WQ0038087_More Information (Received)_20230824

0812412023
REVISED PORTIONS or ADDITIONAL INFO for Permit Mod. Application
RLAP: WQ0038087
Terra Renewal Services, Inc
Original Submittal Date: 7/24/23
Based on site evaluation (8/22/23) and review by Winston Salem DWR
Contents:
- Updated LOA Form
- Revised Buffer Map for Field MF-16
- Revised Portions of Application based on Acreage Change:
o Pg 2 of Form RLAP 06-16
o Form LASC 06-16
o RYE Summary Table
- Pictures of Storage / Transfer tank for DAF Residuals at Tyson -Danville

DW
,w R
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .I100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit.
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .l 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
Qr Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
[Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
Rr A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: I E2fR^ l<EN�. 4�- SE�e..� c� s� _f7— .
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID
Lease
(yes/no)
Land Use or
Cropping Patterns
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Nc-wk-r1F-16
YEs
�� C�oP
�N,.,�� �N
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16 Pagel of 3

I. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-D WR, Non -Discharge Permitting Unit, 1617 Mail
Service Center, Raleigh, NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the land
application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of the
equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals land
application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final soil
pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of nutrients
(e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior to and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
IL RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land application
site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land application
events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-month
period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land application
event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land application
event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the compliance
boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance boundary provided
the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed compliance
boundary to the application package)
O/A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new oroeram:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landownername: "T 14l,3 (7 RyPC(ZT 1 �S LLG
Address: —ASs Mathis Farrms LLC
City: 615 Mathis Farm Rd State:
Roaring River, K 28669
Zip:
Phone: ` (7 E-mail address: Ls rn/-+Tt+t l Qm--t u_ . c a-7
Signature: Date: 3 J 3
NORTH CAROLINA, i V) eS COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the �Jr Y M
day of k-&5 20_ 23 . ��kGsmn+?ssta�
Signature and seal: �,vt 0( 1
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name: AS✓�/-7 7tl-(J ��}-lzw,S CLC_ ('C/or LUIcE e2eTHt�
Address:
615 Mathis Farm Rd
City: Rearing fiver, NG 2 66Q State: Zip:
Phone: L/ - E-mail address: ��f+'I� Tt F tS (� CA-1�1L _Coo
Signature: Date: J-3
Permittee's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name: %•�,4 e ���'�c S2 £N�.Ro. Mw1+abe2 �Tenan
Signature: �� C • -�C Date: S/2 -3 -vs
FORM: LOA 06-16 Page 3 of 3

III. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 615 Mathis Farm Rd (Location of Office of LJC Environmental, LLC)
City: Roaring River State: NC Zip: 25669
Coordinates: Latitude: 36' 08' 51" Longitude: 80' 59' 09"
Datum: NAD 83 Level of accuracy: Nearest Second
Method of measurement: MAP
2. County where residuals land application program is headquartered: Wilkes
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Luke Mathis
LJC Environmental, LLC
1003524
Back -Up ORC
David Coyle
Denali Water Solutions
995723
Additional Back -Up
Will Hodges
Denali Water Solutions
997282
ORCs
Ivan Heatwole
Denali Water Solutions
1002031
if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 5,785 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
36.2
46.4
209,417
268,424
Five -Year Maximum Adjusted
49.4
59.5
285,779
344,208
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
W
Row Crops
1,753.0
Hay
Pasture
Total:
1,753.0
Methods
Surface
_
Incorporation or Injection
I'753.0
Total:
1,753.0
FORM: RLAP 06-16 Page 2 of 5

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North Carolina - Realistic Yield Expectation (RYE) Summary
Permit#: WQ0038087
Permittee: Terra Renewal Services, Inc
2023
(Updated for Permit Modification)
Field ID
Net
Acres
County
Predominent Soil Series & Slope
Crop 1
PAN
(lb/ac)
RYE
Crop 2
PAN
(lb/ac)
RYE
CH-1
21.8
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
CH-2
19.3
Wilkes
RyB - Ronda 0-5%
Corn (silage)
162
13.7 tons/ac
Small Grains (silage)
78
6.4 tons/ac
CH-3
41.6
Wilkes
BaB - Banister 1-6%
Corn (silage)
285
26.6 tons/ac
Small Grains (silage)
113
10.5 tons/ac
CH-4
35.8
Wilkes
CoA- Codorus 0-2%
Corn (silage)
270
26.0 tons/ac
Small Grains (silage)
95
9.0 tons/ac
DF-1
8.8
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
DF-2
68.5
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
DF-3
35.5
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
DF-4
18.5
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
DM-3
11.4
Wilkes & Yadkin
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
DM-5
21.0
Wilkes
Cc62 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
DM-6
25.6
Wilkes
Cc62 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
DM-7
32.6
Wilkes & Yadkin
Cc62 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
DM-8
26.2
Wilkes & Yadkin
CcC2 - Clifford 6-10%
Corn (silage)
231
21.2 tons/ac
Small Grains (silage)
112
10.1 tons/ac
DS-1
53.6
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
DS-2
42.1
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
DS-3
33.6
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
DS-4
28.7
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
DS-5
16.0
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
DS-6
16.7
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
DS-7
23.8
Wilkes
DpB2 - Danripple 2-8%
Corn (silage)
212
19.5 tons/ac
Small Grains (silage)
98
8.8 tons/ac
DS-8
41.4
Wilkes
PaB - Pfafftown 1-6%
Corn (silage)
219
20.1 tons/ac
Small Grains (silage)
101
9.1 tons/ac
DS-9
41.2
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
DS-10
6.3
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
ED-1
30.0
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
ED-2
14.8
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
ED-3
12.1
Wilkes
BaB - Banister 1-6%
Corn (silage)
285
26.6 tons/ac
Small Grains (silage)
113
10.5 tons/ac
ED-4
25.1
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
HP-1
15.9
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
HP-3
14.5
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-6
22.5
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-8
12.7
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-9
13.2
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
MF-10
19.6
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
MF-11
22.5
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-13
33.8
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
MF-14
23.4
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-15
13.8
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-16
48.8
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-17
39.5
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
MF-23
59.2
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
MRF-3
18.9
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
MRF-5
25.3
Wilkes
DpB2 - Danripple 2-8%
Corn (silage)
212
19.5 tons/ac
Small Grains (silage)
98
8.8 tons/ac
MRF-6
21.0
Wilkes
DpB2 - Danripple 2-8%
Corn (silage)
212
19.5 tons/ac
Small Grains (silage)
98
8.8 tons/ac
MRF-12
26.5
Wilkes
PaB - Pfafftown 1-6%
Corn (silage)
219
20.1 tons/ac
Small Grains (silage)
101
9.1 tons/ac
MRF-13
41.0
Wilkes
RyB - Ronda 0-5%
Corn (silage)
162
21.8 tons/ac
Small Grains (silage)
98
9.3 tons/ac
MRF-14
18.5
Wilkes
DpC2 - Danripple 8-15%
Corn (silage)
179
16.4 tons/ac
Small Grains (silage)
82
7.4 tons/ac
MRF-15
34.9
Wilkes
RyB - Ronda 0-5%
Corn (silage)
162
21.8 tons/ac
Small Grains (silage)
98
9.3 tons/ac
MRF-20
52.3
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
MRF-21
27.8
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
MRF-22
31.4
Wilkes
RyB - Ronda 0-5%
Corn (silage)
162
13.7 tons/ac
Small Grains (silage)
78
6.4 tons/ac
RJ-1
20.6
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
RJ-2
57.8
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
RJ-5
45.1
Wilkes
DaA- Dan River & Comus 0-4%
Corn (silage)
237
21.8 tons/ac
Small Grains (silage)
103
9.3 tons/ac
RJ-7
24.6
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
SP-1
12.7
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
SP-2
26.8
Wilkes
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
TA-1
32.3
Yadkin
Cc62 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
WB-1
23.2
Wilkes
RyB - Ronda 0-5%
Corn (silage)
162
13.7 tons/ac
Small Grains (silage)
78
6.4 tons/ac
YF-1
13.5
Yadkin
NaB - Nathalie 2-6%
Corn (silage)
203
18.6 tons/ac
Small Grains (silage)
98
8.8 tons/ac
YF-3
22.3
Yadkin
Cc62 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
YF-4
23.3
Yadkin
CeB3 - Clifford 2-6%
Corn (silage)
246
22.5 tons/ac
Small Grains (silage)
120
10.8 tons/ac
YF-5
51.5
Wilkes & Yadkin
FcC2 - Fairview 8-15%
Corn (silage)
174
16.0 tons/ac
Small Grains (silage)
80
7.2 tons/ac
YF-7
10.3
Wilkes
FcB2 - Fairview 2-8%
Corn (silage)
207
19.0 tons/ac
Small Grains (silage)
95
8.6 tons/ac
NOTES: 1753.0
RYE are based on predominant soil series for field and data provided by NCSU at https://reaIisticyields.ces.ncsu.edu (adjusted rates November 2021)

Transfer / Storaee Tank for DAF Residuals at Tvson-Danville