WQ0003992_Renewal Application_20240207

Initial Review
Reviewer nathaniel.thorn burg
Is this submittal an application? (Excluding additional information.) *
Yes No
Permit Number (IR) * WQ0003992
Applicant/Permittee Town of West Jefferson
Applicant/Permittee Address PO Box 490 West Jefferson NC 28694
Is the owner in BIMS? Yes ) No Is the facility in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Municipal
Town of West Jefferson Class B Residuals Program
Ashe
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
02/07/2024
$0
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

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 * Town of West Jefferson
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.)
Send to State.pdf 13.19MB
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
rYJ tII.YI�!'i/ (�rOrtli7f
Submission Date 2/7/2024

February 6, 2024
NCDEQ - Division of Water Resources
Water Quality Permitting Section
Non -discharge Permitting Section
1617 Mail Service Center,
Raleigh, NC 27699-1617
Reference: Renewal of Permit No. WQ0003992
Town of West Jefferson Land Application Program
West Jefferson, North Carolina
Town of West Jefferson
Permit Renewal
Table of Contents
Residuals Land Application Program Form
Operation and Maintenance Plan
Residuals Source Certification Form
Facility Vicinity Map
Process Flow Diagram and Narrative
Justification for Residuals Production Rate
Residuals Sampling Plan
Analytical Data
Land Application Site Certification Form
Landowner Agreement Attachments
Site Vicinity and Buffer Maps
Cumulative Pollutant Loading Rates and Soil Metal Data
Soil Maps
Your attention in the review of this application for modification would be greatly appreciated.
This renewal does not include any changes to the current permit. Please contact me if you
require additional information or have questions in the review of the permit application.
Brandon Patrick, ORC
Town of West Jefferson
PO Box 490
West Jefferson NC 28694
[e-mail] 336-977-6725

Residuals Land Application Program Form

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permit Ing_L lgit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
I z,A NCAC' 02T .I 100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
The Applicant's Certification on Page 5.ofthis form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02-r .0106(b).
If this project is for a modification of an existing pen -nit, submit one copy of the existing permit.
Please submit this application form at least 180 days prior to the expiration date on the existing permit, or 90 days prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
Q Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification'
Major (land are permitted for > 300 acres) $1,310 $395
...._..._.... ............. ................. ......._.... ................... .......... i ........ ............................................:._...:...... ...:... ...... ................ .............:. .. .. ..,
Minor (land are pennitted for < 300 acres) $810 ? $245 t
£.., ,.. _... _. .._..__.._ .........
' - A major modification shall be defined as any pen -nit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources; or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a pen -nit.
C. Cover Letter (All Application Packages)
List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC I.C. .0300)
Q, Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems if any public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Pagel of 3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
Q For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
Submit the O&M Plan in accordance with 15A NCAC; 021" .1 1 10 and include at a minimum:
Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
ZMaintenance schedules; may include equipment calibration, maintenance of signs, etc.
Safety measures; may include safety training program, manuals, signs, etc.
Spill response plan; including control, containment, remediation, emergency contact information, etc.
Inspection plan including the following information;
® Names and titles of personnel responsible for conducting the inspections.
Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
Sampling and monitoring plan including the following information;
®, Names and titles of personnel responsible for conducting the sampling and monitoring.
Detailed description of monitoring procedures including parameters to be monitored.
Z, Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑', Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NC'AC: 02."f
.1102(12). Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
Q' Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
Q' Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps (All New or Modification Application Packages)
[] Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
El Plans must include the following minimum items:
[] A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
The location of all wells (including usage and construction details if available), streams (ephemeral, intennittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
0 Delineation of the review and compliance boundaries
Setbacks as required by 15A NCAC 02T .1 108
Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
E] Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans maybe labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 2 of 3

1.
J.
K.
L.
M
Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
Submit a detailed hydrogeologic evaluation in accordance with I5A NCAC 02T .1 104(d)(4) and current Division Policy
available at: 1►itp :`www ncwater.or Rules Policies and Re'(�,ulations/. The document shall be signed, sealed and dated by a
qualified professional.
Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with .15A NCAC 02T .1 104(dFor Modifications, submit an updated site map
specific to the modification(s) only.
The design documents must include the following minimum items:
Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
R Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
0 Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
Soil mapping units shown on all disposal sites.
Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
[] Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1 104(d)(5) and current Division Policy
available at: littp "/www ncwater oi-,g/Rules Policies and Regulations/.
Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
[❑ Property ownership documentation shall consist of one of the following:
Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑' An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
Q A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

1. APPLICANT INFORMATION:
1. Applicant's name: Town of West Jefferson
Applicant type: ❑j Individual [] Corporation ❑; General Partnership ❑ Privately -Owned Public Utility
❑', Federal ❑, State Municipal ❑ County
Signature authority's name per 15A NC: AC _02_I _0.106: Brantley Price Title: Town Manager
Applicant's mailing address: PO Box 490
City: West Jefferson
State: NC Zip: 28694- ,,
Telephone number: [phone]
Email Address: wwtp a,townofwi.com
2. Consultant's name:
License Number (for P.E.)::. "
Affiliation: ❑; On Staff ❑j Retained (Firm: )
Consultant's mailing address:
City: State:.
Zip:,, -
Telephone number: O ".i
Email Address "
3. Agronomist's name:
License Number:,
Affiliation: ❑ N/A El On Staff
❑ Retained (Firm: )
Agronomist's mailing address ""
City: State
Zip:
Telephone number: ( ) ":
Email Address
4. Soil Scientist's name
License Number::.
Affiliation: 0 N/A 0' On Staff
❑ Retained (Firm: )
Soil Scientist's mailing address:
City: State:
Zip:
Telephone number: (___L) -
Email Address: ,, .
5. Fee submitted: (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, Z renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00003992
Date of most -recently issued permit:04/22/2019
Date of most -recently certified Attachment A (if different than the permit):
Date of most -recently certified Attachment B (if different than the pennit):
FORM: RLAP 06-16 Page I of 5

111. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
I. Residuals Processing Facility's physical address: 335 Clearwater Drive
City: West Jefferson State: NC Zip: 28694
Coordinates: Latitude: 36' 24' 34.37" Longitude: 81° 29' 25.73"
Datum: NAD 1983 UTM 17N Level of accuracy: V
Method of measurement: Man
2. County where residuals land application program is headquartered: Ashe
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Brandon Patrick
Town of West Jefferson
1003070
Back -Up ORC
Nicholas Walters
Town of West Jefferson
1007912
Additional Back -Up
ORCs,
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test.
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Detennine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 180 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
40.09
7216.2
Five -Year Maximum Adjusted
50.11
9020.25
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
a
Row Crops
Hay
27.98
Pasture
Total:
27.98
Methods
Surface
27.98=
Incorporation or Injection
Total:
27.98
FORM: RLAP 06-16
Page 2 of 5

c. Residuals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
(lbs PAN/ac yr)
Concentrations
Surface
Incorporation or
Surface
Incorporation or
Injection
Injection
50
144.32
180.41
100
72.16
90.21
150
48.11
60.14
200
36.08
45.10
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.): ,
7. Specify type of residuals program (See Instruction F): ZNon-dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
❑'; Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
E] Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
Residuals program contains any land application site(s)"that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain,
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Site
Certification.doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item V1. Applicable to Dedicated Program with fixed irrigation system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. The irrigation system is: El Spray Drip
2. Disposal system is: 11 existing proposed.
3. Minimum depth to mean seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T.0505 requires at least one -foot vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
R Yes or r-1 No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified: �LL�
5. Loading rates recommended by the Soil Scientist Evaluation:
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
M Yes or M No If No, explain why 15A NCAC 02T.0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC: 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
Yes F71j No, Explain;
I, Mr. Brantley Price Town Manager
(Signature Authority's Name — PLEASE PRINT) (Title)
attest that this application for Town of West Jefferson
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: or
FORM: FORM: RLAP 06-16 Page 5 of 5

Operation and Maintenance Plan

Operation and Maintenance Plan
Town of West Jefferson
The WWTP ORC (or Backup ORC if ORC is unavailable) shall be in charge of the following items
as it relates to the current land application program:
• Collection of WWTP Samples
o TCLP Samples
o Pathogen Reduction Samples
o Vector Attraction Reduction Samples
o Collection of Nutrient and Metal Analysis
• As Preparer for the facility under 40 CFR 503
o Being the individual that is familiar with the routine operation of this facility
includes:
■ Insuring solids are ready for land application
■ Insuring solids have undergone proper treatment
■ Proper operation of treatment units
■ Proper maintenance of treatment and storage units
■ Notification of state and land appliers of abnormal conditions
■ All inspections and maintenance of facilities at this plant
The Land Applier shall be in charge of:
■ Buffering Land Application Fields
■ Spreading Materials at Rates Given for Field, Crop, and Soil
■ Calibrating Spreader
■ Inspections and Inspection Log
■ Record Keeping regarding disbursement and Location of material spread
■ Lime Stabilization (if applicable) — collecting pH measurements:
o Initial pH
o Raising the pH to 12
o Monitoring the pH to see that it stays at 12 for 2 hours;
o Making sure it doesn't drop below 11.5 for the next 22 hours
■ Spill Response
■ Signage
Both the WWTP ORC and Land Appliers will complete the aforementioned responsibilities
before the commencement of each land applying event. In the event that an area of
noncompliance is observed, the NCDENR office will be contacted. Inspections should be
performed in the field at the beginning of every land application even, with every change in
loading rate, and post application event for run off. An additional inspection will be performed
if rain occurs after the application event and before the residuals had time to desiccate
(typically 3-5 days). Each field will be inspected pre and post with each application event. The
frequency of inspections will depend on the frequency of application events.

Land Application ORC — Brandon Patrick — 336-246-3558 — 336-977-6725
Land Applier/Backup ORC — Nick Walters — 336-246-3558 — 336-977-9791
Land Applier -Jody Walters — 336-246-3558 — 336-977-4622

Spill Control Plan
Land Application ORC: Brandon Patrick
Telephone: [phone]
Land Applier/Backup ORC: Nick Walters
Telephone: [phone]
Land Applier: Jody Walters
Telephone: [phone]
Plant Operator Telephone: [phone]
Local Police, Fire, Emergencies: 1 911
Carolina Grading
Office Phone: [phone]
NCDENR Regional Office: 336-771-5000
State of NC Warning Point: 800-662-7956

Town, of West40'emn
UAW klow )1j will r1riul cquipinerit unied f ), � .i 0 respomse immI dIeir ocd. da
ll`w
f Pumpm4 trarfd ' etc"
4. earx- or
.. Amher %vamins lights
., ll
7, RmTiodes
8. Motatdetectons
9, Tnix)d & hammsi
>;
18, All pipe (water mlvu Nl
19, Rudios
21. Work, Lighu
2 3 w Qr a due
2'. Bellew
25,� Welder
LOCATION,
Majulvatuice BLAB, . ,, 'rw
i r t it tr Bldg, b Cusp (Old)
:i.rrmum'-'e Bldg, l"'m2 ( 1
MairrEdumco Bldg, Fvia (lot)
tvialutenonme Bldg, , C; (Old)
Assipotl try ; emon t l
Mikutemince ffldgBay (Old)
iinum e Bldg, lot (Pence.)
Pi Lot
AssIgnul to pe-m1
Mainterim,"t Bldg. Offfike
,pince Bldg,
"Now MAinwriance-Mg,
Iiis list will be utiduted,a-'i a , equiptricut is obtained ofold equipm iat,

Residuals Sampling Plan
Prior to application, multiple samples are collected from the sludge holding tank. These
samples as grabs are analyzed for fecal coliform. The multiple samples are composited and
submitted for nutrient, metal, and TCLP analysis. Currently, vector attraction reduction is met
by a 30-day additional aerobic test. Beginning in the upcoming year, 2 or 3 fecal samples will be
collected prior to each haul event. The Town of West Jefferson typically has 3 — 4 haul events
per year. This will provide the seven fecal samples needed over the year and allow specific
information on each of the separate haul events. Additional methods may be used for vector
attraction reduction alternatives. These include volatile solids reduction, SOUR tests, and
incorporation.
Annually, a composite residual solid sample from each of these sources will be analyzed for:
Arsenic, Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum,
Ammonia — Nitrogen, Calcium, Nitrate -Nitrite, Nitrogen, Magnesium, % Total Solids, pH,
Phosphorus, Potassium, TKN, and Sodium. The PAN will be calculated from this information.
The Town of West Jefferson requests that TCLP sample frequency remains at once per permit
cycle. The once per permit cycle will be analyzed for the following parameters:
r riic
cei'hl
T # ddund
ChWIhne
hEA)'Tr'hW.W ito
Chromium
th-CJ'MA
,4-D
set] FAhyl Ketolic
Ni xt,o:
PwWhwWPhCjw
)y
0r%i
Silver
Te4w�hkymmhykae
' 'oulp + .
Math' I.. Sr it &
obility
41fidtWOW C-_V4Iddft, fftr WAVevil,°
Ed d t
fteptacW, or and, fu Hydroxide
` HIA (' ltiriao .

Residuals Source Certification Form

State of North Carolina
Department of Environmental Quality
'WR D
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non-Dischal�Le Permitting) Unit
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with I5A NCAC 02T .I 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map A vicinity map that shows the location of the facility and meets all of the criteria in the
Land ",%Jap„Clidanc�fo
Residugh., �flicati�tPennits ,,_
_...�_....❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the pen -nit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page 1 of 1

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I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of West Jefferson
2. Facility pen -nit holder is: M Federal E State, 0 Local Government, or 0 Private.
Facility pen -nit issued by: [ Div. of Water Resources, Q Div. of Environmental Health,
or Other (explain 2).
3. Facility contact person and title: Brandon Patrick
Complete mailing address: PO Box 490
City: West Jefferson State: NC Zip: 28694
Telephone number: [phone] E-mail address: [e-mail]
4. Facility physical address: 335 Clearwater Drive
City: West Jefferson State: NC Zip: 28694vm
Coordinates: Latitude: 36' 24' 34.37" Longitude: 81 ° 29' 25.73"
Datum: NAD 1983 UTM 17N Level of accuracy: I"
Method of measurement: Map
5. Purpose of the facility:
0 treatment of municipal wastewater, treatment of 100% domestic wastewater,
[ l treatment of potable water, ` treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
percentages: �0 o
(approximate/o .�. industrial and /o domestic)
other (explain.').
6. Does the facility have an approved pretreatment program: Yes C1 No
7. Facility permitted/design flow: 0_5 MGD and facility average daily flow: 0.270 MGD
8. Average amount of residuals being generated at this facility 180 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 190,000 sludge holding tank
Type and volume of residuals storage (i.e., outside of residuals treatment units): none
II. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
M 40 CFR Part 503 or Ej 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1 102(6) as:
Biological ,' Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: yes 0 no.
If yes, list the number(s)
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24:! yes no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Summit Environmental Technologies and Date of analysis: 12/10/2019
Passed corrosivity test: yes ( no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: yesno. Flashpoint: >200 OF (> 140°F)
Passed reactivity test: Eyes Eno. HCN: 5.0 mg/kg (<250) & H2S: <5.0 mg/kg (<500)
TCLP Parameter
Limit
(mg/1)
Result
(mg/1)
TCLP Parameter
Limit
(mg/1)
Result
(mgll)
Arsenic
5.0
<1.25
Hexachlorobenzene
0.13
<0.1
Barium
100.0
<12.5
Hexachloro-1,3-Butadiene
0.5
<0.04
Benzene
0.5
<0.005
Hexachloroethane
3.0
<0.2
Cadmium
1.0
<0.25
Lead
5.0
<1.25
Carbon Tetrachloride
0.5
<0.005
Lindane
0.4
<0.0025
Chlordane
0.03
<0.0125
Mercury
0.2
<0.002
Chlorobenzene
100.0
<5
Methoxychlor
10.0
<0.0025
Chloroform
6.0
<0.005
Methyl Ethyl Ketone
200.0
<10
Chromium
5.0
<0.5
Nitrobenzene
2.0
<0.2
m-Cresol
200.0
<10
Pentachlorophenol
100.0
<0.5
o-Cresol
200.0
<10
Pyridine
5.0
<0.5
p-Cresol
200.0
<10
Selenium
1.0
<0.125
Cresol
200.0
<10
Silver
5.0
<1.25
2,4-D
10.0
<0.5
Tetrachloroethylene
0.7
<0.005
114-Dichlorobenzene
7.5
<0.2
Toxaphene
0.5
<0.025
1,2-Dichloroethane
0.5
<0.005
Trichloroethylene
0.5
<0.005
1,1-Dichloroethylene
0.7
<0.005
2,4,5-Trichlorophenol
400.0
<0.005
2,4-Dinitrotoluene
0.13
<0.1
2,4,6-Trichlorophenol
2.0
<0.005
Endrin
0.02
<0.0025
2,4,5-TP (Silvex)
1.0
<0.5
Heptachlor and its Hydroxide
0.008
<0.0025
Vinyl Chloride
0.2
<0.2
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated -under 15A..;NCAC 02:I'._.._1 105..
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Statesville Analytical and Date of analysis: 12/04/23
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/kg)
Result
(rng1kg)
Arsenic
75
41
<10.6
Cadmium
85
39
<2.13
Copper
4,300
1,500
381
Lead
840
300
17.7
Mercury
57
17
0.085
Molybdenum
75
n/a
13.4
Nickel
420
420
19.4
Selenium
100
100
<10.6
Zinc
7,500
2,800
594
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory ° and Date of analysis: 2M
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
> 0 but < 25
30
200
210
>25 but < 50
34
220
240
Ej > 50 but < 75
39
260
270
> 75 but < 100
46
300
320
j > 100 but < 125
53
360
390
Q > 125
62
450
420
Result m /k
(g g)
FORM: RSC 06-16 1
Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 0.47 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Statesville Analytical and Date of analysis: 12/04/23
Parameter
Result
(mg/kg)
Aluminum
2600
Ammonia -Nitrogen
1221.28
Calcium
19700
Magnesium
7430
Nitrate -Nitrite Nitrogen
7340.43
pH (Standard Unit)
6.4
Phosphorus
8085
Potassium
11800
Sodium
13600
Total Kjeldahl Nitrogen
41536.17
c. Using the results listed in Item II. 5b. above, calculate the sodium adsorption ration (SAR): 2.29
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): 0 default value, or a actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (I It) Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kg
(mg/kg)
Surface
20045.54
25056.93
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses .;.
FORM: RSC 06-16 Page 4 of 5

7. Pathogen Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. For DistributionlLand Application of Class A or Equivalent.
El A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
El A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
Alternative 1 [15A NCAC 02T.1106(b)(3)(A)] - Time/Temperature Compliance.
E] Alternative 2 [15A NCAC 02T.I 106(b)(3)(B)] - Alkaline Treatment.
d Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
E] Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
E] Alternative 5 [15A NCAC 02T.1 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, Q! heat drying, heat treatment,
thennophilic aerobic digestion,] beta ray irradiation,
gamma ray irradiation, or EJ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.]106(c)(1)] -Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T.I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: Q aerobic digestion E air drying, M anaerobic digestion,
composting, or tj lime stabilization.
C. For Surface Disposal.
Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item I1. 7a. above.
ED Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 1I. 7b. above.
Exempt -If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.]106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107. specify how residuals will meet the VAR requirements:
n', Alternative 1 [15A NCAC 02T.1 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
El Alternative 2 [15A NCAC 02T. 1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.I 107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
Q Alternative 7 [15A NCAC 02T.I 107(a)(7)] - Drying of Stabilized Residuals.
EJ Alternative 8 [15A NCAC 02T. 1107(a)(8)] - Drying of Unstabilized Residuals.
Alternative 9 [15A NCAC 02T.1107(a)(9)] - Injection.
Alternative 10 [15A NCAC 02T.1107(a)(10)] - Incorporation.
[Q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. 1107(b)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Facility Vicinity Map

Site Vicinity Map
Land App Sites
0
West Jefferson WWTP
O
Field KP1
O
Field DP1
O
Field DP2
:kerdale�
�` 1541
l � � 1539
1324��
�' Lansing r s µ
1352 T
Jam: 1347
B
ina'� \
Warrensvil� le\
rt
Jefferson
West Jefferson WWTP
221
1552
1553
1557
Crump' le
Shatley
Springs
NOans Creek
Field DP1 Field�DP2
221
Ashe County 15
I Airport i
1587 �i
1`589 i
.. � ,, ..
IQ �—*
11 1159
i1631 C
Map data @2024 Google

Process Flow Diagram and Narrative

WASTEWATER TREATMENT PLANT PROCESS
Town of West Jefferson operates a 0.5 million gallon capacity aerobic wastewater treatment plant.
After bar screening and grit collection, the influent goes from the 500,000 gallon oxidation ditch to
one of two 130,000 gallon clarifiers. Return sludge is sent back to the oxidation ditch from the
clarifiers. Decant from the clarifiers are sent to tertiary sand filters on to an ultraviolet disinfection
process prior to discharge.
Solids are sent to a 190,000 gallon aerobic digester that serves as a sludge holding tank. In this
tank, sludge is generally aerated but also allowed to settle without air to allow decanting and
thickening. Liquids generated from the thickening are sent to the head of the plant. Once the
storage limit is approached, the land appliers of the WWTP perform a land application event.

Wastewater Treatment Plant Process for the Town of West Jefferson

Justification for Residuals Production Rate

Justification For Residuals Production Rate
Over the past several years, the dry ton production has averaged less than half of the current
production rate, which has been set at 180 dry tons per year. Current production is expected to
remain the same for this permit.

Residuals Sampling Plan

Residuals Sampling Plan
Prior to application, multiple samples are collected from the sludge holding tank. These
samples as grabs are analyzed for fecal coliform. The multiple samples are composited and
submitted for nutrient, metal, and TCLP analysis. Currently, vector attraction reduction is met
by a 30-day additional aerobic test. Beginning in the upcoming year, 2 or 3 fecal samples will be
collected prior to each haul event. The Town of West Jefferson typically has 3 — 4 haul events
per year. This will provide the seven fecal samples needed over the year and allow specific
information on each of the separate haul events. Additional methods may be used for vector
attraction reduction alternatives. These include volatile solids reduction, SOUR tests, and
incorporation.
Annually, a composite residual solid sample from each of these sources will be analyzed for:
Arsenic, Cadmium, Copper, Lead, Mercury, Molybdenum, Nickel, Selenium, Zinc, Aluminum,
Ammonia — Nitrogen, Calcium, Nitrate -Nitrite, Nitrogen, Magnesium, % Total Solids, pH,
Phosphorus, Potassium, TKN, and Sodium. The PAN will be calculated from this information.
The Town of West Jefferson requests that TCLP sample frequency remains at once per permit
cycle. The once per permit cycle will be analyzed for the following parameters:
Arm*
iGie&w x*bewn*
ph fbr comwivity
Barra l
H r4htara-1,�-8uauiirans
HCUMM
F Wh crow for *rh*jEuiy
Qxkniuln
iA*d
Carbon TevschlurWc
I•M40M
+triodes aod Cyawdes forrepe6vity
Chkrdane
memory
I, •iirthbc�
t: hkw6b"Izenc
cdloxv
1, t •:?icAbnyks+r
Chlowlbrm
Mtt" Edr)i Kee
z.41Ji lfpwrn
Chrarnium
NWobenz errs
Eadrin
rrs-cmwl
PeaftdAamp b enW
He*dtiorr wd W Hy de
0-C°r001
Pyre
Trichina+ w6ykn*
P-Cftiiol
s4enium
2.4,5-Trkh1w*pbe0W
Crew)
Slim
2,4,6-Triiehkxophwoj
:,44)
Trtraritikxra*viefe
2,4,54P (Sihvi)
1.4-1)kworrmbeweft
Ta"L h�
Wiry{ c hk-Aide

Analytical Data
TCLP, Nutrient, and Metals

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-7 28-0149
[e-mail]
Client:
Water Quality Labs
P. 0. Box 1 167
Banner Ella. N(' I'li604
Attention:
Mr. P. Isenhour
Date Received:
12-Dec-19
Report Date:
09-Jan-20
Sample Date:
10-Dec-19
1311L 4:
BR1.-2019-1010
Lab Sample ID:
LSID-2019-03912
Client Sample ID:
West Jefferson Sludoc
Analysis Analysis
Parameter
Result
MQL
Unit
Method
Time Date
Analyst
1-l; by Cold Vapor AAS
0.005
mg/I
7470A 1994
12I23/2019
Summit
TCLP Extraction Metals
extracted
SW-846-131 l
Summit
A
1.25
mp/l
SW-846-6010
12/-)3l2019
Summit
As
1.25
mo I
SW-846-60 l u
11 to i I
Summit
Ra
12,5
rnO
SW-846-6010
13: 2019
SLIIn2111t
Cd
*
0.25
1
SW-846-6010
12 23'2019
Sttnunit
G
*
0.5
mg/l
SW-846-6010
1123i2019
Summit
Pb
*
1.25
nig/l
SW-846-6010
12,23,2019
Suinn,it
Se
*
0.125
ing/l
SW-846-6010
12/23/2019
Sununit
Reported kid :
S. J. inson, D.R. Wessinger
Concentrations are below Minimum Quantification Limit except where nolcd.
SIC Laboratory Certificate No. 275
Page 12 of 18

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149 [e-mail]
Client : Water Quality Lams
P. 0. Box 1167
Banner Eik, NC 28604
Attention: Mr. P. Isenhour
Date Received: 12-Dec-19
Report Date: 09-Jan-20
Sample Date: I0-Dec-19
RIM 4: BRL-2019-1010
Lab S.1111111C I1): LSID-2019-03913
Client Sample Ill: West Jefferson Sludge
Analysis Analysis
Parameter Result
MQL
Unit
Method
Time Date
Analvst
fcu, Semi-vOC Extraction extracted
SW-846-131 1
Snnlnlit
Cresols (Total)
* I{)
mg/l
SW-846-8270
I2'27,'?[}I9
Sumirlit
Dichlorobenzene, 1,4
* 0.2
nlg/i
SW-846-8270
12/27/2019
Sl1ml]1it
Dini[FOLOIt1CU, 2,4-
* 0.1
mg11
SW-846-8270
12/27/2019
Summil
Ilexachloro-1,3-Butadiene
* 0.04
nigh
SW-846-8270
12/27/2019
SunnlIit
Hexachlorobenzene
* 0.1
mg/l
SW-846-8270
12,'27/2019
Summit
Ilexachloroethane
* 0.2
m4/1
SW-846-8270
12'27'2019
Summit
Nitrobenzene
* 0.2
mg/I
SW-846-8270
12'27'2019
it
Pentachlorophenol
* 0.5
moil
SW-846-8270
12,127`2019
5lunmit
Pyridine
0.5
mg'I
SW-8116-8270
12 27 2oIL)
Summit
lTrichloropluniol.2.4.5-
* 0.005
rn,0
SW-846-8270
12!27!2019
Stlnuilit
l'ricliluropIwm)l_ 2,4,6-
* 0-005
mg/I
SW-846-8270
12I2T 019
Siunmit
Reported By;
S. J. J lson, D.R. Wessinger
* Concentrations are below Minimum Quantification Limit except where noted,
NC Laboratory Certificate No. 275
Page 13 of 18

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149 [e-mail]
Client :
Water Quality Labs
P.O. Box 1167
Banter Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Dec-19
Report Date:
09-Jan-20
Sample ])',,Ic:
10-Dec-19
BIZ 1,N:
BRL-2019-10t0
Lab Sample ID:
LSID-2019-03914
Client Sample ID:
West Jefferson Sludge
Analysis Analysis
Parameter
Result
MQL
Unit
Method
Time Date
Analyst
TCLP ZHE Volatiles
Extraction extracted
SW-846-131 1
Summit
Benzene
*
0.001
in RI
SW846-8260
12 23 2019
Summit
Curbun feuaJ1Ioride
*
0 001
in l
SW816-8260
12 23 2019
summit
Chlorobcrntene
*
5
mgll
SW846-8260
1123/21019
Summit
Chloroform
*
0.005
mg/1
SW846-8260
12/23/2019
Summit
Dichloroethane, 1,2-
*
0.005
mg/1
SW846-8260
12/23/2019
Summit
Dichloroethene.l,l-
*
0.005
mg/1
SW846-8260
12/23/2011)
Srtrnrnit
MEK
*
10
mo11
SW84b-8260
12/2''2019
Summit
TetrachIoroe thene
*
0.00
m 'I
SW8•I6-8260
12.23, 0111
5um1nil
I-richlororthclle
*
0'00�
IIILO
51118 16-8260
12 '-'3 019
SttmIIIi,
Vitll'IChlnridi
*
0.2
mo/I
SW846-8260
1'),+?01`]
tiuiniuit
Reported By:
S. J, hnson, D.R, Wessinger
* Concentrations are below Minimum Qnantiticntion Limit except where noted.
NC Laboralory Cerliticate No, 275
Pa;e 14 of 18

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
[e-mail]
Client :
Water Quality Labs
P. D. Box 1167
Banner Elk, NC 28604
Attention:
Mr. 1'. Isenhour
Date Received:
12-Dec-19
Report Date:
09-Jan-20
Sample Date:
IO-Dec-19
BRL 9:
RRL-2019-1010
Lab Sample Ill:
LSID-2019-03915
Client Sample ID:
West Jefferson Sludge
Aliillj'SiS Anak-sis
P:tratneter
Remlit
VIOL
troll
Method
-t-iuic late
Analyst
I CLP Seini-VOC Extraction
SW-846-131 1
1-1, i -'F
x
OJ
nw/l
SW-846-9080
12.23`2019
StimMit
2.4,5-TP (Silvex)
*
0.5
mg/l
SW-846-8080
12/23/2019
Sunuuit
2.4-D
*
0.5
nig/l
SW-846-8080
12,'23,2019
Summit
Chlordane
*
0.0125
mall
SW-846-8080
12f312019
Summit
E;ndrin
*
0.0025
,ngil
SW-846-8080
12131'2019
Summit
Heptachlor
*
0.0025
mg/l
SW-846-9080
12131/2019
Summit
Heptachlor 1 poxide
*
0.0025
mall
SW-846-8090
12/31/2019
summit
Undane
0.0025
mg/l
SW-846-8080
12;3112019
Summit
Melhoxvcl!lur
*
0.0025
rn,/l
SW-846-8090
12t31 2O19
Slllllmll
Toxaphene
*
0.025
ntg/I
SW-846-8080
12,31/20[9
Sununit
g OF
Reported By: tS,
ltnson, D.R. Wessinger
* Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 15 of 18

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
' 828-728-0149
Client:
Water Quality Labs
P. O. Box 1 167
Banner r-U. NC 28604
Attention:
Mr. P. Isenhour
Date Recei%ed:
12-Dec-19
Report Datc;
09-.Ian-20
Sample Date:
10-Dec-19
BRL 9:
BRL-2019-1010
Lab Sample ID:
LSID-2019-03916
CIient Sample ID:
West Jefferson Sludge
Yar,rmctcr
Rcsolt NIQL
N? • N.3
0.09
' TKN
0.5
blueridgelabslenoir@gmalLcom
Unit Method
m,`I SM194500-N
SM 19 4500-N
Anah-sis An,tl)siS
Time Date Analvsl
Reported By:
S. J. Joti son, D.R. Wessinger
(,'O[leenlr'atillrlS are below Minimum Quantirieation Limit except S+-here noted.
NC Laboratory Certiricale No. 275
Page 16 of 18

Analytical Results -S IET IL
z�
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 12/04/2023
Reported: 12/22/2023
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method Analyzed
Analyst
231204-07-01
Aluminum
SLUDGE
2600
mg/kg
EPA 200.8 Rev 5.4,1994 12/07/2023
MT
231204-07-01
Ammonia Nitrogen
SLUDGE
1221,276595
mg/kg
SM4500NH3BE-1997 12/11/2023
LE
231204-07-01
Arsenic-200.8
SLUDGE
<10.6
mg/kg
EPA 200.8Rev 5.4, 1994 12/07/2023
MT
231204-07-01
Cadmium ICP
SLUDGE
<2,13
mg/kg
EPA 200.8 Rev 5.4,1997 12/07/2023
MT
231204-07-01
Calcium
SLUDGE
19700
mg/kg
SM311162011 12/07/2023
MT
231204-07-01
Chromium
SLUDGE
13.8
mg/kg
EPA 200.8 Rev 5.4, 1994 12/07/2023
MT
231204-07-01
Copper
SLUDGE
381
mg/kg
EPA 200.8 Rev 5.4, 1994 12/07/2023
MT
231204-07-01
Corrosivity
SLUDGE
See Attached
SW-846 12/08/2023
MT
231204-07-01
Ignitability
SLUDGE
See Attached
1010M 12/08/2023
MT
231204-07-01
Lead -Solid
SLUDGE
17.7
mg/kg
SM3113B 12/07/2023
MT
231204-07-01
Magnesium
SLUDGE
7430
mg/kg
EPA200.7 12/07/2023
MT
231204-07-01
Mercury Solid
SLUDGE
0.085
mg/kg
SM3112B-2011 12/07/2023
MT
231204-07-01
Molybdenum
SLUDGE
13.4
mg/kg
EPA 200.8 Rev 5.4,1994 12/07/2023
MT
231204-07-01
Nickel
SLUDGE
19.4
mg/kg
EPA 200.8 Rev 5.4,1994 12/07/2023
MT
231204-07-01
Nitrate/Nitrite -
SLUDGE
7340.4255165
mg/kg
SM450OF/A 12/21/2023
CL
Solids
231204-07-01
Percent Solids
SLUDGE
0.47
%
SM2540B-2011 12/08/2023
MD
231204-07-01
Potassium - Solid
SLUDGE
11800
mg/kg
EPA200.7 12/07/2023
MT
231204-07-01
Reactivity
SLUDGE
See Attached
SW-846 12/19/2023
MT
231204-07-01
Selenium Solid
SLUDGE
<10.6
mg/kg
SM3113B 12/07/2023
MT
231204-07-01
Sodium - Solid
SLUDGE
13600
mg/kg
SM 3111 B 12/07/2023
MT
231204-07-01
T. Phosphorus Solid
SLUDGE
8085
mg/kg
SM450OPE-2011 12/08/2023
CL
231204-07-01
TKN
SLUDGE
41536.17012554
mg/kg
SM4500Norg B-2011 12/14/2023
LE
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 9

Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
231204-07-01 Zinc SLUDGE 594 mg/kg EPA 200.8 Rev 5.4,1994 12/07/2023 MT
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 9

ISLUDGE I
SAMPLE TYPE.,
WASTEWATER
LOCATION:
WEST JEFFERSON
FACILITY ID#:
NCO020451
SAMPLER NAME:
Brandon Patrick
COMPOSITE SAMPLE: START DATE:
Statesville Analytical Holdings, LLC
122 Court St. Statesville, NC 28677
704-872-4697
CHAIN OF CUSTODY
ANNUAL RESIDUAL
SAMPLING
40 CFR PART 503
*PRESERVATION CODE
I — H2SO4, 2 — HNO3, 3 — HCL,
4 — NAOH, 5 — NONE, 6 — COOL ICE
7 — NA2S205, 8 —OTHER
START TIME; STOP DATE- STOP TIME:
SAMPLE
NAIME:
SAM Ct
TYPE
LAB
SAMPLE
ID
NUMBER
fell
RELINQUISHED BY.
DATE
TIME
RECEIVED BY:
DATE
TIME
"RELINWINED13Y.
DATE
TIME
RECEI ED Y.
DATE
TIME
*Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
PH: 'D
(01_1i VC E.00, �tWMJE� MKALAI"MA TUSA�Ilfy 61
ti C 10LI-C, PK,,2I JAMHM�, PHC,*LS. TOT WA.Temp0A : 1
zz' lrul'( Cond: t_q
COUR)W. UACI FRIA
PO Box 228 o Statesville, NC 28687 - 704/872/4697
Page 6 of 9

SLUDGE
SAMPLE TYPE:
WASTEWATER
LOCATION:
WESTJEFFERSON
FACILITY ID4:
NCO020451
SAMPLER NAME-
Brandon Patrick
Statesville Analytical Holdings, LLC
122 Court St. Statesville, NC 28677
704-872-4697
CHAIN OF CUSTODY
ANNUAL RESIDUAL
SAMPLING
40 CFR PART 503
*PRESERVATION CODE
I — "2SO4, 2 — HNO), 3 — HCL,
4 — NAON, 5 — NONE, 6 — COOL ICE
7 — NA25zO3, 8 — OTHER
COMPOSITE SAMPLE: START DATE: STARTTIMF- crno Y%Arr,
SAMPLE
NAME:
PRESERVATION*
RELINQUISHED —BY-
DATETIME
E
RECEIVED BY:
DATE
TIME
:
f
( C-)
RE Ul HE EI
DATE
TIME TIMr
Y:
DATE
TIME
I W
*Laboratory preservation is ensured by addition of preservatives prior to sampie
containers leaving the lab, unless otherwise noted. L",
W-D-CU = ChIcIrine check and dechLofination w.rifjcatjo:j_
R TY CR,VI TURBIDITY pH., Q.W
PAESERVAIION!
,OLO ALKAUNI Z
COOI. 4°C, PIL,2 H,SCIaz NH, NO, -NO,, TKN, O&G, TOC� COD, HARDNESS, PHENOLS, TOT P"OS, Temp: 10.7,Dc-
1) COOL 4`C. PH<2 HNO,: METALS EXCEPT CR, V1 Cond:
J) NONE- CHLORIDE, PH, FLUORIDE
OTHER'
1) COOL W'(_ NASOb7 COUFORM BACTERIA
PO Box 228 - Statesville, NC 28687 - 704187214697
Page 7 of 9

Contact: C. Little Report Date: 12/21./2013
Client: Statesville Analytical
122 Court :St Project: West Jefferson
Statesville, NC 28677 Date Sample Rcvd: 12/5/2013
Moritecll Work Order 4 12052167 Sample. 231204-07-01 Grab 12/4/23
ParztM9.19 Re cults. Angl sibs Matte Reporting'Limit a tlaod
%'rotal Solids
0.47 '1u
12/7/23
0-:100 Flo
SM 2540B
Aluminum, total
2,600 mg/kg
12/7/23
2,50 mg/kg
EPA 200.7
Arsenic, total
<10,6 rile/lig
12/7/23
10.6 ➢ g/kg
EPA 20U
cadmium, total
<2.13 in /kf;
1 2/7/23
2.13 nag/kg
EPA 200.7
Calcium, total
19,7€ 0 mg/kg
12/7/23
5.0 ➢'ng/kg
EPA 200.7
Chromium, total
13.8 m /klog
12/7/23
0.100 ing/kl
EPA 200.7
Copper, total
381 ang/kg
12/7/23
0.100 mg/kg
EPA 2003
Lead, total
17.7 ing/kg
12/7/23
0.500 ing/kg
EPA 200.7
Magnesium total
7,430 mg/kg
1.2/7/23
5.00 mg/kg
EPA 2003
Mercury, total
0,085 mg/kg
1.2/7/23
0.02 mg/kg
FITA, 245.1
Molybdenum, total
13,4 mg/kg
12/7/23
0.250 mg/kg
EPA 200.7
Niche], total
19.4 ing/leg
12/7/23
0.500 mg/kg
EPA 2003
Potassium, total
11,800 mg/kg
12/7/23
10.0 ➢ng/ki;
FT 200.7
ieleniuln, total
<10.6 mg/kg
12/7/23
10,6 mg/kg
EPA 200.7
Sodium, total
13,600 mg/kg
12/`7/23
1.0.0 ➢ng/leg
EPA 200.7
Zinc, total
594 mg/kg
12/7/23
0,500 ntg/kg
EPA 200.7
Cyanide, total
<106 mg/kg
12/.19/23
106 rnlA/l
FPA335.4
Sulfide
21..3 mg/kg
'12/1.9/23
10.0 tng/kg
SM450MD
corros➢tiv➢ty (pit)
6.1 S.tl.
12/8/23
1,0 -14.0 S:11.
SNt 4500 1-1B
Flash point
> 140 °F
12/8/2023
EPA 1020C
I hereby certify that f have reviewed and approve these data. ' a UICL, kmLoc�L
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel,[phone] fax.[phone] a22
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 8 of 9

PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 9 of 9

Analytical Results ETA ESI .
Town of West Jefferson x y
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 02/06/2023
Reported: 02/28/2023
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
230206-01-01
BOD
Inf
446
mg/L
SM521OB-2011
02/06/2023
TP
230206-01-01
TSS
Inf
106
mg/L
SM254OD-2011
02/10/2023
MD
230206-01-02
Ammonia Nitrogen
Eff
0.11
mg/L
SM4500NH3C-2011
02/06/2023
LE
230206-01-02
BOD
Eff
<2
mg/L
SM521OB-2011
02/06/2023
TP
230206-01-02
Copper
Eff
0.010
mg/L
EPA200.8
02/08/2023
MT
230206-01-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXX Cowert 18 MPN
02/06/2023
WC
230206-01-02
TSS
Eff
2.9
mg/L
SM2540D-2011
02/10/2023
MD
230206-01-03
Fecal Coliforms
FC-Sludge
<33
MPN/g
SM92210E-2006
02/06/2023
MD
230206-01-03
Percent Solids
FC-Sludge
0.60
%
SM2540B-2011
02/06/2023
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 5

tea;
€
[
_ _ w
3
■
-H
_q
5
?
S �
..'.q
I
3 €
Y
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 3 of 5

ry ",-
Analytical Results
,.Nz,'„ L. ,
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 02/15/2023
Reported: 02/22/2023
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
230215-12-01
BOD
INF
202
mg/L
SM521OB-2011
02/16/2023
TP
230215-12-01
TSS
INF
150
mg/L
SM2540D-2011
02/17/2023
LE
230215-12-02
Ammonia Nitrogen
EFF
0.11
mg/L
SM4500NH3C-2011
02/20/2023
LE
230215-12-02
BOD
EFF
6.57
mg/L
SM521OB-2011
02/16/2023
TP
230215-12-02
Fecal Coliforms
EFF
<1
MPN/100 ml IDEXX Colilert 18 MPN
02/15/2023
WC
230215-12-02
TSS
EFF
3.3
mg/L
SM254OD-2011
02/17/2023
LE
230215-12-03
Fecal Coliforms
SLUDGE
3509
MPN/g
SM92210E-2006
02/15/2023
MD
230215-12-03
Percent Solids
SLUDGE
0.57
%
SM254OB-2011
02/15/2023
MD
230215-12-04
MLSS
MLSS
3760
mg/L
SM2540G
02/17/2023
LE
Respectfully submitted,
U
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

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5
10
3 6
0
CO
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rr
-8,
1 16
in
TI
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to
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CD
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3
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PO Box 228 * Statesville, NC 28687 * 704/872/4697
Page 3 of 3

TAnalytical Results _ I _�,
Town of West Jefferson µ
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 02/20/2023
Reported: 03/01 /2023
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
230220-01-01
BOD
Inf
107
mg/L
SM521OB-2011
02/20/2023
MD
230220-01-01
TSS
Inf
96
mg/L
SM254OD-2011
02/24/2023
LE
230220-01-02
Ammonia Nitrogen
Eff
<0.1
mg/L
SM4500NH3C-2011
02/27/2023
LE
230220-01-02
BOD
Eff
2.69
mg/L
SM521OB-2011
02/20/2023
MD
230220-01-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXX Colilert 18 MPN
02/20/2023
WC
230220-01-02
TSS
Eff
2.8
mg/L
SM254OD-2011
02/24/2023
LE
230220-01-03
Fecal Coliforms
FC Sludge
469
MPN/g
SM92210E-2006
02/20/2023
MD
230220-01-03
Percent Solids
FC Sludge
0.64
%
SM254OB-2011
02/20/2023
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

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PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 3 of 3

Analytical Results
AN
Town of West Jefferson
PO Box 490
335 Clearwater Drive
West Jefferson, NC 28694
Receive Date: 07/17/2023
Reported: 07/27/2023
For:
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
230717-01-01
BOD
Inf
145
mg/L
SM5210 B-2016
07/17/2023
TP
230717-01-01
TSS
Inf
181.4
mg/L
SM2540D-2015
07/20/2023
LE
230717-01-02
Ammonia Nitrogen
Eff
0.28
mg/L
SM4500NH3C-2011
07/26/2023
LE
230717-01-02
BOD
Eff
3.6
mg/L.
SM5210B-2016
07/17/2023
TP
230717-01-02
Fecal Coliforms
Eff
<1
MPN/100 ml IDEXXColilert18MPN
07/17/2023
WC
230717-01-02
TSS
Eff
<2.5
mg/L
SM2540D-2015
07/20/2023
LE
230717-01-03
Fecal Coliforms
Sludge
<38
MPN/g
SM9221 CE-2014
07/17/2023
WC
230717-01-03
Percent Solids
Sludge
5.31
%
SM2540B-2011
07/17/2023
WC
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2

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WATER QUALITY LA13 & OPERATIONS, INC,
PO' BOX 1167
BANNER ELK, NC, 2860
t828) 89,M277'
CLIENT: WEST JEFFERSON
CLASS 8 SAMPLER:
RESIDUALS RECEIVES DATE;
REPORTED DATE-
III : NCO020451
RANDOM PATRICK
See analysis date, below
S-jan-24
ANALYSIS
ANALY IS
IVIt.�1's
LI(�IiTS
SAMPLE ANALYSISFMETHO-6I
LOCATION STA'.TEDTOTAL
TLTS
SOLIDS _„1.9
`/6
SLUDGE
FECAL COLIFORM
2 2 €3
�
CFU'
1 oaf 7 fi-Cie -23
BPS
TOTAL SOLIDS
�.8
�>, .
SLUDGE
FECAL COLIFORM
556,40
t
CFU s,
2 of 7 1-Deo-23
6v1-922 i)
UV i
TOTAL -SOLIDS
t.8
%
SLUDGE
FECAL COLIFORM
1 448001
CFU's,
8 df v 2C -I? c-23
Iv1-922 C?
BPS
I C�TAL SOLIDS1.7
%,
SLUDGE
FECAL. COLIFORM
68230
1
CFU!s
4 of 7 29-Dec-23
SM-9222D
BPS
InNEPOF'TI D BY: NC CERTIFIED LAB # 544
t
PAUL ISENhIOUR, SUPERVISOR

WATER QUALITY LAB & OPERATIONS, INC.
PO BOX 1167, BANNER ELK, NC 28604
8288986277
SLUDGE
Efl CHAIN OF CUSTODY
AMPLE TYPE:
OCATION:
ACILITYID#:
AMPLER NAME:
WASTEWATER
WEST LEfFERSON
NCO020451
Brandon PatrCick
L_
Its
SAMPLE COLLECTION DELIV
NAME: TEMP
DATE TIME TEMP
Fee mp
ANNUAL RESIDUAL
SAMPLING
40 CFR PART 503
*PRESERVATION CODE
1 — H2SO4, 2 HNO _i, 3 — HCL,
4 — NAOH, 5 — NONE, 6 — COOL ICE
7 — NAZS203i 8 OTHER
START TIM E: STOP DATE, STOP TIME:
SAMPLE CL2-D- LAS
TYPE PRESERVATION" PH
1: CLI SAMPLE
:verify ID
z_Fl: E: L: D,
GRAB COMP A 13 YES] NO NUMBER
mr-tItIVI-Ji uy:
DATE
TIME
-RELINQUISHED BY: DATt TIME )�EIGEIVED BY; DATE TIME
*Laboratory preservation is ensured by additibn Of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
I-D-(12 fikWiflP OCk and tired florinaUorl WIVICMOrl'
UERVAT�O!Ni pH:,
COOL 4"C: BGD, RESHEMKI, CONDUCT MTY, NIBAS, COLOR, AL( AUNITY,V1,
C, ruIajo
me
f)C4C4
Temp:
, 1NOP N. 5, TOCCOD, �WDNESS, P�4F.,.Rot TGT 6 4COS,
)(-,iL 411C, - Z 1-11101'NIE. W.S E VEjl r Cjz, vi and
NOW: CJ"i1-Q;3J0,`_ PH, FLUORIDE
HER-
'00i. C01 15 CIRNI BACT, ERIA

AMPLE TYPE:
MfA TE ATER
O ATIW
WE/ T JEFFEWjO
AGILITY ID :
N O020451
AMPLER NAME,
Brendan Patrick
COMPOSITE SAMPLE: START GATE:
START TIME:
SAMPLE
SAMPLE
COLLECTION
DELI
TYPE
NAME:
TEMP
DATE
TIME
TEMP
%RED
comp
Fecal MPN
Digester # 2 IN..
12/13t23
LfAi7
ANNUADUA
40: OR PART 501
"WE ERVATION CODE
4— I} AOH, 5 — L ONE, 6 —' O L ICE
7 — NA2S203, 8 — OTHER
STOP i ATE: STEP TIME:
CI<.:2-I�µ __ LAB
REERATI4Ih PI! CL2 AIUiPLE
verify III
-FIELD L-LAS i YES NO NUMBER
T
} If -
DATE
� TIME
`laboratory lareserual iraia is ensured by addition of preseniatives prior to sa;mplr
containers leaving the lab, unless otherwise notes.
2i?•CLP� = C!,ic:r7et s_F(,&-,;xr,ci dcrs!?ira inatstz=i v*m,tir;�tl+sr�-,
,Eai:i;VATI >
CSC 4"0 60P,,RESIO E, t GNDUCTIVIr',MDAS COLOR AL4CAUNIT,CR,V!,TtURBIDITY Temp: j '
?(DL 'C P L, H SO,` -NH, N0 - 10� , T N4 Cad ,, ,OxC, COD, HAP-D-NESS. PHENOLS, J-OT
!�"Jf rp ! s Fk%F P!' CR, V1 ond:
ti{ la4P- CHi,t.2MDE. PH, r=4.U{" RU.'1E.

AMPLE TYPE,
WASTEWATER
OCATIO
WEST JEFFERS N
A ILIT'Y ID#:
NCO020451
AMPLER NAME,
Brandon Patrick
COMPOSITE SAMPLE: START DATE-
START TIME:
SAPS.
.AMPLE
COLLECTION
ESE L IV
TYPE
NAME-
TEMP
DATE
TIME
TEMP
GRAS
COMP
Fecai MPt
i ester # 2
12120t23
BY. I DA
rUr4Vu1 r1tu BY:,, LATE ' TIME
•
tMiF !,
1 +i! i. •!
:L ICE
sm
Im
'Laboratory preservation is ertSUred bj addition of preservatives prior to Sample,
containers leaving the lab, unless otherwise rioted..
0,€orir c (,he ,3 and dechlurmation v_q ic,3tiorl,
,ESERVgar€Ors: pH:
f)OL L' BOD,, RESIDUE, CONDUCTIVITY, MBAs, COLOR, A Kt LROT`f, CR, Vl! TURBIDITY Temp.,
COOL # PH<2 H,SO,, NH,, rd07 P"Oi, TKN, o&G, Toc`, GOAD, € ARDNESS, PH NOtS, TOT P1105.-
t)fJL 4 r P :2 ti *i: METALS EXCEPT CR, VI Conti:
INo,'4E'.; CHLORIDE, PH, -.FLUORIDE -

WATER QUA 1TY LAB & OPERATIONS, INC.
PO BOX 1167,
{}ANNERy y ,PAC 60
'gv��� [y�q. U D:EE itrGT B?fB6T t'.
V � �m4
CHAIN OF CUSTODY
AMPLE TYPE:
WASTEWATER
*PRESERVATION. CODE
OCATION:
'QUESTJEFFERSON
1— i$04 2 -- HNO3,3 _., H L,
ACILITY ID#:
NCO020451
4 «- NAOH, 5 — NONEI 6 -- COOL ICE
AMPLER DAME:
Brandqaa Patrick
— %J; zS ,3 $ _ OTHER
IER
COMPOSITE SAMPLE: START DATE:
START TIME:
STOP DATE:
F SAMPLE
COLLECTIOND
LI
IY1i R»
TYPE
PRESERVATION'
H
STOP �T•"yIME,
toe L2—I)-
I CL
8.... t.}
LAB
A AB
PLE
i NAME:
TEMP
� rtfyID
�I
Fecal mPNm
DATE
TIME
TEMP
_._._m_ ._._
GRAB
COMP
F»FIELD
L-LAB
._,__,
YES
ISO
IddLIM EFL
3a ester#
5d Ps t
8
1 8a
'.l- 1
Y�-
DATE TIME 0 RED 13y� DATATIME
r
*Laboratory preservation is,ensuredby a diltion of preservatives Isrl�r tea sa p1e
containers leaving the lab, unless otherwise noted,
dWrk and ein��[nt<<astt;s:rx'vEritr�attt���,
,E5EWATfWk PH:
M€ T L € 0D, RESI 7t, E, ONDUCTIVIT''!_ [APAS, COLOR, AtKA.UNI Pr C;'V7, CllRFitC�t€Y' Temp:;
_L3 L zT sC Ptl<2 f S . Nth fJr),,NO TKN, MS. TO , COD, HARDNESS, Plimot,s Tur PH 1 y
OOt 40C Pry<2 Jjtdj )a METALS EXCEPT CR, Vi ond:
'JOKE C as1.OR!f.,)h, € H,

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
W(
W1
4/1
Bra
4/1
BrE
Dissolved Oxygen Level
)03992
4/17/202
15.
'3 1102
on Patrick
31107
on Patrick
0.67 % Dry Solids
15.9 degrees Celsius
16.5 degrees Celsius
Slope: 0.01
Intercept: 9.2
Correlation Coefficient: 1.00
Oxygen Uptake Rate: 0.46 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 0.07 mg Oxygen/hr/g
Average Temperature: 16 degrees Celsius
Temperature Correction Factor: 1.31
Temperature Corrected Specific Oxygen Uptake Rate: 0.09 mg Oxygen/hr/g
uu�rAuai�a�moumi�w�,�s�
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time:
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
West Je
WQ000:
4/18/23
Brandon
4/01 /23
Brandon
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
0.01
9.4
0.99
0.59 mg Oxygen/hr
0.09 mg Oxygen/hr/g
15 degrees Celsius
1.40
Temperature Corrected Specific Oxygen Uptake Rate: 0.13 mg Oxygen/hr/g
P�ll�CE4191�uL1BIfiNE9U8�Of15u�tiEw:A1�r'
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Facility Name:
Biosolids Permit Number:
Date:
Digester Temperature:
Sampling Date/Time.
Sampled By:
Analysis Date/Time:
Analyzed By:
Total Solids:
Beginning Temperature:
End Temperature:
West Jef
WQ0003
4/19/23 1
Brandon
4/19/23 1
Brandon
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
ck
0.
mom
14.
MM
15.
0.01
9.4
0.99
Dry Solids
?rees Celsius
frees Celsius
0.48 mg Oxygen/hr
0.08 mg Oxygen/hr/g
15 degrees Celsius
1.40
Temperature Corrected Specific Oxygen Uptake Rate: 0.11 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
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:
4/20/2
4/20/23 0930
Brandon Patric
MWAMMUMMMMOWMau
4/20/23 0935
Brandon Patric
0.68 % Dry Solids
14.6 degrees Celsius
15.7 degrees Celsius
0.01
9.5
0.99
0.67 mg Oxygen/hr
0.10 mg Oxygen/hr/g
15 degrees Celsius
1.40
Temperature Corrected Specific Oxygen Uptake Rate: 0.14 mg Oxygen/hr/g
AJ.'�tt�i�WmIMON �:42iNM17�4LN➢�
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
Dissolved Oxygen Level
Slope. -
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
1
0.01
9.3
0.99
Dry Solids
grees Celsius
frees Celsius
0.71 mg Oxygen/hr
0.11 mg Oxygen/hr/g
15 degrees Celsius
1.40
Temperature Corrected Specific Oxygen Uptake Rate: 0.16 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15.
Specific Oxygen Uptake Rate
SOUR
Facility Name:
West Jefferson
Biosolids Permit Number:
WQ0003992
Date:
5/23/2023
,Digester Temperature:
18
Sampling Date/Time:
5/23/23 0822
Sampled By:
Brandon Patrick
Analysis Date/Time:
5/23/23 0827
Analyzed By:
Brandon Patrick
Total Solids:
0.51
% Dry Solids
Beginning Temperature:
18.4
degrees Celsius
End Temperature:
18.8
degrees Celsius
Dissolved Oxygen Level
Slope:
Intercept:
Correlation Coefficient:
Oxygen Uptake Rate:
Ambient Specific Oxygen Uptake Rate:
Average Temperature:
Temperature Correction Factor:
0.01
9.4
0.99
0.61 mg Oxygen/hr
0.12 mg Oxygen/hr/g
19 degrees Celsius
1.07
Temperature Corrected Specific Oxygen Uptake Rate: 0.13 mg Oxygen/hr/g
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Time
(minutes)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Specific Oxygen Uptake Rate
SOUR
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:
0.01
9.4
0.99
Dry Solids
grees Celsius
grees Celsius
Oxygen Uptake Rate: 0.63 mg Oxygen/hr
Ambient Specific Oxygen Uptake Rate: 0.11 mg Oxygen/hr/g
Average Temperature: 19 degrees Celsius
Temperature Correction Factor: 1.07
Temperature Corrected Specific Oxygen Uptake Rate: 0.12 mg Oxygen/hr/g
a•:a;�a;•n»tat<�s=.a���:�:,�.��,�raauiuioru
Instructions: Enter Data in the Blue Boxes. The Calculation and the Spreadsheet execute automatically.
Updated 10/23/2013

Land Application Site Certification Form

Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Quality Permitting Section's Yon --Discharge Permitting I./nit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 15A NCAC 02T .I 100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
® Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments
to the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new, transferred or affected by the
proposed modification.
B. Land Application Site Information:
® The status of the land application site with respect to this residuals land application program must be provided in table 1. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
® Attach the following in accordance with each status code:
Required Item
Status Code
N
R
T
M
County Board
'/
Notification. doc
�ry 3w
Land Owner
Agreement
(If applicable)
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the " t s. �_Gu.idance
[c.r ite.si;l.. �1;.[... iti...:1w�l�li ,zt.iim.._];'e3..r..3it,
✓
✓
✓
W
A soils and agronomic evaluation in accordance with the "Soil �c kt
;.i€i�,,,.
✓
INSTRUCTIONS
FOR FORM: LASC 06-16 Page 1 of

An updated accounting of the land application site's cumulative
nollutant loadine rates (CPLRs)
Required Item
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil 1 vaivaLion Pohcv"
Acknowledgement of field transfer from Land Owner (Fields may not
be permitted to multiple Permittees over the same timeperiod)
Status Code
N R T T M
* This item may be required for land application site with a status code "M", please contact the Division if you need assistant in
determining attachment requirements.
® Crop Type should include the most likely crop types for the life of the permit (five years).
® Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
® Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
® For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
infonnation on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of 6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
® Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD) • Digital or Raw Photo Extraction (EXT)
• Aerial Photography with Ground Control (AER) • Geodetic Quality GPS Survey (GEO)
• Cadastral Survey (SUR) • LORAN-C Navigation Device (LOR)
• Conversion from Coordinate Plane (CP) • Navigation Quality GPS (GPS)
• Conversion from Township -Section -Range (TSR) • Remote Sensing (RS)
• Conversion from Universal Trans Merc (UTM) • Zip Code Centroid (ZIP)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
❑ Use an 8.5 by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: http//deq nc ,( ov4ibotit/divisions water-
resources/warning3 class ification-standards;'class ifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage, and their contact information may be downloaded at:
htt{deci.rfc.�-,ov/contnct/irLw�tonal-of bees
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
1. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x 11-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Detennine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table 1: Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to stream name" as the waterbody name.
3. Open the link http•//deq nc gov/about/divisions/water-l'esourCe5!plannin,7/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of 3

2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
l . Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The tern
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B 0301(i)
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of entry) except:
(A) unnamed streams specifically described in the schedule of classifications;
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnamed streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin
Streams entering Georgia or Tennessee shall be classified "C Tr."
Little Tennesse River
Basin And Savannah
River Drainage Area
Streams entering Georgia or Tennessee shall be classified "C Tr." Such streams in the Savannah
River drainage area entering South Carolina shall be classified "B Tr."
French Broad River
Basin .
Streams entering Tennessee will be classified "B."
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
New River Basin
Streams entering the State of Tennessee are classified "C."
Catawba River Basin
Streams entering South Carolina are classified "C."
Yadkin -Pee Dee River
Basin
Streams entering Virginia are classified "C," and such streams entering South Carolina are
classified "C."
Lumber River Basin
Streams entering South Carolina are classified "C Sw."
Roanoke River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Chowan River Basin
Streams entering Virginia are classified "C."
Tar -Pamlico River
Basin
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
canals to Pamlico Sound and its bays which shall be classified "SC."
Pas uotank River Basin
All drainage canals not noted in the schedule are classified "C."
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3

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Landowner Agreement Attachment

State of North Carolina
Department of Environment and Natural .Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence t
instructions and checking the provided boxes will help produce a quicker review. time and reduce the. amount. of additional
o these
information requested. Failure to submit all of the required items will lead to additional roces
Permit application. Unless otherwise noted the sing and A licant shall submit one original and two co ies of the a review ltime icationrthe
and
supporting documentation
For more information visit the Water Quality Permitting Seetion's Non-Disa'rePerntittL/nit
General. This document is an agreement between the Applicant and land owner(s) of residuals receivingsites for land a 1'c '
Class B residuals (may inelude water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100: Do not
submit this agreement for review without a corresponding application form (FORM: RLAP with
15 10 0 anon of
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below:
A. Land Owner Agreement (FORM: LOA 06-16):
® Submit the completed and appropriately executed Residuals Source Certification (FORM LASC 06-.16 form. Please
make any ,unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attache Please
do the
application may be made, as long as the attachments are nu . ered, . correspond to the section and item to which they refer.
® Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other
Applicant: ty than the
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the les
see/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of West Jefferson
applihereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following la
cation site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given n this
Agreement:
Site/Field ID Lease Land Use or Special note
(yes/no) Cropping Patterns Intended Use of Crops Residuals source p
g (optional) (no-till/over-seed/
pasture)
DP-1 No Fescue Hay/Pasture Animal Feed West Jefferson WWTP
AP-1 No Fescue Ha /Pasture y Animal Feed West Jefferson WWTP
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with. another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner.or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section I I) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
e land appli
5. The Permit musrequest and obtain a permit modification from the Division prior to a transfer of th
ttt cation site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s).
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land, application site(s) is not maintained at 6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the land application site(s) prior to each planting season to enable the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods.
12. Specific residuals land application area boundaries shall be clearly marked on the land application site by the Permittee, the landowner, or
his representative prior to. and during a residuals land application event.
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place. on or related to the land application site(s) at any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application site(s) as required by the permit; copy any records
that must be kept under the terms and.conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a 30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 03.1 .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly
compliance boundary to the application package)
proposeo
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: is currently permitted under another
ledge that by signing this
residuals land application program; Permit Number WQ: The land owner hereby acknow
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
FORnn• t OA 04�_IA Page 2 of 3

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do -hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein.
Landowner name:
Address:
City:— State: c^z_�
Zip:
Phone: E-mail address:_
Signature:
NORTH CAROLINA, 1 IC COUNTY
I, the undersigned Notary Public do hereby certify that `
1 Vt 1/i
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNEnaCular-1.1
nd and official seal this the
day of
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
T
UBLlw
I certify that I have read this Agreement and do hereby agree to abide���n�
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
and restrictions as specified herein.
Zip:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations
Signing official name: .�
Signature:
d
as specified herein.
Date:.. � / � I' -z_., \g,
FORM: LOA 06-16

State of North Carolina
Department. of Environment and Natural Resources
2. Division of Water Resources
Divlslon of Water Resources LAND OWNER AGREEMENT
FORM. LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided _boxes will help produce a quicker review time and .reduce the amount en additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted.. the Applicant shall submit one on final and .two co ies of .the a lication and
supporting documentation
For more information, visit the Water Quality Permitting Section's it
General — This document is an agreement between the Applicant and land owner(s) of residuals receiving saes for.larid application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1100. Do not
submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 66-16):
® Submit the completed and appropriatelyexecuted Residuals Source Cerfifcation (FORM LASC 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be.made, as long as the attachments are numbered to correspond to the sectiori.and item to which they refer.
® Prepare a separate agreement for each set of land application. sites. that are owned or operated by an' entity other than the
Applicant.
® A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of West Jefferson
hereinafter referred to as the Permittee, to land apply residuals from the. following facility(ies) onto the following land
application site(s) (i.e., . see attached setback maps) in . accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID Lease Land Use or
(yes/no) Cropping Patte
KP-1 No I Fescue Hay/Past
ns
Intended Use of Crops
P
Residuals Source
(optional)
Special note.
(no-till/over-seed/
pasture)
ire
Animal Feed
West Jefferson WWTP
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application. program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
Stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page I of 3

1. STIPULATIONS:
1. The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section 11) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non -Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must request and obtain a permit' modification from the Division prior to a transfer of the land application site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land.application site(s). ;>
6. The.. Permittee has provided the laridowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at 6.0 or greater, sufficient amounts of time shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop:
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and cropping patterns for
the ]and application site(s) prior to each`planfing season to enable the Permittee to amerid this Agreement and schedule residuals land
application events at appropriate periods:
12. Speclfrc residuals land application`area boundaries shall be clearly marked on the land application`site(s) by the Permittee; the landowner, or
his representative prior to and during a. residuals land application event. .
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter and
inspect any property, premises, or place on or related to the land application. site(s) at any reasonable time for the purpose .of determining
compliance with the permit; establish monitoring facilities on or near the land application sites) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater; or soil samples during the
term of, and 12 months after termination of, this Agreement.
1I. RESTRICTIONS: _
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may. include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a30-day period following a residuals land application event. Land application
sites that are to be .used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30-day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event.
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
I 11. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02T .0105(h) allows the
compliance boundary to be placed closer, to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
❑ The land application field(s) ID: _ is currently permitted under another
residuals land application program; Permit Number WQ: The land owner hereby acknowledge that by signing this
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program;
(Name of the new program)
Pa nN 7 of '�
VnQN4- i (lA Or, 14

Landowner's Certification:
I certify that 1 am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that I have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application sites as specified
herein. ,n^ ��'�� � t
La_ ndowner name: i
s G
Address:
City: t Mm 4> 19 V State: `. Zip: Q
k ''
Phone: � �" C E-mail address: � / '`
Signature:
D te: 1
NORTH CAROLINA, COUNTY
I, the undersigned Notary Public do hereby certify that
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of b f a Y, , 20 4 ®TA
Signature and seal: J_J.�
t �
My commission expires: �� Ll r 3
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
State:
E-mail address:
Signature: Date:
Permittee's Certification:
Zip:
1 certify that I have read this gre ment and do hereby e to abide by the stipulations and restrictions as specified herein.
Signing official name: c
Signature: Date:
Page 3 of 3
FORM: LOA 06-16

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources
LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted Adherence to
instructions and checking the provided boxes, will hel these
information requested. Failure to submit all of the required itemsgw will lead toer lew time and addit on 1 processing and review time uce.the amount of additional
permit application. Unless otherwise noted the.A Leant shall submit one. on final and two co ies of the a li ationrthe
and
sunuortin>z documentation
For more information, visit the Water Quality Permitting Section's Novi-Discliaie Permitting Unit
General —This document is an agreement between the Applicant and land owier(s) of residuals receiving sites for land a lication o
Class B residuals:(may include water treatment plant `or ather type residuals) in accordance with ISA NCAC 02T ,1100.. Di not
submit this agreement for review without a corresponding application form (FORM: RLAP
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supportingdocumentation below. _ listed
A. Land Owner Agreement (FORM: LOA 0616):
® Submit the completed and appropriately executed.Residuals Source Certifica1.tion (FORM LASE 06-16 form. Plea
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to t
Please do not
application may be made, as long as the -Attachments are numbered to correspond tot section and item to. which they refer.
® Prepare a separate agreement for each set of land application sites that>are owned or operated b an entity Applicant. Y other than the
A copy of the completed and iappropriately executed agreement'must be.prov�ded to the landowner and the less eelo erator.
p _.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: Town of West Jefferson
hereinafter referred to as the Permittee, to land apply residuals from the following facili ies onto
application site(s) (i.e., see attached setback maps) in .accordance with the stipulations and (irestrictionsontothe
as following land
Agreement: g this
Site/Field ID Lease Land Use or
(yes/no) Cropping Patterns Intended Use of Crops Residuals Source Special note
(optional) (no-till/over-seed/
WL-6 pasture)
No Fescue Hay/pasture Animal Feed West Jefferson WWTP
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application sites) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: LOA 06-16
Page 1 of 3

L STIPULATIONS:
l . The landowner or his representative shall not enter into any additional residuals application contracts or agreements with another permitted
entity for the site(s) specified by this Agreement.
2. Should the landowner or his representative lease or otherwise permit the use of the land application site(s) to a third party, the landowner shall
be responsible to ensure that the third party agrees and complies with the terms and conditions of this Agreement.
3. The landowner or his representative shall adhere to the provisions of this Agreement until all of the site restrictions (under Section II) are met.
4. Notification of cancellation of this Agreement shall be immediately forwarded to NCDENR-DWR, Non=Discharge Permitting Unit, 1636
Mail Service Center, Raleigh, NC 27699-1636.
5. The Permittee must 'request and obtain a permit modification from the Division prior to a transfer of the land application. site(s) to a new
landowner. In addition, the current landowner shall give a notice to the new landowner that gives full details of the residuals applied at the
land application site(s). -
6. The Permittee has provided the landowner or his representative with information and data concerning the residuals land application program,
including an analysis of constituents of the residuals, residuals application methods, schedules for typical cropping patterns, a description of
the equipment used by the Permittee.
7. The Permittee will provide the landowner or his representative with a copy of the residuals permit prior to commencement of any residuals
land application event and a copy of the results of each soil analysis.
8. If the soil pH of the land application site(s) is not maintained at.6.0 or greater, sufficient amounts of lime shall be applied to achieve a final
soil pH of at least 6.0, unless an agronomist provides information indicating that the pH of the soil, residuals and lime mixture is suitable for
the specified crop.
9. The landowner or his representative and the Permittee will agree on residuals application rates and schedules based on crop patterns, results of
soil samples, and the permitted application limits.
10. The landowner or his representative will provide the Permittee with information regarding the amount and analysis of other sources of
nutrients (e.g., fertilizer, unregulated animal waste, etc.) that have been applied to the land application site(s).
11. The landowner or his representative will inform the Permittee of any revisions or modifications to the intended use and croppingpatterns for
the land application site(s) prior to each planting season to enable. the Permittee to amend this Agreement and schedule residuals land
application events at appropriate periods
12. Specific residuals land application area boundaries shall be clearly marked on the land application site(s) by the Permittee, the landowner, or
his representative prior. to and during a.residuals land application event. d
13. The landowner or his representative hereby authorizes the Permittee, local officials, and State officials or their representatives to; enter an
inspect any property, premises, or place on or related to. the land application site(s) any reasonable time for the purpose of determining
compliance with the permit; establish monitoring facilities on or near the land application sites) as required by the permit; copy any records
that must be kept under the terms and conditions of the permit; take necessary leachate, surface water, groundwater, or soil samples during the
term of, and 12 months after termination of, this Agreement.
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Permittee and/or the landowner or his representative to control public access to the land
application site(s) during active use and for the 12-month period following a residuals land application event. Such controls may include the
posting of signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not be grazed on the land application site(s) for a'30-day period following a residuals land application event. Land application
sites that are to be used for grazing shall have fencing that will be used to prevent access during these periods after such residuals land
application events.
3. Food crops, feed crops, and fiber crops shall not be harvested for a 30 day period following a residuals land application event.
4. Food crops with harvested parts that touch the residuals/soil mixture and are totally above the land surface shall not be harvested for a 14-
month period following a residuals land application event:
5. Food crops with harvested parts below the surface of the land shall not be harvested for a 20-month period following a residuals land
application event when the residuals remain on the land surface for four months or longer prior to incorporation into the soil.
6. Food crops with harvested parts below the surface of the land shall not be harvested for a 38-month period following a residuals land
application event when the residuals remain on the land surface for less than four months prior to incorporation into the soil.
7. Turf grown on land where residuals are applied shall not be harvested for a 12-month period following a residuals land application event.
III. ALTERNATIVES FOR WATER SUPPLY WELLS INSIDE THE COMPLIANCE BOUNDARY: (please check one)
15A NCAC 02L .0107(d) prohibits water supply wells within the compliance boundary. However, 15A NCAC 02'r .0105(h) allows the
compliance boundary to be placed closer to the waste disposal area, such that the water supply well is situated outside of the compliance
boundary provided the groundwater standards can be met at the newly -established compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for field(s) ID:
(Please include the rationale for the requested re -location of the compliance boundary and attach a map showing the newly proposed
compliance boundary to the application package)
® A re -defined compliance boundary is not needed for this site.
IV. ACKNOWLEDGEMENT OF FIELD TRANSFER: (if needed)
[I The land application field(s) ID: is currently permitted under another
The land owner hereby acknowledge that by signing this
residuals land application program; Permit Number WQ:
agreement, he/she is requesting that the field(s) be removed from the previously permitted residuals land application program and transferred
into the new program; (Name of the new program)
n- `l _r I

Landowner's Certification:
I certify that I am a deeded landowner of the above -referenced land application site(s) and am authorized to make decisions
regarding the use of the land application site(s) on behalf of other deeded landowners OR that I am otherwise authorized, through
a power of attorney or other legal delegation, to make decisions regarding the use of the land application site(s) on behalf of the
deeded landowners. I certify that the above -referenced land application site(s) are not included in any waste disposal contract or
agreement with another municipality, contractor, or other permitted entity. Furthermore, I certify that 1 have read this Agreement,
understand the stipulations, restrictions, alternatives for water supply wells inside the compliance boundary, acknowledgement of
field transfer, and do hereby grant permission to the Permittee to land apply residuals to the land application site(s) as specified
herein. �--
Landowner name:
Address:
City: State:- j Zip: Faqq %
Phone: s o E-mail address:
Signature:
Date: .?` a 4 —,26 J1
L I
NORTH CAROLINA, hs COUNTY
I, the undersigned Notary Public do hereby certify that MMV �f ���e-
personally appeared before me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and official seal this the
day of F'&bLjW or'
n e ,
Signature and seal:
My commission expires:
Lessee's/Operator's Certification:
I certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Lessee/operator name:
Address:
City:
Phone:
Signature:
Permittee's Certification:
State:
E-mail address:
Date:
Zip:
1 certify that I have read this Agreement and do hereby agree to abide by the stipulations and restrictions as specified herein.
Signing official name
Signature:
Date: _19
Pa
FORM: LOA 06-16 ge 3 of 3

Setback Waiver Agreement Attachment

State of North Carolina
Department of Environmental Quality
Division of Water Resources
D
IVISIon of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional: processing and review time for the
permit application. Unless otherwise noted the A licant shall submit one on final and two co ies of the a lication an
supporting documentation d
For more information, visit 'the Water Quality Permitting Section sNon-Discharge Permitting Unit
General — This document is an agreement between. the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02T .1 108(b)(2)[for habitable residences or place of public
assembly only]. Do not submit this agreement for.review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
® Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each property from which a waiver is being sought.
® Any other setbacks required by 15A NCAC 02T .1108, other than those execution of this agreement. referenced above, cannot be waived through
® A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108 b)( )( 2 habitable residences)
(
The undersigned property owner hereby permits:
Applicant's name: Town of West Jefferson
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 100 _ feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 170 Abieail Ct
City: Crumuler State: NC Zip: 28617
This Agreement shall remain in eliect for the length of the Division of Water Resources' (Division) Permitfor tie residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
® I certify that I am a deeded property owner of above -'referenced ro e
P p rty and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner name: /a V LQ 12
�—�
FORM: SWA 06-16
Date: 6? -- o? e 01 q
Page I of 1

D#vis#on f
W
State of North Carolina
Department of Environmental Quality
Division of Water Resources
o ater Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted t]L-
origrinal and two co ies of the a lication and
suuo�documentation
For more information, visit the Water Quality Permitting. Section's Non -Discharge Permitting
General — This document is an agreement between the Applicant and the owner(s) of the P roPrh' adjacent to the land application
e Unit
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC 02-
1108(b)(�)Ifor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
® Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
®application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each property from which a waiver is being sought.
® Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
® A copy of the completed and executed agreement must be provided to the property owner.
..vne c lv�r Iv r r0 WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within the residence or place of public assembly located at the following: 100 feet (i.e., cannot be less than 100 feet) of
Location address of property: 181 Abigail Ct.
City: Crumpler State: NC
Zip:. 28617
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
® I certify that I am a deeded property owner of above -referenced property
ro e property on behalf of other deeded property owners. Furthermore, Icertify thatl have readrand understand thisam authized to make1ons Agreement�andthis
do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
Property owner na : A94I G Z�
Signature:
Date: f
FORM: SWA 06-16
Page IofI

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one on final and two covies of the a lication and
supporting documentation
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 15A NCAC C 02__T .1108(b)(20or habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
® Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 06-16) form. Please do not
make any unauthorized content changes to this form. if necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each property from which a waiver is being sought.
® Any other setbacks required by 15A NCAC 02T 1108, other than those referenced above, cannot be waived through
execution of this agreement.
® A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1 108(b)(2)(habitable residences)
The undersigned property owner hereby permits:
Applicant's name: Town of West Jefferson
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 100 _ feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following:
Location address of property: 144 Abigail Ct.
City: Crumpler State: NC
This Agreement shall remain in effect for the length of the Division of Water Resources' Division
) ermit for theresiduals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
® I certify that I am a deeded property owner of above -referenced
property on behalf of other deeded roeermore, proper
h' and am authorized to make decisions regarding this
hereby grant permission to the Permitt e to land apply residuals to land a pl c I certify that I siread and understand his Agreement and do
tiontes) as specified herein.
_
Property owner name: / /
01? /n a rl - e0
Signature:
Date:
FORM: SWA 06-16
1
Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Dlvlslon Of Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the A licant shall submit one on final and two co ies of the a lication and
su ortin documentation
For more information, visit the Water Quality permitting Section's Non-Discharp-e property permittin L/itit General - This document is an agreement between the Applicant and the owner(s) of the adjacent
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
to the land application
maintained as part of project site(s) in accordance with 15A NCAC 02T .1108(b)(2 )[for habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
® Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
®application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
Prepare a separate agreement for each property from which a waiver is being sought.
® Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
® A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)()( Z habitable residences)
The undersigned property owner hereby permits:
Applicant's name:
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 1_ 00 _ feet (i.e., cannot be less than 100 feet of
the residence or place of public assembly located at the following: )
Location address of property: 315 Flat Rock Acres Road
City: Crumpler State: NC
Zip: 28617
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
® I certify that I am a deeded property owner of above -referenced
property and am authorized to make decisions regarding this
property on behalf of other deeded
property owners. Furthermore I certify that I have read and understand this Agreement and do
hereby grant pennission to the Perm ittee to land apply residuals to land application site(s) as specified herein.
Property owner name: Z-ki h4�-,r 'A �
Signature:
FORM: SWA 06- l 6
Date: t' �� % } Z o / Cy
Page I of I

jDW�­! R
Dfvtsto f
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Inv Water Resources SETBACK WAIVER AGREEMENT (FOR RESIDUALS PROGRAM)
FORM: SWA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the A licant shall submit one on inal and two co ies of the a lication and
sunnortine documentation
For more information, visit the Water Quality Permitting Section's _Non -Discharge Permitting (Init
General — This document is an agreement between the Applicant and the owner(s) of the property adjacent to the land application
site(s) to allow setback reduction for habitable residences or place of public assembly not owned by the permittee or not to be
maintained as part of project site(s) in accordance with 1.5A NCAC 02T .1108 b _ Xfor habitable residences or place of public
assembly only]. Do not submit this agreement for review without a corresponding application form (FORM: RLAP 06-16).
A. Setback Waiver Agreement:
® Submit the completed and appropriately executed Setback Waiver Agreement (FORM: SWA 06-16) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
® Prepare a separate agreement for each property from which a waiver is being sought.
® Any other setbacks required by 15A NCAC 02T .1108, other than those referenced above, cannot be waived through
execution of this agreement.
® A copy of the completed and executed agreement must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED BY 15A NCAC 02T .1108(b)()( 2 habitable residences) The undersigned property owner hereby permits:
Applicant's name: Town of West Jefferson
Applicable Field ID:
hereinafter referred to as the Permittee, to land apply residuals within 1_ _ 00 feet (i.e., cannot be less than 100 feet) of
the residence or place of public assembly located at the following;
Location address of property: 333 Flat Rock Acres Road
City: Cruinpler State: NC
Zip: 28617
This Agreement shall remain in effect for the length of the Division of Water Resources' (Division) permit for the residuals
land application program and shall be renewed each time this permit is renewed. In addition, this Agreement shall only
remain in effect for as long as the undersigned property owner owns the property described herein.
The undersigned property owner agrees to abide by this Agreement until such time as written notification, given 30 calendar
days in advance, modifies or cancels this Agreement.
® I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions regarding this
property on behalf of other deeded property owners. Furthermore, I certify that I have read and understand this Agreement and do
hereby grant permission to the Permittee to land apply residuals to land application site(s) as specified herein.
n t
Property owner,r}ame: �-�-/') r ,�. , qZ
", )�, 1,
Signature: X4 6 r „ .,, V,?- #,. .
Date: !�:X
FORM: SWA 06-16
Page I of I

Site Vicinity and Buffer Maps

Site Vicinity Map
Land App Sites
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z
I I I�lo
N
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N
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Soil Maps

o
462640
36o 26' 47" N
36o 26' 35" N
462540 462680 462720 462760 462800
in
Map Scale: 1:1,770 if printed on A portrait (8.5" x 11") sheet.
o Meters N
0 25 50 100 150
Feet
0 50 100 200 300
Map projection: Web Mercator Conermordinates: WGS84 Edge tics: lfrM Zone 17N WGS84
usoA Natural Resources Web Soil Survey
Conservation Service National Cooperative Soil Survey
Soil Map—Ashe County, North Carolina
(Field DP1)
4626M 462720 462760 462800
462840
462840
N
o
462880
36o 26' 47" N
36o 26' 35" N
462880
b
N
m
2/6/2024
Page 1 of 3

MAP LEGEND
Area of Interest (AOI)
0
Area of Interest (AOI)
Soils
0
Soil Map Unit Polygons
,N
Soil Map Unit Lines
Soil Map Unit Points
Special
Point Features
10,
Blowout
0
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
,
Gravelly Spot
Landfill
A.
Lava Flow
.&
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
o
Sodic Spot
Soil Map—Ashe County, North Carolina
(Field DP1)
MAP INFORMATION
Spoil Area
The soil surveys that comprise your AOI were mapped at
1:24,000.
Stony Spot
Very Stony Spot
Warning: Soil Map may not be valid at this scale.
Wet Spot
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
4�
Other
line placement. The maps do not show the small areas of
Special Line Features
contrasting soils that could have been shown at a more detailed
scale.
Water Features
Streams and Canals
Please rely on the bar scale on each map sheet for map
measurements.
Transportation
Rails
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
0­0
Interstate Highways
Coordinate System: Web Mercator (EPSG:3857)
US Routes
Maps from the Web Soil Survey are based on the Web Mercator
Major Roads
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Local Roads
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
Background
Aerial Photography
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Ashe County, North Carolina
Survey Area Data: Version 21, Sep 13, 2023
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Oct 29, 2011—Nov
28, 2017
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
usoA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 2 of 3

Soil Map—Ashe County, North Carolina
1IM1G1912
Map Unit Legend
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
CfD
Clifton loam, 8 to 15 percent
slopes
8.3
57.5%
CfE
Clifton loam, 15 to 25 percent
slopes
5.1
35.7%
EvF
Evard loam, 25 to 45 percent
slopes
1.0
6.8%
Totals for Area of Interest
14.4
100.0%
USDA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 3 of 3

v
m
o
464080
36o 26' 53" N
0
n
36o 26'40"N
Soil Map—Ashe County, North Carolina
(Field DP2)
464140 4642M 4642M 464320 464380 464440
464080 464140 464200 464260 464320 464380 4
N Map Scale: 1:2,840 if printed on A landscape (11" x 8.5") sheet.
o Meters N
0 40 80 160 240
Feet
0 100 200 400 600
Map projection: Web Mercator Conermordinates: WGS84 Edge tics: UTM Zone 17N WGS84
usoA Natural Resources Web Soil Survey
Conservation Service National Cooperative Soil Survey
o
m
464680
36o 26' 53" N
0
n
1
36o 26' 40" N
464680
m
2/6/2024
Page 1 of 3

MAP LEGEND
Area of Interest (AOI)
0
Area of Interest (AOI)
Soils
0
Soil Map Unit Polygons
,N
Soil Map Unit Lines
Soil Map Unit Points
Special
Point Features
10,
Blowout
0
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
,
Gravelly Spot
Landfill
A.
Lava Flow
.&
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
o
Sodic Spot
Soil Map—Ashe County, North Carolina
(Field DP2)
MAP INFORMATION
Spoil Area
The soil surveys that comprise your AOI were mapped at
1:24,000.
Stony Spot
Very Stony Spot
Warning: Soil Map may not be valid at this scale.
Wet Spot
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
4�
Other
line placement. The maps do not show the small areas of
Special Line Features
contrasting soils that could have been shown at a more detailed
scale.
Water Features
Streams and Canals
Please rely on the bar scale on each map sheet for map
measurements.
Transportation
Rails
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
0­0
Interstate Highways
Coordinate System: Web Mercator (EPSG:3857)
US Routes
Maps from the Web Soil Survey are based on the Web Mercator
Major Roads
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Local Roads
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
Background
Aerial Photography
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Ashe County, North Carolina
Survey Area Data: Version 21, Sep 13, 2023
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Oct 29, 2011—Nov
28, 2017
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
usoA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 2 of 3

Soil Map—Ashe County, North Carolina
1IM1150191 a
Map Unit Legend
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
BrD
Braddock gravelly loam, 8 to
15 percent slopes
1.7
5.9%
CfD
Clifton loam, 8 to 15 percent
slopes
20.5
70.7%
CfE
Clifton loam, 15 to 25 percent
slopes
4.1
14.2%
EvF
Evard loam, 25 to 45 percent
slopes
2.7
9.3%
Totals for Area of Interest
29.0
100.0%
USDA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 3 of 3

o
458280
36o 22' 43" N
36o 22' 25" N
ug
r
Soil Map—Ashe County, North Carolina
(Field KP1)
458340 458400 458460 458520
458280 458340 458400 458460 458520
in
Map Scale: 1:2,690 if printed on A portrait (8.5" x 11") sheet.
o Meters
N 0 35 70 140 210
Feet
0 100 200 400 600
Map projection: Web Mercator Conermordinates: WGS84 Edge tics: lfrM Zone 17N WGS84
usoA Natural Resources Web Soil Survey
Conservation Service National Cooperative Soil Survey
o
45%40
36o 22' 43" N
ug
r
o_
36o 22' 25" N
458640
m
2/6/2024
Page 1 of 3

MAP LEGEND
Area of Interest (AOI)
0
Area of Interest (AOI)
Soils
0
Soil Map Unit Polygons
,N
Soil Map Unit Lines
Soil Map Unit Points
Special
Point Features
10,
Blowout
0
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
,
Gravelly Spot
Landfill
A.
Lava Flow
.&
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
o
Sodic Spot
Soil Map—Ashe County, North Carolina
(Field KP1)
MAP INFORMATION
Spoil Area
The soil surveys that comprise your AOI were mapped at
1:24,000.
Stony Spot
Very Stony Spot
Warning: Soil Map may not be valid at this scale.
Wet Spot
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
4�
Other
line placement. The maps do not show the small areas of
Special Line Features
contrasting soils that could have been shown at a more detailed
scale.
Water Features
Streams and Canals
Please rely on the bar scale on each map sheet for map
measurements.
Transportation
Rails
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
0­0
Interstate Highways
Coordinate System: Web Mercator (EPSG:3857)
US Routes
Maps from the Web Soil Survey are based on the Web Mercator
Major Roads
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Local Roads
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
Background
Aerial Photography
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Ashe County, North Carolina
Survey Area Data: Version 21, Sep 13, 2023
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Oct 29, 2011—Nov
28, 2017
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
usoA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 2 of 3

Soil Map—Ashe County, North Carolina
I11MIG1:12
Map Unit Legend
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
CfD
Clifton loam, 8 to 15 percent
slopes
17.1
54.2%
CfE
Clifton loam, 15 to 25 percent
slopes
13.2
42.0%
TUE
Tusquitee and Spivey stony
soils, 15 to 25 percent
slopes
1.2
3.7%
Totals for Area of Interest
31.4
100.0%
USDA Natural Resources Web Soil Survey 2/6/2024
Conservation Service National Cooperative Soil Survey Page 3 of 3