SLAS7907_APPLICATION_INITIAL_2024

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE LAND APPLICATION SITE
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Site and Operator Information _
1. Applicant 161��-it'aC's �I 1� c��-S ?� �- I rcr4K- cowwLjr:!
Address Lq-9 ? eN N V
Phone 33Lo- 3q2= 1)ca07
2. Contact person for site operation (if different from applicant): (Z t'3 65 L" `(
Title or position Go - vuaN CYZ-- Phone
Address 1 V CWT4 V-0 .
3. Landowner I I �n i Ct N t-1 9-9 . / 5ik.L-\n1bS ot! taSor & nola's u-,(
r
Address V v.Ny5,%-4 � k.L,C , N G ?,:3 3 °L 0 .
4. Site Location: County CZ.oc.-w State Road Number Z�qcay
Directions to site: `[7y tLC jrI N_ � t �asv, g .— 9 ��T
Mk -LP T ,•1 P e="A V- o Ttt�
ON V , Q\GEC c t'Q^ r c� V-C� .
5. Indicate whether request is: new renewal modification ✓
For a permit renewal or modification, provide the following information:
Existing site permit number: '�!� - 02 permit expiration date: T9
6. Number of acres meeting the requirements of the N.C. Septage Management Rules: 3cres.
7. Subs es a er than septage or grease trap pumpings previously disposed of on the site:
(a) one , or (b) Attach a list indicating other substances, the amounts discharged,
and ates of discharge.
8. Attach written, notarized landowner authorization to operate a septage disposal site signed by the
landowner (if the permit applicant does not own the property). If a corporation owns the land
use a corporate landowner authorization form. if Limited Liability Company owns the land,
use a limited liability company landowner authorization form.
9. Attach site evaluation report, including aerial photograph and soil analysis with metals results,
unless the Division prepared the report.
10. Attach a vicinity map (county road map showing site location).
(over)

II. Site Management Information:
1. The following information shall be included with the application form:
(a) Nutrient Management Plan
(b) Soil Erosion and Runoff Control Plan
2. Alternative plan for disposal (detention facility permit number or wastewater treatment plant
authorization): S'P"rF • "1g • 02 W iNj-T C-
.y
3. Types of septage proposed to be discharged at the site (check all that apply):
(a) Domestic septage pumped from septic tanks
(b) Grease trap pumpings _L,--
(c) Portable toilet waste
(d) Commercial 1 Industrial septage
4. Proposed treatment method of each type of septage to be land applied (use additional paper to
explain if necessary): "Q 2A t-1 NNe 42:9�1-M L-P. i aN 'T t� 2
-
Z
5
6.
Proposed method of applying Septage to land, including septage distribution plan if required * (use
additional paper to explain if necessary): PU NK 'MUM,c ��yzt-yyk S-9
Demonstration from the appropriate state or federal government agency that the land application
site complies with the Endangered Species Law ** or if any part of the site specified is not
agricultural land (use additional paper to explain if necessary): -MS
III. Certification
I hereby certify that:
1. The information provided on this application is true, complete, and correct to the best of my
knowledge.
2. 1 have read and understand the N.C. Septage Management Rules, and
3. 1 am aware of the potential consequences, including penalties and permit revocation, for failing
to follow all applicable rules and he o diti Septage Land Application Site permit.
y s of Qg II 2
Aignre (Sign re cK=npany official required) Qb- Date
Print name Title
Note: This application will not be reviewed until all parts of the application are complete.
Refer to Section .0837(e) of the N.C. Septage Management Rules.
" Refer to Section .0837(g) of the N.C. Septage Management Rules.
S:Solid WastelclalseptagelformslSLAS-Application & Authorization\SLAS Permit Application -Jan 2016.docx
Rev 01-07-16

Limited Liability Company Landowner's Authorization to Operate a
Septage Land Application Site
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
�� c..c-C_
I hereby certify that the undersigned limited liability company, �L�iNe6 tSSoci wr�s
MS- 3 acres of land located Its wt w-"scrZ P and identified by
►) IT I322 i�oc�u�crrM co.)MV � 'Kbok and page of recorded deed or tax map parcel) and
that the limited liability company agrees to allow 1 t (operator name) to use
sailland for application of septage for a period of 1 y) 4 �CZ—S(length of time), beginning
ik ! 2a2-�, (give date), and that on behalf of the limited liability company, i have read the North
Carolina Septage Management Rules*, and ISi,,_LiK6sti" ftsoc uny5,ts-(name of limited
liability company) understands and agrees to maintain the restrictions on land use after septage application
ends**. &v4nt-b;t .:24s cname of limited liability company) further understands
that no septage may be land applied until the bivision of Waste Management has issued a permit for a
septage land application site. The above described property is owned solely by the undersigned limited
liability company, or jointly with KPID (name all co -owners, or state none).
Date: � - i I - a 3
(—Lc—
(Authorized
North Carolina
g=pC>,[a jUG VM County
77
L. L C--
I, Oa✓Y r 5 , a Notary Public for said County and State do hereby certify that
LendA. 6 (name of authorized member or manager of limited liability company)
personally =earedre me this day and, being,rst duly swom, acknowledged that he (she) is a (the)
{member or manager) ofl� Ahsc 4ks U c-- , a limited liability
company, and that by authority duly given and as the act of the limited liability company, the foregoing
instrument was signed in its name by its authorized A(member or manager) , and that the
state ents contained therein are true. Witness my hand and official seal, this the /! day of
,20 a 3
A
Add—..,
Notary Public
My Commission expires:7:
*15A N.C. Admin. Code 13B Section .0800
** As required by Rule .0843
(0FFIQIA'�•`�C'�.
Rev. 01-07-16

0
THE FOLLOWING IS THE NUTRIENT MANAGEMENT PLAN, AND
EROSION AND RUNOFF CONTENT PLAN FOR:
SLAS # 79-02 OPERATED BY: , 1
A. GENERAL INFORMATION:
1.
Periodic Sampling (at least 2/year) of
the septage will be
conducted for waste analysis.
2.
Field site #)79-02
permitted for septage
application consist
of:
��O "`,,�
S ��S
�+11
,,-it S`rd�
i�YI`���.�'
r
Field 5A which
established in
Field 5B which
established in
Field 6A which
established in
Field 6B which
established in
contains approximately
Tall Fescue.
contains approximately
Tall Fescue.
contains approximately
Tall Fescue.
contains approximately
Tall Fescue.
86—Sa acres and is
ypp
4 -acres and is
9.7Y
� acres and is
7,51r
1.e. - acres and is f
*3O.1 7
"'a
3. The dominant soil series in fields 5A & 5B is Vance Sandy
Loam and in 6A and 6B is Cecil/Pacolet, with 4-7`s slope.
Copy of Rockingham County Soil and Water Conservation
District, Food Security Act Plan addressing soil
conservation practices is attached.
4. Septage will not be applied where the site is untrafficable.
(Untrafficable is defined as soil that will allow a loaded
truck to leave a depression in sod greater than 3 inches
depth) .
5 When soil conditions do not allow for application, Septage
will be disposed of at a waste treatment plant or septage
storage shall be provided to account for the average volume
of septage pumped per week.
B. CROPS TO BE GROWN AND APPROXIMATE PLANTING AND HARVESTING
TIME:
1. Site # 79-02 located on Penn Road south of Reidsville in
Rockingham County.
2. In order for fescue fields to receive septage, a 90stand
should be maintained and soil test should indicate that the
fields are agronomically suitable for septage applications.
Fescue stands will be monitored to determine when reseeding
is necessary. Septage applications will be suspended in
areas that: 1- need reseeding, which will allow soil
preparation, and establishment of a stand of fescue that

�G �c ve 41: �, ( iG •�l •-�''`Ilsir S �+ �! G,ni�.r �C+'� vt
PAGE 2
can utilize applied nutrients or 2 - are agronomically
unsound. If reseeding becomes necessary, follow seeding
rates and dates recommended in the Planting Guide For Forage
Crops In NC.
3. Septage application rates will be based on nutrient needs of
fescue. Fields will be mowed and removed or utilized for hay
production. When the fescue reaches 12 inches in height it
will be harvested and removed. Approximately 3 to 4 cuttings
is expected.
4. A 30 day waiting period will be observed between the last
application of septage and harvesting.
C. NITROGEN NEEDS FOR CROPS GROWN:
1. Fescue will be harvested and removed. Septage application_
will be based on nutrient needs of fescue and will not
exceed 157.5 lbs. N/acre/year as determined.
R.Y.E. = Realistic Yield Expectations
N App. Rate = Suggested Nitrogen (N) Application rate based
on R.Y E. for soil type.
CroL Cut for Ha-: R.Y.R. N Az: . Rate Lbs N•Acr._
Site ##
79-02 Tall Fescue 3.5 Tons/Acre X 45 Lbs. = 157.50
D RELATIVE APPLICATION RATE FOR SITE:
MONTH
January
February
March
April
May
June
July
August
September
October
November
December
RELATIVE RATE
Low
Medium
Hiah
High
Medium
Low
Low
Low
Medium
Medium
Medium
Low
Low = 5000 Gals. Medium = 10000 Gals. High = 15000 Gals.
NOTE: CUMULATIVE APPLICATION RATE IS NOT TO EXCEED THE
PERMITTED APPLICATION RATE.
I

PAGE 3
E. APPLICATION METHOD:
1. The preceding information is based on septage being evenly
applied over the entire permitted site by truck splash plate
spraying. Application will be uniform over treated area.
F. ADDITIONAL FERTILITY REQUIREMENTS:
2. Site small be soil tested and fertilized according to soil
test results for tall fescue.
3, The application site shall be soil sampled at least once
each year. Nitrogen needs of the fescue are to be met
with the septage applied. Soil test results will be used to
determine other nutrients that should be applied tofertilize
the fescue. Phosphorus and potassium are the nutrients that
will require commercial fertilizer applications.
4. In fescue buffer areas of the fields, soil test shall be
taken and fertilized, according to recommendations, with
commercial fertilizer.
G. HARVEST OF CROPS AND USE:
5. The fescue will be cut and removed or cut as hay and baled
whenever it reaches approximately 12 inches in height. With
four cuttings expected annually.
6. A 30 day waiting period must be observed between the last
application of septage and 'nay harvest.
7. Application and harvest can be rotated between fields 5A,5B,
6A and 5B. -Kls d1' 1 11,e- w1-44 YaaW
8. Accurate records should be maintained of all activities on
these fields and pumping of septage. Records should include
date, amounts and fields that septage was applied.
H. SOIL EROSION AND RUNOFF CONTROL:
1. This application site has a slope of 4-70. Where septage is

PAGE 4
applied care should be taken to honor and maintain setbacks
according to NCDENR standards.
2. Setback needs to be maintained along northwest border of the
field between the septage land application area and the
pond.. As long.as the field remains in an adequate stand of
grass the setback of 200 ft may be reduced to 100 ft.
3. Setback of 15 ft needs to be maintained along grassed
drainageway running north to south that divides the field
into two portions.
4. Areas should be flagged to show all application areas and
setbacks.
THE NORTH CAROLINA COOPERATIVE EXTENSION SERVICE IS COMMITTED TO
PROVIDING EDUCATIONAL OPPORTUNITIES TO CITIZENS, IT IS NOT OUR
ROLE TO GUARANTEE, MONITOR, REPORT, OR ENFORCE COMPLIANCES WITH
THIS PLAN. IT IS HOWEVER, YOUR RESPONSIBILITY TO ENSURE THE
ACCURACY OF THE PLAN AND. THE IMPLEMENTATION PROCEDURES THAT MAY
BE CONTAINED IN THE PLAN.
A4117Submitted By: Date
a 3
Site Operator
Plan Prepared Sx' - Date /
`en Chase
Agricultural Extension Agent
P.O. Box 200
Wentworth, NC 27375-0200
Phone: [phone]