WQ0004166_More Information (Received)_20200828

ALDERMEN
302 East Main Street
Cathy Ballou
PO Box 67
Charles Caudill
Jefferson, NC 28640
Mark Johnston
Wes Williams
Phone [phone]
Max Yates
Fax [phone]
Tax ID * 56-0896625
August 28, 2020
Poonarn Giri, Hydrogeologist
NC Department of Environmental Quality
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
SUBJECT: Application No. WQ0004166 / Jefferson, Ashe County
Additional Information Request
Town of Jefferson Land Application of Class B Residuals
Dear Ms. Giri:
MAYOR
Bluferd Eldreth
TOWN MANAGER
Cathy L. Howell
FINANCE OFFICER
Anna M. Brooks
Please find enclosed the additional information requested for the Town of Jefferson renewal of
Class B residuals permit # WQ0004166.
A. Property Ownership Documentation
1. Please find the revised LOA 06-16 signed by James Nathan Walters as the owner of
the property referenced as Field 5.
2. Due to the recent requirement by NC Division of Water Resources obligating
property owners to record setback waivers with the county Register of Deeds, the
Town of Jefferson will remove Site 3 from the permit.
B. Site Map
1. As noted in the email of August 17, 2020, with the removal of Field 3 a revised site
map will be unnecessary.
As requested, the Town is providing two paper copies and one electronic copy to you today. If
you have questions or require additional information please contact Mr. Tim Church at (336)
246-2165 or Thank you for your assistance toward this permit
re news 1.
Respectfully,
-1v� AAX� �or Howd(
Tim Church, Water Resources
irector

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources ISA NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted,, the Applicant shalt submit one original and two conies of the application and
supporting documentation
For more information, visit the Water duality Permitting Section's ion-Disclutrge 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 15 A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not matte any unauthorized content changes to this form if necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name:
Town of Jefferson
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
es/no
(Y )
Land Use or
Cropping Patterns
ppg
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-tiWover-seed/
pasture)
Field 5
n0
Hay/fescue
Hay/pasture
NCO021709
El
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page 1 of 3

1. STIPUILATIONS:
I . The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his rcpresentattic [ease or otherwise permit the use of the land application sites) to a third pariv, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions ofthis Agreement
3, The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) arc ma
4. Notification ofcanccliation of this Agreement shall be immediately forwarded to NCDENK-DWR. Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh. NC 27699-1617.
5. The Pennines must request and obtain a permit modification from the Division prior to a transfer of the land application sitets) to a new
lando,wrier. In addition, the current landowner shall gi% c a notice to the neck landowner that gives full details of the residuals applied at die land
application site(s).
6. The Permatee has provided the landowner or his representative with information and data concerning the residuals land application program,
includinp, at) analysis of constituents of the residuals- residuals application methods- schedules for typical cropping patterns, a description of the
equipment used by the Permlittec.
7. The Perininec will provide [lie landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of die results of each soil analysis.
8. If the soil pH of the land application sitc(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 inforniation indicating that the PH of the soil, residuals and time mixture is suitable for the
specified crop.
9. The landovvncr or his representative and the Permittoc 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, ctc.) that have been applied to the land application site(s)
I I . The landowner or his representative will inform the Pcrtnittec of auvr revisions or modifications to die intended use and cropping patterns for
the land application sites) 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 sites) by the Pennittec, the landokvuer, or
his representative prior to and during a residuals land application event.
13. Tice landowner or his representative herelly, authorizes the Permittec_ local offends, 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 deterillilling
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
terns of. and 12 months after termination of, this Agreement,
IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittec 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 sitc(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 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 rosidualsisoil mixturcand are totally above the land surface shall not be harvested for a 14-nionth
period following a residuals land application went.
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 k%,hcn the residuals remain on the land surface for lour 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 sod,
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.AILTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
I SA NCAC 02L.0 107(d) prohibits water SLIPPI\ \Ncll- vvithin the compliance boundary. However, 1 1 ldi)ih i allows the compliance
boutidar\ to be placed closer to the waste disposal area, such that the \\alcr supply well is situated Outside of the compliance boundar\ provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
El A re-definc-d compliance boundam 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 boundan, is not needed for this -,lie,
IV. ACKNOWLEDG EM ENT OF FIELD TRANSFER: (if needc: (1) N/A
E3 The land application field(s) ID: is currently permitted under another
residuals land application program: Permit Number WQ: The land owner licreby 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 nc\N program)
FORM,� LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore. I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Vermittee to land apply residuals to the land application sites) as specified
herein
Landowner name: James Nathan Walters
Address: ✓ Ati—,6e,1L
City: State d Zip, 2 211
Phone: J3 E-mail address: ;4 CA A _C_ Z>
Signature: A0. At;= z=�, Date:
NORTH CAROLINA, Ashe — COUNTY
L the undersigned Notary Public do hereby certify that James Nathan Walters
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official sea] this the
T A
day of )br 1 4 20
MY Comm. Exp.
Signature and seal.
L
My commission expires: C, k, . _. 'C'
V tj V_
c()U`tA
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-, Tim Church, Town of Jefferson
Address: P.O. Box 67
City: Jefferson
State: NC
W-Iffloms
Phone. [phone] E-mail address:jef f wns,A.cerituryl ink. net
Signature: Date: 912412Q20
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official
Signature:
Date 2/24/2020
FORM: LOA 06-16 Page 3 of 3