WQ0003992_2022 Residual Annual Report_20230228 (2)

Initial Review
Reviewer
Nathaniel.Thornburg
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) * WQ0003992
Applicant/Permittee Town of West 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* Brandon Patrick
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*
3369776725
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:* WQ0003992
Has Current Existing permit number
Applicant/Permittee Address* PO Box 490 West Jefferson NC 28694
Facility Name* Town of West Jefferson Class B 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.)
Land App to state 2022.pdf 5.65MB
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
0"W.,r� �itGtem
Submission Date 2/28/2023

Tom Hartman, Mayor
Brantley Price, Town Manager
Bradley Jordan, Chief of Police
John B. "Jak" Reeves, Town Attorney
Esta6fished 1915
"Prosperity, growtk, AcFiievement"
February 28, 2023
DENR/DWQ
Water Quality Section
Non -Discharge Compliance Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Russell W. Barr, Alderman
Calvin Green, Alderman
John K. Reeves, Alderman
Stephen Shoemaker, Alderman
Crystal C. Miller, Alderman
Enclosed please find the Town of West Jefferson's Annual Report for the Land Application of
Bio-solids for the calendar year 2022. If you have comments, questions, or require additional
information, please let me know.
Respectfully,
Brandon Patrick
Town of West Jefferson
336-246-3558
[e-mail]
Post Office Box 490
Phone: 336-246-
Fax: [phone]
of S. Jefferson Ave.
cis institution is an equalopportunity providerandempCayer.
www.townofwjnc.com
West Jefferson, NC 28694
3551

Dale Baldwin, Mayor
Brantley Price, Town Manager
Bradley Jordan, Chief of Police
John B. "Jak" Reeves, Town Attorney
Im
TOWN OF WEST JEFFERSON
BIO-SOLIDS PROGRAM 2022
SLUDGE PERMIT #WQ0003992
NPDES #NC0020451
Report Contents:
FORM ACF
FORM RSSF
FORM RSSF - B
FORMS MFLSF:
Fields: DP-2
FORMS FSF:
Fields: DP-2
Lab Sheets
Pathogen Reduction Summary
FORM PVRF 2T
Field Soils Test
IY�
Esta6fished 191 S
Vrosperiq, Growth, Achievement"
Calvin Green, Alderman
Jerry C. McMillan, Alderman
John K. Reeves, Alderman
Stephen Shoemaker, Alderman
Brett T. Summey, Alderman
One field in our program was used for haul events. We only hauled during the month of June.
We pressed and hauled 477 tons to the landfill.
Town of West Jefferson
Po Box 490
West Jefferson, NC 28694
Brandon Patrick, ORC
[e-mail]
336-246-3558
Post Office Box 490
Phone: 336-246-
Fax: 336-246-
of S. Jefferson Ave.
This institution is an equalopportunity providerandemproyer.
www.townofwjnc.com
West Jefferson, NC 28694
3551
4409

ANNUAL LAND) APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0003992 County:_ ASHE Year: 2022
Facility Name (as shown on hermit): Town of West Jefferson
1,and Application Operator Brandon Patrick Phone: [phone]
band application of residuals as allowed by the permit occurredduringthe past calendar ,year?
RJ Yes EJ 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 - ilncitinale Annlientinn Rnmimarv-_
Total number of application fields in the ermit
3
Total number of fields utilized for land application during the year:1
I
Total amount of dry tons applied during the year for allapplicationsites:
2.1717
Total number of acres utilizes for land application dtu•ing the year:
10.53
Part II - Annual Compiance Statement:
Facility was compliant during calendaryear 2022 with all conditions of the land applicaation permit
(including but not limited to items 1-13 below) issued by the Division of Water .Resources. R1 Yes EJ No
If no please, provide a written description why (lie facility was not compliant, the (fates, and explain corrective action
taken.
1) Only residuals approved for this permit were applied to the permitted sites.
2) Soil p1l 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 "t'C1 l? analysis (if required) was performed and three (3) copies of certified laboratory results are, attached.
5) All other monitoring was perforined 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 .1 105(a) or the Pollutant
Loading Rates in 15A NCAC 021' .1 105(b) (applicable to 40 C FR fart 503 regulated facilities).
7) All general requirements in as specified in the Land .Application Permit were cornplied with (applicable to 40 Cl='R fart
503 regulated facilities).
8;) All monitoring and reporting requirements in 15A NCAC 021' .111 I. were complied with (applicable to 40 CF'R Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior
author•icationwas received from the Division of Water Resources.
10) No contravention of Ground Water Quality Standards: iaccurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
1 1) Vegetative cover was maintained and proper crap management was performed on each site r'eceing 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 butter 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 ant aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment foi- knowing violations."
Brantley Price/ ]'own Manager a � "
Permittee Name and Title (type or print)Signature o ermitte�e Date
Signafu-re of Preparer* L Date Signature of 1,and Applier Date
(if different from Pennittee) (if different from Pennittee and Preparer)
* Preparer is defined in40C'FR Part 503.9 (r) and 15A NCAC 02T .1102 (26) DENR FORM ACF (12/2006)

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ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Town of West Jefferson Total Dry Tons Applied (Annual) 2.17
Permit #: WQ0003992 , Cation Exchange Capacity (non 503 only):
Operator: Brandon Patrick Owner: Dennis Pennington 'redominant Soil Series:
Acres Used: 10.53 Acres Permitted: 10.53 Site #: DP-2 Field #; 1
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Annual Heavy
Metal Yield Loadings (Ualculated
in lbs/acre):
Total -
1
2
3
4
5_j
8 1
9
10
11
12
_
DT/Ac./
0
App.
y
Event
0.21
Arsenic
0.000
0.000
0.000
0000
0.000
0.000
0.000
0:000
0.000
0.000;
0.000
0.000
0000
Cadmium
0.000
0.000
0.000
0.000
0.000 ;
0.000
0.000
0.000
0.000
0.000
0.000,
0.000
0.000
Copper
0.194
0.000
0,000
0 000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.194
-hromiurr
0.012
10.000
0.000
0000
0.000
0.000
0.000
0.000
:.0.000
0.000
0.000
0.000
0012
Lead
0.003
0.000
0.000
0000
0.000
0.000
0.000
0.000
0.000 '
0.000`
0.000
0.000
1 0.003
Mercury
0.000
0.000
0.000
0000
0.000 :
0.000
10.000
.0.000
0.000
0.000
0.000
0.000
0000
Molyb-
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000.
0.000
0.000
0.003
denum
Nickel
0.009
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.009
Selenium
0.001
0.000
0.000
0,000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.001
Zinc
0.168
0.000
ONO
0:000
0.000
0.000
0.000
0.000
0.000
0.000'
0.000
0.000
0.168
Total
Phos-
4.660
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
4.660
nhorus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gathered and evaluated the
information submitted. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations".
�. -- Z Z2,9 17-3
ignature of Land Applier Date
DENR FORM MFLSF (12/2006)

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Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
West Jefferson I
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
1 /22 0755
0.66 % Dry Solids
19.7 degrees Celsius
20.8 degrees Celsius
0.03
7.8
0.97
1.90 mg Oxygen/hr
0.29 mg Oxygen/hr/g
20 degrees Celsius
1.00
Temperature Corrected Specific Oxygen Uptake Rate: 0.29 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
6/02/22 0820
randon Patric
ndon Patrick
Dry Solids
grees Celsius
grees Celsius
0.03
7.9
1.00
1.72 mg Oxygen/hr
0.28 mg Oxygen/hr/g
21 degrees Celsius
0.95
Temperature Corrected Specific Oxygen Uptake Rate: 0.27 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
06/03/22 0915
Brandon Patrick
06/03/22 0935
Brandon Patrick
Dry Solids
grees Celsius
cirees Celsius
0.03
8.0
0.99
1.85 mg Oxygen/hr
0.31 mg Oxygen/hr/g
20 degrees Celsius
1.00
Temperature Corrected Specific Oxygen Uptake Rate: 0.31 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name: West J
Biosolids Permit Number: WQ00f
Date:
Digester Temperature:
Sampling Date/Time: 06/06/,'
Sampled By: Brandc
Analysis Date/Time: 06/06/,
Analyzed By: Brandc
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
19
0845
Patrick
o Dry Solids
egrees Celsius
egrees Celsius
0.03
8.0
0.87
1.97 mg Oxygen/hr
0.28 mg Oxygen/hr/g
21 degrees Celsius
0.95
Temperature Corrected Specific Oxygen Uptake Rate: 0.27 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
J
20.8
07/06/22 1020
Brandon Patrick
07/06/22 1030
Brandon Patrick
21
0.03
7.7
0.99
o Dry Solids
egrees Celsius
egrees Celsius
2.01 mg Oxygen/hr
0.32 mg Oxygen/hr/g
22 degrees Celsius
0.91
Temperature Corrected Specific Oxygen Uptake Rate: 0.29 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
0.55 %Dry Solids
21.3 degrees Celsius
22.1 dearees Celsius
0.03
7.7
0.98
1.90 mg Oxygen/hr
0.35 mg Oxygen/hr/g
22 degrees Celsius
0.91
Temperature Corrected Specific Oxygen Uptake Rate: 0.31 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Specific Oxygen Uptake Rate
SOUR
Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
� Dry Solids
egrees Celsius
egrees Celsius
0.03
7.7
0.99
2.01 mg Oxygen/hr
0.35 mg Oxygen/hr/g
22 degrees Celsius
0.91
Temperature Corrected Specific Oxygen Uptake Rate: 0.32 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Analytical Results
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, INC 28694
Receive Date: 02/07/2022
Reported: 02/23/2022
For: Sludge
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
220207-12-01
Aluminum
Sludge
5119.05
mg/kg
SM 3111 D-2011
02/17/2022
MD
220207-12-01
Ammonia Nitrogen
Sludge
773.81
mg/kg
SM4500NH3BE-1997
02/08/2022
LE
220207-12-01
Arsenic - Solid
Sludge
<0.005
mg/kg
SM3113 B-2004
02/09/2022
MD
220207-12-01
Cadmium - Solid
Sludge
0.286
mg/kg
SM3111B-1999
02/10/2022
MD
220207-12-01
Calcium
Sludge
25714.3
mg/kg
SM3111B2011
02/17/2022
MD
220207-12-01
Chromium - Solid
Sludge
28.3
mg/kg
SM3113 B
02/14/2022
MD
220207-12-01
Copper - Solid
Sludge
471.4
mg/kg
SM31118-2011
02/18/2022
MD
220207-12-01
Corrosivity
Sludge
See Attached
SW-846
02/09/2021
PACE
220207-12-01
Ignitability
Sludge
See Attached
1010M
02/09/2021
PACE
220207-12-01
Lead -Solid
Sludge
7.928
mg/kg
SM3113B
02/15/2022
MD
220207-12-01
Magnesium
Sludge
6690
mg/kg
EPA200.7
02/08/2022
MD
220207-12-01
Mercury Solid
Sludge
0.238
mg/kg
SM3112B-2011
02/09/2022
MD
220207-12-01
Molybdenum - Solid
Sludge
7.38
mg/kg
EPA200.7
02/15/2022
MT
220207-12-01
Nickel - Solid
Sludge
21.07
mg/kg
SM3113 B
02/21/2022
MD
220207-12-01
Nitrate/Nitrite -
Sludge
5166.67
mg/kg
SM4500F/A
02/11/2022
CL
Solids
220207-12-01
'Percent Solids
Sludge
0.42
%
SM2540B-2011
02/07/2022
MD
220207-12-01
Potassium - Solid
Sludge
6980
mg/kg
EPA200.7
02/21/2022
MT
220207-12-01
Reactivity
Sludge
See Attached
SW-846
02/14/2021
PACE
220207-12-01
Selenium
Sludge
2.62
mg/kg
EPA200.8
02/15/2022
MT
Subcontracted
220207-12-01
Sodium - Solid
Sludge
9071.43
mg/kg
SM 3111 B
02/08/2022
MD
220207-12-01
T. Phosphorus Solid
Sludge
11310
mg/kg
SM450OPE-2011
02/11/2022
CL
220207-12-01
TKN
Sludge
42800
mg/kg
SM4500Norg B-2011
02/11/2022
CE
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 22

Sample Number parameter
220207-12-01 Zinc - Solid
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
Sample ID Result
Sludge 407.143
Unit Method
mg/kg SM3111B-2011
Analyzed Analyst
02/11/2022 MD
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 22

Condition of Receipt
Sample Number 220207-12-01 Temp on Arrival: 2.3
Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Aluminum
Nitric Acid
Received on Ice
Chemicals in containers, lab
Chemicals in containers, lab
Received on Ice
Parameter Schedule:
Arsenic - Solid
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Cadmium
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Cadmium - Solid
Nitric Acid
Chemicals in containers, lab
Received on Ice
Parameter Schedule:
Chromium
Nitric Acid
Chemicals in containers, lab
Received on Ice
Parameter Schedule:
Chromium - Solid
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Copper
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Copper - Solid
Nitric Acid
Chemicals in containers, lab
Received on Ice
Parameter Schedule:
Nickel
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Nickel - Solid
Nitric Acid
Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Zinc - Solid
Nitric Acid
Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 3 of 22

Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule:
Parameter Schedule:
Parameter Schedule:
Received on Ice
Chemicals in containers, lab
Received on Ice
Chemicals in containers, lab
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Corrosivity
Received on Ice
Parameter Schedule: Reactivity
Received on Ice
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Ignitability
Received on Ice
Parameter Schedule:
Received on Ice
Parameter Schedule: Phosphate, Total as P
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TKN
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 4 of 22

Parameter Schedule:
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Molybdenum - Solid
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Potassium
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Potassium - Solid
Chemicals in containers, lab
Received on Ice
Parameter Schedule: Nitrate/Nitrite
Received on Ice
Chemicals in containers, lab
Parameter Schedule: Nitrate/Nitrite - Solids
Parameter Schedule:
Received on Ice
Chemicals in containers, lab
Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 5 of 22

Statesville Analytical Holdings, LLC
Sl l)t
122 Court St, Statesville, NC 28677
704-872-46 7
ANNUAL RESIDUAL
SAMPLING
CHAIN OF CUSTODY
40 CFR PART 503
SAMPLE TYPE, WASTEWATER
*PFtESERltATdL?ISI CC1L3E
LOCATION: r"EST IEFF RSON
I — H2SCl4, 2 — HNOa, 3—141CL,
FACILITY ID11: hLCO020451
4 -- NAO , S — NONE, 6- COOL ICE
SAMPLER NAME: Brandon Patrick
7 — NAxS20,a, 8 — OTHER
COMPOSITE SAMPLE, START DATE:
START TIMFi I, 10 nATP, r'r^D °rafenr.
SAMPLE
• • a
SA
-
r
SAMPLE
ID
NUMBE
t► +
RELINQUISHED BY:
DATE
TIME
RECEIVED BY: DATE
TIME
Lj
�.
REL.INQUI SHED BY.
DATE
TIME
RECEIVED BY: DATE;
TIME
k,,1
o
,^%.y
*Laboratory Preservation is ensured by a ddition of presprva fives prior to s,,implea
cantainers leaving the tab, unless otherwise noted.
w
i?, RE i,i FLS £ P:Gni e[E 9Y€ Temp.
€ rY/f tee .'Y� ir
$/ tea' 3
PO Box 228 - Statesville, NC 28687 - 704/872/4697
Page 6 of 22

Statesville Analytical Holdings, LLC
122 Court St. Statesville, NC 28677
704-872-4697 ANNUAL RESIDUAL
SLLtLiGE SAMPLING
CHAIN OF CUSTODY 40 CFR PART 503
SAMPLE TYPE: WASTEWATER *PRESERVATION CODE
LOCATION: WEST 1£FFERSON 1— H2904, 2 — HNO3, 3 — HCL,
FACILITY ID#: NC00204S1 4—NAOH, 5— NONE, 6—COOL ICE
SAMPLER NAME* Brandon Patrick 7 — NA2S20a, 8 -'OTHER
COMPOSITE SAMPLE: START DATE: START TIME: STOP DATE: STOP TIME,
SAMPLE
NAME:
COLLECTION
DELIV
TEMP
SAMPLE
TYPE
PRESERVATION*
PH
verify
CL2-13-
CI-2
LAS
SAMPLE
10
NUMBER
DATE
TIME
TEMP
GRAB
COMP
F-FIELD
L-LAB
YES
NO
ALUMINUM
`]—W
C27110
41
— -
-
CHROMIUM'
SELENIUM
ZINC
NICKEL
30 0a Bench
'1 • #-
b 73
RELINQUISHER BY:
q�� G)
DATE
a —,) -21,
TIME
() f a
RECEIVED BY:
DATE
TIME
RELINQUISHED BY:
DATE
TIME
RECEIVER BY:
MATE
TIME
*Laboratory:preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted. )j
C1.2 O C.L? = Chlorine check and deck IONnatlan VPrlftnttom pH'
.6:
PRESERVATION: : l �y
q COOL 4°C; Bob, RESIDUE, CONDUCTIVITY,.MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY Temp:
()COOL. 4°C, PH<2 H404: NH3, NO2NO3, TKN, 0&G, TOC, C,OD, HARDNESS, PHENOLS, TOT PHOS'. Conti-
0 COOL 4°C; PH<2 HNO3: METALS EXCEPT CR, V!
Q NONE: CHLORIDE, PH, FLUORIDE
OTHER:
(I COOL 4°C, NA:S,O,' . COLIFORM BACTERIA
PO Box 228 - Statesville, NC 28687 - 704/872/4697
Page 7 of 22

eritec , Inc.
Environmental Laboratory
Laboratory Certification No,165
Contact: C. Little
Report Bate:
2/23/2022
Client: Statesville Analytical
122 Court St
Project:
W1 Sludge
Statesville, NC 28677
Date Sample Rcvd:
2/8/2022
Meritecli Work Order# 02082238
Sample: 220207-12-01 Grab
2/7/2022
Parat er
Resnl 4nalysisDate Reporting Lim
ethod
Molybdenum, total
0.031 mg/L 2/15/2022 0.002 rng/L
EPA 2008
Potassium, total
29.3 mg/L 2/21/2022 0.200 mg/L
EPA 200.7
Selenium, total
0.011 mg/L 2/15/2022 0.001 mg/L
EPA 200.8
F hereby certify that 1 have reviewed and approve these data. JMCA
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 8 of 22

SAR for Biosolids or Wastewater
Sodium Absorption Ratio Na M /L Ca M /L) M M /L
Na: Sodium (Mg/L) Equivalent weight: 23 38.1 1 108 1 28.098
Ca: Calcium (Mg/L) Equivalent weight: 20
Mg : Magnesium (Mg/L) Equivalent weight: 12 Na (ME) Ca (ME) Mg (ME)
1.656,122 5.4 1 2.3415
Milli Equivalent = Mg/L / Equivalent weight The amount of exchangeable sodium ions versus the
amount of exchangeable calcium & magnesium ions in a given material.
SAR= Na Milli Equivalent/[0.5 X (Ca Milli Equivalent + Mg Milli equivalent)]0.5 power
Permit Limit is 10. CONTACT REGIONAL OFFICE
SAR = 0.841976 (From Mo/L entered above)
If your lab reports in Milli Equivalents enter Na, Ca, & Mg below:
SAR= #DIV/01: (From ME entered below)
Na (ME) Ca (MEIIMMe (ME)
Exchangeable Sodium Percentage (FOR SOIL SAMPLE RESULTS)
ESP = Na (Milli Equivalents) / CEC X 100 The percentage of sodium ions occupying the cation exchange complex of soils
Na ME CEC
ESP = #DIV.:O! %,
Na on NC soil test is expressed as meq.
Should be less than 15% (15-20%)

Analytical Results
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 02/07/2022
Reported: 02/15/2022
For:
Comments: -
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
220207-01-01
BOD
Inf
169
mg/L
SM521OB-2011
02/07/2022
CE
220207-01-01
TSS
Inf
36.67
mg/L
SM254OD-2011
02/11/2022
LE
220207-01-02
Ammonia Nitrogen
Eff
0.22
mg/L
SM4500NH3C-2011
02/08/2022
LE
220207-01-02
BOD
Eff
<2
mg/L
SM521OB-2011
02/07/2022
CE
220207-01-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXX Colilert 18 MPN
02/07/2022
WC
220207-01-02
TSS
Eff
<2.778
mg/L
SM2540D-2011
02/11/2022
LE
220207-01-03
Fecal Coliforms
Sludge
19048
MPN/g
SM92210E-2006
02/07/2022
MD
220207-01-03
Percent Solids
Sludge
0.42
%
SM254OB-2011
02/07/2022
MD
Respectfully submitted,
iW/,,�V -- 01 �K-Z--21
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
G
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 4

Condition of Receipt
Sample Number 220207-01-01 Temp on Arrival: 3.0
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: BOD
Received on Ice
Sample Number 220207-01-02 Temp on Arrival: 3.0
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Sample Number 220207-01-03 Temp on Arrival: 3.0
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 4

West Jefferson, NC 28694
Receive Date: 02/14/2022
Reported: 02/28/2022
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
220214-01-01
BOD
Inf
140
mg/L
SM521OB-2011
02/14/2022
CE
220214-01-01
TSS
Inf
304.2
mg/L
SM254OD-2011
02/18/2022
LE
220214-01-02
Ammonia Nitrogen
Eff
5.15
mg/L
SM4500NH3C-2011
02/14/2022
CE
220214-01-02
BOD
Eff
4.58
mg/L
SM521OB-2011
02/14/2022
CE
220214-01-02
Fecal Coliforms
Eff
<1
MPN/100ml IDEXXcolilert18MPN
02/14/2022
MD
220214-01-02
Nitrate/Nitrite
Eff
0.2
mg/L
SM450OF-2011
02/21/2022
CL
220214-01-02
T. Phosphorous
Eff
0.32
mg/L
SM450OPE-2011
02/21/2022
CL
220214-01-02
TKN
Eff
8.18
mg/L
SM4500NorgB-2011
02/22/2022
CE
220214-01-02
TSS
Eff
<2.778
mg/L
SM254OD-2011
02/18/2022
LE
220214-01-03
Fecal Coliforms
Sludge
7894
MPN/g
SM92210E-2006
02/14/2022
MD
220214-01-03
Percent Solids
Sludge
0.38
%
SM254OB-2011
02/14/2022
MD
220214-01-04
30 Day Benchscale
WJ 30 Day
%
EPA625-R-92/0
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 4

Condition of Receipt
Sample Number 220214-01-01 Temp on Arrival: 3.0
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: BOD
Received on Ice.
Sample Number 220214-01-02 Temp on Arrival: 3.0
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: TKN
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Nitrate/Nitrite
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: T. Phosphorous
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Sample Number 220214-01-03 Temp on Arrival: 3.0
Parameter Schedule: Percent Solids
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 4

Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
220221-01-01
BOD
Inf
199
mg/L
SM521OB-2011
02/21/2022
CE
220221-01-01
TSS
Inf
70
mg/L
SM254OD-2011
02/25/2022
LE
220221-01-02
Ammonia Nitrogen
Eff
1.34
mg/L
SM4500NH3C-2011
02/21/2022
CE/LE
220221-01-02
BOD
Eff
<2
mg/L
SM521OB-2011
02/21/2022
CE
220221-01-02
Fecal Coliforms
Eff
<1
MPN/100ml IDEXX Colilert 18 MPN
02/21/2022
WC
220221-01-02
TSS
Eff
<2.747
mg/L
SM2540D-2011
02/25/2022
LE
220221-01-03
Fecal Coliforms
Sludge
20000
MPN/g
SM92210E-2006
02/21/2022
MD
220221-01-03
Percent Solids
Sludge
0.4
%
SM2540B-2011
02/21/2022
MD
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 220221-01-01 Temp on Arrival: 3.0
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: BOD
Received on Ice
Sample Number 220221-01-02 Temp on Arrival: 3.0
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Sample Number 220221-01-03 Temp on Arrival: 3.0
Parameter Schedule:
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

Analytical Results
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 07/06/2022
Reported: 07/15/2022
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit Method
Analyzed
Analyst
220706-14-01
BOD
Inf
286
mg/L SM521OB-2011
07/07/2022
CE
220706-14-01
TSS
Inf
2477
mg/L SM254OD-2011
07/08/2022
LE
220706-14-02
Ammonia Nitrogen
Eff
0.78
mg/L SM4500NH3C-2011
07/11/2022
CE/LE
220706-14-02
BOD
Eff
2.11
mg/L SM521OB-2011
07/07/2022
CE
220706-14-02
Copper
Eff
0.004
mg/L EPA200.8
07/11/2022
MT
220706-14-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXX Colilert 18 MPN
07/06/2022
MD
220706-14-02
Hardness
Eff
101
mg/L CaCO3 Caicuiatlon
07/08/2022
MD
220706-14-02
Selenium
Eff
<0.001
mg/L EPA200.8
07/11/2022
MT
Subcontracted
220706-14-02
TSS
Eff
<2.632
mg/L SM254OD-2011
07/08/2022
LE
220706-14-03
Hardness
Upstream
86.0
mg/L CaCO3 CaicuiaUon
07/08/2022
MD
220706-14-04
MLSS
MLSS
2270
mg/L SM254OG
07/11/2022
LE
220706-14-05
Fecal Coliforms
Sludge
317
MPN/g SM92210E-2006
07/06/2022
MD
220706-14-05
Percent Solids
Sludge
0.63
% SM254OB-2011
07/06/2022
MD
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 Statesville, NC 28687 • 704/872/4697
Page 1 of 6

Condition of Receipt
Sample Number 220706-14-01 Temp on Arrival: 2.3
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Sample Number 220706-14-02 Temp on Arrival: 2.3
pH on Arrival: <2 Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: BOD
Received on Ice
pH on Arrival: <2 Parameter Schedule: Hardness
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
pH on Arrival: <2 Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Sample Number 220706-14-03 Temp on Arrival: 2.3
pH on Arrival: <2 Parameter Schedule: Hardness
Nitric Acid Received on Ice
Chemicals in containers, lab
Sample Number 220706-14-04 Temp on Arrival: 2.3
Parameter Schedule: MLSS
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 6

Analytical Results
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 07/12/2022
Reported: 07/25/2022
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
220712-61-01
BOD
Inf
226.2
mg/L
SM521OB-2011
07/13/2022
CE
220712-61-01
TSS
Inf
38.2
mg/L
SM2540D-2011
07/14/2022
LE
220712-61-02
Ammonia Nitrogen
Eff
<0.1
mg/L
SM4500NH3C-2011
07/19/2022
CULE
220712-61-02
BOD
Eff
<2.0
mg/L
SM521OB-2011
07/13/2022
CE
220712-61-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXX Colilert 18 MPN
07/12/2022
WC
220712-61-02
TSS
Eff
<2.762
mg/L
SM2540D-2011
07/14/2022
LE
220712-61-03
Fecal Coliforms
Sludge
<351
MPN/g
SM92210E-2006
07/12/2022
MD
220712-61-03
Percent Solids
Sludge
0.57
%
SM254OB-2011
07/12/2022
MD
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
n
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 220712-61-01 Temp on Arrival: 3.0
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Sample Number 220712-61-02 Temp on Arrival: 3.0
Parameter Schedule: BOD
Received on Ice
Parameter Schedule: TSS
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Parameter Schedule: Ammonia Nitrogen
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Sample Number 220712-61-03 Temp on Arrival: 3.0
Parameter Schedule: Percent Solids
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

Pathogen and vector reduction at the West Jefferson WWTP is accomplished
through aerobic digestion and utilization of fecal density and SOUR tests.
As indicated on the attached WWTP schematic, three aerobic digsters are used for
sludge storage and assimilation.
Measurement of PH is performed using an Orion Star A121 Portable PH Meter.
Once the contents of this digester meets PSRP and Vector attraction criteria,
sludge is removed from the unit and land applied by surface method.

i
r�
MINI
ik West Jeffe
- Sewagei
F }
340
I
r
40
- -f
Clf
oe'31,µatef or
4{
L1 1
.*,.Y
ti • *l •49
# ♦'dry , 1 �� r
'14 } e
�^
iti.� rskr^
Convenie
Conve
Cf eci ri
Jeffer

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
Facility Name: Town of West Jefferson
WWTP Name: Town of West Jefferson
WQ Permit Number:
NPDES Number:
WQ0003992
NCO020451
Monitoring Period: From 1/l/2022
To 12/31/2022
Pathogen Reduction (15A NCAC 02T .1106) - Please indicate level achieved and alternative nerfnrm,-d-
Class A:
Alt. A (time/temp)
Alt B (Alk Treattnent)
Alt. C (Prior Testing)'
A1t.D (No Prior Test)
Process to Further Reduce Pathogergs
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost
Heat Drying L3
Heat Treatment El
Thermophilic
Beta Ray
Gamma Ray
Pasteurization
Class B:
Alt. (1) Fecal Density 21
Alt. (2) Process to Significantly Reduce Pathogens
If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization E3
Air Drying
Composting L3
jAcrobic Digestion Er
Anaerobic Digestion
=
If applicable to alternative performed (Class A or Class B) complete the following
monitoring data:
Parameter
Allowable Level
in Sludge
Pathogen Density
N tun ber q
Excel-
deuces
Frequency
of Analysis
Sample
Type
Analytical
�ica
Tech -
ni ue
Minimum
Geo. Mean
Maximum
Units
Fecal Coliform
2 x 10 to the
6th power
per gram of
total solids
MPN
317
3198.222
20000
mpn/g
CFU
1000 mpn per gram
of total solid (dry
weight)
Salmonella bacteria
(in lieu of fecal
coliform) I
3 MPN per 4 grams
total solid (dry
weight)
vector Attraction Reduction (15A NCAC 02,F .11U7)`- Please indicate alternative Derformed
Alt.I (VS reduction) 0
Alt. 2 (40-day bench)
Alt. 3 (30-day tench) 0Alt.
4 (Spec; 0_"uptake) 21
Alt. 5 (14-Day Aerobic) Q
Alt. 6 (Alk. Stabilization L3
Alt 7 (Drying - Stable) 0
jAlt. 8.(Drying - Unstable) El
Alt. 9 (Injection)
Alt. 10 (Incorporation) Ej
No vector attraction reduction alternatives were performed El
CERTIFICATION STATEMENT (please check the appropriate statement)
Rl "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 have been met."
13 " I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 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."
Brandon Patrick
Preparer Name and Title r print)
nature of Preparer*
Brandon Patrick/ ORC
Land Applier Name and Title (if applicable)(type or print)
'2�Z
Date /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 02T (12/2006)

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