WQ0022155_Residual Annual Report 2021_20220211

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
En.anmemfal 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) * WQ0022155
Applicant/Permittee Town of Jefferson VVWTP
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*
Tim Church
Email Address* Phone Number*
[e-mail] 13362462165
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deg.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: * WQ0022155
Has Current Existing permit number
Applicant/Permittee Address*
Facility Name*
1233 NC Highway 16 South, Jefferson, NC 28640
Town of Jefferson Class A Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here. *
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Residuals Report A 202120220211_15364113.pdf 11.62MB
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
Submission Date 2/11/2022

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0022155 County:
Facility Name (as shown on permit):
Ashe
Year: 2021
Town of Jefferson WWTP
Land Application Operator: Tim Church Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
0 Yes ❑ No - If No, skip Part A, and Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A - Residuals Application Summary:
Total number of application fields in the permit:
n/a
Total number of fields utilized for land application during the year:
n/a
Total amount of dry tons applied during the year for all application sites:
5.6
Total number of acres utilizes for land application during the year:
n/a
Part B - Annual Compiance Statement:
Facility was compliant during calendar year
(including but not limited to items 1-13 below) issued by the Division of Water Resources. L7 Yes ❑ No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
2021 with all conditions of the land application permit
1) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pH was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pH of at least 6.0 or
the limit specified in the permit.
3) Annual soils analysis were performed on each site receiving residuals during the past calendar year and three (3) copies
of laboratory results are attached.
4) Annual TCLP analysis (if required) was performed and three (3) copies of certified laboratory results are attached.
5) All other monitoring was performed in accordance with the permit and reported during the year as required and three (3)
copies of certified laboratory results are attached.
6) The facility did not exceed any of the Pollutant Concentration Limits in 15A NCAC 02T .1105(a) or the Pollutant
Loading Rates in 15A NCAC 02T .1105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 15A NCAC 02T .1111 were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior
authorization was received from the Division of Water Resources.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
11) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"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."
Tim Church, Water Resources Director
Permittee Name and Title (type or print)
Signature of Permittee
24//22-
Date
Signature of Preparer* Date Signature of Land Applier Date
(if different from Permittee) (if different from Permittee and Preparer)
* Preparer is defined in 40 CFR Part 503.9 (r) and 15A NCAC 02T .1102 (26) DENR FORM ACF (12/2006)

**Preparer is defined in 40 CFR Part 5039(r) and 15A NCAC 2T .1102 (26)
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Mercury
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ANNUAL RESIDUAL SAMPLING SUMMARY FORM

ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Meritech, Inc.
•-. N M V'•
Town of Jefferson WWTP
Facility Name:
NC0021709
Residual Source
NPDES # or WQ#:
Jefferson WWTP
Sample or Composite Date
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DENR FORM RSSF - B (12/2006)

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (503 Rules)
Facility Name: Town of Jefferson WWTP
WWTP Name: Jefferson WWTP
WQ Permit Number: WQ0022155
NPDES Number: NC0021709
Monitoring Period: From
1.1.21 To 12.31.21
n Reduction (40 CFR 503.32) - Please indicate level achieved and alternative performed:
Class A:
Alternative 1 0
Alternative 2 a
Alternative 30
...................
Alternative 4 Li
Alternative 5 ❑
Alternative 6 ❑
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying El
Heat Treatment ❑
Thermophilic
Beta Ray 0
Gamma Ray ❑
Pasteurization 0
Class B:
Alternative 1 0
Alternative 2 0
.............................. ...................... .
If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization 0
Air Drying❑
Composting ❑
Aerobic Digestion ❑
Anaerobic Digestion ❑
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Analytical
Tech -
niaue
Parameter
Allowable Level
in Sludge
in
Pathogen Density
Number of
Excee-of
dences
Frequency
Analysis
Sample
Type
yp
Minimum
Geo. Mean
Maximum
Units
Fecal Coliform
2 x 10 to the
6th power
per gram of
total solids
MPN
120
120
120
MPN
0
_
1
Grab
SM9222D
CFU
1000 mpn per gram
of total solid (dry
weight)
Salmonella bacteria
(in lieu of fecal
coliform)
3 MPN per 4 grams
total solid (dry
weight)
Vector Attraction Reduction (40 CFR 503 33) - Please indicate option performed:
Alt.1 (VS reduction)
❑
Alt. 2 (40-day bench) ■'
Alt. 3 (30-day bench) ❑
Alt. 4 (Spec. 02 uptake)
❑
Alt. 5 (14-Day Aerobic)
0
Alt. 6 (Alk. Stabilization ❑
Alt 7 (Drying - Stable) 0
Alt. 8 (Drying - Unstable)
0
Alt. 9 (Injection)
❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed
0
CERTIFICATION STATEMENT (please check the appropriate statement)
0 "I certify, under penalty of law, that the pathogen requirements in 40 CFR 503.32 and the vector
attraction reduction requirement in 40 CFR 503.33 have been met."
"I certify, under penalty of law, that the pathogen requirements in 40 CFR 503.32 and the vector
attraction reduction requirement in 40 CFR 503.33 have not been met." (Please note if you check
this statement attach an explanation why you have not met one or both of the requirements.)
"This determination has been made under my direction and supervision in accordance with the system
designed to ensure that qualified personnel properly gather and evaluate the information used to determine
that the pathogen and vector attraction reduction requirements have been met. I am aware that there are
significant penalties for false certification including fine and imprisonment."
Tim Church, Water Resources Director
Preparer Name and/Title (type or print)
ll�
Land Applier Name and Title (if applicable)(type or print)
Signature of Preparer* Date Signature of Land Applier (if applicable)
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Date
DENR FORM PVRF 503 (12/2006)

aol'
Class A Dry Biosolids Production Record
Pathogen Reduction Alternative 1
(Complete a line for each batch produced, not just a line for each day.)
DATE
Thermal Fluid
Degrees F
Discharge Temperature
Degrees F
Drying
Time, hrs.
Time of
Discharge
I.ly•Zi
4150
21?
3
//30
i. IA. 2I
950
2(17
/530
1.15.Z1
450
2,g7
3
lll5
l.15.2I
M54
2q7
/(0(O
1.21.2.1
45 0
2q$
3
/010
(. 2,1. 2t
t150
2,c113
3
/
I . 2,1
4450
2,97
3
/ Ho
i _zz 1
15)
2)47
3
/S240
I. 7,q.21
tI50
211(1)
3
1030
I-2,(1.41
'50
297
3
1506
2.4. ZI
Lf 0
294?
3
1/0D
2,4. ZI
450
2,?7
3
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2.. 5.
0
2 7
3
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2.5. za
'450
zR7
3 /Eon
2.15.21
Lt50
zq8
3 /6/5
2.25. zl
4 5o
2A7
3
/030
z. 25. 21
450
z4g
3
/9/5
2.24, 2I
4150
2 7
3
/030
2.2(o.zi
ii 50
2.i7
3
/4130
3.y. Z.1
50
Z97
3
/O• 0
3, / 2l
4ISo
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Hzo
3, a.21
Lt50
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1020
5 J
j,11
4150
2,07
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th7
3
/000

Fenton Environmental Technologies, Inc.
RK Series Municipal Biosolids Dehydrator.
1(800) 777-1371
Class A Compliance Under the 503 Rules
The SludgeMASTER RK series automatic batch style biosolids dehydrator is uniquely suited to
insure compliance with the 40 CFR 503 regulations pertaining to achieving Class "A" biosolids.
The RK dehydration chamber is loaded automatically with a predetermined amount of dewatered
biosolids which starts the batch cycle.
The total sludge load is subjected to a minimum temperature of 212 degrees F for a minimum of
two and one-half hours which exceeds the time and temperature requirements of the 503
regulations pertaining to to en fldudion. This compliancb is shown as follows using Regime
A under Ahernative 1 which requires that solids be heated at 50 degrees C or higher for 20
minutes or longer.
Time (in days) = 131.700.000
10A 0.14 (temperature) 9s, for the RK dehydrator at 212 degrees F (=100 C)
Time= 131.700,000 Qr Time 131.700.000 or Time = less than 1.3/10^6 day.
10A 0.14(100) 10^14
The time required in the RK for pathogen reduction would be less than 1 minute. Therefore, the
minimum time requirement of 20 minutes specified in the 503 Rules must be followed. Following
the 20-minute requirement, the RK dehydrator exceeds the time requirement by about 700%.
Total cycle time is determined by achieving the desired sludge dryness. We normally recommend a
minimum of 90 % dry solids for a finished product to quflify under 503.33 "Option-8" regarding
vector attraction reduction. (Fully digested sludges need be dried to 75%- 503.33 "Option T'.)
The SludgeMASTER RK patented process automatirally adjusts the time and temperature regime
for the varying incoming wet sludge solids content. This feature is very important since dewatering
operations will vary from time to time in solids consistency yet we must maintain consistent Class
A biosolids at all times. Convetrscly, automatic flow through systems cannot adjust to varying
conditions without disrupting their normal operation and compromising the finished Product
Class "A" parameters.
Please refer to 40 CFR 503.32 Pathogens - (a) (3) (ii) (9) for pathogen reduction requirements and
to 40 CFR 503.33 (b) (7) and (8) for vector attraction reduction requirements.
Fenton Environmental Technologies, Inc. guarantees Class A compliance on a continued basis
with each SludgcMASTER RK Dehydration System.
In choosing Class A biosolids thermal dehydration vtilizing SludgeMAS I ER RK technology, your
utility will be assured of an environmentally correct sludge handling solution for many years in the
future.

Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Page 3
Revised Date: 3/16/2021
Report Date: 3/8/2021
NPDES #: NC0021709
Project: Class A Dry Residuals
Date Sample Rcvd: 2/15/2021
Meritech Work Order # 02152105
Parameters Results
% Total Solids
Ammonia, Nitrogen
TKN
Nitrate/Nitrite, Nitrogen
Aluminum, total
Arsenic, total
Cadmium, total
Calcium, total
Copper, total
?ad, total
'`--Magnesium, total
Mercury, total
Molybdenum, total
Nickel, total
Phosphorus, total
Potassium, total
Selenium, total
Sodium, total
Zinc, total
pH
Sample: Class A Dry Residuals Grab 2/12/2021
93.3 %
2800 mg/kg
11,300 mg/kg
<10.7 mg/kg
8,320 mg/kg
<0.536 mg/kg
0.470 mg/kg
12,800 mg/kg
429 rng/kg
14.1 mg/kg
4,210 mg/kg
2.09 mg/kg
4.51 mg/kg
16.3 mg/kg
16,500 mg/kg
3,110 mg/kg
<0.536 mg/kg
614 mg/kg
643 mg/kg
5.6 S.U.
Analysis Date
2/23/2021
2/22/2021
3/1/2021
2/23/2021
2/25/2021
2/25/2021
2/25/2021
2/26/2021
2/25/2021
2/25/2021
2/25/2021
2/23/2021
2/25/2021
2/25/2021
2/26/2021
2/25/2021
2/25/2021
2/25/2021
2/26/2021
2/19/2021
Reporting Limit Method
0-100 %/a
10 rng/kg
20 mg/kg
10.7 mg/kg
2.50 mg/kg
0.536 mg/kg
0.200 mg/kg
10.0 mg/kg
1.00 mg/kg
0.500 mg/kg
10.0 mg/kg
0.02 mg/kg
0.500 rng/kg
2.0 mg/kg
2.00 mg/kg
20.0 mg/kg
0.536 mg/kg
20.0 mg/kg
0.500 mg/kg
1.0 - 14.0 S.U.
SM 2540B
EPA 350.1
EPA 351.1
EPA 353.2
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 245.1
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200,7
EPA 200.7
SM 4500-HB
r.hereby certify that I have reviewed and approve these data.
nap. kAT(Pt
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Revised Date:
Report Date:
NPDES #:
Project:
Date Sample Rcvd:
QQ Page 1
(1( 3/16/2021
3/8/2021
NC0021709
Class A Dry Residuals
2/15/2021
Meritech Work Order # 02152105
Sample: Class A Dry Residuals Grab
2/12/2021
1311 - TCLP Metals
Parameter
Arsenic
Barium
Cadmium
Chromium
Lead
Mercu ry
'elenium
`3ilver
Results
<0.100 mg/L
0.629 mg/L
<0.020 mg/L
0.122 mg/L
<0.100 mg/L
<0.02 mg/L
<0.100 mg/L
<0.050 mg/L
Analysis Date Det. Limit Reg. Limit Method
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/23/2021
2/25/2021
2/25/2021
0.100 5.0 EPA 200.7
0.050 100.0 EPA 200.7
0.020 1.0 EPA 200.7
0.050 5.0 EPA 200.7
0.100 5.0 EPA 200.7
0.02 0.2 EPA 245.1
0.100 1.0 EPA 200.7
0.050 5.0 EPA 200.7
Parameter
Volatiles 8260
Semi Vol. 8270
Results
Attached
Attached
TCLP Organics
Analysis Date
2/23/2021
2/25/2021
Reporting Limit
Method
8260
8270
Other Tests
Para meter
Cyanide, total
Sulfide
lgnitability
Corrositivity (pH)
Results
<0.500 mg/kg
<10.0 mg/kg
<2.2 mm/sec
5.6 S.U.
Analysis Date Reporting Limit
2/17/2021 0.500 mg/kg
2/17/2021 10.0 mg/kg
3/1/2021
2/19/2021 1.0 - 14.0 S.U.
Method
EPA 335.4
SM4500S2DB
EPA 1030
SM 4500 FIB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Page 2
Revised Date; 3/16/2021
Report Date: 3/8/2021
NPDES #: NC0021709
Project: Class A Dry Residuals
Date Sample Rcvd: 2/15/2021
Meritech Work Order # 02152105 Sample: Class A Dry Residuals Grab 2/12/2021
1311 - TCLP Pesticides & Herbicides
Pesticide SW-846 8081A
Parameter
Results Analysis Date Det. Limit Reg. Limit Dilution Factor
Endrin Attached
Chlordane Attached
Toxaphene Attached
Methoxychlor Attached
Heptachlor Attached
ndane Attached
Herbicides - SW-84-6 81S1A
Parameter Results
2,4-D Attached
2,4,5-TP (Silvex) Attached
Analysis Date Det. Limit Re.g. Limit Dilution Factor
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

MERITECH, ir11C
Client:
Project:
Client Sample ID:
Sample Collection:
Meritech Sample ID:
Volatiles: SW-846 8260
Analysis: 02/23/21
Analyst: VWWV
Para meter
Benzene
Carbon Tetrachloride
Chlorobenzenc
Chloroform
1,2-Dichloroethane
1,1-Dichloroethene
Methyl Ethyl Ketone
Tetrachloroethylene
Trichloroethene
Vinyl Chloride
Environmental Laboratories
Laboratory Certificate #165
Town of Jefferson
Class A Dry Residuals
Class A Dry Residuals
02/ 12/21
02152105
Semi-Volatiles: SW-846 8270
Analysis: 02/25/21
Analyst: PM
Parameter
1,4-Dichlorobenzene
Hexachlorobenzene
Hexachloro-1.3-butadiene
Hexachloroethane
o-cresol
m&p-cresol
Total cresols
Nitrobenzene
Pentachlorophenol
Pyridine
2.4.5-Trichlorophenol
2.4,6-Trichlorophenol
2.4-Dinitrotoluene
1311 - TCLP Organics
Extraction: 02/ 15/21
Repon Date: 02/25/21
Result Units Det. Limit Rea. Limit Dilution Factor
< 0.0100 mg/L 0.0100 0.50
< 0.0100 mg/L 0.0100 0.50
< 0.0100 mg/L 0.0100 100
< 0.0100 mg/L 0.0100 6.0
< 0.0100 mg/L 0.0100 0.50
< 0.0100 mg/L 0.0100 0.70
< 0.100 mg/L 0.100 200
< 0.0100 mg/L 0.0100 0.70
< 0.0100 mg/L 0.0100 0.50
< 0.0200 mg/L 0.020 0.20
Extraction: 02/ 15/21
Report Date: 02/76/21
Result Units Det. Limit Ree.. Limit
<0.100 mg/L 0.100 7.5
<0.100 mg/L 0.100 0.13
<0.100 mg/ 0.100 0.5
<0.100 mg/L 0.100 3.00
<0.100 mg/L 0.100 200
0.324 mg/L 0.200 200
0.324 mg/L 0.300 200
<0.100 mg,'L 0.100 2.00
<0.500 mg/L 0.500 100
<0.100 mg/L 0.100 5.0
<0.100 mg/L 0.100 400
<0.100 mg/L 0.100 2.00
<0.100 mg/L 0.100 0.13
/ hereby certir that / have reviewed and approve these data.
10
10
10
10
10
10
10
10
10
10
Dilution Factor
10
10
10
10
10
10
10
10
10
10
10
10
10
Laboratory Representative
642 Tamco Road * Reidsville, NC 27320
[phone] * [e-mail]

ANALYTICAL RESULTS
Description: 021521-05
Matrix: Soil
Project: TCLP Pest/Herb
Lab Sample ID:AE01285-03
Sa m p l ed: 02/12/21 11:00
Sampled By:
www,encolabs.com
Received: 02/17/21 10,15
Work Order: AE01285
% Solids:
TCLP Pesticides by GC
^ - 5VLU 34andv ceitalect sneyre !A'. 4242
Analvte ICAS Numberl Result@ Flaq ink pF MILL EQ1 Batch Method 6r llvxe® ICY Notes
Chlordane (tech) (1.2789-03-6)' 0.00036 U mg/L. 0.00036 0.00050 1817045 EPA 80818 03;05'21 15.02 ):e
Endnn (72.20.8)^ 0,000014 U mg/1 1 0.000014 0.000050 1617045 EPA 8081e 03; 05/21 15.02 315
gamma-8HC (58.89.9]^ 0.000021 U mg/L 1 0.0000210.000050 1617045 EPA 80818 03;05/21 15:02 118
Hepta7nlot(76-44-8)^ 0.000026 U mg/1. 1 0.000026 0.000050 1517045 EPA B0515 03/05/21 15:02 371
Heptachlor epoxide (1024.57.3)^ 0.000018 U mg/L 1 0.000016 0.000050 1517045 EPA 80818 03/05/21 15:02 138
Metnoxychlor (72.43-5)^ 0.000020 U mg/L 1 0.000020 0.000050 1617045 EPA 80810 03/05/21 15:02 1 00
Toxaphene[8001-35.2]^ 0.00048 U mg'L 1 0.00048 0.00050 1617045 EPA 8031E 03/05/21 15.02 316
5trrooates
6-T MX
Oecadrlaobipt eny!
Results
0.0055
C.0035
12f 5Dtk0 Iv! 46 Rec 4/0 Rec Limits Balch Method Analv:ed fix Notes
1 0.00500 113 58 36-142 18.'7045 EPA 30813 03/05;21 15:02 J-'S
1 0.025C0 73 % 34-159 1817045 EPA 80315 0205'21 15.02
0v70 1Z--0c ; e r!4 v anv.'1re (AC 424]
Analvte (CAS Numberl
2,4,5-TP (Silvex) [93.72-1)^
2,4-0 (94-75.7]^
5urrlwates
2, 4-OC4A
Results ins LJ'tl
0.00044 U mg/L
0.00027 U mg/L
05
1
MPl Pg..
C.00044 0.00050
C.00027 0.00050
Batch MSth:l0 Pnalvze4 NOtel
1823035 EPA s1517 02/26/21 18:41 FCV
1823035 EPA8151A 02/26/21 18:41 FCv
Results ,Qf Spike tvl 48 RM' 46 Rec Limits Batch MethoQ Analyze ¢y Note
0.011 1 0.0100 113 % 37.134 11323035 EPA 8151A 021i6/2! 1d:4: f{v
FINAL
Pus rep0.'t reiates only to the sample 83 Iece+Y8d by the tabosatt,/, and 0'Jv enh' tH.' reproduc84 .n tVV. Page 5 cf .0

Hand Delivery
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Method of
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ENVIRONMEN
642 Tamco Rd.
• Reidsville NC 27320
Email: info@
www.meritechl,
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Relinquished by: Date: Time:
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Are these results for regulatory purposes? Yes 1-0 No .,Frj
Comments:
*** Dechiorination (<0.5 pprn) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation. ***
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SAR Calculator
Adjusted SAR Calculator
EC
Ca
Mg
Na
HCO3
1
11942
3927
572
µS
mg/1 or ppni
mg/l or ppm
mg/1 or ppm
mg/1 or ppm
SAR 1.2
adj SAR 0.7
Use the larger of the two
Reset
adj
SAR
< 1 Excellent
1-2 Good
2-4 Fair
4-8 Poor
8-15 Very Poor
> 15 Unacceptable
Classification
A. z/iz7zl
l'As5iKj) /Yitcj
Co, iz, gCe, x 0 c3_ = 1I,g ?
,zi o. T3- 327
�( L.j x . i3 3 7- 5 72
Q ;fir/
Management Considerations
None
Little concern, add pelletized gypsum periodically
Aerify soil, sand topdress, apply pelletized gypsum, monitor soil
salinity
Aerify soil, sand topdress, apply pelletized gypsum, leach soil
regularly, monitor soil salinity closely
Requires special attention; consult water quality specialist
Do not use
Z. 2021 - Oklahoma State University I All rights reserved

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
ID#:
Cass -fl�
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
22-Jan-21
8-Feb-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
93.1
120
1
_LOCATION
MPN
A
26-Jan-21
SM-9221E
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

Class A
SAMPLE TYPE:
LOCATION:
FACILITY IDI1:
WASTEWATER
Jefferson Wastewater Treatment Plant
SAMPLER NAME: Tim Church
WATER QUALITY SERVICES, INC.
P.O BOX 1 102, BANNER ELK, NC. 28604
sitkot5e„ (828)-898-6277
fax (82S)-898-6255
CHAIN OF CUSTODY
•i'Rt:SERVA 1 !UN CEDE
l H2SO4, 2 • FIN03, 3 - HCL.
- NAOH, 5 • NONE, 6•COOL IC1.1
7 • NA2S203, S • OTHER
COMPOSITE SAMPLE; START TIME: . STOP 'FI:ME:
SAMPLE NAME:
E30D - INF.
COLLECTION DELIV SAMPLE TYPE PRESERVATION'
DATE TIME TEMP TEMP GRAB COMP F-FIELD E L•LAB
Er ), YES' \0
TS S • INF.
BOD • EFF.
TSS•EFF.
NH3 as N
OIL R GREASE
TOTAL NIT.
TOTAL PHOS.
FECAL • UP
FECAL -
1.22.2.E
FECAL • DO\VN
HARDNESS UPST.
I-IARDNESS EFFL.
�IY6I o1 :4s -Lat2 I J O°
COPPER ZINC
Cyanide .
LEAD NICKEL
. SILVER
7
L1
LI
L!
L1
L7
IL7
L7
L2
t•,2
T,2
1 L4
r,7
CADMIUM
CFIROMIUM
r
H BY.
ELIN• ISHED B
xx-e-
ftrLINQUISHEn
1 �5 J/
DATE TIME RELtom''
••Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
CL2•D•CL2. Chlorine check and dechlorination verification
PRESERVATION:
() COOL 4C: BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY. CR, VI. TURi3IDI I
) COOL 4C , PH<2H2S0a : NH3, NO2-NO3, TKN, O":G, IOC. COD, HARDNESS. PHENOLS, TOT Pi:JS
() COOL 4C. PH<2 HNO3 : METALS except CR, VI
() NOSE :CHLORIDE, PH, FLUORIDE
OTHER.
) COOL -IC. NA2S20) COLIFORM i3,\CTERtA
i
SAMPLE DEVIATION _- -
NOTIFICATION __

SOUTH FORK 6-1-0 Biosolids Fertilizer
Produced by Town of Jefferson
P.O. Box 67 Jefferson, NC 28640
South Fork 6-1-0 (SF 610) is a high organic content fertilizer manufactured by the Town of Jefferson Wastewater
Treatment Facility. This product produces superior results on lawns, Christmas trees, flower beds, and shrubs
providing nutrients at the rates indicated below.
Lawn -Sod Establishment:
Turf Maintenance:
Plant Bed Establishment:
Plant Bed Maintenance:
GUARANTEED ANALYSIS
Total Nitrogen 6 %
Water Insoluble Nitrogen 3.5%
Available Phosphoric Acid 1 %
Soluble Potash ..0 %
Iron 1
RECOMMENDED APPLICATION RATES
Apply SF 610 at a rate of 30 lbs./1000 square feet at time of planting
Apply SF 610 at a rate of 10-15 lbs./1000 square feet every 3 months
Apply SF 610 at a rate of 2 lbs. / 100 square feet and mix into the soil
Apply SF 610 at a rate of 2 lbs. / 100 square feet in the Spring and Fall
WARNINGS: HC 610 is environmentally safe when used as directed, but can become a hazard if mismanaged. This product
should not be used on soils intended for food crop production. This product should not be used as a starting medium for
germinating seeds other than grasses. Cover SF 610 with a tarp or plastic during transport. Store SF 610 in a dry area away from
wells or surface waters where it could be washed into streams: keep bulk product away from areas where children may play or pets
may wander.
LIMITED WARRANTY AND DISCLAIMER: The Town ofJefferson warrants that SF 610 meets the specifications stated
above, and that the heavy metals content is less than or equal to the limitations specified in EPA and NC DENR sludge quality
criteria for land application. There are no warrantees expressed or implied that extend beyond the description contained herein.
Specifically, there are no warrantees of merchantability or fitness for a particular purpose. If SF 610 fails to meet its specifications
the buyer's sole remedy shall be the recovery of the purchase price. Under no circumstances shall the Town ofJefferson be liable
for any other damages, including direct, indirect, consequential or special damages.
ACKNOWLEDGEMENT: The undersigned Buyer acknowledges that he/she has read this brochure and is familiar with its
contents. The undersigned Buyer agrees to abide by the following restrictions:
1. SF 610 shall not be applied to land except in accordance with the instructions contained herein.
2. SF 610 shall not be applied to any site that is flooded, frozen, or snow-covered.
3. SF 610 shall not b- applied within 25 feet of any water supply, stream, or lake.
4. Adequate measujs shall be provi r• to prevent surface runoff from carrying this product into surface waters.
Buyer Signature
Name (print) Fred W(�''(�is
rg.07 D r, VW-6rs Rdl .
Address
JfSOr\, NC zg(
Telephone: (330 2,14 60 2-1 &5
Date 2/11/22/
Quantity: S.Co
Intended Use PckS1UY�.
Lbs Tons
Amount Collected S/6
;>n 2,021

NCDA&CS Agronomic Division
Phone: [phone] Webstte: www.ncag►.govlagronoml/
Report No. FY22-51.006967
Predictive
Soil Report
Links to Helpful hitormalion
pied.09/30/2021 Received: 10/05/2021 completed: 10(15/2021 Farm:
Mehlich-3 Extraction
Client: 1 own of Jefferson
302 East Main St / PO Box 67
Jefferson, NC 28640
Sampled County : Ashe
Client ID: 88367
Advisor: Micah Orfield
Ashe CES HOUSE ACCT
134 Gov. Cir. / PO Box
1032
Jefferson. NC 28640
Advisor ID: 396894
Sample ID: FWALT
l:!
Lime History:
Recommendations: time
Nutrients (Ib/acre)
More
Information
Crop (tonsfacre) N P205
1-Fescue/OGrass/Tim, E 0.0 50-70 0
2-Fescue/OGrass1Tim, E 0.0 50-70 0
K20
20
20
Mg
0
0
S
0
0
Mn Zn
pl-IS 0
pH$ 0
Cu
0
0
B
0
0
Test Results (units - WN In g/cnrt; CEC and Na in megf100 cm3; NO3-N In mg/drill):
HM% WN CEC BS% Ac pH P-I K4 Ca% Mg%
0.46 0.83 14.8 91 1.4 6.5 80 39 63 27
S4
52
Mn4
219
Mn-Ail
140
Soil Class:
Mn-Al2
140
Mineral
Zn-1 Zn-Al
771 771
Cu-I
514
Na
0.1
ESP
1
SS -I NO3-N
Sample ID: FPAST
.(i..
Lime History:
Recommendations: Lime
Nutrients (Ib/acre)
Mg S
0 0
0 0
Mn Zn
0 0
0 0
More
Information
Crop (tons/acre) N P205
1-Fescue/OGrassfTim. E 1.3 50-70 100
2-Fescue/OGrass/Tim, E 0.0 50-70 100
K20
40
40
Cu
0
0
B
0
0
Test Results [units - WN in gicrrft; CEC and Na in meq/100 cm3; NO3-N in mg/dnmi):
HM% WN CEC BS% Ac pH P-I K-I Ca% Mg%
0.51 _ l0_87 _ „ 1220 86 1.7 6.2 19 31 59 26
S-I
38
Mn-I
607
Mn-AI1
374
Soil Class:
Mn-Al2
374
Mineral
Zn-I Zn-AI
322 322
Cu-I
318
Na
0.1
ESP
1
SS-1 NO3-N
Reprogramming of the laboratory -information -management system that makes Otis report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Tmxler, Commissioner of Aaricu/ure