WQ0003351_Modification_20220906

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0003351
Applicant/Permittee Town of Mocksville
Applicant/Permittee Address 171 Clement Street, MoCksville, NC 27028
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Municipal
Town of Mocksville Class B Residuals Program
Davie
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Yes No
Fee Amount $245
Complete App Date 09/06/2022
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

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*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
336-399-3646
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: *
WQ0003351
Has Current Existing permit number
Applicant/Permittee*
Town of Mocksville
Applicant/Permittee Address*
171 Clement Street, Mocksville, NC 27028
Facility Name*
Town of Mocksville Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Town of Mocksville Land Transfer - WO0003351.pdf 4.59MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature

Submission Date 8/26/2022

August 26, 2022
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Services Center
Raleigh, NC 27699-1617
RE: Permit Modification — WQ0003351
To Whom it May Concern:
EMA Resources is submitting the included permit modification for the Town of
Mocksville - WQ0003351. We are requesting a transfer of one field from the Davie
County Land Application Permit— WQ0010583 to the Mocksville Land Application
Permit. A permit renewal and inspection was recently completed for the Davie County
program. A check for $245 is being mailed separately.
If you have any questions concerning this modification, please contact Brent Collins —
Director of Technical Services
Respectfully,
Brent Collins
Director of Technical Services
r��..t c_c111_i�._;...c6emaresourcesinc.coni
[phone]
Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

Phone [phone] — Fax [phone]
755 Yadkinville Rd — Mocksville, NC 27028

g
Inc.
Permit Modification Application
For
Town of Mocksville
WQ0003351
Land Application of Residual Solids
Prepared By:
EMA Resources Inc.
Phone [phone] — Fax [phone]
755 Yadkinville Road — Mocksville, NC 27028

Table of Contents
1) RLAP Form
a) Current Permit
2) LASC Form
a) Landowner Agreement
b) Vicinity Map
c) Aerial/Application Map
d) Cumulative Loading Data

I. APPLICANT INFORMATION:
1. Applicant's name: Town of Mocksville
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Ken Gamble Title: Town Manager
Applicant's mailing address: 171 Clement St
City: Mocksville State: NC Zip: 27028-
Telephone number: 3( 36) 753-6702 Email Address: kgamblekmocksvillenc.gov
2. Consultant's name: Brent Collins License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: EMA Resources Inc.)
Consultant's mailing address: 755 Yadkinville Rd
City: Mocksville State: NC Zip: 27028-
Telephone number: 3( 36) 399-3646 Email Address: brent.collinskemaresourcesinc.com
3. Agronomist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained (Firm: )
Agronomist's mailing address:
City: State: Zip: -
Telephone number: (_) Email Address:
4. Soil Scientist's name: License Number:
Affiliation: ❑ N/A ❑ On Staff ❑ Retained Firm O
Soil Scientist's mailing address:
City: State: _ Zip: -
Telephone number: Email Address
5. Fee submitted: $245 (See Instruction B)
IL PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00003351
Date of most -recently issued permit: 07/08/2022
Date of most -recently certified Attachment A (if different than the permit): 07/08/2022
Date of most -recently certified Attachment B (if different than the permit): 07/08/2022
FORM: RLAP 06-16 Page 1 of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 291 Garwood Rd
City: Mocksville State: NC Zip: 27028-
Coordinates: Latitude: 35' 53' 30" Longitude: 80. 30' 06"
Datum: NAD83
Method of measurement: GPS
Level of accuracy: Nearest Second
2. County where residuals land application program is headquartered: Davie
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Roy Whitaker
EMA Resources Inc
13283
Back -Up ORC
Brent Collins
EMA Resources Inc
27651
Additional Back -Up
ORCs
if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrozen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 250 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
50.62
56.79
12655
14197
Five -Year Maximum Adjusted
76.79
82.96
19197
20740
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
0
Hay/Pasture
87.39
Total:
87.39
Methods
Surface
87.39
Incorporation or Injection
0
Total:
87.39
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Application Rate
(lbs PAN/ac yr)
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
253.1
283.94
383.94
414.8
100
126.55
141.97
191.97
207.4
150
84.36
94.65
127.98
138.27
200
63.28
70.99
95.99
103.7
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑ Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
❑ Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
❑ Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505(b) requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Field /Zone
Design Area
ft2
Number of
Nozzles
Maximum Application
Rate allons/hr
Design Annual Loading
Rate allons/ r
Total
11
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Pi a Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft,
Nozzle capacity
gpm
Nozzle manufacturer / model
/
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
I, Ken Gamble Town Manager
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Town of Mocksville
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Zee a2�bG.......................................... Aug26, 2022
Ken Gamble (Aug 26, 2€122 08:59 ED 111 Date:
FORM: RLAP 06-16 Page 5 of 5

RCY COOPER
(";overrmor
ELIZABETH S. BISER
Sec,rerera.t.
RICH RD E. RCGER.S, jR,
Direcicta..
KENNETH W. GAMBLE — TOWN MANAGER
TOWN OF MOCKSVILLE
171 CLEMENT STREET
MOCKSVILLE, NORTH CAROLINA 27028
Dear Mr. Gamble:
NOR- d C.4ROLINA
! nvirorrrrertaatal Quality
July 8, 2022
Subject: Permit No. WQ0003351
Town of Mocksville Class B
Residuals Program
Land Application of
Class B Residuals
Davie County
In accordance with your permit renewal request received March 31, 2022, and subsequent
additional information received June 30, 2022, we are forwarding herewith Permit No. WQ0003351 dated
July 8, 2022, to the Town of Mocksville for the continued operation of the subject residuals management
program.
Modifications to the subject permit are as follows:
➢ The removal of all fields within NC-DV-05 in Davie County, resulting in a reduction of 25.5
acres.
➢ The adjustment of acreages associated with the remaining fields to account for more accurate
mapping methods, resulting in a net change of 0.63 acres.
This permit shall be effective from the date of issuance through December 31, 2028, shall replace
Permit No. WQ0003351 issued January 8, 2018, and shall be subject to the conditions and limitations as
specified therein. The Permittee shall submit a renewal application no later than July 4, 2028.
Please pay particular attention to the monitoring requirements listed in Attachment A for they may
differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
Please note that on September 1, 2018, North Carolina Administrative Code Title 15A Subchapter
02T — Waste not Discharged to Surface Waters was readopted. Accordingly, this permit incorporates the
requirements of these rules, therefore, please take the time to review this permit thoroughly.
North Cambia Dep artment of Lnvurcanmentat Qarality I Divfsiern ofWarer ReS errrceS
� 512 "North SallrsNrry Street I IOU MaH Service C,enter� I I0169h„ North Corohna 27699 Ir5I J
Il i3f I `Ali
!a�BrroMuvonnt �u4 Fr�wunWudi+s�➢a0'm94VUFmiIM, 9'I9.70Z9000

Mr. Kenneth W. Gamble
July 8, 2022
Page 2 of 2
The Division has removed the following permit conditions since the last permit issuance dated
January 8, 2018:
➢ Old Conditions I.2. and L3. — These conditions have been removed because the schedules have
been met.
➢ Old Condition IL8. —This condition has been removed because there are no treatment or storage
facilities covered in this permit.
➢ Old Condition II1.10. —This condition has been removed because it is covered under the new
Condition III.1O.h.
➢ Old Condition II1.13. —This condition has been removed.
➢ Old Condition VL2. — This condition has been removed because this permit is not voidable
The following permit conditions are new since the last permit issuance dated January 8, 2018:
➢ Condition IIL10.1. — Residual land application may not occur if the land application sites are
located within a WS-1 watershed pursuant to 15A NCAC 02B .0212 or within the Critical Area
of a WS-II, WS-III, or WS-IV watershed.
➢ Condition IIL 1 I.e. — Dedicated land sites are to have public access restricted continuously
while the land is under permit and for one year afterward. Note, there are no dedicated land
sites in the current permit.
➢ Condition VL8. — This permit shall not be renewed if the Permittee or any affiliation has not
paid the required annual fee
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Erick Saunders at (919)
707-3659 or erickson.saundersL),ncdenr.�4ov.
Sincerely,
°z Richard E. Rogers, Jr., Director�o
Division of Water Resources
cc: Davie County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Brent Collins — EMA Resources (Electronic Copy)
Protection and Enforcement Branch (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Mocksville
Davie County
FOR THE
continued operation of a residuals management program for the City of Mocksville and consisting of the
land application of Class B residuals generated by the approved facility listed in Attachment A to the
approved fields listed in Attachment B, with no discharge of wastes to surface waters, pursuant to the
application received March 31, 2022, subsequent additional information received June 30, 2022, and in
conformity with other supporting data subsequently filed and approved by the Department of
Environmental Quality and considered a part of this permit. The disposal of residuals is regulated under
Title 40 Code of Federal Regulations Part 503. This permit does not exempt the Permittee from complying
with Federal Regulation 40 CFR Part 503.
This permit shall be effective from the date of issuance through December 31, 2028, shall replace Permit
No. WQ0003351 issued January 8, 2018, and shall be subject to the following conditions and limitations:
I. SCHEDULES
1. The Permittee shall request renewal of this permit on Division -approved forms no later than July 4,
2028. [15A NCAC o2T .0105(b), o2T .0109]
IL PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject residuals management program so there is no
discharge to surface waters, nor any contravention of groundwater or surface water standards. In the
event the residuals management program fails to perform satisfactorily, including the creation of
nuisance conditions due to improper operation and maintenance, the Permittee shall immediately cease
land applying residuals, take immediate corrective actions, and contact the Winston-Salem Regional
Office supervisor. [15A NCAC 02T .0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this residuals management program. [15A NCAC 02T
.0108(b)(1)(A)]
3. Only residuals generated by the facility listed in Attachment A are approved for land application in
accordance with this permit. [15A NCAC 02T .1101]
WQ0003351 Version 4.0 Shell Version 210928 Page 1 of 12

4. Only the fields listed in Attachment B are approved for residuals land application. [G.S. 143-
215.1(a)(9)]
5. Pollutant concentrations in residuals land applied to the sites listed in Attachment B shall not exceed
the following Ceiling Concentrations or Cumulative Pollutant Loading Rates (CPLRs), on a dry
weight basis:
Parameter
Ceiling
Concentration
Cumulative Pollutant Loading Rates
(mg/kg)
(kg/ha)
(lbs/ac)
Arsenic
75
41
36
Cadmium
85
39
34
Copper
4,300
1,500
1,338
Lead
840
300
267
Mercury
57
17
15
Molybdenum
75
N/A
N/A
Nickel
420
420
374
Selenium
100
100
89
Zinc
7,500
2,800
2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application has not occurred or for which the required data is incomplete,
by determining background concentrations through representative soil sampling.
[15A NCAC 02T. I 105(a), 02T. I 105(b)]
6. Class B biological residuals shall meet the pathogen reduction requirements in 15A NCAC 02T .1106
(b). Exemptions to this requirement shall be specified in Attachment A. [15A NCAC 02T .1106(b),
02T .1106(d)]
7. Class B biological residuals shall meet one of the vector attraction reduction alternatives in 15A NCAC
02T .1107(a). Exemptions to this requirement shall be specified in Attachment A. [15A NCAC 02T
.1107(a), 02T .1107(c)]
WQ0003351 Version 4.0 Shell Version 210928 Page 2 of 12

8. The facilities and sites herein were permitted per the following setbacks:
a. Setbacks for Class B land application sites are as follows (all distances
in feet):
Surface
Irrigation
Injection /
Application
Surface
Incorporation
by Vehicle
Application
i. Each habitable residence or place of assembly
400
400
200
under separate ownership:
ii. Each habitable residence or places of assembly
owned by the Permittee, the owner of the land,
0
200
0
or the lessee or operator of the land:
in. Each property line:
50
150
50
iv. Public right of way:
50
50
50
v. Each private or public water supply source:
100
100
100
vi. Surface waters such as intermittent and
perennial streams, perennial waterbodies, and
32.8
32.8
32.8
wetlands:
vii. Surface water diversions such as ephemeral
25
25
25
streams, waterways, and ditches:
viii. Groundwater lowering ditches where the
25
100
25
bottom of the ditch intersects the SHWT:
ix. Subsurface groundwater lowering systems:
0
100
0
x. Each well with exception of monitoring wells:
100
100
100
xi. Bedrock outcrops:
25
25
25
xii. Top of slope of embankments or cuts of two
15
15
15
feet or more in vertical height:
xiii. Each building foundation or basement:
0
15
0
xiv. Each water line:
0
10
0
xv. Nitrification field:
0
20
0
Setbacks to property lines are not applicable when the Permittee, the entity from which the
Permittee is leasing, or the entity that executed the
notarized landowner agreement, owns both
parcels separated by the property line.
[15A NCAC 02T .1108(c)]
9. Class B land application areas shall be clearly marked on each site prior to and during any residuals
application event. [15A NCAC 02T .1110(g)]
WQ0003351 Version 4.0 Shell Version 210928 Page 3 of 12

10. Residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in exceedance of
agronomic rates. Appropriate agronomic rates shall be calculated using expected nitrogen requirements
based on the determined Realistic Yield Expectations (RYE) using any of the following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the last five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina State
University Department of Soil Science (http://nutrients.soil.ncsu.edu/yields/index.php). A copy
shall be kept on file and reprinted every five years in accordance with Condition IV.6.
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
and appropriate nutrient application rates reported in any of the following documents:
I. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group -Guidance
Document: Chapter 1
(http://www.ncagr.gov/SWC/tech/documents/9th_Guidance_ Doc_100109.pdf).
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (NRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards(ftp://ftp-fc.sc.egov.usda.gov/NHQ/practice-standards/standards/590.Rdf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
[I5A NCAC 02T .I 109(a)(1)(K)]
11. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25%. [15A NCAC o2T .0108(b)(1)(A)]
12. If residuals land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the
summer and rye grass in the winter with both crops to receive residuals), then the second crop can
receive an application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This
practice may be allowed as long as the second crop is to be harvested or grazed. If the second crop is
to be planted for erosion control only and is to be tilled into the soil, then no additional PAN shall be
applied. [15A NCAC 02T .0108(b)(1)(A)]
13. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee shall
maintain written records of these recommendations and details of their implementation. [15A NCAC
02T .0108(b)(1)(A)]
14. Residuals land application fields permitted on or after December 30, 1983 have a compliance boundary
that is either 250 feet from the residual land application area, or 50 feet within the property boundary,
whichever is closest to the residual land application area. Any exceedance of groundwater standards
at or beyond the compliance boundary shall require corrective action. Division -approved relocation of
the compliance boundary shall be noted in Attachment B. Multiple contiguous properties under
common ownership and permitted for use as a disposal system shall be treated as a single property with
regard to determination of a compliance boundary. [15A NCAC 02L .0106(d)(2), 02L .0107(b), 02T
.0105(h), G.S. 143-215.1(1), G.S. 143-215.1(k)]
WQ0003351 Version 4.0 Shell Version 210928 Page 4 of 12

15. The review boundary is midway between the compliance boundary and the residual land application
area. Any exceedance of groundwater standards at or beyond the review boundary shall require
preventative action. [15A NCAC 02L .0106(d)(1), 02L .0108]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The Permittee shall operate and maintain the residuals management program as anon -discharge system.
[15A NCAC 02T. I 100]
2. The Permittee shall notify the Winston-Salem Regional Office, telephone number [phone], and
the appropriate local government official (i.e., county manager, city manager, or health director) at least
two business days in advance of a site's initial residuals land application event. [15A NCAC 02T
.0108(b)(1)(A)]
The Permittee shall notify the Winston-Salem Regional Office, telephone number [phone], at
least one business day in advance of conducting any land application activity. Notification shall include
the anticipated application date, time, and field name as listed in Attachment B. Exceptions to this
requirement shall be approved by the Winston-Salem Regional Office. [15A NCAC 02T
.0108(b)(1)(A)]
4. The Permittee shall maintain a Division -approved Operation and Maintenance Plan that shall include:
a. Description of the program, and associated facilities and equipment, in sufficient detail to show
what operations are necessary for the program to function and by whom the functions are to be
conducted;
b. Description of anticipated maintenance of facilities and equipment associated with the program;
c. Include provisions for safety measures, including restriction of access to sites and equipment;
d. Spill control provisions:
I. Response to upsets and bypasses including control, containment, and remediation; and
ii. Contact information for plant personnel, emergency responders, and regulatory agencies;
e. Detailed inspection procedures:
i. Names or titles of personnel responsible for conducting inspections;
ii. Frequency and location of inspections, and procedures to assure that the selected locations and
inspection frequency are representative of the residuals management program; and
iii. Description of record keeping and actions to be taken by the inspector in the event that
noncompliance is observed;
f. Detailed sampling and monitoring procedures:
I. Names or titles of personnel responsible for conducting sampling and monitoring;
ii. Description of monitoring procedures including parameters to be monitored; and
iii. Sampling frequency and procedures to assure that representative samples are collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during aparticular sampling event. The sampling plan shall account for any
foreseen fluctuations in residuals quality and indicate the most limiting times for residuals to
meet pathogen and vector attraction reduction requirements.
[I5A NCAC 02T. I I I0(a)]
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5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the residuals management program, the Permittee shall designate and employ a
certified operator in responsible charge (ORC), and one or more certified operators as back-up ORCs.
The ORC or their back-up shall visit the facilities in accordance with 15A NCAC 08G 0204 and shall
comply with all other requirement in 15A NCAC 08G 0204. [15A NCAC 02T .0117, 08G .0204]
6. The Permittee shall ensure that a copy of this permit and the Division -approved Operation and
Maintenance Plan is available when land applying residuals. [15A NCAC 02T .1110(b)]
7. The Permittee shall ensure that spill control provisions are available when transporting or land applying
residuals. [15A NCAC 02T .1110(a)(4)]
8. Class B residuals shall not be stored or staged at any land application site without prior written approval
from the Division. Class B residuals approved for storage shall be stored or staged in a manner to
prevent runoff of leachate and other wastewaters generated. [15A NCAC 02T .1110(c), 02T .1110(e)]
9. Adequate measures shall be taken to prevent wind erosion and runoff from the land application sites
listed in Attachment B. [15A NCAC 02T .0108(b)(1)(A)]
10. Class B residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under section
4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of surface
water or groundwater standards;
d. If the land is flooded, frozen, or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100-year flood elevation, unless the residuals are injected or incorporated within a 24-
hour period following a residuals land application event;
f. During precipitation events, or within 24 hours following a rainfall event of 0.5 inches or greater
in a 24-hour period;
g. If the slope of the land is greater than 10% when liquid residuals are surface applied, or if the slope
of the land is greater than 18% when liquid residuals are injected or incorporated;
h. If the land does not have an established vegetative cover crop unless the land is a Division -approved
no -till site, or the residuals are injected, or incorporated within a 24-hour period following the
application of residuals;
i. If the vertical separation of the seasonal high water table and the depth of residuals application is
less than one foot;
j. If the vertical separation of the depth to bedrock and the depth of residuals application is less than
one foot;
k. If the application exceeds agronomic rates; or
1. If the land application sites are located within a WS-I watershed pursuant to 15A NCAC 02B .0212
or within the Critical Area of a WS-II pursuant to Sub -Item (4)(g) of Rule 15A NCAC 02B .0212,
or within the Critical Area of a WS-III or WS-IV watershed pursuant to Sub -Item (4)(h) of Rules
15A NCAC 02B .0215, and .0216.
[I5A NCAC 02T .I 109(a)(1)]
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11. Class B land application sites shall have the following public access restrictions:
a. Public access to public contact sites shall be restricted for one calendar year after a residuals land
application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event;
c. Public access to land associated with a dedicated land application site shall be restricted
continuously while the land is permitted for active use, and for one calendar year after the final
land application of residuals.
[15A NCAC 02T .1109(a)(2)]
12. Class B land application sites shall have the following harvesting and grazing restrictions:
a. Animals shall not be allowed to graze on land for 30 calendar days after any land application of
residuals;
b. Food crops, feed crops, and fiber crops shall not be harvested for 30 calendar days after any land
application of residuals;
c. Food crops with harvested parts that touch the mixture of residuals and soil and are totally above
the land surface shall not be harvested for 14 months after any land application of residuals;
d. Food crops with harvested parts below the land surface shall not be harvested for 20 months after
any land application of residuals if the residuals remain on the land surface for four months or
longer prior to incorporation into the soil;
e. Food crops with harvested parts below the land surface shall not be harvested for 38 months after
any land application of residuals if the residuals remain on the land surface for less than four months
prior to incorporation into the soil; and
f. Turf grown on land where residuals are applied shall not be harvested for one calendar year after
any land application of residuals.
[15A NCAC 02T .1109(a)(3)]
13. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for those
operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (MRCS) or other State Agencies. The Permittee shall calculate allowable nutrient
loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan. [15A NCAC 02T .0108(b)(1)(A), 02T .1104(c)(3)]
14. Class B residuals shall not be land applied to the fields listed in Attachment B unless the Landowner
Agreement between the Permittee and the respective field owners or lessees/operators of the land
application site is valid. The Landowner Agreements shall expire concurrent with the permit expiration
date of December 31, 2028. [15A NCAC 02T .1104(c)(4)]
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IV. MONITORING AND REPORTING REQUIREMENTS
1. The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
program's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. The residuals from each source generating facility shall be analyzed to demonstrate they are non-
hazardous under the Resource Conservation and Recovery Act (RCRA). Residuals that test or are
classified as a hazardous or toxic waste under 40 CFR Part 261 shall not be land applied. The analyses
(i.e., corrosivity, ignitability, reactivity, and toxicity characteristic leaching procedure (TCLP)) shall be
performed at the frequency specified in Attachment A, and the Permittee shall maintain these results
for five years. Any exemptions from the requirements in this condition shall be specified in Attachment
A. The TCLP analysis shall include the following parameters, and the Federal regulatory level (mg/L)
is in parentheses:
Arsenic (5.0)
1,4-Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1,1-Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Heptachlor (and its epoxide)
0.008
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Hexachlorobenzene (0.13)
Toxaphene (0.5)
Chloroform (6.0)
Hexachlorobutadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5-Trichlorophenol (400.0)
m-Cresol (200.0)
Lead (5.0)
2,4,6-Trichlorophenol (2.0)
o-Cresol (200.0)
Lindane (0.4)
214,5-TP (Silvex) (1.0)
p-Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A, the
Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
[15A NCAC 13A .0102(b), 02T .1101, 02T .1105]
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The residuals from each source generating facility shall be analyzed at the frequency specified in
Attachment A, and the Permittee shall maintain the results for a minimum of five years. Each analysis
shall include the following parameters:
Aluminum
Mercury
Potassium
Ammonia -Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
[15A NCAC 02T .1101]
4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A. The monitoring results shall specify the
stabilization process utilized, and demonstrate compliance with the Class B pathogen reduction
requirements in 15A NCAC 02T .1106(b), and one vector attraction reduction requirement in 15A
NCAC 02T .1107(a) shall be met. Any exemptions from the requirements in this condition shall be
specified in Attachment A. [15A NCAC 02T .1106(b), 02T .1107(a), 02T .1111(c)]
An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B that received residuals during the calendar year. This
analysis shall be in accordance with the soil sampling guidance located in the Sampling Instructions
section of the NC Department of Agriculture & Consumer Services' website
(http://www.ncagr.gov/agronomi/pubs.htm). The Permittee shall maintain these results for aperiod of
no less than five years, and these results shall be made available to the Division upon request. Each
Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
[15A NCAC 02T .0108(c), 15A NCAC 02T .1I I I(d)]
6. Representative samples of residuals that are prepared for land application shall be collected and
analyzed. [15A NCAC 02T .1111(a)]
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7. The Permittee shall maintain records for all residual land application events. These records shall
include the following:
a. Residuals source (as listed in Attachment A);
b. Date of application;
c. Location of land application (field name as listed in Attachment B);
d. Approximate acreage applied;
e. Method of application;
f. Weather conditions;
g. Dominant soil series;
h. Soil conditions;
i. Proposed crop;
j. Nitrogen Application Rate based on RYES;
k. Volume of residuals applied per acre in gallons, cubic yards, dry tons, or wet tons;
1. Volume of animal waste or other nutrient source applied per acre in gallons, cubic yards, dry tons,
or wet tons;
in. Volume of soil amendments applied per acre in gallons, cubic yards, dry tons, or wet tons; and
n. Annual and cumulative totals applied to each field for the following:
I. Class A and Class B residuals (dry tons per acre);
ii. Animal waste and other sources of nutrients (dry tons per acre);
iii. Heavy metals as specified in Condition IL5. (pounds per acre);
iv. Plant available nitrogen (pounds per acre); and
v. Phosphorus (pounds per acre).
[15A NCAC 02T .0108(c)]
8. One hard copy and one electronic copy of an annual report shall be submitted on or before March I"
The annual report shall meet the requirements described in the Instructions for Residuals Application
Annual Reporting Forms. Instructions for reporting and annual report forms are available at
http://deg.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/non-
discharge-permitting-unit/reporting-forms, or can be obtained by contacting the Non -Discharge Branch
directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[15A NCAC 02T .I I I I(d)]
9. Noncompliance Notification
The Permittee shall report to the Winston-Salem Regional Office, telephone number [phone],
within 24 hours of first knowledge of the:
a. Any process unit failure (e.g., mechanical, electrical, etc.) rendering the facility incapable of
adequate residual treatment.
b. Any failure resulting in a discharge to surface waters.
c. Any time self -monitoring indicates the program has gone out of compliance with its permit
limitations.
d. Land application of residuals abnormal in quantity or characteristic.
e. Any discharge from a vehicle or piping system transporting residuals.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Winston-Salem Regional Office within
five days of first knowledge of the occurrence, and this report shall outline the actions proposed or
taken to ensure the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
WQ0003351 Version 4.0 Shell Version 210928 Page 10 of 12

V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the Permittee's
storage, distribution, and application facilities. [15A NCAC 02T .1110(f)]
2. The Permittee shall inspect the Permittee's residuals storage, transport, and application facilities to
prevent malfunctions, facility deterioration, and operator errors that may result in discharges of wastes
to the environment, threats to human health, or public nuisances. The Permittee shall maintain an
inspection log that includes the date and time of inspection, observations made, and maintenance,
repairs, or corrective actions taken. The Permittee shall maintain this inspection log for a period of five
years from the date of inspection, and this log shall be made available to the Division upon request.
[I5A NCAC 02T .0108(b)(1)(A), 02T .I I10(f)]
Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the land application sites or facilities permitted herein at any
reasonable time for determining compliance with this permit. Division authorized representatives may
inspect or copy records maintained under the terms and conditions of this permit, and may collect
groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
VL GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215.1(d)]
Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes, rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
If the permitted residuals program change ownership, or the Permittee changes their name, the
Permittee shall submit a permit modification request on Division -approved forms. The Permittee shall
comply with all terms and conditions of this permit until the permit is transferred to the successor -
owner. [G.S.143-215.1(d3)]
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6. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02T;
b. obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
I. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants;
d. the Permittee's failure to pay the annual fee for administering and compliance monitoring; or
e. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[15A NCAC 02T .0110]
7. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.613, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.613, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[15A NCAC 02T .0120(b), 02T .0120(d)]
8. This permit shall not be renewed if the Permittee or any affiliation has not paid the required annual fee.
[15A NCAC 02T .0120(c)]
Permit issued this the 8th day of July 2022
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Richard E. Rogers, Jr., Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0003351
WQ0003351 Version 4.0 Shell Version 210928 Page 12 of 12

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Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall subunit one original and two copies of the application end
support►n� docutaaentation
For more irafizrmation, visit the Water Quality Permitting Section's
General —'This document is an agreement between the Applicant and Land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 1 ` A N mAC-02', 8 , II G 00. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 116-1.6).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION PRIVATELYD
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of Mocksville
hereinafter referred to as the Permittee, to land apply residuals from the following fhcility(ies) onto the following land
application site(s) (i.e., see attached setback: maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/field l
Lease
es/no
(y )
Land Use or
Cropping patterns
pp g
Intended tJse of Crops
residuals Source
(optional)
Special 'note
(no-tilllover�-seed/
pasture)
NC-D`'d`-008-08
No
ltay/P'asture
feed
The landowner or his representative receives, in consideration, full use of'the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals lased application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FCltl'v'l: LOA 06-16 Page] of 3

I, STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application sitc(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDr,,NR-DWR, Non -Discharge Permitting Unit, 1.617 Mail
Service Center, Raleigh, NC 27699461T
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application sitc(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules fbr typical cropping patterns, a description ofthe
equipment used by the Permittee..
7. The Permittee will provide the landowner or his representative with a copy ofthe residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH ofthe land application site(s) is not maintained at 6.0 or greater, sufficient amounts of time shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH ofthe soil, residuals and time mixture is suitable for the
specified crop.
9. The landowner or h:is representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits,
M The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application sitc(s).
11, The landowner or his representative will inform the Pem-iittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals ]and application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event,
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application sitc(s) at any reasonable time for the purpose of determining
compliance with the permitestablish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachatc, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
It, RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event Such controls may include the Posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
1 Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a I 4-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall no[ be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event,
IILALTERNATIVES FOR WATER SUPPLY WELLS INSIDE'rHE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, -(- .A. . allows the compliance
_1 1-1 ... ........
boundary to be placed closer to, the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the ne" ly-establi shed compliance boundary. Please mark one of the following;
A re -defined compliance boundary is needed for field(s) ID: NC ' D4 - 0 0 %1- 0 9
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
ance
boundary to the application package)
El A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
The Ind application field(s) ID-. NC-DV-008-08 is currently permitted under another residuals
land application program-. Permit Number WQ:00 105 83 The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;_ Town ul'Mocksviflc
(Name of the new program)
FORM: LOA 06-16 Page of3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions.
regarding the use of the land application site(s) on behalf of other deeded Landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified.
herein.
Landowner name: Roger Spillman
Address: PO Box 738
City: Cooleemee State: NC Zip: 27014
Phone: [phone] E-mail address:
i
.. Vj 7-'
Signature: ,. �.-,,., ,; l: ',-i � Date:
NORTH CA CDLINA. �� `' COUNTY
I, the undersigned Notary Public do hereby certify that P95er+ r 1 a
personally appeared before me this day and acknowledged the due execution of the forgoing instrument,
WITNESS my hand and official seal this the g els
day of IgVS v
Signature and seal: w ,
y commission expires: 3 AF0hiog 4.
Lessee's/Operator's Certification:
2022.
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name
Address:
City
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
I certify that. I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: Ken. Gamble —Town Manager
-ea„ k�rb/� ........ Aug 26 2022
,,,,,
(', nkl P ()(, )G22 0131Y,IST) f
lgnatLlreTate:
FORM: LOA 06-I6 Page 3 of 3

The compliance boundary is established either 250 ft from the residuals application area or 50 ft within the property boundary, whichever is closest to the application area. The review boundary is established midway between
the compliance boundary and the perimeter of the residuals application area. The review boundary for DV08-08 has been modified to allow for application up to 100 feet from on -site water supply well
Field Total Acres Applicable Acres
8 27.2 17.09
SCALE: ° = 440,*—Resources,
DATE: 08-25-22DRAWN BY: BC Inc.
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Town of MOCKSVllle FIGURE NO.
Land Application Program
NC-DV-08
Roger Spillman
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Town of Mocksville L, ins T, s e0335,1
Final Audit Report 2022-08-26
Created:
2022-08-26
By:
Brent Collins ([e-mail])
Status:
Signed
Transaction ID:
CBJCHBCAABAADUG2TkEw8NXL1npB1248HH_OD18APndk
"Town of Mocksville Land Transfer - WQ0003351" History
Document created by Brent Collins ([e-mail])
2022-08-26 - 12:43:22 PM GMT- IP address: 206.85.202.26
Document emailed to [e-mail] for signature
2022-08-26 - 12:45:06 PM GMT
Email viewed by [e-mail]
2022-08-26 - 12:58:40 PM GMT- IP address: 67.213.52.2
A, Signer [e-mail] entered name at signing as Ken Gamble
2022-08-26 - 12:59:36 PM GMT- IP address: 67.213.52.2
Document e-signed by Ken Gamble ([e-mail])
Signature Date: 2022-08-26 - 12:59:38 PM GMT - Time Source: server- IP address: 67.213.52.2
Agreement completed.
2022-08-26 - 12:59:38 PM GMT
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