WQ0037135_More Information Received_20240729

Initial Review
Reviewer
nathaniel.thorn burg
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) * W00037135
Applicant/Permittee U.S. Biosolids, Inc.
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* Zachery Key
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*
3364673550
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.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0037135
Has Current Existing permit number
Applicant/Permittee Address*
PO Box 146 Ronda, NC 28670
Facility Name*
U.S. Biosolids Class B Residuals Program
Please provide comments/notes on your current submittal below.
Additional Information Request for U.S. Biosolids, Inc. Land Application Permit WQ0037135
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.)
WQ0037135 Additional Information.pdf 5.45MB
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
Submission Date 7/29/2024

PO Box 146 Ronda, NC 28670
336-777-6909
www.usbiosolids.com
Thursday, July 18, 2024
Erick Saunders
North Carolina Department of Environmental Quality
Division of Water Resources
512 North Salisbury Street
Raleigh, NC 27699
Reference: Additional Information Request
Application No. WQ0037135
U.S. Biosolids, Inc. Class B Program
In a letter received from the Division of Water Resources, additional information was requested in the
review of Application No. WQ0037135.
The first request (item F) was in the summary form RSC 06-16. The annual dry tonnage for both Yadkin
Valley Sewer Authority and the Forest City WWTP are being increased due to approaching the dry
tonnage limits in previous years. A payment of $528.00 has been mailed, a copy of the check is included
with this letter.
The second issue (item G, number 1) was with the TCLP parameter of Methyl Ethyl Ketone. It is unknow
why there was an increase in this parameter across multiple residuals sources. As all samples were
reported using the same laboratory, it is my hypothesis that it was a laboratory issue, however they
have been unable to confirm this. All new samples were below the reportable limit. We will continue to
keep a close monitoring on this and may change laboratories if this or similar issues arise again.
In item G, number 2, it is stated that the TKN is less than the laboratory results. An updated RSC form for
the City of Belmont has been included with this letter.
Item G, number 3 states that the PAN calculation is incorrect for the Town of Spindale. An updated form
RSC for the Town of Spindale has been included with this letter.
Item G, Number 4 states that the SAR and the first year PAN Calculations appear to be incorrect for the
Yadkin Valley Sewer authority on form RSC. An updated form RSC has been included with this letter.
The following changes were updated on form LASC 06-16:

• The soil type for Fields NC-RU-NM-01 and 02 were corrected
• The acreage for field NC-WK-TL-03 has been updated to 2.3 acres
• The acreage for field NC-WK-BP-01 has been updated to 11.04 acres
• The acreage for field NC-WK-CM-02, subfield 2A has been removed
• The acreage for field NC-WK-TL-01 has been updated 2.4 acres
• The acreage for field NC-WK-TL-03 has been updated to 2.2 acres
A Landowners Agreement (LOA) has been signed by Rhonda Martin for the fields on site NC-GA-MH-02
A Landowners Agreement (LOA) has been signed by Kathleen Porter for her portion of field BP-04.
In section R the concerning the vicinity/setback maps:
1. An update map labeling fields NC-RU-FC-02 and 03 and been included.
2. There is no residence to the North of field NC-RU-FLA-02 on parcel 1632860. A copy of the
property summary from Rutherford County has been included showing no record of a
residence.
3. Due to the large buffer required for this residence, field NC-RU-NM-02 has been deleted
from the program.
4. Buffer maps for field NC-WK-BP-02 have been updated to reflect buffer changes.
5. There was no pond that could be found on maps nor on physical search of field NC-WK-BP-
01, so no changes to the map have been made.
6. Buffer map for field NC-WK-TL-01 has been updated to show a residence on parcel 0600534
7. Buffer map for field NC-WK-TL-03 has been updated to show a residence on parcel 0606284
and 0604164.
If you have any questions, please contact me at [e-mail] or at my direct line at 336-
467-3550.
Zach Key
U.S. Biosolids, Inc.

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 Policv"
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 Mere (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: httn:Hdea.nc.Rov/about/divisions/water-
re source s/Ulanninv/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:
httn://dea.nc. aov/contact/regional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link httD:Hdea.nc.2ov/about/divisions/water-resources/blannin2/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 tern
"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
Little Tennesse River
Basin And Savannah
River Drainage Area
French Broad River
Basin
Watauga River Basin
Broad River Basin
New River Basin
Catawba River Basin
Yadkin -Pee Dee River
Basin
Lumber River Basin
Roanoke River Basin
Chowan River Basin
Tar -Pamlico River
Basin
Pasquotank River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
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."
Streams entering Tennessee will be classified "B."
Streams entering the State of Tennessee are classified "C."
Streams entering South Carolina are classified "C."
Streams entering the State of Tennessee are classified "C."
Streams entering South Carolina are classified "C."
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Streams entering South Carolina are classified "C Sw."
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
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."
Streams entering Virginia are classified "C."
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."
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 U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acres.
ruction a);
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Code' ID O O ry PO Series Nameb Mapping Unit
or Rep. Slope'
R TL1 Eva Lucas
2.4
Wilkes
Corn
Fairview
FcB2
R TL2 Eva Lucas
3.5
Wilkes
Corn
Fairview
FcB2
R TL3 Eva Lucas
2.2
Wilkes
Corn
Fairview
FcB2
R TL4 Eva Lucas
6
Wilkes
Corn
Fairview
FcB2
R BPI Kathleen Porter
Joesph Bryant
11.04
Wilkes
Corn
Fairview
FcB2
R BP2 Kathleen Porter
Joesph Bryant
27.3
Wilkes
Corn
Fairview
FcB2
R BP3 Kathleen Porter
Joesph Bryant
13.36
Wilkes
Corn
Fairview
FcB2
R BP4 Joesph Bryant
26.6
Wilkes
Corn
Fairview
FcB2
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed)
♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
IL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID Latitude Longitude
Location Location Method Code Location Accuracy
Waterbody Subbasin and
Current
and Proposed
p
Datum
Stream Index No.
Class
TL1 36.2803030-80.9981030
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
TL2 36.2790080-80.9964750
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
TL3 36.2770720-80.9946280
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
TL4 36.2805640-81.0013360
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
BPI 36.2778190-81.0035920
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
BP2 36.2846640-81.0113750
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
BP3 36.2787530-81.0093610
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
BP4 36.2761920-81.0061470
NAD 83 MAP
Nearest Second
YADO1 12-48-1-(1)
C
C
FORM: LASC 06-16 Page 1

LAND APPLICATION SITE CERTIFICATION
Note: Please keep the site information (I.) and waterbody information (II.) of the same field on the same page.
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 502.12 net
acre. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Codes ID O O �' PO b Mapping Unit
Series Name or Rep. Slope'
R LW1 Barbara Walker
14.05 Wilkes
Fescue Fairview
FcB2
R LW2 Barbara Walker
8.16 Wilkes
Fescue Fairview
FcB2
R LW3 Barbara Walker
17.7 Wilkes
Fescue Fairview
FcB2
R DKl Charles Key
6.36 Wilkes
Fescue Pacolet
Pb132
R NMA Norman McDaniel
9.4 Rutherford
Corn/Wheat/Soybeans Cecil
CaB2
R NMB Norman McDaniel
13.0 Rutherford
Corn/Wheat/Soybeans Cecil
CaB2
R NMC Norman McDaniel
9 Rutherford
Corn/Wheat/Soybeans Cecil
CaB2
R NMI Norman McDaniel
6.2 Rutherford
Fescue Pacolet
PaC2
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified)
♦ T (Trans erred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling, Cecil, etc.)
Mapping Unit must be consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the
mapping unit is CeB2)
IL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Location
Site/Field ID Latitude Longitude Location Method Code Location Accuracy
Waterbody Subbasin and Current and Proposed
p
Datum
Stream Index No.
Class
LW1 36.1605030-80.92818110 NAD 83 MAP
Nearest Second
UT to West Swan Creek 12-51-1-(1)
C
C
LW2 36.1628530-80.9292560 NAD 83 MAP
Nearest Second
UT to West Swan Creek 12-51-1-(1)
C
C
LW3 36.1662080-80.9297810 NAD 83 MAP
Nearest Second
UT to West Swan Creek 12-51-1-(1)
C
C
DKO1 36.2648670-80.9696210 NAD 83 MAP
Nearest Second
Big Bugaboo 12-48-(0.7)
M
M
NMA 35.3655370-81.7605040 NAD 83 MAP
Nearest Second
West Fork Sandy Run 9-46-2
C
C
NMB 35.3668490-81.76241A° NAD 83 MAP
Nearest Second
West Fork Sandy Run 9-46-2
C
C
NMC 35.3820060-81.73818�0 NAD 83 MAP
Nearest Second
West Fork Sandy Run 9-46-2
C
C
NMI �5.3639900 -81.742841,0 NAD 83 Map
Nearest Second
U.t to West Fork Sandy Creek 9-46-2
C
C
Note: Please keep the site information (I.) and waterbody information (IL) of the same field on
the same page.
FORM: LASC 06-16 Page 2

LAND APPLICATION SITE CERTIFICATION
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acre. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s)
Codes ID O O � Series Name Mapping Unit
or Rep. Slope'
D NM2
Norman McDaniel
0
Rutherford
Fescue Pacolet
PaC2
R FC2
Forest Calton
5.5
Rutherford
Fescue Pacolet
PbB2
R FC3
Forest Calton
1.6
Rutherford
Fescue Pacolet
PbB2
R FLA1
Frank Lawson
7.2
Rutherford
Fescue Pacolet
PbB2
R FLA2
Frank Lawson
16.3
Rutherford
Fescue Pacolet
PbB2
R FLB 1
Frank Lawson
j?.7
Rutherford
Fescue Pacolet
PbB2
R FLB2
Frank Lawson
16.7
Rutherford
Fescue Pacolet
PbB2
R FLB3
Frank Lawso
Rutherford
Fescue Pacolet
PbB2
a Status Code for land application sites are: ♦ N (New) ♦ R (Renewed) ♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling,
Cecil, etc.)
Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope Cecil
in Anson County the mapping
unit is CeB2)
IL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude Longitude
Location Location Method Code Location
Accuracy
Waterbody Subbasin and
Current and Proposed
Datum
Stream Index No.
Class
NM2
35.3981680-81.7605040
NAD 83 MAP
Nearest Second
Sandy Run Creek 9-46-(1)
C
C
FC2
34.4379570-81.7986090 "
NAD 83 MAP
Nearest Second
Roberson Creek 9-41-14
WS-V
WS-V
FC3
35.4405620-81.7941460
NAD 83 MAP
Nearest Second
Roberson Creek 9-41-14
WS-V
WS-V
FLA1
35.3211030-81.7660030
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
WS-V
WS-V
FLA2
35.3204390-81.77156A°
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
WS-V
WS-V
FLB1
35.3277170-81.76519J°
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
WS-V
WS-V
FLB2
35.3294190-81*711720
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
WS-V
WS-V
FLB3
35.3297530 -81 O
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
WS-V
WS-V
Note: Please keep the site information (I.) and waterbody information (IL) of the same field on the same page
FORM: LASC 06-16 Page 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acre. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Codes ID O O �' PO b Mapping Unit
Series Name or Rep. Slope'
R FL134
Frank Lawson
2.9
Rutherford
Fescue Pacolet
Pb132
R FLC1
Frank Lawson
7.6
Rutherford
Fescue Pacolet
Pb132
R LB 1
Larry Bailey
8.0
Rutherford
Fescue Pacolet
Pb132
R LB2
Larry Bailey
11.7
Rutherford
Fescue Pacolet
PbB2
R LB3
Larry Bailey
3.1
Rutherford
Fescue Pacolet
PbB2
R LB4
Larry Bailey
5.4
Rutherford
Fescue Pacolet
Pb132
R LB2
Larry Bailey
`,6
Rutherford
Fescue Pacolet
Pb132
R LB6
Larry Bailey
0
Rutherford
Fescue Pacolet
PbB2
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed)
♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling,
Cecil, etc.)
Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope Cecil
in Anson County the
mapping unit is CeB2)
IL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude Longitude
Location Location Method Code
Location Accuracy
Waterbody Subbasin and
Current and Proposed
p
Datum
Stream Index No.
Class
FL134
35.3279830-81.7619030
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
FLC1
35.3202530-81.7597640
NAD 83 MAP
Nearest Second
Webbs Creek 9-41-22-(1)
KS-V
LB 1
35.3975100-81.7534630
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
�C
C
LB2
35.3991130-81.7563700
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
C
C
LB3
35.3952990-81.7571430
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
C
C
LB4
35.3948940-81.7571940
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
C
C
LB5
35.3935330-81.75451do
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
C
C
LB6
35.3944250-81.7545210
NAD 83 MAP
Nearest Second
U.T to West Fork Sandy Creek 9-46-2
C
C
Note: Please keep the site information (I.) and waterbody information (IL) of the same field on the same page
FORM: LASC 06-16 Page 4

LAND APPLICATION SITE CERTIFICATION
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acres.
TTT LAN
N 9 APPLIC-2A,T-10N SITE INFORMATION (S
s(cruclivn a)-.
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Code' ID O O ry PO Series Name Mapping Unit
or Rep. Slope
R MH 2-1
Charlie Killian
28.5 Gaston
Fescue
Cecil
CeB2
R MH 2-2
Charlie Killian
24.6 Gaston
Fescue
Cecil
CeB2
R MH 2-4
Charlie Killian
4.3 Gaston
Fescue
Cecil
CeB2
R MH 2-5
Charlie Killian
23.7 Gaston
Fescue
Cecil
CeB2
R JH-01
John Harrill
Norman McDaniel
14.1 Rutherford
Fescue
Pacolet
PaC2
R NM-03
Norman McDaniel
6.6 Rutherford
Fescue
Cecil
CaB2
R RD1A
Norman McDaniel
4.3 Rutherford
Fescue
Cecil
CaB2
R RD1B
Norman McDaniel
29.3 Rutherford
Fescue
Cecil
CaB2
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed)
♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling,
Cecil, etc.)
'Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope
Cecil in Anson County the mapping unit is CeB2)
IV. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude Longitude
Location Location Method Code Location Accuracy
Waterbody Subbasin and
Current and Proposed
Datum
Stream Index No.
Clsss
MH 2-1
81° X' W"
NAD 83 MAP
Nearest Second
Dutchmans Creek
WS IV
WS IV
MH 2-2
35° 24' 19" 81° 03' 06"
NAD 83 MAP
Nearest Second
Dutchmans Creek
WS IV
WS IV
MH 2-4
350 24' 12" 810 02' 38"
NAD 83 MAP
Nearest Second
Dutchmans Creek
WS IV
WS IV
MH 2-5
00 ft' 09" UO f' M"
NAD 83 MAP
Nearest Second
Dutchmans Creek
WS IV
WS IV
JH-01
35.3640580-81.7215750
NAD 83 MAP
Nearest Second
Sandy Run Creek 96-46-(1)
C
C
NM-03
35.3638120-71.724141 °
NAD 83 MAP
Nearest Second
West Fork Sandy Run Creek 9-46-2
c
c
RD1A
35.3604380-81.7387080
NAD 83 MAP
Nearest Second
West Fork Sandy Run Creek 9-46-2
C
C
RD1B
35.3270390-81.7355470
NAD 83 MAP
Nearest Second
West Fork Sandy Run Creek 9-46-2
C
C
Note: Please keep the site
information (I.) and waterbody information (IL) of the same field on
the same page.
FORM: LASC 06-16 Page 5

LAND APPLICATION SITE CERTIFICATION
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acres.
V. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Codes ID O O ry PO b Mapping Unit
Series Name or Rep. Slope'
R RD2
Norman McDaniel
19.6
Rutherford
Fescue Cecil
CaB2
R CM-01
Billy Hinson
3.45
Wilkes
Fescue Fairview
FcB2
R CM-02
Billy Hinson
4.7
Wilkes
Fescue Fairview
FcB2
R SK-01
Stephen Key
17.1
Wilkes
Fescue Fairview
FcB2
R SK-02
Stephen Key
0.80
Wilkes
Fescue Fairview
FcB2
R SK-03
Stephen Key
3.50
Wilkes
Fescue Codorus
CoA
R SK-04A
Stephen Key
7.10
Wilkes
Fescue Fairview
FcB2
R SK-04B
Stephen Key
3.47
Wilkes
Fescue Fairview
FcB2
'Status Code for land application sites are: ♦ N (New) ♦ R (Renewed)
♦ M (Modified)
♦ T (Transferred) ♦ D (Deleted)
b Soil Series Name (i.e. Appling,
Cecil, etc.)
Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope Cecil
in Anson County the mapping unit is CeB2)
VI. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude Longitude
Location Location Method Code Location
Accuracy
Waterbody Subbasin and Current and Proposed
p
Datum
Stream Index No.
Class
RD2
35.3576380-81.7387240
NAD 83 MAP
Nearest Second
West Fork Sandy Run Creek 9-46-2
C
C
CM-01
36.2688970-80.9618660
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
CM-02
36.2688970-80.9618660
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
SK-01
36.2545590-80.9457060
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
SK-02
36.2474500-80.9471430
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
SK-03
36.2515970-80.9483930
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
SK-04A
36.2546310-80.9486630
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
SK-04B
36.2530290-80.9478190
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV
WS-IV
Note: Please keep the site information (I.) and waterbody information (IL) of the same field on the same page
FORM: LASC 06-16 Page 6

LAND APPLICATION SITE CERTIFICATION
Applicant's name: U.S. Biosolids, Inc.
Land application sites currently certified: 509.17 net acres and Total to be certified: 501.12 net
acre
VII. LAND APPLICATION SITE INFORMATION (See Instruction B):
Predominant Soil
Status Site/Field Landowners Lessees or Operator(s) Net Acres County Crop(s) s
Codes ID O O ry PO Series Name Mapping Unit
or Rep. Slope'
R SK-04C
Stephen Key
2.73
Wilkes
Fescue
Fairview
FcB2
R TB-01
Tristen Blevins
14.9
Wilkes
Fescue
Fairview
FcB2
R TB-02
Tristen Blevins
4.1
Wilkes
Fescue
Fairview
FcB2
N
N
N
N
N
p
a Status Code for land application sites are: ♦ N (New) ♦ R (Renewed)
♦ M (Modified)
♦ T (Transferred)
♦ D (Deleted)
b Soil Series Name (i.e. Appling,
Cecil, etc.)
Mapping Unit must be consistent with those used in the County
Soil Survey (i.e. for a 2-8% slope Cecil in
Anson County the mapping unit is Ce132)
VIIL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude Longitude
Location Location Method Code Location Accuracy
Datum
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class
SK-04C
36.2530290-80.9478190
NAD 83 MAP
Nearest Second
Big Bugaboo Creek 12-48-(0.7)
WS-IV WS-IV
TB-01
36.2635530-81.0055660
NAD 83 MAP
Nearest Second
Little Bugaboo Creek 12-48-1-(1)
C C
TB-02
36.2620960-81.0069260
NAD 83 MAP
Nearest Second
Little Bugaboo Creek 12-48-1-(1)
C C
_
00 O'." 00 O'."
NAD 83 ADD
Nearest Second
_
_
00 O'." 00 O'."
NAD 83 ADD
Nearest Second
_
_
00 O'." 00 O'."
NAD 83 ADD
Nearest Second
_
_
00 O'." 00 O'."
NAD 83 ADD
Nearest Second
_
_
00 O'." 00 O'."
NAD 83 ADD
Nearest Second
_
Note: Please keep the site information (I.) and waterbody information (IL) of the same field on the same page
FORM: LASC 06-16 Page 7

h ro
iepartme
State of ina
f Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
it t
2. Facility permitlholN&qs: y NW jqfBeW State,0 Local Government, or 0 Private.
Facility permit issued by: ® Div. of Water Resources, Div. of Environmental Health,
or A Other (explain: _).
3. Facility contact person and title: Tanva Setzer. WWTP Superintendent-ORC
Complete mailing address: PO Box 431
City: Belmont State: NC Zip: 28012
Telephone number: [phone] E-mail address: tsetzer6 citvofbelmont.om
4. Facility physical address: 298 Parkdale Drive
City: Belmont State: NC Zip: 28012
Coordinates: Latitude: 35' 13' 50.04" Longitude: 81' OF 03.61"
Datum: NAD83 Level of accuracy: 0.01
Method of measurement: MAP
5. Purpose of the facility:
® treatment of municipal wastewater, treatment of 100% domestic wastewater,
❑ treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
other (explain: _ ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 5 MGD and facility average daily flow: 3.2 MGD
8. Average amount of residuals being generated at this facility _ dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 1.7 Million Gallon Sludge Holding Tank
Type and volume of residuals storage (i.e., outside of residuals treatment units): _
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Biological 0 Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination:
Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR
§261.31-§261.33: 0
yes ❑ no.
If yes, list the number(s): _
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: 0 yes Ui no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: PAR and Date of analysis: 4-26-2023
Passed corrosivity test: yes
no. pH: s.u.
(2 < pH < 12.5)
Passed ignitability test: yes
no. Flashpoint: 200 OF (> 140°F)
Passed reactivity test: Eyes Ono. HCN: NON mg/kg
(<250) & H2S: NON mg/kg (<500)
TCLP Parameter
Limit Result
TCLP Parameter
Limit
Result
(mg17) (mg17)
(mg17)
(mg17)
Arsenic
5.0 0.5
Hexachlorobenzene
0.13
0.013
Barium
100.0 10
Hexachloro-1,3-Butadiene
0.5
0.05
Benzene
0.5 0.05
Hexachloroethane
3.0
0.3
Cadmium
1.0 0.1
Lead
5.0
0.5
Carbon Tetrachloride
0.5 0.05
Lindane
0.4
0.04
Chlordane
0.03 0.003
Mercury
0.2
0.1
Chlorobenzene
100.0 10
Methoxychlor
10.0
1
Chloroform
6.0 0.6
Methyl Ethyl Ketone
200.0
318
Chromium
5.0 0.5
Nitrobenzene
2.0
0.2
m-Cresol
200.0 20
Pentachlorophenol
100.0
10
o-Cresol
200.0 20
Pyridine
5.0
0.5
p-Cresol
200.0 20
Selenium
1.0
0.5
Cresol
200.0 20
Silver
5.0
0.5
2,4-D
10.0 1
Tetrachloroethylene
0.7
0.07
1,4-Dichlorobenzene
7.5 0.75
Toxaphene
0.5
0.05
1,2-Dichloroethane
0.5 0.05
Trichloroethylene
0.5
0.05
1, 1 -Dichloroethylene
0.7 0.07
2,4,5-Trichlorophenol
400.0
40
2,4-Dinitrotoluene
0.13 0.013
2,4,6-Trichlorophenol
2.0
0.2
Endrin
0.02 0.002
2,4,5-TP (Silvex)
1.0
0.1
Heptachlor and its Hydroxide
0.008 0.008
Vinyl Chloride
0.2
0.02
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: WavDoint Analvtical and Date of analysis: 3-16-2023
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mglkg)
(mglkg)
(mglkg)
Arsenic
75
41
16.7
Cadmium
85
39
3.33
Copper
4,300
1,500
329
Lead
840
300
17.7
Mercury
57
17
6.17
Molybdenum
75
n/a
8.33
Nickel
420
420
21.1
Selenium
100
100
16.7
Zinc
7,500
2,800
1880
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: = and Date of analysis: =
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
❑ >0but <25
❑ >25but <50
❑ > 50 but < 75
❑ > 75 but < 100
❑ > 100 but < 125
❑ > 125
Result (mg/kg)
Arsenic
Chromium
Nickel
(mglkg)
(mglkg)
(mglkg)
30
200
210
34
220
240
39
260
270
46
300
320
53
360
390
62
450
420
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 3.04 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: WavDoint Analvtical and Date of analysis: 3-16-2023
Parameter
Result
(mglkg)
Aluminum
43700
Ammonia -Nitrogen
330
Calcium
16500
Magnesium
4130
Nitrate -Nitrite Nitrogen
343
pH (Standard Unit)
6.4
Phosphorus
27900
Potassium
4570
Sodium
5400
Total Kjeldahl Nitrogen
149000
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): 1.69
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): JW default value, or 0 actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, ex lain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method First (15) Year PAN Five -Year
Maximum Adjusted PAN
(mglkg) (mg/kg)
Surface 45709 72298.55
Injection/Incorporation 47374 73534.94
6. Other Pollutants Determination• S ecify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
JJ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
IR Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
q Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
q Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
q Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, i heat drying, II heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.I 106(c)(01 - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(c)(2 - Process to Si ficantly Reduce Pathogens (PSRP).
Specify one: El digestion air drying, , anaerobic digestion,
❑ composting, or lime stabilization.
c. For Surface Disposal:
14 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
J Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
J Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
J Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
71 Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
El Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
El Alternative 5 [15A NCAC 02T. I 107(a)(5)] - 14-Day Aerobic Processes.
El Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
El Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
El Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
El Alternative 9 [15A NCAC 02T. I 107(a)(9)] - Injection.
El Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
id Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 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 ADnlicant shall submit one original and two conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharze Permittinty Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) 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 a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Man Guidance for
Residuals Land Annlication Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of SDindale
2. Facility permit holder is: ❑ Federal, 0 State, 0 Local Government, or 0 Private.
Facility permit issued by: Div. of Water Resources, Div. of Environmental Health,
or Other (explain: M.
3. Facility contact person and title: Guv O' Connor
Complete mailing address: PO Box 186
City: SDindale State: NC Zip: 28160
Telephone number: [phone] E-mail address: 2oconnor(d�Windalenc.net
4. Facility physical address: 101 Ecolo2v Street
City: SDindale State: NC Zip: 28160
Coordinates: Latitude: 35.375789' Longitude:-81.905717'
Datum: NAD83 Level of accuracy: 0.01
Method of measurement: GPS
5. Purpose of the facility:
® treatment of municipal wastewater, treatment of 100% domestic wastewater,
❑ treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
other (explain: _ ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 6.0 MGD and facility average daily flow: 0.75 MGD
8. Average amount of residuals being generated at this facility 50 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Two 200.000 gallon digesters
Type and volume of residuals storage (i.e., outside of residuals treatment units): _
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Biological E Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination:
Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have
to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater
only)
a. Are the residuals listed in 40 CFR
§261.31-§261.33: 0
yes ® no.
If yes, list the number(s): _
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: N yes 5 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: PAR and Date of analysis:
7-12-2023
Passed corrosivity test: yes
IF no. pH: s.u.
(2 < pH < 12.5)
Passed ignitability test: yes
❑ no. Flashpoint: 200 OF (> 140°F)
Passed reactivity test: Eyes Ono. HCN: NON mg/kg
(<250) & H2S: NON mg/kg (<500)
TCLP Parameter
Limit Result
TCLP Parameter
Limit
Result
(mg17) (mg17)
(mg17)
(mg17)
Arsenic
5.0 0.5
Hexachlorobenzene
0.13
0.013
Barium
100.0 10
Hexachloro-1,3-Butadiene
0.5
0.05
Benzene
0.5 0.05
Hexachloroethane
3.0
0.3
Cadmium
1.0 0.1
Lead
5.0
0.5
Carbon Tetrachloride
0.5 0.05
Lindane
0.4
0.04
Chlordane
0.03 0.003
Mercury
0.2
0.02
Chlorobenzene
100.0 10
Methoxychlor
10.0
1
Chloroform
6.0 0.6
Methyl Ethyl Ketone
200.0
20
Chromium
5.0 0.5
Nitrobenzene
2.0
0.2
m-Cresol
200.0 20
Pentachlorophenol
100.0
10
o-Cresol
200.0 20
Pyridine
5.0
0.5
p-Cresol
200.0 20
Selenium
1.0
0.1
Cresol
200.0 20
Silver
5.0
0.5
2,4-D
10.0 1
Tetrachloroethylene
0.7
0.07
1,4-Dichlorobenzene
7.5 0.75
Toxaphene
0.5
0.05
1,2-Dichloroethane
0.5 0.05
Trichloroethylene
0.5
0.05
1,1-Dichloroethylene
0.7 0.07
2,4,5-Trichlorophenol
400.0
40
2,4-Dinitrotoluene
0.13 0.013
2,4,6-Trichlorophenol
2.0
0.2
Endrin
0.02 0.002
2,4,5-TP (Silvex)
1.0
0.1
Heptachlor and its Hydroxide
0.008 0.0008
Vinyl Chloride
0.2
0.02
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: WavDoint and Date of analysis: 6-7-2023
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mglkg)
(mglkg)
(mglkg)
Arsenic
75
41
23.8
Cadmium
85
39
4.76
Copper
4,300
1,500
729
Lead
840
300
71.4
Mercury
57
17
7.67
Molybdenum
75
n/a
11.9
Nickel
420
420
37.2
Selenium
100
100
23.8
Zinc
7,500
2,800
1830
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: = and Date of analysis: =
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
❑ >0but <25
❑ >25but <50
❑ > 50 but < 75
❑ > 75 but < 100
❑ > 100 but < 125
> 125
Result (mg/kg)
Arsenic
Chromium
Nickel
(mglkg)
(mg1kg)
(mglkg)
30
200
210
34
220
240
39
260
270
46
300
320
53
360
390
62
450
420
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 2.14 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Wavnoint and Date of analysis: 6-7-2023
Parameter
Result
(mg1kg)
Aluminum
30900
Ammonia -Nitrogen
10900
Calcium
18100
Magnesium
3800
Nitrate -Nitrite Nitrogen
238
pH (Standard Unit)
6.9
Phosphorus
19100
Potassium
4600
Sodium
10400
Total Kjeldahl Nitrogen 62400
c. Using the results listed in Item IL 5b. above, calculate the sodium adsorption ration (SAR): 2.68
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): Ji default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, ex lain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method First (1st) Year PAN Five -Year
Maximum Adjusted PAN
(mg/kg) (mg/kg)
Surface 21338 26588
Injection/Incorporation 31759.82 35806.86
6. Other Pollutants Determination• S ecify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Eauivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
JJ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
14 Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
J Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
E] Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, W heat drying, heat treatment,
thermophilic aerobic digestion, beta ray irradiation,
gamma ray irradiation, or I pasteurization.
b. For Land Application of Class B.
Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: ❑ aerobic digestion, I
air drying, ❑ anaerobic digestion,
❑ composting, or lime stabilization.
c. For Surface Disposal:
14 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
J Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
J Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
J Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107. specify how residuals will meet the VAR requirements:
Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
E] Alternative 4 [15A NCAC 02T. 1107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
E] Alternative 5 [15A NCAC 02T. I 107(a)(5)] - 14-Day Aerobic Processes.
E] Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
E] Alternative 7 [15A NCAC 02T. 1107(a)(7)] - Drying of Stabilized Residuals.
E] Alternative 8 [15A NCAC 02T. 1107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T. 1107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.I107(a)(10)] - Incorporation.
q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
id Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 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 conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Discharze Permittinty Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) 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 a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Man Guidance for
Residuals Land Annlication Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item I. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Yadkin Vallev Sewer Authoritv
2. Facility permit holder is: ❑ Federal, 0 State, 0 Local Government, or 0 Private.
Facility permit issued by: ❑ Div. of Water Resources, Div. of Environmental Health,
or ❑ Other (explain: _).
3. Facility contact person and title: Nichole Johnston. Executive Director
Complete mailing address: PO Box 828
City: Elkin State: NC Zip: 28621
Telephone number: [phone] E-mail address: Nichole.iohnston(n vvsa.om
4. Facility physical address: 200 Marion St.
City: Elkin State: NC Zip: 28621
Coordinates: Latitude: 36' 49' 24.58" Longitude: 80' 49' 57.66"
Datum: NAD 83 Level of accuracy: .01
Method of measurement: MAP
5. Purpose of the facility:
® treatment of municipal wastewater, treatment of 100% domestic wastewater,
❑ treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and _ % domestic)
other (explain: _ ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 1.8 MGD and facility average daily flow: 0.805 MGD
8. Average amount of residuals being generated at this facility 85.13 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 300.000 Gallon & 210.000 gallons residuals holding tank
Type and volume of residuals storage (i.e., outside of residuals treatment units): _
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
40 CFR Part 503 or 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1102(6) as:
Biological 0 Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination:
Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR
§261.31-§261.33: 0
yes ® no.
If yes, list the number(s): _
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: 0 yes Ui no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: PAR and Date of analysis:
5-10-2023
Passed corrosivity test: yes
no. pH: s.u.
(2 < pH < 12.5)
Passed ignitability test: yes
no. Flashpoint: 200 OF (> 140°F)
Passed reactivity test: Eyes Ono. HCN: NON mg/kg
(<250) & H2S: NON mg/kg (<500)
TCLP Parameter
Limit Result
TCLP Parameter
Limit
Result
(mg17) (mg17)
(mg17)
(mg17)
Arsenic
5.0 0.5
Hexachlorobenzene
0.13
0.013
Barium
100.0 10
Hexachloro-1,3-Butadiene
0.5
0.05
Benzene
0.5 0.05
Hexachloroethane
3.0
0.3
Cadmium
1.0 0.1
Lead
5.0
0.5
Carbon Tetrachloride
0.5 0.05
Lindane
0.4
0.04
Chlordane
0.03 0.003
Mercury
0.2
0.02
Chlorobenzene
100.0 10
Methoxychlor
10.0
1
Chloroform
6.0 0.6
Methyl Ethyl Ketone
200.0
0.2
Chromium
5.0 0.5
Nitrobenzene
2.0
0.2
m-Cresol
200.0 20
Pentachlorophenol
100.0
10
o-Cresol
200.0 20
Pyridine
5.0
0.5
p-Cresol
200.0 20
Selenium
1.0
0.1
Cresol
200.0 20
Silver
5.0
0.5
2,4-D
10.0 1
Tetrachloroethylene
0.7
0.07
1,4-Dichlorobenzene
7.5 0.75
Toxaphene
0.5
0.05
1,2-Dichloroethane
0.5 0.05
Trichloroethylene
0.5
0.05
1, 1 -Dichloroethylene
0.7 0.07
2,4,5-Trichlorophenol
400.0
40
2,4-Dinitrotoluene
0.13 0.013
2,4,6-Trichlorophenol
2.0
0.2
Endrin
0.02 0.002
2,4,5-TP (Silvex)
1.0
0.1
Heptachlor and its Hydroxide
0.008 0.0008
Vinyl Chloride
0.2
0.02
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: WavDoint Analvtical and Date of analysis: 4-5-2023
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(ClassA & ClassB)
(Class A Only)
(mglkg)
(mglkg)
(mglkg)
Arsenic
75
41
19.2
Cadmium
85
39
3.85
Copper
4,300
1,500
240
Lead
840
300
18.5
Mercury
57
17
6.85
Molybdenum
75
n/a
9.62
Nickel
420
420
17.8
Selenium
100
100
19.2
Zinc
7,500
2,800
523
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: = and Date of analysis: =
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
❑ >0but <25
❑ >25but <50
❑ > 50 but < 75
❑ > 75 but < 100
❑ > 100 but < 125
❑ > 125
Result (mg/kg)
Arsenic
Chromium
Nickel
(mglkg)
(mglkg)
(mglkg)
30
200
210
34
220
240
39
260
270
46
300
320
53
360
390
62
450
420
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 2.57 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Wavnoint Analvtical and Date of analysis: 4-5-2023
Parameter
Result
(mglkg)
Aluminum
49600
Ammonia -Nitrogen
10800
Calcium
11700
Magnesium
3850
Nitrate -Nitrite Nitrogen
192
pH (Standard Unit)
6.7
Phosphorus
33400
Potassium
6580
Sodium
2030
Total Kjeldahl Nitrogen
72300
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 0.66
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local
Cooperative Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, a North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals.
The recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism
for maintaining site integrity and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %.
This rate is a (check one): iii default value, or 0 actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide
technical justification as to why the selected default value is appropriate to be applied to these_ials:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method First (15) Year PAN Five -Year
Maximum Adjusted PAN
(mglkg) (mg/kg)
Surface 24042 36464.75
Injection/Incorporation 29442 40474.67
6. Other Pollutants Determination• S ecify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
JJ A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
IR Alternative 1 [15A NCAC 02T.I 106(b)(3)(A)] - Time/Temperature Compliance.
q Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
q Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
q Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, i heat drying, II heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.I 106(c)(01 - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(c)(2 - Process to Si ficantly Reduce Pathogens (PSRP).
Specify one: El digestion air drying, , anaerobic digestion,
❑ composting, or lime stabilization.
c. For Surface Disposal:
14 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above.
J Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item II. 7b. above.
J Exempt -If Daily Cover Alternative is chosen in Item II.8. below [15A NCAC 02T.1106(a)(2)].
J Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1107, specify how residuals will meet the VAR requirements:
71 Alternative 1 [15A NCAC 02T.1107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
El Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
El Alternative 5 [15A NCAC 02T. I 107(a)(5)] - 14-Day Aerobic Processes.
El Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
El Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
El Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabilized Residuals.
El Alternative 9 [15A NCAC 02T. I 107(a)(9)] - Injection.
El Alternative 10 [15A NCAC 02T.I 107(a)(10)] - Incorporation.
q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
id Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
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 conies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Nan -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 lesse eloperator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
U.S. Biosolids. Inc.
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field 1D
Lease
Land Use or
Intended Use of Crops
(yes/no)
Cropping Patterns
MH 2-1
No
Fescue
Hay
MH 2-2
No
Fescue
Hay
MH 2-4
No
Fescue
Hay
MH 2-5
No
Fescue
Hay
Residuals Source Special note
(optional) (no-till/over-seed/
pasture)
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 Iandowner 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 teens 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 Pennittce 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 f'or 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 terns 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.
IL 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 f'or 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 fbr 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)
® 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 WO: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program -
(Name of the new program)
FORM: LOA 11-13 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to 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: � � Q^ a a M 0.r--1 ` n
Address: -1 Lj 1 d 3 1 c.
v
City: State: N L Zip: a 8( 26
Phone: _ _ E-mail address:
Signature:. Date:
NORTH CAROLINA, Gee h COUNTY
I, the undersigned Notary Public do hereby certify that R � dt%rfit
personally appeared before me this day and acknowledged the due % of t�y forgoing instrument.
WITNESS my hand and official seal this the
day of J `�� Notary ovw,,, 20 L/
— Wilkes Coon
Signature and seal:
f0
My commission expires:?I
4 j�, �'�I
Lessee's/Operator's Certification:
I certify that 1 have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State: Zip:
E-mail address:
Date:
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: 7111-4
Zoo I. Ke �,
Date: I-?). ? O .pq
FORM: LOA 11-13 Page 3 of

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
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:
U.S. Biosolids. Inc.
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
Land Use or
Intended Use of Crops
(yes/no)
Cropping Patterns
BPI
Yes
Corn
Silage
BP2
Yes
Corn
Silage
BP3
Yes
Corn
Silage
BP4
Yes
Corn
Silage
Residuals Source Special note
(optional) (no-till/over-seed/
pasture)
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 Pagel 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 Iime 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 patters, 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 landapplication site(s) prior to each planting season to enablethe 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 compliance
boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program; _
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OQi 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: Kathleen Porter
Address: 3573 Greenhorn Road
City: Roaring River State: NC Zip: 28669
Phone: [phone] E-mail address:
Signature: Ailw— 1 rl"-4 Date: 2�-`�%
NORTH CAROLINA, Wilkes COUNTY
1, the undersigned Notary Public do hereby certify that Eva Jolly Lucas
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of ✓� `<t`���tu►�i jjfI4,'o 2
Signature and seal:
My commission expi es: Ll �i' �d� V Notory Public
r Wilkes County
Lessee's/Operator's Certification: �'" 0
CA(ZO���`�
I certify that I have read this Agreement and do hereby agree to abide by the S�rLi'%1'tt�t�ations and restrictions as specified herein.
Lessee/operator name: Joesoh Garret Bryant
Address: 1460 GREENHORN ROAD
City: Roaring River State: NC
Phone: [phone] E-mail address:
�
Signature: ! �r /lam
Permittee's Certification:
Zip: 28669
Date:
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: Z�jacch, Key
Signature: / G_
Date:
FORM: LOA 06-16 Page 3 of 3

FILED
WILKES COUNTY
MISTY M. SMITHEY
REGISTER OF DEEDS
FILED Jul 26, 2024
AT 01:10:54 pm
BOOK 01399
PAGE
0334
INSTRUMENT # 04925
EXCISE TAX (None)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR RESIDUAL TREATMENT, STORAGE, AND DISPOSAL UNITS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(a) and 02T .1108(d)
I, Joseph Brvant
, certify that I am a deeded owner of the property located at:
Address: KENNETH CHEEK LOT 8 Parcel No.: 0606476
City: Roaring River State: NC. __ Zip Code: 28669 County: Wilkes
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.
® For the parcel identified above, I consent to a reduced setback from 100 feet to 0 feet, thereby
allowing the construction of residuals treatment, storage, and surface disposal units as near as
Q feet from my property line.
❑ For the parcel identified above, I consent to a reduced setback from __ feet to feet,
thereby allowing the construction of residuals treatment and storage units as near as feet
from my residence.
❑ For the parcel identified above, I consent to a reduced setback from ^_ feet to feet,
thereby allowing the construction of surface disposal units as near as feet from my
residence.
Signature: _4�
Date: 7-16 3oal
FORM: NDRMPW-S&T 11-18 Page 1 of

Applicant/Permittee: U. S Biosolids,I nc.
Address: PO Box 146 Parcel No.: 0606478
City: Ronda State: _NC_ Zip Code: 28670 County: Wilkes
NORTH CAROLiI//NA, W l�P_$ COUNTY
I, LU C l.t� r�P�,, , a Notary Public for k/ . 1 K,,-S County, North Carolina,
do hereby certify that 05 c pk & �„ _" f personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the a" C day of
AL
Notary Public
Wilkes County
'r111rlf rlllt0
l44� /
Sign ture of Notary Public
My commission expires / 'q'.7 C O-S
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-S&T 11-18 Page 2 of 2

FILED
WILKES COUNTY
MISTY M. SMITHEY
REGISTER OF DEEDS
FILED Jul 26, 2024
AT 01:10:55 pm
BOOK 01399
PAGE
0335
INSTRUMENT # 04926
EXCISE TAX (None)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR RESIDUAL TREATMENT, STORAGE, AND DISPOSAL UNITS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(a) and 02T .1108(d)
1, Kathleen Porter , certify that I am a deeded owner of the property located at:
Address: KENNETH CHEEK LOT 8 Parcel No.: 0606478
City: Roari rg River State: NC__ Zip Code: 28669 County: Wilkes
Furthennore, 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.
® For the parcel identified above, I consent to a reduced setback from 100 feet to 0 feet, thereby
allowing the construction of residuals treatment, storage, and surface disposal units as near as
0 feet from my property line.
❑ For the parcel identified above, I consent to a reduced setback from feet to feet,
thereby allowing the construction of residuals treatment and storage units as near as feet
from my residence.
❑ For the parcel identified above, 1 consent to a reduced setback from feet to feet,
thereby allowing the construction of surface disposal units as near as feet from my
residence.
Signature: C � P"t'—
FORM: NDRMPW-S&T 11-18
Date:
Page 1 of 2

Applicant/Permittee: U.S. Biosol idyl nc.
Address: PO Box 146 Parcel No.: 0606476
City: Ronda State: NC Zip Code: 28670 County! Wilkes
NORTH CAROLjINA, �"� ` xy-C-S COUNTY
I, Z``� �`r'� l , a Notary Public for �� l�rS County, North Carolina,
do hereby certify that z }K I' P '� �personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
y --
Witt and official seal, this the day of �-F —'�
SE#Jory PublfC
ices countyAll
tit
Sign04e of Notary Public
/'
O
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: NDRWW-S&T 11-18 Page 2 of 2

f
Compliance and Review Boundaries
The compliance boundary is established either 250 feet from the
edge of the residuals application area or 50 feet within the property
boundary, whichever is closest to the application area The review
boundary is established halfway between the compliance boundary
and the edge of the residuals application area.
a ,
` • •;•L . . ABC* a
f ♦ � Lr 'rM
r I Mission Dr.
�` a ',• ��• . .� �`�
�
F
w-
i
Buffers
i
Property Line (50')
� 4
Surface Water (100') -
Perennial Stream (100')
House (400') E�
Legend Well
House
Pro pert' Line X Soil Boring
Field Boundary _ Surface Water
Perennial Stream wwa Unused Area
Calton, F.: Compiiance and Review, Field 2 Field FC2 & FC3
Parcel: 164 484 3
0 250 500
Rutherford County NC
35.4379-81.7984 North Carolina Stater lane NAD8:3
1,000 Feet
Nov. 2016
Shaffer Soil Services Inc.

7124/24, 4:15 PM Print Property Info
Property Summary
Tax Year: 2024
REID 1632860 PIN 1578-33-5886 Property Owner BLEIGH, DAVID W
Location Address 391 WEBB CHURCH RD Property Description Owner's Mailing Address PO BOX 103
BOLT WV 25817
Administrative Data
Transfer Information
Plat Book & Page
Deed Date
11/29/2021
Old Map #
NONE
Deed Book
002054
Market Area
A21C
Dead Page
01270
Township
Colfax
Revenue Stamps
$10
Planning
RUTHERFORD
Package Sale Date
11/29/2021
Jurisdiction
Package Sale Price
$2,500
City
ELLENBORO
Land Sale Date
Fire District
F11 ELLENBORO
Land Sale Price
Spec District
Land Class
SINGLE FAMILY
Improvement Summary
RES
Total Buildings
0
History REID 1
Total Units
0
History REID 2
Total Living Area
0
Acreage
3.31
Total Gross Leasable Area
0
Permit Date
Permit
Photograph
No Photo Pound
Building Summary
Property Value
Total Appraised Land Value
$26,200
Total Appralsed Building Value
Total Appraised Mlsc
$2,300
Improvements Value
Total Cost Value
$28,500
Total Appraised Value -vaiwd By
$28,500
cost
Other Exemptions
Exemption Desc
Use Value Deferred
Historic Value Deferred
Total Deferred Value
Total Taxable Value
$28,500
httpsaArcpwa,ncptscloud.corn/Rutherford/PrintPRC_aspx?PARCELPK=42483 1 /2

7/24/24, 4:15 PM
Misc Improvements Summary
Card Unit Measure Type
# Quantity
Print Property Info
Base . Size Adj Eff Phys Econ Funct Common
Price :Factor Year Depr (% Depr (% Depr (% Interest (% Value
Bad) Bad) Bad) Good)
0 t SIZE R/V $2,300.00 2014 0 0 0 $2,300
CAMPSITE
Total Misc Improvements Value Assessed: $2,300
Land Summary
Land Class: SINGLE FAMILY RES Deeded Acres: 0
Zoning Soll Class Description Size
NONE RESIDENTIAL 3.31 BY THE ACRE PRICE
Total Land Value Assessed: $26,200
Ownership History
Owner Name
Current BLEIGH, DAVID W
1 Back BLEIGH, DAVID W/ BLEIGH, LILA R
2 Back LAUGHTER, ANTHONYA/ LAUGHTER, NANCY
GAIiJ GRAVELY, JEREMY SHANE/ GRAVELY,
GEORGIANA SPRING
3 Back LAUGHTER, ANTHONY A
Notes Summary
Building Card
No Data
Calculated Acres: 0
Rate Size Adj. Factor Land Adjustment Land Value
$5,600 1.77 SHAPE-80.00 $26,200
Deed Type
% Ownership
Stamps
Sale
Book
Page
Deed Date
Price
DEED,
100
10
$2,500
002054
01270
11/29/2021
QUIT
CLAIM
DEED
100,100
20
$10,000
001091
00387
9/11/2014
DEED
100, 100,
0
001075
00642
12/5/2013
100,100
DEED
Date
100 44 $22,000 000919 00397 11/22/2006
Line
Notes
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BP 2-2
COMPIANCE AND REVIEW BOUNDARIES:
The compliance boundary is established either 250 feet from the
edge of the residuals application area or 50 feet within the
property boundary, whichever is closest to the application area
The review boundary is established halfway between the
compliance boundary and the edge of the residuals application
area. �Cr
BP 2-1
21.6 Acres
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2.4 Acres
COMPIANCE AND REVIEW BOUNDARIES:
The compliance boundary is established either 250 feet from
the edge of the residuals application area or 50 feet within the
property boundary, whichever is closest to the application area.
The review boundary is established halfway between the ..=r,
compliance boundary and the edge of the residuals application
area.
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COMPIANCE AND REVIEW BOUNDARI
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The compliance boundary is established
either 250 feet froff0the edge of the residuqls
Rapplication area or 10 feet within the property
boundary, whichevi is closest to the
rOJO application area. TIC review boundary i
Ila established halfway between the compl'
boundary and the edge of the residual
application area.
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110"
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U.S. Biosolids, Inc.
TRUIST FINANCIAL
PO Box 146
1661 N Bridge St.
1` Ronda, NC 28670
Elkin, NC 26621
(33e) 777 5909
66-1121531
U.S. Biosolids www.usbiosolids.com
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6223 k
07/29/2024
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PAY TO THE NCDEQ -Division of Water Resources "*52$.OU
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DOLLARS
NCDEQ-Division of Water Resources
1617 Mail Service
v
Raleigh, NC 27699-1617
MEMO Application No. WQ0037135
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U.S. Biosolids, Inc.
07/29/2024
Checking 4849 (4849)
U.S. Biosolids, Inc.
07/29/2024
NCDEQ-Division of Water Resources
Application No. WQ0037135
Application No. WQ0037135
NCDEQ-Division of Water Resources
Application No. WQ0037135
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