WQ0022155_2022 Residual Annual Report_20230203 (2)

Initial Review
Reviewer
Thornburg, Nathaniel D
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* 2022
Permit Number (IR) * WQ0022155
Applicant/Permittee Town of Jefferson
Email Notifications
Does this need review by the hydrogeologist? * Yes U No
Regional Office Winston-Salem
CO Reviewer
Admin Reviewer

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*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
3362462165
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-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://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0022155
Has Current Existing permit number
Applicant/Permittee Address*
1233 NC Highway 16 South, Jefferson, NC 28640
Facility Name*
Town of Jefferson Class A Residuals Program
Please provide comments/notes
on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [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 202220230203_15085552.pdf 12.59MB
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 2/3/2023

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0022155 County: Ashe Year:
Facility Name (as shown on permit):
Town of Jefferson WWTP
2022
Land Application Operator: Tim Church Phone:
Land application of residuals as allowed by the permit occurred during the past calendar year?
0 Yes CI 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:
336246
Total number of application fields in thepermit:
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:
3.6
Total number of acres utilizes for land application during the year:
n/a
Part B - Annual Compiance Statement:
Facility was compliant during calendar year 2022 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. 0 Yes ❑ No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
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[/Y1'h (�,,I_ z/3��0�3
Permittee Name and Title (type or print) Signature of Permittee 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)

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ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (503 Rules)
Facility Name: Town of Jefferson WWTP
WWTP Name: Jefferson WWTP
WQ Permit Number:
NPDES Number:
WQ0022155
NCO021709
Monitoring Period: From 1.1.22 To 12.31.22
Pathogen Reduction (40 CFR 503.32) - Please indicate level achieved and alternative performed:
Class A:
Alternative 1 C]
Alternative 2 ❑
Alternative 3 ❑
Alternative 4 ❑
Alternative 5 ❑
Alternative 6 ❑
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying ❑
Heat Treatment ❑
Thermophilic ❑
Beta Ray ❑
Gamma Ray ❑
Pasteurization ❑
Class B:
Alternative 1 ❑
Alternative 2 ❑
If applicable to alternative performed (Class B only) indicate "Process to Signiticantiv Reduce Pathogens":
Lime Stabilization ❑
Air Diving[]
Composting ❑
JAerobic Digestion ❑
Anaerobic Digestion
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Parameter
Allowable Level
in
in Sludge
Pathogen Density
Number ol
Excee-
Frequency
of Analysis
Y
Sample
Type
Analytical
Tech -
i oue
Minimum
Geo. Mean
Maximum
Unitsences
Fecal Coliform
2 x 10 to the
6th power
per gram of
total solids
MPN
224
271
330
MPN
0
2
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) ❑
jAlt. 4 (Spec. OZ uptake) ❑
Alt. 5 (14-Day Aerobic) ❑
Alt. 6 (Alk. Stabilization ❑
Alt 7 (Drying - Stable) RI
Alt. 8 (Drying - Unstable) ❑
Alt. 9 (Injection) ❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed ❑
CERTIFICATION STATEMENT (please check the appropriate statement)
❑ "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."
Ilm�. Wahl Resources �1fCUOY
Preparer Name and Title (type or print)
&AtL
Signa ire of Preparer* Date
Land Applier Name and Title (if applicable)(type or print)
Signature of Land Applier (if applicable) Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM PVRF 503 (12/2006)

Town of Jefferson WWTP
Class A Residuals WQ0022155
2022
MONTH
GALLONS
DRY TONS
January, 2022
11,800
0.5
March, 2022
8,7003
0.35
April, 2022
4,500
0.19
May, 2022
20,200
0.83
June, 2022
13,600
0.56
July, 2022
16,200
0.67
December, 2022
12,600
0.52
TOTAL
87,600
3.6
F7,600 x 0. OW X 8.
,Dry Tons
z, 060

6td Sep ) 21
Class A Dry Biosolids Production Record
Pathogen Reduction Alternative 1
ZO?M
(Complete a line for each batch produced, not just a line for each day.)
DATE Thermal Fluid Discharge Temperature
Degrees F 1 Degrees F
--!
Drying Time of
Time, hrs._ Discharge
3 Z2
4
3
DDO
"
s
45-0
Zq7/33
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"15-0
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q5-0
297
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397
1100
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2 7
297
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Fenton Environmental Technologies, Inc.
RK Series Municipal Biosolids Dehydrator
1(800) 777-1371
Class A Compliance Under the 503 Rules
The SludgeMA.STER 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 dewutered
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 ho urn n. This cornplianrk is shown as follows using Regime
A under Alternative I which requires that solids be heated at 50 degrees C or higher for 20
minutes or longer.
'Time (in days) = 131 7 0.000
10^ 0.14 (teruperasure) gr, for die RK dehydrator at 212 degrees F (=100 C)
Time= 131.7 000 Qr Time= 131.700.000 or Time = less than 1.3/10"6 day.
10^ 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 tic time requirement by about 7000/'o.
Total cycle time is determined by achieving the desired sludge dryness. We normally rmommcnd a
minimum of 90 % dry solids for a finished product to qualify under 503.33 "Option-8" regarding
vector attraction reduction. (Fully digested sludges need be dried to 75%- 503.33 "Option 7".)
The Sludge"TER RK patented process automatically adjusts the time and temperature regunc
for the varying incoming wet sludge solids content. This feature is very unportnnt since dcwatering
operations will vary from time to time in solids consistency yet we must maintain consistent Ckiss
A biosolids at all times. Convey, xly, 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 SludgetviASTER RK Dehydration System.
In choosing Class A biosolids thermal dehydration utilizing StudgeMAS7EER RK technology, your
utility will be assured of an environmentally correct sludge: handling solution for many years in the
future.

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Tiro Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Report Date:
NPDES #:
Project:
P.O. #:
Date Sample Rcvd:
Meritech Work Order # 02082206 Sample: Class A Dry Residuals Grab
Page 3
2/28/2022
NCO021709
Class A Dry Residuals
2165
2/8/2022
2/7/2022
Parameters Results Analysis Date Reportii3gLimit Method
% Total Solids
88.1 %
2/9/2022
0-100 %
SM 2540B
Ammonia, Nitrogen
<11.4 mg/kg
2/11/2022
11.4 mg/kg
EPA 350.1
TKN
3,500 mg/kg
2/16/2022
20 mg/kg
EPA 351.1
Nitrate/Nitrite, Nitrogen
<11.4 mg/kg
2/14/2022
11.4 mg/kg
EPA 353.2
Aluminum, total
3,090 mg/kg
2/24/2022
2.50 mg/kg
EPA 200.7
Arsenic, total
<0.568 mg/kg
2/24/2022
0.568 mg/kg
EPA 200.7
Cadmium, total
0.222 mg/kg
2/24/2022
0.575 mg/kg
EPA 200.7
alcium, total
3,590 mg/kg
2/24/2022
10.0 mg/kg
EPA 200.7
Copper, total
133 mg/kg
2/24/2022
1.00 mg/kg
EPA 200.7
Lead, total
4.32 mg/kg
2/24/2022
0.500 mg/kg
EPA 200.7
Magnesium, total
1,310 mg/kg
2/24/2022
10.0 mg/kg
EPA 200.7
Mercury, total
1.53 mg/kg
2/11/2022
0.02 mg/kg
EPA 245.1
Molybdenum, total
0.871 mg/kg
2/24/2022
0.500 mg/kg
EPA 200.7
Nickel, total
5.54 mg/kg
2/24/2022
2.0 mg/kg
EPA 200.7
Phosphorus, total
4,670 mg/kg
2/24/2022
2.00 mg/kg
EPA 200.7
Potassium, total
924 mg/kg
2/24/2022
20.0 mg/kg
EPA 200.7
Selenium, total
<0.568 mg/kg
2/24/2022
0.568 mg/kg
EPA 200.7
Sodium, total
156 mg/kg
2/24/2022
20.0 mg/kg
EPA 200.7
Zinc, total
193 mg/kg
2/24/2022
0.500 mg/kg
EPA 200.7
PH
6.7 S.U.
2/11/2022
1.0 - 14.0 S.U.
SM 4500-1-1B
1 hereby certify that 1 have reviewed and approve these data.Q(�)
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Page 1
Report Date:
2/28/2022
NPDES #:
NCO021709
Project:
Class A Dry Residuals
P.O. #:
2165
Date Sample Rcvd:
2/8/2022
Meritech Work Order #
02082206 Sample: Class A Dry Residuals Grab
2/7/2022
1311
- TCLP Metals
Parameter
Results
Analvsis Date Det, Limit
Reg. Limit
Method
Arsenic
<0.100 mg/L
2/24/2022 0.100
5.0
EPA 200.7
Barium
0.848 mg/L
2/24/2022 0.050
100.0
EPA 200.7
Cadmium
<0.020 mg/L
2/24/2022 0.020
1.0
EPA 200.7
Chromium
0.054 mg/L
2/24/2022 0.050
5.0
EPA 200.7
Lead
<0.100 mg/L
2/24/2022 0.100
5.0
EPA 200.7
w Mercury
<0.02 mg/L
2/11/2022 0.02
0.2
EPA 245.1
Selenium
<0.100 mg/L
2/24/2022 0.100
1.0
EPA 200.7
Silver
<0.050 mg/L
2/24/2022 0.050
5.0
EPA 200.7
TCLP Organics
Parameter
Results
Analysis Date
Volatiles 8260
Attached
2/11/2022
Semi Vol. 8270
Attached
2/21/2022
Other Tests
Parameter Results Analvsis Date
Reporting Limit Method
8260
8270
Reporting Limit Method
Cyanide, total
<0.500 mg/kg
2/11/2022
0.500 mg/kg EPA 335.4
Sulfide
15.2 mg/kg
2/14/2022
1.00 mg/kg SM4500S2D
Flash Point
>140 °F
2/11/2022
- EPA 1020C
Corrositivity (pH)
6.7 S.U.
2/11/2022
1.0 - 14.0 S.U. SM 4500 HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
A off
Page 2
Report Date: 2/28/2022
Contact: Tim Church NPDES #: NC0021709
Client: Town of Jefferson WWTP Project: Class A Dry Residuals
11.0. Box 67 P.O. #: 2165
Jefferson, NC 28640 Date Sample Rcvd: 2/8/2022
Meritech Work Order # 02082206 Sample: Class A Dry Residuals Grab 2/7/2022
1311 - TCLP Pesticides & Herbicides
Pesticide - SW-846 8081A
Parameter Results Analysis Date Det. Limit Reg. Limit Dilution Factor
Endrin
Chlordane
Toxaphene
Methoxychlor
Heptachlor
Lindane
Herbicides - SW-846 8151A
Parameter
2,4-D
2,4,5-TP (Silvex)
Attached
Attached
Attached -
Attached -
Attached
Attached -
Results Analysis Date Det. Limit Reg. Limit Dilution Factor
Attached
Attached
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

MERITECH, INC.
Environmental Laboratories
Laboratory Certificate #165
Client: Town of Jefferson WWTP
Project: Class A Dry Residuals
Client Sample ID: Class A Dry Residuals
Sample Collection: 02/07/22
Meritech Sample ID: 02082206
1311 - TCLP Organics
Volatiles: SW-846 8260
Analysis: 02/ 11 /22
Extraction:
02/08/22
Analvst: VWV
Report Date:
02/15/22
Parameter
Result
Units
Det. Limit
Rea. Limit
Dilution Factor
Benzene
< 0.0100
mg/L
0.0100
0.50
10
Carbon Tetrachloride
< OA 100
mg(L
0.0100
0.50
10
Chlorobenzene
<0.0100
mg/1-
0.0100
100
10
Chloroform
< 0.0100
mg/L
0.0100
6.0
10
2-Dichloroethane
<0.0100
mg/L
0.0100
0.50
10
1,1-Dichloroethcne
<0.0100
mgfl..
0.0100
0.70
10
.Methyl Ethyl Ketone
<0.100
mg/L
0.100
200
10
Tetrachloroethylene
< 0.0100
mg/L
0.0100
0.70
10
Trichloroethene
< 0.0100
mg/L
0.0100
0.50
10
Vinyl Chloride
< 0.0200
mgfL
0.020
0.20
10
Semi-Volatiles: SW-846 8270
Analysis: 02/21/22
Extraction:
02/08/22
Analyst: PM
Report Date:
02/25/22
Parameter
Result
lniti
Det. Limit
Rea. Limit
Dilution Factor
1.4-Dichlorobenzene
<0.100
mgil,
0.100
7.5
10
Hexachlorobenzene
<0.100
mgiL
0.100
0.13
10
Hexachloro-1,3-butadiene
<0.100
mg/L
0.100
0.5
10
Hexachloroethane
<0.100
mgi7.
0.100
3.00
10
o-cresol
<0.100
mg/L
0.100
200
10
mR,p-cresol
<0.200
mg/L
0.200
200
10
Total cresols
<0.300
mg/L
0.300
200
l0
Nitrobenzene
<0.100
mg/L
0.100
2.00
10
Pentachlorophenol
<0.500
mgR.
0.500
100
10
Pvridine
<0.100
mg/L
0.100
5.0
10
2,4,5-Trichlorophenol
<0.100
mg/L
0.100
400
10
2,4,6-Trichlorophenol
<0.100
mg/L
0.100
2.00
10
2.4-Dinitrotoluene
<0.100
mg/L
0.100
0.13
10
I hereby certify that I have revie;ved and approve there data. -
44 t'YL,f`Y1J��
Laboratory Representative
642 Tamco Road ` Reidsville, NC 27320
[phone] * [e-mail]

sum nritEnvironmental Technologies. Inc . Analytical Report
c "' 3310 Win St.
t (consolidared) NIMUT
eWVMbiUEWAL4MCHWUl4WX, WC Cuyahoga Falls. Ohio 44223
TEL: [phone] FAX.- (330) 2534489 � 0� 220207i0
t4'ebsue: rr •lhvww seuek com Date Reported: 2/1712022
Lab ID: 22020750-002 Collection Date: 2/7/2022 11:30:00 AM
Client Sample ID 020822-06 Matrix: SOLID
Analysis Rcsult Units Dilution Batch Date Analyzed
TCLP PESTICIDES ANALYSIS (SW131118081) EPA 8081B Analyst CSS
Chlordane, total ND 0.380 25.0 U µg/L to 54991 2/17i2022 7:58:00 AM
Toxaphenc ND 1.60 50.0 U µg/L 10 54991 2/17/2022 7.58:00 AM
Endrin ND 0.0634 5.00 UQC- µg/L 10 54991 2/17/2022 7:58 00 AM
gamma-BIIC ND 0.0429 5.00 UQC 118/1 10 54991 2/17/2022 7:58 00 AM
Heptachlor ND 0.0336 5.00 UQC+ µg/L 10 54991 2/17/2022 7 58 00 AM
Heptachlor epoxide ND 0.0676 5.00 U µg'L 10 54991 2/17/2022 7:58:W AM
Meawxychlor ND 0.0509 5.00 UQC+ µg'L 10 54991 211712022 7:58:00 AM
TCLP HERBICIDES BY EPA 8321B EPA 8321B Analyst RIS
, 4-D LD 0.500 0-500 U mg/L 50 R140248 2/16/2022 4:28 Go AM
_ 1 i ND 0.500 0.500 U mg/L 50 R140248 2/16/2022 4:2&00 AM
Qualifiers: 13 Analyte detected in the associated Method Blank
H Holding times for preparation or analysis exceeded
MC Value is below Minimum Compound Limit.
ND Not Detected
P Second column confirmation exceeds
Page 5 of 13
E Value above quanotation range
M Manual Integration used to determine area response
N Tentatively identified compounds
OGI Page 5 of 12
PL Permit Limit

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SAR Calculator Class A
Adjusted SAR Calculator
EC
1
µS
Ca
316Z
mg/1 or ppm
I
1154
mg/l or ppm
Na
1137
mg/1 or ppm
HCO3
1
mg/1 or ppm
SAR
'0.5
adj SAR
0.3
Use the larger
of the tNvo
0.5
;Reset
adj Classification
SAR
< 1 Excellent
1-2 Good
2-4 Fair
4-8 Poor
8-15 Very Poor
> 15 Unacceptable
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
Contact Information

I
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WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,13ANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 1
COLLECTED DATE: 6-Jan-22
REPORTED DATE: 7-Feb-22
IDS;:
ANALYSIS ANALYSIS MQL's UNITS SAMPLE ANALYSIS
RESULTS LOCATION COMPLETED
TOTAL SOLIDS 91.2 %
FECAL COLIFORM 224 1 N/IPN SLUDGE 30-Dec-99
REPORTED BY: NC CERTIFIED LAB # 544
i
PAUL ISENHOUR, SUPERVISOR
METHOD INT
CODE
SM-9222D WPS

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
itfax [phone]
CHAIN OF CUSTODY
LOCATION ��P, rSOn W 1 - H2SO4 2 - HNO3 3 - HCL
FACILITY ID Class fP,CI duo1S 4 - NAOH 5 - NONE, 6 - COOL ICE
SAMPLER NAME —Time` txrc�.� 7 - NA2S2O3 8 OTHER
COMPOSITE SAMPLE. START TIME. - STOP TIME
TYPE PRESERVATION' PH CL2 D CL2
COMP F - FIELD L - LAB verif YES NO
LAB SAMPLE t
ID NUMBER
SAMPLE NAME
L
COLLECTION
DELIV.
TEMP
SAMPLE
DATE TIME TEMP
GRAB
VOT61SOUS
(o
y
_E Idiom,
Vid
A-M
/+
I
--
i
-
l
—
i
FZELINQUISHED BY
DATE
TIME
RECEIVED BY
DATE
TIME j
1
RELINQUISHED BY
DATE
TIME
j REC ED BY
DATE
TIME
s
lII
I
Lat)ofalory preservation is ensureo uy auumun Gf uiebt�fvcwvr.� �JTIUI t.)
containers leaving the lab, unless otherwise notes
CL2-D-CL2= Chlorine check and dechlorination verification
P:�tSERVA,rION
f COOL 4C BOG, RESIDUE, CONDUCTIVITY. MBAS COLOR. ALKALINITY CR VI TURBIDITY
COOL 4C PH<2 H2SO4 N113 NO2-NO3 TKN O&G TOC COD HARDNESS PHENOLS TOT PHOS
} COOL 4C PH-2 HNO3 %1ETALS ex ept CR VI
NONE CHLORIDE, PH FLUORIDE SAMPLE DEVIATION
OTHER
I COOL 4C. NA2S203 COLIFORrV BACTERIA
NOTIFICATION
m

CLIENT: JEFFERSON 1
ADDRESS:
CITY:
STATE:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIPJIE:
SAMPLER:
COLLECTED DATE: 23-Mar-22
REPORTED DATE 8-Apr-22
I D#:
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
ANALYSIS
TOTAL SOLIDS
92.3
°/"
E
SM 9222D
\NPS
FECAL COLIFORM
330
1
MPN
REPORTED BY: NC CERTIFIED LAB 9 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATIONS, INC.
P.0. BOX -1167, BANNER ELK, NC 28604
f [phone]
fax [phone]
mob-- Aass CHAIN OF CUSTODY
1 - H2SO4, 2 - HNO3, 3 - HCL.
LOCATION! Jefferson WVVTP 4 - NAOH. 5 - NONE. 6 - COOL ICE
FACILITY ID #. NCO021709 —
7 - NA2S203, 8 -OTHER
SAMPLER NAME: T. Church F Walters
COMPOSITE SAMPLE, START TIME: 800 800
SAMPLE E NAME: COLLECTION DEUV. SAMPLE TYPE PRESERVATION' PH CL2 D CL2 LAB SAMPLE
_ DATE TIME 1'CMP TEMP GRAB CO MP F FIELD L -LAB verif YES NO ID NUMBER
r r 6
InXfluent BODITSS I }--- 6
Effluent BOD/TSS I X
Effluent NH3 N X 6
Mum f coliform Q` x
C an,de 2 x
Cooper.Zinc _ X 6 2
---` ----._
Total Nitrogen 6
-`_
jTotaf Phosphorus X
7)
-- i -- X 6
�-;Tn,ent Hardness — — G i
.ups.r Hardness _�. I ! —�--� X--r--- _ —
RECEIVED BY. DATE TIME
ELiN ISHED BY: AT TIME �!
'� 7n osm
Uv`"'Ckmd,TIME
RELINQUISIIEO BY' DATE T!P,1E ECEIVED BY: DATE
Laboratory preservation is ensured by additicn of pres rvatives prior to sample
containers leaving the lab, uniess otherwise noted
CL2-D-CL2= Chlorine check and dechlorination verification
PRESERVATION
COOL 4C : BCD, RESIDUE, CONDUCTIVITY, tv1BAS COLOR, ALKALINITY, CR, VI, TURBIDITY
COOL. 4C, PI-1-<2 H2S0,' , NH3. NO2-NO3. TKN, O&G, TOC, COD. HARDNESS, PHENOLS TOT PROS
COOL 4C. PH<2 HNO3 METALS except CR. VI SAMPLE DEVIATION
j NONE CHLORIDE Pi FLUORIDE
OTHER
COOL 4C. NA2S203 ' COLIFORM BACTERIA 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
lawtnsf, Christmas trees, bedsr and shrubs Wastewater
Treatment Facility. This product produces superior resultson
providing nutrients at the rates indicated below.
GUAILANTEED ANALYSIS
Total Nitrogen.........................................6
Water Insoluble Nitrogen ..........................3.5%
Available Phosphoric acid ......................... } %
Soluble Potash.........................................0 %
n
Iron...........................................................1 0
RECOMMENDED APPLICATION RATES
Lawn -Sod Establishment: Apply SF 610 at a rate of 30 Ibs./1000 square feet at time of planting
Turf Maintenance; Apply SF G10 at a rate of 10-15 lbs./1000 square feet every 3 months
Plant Bed Establishment: Apply SF 610 at a rate of 2 lbs. / 100 square feet and mix into the soil
Plant lied Maintenance: Apply SF 610 at a rate of 2 lbs. / 100 square feet in the Spring and Fall
ed. This
WARNINGS: tIC 610 is environmentally safe wherdas dThis product should not be used as a stariiirected, but can become a hazard nggmedium forroduct
should not be used on soils intended for food crop production. area awav from
germinating seeds other than grasses. Cover washed 6in oast eamsrnkcepor lastic during bulk product ta nap from areas ort, Store where children may play or pets
wells or surface eaters where it could be
may wander. nts that
610 meets the
cations
LIMITED WARRANTI' AND DISCLAIMER: The Town ofiefferson
the limitatwarra ions ns specified m EPA and NC DENR sludge quality
above, and that the heavy metals content is less than or equal
n.
criteria for land application. There are no warrantbe'tt� or fitnespressed s for a partcufr implied textend ar Purpose. if SF 6ond the a0 fails to meet tits specifications
Specifically, there are no Nvarrantees of merchants
the buyer's sole remedy shall be the recovery of the purchase price. Under no circumstances shall the Town of Jefferson be liable
for any other damages, including direct, indirect, consequential or special damages.
has read this brochure and is familiar with its
ACKNOWLEDGEMENT: The undersigned 13uyer acknowledges that he/she
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.
;. SF 610 shall not be applied within 25 feet of any water supply, stream, or lake.
4. Adequate measures shall be provided to prevent surface runoff from carrying this product insurface waters.
into
Date G ?
Buyer Signature
Lbs Tons
Name (print) jgn�r ___. coeK—
Address
(Oa) or^AnOb �le
Telephone: 336_- 3 0 9—
Quantity:
Intended Use_ for
Amount Collected S ----
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