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Home My WebLink AboutWQ0021632_Residual Annual Report 2021_20220211Non -Discharge Branch Upload/Submittal Form NORTH CAROLINA EnWrvnmemfal Qualify Version 2 - Revised June 23, 2020 Initial Review Reviewer EADS\ndthornburg Is this submittal an application? (Excluding additional information.)* Yes No If not an application what is the submittal type?* Annual Report Residual Annual Report Additional Information Other Annual Report Year* 2021 Permit Number (IR) * WQ0021632 Applicant/Permittee City of Burlington Email Notifications Does this need review by the hydrogeologist?* Yes • No Regional Office CO Reviewer Admin Reviewer Winston-Salem Submittal Form Project Contact Information Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence. Name* Brent Collins Email Address* brent.collins@emaresourcesinc.com Project Information Phone Number* 336-399-3646 Application/Document Type* New (Fee Required) Modification - Minor Modification - Major (Fee Required) Renewal Renewal with Major Modification (Fee GW-59, NDMR, NDMLR, NDAR-1, Required) NDAR-2 Annual Report Residual Annual Report Additional Information Change of Ownership Other We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form. https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report Permit Type: * Wastewater Irrigation High -Rate Infiltration Other Wastewater Reclaimed Water Closed -Loop Recycle Residuals Single -Family Residence Wastewater Other Irrigation Permit Number:* WQ0021632 Has Current Existing permit number Applicant/Permittee Address* Facility Name* PO Box 1358, Burlington, NC 27216 City of Burlington Class A Residuals Program Please provide comments/notes on your current submittal below. At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg at nathaniel.thornburg@ncdenr.gov. Please attach all information required or requested for this submittal to be reviewed here. * (Application Form, Engineering Plans, Specifications, Calculations, Etc.) 2021 Mackintosh WTP Annual Report - WQ0021632.pdf 7.84MB Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger than upload limit. By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has been received by the Non - Discharge Branch. Application fees must be submitted by check or money order and made payable to the North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts of the application in correct order (as specified by the application). Mail payment to: NCDEQ — Division of Water Resources Attn: Non -Discharge Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Signature ate - -ad(e..;r¢ Submission Date 2/11/2022 City of URLINGTON Water Resiaurces January 11th 2022 North Carolina Department of Environment and Natural Resources Division of Water Resources Water Quality Permitting Section Non -Discharge Permitting Unit 512 N. Salisbury Street Raleigh, NC 27604 RE: 2021 Annual Report, Permit No. WQ0021632 To Whom It May Concern: The City of Burlington is submitting this annual report with the assistance of EMA Resources. This annual report differs from previous years by only containing reporting for the Mackintosh Water Treatment Plant Class A Residuals. The City of Burlington did not generate or distribute any Class A compost in 2021 therefore we have no data to report. If you have any questions concerning this application, please contact Shane Fletcher at (336) 675-5927 or SFletcher@burlingtonnc.gov Respectfully, Shane Fletcher Residuals Management Coordinator City of Burlington PO Box 1358 Burlington, NC 27216-1358 BCity of URLINGTON 1►titer Res urees City of Burlington, NC 2021 Annual Report Permit Number WQ0021632 le ,Ipsifri `�a .71 CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM WQ PERMIT #: WQ0021632 FACILITY NAME: City of Burlington - Mackintosh WTP PHONE: (336) 675-5927 COUNTY: Alamance OPERATOR: City of Burlington FACILITY TYPE (please check one): ❑ Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C) p Distribution and Marketing (complete Parts A, B, and C) Was the facility in operation during the past calendar year? Yes 0 No ❑ —► If No skip parts A, B, C and certify form below Part A*: Part B*: Month Sources(s) (include NPDES # if applicable) Volume (dry tons) Recipient Information Amendment/ Bulking Agent Residual In Product Out Name(s) Volume (dry tons) Intended use(s) January February March April May June July August September October November December Total from FORM DMSDF (sup) 0 319.89 319.89 319.89 Totals: Annual (dry tons): 0 319.89 319.89 319.89 Amendment(s) used: I Bulking Agent(s) used: DMSDF (Supp) * If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form 1 Part C: Facility was compliant during the past calendar year with all conditions of the land application permit (including but not limited to items 1-3 below) issued by the Division of Water Quality: 0 Yes ❑ No > If No, Explain in Narritive 1. All monitoring was done in accordance with the permit and reported for the year as required and three (3) copies of certified laboratory results are attached. 2. All operation and maintenance requirements were compiled with or, in the case of a deviation, prior authorization was received from the Division of Water Quality. 3. No contravention of Ground Water Quality Standards occurred at a monitoring well. "I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee //// //O Z Y Date Signature of Preparer** (if different from Permittee) **Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26) Date DENR FORM DMSDF (12/2006) WQ PERMIT #: WQ0021632 FACILITY NAME: PHONE: (336) 675-5927 COUNTY: CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM Supplemental Information City of Burlington - Mackintosh WTP Alamance OPERATOR: City of Burlington FACILITY TYPE (please check one): ❑ Surface Disposal (complete Part A - "Month", "Source(s)" and "Residual In" columns only) ❑ Distribution and Marketing (complete Parts A, and B) Part A*: Part B*: Month Sources(s) (include NPDES # if applicable) Volume (dry tons) Recipient Information Amendment/ Bulking Agent Residual In Product Out Name(s) Volume (dry tons) Intended use(s) June Mackintosh WTP 57.47 57.47 Tom Neal 57.47 Soil Amendment June Mackintosh WTP 49.13 49.13 Leonidas Newlin 49.13 Soil Amendment July Mackintosh WTP 31.52 31.52 Chapman McQueen 31.52 Soil Amendment August Mackintosh WTP 87.99 87.99 Michael Hadley 87.99 Soil Amendment September Mackintosh WTP 35.91 35.91 Chapman McQueen 35.91 Soil Amendment September Mackintosh WTP 16.22 16.22 Shirley Dreschel 16.22 Soil Amendment October Mackintosh WTP 41.65 41.65 Elizabeth Kirby 41.65 Soil Amendment Totals: Annual (dry tons): 0 319.89 319.89 319.89 Amendment(s) used: Bulking Agent(s) used: DMSDF (Supp) * If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form 1 DENR FORM DMSDF (Supp) (12/2006) ANNUAL RESIDUAL SAMPLING SUMMARY FORM Please note that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF - B WQ Permit Number: Facility Name: Residual Source WQ # or NPDES #: WWTP Name: WQ0021632 City of Burlington NC0083828 J.D. Mackintosh Jr. WTP Laboratory: 1) American Testing Technologies Inc. 2) 3) 4) 5) Residual Analysis Data Parameter (mg/kg) Conc. Limit (mg/kg), Sample or Composite Date 5/19/21 7/15/21 8/23/21 9/9/21 Percent Solids (%) NA 1.18 3.42 1.87 2.7 Arsenic 75 <5 <5 <5 <5 Cadmium 85 <5 <5 <5 <5 Copper 4,300 50 40 40 28 Chromium NA 90 100 94 139 Lead 840 <5 <5 <5 <5 Mercury 57 <0.2 <0.2 <0.2 <0.2 Molybdenum 75 <5 <5 <5 <5 Nickel 420 12 <5 <5 <5 Selenium 100 <5 <5 <5 <5 Zinc 7,500 150 70 67 60 Total Phosphorus NA 1900 1700 9000 3000 TKN NA 12000 15000 17000 12000 Ammonia -Nitrogen NA 8000 9000 11000 8000 Nitrate and Nitrite NA 15 18 12 10 a For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits. "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." /Zpzv Signature 6f Preparer * Date *Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26) DENR FORM RSSF (12/2006) ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B Report all sampling analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past calendar year. Use additional forms as needed. WQ Permit Number: Facility Name: Residual Source NPDES # or WQ#: WWTP Name: WQ0021632 City of Burlington NC0083828 J.D. Mackintosh Jr. WTP Laboratory: 1) American Testing Technologies Inc. 2) 3) 4) 5) Residual Analysis Data Parameter (mg/kg) Sample or Composite Date 5/19/21 7/15/21 8/23/21 9/9/21 Aluminum 145000 176500 139000 92000 Calcium 6600 4300 3200 5700 Magnesium 2100 1400 1300 1400 Potassium 400 340 370 100 Sodium 4000 2400 2000 570 pH 6.35 5.9 6.18 5.98 PAN 5615 6918 7912 5610 SAR 1.19 1.5 1.03 0.29 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." /////,40LZ Signature of Preparer * Date *Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26) DENR FORM RSSF - B (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 27.81 Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: AbB 8.71 Acres Permitted: 8.71 Site #: AM006 Field #: 2 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orU Com- posite Date 1 2 3 1 4 1 5 16 1 7 18 1 9 110 111 112 Mack 7/15/21 % Solids 3.42 Arsenic 5 Cadmium 5 Copper 40 Chromium 100 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 70 Total Phos- phorus 1700 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 3.19 Arsenic 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Cadmium 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Copper 0.255 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.255 Chromium 0.639 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.639 Lead 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Nickel 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Selenium 0.032 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Zinc 0.447 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.447 Total Phos- phorus 10.856 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 10.856 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 2 City of Burlington Land Owner: Walter Hessenthaler Annual Dry Tons Applied: 27.81 Operator: Tom Neal Crop 1 Name: Fescue -Pasture Predominant Soil Series: AbB Site #: AM006 Crop 1 Max. PAN: 177 Crop 2 Name: Acres Utilized: 8.71 Acres Permitted: 8.71 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 6/14 162500 3.42 2.661 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 36.814 NA Fescue 6/16 32500 3.42 0.532 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 7.363 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 195000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 44.176 0.000 Lime Applied Annual lbs/acre 0.032 0.032 0.255 0.639 0.032 0.001 0.032 0.032 0.032 0.447 10.856 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.032 0.032 0.255 0.639 0.032 0.001 0.032 0.032 0.032 0.447 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 177 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 9.27 Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: HeB 4 Acres Permitted: 4 Site #: AM006 Field #: 9A Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orl Com- posite Date l 1 2 3 14 1 5 1 6 1 7 1 8 1 9 110 111 112 Mack 7/15/21 % Solids 3.42 Arsenic 5 Cadmium 5 Copper 40 Chromium 100 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 70 Total Phos- phorus 1700 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 2.32 Arsenic 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Cadmium 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Copper 0.185 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.185 Chromium 0.463 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.463 Lead 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Nickel 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Selenium 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Zinc 0.324 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.324 Total Phos- phorus 7.878 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 7.878 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: Walter Hessenthaler Annual Dry Tons Applied: Operator: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 9A City of Burlington Tom Neal Crop 1 Name: Fescue -Pasture 9.27 Site #: AM006 Predominant Soil Series: HeB Crop 1 Max. PAN: 126 Crop 2 Name: Acres Utilized: Acres Permitted: 4 4 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#, Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* 110pUZMIVIOA Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application etc) Crop 1 Crop 2 Crop 1 Crop 2 6/16 65000 3.42 2.317 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 32.065 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 65000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 32.065 0.000 Lime Applied Annual lbs/acre 0.023 0.023 0.185 0.463 0.023 0.001 0.023 0.023 0.023 0.324 7.878 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.023 0.023 0.185 0.463 0.023 0.001 0.023 0.023 0.023 0.324 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 126 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 20.39 Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: DdB2 6.75 Acres Permitted: 6.75 Site #: AM006 Field #: 11 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orU Com- posite Date 1 2 3 1 4 1 5 16 1 7 18 1 9 110 111 112 Mack 7/15/21 % Solids 3.42 Arsenic 5 Cadmium 5 Copper 40 Chromium 100 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 70 Total Phos- phorus 1700 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 3.02 Arsenic 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Cadmium 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Copper 0.242 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.242 Chromium 0.604 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.604 Lead 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Nickel 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Selenium 0.030 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.030 Zinc 0.423 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.423 Total Phos- phorus 10.271 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 10.271 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 11 Land Owner: Walter Hessenthaler Annual Dry Tons Applied: 20.39 Site #: AM006 Operator: Tom Neal Crop 1 Name: Fescue -Pasture Predominant Soil Series: DdB2 Crop 1 Max. PAN: 127 Crop 2 Name: Acres Utilized: 6.75 Acres Permitted: 6.75 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 6/16 45500 3.42 0.961 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 13.301 NA Fescue 6/17 97500 3.42 2.060 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 28.502 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 143000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 41.803 0.000 Lime Applied Annual lbs/acre 0.030 0.030 0.242 0.604 0.030 0.001 0.030 0.030 0.030 0.423 10.271 Date lbs/ac Prior Years Cumulative lbs/ac o 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.030 0.030 0.242 0.604 0.030 0.001 0.030 0.030 0.030 0.423 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 127 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 53.49 Michael Hadley Owner: Michael Hadley Predominant Soil Series: AaB 23.46 Acres Permitted: 23.46 Site #: AM016 Field #: 2 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orU Com- posite Date 1 2 3 1 4 1 5 16 1 7 18 1 9 110 111 112 EB 7/6/21 Mack 8/23/21 % Solids 2.7 1.87 Arsenic 5 5 Cadmium 5 5 Copper 117 40 Chromium 35 94 Lead 5 5 Mercury 0.2 0.2 Molyb- denum 5 5 Nickel 5 5 Selenium 5 5 Zinc 450 67 Total Phos- phorus 7000 9000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 1.65 0.63 Arsenic 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Cadmium 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Copper 0.387 0.050 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.437 Chromium 0.116 0.118 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.234 Lead 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Nickel 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Selenium 0.017 0.006 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Zinc 1.488 0.084 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1.572 Total Phos- phorus 23.142 11.286 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 34.428 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: Michael Hadley ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 2 City of Burlington Operator: Michael Hadley Crop 1 Name: Fescue -Pasture Annual Dry Tons Applied: 53.49 Predominant Soil Series: AaB Site #: AM016 Crop 1 Max. PAN: 190 Crop 2 Name: Acres Utilized: 23.46 Acres Permitted: 23.46 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 8/5 97500 2.7 0.468 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 11.904 NA Fescue 8/6 182000 2.7 0.873 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 22.221 NA Fescue 8/7 19500 2.7 0.094 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 2.381 NA Fescue 8/9 45500 2.7 0.218 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 5.555 NA Fescue 8/25 110500 1.87 0.367 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 5.812 NA Fescue 8/26 78000 1.87 0.259 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 4.103 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 533000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 51.976 0.000 Lime Applied Annual lbs/acre 0.023 0.023 0.437 0.234 0.023 0.001 0.023 0.023 0.023 1.572 34.428 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.023 0.023 0.437 0.234 0.023 0.001 0.023 0.023 0.023 1.572 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 190 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 103.96 Operator: Michael Hadley Owner: Russell Hadley Trust Predominant Soil Series: HdC2 Acres Used: 32.94 Acres Permitted: 32.94 Site #: AM016 Field #: 4 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orU Com- posite Date I 3 14 r 5 16 17 18 19 110 111 112 EB 7/6/21 Mack 7/15/21 Mack 8/23/21 % Solids 2.7 3.42 1.87 Arsenic 5 5 5 Cadmium 5 5 5 Copper 117 40 40 Chromium 35 100 94 Lead 5 5 5 Mercury 0.2 0.2 0.2 Molyb- denum 5 5 5 Nickel 5 5 5 Selenium 5 5 5 Zinc 450 70 67 Total Phos- phorus 7000 1700 9000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event 1 J 1.18 3J 0.51 4 J 6 7 91 1II 11 ] 12 Totals: 1.47 Arsenic 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Cadmium 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Copper 0.343 0.095 0.041 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.478 Chromium 0.103 0.236 0.096 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.435 Lead 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb- denum 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Nickel 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Selenium 0.015 0.012 0.005 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.032 Zinc 1.319 0.165 0.068 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1.553 Total Phos- phorus 20.524 4.019 9.144 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 33.687 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 4 City of Burlington Land Owner: Russell Hadley Trust Operator: Michael Hadley Crop 1 Name: Fescue -Pasture Annual Dry Tons Applied: 103.96 Predominant Soil Series: HdC2 Site #: AM016 Crop 1 Max. PAN: 148 Crop 2 Name: Acres Utilized: 32.94 Acres Permitted: 32.94 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 8/2 78000 2.7 0.267 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 6.782 NA Fescue 8/3 26000 2.7 0.089 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 2.261 NA Fescue 8/4 188500 2.7 0.644 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 16.391 NA Fescue 8/5 136500 2.7 0.467 East Burlington Dry <.5" S 0.5 0.3 33000 14000 20 11.869 NA Fescue 8/13 123500 3.42 0.535 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 7.398 NA Fescue 8/14 149500 3.42 0.647 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 8.956 NA Fescue 8/23 123500 1.87 0.292 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 4.626 NA Fescue 8/24 91000 1.87 0.215 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 3.409 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 916500 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 61.692 0.000 Lime Applied Annual lbs/acre 0.032 0.032 0.478 0.435 0.032 0.001 0.032 0.032 0.032 1.553 33.687 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.032 0.032 0.478 0.435 0.032 0.001 0.032 0.032 0.032 1.553 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 148 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 17.61 Operator: Michael Hadley Owner: Russell Hadley Trust Predominant Soil Series: HdC2 Acres Used: 9 Acres Permitted: 9 Site #: AM016 Field #: 4-Buffer Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orl Com- posite Date 1 1 2 3 4 1 5 1 6 1 7 1 8 1 9 110 111 112 Mack 7/15/21 % Solids 3.42 Arsenic 5 Cadmium 5 Copper 40 Chromium 100 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 70 Total Phos- phorus 1700 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 1.96 Arsenic 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Cadmium 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Copper 0.157 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.157 Chromium 0.391 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.391 Lead 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Nickel 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Selenium 0.020 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.020 Zinc 0.274 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.274 Total Phos- phorus 6.654 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 6.654 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 4-Buffer Land Owner: Russell Hadley Trust Annual Dry Tons Applied: 17.61 Site #: AM016 Operator: Michael Hadley Crop 1 Name: Fescue -Pasture Predominant Soil Series: HdC2 Crop 1 Max. PAN: 148 Crop 2 Name: Acres Utilized: Acres Permitted: Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 9 9 0 Date or Month Volume (enter one) Liquid Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#, Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* 110pUZMIVIOA Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application etc) Crop 1 Crop 2 Crop 1 Crop 2 8/12 123500 3.42 1.957 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 27.077 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 123500 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 27.077 0.000 Lime Applied Annual lbs/acre 0.020 0.020 0.157 0.391 0.020 0.001 0.020 0.020 0.020 0.274 6.654 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.020 0.020 0.157 0.391 0.020 0.001 0.020 0.020 0.020 0.274 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 148 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Lonnie Thompson Owner: Chapman McQueen Predominant Soil Series: HcB Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 52.79 Cation Exchange Capacity (non 503 only): 10.91 Acres Permitted: 10.91 Site #: AM109 Field #: 1 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample oru Com- posite Date L 3 14 r 5 16 17 18 19 110 111 112 Mack 7/15/21 Mack 8/23/21 Mack 9/9/21 % Solids 3.42 1.87 2.7 Arsenic 5 5 5 Cadmium 5 5 5 Copper 40 40 28 Chromium 100 94 139 Lead 5 5 5 Mercury 0.2 0.2 0.2 Molyb- denum 5 5 5 Nickel 5 5 5 Selenium 5 5 5 Zinc 70 67 60 Total Phos- phorus 1700 9000 3000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L Li L L t 9, 10 11 12 Totals: 2.89 0.14 1.81 Arsenic 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Cadmium 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Copper 0.231 0.011 0.101 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.344 Chromium 0.578 0.026 0.503 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 1.107 Lead 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Mercury 0.001 0.000 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.002 Molyb denum 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Nickel 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Selenium 0.029 0.001 0.018 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.048 Zinc 0.404 0.019 0.217 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.640 Total Phos- phorus 9.823 2.502 10.866 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 23.191 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 1 City of Burlington Land Owner: Chapman McQueen Operator: Lonnie Thompson Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 52.79 Predominant Soil Series: HcB Site #: AM109 Crop 1 Max. PAN: 169 Crop 2 Name: Acres Utilized: 10.91 Acres Permitted: 10.91 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 7/15 104000 3.42 1.359 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 18.810 NA Fescue 7/16 117000 3.42 1.529 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 21.161 NA Fescue 9/8 19500 1.87 0.139 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 2.205 NA Fescue 9/9 117000 2.7 1.207 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 13.547 NA Fescue 9/10 58500 2.7 0.604 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 6.774 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 416000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 62.497 0.000 Lime Applied Annual lbs/acre 0.048 0.048 0.344 1.107 0.048 0.002 0.048 0.048 0.048 0.640 23.191 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.048 0.048 0.344 1.107 0.048 0.002 0.048 0.048 0.048 0.640 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 169 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Lonnie Thompson Owner: Chapman McQueen Predominant Soil Series: HcB Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 14.64 Cation Exchange Capacity (non 503 only): 5.66 Acres Permitted: 5.66 Site #: AM109 Field #: 2 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 I Mack 9/9/21 2 3 1 4 1 5 1 6 1 7 1 8 1 9 110 111 112 % Solids 2.7 Arsenic 5 Cadmium 5 Copper 28 Chromiumr 139 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 60 Total Phos- phorus 3000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 2.59 Arsenic 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Cadmium 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Copper 0.145 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.145 Chromium 0.719 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.719 Lead 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Nickel 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Selenium 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.026 Zinc 0.310 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.310 Total Phos- phorus 15.516 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 15.516 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 2 City of Burlington Land Owner: Chapman McQueen Operator: Lonnie Thompson Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 14.64 Predominant Soil Series: HcB Site #: AM109 Crop 1 Max. PAN: 169 Crop 2 Name: Acres Utilized: 5.66 Acres Permitted: 5.66 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 9/9 39000 2.7 0.776 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 8.704 NA Fescue 9/10 91000 2.7 1.810 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 20.310 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 130000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 29.015 0.000 Lime Applied Annual lbs/acre 0.026 0.026 0.145 0.719 0.026 0.001 0.026 0.026 0.026 0.310 15.516 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.026 0.026 0.145 0.719 0.026 0.001 0.026 0.026 0.026 0.310 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 169 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 99.43 Leonidas Newlin Owner: Leonidas Newlin Predominant Soil Series: GaB 19.48 Acres Permitted: 19.48 Site #: AM110 Field #: 1 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orl Com- posite Date l 1 2 3 14 1 5 1 6 1 7 1 8 1 9 110 111 112 Mack 7/15/21 EB 5/3/21 % Solids 3.42 5.8 Arsenic 5 5 Cadmium 5 5 Copper 40 115 Chromium 100 38 Lead 5 5 Mercury 0.2 0.2 Molyb- denum 5 5 Nickel 5 14 Selenium 5 5 Zinc 70 400 Total Phos- phorus 1700 10000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 2.52 2.58 Arsenic 0.025 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.051 Cadmium 0.025 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.051 Copper 0.202 0.594 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.796 Chromium 0.504 0.196 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.701 Lead 0.025 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.051 Mercury 0.001 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.002 Molyb denum 0.025 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.051 Nickel 0.025 0.072 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.098 Selenium 0.025 0.026 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.051 Zinc 0.353 2.066 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 2.419 Total Phos- phorus 8.575 51.640 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 60.215 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: Leonidas Newlin ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 1 City of Burlington Operator: Leonidas Newlin Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 99.43 Predominant Soil Series: GaB Site #: AM110 Crop 1 Max. PAN: 211 Crop 2 Name: Acres Utilized: 19.48 Acres Permitted: 19.48 Cation Exchange Capacity (non 503): 0 Crop 2 Max. PAN: Date or Month Volume (enter one) Liquid 9 Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,7j Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 6/14 162500 3.42 1.190 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 16.460 NA Fescue 6/16 32500 3.42 0.238 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 3.292 NA Fescue 6/18 136500 3.42 0.999 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 13.827 NA Fescue 6/24 13000 3.42 0.095 Mackintosh Dry <.5" S 0.5 0.4 15000 9000 18 1.317 NA Fescue 6/24 19500 5.8 0.242 East Burlington Dry <.5" S 0.5 0.3 32000 16000 20 6.208 NA Fescue 6/25 117000 5.8 1.453 East Burlington Dry <.5" S 0.5 0.3 32000 16000 20 37.246 NA Fescue 6/26 32500 5.8 0.404 East Burlington Dry <.5" S 0.5 0.3 32000 16000 20 10.346 NA Fescue 6/28 39000 5.8 0.484 East Burlington Dry <.5" S 0.5 0.3 32000 16000 20 12.415 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 552500 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 101.111 0.000 Lime Applied Annual lbs/acre 0.051 0.051 0.796 0.701 0.051 0.002 0.051 0.098 0.051 2.419 60.215 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.051 0.051 0.796 0.701 0.051 0.002 0.051 0.098 0.051 2.419 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 211 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 13.18 Shirley Dreschel Owner: Shirley Dreschel Predominant Soil Series: HeB 10.27 Acres Permitted: 10.27 Site #: AM128 Field #: 1 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 Mack 8/23/21 3 3 1 4 1 5 1 6 1 7 1 8 1 9 110 111 112 % Solids 1.87 Arsenic 5 Cadmium 5 Copper 40 Chromiumr 94 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 67 Total Phos- phorus 9000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 1.28 Arsenic 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Cadmium 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Copper 0.103 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.103 Chromium 0.241 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.241 Lead 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Nickel 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Selenium 0.013 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.013 Zinc 0.172 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.172 Total Phos- phorus 23.094 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 23.094 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 1 Site #: AM128 City of Burlington Shirley Dreschel Operator: Shirley Dreschel Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 13.18 Predominant Soil Series: HeB Crop 1 Max. PAN: 163 Crop 2 Name: Acres Utilized: 10.27 Acres Permitted: 10.27 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual Sources (NPDES #, WQ#, Fert., Animal Waste, etc) Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* * *atn2I uOTTEZTTTWTOA Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Appl.cation Crop 1 Crop 2 Crop 1 Crop 2 9/7 169000 1.87 1.283 Mackintosh D <.5" S 0.5 0.4 17000 11000 12 20.305 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 169000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 20.305 0.000 Lime Applied Annual lbs/acre 0.013 0.013 0.103 0.241 0.013 0.001 0.013 0.013 0.013 0.172 23.094 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.013 0.013 0.103 0.241 0.013 0.001 0.013 0.013 0.013 0.172 Permitted C. P. L. R.**** 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 163 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." 1/3/2022 Signature of Land Applier Date *Application Method: S - Surface, IN - Injection, INC - Incorporation **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 3.04 Shirley Dreschel Owner: Shirley Dreschel Predominant Soil Series: HeB 2.94 Acres Permitted: 2.94 Site #: AM128 Field #: 2 Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date LL 3 3 14 15 16 17 18 19 110 111 112 Mack 8/23/21 % Solids 1.87 Arsenic 5 Cadmium 5 Copper 40 Chromium 94 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 67 Total Phos- phorus 9000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L 3 Li L L 6 t L L 10 11 12 Totals: 1.03 Arsenic 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Cadmium 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Copper 0.083 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.083 Chromium 0.194 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.194 Lead 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Mercury 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Molyb denum 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Nickel 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Selenium 0.010 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.010 Zinc 0.139 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.139 Total Phos- phorus 18.612 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 18.612 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 2 Site #: AM128 City of Burlington Shirley Dreschel Operator: Shirley Dreschel Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 3.04 Predominant Soil Series: HeB Crop 1 Max. PAN: 163 Crop 2 Name: Acres Utilized: 2.94 Acres Permitted: 2.94 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#, Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* 110pUZMIVIOA Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application etc) Crop 1 Crop 2 Crop 1 Crop 2 9/8 39000 1.87 1.034 Mackintosh Dry <.5" S 0.5 0.4 17000 11000 12 16.369 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 39000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 16.369 0.000 Lime Applied Annual lbs/acre 0.010 0.010 0.083 0.194 0.010 0.000 0.010 0.010 0.010 0.139 18.612 Date lbs/ac Prior Years Cumulative lbs/ac o 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.010 0.010 0.083 0.194 0.010 0.000 0.010 0.010 0.010 0.139 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 163 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 12.38 Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2 6 Acres Permitted: 6 Site #: CS113 Field #: 2 (Buffers) Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sampleorl Com- posite Date 1 _2' 31 4' r 5 r [I r 7 r 19 110 111 112 Mack 09/09/21 % Solids 2.7 Arsenic 5 Cadmium 5 Copper 28 Chromium 139 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 60 Total Phos- phorus 3000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L3 Li LS L6 t 9 10 11 12 Totals: 2.06 Arsenic 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Cadmium 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Copper 0.116 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.116 Chromium 0.574 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.574 Lead 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Nickel 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Selenium 0.021 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.021 Zinc 0.248 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.248 Total Phos- phorus 12.384 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 12.38 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 2 (Buffers) Land Owner: Elizabeth Kirby Annual Dry Tons Applied: 12.38 Site #: CS113 Operator: Elizabeth Kirby Crop 1 Name: Fescue -Hay Predominant Soil Series: CuB2 Crop 1 Max. PAN: 209 Crop 2 Name: Acres Utilized: Acres Permitted: Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 6 6 0 Date or Month Volume (enter one) Liquid q Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,g Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' * 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 10/22 52000 2.7 0.976 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 10.948 NA Fescue 10/25 58000 2.7 1.088 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 12.212 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 110000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 23.160 0.000 Lime Applied Annual lbs/acre 0.021 0.021 0.116 0.574 0.021 0.001 0.021 0.021 0.021 0.248 12.384 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.021 0.021 0.116 0.574 0.021 0.001 0.021 0.021 0.021 0.248 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 209 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington WQ0021632 Total Dry Tons Applied (Annual): 14.64 Cation Exchange Capacity (non 503 only): Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2 5.4 Acres Permitted: 5.4 Site #: CS113 Field #: 6A Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample or Com- posite Date 1 1 _2' 3' 4' r 5 [ I r 7 1 8 1 9 110 111 112 Mack 09/09/21 % Solids 2.7 Arsenic 5 Cadmium 5 Copper 28 Chromium 139 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 60 Total Phos- phorus 3000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L3 Li LS L6 t 9 10 11 12 Totals: 2.71 Arsenic 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Cadmium 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Copper 0.152 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.152 Chromium 0.754 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.754 Lead 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Nickel 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Selenium 0.027 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.027 Zinc 0.325 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.325 Total Phos- phorus 16.266 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 16.27 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 6A Land Owner: Elizabeth Kirby Annual Dry Tons Applied: 14.64 Site #: CS113 Operator: Elizabeth Kirby Crop 1 Name: Fescue -Hay Predominant Soil Series: CuB2 Crop 1 Max. PAN: 209 Crop 2 Name: Acres Utilized: 5.4 Acres Permitted: 5.4 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid q Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper PP Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,g Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' * 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 10/14 65000 2.7 1.355 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 15.206 NA Fescue 10/15 13000 2.7 0.271 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 3.041 NA Fescue 10/22 52000 2.7 1.084 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 12.165 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 130000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 30.412 0.000 Lime Applied Annual lbs/acre 0.027 0.027 0.152 0.754 0.027 0.001 0.027 0.027 0.027 0.325 16.266 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.027 0.027 0.152 0.754 0.027 0.001 0.027 0.027 0.027 0.325 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 209 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) ANNUAL METALS FIELD LOADING SUMMARY FORM* Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report Facility Name: Permit #: Operator: Acres Used: City of Burlington Total Dry Tons Applied (Annual): WQ0021632 Cation Exchange Capacity (non 503 only): 14.63 Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2 6.3 Acres Permitted: 6.3 Site #: CS113 Field #: 6B Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #): Sample orl Com- posite Date 1 _2' 3' 4' 15 . [ I 17 . 1 8 1 9 110 111 112 Mack 09/09/21 % Solids 2.7 Arsenic 5 Cadmium 5 Copper 28 Chromium 139 Lead 5 Mercury 0.2 Molyb- denum 5 Nickel 5 Selenium 5 Zinc 60 Total Phos- phorus 3000 Annual Heavy Metal Field Loadings (Calculated in lbs/acre): Total DT/Ac./ App. Event L L3 Li LS L6 t 9 , 10 11 12 Totals: 2.32 Arsenic 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Cadmium 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Copper 0.130 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.130 Chromium 0.646 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.646 Lead 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Mercury 0.001 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.001 Molyb denum 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Nickel 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Selenium 0.023 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.023 Zinc 0.279 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.279 Total Phos- phorus 13.938 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 13.94 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations". Signature of Land Applier 1/3/2022 Date DENR FORM MFLSF (12/2006) Facility Name: Land Owner: Operator: ANNUAL LAND APPLICATION FIELD SUMMARY FORM PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE. WQ Permit #: WQ0021632 Field #: 6B City of Burlington Elizabeth Kirby Elizabeth Kirby Crop 1 Name: Fescue -Hay Annual Dry Tons Applied: 14.63 Site #: CS113 Predominant Soil Series: CuB2 Crop 1 Max. PAN: 209 Crop 2 Name: Acres Utilized: 6.3 Acres Permitted: 6.3 Cation Exchange Capacity (non 503): Crop 2 Max. PAN: 0 Date or Month Volume (enter one) Liquid q Cu. Yds applied Solids/ Gallons % Solids Volume Appliedper pp Acre (Dry Tons/Ac) Residual (NPDES Fert , Waste, Sources #, WQ#,g Animal Soil Cond. (Dry, Wet, Moist) Precip. Past 24 Hrs. inches Application Method* o w w . N' * 1,?-,' Mineralizatio n Rate* * * TKN mg/kg Ammonia Y rn Nitrogen E Nitrate and Nitrite mg/kg PAN Applied (lbs/acre) Name of Crop Type Receiving Residual Application PP etc) Crop 1 Crop 2 Crop 1 Crop 2 10/15 45500 2.7 0.813 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 9.124 NA Fescue 10/16 84500 2.7 1.510 Mackintosh Dry <.5" S 0.5 0.4 12000 8000 10 16.944 NA Fescue 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0 0 0.000 Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): 0.000 0.000 TOTALS: 0 130000 As Cd Cu Cr Pb Hg Mo Ni Se Zn P 26.067 0.000 Lime Applied Annual lbs/acre 0.023 0.023 0.130 0.646 0.023 0.001 0.023 0.023 0.023 0.279 13.938 Date lbs/ac Prior Years Cumulative lbs/ac 0 0 0 0 0 0 0 0 0 0 Current Cumulative lbs/ac 0.023 0.023 0.130 0.646 0.023 0.001 0.023 0.023 0.023 0.279 Permitted C. P. L. R. * * * * 36 34 1338 267 15 374 89 2498 Permit PAN Limit 1 st/2nd Crop 209 "I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Land Applier *Application Method: S - Surface, IN - Injection, INC - Incorporation 1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0 Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2, aerobically digested -0.3, raw sludge -0.4 ****C.P.L.R.: Cumulative Pollutant Loading Rate DENR FORM FSF (12/2006) 05/28/2021 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 American Testing Technologies, Inc. Report No.: 052421-64 Enclosed are the results of the sample(s) submitted to our laboratory on 05/24/2021. All analyses were performed according to our laboratory's quality assurance program. All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to NELAP, this report may not be reproduced except in full, and with written approval from the laboratory. If you have any questions please contact the laboratory manager at 330-634-9906 or via email at samy(4americantesiingtechnologies.com ely Manager SL- Test performed by an approved subcontract laboratory BRL- Below Reporting limit The results relate only to the items tested. ATT shall have no liability to the client or client's customer with respect to decisions or recommendations made, actions taken or courses of conduct implemented by either the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's liability with respect to the Test Results exceed the amount paid to ATT by the client therefore. 1350 Home Avenue Akron, Ohio 44310 Toll Free: 677.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 1 of 2 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Date Received: 05/24/2021 Date Reported: 05/28/2021 Date Collected: 05/19/2021 Time Collected: 0840 Client ID #: Mackintosh Iagoon #1 Laboratory ID #: 052421-64 American Testing Technologies, Inc. Certificate of Analysis Parameter. Result (%) Result (mg/kg) Analysis Date Method Aluminum, Total 145,000 05/25/2021 6010D Arsenic, Total <5.0 05/25/2021 6010D Cadmium, Total <5.0 05/25/2021 6010D Calcium, Total 0.66 6,600 05/25/2021 _ 6010D Chromium, Total 90 05/25/2021 6010D Copper, Total 50 . 05/25/2021 6010D Iron, Total 10,400 05/25/2021 6010D Lead, Total <5.0 05/25/2021 6010D Magnesium, Total 0.21 2,100 05/25/2021 6010D Manganese, Total 1,600 05/25/2021 6010D Mercury, Total - <0.20 05/25/2021 7471B Molybdenum, Total <5.0 05/25/2021 6010D Phosphorus, Total _ 0.19 1,900 05/25/2021 6010D Nickel, Total 12 05/25/2021 6010D Potassium, Total 0.04 400 05/25/2021 6010D Selenium, Total <5.0 05/25/2021 6010D Sodium, Total 0.4 4,000 05/25/2021 6010D Sulfur, Total 1.1 11,400 05/25/2021 6010D Zinc, Total _ 150 05/25/2021 6010D Total Kjeldahl Nitrogen 1.2 12,000 05/27/2021 SM-4500 Ammonia Nitrogen 0.8 8,000 05/27/2021 _ SM-4500 Organic Nitrogen _ 0.4 4,000 _ 05/27/2021 Calculation Nitrate+Nitrite- N 15 05/27/2021 SM-4500C Calcium Carbonate Equivalent 30 300,000 05/26/2021 AOAC 955.01 Total Solids 1.18 11,800 05/24/2021 SM-2540G Total Volatile Solids 52 520,000 05/24/2021 SM-2540G Moisture 98.82 05/24/2021 SM-2540G 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone:330.634.9906 Fax 330.634.9907 Page 2 of 2 www.AmericanTestingTechnologies.com a 0 we 0 2 cz n ra � sy O 4C sir ur � 0 CO CO C9 MC w 0 0 0,_ cL z Orr 41 cn m0 = 2 a y: cc 0 0, 1- 0 0 s CO w n 0 1- uJ 0 vt 0 {" lams Qln n snoattrom bilk/ all05IW3S80 Df105 3 (Ham) Sn03nbv 3140fO1J1 f9l Et'4e el D (.3)3JJ50d 103 z CC 1.11 r CC LI-1 o LLE o Z CC a La 0 0 z 0 u= w 0 J iL 0 m n CO 0 0 L CC a 0., n L11 2 CO z a w LA tt▪ i tti a � a - a 0' N CITY OF BURLINGTON LABORATORY SERVICES NC Wastewater Laboratory Certification #188 336-222-5133 Sampled pH Analyzed Sample ID # date time SU date time analyst South WWTP Digester #2 South WWTP Digester #3 South WWTP Digester #4 East WWTP Digester #1 Mackintosh Lagoon #1 , . I its 1ogiv f L O ,) fr) 7( 1000 ')ID Mackintosh Lagoon #2 Compost Other Certified by avt t/atD,N, date 10 (G 1/0 CITY OF BURLINGTON POST OFFICE BOX 1358 BURLINGTON NC 27216-1358 336-570-6138 CONTACT PERSON - SHANE FLETCHER MACKINTOSH WATER TREATMENT PLANT CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE SAMPLE LOCATION: fa 42.-4 Z_ av� SAMPLED BY: DATE: // 9 ?t/� / Tam: t% e �D PH RESULT PH TIME PH ANALYST DELIVERED TO C.O.B. LAB BY: DATE: 517 ?/ L I RECEIVED IN C.O.B. LAB BY: DATE: _r Z TIME: f SHIPPED FROM C.O.B. LAB BY: 4/cam U/G DATE: RECEIVED IN -I, LAB BY; TIME: DATE; TIME; URT 7103 TE 7 FAX - SEND COPY TO SHANE FLETCHER City of Burlington P.O. BOX 1358 BURLINGTON NC 27216-1358 TELEPNONE 336-570-6138 FAX 336-570-6139 SAMPLE I.D.#ML /' /el crd DO NOT RUN pH PLEASE RUN RUN SO4 RUN SL1 & SL2 plus the following - RUN NH4-N, NO3-N, ORGANIC N, Cd, C Ni, Pb, As, Hg, Se, CaCG3-equiv., Volatile Solids, Mo, Cl Will the results of this sample be used for compliance reporting. YES NO NCDENR-DWQ WATER QUALITY SECTION NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION 1617 MAIL SERVICE CENTER RALEIGH NC 27699-1617 Sodium Calcium Magnesium Percent Solids Mackintosh 5/19/21 mg/kg mg/L Equiv Weight Milli Equiv 4000 47.2 23 2.052174 6600 77.88 20 3.894 2100 24.78 12 2.065 1.18 SAR= SAR 1.19 Na+ /2 (Ca2+ + Mg2+) American Testing Technologies, Inc. 07/30/2021 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Report No.: 071921-85 Enclosed are the results of the sample(s) submitted to our laboratory on 07/19/2021. All analyses were performed according to our laboratory's quality assurance program. All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to NELAP, this report may not be reproduced except in full, and with written approval from the laboratory. If you have any questions please contact the laboratory manager at 330-634-9906 or via email at samy@americantestingtechnologies.com Labor o Manager SL- Test performed by an approved subcontract laboratory BRL- Below Reporting limit The results relate only to the items tested. ATT shall have no liability to the client or client's customer with respect to decisions or recommendations made, actions taken or courses of conduct implemented by either the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's liability with respect to the Test Results exceed the amount paid to ATT by the client therefore. 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 1 of 2 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Date Received: 07/19/2021 Date Reported: 07/30/2021 Date Collected: 07/15/2021 Time Collected: 1030 Client ID #: Mackintosh lagoon #1 Laboratory ID #: 071921-85 American Testing Technologies, Inc. Certificate of Analysis Parameter Result (%) Result (mg kg) Analysis Date Method Aluminum, Total 176,500 07/26/2021 6010D Arsenic, Total <5.0 07/26/2021 6010D Cadmium, Total <5.0 07/26/2021 6010D Calcium, Total 0.43 4,300 07/26/2021 6010D Chromium, Total 100 07/26/2021 6010D Copper, Total 40 07/26/2021 6010D Iron, Total 14,500 07/26/2021 6010D Lead, Total <5.0 07/26/2021 6010D Magnesium, Total 0.14 1,400 07/26/2021 6010D Manganese, Total 1,100 07/26/2021 6010D Mercury, Total <0.20 07/26/2021 7471B Molybdenum, Total <5.0 07/26/2021 6010D Phosphorus, Total 0.17 1,700 07/26/2021 6010D Nickel, Total <5.0 07/26/2021 6010D Potassium, Total 0.03 340 07/26/2021 6010D Selenium, Total <5.0 07/26/2021 6010D Sodium, Total 0.24 2,400 07/26/2021 6010D Sulfur, Total 0.9 9,000 07/26/2021 6010D Zinc, Total 70 07/26/2021 6010D Total Kjeldahl Nitrogen 1.5 15,000 07/2.7/2021 SM-4500 Ammonia Nitrogen 0.9 9,000 07/27/2021 SM-4500 Organic Nitrogen 0.6 6,000 07/27/2021 Calculation Nitrate+Nitrite- N 18 07/27/2021 SM-4500C Calcium Carbonate Equivalent 34 340,000 07/28/2021 AOAC 955.01 Total Solids 3.42 34,200 07/20/2021 SM-2540G Total Volatile Solids 61 610,000 07/20/2021 SM-2540G Moisture 96.58 07/20/2021 SM-2540G 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 2 of 2 American Testing Technologies, Inc. 1350 Home Avenue Akron, OH 44310 Website: www.AmericanTestingTechnologies.com Toll Free: 877-634-9906 Phone: (330) 634-9906 Fax: (330) 634-990)1''7 o STANDARD REPORT a ,a DELIVERY DATE DUE EXPEDITED REPORT DELIVERY (SURCHARGE) DATE DUE NUMBER OF COOLERS SUBMITTED PER SHIPMENT: REMARKS n 2d :r. TIME LABORATORY USE.ONLY Pc ¢ DATE w n w RELINQUISHED BY: (SIGNATURE) RECEIVED BY: (SIGNATURE) REQUIRED ANALYSIS C°‘r1 ` NUMBER OF CONTAINERS SUBMITTED V Q ti ti TIME DATE w 2 0 AT.T. LOG NO:. RELINQUISHED BY:(SIGNATURE) RECEIVED BY: (SIGNATURE) 1-41 ("" '1N3A1 OS '110) 01nb11 S11031bVVNON '?CUSTODY' ;SEAL NO.. ArTiANALYSIS REQUEST AND CHAIN OF CUSTODY. RECORD American Testing Technologies, Inc. 0110S114.13S H0 0110S (SI M) sn03nbb 3111310N1(9) Eine 2io (0) 31130d01o0 PROJECT LOCATION (STATE) ,� G.. CONTRACT N0: CLIENT FAX -CLIENT-E-MAIL OtA)I I Td xi ., 'r1rin0S-4-c . /1KVo Z17- I ( . SAMPLE IDENTIFICATION z E CUSTODY I YES N0:'•O PROJECT NO. P.0, NUMBER CLIENT PHONE E33) Zz..-5I33 111 DATE PROJECT REFERENCE fYoM411 10001 u0 PROJECT MANAI ER • >rA roil 1 NI, rAcitswler CLIENT (SITE) (.1 CLIENT*NAME �R i� ` y , l rl c L7 r. n/1 rd'I-oi i RELI 1 UISHED BY' (s)NATURE) RECEIVED BY: (SIGNATURE) • RECEIVED FOR LABACRATORY•BY: (SIGNATU E) SAMPLE) TIME t, w G 0 N us I ORIGINAL - RETURN TO LABORATORY WITH SAMPLE(S) CiTh' OF URIfNGTON LA ORATORY SERVICES NC Wastewater Laboratory Certification #188 336-222-5133 Sampled pH Analyzed Sample ID # date time SU date time analyst South WWTP Digester #2 South WWTP Digester #3 South WWTP Digester #4 East WWTP Digester #1 Mackintosh Lagoon #1 Mace 441 7/i /2l 10 aL L. 7/15/21 l (7,S 4 Mackintosh Lagoon #2 Compost Other Certified by 5)-Ic,1roY V\ic1n-eir date 7/1S/ Z� CITY OF BURLINGTON POST OFFICE BOX 1358 BURLINGTON NC 27216-1358 336-570-6138 CONTACT PERSON — SHANE FLETCHER MACKINTOSH WATER TREATMENT PLANT CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE SAMPLE LOCATION: 144ck4.1164 SAMPLED BY: DATE: %((r/'7fl y/ PH RESULT DELIVERED TO C.O.B. LAB BY: DATE: 1/15/7I RECEIVED IN C.O.B. LAB BY: DATE: 7; / / z SHIPPED FROM C.O.B. LAB BY: DATE: TIME: /03b PH TIME PH ANALYST TIME: 1 1 2-0 1./1,---6-Az 47y A TEME: l (a O L TIME: RECEIVED IN A & L LAB BY; DATE; TIME; SEND RO A • C. A HACKERS BEND COURT WINSTON-SALEM NC 27103 TELEPHONE-1-877-267-2687 FAX - 336-766-8652 SEND COPY TO SHANE FLETCHER City of Burlington P.O. BOX 1358 BURLINGTON NC 27216-1358 TELEPHONE 336-570-6138 FAX 336-570-6139 SAMPLE I.D.#ML Q4/0 --6.114 L4, Will the results of this sample be used for compliance reporting. YES NCDENR-DWQ WATER QUALITY SECTION NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION 1617 MAIL SERVICE CENTER RALEIGH NC 27699-1617 DO NOT RUN pH PLEASE RUN RUN SO4 RUN SL1 & SL2 plus the following - RUN NH4-N, NO3-N, ORGANIC N, Cd, Cr, Ni, Pb, As, Hg, Se, CaC034quiv., Volatile Solids, Mo, Cl NO Sodium Calcium Magnesium Percent Solids Mackintosh 7/15/21 mg/kg mg/L Equiv Weight Milli Equiv 2400 82.08 23 3.568696 4300 147.06 20 7.353 1400 47.88 12 3.99 3.42 SAR= SAR 1.50 Na+ /2 (Ca2+ + Mg2+) 09/08/2021 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Report No.: 082521-114 American Testing Technologies, Inc. Enclosed are the results of the sample(s) submitted to our laboratory on 08/25/2021. All analyses were performed according to our laboratory's quality assurance program. All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to NELAP, this report may not be reproduced except in full, and with written approval from the laboratory. If you have any questions please contact the laboratory manager at 330-634-9906 or via email at samy@americantestingtechnologies.com S S Lro ory Manager SL- Test performed by an approved subcontract laboratory BRL- Below Reporting limit The results relate only to the items tested. ATT shall have no liability to the client or client's customer with respect to decisions or recommendations made, actions taken or courses of conduct implemented by either the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's liability with respect to the Test Results exceed the amount paid to ATT by the client therefore. 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 1 of 2 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Date Received: 08/25/2021 Date Reported: 09/08/2021 Date Collected: 08/23/2021 Time Collected: 1215 Client ID #: Mack lagoon Laboratory ID #: 082521-114 Certificate of Analysis Parameter Result (%) Result (mg/kg) Analysis Date Method Aluminum, Total 139,000 09/02/2021 6010D Arsenic, Total <5.0 09/02/2021 6010D Cadmium, Total <5.0 09/02/2021 6010D Calcium, Total 0.32 3,200 09/02/2021 6010D Chromium, Total 94 09/02/2021 6010D Copper, Total 40 09/02/2021 6010D Iron, Total 14,500 09/02/2021 6010D Lead, Total <5.0 09/02/2021 6010D Magnesium, Total 0.13 1,300 09/02/2021 6010D Manganese, Total 1,400 09/02/2021 6010D Mercury, Total <0.20 09/02/2021 7471B Molybdenum, Total <5.0 09/02/2021 6010D Phosphorus, Total 0.90 9,000 09/02/2021 6010D Nickel, Total <5.0 09/02/2021 6010D Potassium, Total 0.04 370 09/02/2021 6010D Selenium, Total <5.0 09/02/2021 6010D Sodium, Total 0.2 2,000 09/02/2021 6010D Sulfur, Total 0.95 9,500 09/02/2021 6010D Zinc, Total 67 09/02/2021 6010D Total Kjeldahl Nitrogen 1.7 17,000 09/03/2021 SM-4500 Ammonia Nitrogen 1.1 11,000 09/03/2021 SM-4500 Organic Nitrogen 0.6 6,000 09/03/2021 Calculation Nitrate+Nitrite- N 12 09/03/2021, SM-4500C Calcium Carbonate Equivalent 37 370,000 08/30/2021 AOAC 955.01 Total Solids 1.87 18,700 08/30/2021 SM-2540G Total Volatile Solids 62 620,000 08/30/2021 SM-2540G Moisture 98.13 08/30/2021 SM-2540G Pale 2 of 2 American Testing Techn®D'lies, One. 1350 Home Avenue Akron, OH 44310 Website: www.AmericanTestingTechnologies.com Toll Free: 877-634-9906 Phone: (330) 634-9906 Fax: (330) 634-990p 7 L. O STANDARD REPORT DELIVERY DATE DUE EXPEDITED REPORT DELIVERY CD (SURCHARGE) DATE DUE NUMBER OF COOLERS SUBMITTED PEP SHIPMENT: REMARKS ' '\ \� ' - 1= TIME w F- LABORATORY USE ONLY LABORATORY REMARKS DATE w a RELINQUISHED BY: (SIGNATURE) RECEIVED BY: (SIGNATURE) REQUIRED ANALYSIS L vsnlANUMBER OF CONTAINERS SUBMITTED C� =v c L1 TIME A.T.T. LOG NO. U 9?SZ1- Il DATE w RELINQUISHED BY: (SIGNATURE) RECEIVED BY: (SIGNATURE) MATRIX TYPE (""1N3A1OS'110) 01na11 Sf103nbvN0N CUSTODY SEAL NO. a1V ATT ANALYSIS REQUEST AND CHAIN OF CUSTODY RECORD American Testing Technologies; Inc. 0110SIW1S 80 0110S (2131VM) sno3naV 31VOION1(9) 0V80 210 (0) 311S0d1N00 t i PROJECT LOCATION (STATE) V C CONTRACT NO. CLIENT FAX CLIENT E-MAIL (jai) CLIENT fkDDK.SS 1 i 1 C5X i:5 rYno+osn A Zi'z SAMPLE IDENTIFICATION O O H co w O U Y z PROJECT NO. P.O. NUMBER CLIENT PHONE ` 7to) VZ.Z. 1 3 TIME - w 2 w DATE w o N ff. PROJECT REFERENCE irn(rnTh 1.,+ IO ,rA u PROJECT MANAGtER t 4 SJ, a Q v'1 l AJ flann ' CLIENT (SITE) CLIENT NAME ?i/�r ltnit7/I_ RELI UIS ED BY: (SIGNATUURE)� RECEIVED BY: (SIGNATURE) 1 } O`,cc Q O SAMPLE) w ,,..f E DATE '',..i O. 0 Ce CO0 0 ct 2 J Z CITY OF BURL][NGTON LABORATORY SERVICES NC Wastewater Laboratory Certification #188 336-222-5133 Sampled pH Analyzed Sample ID # date time SU date time analyst South WWTP Digester #2 , South WWTP Digester #3 South WWTP Digester #4 East WWTP Digester #1 Mackintosh Lagoon #1 r,,x,,n i o1C. IG- \ c6/13111 IZ1S .1� b/612,1 •1-Z:-�` -A-A/,_ Mackintosh Lagoon #2 Compost Other Certified by J 7Gi ir-oin onfLy date b/2-_?/Z i i FAX SAMPLE LOCATION: CITY OF BURLINGTON POST OFFICE BOX 1358 BURLINGTON NC 27216-1358 336-570-6138 CONTACT PERSON — SHANE FLETCHER MACKINTOSH WATER TREATMENT PLANT CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE Aackivhsil La .o)/! / SAMPLED BY: -al o ,t i e) “, DATE: P/ok3/2. z/ PH RESULT U t le DELIVERED TO C.O.B. LAB BY: DATE: l 02-.3(-0 RECEIVED IN C.O.B. LAB BY:IC6'v0 PH TIME 1.1q5 PH ANALYST ,04\i DATE: u/ ` / 7, SHIPPED FROM C.O.B. LAB BY: DATE: TIME: /Zia TIME: T 7 �f 1 /1-717-vi (4/7//,C/LI-- TIME: RECEIVED IN ± L LAB BY; DATE; TIME; i1" :.11IF Cigar • �. 0 INC. 8652 3 7 SEND COPY TO SHANE FLETCHER T City of Burlington P.O. BOX 1358 BURLINGTON NC 27216-1358 TELEPNONE 336-570-6138 FAX 336-570-6139 SAMPLE I.D.#ML Atkin fj1 14fcra 1' Will the results of this sample be used for compliance reporting. YES NCDENR DWQ WATER QUALITY SECTION NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION 1617 MAIL SERVICE CENTER RALEIGH NC 27699-1617 DO NOT RUN pH PLEASE RUN RUN SO4 RUN SL1 & SL2 plus the following - RUN N114-N, NO3-N, ORGANIC N, Cd, C] Ni, Pb, As, Hg, Se, CaC033equiv., Volatile Solids, Mo, Cl NO Sodium Calcium Magnesium Percent Solids Mackintosh 8/23/21 mg/kg mg/L Equiv Weight Milli Equiv 2000 37.4 23 1.626087 3200 59.84 20 2.992 1300 24.31 12 2.025833 1.87 SAR= SAR 1.03 Na+ /2 (Ca2+ + Mg2+) 09/24/2021 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Report No.: 091021-52 American Testing Technologies, Inc. Enclosed -are -the -results -of the-sample(s)-submitted to our laboratory -on 09/10/2021. All analyses were performed according to our laboratory's quality assurance program. All sample results are reported on an "as -received" wet basis unless otherwise noted. The test results meet requirements of the NELAP standards for methods listed on the laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010, 6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted. Results apply only to the items submitted to the laboratory for analysis. Pursuant to NELAP, this report may not be reproduced except in full, and with written approval from the laboratory. If you have any questions please contact the laboratory manager at 330-634-9906 or via email at samy@americantestingtechnologies.com anager SL- Test performed by an approved subcontract laboratory BRL- Below Reporting limit The results relate only to the items tested. ATT shall have no liability to the client or client's customer with respect to decisions or recommendations made, actions taken or courses of conduct implemented by either the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT `s liability with respect to the Test Results exceed the amount paid to ATT by the client therefore. 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 1 of 2 City of Burlington, NC Attn: Sharon Wagoner 1302 Belmont Street Burlington, NC 27215 Date Received: 09/10/2021 Date Reported: 09/24/2021 Date Collected: 09/09/2021 Time Collected: 0930 Client ID #: Mack Lagoon #1 Laboratory ID #: 091021-52 American Testing Technologies, Inc. Certificate of Analysis Parameter Result (%) Result (mg/kg) Analysis Date Method Aluminum, Total 92,000 09/15/2021 6010D Arsenic, Total <5.0 09/15/2021 6010D Cadmium, Total <5.0 09/15/2021 6010D Calcium, Total 0.57 5,700 09/15/2021 6010D Chromium, Total 139 09/15/2021 6010D Copper, Total 28 09/15/2021 6010D Iron, Total 20,000 09/15/2021 6010D Lead, Total <5.0 09/15/2021 6010D Magnesium, Total 0.14 1,400 09/15/2021 6010D Manganese, Total 1,500 09/15/2021 6010D Mercury, Total <0.20 09/15/2021 7471B Molybdenum, Total <5.0 09/15/2021 6010D Phosphorus, Total 0.30 3,000 09/15/2021 6010D Nickel, Total <5.0 09/15/2021 6010D Potassium, Total 0.01 100 09/15/2021 6010D Selenium, Total <5.0 09/15/2021 6010D Sodium, Total 0.06 570 09/15/2021 6010D Sulfur, Total 1.26 12,600 09/15/2021 6010D Zinc, Total 60 09/15/2021 6010D Total Kjeldahl Nitrogen 1.2 12,000 09/21/2021 SM-4500 Ammonia Nitrogen 0.8 8,000 09/21/2021 SM-4500 Organic Nitrogen 0.4 4,000 09/21/2021 Calculation Nitrate+Nitrite- N 10 09/16/2021 SM-4500C Calcium Carbonate Equivalent 32 320,000 09/17/2021 AOAC 955.01 Total Solids 2.70 27,000 09/15/2021 SM-2540G Total Volatile Solids 46 460,000 09/10/2021 SM-2540G Moisture 97.30 09/10/2021 SM-2540G 1350 Home Avenue Akron, Ohio 44310 Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907 www.AmericanTestingTechnologies.com Page 2 of 2 American Testing Technologies, Inc, ANALYSIS REQUEST AND 1.350 Home Avenue Akron, OH 44310 CHAIN OF CUSTODY. RECORD JVebsite: Nww.AmericanTestingrechnologies.com Toll Free: 877-634-9906 Phone: (330) 634-9906 Fax: (330) 634-990,7 OF STANDARD REPORT DELIVERY DATE DUE EXPEDITED REPORT DELIVERY (SURCHARGE) DATE DUE NUMBER OF COOLERS SUBMITTED PER DINIPMENY REMARKS TIME RELINQUISHED BY: (SIGNATURE) DATE TIME J I a.CAMMBER OF CONTAINERS SUBMITTED V1 �r 111 Zee _r ("''1N3A10S'llo) atnbn SRAM/NON AM/NON HIV 0110SIMS UO (1I105 (a31VM)5no3nbv 31VO1i3N1(0) HYdD ao (0)31150dJ0o r j PROJECT LOCATION I (STATE) / C- CONTRACT NO. CLIENT FAX o �C jr PLE IDENTIFICATION r; a �fl� z..1 h� .—Jr RECEIVED FOR LABAOR BY: DAT • . TIME 7 (SIGNATURE ..., _ .. , cr.] American Testing Technologies; Inc. PROJECT REFERENCE PROJECT NI iI / IBC/ c p PROJECT MANAGER P.O. NUMB C iAn ro,tj \pj {^AC,rt'i CLIENT (SITE) 1 CLIENT PHC CLIENT NAME CLIENT E-M) (;1 O S t& rl nnct S AJ of CLIENT DD SS ( aTO x ,S5t p �'p�g r in 0 / 4J�Cx Z E $-1 rctr SHto BY: (SI NATU E) RECCEIVED BY: (SIGNATURE) SAMPLE./ DATE I TIME 03 � crrY OF URLIN4STON LA ORATORY sERYICES NC Wastewater Laboratory Certification #188 336-222-5133 Sampled 1 pH Analyzed Sample ID # date time SU date time analyst South WWTP Digester #2 South WWTP Digester #3 South WWTP Digester #4 East WWTP Digester #1 Mackintosh Lagoon #1 rno6L la ci%cI It Uc130 5,05 q/qi/zt i 1-15 Ai Mackintosh Lagoon #2 Compost Other Certified by (i)CW01/1 V)cii90,4--et date vl /9/ &) CITY OF BURLINGTON POST OFFICE BOX 1358 BURLINGTON NC 27216-1358 336-570-6138 CONTACT PERSON — SHANE FLETCHER MACKINTOSH WATER TREATMENT PLANT CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE SAMPLE LOCATION: A &kid -AS l SAMPLED BY $. Q'& QL qfr/h9# DATE: PH RESULT G, DELIVERED TO C.O.B. LAB BY: DATE: 9/0 197e RECEIVED IN C.O.B. LAB BY: TIME: PH TIME i I `i 5 PH ANALYST TIME: 5 DATE: "1 ( / 1 TIME: (j (7 Co SHIPPED FROM C.O.B. LAB BY: DATE: RECEIVED IN A & L LAB BY; DATE; TIME; SEND COPY TO SYNAGRO c SYNAGRO SOUTHEAST, INC. 6220 A HACKERS BEND COURT WINSTON-SALEM NC 27103 TELEPHONE-1-877-267-2687 FAX - 336-766-8652 TIME: SEND COPY TO SHANE FLETCHER City of Burlington P.O. BOX 1358 BURLINGTON NC 27216-1358 TELEPNONE 336-570-6138 FAX 336-570-6139 4d0la WM the results of this sample be used for compliance reporting. YES NCDENR DWQ WATER QUALITY SECTION NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION 1617 MAIL SERVICE CENTER RALEIGH NC 27699-1617 DO NOT RUN pH PLEASE RUN RUN SO4 RUN SL1 & SL2 plus the following - RUN NH4-N, NO3-N, ORGANIC N, Cd, Cr, Ni, Pb, As, Hg, Se, CaCQuiv., Volatile Solids, Mo, Cl NO Mackintosh 9/9/21 mg/kg mg/L Equiv Weight Milli Equiv Sodium 570 15.39 23 0.66913 Calcium 5700 153.9 20 7.695 Magnesium 1400 37.8 12 3.15 Percent Solids 2.7 Na+ SAR= SAR 0.29 /2 (Ca2+ + Mg2+)