HomeMy WebLinkAboutWQ0021632_Residual Annual Report 2021_20220211Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnWrvnmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
EADS\ndthornburg
Is this submittal an application? (Excluding additional information.)*
Yes No
If not an application what is the submittal type?*
Annual Report
Residual Annual Report
Additional Information
Other
Annual Report Year* 2021
Permit Number (IR) * WQ0021632
Applicant/Permittee City of Burlington
Email Notifications
Does this need review by the hydrogeologist?* Yes • No
Regional Office
CO Reviewer
Admin Reviewer
Winston-Salem
Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name*
Brent Collins
Email Address*
brent.collins@emaresourcesinc.com
Project Information
Phone Number*
336-399-3646
Application/Document Type* New (Fee Required) Modification - Minor
Modification - Major (Fee Required) Renewal
Renewal with Major Modification (Fee GW-59, NDMR, NDMLR, NDAR-1,
Required) NDAR-2
Annual Report Residual Annual Report
Additional Information Change of Ownership
Other
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation High -Rate Infiltration
Other Wastewater Reclaimed Water
Closed -Loop Recycle Residuals
Single -Family Residence Wastewater Other
Irrigation
Permit Number:* WQ0021632
Has Current Existing permit number
Applicant/Permittee Address*
Facility Name*
PO Box 1358, Burlington, NC 27216
City of Burlington Class A Residuals Program
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at nathaniel.thornburg@ncdenr.gov.
Please attach all information required or requested for this submittal to be reviewed here. *
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
2021 Mackintosh WTP Annual Report - WQ0021632.pdf 7.84MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
ate - -ad(e..;r¢
Submission Date 2/11/2022
City of
URLINGTON
Water Resiaurces
January 11th 2022
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
512 N. Salisbury Street
Raleigh, NC 27604
RE: 2021 Annual Report, Permit No. WQ0021632
To Whom It May Concern:
The City of Burlington is submitting this annual report with the assistance of EMA Resources. This
annual report differs from previous years by only containing reporting for the Mackintosh Water
Treatment Plant Class A Residuals. The City of Burlington did not generate or distribute any Class A
compost in 2021 therefore we have no data to report.
If you have any questions concerning this application, please contact Shane Fletcher at (336) 675-5927
or SFletcher@burlingtonnc.gov
Respectfully,
Shane Fletcher
Residuals Management Coordinator
City of Burlington
PO Box 1358
Burlington, NC 27216-1358
BCity of
URLINGTON
1►titer Res urees
City of Burlington, NC
2021 Annual Report
Permit Number WQ0021632
le
,Ipsifri `�a .71
CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0021632 FACILITY NAME: City of Burlington - Mackintosh WTP
PHONE: (336) 675-5927 COUNTY: Alamance OPERATOR: City of Burlington
FACILITY TYPE (please check one): ❑ Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C)
p Distribution and Marketing (complete Parts A, B, and C)
Was the facility in operation during the past calendar year? Yes 0 No ❑ —► If No skip parts A, B, C and certify form below
Part A*:
Part B*:
Month
Sources(s) (include NPDES # if
applicable)
Volume (dry tons)
Recipient Information
Amendment/
Bulking Agent
Residual In
Product Out
Name(s)
Volume (dry tons)
Intended use(s)
January
February
March
April
May
June
July
August
September
October
November
December
Total from FORM DMSDF (sup)
0
319.89
319.89
319.89
Totals:
Annual (dry tons):
0
319.89
319.89
319.89
Amendment(s) used: I
Bulking Agent(s) used:
DMSDF (Supp)
* If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form
1
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit
(including but not limited to items 1-3 below) issued by the Division of Water Quality:
0 Yes
❑ No > If No, Explain in Narritive
1. All monitoring was done in accordance with the permit and reported for the year as required and three (3) copies of certified laboratory results are attached.
2. All operation and maintenance requirements were compiled with or, in the case of a deviation, prior authorization was received from the Division of Water Quality.
3. No contravention of Ground Water Quality Standards occurred at a monitoring well.
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee
//// //O Z Y
Date Signature of Preparer**
(if different from Permittee)
**Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Date
DENR FORM DMSDF (12/2006)
WQ PERMIT #: WQ0021632 FACILITY NAME:
PHONE: (336) 675-5927 COUNTY:
CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
Supplemental Information
City of Burlington - Mackintosh WTP
Alamance
OPERATOR: City of Burlington
FACILITY TYPE (please check one): ❑ Surface Disposal (complete Part A - "Month", "Source(s)" and "Residual In" columns only)
❑ Distribution and Marketing (complete Parts A, and B)
Part A*:
Part B*:
Month
Sources(s) (include NPDES # if
applicable)
Volume (dry tons)
Recipient Information
Amendment/
Bulking Agent
Residual In
Product Out
Name(s)
Volume (dry
tons)
Intended use(s)
June
Mackintosh WTP
57.47
57.47
Tom Neal
57.47
Soil Amendment
June
Mackintosh WTP
49.13
49.13
Leonidas Newlin
49.13
Soil Amendment
July
Mackintosh WTP
31.52
31.52
Chapman McQueen
31.52
Soil Amendment
August
Mackintosh WTP
87.99
87.99
Michael Hadley
87.99
Soil Amendment
September
Mackintosh WTP
35.91
35.91
Chapman McQueen
35.91
Soil Amendment
September
Mackintosh WTP
16.22
16.22
Shirley Dreschel
16.22
Soil Amendment
October
Mackintosh WTP
41.65
41.65
Elizabeth Kirby
41.65
Soil Amendment
Totals:
Annual (dry tons):
0
319.89
319.89 319.89
Amendment(s) used:
Bulking Agent(s) used:
DMSDF (Supp)
* If more space is required, attach additional information sheets (FORM DMSDF (supp)): Total Number of Form
1
DENR FORM DMSDF (Supp) (12/2006)
ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Please note that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF - B
WQ Permit Number:
Facility Name:
Residual Source WQ # or
NPDES #:
WWTP Name:
WQ0021632
City of Burlington
NC0083828
J.D. Mackintosh Jr. WTP
Laboratory: 1) American Testing Technologies Inc.
2)
3)
4)
5)
Residual Analysis Data
Parameter
(mg/kg)
Conc.
Limit
(mg/kg),
Sample or Composite Date
5/19/21
7/15/21
8/23/21
9/9/21
Percent Solids (%)
NA
1.18
3.42
1.87
2.7
Arsenic
75
<5
<5
<5
<5
Cadmium
85
<5
<5
<5
<5
Copper
4,300
50
40
40
28
Chromium
NA
90
100
94
139
Lead
840
<5
<5
<5
<5
Mercury
57
<0.2
<0.2
<0.2
<0.2
Molybdenum
75
<5
<5
<5
<5
Nickel
420
12
<5
<5
<5
Selenium
100
<5
<5
<5
<5
Zinc
7,500
150
70
67
60
Total Phosphorus
NA
1900
1700
9000
3000
TKN
NA
12000
15000
17000
12000
Ammonia -Nitrogen
NA
8000
9000
11000
8000
Nitrate and Nitrite
NA
15
18
12
10
a For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits.
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/Zpzv
Signature 6f Preparer *
Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF (12/2006)
ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Report all sampling analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past
calendar year. Use additional forms as needed.
WQ Permit Number:
Facility Name:
Residual Source
NPDES # or WQ#:
WWTP Name:
WQ0021632
City of Burlington
NC0083828
J.D. Mackintosh Jr. WTP
Laboratory:
1) American Testing Technologies Inc.
2)
3)
4)
5)
Residual Analysis Data
Parameter
(mg/kg)
Sample or Composite Date
5/19/21
7/15/21
8/23/21
9/9/21
Aluminum
145000
176500
139000
92000
Calcium
6600
4300
3200
5700
Magnesium
2100
1400
1300
1400
Potassium
400
340
370
100
Sodium
4000
2400
2000
570
pH
6.35
5.9
6.18
5.98
PAN
5615
6918
7912
5610
SAR
1.19
1.5
1.03
0.29
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/////,40LZ
Signature of Preparer * Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF - B (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632 Cation Exchange Capacity (non 503 only):
27.81
Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: AbB
8.71 Acres Permitted: 8.71 Site #: AM006 Field #:
2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orU
Com-
posite
Date
1 2
3
1 4
1 5
16
1 7
18
1 9
110
111
112
Mack
7/15/21
% Solids
3.42
Arsenic
5
Cadmium
5
Copper
40
Chromium
100
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
70
Total
Phos-
phorus
1700
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
3.19
Arsenic
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Cadmium
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Copper
0.255
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.255
Chromium
0.639
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.639
Lead
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Nickel
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Selenium
0.032
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Zinc
0.447
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.447
Total
Phos-
phorus
10.856
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
10.856
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 2
City of Burlington
Land Owner: Walter Hessenthaler Annual Dry Tons Applied: 27.81
Operator:
Tom Neal
Crop 1 Name: Fescue -Pasture
Predominant Soil Series:
AbB
Site #: AM006
Crop 1 Max. PAN: 177
Crop 2 Name:
Acres Utilized: 8.71
Acres Permitted: 8.71
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
6/14
162500
3.42
2.661
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
36.814
NA
Fescue
6/16
32500
3.42
0.532
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
7.363
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
195000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
44.176
0.000
Lime Applied
Annual lbs/acre
0.032
0.032
0.255
0.639
0.032
0.001
0.032
0.032
0.032
0.447
10.856
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.032
0.032
0.255
0.639
0.032
0.001
0.032
0.032
0.032
0.447
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
177
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632 Cation Exchange Capacity (non 503 only):
9.27
Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: HeB
4 Acres Permitted:
4 Site #: AM006 Field #: 9A
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orl
Com-
posite
Date
l
1 2
3
14
1 5
1 6
1 7
1 8
1 9
110
111
112
Mack
7/15/21
% Solids
3.42
Arsenic
5
Cadmium
5
Copper
40
Chromium
100
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
70
Total
Phos-
phorus
1700
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
2.32
Arsenic
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Cadmium
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Copper
0.185
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.185
Chromium
0.463
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.463
Lead
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Nickel
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Selenium
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Zinc
0.324
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.324
Total
Phos-
phorus
7.878
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
7.878
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner: Walter Hessenthaler Annual Dry Tons Applied:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 9A
City of Burlington
Tom Neal
Crop 1 Name: Fescue -Pasture
9.27 Site #: AM006
Predominant Soil Series:
HeB
Crop 1 Max. PAN: 126
Crop 2 Name:
Acres Utilized:
Acres Permitted:
4
4
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
110pUZMIVIOA
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
etc)
Crop 1
Crop 2
Crop 1
Crop 2
6/16
65000
3.42
2.317
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
32.065
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
65000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
32.065
0.000
Lime Applied
Annual lbs/acre
0.023
0.023
0.185
0.463
0.023
0.001
0.023
0.023
0.023
0.324 7.878
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.023
0.023
0.185
0.463
0.023
0.001
0.023
0.023
0.023
0.324
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
126
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632 Cation Exchange Capacity (non 503 only):
20.39
Tom Neal Owner: Walter Hessenthaler Predominant Soil Series: DdB2
6.75 Acres Permitted: 6.75 Site #: AM006 Field #: 11
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orU
Com-
posite
Date
1 2
3
1 4
1 5
16
1 7
18
1 9
110
111
112
Mack
7/15/21
% Solids
3.42
Arsenic
5
Cadmium
5
Copper
40
Chromium
100
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
70
Total
Phos-
phorus
1700
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
3.02
Arsenic
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Cadmium
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Copper
0.242
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.242
Chromium
0.604
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.604
Lead
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Nickel
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Selenium
0.030
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.030
Zinc
0.423
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.423
Total
Phos-
phorus
10.271
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
10.271
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 11
Land Owner: Walter Hessenthaler Annual Dry Tons Applied: 20.39 Site #: AM006
Operator:
Tom Neal
Crop 1 Name: Fescue -Pasture
Predominant Soil Series:
DdB2
Crop 1 Max. PAN: 127
Crop 2 Name:
Acres Utilized: 6.75
Acres Permitted: 6.75
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
6/16
45500
3.42
0.961
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
13.301
NA
Fescue
6/17
97500
3.42
2.060
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
28.502
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
143000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
41.803
0.000
Lime Applied
Annual lbs/acre
0.030
0.030
0.242
0.604
0.030
0.001
0.030
0.030
0.030
0.423
10.271
Date
lbs/ac
Prior Years Cumulative lbs/ac
o
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.030
0.030
0.242
0.604
0.030
0.001
0.030
0.030
0.030
0.423
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
127
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
53.49
Michael Hadley Owner: Michael Hadley Predominant Soil Series: AaB
23.46 Acres Permitted: 23.46 Site #: AM016 Field #:
2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orU
Com-
posite
Date
1 2
3
1 4
1 5
16
1 7
18
1 9
110
111
112
EB
7/6/21
Mack
8/23/21
% Solids
2.7
1.87
Arsenic
5
5
Cadmium
5
5
Copper
117
40
Chromium
35
94
Lead
5
5
Mercury
0.2
0.2
Molyb-
denum
5
5
Nickel
5
5
Selenium
5
5
Zinc
450
67
Total
Phos-
phorus
7000
9000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
1.65
0.63
Arsenic
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Cadmium
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Copper
0.387
0.050
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.437
Chromium
0.116
0.118
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.234
Lead
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Nickel
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Selenium
0.017
0.006
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Zinc
1.488
0.084
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.572
Total
Phos-
phorus
23.142
11.286
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
34.428
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner: Michael Hadley
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 2
City of Burlington
Operator: Michael Hadley
Crop 1 Name: Fescue -Pasture
Annual Dry Tons Applied: 53.49
Predominant Soil Series:
AaB
Site #: AM016
Crop 1 Max. PAN: 190
Crop 2 Name:
Acres Utilized: 23.46
Acres Permitted: 23.46
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
8/5
97500
2.7
0.468
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
11.904
NA
Fescue
8/6
182000
2.7
0.873
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
22.221
NA
Fescue
8/7
19500
2.7
0.094
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
2.381
NA
Fescue
8/9
45500
2.7
0.218
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
5.555
NA
Fescue
8/25
110500
1.87
0.367
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
5.812
NA
Fescue
8/26
78000
1.87
0.259
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
4.103
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
533000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
51.976
0.000
Lime Applied
Annual lbs/acre
0.023
0.023
0.437
0.234
0.023
0.001
0.023
0.023
0.023
1.572 34.428
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.023
0.023
0.437
0.234
0.023
0.001
0.023
0.023
0.023
1.572
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
190
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632 Cation Exchange Capacity (non 503 only):
103.96
Operator: Michael Hadley Owner: Russell Hadley Trust Predominant Soil Series: HdC2
Acres Used:
32.94 Acres Permitted: 32.94 Site #: AM016 Field #: 4
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orU
Com-
posite
Date
I 3
14
r 5
16
17
18
19
110
111
112
EB
7/6/21
Mack
7/15/21
Mack
8/23/21
% Solids
2.7
3.42
1.87
Arsenic
5
5
5
Cadmium
5
5
5
Copper
117
40
40
Chromium
35
100
94
Lead
5
5
5
Mercury
0.2
0.2
0.2
Molyb-
denum
5
5
5
Nickel
5
5
5
Selenium
5
5
5
Zinc
450
70
67
Total
Phos-
phorus
7000
1700
9000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
1
J
1.18
3J
0.51
4
J
6
7
91
1II
11 ]
12
Totals:
1.47
Arsenic
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Cadmium
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Copper
0.343
0.095
0.041
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.478
Chromium
0.103
0.236
0.096
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.435
Lead
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb-
denum
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Nickel
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Selenium
0.015
0.012
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.032
Zinc
1.319
0.165
0.068
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.553
Total
Phos-
phorus
20.524
4.019
9.144
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
33.687
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 4
City of Burlington
Land Owner: Russell Hadley Trust
Operator: Michael Hadley
Crop 1 Name: Fescue -Pasture
Annual Dry Tons Applied: 103.96
Predominant Soil Series:
HdC2
Site #: AM016
Crop 1 Max. PAN: 148
Crop 2 Name:
Acres Utilized: 32.94
Acres Permitted: 32.94
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
8/2
78000
2.7
0.267
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
6.782
NA
Fescue
8/3
26000
2.7
0.089
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
2.261
NA
Fescue
8/4
188500
2.7
0.644
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
16.391
NA
Fescue
8/5
136500
2.7
0.467
East Burlington
Dry
<.5"
S
0.5
0.3
33000
14000
20
11.869
NA
Fescue
8/13
123500
3.42
0.535
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
7.398
NA
Fescue
8/14
149500
3.42
0.647
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
8.956
NA
Fescue
8/23
123500
1.87
0.292
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
4.626
NA
Fescue
8/24
91000
1.87
0.215
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
3.409
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
916500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
61.692
0.000
Lime Applied
Annual lbs/acre
0.032
0.032
0.478
0.435
0.032
0.001
0.032
0.032
0.032
1.553 33.687
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.032
0.032
0.478
0.435
0.032
0.001
0.032
0.032
0.032
1.553
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
148
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
17.61
Operator: Michael Hadley Owner: Russell Hadley Trust Predominant Soil Series: HdC2
Acres Used:
9 Acres Permitted:
9 Site #: AM016 Field #: 4-Buffer
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orl
Com-
posite
Date
1
1 2
3
4
1 5
1 6
1 7
1 8
1 9
110
111
112
Mack
7/15/21
% Solids
3.42
Arsenic
5
Cadmium
5
Copper
40
Chromium
100
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
70
Total
Phos-
phorus
1700
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
1.96
Arsenic
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Cadmium
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Copper
0.157
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.157
Chromium
0.391
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.391
Lead
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Nickel
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Selenium
0.020
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.020
Zinc
0.274
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.274
Total
Phos-
phorus
6.654
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
6.654
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 4-Buffer
Land Owner: Russell Hadley Trust Annual Dry Tons Applied: 17.61 Site #: AM016
Operator: Michael Hadley
Crop 1 Name: Fescue -Pasture
Predominant Soil Series:
HdC2
Crop 1 Max. PAN: 148
Crop 2 Name:
Acres Utilized:
Acres Permitted:
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
9
9
0
Date or
Month
Volume
(enter one)
Liquid
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
110pUZMIVIOA
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
etc)
Crop 1
Crop 2
Crop 1
Crop 2
8/12
123500
3.42
1.957
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
27.077
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
123500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
27.077
0.000
Lime Applied
Annual lbs/acre
0.020
0.020
0.157
0.391
0.020
0.001
0.020
0.020
0.020
0.274 6.654
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.020
0.020
0.157
0.391
0.020
0.001
0.020
0.020
0.020
0.274
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
148
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator: Lonnie Thompson Owner: Chapman McQueen Predominant Soil Series: HcB
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
52.79
Cation Exchange Capacity (non 503 only):
10.91 Acres Permitted: 10.91 Site #: AM109 Field #:
1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample oru
Com-
posite
Date
L
3
14
r 5
16
17
18
19
110
111
112
Mack
7/15/21
Mack
8/23/21
Mack
9/9/21
% Solids
3.42
1.87
2.7
Arsenic
5
5
5
Cadmium
5
5
5
Copper
40
40
28
Chromium
100
94
139
Lead
5
5
5
Mercury
0.2
0.2
0.2
Molyb-
denum
5
5
5
Nickel
5
5
5
Selenium
5
5
5
Zinc
70
67
60
Total
Phos-
phorus
1700
9000
3000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L
Li
L
L
t
9,
10
11
12
Totals:
2.89
0.14
1.81
Arsenic
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Cadmium
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Copper
0.231
0.011
0.101
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.344
Chromium
0.578
0.026
0.503
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.107
Lead
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Mercury
0.001
0.000
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.002
Molyb
denum
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Nickel
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Selenium
0.029
0.001
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.048
Zinc
0.404
0.019
0.217
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.640
Total
Phos-
phorus
9.823
2.502
10.866
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
23.191
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 1
City of Burlington
Land Owner: Chapman McQueen
Operator: Lonnie Thompson
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 52.79
Predominant Soil Series:
HcB
Site #: AM109
Crop 1 Max. PAN: 169
Crop 2 Name:
Acres Utilized: 10.91
Acres Permitted: 10.91
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
7/15
104000
3.42
1.359
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
18.810
NA
Fescue
7/16
117000
3.42
1.529
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
21.161
NA
Fescue
9/8
19500
1.87
0.139
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
2.205
NA
Fescue
9/9
117000
2.7
1.207
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
13.547
NA
Fescue
9/10
58500
2.7
0.604
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
6.774
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
416000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
62.497
0.000
Lime Applied
Annual lbs/acre
0.048
0.048
0.344
1.107
0.048
0.002
0.048
0.048
0.048
0.640
23.191
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.048
0.048
0.344
1.107
0.048
0.002
0.048
0.048
0.048
0.640
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
169
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator: Lonnie Thompson Owner: Chapman McQueen Predominant Soil Series: HcB
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
14.64
Cation Exchange Capacity (non 503 only):
5.66 Acres Permitted: 5.66 Site #: AM109 Field #: 2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
1 I
Mack
9/9/21
2
3
1 4
1 5
1 6
1 7
1 8
1 9
110
111
112
% Solids
2.7
Arsenic
5
Cadmium
5
Copper
28
Chromiumr
139
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
60
Total
Phos-
phorus
3000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
2.59
Arsenic
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Cadmium
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Copper
0.145
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.145
Chromium
0.719
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.719
Lead
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Nickel
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Selenium
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.026
Zinc
0.310
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.310
Total
Phos-
phorus
15.516
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
15.516
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 2
City of Burlington
Land Owner: Chapman McQueen
Operator: Lonnie Thompson
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 14.64
Predominant Soil Series:
HcB
Site #: AM109
Crop 1 Max. PAN: 169
Crop 2 Name:
Acres Utilized: 5.66
Acres Permitted: 5.66
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
9/9
39000
2.7
0.776
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
8.704
NA
Fescue
9/10
91000
2.7
1.810
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
20.310
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications
totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
130000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
29.015
0.000
Lime Applied
Annual lbs/acre
0.026
0.026
0.145
0.719
0.026
0.001
0.026
0.026
0.026
0.310
15.516
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.026
0.026
0.145
0.719
0.026
0.001
0.026
0.026
0.026
0.310
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
169
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
99.43
Leonidas Newlin Owner: Leonidas Newlin Predominant Soil Series: GaB
19.48 Acres Permitted: 19.48 Site #: AM110 Field #:
1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orl
Com-
posite
Date
l
1 2
3
14
1 5
1 6
1 7
1 8
1 9
110
111
112
Mack
7/15/21
EB
5/3/21
% Solids
3.42
5.8
Arsenic
5
5
Cadmium
5
5
Copper
40
115
Chromium
100
38
Lead
5
5
Mercury
0.2
0.2
Molyb-
denum
5
5
Nickel
5
14
Selenium
5
5
Zinc
70
400
Total
Phos-
phorus
1700
10000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
2.52
2.58
Arsenic
0.025
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.051
Cadmium
0.025
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.051
Copper
0.202
0.594
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.796
Chromium
0.504
0.196
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.701
Lead
0.025
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.051
Mercury
0.001
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.002
Molyb
denum
0.025
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.051
Nickel
0.025
0.072
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.098
Selenium
0.025
0.026
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.051
Zinc
0.353
2.066
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
2.419
Total
Phos-
phorus
8.575
51.640
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
60.215
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner: Leonidas Newlin
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 1
City of Burlington
Operator: Leonidas Newlin
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 99.43
Predominant Soil Series:
GaB
Site #: AM110
Crop 1 Max. PAN: 211
Crop 2 Name:
Acres Utilized: 19.48
Acres Permitted: 19.48
Cation Exchange Capacity (non 503): 0
Crop 2 Max. PAN:
Date or
Month
Volume
(enter one)
Liquid
9
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,7j
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
6/14
162500
3.42
1.190
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
16.460
NA
Fescue
6/16
32500
3.42
0.238
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
3.292
NA
Fescue
6/18
136500
3.42
0.999
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
13.827
NA
Fescue
6/24
13000
3.42
0.095
Mackintosh
Dry
<.5"
S
0.5
0.4
15000
9000
18
1.317
NA
Fescue
6/24
19500
5.8
0.242
East Burlington
Dry
<.5"
S
0.5
0.3
32000
16000
20
6.208
NA
Fescue
6/25
117000
5.8
1.453
East Burlington
Dry
<.5"
S
0.5
0.3
32000
16000
20
37.246
NA
Fescue
6/26
32500
5.8
0.404
East Burlington
Dry
<.5"
S
0.5
0.3
32000
16000
20
10.346
NA
Fescue
6/28
39000
5.8
0.484
East Burlington
Dry
<.5"
S
0.5
0.3
32000
16000
20
12.415
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
552500
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
101.111
0.000
Lime Applied
Annual lbs/acre
0.051
0.051
0.796
0.701
0.051
0.002
0.051
0.098
0.051
2.419 60.215
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.051
0.051
0.796
0.701
0.051
0.002
0.051
0.098
0.051
2.419
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
211
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
13.18
Shirley Dreschel Owner: Shirley Dreschel Predominant Soil Series: HeB
10.27 Acres Permitted: 10.27 Site #: AM128 Field #:
1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
1
Mack
8/23/21
3
3
1 4
1 5
1 6
1 7
1 8
1 9
110
111
112
% Solids
1.87
Arsenic
5
Cadmium
5
Copper
40
Chromiumr
94
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
67
Total
Phos-
phorus
9000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
1.28
Arsenic
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Cadmium
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Copper
0.103
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.103
Chromium
0.241
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.241
Lead
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Nickel
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Selenium
0.013
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.013
Zinc
0.172
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.172
Total
Phos-
phorus
23.094
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
23.094
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 1
Site #: AM128
City of Burlington
Shirley Dreschel
Operator: Shirley Dreschel
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 13.18
Predominant Soil Series:
HeB
Crop 1 Max. PAN: 163
Crop 2 Name:
Acres Utilized: 10.27
Acres Permitted: 10.27
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
* *atn2I
uOTTEZTTTWTOA
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Appl.cation
Crop 1
Crop 2
Crop 1
Crop 2
9/7
169000
1.87
1.283
Mackintosh
D
<.5"
S
0.5
0.4
17000
11000
12
20.305
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
169000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
20.305
0.000
Lime Applied
Annual lbs/acre
0.013
0.013
0.103
0.241
0.013
0.001
0.013
0.013
0.013
0.172 23.094
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.013
0.013
0.103
0.241
0.013
0.001
0.013
0.013
0.013
0.172
Permitted C. P. L. R.****
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
163
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
1/3/2022
Signature of Land Applier
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
3.04
Shirley Dreschel Owner: Shirley Dreschel Predominant Soil Series: HeB
2.94 Acres Permitted: 2.94 Site #: AM128 Field #: 2
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
LL
3
3
14
15
16
17
18
19
110
111
112
Mack
8/23/21
% Solids
1.87
Arsenic
5
Cadmium
5
Copper
40
Chromium
94
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
67
Total
Phos-
phorus
9000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L 3
Li
L
L 6
t
L
L
10
11
12
Totals:
1.03
Arsenic
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Cadmium
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Copper
0.083
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.083
Chromium
0.194
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.194
Lead
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Mercury
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Molyb
denum
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Nickel
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Selenium
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Zinc
0.139
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.139
Total
Phos-
phorus
18.612
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
18.612
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 2
Site #: AM128
City of Burlington
Shirley Dreschel
Operator: Shirley Dreschel
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 3.04
Predominant Soil Series:
HeB
Crop 1 Max. PAN: 163
Crop 2 Name:
Acres Utilized: 2.94
Acres Permitted: 2.94
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
110pUZMIVIOA
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
etc)
Crop 1
Crop 2
Crop 1
Crop 2
9/8
39000
1.87
1.034
Mackintosh
Dry
<.5"
S
0.5
0.4
17000
11000
12
16.369
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
39000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
16.369
0.000
Lime Applied
Annual lbs/acre
0.010
0.010
0.083
0.194
0.010
0.000
0.010
0.010
0.010
0.139 18.612
Date
lbs/ac
Prior Years Cumulative lbs/ac
o
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.010
0.010
0.083
0.194
0.010
0.000
0.010
0.010
0.010
0.139
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
163
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
12.38
Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2
6 Acres Permitted: 6 Site #: CS113 Field #: 2 (Buffers)
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sampleorl
Com-
posite
Date
1
_2'
31
4'
r 5 r
[I
r 7 r
19
110
111
112
Mack
09/09/21
% Solids
2.7
Arsenic
5
Cadmium
5
Copper
28
Chromium
139
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
60
Total
Phos-
phorus
3000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L3
Li
LS
L6
t
9
10
11
12
Totals:
2.06
Arsenic
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Cadmium
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Copper
0.116
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.116
Chromium
0.574
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.574
Lead
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Nickel
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Selenium
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Zinc
0.248
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.248
Total
Phos-
phorus
12.384
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
12.38
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 2 (Buffers)
Land Owner: Elizabeth Kirby Annual Dry Tons Applied: 12.38 Site #: CS113
Operator: Elizabeth Kirby
Crop 1 Name:
Fescue -Hay
Predominant Soil Series:
CuB2
Crop 1 Max. PAN: 209
Crop 2 Name:
Acres Utilized:
Acres Permitted:
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
6
6
0
Date or
Month
Volume
(enter one)
Liquid
q
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,g
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
* 1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
10/22
52000
2.7
0.976
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
10.948
NA
Fescue
10/25
58000
2.7
1.088
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
12.212
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
110000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
23.160
0.000
Lime Applied
Annual lbs/acre
0.021
0.021
0.116
0.574
0.021
0.001
0.021
0.021
0.021
0.248 12.384
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.021
0.021
0.116
0.574
0.021
0.001
0.021
0.021
0.021
0.248
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington
WQ0021632
Total Dry Tons Applied (Annual): 14.64
Cation Exchange Capacity (non 503 only):
Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2
5.4 Acres Permitted:
5.4 Site #: CS113 Field #:
6A
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
1 1
_2'
3'
4'
r 5
[ I
r 7
1 8
1 9
110
111
112
Mack
09/09/21
% Solids
2.7
Arsenic
5
Cadmium
5
Copper
28
Chromium
139
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
60
Total
Phos-
phorus
3000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L3
Li
LS
L6
t
9
10
11
12
Totals:
2.71
Arsenic
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Cadmium
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Copper
0.152
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.152
Chromium
0.754
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.754
Lead
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Nickel
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Selenium
0.027
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.027
Zinc
0.325
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.325
Total
Phos-
phorus
16.266
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
16.27
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: City of Burlington WQ Permit #: WQ0021632 Field #: 6A
Land Owner: Elizabeth Kirby Annual Dry Tons Applied: 14.64 Site #: CS113
Operator: Elizabeth Kirby
Crop 1 Name:
Fescue -Hay
Predominant Soil Series:
CuB2
Crop 1 Max. PAN: 209
Crop 2 Name:
Acres Utilized: 5.4
Acres Permitted: 5.4
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
q
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
PP
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,g
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
* 1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
10/14
65000
2.7
1.355
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
15.206
NA
Fescue
10/15
13000
2.7
0.271
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
3.041
NA
Fescue
10/22
52000
2.7
1.084
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
12.165
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
130000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
30.412
0.000
Lime Applied
Annual lbs/acre
0.027
0.027
0.152
0.754
0.027
0.001
0.027
0.027
0.027
0.325 16.266
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.027
0.027
0.152
0.754
0.027
0.001
0.027
0.027
0.027
0.325
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
City of Burlington Total Dry Tons Applied (Annual):
WQ0021632
Cation Exchange Capacity (non 503 only):
14.63
Elizabeth Kirby Owner: Elizabeth Kirby Predominant Soil Series: CuB2
6.3 Acres Permitted:
6.3 Site #: CS113 Field #:
6B
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orl
Com-
posite
Date
1
_2'
3'
4'
15 .
[ I
17 .
1 8
1 9
110
111
112
Mack
09/09/21
% Solids
2.7
Arsenic
5
Cadmium
5
Copper
28
Chromium
139
Lead
5
Mercury
0.2
Molyb-
denum
5
Nickel
5
Selenium
5
Zinc
60
Total
Phos-
phorus
3000
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
L
L3
Li
LS
L6
t
9 ,
10
11
12
Totals:
2.32
Arsenic
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Cadmium
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Copper
0.130
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.130
Chromium
0.646
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.646
Lead
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Mercury
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Molyb
denum
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Nickel
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Selenium
0.023
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.023
Zinc
0.279
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.279
Total
Phos-
phorus
13.938
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
13.94
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
1/3/2022
Date
DENR FORM MFLSF (12/2006)
Facility Name:
Land Owner:
Operator:
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0021632 Field #: 6B
City of Burlington
Elizabeth Kirby
Elizabeth Kirby
Crop 1 Name:
Fescue -Hay
Annual Dry Tons Applied: 14.63 Site #: CS113
Predominant Soil Series:
CuB2
Crop 1 Max. PAN: 209
Crop 2 Name:
Acres Utilized: 6.3
Acres Permitted: 6.3
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
Date or
Month
Volume
(enter one)
Liquid
q
Cu. Yds
applied
Solids/
Gallons
%
Solids
Volume
Appliedper
pp
Acre
(Dry Tons/Ac)
Residual
(NPDES
Fert ,
Waste,
Sources
#, WQ#,g
Animal
Soil
Cond.
(Dry, Wet,
Moist)
Precip.
Past 24
Hrs.
inches
Application
Method*
o
w w
. N'
* 1,?-,'
Mineralizatio
n Rate* * *
TKN
mg/kg
Ammonia Y
rn
Nitrogen E
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
PP
etc)
Crop 1
Crop 2
Crop 1
Crop 2
10/15
45500
2.7
0.813
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
9.124
NA
Fescue
10/16
84500
2.7
1.510
Mackintosh
Dry
<.5"
S
0.5
0.4
12000
8000
10
16.944
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0
0
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
0.000
0.000
TOTALS:
0
130000
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn P
26.067
0.000
Lime Applied
Annual lbs/acre
0.023
0.023
0.130
0.646
0.023
0.001
0.023
0.023
0.023
0.279 13.938
Date
lbs/ac
Prior Years Cumulative lbs/ac
0
0
0
0
0
0
0
0
0
0
Current Cumulative lbs/ac
0.023
0.023
0.130
0.646
0.023
0.001
0.023
0.023
0.023
0.279
Permitted C. P. L. R. * * * *
36
34
1338
267
15
374
89
2498
Permit PAN Limit 1 st/2nd Crop
209
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
1/3/2022 **Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
Date
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)
05/28/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
American Testing Technologies, Inc.
Report No.: 052421-64
Enclosed are the results of the sample(s) submitted to our laboratory on 05/24/2021.
All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The
test results meet requirements of the NELAP standards for methods listed on the
laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010,
6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted.
Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from
the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via
email at samy(4americantesiingtechnologies.com
ely
Manager
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 677.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 1 of 2
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 05/24/2021
Date Reported: 05/28/2021
Date Collected: 05/19/2021
Time Collected: 0840
Client ID #: Mackintosh Iagoon #1
Laboratory ID #: 052421-64
American Testing Technologies, Inc.
Certificate of Analysis
Parameter.
Result
(%)
Result
(mg/kg)
Analysis Date
Method
Aluminum, Total
145,000
05/25/2021
6010D
Arsenic, Total
<5.0
05/25/2021
6010D
Cadmium, Total
<5.0
05/25/2021
6010D
Calcium, Total
0.66
6,600
05/25/2021
_
6010D
Chromium, Total
90
05/25/2021
6010D
Copper, Total
50 .
05/25/2021
6010D
Iron, Total
10,400
05/25/2021
6010D
Lead, Total
<5.0
05/25/2021
6010D
Magnesium, Total
0.21
2,100
05/25/2021
6010D
Manganese, Total
1,600
05/25/2021
6010D
Mercury, Total -
<0.20
05/25/2021
7471B
Molybdenum, Total
<5.0
05/25/2021
6010D
Phosphorus, Total
_ 0.19
1,900
05/25/2021
6010D
Nickel, Total
12
05/25/2021
6010D
Potassium, Total
0.04
400
05/25/2021
6010D
Selenium, Total
<5.0
05/25/2021
6010D
Sodium, Total
0.4
4,000
05/25/2021
6010D
Sulfur, Total
1.1
11,400
05/25/2021
6010D
Zinc, Total
_
150
05/25/2021
6010D
Total Kjeldahl Nitrogen
1.2
12,000
05/27/2021
SM-4500
Ammonia Nitrogen
0.8
8,000
05/27/2021
_
SM-4500
Organic Nitrogen _
0.4
4,000
_
05/27/2021
Calculation
Nitrate+Nitrite- N
15
05/27/2021
SM-4500C
Calcium Carbonate Equivalent
30
300,000
05/26/2021
AOAC 955.01
Total Solids
1.18
11,800
05/24/2021
SM-2540G
Total Volatile Solids
52
520,000
05/24/2021
SM-2540G
Moisture
98.82
05/24/2021
SM-2540G
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone:330.634.9906 Fax 330.634.9907 Page 2 of 2
www.AmericanTestingTechnologies.com
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CITY OF BURLINGTON LABORATORY SERVICES
NC Wastewater Laboratory Certification #188
336-222-5133
Sampled
pH
Analyzed
Sample
ID #
date
time
SU
date
time
analyst
South WWTP Digester #2
South WWTP Digester #3
South WWTP Digester #4
East WWTP Digester #1
Mackintosh Lagoon #1
, . I its 1ogiv
f L O
,) fr)
7(
1000
')ID
Mackintosh Lagoon #2
Compost
Other
Certified by
avt t/atD,N,
date 10
(G
1/0
CITY OF BURLINGTON
POST OFFICE BOX 1358
BURLINGTON NC 27216-1358
336-570-6138
CONTACT PERSON - SHANE FLETCHER
MACKINTOSH WATER TREATMENT PLANT
CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE
SAMPLE LOCATION: fa 42.-4 Z_ av�
SAMPLED BY:
DATE: // 9 ?t/� / Tam: t% e �D
PH RESULT PH TIME PH ANALYST
DELIVERED TO C.O.B. LAB BY:
DATE: 517 ?/ L
I
RECEIVED IN C.O.B. LAB BY:
DATE: _r Z
TIME: f
SHIPPED FROM C.O.B. LAB BY: 4/cam U/G
DATE:
RECEIVED IN -I, LAB BY;
TIME:
DATE; TIME;
URT
7103
TE 7
FAX -
SEND COPY TO
SHANE FLETCHER
City of Burlington
P.O. BOX 1358
BURLINGTON NC 27216-1358
TELEPNONE 336-570-6138
FAX 336-570-6139
SAMPLE I.D.#ML /' /el crd
DO NOT RUN pH
PLEASE RUN
RUN SO4
RUN SL1 & SL2 plus the following -
RUN NH4-N, NO3-N, ORGANIC N, Cd, C
Ni, Pb, As, Hg, Se, CaCG3-equiv.,
Volatile Solids, Mo, Cl
Will the results of this sample be used for compliance reporting. YES NO
NCDENR-DWQ
WATER QUALITY SECTION
NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION
1617 MAIL SERVICE CENTER
RALEIGH NC 27699-1617
Sodium
Calcium
Magnesium
Percent Solids
Mackintosh 5/19/21
mg/kg mg/L Equiv Weight Milli Equiv
4000 47.2 23 2.052174
6600 77.88 20 3.894
2100 24.78 12 2.065
1.18
SAR=
SAR 1.19
Na+
/2 (Ca2+ + Mg2+)
American Testing Technologies, Inc.
07/30/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Report No.: 071921-85
Enclosed are the results of the sample(s) submitted to our laboratory on 07/19/2021.
All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The
test results meet requirements of the NELAP standards for methods listed on the
laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010,
6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted.
Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from
the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via
email at samy@americantestingtechnologies.com
Labor o Manager
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 1 of 2
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 07/19/2021
Date Reported: 07/30/2021
Date Collected: 07/15/2021
Time Collected: 1030
Client ID #: Mackintosh lagoon #1
Laboratory ID #: 071921-85
American Testing Technologies, Inc.
Certificate of Analysis
Parameter
Result
(%)
Result
(mg kg)
Analysis Date
Method
Aluminum, Total
176,500
07/26/2021
6010D
Arsenic, Total
<5.0
07/26/2021
6010D
Cadmium, Total
<5.0
07/26/2021
6010D
Calcium, Total
0.43
4,300
07/26/2021
6010D
Chromium, Total
100
07/26/2021
6010D
Copper, Total
40
07/26/2021
6010D
Iron, Total
14,500
07/26/2021
6010D
Lead, Total
<5.0
07/26/2021
6010D
Magnesium, Total
0.14
1,400
07/26/2021
6010D
Manganese, Total
1,100
07/26/2021
6010D
Mercury, Total
<0.20
07/26/2021
7471B
Molybdenum, Total
<5.0
07/26/2021
6010D
Phosphorus, Total
0.17
1,700
07/26/2021
6010D
Nickel, Total
<5.0
07/26/2021
6010D
Potassium, Total
0.03
340
07/26/2021
6010D
Selenium, Total
<5.0
07/26/2021
6010D
Sodium, Total
0.24
2,400
07/26/2021
6010D
Sulfur, Total
0.9
9,000
07/26/2021
6010D
Zinc, Total
70
07/26/2021
6010D
Total Kjeldahl Nitrogen
1.5
15,000
07/2.7/2021
SM-4500
Ammonia Nitrogen
0.9
9,000
07/27/2021
SM-4500
Organic Nitrogen
0.6
6,000
07/27/2021
Calculation
Nitrate+Nitrite- N
18
07/27/2021
SM-4500C
Calcium Carbonate Equivalent
34
340,000
07/28/2021
AOAC 955.01
Total Solids
3.42
34,200
07/20/2021
SM-2540G
Total Volatile Solids
61
610,000
07/20/2021
SM-2540G
Moisture
96.58
07/20/2021
SM-2540G
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 2 of 2
American Testing Technologies, Inc.
1350 Home Avenue Akron, OH 44310
Website: www.AmericanTestingTechnologies.com
Toll Free: 877-634-9906 Phone: (330) 634-9906
Fax: (330) 634-990)1''7
o
STANDARD REPORT a ,a
DELIVERY
DATE DUE
EXPEDITED REPORT
DELIVERY
(SURCHARGE)
DATE DUE
NUMBER OF COOLERS SUBMITTED
PER SHIPMENT:
REMARKS
n
2d
:r.
TIME
LABORATORY USE.ONLY
Pc
¢
DATE
w
n
w
RELINQUISHED BY: (SIGNATURE)
RECEIVED BY: (SIGNATURE)
REQUIRED ANALYSIS
C°‘r1 ` NUMBER OF CONTAINERS SUBMITTED
V
Q
ti
ti
TIME
DATE
w
2
0
AT.T.
LOG NO:.
RELINQUISHED BY:(SIGNATURE)
RECEIVED BY: (SIGNATURE)
1-41
("" '1N3A1 OS '110) 01nb11 S11031bVVNON
'?CUSTODY'
;SEAL NO..
ArTiANALYSIS REQUEST AND
CHAIN OF CUSTODY. RECORD
American Testing Technologies, Inc.
0110S114.13S H0 0110S
(SI M) sn03nbb
3111310N1(9) Eine 2io (0) 31130d01o0
PROJECT LOCATION
(STATE) ,� G..
CONTRACT N0:
CLIENT FAX
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111
DATE
PROJECT REFERENCE
fYoM411 10001 u0
PROJECT MANAI ER •
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CLIENT*NAME �R i� ` y ,
l rl c L7 r. n/1 rd'I-oi i
RELI 1 UISHED BY' (s)NATURE)
RECEIVED BY: (SIGNATURE)
• RECEIVED FOR LABACRATORY•BY:
(SIGNATU E)
SAMPLE)
TIME
t,
w
G
0
N
us
I
ORIGINAL - RETURN TO LABORATORY WITH SAMPLE(S)
CiTh' OF URIfNGTON LA ORATORY SERVICES
NC Wastewater Laboratory Certification #188
336-222-5133
Sampled pH Analyzed
Sample
ID #
date
time
SU
date
time
analyst
South WWTP Digester #2
South WWTP Digester #3
South WWTP Digester #4
East WWTP Digester #1
Mackintosh Lagoon #1
Mace 441
7/i /2l
10 aL
L.
7/15/21
l (7,S
4
Mackintosh Lagoon #2
Compost
Other
Certified by 5)-Ic,1roY V\ic1n-eir
date 7/1S/ Z�
CITY OF BURLINGTON
POST OFFICE BOX 1358
BURLINGTON NC 27216-1358
336-570-6138
CONTACT PERSON — SHANE FLETCHER
MACKINTOSH WATER TREATMENT PLANT
CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE
SAMPLE LOCATION: 144ck4.1164
SAMPLED BY:
DATE: %((r/'7fl y/
PH RESULT
DELIVERED TO C.O.B. LAB BY:
DATE: 1/15/7I
RECEIVED IN C.O.B. LAB BY:
DATE: 7; / / z
SHIPPED FROM C.O.B. LAB BY:
DATE:
TIME: /03b
PH TIME PH ANALYST
TIME: 1 1 2-0
1./1,---6-Az 47y
A TEME: l (a O
L
TIME:
RECEIVED IN A & L LAB BY;
DATE; TIME;
SEND
RO A
• C.
A HACKERS BEND COURT
WINSTON-SALEM NC 27103
TELEPHONE-1-877-267-2687
FAX - 336-766-8652
SEND COPY TO
SHANE FLETCHER
City of Burlington
P.O. BOX 1358
BURLINGTON NC 27216-1358
TELEPHONE 336-570-6138
FAX 336-570-6139
SAMPLE I.D.#ML Q4/0 --6.114 L4,
Will the results of this sample be used for compliance reporting. YES
NCDENR-DWQ
WATER QUALITY SECTION
NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION
1617 MAIL SERVICE CENTER
RALEIGH NC 27699-1617
DO NOT RUN pH
PLEASE RUN
RUN SO4
RUN SL1 & SL2 plus the following -
RUN NH4-N, NO3-N, ORGANIC N, Cd, Cr,
Ni, Pb, As, Hg, Se, CaC034quiv.,
Volatile Solids, Mo, Cl
NO
Sodium
Calcium
Magnesium
Percent Solids
Mackintosh 7/15/21
mg/kg mg/L Equiv Weight Milli Equiv
2400 82.08 23 3.568696
4300 147.06 20 7.353
1400 47.88 12 3.99
3.42
SAR=
SAR 1.50
Na+
/2 (Ca2+ + Mg2+)
09/08/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Report No.: 082521-114
American Testing Technologies, Inc.
Enclosed are the results of the sample(s) submitted to our laboratory on 08/25/2021.
All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The
test results meet requirements of the NELAP standards for methods listed on the
laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010,
6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted.
Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from
the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via
email at samy@americantestingtechnologies.com
S
S
Lro
ory Manager
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT 's
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 1 of 2
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 08/25/2021
Date Reported: 09/08/2021
Date Collected: 08/23/2021
Time Collected: 1215
Client ID #: Mack lagoon
Laboratory ID #: 082521-114
Certificate of Analysis
Parameter
Result
(%)
Result
(mg/kg)
Analysis
Date
Method
Aluminum, Total
139,000
09/02/2021
6010D
Arsenic, Total
<5.0
09/02/2021
6010D
Cadmium, Total
<5.0
09/02/2021
6010D
Calcium, Total
0.32
3,200
09/02/2021
6010D
Chromium, Total
94
09/02/2021
6010D
Copper, Total
40
09/02/2021
6010D
Iron, Total
14,500
09/02/2021
6010D
Lead, Total
<5.0
09/02/2021
6010D
Magnesium, Total
0.13
1,300
09/02/2021
6010D
Manganese, Total
1,400
09/02/2021
6010D
Mercury, Total
<0.20
09/02/2021
7471B
Molybdenum, Total
<5.0
09/02/2021
6010D
Phosphorus, Total
0.90
9,000
09/02/2021
6010D
Nickel, Total
<5.0
09/02/2021
6010D
Potassium, Total
0.04
370
09/02/2021
6010D
Selenium, Total
<5.0
09/02/2021
6010D
Sodium, Total
0.2
2,000
09/02/2021
6010D
Sulfur, Total
0.95
9,500
09/02/2021
6010D
Zinc, Total
67
09/02/2021
6010D
Total Kjeldahl Nitrogen
1.7
17,000
09/03/2021
SM-4500
Ammonia Nitrogen
1.1
11,000
09/03/2021
SM-4500
Organic Nitrogen
0.6
6,000
09/03/2021
Calculation
Nitrate+Nitrite- N
12
09/03/2021,
SM-4500C
Calcium Carbonate Equivalent
37
370,000
08/30/2021
AOAC 955.01
Total Solids
1.87
18,700
08/30/2021
SM-2540G
Total Volatile Solids
62
620,000
08/30/2021
SM-2540G
Moisture
98.13
08/30/2021
SM-2540G
Pale 2 of 2
American Testing Techn®D'lies, One.
1350 Home Avenue Akron, OH 44310
Website: www.AmericanTestingTechnologies.com
Toll Free: 877-634-9906 Phone: (330) 634-9906
Fax: (330) 634-990p 7
L.
O
STANDARD REPORT
DELIVERY
DATE DUE
EXPEDITED REPORT
DELIVERY CD
(SURCHARGE)
DATE DUE
NUMBER OF COOLERS SUBMITTED
PEP SHIPMENT:
REMARKS
'
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\�
'
- 1=
TIME
w
F-
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DATE
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REQUIRED ANALYSIS
L vsnlANUMBER OF CONTAINERS SUBMITTED
C�
=v
c
L1
TIME
A.T.T.
LOG NO.
U 9?SZ1- Il
DATE
w
RELINQUISHED BY: (SIGNATURE)
RECEIVED BY: (SIGNATURE)
MATRIX
TYPE
(""1N3A1OS'110) 01na11 Sf103nbvN0N
CUSTODY
SEAL NO.
a1V
ATT ANALYSIS REQUEST AND
CHAIN OF CUSTODY RECORD
American Testing Technologies; Inc.
0110SIW1S 80 0110S
(2131VM) sno3naV
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CITY OF BURL][NGTON LABORATORY SERVICES
NC Wastewater Laboratory Certification #188
336-222-5133
Sampled pH Analyzed
Sample
ID #
date
time
SU
date
time
analyst
South WWTP Digester #2
,
South WWTP Digester #3
South WWTP Digester #4
East WWTP Digester #1
Mackintosh Lagoon #1
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Mackintosh Lagoon #2
Compost
Other
Certified by J 7Gi ir-oin
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date b/2-_?/Z
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FAX
SAMPLE LOCATION:
CITY OF BURLINGTON
POST OFFICE BOX 1358
BURLINGTON NC 27216-1358
336-570-6138
CONTACT PERSON — SHANE FLETCHER
MACKINTOSH WATER TREATMENT PLANT
CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE
Aackivhsil La .o)/! /
SAMPLED BY: -al o ,t i e)
“,
DATE: P/ok3/2. z/
PH RESULT U t le
DELIVERED TO C.O.B. LAB BY:
DATE: l 02-.3(-0
RECEIVED IN C.O.B. LAB BY:IC6'v0
PH TIME 1.1q5 PH ANALYST
,04\i
DATE: u/ ` / 7,
SHIPPED FROM C.O.B. LAB BY:
DATE:
TIME: /Zia
TIME: T 7 �f 1
/1-717-vi (4/7//,C/LI--
TIME:
RECEIVED IN ± L LAB BY;
DATE; TIME;
i1" :.11IF Cigar
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8652
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SEND COPY TO
SHANE FLETCHER
T City of Burlington
P.O. BOX 1358
BURLINGTON NC 27216-1358
TELEPNONE 336-570-6138
FAX 336-570-6139
SAMPLE I.D.#ML Atkin fj1 14fcra 1'
Will the results of this sample be used for compliance reporting. YES
NCDENR DWQ
WATER QUALITY SECTION
NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION
1617 MAIL SERVICE CENTER
RALEIGH NC 27699-1617
DO NOT RUN pH
PLEASE RUN
RUN SO4
RUN SL1 & SL2 plus the following -
RUN N114-N, NO3-N, ORGANIC N, Cd, C]
Ni, Pb, As, Hg, Se, CaC033equiv.,
Volatile Solids, Mo, Cl
NO
Sodium
Calcium
Magnesium
Percent Solids
Mackintosh 8/23/21
mg/kg mg/L Equiv Weight Milli Equiv
2000 37.4 23 1.626087
3200 59.84 20 2.992
1300 24.31 12 2.025833
1.87
SAR=
SAR 1.03
Na+
/2 (Ca2+ + Mg2+)
09/24/2021
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Report No.: 091021-52
American Testing Technologies, Inc.
Enclosed -are -the -results -of the-sample(s)-submitted to our laboratory -on 09/10/2021.
All analyses were performed according to our laboratory's quality assurance program.
All sample results are reported on an "as -received" wet basis unless otherwise noted. The
test results meet requirements of the NELAP standards for methods listed on the
laboratory's current fields of accreditation (EPA 8260, 8082, 8081, 8151, 8270, 6010,
6020, 1010, 9045, 7471, 1010, 1311, 150.1, 200.7, 200.8, and 245.1) except as noted.
Results apply only to the items submitted to the laboratory for analysis. Pursuant to
NELAP, this report may not be reproduced except in full, and with written approval from
the laboratory.
If you have any questions please contact the laboratory manager at 330-634-9906 or via
email at samy@americantestingtechnologies.com
anager
SL- Test performed by an approved subcontract laboratory
BRL- Below Reporting limit
The results relate only to the items tested. ATT shall have no liability to the client or client's customer with
respect to decisions or recommendations made, actions taken or courses of conduct implemented by either
the client or the client's customer as a result of or based upon the Test Results. In no event shall ATT `s
liability with respect to the Test Results exceed the amount paid to ATT by the client therefore.
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 1 of 2
City of Burlington, NC
Attn: Sharon Wagoner
1302 Belmont Street
Burlington, NC 27215
Date Received: 09/10/2021
Date Reported: 09/24/2021
Date Collected: 09/09/2021
Time Collected: 0930
Client ID #: Mack Lagoon #1
Laboratory ID #: 091021-52
American Testing Technologies, Inc.
Certificate of Analysis
Parameter
Result
(%)
Result
(mg/kg)
Analysis Date
Method
Aluminum, Total
92,000
09/15/2021
6010D
Arsenic, Total
<5.0
09/15/2021
6010D
Cadmium, Total
<5.0
09/15/2021
6010D
Calcium, Total
0.57
5,700
09/15/2021
6010D
Chromium, Total
139
09/15/2021
6010D
Copper, Total
28
09/15/2021
6010D
Iron, Total
20,000
09/15/2021
6010D
Lead, Total
<5.0
09/15/2021
6010D
Magnesium, Total
0.14
1,400
09/15/2021
6010D
Manganese, Total
1,500
09/15/2021
6010D
Mercury, Total
<0.20
09/15/2021
7471B
Molybdenum, Total
<5.0
09/15/2021
6010D
Phosphorus, Total
0.30
3,000
09/15/2021
6010D
Nickel, Total
<5.0
09/15/2021
6010D
Potassium, Total
0.01
100
09/15/2021
6010D
Selenium, Total
<5.0
09/15/2021
6010D
Sodium, Total
0.06
570
09/15/2021
6010D
Sulfur, Total
1.26
12,600
09/15/2021
6010D
Zinc, Total
60
09/15/2021
6010D
Total Kjeldahl Nitrogen
1.2
12,000
09/21/2021
SM-4500
Ammonia Nitrogen
0.8
8,000
09/21/2021
SM-4500
Organic Nitrogen
0.4
4,000
09/21/2021
Calculation
Nitrate+Nitrite- N
10
09/16/2021
SM-4500C
Calcium Carbonate Equivalent
32
320,000
09/17/2021
AOAC 955.01
Total Solids
2.70
27,000
09/15/2021
SM-2540G
Total Volatile Solids
46
460,000
09/10/2021
SM-2540G
Moisture
97.30
09/10/2021
SM-2540G
1350 Home Avenue Akron, Ohio 44310
Toll Free: 877.634.9906 Phone: 330.634.9906 Fax: 330.634.9907
www.AmericanTestingTechnologies.com
Page 2 of 2
American Testing Technologies, Inc,
ANALYSIS REQUEST AND 1.350 Home Avenue Akron, OH 44310
CHAIN OF CUSTODY. RECORD JVebsite: Nww.AmericanTestingrechnologies.com
Toll Free: 877-634-9906 Phone: (330) 634-9906
Fax: (330) 634-990,7
OF
STANDARD REPORT
DELIVERY
DATE DUE
EXPEDITED REPORT
DELIVERY
(SURCHARGE)
DATE DUE
NUMBER OF COOLERS SUBMITTED
PER DINIPMENY
REMARKS
TIME RELINQUISHED BY: (SIGNATURE) DATE TIME J
I a.CAMMBER OF CONTAINERS SUBMITTED
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PROJECT REFERENCE PROJECT NI
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PROJECT MANAGER P.O. NUMB
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RECCEIVED BY: (SIGNATURE)
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DATE I TIME
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crrY OF URLIN4STON LA ORATORY sERYICES
NC Wastewater Laboratory Certification #188
336-222-5133
Sampled 1 pH Analyzed
Sample
ID #
date
time
SU
date
time
analyst
South WWTP Digester #2
South WWTP Digester #3
South WWTP Digester #4
East WWTP Digester #1
Mackintosh Lagoon #1
rno6L la
ci%cI It
Uc130
5,05
q/qi/zt
i 1-15
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Mackintosh Lagoon #2
Compost
Other
Certified by (i)CW01/1 V)cii90,4--et
date vl /9/ &)
CITY OF BURLINGTON
POST OFFICE BOX 1358
BURLINGTON NC 27216-1358
336-570-6138
CONTACT PERSON — SHANE FLETCHER
MACKINTOSH WATER TREATMENT PLANT
CHAIN OF CUSTODY FOR LAND APPLICATION OF ALUM SLUDGE SAMPLE
SAMPLE LOCATION: A &kid -AS
l
SAMPLED BY $. Q'& QL
qfr/h9#
DATE:
PH RESULT G,
DELIVERED TO C.O.B. LAB BY:
DATE:
9/0 197e
RECEIVED IN C.O.B. LAB BY:
TIME:
PH TIME i I `i 5
PH ANALYST
TIME: 5
DATE: "1 ( / 1 TIME: (j (7 Co
SHIPPED FROM C.O.B. LAB BY:
DATE:
RECEIVED IN A & L LAB BY;
DATE; TIME;
SEND COPY TO SYNAGRO c
SYNAGRO SOUTHEAST, INC.
6220 A HACKERS BEND COURT
WINSTON-SALEM NC 27103
TELEPHONE-1-877-267-2687
FAX - 336-766-8652
TIME:
SEND COPY TO
SHANE FLETCHER
City of Burlington
P.O. BOX 1358
BURLINGTON NC 27216-1358
TELEPNONE 336-570-6138
FAX 336-570-6139
4d0la
WM the results of this sample be used for compliance reporting. YES
NCDENR DWQ
WATER QUALITY SECTION
NON -DISCHARGE COMPLIANCE ENFORCEMENT SECTION
1617 MAIL SERVICE CENTER
RALEIGH NC 27699-1617
DO NOT RUN pH
PLEASE RUN
RUN SO4
RUN SL1 & SL2 plus the following -
RUN NH4-N, NO3-N, ORGANIC N, Cd, Cr,
Ni, Pb, As, Hg, Se, CaCQuiv.,
Volatile Solids, Mo, Cl
NO
Mackintosh 9/9/21
mg/kg mg/L Equiv Weight Milli Equiv
Sodium 570 15.39 23 0.66913
Calcium 5700 153.9 20 7.695
Magnesium 1400 37.8 12 3.15
Percent Solids 2.7 Na+
SAR=
SAR 0.29
/2 (Ca2+ + Mg2+)