HomeMy WebLinkAboutWQ0019960_Renewal Application_20210225Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0019960
Applicant/Permittee City of Marion
Applicant/Permittee Address PO Office Drawer 700 Marion, INC 28752-0700
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Municipal
Facility Name City of Marion
County McDowell
Fee Category Minor Fee Amount $0
Is this a complete
application?*
r Yes r No Complete App Date 02/25/2021
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO
Comments for Reviewer
Comments for Applicant
Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by NI3 Staff
Name * Zach Key
Email Address*
zachkey@usbiosolids.com
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ .....................................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
3369577871
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r 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.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation r High -Rate Infiltration
r Other Wastewater r Reclaimed Water
r Closed -Loop Recycle r Residuals
r Single -Family Residence Wastewater r Other
Irrigation
Permit Number:*
W00019960
Has Current Existing permt number
Applicant/Permittee *
City of Marion
Applicant/Permittee Address*
PO Office Drawer 700 Marion, NC 28752-0700
Facility Name *
City of Marion RLAP
Please provide comments/notes
on your current submittal below.
Attached is the land application permit
renewal package WQ0019960 for the City of Marion's
WWTP.
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 Hans, Specifications, Calculations, Bc.)
WQ0019960 Renewal.pdf 2.68MB
Upload only 1 RCFdocurrent (less than 250 N8). Nuftiple documents nest be corrbined into one RDFfile unless file is larger than
upload limit.
* W 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 2/25/2021
PO Box 146 Ronda, NC 28670
336-777-6909
www.usbiosolids.com
Thursday, February 25, 2021
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: Permit Renewal for the City of Marion
Land Application Permit No. WQ0019960
The City of Marion is applying for a renewal to its current land application permit WQ00019960.
There are no changes in this permit renewal package since the last issuance, except for changes the
deletion of two fields that have had a change of ownership and have been parceled off.
Your attention to this permit application package is greatly appreciated. If you have any questions or
concerns, please feel free to contact me at 336-957-7971 or at zachkey@usbiosoilds.com
Sincerely,
Zach Key
US Biosolids, Inc.
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Qualio,, Permitting Section's Non -Discharge Permittft Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T . 1100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
❑ Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 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.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in I SA
NCAC 02T .0106(b).
❑ If this project is for a modification of an existing permit, submit one copy of the existing permit.
[. Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
C.
Facility Classification New Permit
Major (land are permitted for > 300 acres) $1,310
. ........... -
Major Modification'
$3 95
Minor (land are permitted for < 300 acres) $810 $245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
Cover Letter (All Application Packages)
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
Environmental Assessments (May be Required — See 15A NCAC l C .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06- l6 Page I of 3
E. Operation and Maintenance Plan (New and Renewal Application Packages)
For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
[] Submit the O&M Plan in accordance with 15A NCAC 02T .I 110 and include at a minimum:
0 Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
[] Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
El Inspection plan including the following information;
0 Names and titles of personnel responsible for conducting the inspections.
El Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
❑ Sampling and monitoring plan including the following information;
El Names and titles of personnel responsible for conducting the sampling and monitoring.
0 Detailed description of monitoring procedures including parameters to be monitored.
Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular 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 (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS C to M ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
El Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.110202 1. Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
Submit three (3) sets of standard size plans and two (2) sets of I I " by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
Ej Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T . 1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
[] Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3
I. Project Evaluation and Receiver Site Management Plan (AI1 New Application Packages or Modifications that include new sites)
❑. Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑. Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1 104 d 4 and current Division Policy
available at: http://www.ncwater.org/Rules_ Policies and Regulations/. The document shall be signed, sealed and dated by a
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .1 104(d)(2). For Modifications, submit an updated site map
specific to the modification(s) only.
The design documents must include the following minimum items:
Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1 104 d 5 and current Division Policy
available at: htt ://www.ncwater.or /Rules Policies and Re ulationsl.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
0 Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02 L .0107 , or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT rrO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: (919) 807-6464
INSTRUCTIONS FOR FORM: RLAP 06-16
B.V Courier/S ecial Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: (919) 807-6496
Page 3 of 3
State of North Carolina
Department of Environmental Quality
Division of Water Resources
VS on o Ater esources 15A NCAC 02T .I 100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Marion
Applicant type: ❑ Individual [] Corporation ❑ General Partnership
❑Privately-Owned Public Utility
Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Bob Boyette Title: City Manahr
Applicant's mailing address: PO Office Drawer 700
City: Marion State: NC Zip: 28752-0700
Telephone number: (828) 652-3551 Email Address: bboyette@marionnc.org
2. Consultant's name: Zach Key License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: US Biosolids. Inc.)
Consultant's mailing address: 958 Hoots Road
City: Roaring River
State: NC Zip: 28669-9148
Telephone number: (336) 957-7871
Email Address: zachkeyfca,usbiosolids.com
3. Agronomist's name:
License Number:
Affiliation: 0 NIA 0 On Staff
❑ Retained (Firm: )
Agronomist's mailing address:
City: State:
Zip:
Telephone number: O _-
Email Address:
4. Soil Scientist's name:
License Number:
Affiliation: ❑ NIA ❑ On Staff
❑ Retained (Firm: )
Soil Scientist's mailing address:
City: State:
Zip:
Telephone number: (—) _-
Email Address:
5. Fee submitted: $0.00 (See Instruction B)
PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, modified,
0 renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0019960
Date of most -recently issued permit: 4-14-2106
Date of most -recently certified Attachment A (if different than the permit): 4-14-2016
Date of most -recently certified Attachment B (if different than the permit): 4- 14-20 16
FORM: RLAP 06-16 Page 1 of 5
III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
I. Residuals Processing Facility's physical address: 3982 Highway 226 South
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 350 39' 09.72" Longitude: 810 57' 23.81"
Datum: NAD83 Level of accuracy: 0.01
Method of measurement: MAP
2. County where residuals land application program is headquartered: McDowell
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
Dennis Key
US Biosolids, Inc.
15704
Back -Up ORC
Zach Key
US Biosolids, Inc.
27660
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 Nitrogen 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: 29_0 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
37.182
39.982
10782.78
11594.78
Five -Year Maximum Adjusted
39.12
41.92
1 1334.8
121572
b. Laud 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
0
Pasture
56.9
Total:
56.9
Methods
Surface
56.9
Incorporation or Injection
0
Total:
56.9
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
(Ibs PANlac 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
215.65
231.89
226.8
243.14
100
107.82
115.94
113.4
121.5
150
71.88
77.29
75.5
81
200
53.91
57.97
56.7
60.78
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
Ce rtif ication. doc
FORM: RLAP 06-16 Page 3 of 5
Note: Item VI. Applicable to Dedicated Program with fixed irrigation system only.
V1. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: 0 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 l 5A NCAC 02T .0505(nl 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
inl 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):
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page 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 Certifieatian (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 I SA N A 5.
93, es ❑ No, Explain;
,•
(Signature Authority's Name - PLEASE PRINT) 1 _ D(Title)
attest that this application for CI ��[ ,.,E�� n ,� n r>ry f �.►
I (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 3143-215.613, 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 525,000 per violation.
Signature' Date: --
FORM: RLAF 06-16 Page 5 of 5
Operation and Maintenance Plan
City of Marion, W WTP
Permit No. WQ0019960
In accordance with the requirements set forth by the North Carolina
Department of Environmental and Natural Resources using
NCGS 143-215.1 and 143-215.3(a) based on 15A NCAC 02T .1 10, U.S
Biosolids, Inc. and the City of Marion are implementing this Operation
and Maintenance Plan.
The project manager of the land application event will make sure a daily
check off is performed at the start of each workday. This inspection is to
prevent any spills, leaks, or run-offs.
The daily check -off will consist of inspection the following items:
1. Access to the facility will be controlled with a locked gate and
signs to prevent any unauthorized entry into the complex.
2. All pumps and hose will be checked at the start of each day for
leaks or loose fittings.
3. All tanker valves are closed prior to loading and lids are closed
prior to transport.
4. All dump trailers or dump trucks gates are tightly fastened and
do not leak prior to transport.
5. All on road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
6. All equipment is secured at the end of each working day to
prevent any tampering or unauthorized use.
The ORC or back up ORC will inspect the field after each land application
event to make sure all regulations as required by the permit are followed.
Also the project manager at the end of each working day during a land
application event will make sure that all gates if present are closed.
All samples shall be taken as early as possible before the first application
event of the calendar year to make sure the facility is compliance.
The samples will be taken in a matter that is representative of the residuals
and all grab samples will be mixed prior to be placed into the containers
that will go to the laboratory. These samples must be collected and
transported as outlined in the Sampling Plan attached to this O&M Plan.
All records of these laboratory results as well as the annual report and
loading rates will be kept on file for a minimum of five (5) years.
Also, in the unlikely event of a spill or unintended release of residuals,
actions should be immediately taken as outlined in a copy of the
spill control plan attached.
City of Marion, WWTP
Permit No. WQ0019960
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are
collected from the digester. Samples from the digester will be combined
to form individual grab samples to be sent to a laboratory for analysis. If a
land application event is to occur in the early part of a calendar year (Le,
January or early February) these samples may have to be taken in
December so results can be obtained before the land application event,
as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform
analysis, SOUR test, nutrient analysis, and a TCLP test. These tests will be
taken by the City of Marion. All samples with the exception of the SOUR
test will be taken to a North Carolina certified laboratory; the SOUR test
will be ran in house at the Marion WWTP. All samples taken will be taken in
the same condition as the residuals are to be land applied.
The volatile solids will first be attempted to be achieved using option 4
[503.33(b) (1)]; Specific Oxygen uptake know as a SOUR test. This sample
will be taken from the digester.
Fecal Coliform is gathered in seven (7) individual samples and
tested to meet the requirements of [503.32(b)(2)]. This requirement is for
the geometric mean fecal coliform density of the samples be less than
two million (2,000,000) MPN per gram. These samples will be placed in
250ml containers and placed on ice, in a cooler for transport to the
laboratory before 1600 hours (4pm) the same day the samples are
obtained.
Annually, if land application occurs, a composite residual sample
will be analyzed, prior to a land application event for:
Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc,
Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nitrogen, Magnesium,
total Solids, pH, Phosphorus, Potassium, TKN, Sodium
From this information, the Plant Available Nitrogen (PAN) and a Sodium
Absorption Ratio (SAR) will be calculated. This sample will be collected in
a non -breakable container, at least one quart in size. This sample will be
taken from the digester.
SPILL CONTROL PLAN- U.S. Biosolids Inc.
City of Marion NC -Permit No. WQ0019960
In the event of a spill, the following should be taken IMMEDITALY.
Make sure all personal and bystanders are safe- if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to form a dike to
contain the spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as
much of the spilled material as possible. Use straw to soak -up the
remaining material. Dispose of the some in a landfill.
5. Flush the roadways with water if needed. If the spill occurred on a tillable
area, till the same into the soil and spread lime if necessary. If a spill occurs
on private property, final clean-up should be to the satisfaction of the
owner.
6. Notification. (This should be done as soon as safely possible.)
A. U.S Biosolids, Inc. Main Office (336)777-6909
B. City of Marion, WWTP- (828) 652-8843
C. NCDEQ-Asheville Regional Office (828) 296-4500
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting:
The Permittee shall report by telephone to the Asheville Regional Office,
telephone number (828) 296-4500, as soon as possible, but in no case
more than 24 hours or on the next working day following the occurrence
or first knowledge of the occurrence of any of the following:
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any failure of the surface disposal program resulting in a release of
material to surface waters.
C. Any time self -monitoring indicates the facility has gone out of
compliance with its permit limitations.
D. Any process unit failure, due to known or unknown reasons,
rendering the facility incapable of adequate residual treatment
E. Any spill or discharge from a vehicle or piping system during
residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to
surface waters, imminent failure of a storage structure, etc.) outside of
normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number (800) 662-7956, (800) 858-0368,
or (919) 733-3300. Persons reporting such occurrences by telephone shall
also file a written report in letter form within five days following first
knowledge of the occurrence. This report shall outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
8. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed
C. Inspect all seals and replace if necessary.
State of North Carolina
W. D. Department of Environmental Quality RDivision of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T.1 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 1 1-15) 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.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map -A vicinity map that shows the location of the facility and meets all of the criteria in the "M,ap_Guidan,ee_for
Residuals Land Application,Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page l of 1
RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: City of Marion
Status
Codea
Facility Permit Holder
Facility Name
County
Permit Number
Maximum Dry Tons Per Year
Current n
Proposed
R
City of Marion
Corpening Creek
McDowell
WQ0019960
290
290
a Status Code for source facility are: ♦ N (New) • R (Renewed) ♦ M (Modified) ♦ D (Deleted)
b The amount of residuals currently permitted for distribution. land application. or disposal (i.e, not applicable to new I'acility).
SUMMARY FOR FORM: RSC 06-16 Page I
State of North Carolina
DW
Department of Environmental Quality w wRDivision of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1, Facility Name: City of Marion Corpening Creek WWTP
2. Facility permit holder is: Federal, 0 State, Z Local Government, or El Private.
Facility permit issued by: Div. of Water Resources, Q Div. of Environmental Health,
or Other (explain: ).
3. Facility contact person and title: Tim Horton
Complete mailing address: PO Drawer 700
City: Marion State: NC Zip: 28752-0700
Telephone number: (828) 652-8843 E-mail address: thorton2marionnc.org
4. Facility physical address: 3982_14ighway 226 South
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 35" 39' 09.72" Longitude: 81 ° 57' 23.81 "
Datum: NAD83 Level of accuracy: 0.01
Method of measurement: MAP
5. Purpose of the facility:
treatment of municipal wastewater, l treatment of 100% domestic wastewater,
�] treatment of potable water, Q treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater.
(approximate percentages: % industrial and % domestic)
Ej other (explain ).
6. Does the facility have an approved pretreatment program: Yes No
7. Facility permitted/design flow: 330 MGD and facility average daily flow: 0_9 MGD
8. Average amount of residuals being generated at this facility 66.68 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Two 0,780 MG Aeration Basins
Type and volume of residuals storage (i.e., outside of residuals treatment units): 700,00)-gallon digester
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
0 40 CFR Part 503 or 0 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T. l 102(6) as:
0 Biological [ Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page] of 5
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: 0 yes. no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: [] yes 0 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: l 1-12-2020
Passed corrosivity test: yes 0 no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: yes 0 no. Flashpoint: 200 OF (> 140°F)
Passed reactivity test: 0 yes Ono. HCN: ND mg/kg (<250) & H2S: ND mg/kg (<500)
TCLP Parameter
Limit
Result
TCLP Parameter
Limit
Result
(mg/1)
(mg/1)
(m9/0
(mg/l)
Arsenic
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1,3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
1.0
ND
Lead
5.0
ND
Carbon Tetrachloride
0.5
ND
Lindane
0.4
ND
Chlordane
0.03
ND
Mercury
0.2
ND
Chlorobenzene
100.0
ND
Methoxychlor
10.0
ND
Chloroform
6.0
ND
Methyl Ethyl Ketone
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
5.0
ND
p-Cresol
200.0
ND
Selenium
1.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2,4-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1, 1 -Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene
0.13
ND
2,4,6-Trichlorophenol
2.0
ND
Endrin
0.02
ND
2,4,5-TP (Silvex)
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
Vinyl Chloride
0.2
ND
FORM: RSC 06-16 Page 2 of 5
4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T .1 105.
a. For Distribution/Lund Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory; EYS and Date of analysis: 6-20-2020
Parameter
Ceiling
Concentration Limits
(ClasYA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(mg/kg)
Arsenic
75
41
28.2
Cadmium
85
39
11.3
Copper
4,300
1,500
422
Lead
840
300
47.5
Mercury
57
17
1.5
Molybdenum
75
n/a
39
Nickel
420
420
20.2
Selenium .
100
100
28.2
Zinc
7,500
2,800
1020
b. For Surface Dls osal Unit land ill : Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laborator
y: _. ,: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Mickel
(mg/kg)
0 > 0 but < 25
30
200
210
25 but < 50
34
220
240
[l > 50 but < 75
39
260
270
El > 75 but < 100
46
300
320
0. > 100 but < 125
53
360
390
0 > 125
62
450
420
Result (mg/kg)
FORM: RSC 06-16 Page 3 of 5
5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 1.8 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: ETS and Date of analysis: 6-2-2020
Parameter
Result
(mg/k9)
Aluminum
20800
Ammonia -Nitrogen
2500
Calcium
15300
Magnesium
5740
Nitrate -Nitrite Nitrogen
511
pH (Standard Unit)
6.2
Phosphorus
23000
Potassium
5570
Sodium
2810
Total Kjeldahl Nitrogen
�58400����
c. Using the results listed in Item 11, 5b. above, calculate the sodium adsorption ration (SAR): 0.65
[Note: if residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from 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, prior to land application of residuals. 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].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): 0 default value, or 0 actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1") Year PAN
Five -Year
Maximum Adjusted PAN
(mg/k
(mg/kg)
Surface
18591
18882.86
Injection/incorporation
19991
20282.86
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5
7. Pathoeen Reduction: Per 15A NCAC 02T.1 106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or Equivalent:
A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
El A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
E] Alternative 1 [I5A NCAC 02T.] 106(b)(3)(A)] - Time/Temperature Compliance.
Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
{ Alternative 3 [15A NCAC 02T.1 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
E3 Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helm inth Ova.
Alternative 5 [15A NCAC 02T.I I06(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: 0 composting, El heat drying, rJ heat treatment,
El thermophilic aerobic digestion, Q beta ray irradiation,
L] gamma ray irradiation, or ❑ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.1 106(c)(1)] - Fecal Coliform Density Demonstration.
0 Alternative 2 [15A NCAC 02T.1 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: [] aerobic digestion, [ air drying, ❑ anaerobic digestion,
0 composting, or lime stabilization.
c. For Surface Disposal.
L1 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in item 11. 7a. above.
0 Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
Q Exempt - if Daily Cover Alternative is chosen in Item 11.8. below [ 15A NCAC 02T.1 l06(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per I5A NCAC 02T.1 107, specify how residuals will meet the VAR requirements:
El Alternative l [15A NCAC 02T.I 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
E] Alternative 2 [15A NCAC 02T. l 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [I5A NCAC 02T.1 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [I5A NCAC 02T.1 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.1107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T. 1107(a)(6)] - Alkaline Stabilization.
Q Alternative 7 [15A NCAC 02T.1 107(a)(7)] - Drying of Stabilized Residuals.
Q Alternative 8 [15A NCAC 02T. l 107(a)(8)] - Drying of Unstabilized Residuals.
[] Alternative 9 [15A NCAC 02T.1 107(a)(9)] - Injection.
[] Alternative 10 [15A NCAC 02T.1 107(a)(10)] - Incorporation.
Alternative for Surface Disposal Units Only - Soil/Other Material Cover [ I5A NCAC 02T. 1107(b)(2)].
E] Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5
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ripnina Creek WWTP - NCOU31879
QUANTITATIVE JUSTIFICATION FOR RESIDUALS PRODUCTION RATE
Since the last issuance of Permit WQ0019960 the City of Marion has produced the following dry tons:
2020 58.06 DT
2019 145.89 DT
2018 0 DT
2017 94.34 DT
2016 35.13 DT
This comes to an average of 66.68 Dry Tons peryear, which is less than the amount of dry tons
requested in this permit renewal application.
City of Marion, WWTP
Permit No. WQ0019960
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are
collected from the digester. Samples from the digester will be combined
to form individual grab samples to be sent to a laboratory for analysis. If a
land application event is to occur in the early part of a calendar year (i.e.
January or early February) these samples may have to be taken in
December so results can be obtained before the land application event,
as some results take 30+ days to receive.
These individual grab samples are collected and tested for fecal coliform
analysis, SOUR test, nutrient analysis, and a TCLP test. These tests will be
taken by the City of Marion. All samples with the exception of the SOUR
test will be taken to a North Carolina certified laboratory; the SOUR test
will be ran in house at the Marion WWTP. All samples taken will be taken in
the same condition as the residuals are to be land applied.
The volatile solids will first be attempted to be achieved using option 4
[503.33(b)(1)]; Specific Oxygen uptake know as a SOUR test. This sample
will be taken from the digester.
Fecal Coliform is gathered in seven (7) individual samples and
tested to meet the requirements of [503.32(b)(2)]. This requirement is for
the geometric mean fecal coliform density of the samples be less than
two million (2,000,000) MPN per gram. These samples will be placed in
250ml containers and placed on ice, in a cooler for transport to the
laboratory before 1600 hours (4pm) the same day the samples are
obtained.
Annually, if land application occurs, a composite residual sample
will be analyzed, prior to a land application event for:
Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc,
Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nitrogen, Magnesium, %
total Solids, pH, Phosphorus, Potassium, TKN, Sodium
From this information, the Plant Available Nitrogen (PAN) and a Sodium
Absorption Ratio (SAR) will be calculated. This sample will be collected in
a non -breakable container, at least one quart in size. This sample will be
taken from the digester.
Cto-lificale of Analysis
il—M —r
I...... r»rr.r
Iti I "i"
41.5
2.
jo,r,
111
llr 13
13 1
2-2 k
W -1
I II.411
MI.
11 1
MW O"
Certificate of Analysis
Project name: Marion WWTP
Collection date: 17-Feb-20
Date received: 17-Feb-20
Sample identification: Sludge #1 : Grab
PO Box 7565
Asheville, NC 28802
Phone: (828) 350-9364
Fax: (828)350-9368
Project number: 200217.500
Sample number: 196656
Parameter Method Result RL Units Date Analyst Footnotes
Analyzed
%TS SM 2540 G 1.7 0. i0 % 17-Fob-20 KEK
Mulitple Tube fermentation Procedure SM 9221-E 9520 3.1 MPN 17-Feb-20 KEK
Sample identification: Sludge #2 - Grab Sample number
196657
Parameter Method Result RL Units Date Analyst Footnotes
Analyzed
%TS SM 2540 G 1.8 0.10 % 17-Fob-20 KEK
Mulitple Tube Fermentation Procedure SM 9221-F 4140 3.6 MPN 17-Feb.20 KEK
Sample identification: Sludge 43 Grab Sample number:
196658
Parameter Method Result RI, Units Date Analyst Footnotes
Analyzed
%TS SM 2540 G 1.8 0.10 % 17-Feb-20 KEK
ivlulitple Tube Fermentation Procedure SM 9221-F 10080 3.6 MPN 17-Feb-20 KEK
Sample identification: Sludge 44 Grab Sample number: 196659
Parameter Method Result RL Units Bate Analyst Footnotes
Analyzed
%TS SM 2540 G 1.7 0.10 % 17-Feb•20 KEK
Mulitple Tube Fermentation Procedure SIV4 9221-E 2210 3 A MPN 17-reb-20 KEK
Footnotes:
RL �, Reporting Limit. Values are reported down to the Reporting Limit only.
Date reviewed: Okag • _ NC Certification Number: 600
Data reviewed by: Kellen E. Keenan_ SC Certification Number: 99053
Signature: g NC Drinking Water Certification Number: 37786
This report should not be reproduced, ex pt in its entirety, without the written consent of Environmental Vesting Solutions, ]ac
The results in this report relate only to the samples submitted for analysis.
Certificate of Analysis
Project name: Marion WWTP
Collection date: 24-Feb-20
Date received: 24-Feb-20
Sample identification: Sludge #5 - Grab
110 Boa 7565
Asheville, NC 28802
Phone: (828)350-9364
Fax: (828)350-9368
Project number: 200224.501
Sample number
196856
Parameter Method Result RL Units Date Analyst Footnotes
Analyzed
%TS SM 2540 G 1.8 0.10 % 24-Feb-20 KEK
Mulitple Tube Fermentation Procedure SM 9221-E 8100 3.6 MPN 24-Feb-20 KEK
Sample identification: Sludge #6 - Grab Sample number: 196857
Parameter Method Result RL Units Rafe Analyst Footnotes
Analyzcd
%TS SM 2540 G 1.8 0.10 % 24-Feb-20 KEK
MulitpleTube Fermentation Procedure SM 9221-E 2340 3.6 MPN 24-F6-20 KEK
Sample identification: Sludge #7 Grab Sample number: 196858
Parameter Method Result RL Units Date Analyst Footnotes
Analyzed
%TS SM 2540 G L8 0.10 % 24-Fcb-20 KEK
Mulitple Tube Fermentation Procedure SM 9221-E 2340 3,6 MPN 24-1--eb-20 KEK
Footnotes:
RL = Reporting Limit. Values are reported down to the Reporting Limit only.
Date reviewed: NC Cet-titication Number: 600
Data reviewed by: Kelley E, Keenan SC Certilication Number: 99053
Signature:
NC Drinking Water Certilication Number: 37786
This report should not be reprodUiced, wept in its entirety, without the written consent of Environmentil Testing Solutions, 111c
The results in this report relate only to the samples submitted for analysis.
Time
(minutes)
a
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name.
Biosolids Permit Number
Date.
Digester Temperature
Sampling Date/Time
Sampled By
Analysis Date/Time
Analyzed By
Sample Volume
Total Solids
Beginning Temperature
End Temperature
Dissolved Oxygen Level
7.64
7.4
72
6.98
6.75
6.54
6.3
6.1
5.88
5.63
5.45
5.22
5
4,75
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
Corpening
Creek
WQ 0019960
4/28/2020
16
4/28/2020
0906
TH
4/28/2020
1035
RGC
1000
0.73
25
25
0.2
8.1
1.0
-milliliters
'/o Dry Solids
legrees Celsius
legrees Celsius
13.25 mg Oxygen/hr
1.81 mg Oxygen/g/hr
25 degrees Celsius
0.783526166
Temperature Corrected Specific Oxygen Uptake Rate: 1.42 mg Oxygen/g/hr
Instructions: Enter Data in the Blue Boxes, The Calculation and the Spreadsheet execute automatically.
0
G
CITY OF MARION
CORPENINC CREEK WASTE TREATMENT PLANT LABORATORY
T+1111 Solids: In Solid and Semisolid Samples —Dried at 103=1066C
8 atd MOOM61-4 2540 0-2011
Ft N-DATE: '(" TIME IN: d9F5�
Y6T. TIME OUT: / Z L10
Time Weighed:
R R A A b
TEMP IN: /1023 °C
TEMP OU %. /O'3 'C
(A.t31 X 700
M n w w
SAMPLIE;
j ID
DATE
COLLECT
sample
Vol.
ML.
Dish—
WT.
MG
Dish
Wet sample
MO
Dish fi
Dried Residue
MO
Residue
Weight
MG
Residue
Weight
MO
Tots
Solids
6777
siu'd .
29a,nz0
'/
J6, s"73S'
d � I
o,
:3S'97i to- I3
A Weight of dried residue + dish, mg;
8 weight of dish,
C Weight of wet sample + dish, mg ,
i
46 Total Solids �+ �� c-e 3
i
SOUR OXYGEN UPTAKE RATE
D.O. WORKSHEET
DATE: 4(` 29' T.OZ"
TIME: 1035" Z� i
TEMPERATURE:��
ANALYST.,
AERATION TIME
START:
STOP:
DO READING START TIME:
RECORD DO READINGS Q Intervals less than one MINUTE FOR AT LEAST ,15 MIN
2
12
Sr
3
�, D
13
Z
4
7r 7��
14
0�
5
6
S°a`%�
16
7
�p. 5�
17
8
(D.D
18
f05
9
�� /�
19
10
sl
20
r C�
Record the temperature at the end of the test: ;) `; r' C°i
y = -0.2208x + 8.3008 ,
Oxygen Uptake Rate Chart
9
8
7
6
j
j
E
i
5
d
w
> 4
Q
i
3
i
i
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 is 16
Time (minutes)
Specific Oxygen Uptake Rate
Sour Test
Corpening Creek Wastewater Lab
Marion, N.C.
Method: SM 2710 B-2011
Date: 4/28/2020
Time Sampled: 0906
Sampled By: TH
Time Started Aeration: 0915
Time Ended Aeration:1030
Time Analyzed:1035
Analyzed By: RGC
Total Time of Test: < 2 hrs. ( 1 hour 44 mins. )
Total time of test includes the time sample was aerated.
Analytical Results
U.S. Biosolids Inc
958 Hoots Road
Roaring River, NC 28669
Receive Date: 11112)2020
Reported'. 12/1 OJ2020
For: MARION
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
201112-18-01 TCLP MARION See Attached a5 Now 1V13/2020 PACE
Respectfully submitted,
Dona Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 * Statesville, NC 28687 • 704/972/4697
Page 1 of 30
Condition of Receipt
Sample Number 201112-18-01 Temp on Arrival: 3.0
Parameter Schedule: TCLP
Received on Ice
PO Box 229 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3U
h
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Relinquished by: I -_-_- --- Time isy am, Date �!11121iv Sampled by: CR•,�
Received by: I ! `---_-.__ TimprtlJ
e 'I Date r � 1I z Transported by: L�
Reiinquishetl by: Time am, pm Date ___ 1 I Molding times met:
Received by: Time am, pm Date 1 _1_ Compliance work -
Time begin_ am. pm Date ! ! Non-compliance work.
Time end..-----__-. am, pm Date T! - _1 Lab GOMMWOS_ Samples Tranepoded On Ire:
Time begin am. pm Date
I
Time end.- . -__ am, pm Date
T
aceArwca!
rwaeeNNs.rnw
ANALYTICAL RESULTS
Pace Analyticar Servleee, L40
967D Kincey Aoa Suft 1 DO
Hvnlersdie, NC 28078
17D4)875-9092
Project US 0i0 Marion
Pace ProleCl No: 92506064
Sample: Sludge
Lab ID: 22506084001 Colleclad: 11/12120 11:30 Received: 1111312o 08-55 Matrix, Solid
Restlats reported on a "dry weigh!' basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters
Results Units Reporl Limit OF Prepared Analyzed CAS No. Qual
Chlorinated Herb- (dC)9161A
AnalylicalMelhod:EPA8151A PreoaraeonMelhod:8151A
Leachale MethadiDale: 1311. 1111912009.49 lA11W pH'. 5.72: Final pH- 5
Pace National - Mt. Juliet
2.4 5-TP (S4vex)
ND mg7L 0.00200 1 11121120 19 D9 11/25120 n N 93-72-1
2 40
NO mg7L 0.00200 1 11/21120 19 09 1V2512C 23:32 94-75-1
Surrogates
2.4•DCAA(S)
714 45 14.0-158 1 111211201909 11!2512023:32 19119-28.9
8081 TCLP Pesticides RVE
Analytical Melhoq EPA 8081E Preparation Method: EPA 351W
Leachale MelhadlDate: FPA 1311', 11/24120 16:55 Initial pH. ; Final pH: 6
Pace Analytical Services • Charlotte
gamma-BHC (Llndanel
ND uglt 0 w 1 11130f20 08:06 11130/20 15:11 58.89-9
ChiorGane (Technical)
NO ug)L 3 0 1 11130I20 08:06 11130/20 15:11 5T-74-9
Endrin
ND ug1L 0.50 1 li,'21 2D 08'.06 T1130120 t5:ll 72.20-B
Heptachlor
NO ugrL 0.50 1 11r3012008'.06 1113012015,11 76.44.8
Heptmhlorepoxtde
ND ugrL 050 1 111301200&06 111301'201511 1024,57.3
Methoxychbr
ND Ug'L 16D0 1 11130120 08'06 I IJ30120 15.11 72.43.5
Toxaphene
ND U91L 3.0 1 11130120 Ca.06 11/30120 15 11 8001-35.2
Surrogatea
Decachlorobiphenyl (S)
103 % 10-154 1 11130.20 08'06 11/30120 15.11 2051-24.3
Tetrachlord-m.xylene IS)
26 % 10-184 1 11r30120 06:06 n130120 15:11 877-09-8
8082 TCLP PCBs RVE
Analytical Method. EPA 8082A Preparation Method: EPA 3510C
Leachale MalhedlDate: EPA 1311. 11124120 15:55 Initial pH:. Final pH- 5
Pars A.-talylical Services • Charlotte
PCB-1016(Arodo(1016)
NO ugrL 1000 1 11r301200739 11i3012013:17 12674.11-2
PCB-1221 (Afodor 1221)
ND ugrL 1000 1 1113012007.39 116012015:17 111D4-2B-2
PCB-1232 (Arocbr 1232)
ND ugrL lom t 1113012007.39 11130)2013.17 11141-16.5
PC8-&1242 (Arocor 1242)
ND uyL 1006 1 1113012007,39 11130/2013 17 53469-21-9
PCB-1248 (Arottor 1248)
NO ugrL 100C 1 11/301200739 11!30720 13:17 12672.29.6
PCB•1254(Arocior1254)
NO ugll. 1000 1 11301200739 1130/2013:17 11097-69-1
PCS-1260 (ArodoF 1260)
NO uggiL 1000 1 11130�20 07.39 1113012D 13.17 11096-82-5
Surrogatas
Decachlombiphanyl {S)
78 % 10.181 1 11130120 07 39 11130/20 13.17 2051.24.3
601D MET ICP, TCLP
Analytical Memo: EPA 6010D Preparation Method EPA 3010A
Leachale MelhodlDate: EPA 13l l: 11116120 15:37 Initial pH:: Final pH: 2
Pace Analytical Services - Asheville
Arsenic
ND mg7L 0,050 1 11118f200211 11118120 11 18 7440.314.2
133rwrn
NO mg1L 025 1 1111512002,31 11118/2011,113 1440-39,3
Cadr1111m
NO mg7L 0.0050 1 111181200211 11118r2011.14 7440-43-9
Chromium
NO mq'L 1).C50 1 111182602L31 11118r2D1t'10 7440-47.3
Lead
NO mg7L D,C25 I 1111812002'31 11!18/2011.18 7439-92-i
Selenium
NO mg7L 0.10 1 1111812D 02:31 1111600 11 18 7782-49-2
Silver
NO mg7L 0.026 1 Ili 4812D 0731 ll118i2011'18 1440-22-4
REPORT OF LABORATORY ANALYSIS
11iis reuorl shall not be reproeuceo. euceot in hiA,
Dale 12!0812020 05-14 PM
without the written consent of Pace Am^ijcal Sem"5, LtC Page 5 of 27
PO Box 228 a Statesville, NC 28687 a 704/872/4697
Page 8 of 30
1. ceAralytical
-. rlale.aaulelscae
ANALYTICAL RESULTS
Pate Amlytical Strikes, LLC
98M Kincey Ave Suite 100
Huntersvllle, NC 28010
(704)875-9092
Prcieck- US Bio Marlon
Pace Protect No : 92506064
Sample: Sludge
Lab IQ: 92506084001 Cdiecled:
11112121) 11 30
Received 111I T20 98 55 Matrix, Solid
Results reported on a -dry weight- basis and are adjusted for pereanl moisture, sample sire and any dilutions.
Parameters
Results Units Repon Limit DF
Prepared Analyzr:d CAS No Qual
7470 Mercury, TCLP
Analyticai Method, EPA 7470A Preparation Method- EPA 7470A
Laachate MelhodlDate: EPA 1311, 1lil6120 15:37 Intltal pH: Final pH: 2
Pace Analytical Services - Asheville
Mercury
NO ni
0.00020 1
11118/20 11.30 1111912C 14:04 7439-97.6
8270E TCLP RVE
Analytical Method: EPA 8270E Pre9arahnn Method EPA 351 DO
Leachale MelhodlDale. EPA 1311: 11
f24120 15:55 Iniliw pH.: Final pH: 5
Pace Analytrcal Services - Charlotte
I.4-clthtorobenzene
NO ug1L
50.0 1
11 J3012008.04 1V3012014:40 106-46-1
2,4•pulitrotoluene
NO ug1L
50.0 1
11 J30120 08 04 1VM2014:40 121-14-2
Hexachloro-1.3-buladlene
NO ug1L
50.0 1
1113012008:04 11130r O W40 87-U-3
Hexachlcrobenzene
ND ug/L
500 1
1113012008:04 1113000 14:4 0 118,74.1
Hexacriloroelhare
ND ugfl-
50.0 1
1113012008'04 lV30/2014,40 67-72.1
2-Melhylphetlol(o-Cresol)
ND ug1L
50.0 1
1113012008:04 11PNU2014'.40 95.48-7
384-Melhylphwto4mdPCresol)
NO ug/L
50,0 1
11130)2008.04 1113012014A0 15831.10-4
Niuobenzerie
NO og1L
50-0 1
1113012008:04 1113D12014:40 9B-95-3
Pentachiorophenol
ND ug/L
100 1
11130/2008.04 11/3012014,40 57-1516-6
Pyridine
NO uglL
50.0 1
11130f20 OB-04 11/30/20 1440 110-86.1
2,43-Trichlprophenol
NO ug1L
50 0 1
11130/20 08:04 1 VM20 14:40 95-95A
2,4.6-Trichloropllernol
ND ugll
50 D 1
11)3012001104 1113020 14-.40 B8-06-2
Surrogates
Nitrobenzene-d5(Si
77 ?k
10-144 1
11130120 08 04 1V3072014:40 4165-60.0
2-I'Wrobiphenyl (S I
54 %
10-130 1
11/30120 08:04 1 V30120 14 40 321-60-8
Terphenyt-d14 (S)
108 `'7e
34-163 1
1113CIZC 08:04 11/30;20 1440 1718.51-0
Phenol-d6(S)
41 %
10-130 1
1113012008'04 11130r2014'4D 13127-68-3
2-Fuo(ophenoi IS)
58 A
10-130 1
1113N20 a8.04 11/30120 1440 367-12-4
2.4.6-Tr Invomophenol(S)
75 %
10-144 1
11/30120 08 04 11130/70 14,4t1 118-79.6
8260D MSV TCLP
Analylical Method: EPA 8260D Learhate MethodfDale: EPA 1111: 11123/20 17:16
Pace Analytical Seances - Charlotte
Benzene
NO uglL
1DO 20
1112412017:22 71-43-2
2•Butanone(MEK!
NO ug!L
200 20
11 Q4120 17,22 78-93-3
Carbon tetrachloride
NO uglL
100 217
llf24i201722 56-23-5
Chlarooenzerle
NO ug!!L
100 211
11i24/2017,22 108-90-7
cNicrololm
N, uglL
10G 20
ili?412017.22 67-66-3
1,4.0lchldrohenzene
NO ug1L
t00 20
1112412017.22 106-46.7
12-DichioMetrlare
NO ugiL
10b 20
11124,72017,22 167-06.2
1,1-Dichtoroelhene
NO ug1L
100 20
11;242017,22 75.35.4
Telrachiorpetharl6
NO ug!L
100 20
11124/20 17:22 127-18-4
Tridlloroetnere
NO ug1L
100 20
1124f201722 79.01-6
Vinyl chloride
NO ugll
100 20
11124f20 1722 75-01.4
Surrogates
1.2-Dirhloroathane,d4 (S)
100 °%
70.130 20
11124120 17:22 17060.07-0
Toluene-d8 (S)
IQ °%
67-135 20
11/24120 t7:22 2037.25-5
4-8rorneuoMbenzana JSF
98 %
70.130 20
1I!24120 t7:22 460.004
REPORT OF LABORATORY ANALYSIS
Tias report Shalt ncE t7e reproeuoed. ex"pi in full.
Date: 12M 2020 05:14 PM
without the wriffm consent M Face Analytical Services L LC. Page 6 of 27
PO Box 228 a Statesville, NC 28687 a 704/972/4697
Page 9 of 30
/-,�aceAnaloca(
y1rlr,eedlNllM
ANALYTICAL RESULTS
Pace AnNyti64t Servicsz, LLC
WOO Kmcey Ave Suite I
Hm+lerswee, NE 2a0T8
f7,41815-9092
Project: US Bio Marion
Pace Project No. 92606W4
Sample: Sludge
Lab ID: 92506094001 Cotlected: 11(1212011:30 Received: 11)1312008:55 Matruh Solid
Results reported on a 'dry weight' basis and are adjusted for percent moisture, sample sire and any dilutions.
parameters
Results Units Report Limit OF Prepared Analyzed CAS No ouai
Percent kiloisture
Analytical Method: ASTM 02974.67
Pace Analytical Services - Charinne
Percent Moisture
98.3 % 0.10 1 11113120 19:38
1010 Flashpolnt,Closed Cup
Analytical Method. EPA 1010A
Para Analytical Services - Ashevitle
Flashocint
>200 deg F 10.0 1 12106/20 14:42
9045 pH Soil
Analytical Method. EPA 90450
Pace Analytical Services - Asheville
PH at 25 Degrees C
5.9 Sid. Units 0-t0 1 IV07120 16 45 H3
9095 Paint Filter Liquid Teat
Analytical Method. EPA 9095E
Pace Analytical Services - Ashevele
Free Liquids
Fail 1.0 1 12.102120 16'21
733C S Reactive Cyanide
Analytical MethodEPA9014 Preparation Method: SW-846 7.3.3.2
Pace Analytical Services - Greensburg
Cyanide, Reactive
ND rnglkg 0,99 1 111'18/20 1823 1109120 18:58
734E Reactive Sulhde
Analytical Method: SM. 4500S2F-2011 Preparation Method. SW-846 7,34,2
Pace Analytical Services - Greensburg
Sulfide, Reactive
ND mgAg 9.9 1 11,'1&20 18,23 Ili18120 1825
Sample, PCB
Pararneters
Lab ID: 92506004002 Collected: 11/12120 11:30
Resul(s Units Report Limit OF
Received' 11/13120 0855 Matrix: Water
Prepared Analyzed CAS No. Qual
0002 GCS PCB RVE
Analytical Method: EPA 8082A Preparation Method: EPA 351 OC
Pace Analytical Serv.ces - Charintte
PCB-1016(Arocldr1016)
NO uglL 2,5 1
1MV2010:28 QM212002.16 12674-11.2
PCB-1221 (Aroclor 1221)
NO u91L 2.5 1
12101120 10:28 1210212002.le 11104-28-2
POP- 1232(Arodor1232)
ND ugll- 25 1
1210112010:28 1210212002,16 11141-16.5
PCB-1242 (Arodor 1242)
NO u9A 2.5 1
12W120 10-.2B 12/02120 WAf; 5A69-21-9
PCB-1248 (Aroclor 12481
NO uglL 2-5 1
12r01f20 10:28 12l02!2C 02:16 12672.29-5
PCB-t254(Aroclor1254j
NO uq/L 25 1
12.10112010:28 12M212002:16 11097-60-1
PCB-1260 (Arodor 1260}
NO ugil- 2.5 1
12101120 10,28 12/02120 02.16 11096-82-5
Surrogates
Decacriloroblphenyl(5)
42 % 10-181 1
1210112010:26 121C212002.16 2051-24.3
REPORT OF LABORATORY ANALYSIS
1r,s MpW shall not be repr6auced. iUG&pt in
tali_
Date: 12/08/2020 05:14 PM
without the written consent of Pace Anaiyitcal Services, LLC Page 7 01 27
PO Box 229 a Statesville, NC 28687 a 704/872/4697
Page 10 of 30
State of North Carolina
Department of Environmental Quality
.W Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted. the Applicant shall submit one original and two copies of the application and
supp rting documentation
For more Information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .I 100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 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.
❑ For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
❑ The status of the land application site with respect to this residuals land application program must be provided in table 1. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
County Board
Notification, doc
Land pawner
✓
✓
Agreement
(If applicable)
ik;T
.:.:.,.
✓
✓
✓
✓
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map
_Guidance
for Resi,duals-Land Application ferm.its'
A soils and agronomic evaluation in accordance with the "Soil Scientist
Evaluation Policy,"
✓
INSTRUCTIONS FOR FORM: LASC 06-16
Page I of 3
s
An updated accounting of the land application site's cumulative
_pollutant loading rates CPLRs
Required Item Status Code
N R T M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map re uirements in the "Soil Scientist Evaluation Policy"
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same timeperiod)
* This item may be required for land application site with it status code "M please contact the Division if you need assistant in
determining attachment requirements.
❑ Crop Type should include the most likely crop types for the life of the permit (Five years).
❑ Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
❑ Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
❑ Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Mere (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by I 1-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: htt ://de .nc. Gov/about/divisions/water-
resources/ tannin /classification-standards/classifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
htt://de .nc. ov/contact/re ional-offices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x I 1-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
UT to stream name' as the waterbody name.
3. Open the link http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER 1S LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2.Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .030E(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C", or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams enteri[Ig South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Cho van River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pas uotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of
LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Marion
Land application sites currently certified: 103.6 net acres and Total to be certified: 56.9 net acres.
L LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
CodeA
Site/Field
ID
Landowners
O
Lessees or Operator(s)
O
Net Acres
Count y
Crop(s) s
PO
Predominant Soil
Series Namee
Mapping Unit
or Rep. Slope'
D
K I
Mario DeLuca
16.4
McDowell
Fescue
Hayesville
HaC
D
K2
Mario DeLuca
30.3
McDowell
Fescue
Hayesville
HaC
R
F I
John Fisher
9.9
McDowell
Fescue
Braddock
BrB2
R
F2
John Fisher
2.4
McDowell
Fescue
Braddock
BrB2
R
F3
John Fisher
7.0
McDowell
Fescue
Hayesville
HaC
R
F4
John Fisher
6.7
McDowell
Fescue
Hayesville
HaC
R
R I
Brian Kay
17.2
McDowell
Fescue
Hayesville
HaC
R
R2
Brian Kay
13.7
McDowell
Fescue
Hayesville
HaC
i Status Code for land application sites are: • N (New) ♦ R (Renewed) ♦ M (Modified) ♦ 1' (Transferred) • D (Deleted)
e Soil Series Name (i.e. Appling, Cecil. etc.)
° Mapping iJnit must be consistent with those used in the County Soil Survey (i.e, for a 2-8% slope Cecil in Anson County the mapping unit is CcB2)
IL WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Datum
Location Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
Class
K1
350 34' 43"
810 51' 48"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 1 1-32-2-9
C
C
K2
35' 34' 43"
81051' 58"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 1 1-32-2-9
C
C
F1
350 35' 39"
810 51' 04"
NAD 83
ADD
Nearest Second
Magazine Creek 1 ]-32-2-9-2
C
C
F2
350 35' 32"
81° 50' 60"
NAD 83
ADD
Nearest Second
Magazine Creek 1 1-32-2-9-2
C
C
F3
35" 35' 33"
810 50' 42"
NAD 83
ADD
Nearest Second
Magazine Creek 1 1-32-2-9-2
C
C
F4
350 35' 31"
810 50' 36"
NAD 83
ADD
Nearest Second
Magazine Creek 1 1-32-2-9-2
C
C
R 1
350 34' 40"
810 51' 24"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 11-32-2-91
C
C
R2
350 34' 50"
810 51' 20"
NAD 83
ADD
Nearest Second
S Fork Hoppers Creek 1 1-32-2-91
C
C
Note: Please keep the site inhumation (I.) and waterbody information (11.) of the same field on the same page.
FORM: LASC 06-16 Page 1
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 -- LANDOWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies „of, the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: City of Marion
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Fl
no
Pasture
Animal Feed
F2
no
Pasture
Animal Feed
F3
no
Pasture
Animal Feed
F4
no
Pasture
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page I of 3
I. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR. Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program.
including an analysis of constituents of the residuals. residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of -at least 6.0. unless an agronomist provides information indicating that the pH of the soil. residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns. results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Pennittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner.. or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials. and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary Ieachate, surface water. groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
11. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface ofthe land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However. 15A NCAC 02T A 1051h1 allows the compliance
boundary to be placed closer to the waste disposal area. such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) 11):
(Please include the rationale far the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
® A re-dctined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID:.__ , is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3
Landowner's Certification:
f certifv 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 sitc(s) on behalf of other deeded landowners OR that 1 am otherwise authorized, throueh
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 sile(s) are not included in anv 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: _ John Fisher
Address: _.._...�_ 398 Dairy -,Road
_..........___
City:
State: --- _._ iC._. - Zip:.._. .'8761
Phone: _ 828-439-40.35 _ _-- E-mail address
Signature:
Date -
NORTH CAROLINA, _ !''� ��.,r,•.�...,� COUNTY
1, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seat this the
lllllilfl
day of zb r-
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
1
�-N-23
3
NofQty_pJ._
Z Coup c
O t.
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessec/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 nnrf ri—irivrinm ne enaoifi 4 i oral.,
Signing off
Signature:
FORM: LOA 06-16 Page 3 of 3
MIN
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .I 100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of„the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting_Unit.
General - This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: City of Marion____
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
(Y )
Land Use or
Cropping Patterns
pp� g
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seedl
pasture)
R2
no
Pasture
Animal Feed
R1
no
Pasture
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Page l of')
I. STIPULATIONS:
I. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement,
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all ofthe site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR. Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals. residuals application methods, schedules for typical cropping patterns. a description ofthe
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy ofthe results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater. sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0. unless an agronomist provides information indicating that the pi I of the soil, residuals and lime mixture is suitable for the
specified crop.
9. 'The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis oi'other sources of'nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals ]and application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application sitc(s) by the Permittee, the landowner. or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit: copy any records
that must be kept under the terms and conditions of the permit:. take necessary leachate. surface water, groundwater, or soil samples during the
term of.. and 12 months after termination ol'. this Agreement.
11, RESTRICTIONS:
I . Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
sitc(s) during active use and for the 12-month period IbIlowing 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 forgrazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface ofthe land shall not be harvested for a 20-month period follo,,t ing a residuals land application
event when the residuals remain on the land surface f f)r lour months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turfgrown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
Il1.ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 021.0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105 h allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundajti is needed for field(s) ID:
(Please include the rationale for the requested re -location ofthe compliance boundary and attach a map showing the newly proposed compliance
bonndan' to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previous]), permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3
Landowner's Certification:
I certify that 1 anti 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 certily 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 peniiission to the Permittee to land apply residuals to the land application she(s) as specified
herein.
Landowner nante: Brian Kav
Address: 98U Arlvs Lane
City: Nebo State:
Zip: ?&7
Phone: E-mail address:
Signature: Date:
NORTH CAROLINA, — f ' '4: 001,04 I( .--_COUNTY
1, the undersigned Votary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution ofthe forgoing instrument.
WITNESS my hand and official sea] this [lie ' . '��az%HE.Ry'�%�,,
day of �1.� s•.�•r 20 �.
" o or y a€,oxo
Signature and seal: = wllFk
My commission expires: L ' L U 0
2
H �?
CARrJL\
Lessee'slOperator's Certification:
I certify that 1 have read this Aarcemeni and do hereby agree to abide by the stipulations and restrictions as specified herein
Lessee"operator name:
Address:
City:
Phone:
Signature:
Perm ittee's Certification:
I certify that I have read this
Signing official nanrer�-
Signature: — %-
State:
E-mail address:
[late:
Zip:
;reernent and do hereby agree to abide by the stipulations and restrictions as specified herein.
;a__6A vl YV ,-v j to c a �
_ 7 �
Date:
FORM: I.AA 06-16
Page 3 of
The Compliance Boundary is estahlished either 250 feet from the perimeter of the residuals application area or 50 feet within
the property boundary, whichever is closer. The Review Boundary is established midway between the Compliance Boundary
and the perimeter or the residuals application area.
'— 7- - -
• Field R2
i'
2.7 acres
A
r
t:
Ross, Wayne: Buffer Map
Parcel 1657001 A 1637
McDowell County, NC
Field R1
17.2 acres
r �A
AIJ
R 'y / + •' .
Field R2 r•
13.7 acres + w
1 f A' 't 1W
* /• t 1
ti
` Buffers
Property Line (50' Perennial Stream (100')
House (400')
Well (100' )
t Legend
} Propery Line
Field Boundary a Well
Perennial Stream House
= Surface Water
® Unused Area
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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 Marion WQ Permit #: W00019960 Field #: F1 Acres Utilized: 9.9
Land Owner: John Fisher Annual Dry Tons Applied: 8,2941 Site #: Fl Acres Permitted: 9.9
Operator: John Fisher Predominant Soil Series: BrB2 Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop I Max. PAN: 239 Crop 2 Name: Crop 2 Max. PAN:
O -
c
y
Q
Volume applied
( enter one) Solid,/
Liquid
u. Yds Gallons
o
/o
Solids
volume
Applied per
Acre
(Dry TonslAc)
Residual Source,
,
(NI)DES # u Q#.
Fen- Animal
Waste. etc)
(hand.
(Dry,
Moist)
Precip.
, �_
] ast 1
firs
mr-hes
>
K �
= -
5
c
z
= =
-
. �
�
ry
� -
ry '
-
TKN
mg/kg
z n
ti
G
ro y.
mglkg
Nitrate
and
Nitrite
mglkg
PAN Applied
I Ibslacre)
Name Of CropTy
Receiving Residual
Application
Crnp 1
Crop 2
Crop 1
Crop 2
7-2020
110500
).8
0.838
NCO031879
dry
0
S
0.5
0.3
58400
2800
1 511
31.151
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
0A00
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
Residuals Applications totals on FORM FSF supp ( Attach FORM FSF supp to this form):
TG1'ALS
0
11u500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
31.151
0.000
Lime Applied
Annual
Ibs/acre
0.047
0.103
0.150
36
0 019
0 046
0.065
34
0.707
5.27
5977
NA
#######
0
######a
1338
0.080
0.828
0.908
267
0.003
0.322
0.325
15
0.065
0.243
0.308
NA
0.034
0.393
0.427
374
0.047
0.101
0.148
89
1310
15,683
17.393
2498
38.548
Date
lbs/ac
Prior Years Cumulative lbs/ac
12-2020
2000
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit Ist/2nd Crop
239
"l 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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface- 0.5, Injection/Incorporation - 1.0
Signature of Land Applies 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 (1212006)
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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Marion WQ Permit #: WQ00199b0 Field #• F2 Acres utilized: 2.4
Land Owner: John Fisher Annual Dry Tons Applied: 1.4637 Site #: F2 Acres Permitted: 2.4
Operator: John Fisher Predominant Soil Series: BrB2 Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop 1 Max. PAN- 239 Crop 2 Name: Cron 2 Max. PAN:
r
c
Volume a Iled
PP
(enter one) Solids!
]Jquid
Cu. Yds Gallons
q4,
Solids
V0411TIC
Applied per
p P
Acre
1Dry Torts/AC)
Residual Sources
(NI I)ES #. 1� Q4.
l:ert.. Animal
Waite, etc)
Soil
Cond.
(17r-
N'ct.
moist)
Prccip.
Past 24
lirs.
nLh25
D
a --
-_~
�
_ ?
x
_
TKN
mglkg
z _�
_
c
a
mglkg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lhslacre)
Name ol-Cru Cv
P _ Pe
Receiving Residual
Application
Crap 1
Crop 2
Crop 1
Crop 2
7-2020
19500
1.8
0.610
NC0031879
do
0
s
0.5
0.3
58400
2800
k 51 ]
22.676
NA
Fescue
0.000
0.000
0.000
0.000
0.000
um
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
Residuals Applications totals on FORM F'SF supp ( attach FORM FSF supp to this form):
F.
TOTA1,5:
01
195M
As
Cd
Cu
Cr
Pb I
HP,
Mo
Ni
Se
Zn
P
22.676
0.000
Lime Applied
Annual
lbs/acre
0.034
0.014
0.513
#######
0.058
0.002
0.048
0.025
0.034
1.244
28.060
Date
lbs/ac
Prior Years Cumulative lbs/ac
0.132
0.166
36
0.172
0 186
34
4.016
4.531
NA r
0
#a#4449
1338
0.611
0.669
267
0.032
0.034
15
1.81
1.858
NA
0.288
0.313
374
0.078
0.112
89
11.589
12.833
2498
0
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit Ist/2ndCrop
239
--a ccruly, unuer penalty of law, tnat tnls 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."
"Application Method: S - Surface, 1N - Injection, INC - Incorporation
� ?�7�a **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Lan Applier Date Mineralization Rates: Compost -0.1, anaerobialty digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12l2006)
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 "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Marion WQ Permit 9: WQ0019960 Field #: F3 Acres Utilized: 7
Land Owner: John Fisher Annual Dry Tons Applied: 9,7820 Site #: F3 Acres Permitted: 7
Operator: John Fisher Predominant Soil Series: HaC Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop 1 Max. PAN: 7Q2 Crop 2 Name: CroD 2 Max. PAN:
w
Volume applied
Volurne
Residual Sources
Soil
Wecip.
7
<
? D
Nitraic
Name
ol'CruP Type
`
one) Solids/
fi
Applied r
(\PI)1S f. 1Q#.
P tti24
K
x ?(enter
KN
and
PAN Applied
Receiving Residual
Liquid
Solids
Acre
Fert.. Anima!
(t)r,,
Hrs.
n --
M
r Zf
Z
Nitrite
t Ihs/acre)
Application
Cu. Yds Gallons
(DryTonslAc)
Waste, etc)
w,eE
Moist)
lncnes
Y
,Z
m rk9
T"r9fk9
m Aq
Crop I
Crop
Crop I
Crop 2
7-2020
J
117000
1.8
1.255
N(:0031879
dry
0
s
0.5
03
58400
2800
1 511
46.648
NA
rescue
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.00()
1 0.wo
0.000
0.000
0,000
0.000
0.000
0.000
U.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
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOYALS,
01
117000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se I
Zn
P
46.648
O.OUO
Lime Applied
Annual
Ibs/acre
0.071
0.028
1.059
##q####
0.119
0,004
9.098
0.051
0.071
2.560
57.730
Date
Ibs/ac
Prior Years Cumulative !bs/ac
0.353
0.424
36
0.143
0.171
34
9,888
10.947
NA
1.763
#######
113
1.46
1.579
2267
0.051
0.055
15 1
0.639
0.737
NA
0.624
0.675
374
0.349
0.420
89
27.39
29.950
2498
12-2020
200t)
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit 1 st/2nd Crop
202
i %XJ ►uy, uJiucl- penalty UI law, tnat tuts aocument 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."
*Application Method: S - Surface, 1N - Injection, INC - Incorporation
�"' ��" �•i **Volatilization Rate: Surface- 0.5, Injection/Incorporation - 1.0
Signature of Land Applier 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 (1212006)
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 Marion WQ Permit #. WQ0019960 Field #: F4 Acres Utilized: 6.7
Land Owner: John Fisher Annual Dry Tons Applied: 6.3426 Site #; F4 Acres Permitted: 6.7
Operator: John Fisher Predominant Soil Series. HaC Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop I Max. PAN: 202 Crop 2 Name: Crop 2 Max. PAN:
0
o
VolLimC ii Ill'd
pp
(enter one Sn1id<
Liquid
Cu. Yds Gallons
y
Solids
Volume
Applied per
Acre
Ory ToiVAc)
Re.idualSources
(NPD.S 9, WQ9,
Fert.. Animal
Wastc. cle)
Sn31
Cored.
IDrv.
Wlt
Moist)
F'recip.
,, _
1 ast 24
11rs.
arches
>
z
ry _
z
a
0
=
r-
_
5
n
ry=
y
TKN
mg1k9
z
�' -
a
ry
M �.
mglkg
Mir=
and
Nitrite
r;glkg
PAN Applied
( Ibs/acre)
Name ofCrupType
Receiving Residual
Application
Crup I
Crop 2
Crop I
Crop 2
7-2020
84500
1.8
1 0.947
NCO031879
dry
0
s
0.5
0.3
59400
2800
511
35.198
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.Wo
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
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS
0
84500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
3 5. 198
0.000
Lime Applied
Annuallbs/acre
0.053
0.021
0.799
flfih#4#u
0.090
0.003
0.074
0.038
0.053
1.932
43.562
Date
lbslae
Prior Years Cumulative lbslae
0.341
0.884
12.479
2.109
1.759
0.062
0.632
0.755
0.351
30.412
12-2020
1000
Current Cumulative lbslae
0.394
0.905
13.279
#fiu9444
1.849
0.065
0.706
0.793
0.404
32.344
Permitted C. P. L. R.****
36
34
NA
1338 1
267
15
NA
374
89
2498
Permit PAN Limit Ist/2nd Crop
202
"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."
Q *Application Method: S - Surface, 1N - Injection, INC- Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.; Cumulative Pollutant Loadint3 Rate
DENR FORM FSF (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 "VIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Marion WQ Permit #t WQ0019960 Field #: RI Acres Utilized: 17.2
Land Owner: Brian Kay Annual Dry Tons Applied: 15.6125 Site #: RI Acres Permitted: 172
Operator: Brian Kay Predominant Soil Series: HaC Cation Exchange Capacity (non 503):
Crop I Name: Fescue Crop I Max. PAN: 202 Cron 2 Name: Cron 2 Max_ PAN_
o
Volume a lied
PP
Vuhime
Rrsidual Sourer~
~oil
Yrrcip.
7
Z
Nitrate
Name of Crop -type
y o
(enter one) Solids/
(N
o
A Irui per
pp p'
�
(N1 DES #. INQ4.
Cond.
,
1 as 224
� �
3 _
;n _
x �
'4
"1 KN
=
r
and
PAN Applied
Receiving Residual
ro
I.icluid
Solids
Acre
Fen- Animal
tDr},
llrs.
�`
^•
Nitrite
t ihsl:ier)
Application
Cu. yds Gallons
(DyTonsAc)
Waste. etc)
N1Ws3 1
rche5
�
-
�
m !k
9 9
m, R
Q 9
m k
�9
Cra 1
p
[.r15 2
P
Crop ]
P
Crop �
p-
7-2120
209000
1.8
0.908
N00031879
do
0
s
U.5
0.3
58400
2800
1 511
33.750
NA
Fescue
0.000
0.000
0.000
0.000
0,040
{1,000
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
9.000
o 000
0.000
R000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp
to this form):
T0TA1,S"i
01 208000
As Cd Cu Cr Pb Hg Mo NJ Se Zn P 33.750 O.ur}0
Lime
Applied
Annual
Ibs/acre
0.051 0.021 0.766 ####### 0.086 0.0(13 0071 0.037 0.051 1.852 4E.768
0.151 0.079 10.257 1.475 1.545 0.059 1.33 0.635 0.192 25.99
0.202 0.100 11.023 44#4494 1.631 0.062 1 4111 0.672 0.243 27.842
36 34 1 NA 1 1338 267 1 15 NA 374 1 89 2498
Date
]bs/ac
Prior Years Cumulative Ibs/ac
12-20
1000
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit I st/2nd Crop
202
t Uri My, unuer penalty 01 taw, Mal IRIS 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 a,are that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S -Surface, IN - Injection, INC- incorporation
a-3 '"Volatilization Rate: Surface- 0.5, Injection/Incorporation - 1.0
Signature of• Land Applier 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 (1212006)
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLF,TED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" 1N A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Marion WQ Permit 4: WQ0019960 Field #: R2 Acres Utilized:
Land Owner: Brian Kay Annual Dry Tons Applied: 17.5640 Site #: R2 Acres Permitted:
Operator: Brian Kay Predominant Soil Series: HaC Cation Exchange Capacity (non 503):
Crop 1 Name: Fescue Crop 1 Max. PAN: 202 Crop 2 Name: Crop 2 Max. PAN:
13.7
13.7
0
Volume applied
{ enter one> tiolids/
l.icuicl
I
Cu. Yds Gallons
/o
Solids
Volume
Applied per
Acre
(DryTnnstAcl
Residual Sources
(NYl)GS, W(1q,
Fert.. Animal
Waste. etc)
Soil
Cond.
{1)n.
Wei.11rs.
Moist)
Precip.
>
Past -4
inches
>
b
= _
- r.
�,
f
_
-
K
x
, -
n
-
1'K\
mglkg
Z. �
a-
mg/kg
Nitrate
,
and
Nitrite
mg(kg
PAN Applied
(khs/acre)
Name ol'Crop Type
Receiving Residual
Application
Crop I
Crop 2
Crop I
Crop 2
7-2020
234000
1.8
1.282
NCO031879
dry
0
s
0.5
0.3
58400
2800
511
47.669
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
6.000
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
Residuals Applications totals on FORM FSF supp (attach FORM FSF supp to this form):
TOTALS
a
234000
As
Cd
Cu
Cr
Pb
H.L
Mo
Ni
I Se
Zn
P
47.669
0.000
Lime Applied
Annuallbs/acre
0.072
0.159
0.231
36
0.029
0.086
0.115
34 1
1.082
10.76
11.842
NA
#4#4###
0.065
0494004
1339
0.122
1.386
1.508
267
0.004
0.341
0.345
15
0,100
1,039
1.139
NA
0,052
0.602
0.654
374
0.072
0.179
0.251
89
2.615
25.62
28,235
2498
59.972
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
Current Cumulative Ibs/ac
Permitted C. P_ L_ R.****
Permit PAN Limit 1 st/2nd Crop
202
"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."
JI-4
r
Signature of Land Applier
12t03
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 LoadinS Rate
DENR FORM FSF (1212006)