WQ0003902_Modification_1_20210609

Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional
information.)*
r Yes r No
Permit Number (IR)*
WQ0003902
Applicant/Permittee
City of Newton
Applicant/Permittee Address
1407 McKay Rd Newton INC 28658
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 Newton RLAP
County
Catawba
Fee Category Major
Fee Amount $0
Is this a complete
application?*
r Yes r No
Complete App Date 06/09/2021
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 Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by N B Staff
Name * Alex Fox
Email Address*
[e-mail]
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*
704-881-3429
O Modification - Minor
C 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:*
W00003902
Fbs Current Existing perrrit number
Applicant/Permittee *
City of Newton
Applicant/Permittee Address*
1407 McKay Rd Newton NC 28658
Facility Name *
City of Newton RLAP
Please provide comments/notes
on your current submittal below.
One site changed ownership and wishes to keep it in the program.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Spec'rfications, Calculations, Rc.)
Newton MOD 21.pdf 6.56MB
Upload only 1 RCFdocurrent (less than 250 NS). NLftiple documents nest be coal fined into one R7Ffile unless file is larger than
upload lirrit.
* 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 6/9/2021

June 3, 2021
N.C. Department of Environment and Natural Resources
Water Quality Section
Non -Discharge Permitting Unit — Non discharge permitting Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
ATTENTION: Mr. Nathaniel Thornburg
REFERENCE: Minor Modification for the City of Newton Permit (WO0003902)
Dear Mr. Thornburg
Site CA-16 that was previously owned by Richard Biggerstaff was sold to James Parlier. Mr.
Parlier wishes to keep the land in the program and continue to get sludge. Attaches is all the
information to do a Minor Modification to the City of Newton's permit. Let me know if you need
anything else.
Sincerely,
Alex Fox
Technical Services Specialist
Synagro East Division, LLC

State of North Carolina
DWR
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 tune for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two conies of the application and
supnorting documentation
For more it formalion, visit the fluter Quality Permitting Section's Non -Discharge Permitting Uni!
General —This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated fi•om 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 snake 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 sighed 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 15A
NCAC 02T .0106fb}.
® If this project is foi• 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(ics) 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 finds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification
Major(land are permitted for � 300 acres) J $1,310 $395
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 fields) f.oni
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.
C. Cover Letter (All Application Packages)
® List all items included in (lie application package, as well as a brief description of the requested pennitting action.
D. Environmental Assessments (May be Required — See ISA NCAC 1C .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 an), public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORNI: R(.Al' 06-16 Page 1 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 t5A NCAC 02T .t 110 and include at a milninuum:
❑ 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, contairument, reniediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ 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;
❑ Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ 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 fG to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet tine criteria in 15A NCAC 02T
.110202). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
0 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 fornnat is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
® Plans must include tine following minimum items:
® A general location map, a vicinity neap 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 welted 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

1. Project Evaluation and Receiver Site Management Plan (All 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 lnydrogeologic evaluation in accordance with 15A NCAC 02T .I 104 d 4 and current Division Policy
available at: http://www.ncwater.ot-g!Ruies 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 tlunugh 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 J 104(d)(2). For Modifications, submit an updated site map
specific to the modifications) only.
❑ The design documents must include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously pennitted 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, inethod of construction, and means for ensuruig 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
carve 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 I5A NCAC 02T .I 104 d S and current Division Policy
available at: http://www.ncwater.orp Ru,les_Policies _and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
® Property ownership documentation shall consist of one of the following:
® Legal documentation of ownership (i.e„ GIS, deed or article of incorporation), or
❑ Wrilten 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
SA NCAC 02L A107(f), 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 TO 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: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T A100—RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: City of Newton
Applicant type: ❑ hidividuai ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Todd Clark Title: City Manager
Applicant's mailing address: P.O. Box 550
City: Newton State: NC Zip: 28658
Telephone number. [phone] Email Address: telark newtonnc. ov
2. Consultant's name: Alex Fox License Number (for P.E.):
Affiliation: ❑ On Staff ® Retained (Firm: Synagro Central LLC.)
Consultant's mailing address: 284 Boer Rd
City: Mocksville State: NC Zip: 27028
Telephone number: [phone] Email Address: [e-mail]
3. Agronomist's name:
License Number:
Affiliation: ❑ NIA ❑ On Staff
® Retained (Firm: Piedmont Environmental)
Agronomist's mailing address
City: State: NC
Zip:
Telephone number: {)-
Email Address:
4. Soil Scientist's name: Chris Murray
License Number: 1284
Affiliation: ❑ NIA ❑ On Staff
® Retained (Firm: )
Soil Scientist's mailing address:: 216 S. Swine Rd. Suite_I
City: Greensboro State: NC
Zip: 27028
Telephone number: [phone]
Email Address: cliris iedmontsoil.com
5. Fee submitted: (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ® modified, ❑ renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00003902
Date of most -recently issued permit: March 19, 2021
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page I of 5

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1, Residuals Processing Facility's physical address: 1407 McKay Farm Rd.
City: Newton State: NC Zip: 28658
Coordinates: Latitude: 35' 37' 40" Longitude: 81 ° 14' 03"
Datum: NAD83 Level of accuracy: Map
Method of measurement: Second
2. County where residuals land application program is headquartered: Catawba
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
Mike Cox
Synagro
13191
Back -Up ORC
Alex Fox
Synagro
1009495
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: Alex Fox Spring 2020
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitraeen Stiminan , Deletmine 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: 3438 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
o- Injection
Surface
Incorporation
or Injection
First -Year
13.00
19.52
44686
67102
Five -Year Maximum Adjusted
17.20
23.72
59147
81562
b. LandAnnliention Site UseStumnart•: 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
111.2
Hay
104.7
Pasture
852.7
Total:
1068.6
Methods
Surface
1068.6
bworpor,don or Injection
0
Total:
1068.6
FORM: RLAP 06-16 Page 2 of 5

e- Residuals Lattd Aunlicatiort Sirrrturnrp: 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
(16s PAN/ac yfr)
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
893.7
1342
1182.9
1631.2
100
446.9
671
591.5
815.6
150
297.9
447.3
394.3
543.7
200
223.4
335.5
295.7
407.8
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.
n6i
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 Silo Cerlifrcalion and all associated documentation.
R-5
Land Application Silte
Certification.doc
FORM: RLAP 06-I6 Page 3 of 5

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

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crhiie, has not abandoned a wastewater facility without proper
Closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
® Yes ❑ No, Explain;
1, E. Todd Clark City Manager
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for .. Citv of Newton WWTP
(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 itIclude civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and § 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of Class 2 misdemeanor, which may include a fine not to
exceed S 10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
JOIF
FORM: RLAP 06-16 Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
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 ARMicant shall submit one on inal and two copies of the application and
supporting documentation,
For more information, visit the Water Quality Permitting Section 'sNon-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 .1100. 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 documentatio n fisted
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, attachment s
to the application may be made, as long as the atta chments are numbered to correspond to the section and item to which they
refer.
® For new or renewed perm its, 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 I. Th e
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 eachstatuscode:
Status Code
Required Item
R
T
III
R
County Board
Notification. doc
Land Owner
Agreement
(If applicable)
��
✓
✓
✓
✓
Setback Waiver
Ag reerrent
An updated vicinity/setback map in accordance with the "Map Guidance
✓
✓
fOr Residuals Land Application Permits"
A soils and agronomic evaluation in accordance with the "Soil Scientist
l-,valuation Polic""
✓
INSTRUCTIONS FOR FORM: LASC 06-16 Page I of

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 requirements in the "Soil Scientist Evuluation 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 a status code "M", please contact the Division if you need assistant in
detenn fining attachment requirements.
® Crop Type should include the most likely crop types for the life of thepermit (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
mappingunit. If representative slope is provided, it must be determined accordingly:
® For sites previously pennitted 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 detennine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A sail 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)
• Cadastra I 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 Merc (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 11-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: http://deg.ne.gov/about/divisions/water-
resources/planning/cla ssification-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:
http: /Idea .nc. gov/contac t/reLional-offices
® General Instructions: There are 17 river basins if North Carolina. Each basin has associated waterbodies with assigned
subba sins, 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 11-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 I: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT tostreani name" asthe waterbodyname.
3. Open the link http://deci.ne.gov/about/divisions/water-resources/planning/classification-standards/classifications.
® Stream Classification Process: One of the optionsbelow maybeused dependingon theknown 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 thename 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 IS LOCATED
I. 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 fist.
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 ofthe 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 0213.0301(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 projectswill be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following riverbasi ns 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 entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba RiverBasin
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 cant' 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."
Chowan 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 bayswhich shall be classified "SC."
Pas uotankRiverBasin 1
All drainage canalsnotnotedinthescheduleareclassified"C."
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: City of Newton
Land application sites currently certified: 1068.6 net acres and Totalto be certified: 1068.6 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Codes
Site/Field
ID
Landowner(s)
Lessee(s) or Operamr(s)
Net Acres
County
Crops)
Predominant Sort
Series Name'
Mapping Unit
or Rep. Slope`
M
CA-16-1
12.0
Catawba
Fescue Hay
Cecil
M
CA-16-2
7a'itiesParher
15.0
Catawba
Fescue Hay
Lloyd
�ua�u> wuc .w .aaru uyyu.,ae..ca ago. . i. kiscw) . n �nMuwcu) v ivr linuumeu) ♦ r tlransrerreu) ♦ 0 loeretea)
'Soil Series Name (i.e. Appling, Cecil, etc.)
'Mapping Unit 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 CeB2)
H. WATER13ODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
Latitude
Longitude
Location
Location
Datum
Method Code
Location Accuracy
Waterbody Subbasin and
Stream Index No.
Current and Proposed
P
Class
c i �..3 i�
o �^ -,
s.:f L:
were-�a
e
;�..
Note: Please keep the site information (1.) and waterbody information (II.) of the same field on the same page.
FORM: LASC 06-16 Page 1

LAND APPLICATION SITE CERTIFICATION
FORM: LASC 06-16 Page 2

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checItlist 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
supportiniz documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General —'Phis 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 .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise -noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. La d Owner Agreement (FORM: LOA 06-16):
Submit the completed and appropriately executed Residuals Source 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
pplicant.
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
fhe undersigned landMppr or his representative hereby permits:
Applicant's name:
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
(yestno)
Land Use or
Cropping Patterns
Intended Use of Craps
Residuals Source
(optional)
Special note
(no-till/over-seed)
pasture)
tt
NO
1 r� f
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
;hall 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

11. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application 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 II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
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 Permittee 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 leachate, surface water, groundwater, or soil samples during the
term of., and 12 months after termination of, this Agreement.
II. 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 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 of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall 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.
I IL 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 021' .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 boundary is needed for field(s) ID: _
(Please include the rationale for the requested re -location
compliance boundary to the application package)
Z A re -defined compliance boundary is not needed for this site.
of the compliance boundary and attach a reap showing the newly proposed
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 pr•eviausly permitted residuals land application program and transferred
into the new nroaram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Pennittee to land apply residuals to the Iand application site(s) as specified
herein. Landowner name: Faem _AC
i
A
/
�car+tiG, �r �i�� ,7Jr.
Address:
City:Neiden State: I� C Zip: 0:2 T®r
Phone: a 9 / d E-mail address: (�
Signature: Mwc 4t�_ Date: ` 2�
NORTH CAROLINA, C,(JkjrII_COUNTY
I, the undersigned Notary Public do hereby certify that P 1.r Let— J_
personally appeared before me this day and acknowledged the due execution of the forgoing instrument. `o11 1I1dhiI,,
WI'1 NI SS my hand and official seal this the �, i, *VN", �. ,
day of . - .' i 20 _
Signature and seal: 73
My commission expires: r�G
r„u
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail
Date:
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
1
Signing official nalpe: j#15,7�CL51.r� j Z
Signature:
Date: SAV-7-DiZ
FORM: LOA 06-16
Page 3 of 3

APPLICATION MAP
LEGEND
APPLICATION AREA
UNSUITABLE AREA
WATER
—--n—n�— PRIVATE ROAD
GRAPHIC SCALE
— — — — STREAM
®
ON51TE HOUSE 1" = 660'
ssao ssa
— DRAIN
.
OFFS7E HOUSE
FENCE
❑
OUTBUILDING
PROPERTY LINE
0
WELL
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC-CA-1 6
in the property boundary, whichever is closest to the appiication area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1-2

SOIL SURVEY
�dC2
.Y
7.
' �, � -" '� "'GAF r b/ " •P � 1 � r,a �'��?- L\� h`� G r
1
OR
y r .
Ve
GRAPHIC SCALE
1 " = 660'
660, 0 660,
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area, All
locations are approximate.
ji S
y
321
NC-CA-16
Fields 1-2

0
at
z
Ln
TOPOGRAPHIC MAP
GRAPHIC SCALE
I" = 660'
Bsa' a sso,
5�S
The compliance boundary is established either 250 ft from the residuals application area or 50 feet within NC-CA-1 6
in the property boundary, whichever is closest to the application area. The review boundary is established
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate. Fields 1 "2

VICINITY MAP
Ln
1 2i4i�
3i1
I p
!• LM '
�1>
,II73
321 _
1Z7_ 5
��,.n�4Zc�. ;,1
MaiuF-n-
a
•
s ¢
i r
GRAPHIC SCALE
1,500` 0 1'500'
The
compliance boundary is established either 250 ft from the residuals application area or 50 feet within
N C-CA-16
in the property boundary, whichever is closest to the application area. The review boundary is established
Field 1 A2
midway between the compliance boundary and the perimeter of the residuals application area. All
locations are approximate.