2.5YR 4/6
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 11
Coordinates: 35.87278 N
81.29966 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
0 PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
w
N
N
4-
N
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-20
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
20-31
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
31-40
2.5YR 4/6
-
-
-
-
moist
massive, structureless
R
40
-
-
-
-
-
-
- I - I - I -
- I
- I -
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky
single grained
massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 22
Coordinates: 35.88814 N
81.30370 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-3
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
3-21
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
21-30
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
30-42
2.5YR 4/6
-
-
-
-
moist
massive, structureless
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, AL17
Field: Field 17
Coordinates: 35.84012 N
81.24879 W
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 1 /31 /2022
Soil Series: Hibriten
Mottle Size
Moisture Status
L
X
H
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
a
4-
0
a
AB
0-14
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
14-27
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
CR
27+
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, YK 26
Field: Field 3
Coordinates: 36.262730 N
80.68208 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
U)
0
a
Ap
0-4
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, YK 26
Field: Field 2
Coordinates: 36.26281 N
80.68461 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 4/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, YK 26
Field: Field 2
Coordinates: 36.26281 N
80.68461 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Poplar Forest
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-2
7.5YR 4/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
2-21
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
21-30
2.5YR 4/9
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
30+
-
-
-
-
-
-
-
-
-
-
-
-
-
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, YK 26
Field: Field 5
Coordinates: 36.16722 N
80.81635 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Poplar Forest
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-4
7.5YR 4/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-20
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
20-31
2.5YR 4/9
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
CR
31
-
-
-
-
-
-
-
-
-
-
-
-
-
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, IR32
Field: Field 7
Coordinates: 36.04189 N
80.73346 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-5
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Shane Porter, IR32
Field: Field 6
Coordinates: 36.04805 N
80.73809 W
0
L
0
x
w
a)
i
4-
a
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Fairview
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-5
7.5YR 4/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-23
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
23-36
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
C
36+
2.5YR 4/6
-
-
-
-
-
-
-
-
-
-
-
-
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Kent Renniger, NC-IR-40 Crop: Forage/Pasture
Field: Field 1 Conducted By: GC Murray
Coordinates: 35.98145 N Date: 2/1/2022
80.77439 W Soil Series: Clifford
0
L
0
x
w
a)
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Mottle Size
d
a)
0
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
4-
U)
0
a
Ap
0-8
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
8-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247)
Site: Casey Richey, CA37
Field: Field 1
Coordinates: 35.81257 N
80.77439 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
% Slope: 3%
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Clifford
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-6
7.5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
6-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Casey Richey, NC-AL-17 Crop: Forage/Pasture
Field: Field 16 Conducted By: GC Murray
Coordinates: 35.92852 N Date: 2/1/2022
81.28374 W Soil Series: Fairview
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
AB
0-11
10YR 7/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
11-28
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
28-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Casey Richey, NC-AL-17 Crop: Forage/Pasture
Field: Field 18 Conducted By: GC Murray
Coordinates: 35.92852 N Date: 2/1/2022
81.28374 W Soil Series: Clifford
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Mottle Size
Moisture Status
L
X
H
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
4-
0
a
Ap
0-6
10YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
6-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Casey Richey, NC-AL-17 Crop: Forage/Pasture
Field: Field 19 Conducted By: GC Murray
Coordinates: 35.87581 N Date: 2/1/2022
81.16556 W Soil Series: Fairview
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Mottle Size
Moisture Status
L
X
H
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
4-
0
a
Ap
0-4
10YR 7/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
4-22
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
22-30
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
CR
30+
-
-
-
-
-
-
-
-
-
-
-
-
-
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope:
Site: Casey Richey, NC-AL-17 Crop:
Field: Field 20 Conducted By:
Coordinates: 35.83405 N Date:
81.13836 W Soil Series:
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Mottle Size
3%
Forage/Pasture
GC Murray
2/1/2022
Fairview
Moisture Status
L
X
H
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
4-
0
a
Ap
0-11
10YR 7/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
11-28
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
28-41
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
CR
41-48+
2.5YR 4/8
-
-
-
-
moist
sl
-
-
-
-
-
-
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Casey Richey, NC-AL-17 Crop: Forage/Pasture
Field: Field 23 Conducted By: GC Murray
Coordinates: 35.83416 N Date: 2/1/2022
81.097820 W Soil Series: Yadkin
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-6
5YR 7/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt1
6-29
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Bt2
29-48
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Casey Richey, NC-AL-17 Crop: Forage/Pasture
Field: Field 24 Conducted By: GC Murray
Coordinates: 35.83416 N Date: 2/1/2022
81.097820 W Soil Series: Fairview
0
L
0
x
w
a)
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Mottle Size
d
a)
0
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
4-
0
a
Ap
0-5
5YR 7/4
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt
5-32
2.5YR 4/8
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
BC
32-48
2.5YR 4/8
-
-
-
-
moist
cl
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Jimmy Gibson, CA-38
Field: Field 1
Coordinates: 35.60635 N
81.24573 W
0
L
0
x
w
a)
i
4-
Q
a)
Matrix Color
0
O
0
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Lloyd
Mottle Size
d
a)
0
a
O
0
a)
Moisture Status
L
X
H
w
0
C9
a)
4-
N
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
a
N
N
a
O
0
to
2
N
0
a)
a
4-
0
a
Ap
0-7
5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt1
7-29
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Bt2
29-48
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: W. Piedmont (WQ 0016247) % Slope: 3%
Site: Jimmy Gibson, CA-38
Field: Field 2
Coordinates: 35.60565 N
81.29306 W
0
L
0
x
w
a)
t
47.
4-
a
a)
Matrix Color
0
O
U
a)
O
2
Mottle Abundance
Crop: Forage/Pasture
Conducted By: GC Murray
Date: 2/1/2022
Soil Series: Lloyd
Mottle Size
Moisture Status
L
X
H
w
N
co
4-
N
PIEDMONT
ENVIRONMENTAL
ASSOCIATES, P.A.
N
0
a)
a
4-
0
a
Ap
0-7
5YR 3/3
-
-
-
-
moist
sl
mod
med
gr
fr
ns
np
Bt1
7-29
2.5YR 4/6
-
-
-
-
moist
c
mod
med
sbk
fi
s
p
Bt2
29-48
2.5YR 4/6
-
-
-
-
moist
c
mod
med
abk
fi
s
p
Legend:
Texture
s sand
I loam
si silt
sil silt loam
c clay
cl clay loam
scl sandy clay loam
sl sandy loam
sicl silty clay loam
Structure Grade
wk weak
m moderate
strong
gr
pl
pr
cpr
abk
sbk
sg
ma
Structure Type
granular
platy
prismatic
columnar
angular blocky
subangular blocky Moist Consistency
single grained fr friable
massive vfr very friable
fi firm
vfi very firm
Structure Size
f fine
med medium
Seasonal High Water Table:
Depth (") Type (apparent/perched)

APPLICATION
MAP
SYNAGR
fr..
0,,,,,
► 1 w_dw-,
O
7
1110
7
r
.41110p.
LEGEND
>v v v<
APPLICATION AREA
///
UNSUITABLE AREA
AAAP
- - - - - - PRIVATE ROAD © WATER
— — — — STREAM ONSITE HOUSE GRAPHIC SCALE
1" = 660'
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING 660o sso
x x x
PROPERTY LINE 0 WELL
Q 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.
N C-RA-62
Field
1

le)
APPLICATION
MAP
SYNAGR1
4(04)
ilk-4.1...ippp......
0
illIO''
AO
Vklitr
o.
■
LEGEND
APPLICATION AREA
UNSUITABLE AREA
j//
>v v v<
> <
AAA t
-
- - - -
- PRIVATE ROAD © WATER
STREAM • ONSITE HOUSE GRAPHIC SCALE
— — —
DRAIN . 1" = 660'
OFFSITE HOUSE
x x x
FENCE OUTBUILDING
660o sso
PROPERTY LINE 0 WELL
Q 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
N C-RA-62
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 2

10 APPLICATION
MAP
SYNAGR
•i
<
.
.
Oirp
,
At*IFIN,/
/
0
o
ii‘r
______
•►
j
Ae.k
/
/ 141
___.,
gi
% ►
�O.O
Iiii
ry ,
LEGEND
>v v v<
APPLICATION AREA
j//
UNSUITABLE AREA
AAA P
— — — — — — PRIVATE ROAD © WATER
— — — STREAM ONSITE HOUSE GRAPHIC SCALE
1" = 660'
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING 660o sso
x x x
PROPERTY LINE 0 WELL
Q 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.
NC-RC-50
Fields
1-2

cc
L9
0
z
>-
0
SOIL SURVEY
660'
GRAPHIC SCALE
1"=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-RC-50
Fields 1-2

TOPOGRAPHIC MAP
SYNAGR1
it
\ \\ g 1 r I 1 Lr,
r �
-
,7:7 .�
- ✓ l
___!
-....1
a
4
5 '1 1 a:
-. 481
(.._. 1,-
—` ‘ ,\�
��
► ,� \ r 1,
)
• :
\N,
7 I/' Ye90
\\
'!
/'
I
ram.✓-
•� •''--.
''''?
•�
j ; _ /�
j/f� jjff
C '.-.,----"'-''''---1,- -
.,-
I-'
GRAPHIC SCALE
1"=800'
800' 0 800'
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-RC-50
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1-2

a
z
VICINITY MAP
ea ,co3..:n3
a
aadFd
ao
0
Palestine Ara
Methodist Church y
'Atlantis Shoremaster Boat
1.4 (e
snennn it,
National Roof Brainage9
Rd
ti Sranieg Rd
ti
n
Patricia Ln
JAM'N 104.79
Antique Barns9
4
LPNet Rd S
6-
Precision Body Works 9
New Hope Church
9 .ice, Au3SDr
Qs.
"IGoogle
1 1st I
dbv
Scott Court Reporting
Green Acres Horse Farm 9
9woDE Acres Lr
GRAPHIC SCALE
1" = 2,000'
2,000 0 2,000
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-RC-50
Fields 1-2

PWIL
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 Permitting Unit
General — This document is an agreement between the Applicant and land owners) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
[Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
[.A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Sy 1..s ra (-ledge, G"P{ Lin 4-
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Ai-1-12_ 3
n/a
, Dios
/�
Ail
((
� ^c f L
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
npliance 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 beha if of other deeded landowneis OR that am otherwise authorized, thro ugh
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.
Landownername: (14r Af1n Tit/1ovr
Address: (� 2 0 Fa1w► c L p 0"k z
City: tC+ ( 140%v e Ile State: A/
Zip: 10 G56
Phone: E-mail atjdress:
Signature: /L. /A,
NORTH CAROLI
I, the undersigned Notary Public do hereby certify that
COUNTY
Date:
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
(0 } %%ototi ef
° X'w
20 �
--
V
•
•
•
WITNESS my hand and official seal this the
day of +� ,
Signature and seal:
My commission expires: 0 t/- 1't 0.0at1
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/opera tor na me:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
2ohe ,l. j2.0
Signing official name:
Signature:
Date: VN 2 2
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
[Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
pplicant.
lLf 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:
gill (142,f "
Applicant's name: 4�ah L./lrib,-n
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
1
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
NC-CA-06-03
,tie)
H 4 / kik:eV .
Q/l&1lk( -1n^ ee,/•
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
1�A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: . The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address:
City:
Phone:
12 FE 6/As zc_.
OD 130v, 3aib
Signature:
N'. kor
VIP - y_ 472 (tS
State:
E-mail address:
Zip: 0360
Date: q' 1' Z
NORTH CAROLINA, COUNTY/�
I, the undersigned Notary Public do hereby certify that RFK f ArmS TAL,
personally appeared before me this day and acknowledged the due execution of the forgoing instrument. ```` 111 1,,,,,,
WITNESS my hand and official seal this the F� ``���� P k '% ,i
i
day of ���ir�/i , 20 2 •
A /
111 Signature and seal: �✓ �t� -m
: p
II
My commission expires: OcJ Z 2, Joe/. al
��e( �c.)
4��, ,' ````-
UNS
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
her4- HI
',AA" -
Date:
1/Zo/z z
FORM: LOA 06-16 Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Z. Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
PrA 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: J kol as r o 1JPS cn Prof iron
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(yes/no)
Land Use or
Cropping Patterns
pp' g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Cl— -3-3
No
i-(��
11a,,,.( frrL
LI- - I
,✓�
��
��,,n„ �t.
Y
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. 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 pattems 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 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
ympliance 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: $TO I /-. v.i_ ✓ ,f �"
Address: / c '7 / /Vet A
City: Oa j Fr►
Phone: e5-2 )— 23 `,' '/2 '7‘
Signature:
E-mail address:
NORTH CAROLINA, L ' ((1 (.9 I r\
I, the undersigned Notary Public do hereby certify that
COUNTY
State: /VC Zip: e� � v
!-f
cc
Date: -3-4 2--
•/0,/ r %,7;-10,1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument``���l��1wt 4,�''
WITNESS my hand and official seal this the Li l`~ :� It- -1 0- �
day of , 20 2
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
0C1- zz, 2.O2L
TAgy
r
e
'gf /stisob I2�,
r,�'Oit L co''�♦•�
� �
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
ht-A-
2/7
Signing official na
Signature:
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Lad 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.
DI 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: -6,1 i) r <, lit78 iitrn
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
Agreem ent:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
CD-03-213 ,
f/
VY 1 PC'`,f irt4
Ant,n.A C#41-,
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

L 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 tinit, 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 an 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.
H. 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 Iand
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 he harvested for a 38-month period following a residuals land
application event when the residuals remain on the Iand 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, I5A 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: 4L
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: • is currently permitted under another
residuals land application program; Permit Number WC): . 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 l 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 l 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: fa,.
ri G `� / ma c 5
Address: PC 8 d �G. % 1 o rc, ,f1 F C /-c1 / / 1
City: (> r )e_ 1/ 5" State: Al C
Phone:'? ' " '�'��Q $ -' V.3 O �� E-mail address:
Signature: 124t'"�` JOrT--------
Date: I' /2 - 2 Z.
NORTH CAROLINA, CA, [Lit- l ( COUNTY
I, the undersigned Notary Public do hereby certify that it lr. S 714-rr5 to1111111o,
personally appeared before me this day and acknowledged the due execution of the forgoing instrum t. It . y
IND O.
*IP
ft.w'
day of Gau.«l, , 20 2Z. 4 .'�
Signature and seal: . liy
I r
My commission expires: Oc ' /tr, 2 2, ,2091,(
WITNESS my hand and official seal this the
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Perrnittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: .404-1'
1-41
Lt
Signature:
Date: 3/4/0
FnPnir• r.nA n6-1 F
Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® 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: Synagro Western Piedmont RLAP
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�7 n
�CJ
j ,
' J �,,
Shur t ;:e1.
—{�
.S1 �`' 1' t i °�`
r
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 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 Pennittee 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 Pennittee 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:
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please nark 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
mpliance boundary to the application package)
AJ " 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: ltI )1/5"
Address: /6? / * fol £ / ,04. , �r 4
City: fjl0/, +t&.r//G
Phone: 70 4i— p6 62 — 3.72 / f'
Signature;
NORTH CAROLINA,
,ZLk-'1?
State:
E-mail address:
I, the undersigned Notary Public do hereby certify that
Zip: .c fi`•�
COUNTY CUjs JOLLs,,,1
personally appeared before me this day and acknowledged the due execution of the forgoing instrumerli, veY. WPQ
WITNESS my hand and official seal this the
day of
Signature and seal: jt(
My commission expires: 0 c 4 G z,` p,►,p
Lessee's/Operator's Certification:
, 20
41.
le
00,0it Co)I
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
2nit) tr - —V-gs14
-fat,-
9
Signing official name:
Signature:
Date: `�// 3/Z Z
FORM: LOA 06-16 Page 3 of 3

�R
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 Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
I "Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
2(A pplicant.
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: 61(1Cg (4, �/` 5}r rn 1°4~1(-
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source -
(optional)
Special note
(no-till/over-seed/
pasture)
L-1--ram- 13
.ti:,
Z.,,, ,,r5
f`i/�lm��
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
dA re -defined compliance boundary is not needed for this site.
IV. ACyNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
The land application field(s) ID: — Ja'� " a 3 , is currently permitted under another
residuals land application program; Permit Number WQ: 0 O b 0 4 3 c7 . The land owner hereby acknowledge that by signing this
agreement, he/she is requesting t t the field(s) be removed from t previously permitted residuals land application program and transferred
into the new program; 3 yac t /e v-n
(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: `^' G Y AL-- " 'A i '-r
Address:
City: V IL. State: A/C,' Zip:
Phone: [ 0 — 01 & 117 I E-mail address:
Date: �����'2(
Signature:
• /'
NORTH CAROLINA, Leff Cd (n COUNTY
I, the undersigned Notary Public do hereby certify that W i, y d C— 6—° i jer ,�:�.011111, 14 4„//is
, -�. .•••.......� „i
personally appeared before me this day and acknowledged the due execution of the forgoing instrur nv .•' •.ti 0�
WITNESS my hand and official seal this the 2{ Ti o.eaRy s� o
Z=
_ .'.
day of ���� ryu �1G{ SI,. .
9•• ?�
e,/pFLL Gp��``
Signature and seal: 1 7 IA (✓4'
My commission expires: DJ-
Lessee's/Operator's Certification:
20 �l
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
!
Signing official name:
Signature:
Date: !
F(1T?TvT• T.()A
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
2/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: JYn c. rs \ Lrn I'
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
44 — I 7- 21
/(/o
ekStwy_/Pwy
Ivry_
PO.'r✓I w ( L
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
[r A re -defined compliance boundary is not needed for this site.
IV. ANOWLEDGEMENT OF FIELD TRANSFER: (if needed)
The land application field(s) ID: �.. T — l O '1 1 t Z- , is currently permitted under another
residuals land application program; Permit Number WQ: D t� o� �! 3 . The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removggd from the,previously permitted residuals land application program and transferred
into the new program; S n S -() ✓iS4rrn (f,'a mon f Do ll02 -(,
(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 Pennittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: 4.6 n At o' 4-4—
Address: 2 I-- Bess
City: ,Gfr Von//�
Phone: -7 (9S3 c{ — 04S 5
State: v✓(_ Zip: 2soa-
E-mail address:
Signature: J�jfr — 7I.IitQ/VV
NORTH CAROLINA, - �a 1 c o 1 COUNTY
Date: - Z
I, the undersigned Notary Public do hereby certify that � �S� n U ✓ r•)' a.011111 i/i f�®'
personally appeared before me this day and acknowledged the due execution of the forgoing instrument ®®i®®
WITNESS my hand and official seal this the IC = OlAAy 111 0-1
day of f'z; �guAry , 20 Z Z P G z:. ( �
��t pU9� r�.�
Signature and seal: Y/ v jL- s-0,d - -
My commission expires: Vc.� 11, 20'2 2 7t -o',®F� ;, co-„ �
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do�hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: yJ„Y-' -1
Signature: 4 777 Date: 2/24
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
pplicant.
e 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: S 4 IIp s r n I.✓P5+<r.�.vl on +
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
L -1{ C-
/lh
J ii.,(
�n1in , ( ) c L
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
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 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
dA
ompliance boundary to the application package)
re -defined compliance boundary is not needed for this site.
IV. AACOWLEDGEMENT OF FIELD TRANSFER: (if n eded)
The land application field(s) ID: L 4 - O C. - Z- L I---14 r I , is currently permitted under another
residuals land application program; Permit Number Q OD o Z 1 tZ 1✓0.0 001 011ie land owner hereby acknowledge that by signing this
agreement, he/she is requesting hat the field(s),b�7 re oved fro th previ9usly permitted residuals land application program and transferred
into the new program; sy n `5 (b wco 4 rn f f. m n /Q o a t 102 y 7
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address: G —1 3 - ` J` N`vr r I?
City: LRf Y1 Co I�l�e1
Phone: 2'4-t S ( S 3 E-mail address:
Date: % " .�
11407 riv6k9
Signature:
NORTH CAROLINA,
State:
A/L
I, the undersigned Notary Public do hereby certify that
Zip:
'2 o r, 2 .
COUNTY
m{4comaAbn
personally appeared before me this day and acknowledged the due execution of the forgoing instrun#ut@"
341` ?01aRy
..
,20 2Z PUBO6
',#I,NI...ac %%
WITNESS my hand and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
O c,\t' 'Z-21 't
•
Z
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement andndo hereby — agree to abide by the stipulations and restrictions as specified herein.
Signing official name: rZO }" �r1— `
Signature: Date: ?/i/Z Z
T TM•TfAM-1h
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. La Owner Agreement (FORM: LOA 06-16):
I f' 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
Prpplication may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
epare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
plicant.
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: r�
Applicant's name: 5(1 /' rc We'. ily1- n P✓/i C
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
'i
.t
PIN ,.( AL
Al iI01, ( ` I -
-I�-€3 ,q,) r
7
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
QrA 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: L 4
Address: I 0 P45e H ,
City: Q�� ✓Z ��., State: NC- Zip: ')'7O/43
Phone: —70 `d`z,° 7` GA tt 1_ E-mail address:
Signature:
NORTH CAROLINA,
J
Tre
COUNTY
Date: 2— 1- 2. Z
I, the undersigned Notary Public do hereby certify that �� ti F n td� �`Sr'_ `114t11/�
personally appeared before me this day and acknowledged the due execution of the forgoing instrum r �` P.NEX j
%
WITNESS my hand and official seal this the �10T
q
day of r .4 0,,, , 20 R7 t
7 o "@LIG
Signature and seal: 1.e� V',
��
"UN�a'i `ji/iP1%
%%
My commission expires:
Lessee's/Operator's Certification:
OJ-
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: ,c✓—
Address: tJ / (o &c, rt I I- I-1,,r,� g L
City: 51`4 -4 ,„ / /4 State: L Zip: a. 62
Phone: —70 - 9 0 a ' j 7s 1 1 E-mail address:
Signature: =z:. ("
Permittee's Certification:
Date: , . 0 ,2 2
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Lad 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
PApplicant.
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: t1.5t"t, 6✓90-f,
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
co - Z,3,�, �' 7
Al
34,i I L „toi-t�nr,�rA
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
H. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
Fr.iA 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)
[`t A e-defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
0 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: Pa. {It C / c(/ /l c 5-
Address: fo 6 oy.`T � � % �c r � � �C / / %
City: r c,
State: Al C` Zip:
Phone: "0 ? -" As/ 5 2•1-/ E-mail address:
Signature:
NORTH CAROLINA, l /wt 1.
I, the undersigned Notary Public do hereby certify that
COUNTY
Date:
personally appeared before me this day and acknowledged the due execution of the forgoing instrumet. P'
WITNESS my hand and official seal this the
day of l Gnuk�y
Signature and seal: L✓ Jiy�
My commission expires: C o h.e,
Lessee's/Operator's Certification:
/2'I\
(Z f . o9t-{
,20 2�
Z9
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
State:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: 2/24-
FnRM• T (lA 11-1F
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Dlvlslon of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. LanOwner 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
pplication 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
plicant.
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:
Syntyo
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
nn //
CO- olo -3
'fib
p I
tiLLI t_ /Hti
PW/Tai, ( rtel,
CA -Ot. -'I
A
f 46)-u1/4./14,1
J7(1''"/ I
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, 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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
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 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
kg A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: . The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address: 5 3 ( Cc, 1 gC_ CI f. /'a ('IA >Z L
City: !V C.-✓ ..c> State: 1/1/L Zip: 2,- 6 Ss-
Phone: '2 - ( 7 t� E-mail address:
Signature: D„.....--
F. /L Date: 1- I)-- ' 22- —
NORTH CAROLINA, C f-h / COUNTY
I, the undersigned Notary Public do hereby certify that Cc nn✓'S f 1-u iZ ```,iiiiiH/jo�
personally appeared before me this day and acknowledged the clue execution of the forgoing instr ` bi�,� VI .O.r���00
WITNESS my hand and official seal this the 2 { h�p '...
day of J ,inv„ 20 22 .. 0:
..I
Signature and seal: V h
op
My commission expires: Di- .z, ''f '',I��� �"CO'
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
4
Signature: �%Y< Date: ,Y2/7
rat»r fr
r)MJ
PflR \a• T nA nA-1fS
Page 3 of 3

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 Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
[v]�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.
EA 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: S f(1 tis . a t ✓ c -, P,toy i
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
.1E),-f 2(41(
Q�,,, e,oPs//tir
AA,i14.wt L
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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
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 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
zAnpliance boundary to the application package)
e-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: Lynette, G� Vi- t. • Al/lies-so 047
c
Address: ,z 4ry Z 4oA J (y tki R;st- L Q Yi e
City: k bl Q State: � Zip: 2 g1Z
Phone: 7d gs O e(, E-mail address: EClA4d a rscai g C 11 et
Y
Signatur• t..,i�/ -� / � . i.� _._.� Date: 6/2. /
NOR CAROLINA,
I, the undersigned Notary Public do hereby certify that
COUNTY
L p ,11-c 0, )1n c(1.,.,„
personally appeared before me this day and acknowledged the due execution of the forgoing instrument``��1����//H//��
f l� �0� 1 W F04,
WITNESS my hand and official seal this the ��S ``� i .00
• Q' �q•
- iz' Y 0
Z=
day of
Signature and seal:
,Vtx `771-v
My commission expires: r c. t 22, (720 9/ (
Lessee's/Operator's Certification:
,20 a
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
` d' —
Signature: Date: /7./iZ
FORM: LOA 06-16 Page 3 of 3

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Anplicant shall submit one original and two conies of the application and
sunnortine documentation
For more infori
n, visit e Water Quality Permitting Section's Nan-Disciiarge Permitting [nit.
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 I 5A 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:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/field ID
Lease
{yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
[optional)
Special note
(no-till/over-seed/
pasture)
SD' WV
p
/ )c
4—ems
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
critity for the sitc(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
he 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 he 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 Nvith 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 modifieations 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 Permrttee, the landowner. or
his representative prior to and during a residuals land application event.
I3. The landowner or his representative hereby authorizes the Perrittee, 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. \nimals shall not be grazed on the land application site(s) for a 30-day period follow ing 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 attar such residuals land application
ents.
3. Food crops. feed crops, and fiber crops shall not he 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 hour 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.
ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T.0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
0 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)
[j A re -defined compliance boundary is not needed for this site.
IV. AC OWLEDGEMENT OF I ILLD TRANSFER: (if needed)
In/The land application fielii(s) ID. 1C— I f)p1 2-
. is currently permitted under another
residuals land application program: Permit Number WQ: 000237b . The Iand owner hereby acknowledge that by signing this
agreement, he/she is requestiqg that the field(s) be removed from the previously hemined residuals land application program and transferred
into the new program: 5staglineo CLASS 6 W ENi l ►
(Name of the new program)
FORM: LOA 06-16
Page 2of3

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 1 am otherwise authoritedthrough
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 certifythat the above-rethrenced 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 Pennittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: 0661-AS
Address: PO 3,2)c COI
City: (747115-ffr
Phone:
Signature:
EQ6-4-)Tr
State: OArrAysi A Zip:
E-mail address:
NORTH CAROLINA, 2-26)41A-61-641.4
I, the undersigned Notary Public do hereby certify that
Date:
COUNTY
u6-c../45
personally appeared before me this day and acknowledged the due execution of the forEtoing instrume, ELA
.t''‘'s C.) , • ,,,,,,,,,
47.
„lc ic?
CC :2
WITNESS my hand and official seal this the
Sterevneat-
day of
Signature and seal: 41\-) (oPt-7)
-
My commission expires: .7 16 2.7z9
, 2 o Z 2
July %.••Ld
, A NcS
Lessee's/Operator's Certification:
I certify that I have read this A s ent and do hereby agree to abide by the stipulations and restrictions as specified herein.
A-)1611er
Lessee/operator name:
Address: 7005— )4 Pqr4 ni
City: D4- APEse State: AJC-- hip: 273 i
Phone: -336clq7t E-mail address:
Signature:
Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: 9e.(4.- Aj go 11-4‘
Signature: Date: e/A//
iz
Page 3 of 3
FORM: LOA 06-16

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 1
Land Owner: Melba Merritt Annual Dry Tons Applied: 19.73 Site #: RC018 Acres Permitted:
Operator: Barry Knight
Crop 1 Name: Fescue -Pasture
Predominant Soil Series:
CgB2
Crop 1 Max. PAN: 156
Crop 2 Name:
Acres Utilized: 16.95
16.95
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)Solids/
Liquid
Cu. Yds
applied
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
Volatilization
Rate**
Mineralizatio
n Rate***
TKN
mg/kg
Ammonia
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
ReceivingResidual
Application
Crop 1
Crop 2
Crop 1
Crop 2
7/13
123500
1.07
0.325
Reidsville WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
14.988
NA
Fescue
7/14
104000
1.07
0.274
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
12.622
NA
Fescue
7/17
123500
1.07
0.325
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
14.988
NA
Fescue
7/18
91000
1.07
0.240
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
58300
27800
1.69
11.044
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
0
442000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
53.642
0.000
Lime
Applied
Annual lbs/acre
0.011
0.005
0.326
0.080
0.087
0.001
0.012
0.039
0.012
1.062
49.121
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.087
0.027
2.346
1.214
0.296
0.01
0.101
0.462
0.059
5.612
Current Cumulative lbs/ac
0.098
0.032
2.672
1.294
0.383
0.011
0.113
0.501
0.071
6.674
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1st/2nd Crop
156
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/22/2018 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Reidsville WQ Permit #: WQ0002376 Field #: 2
Land Owner: Melba Merritt Annual Dry Tons Applied: 4.07 Site #: RC018 Acres Permitted:
Operator: Barry Knight
Crop 1 Name: Fescue -Pasture
Predominant Soil Series:
CgB2
Crop 1 Max. PAN: 156
Crop 2 Name:
Acres Utilized: 14.7
14.7
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
( enter one)Solids/
Liquid
Cu. Yds
applied
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
Volatilization
Rate**
Mineralizatio
n Rate***
TKN
mg/kg
Ammonia
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
ReceivingResidual
Application
Crop 1
Crop 2
Crop 1
Crop 2
10/31
149500
0.6
0.254
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
210000
20000
4.43
34.099
NA
Fescue
11/1
13000
0.6
0.022
Reidsviile WWTP
Dry
<.5"
S
0.5
0.3
210000
20000
4.43
2.965
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
0
162500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
37.064
0.000
Lime
Applied
Annual lbs/acre
0.003
0.002
0.120
0.026
0.034
0.001
0.004
0.013
0.003
0.343
12.631
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.077
0.015
1.423
0.802
0.189
0.006
0.066
0.296
0.03
3.624
Current Cumulative lbs/ac
0.080
0.017
1.543
0.828
0.223
0.007
0.070
0.309
0.033
3.967
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1st/2nd Crop
156
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/22/2019 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

September ZCth,ZOZ2
NI.Department ofEnvironment and Natural Resources
Division of Water Resources
Water Quality Permitting Section —Non-Discharge Permitting Unit
1617Mail Service Center
Raleigh, WC27699-1617
ATTENTION: Mr. Erickson Saunders
REFERENCE: Follow uptoAdditional Info RequestVVO00l6Z47
SynaDnoVVestern Piedmont
Dear Mr. Saunders:
As a follow up to the additional information request dated August 23rd, 2022,
the following is a note for each field requiring a redefined compliance boundary due to onsite water
supply wells.
NC-LT-06-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is centrally located in this field and shall be located 50 feet from
the well.
NC-LT-23-1: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the south of this field and shall be located 50 feet from
the well.
NC-PO-07-02: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the North of this field and shall be located 50 feet
from the well.
NC-ST-03-113: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of this field and shall be located 50 feet from the
well.
NC-ST-03-04: A redefined compliance boundary is requested for this site. The
redefined compliance boundary is to the southeast of this field and shall be located 50 feet from

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
a plication may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
62
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
pplicant.
[A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: S ti A. 6 S r n 1.✓P5 L'r V 'e ,Mon
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
LA-- o G - L
rt/
)-1hy
01i'„1
L _� C' I
M
'-/
Ali -1., ( l
I
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, 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. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
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 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: L4-' 0 6 -I.
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
iAmpliance
boundary to the application package)
re -defined compliance boundary is not needed for this site.
IV. AOWLEDGEMENT OF FIELD TRANSFER: (if needed))
The land application field(s) ID: L -�-- O tr+ - 7--L t- 1-{ r I , is currently permitted under another
residuals land application program; Permit Number Q: 00 o 21 it tJ&o o 0 I flidie land owner hereby acknowledge that by signing this
agreement, he/she is requesting at the field(s) b9r re owed fr9in th previqusly permitted residuals land application program and transferred
into the new program; n ` eo 17, M.n (,✓ U O O I Lo 2 y 7
(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. M
Landowner name: I' ►•k Ala /1"-5 o r\
Address: L' 3 CA R. V.(/ U
City:
State:
A/ -
Zip:
'2 oc, 2
Phone: E-mail`<60 - 2 `t S (S 3 address:
Signature:
NORTH CAROLINA,
LACo\r\
I, the undersigned Notary Public do hereby certify that
COUNTY
Date: - 2
`owittNitfii
v01, W Fp�„'00
personally appeared before me this day and acknowledged the due execution of the forgoing instrun nt�ti e
.. .ma),
-•
v-
,20 2Z � ik113 ° Z
0.
WITNESS my hand and official seal this the
day of
Signature and seal: F''- _-
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: E-mail address:
Signature:
State:
Permittee's Certification:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: O ��"1-1
Signature: /' Date: 2/Z/0 2
Ff1RM• T.(lA (-1F
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owners) 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. Lad 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
pplicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: S:un‘Nsry L45 Itrr\ Pi, cirnw/'
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
`j 4-''7 -`j - ,� (3 y,5,
N
Hw / �IdLi't
4n r, a ( L
f
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 clays in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
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 SIJPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
I5A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID: 0 1 8,
(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)
El 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 1]
residuals land application program; Permit Nwnber 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. Furtheiiuore, 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. II 9 j
Landowner name: p � �h! . Kf��n 1,,
Address:
City: r''1 p(CxsA, ,L
Phone:
nature:
NORTH CAROLINA,
6 6 5, 2 L
State: / V C—
Ick E-mail address:
I, the undersigned Notary Public do hereby certify that
Zip: 2q iafy
COUNTY
got. 4-
Date:
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
VI -
day of
Signature and seal: ff
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: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read
Signing official name:
Signature:
is Agreemen
and do hereby agree to abide by the stipulations and restrictions as specified herein.
Date:
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land,Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
implication 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
pplicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
co (ies4rn
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
PO — c7 `7— Z
(LY
hr1dkAt„. ( A.
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 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7, The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Perniittee, 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 pennit; 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.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID: - 0
(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)
El 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: Z \ 0(
Address: S oc i I/i e_ ' L.
City: )
Phone:
Signature: :j JC.�'`""' Date:
Zip: p2(i a_a-
NORTH CAROLINA, Po k COUNTY
Qo, —GI Lo.
I, the undersigned Notary Public do hereby certify that
WITNESS my hand and official seal this the
day of rC b,,,
Signature and seal: L✓,
My commission expires: hi -6Zt 2-d a`$
personally appeared before me this day and acknowledged the due execution of the forgoing instrument. ottuniiiiito
viz
O`
•
G`
jREO
Lessee's/Operator's Certification:
Lessee/operator name:
EitAddress:
01 ( ",�./ IC r�
City: I ti v Li j State: ✓ " / C Zip;:, . D. i gD
Phone:CPcZ)g- I —'313'1 E-mail address: eiLtiii ( te(wafh QMitt ` tic t•
Signature: L/ft,4 ,j,{/i Date: 0 ( a. (2 2
State: /VC
E-mail address:
, 20
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
in El IA-6.0--1.5
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Iadr+ ` J.N
Date:
3/z/zz
FORM: LOA 06-16
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section 's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Lan 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
pplicant.
i. 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'hereb permits:
Applicant's name: 5 Yrii,s ID L4- -n 'r /,v i
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
1
1-4-') / - 112
^ /
44
I'►�i /Pb6 Lu.,1'L
/)
4/14 ,,c. ( f' 1-€ L
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 pen -nit 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 Perniittee 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 Permit -tee, 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.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID: L..4
(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)
El A re -defined coinpliance 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: Oil CV; C., . 111.6
Address: fichraion.
City: i\Co IrCrON
Phone: 1.5 7 07,- 7 9q471
Signature:
1)1602e ft iYuJevcc
NORTH CAROLINA,
C) \
State:
E-mail address:
I, the undersigned Notary Public do hereby certify that
Zip:
mor ee
Date: 0061
COUNTY
'Otte.% r tat
IAA L 1
personally appeared before me this day and acknowledged the due execution of the forgoing instrument..01111/1
i‘r 0' LEX
WITNESS my hand and official seal this the Z
day of (Ark kri , 20 1- Z--
Signature and seal: 11,
My commission expires:
Lessee's/Operator's Certification:
)— 2t
l
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State: Zip:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date: 19/7/2 Z
pripm• T (IA 116-1
Page 3 of 3

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section 's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Layd Owner Agreement (FORM: LOA 06-16):
Z1 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.
127A 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 landownerdor his representative hereby Ipermits:
I $ Qom. '-(114.5/1.* L4. , I'f (1.M,,,1 J_
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Li-^Z 3- /, Z
AzO
/'hski,,Y 1/7
4a.,a,, ( /:i
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, 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

STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Pennittee 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.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boun 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) 3
(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 n eeded)
El 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: �— c r ^ `{ ije t*
Address: 3 001
City:
Mtir rn.o
gC
)-..fnc°(4 J-o
State: ,i✓C,
Phone: 0 - 7`? o sa°n E-mail address:
Signature:
NORTH CAROLINA, L_, `n c--' 'Z COUNTY
I, the undersigned Notary Public do hereby certify that
A./motAC-L
Zip:
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
r `wilt/!`il
WITNESS my hand and official seal this the 2 `.�i j ' N FO4° 1/ice
i
day of rt bu A 7 , 20 �Z- Z��1 �� i
�tARy
•
—
Signature and seal: - Z
My commission expires: 0 L7 2 Z 4-9, .5`%.
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: State:
Phone: E-mail address:
Signature: Date:
Zip:
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
s
Signing official name:
Signature: ,07 `' Date: 4/Z/Z
F(1RM• T (A
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