WQ0036561_Final Permit_20140827

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 27, 2014
Barry T. Dunkley, P.E., Director
Division of Water and Waste Treatment
City of Danville
279 Park Avenue
Danville, Virginia 24540
Dear Mr. Dunkley:
John E. Skvarla, III
Secretary
Subject: Permit No. WQ0036561
City of Danville
Northside WWTP Land
Application of Class B
Residuals (Non -Dedicated)
Pittsylvania (Virginia)
In accordance with your permit major modification request received May 30, 2014, and
subsequent additional information received by the Winston Salem Regional Office on July 2, 2014, we
are forwarding herewith Permit No. WQ0036561 dated August 27, 2014, to the City of Danville for the
continued operation of the subject residuals management program.
Modifications to the subject permit are as follows:
Transferring eight fields from the City of Eden's land application program to the City of
Danville's land application program (NC-CS06-01, NC-CS06-02, NC-CS06-03, NC-
CS06-04. NC-CS08-01, NC-CS08-02, NC -CS -08-03, and NC-CS09-02)
Transferring and modifying three fields from the City of Eden's land application program
to the City of Danville's land application program (NC-CS09-01, NC-CS09-03, and NC-
CS09-09)
Adding nine new fields to the land application program (NC-CS09-10, NC-PSO1-01, NC-
PS02-01, NC-PS02-02, NC-PS02-03, NC-PS02-04, NC-PS02-05, NC-PS02-06, and NC-
PS03-01)
As a result of this modification the City of Danville will have 894.64 acres of certified land
application area in their permit.
This permit shall be effective from the date of issuance until December 31, 2016 and shall void
Permit No. WQ0036561 issued July 25, 2013 and shall be subject to the conditions and limitations as
specified therein. Please pay particular attention to the monitoring requirements listed in Attachments A
for they may differ from the previous permit issuance. Failure to establish an adequate system for
collecting and maintaining the required operational information shall result in future compliance
problems.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] Internet: htto://Portal.ncdenr.orglwebfwg
An Equal Opportunity l Afumative Action Employer— Made in part with recycled paper

Mr. Dunkley
August 27, 2014
Page 2 of 2
If any parts, requirements or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Alice M. Wessner at
[phone] or [e-mail].
Sincerely,
ho asl� A. Reeder Director
Division of Water Resources
cc: Caswell County Health Department (Electronic Copy)
Winston Salem Regional Office, Water Quality Regional Operations Section
Rob Wilcox, S&ME, Inc. 3718 Old Battleground Road, Greensboro, North Carolina 27410
(Electronic Copy)
Beth Buffington — Protection and Enforcement Branch (Electronic Copy)
Central Files
Digital Permit Archive (Electronic Copy)

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
LAND APPLICATION OF CLASS B RESIDUALS PERMIT (NON -DEDICATED)
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
City of Danville
Pittsylvania County (Virginia)
FOR THE
continued operation of a residuals management program for the City of Danville and consisting of the
land application of Class B residuals generated by the approved facilities Iisted in Attachment A to the
approved sites listed in Attachment B with no discharge of wastes to surface waters, pursuant to the
application received May 30, 2014, and subsequent additional information received by the Division of
Water Resources, and in conformity with other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit. The use and
disposal of residuals are regulated under Title 40 Code of Federal Regulations Part 503.This permit does
not exempt the Permittee from complying with the federal regulations.
This permit shall be effective from the date of issuance until December 31, 2016 shall void Permit No.
WQ0036561 issued July 25, 2013 and shall be subject to the following specified conditions and
limitations:
I. SCHEDULES.
1. No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application.
H. PERFORMANCE STANDARDS
The subject residuals management program shall be effectively maintained and operated at all times
so there is no discharge to surface waters, nor any contravention of groundwater or surface water
standards. In the event the facilities fail to perform satisfactorily, including the creation of nuisance
conditions due to improper operation and maintenance, the Permittee shall immediately cease land
applying residuals to the site, contact the Winston Salem regional office supervisor, and take any
immediate corrective actions.
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2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or
surface water resulting from the operation of this residuals management program.
3. Only residuals generated by the facilities listed in Attachment A are approved for land application in
accordance with this permit.
4. Only the sites listed in Attachment B are approved for residuals land application.
5. Pollutant concentrations in residuals applied to land application sites listed in Attachment B shall not
exceed the foIIowing Ceiling Concentrations (i.e., dry weight basis) or Cumulative Pollutant
Loading Rates (CPLRs):
Parameter
Ceiling Concentration
(milligrams per kilogram)
CPLR
(poundsper acre)
Arsenic
75
36
Cadmium
85
34
Copper
4,300
1,338
Lead
840
267
Mercury
57
15
Molybdenum
75
nla
Nickel
420
374
Selenium
100
89
Zinc
7,500
2,498
The Permittee shall determine compliance with the CPLRs using one of the following methods:
a. By calculating the existing cumulative level of pollutants using actual analytical data from all
historical land application events of residuals, or
b. For land where residuals application have not occurred or for which the required data is
incomplete, by determining background concentrations through representative soil sampling.
6. Residuals that are land applied shall meet Class B pathogen reduction requirements in 15A NCAC
02T .1106 (a) and (c). Exceptions to this requirement shall be specified in Attachment A.
7. Biological residuals (i.e. residuals generated during the treatment of domestic or animal processing
wastewater, or the biological treatment of industrial wastewater, and as identified in Attachment A)
that are land applied shall meet one of the vector attraction reduction alternatives in 15A NCAC 02T
.1107(a). Exceptions to this requirement shall be specified in Attachment A.
8. Setbacks for treatment and storage facilities shall be as follows:
Setback Description
Setback
feet
Habitable residence or place of public assembly under separate ownership or not
100
to be maintained as part of the project site
Property lines
50
Private or public water supply
100
Surface waters (streams — intermittent and perennial, perennial waterbodies, and
50
wetlands)
Wells with exception to monitoring wells
100
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and appropriate nutrient application rates reported in any of the following documents:
i. Crop management plan as outlined by the local Cooperative Extension Office, the North
Carolina Department of Agriculture and Consumer Services, the Natural Resource
Conservation Service, or other agronomist.
ii. Waste Utilization Plan as outlined by the Senate Bill 1217 Interagency Group - Guidance
Document: Chapter I
(IMV://www.neaar.gov/SWC/tech/documents/9th Guidance_ Doc 100109.1)d
iii. Certified Nutrient Management Plan as outlined by the Natural Resources Conservation
Services (MRCS). These plans must meet the USDA-NRCS 590 Nutrient Management
Standards (ft://ftp-fc.se.egov.usda.gov/NHOipractice-standards/standardsi590.pdf).
d. If the RYE and appropriate nutrient application rates cannot be determined, the Permittee shall
contact the Division to determine necessary action.
12. When residuals are land applied to grazed pasture, hay crop realistic nitrogen rate shall be reduced by
25% in accordance with the USDA-NRCS 590 Nutrient Management Standards.
13. If land application sites are to be over -seeded or double -cropped (e.g., bermuda grass in the summer
and rye grass in the winter with both crops to receive residuals), then the second crop can receive an
application of PAN at a rate not to exceed 50 pounds per acre per year (lbs/ac/yr). This practice may
be allowed as long as the second crop is to be harvested or grazed. If the second crop is to be planted
for erosion control only and is to be tilled into the soil, then no additional PAN shall be applied.
14. Prior to land application of residuals containing a sodium adsorption ratio (SAR) of 10 or higher, the
Permittee shall obtain and implement recommendations from at least one of the following: the local
Cooperative Extension Office; the Department of Agriculture and Consumer Services; the Natural
Resource Conservation Service; a North Carolina Licensed Soil Scientist; or an agronomist. The
recommendations shall address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a
mechanism for maintaining site integrity and conditions conducive to crop growth. The Permittee
shall maintain written records of these recommendations and details of their implementation.
15. The compliance boundary for residual land application sites shall be specified in accordance with
15A NCAC 02L .0107(b). These sites were individually permitted on or after December 30, 1983;
therefore, the compliance boundary is established at either 250 feet from the residual land application
area, or 50 feet within the property boundary, whichever is closest to the residual land application
area. An exceedance of groundwater standards at or beyond the compliance boundary is subject to
remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement actions in
accordance with North Carolina General Statute 143-215.6A through 143-215.6C. Any approved
relocation of the COMPLIANCE BOUNDARY will be noted in Attachment B.
16. In accordance with 15A NCAC 02L .0 108, the review boundary shall be established midway between
the compliance boundary and the residual land application area. Any exceedance of groundwater
standards at the review boundary shall require action in accordance with 15A NCAC 02L.01 K
1. OPERATION AND MAINTENANCE REOUIREMENTS
1. The residuals management program shall be properly maintained and operated at all times. The
program shall be effectively maintained and operated as a non -discharge system to prevent any
contravention of surface water or groundwater standards.
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9. Setbacks for Class B land application sites shall be as follows:
10. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
11. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the Iast five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science(htti)://nutrients.soil.nesu.edu/yields/l*ndex.phl) .
A copy shall be kept on file and reprinted every five years in accordance with Condition N.6.
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
WQ0036561 Version 1.1 Shell Version 140324 Page 3 of 12
Setback by application type
(feet)
Setback Description
Vehicular
irrigation
Surface
Surface
injection /
Application
Application
Incorporation
Habitable residence or place of public assembly
under separate ownership or not to be maintained as
400
400
200
art of the project site
Habitable residence or places of public assembly
owned by the Permittee, the owner of the land, or the
0
200
0
lessee/operator of the land to be maintained as part
of the project site
Property lines
50
150
50
Public right of way
50
50
50
Private or public water supply
100
100
100
Surface waters (streams — intermittent and perennial,
100
100
50
perennial waterbodies, and wetlands
Surface water diversions (ephemeral streams,
waterways, ditches)
25
100
25
Groundwater lowering ditches (where the bottom of
25
100
25
the ditch intersects the SHWT
Subsurface groundwater lowering system
0
100
0
Wells with exception to monitoring wells
100
100
100
Bedrock outcrops
25
25
25
Top of slope of embankments or cuts of two feet or
more in vertical height
15
15
15
Building foundations or basements
0
15
0
Water lines
0
10
0
Swimming pools
100
100
100
Nitrification fields
0
20
0
10. Land application areas shall be clearly marked on each site prior to and during any residuals
application event.
11. Bulk residuals and other sources of Plant Available Nitrogen (PAN) shall not be applied in
exceedance of agronomic rates. Appropriate agronomic rates shall be calculated using expected
nitrogen requirements based on the determined Realistic Yield Expectations (RYE) using any of the
following methods:
a. Division's pre -approved site specific historical data for specific crop or soil types by calculating
the mean of the best three yields of the Iast five consecutive crop harvests for each field.
b. North Carolina Historical Data for specific crop and soil types as provided by North Carolina
State University Department of Soil Science(htti)://nutrients.soil.nesu.edu/yields/l*ndex.phl) .
A copy shall be kept on file and reprinted every five years in accordance with Condition N.6.
c. If the RYE cannot be determined using methods (a) or (b) above, the Permittee may use the RYE
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2. The Winston Salem Regional Office, telephone number [phone], and the appropriate local
government official (i.e., county manager, city manager, or health director) shall be notified at least
48 hours prior to the initial residuals land application to any new land application site. Notification to
the regional supervisor shall be made from 8:00 a.m. until 5:00 p.m. on Monday through Friday,
excluding State Holidays,
3. The Winston Salem Regional Office shall be notified via email or telephone, [phone], at least
24 hours prior to conducting any land application activity. Such notification shall indicate, at a
minimum, the anticipated application times, field IDs, and location of land application activities. If it
becomes necessary to apply to additional fields due to unforeseen events, the Regional Office shall be
notified prior to commencing the application to those fields.
4. The Permittee shall maintain an approved Operation and Maintenance Pian (O&M Plan) pursuant to
15A NCAC 02T .1110. Modifications to the O&M Plan shall be approved by the Division prior to
utilization of the new plan. The O&M Plan, at the minimum, shall include:
a) Operational functions;
b) Maintenance schedules;
c) Safety measures;
d) Spill response plan;
e) inspection plan including the following information:
i. Names and/or titles of personnel responsible for conducting the inspections;
ii. Frequency and location of inspections, including those to be conducted by the ORC, and
procedures to assure that the selected location(s) and inspection frequency are representative
of the residuals management program;
iii. Detailed description of inspection procedures including record keeping and actions to be
taken by the inspector in the event that noncompliance is observed pursuant to the
noncompliance notification requirements under the monitoring and reporting section of the
permit;
f) Sampling and monitoring plan including the following information:
i. Names and/or titles of personnel responsible for conducting the sampling and monitoring;
ii. Detailed description of monitoring procedures including parameters to be monitored;
iii. Sampling frequency and procedures to assure that representative samples are being collected.
Fluctuation in temperature, flow, and other operating conditions can affect the quality of the
residuals gathered during a particular sampling event. The sampling plan shall account for
any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that
land apply multiple times per year but have an annual sampling frequency, may need to
sample during winter months when pathogen reduction is most likely to be negatively
affected by cold temperatures).
5. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the facility, the Permittee shall designate and employ a certified operator in
responsible charge (ORC) and one or more certified operators as back-up ORCs in accordance with
15A NCAC 08G .0201. The ORC or their back-up shall visit the facilities in accordance with 15A
NCAC 08G. 0204, or as specified in the most recently approved O&M plan (i.e., see Condition III.
4.), and shall comply with all other conditions of 15A NCAC 08G. 0204. For more information
regarding classification and designation requirements, please contact the Division of Water
Resources' Technical Assistance & Certification Unit at [phone].
6. When the Permittee land applies bulk residuals, a copy of this permit and a copy of O&M PIan shall
be maintained at the land application sites during land application activities.
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7. When the Permittee transports or land applies bulk residuals, the spill control provisions shall be
maintained in all residuals transport and application vehicles.
8. Residuals shall not be stored at any land application site, unless written approval has been requested
and received from the Division.
9. When the Permittee land applies bulk residuals, adequate measures shall be taken to prevent wind
erosion and surface runoff from conveying residuals from the land application sites onto adjacent
properties or into surface waters.
10. When the Permittee land applies bulk residuals, a suitable vegetative cover shall be maintained on
land application sites onto which residuals are applied, or application shall be in accordance with the
crop management plan outlined by the local Cooperative Extension Office, the Department of
Agriculture and Consumer Services, the Natural Resource Conservation Service, or an agronomist
and as approved by the Division.
11. Bulk residuals shall not be land applied under the following conditions:
a. If the residuals are likely to adversely affect a threatened or endangered species listed under
section 4 of the Endangered Species Act or its designated critical habitat;
b. If the application causes prolonged nuisance conditions;
c. If the land fails to assimilate the bulk residuals or the application causes the contravention of
surface water or groundwater standards;
d. If the land is flooded, frozen or snow-covered, or is otherwise in a condition such that runoff of
the residuals would occur;
e. Within the 100 -year flood elevation, unless the bulk residuals are injected or incorporated within
a 24-hour period following a residuals land application event;
f. During a measurable precipitation event (i.e., greater than 0.01 inch per hour), or within 24 hours
following a rainfall event of 0.5 inches or greater in a 24-hour period;
g. If the slope is greater than 10% for surface applied liquid residuals, or if the slope is greater than
18% for injected or incorporated bulk liquid residuals;
h. If the soil pH is not maintained at 6.0 or greater, unless sufficient amounts of lime are applied to
achieve a final soil pH of at least 6.0, or if an agronomist provides information indicating that the
pH of the soil, residuals and lime mixture is suitable for the specified crop. Any approved
variations to the acceptable soil pH (6A) will be noted in this permit;
L If the land does not have an established vegetative cover unless the residuals are incorporated or
injected within a 24-hour period following a residuals land application event. Any field that is in
a USDA no -till program shall be exempted from meeting this vegetative cover requirement;
j. If the vertical separation between the seasonal high water table and the depth of residuals
application is less than one foot;
k. If the vertical separation of bedrock and the depth of residuals application is less than one foot;
1. Application exceeds agronomic rates.
12. The following public access restrictions apply to residual land application sites:
a. Public access to public contact sites (e.g., golf courses, parks, ball fields, etc.) shall be restricted
for 365 days after a residuals land application event;
b. Public access to non-public contact sites shall be restricted for 30 days after a residuals land
application event.
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2. Residuals shall be analyzed to demonstrate they are non -hazardous under the Resource Conservation
and Recovery Act (RCRA). The analyses [corrosivity, ignitahility, reactivity, and toxicity
characteristic leaching }procedure (TCLP)] shall be performed at the frequency specified in
Attachment A, and the Permittee shall maintain these results for a minimum of five years. Any
exceptions from the requirements in this condition shall be specified in Attachment A.
The TCLP analysis shall include the following parameters (the regulatory level in milligrams per liter
is in parentheses):
Arsenic (5.0)
1,4 -Dichlorobenzene (7.5)
Nitrobenzene (2.0)
Barium (100.0)
1,2-Dichloroethane (0.5)
Pentachlorophenol (100.0)
Benzene (0.5)
1, 1 -Dichloroethylene (0.7)
Pyridine (5.0)
Cadmium (1.0)
2,4-Dinitrotoluene (0.13)
Selenium (1.0)
Carbon tetrachloride (0.5)
Endrin (0.02)
Silver (5.0)
Chlordane (0.03)
Hexachlorobenzene (0.13)
Tetrachloroethylene (0.7)
Chlorobenzene (100.0)
Heptachlor (and its hydroxide)
(0.00s
Toxaphene (0.5)
Chloroform (6.0)
Hexachloro-1,3-butadiene (0.5)
Trichloroethylene (0.5)
Chromium (5.0)
Hexachloroethane (3.0)
2,4,5 -Trichlorophenol (400.0)
in -Cresol (200.0)
Lead (5.0)
2,4,6 -Trichlorophenol (2.0)
o -Cresol (200.0)
Lindane (0.4)
2,4,5 -TP (Silvex) (1.0)
p -Cresol (200.0)
Mercury (0.2)
Vinyl chloride (0.2)
Cresol (200.0)
Methoxychlor (10.0)
2,4-D (10.0)
Methyl ethyl ketone (200.0)
Once the residuals have been monitored for two years at the frequency specified in Attachment A,
the Permittee may submit a permit modification request to reduce the frequency of this monitoring
requirement. In no case shall the monitoring frequency be less than once per permit cycle.
3. An analysis shall be conducted on residuals from each source generating facility at the frequency
specified in Attachment A, and the Permittee shall maintain the results for a minimum of five years.
The analysis shall include the following parameters:
Aluminum
Mercury
Potassium
Ammonia -Nitrogen
Molybdenum
Selenium
Arsenic
Nickel
Sodium
Cadmium
Nitrate -Nitrite Nitrogen
Sodium Adsorption Ratio
(SAR)
Calcium
Percent Total Solids
TKN
Copper
pH
Zinc
Lead
Phosphorus
Magnesium
Plant Available Nitrogen
(by calculation)
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13. Public access controls shall include the posting of signs with a minimum area of 3 square feet (e.g.,
1.5' x 2'). Each sign shall indicate the activities conducted at each site, permit number, and name and
contact information, including the Permittee or applicator's telephone number. Signs shall be posted
in a clearly visible and conspicuous manner at the entrance to each land application site during a land
application event, and for as long as the public access restrictions required under III.12 apply.
14. The following harvesting and grazing restrictions apply to residual land application sites after each
land application event:
Harvesting and Grazing Description
Restricted
Duration
Animals shall not be allowed to graze during land application activities and
restricted period. Sites that are to be used for grazing shall have fencing to
30 days
prevent access after each land application event.
Food crops, feed crops and fiber crops shall not be harvested for:
30 days
Turf grown on land where residuals have been applied shall not be harvested for:
12 months
Food crops with harvested parts that touch the residual/soil mixture and are
totally above the land surface (e.g., tobacco, melons, cucumbers, squash, etc.)
14 months
shall not be harvested for:
When the residuals remain on the land surface for four months or longer prior to
incorporation into the soil, food crops with harvested parts below the land
20 months
surface (e.g., root crops such as potatoes, carrots, radishes, etc.) shall not be
harvested for:
When the residuals remain on the land surface for less than four months prior to
incorporation into the soil, food crops with harvested parts below the land
3 S months
surface shall not be harvested for:
15. The Permittee shall acquire from each landowner or lessee/operator a statement detailing the volume
of other nutrient sources (i.e., manufactured fertilizers, manures, or other animal waste products) that
have been applied to the site, and a copy of the most recent Nutrient Management Plan (NMP) for
those operations where a NMP is required by the US Department of Agriculture — National Resources
Conservation Service (MRCS) or other State Agencies. The Permittee shall calculate allowable
nutrient loading rates based on the provided information and use appropriate reductions.
For the purpose of this permit condition, a Crop Management Plan (CMP), Waste Utilization Plan
(WUP) or Certified Nutrient Management Plan (CNMP) shall also be considered a Nutrient
Management Plan.
16. No residuals shall be land applied unless the submitted Land Owner Agreement Attachment (LORA)
between the Permittee and landowners or lessees/operators of the land application site is in full force
and effect. These agreements shall be considered expired concurrent with the permit expiration date,
and shall be renewed during the permit renewal process.
2. MONITORING AND REPORTING REQUIREMENTS
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water
analyses) necessary to ensure groundwater and surface water protection shall be established, and an
acceptable sample reporting schedule shall be followed.
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3.
n. Annual and cumulative totals in dry tons per acre of residuals as well as animal waste and other
sources of nutrients (e.g., if applicable), annual and cumulative pounds per acre of each heavy
metal (e.g., shall include, but shall not be limited to, arsenic, cadmium, copper, lead, mercury,
molybdenum, nickel, selenium, and zinc), annual pounds per acre of PAN, and annual pounds per
acre of phosphorus applied to each field.
8. Three copies of an annual report shall be submitted on or before March 1'. The annual report shall
meet the requirements described in the Instructions for Residuals Application Annual Reporting
Forms. Instructions for reporting and annual report forms are available at
http:iiportal.ncdenr.org/wekl/wq/aps,`lau/reportin_,or can be obtained by contacting the Land
Application Unit directly. The annual report shall be submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
9. Noncompliance Notification
The Permittee shall report by telephone to the Winston Salem Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working day
following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence with the land application program resulting in the land application of significant
amounts of wastes that are abnormal in quantity or characteristic.
b. Any failure of the land application program resulting in a release of material to surface waters.
c. Any time self-monitoring indicates the facility has gone out of compliance with its permit
Iimitations.
d. Any process unit failure, due to known or unknown reasons, rendering the facility incapable of
adequate residual treatment.
e. Any spill or discharge from a vehicle or piping system during residuals transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
be taken to ensure that the problem does not recur.
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
subject facilities and shall be in accordance with the approved O&M Plan.
2. Prior to each bulk residuals land application event, the Permittee or his designee shall inspect the
residuals storage, transport and application facilities to prevent malfunctions, facility deterioration
and operator errors resulting in discharges, which may cause the release of wastes to the
environment, a threat to human health or a public nuisance. The Permittee shall maintain an
inspection log that includes, at a minimum, the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken. The Permittee shall maintain this inspection log
for a period of five years from the date of inspection, and this log shall be made available to the
Division upon request.
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4. Residuals shall be monitored for compliance with pathogen and vector attraction reduction
requirements at the frequency specified in Attachment A, and at the time indicated in the sampling
and monitoring sections of the approved O&M plan. The required data shall be specific to the
stabilization process utilized, and sufficient to demonstrate compliance with the Class B pathogen
reduction requirements in 15A NCAC 02T .1106 (a) and (c) and one vector attraction reduction
requirement in 15A NCAC 02T .1107 (a) shall be met. Any exceptions from the requirements in this
condition shall be specified in Attachment A.
5. An annual representative soils analysis (i.e., Standard Soil Fertility Analysis) shall be conducted on
each land application site listed in Attachment B on which a residuals land application event will
occur in the respective calendar year. This analysis shall be in accordance with the "Guidance on Soil
Sampling" located in the Sampling Instructions section of the NC Department of Agriculture &
Consumer Services' website (http://www.ncagr.gov/agronomi/pubs.htm). The Permittee shall
maintain these results and a description of the sampling methodologies used to determine soil fertility
for a period of no less than five years, and shall be made available to the Division upon request. At a
minimum, the Standard Soil Fertility Analysis shall include the following parameters:
Acidity
Exchangeable Sodium Percentage
Phosphorus
Base Saturation (by calculation)
Magnesium
Potassium
Calcium
Manganese
Sodium
Cation Exchange Capacity
Percent Humic Matter
Zinc
Copper
pH
6. Laboratory parameter analyses shall be performed on the residuals as they are land applied all be in
accordance with the monitoring requirements in 15A NCAC 02B .0505.
7. The Permittee shall maintain records tracking all residual land application events. At a minimum,
these records shall include the following:
a. Source of residuals;
b. Date of land application;
c. Location of land application (i.e., site, field, or zone number as listed in Attachment B);
d. Approximate areas applied to (acres);
e. Method of land application;
f. Weather conditions (e.g., sunny, cloudy, raining, etc.);
g. Predominant Soil Mapping Unit (e.g., CbB2);
h. Soil conditions (e.g., dry, wet, frozen, etc.);
i. Type of crop or crops to be grown on field;
j. Nitrogen Application Rate based on RYEs (if using data obtained from the North Carolina State
University Department of Soil Science Website, the printout page shall be kept on file and
reprinted every five years);
k. Volume of residuals land applied in gallons per acre, cubic yard per acre, dry tons per acre, or wet
ton per acre;
Volume of animal waste or other nutrient source applied in gallons per acre, dry ton per acre, or
wet tons per acre;
m. Volume of soil amendments (e.g., lime, gypsum, etc.) applied in gallons per acre, dry ton per
acre, or wet tons per acre; and
WQ0036561 Version 1.1 Shell Version 140324 Page 9 of 12

Permit issued this the 27th day of August 2014
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
'mas VReeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0036561
WQ0036561 Version L 1 Shell Version 140324 Page 12 of 12

M
I Any duly authorized Division representative may, upon presentation of credentials, enter and inspect
any property, premiscs or place on or related to the land application sites or facilities permitted herein
at any reasonable time for the purpose of determining compliance with this permit; may inspect or
copy any records required to be maintained under the terms and conditions of this permit; and may
collect groundwater, surface water or leachate samples.
GENERAL CONDITIONS
Failure to comply with the conditions and limitations contained herein may subject the Permittee to
an enforcement action by the Division in accordance with North Carolina General Statutes 143-
215.6A to 143-215.6C.
2. This permit shall become voidable if the residuals land application events are not carried out in
accordance with the conditions of this permit.
3. This permit is effective only with respect to the nature and volume of residuals described in the
permit application and other supporting documentation.
4. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., locaI, state, and federal). Of particular concern to the Division are applicable river buffer rules
in 15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4
and under the Division's General Permit NCG010000; any requirements pertaining to wetlands under
15A NCAC 02B .0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of
Chapter 143 of the General Statutes.
5. In the event the residuals program changes ownership or the Permittee changes their name, a formal
permit modification request shall be submitted to the Division. This request shall be made on official
Division forms, and shall include appropriate documentation from the parties involved and other
supporting documentation as necessary. The Permittee of record shall remain fully responsible for
maintaining and operating the residuals program permitted herein until a permit is issued to the new
owner.
6. This permit is subject to revocation or unilateral modification upon 60 days notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T.01 10.
7. Unless the Division Director grants a variance, expansion of the permitted residuals program
contained herein shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC
02T .0120(b).
The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to
pay the annual fee accordingly shall be cause for the Division to revoke this permit pursuant to 15A
NCAC 02T .0105(e)(3).
WQ0036561 Version 1.1 Shell Version 140324 Page 11 of 12

ATTACHMENT A - Approved Residual Sources
City of Danville
Certification Date: August 27, 2014
Permit Number: WQ0036561 Version: 1.1
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and cQrrosivity) as stipulated under permit Condition IV. 2.
3. Testing of metals and nutrients as stipulated under permit Condition IV. 3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
short tons per ear
Monitoring Frequency
Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1/Year
=>319 - <1,650
Maximum
Monitoring Monitoring
Monitoring
Frequency for
Approved
Owner
Facility Name
County
Permit
Biologics[
Dry Tons,
Frequency for Frequency for
Pathogen &
Mineralization
Number
Residuals
Per Year
Non -hazardous Metals and
Vector Attraction
Rate
Characteristics 2 Nutrients 3' 5
Reductions' 5
City of Danville
Northside WWTP
(Virgvaniainia)
Vi
VA0060593
Yes
1,400
Annually See Table Below
See Table Below
0.30
Total
1,400
1. Maximum Dry Tons per Year is the amount of residuals approved for land application from each permitted facility.
2. Analyses to demonstrate that residuals are non -hazardous (i.e., TCLP, ignitability, reactivity, and cQrrosivity) as stipulated under permit Condition IV. 2.
3. Testing of metals and nutrients as stipulated under permit Condition IV. 3.
4. Analyses of pathogen and vector attraction reductions as stipulated under permit Condition IVA.
5. Monitoring frequencies are based on the actual dry tons applied per year using the table below, unless specified above.
Dry Tons Generated
short tons per ear
Monitoring Frequency
Established in 40 CFR 503 and 15A NCAC 02T.1111)
<319
1/Year
=>319 - <1,650
II Quarter 4 times per ear)
=>1,650-<16,500
1160 Days (6 times per year)
=>16,500
l/month (12 times per ear
If no land application events occur during a required sampling period (e.g. no land application occur during an entire year when annual monitoring is required), then no
sampling data is required during the period of inactivity. The annual report shall include an explanation for missing sampling data. Those required to submit the annual
report to EPA may be required to make up the missed sampling, contact the EPA for additional information and clarification.
Page i of 2

ATTACHMENT A - Approved Residual Sources
City of Danville
Page 2 of 2
Certification Date: August 27, 2014
Permit Number: WQ0036561 Version: 1..1

ATTACHMENT B - Approved Land Application Sites
City of Danville
Certification Date: August 27, 201.4
Permit Number: WQ0036561 Version: 1.1
Field/
Owner
Lessee
County
Latitude
Longitude
A Neff a
Baminant Soil Series
Footnotes
NC -CS -06-01
Blackwell, James
Caswell
36023'05"
79028'19"
24.9
Clifford
1,2
NC -CS -06-02
Blackwell, James
Caswell
36023'14"
7902$'14"
26.6
Rhodhiss
2
NC -CS -06-03
Blackwell, James
Caswell
36022'38"
7902634"
20.7
Fairview
3
NC -CS -06-04
Blackwell, James
Caswell
36022'38"
79026'47"
27.0
Clifford
1,4,5
NC -CS -08-01
Neese, John and Friddle, Jerry
Blackwell, James
Caswell
36023'19"
7902646"
20.6
Clifford
NC -CS -08-02
Neese, John and Friddle, Jerry
Blackwell, James
Caswell
36023'05"
79026'50"
25.9
Rhodhiss
NC -CS -08-03
Neese, John and Friddle, Jerry
Blackwell, James
Caswell
36°23'16"
79°2632"
26.8
Clifford
NC -CS -09-01
Hodges, Jr., Glenn
Caswell
36023'10"
79027'50"
37.0
Clifford
1
NC -CS -09-02
Hodges, Jr., Glenn
Caswell
36023'17"
79028'03"
18.4
Fairview
NC -CS -09-03
Hodges, Jr., Glenn
Caswell
36023'32"
79027'58"
65.0
Rhodhiss
NC -CS -09-09
Hodges, Jr., Glenn
Caswell
36°24147"
79°2774"
28.3
Fairview
1,6
NC -CS -09-10
Hodges, Jr., Glenn
Caswell
36023'52"
79028'49"
15.5
Cecil
NC -CS -10-1
Thomas, Marc
Caswell
36030'09"
79014'59"
9.80
Clifford
NC -CS -10-2
Thomas, Marc
Caswell
36030'05"
79°15'15"
39.20
Clifford
NC -CS -10-3
Thomas, Marc
Caswell
36029'54"
79°15'22"
10.40
Clifford
NC -CS -10-4
Thomas, Marc
Caswell
36029'47"
79015'22"
9.80
Clifford
NC -CS -10-5
Thomas, Marc
Caswell
36°29'46"
79"15'10"
38.50
Clifford
NC -CS -I 6
Thomas, Marc
Caswell
36030'09"
79014'56"
9.50
Clifford
NC -CS -12-1
Hatchett, Margaret
Hatche% William
Caswell
36025'40"
79027'05"
21.30
Appling
NC—CS-12-2
Hatchett, Margaret
Hatchett, William
Caswell
3602543"
7902641"
23.10
Toast (Sim)
NC -CS -12-3
Hatchett, William
Hatche% William
Caswell
3602521"
7902634"
22.60
Clifford
1
NC -CS -12-4
Nottingham, Robert
Hatchett, William
Caswell
36025'27"
79027'16"
18.30
Clifford
NC -CS -12-5
Hatchett, Margaret
Hatchett, William
Caswell
36024'52"
79027'33"
12.84
Clifford
NC -CS -12-6
Nottingham, Robert
Hatchett, William
Caswell
36025'05"
79026'47"
18.90
Clifford
Pagel of 3

ATTACHMENT B - Approved Land Application Sites
City of Danville
Certification Date: August 27, 2014
Permit Number: WQ0036561 Version: 1.1
Field
tet
Owner
Lessee
County
Latitude
Longitude
A eta
Dominant Soil Series
Footnotes
NC -CS -14-1
Sartin, David
Sartin, David
Caswell
36°28'17"
79024'53"
61.40
Toast (Sim)
1
NC -CS -14-2
Sartin, David
Sartin, David
Caswell
36028'16"
79024'42"
24.30
Toast
1
NC -CS -14-3
Sartin, David
Caswell
36°28'31"
79024'06"
6.10
Clifford
1
NGCS-15-1
Dailey, Richard
Caswell
36029'46"
79019'07"
11.30
Clifford
NC -CS -15-2
Dailey, Richard
Caswell
36028'52"
79018'09"
2.60
Clifford
NC -CS -15-3
Dailey, Richard
Caswell
36029'03"
79017'53"
13.50
Appling
Totat for Caswell County
690.14
NC -PS -01-01
Circle P Farms
Poindexter, James
Person
36°31'25"
79003'35"
12.0
Siloam
NC -PS -02-01
Poindexter, James
Person
36°31'43"
79002'53"
22.0
Fairview
NC -PS -02-02
Poindexter, James
Person
36031'34"
79002'42"
17.0
Halifax
NC -PS -02-03
Poindexter, James
Person
36°31'52"
79003'08"
21.5
Fairview
NC -PS -02-04
Poindexter, James
Person
36032'03"
79003'10"
26.0
Fairview
NC -PS -02-05
Poindexter, James
Person
36032'12"
79003'14"
14.0
Fairview
NC -PS -02-06
Poindexter, James
Person
36032'15"
79002157"
34.0
Fairview
NC -PS -03-01
ETree, LLC.
Poindexter, James
Person
36032'14"
79003'36"
58.0
Fairview
Total for Person County
204.5
Total
894.64
7A
. A re -defined compliance boundary has been approved for this land application site. This re -defined compliance boundary is located 100 feet from the water supply well on the property. Note that the
100 -foot setback between wells and the land application area shall still be met
2. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by Pencie S. Pruitt
at 8782 US Highway 158W, Ruffin, North Carolina 27326 (i.e., indicated by the label "SWA-B" on the approved setback map), regardless of whether a surface or a subsurface application method is
used.
3. A reduced setback from a residence under separate ownership has been approved for this land application site_ Residuals may be land applied within 100 feet ofthe residence owned by Kenneth
Hammock at 6908 US Highway 158W Yanceyville, North Carolina 27379 (i.e., indicated by the label "SWA-C" on the approved setback map), regardless of whcther a surface or a subsurface
application method is used.
4. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by James Y.
Blackwell at 7199 US Highway 15 9W, Yanceyville, North Carolina 27379 (i.e., indicated by the label "SWA-A" on the approved setback map), regardless of whether a surface or a subsurface
application method is used.
(Footnotes continued on next page)
Page 2 of 3

ATTACHMENT B - Approved Land Application Sites
Certification Date: August 27, 2014
City of Danville Permit Number: WQ0036561 Version: 1.1
5. A reduced setback from a residence under separate ownership has been approvcd for this land application site. Residuals may be land applied within 100 feet of the residence owned by Roger
Henderson at 7307 US Highway 158W, Yanceyville, North Carolina 27379 (i.e., indicated by the label "SWA-D" on the approved setback map), regardless of whether a surface or a subsurface
application method is used.
b. A reduced setback from a residence under separate ownership has been approved for this land application site. Residuals may be land applied within 100 feet of the residence owned by Larry Woodall
(i.e., indicated by the label "SWA-E" on the approved setback map), regardless of whether a surface or a subsurface application method is used.
Page 3 of 3

JwA-4
State of forth Carolina
DelaarMent of Environment and Natural Resources
M)w Division ®f Water Resources
Division Reso-u ces -- - -SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 08-13
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 -subunit_ one original and two copies of the application and
supporting. documentation
For more information or for an electronic version of this form, visit the Land,lpplication Unit (LAU) web site at:
hgp:IlQortal.nedenr.or /rpeblivgla sy 1lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part: of project site(s) in accordance with 15A NCAC 02T .1108(b)(2Hfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 08-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 08-11) 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 maybe made, as long as the attachments are numbered to correspond to the section anal item to which they refer.
❑ Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement_
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID: fuc <6 0& -
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the following:
Location address ofprope 9
City: Jk, A4_c 1V - - State:
s
10 _�, feet (i.e., cannot be less than 100 feet) of
Zip: -
This Agreement shall remain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
da s in advance, modifies or cancels this Agreement.
71 certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, 1 certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner naive:
Ltw
Signature:-- L._ ` �' Date:
FORM: SWA 08-13 Page 1 of 1

5tlA-6
State of North Carolina
Department of Environment and Natural Resources
r
Division of Water Resources
SETBACK WAIVER -AGREEMENT- (-FOR RESIDUALS -PROGRAM)... _ ..
FORM: SWA 08-13
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 aDDlication and
supporting documentation
For more information or for an electronic version of this form, visit the Land Application Unit (LA U) web site at:
httu:llportal.ncdenr.or /weblwglaps/lau
General -- This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1105 2 for habitable residences or place of public
assembly only). Do not submit this agreement for review without a corresponding application form (FORM: RLAP 08-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 08-11) 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's naive: _� 0d -
Applicable Field ID: C-CSoLe
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the following: f
Location address of property:
I E feet (i.e., caviraot be less than 100 feet) of
State: Zip: `L
This Agreement shall remain in effect for the leligth of the Divisioll of Watcr Quality's (Division) pee•anit for- the _residuals
land application: program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such tirne as written notification, given 30 calendar
days in advance, modiiics or cancels this Agreement.
I certify that I am a deeded property owner of above -referenced property and arra authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I ]rave read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: (iL ti 5: t Ir I t T
Signature:I f `��'l�3t' l�;l ���� Date:, •' `f
FORM: SWA 08-13 Page 1 of 1

5wA e-
�. State of North Carolina
WRDepartment of Environment and Natural Resources
Division of Water Resources
DIVIslon SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA OS -13
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 ajplication and
supporting documentation
Fop more information or for an electronic version of this forma, visit the Land Application Unit (LAU) web site at:
ht7z?://
portal. ncdenr. org/web/wgaps/1au
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b}(2yfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: ILAP 08-13).
A. Setback Waiver Agreement:
Submit the completed and appropriately executed Setback Waiver Agreement (NORM: SWA 08-11) 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: :%Y aF NAr;114 - - -- -
Applicable Field ID: iJC -G50& -03
hereinafter referred to as the Permittee, to land apply residuals within '; feet (Le., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: F
1 G�
City. �I�,,_.� c - V t .. State: -� zip: _ 17
This Agreement shall remain in effect for the length of the Division of 'Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
da s in advance, modifies or cancels this Agreement.
I certify that i air a deeded property owner of above -referenced property and ain authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Peixnittee to -land appl esiduals to land application sitc(s) as specified herein.
Property owner route; �/ "'z'"'` ��
signature: JG/ .Y.r ��
f ` �fl --._ ..._ Date: f
i
FORM: SWA 08-13 Page I of 1

SWA- b
State of Forth Carolina
--- Department of Environment and Natural Resources
Division of Water e Resources
Division of Writer Resaa yes SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM.' SWA OS -13
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 voted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information or for an electronic version of this form, visit the LandApplication Unit (LA U) -web site at:
http:/2ortal.ncdenr.ora/tiyeb/tivc�/as� /lau
General -- This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b)(2)ffor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application forme (FORM: RLAP 08-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 08-11) farm. PIease do not
snake any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ Prepare a separate agreement for each property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .11081 other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO N'AI'VE THE SETBACK REQUIRED BY 15A NCAC €12T .1108(b)(2)(habitable residences)
`.i'he undersigned property owner hereby permits-.
Applicant's name: mm 6J7 0k 5041.1;11e,
Applicable Field ID: t-jC - 0�4(�
hereinafter refereed to as the Permittee, to land apply residuals within tfeet (i.e., cannot be less than 100 feet) of
he residence or [dace of public assembly loc ted at the followinrg-) �
s` 1_,ocation address of property:
City: State: �Ci� i! ts�/ Stater S J zip:
This /Agreement shall rew.nhi in effect fon- the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. lit addition, this Agreement shall only
remain in effect for as long as the undersigned property own -ter owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
[O I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners- Furthermore, I certify that I haveread and understand this Agreement and do
hereby grant permission to the Pennittee to land apply residuals to land application site(s) as specified herein.
I/Property ov
Signature:
FOPJA: SWA 08-13 Page I of I

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State of North Carolina
Department of Environment and. Natural Resources
OWK Division of mater Resources
Divizion of-Water-Resaumes SETBACIK WAA[VER AGREEM.Fi` T .(FDR R FSEDUALS PROGY2AM)_.-
FORM: SWA 08-13
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 origjUl_and two copies of the annlication and
su)2porting documentation
For more information or for an electronic version of this form, visit the band Application Unit (LA U} web site at:
htto://portal.ncdenr or /vug eb/wq/aps/lau
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1193D)2iffor habitable residences or place of public
assembly only]. Igo not submit this agreement for review without a corresponding application form (FORM: R1t,AP 08-13).
A. Setback Waiver Agreement:
❑ Submit the completed and appropriately executed Setback Waiver Agreement (.FORM: SWA 08-11) 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 property from which a waiver is being sought.
❑ Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
❑ A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T.1 108(b)(2) (habitable residences)
Phe undersigned property owner hereby permits:
Applicant's name: , 7 0 N't 0111&
Applicable Field ID: /JC -0509 r O
hereinafter referred to as the Permittee, to land apply residuals within
the residence or place of public assembly located at the followin
Location address of property:
City: l° State:
I o u feet (i.e., cannot be less than 100 feet) of
Zip: t
This Agreement shall rernain in effect for the length of the Division of Water Quality's (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
d s in advance, modifies or cancels this Agreement.
71 certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that 1 have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name:
Signature:
;vl*1k
Date:
FORM: SWA 08--13 Page 1 of 1

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