Rev.

5/2004 BOO-FM-WSWMO343

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C O M M O N W E A L TO F P E N N S Y L V A N I A H PR D E P A R T M E NO F E N V I R O N M E N T A L O T E C T I O N T MANAGEMENT BUREAUOF WATERSUPPLYAND WASTEWATER

N O T I F I C A T I OO F F I R S TL A N DA P P L I C A T I O N N ( 3 0 - D a iN o t i c e )
INFORMATION PERMITTEE A See Nameof Permittee: Aitachment n Location: Attachme t A Facility See 1 A t t a c h m e n t. 1 M u n i c r p a l rSy :e te See AttacimeXlllGeneral PermitNumber: Current A used:SeeAttachment i'eduction alternative Pathogen A used:See Attachment option Vectorattraction reduction A (liquid cake):See Attachment or Method applicatton of Mid-Atlantic Svnaqro Nameof landapplier: r d r d H a st h r sa p p l i ec o m p l e t e D E P r e q u i r e b i o s o l i dts a i n i n g ? SITEINFORMATION F S i t eN a m e M a n q o l d a r m Manqold Marshall Nameof Landowner.
L o c a t i o no f S i t e O s w a l d R o a d

County: See Attachment 1.1 lssuedDate:See Attachment l.1

X Yes

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of is Consent Landowner attached: [] tlo A copy of the Contractual X Yes be at septage stored the site? or Will biosolrds residential X ves I tlo and description the design construction of the storage areasand a detailed lf YES attacha map locating proposed withthisform area(s) of operarion the storage s sl w t landowners the site been notifted to that b i o s o l r do r r e s i d e n t i a e p t a g e i l l b e a p p l i e d o t h e s r t e ? Have all adiacent

X Yes

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3800-FM-WSWM0343Rev. 5/2004

(E&S) or a Farm Conservation Plan developed this land application for area as ls an Erosionand Sedimentation n s p e c i f i e id $ 2 7 1 . 9 1 ( c ) ( a ) ? f Yes I t'lo 5 s on l f Y E S ,a t t a c h c o p yo f t h e p l a na n d i m p l e m e n t a t i s c h e d u l e .l fN O , b i o s o l i dm a y n o tb e a p p l i e d t t h i ss i t e . a a _ ls incorporatron used? I application Ves X t'lo lf YES, indicatehow soon incorporation performedafter land is

everapplied thissite? to was To the bestof yourknowledge, biosolids pollutant loading data? to cumulative lf YES,was DEP contacted obtain to application areas: related the proposed Complete following the information (a) Foragricultural utilization, doesthe slopeexceed25%? ( b ) F o rl a n dr e c l a m a t i o d o e st h e s l o p e x c e e d 5 % ? e 3 n, perennial (c) ls any areawithin100ft. of a stream? (d) ls any areawithin33 ft. of an intermittent stream? (e) ls any areawithin300 ft. of an occupied dwelling? (f) ls any areawithin100ft. of an exceptional valuewetland? '1in. of the seasonal (g) ls any areawithin1 highwatertable? groundwater (h) ls any areawithin3.3 ft. of the regional table? (i) Havesignsbeenposted the property line? at (j) Hasoccupant the landreceived userinstruction sheet? of (k) Any otherrestrictions?

Ives Iyes IYes Ives fves !ves I ves E Yes E Yes fl ves Xves ffives

Xruo Eruo Xwo Iruo Xruo XNo I t'to X tto X tt o X tto f]ruo INo

l n d i c a t et h e w a t e r s h e d ( s )a n d s t r e a m c l a s s i f i c a t i o n ( s ) n a c c o r d a n c ew i t h D E P ' s C h a p t e r 9 3 r e g u l a t i o n s . i,

AoplicationArea

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StreamName OntelauneeCreek

Chapter93 Classification CWF

EVDesiqnation?

Yes tr
YesI YesI

NoX NoX NoI

N O T E : L A N DA P P L I C A T I O O F B I O S O L I D S T H E W A T E R S H E D ( S ) E S I G N A T E A S " E X C E P T I O N A LA L U E " N lN D D V I N C H A P T E R 3 I S N O T E L I G I B L E N D E R H E G E N E R A L E R M I T .A N I N D I V I D U AS I T EP E R M I T S R E Q U I R E D . 9 U T P L I ENTS ADDITIONAL ATTACHM Attacha Natural Resources Conservation Service map of the siteor a sitemap of a scalenot smaller than '1inchequals 400 feet. Boundaries the site and intended of application areasshouldbe clearly delineated the acreage each and for fieldindicated: nr + ^ ^ L r ; ^ r r ^ ' ' ^ ^ ^ n t l a n d o w n e r ( t o t h e s i t et h a ta r e r e q u i r e t o b e n o t i f i e u n d e r ^ ^ s) d d ( $ 2 7 1 . 9 1 3g ) . Providesoilchemical analytical results the following parameters eachfieldat the site:arsenic, for in cadmium, copper, l e a d ,m e r c u r y , o l y b d e n u m i, c k e ls e l e n i u m ,i n c , o l y c h l o r i n a tb id h e n o l(s C B s ) a n d H . m n , p ep z P p Attenhr conrrrro an of ratesfor thissitewillbe calculated. "heet showing example how agronomic Pennsylvania Attachthecompleted Natural Diversity lnventofv Form.

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