WQ0000057_Renewal Application_20200423

Initial Review
INITIAL REVIEW
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Is this a complete
application?* Complete App Date
r Yes r No 10/25/2019
Project Number* WQ0000057
Applicant/Permittee Charlotte Water
Applicant/Permittee 12701 Lancaster Mroy, Pineville NC 28134
Address
Is the owner in BIMS?
r Yes r No
Owner Type
Facility Name McAlpine WWTP
County
Fee Category
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if
non -application)
Email Notifications
Does this need review by the hydrogeologist?*
r Yes r No
Regional Office
CO Reviewer Ranveer Katyal: eads\rkatyal
Is the facility in BIMS?
r Yes r No
Fee Amount

Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notification
Comments for Kendall
Comments for RO
Comments for Reviewer
Comments for Applicant

Submitted Form
Project Contact Information
Rease provide information on the person to be contacted by MB Staff regarding electronic subnittal, confirmation of receipt, and other issues.
........................................................................................................................................................................................................................................................................................................................................................................
Name * Adam Brigman
Email Address*
[e-mail]
Project Information
Submittal Type* r New Permit Application
r Renewal
r Annual Report
r Other
Permit Type * r Wastewater Irrigation
r Other Wastewater
r Closed -Loop Recycle
r Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?
r Yes r Nor N/A
Permit Number WQ0000057
currently has project
Applicant\Permittee * Charlotte Water
Phone Number*
704-650-4341
Applicant/Permittee 12701 Lancaster Hwy, Pineville NC 28134
Address*
Facility Name * McAlpine WWTP
r Modification (Major or Minor)
r Additional Information
r Residual Annual Report
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
This is part two of two parts of the Charlotte Water Permit Renewal that was submoitted last year, but here is the
electronic version.
Please attach all information required or requested for this submittal to be review here.
Application Formt Engineering Rans, Specifications, Calculations, Etc.)
Charlotte Water Renewal PArt 2.pdf 161.99MB
upload only 1 PJF document. NLltiple docurrents rust be corrbined into one PJF file.

For new and modification permit applications, a paper copy may be required. If you have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a paper --polka*-ion is required,
be advised, applications accepted' far pre -review until both the paper and eIect-c-,i_ co1)ies nave been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments (calcs, soils report, specs, etc.)
o One full-size engineering plan set
o One 11x17" engineering plan set
o One extra set of specifications
o Fee (if required)
MallinE address:
❑iuision of Water Resources1 Division of Water Resources
Non -Discharge Branch I Non -Discharge Branch
1617 Mail Service Center 1 Aft: Nathaniel Thornburg, 91° Floor, Cfice #942W
----------------------------------------------------------- -----------------------------------------
Raleih, NC 27699-1617 512 N. Salisbury St.
Far questions or problems contact Tessa Monday [e-mail] or 919.707.3560.
* W By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. 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).
Signature
Submission Date 4/23/2020

0
•
0

State of North Carolina
Department of Environment and Natural Resources
__WRDivision
of Water Resources
6
` ivlslan ofWater Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information visit the Water Quality Permitting, Section's Non -Discharge Permitting Unit
General -- This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
XSubmit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
fhe undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
SiteXield ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Craps
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
.�
f
1�
�M
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.
'Js Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
..nail be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the Iandowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under ,Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWIL, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc,) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and durizrg 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; tape necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
11. RESTRICTIONS:
L Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application sites) 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 sball'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.
HI.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;
f�A re -defined compliance boundary is needed for field(s) ID: ] r0 f "ID (' 1 t "E6
)(Please include the rationale for the requested re -location of the compliance boun ary and attach'
compliance boundary to the application package)
n A re -defined compliance boundary is not needed for this site.
TV. ACKNOWLEDGE, MENT OF FIELD TRANSFER: (if needed)
map showing the newly proposed
❑ 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 Iand 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 Iand application site(s) as specified
herein.
Landowner name:
Address: '94c)6 m A-r_ i N 'rvJc-t..,C. Z�D - _-
City: 0"4-p—oE State: /4 � Zip: ZY D
Phone: n77 . 0 Z Z - 2_4_9 S E-mail address: .7v G 11 G. eawn
Signature.(AA Date:.. r� /
-2
lido,
KilifRfl ,
I, the undersigned Notary Public do hereby certify that C M 42-C A, Tuc o-'
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
Signature and sea[:
My commission expires:
Lessee's/Operator's Certification:
, 20
4 /,Z AOAM BRIGMAN
NOTARY RI1RI Ir:
GASTON COUNTY, NC
MY COMMISSION EXPIRES APA1 29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: TA G (3y
Signature: ` Date:
to -9 -1&)
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/2412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NW'
Date
Fuld
1D
Last Applied
As
Cd
Cr
Cu
Pb
Hoc.
Mo
Ni
Se
Zn
NC-AN-00001-0-0005
01/2212014
0.0346
0.0180
0.5217
1.8806
0.3220
0.0075
0.0898
0.1987
0.0402
6.4998
NC-AN-00001-0-0006
01/22/2014
0.0575
0.0278
0.7934
2.9135
0.4668
0.0285
0.1397
0.3175
0.0605
9.7094
NC-AN-00001-0-0007
01/23/2014
0.0831
0.0313
1.0056
3.2381
0.5623
0.0222
0.1586
0.3630
0.0667
10.9194
NC-AN-00001-0-0008
01123/2014
0.0693
0.0197
0.7138
1.9030
0.2585
0.0232
0.0838
0.2179
0.0508
7.3624
NC-AN--00001-0-0009
01/23/2014
0.0660
0.0189
0.5108
1.5693
0.2001
0.0406
0.0770
0.1980
0.0462
6.0833
NC-AN--00001-0-0010
01123/2014
0.0795
0.0330
1.1287
3.6030
0.6190
0.0106
0.1936
0.3878
0.0713
12.0935
NC-AN-00001-0-0011
01/21/2014
0.1151
0.0287
0.9776
2.5015
0.3462
0.0383
0.1217
0.3095
0.0682
9.5710
NC-AN--00001--0-0012
01/23/2014
0.0486
0.0206
0.6035
2.0645
0.3301
0.0185
0.0977
0.2265
0.0478
7.3482
NC-AN-00001-0-0013
01122/2014
0.0924
0.0312
1.0123
3.1047
0.5193
0.0264
0.1524
0.3557
0.0679
10.7289
NC-AN--00001-0-0014
01/23/2014
0.0677
0.0280
0.7914
2.9412
0.4870
0.0295
0.1422
0.3225
0.0604
9.7600
NC-AN--00001-0-0015
01122/2014
0.0820
' 0.0307
0.8489
2.9627
0.4734
0.0447
0.1478
0.3457
OA669
10.1328
NC-AN-0OOO1-0-0016
01/2312014
0.0954
0.0235
0.7944
1 A245
0.2747
0.0164
0.0963
0.2362
0.0556
7.7038
NC-AN-00001-0-0017
05/12/2014
0.1189
0.0293
1.3562
2.9292
0.6358
0.0058
0.1419
0.3624
0.0746
9.4776
NC-AN-00001-0-0018
05/08/2014
0.0804
0.0247
1.1236
2.7756
0.8379
0.0049
0.1319
0.3280
0.0628
8.6302
NC-AN-00001-0-0019
03/17/2015
0.1393
0.0384
1.6662
3.7042
0.8774
0.0094
0.1530
0.4878
0.0991
11.71M
Page. 1 cf 2 1012412C19

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/24/2019
The Cumulative metals for this report come from HISTORY records (i.e, a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "W'
Date
Field ID Last Applied As Cd Cr Cu Pb h{q Mo Ni Se Zn
NC-AN-00001-0-0020 06/09/2014 0.2147 0.0362 1.5990 2.0651 0.2328 0.0072 0.1115 0.3296 0.0963 8.4769
NC AN-00001-0-0021 05/21/2014 0.2765 0.0422 1.8909 2.0040 0.1413 0.0084 0,1138 0.3540 0,1120 9.0170
Page: 2 of 2 10/24/2019

SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
Site ID: NC-AN-01
Owners Name: Jimmy Tucker
Address: 8405 Martin Tucker Rd
Monroe, NC 28110
Phone: M - (704)-242-2495
Operator: SAME
Date: October 12019
Anson Co.
Fields Applicable Acres Crop(s) RYE -based Predominant
Annual PAN Soil Series
(LB/AC/YR)
Latitude Longitude
AN-01-01
27.2
Row Crops
crop based
Mayodan
34 53 18 N I
80 9 55 W
AN-01-02
4.2
Row Crops
crop based
Mayodan
34 53 12 N
80 10 10 W
AN-01-03
8.0
Row Crops
crop based
Mayodan
34 53 7 N
80 10 13 W
AN-01-04
24.6
Row Crops
crop based
Mayodan
34 53 8 N
80 9 56 W
AN-01-05
4.7
Row Crops
crop based
Badin
34 5121 N
80 10 3 W
AN-01-06
10.7
Row Crops
crop based
Badin
34 5119 N
80 9 58 W
AN-01-07
13.2
Row Crops
crop based
Badin
34 5116 N
80 9 47 W
AN-01-08
6.0
Row Crops
crop based
Badin
34 5129 N
80 9 45 W
AN-01-091
3.8
Row Crops
crop based
Badin
34 5117 N
80 9 33 W
AN-01-10
25.8
Row Crops
crop based
Badin
34 514 N
80 9 49 W
AN-01-12
19.4
Row Crops
crop based
Badin
34 50 58 N
80 9 54 W
AN-01-13
11.7
Row Crops
crop based
Badin
34 5111 N
80 9 36 W
AN-01-14
8.9
Row Crops
crop based
Badin
34 5115 N
80 9 19 W
AN-01-15j
16.9
Row Crops
crop based
Badin
34 514 N
80 9 33 W
AN-01-16
9.7
Row Crops
crop based
Nason
34 51 18 N
80 9 7 W
TOTAL 194.8
NOTES:

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
PRIVATE ROAD
STREAM
DRAIN
-- FENCE
PROPERTY LINE
WATER
GRAPHIC SCALE
ONSITF HOUSE 1" = 660'
660, 0 660,
OFFSITF HOUSE
❑
OUTBUILDING
(0
WELL
Fhe compliance boundary is established either 250 ft from the res[duals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuais application area, Ali
locations are approximate.
N C-AN-01
Fields 1-4

APPLICATION MAP
1 Cr2l=ntn
APPLICATION AREA
— — — — PRIVATE ROAD
— — — — STREAM
— DRAIN
■
M XX FENCE
PROPERTY LINE
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
ocationS are approximate.
GRAPHIC SCALE
1" = 660'
660' 0 660,
NC-AN-01
Fields 5-10, 12-13,15

APPLICATION MAP
LEGEND
APPLICATION AREA F/�] UNSUITABLE AREA
PRIVATE ROAD
STREAM
DRAIN
x --- FENCE
PROPERTY LINE
WATER GRAPHIC SCALE
o 1, = 660'
ONSITE HOUSE
660, 0 660,
OFFSITE HOUSE
OUTBUILDING
(0 WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-AN -41
Fields 14 & 16

■14
aC ++
{ Pn-7 lf�=,
NaD
3 \ 1NoB NsB YYYYYY
w traBi

NaB
'1NaBi
BcfBZ'g��"ZM
�_. NaB
NO
StA
ChI►
j�
�r y
w f }
Na
z
BdB.2. Ali
TgC
BaC
4_ Ern rn
NgC s,
r � '�.�� _ 1 f•f a..V

TOPOGRAPHIC MAP
-"`per
-�
`�• J
1,
�ti �__ -�
II —
.ry
a`h 1
ISO
^w, ,_1,11JPIT) I t II�rI1"
r I _
r
I
t1°lk'I pI
--- - ;'I,�irrr3
i
I
GRAPHIC SCALE
1" = 500`
500' 0 500'
Me compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C„AN -01
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1
_4

TOPOGRAPHIC MAP
GRAPHIC SCALE
1 " = 500'
500' 0 go,
f he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-01
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 14,16

laN
i 003
lzrr
am
VICINITY MAP
Fiji &—o
lTi6
MO
Gulledge Valunleer
F Ile [kept
II
GRAPHIC SCALE
V = 2,500`
2,500' 0 2,500'
rrrr rrr
10--
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-01
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All locations are approximato. Fields 1-10 ,1 2-1 6

0
•

State of North Carolina
Department of Environment and Natural Resources
"Dtvlslon of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one on inal and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General —"Phis document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise: noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. La d Owner Agreement (FORM: LOA 06-16):
]Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
[ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
[� A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
i'he undersigned landowner or his representative hereby permits:
Applicant's name: -fe- o gr-
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
AN
�j
east
Hv
A �� 7����/ ff1
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 Iand application sites) described above for the disposal of the residuals.
his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
:,hall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third parry 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 Il) are met,
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR DWF, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application sile(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 Permittec.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The Iandowner 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 sites) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of this Agreement.
I1. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application sites) 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.
IMALTERNATIVES 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
bo dary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
7A re -defined compliance boundary is needed for field(s) ID: ! Vo3
(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.
'V. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
held transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein. n . A
Landown
Address:
City: L tl ({j C>(n ��__ State: /V Zip: (2 -
Phone: E-mail address:
Signature: Date: `
NORTH CAROLINA, COUNTY {,�[
I, the undersigned Notary Public do hereby certify that R
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
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
520.
ADAM BRIQMAN
GASTON COUNTY, NO
MY COMMISSION EXPIRES APRIL 29,
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
Date:
to -q : )q
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBS/ACRE) AS OF 1012412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field
ID
Last Applied
As
Cd
Cr
Cu
Pb
Hq
Mo
Ni
Se
Zn
NC-AID[-00003-0-0001
02/01/2017
0.6885
0.1375
5.2741
13.7627
1.9789
0.0692
0.6921
1.8896
0.3587
42.5115
NC-AN-00003-0-0002
G5120/2019
0.6822
0.1994
7.3519
24.8125
4.0506
0.1251
1.1929
3.2076
0.4861
69.3231
NC-AN-00003-0-0003
01/06/2012
0.0843
0.0685
1.7905
7.2331
12440
0.0560
0.4242
0.9005
0.1028
21,2656
NC-AN-00003-0-0004
01106/2012
0.1085
0.0942
2.0691
8.0021
1.5060
0.0620
0.4634
0.9533
0.0998
22.3202
NC-AN-00003-0-0006
05/15/2019
0.5495
0.1397
4.6416
24.1106
3.7571
0.1021
0.8862
2.4527
0.3319
50,8647
NC-AN-00003--0-0007
01/27/2017
0.4892
0.1004
3.1544
10.8261
2.1562
0.0764
0.5586
1.6075
0.2260
31.6710
NC-AN-00003-0-0008
05120/2019
0.2800
0.0987
2.8623
18.4313
2.3281
0.0660
0.6057
1.7890
0.2373
34.5654
NC
AN-00003-0-0009
05/16/2019
0.6664
0.1371
4.7551
17.7617
2.7213
0.0865
0.7691
2.1381
0.3074
41.8713
NC-AN-00003-0-0010
01/26/2017
0.3319
0.1219
3.9570
19.5119
2.1331
0.0782
0.7001
1.7326
0.2555
38.4021
NC-AN-00003-0-0011
05/15/2019
0.5947
0.1563
5.0729
19.8689
2.8015
0.0840
0.8369
2.2507
0.3559
49.7249
NC-AN-00003-0-0012
02/02/2017
0.1339
0.0554
1.8511
6.1124
0.8253
0.0199
0.3108
0.7006
0.1295
20.0212
NC-AN-00003-0-0013
02/0212017
0.3705
0.1154
3.9731
12.5349
2.0195
0.0574
0.6620
1.6562
0.2629
37.6232
Page: 1 of 1 1 C1241201 9

SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
Site ID: NC-AN-03 Date: Ocotber 1, 2019
Owners Name: Michael Ryan Morgan
Address: 333 Crawford Pond Rd
Moruen, NC 28119
Prone: M - (704)-694-8140 (Rya
M - (704)-694-8348 (Ron
Operator: SAME
Anson Co.
Applicable Crop(s)RYE-based Predominant Soil Latitude
Fields Acres Annual PAN Series
rl n/nr/VDI
Longitude
29.0
49.6
Common Bermuda
Common Bermuda
175
166
Ailey (AeB)
Candor (CaB)
34 50 58 N
34 5114 N
80 2 32 W
80 2 13 W
AN-03-01
AN-03-02
AN-03-03
3.1
2.9
7.9
7.2
4.0
2.8
6.8
7.3
35.8
7.7
64.6
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Common Bermuda
Row Crops
Row Crops
166
175
175
175
162
175
175
162
175
crop based
crop based
Candor (CaB)
Ailey (AeB)
Ailey (AeB)
Ailey (AeB)
Pelion (PnB)
Ailey (AeB)
Ailey (AeB)
Pelion (PnB)
Ailey (AeB)
Emporia (EmB)
Emporia (EmB)
34 5128 N
34 51 35 N
34 5125 N
34 50 21 N
34 50 12 N
34 50 23 N
34 50 18 N
34 50 9 N
34 5Q 11 N
34 50 51 N
34 50 46 N
80 2 21 W
8Q 2 23 W
80 2 34 W
80 2 36 W
80 2 36 W
80 2 29 W
80 2 30 W
80 2 32 W
80 2 23 W
79 58 39 W
79 58 58 W
AN-03-04
AN-03-05
AN-03-06
AN-03-07
AN-03-08
AN-03-09
AN-03-10
AN-03-11
AN-03-12
AN-03-13
TOTAL, 228.71
NOTES:

APPLICATION MAP
GRAPHIC SCALE -
1 ` _ 660'
66q' 0 6f 0'
0
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
POOL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
UNSUITABLE AREA
WATER
.
CNSITF HOUSE
.
OFFSITE HOUSE
OUTBUILDING
WELL
NC-AN-03
Fields 1-5

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
WATER
— — — — — — PRIVATE ROAD
— — — — STREAM
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
X FENCE
F�
OUTBUILDING
PROPERTY LINE
0
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
iocations are approximate.
GRAPHIC SCALE
1"�660'
660, 0 660,
NC-AN-03
Fields 6-11

rig
z
V)
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
CD
El
0%
UNSUITABLE AREA
WATER
ONSITF HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " = 660'
660' 0 660,
i
NC-AN-03
Fields 12-13

SOIL SURVEY
GRAPHIC SCALE
V = 800'
800, 0 800,
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN -03
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-5

SOIL SURVEY
GRAPHIC SCALE.
1 " = 500'
500' 0 500,
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C--AN -03
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 2- 1 3

TOPOGRAPHIC MAP
GRAPHIC SCALE
I" = 800'
a60' 0 800'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-03
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-5

TOPOGRAPHIC MAP
t
- I
i_i
UITIT W-11'1,
JI
GRAPHIC SCALE
V = 500'
Soo, a 5aa
3
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-AN -03
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 6-11

TOPOGRAPHIC MAP
z
V)
.
I
'�4
S
GRAPHIC SCALE
1"=500'
500, 0 500,
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-03
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate. Fields 12-13

VICINITY MAP
112a g
ts�a
6
S2 145)
(1�5�
r,
1832
'f.
t@3!
1833
I r:3+3
18�5 1Gb3
I�3a
GRAPHIC SCALE
1" = 4,000'
4,000' o 4,000'
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, Ali
locations are approximate.
NC-AN-03
Fields 1-13

60

Mate of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
'Division of 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
su ortin documentation
For more information, visit the Water Quality Permitting Section's NonDischar a Permitting Unit
General — This document is an agreement between the Applicant and laud owners) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. L d Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make, any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to wbich they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
— A-pplicamt— --
Lig A copy of the completed and appropriately executed agreement roust be, provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
tie undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
special note
(no-till/over-seed/
pasture)
cal
_^'�'",
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.
-'his Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
.all 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

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application sites) 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 male decisions regarding the use of the land application site(s) on behalf of the
deeded Iandovrners. 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: / eyC-ff
Address: o AQr7j::-+L-o --
City; W L-2> 0 )? 0State: L zip:
Phone: f 7c, *) (al 4 r 8 66 _ E-mail address:_
Signa�x . " ►"r� Date.
NORTH CAROLINA, Am G�! V COUNTY
I, the undersigned Notary Public do hereby certify that FL-y7eke/- b ma�
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the S
day of
Signature and seal:
My commission expires: CJ Z f
Lessee's/Operator's Certification:
, 20 1
ADAM 9RIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES AWL 29.2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: SA C-cS '� Cl', N
Signature: �- �^'� IS-- C. Date:
FORM: LOA 06-16 Page 3 of 3

Operator,
WE SUMMARY
Y
Charlotte Mecklenburg Utilities
Charlotte, NC
NC-AN-04
Pincher L. Martin
740 Buffalo Creek Rd.
Wadesboro, NC 2817G
M - (704)-694-8665
SAM E
Date: September 22, 2014
Anson Co.
Applicable RYE -based Predominant Soil
Fields Acres crop(s) AnnualPAN Series
(LR/AC/YRI
Latitude Longitude
Polkston-White
,N-04-01
9,9
Row Crops
crop based
35 0 13 N
80 5 58 W
Store (Pw133)
Polkston-White
AN-04-02
8.1
Fescue
117
35 0 6 N
80 5 52 W
Store (PwB3)
Polkston-White
AN-04-03
20.2
Fesclue
117
34 59 57 N
80 6 2 W
Store (PwB3)
Polkstooa-White
AN-04-04
16.3
Row Crops
crop based
Store (PwB3)
34 59 48 N
80 5 53 W
_
Polkston-White
AN-04-05
4.8
Row Crops
creep based
34 59 46 N
80 5 36 W
Store (PwB3)
Polkston-White
AN-04-06
49.7
Row Crops
crop based
34 59 27 N
80 5 51 W
Store (PwB3)
AN-04-07
7.5
Row Crops
crop based
Badin (BaB)
35 7 1 N
80 5 46 W
AN-04-08
22.0
Fescue
163
Badin (BaB)
35 7 16 N
80 5 54 W
AN-04-09
25.7
Row Crops
crop based
Badin (BaB)
35 7 6 N
80 6 2 W
AN-04-10
41.5
Row Crops
crop based
Badin (BaB)
35 7 17 N
_80 6 8 W
AN-04-11
42.1
Row Crops
crop based
Goldston (GoB)
35 7 7 N
80 6 52 W
AN-04-12
14.7
Row Crops
crop based
Badin (BaB)
35 7 12 N
80 6 34 W ,
N-04-13
23.8
Fescue
166
Goldston (GoB)
35 7 20 N
80 6 38 W
wN-04-14
16.8
Row Crops
crop based
Badin (BaB)
35 7 40 N
80 6 18 W
:`AN-04Crops
crisp based
Badin (BaB)
35 7 58 N
80 6 19 W

40.1
1?.3
12.7
31.1
18.7
7.6
5.7
22.8
23.5
19.3
14.7
26.0
8.1
6.1
15.8
3200
22.9
34.7
203
Fescue
Raw Crops
Fescue
Raw Craps
Row Crops
Row Crops
Raw Crops
Raw Crops
Raw Craps
Raw Crops
Raw Craps
Raw Crops
Raw Crops
Row Craps
Raw Crops
Row Crops
Row Crops
Row Crops
Row Craps
163
crop based
163
crap based
crap based
crap based
crap based
crop based
crap based
crop based
crap based
crop based
crop based
crop based
crop based
crop based
crop based
I crop based
crop based
Badin (BaB)
Badin (BaB)
Badin (BaB)
Badin (Baia)
Badin (BaB)
Georgeville (GeB2)
Chewacia (ChA)
Hiwassee (HeB2)
Nanford (NaB)
Georgeville (GeB2)
Badin (BaB)
Ba&n (BaB)
Badin (BaB)
Riverview (grnA)
Riverview (Rrn )
Riverview (Rr
Riverview (RrnA)
Georgeville (GeB2)
McQueen (fVirB)
35 7 35 N
35 7 47 N
35 7 46 N
35 7 53 N
35 7 50 N
35 7 40 N
35 7 43 N
35 7 51 N
35 B 2 N
35 B 2 N
35 7 59 N
35 B 4 N
35 9 12 N
35 B 9 N
35 B 11 N
35 7 40 N
35 7 44 N
35 7 37 N
35 7 44 N
8067 1f1I
a30 610 W
30 61 W
80 5 57 W
B0 5 43 W
BO 5 30 W
BO 5 21 W
BO 5 24 W
80 5 26 W
$0 5 35 W
BO 5 47 W
BO 51B W
BO 5 9 W
$0 4 47 W
BO 4 40 W
BO 4 34 W
BO 4 43 W
80 5 2 W
80.5 4 W
AN-04-16
`�-04-17
N-04-18
AN-04-19
AN-04-20
AN-04-21
AN-04�-22
AN-04-23
AN-04-24
AN-04-25
AN-04-26
AiN-04-27
AN-04-28
AN-04-29
AN-04-30
AN-04-31
AN-04-32
AN-04-33
AN-04-34
T®TAD. 681.4
NOTES:

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
PRIVATE ROAD
STREAM
111 1:12111
M X X FENCE
PROPERTY LINE
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
i'he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundaryis estaNished
midway between the compliance boundary and the perimeter of the residuals application area. Alf
ocaticns are approximate.
GRAPH[C SCALE
1 " = 660'
660, 0 660,
l I
N C-AN-04
Fields 1-5

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
— — — — PRIVATE ROAD WATER
GRAPHIC SCALE
— — — — STREAM ONSITE HOUSE
1"=66D'
660,
0 5K,
— DRAIN . OFF&TE HOUSE
FENCE H OUTBUILDING
PROPERTY LINE 0 WELL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-AN-04
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Field 6

APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
X X X FENCE
PROPERTY LINE
UNSUITABLE AREA
WATER
ONSITL HOUSE
OFFSITE HORSE
OUTBUILDING
WELL
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1"= 660'
660' 0 660`
NC-AN-04
Fields 7-10

APPLICATION MAP
1 I=r1=Aln
APPLICATION AREA
UNSUITABLE AREA
— ----- --d PRIVATE ROAD
CD
WATER
— — — — STREAM
.
ONSITE HOUSE
— DRAIN
■
OFFSITE HOUSE
X X X FENCE
OUTBUILDING
PROPERTY LINE
WELL
f he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 666'
sso, a ssa,
NC„AN-04
Fields 11-13

APPLICATION MAP
LEGEND
�©
APPLICATION AREA
UNSUITABLE AREA
PRIVATE ROAD
WATER
— — _ —
STREAM
.
ONSITE HOUSE
—
DRAIN
OFFSITE HOUSE
FENCE
❑
OUTBUILDING
PROPERTY LINE
CEMETARY
WELL
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1"=660'
660, 0 660,
NC-AN-04
Fields 14-20,26

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
PRIVATE ROAD
STREAM
DRAIN
ace X FENCE
--- PROPERTY LIME
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
iocations are approximate.
GRAPHIC SCALE
1" = 660'
660' 6 660'
NC-AN-04
Fields 21-25, 27-28

APPLICATION MAP
I Fri=Nlt1
APPLICATION AREA
UNSUITABLE AREA
WATER
- — — — — - PRIVATE ROAD
— - — STREAM
ONSiTE HOUSE
- DRAIN
.
OFFSITE HOUSE
-- FENCE
OUTBUILDING
PROPERTY LINE
0
WELL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feetwithin
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
V = 660'
660' 0 660,
NC-AN-04
Fields 29-30

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
WATER
— -- — — — — PRIVATE ROAD
— — — STREAM
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
-X X FENCE.
OUTBUILDING
PROPERTY LINE
0/
WELL
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " 660'
ssa o sso'
NC-AN-04
Fields 31-34

6
.qnii ' HRVFY
GRAPHIC SCALE
1" = 800'
Boo, p 800,
the compliance boundary is established either 250 ft from the residuals application area or 50 7feetwithin NC-AN-04
In the property boundary, whichever is closest to the application area, The review boundary is esad
midway between the compliance boundary and the perimeter of the residuals application area. All Fields -6
locations are approximate.

SOIL SURVEY
GRAPHIC SCALE
1"=660'
660, 0 660'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN -04
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Fields 1-7
- 1 0

0
a
z
SOIL SURVEY
GRAPHIC SCALE
1" = 666'
660, 0 660'
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN -04
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 11-13

GoD�
�•,,.� z•� BaC
.:� TaB
ttY
ago
TaB

a
z
0
SOIL SURVEY
GRAPHIC SCALE
1 " = 800'
Boo, 0 800,
Me compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the appllcation area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuais application area. X1
locations are approximate.
NC-AN-04
Fields 27-34

TOPOGRAPHIC MAP
�(D
o� 11
u7 `
Jill
tI
GRAPHIC SCALE
1"=800'
860' 0 800,
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C_AI V „04
in the property boundary, whichever is ciosest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-6

r1C
a
z
TOPOGRAPHIC MAP
GRAPHIC SCALE
1" = 660'
660' 0 660,
Fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-04
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All Fields 7-1 0
locations are approximate.

e4
k
x
4
0
TOPOGRAPHIC MAP
GRAPHIC SCALE
1 " = 660'
U0, 0 U0,
I
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-04
In the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 11-1 3

TOPOGRAPHIC MAP
GRAPHIC SCALE
1 ° = 800'
800, 0 800`
1 he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ali
locations are approximate.
N C-AN-04
Fields 14-21, 25-26

TOPOGRAPHIC MAP
GRAPHIC SCALE
V = 800'
sae 0 800,
NO compliance boundary is established either 250 ft from the residuais application area or 50 feet within N C—AN-04
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuais application area. All Fields 22-24, 27-34
locations are approximate.

5
VICINITY MAP
!i
( F42)
ld23
7d
10 Anson fligii School
Mile 004 sx
ai
qq
52
VfMCr S%f't W $
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
IN
'D aLR�
NC-AN-04
Fields 1-6

VICINITY MAP
161�
iayfl,
7
y rate t�sg� ,�
FJ
L
I
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
]-he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-04
Fields 7-34

co1 /[ Ys—

-__
-R
6ivi'slon of ey Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
LAND OWNERAGREEMENT
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
supportiva 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) i-a 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):
RS.ubmit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form_ Please do not
make any unauthorized content changes to this form. if necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section. and 'item to which they refer.
Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
—/ A-pplllioant---- -- ---- _.�
Id A copy of tho 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
,ie undersigned landowner or his representative hereby permits:
Applicant's nine:
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
Leose
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilllover-seed!
pasture)
c
0-1
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
''tis Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
all be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of

Z. STIPULATIONS:
The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the sites) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3_ The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDF-NR DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-I636.
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 Permtttee 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 sites) 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 agronornist 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 Permitter 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 sitc(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 Iand 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 laud application area boundaries shall be clearly marked on the laud 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.
.tl. 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 laud 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 craps, 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 Ind surface for four months or Longer prior to incorporation into the soil.
6. Food crops wit harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals laud
application event when the residuals remain on the land surface for Iess than four months prior to incorporation into the soil.
7. Turf grown on Iand where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
111.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLTA.NCJE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC a2T .01 5 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-establishedliance boundary. Please mark one of the following;
dAre-defined compliance boundary is needed for field(s) ID: - 06 0- if
(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. ACKNOWLEDGE' AUNT 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 Iand 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 sitc(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 in 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, aclrnowledgement 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: e Q>e I-n R R IF �-% EA JC,"Tk-A � r � nor
Address:
City: State:.' 'ON (_ Zip: LKI 1 Z
Phone: 7M 3t:rl' 3`94 E-mail address: j% tlsS41,LrfCpk L . Ca.,•i
xipatffe:
NORTH CAROLINA, (411`04
I, the undersigned Notary Public do hereby certify that
COUNTY
fi&UV/1.
ok,
personally appeared before me this day and acknowledged the due execution of the forgoing instrunaent.
WITNESS my hand and official seal this the
day of r Mq U 120 1
Signature and seat:
My commission expires:
Lessee's/Operator's Certification:
1112
ARAM BRIGMAN
GASTON COUNTY! INC
MY COMMISSION EXPIRES APRIL 29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: :'A c s V e L 1P-j A- �A ILact4-
Signature: 1� -`" Date:
FORM: LOA 06-16 Page 3 of 3

SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
Site ID: NC-AN-06
Owners Name: Cox Bros. Farms
Address: 6409 Rape Rd.
Monroe, NC 28113
Phone: M - (704)-309-3684 (Rusty Cox)
Operator: SAME
Anson Co.
Date: September 22, 2014
Fields
Applicable Acres
Crop(s)
RYE -based
Predominant Soil
Latitude
Longitude
Annual PAN
Series
(LB/AC/YR)
AN-01-01
27.2
Row Crops
crop based
Claycreek (CnA)
34 54 11 N
80.16 37 W
AN-01-02
10.0
Row Crops
crop based
Claycreek (CnA)
34 54 1 N
80 16 31 W
AN-01-03
101.9
Row Crops
crop based
Claycreek (CnA)
34 54 17 N
80 16 19 W
AN-01-04
24.8
Row Crops
crop based
Hornsboro (HoA)
34 54 4 N
80 16 3 W
TOTAL. 163.9
NOTES.

a
Q
z
APPI (CATION MAP
LEGEND
UNSUITABLE AREA
APPLICATION AREA
WATER
— — — — — — PRIVATE ROAD
— — — — STREAM
.
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
-� FENCE
OUTBUILDING
PROPERTY LINE
0
WELL
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
V = 660`
660' 0 660'
NC-AN-06
Fields 1-4

Sell St]RVFY
GRAPHIC SCALE
V = 660'
ssoo sso
t
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-06
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ali i,
locations are approximate. Fields 1 "4

TOPOGRAPHIC MAP
O �
urn",
GRAPHIC SCALE
V = 660'
660, 0 660'
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-AN-06
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Fields 1-4

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-06
Fields 1-4

rIJ
L 1 /1'�'�
�� ,� 1 ��

Mate of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
ton of Water Resources
LAND OWNER AGREEA ANT
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 ori2znal and two copies of the application and
supporting documentation
For more information, visit the Water -Quality PeNmining Section's Nan -Discharge Permitting Unit
General— This document is an agreement between the Applicant and laud owners) of residuals receiving sites for land application of
Class B residuals (may include -water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Appiicant shall submit one original and two copies of the application and supporting documentation listed
below.
A, Land Owner Agreement (FORM: LOA, 06-16):
MSubmit the completed and appropriately executed Residuals Source Certiffcation (FORM: LASC 06-16) form. Please do not
mare any unauthorized content changes to this form.. If necessary for clarity or due to space restrictions, attachments to the
application may he made, as long as the attachments are numbered to correspond to the section and item to which they refer.
L1 Prepare a separate agreement for each set of laud 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
. undersigned landown
Applicant's name: e
or his representative hereby permits:
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 ruaps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
{yes/no)
Land Use or
Cropping l?atterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tiillover-seed/
pasture)
r
The landowner or his representative receives, in consideration., full use of the nutrient -value of the applied residuals while the
P -nittee receives, inconsideration, the use of the land application site(s) described above for the disposal of the residuals.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program. and
I be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 page 1 of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
Should the landowner or his representative lease or otherwise permit the use of the land application sites) 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.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) axe met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5, The Permitter 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 Permitter 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 Pennittee will provide the landowner or his representative with a ropy of the residuals permit prior to commencement of any residuals
land application event and a copy ofthe 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 Ieast 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 Permitter 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 Permitter 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 sites) 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 fit land application she(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 alder termination of this Agreement,
u. RESTRICTIONS:
I. Appropriate measures must be taken by the Pemittee andlor the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-mouth period fallowing 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,
MALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(6) prohibits water supply wells within the compliance boundary. However, t5A N$C.AC 02T _01051h) 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 newlyA--`established compliance boundary. Please mark one of the following;
❑q/A re -defined compliance boundary is needed for freld(s) ID: A ! Y ` g OL
(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.
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 vroRram:
(Name of the new program)

�andowner's Certification:
ertify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
•garding 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 Form.ittee to land apply residuals to the land application site(s) as specified
herein., I, I
Landowner name:
Address: ` a q J 8 e:0y t Ad, -
City: W44
�j - State: Cv C zip: G. a C T 0
Phone: �� r ^ Q E-mail address:
.�5ignatare: `""" —Date:.
NORTH CAROLINA, _ A oe � COUNTY
I, the undersigned Notary Public do hereby certify that
x1o,--
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the l � A
day of oc�414-e/"
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
g_q/23
, 2D 4
ADAM BRIQMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRIL 29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
v G1, t r.1 C . �1 • � � 12�,L
Date: 16 ^ e) f 14

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/24/2019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field 1D
Last Applied
As
Cd
Cr
Cu
Pb
!jR
Mo
Ni
Se
Zn
NC-AN-00008-0-0001
03/29/2018
0.5050
0.1288
6.7896
17.2794
2.8944
0.0688
0.8622
2.0645
0.3456
48.7074
NCAN-00008-0-0002
02/23/2012
0.2338
0.0276
1,5914
4.3680
0.5138
0.0156
0.1831
0.5168
0.0848
11.6748
NC-AN-00008--0-0003
03/2712018
0.4650
0.1121
5.9254
15.5970
2.5603
0.0486
0.7300
1.8489
0.3205
44.5660
NC-AN-00008-0-0004
03/30/2018
0.5700
0.1040
5.7628
13.2140
2.0720
0.0463
0.6294
1.7370
0.2688
37.9314
NC-AN-00008-0-0005
01/29/2015
0.4575
0.0771
3.6343
7.8084
1.3192
0.0335
0.4029
1,0789
0.1911
25.4901
NC-AN-00008-0-0006
03/19/2018
0.6824
0.0278
1.6936
116.3082
6.3717
0.8171
5,6678
0.6501
0.0868
78.6315
Page: 1 of 1 10/24/2019

Site I®: NC--AN-08
Owners Name: Glenn Trexler
Address: 1095 Bethel Rd.
Wadesboro, NC 28170
Phone: H - (704)-694-5644
M - (704)-694-0628
Operator: SAME
Applicable
Fields Acres
AN-08-02
AN-08-03
AN-01-04
AN_08-05
TOTAL
NOTES:
15.2
M
12.2
16.4
25.5
48.4
128.2.
Crop(s)
Bermuda
Bermuda
Bermuda
Bermuda
Bermuda
Bermuda
SITE SUMMARY
Charlotte Water
Charlotte, NC
®ate: April 15, 2016
Anson Co.
RYE -based
Predominant
Latitude
Longitude
Annual PAN
Soil Series
(LBIAC/YR)
233
Aiiey (AeB)
34 53 42 N
80 6 81lV
233
Ailey (AeB)
34 53 37 N
80 6 15 W
233
Ailey (AeB)
34 53 43 N
80 6 24 W
233
Ailey (AeB)
34 53 34 N
80 6 48 W
233
Ailey (AeB)
34 53 33 N
80 6 36 W
166 � Candor (CaB) 1 34 53 33 N 180 6 36 W

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— — — —
PRIVATE ROAD
WATER
— — — —
STREAM
ONSITE HOUSE
—
DRAIN
FENCE
■
OFFSITE HOUSE
PROPERTY LINE
OUTBUILDING
POOL
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
I"=660'
660, 0 660,
NC-AN-08
Fields 1-3

APPLICATION MAP
1 Cr_GNln
APPLICATION AREA
UNSUITABLE AREA
ROAD
CD
WATER
— — — PRIVATE
— — — — STREAM
.
ONSITE HOUSE
— DRAIN
■
OFFSITE HOUSE
x� FENCE
OUTBUILDING
PROPERTY LINE
0/
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " = 660'
Ho' 0 660,
1 '0
Fields 4-5

APPLICATION MAP
►� ►fit
�Y
LEGEND '
APPLICATION AREA UNSUITABLE AREA ,
PRIVATE ROAD WATER
BE�I-IEL RO r
STREAM ONSITE HOUSE
DRAIN GRAPHIC SCALE
FENCE � OFFSITE HOUSE
V = 660{
PROPERTY LINE
OUTBUILDING 660' a sso
❑ r•r,�
WAIVED HOUSE WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet witHn
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approAmate.
NC-AN-08
Field 6

0-
gn11 RlIRI/FY
GRAPHIC SCALE
1 " = 800'
Boo, o aoo,
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C—AN-0 S
in the property boundary, whichever is closest to the application area. The review boundary is established {
midway between the compliance boundary and the perimeter of the residuals application area, All F+ef d s 1.5
locations are approximate.

SOIL SURVEY
RMX veil
GRAPHIC SCALE
1" = 660'
660' 660'
The compliance boundary is established either 250 ft from the residuals appkation area or 50 feet within N C-AN -0 S
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All Field 6
locations are approximate.

0
TOPOGRAPHIC MAP
r'A
,ulrn I Puri
14 _
11 TTV
du[rr.
GRAPHIC SCALE
1" = 800'
800, 0 800,
Che compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN -0 S
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ali
locations are approximate. Fields 1-5

a
z
0
TOPOGRAPHIC MAP
I
is 411 wool;
L I. Jr
GRAPHIC SCALE
1" = 500'
500, 0 500,
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C WAN _08
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 6

�t Y
Ln
VICINITY MAP
GRAPHIC SCALE
V = 4,000'
4,000` 0 4,000'
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-08
Fields 1-5

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000` 0 4,000,
- The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-06
Field 6

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
°11D1vls100 of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a .quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one orfginaI and two copies of the application and,
supporting documentation T
Far more information, visit the Water Quality Permitting Section's Non-Dischcr a 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: RLA-P 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
e
A. La d Owner Agreement (FORM: LOA 06-16):
�Submitthe completed and appropriately executed Residuals Source Certification (NORM: 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.
ff,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 TITS LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
ane undersigned landowner or his representative hereby permits:
Applicant's name: &5rzr e-..._.. _..
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:
Sitelf'ield ID
Lease
(yeslno)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
r #
/ C)
,
r
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
'1is Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
.,all be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of

I. STIPULATIONS:
1. _ The landowner or his representative shall out enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement_
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The Landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application sitc(s).
6. The Pe:nnittee bas provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
S. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and 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).
I1. The landowner or his representative will inform the Permitted 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. Speeific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permitted, 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 laud 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.
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 Iand 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 Eber 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 laud 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 laud
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 laud
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 WELL TNSID>; 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;
by A re defined compliance boundary is needed for field(s) ID: &/- ^�{�I ^ 10 - of
(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.
TV.ACKNOWLE,DGEM-UNT OFFIELD 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 nroeram:
(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 sites) and am authorized to make decisions
regarding the use of the land application sites) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to mare 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 1 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 Permnittee to land apply residuals to the land application site(s) as •specif.ed
herein. r
Landowner name:
Address:
city: M C2,N r State: /V C_ Zip: ,Z.rC 1 L 7 --
Phone? O 77 35 E-m it address:
Siguaturl__ -- Dater
lu of
NORTH CA.ROLINA, fi{1�f COUNTY
I, the undersigned Notary Public do hereby certify that i � o17
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
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
412
2Z
,20
ADAM BRIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRiL 29,202a
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
I certify that I have read this Agreement and do
Signing official name:
Signature:
State:
Email address:
D ate:
Zip:
agree to abide bX the stipulations and restrictions as specified herein.
y) Co- v C ,. I a i:; A - --T) D,YLYL"u-
Date: I 0 — 1)
FORM: LOA 06-16 Page 3 of 3

Site I D:
owners Name:
Address:
Phone:
Operator:
SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
NC-AN-10
Lois
6218 Rape Rd.
Monroe, NC 28112
M - (704)-764-3455
,"eff Long
Applicable
Fields Acres
AN-10-01 49.5
'OTAL 49.5
NOTES:
Crop(s)
Bermuda
Date: September 22, 2014
Anson Co. RYE
based Annual Predominant Soil Latitude Longitude
PAN (LB/AC/YR) Series
270 Emporia (EmB) 34 52 44 N 80 S 8 W

APPI IC:ATION MAP
LEGEND
AREA
UNSUITABLE AREA
APPLICATION
CD
WATER
— — — — PRIVATE ROAD
— — — STREAM
.
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
(�
WELL
i he compliance boundary is established either 250 ft from the residuals application area or 5C feet within
in the properly boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
ssaa sso
NC-AN-10
Field 1

Snll q[ lR\/l;v
GRAPHIC SCALE
V = 660'
660' 0 660'
ne compliance boundary is established either 250 ft from the residuals application area or 50 feet within =NC-AN-1
in the property boundary, whichever is closest to the application area. The review boundary is established O
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field

rVI
TOPnr,RAPNI( NAAD
GRAPHIC SCALE
V = 500'
5oa o 5oa'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N �_AI �E_ 0
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 1

Ln
1/1r1r\1JTV KAA n
GRAPHIC SCALE
2,500'
2,500' 0 2,500'
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ali
locations are approximate.
NC-AN-10
Field I

U
11
.•

State of North Carolina
Department of Environment and Natural. Resources
Division of Water Resources
P ' -ton of Water [tesaurces 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 co ies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge PermiWng Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. La d Owner .Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. if necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the sectioa and item to which they refer.
dPrepare 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
undersigned landownneer, or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s). (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Sitelli'ield ID
Lease
estno
(Y )
Land Use or
Cro in Patterns
pp g
Intended Use of Crops
Residuals Source
o tional
(optional)
Special note
(no-till/over-seed/
pasture)
7 j
IVA
+
�L j FeaL . �5
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
pFLrmittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
A 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

x. 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.
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
je responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notifieation of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Dion -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8, If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted.application limits_
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g„ fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any rev v'isions 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 Permittce, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittm, 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.
ar. 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 sites) 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/saii mbdure 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-inonth 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 3$-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 evcnt.
III.ALTERNAITPES F'OR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L ,0107(d) prohibits water supply wells within the compliance boundary. however, t5A NCAC 02T ®I allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of tho compliance
boundary provided the groundwater standards canbe 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.
ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The laud 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 transfen'ed
into the new program;
(Name of the new program)

Landowner's Certification:
:ertify that I am a deeded landowner of the above -referenced land application sites) and am authorized to make decisions
agarding 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: t vk?
Address: Ifv
ee
/] 2� j
City: State: lzip.. l
Phone: D G .7 E-mail address:_ D y - [�0
Signature: Date:
NORTH CAROLINA, _ +a4( COUNTY
v
I, the undersigned Notary Public do hereby certify that Fmi ),69
JC
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS rm�y hand and official seal this the
V
day of C1d
Signature and seal:
My commission exp
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator naive:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that i have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature: S;�a e
M
rJc _F- _-Mgr-bn,L
Date: 10 , 10 )
time *) ­R1

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10124/2019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field ID Last Applied As Cd Cr Cu Pb Hg, Mo Ni Se Zn
IBC-AN-00013-0-0004 02/28/2014 0.0129 0.0045 0.1411 0.4548 0.0601 0.0082 0.0200 0.0604 0.0118 1.7138
Page: 1 of 1 10/24/2019

SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
Site ID: NC-AN-13
®ate: September 22, 2014
Owners Dame: Frank Lee
Address:
40465 Nit Zion Church Ind.
Norwood, NC 28128
Phone:
NI - (704)-985-6721
Operator:
SAME
Anson Co.
Applicable Crop(s)
RAPE -based
Predominant Soil Latitude Longitude
Fields
Acres
Annual PAN
Series
(LB/AC/YR)
AN-13-02
13.4
Fescue
175
Shellbluff (ShA)
34 53 42 N
80 6 8 W
-1-13-041
23.7
Fescue
198
Badin (BaB)
34 53 37 N
80 6 15 W
TOTAL 37.1
NOTES:

APPLICATION MAP
LEGEND
APPLICATION AREA 0�2
PRIVATE ROAD
STREAM
DRAIN
-x— FENCE
PROPERTY LINE
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
the compliance boundary is established either 250 ft from the residuals application area or 50 feetwithin
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660, 0 660,
NC-AN-1 3
Field 2

APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
FENCE
PROPERTY LINE
El
0
UNSUITABLE AREA
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
iocatlons are approximate.
GRAPHIC SCALE
1" = 660'
660' 0 660'
NC-AN-1 3
Field 4

SOIL SURVEY
GRAPHIC SCALE
1 " = 660'
666' 0 660'
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN- 1 3
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All Fields 2 & 4
locations are approximate.

L
TOPOGRAPHIC MAP
k� 415.r
GRAPHIC SCALE
1" = 1,000'
1,000' 0 1,05o.
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate,
NC-AN-13
Fields 2 & 4

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-1 3
Fields 2 & 4

1��j t
is

- W-R
`"®ivlslon of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Wafer Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
PIease 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-Discharee Permitting Unit
General This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form.. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Ij Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
--Lq-Aplicaut:--- ---- — — -- — -- —
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
ae undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
/J0
----------------
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
call be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third pasty, the landowner shall
be responsible to ensure that the third parry agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
Iand 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 comaimcement of any residuals
land application event and a copy of the results of each soil analysis.
& 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 aal
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 crap.
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, Iocal 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 pertnit; 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,
�. RESTRICTIONS:
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3_ Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residualstsoil mixture and are totally above the laud 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 WELTS 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 ba 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 marls one of the following;
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 sites) 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(N) 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. �J
Landowner name: K O N U
Address: .� 2
City: ��A c-� State: AI L Zip: z 1 33
Phone: % n E-mail address: A�, — C
Signatut�,/ 1 ` �{ / V 1 ,( _ Date. ! !
NO
//R�`TH CAROLINA, t`�� COUNTY
I, the undersigned Notary Public do hereby certify that Oka
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 'i
Signature and seal:
My commission expires.
t
Lessae'slOperator's Certification:
, 20
ADAM BR*MAN
NOTARY PUBLIC
GASTON COUNTY, NC
MY cOMM4SSION EXPIRES APRIL 29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein-
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: C 4v U" ,
Signature: ��—�`-^- Date:
FORM: LOA 06--16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF/012412019
The Cumulative laboresult w soNot Reported to SyOnagro or traciking of the metal a al loading ad ng was Not Required he loading on he report is displayed as ort has been produced and the loadings have been archived to History).
R"
!n cases where a trace metaletal I
Date
Field !D Last Applied As Gd Cr Cu Pb �. lV[o 1Vi Se �
0.0272 0.0105 0.3520 1.1418 0.1441 0.0021 0.0538 0.1633 0.0264 3.0842
N C-AN-00014-fl-0001 03I2412017
NC-AN-00014-0-0002 03/24/2017 0.0489 0.0123 0.4217 1.1545 0.0988 0.0028 0.0628 0.1691 0.0309 3.6444
NC-AN-00014-0-0003 03/23/2017 0.0160 0.0104 0.3426 1.2717 0.1222 0.0020 0.0561 0.1765 0.0260 3.1406
NC-AN-00014-0-0004 03/27/2017 0.0286 0A109 0.3517 1.1490 0.1135 0.0025 0_0519 0.1644 0.0272 3.1761
NC-AN-00014-0-0005 03/24/2017 0.0166 0.0104 0.3502 1.3132 0.0943 0.0020 0.0557 0.1766 0.0260 3.1945
NC-AN-00014-0-0006 03/24/2017 0.0836 0.0113 0A362 0.6592 0.0979 0.0022 0.0377 0.1212 0.0282 3.0135
1012412019
Page: 1 of 1

SITE SUMMARY
Charlotte Water
Charlotte, NC
Site ID: NC-AN-14 Date: April 15, 2016
Owners Name: Ronald Mills
Address: 2038 Jackson Road
Peachland, NC 28133
Phone: H - (704)-994-7839
M. - (704.)-272-7412
Operator: SAME
Anson Co.
Applicable
RYE -based
Predominant
Latitude
Longitude
Fields
Acres
Crop(s)
Annual PAN
Soil Series
(LB/AC/Yit)
136
Creedmoor
34 51. 15 N
80 13 53 W
AN-14-01
14.8
Fescue
CrB
117
White Store
34 5115 N
SO 14 4 W
AN-14-02
16.9
Fescue
WhB2
117
White Store
34 51 3 N
80 14 13 W
AN-14-03
9.4
Fescue
WhB2
117
Polkton
34 5141 N
80 13 55 W
AN-14-04
17.5
Fescue
PwB3
117
Polkton
34 5127 N
80 13 50 W
AN-14-05
6.1
Fescue
PWB3
136
Creedmoor
34 5118 N
80 13 47 W
AN-14-06
5.0
Fescue
CrB
TOTAL
69.7
NOTES:

APPLICATION MAP
LEGEND
AREA
UNSUITABLE AREA
APPLICATION
WATER
- — — — — - PRIVATE ROAD
— - - — STREAM
ONSITE HOUSE
- DRAIN
OFFSITE HOUSE
__-- FENCE
OUTBUILDING
PROPERTY LINE
0
WELL
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is ciosest to the application area. The review boundary is estabiished
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " = 660`
666' 6 660'
NC-AN-14
Fields 1-3, 6

is
J.
z
APPI lr.ATinN MAP
LEGEND
AREA
UNSUITABLE AREA
APPLICATION
WATER
PRIVATE ROAD
STREAM
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
(�
WELL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660, 0 660,
NC-AN-14
Fields 4-5

.qnll fi11R1/FY
GRAPHIC SCALE
1" = 800'
soo, a soo,
i he compliance boundary is established either 250 ft from the residuais application area or 50 feet within
in the property boundary, whichever is ciosest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-14
Fields 1-6

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=800'
8pp' 0 800'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN-14
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 `6

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,006' D 4,000'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-14
Fields 1-6

State of North Carolina
Department of Environment and Natnral Resources
Division of Water Resonrees
k
M=- .
Divlslon of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
su ortin 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 fox land application of
Class B residuals (may include water teatMent 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. L d Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they zcfer.
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
undersigned landowner or his representative hereby permits:
AppIicant's name: Olnqw f Y c Wdy' -
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s), (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
(Y )
Land Use or
Cropping Patterns
PP g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tilllover-seedl
pasture)
IVY-
.-15 - 2-4-S)
IVO
H6f Ra-L
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
A be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 page I of 3

L STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another pcnnitted
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.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail. Service Center, Raleigh, NC 27699-1636,
5. The Permitter, 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 Permitter, 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 Permitter, 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 permitter, 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 she(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 Permiitee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application sites) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
A. 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 3 C-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-inonth 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 laud 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 applications event.
IMALTERNATIVES FOR WATER SUPPLY WELDS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A N'CAC 92T Ol 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;
[VA re -defined compliance boundary is needed for freld(s)1D: 2 —
(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.
ACICNOWLE,DOEMEN`I' OI+ 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)
'0n'1,.Vs

-landowner's Certification:
ertify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to snake decisions
Qarding the use of the ]and application sites) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreernezit,
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 naive:
Address: i i
City:
W&Aa lb d State: f V ( zip:
Phone
704 — W —9Z E0 E-mail address:
* Signatur"
NORTH CAROLINA, oso �" COUNTY ,,�/f x/��
I, the undersigned Notary Public do hereby certify that i � I� � �' `�=' gj& �
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNES5 my hand and official seal this the
day of
Signature and seal:
My commission exl
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address
Date:
Zips
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
signing official naive: S fA C a U -Z_P ��YL 'I'
sib ague:
Date: 1 0 t
6
`�`` - 1

CUMULATIVE METAL LOADINGS (LESIACRE) AS OF 10/2412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NW'
Date no- NI Se Zn
Field lD Last Applied As Gd Cr Cu Pb �.
0.0499 0.0285 1.1191 3.9100 02769 0.0203 0.1776 0.5973 0.0825 10.1684
N C-A N-0 0015-0-0 0 01 05/29/2019
NC-AN-00015-0-0003 02/07/2017 0.0471 0.0225 0.8263 2.5788 0.2729 0.0151 0.1281 0.3890 0.0564 7.1014
NC-AN-00015-0-0004 09/25/2017 0.0391 0.0125 0.3040 1.0706 0.1505 0.0025 0.0438 0.1333 0.0312 3.4190
NC-AN-00015-0-0005 05/29/2019 0.0568 0.0210 0.8895 3.2990 0.2932 0.0125 0.1496 0.4696 0.0750 8.8631
1012412019
Page: 1 of 1

SITE SUMMARY
Charlotte Water
Charlotte, NC
Site ID: NC-AN-15
Owners Name: William H. Ratliff 1r. (Bill)
Date: Ocotber 1, 2019
Address: 4437 Beck Road
Wadesboro, NC 28170
Phone: M - (704)-694-8250
Operator: SAME
Anson Co.
Applicable RYE -based Predominant
Fields crop(s) Acres Annual PAN Soil Series
AN-15-02
12.2 Fescue
AN-15-04
46.3 Row Crop
AN-15-05
43.6 Bermuda
TOTAL
102.1
NOTES:
Latitude Longitude
163 Badin (BdB2) 34 50 12 N 80 8 54 W
crop based Badin (BdB2) 34 49 39 N 80 9 30 W
Emporia 34 49 53 N 80 8 56 W
203 /r _ n,

APPLICATION MAP _ ___ I
LEGEND
APPLICATION AREA
UNSUITABLE AREA
WATER
PRIVATE ROAD
— — — STREAM
■
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
FENCE
OUTBUILDING
PROPERTY LINE
WELL
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
seo, o sso
NC-AN-15
Fields 2-3,5

1a
z
Annl 10ATION1 NAAP
Q WATER GRAPHIC SCALE
_ — — — — PRIVATE ROAD �„ _ 660'
STREAM . ONSITE HOUSE
660' 6 660`
— DRAIN ■ OFFSITE HOUSE
_— FENCE OUTBUILDING
PROPERTY LINE 0 WELL
he compliance bounda1 5
ry is established either 250 ft from the residuals application area or 50 feetwithin NC-AN-1
in the property boundary, whichever is closest to the application area. The review boundary is established I
midway between the compliance boundary and the perimeter of the residuals application area. All F i eld 4
locations are approximate.

Ln
SOIL SURVEY
GRAPHIC SCALE
1" = 800'
Boa` 0 800,
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-AN- 1 5
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ali F j el ds 2, 4, 5
locations are approximate.

y
Ln
TOPOGRAPHIC MAP
GRAPHICSCALE
00
1,Oo0' � 1,000'
.he compliance boundary is established either 250 fit from the residuals application area or 50 feet within NC—AN-1 5
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ail Fields 2 �4 5
locations are approximate.

�!�fl;lii
VICINITY MAP
Eg
1f1.
3
x
IIN
1113 S ffF3] Tamrs �fN�
�� 111] 1115
o
R
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary. whichever is closest to the application area. The review boundary is ostablished
midway between the compliance boundary and the perimeter of the fesiduals application area. All
locations are approximate.
NC-AN-15
Fields 1121455

7,r,s6r,'j � ctt7, Ic L"e /C�,-

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
16lvlslou ofWaterresources 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 co ies of the..app1tjca#9n 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):
Submitthe completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form.. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer-
Prepare a separate agreement for each set of land application sites that are owoed or operated by an entity other than the
LJ Afaglicaut --
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
to undersigned landowner or his representative hereby permits:
Applicant`s name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ics) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed(
pasture)
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
all 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

x. STIPULATIONS:
1. , The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the sites) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third parry 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 U) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENit DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699.-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. fin addition, the current landowner shall give a notice to the new landowner that gives fail 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 constitueuts 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
laud 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).
l I. 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 laud application event.
13. The Iandowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application sites) at any reasonable time for the purpose of determining
compliance with the permit, establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of; and 12 months after termination of this Agreement.
RESTRICTIONS:
I. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period, following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application sitc(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(hl 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;
FfA re -defined compliance boundary is needed for field(s) M: U (( 5r 1-7- 22 ( _
(Please include the rationale for the requested re -location of the compli rice 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.
IEV. 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/shc is requesting that the field(s) be removed from the previously permitted residuals Iand application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

J 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 Iand application sitc(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other pennitted 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
held transfer, and do hereby grant permission to the Perrbittee to land apply residuals to the land application site(s) as specified
herein.
Landownername: "—J+50,q 2L14-C_4WC"
Address: �4 v !•1
City: [.l7 Rai State: N L Zip; v
Phone: C7 04 — (P E-mail address:%
CAROLINA, WO 1
COUNTY
Da)�0
I, the undersigned Notary Public do hereby certify that ow L� �
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the ` w01f,11
day of ✓Y 20 17
Signature and seal: p
My commission expires:
Lessee's/Operator's Certification:
ARAM BRIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRIL 29, 2023
I certify that I have read this Agreernont and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing officialnamo: :TAC(S. UAL I h)•
Signature: �e `,, Date: 10 -- 10 -- V)
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/2412019 .
The Cumulative metals for this report come from HISTORY records (i.o_ a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal tab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field 1D
Last Applied
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
So
Zn
NC-AN-00017-0-0017
01/14/2017
0.0579
0.0214
0.7517
2.1149
0.5375
0.0080
0.1173
0.2631
0.0535
6.5979
NC-AN-00017-0-0018
01/13/2017
0.0680
0.0261
0.9708
2.7003
0.7674
0.0098
0.1550
0.3303
0.0653
8.2526
NC-AN-00017-0-0019
01/16/2017
0.0217
0.0078
0.2626
0.7456
0.1721
0.0029
0.0402
0.0939
0.0195
2.3628
NC-AN-00017-0-0020
01/17/2017
0.0590
0.0207
0.6711
1.9214
0A018
0.0077
0.1010
0.2450
0.0518
6.1772
NC-AN-00017-0-0021
01/12/2017
0.0142
0.0057
0.2244
0.6177
0.1933
0.0021
0.0366
0.0743
0.0143
1.8502
Page: 1 of 1 10/2412019

Site ID: NC-AN-17
Owners Name: Jason Blackwelder
Address: 2842 Horton Road
Wadesboro, NC 2817
Phone: M - (704)-467-4,566
Operator: SAME
Applicable
Fields Crop(s)
Acres
SITE SUMMARY
Charlotte Water
Charlotte, NC
Date: April 15, 2016
Anson Co.
RYE -based Predominant Soil
Annual PAN Series
(LB/AC/YR)
Latitude Longitude
AN-17-01
12.8
Fescue
195
Mayodan (MgB)
34 55 24 N
80 9 48 W
AN-17-02
18.0
Fescue
195
Mayodan (MgB)
34 55 50 N
80 9 48 W
AN-17-03
26.3
Fescue
195
Mayodan (MgB)
34 55 43 N
80 9 41 W
AN-17-04
37.6
Fescue
195
Mayodan (MgB)
34 55 38 N
80 9 36 W
AN-17-05
33.5
Fescue
117
White Store (WhB2)
34 55 18 N
80 9 37 W
AN-17-17
16.3
Bermuda
196
Fuquay (FuA)
34 53 14 N
80 7 48 W
AN-17-18
8.8
Bermuda
196
Fuquay (FuA)
3453 05 N
80 7 48 W
AN-17-19
23.7
Bermuda
175
Ailey (AeB)
34 53 19 N
80 7 33 W
AN-17-20
11.6
Bermuda
196
Fuquay (FuA)
34 53 8 N
1 80 7 26 W
AN-17-21
24.5
Bermuda
175
Ailey (AeB)
34 53 2 N
1 80 7 31 W
TOTAL 1 213.1
NOTES:

APPLI(
a
z
ILA
GRAPHIC SCALE
1" = 660'
666' 0 660,
LEGEND
APPLICATION AREA
— — — — — —
PRIVATE ROAD
STREAM
— — — —
DRAIN
X
FENCE
X
PROPERTY LINE
UNSUITABLE AREA
WATER
ONSITE HOUSE
.
OFFSITE HOUSE
OUTBUILDING
WELL
compliance boundary is established either 250 ft from the residuals application area or 50 feet within in the
rloperty boundary, whichever is closest to the application area. The review boundary is established midway
between the compliance boundary and the perimeter of the residuals application area. All locations are
approximate.
NC-AN-17
Fields 1-5

APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD
STREAM
DRAIN
X X X FENCE
PROPERTY LINE
■
0
UNSUITABLE AREA
WATER
ONSITL HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
compliance boundary is established either 250 ft from the residuals application area or 50 feet within in the
property boundary, whichever is closest to the application area. The review boundary is established midway
between the compliance boundary and the perimeter of the residuals appiication area. All locations are
approximate.
GRAPHIC SCALE
1 " = 660`
660' 0 660'
NC-AN-17
Field 6

Rc
APPLICATION MAP
I >=r17r\ln
APPLICATION AREA
UNSUITABLE AREA
WATER
— — -- — — — PRIVATE ROAD
— — — — STREAM
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
X X FENCE
OUTBUILDING
PROPERTY LINE
WELL
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the appiication area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660' 0 660,
N C-AN-17
Fields 17-21

SOIL SURVEY
GRAPHIC SCALE
1 " = 660`
660` 0 680'
ne compliance hourdary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-17
Field 6

l
a
z
GRAPHIC SCALE
1"=660'
660' 0 660,
SOIL SURVEY
no compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-1 7
Fields 1-5

SOIL SURVEY
GRAPHIC SCALE
1" = 660'
660' 0 660,
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-17
Fields 17-21

TOPOGRAPHIC MAP
0
0
1,
0
l
0
GRAPHIC SCALE
1" = 1,320'
1,320' 0 1,320'
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-17
Fields 1-5

01141
z
V)
TOPOGRAPHIC MAP
GRAPHIC SCALE
V = 660'
660, o sso
ne compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC-AN-1 7
n the property boundary, whichever is closest to the application area, The review boundary is established I f
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 I -2 1

NO
VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,600- 0 4,000-
ne compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-17
Fields 1-5, 17-21

TcIl�'1 'H Gv L- h e�

DWR
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Dlvlsion of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following .instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the. provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit applieatiom -Unless otherwise noted the Applicant shall submit one on final and two copies of the application and
supportin 'documentation:.
Fbr more information, visit the Water. Quality Permitting Section's -Non -Discharge Permitting Unit
Genera*] — This, document -is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
.Submit this agreement for,review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise. noted,,, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.:
A: La d- Ovvner Agreement (FORM: LOA 06-10:
..Suliin1the completed and:.appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make. any'ui authorizedr.conteht changes to this form: If necessary for clarity or due to space restrictions, attachments to the
application,rnay be anade, as:long as the attachments are numbered to correspond to the section and item to which they refer.
ach set of land application sites that are owned or operated by an entity other than the
Prepare a separate agreement for e
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
_he undersigned landowner or his representativeth�e�r�ebby permits:
Applicant's name: T
4
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
SitelFieid ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
MAN-
A64-11kd Feed
The landowner or.his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives; in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the:Division's permit for the residuals land application program and
hall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

1. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met,
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits,
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application sites) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
11. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. hand 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
compliance boundary to the application package)
MA re -defined compliance boundary is not needed for this site.
of the compliance boundary and attach a map showing the newly proposed
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: L,OA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. T 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:I-r
Address: ® k i3 U X - 2S�'jSQ
City: ,Mfg �t.W,S State: i'� zip: 2�� 7
Phone: /% E-mail address: 6y"fccab~�.Can'1 . ..
Date: t'5_'(�;o ' / 9
NORTH CAROLINA, '6"I O'COUNTY
I, the undersigned Notary Public do hereby certify that Lkmax ffgr&' eYS
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the C
day of
Signature and seal://
My commission expires: �._ - Z
Lessee's/Operator's Certification:
20 tQ
ARAM BRIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APR«29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: -a A Ca V e L I N t_� I) .
Signature: Date: { - 1 0 - 1Gi
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/2412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field ID
Last Applied
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
NC-AN-00020-0-0001
05/0912019
0.1917
0.0444
1.5500
5.4440
0.4652
0.0154
0.2543
0.7066
0.1445
15.8719
NC-AN-00020--0-0002
05/09/2019
0.2455
0.0627
2.1442
7.8627
0.7423
0.0191
0.3341
1.0254
0.1976
22.1895
NC-AN-00020-0-0003
05/1012019
0.1618
0.0455
1.7524
7.4162
0.6350
0.0170
0.3161
0.9206
0.1704
19.5559
Page: 1 of 1 10/24/2019

SITE SUMMARY
Charlotte Water
Charlotte, NC
Site ID: NC-AN-20 Date: April 15, 2016
Owners Name: Thomas Harkness
Address: P.D. Box 2585
Matthews, NC 28105
Phone; M - (704)-533-1.741
Operator, SAME
Anson Co.
Applicable Crap() s RYE -based Predominant
Fields Acres Annual PAN Soil Series
fLBIACIYRl
Latitude Longitude
AN-20-01
14.2
Bermuda
��214
Candor (CaB)
34 49 58 N
180:44�9W
AN-20-02
26.8
Bermuda
233
Ailey (AeB)
34 49 4S N
80 4 55 W
AN-20-03
V 3
Bermuda
3
E23
Ailey (AeB)
34 49 34 N j
80 5 19 W
TOTAL 68.3
NOTES:

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
- — — - — - PRIVATE ROAD
WATER
— - — STREAM
.
ONSITE HOUSE
- DRAIN
WAIVED HOUSE
OFF&TE HOUSE
— x— FENCE
❑
OUTBUILDING
PROPERTY LINE
WELL
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1 " = 660'
fi60 p 660'
NC-AN-20
Fields 1-3

I
APPLICATION MAP
LEGEND
APPLICATION AREA
PRIVATE ROAD Q WATER
GRAPHIC SCALE
— — — — STREAM . ONSITE HOUSE
sso
a sso
— DRAW ■ OFFSITE HOUSE
^ ^,
FENCE OUTBUILDING
PROPERTY LINE WEt-L
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-AN-20
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
Fields 2-3
locations are approximate.

cn
Snu SURVEY
GRAPHIC SCALE
I" = 800'
800, 0 800'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-AN-20
Fields 1-3

TOPOGRAPHIC MAP
GRAPHIC SCALE
1" = 1,000'
1,000 0 noon,
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-AN-20
Fields 1-3

VICINITY MAP
ya
AlI
IG
I
lii4
2
WJ3
Cuomo Otdtielll Ad
IIM
11.5
1110
�
N�
s
Soovl A43eC+/
I1741I10
id]
F1
3
�
fr
laaa
nes
s
i
a
F1 17C-
i Imo-'
-I1
nm
'�
R V
1
�I
a
Ak
� a d
GRAPHIC SCALE
1" = 4,000'
4,000- 0 4,000'
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within A I C_A� V I _2O
in the property boundary, whichever is closest to the application area, The review boundary is established I V I L
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-3

11
•

State of North Carolina
Department of Environment and Natural Resources
D. R.� Division of Water Resources
.1"DivEslon of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Dischara Permitting Unit
General - This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class 13 residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
[✓� Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form.. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
[t� Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Appalioant- - — - _ — - - — — -- — — -
A copy of the completed and appropriately executed agreement must be provided to the landowri ar and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
ie undersigned landownejor his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
SitelField ID
Lease
(yeslno)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
D
N-21 2i3
,� i
7V O
�
sl�r�i•n�-t. {!mod
r
AIV
14 6
�Jzz
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
all be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise pert -nit 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 teams 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 H) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Pertnittee 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
Iand application event and a copy of the results of each soil analysis.
S. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amouuts 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 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 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 aresiduals 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.
RESTRICTIONS:
1. Appropriate measures must be taken by the Pent ittee 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 sites) 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 lend
application event when the residuals retrain 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 arc 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-estabhshed compliance boundary. Please mark one of the following;
[� A ro-defined compliance boundary is needed for field(s) ID: / /► f � ` 2 1 "- {r11 Z-)
(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. ACKNOWLEDGEM)FNT 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 06-1.6 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 Perrnittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: !VD ..—
Address: 2-4773 �z, �. 5, n�1 S,Zr >DCTX� J?-0,*0
City: rY1 D.CA&eid State: N [_ .Zip:
Phone: Q E-mail address: �dM u wcJ u MM -13
C • uDj^
Signaturet/ Date:
NORTH CAROLIN OhwaP7 COUNTY
I, the undersigned Notary Public do hereby certify that t,-dwg P
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the Z 0
day of
Signature and seal:
A©AM BRIGMAN
My commission expires:
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRIL 29, 2023
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Perniittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: J A C-Q il -1 1 NC �7A YLI-1:
Signature: Date: 10
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 10/24/2019
The Cumulative metals for this report come from H[STORY records (Le. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Meld ID
Date
Last Applied
As
Cd
Cr
-
Cu
Pb
!iq
MO
Ni
Se
Zn
NC-AN-00021-0-0001
05/2412019
0.1610
0.0061
0.8202
1.8465
0.1257
0.0027
0.0665
0.2997
0.0585
5.8934
NC-AN-00021-0-0002
05/22/2019
0.0359
0.0058
0.3862
1.4684
0.1549
0.0029
0.0601
02220
0.0380
4.0757
NC-AN-00021-0-0003
05/23/2019
0.1861
0.0070
0.9095
2.0561
0.1706
0.0033
0.0674
0.3466
0.0698
6.8399
NC-AN-00021-D-0004
05/24/2019
0.0364
0.0156
0.6668
2.9022
0.2993
0.0051
0.1016
0.3673
0.0622
7.6068
NC-AN-00021-0-0005
05/21/2019
0.0461
0.0100
0.6238
2.4923
0.2532
D.0051
0.1024
0.3776
0.0624
6.7482
1 C12412CZ 9
Page: 1 of 1

SITE SUMMARY
Charlotte Water
Charlotte, NC
Site ID,. NC-AN-21
owners Name: Ldmund P. Huntley (Edd!e)
Address: 2473 Robinson Bridge Road
Morven, NC 28119
Phone: M - (704)-984-0030
Operator: SAME
Applicable
Melds Acres
AN-21-01
AN-21-02
AN-21-03
AN-21-04
AN-21-05
TOTAL
NOTES:
8.1
29.7
M
14.2
22.3
EMI
Crops)
Bermuda
Row Crop
Row Crop
Fescue
Row Crop
Date: April 15, 2016
Anson Co.
RYE -based
Predominant
Latitude
Longitude
Annual PAN
Soil Series
(LB%ACJYR)
Fuquay (FuA)
34 53 21 N
80 3 53 W
R19
d
Fuquay (FuA)
34 53 8 N
80 3 42 W
crop based
Pacolet
3453 1 N
80 3 31 W
PmB2
188
Pacolet
34 52 47 N
80 3 38 W
PmB2
crop based
Hiwassee
34 52 Z6 N
80 3 4 W
(HeB2)

K
iL

APPI ICATION MAP
LtVtNU
APPLICATION AREA r/;7� UNSUITABLE AREA
PRIVATE ROAD
— — — STREAM
DRAIN
FFNCE
W
PROPERTY LINE
WATER
ONSITE HOUSE
WAIVED HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
, he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
V = 660'
660' 0 660'
NC-AN-21
Field 5

L4
1
14 z
enll CIIP\/PY
vr<Hrniu ount--
1" = 1,000'
9,000` 0 1,000'
NC-AN-21
ne compliance boundary is established either 250 fk frol the cation area, The pelview boundary5s0established
in the property boundary, whichever is closest to the application I
midway between the compliance boundary and the perimeter of the residuals application area. Ali Fields l -5
locations are approximate.

--nnn(--D A 1-II(' NAAP
lJr��`1r` I Ilv vvi �-�-
1 1,000,
1,000 0 1,000,
hcation area or 50 feet within N C-AN-2
he compliance boundary is established either 25tJ ft from the residuals app'
in the properly boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All Fields 1-5
locations are approximate.

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000- 0 4,000'
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
La�d�j%glsie Church nd
t1451 lw_1
NC-AN-21
Fields 1-5

0

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
DI-Iston of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided bones 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-Diseharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class 13 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 otherwisc -acted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below_
A. L d Owner Agreement (FORM: LOA 06.16):
'Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section, and item to which they refer.
E/ Prepare a separate agreement for each set of laud application sites that aze owned or operated by an entity other than the
Applicant.
WA 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
undersigned landowner or his representative hereby permits:
Applicant's name; �:6jj�GUr�
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s)_ (l.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(Yes/no )
band Use or
Cra ppin g Patterns
Intended Use of Crops
Residuals Source
o tional
(P )
Special note
(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.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
.11 be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

1. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
'ee responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from. the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Formittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. if the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc,) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall he 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 sitc(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 pemrit; take necessary lcachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
at. 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 mbtture 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.
IMALTERNATWES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCA.0 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A WCAC 02T .0105fh) 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-cstabhshed compliance boundary. Please mark one of the following;
I(A re -defined compliance boundary is needed for field(s) ID: 10 Was (1-5)
(Please iuclude. the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
El A re -defined compliance boundary is not needed for this site.
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)
-T) K if. T n n nc z c paaP 7 of'A

. andowner's Certification:
ertify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
garding 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 sites) 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 perrsaitted entity. Furtheizno-re, 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: 170 e f I fit,
Address
City:
State: �7_? �` Zip:
v r
Phone: E-mail address:
/ - Date: 10 lq
Signature:
NORTH CAROLINA, (O b COUNTY
I, the undersigned Notary Public do hereby certify that :be CAS
personally appeared before me this day and aclm owledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the ! [Vq
day of &_*A- , 20
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
ADAM BRIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRIL 29, 2023
1 certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lesscelope-rator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official naive: A C O U C%-- �2 �-�--
Sib ature: 71Y�_
� Date: 0 b
--- , rf. i t h 1) K I C 'D rc 'a ni l

CUMULATIVE METAL LOADINGS (LDS/ACRE) AS OF 10/24/2019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field ID
Last Applied
As
Cd
Cr
Cu
Pb
Hoc
Mo
Ni
Se
Zn
NC-CB-00003-0-0001
04/11/2017
0.1379
0.0510
2.9701
9.0294
1.6057
0.0626
0.6166
1.5105
0.1525
25.1381
NC-CB-00003-0-0001-A
10/21/1991
NR
0.3050
6.0160
24,2241)
10.6350
NR
NR
3.1340
NR
43.5570
NC-CB-00003-0-0002-A
10/18/2001
0.0756
0.3108
9,1724
32.2094
12.6961
0.0714
0.5215
4.8235
0.1271
67.6130
NC-CB-00003-0-0002-B
10/19/2001
0.0857
0.3030
8.6051
30.5422
12.1352
0.0611
0,4679
4.4941
0.1104
53.0973
NC-CB-00003-0-0002-C
10/17/1996
0.0160
NR
0.4390
1.7480
0.5160
0,0150
0.2160
0.2310
M290
5.0360
NC-CB-00003-0-0003
10117/1996
0.0630
0.2950
8.6580
30.2090
12.1640
0.0570
0.4210
4.4920
0.0980
51.9260
NC-CB-00003-0-0004
11/09/2001
0.0100
0.1055
1.6716
9,8633
5.9590
0.0124
0.0890
1.7432
0.0279
21.8839
NC-CB-00003-0-0005
11/30/2001
0.0202
0.0118
0.2463
1.0566
0.1031
0.0082
0.0593
0.1344
0.0188
3.0297
NC-CB-00003-0-0006
05/0911995
0.0438
0.4782
8.5421
35.6791
14.0093
0.0537
0.2099
3.9743
0.1421
63.2572
Page: 1 of 1 10/24/2019

SITE SUMMARY
Charlotte Mecklenburg Utilities
Charlotte, NC
Site ID:
PVC-CB-03
Date. September 22➢ 2014
Owners Name:
Joe Harris
Address-
1643 Eerribrook Rd.
Harrisburg, NC 20'075
Phone:
M - (704)-455-2349
Operator:
SAME
Cabarrus Cu.
Fields
Applicabh�
Cry §
��)
RAPE -based
Predominant Soil
Latitude
Longitude
Acries
Annual PAN
Series
(LE/AC/VR)
CB-03-01
22.9
Fescue
209
Cecil (CCB2)
35 17 44 N
80 36 13 W
:B-03-2A
7.7
Fescue
189
Chewacia (ChA)
35 17 37 N
80 36 20 W
CEO-03-2C
3.P
Fescue
188
Mecklenburg (MeB)
35 17 37 N
80 36 37 W
CB-03-03
36.8
Fescue
188
Enos -Urban (EeB)
35 17 20 N
80 36 38 W
CB-03-04
4.6
Fescue
209
Cecil (CeB2)
35 17 53 i�
80 36 E2W
EB-03-05
16.8
Fescue
189
ChewaclaChA)
35 17 51 N
80 35
TOTAL
92.6
NOTES:

APPLICATION MAP
i r:r-C:nin
APPLICATION AREA
UNSUITABLE AREA
ROAD
WATER
— — — — — — PRIVATE
— — — — STREAM
.
ONSITE HOUSE
— DRAIN
.
OFFSITE HOUSE
X X FENCE
OUTBUILDING
PROPERTY LINE
(
WELL
�'he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
660, 0 660,
N C-CB-03
Fields 1,2A,4,5

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE ARLA
PRIVATE ROAD WATER
— — STREAM ONSITE HOUSE
— DRAIN ■ OFFSITE HOUSE
-X X---X'-- FENCE OUTBUILDING
PROPERTY LINE WELL
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
V 666'
660, 0 E60'
NC-CB-03
Fields 2C, 3

SOIL SURVEY
GRAPHIC SCALE
1" -:: 800'
aoo, a aoo
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-C B-0 3
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-5

WIJ
TOPOGRAPHIC MAP
GRAPHIC SCALE
V' = 800'
800' 0 800,
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C„CB_03
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-5

VICINITY MAP
E�
113�3
�¢y%aka409
� llarYrSburtl
1'frO
3 Ikk p
sAa
v
�rl
i I #r6
i l 34
000
GRAPHIC SCALE
1 ° = 4,000'
4,000` 0 4,000,
. he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CB-03
Fields 1-5

'Aaoc

State of North Carolina
Department of Environment and Natural Resources
W—
Division of Water Resources
P't-lon of Water Itesourtes 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
su2porting 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 Iand owner(s) of residuals receiving sites for land applications of
Class B residuals (may include water treatrtient plant or other type residuals) in accordance with 15A N_ CAC_Q2T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form., Please do not
make any unauthorized content changes to this form. if necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which tb.ey refer.
Prepare a separate agreement for each set of laud application sites that are owned or operated by as entity other than the
Applicant.
[jf 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
. undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s). (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field I17
Lease
eslno
(Y )
Land Use or
Cropping Patterns
Pp
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
c—cL—off3-ft
11�4K
Fee d I
C
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.
Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
.11 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 suet time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
q. 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
')e responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section Il) are met.
4. Notificatlon of cancellation of this Agreement shall be, immediately forwarded to NCDENR-DWR, Nan -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application sites) 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 desofiption 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 pE of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Pemuttee 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 bave 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 Permittce 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 authozizes 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 aRor termination of, this Agreemeut.
A. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittce 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 grating shall have fencing that will be used to prevont 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.ALTERNA'T'IVES FORWATER 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 07T 0105 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-establis
�hed compliance boundary. Please mark one a£ the following;
[Jf A re -defined compliance boundary is needed for field(s) ID: C L — 4 + yr- (1/ 3 ^ 11)
(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.
ACKNOWLED GEM -ENT 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 fields) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
�onRr,4. T me nr,_7ti Page 2 of

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded Iandowners OR that I am otherwise authorized, through
a power of attorney or other Legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address: r e
City: 540-4 esy ij Te State: �n _ - Zip:
Phone: 70V ` .12 76 F-rnnail address: �L 01 eG�- lrt2itr C �
rcSignature: JX
Date: g
NORTH CAROLINA, _chy- 10114 COUNTY
I, the undersigned Notary Public do hereby certify that Pa-f `iC L 0 Leqry
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
Signature and seal:.
My commission expires:
Lessee's/Operator's Certification:
5•f/r
720 l q
ADAM WOMAN
WTON COUITrY, NC
MY COMMISSION EXPIRES APRIL29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: A C,@ V t'�_ i tv G � X-L l<A-L-
Signature: Date: i - 1 6 ' 1CIN
FORM: LOA 06-16 Page 3 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application sites) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application sites) 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, acluiowledgement of
held transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: `&rj aw GtfYM -L c
Address:
City: _ � C a" P State: IV( .dip: 2 j 6 — 6q � q
Phone: ��12 7�p E-mail address: CI earl iti f 01"
Signature: Date: 9 l e�
NORTH CAROLINA, Clief��1 0'_ COUNTY p
I, the undersigned Notary Public do hereby certify that GtTi� 71 0 Lev -
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the alb
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
,20 l
ADAM BAIGMAN
GASTON COUNTY NC
1AY OMMISSION EXPI RES APRIL 29,2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Perrrrittee's Certification:
State:
Email
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: --TPCL0 U - i e -q)`� 12VL.
Signature: Date: . 711
.r
FORM: L,OA 06-16 Page 3 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: (e4i, I c, �R 5 W-C
Address: Cox q {
City: Ile State: /VC Zip: 7— 6 q C
Phone: "i ;7 E-mail address; f
Signature: Date: �d ' l
NORTH CAROLINA,
("l"PW [a/4 COUNTY
I, the undersigned Notary Public do hereby certify that04(,�c
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 Amvs
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
120 1
ARAM BRIGMAN
NOTARY PUBLIC
GASTON COU" NC
COMMISSION EXPIRES APRIL 29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name;
Address:
City:
Phone:
Signature:
Pernaittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: :T
Signature: �- e t- Date
a
-21-io1
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 1012412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Meld ID
Last Applied
As
Cd
Cr
Cu
Pb
t
Mo
Ni
Se
Zn
NC-CL-00009-0-0001
04/03/2019
0.1762
0.0662
2.3653
10.0481
0.8994
0.0237
0.3819
1.2137
0.2174
28.3239
NC-CL-00009-0-0003
04/04/2019
0.1621
0.0626
22712
9.8561
0.8515
0.0241
0.3666
1.1774
0.2097
27.5693
NC-CL-00009-0-0004
04/2512019
0.1587
0.0569
2.2388
8.8858
0.6873
0.0259
0.3547
1.1756
0.1952
25,9771
NC-CL-00009-0-0005
04/19/2019
0.1438
0.0510
2.4968
9.6033
0.9329
0.0292
0.3958
1.2964
0.2132
27.1266
NC-CL-00009-0-0006
05/01/2019
0.1648
0.0476
1.9774
6.7378
0.7583
0.0174
0.3059
0.9797
0.1555
19.3218
NC-CL-00009-0-0007
04/29/2019
0.1248
0.0564
2.1832
8.6201
0.8278
0.0262
0.3530
1.0969
0.1786
22.8329
NC-CL-00009-0-0008
04/20/2018
0.1033
0.0435
1.3964
5.7253
0.7051
0.0162
0.2505
0.6796
0.1254
15.7105
NC-CL-00009-0-0009
05/03/2019
0.1859
0.0567
2.2018
7.6200
0.8224
0.0202
0.3375
1.0622
0.1859
21.8633
NG-CL-00009-0-0010
10/25/2018
0.1006
0.0335
1.2913
4.6300
0.5053
0.0135
0.2004
0.5921
0.1053
13.6439
NC-CL-00009-0-0011
04/04/2019
0.0545
0.0191
0.6782
2.8436
0.2798
0.0063
0.1249
0.3662
0.0631
8.4384
Page: 1 of 1 10/24/2019

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
COUNTY BOARD NOTIFICATION
INSTRUCTIONS FOR FORM: CBN 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This notification is intended to provide the county board in which the land application site is proposed to be located with
general information on the size, location and type of residuals land application proposed to occur in their county, and to give them an
opportunity to comment on the pending permitting request as stipulated in Session Law 2013-340. Notification is not required for
fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100. Do not submit this document for review
without a corresponding residuals program application form (FORM: RLAP 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. County Board Notification (FORM: CBN 11-15):
® Submit the completed and appropriately executed County Board Notification (FORM: CBN 11-15). Please do not make any
unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the form may
be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate County Board Notification (FORM: CBN 11-15) for each county in which the proposed land application
sites are located.
B. Critical Watershed Areas Information:
® Under 15A NCAC 02B .0212, no new permitted sites for land application of residuals are allowed within critical watershed
areas. It is the Applicant's responsibility to ensure that the proposed land application sites are not located within these areas.
® For more information regarding Water Supply Watershed Protection Program, please visit the Division website at:
h s://de .ne. ov/about/divisions/water-resources/water-resources-rules/water-su 1 -watershed- rotection- ro ram
® If uncertain about whether the proposed sites are located within the critical areas, contact the Division or call [phone].
C. Notification Package Submission:
® Complete and mail the notification letter, source facility summary, land application site summary, and site location maps to
the appropriate County Board by certified mail with a return receipt requested. It is recommended that a copy of the
notification package also be sent to the County Manager.
® The most current publication of the Directory of State and County Officials may be downloaded at:
hlt2s://www.sosnc..goyZpublications/direct.aWx
® A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
b.9p://deq.nc.gov/contact/re.gional-offices.
® The source facility summary shall include: facility name; county where it is located; and the proposed annual dry tonnage
(i.e., a copy of "Residuals Source Facility Summary" is adequate but not required).
® The land application site summary shall include: field ID; acreage; county where it is located; latitude and longitude (i.e., a
copy of "Land Application Site Certification" is adequate but not required).
D. Proof of Submission:
® Attach an 8.5 by 11-inch copy of the return receipt to the back of this attachment prior to submission of the application to the
Division for review.
INSTRUCTIONS FOR FORM: CBN 06-16 Page 1 of I

North Carolina Department of Environmental Quality
,t McCrory Donald R. van der Vaart
Governor Secretary
Date: 10/8/ 19
To: Name of Chairman to the Board of County Commissioners: Susan Allen
Complete mailing address: 110 Harbor Point Drive
City: Cherryville
State: NC Zip: 28021-
County where land application sites are located: Cleveland
From: Applicant's name: Charlotte Water (on behalf of the Division of Water Resources in accordance with Session
Law 2013-340)
Contact person and title: Jean Creech, Biosolids Coordinator
Complete mailing address: 12701 Lancaster Hwy
City: Pineville State: NC Zip: 28134-1
Telephone number: [phone] E-mail address: ceech ci.charlotte.nc.us
Subject: Notification of residual land application site proposal
This is to notify you: that the Applicant listed above will be submitting an application to the Division of Water
Resources for the land application of residual solids to sitc(s) located in your county. During this review, the Division
;II ensure that all federal and state regulations are enforced. Attached to this form is information regarding residuals-
oenerating sources and locations of the proposed land application sites. Please forward this letter and its associated
attachments to the appropriate Department within your County (i.e., Health or Environmental Health Department and
Planning Department) if applicable.
More information of the land application sites included in this application will be available at the following
Division of Water Resources Regional Office:
Name of appropriate regional office: Mooresville Regional Office
Complete mailing address: 610 East Center Avenue Suite 301
City: Mooresville State: NC Zip: 28115
Telephone number: [phone]
Expected date of application submission: 01/30/18
Should you desire to comment on this application, please do so no later than 30 calendar days following the
expected application submission date. If you have any questions or comments about this notification, or if you would like
more information, please contact the appropriate regional office at the telephone number provided above. Thank you in
advance for your attention to this matter.
Enclosures: Source Facility Summary
Land Application Site Summary
Maps
Non -discharge Permitting Unit
1617 Mail Service Center, Raleigb, North Carolina 27699-1617
Phone: 9IM07-646411ntemet: htt :1! ortEi.nodenr.o lweblw
An Equal Opportunity 1Afirmative Action Employer -Made in part with recycled paper FORN4: C:BN 06-16

10/17/2019
Mail - Adam Brigman - Outlock
UPS Delivery Notification, Tracking Number 1Z511778W2500181462
UPS Quantum View <[e-mail]>
Thu 10/10/2019 10:07 AM
To: Adam Brigman <[e-mail]>
Your package has been delivered.
Delivery Date. Thursday, 10/10/2019
Delivery Time: 10:03 AM
At the request of Synagro this notice alerts you that the status of the shipment listed below has changed.
Shipment Detail
Tracking Number:
Ship To:
UPS Service:
Number of Packages;
Weight:
Delivery location:
Reference Number 1:
Download the UPS mobile app
1ZSIF78W2500181462
Susan K. Allen
110 HARBOR POINT DR
CHERRYVILLE, NC 28021
US
UPS NEXT DAY AIR
1
3.0 LBS
FRONT DOOR
county notification
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https:lloutlook.office.com/mail/deeplink?version=2019100701.12&popoutv2=1 112

NCDA&CS Agronomic Division Phone: [phone] Website: www.neagr.gov/agronomii Report No. FY20-SL009886
Client: River Taw Farms Advisor: Synagro
126 Cedar Lake Farm Rd 12701 Lancaster Hwy
Heavy Metals
Cherryville, NC 28021 Pineville, NC 28134
Mehlich-3 Extraction
Soil Report
Sampled County! Cleveland
Links to Helpful Information
Client ID: 475545 Advisor ID: 449334
Sampled: 10/01/2019 Received: 10/15/2019 completed: 10/1812019 Farm: NC- CL-09
Agronomist's Comments:
This report contains both routine soil test information as well as heavy metals data in a section labeled as Heavy Metals under soil test lab results. Using Mehlich 3 as a
soil test extractant, background levels of these metals typically seen in NC soils when analyzed are as follows: arsenic (As)- 4.5 ppm, cadmium (Cd)- 0.1 ppm, chromium
(Cr)- 0.2 ppm, lead (Pb)- 4.2 ppm, nickel (Ni)- 0.8 ppm, & selenium (Se)- 0.2 ppm (FY2005-2007). Note elevated lead(Pb) in sample 09-16.Although the above metals here
are not believed to pose a concern for plant growth, continue to monitor these and note where elevated above background levels. Note any lime and fertilizer
recommendations. Ja athi Karralakanthan 1011812019
Sample ID: 09-13 Recommendations: Lime Nutrients (Ib/acre) More
Crop (tonslacre) N P205 K20 Mg S Mn Zn Cu B information
Lime History: 1 - Fescue/OGrass/Tim, E 0.0 50-70 150 0 0 0 $ $ $ 0 Note: 12 Note:
2 - Fescue/OGrasSlTlm, M 0.0 120-200 150 30 0 0 $ $ $ 0 Note: 12 Note: $
'test Results [units - WN in glcm3; CEC and Na in meg1100 cma; NO3-N in mgldm3): Soil Class: Mineral
HM% WIV CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-AI Cu-1 Na ESP SS-1 NO3-N
0.04 0.92 3.6 94 0.2 6.3 1 57 53 34 404 14 18 20 4 4 17 0.1 3
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.1 Lead, 9.1 Selenium, 0.0
Sample ID: 09-14 Recommendations: Lime Nutrients (lb/acre) More
Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information
Lime History: 1 -Fescue/OGrasslTlm, E 0.9 50-70 150 70 0 0 0 $ $ 0 Note: 12 Note:
2 - Fescue/OGraSslTlm, M 0.0 120-200 150 110 0 0 0 $ $ 0 Note: 12 Note:
Test Results [units - WN in g1cm3; CEC and Na in meg1100 cm3; NO3-N in mgfdrn3]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg% S-1 Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-1 NO3-N
0.04 1.03 3.5 72 1.0 5.3 1 17 43 26 346 87 62 69 7 7 18 0.1 3
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0 Nickel, 0.2 Chromium, 0.1 Lead, 5.1 Selenium, 0.1
North Carolina
'�S9L'JSQ' I'1711Li LC1�Sil7i4hAViaE�
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
_ Steve Troxfer, Commissioner ofAoriculture

NCDA&C5 Agronomic Division Phone: [phone] Website: www.ncagr.govlagronomil
Report No. FY20-SL009886
Page 2 of 4
Sample ID: 09-15 Recommendations: Lime
Nutrients (Ib/acre)
More
Crop (tonslacre) N P2O6
K2O
Mg 5
Mn
Zn
Cu B
Information
Lime History: 1 Fescue/OGrass/Tlm, E 0.0 50-70 150
0
0 0
$
$
$ 0
Note: 12 Note:
2 - Fescue/DGrass/Tim, M 0.0 120-200 150
40
0 0
$
$
$ 0
Note: 12 Note:
Test Results [units - W!V in g/cm3; CEC and Na in meg1100 cm3; NO3-N in mg/dm3]:
Soil Class:
Mineral
HM% WIV CEC BS% Ac pH P-1 K-I Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2 Zn-I
Zn-AI
Cu-I Na ESP
SS -I NO3-N
0.04 0.91 3.4 100 0.0 6.8 1 51 48 44
316 18
15 15
16
16
19 0.1 3
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0-0
Nickel, 0.2
Chromium, 0.1
Lead,
4.4 Selenium,
0.0
Sample 1D: 09-16 Recommendations: Lime
Nutrients (lblacre)
More
Crop (tonslacre) N P2O5
K2O
Mg S
Mn
Zn
Cu B
Information
Lime History: 1 -Fescue/OGrass/Tim, E 1.7 50-70 150
80
0 0
$
$
$ 0
Note: 12Note:
2 - FescuelDGrass/Tim, M 0.0 120-200 150
110
0 0
$
$
$ 0
Note: 12 Note:
Test Results [units - WN in g1cm3; CEC and Na in meq/100 cm3; NO3-N in mgldm?]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2 Zn-1
Zn AI
Cu-I Na ESP
SS-1 NO3-N
0.04 0.97 3.9 54 1.8 4.9 1 14 36 15
640 4
12 19
2
2
9 0.1 3
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0
Nickel, 0.2
Chromium, 0.4
Lead,
6.4 Selenium,
0.0
Sample ID: 09-17
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tonslacre) N P2O5
K2O
Mg S
Mn
Zn
Cu B
Information
Lime History:
1 -Fescue/OGrass/Tlm, F 0.7 50-70 150
70
0 0
$
$
$ 0
Note: 12 Note:
2 - Fescue/OGrasslTim, M 0.0 120-200 150
110
0 0
$
$
$ 0
Note: 12 Note:
Test Results [units - W[V in glcm3; CEC and Na in meq/100 cm3; NO3-N in mg1dm3]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1 Ca% Mg%
S-1 Mn-1
Mn-Ali Mn-Al2
Zn-I
Zn-AI
Cu-1 Na ESP
SS-1 NO3-N
0.04 0.89 3.5 77 0.8 5.7 1 17 45 29
551 10
15 23
3
3
14 0.1 3
Heavy Metals (parts per million): Arsenic, 0.1 Cadmium, 0.0
Nickel, 0.2
Chromium, 0.7
Lead,
24 Selenium,
0.0

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.govlagronomii Report No. FY20-SL009886
Page 4 of 4
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Ac
exchangeable acidity
Lime
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
13
boron
tonlacre or Ibl1000 sq ft. For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
BS%
% CEC occupied by basic cations
For no -till or established plantings where this is not possible, apply no more than 4 to 1.5 ton/acre (50 Ib11000 sq ft) at on
Ca%
% CEC occupied by calcium
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
GEC
cation exchange capacity
is applied. if MG is recommended and lime is needed, use dolomitric lime.
Cu-1
ESP
copper index
exchangeable sodium percent
HM%
percent humic matter
Fertilizer
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
K-I
potassium index
Iblacre unless otherwise specified). Recommendations for N (and sometimes for B) are based on research/field studies
K20
Mg%
potash
% GEC occupied by magnesium
for the crop being grown, not on soil test results. K-I and P-1 values are based on test results and should be > 50_ If they
MIN
mineral soil class
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
Mn
manganese
an excellent source; 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn Ali
Mn-availability index for crop 1
only on reports for greenhouse soil or problem samples.
Mn-Al2
Mn-availability index for crop 2
Mn-I
manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pH$, $pH, C or Z
M-0
mineral -organic soil class
notations appear on the soil report, refer to Note: Secondary Nutrients and Micronutrients In general, homeowners do not
N
nitrogen
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.gov/agronomi/pubs.htrn.
NO3-N
nitrate nitrogen
ORG
organic soil class
Recommendations forsmall areas, such as home lawns/gardens, are listed in units of lb/1000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit wuwv.nca r. ov/a ronomi/o6 art4.ht ind information that
P-1
phosphorus index
may help you choose a comparable alternate_ For more information, read A Homeowner's Guide to Fertilizer.
P20s
phosphate
5-1
sulfur index
SS-1
soluble salt index
Test Results
WN
weight per volume
Zn-AI
zinc availability index
The first seven values [soil class, HM%, WN, CEC, l3S%, Ac and pH] describe the soil and its degree of acidity. The
Zn-I
zinc index
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-1, Mn-All, Mn-AI2, Zn-1, Zn-AI, Cud, S-I, SS -I, Na, ESP, SS -I, NO3-N (not routine[
available)] indicate levels of plant nutrients or other fertility measurement. Visit wwwncagrgov/agronomUuyrst.htm

Site ID: NC-CL-09
Owners Name: Patrick J. O'Leary
River Taw Farms
Address: P.O. Box 6929
Statesville, NC 28687
Phone:
Operator: Same
SITE SUMMARY
Charlotte Water
Charlotte, NC
Cleveland Co.
Applicable Crop(s)RYE-based
Fields Acres Annual PAN
(LB/AC/YR)
Date: Oeotber 1, 2019
Predominant Soil Latitude Longitude
Series
CL-09-01
17.5
Fescue
209
Cecil (CaB2)
35 25 7 N
813126 W
CL-09-03
8.9
Row Crop
Crop based
Cecil (CaB2)
35 24 31 N
813137 W
CL-09-04
27.9
Fescue
209
Cecil (CaB2)
35 2151 N
8129 35 W
CL-09-05
CL-09-06
17.2
34.3
Fescue
Fescue
209
209
Cecil (CaB2)
Cecil (CaB2)
35 22 1 N
35 2Z 35 N
9129 47 W
81 Z9 32 W
CL-09-07
48.9
Fescue
209
Cecil (CaB2)
35 22 46 N
81 27 24 W
CL-09-08
22.5
Row Crop
Crop based
Cecil (CaB2)
35 22 49 N
8127 52 W
CL-09-09
61.8
Fescue
209
Cecil (CaB2)
35 23 10 N
8127 22 W
CL-09-10
58.0
Fescue
158
Pacoloet (PaC2)
35 2413 N
8128 11 W
CL-09-11
29.2
Fescue
158
Pacoloet (PaC2)
35 24 38 N
81 Z7 5Z W
CL-09-12
CI-09-13
CL-09-14
48.3
44.0
32.9
Fescue
Fescue
Fescue
158
209
158
Pacoloet (PaC2)
Cecil (CaB2)
Pacoloet (PaC2)
35 2138 N
35 23 33 N
35 23 41 N
8125 20 W
8126 50 W
81 27 03 W
CL-09-15
29.2
Fescue
209
Cecil (CaB2)
35 ZZ 42 N
8126 11 W
CL-09-16
4.4
Fescue
209
Cecil (CaB2)
35 25 18 N
8129 13 W
CL-09-17
6.0
Fescue
209
Cecil (CaB2)
35 25 10 N
8129 02 W
CI-09-18
30.5
Fescue
209
Cecil (CaB2)
35 27 03 N
8129 49 W
TOTAL 521.4
NOTES:

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— -- — — — — PRIVATE ROAD
CD
WATER
— — — — STREAM
.
ONSITE HOUSE
— DRAIN
WAIVED HOUSE
OFFSITE HOUSE
�---�� FENCE
OUTBUILDING
PROPERTY LINE
WELL
the compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
V = 660`
660, 0 660'
NC-CL-09
Field 1

APPLICATION AREA
PRIVATE ROAD
STREAM
— DRAIN
_.._ FENCE
PROPFRTY LINE
ADDI irLMONI NAAP 1
WATER
ONSITE HOUSE
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 ft from the residuals application area ar 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. Ail
Vocations are approximate.
GRAPHIC SCALE
1 = 660'
ssoo s6a
NC-CL-09
Field 3

APPLI-CATION MAP
LEGEND
APPLICATION AREA
WATER
_ _ _ _ PRIVATE ROAD
ONSiTE
HOUSE
OFFSIT
E HOUSE
OUTBUILDING
WELL
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is estabtished
midway betwcen the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
RI
EC
GRAPHIC SCALE
1" = 660`
660' 0 660,
T
NC-CL-09
Fields 4-5

APPLICATION MAP
i A-
O • � � /III �f % %
-02
LEGEND
APPLICATION AREA
WATER
- — — PRIVATE ROAD
— - - — STREAM
ONSITE HOUSE
- DRAIN
.
OFFSITE HOUSE
X X X FENCE
❑
OUTBUILDING
PROPERTY LINE
0
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
I" = 660'
660, 0 660,
I 5
NC-CL-09
Field 6

L
APPLICATION MAP
�ZIpTRD� ��
.-■
k
-i i
f
LEGEND
APPLICATION AREA
WATER
— — — — — — PRIVATE ROAD
— — — — STREAM
ONSITE HOUSE
— DRAIN ■
OFFSITE HOUSE
�— FENCE
OUTBUILDING
-- PROPERTY LINE 0
WELL
(he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area.
The review boundary is established
midway between the compliance boundary and the perimeter of the
residuals application area. All
locations are approximate.
IMP
IN
■
GRAPHIC SCALE
1" = 660'
660' 0 660,
NC-CL-09
Fields 7-9

a
z
APPLICATION MAP
LEGEND
APPLICATtON AREA
— — — — — -- PRIVATE ROAD Vl WATER GRAPHIC SCALE
— — — — STREAM ONSITE HOUSE
1" = 660'
660' 0 660'
— DRAIN ■ OFFSITE HOUSE
FENCE. OUTBUILDING
PROPERTY LINE WELL
(he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-CL-09
in the property boundary, whichever is closest to the appkcation area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 0-1 1

SOIL SURVEY
' �� F ��✓4�� a ��Y A' � ,yam �, ice.• -�s� �a✓ �-
f sue.. GRAPHIC SCALE
,:� •� 1" - 1,000'
r
Che compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-09
Fields 1 & 3

SOIL SURVEY
GRAPHIC SCALE
1" 1,000'
1,000 o 1,000,
i he compliance boundary is established either 25C ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-09
Fields 4-6

1:
4r
2
SOIL SURVEY
GRAPHIC SCALE
1" = 1,000'
1,000, 0 1'000'
1-he compliance boundary is estabiished either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-09
Fields 7-9

a
a
z
SOIL SURVEY
r g, 'ter►rfsx
kA
Ili +�♦
F 3 —
a
AL
rp
GRAPHIC SCALE
1" 1,000'
1,000, 0 1,000'
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter cf the residuals application area. All
locations are approximate,
N C-C L-09
Fields 10-11

jyf
TOPOGRAPHIC MAP
GRAPHIC SCALE
1" 800'
Me, a 800,
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-09
Field 1

TOPOGRAPHIC MAP
GRAPHIC SCALE
1" W 800'
800, 0 B00'
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C_CL-09
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Field 3

TOPOGRAPHIC MAP
LL'
Q
Z
GRAPHIC SCALE
1" 1,000'
1,000, o 1,000,
fhe compliance boundary is estab5shed either 250 ftfrom the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-C L-09
Fields 4-6

z
V)
TOPOGRAPHIC MAP
O
®
O
I
-
E
GRAPHIC SCALE
1" _ 1,000'
1,000, 0 i ,000'
i he compliance boundary is estabiished either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is estabiished
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-CL-09
Fields 7-9

a
Q
z
,F
i
TOPOGRAPHIC MAP
GRAPHIC SCALE
V = 800'
800, 0 800,
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
Taw
M
NC-CL-09
Fields 1 0-1 1

VICINITY MAP
r,, F�Il::zrn
Ry
Q 1553
1E
zCIE)
R�
of �
U u
j9o7
1?�3
P LW'
[yw+l}hiP �h7aJ� �h
561
05
C~.ifry�
1
z,
5924
IEi7 I
' 11, Fir
152
1657
V16 I'Yrmpy
4
I.
� 1 fiGl
iu6leS3✓1iiS}4%
.4
J.r
13".E
n
a
v
R
0.
19T5
I EA5
GRAPHIC SCALE
1" - 4,000'
Owl 0 4,00o'
I he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate,
Cy
4
OF
NC-CL-09
Fields 1-1 1

APPLICATION MAP
LECIEhM
PROPERTY LINE
—,...— DRAIN
APPLICATION AREA
OFFSITE HOUSE
UNSUITABLE AREA
ONSITE HOUSE
-�.•—•. STREAM
(2 WELL
1 inch = 660 feet
Feet
0 165 330 660 990 1,320
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
.All locations are approximate.
NC--CL-09
Field 12

lr(&1

APPLICATION MAP
LEGEND
PROPERTY LINE
-•-•- DRAIN
APPLICATION AREA
F-1 OFFSITE HOUSE
® UNSUITABLE AREA
■ ONSITE ROUSE
--•—•- STREAM
f WELL
1 inch = 660 feet
Feet
0 165 330 660 990 1,320
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area.
The review boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
All locations are approximate.
NC-CL-09
Field 14

7
W�I

APPLICATION :MAP
I�S�F,NJ�
PROPERTY LINE
---•— DRAIN
APPLICATION AREA
OF£SITE HOUSE
® UNSUITABLE AREA
■ ONSITE HOUSE
— • • — • • STREAM
WELL
I inch = 660 feet
Feet
0 165 330 660 990 1,320
The compliance boundary is established at
either 250 feet from the residuals application
area or 50 feet within the property boundary,
whichever is closest to the application area.
The zeniew boundary is established midway
between the compliance boundary and the
perimeter of the residuals application area.
All locations are approximate.
NC-CL-09
Fields 16-17

v� f • 'PAO
4
4 As
�• �!�! �o�c.w J y ,;�-a f 5 is
v. \5 gyp• i ,t. '-ft�{ 7.
A
r �
�`�� •'� "" J� ( �' .ice w� } _
tk
�i ,y� � •`/ � '�' y � i '• '.mil '9�
'ki m On
� •� � �At ��•/% f !� ��' � ip'�®�` [fit �- . � --.+.''.
Y`f'`• 'q;Q°fa►d'g8�41i63�ONf
i

611
L
a
z
V)
NC-CL-09
Field 12
SOIL SURVEY
Z inch = 660 feet
0 165 330 660 990 1,320
Feet
All locations are approximate.

SOIL SURVEY
NC-CL-o9 I inch = 660 feet
Fields 13-14 0 165 330 660 990 1,320
Feet
All locations are approximate.

5#1
a
z
V)
SOIL SURVEY
NC-CL-09 1 inch = 500 feet
Field 15 0 125 250 500 750 1,000
Feet
All locations are approximate.

w
a
z
r
SOIL SURVEY
NC-CL-o9 I inch = 660 feet
Fields 16-17 0 165 330 660 990 1,320
ff Feet
All locations are approximate.

a
z
N
SOIL SURVEY
NC-CL-09 x inch = 500 feet
Field IS 0 125 250 500 750 1,000
Feet
All locations are approximate.

n
i�
a
z
TOPOGRAPHIC MAP
NC CL_o9 1 inch = 1,667 feet
Feet
Fields 12 & 15 0 450 900 iAo 2,700 3,600
All locations are approximate.

'FOPOGRAPHIC MAP
1 inch = 1,667 feet
NC-CL-09 Feet
Fields 13-14 0 450 900 1,800 2,700 3,600
All locations are approximate.

NC-CL-o9
Fields 16-17
TOPOGRAPHIC MAP
1 inch = 1,667 feet
Feet
0 450 900 1,800 2,700 3,600
All locations are approximate.

a
z
r
TOPOGRAPHIC MAP
1 inch = 1,667 feet
NC-CL--o9 Feet
Field 18 0 450 900 1,800 2,700 3,600
All locations are approximate,

WATERSHED MAP
1 inch = 2,000 feet
NC-CL-09 Feet
Fields 12 & 15 0 5001,000 2,000 3,000 4,000
All locations are approximate.

WATERSHED MAP
1 inch = 2,000 feet
NC-CL-09 Feet
Fields 13-14 0 SOD 1,000 2,000 3,000 4,000
All locations are approximate.

WATERSHED MAP
p 1
Av
Aj7ti 1 Y
!llddd ' e P -
s "
• 1 � LLLfiiiii iii r i
t 1 1 `
r
s..
• ¢. 1 tf � LPG } h P;:e:tdahi • �. J •`� `.� •\ _ ' � -� � �. ��6�'�. ��G
lj'%� _• =r ' ,i Allston
41
lo
x inch 2,000 feet
NC—CL—o9 Feet
Field 18 0 5001,000 2,000 3,000 4,000
All locations are approximate.

VICINITY MAP
J/S�p
ft
x
n
m
�th
44 Barr, ett Pd
�j
N
d
G
Or14iPn RU
i
w
7
d�
ej. L
"py
rr
a�
v�
V.
_ dies �
i ryrd fid
fl
S®drp; '�1`�'tf4'`tc� 12
�'.� Waco
r
e
Ic
e vim, x
4
m
A
c`3
L
C
NC-CL-09
Fields 12-15
I inch � 4,167 feet
Feet
0 I,150 2,300 4,6c0 6,900 9,200
All locations are approximate,

NC-CL-09
Fields 16-18
VICINITY MAP
I inch = 4,167 feet
F,et
0 1,150 2,300 4,600 9oo 9,?Oo
Allocations are approximate.

SYNAGRO, CHARLOTTE WATER CLASS B PERMIT
WQ 0000057
SOIL SCIENTIST CERTIFICATION
This is to certify that soil profile evaluations were conducted on the proposed application
sites for the Charlotte Water project by Piedmont Environmental Associates, P.A. on
behalf of Synagro Central, LLC. The evaluations consisted of hand auger borings and
descriptions of the soils on the application sites. All hand auger borings included in this
package were either performed by me or under my direct supervision. All other work
performed for this permit application was conducted by Synagro Central, LLC.
0P E;?
G. Christopher Murray, L.S.S.
No. 1284
Synagro, Charlotte Water Project, Various Fields

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WQ 0000057)
% Slope: 5%
Site: 09
Crop: Forage/Pasture
Field: 09-12
Conducted By: GC Murray
PIEDMONT
Coordinates: 35"21'43"N
Date: 812212019
ENVIRONMENTAL
81 °25'05"W
Soil Series: Pacolef
w z s o c i w r s s. P. A.
CD
w
ul
C Cf N
'o
Q
a
LU
N
a. G
a. ry
.ac
U
m
7 N N
C�
to
F -Ln
i C
O
O
C
d)
7
N
m
N�
w
«:
� x Y �
N �I
w
w c u
N
a
i
i u m
A
1 0-5
1 10YR 313
moist
sl
mod
med
V r
fr
ns
n
AB
5-11
10YR 316
moist
scl mod
med
sbk
fi
s
p
Bt
11-36
2.5YR 416
moist
c mod
med
sbk
fi
s
BC
36-48
2.5YR 418
moist
cf wk
med
sbk
fi
s
p
Legend.
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay loam
sl
sandy loam
sid
silty clay loam
Structure Grade
Structure Type
wk weak
gr granuiar
m moderate
pl platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Size
f fine
med medium
Moist Consistency
fr friable
vfr veryfriable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched)

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (Wq 0000057)
% Slope: 5%
Site:09
Crop: ForageGC
r .
PIEDMONT
Fifes: 09-13
Conducted GC Murray
Coordinates: 35°23'27"N
Date:
Date: 8/22/209 9
...
81 "26'41 "W
Soil Series: Cecil
�. j'
A s o c c AV r s, P. w.
u
❑
W
Q
U
O. G1
N
N
O
N
V O
O
a N
C
N
C
Q Vl U j LI
N
O
y
y
i N
7 U c 'V
N
X
N Y 'ln
ti
T h S
S
Q7 O
S S N S13)
.�.
.i.
.�". p N
0 n
Legend:
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
clay loam
scl
sandy clay foam
sl
sandy loam
sici
silty clay loam
Structure Grade
Structure Type
wk weak
gr granular
m moderate
pi platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
ma massive
Structure Sfze
f fine
med medium
Moist Corsistency
fr friable
vfr veryfriable
fi firm
of very firm
Seasonal High Water Table:
Depth (") Type (apparent! erched)

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WQ 0000057) % Slope: 6%
Site: 09 Crop: Forage/Pasture
Field: 09-14 Conducted By: GC Murray PIEDMONT
Coordinates: 35"23'45"N Date: 812212019r'Ja3HEL
81`27'03"W Soil Series: Pacolet/Bethlehem l '' w s x a c i Arms, P.A.
Legend,
Texture
s
sand
I
loam
si
silt
sil
silt loam
c
clay
cl
Clay loam
scl
sandy clay loam
sl
sandy loam
sicl
silty clay loam
Structure Grade
Structure Type
A weak
gr granular
m moderate
pl platy
str strong
pr prismatic
cpr columnar
abk angular blocky
sbk subangular blocky
sg single grained
me massive
Structure Size
f fine
coed medium
Moist C-- onsistencY
fr friable
vfr very friable
fi firm
vfi very firm
Seasonal High Water Table:
Depth (") T pe (apparentlperched}

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WQ 0000057) % Slope: 5%
Site: 09 Crop; Forage/Pasture
Field: 09-15 Conducted By: GC Murray PIEDMQNT
Coordinates: 35°22'45"N Date: 8/22/2019 ENVIRONMENTAL
81 °25'60"W Soil Series: Cecil As nor i& r s s, •. w.
i-egeno:
Texture
s sand
Structure Grade
Structure T
---yam
Structure Size
I loam
wk weak
gr granular
f fine
si silt
m moderate
pl platy
mad medium
sii silt loam
str strong
pr prismatic
c clay
cpr columnar
cl clay loam
abk angular blocky
s c sandy clay loam
sbk subangular blocky
Moist Consjsten
sl sandy loam
sg singie grained
fr friable
sicl silty clay loam
ma massive
vfr very friable
fi firm
A very firm
Seasonal High Water Table:
Depth (") Type (apparent/perched

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WQ 0000057) % Slope: 6%
Site: 09 Crop: Forage/Pasture
Field: 09-16 Conducted By: GC Murray PIEDMONT
W
Coordinates: 35°25'17"N Date: 8/22/2019 PlEDPIEDMME�T
81 °2912 Soil Series: Cecil
A 3 1 0 C[ A T E 1, P.A.
L yur7Q:
Texture
s sand
Structu,_ re Grade
Structure T e
— —yam
Structure Size
loam
wk weak
gr granular
f fine
si silt
m moderate
pl platy
med medium
sil silt loam
str strong
pr prismatic
c clay
cpr columnar
clay loam
abk angular blocky
c sandy clay loam
sbk subangular blocky
Moist Consisted
Sl sandy loam
sg single grained
fr friable
sicl silty clay loam
ma massive
vfr very friable
fi firm
vfi very firm
ff
sonal Hi h Water Table:
epth (") Type (apparentiperched)

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WQ 0000057) % Slope: 6%
Site: 09 Crop: ForagelPasture
Field: 35*25 Conducted By: GC Murray PIEDMONT
Coordinates: 3525'o9" N 81 °2901W Cate: 8/2212019 ENVIRONMENTAL
Soil Series: Cecil 4:0 AS SO c l A r s s, P. A.
­yw1u.
Texture
s sand
Structure Grade
Structure Type
Structure Size
I
loam
wk weak
gr granular
f fne
si
silt
m moderate
pf plat Y
med medium
sil
silt loam
str strong
pr prismatic
c
clay
cpr columnar
Cl
clay loam
abk angular blocky
scl
sandy clay loam
sbk subangufar block Y
Moist Consistency
sl
sandy loam
sg single grained
fr friable
sicl
silty ciay loam
ma massive
vfr very friable
f firm
vfi very firm
Seasonal High Water Table•
Depth (") Type (apparenttperched)

Soil Profile Descriptions in Field Locations
Project: Charlotte Water (WO 0000057) % Slope: 5%
Site: C9
Field: 09-18 Crop: Forage/Pasture
Coordinates: 35-26`58"N Conducted By: GC Murray "'4 PIEDMONT
81 °29'53"W Date: 8/22/2019
Soil Series: Cecil
II A! iO C 1 AT i, iF. A.
V'
s
Texture
sand
Structure Grade
Structure Type
Structure Size
I
loam
W' weak
gr granular
f fine
Si
silt
m moderate
str
p I platy y
med medium
sil
silt loam
strong
pr prismatic
c
clay
cpr columnar
cl
clay loam
abk angular blocky
scf
sandy clay loam
sbk subangular blocky
Moist C� onsisiency
sl
sandy loam
s9 single grained
fr friable
sicl
silty clay loam
ma massive
vfr very friable
fi firm
vfi very firm
Seasonal Hiah Water Tabig
Depth (") Type {apparerntrperched)

r_
i

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
`� '�� LAND OWNER AGREEMENT
Zvlslion of Water Resources
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 bonzes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water'Quality Permitting Section's Non-Dischar a Permittin Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form.. if necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
[71 Prepare a separate agreement for each set of land application sites that are owned or operated by au entity other than the
Applicant.
Pq A copy of the completed and appropriately executed agreement must be provided to the landowner and the lesseeloperator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
undersigned landowner or his representative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Special note
Lease Land Use or Residuals Source no-till/over-seed/
Site/Field field ID i Intended Use of Craps a tional
(yes/no) Cropping Patterns (optional) 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.
s Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
11 be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

r. STIPULATIONS:
L 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.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section Il) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDI NR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to anew
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 pattelms, 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 Ieast 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 Iimits.
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 tc; 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 sites) 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.
,�. 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 sites) 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 Iand 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.
U1.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 02'T .0102M allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
El"A re -defined compliance boundary is needed for field(s) ID: 1A-31 2,- 5
(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.
ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land applicationfreld(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;
(Marne of the new program)
T= r a n /fir Y L Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:,/,'L !/
Address: Jl drkZ
fi r
City: ��- >�' S.r�%Z State: - Zip: _ r�1
Phone: r% ' E-mail address: Q
Signature: Date:-
NORTH CAROLINA, - iced COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the 1 Z 14
day of
Signat
My co:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City: State:
Phone: E-mail address:
Signature: Date:
Permittee's Certification:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: :3A
Signature:
(:;L,iN'C', A, S`A1Z
Date
10 -k0 -\q
FORM: LOA 06-16 Page 3 of 3

State of North Carolina
Department of Environment and Natural Resources
Rw- Division of Water Resources
Iltvlslon of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two coliies 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
CIass B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
�] Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
undersigned landowner or his represientative hereby permits:
Applicant's name:
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s). (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
T (yes/no)Cropping
Land Use or
pp g Patterns(optional)
fntendedUse of Crops
Residuals Source
Special note
{no-tilllover-seed)
pasture)
V
r
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the Iand application site(s) described above for the disposal of the residuals.
s Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
11 be renewed each time this permit is renewed.
The undersigned Iandowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3

>. 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.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e,g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application sites) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13, The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application sitc(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.
li. 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 sites) 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 pirevent 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 laud 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 thanfour 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 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;
TA re -defined compliance boundary is needed for field(s)1D:
(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.
ACKNOWLEDGEMENT Ol? 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 aclmowledge 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)
-Pnaa °7 of I

Landowner's Certification:
certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
;garding the use of the land application sitc(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: ' I pw, j< Ar--) j
Address: 2 0 L (2a 4 q
City: State: Zip:
Phone: 70 ` - T0Z - �02 E ail address:
Signature:
NORTH CAROLINA, 1-ecjc COUNTY
L the undersigned Notary Public do hereby certify that M cM �f
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 0(�0 - )20 t7
Signature and seal:
ADAM EIRIGMAN
My commission expires:
GASTON COVNTY NC
MY COMMISSION EXPIRES APRIL 28,.
Lessee's/Operator's Certification:
I certify that l have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator nanne:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Datc:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official nania: ��► C�Q V C 1, t',--���k�Ll -
Signature: Date:
_­ X. r r A nc 1 c PnaP I of i

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 1012412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have.been archived to History).
In cases where a trace metal lab result was Not Deported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field ID
Last Applied
As
Cd
Cr
Cu
Pb
Hg
Mo
Ni
Se
Zn
NC-IR-00032-0-0002
11/01/2018
0.0763
0.0417
1.5111
6.0654
0.5306
0.0109
0.2180
0.7678
0.1116
17.2155
NC -I R-00032-0-0003
11 /20/2017
0.1082
0.0364
1.2984
4.2244
0.4527
0.0087
0.1783
0.5374
0.0912
12.2846
NC-tR-00032-0--0004
11/16/2017
0.1191
0.0387
1.4270
4.4125
0.4852
0.0097
0.1921
0.5616
0.0967
12.6013
NC-IR-00032--0-0005
11/21/2017
0.1633
0.0290
1.0876
2.6171
0.2784
0.0070
0.1289
0.3547
0.0726
8.3729
Page: 1 of 1 10/24/2019

Site ID:
Owners Name:
Address:
Phone:
Operator:
SITE SUMMARY
Charlotte Water
Charlotte, NC
NC-IR-32
Eddie Porter
4437 Beck Road
Wadesboro, NC 28170
M - (704)-838-3388 (Eddie)
M - (704)-902-5814 (Shane)
Shane Porter
©ate: Ocotber 1, 2019
Iredell Co.
Applicable Crop() s RYE -based Predominant Soil
Fields Acres Annual PAN Series
(i R/OC/VRi
Latitude Longitude
IR-32-02
42.3
Fescue
188
Tomlin (ToB2)
35 53 23 N
80 45 18 W
IR-32-03
90.0
Fescue
188
Tomlin (ToB2)
35 53 12,N
80 44 52 W
IR-32-04
24.2
Fescue
218
Banister (BcB)
35 52 38 N
80 44 56 W
IR-32-05
44.3
Row Crop
crap based
Dan Ripple (DeB)
35 52 23 N
80 44 44 W
TOTAL
200.8
NOTES: Field 2 leased from Mark Gantt

— — — — PRIVATE ROAD
— — — — STRRAM
— — -- DRAIN
FENCE
APPLICATION MAP
LLUENU
APPLICATION AREA UNSUITABLE AREA
PROPFRTY LINE 0
WATER
ONSITE HOUSE.
OFFSITE HOUSE
OUTBUILDING
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
GRAPHIC SCALE
1" = 660'
Egp' 6 660'
N C-i R-32
Fields 1-2

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
— — — — — — PRIVATE ROAD
WATER
GRAPHIC SCALE
1 ° 660'
-- — — — STREAM .
ONSITE HOUSE sso'
o ssa'
— DRAIN .
OFFSITF HOUSE
�^
_---- FENCE
OUTBUILDING
PROPERTY LINE 0
WELL
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C`I R-32
in the property boundary, whichever is closest to the appiication area.
The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
Fields 3
locations are approximate.

APPLICATION MAP
LEGEND
APPLICATION AREA UNSUITABLE AREA
— — — — PRIVATE ROAD WATER GRAPHSC SCALE
660'
— — STREAM ■ ONSITE HOUSE 660, a 660,
DRAIN . OFFSITE HOUSE
FENCE OUTBUILDING
PROPLRTY LINE 0 WELL
f he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C-I R-32
in the property boundary, whichever is closest to the application area. The review boundary is established I
midway between the compliance boundary and the perimeter of the residuals application area. All Fields 4`5
locations are approximate,

. r.
41 ru -
SOIL SURVEY
y�s
0
W-1- -
u t
ti
♦ �Y
l F a'
y4. `
GRAPHIC SCALE
1" = 660'
660, 0 660,
ncf
F
i he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
NC-IR-32
Fields 1-2

SOIL SURVEY
GRAPHIC SCALE
1"=1,320'
9 ,320' 0 1,320'
[he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
N C-I R-32
Fields 3-5

TOPOGRAPHIC MAP
GRAPHIC SCALE
1"=1,320'
1,320' 0 1,320'
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
t
NC-IR-32
Fields 1-5

VICINITY MAP
GRAPHIC SCALE
1" = 5,000'
5,000, 0 5,000'
fhe compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
NC-IR-32
Fields 1-5
locations are approximate.

State of North Carolina
RWR
Department of Environment and Natural Resources
Ilk
Division of Water Resources
Division of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supportindocumentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source Certification (FORM: LASC 06-16) form... Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attacbments 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
undersigned landowner or his rep
Applicant's name:
entative hereby permits:
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:
SitelField ID
Lease
ease
(Y }
Land Use or
Cro d Patterns
Pp g
Iutended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
�J r
,L � ` i 3— C1/�
/Vol
J
� C a'adi,o
:rd ry�#�1fr�n7➢�lay.�
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.
is Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
It be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page, I of 3

1. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the laud application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
S. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and 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 laud application area boundaries shall be clearly marked on the land application sites) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or theix 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 sites) 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.
�i. 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-inonth 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 wben the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
11I.ALTERNATI'VES. 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 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
bon ary 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.
ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Nrunber 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: LO,A. 06--16 Page 2 of 3

Landowner's Certification:
" certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
:garding 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 Perinittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name: J e
Address: 2`'t 2 -Jarab j+; o Ljrj
City: � i c': � `U % ref 2 State: /V6 zip
Phone: ' (L j ' Ef (o Z E-mail address:
Signature. Date:
NORTH OLINA,COUNTY
2'1 z 5
fa - 15 - Iq
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
r LT-h
day of. od
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
ADAM BRIGMAN
GASTON COUNTY, NC
MY COMMISSION EXPIRES APRIL29, 2023
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator naive:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name:
Signature:
vlc�L )Qcl� A . __DA
Date; 1 U- 1 O— j J)
FORM: LOA 06-16 Page 3 of 3

CUMULATIVE METAL LOADINGS (LBSIACRE) AS OF 1012412019
The Cumulative metals for this report come from HISTORY records (i.e. a Monthly Report has been produced and the loadings have been archived to History).
In cases where a trace metal lab result was Not Reported to Synagro or tracking of the metal loading was Not Required the loading on the report is displayed as "NR"
Date
Field CD Last Applied
As Cd Cr Cu Pb Hq Mo Ni Se Zn
NC-IR-00033-0-0001 03/19/2018
0.2706 0.0534 1.9736 4.4347 0.5815 0.0127 0.2340 0.6352 0.1378 15.5574
NC-IR-00033-0-0002 07/28/2017
0.1737 0.0435 1.4802 4.2312 0.4464 0.0100 0.1901 0.5576 0.1089 13.9501
Page_ 1 of 1 10124/2019

Site ID: NC=lR=33
Owners Name: Joseph W, Knox
Address: 243 Jarab Hill Lane
Statesville, NC 29625
Phone: M - (704)-361-3462
Operator: SAME
Applicable
Fields Crop(s)
Acres
SITE SUMMARY
Charlotte Water
Charlotte, NC
Date: April 1.5, 2016
Iredeli Co.
RYE -based Predominant
Annual PAN Soil Series
(LB/AC/YR)
Latitude Longitude
Mecklenburg
IR-33-01
10A
Fescue
188
35 46 36 N
80 44 11 W
McB2
Mecklenburg
IR-33-02
11.6
Fescue
188
35 46 57 N
80 44 10 W
McB2
TOTAL
22.0
NOTES:

APPLICATION MAP
w qF 1
IREDELL CC. ! POWNN CO, 't
J.
a �
r
LEGEND
APPLICATION AREA
— — PRIVATE ROAD WATER GRAPHIC SCALE
— — — — STREAM ONSITE HOUSE
1"=660'
660' 0 6fi0'
— DRAIN ■ OFFSiTE HOUSE
M X— X FENCE OUTBUILDING
PROPERTY LINE 0 WELL
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within N C- I R-33
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All locations are approximate. Fields 1-2

SOIL SURVEY
GRAPHIC SCALE
1" = 660'
ssoo ssa
he compliance boundary is established either 25C ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
NC-IR-33
Fields 1-2

i�
i
a
t,
TOPOGRAPHIC MAP
,
d
c r
GRAPHIC SCALE
1 1,000'
�,000o �,aca
_J
he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
N C-I R-33
Fields 1-2

VICINITY MAP
GRAPHIC SCALE
1" = 4,000'
4,000' 0 4,000'
, he compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
NC-IR-33
Fields 1-2

l�. e � ��z^�1�

VICINITY MAP
R18
v,
(i18
rill Shop
[:1.)
9rla
I
Agry ereera Sprttyln® c�
sa
GRAPHIC SCALE
1" = 2,500'
2,500' 0 2,500'
he compliance boundary is established either 250 ft from the residuals application area OF 50 feet within
in the property boundary, whichever is closest to the application area, The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.
T
r ais'1
NC-UN-130
Fields 1-3