WQ0004166_Residual Annual Report 2018_20190214

1233 Highvray 16 South P.Q. Boss 67 Jefferson, NC 26640 3136.246.2165
"P -9tW ° B
Cathy Howell, Town Manager
February 12, 2019
NC Division of Water Resources
1617 Mail Service Center
Information Processing Center
Raleigh, NC 27699-1617
Annual Sludge Reports
Tian Church, Director
SUBJECT: Annual Town ofJReport for Land Application of ds
Jefferson WWTP NPDES NC0021709
Class B Permit WQ0004166
RECCEIVED/MCDEQIDWR
Dear Staff:
FEB 1 4 2019
Please find enclosed three copies of the Town of Jefferson Water Resources Annual Non -Discharge
Report for the Land Application of Biosolids for the calendar year 2018. This mailingermitting Unit
contains the report for Class B liquid residuals disposal.
If you have questions or require additional information please call [phone] or by
e-mail at jeffwns(&entMlink.net.
Respectfully,
rL;v,``
Tim Church, Water Resources .Director
Town of Jefferson

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit{: WQ0004166 County:
Facility Name (as shown on permit):
Land Application Operator:
Ashe
Tirn Church
Y ca r: 2018
Town of Jefferson
Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
2 Yes 0 No - If No, sIdp Part'A,jand Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A - D-Lithinic Anni—tion -qu marv:
Total number of app] ica_tion fields in the permit: 3
Total number of fields utilized for land application during the year:
L 3
Total amount of dry tons applied during the year for all application
66
Total number of acres utilizes for land application during the year:
43
Part B - Annual Compiance Statement:
Facility was compliant (luring calendar year 2018 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. 10 Yes E3 No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
I ) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pl-1 was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pl-I of at least 6.0 or
the limit specified in the permit.
3) Annual sails analysis were performed on each site receiving residuals during the past calendar year and three (3) copies
of laboratory results are attached.
4) Annual TCUI analysis (if required) was performed and three (3) copies of certified laboratory results are attached.
5) All other monitoring was performed in accordance with the permit and reported during the year as required and three (3)
copies of certified laboratory results are attached. I
6) The facility did not exceed any of the Pollutant Concentration Limits in 15A 14CAC 02T.1105(a) or the Pollutant
Loading Rates in 15A NCAC 02T .1 105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR fart
503 regulated facilities).
8) All monitoring and reporting requirements in 15A NCAC 02T.i 11 i were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior
authorization was received from the Division of Water Resources.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
11) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred,
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate,
k�
and cornplet�- I ani aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations."
Tim Church, Water Resources Director
Permittee Name and Title (type or print)
Signature of Permittee Date
Signature of Preparcr* Date Signature of Land Appher onus
(if different from Permittee) (if different from Permittee and Preparer)
. . - .. - . — . — ^-- . — —e\ I nf=xip rnpm Ar,;r tigigrinri)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Please note.that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF - 13
WQ Permit Number: WQ0004166
Facility Name:
Residual Source WQ # or
NI'DES #:
WWTP Name:
D: 1-11 A 11ofo
Town of Jefferson WWTP
NCO021709
Jefferson WWTP
Laboratory: 1)
2)
3)
4)
5)
Meritech, Inc.
Parameter
(mg/kg)
Conc.
Limit
(mg/kg) a
Sample or Composite Date
2122/ 18
Percent Solids (%)
NA
2.8
Arsenic
75
6.08
Cadmium
85
<0.35
Copper
4,300
417
Chromium
NA
Lead
840
8.41
Mercury
57
0.63
Molybdenum
75
<0.88
Nickel
420
5.27
Selenium
100
<1.77
Zinc
7,500
116
Total Phosphorus
NA
2160
TKN
NA
43,500
Ammonia -Nitrogen
NA
678
Nitrate and Nitrite
NA
548
1=or surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reterence the individual permit tar metals limns.
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
I A Aq
Signature of Preparer Date
*Preparer is defined in 40 Cl-R Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF (12/2006)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Report all sampling'analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past
calendar year. Use additional forms as needed.
WQ Permit Number: WQ0004166
L,aboratoi-y: 1)
Facility Name: Town of Jefferson
2)
Residual Source NCO021709
3)
NPDES # or WQ#:
4)
WWTP Name: Jefferson WWTP
5)
Meritech, Inc.
1\{rJIU Ui{{ iall[1{�J{J AJ a1�u
Parameter
�mg/kg)
Sample or Composite Date =
2/22/18
Aluminum
7,770
Calcium
9,540
Magnesium
2,600
Sodium
1,170
SAR
0.459
Potassium
2,560
PAN
13,751
PH
6.2
641 certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Preparer
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1 102 (26)
QM
Date
DENR FORM RSSF - B (12/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM'
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
Town of Jefferson WWTP Total Dry Tons Applied (Annual):
WQ0004166 Cation Exchange Capacity (non 503 only):
Tim Church Owner:
26 Acres Permitted:
41.10
12.6
Fred Walters Predominant Soil Series: Watauga
26 Site #: Fred Walters Field #: I
Residual Analvsis Data (Heavy Metals and Total Phosphorus use Ong/kg, % Solids use Raw Percent #):
Com-
posite
Date
VIE In.
Total
Phos-
Phonis
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
1 1
1 11!
1 Ilr
1 Ilr
r !rl
! 111
! III
NMI
KIMIMIMI
1 rl
1 Iil
1 !11
1 Irl
r I1r
1 !rifflmfffl
lil
I Ilr
r r11
1 Ill
Ir1
1 i/
.•.
:
r Ir1
l Ilr
r rri
11!
1 Irl
1 1!1
r Iil
r lrl
r 111
1 111
r 111
:
r Ilr
1 Ill
l 111
1 111
1 Irr
1 rll
1 rrl
ff! rrl
1 110
i 111
! IIr
1 Ill
Irr!
. ',
1 1
r rrI
1 111
1 111
! lit
1 111
r Irr
ill
1 rrl
r 111
! 111
1111
1 1
I rl
1 111
r 111
lilt
f ! 1
rrir
1 1l!
Womming,
I NOT,
Efro1
1 !r
''� '
r rl
1 11l
1 1l1
I rlr
1 11!
1 111
1 111
1 !rl
l ilr
I rrr
r 111
(lil
1 11
1 1
I rll
l Irl
Elrl
1 rrr
r 1r1
IT=r
Ill
l Iri
1 111
rrir
1 Irr
r l
ARMIII
1 11
XITIMIKIWIIM
r11
rill
1 Irr
l Ili
I IIl
1 Irl
1 ITI
r 1r1
1 !rr
1 11
� �
WoM X
1 11r
r !!1
MWITI!
MITII
N 111
r 111
r Ili
r 111
! 11/
MITI=
KIM M.
Total
Phos-
1 111
1 rrr
1 r!I
r rrr
1 11!
! 111
1 111
!Irr
!rrr
r 111
! !Ir
�.
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of Imes and
el
imprisonment for knowing violations".
-
Aq
Signature of Land Applies Date
DENR FORM MFLSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOY WHEN NOT APPLICABLE.
Facility Name: Torun of Jefferson WW TP
Land Owner: Fred Walters
Operator: Tim Church
Crop 1 Name: Fescue Hay
WQ Permit #: WQ0004166 Field it:
Acres Utilized: 26
Annual Dry Tons Applied: 41.1929 Site #: Fred Walters Acres Permitted: 26
Predominant Soil Series: Watauga Cation Exchange Capacity (non 503): 12.6
Crop 1 Max. PAN: 155 Crop 2 Name:
Crop 2 Max. PAN:
..
° y
° °
ca °
Volume applied
PP
enter one Solids/
( )
Liquid
9
Cu. Yds Gallons
/o
Solids
Volume
Applied per
PP P
Acre
(Dry Tons/AC)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
wry'
Wet,
Moist)
Preci P•
Past 24
Hrs.
inches
y
�'
* 2
C
e
e
°
ry
,.
°
T
TKN
mg/kg
a
;'
o
"'
mg/kg
Nitrate
and
Nitrite
mglkg
PAN Applied
PP
(lbs/acre)
Naive of Crop T c
P yP
Rccehring Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
January
39600
2.8
0.178
NIC0021709
Dn,
0
S
0,5
30%
43500
678
548
4.885
NA
fescue
February
21600
2.8
0.097
NCO021709
Dn,
0
S
0.5
30%
43500
678
548
2.664
NA
fescue
March
55,800
2.8
0.251
NCO021709
Dry
0
S
0.5
30%
43500
678
548
6.883
NA
fescue
April
52.200
2.8
0.234
NCO021709
Dry
0
S
0.5
30%
43500
678
548
6.439
NA
fescue
June
39600
2.8
0.178
NCO021709
Dry
0
S
0.5
30%
43500
1 678
548
4,885
NA
fescue
July
64800
2.8
0.291
NCO021709
Dry
0
S
0.5
30%
43500
678
548
7.993
NA
fescue
October
43200
2.8
0.194
NCO021709
Dry
0
S
0.5
30%
43500
678
548
5.329
NA
fescue
RIovemb
36000
2.8
0.162
NCO021709
Dry
0
S
0.5
30%
43500
678
548
4.441
NA
fescue
0.000
0.000
0.000
0.000
000
0.000
000
0.000
X43517
000
,...
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp to this form):
aTALs:
a
352800
:;;:::::
As
Cd
Cu
Cr
Pb
H�
Mo
Ni
Se
Zn
P
o00
Lime Applied
knnuallbs/acre
0.019
0.001
1.318
0.000
0.027
0.002
0.003
0.017
0.006
0.367
6.826
> :;
Date
Ibs/ac
'rior Years Cumulative lbs/ac
0.661
0.680
36 1
0.14
0.141
344
24.247
25.565
1 1338
na
419#M#
na
1.512
1.539
1 267
0.029
0.031
1 13
0.711
0.714
na
1.291
1.308
3741
1.056
1.062
1 1 89
82.308
82.675
2498
,urrent Cumulative lbs/ac
'ermitted C. P. L. R.****
ermit PAN Limit 1 sd2nd Crop
IS 5
'I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
lualified personnel properly gathered and evaluated the information submitted. I am aNvare that there are significant penalties for submitting false
nformation, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
/ *Application Method: S - Surface, IN - Injection, INC - Incorporation
/ **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
*-`-*C.P.L.R.: Cumulative Pollutant Loadine Rate

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
Town of Jefferson WWTP
WQ0004166
Tim Church Owner:
Total Dry Tons Applied (Annual):
Cation Exchange Capacity (non 503 only): 13.4
Fred Walters
8 Acres Permitted: 8 Site #•
Predominant Soil Series: Watauga
Bower Walters Field #: 3
Residual Analysis Data (Heav_y Metals and Total Phosphorus use Lkg_ % nlitic neP Raw P-repnt #1-
.
Com-
posite
Date
1
UME
N
Total
Phos-
h
.�
Annuai heavy inetai v iela I oaaings (Ualculated in lbs/acre):
Total
F41
L51-6
J
7 J
L8.I--9
10
11
12
DT/Ac./
c
App-
Event
1.65
Arsenic
<{ro 02o
a 0 a>aa
a oaa
a aaa F,
a aa`a
a ooa f
ja aao
oaa
a{aaa
a ooa`i
a aao
0 ooa.
o a2a..
Cadmium
k0'001°'
f ,0 000
0 000 '
'0 00`0
0'000
0 000 ;
0 OQO 1
Q 000 =
'0 00'0
'0 Q00
0 000
Q 000,
r
0 OQl.,'°
Copper
1 396.
+ 0 ;b00
,; 0 000
0 000
O,Q00'
0 000i,
0 00`U
0{000
U OOOr,
0 00Q
0`000:
x Q OOO.h
; 1 3 76<
Chromi
o {000 ,
o 000
k o 000
a 000
x 000 `
000
E
°o
x
0
�
r
,
r0
'0
w ooq
o.000
0 000
a
0 00,0
000
0 000
0 000 ='
Lead
0 028
a 000
%0 000
0 000
�0 000�
0 000 _'
0 0,04
0 0�0
;0 000;0
000
0000
0 000
0 028�
Mercury
0�0020000000.0`000
0 000'"
, 0000;
0000
` f0 000
:O OOO�
00,00
600
�0 000
0 002 `
Mol b-
y
o 003
or000sf
o 000
0 odeoa
o oao
o 000
0 000
0 000
0 000
y0
o aao
0 000
0 000
_
d
4; a o03
Nickel
0 0170
000
a 000 `
" 0 �a00
0OaO
' 0 Q00 ,
0 000
0 Q00
` 0 000
0 000
0 d00 `
0 000
0 01,7�;
Selenium
0 OU6
0 000,;
0 000 "
0 000
0 000000
;
30 000
Q
0
,
000
ao0;v
h.0 OOOr
0 006 F
Zinc
0 383�
0 000
`�.0 Oa0
0 000
0 000
0{'oQO ;;
0 OQ{0
0 000
0 aa`0 s�
0 000�
0 000
0000
0 383.4
Total
,
,
�
Phos-
" L
�{ 7 128
0 000
0 000 '
0 °000
0 000
0 OOOk
0 OOQ
0a0
0
horus
, Q„ 000
0
0 000
000
0' 000
= 7 12$ a
4
"i certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier
-zhilIq
Date
DENR FORM MFLSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
Facility Name: Town of Jefferson WWTP
Land Owner: Fred Walters
Operator: Tim Church
Crop 1 Name: Fescue Hay
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
WQ Permit #: WQ0004166 Field #: 3
Annual Dry Tons Applied:!!32406•.>-` " _- _ "' Site #: _Bower Walters
Predominant Soil Series: Watauga
Crop 1 Max. PAN: 155 Crop 2 Name:
Acres Utilized: 8
Acres Permitted: 8
Cation Exchange Capacity (non 503): 13.4
Crop 2 Max. PAN:
ti
°
Volume applied
Volume
Residual Sources
SoilPrecip•
Cond.
Y
`t+
o
Z
Nitrate
Name of Crop Type
ti
a� s~
°
(enter one) Solids/
%
Applied per
P
(NPDES #, WQ#,
Past 24
4
r, b
a.w
7d �,
c
TKN
q
o
and
PAN Applied
Receiving Residual
s
Liquid
Solids
Acre
Fert., Animal
(D�>
Hrs.
o.
a. a.
*
#
*
IQ 0
Nitrite
(lbs/acre)
Application
A
Cu. Yds Gallons
(Dry Tons/Ac)
Waste, etc)
Wet
Moist)
inches
N
* 0
mg/kg
mg/kg
mg/kg
Crop 1,
Crop 2
Crop 1
Crop 2
April
45000
2.8
=<''t) 657t ''` `,
NCO021709
Dry
0
S
0.5
30%
43500
678
548
4,8:040
fescue
June
32400
2.8
0 4?34-71
NC0021709
Dry
0
S
0.5
30%
43500
678
548
.12 984
NA' :,_:
fescue
October
36000
2.8
, s.0 §25 a :'•%
NCO021709
Dry
0
S
0.5
30%
43500
678
548
-14 432
.,NA h
fescue
rum- t100 '
O000
00E^^.
:-�OiQ9U;r,W+r
M'0000:`'
� �0000""a
YO QOO
;r,o:000',;
-
-
R
esidu A Residuals Applications n pp at o s totals on FORM
FSF supp (attach FORM
FSF supp to this form):
_ ,,,, ,:.
;'�
;:•`.:::::::::::::<:::::,:;>:�:�:�:::�::
TOTALS:17
o
`-^ 1I3400
::.:.:.:.:.:.
AS
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
4560
0 000 '
Lime Applied
Annual
lbs/acre
Q020
0.386
0, 4'Q6-
36
0 001 „
0.127
^ 0 128 -,
34
1 376
20.421
_,21797
1 1338 1
0900 "_
0 000-
na
0 028
1.228
=- 1 256�-
267
0 002
0.029
_0 031 --
13 1
0,093 ,
0.709
- 0 712
na
0,017
1.174
1191
374
Q 006 ,
0.854
0 860 .79
89
0 383
79.1
483
2498
' 7128r, ?:
.:. • , • . _ . • • .... :.:
Date
lbs/ac
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Pe it PA
N AN Limit1 st/2n d Crop
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
. **Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
Town of Jefferson WWTP
Total Dry Tons Applied
PP d (Annual):
WQ0004166 Cation Exchange Capacity (non 503 only): 12.5"
Tim Church Owner: Johnny Walters Predominant Soil Series: Watauga
9 Acres Permitted: 9 Site #: Johnny Walters Field #: 5
Residual Analysis Data (Reavy Metals and Total Phosphorus use in P, ° Cnliric neP Raw Pnrrnnt ffl•
�T-M-1VOICK11
C om-
posite
Date
I
Non
I NINE
a
Annuat heavy Metal field Loadings (Ualculated in lbs/acre):
Total
1
21
3
4
5
6
17
g J
9 J
10
11
12
DT/Ac./
c
App.
Event
1.34
Arsenic
0 016
x 0 000
"0 000
0 000„
0.000,E
; Q Obo
0 000
0 0004
0 0005
" 0 000 ;
0 q00
, Q 000,;,
.' 0 016,.
Cadmium
0 001,
T `0 600 '
0 000 >
0 00'0
q. 000 `
;6 OOU ,:
0 000
0.000
0 000 ,'
0 OU.O,
0 ;0003
0
061
Copper
1 118 '
{ O OOOF
U OQ0 'O
U00
O'OQ0
600,,:
0 000
;'0"OUO
O'000, ;
0 00,0
0; 000
OOO z
r'1 `118>:
Chromiu
0 000
64000
„4 000
0 000
0 00'0`
,'q
0 000
0 000
0 U00
0 000
O'000
OTQ00
„„Q
"; Q 000 h
0 000 `:
Lead12
0 023
0 000 f0
000k .
; O'000
0`000
:0 000'_,
0 000
Et 0 6�0
0 000 '
r0 o0Q
0 000`'
?Q 000
> 0 023 '.
Mercury
0 002
0 000
WOO,
0 000
Q 00,0
,: 0 000;„;
0 OOQ
Q 000
i.0 000
0 040Q
0 `0.00
Og 006
N`0 002M
Molb-
y
0 0025
0 000,
0 000 .,
0 "000
0 000 r
�0 000
F ,t
0 000
O'000
0 000 .
0 600
0 000
0.000
002
denum
ri
.
i
,JYvs ry•
0
Nickel
0 U14
0 000
Q 000%,
' 0 000
0 000
0 000{
' 0`000
0 000
Q
`
:
,
. 000
°O;000
0 000
, Q 000
0 014
Selenium
0 005
0 000
0 60"0 _
0 000 `
`0 000 '
0 000
0"000
0tU0Q
0 OOOt:�'
0 000
000;
6
;0
000;
; 0 005 .
Zinc
0 31.E
0 000
0 000 ;
0 000
0 q00
0 00,0
0 000
0, 000
' 0 000" :
' 0 OOp,
0 000
0'. 000
` 0 311
Total
Y
"'
t
Phos-
5 789
0`0004
0 000
0 000
0 000
0 000
> 0 OOU
U;000y
T A 000
0 OOQ
0 000,Q
000
horus
a
��:`�
u
x
t..'
,
5`789:n
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility_ of fines and
imprisonment for )mowing violations".
awtzJ
Signature of Land Applier
_z/11/a
Date
DENR FORM MFLSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Town of Jefferson W WTP
Land Owner: Johnny Walters
Operator: Tim Church
Crop 1 Name: Fescue Hay
WQ Permit #: WQ0004166 Field #: 5 Acres Utilized: 9
Annual Dry Tons Applied: `12 I897 - Site #: Johnny Walter! Acres Permitted: 9
Predominant Soil Series: Watauga Cation Exchange Capacity (non 503): 12.5
Crop 1 Max. PAN: 155 Crop 2 Name: Crop 2 Max. PAN:
Q°
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
(Dry,
e
Moist)
Precip.
past 24
Hrs.
inches
y
b
a o
p
c
a.
#.
o
es
�+°
N
#
0
�
TKN
mg/kg
Z
o 6
°�°
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of Crop Type
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
April
14400
2.8
`0 187': ';
NCO021709
Dry
0
S
0.5
30%
43500
678
548
rrt; 5131
' =`NA
fescue
May
90000
2.8
_.l%`68., ;
NC0021709
Dry
0
S
0.5
30%
43500
678
548
32,07Ts
:.<,.,NA
fescue
o 000
„ o oboe,
-o oaa�r
Uo
4�aooay;:,ti
000a �
:000; ��
-PP
Residuals Applications totals on FORM FSF
S su (attach
(
h FORM
FSF su to this form
PP
TOTaLs:
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
`372t)2.=
`„oboo'"
Lime Applied
Annual lbs/acre
::
4:015; e <,
0.422
0:'438
36
-;, .; 41r,
-:0 00
0.02
0 021 .:`7.955
._ ..: _ M..n .
34
_.,_1:., ..:............
- -1 I
6.837
_
1338 i5
<.... .
0.000
yna /.
:.: ... -::
0.476
O'499<"_
267
. : _ ,
0.002 _
0.001
_ 0:003
\ 13
...., .. ,:...,:
_ 00.02 ,
0.015-
0017.
na
_ _.._
. _0 014
0.277
0 :291
_.....
374
:x,,,..-_.,_..
0 005 ,
0.361
`0 3 66 r
r ..
89
p 40311
12.22
n12.531s
2498
....................
5 789�:.:.:::.:_:;.:.:,>:.:,>:.:,:_:.:.:_
Date
lbs/ac
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R. * * *
Permit PAN Limit 1 2n
t st/ d Crop
155' -
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Iniection/Incorporation - 1.0
Date's Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically'digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

"I
M„ Meritech, Inc.
]Environmental Laboratory
Laboratory Certification No.165
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Report Date: 3/6/2018
Project: Sludge
Date Sample Rcvd: 2/22/2018
Meritech Work Order It
022218102
Sample: Digester Sludge Grab
2/22/18
Parameters
Results
Analysis Date Reporting Limit
Met ocl
Total Solids
2.83 %
2/23/2018
0-100 %
SM 2540B
Ammonia, Nitrogen
678 mg/kg
2/26/2018
10 mg/kg
EPA 350.1
TKN
43500 mg/kg
2/27/2018
0.20 mg/kg
EPA 351.1
Nitrate/Nitrite, Nitrogen
548 mg/kg
2/23/2018
31.3 mg/kg
EPA 353.2
Aluminum, total
7770 mg/kg
2/28/2018
2.5 mg/kg
EPA 200.7
Arsenic, total
6.08 mg/kg
2/28/2018
2.44 mg/kg
EPA 200.7
Cadmium, total
<0.353 mg/kg
2/28/2018
0.353 mg/kg
EPA 200.7
Calcium, total
9540 mg/kg
2/28/2018
10.0 mg/kg
EPA 200.7
Copper, total
417 mg/kg
2/28/2018
1.00 mg/lcg
EPA 200.7
Lead, total
8.41 mg/lcg
2/28/2018
0.500 mg/lcg
EPA 200.7
Magnesium, total
2600 mg/kg
2/28/2018
10.0 mg/lcg
EPA 200.7
Mercury, total
0.636 mg/kg
2/27/2018
` 0.100 mg/kg
EPA 245.1
Molybdenum, total
<0.883 mg/kg
2/28/2018
0.883 mg/1%
EPA 200.7
Nickel, total
5.27 mg/kg
2/28/2018
2.0 mg/lcg
EPA 200.7
Phosphorus, total
2.160 mg/kg
2/28/2018
2.00 mg/kg
EPA 200.7
Potassium, total
2560 mg/kg
2/28/2018
20.0 mg/kg
EPA 200.7
Selenium, total
<1.77 mg/kg
2/28/2018
1.77 mg/kg
EPA 200.7
Sodium, total
1170 mg/kg
2/28/2018
20.0 mg/kg
EPA 200.7
Zinc, total
116 mg/kg
2/28/2018
0.500 mg/kg
EPA 200.7
Al I Te
rs a
s0 10
av t
1 hereby certify thatt have reviewed and approve these data.
642 Tamco Road, Reidsville, North Carc _--- __ __ _ _ _
tel.[phone] fax.[phone]

Chain of Custody Record (COC)
NPDES#: N 0 -
i
MERITECH., INC.
Clientl w r,, Phone:
Address: P 0. Rny 0 Fax: %
M
ENVIRONMENTAL LABORATORIES1PfpCSdf1
NG Email-ns up
10
642 Tamco Rd. Phone: [phone]
Project:
Reidsville NC 27320 Fax: [phone]
IJ
P.O.#:
Email: [e-mail]
Attention: Turn Around Time-*--
www.meritechiabs.com
How would you like your report sent? *RUSH work needs prior approval.
I
Circle all that apply: referred), Fax, Mail 24 - 48 Firs
E�
Sampling Dates & Times
Person Taking Sample (Sign/Print 7Lab Use Only
im 0h "r-
Sample Location
and/or ID # Start End
Date Time Date Time
comp?
Grab?
# of
Cont,
Test(s) Required
On ice? Yes
No
pH OK?
Z.22-A
NJITo�-- Nir�ih_ Amftn;a, N
Cl OK?
TK
J
114
/0
G
.1
Rmili\wy\ A*fsq4c_ WMIUM U6
&Dper
Le MannPSWA
-ad
M01
Me-hUm
Ko 3
-Nlkd
I
fisz,,�Ium_
1
i Lim YYA
7
—Z
Temperature Upon Receipt.
Method of
Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation. 0.1 6
Shipment:
Comments:
Compositor
UPS
Fed Ex
Jug H
Are _these res regulatory purposes? Ad2r r es? Yes 2f No R ort results in: mg/L ID mg/kg ug/L
�_e P
Hand Delivery
Relinquished by: Date e:
224m /2
Rec Time:
7,q
Other
Relin i Time:
r? M,/ 9
m
R J�,
ece T Date: Time:
Relinquished 1�y�'Date; 'rime:
Received ' b: Date:
_2_

SAR for Biosolids or Wastewater
Sodium Absorption Ratio
Na : Sodium (Mg/L) Equivalent weight: 23
Ca : Calcium (Mg/L) Equivalent weight: 20
Mg : Magnesium (Mg/L) Equivalent weight: 12
Milli Equivalent = Mg/L / Equivalent weight
Sarnplt�, Z- 7 .1 g
Na M /L Ca M /L M M iL
33.1 1 269.9 1 73.5
Na ME
Ca (ME)
Mcl (ME)
1 A3913
13.495
1 6.125
SAR= Na Milli Equivalent/[0.5 X (Ca Milli Equivalent+ Mg Milli equivalent)]0.5 power
t;JtR is O�1594T9(From Mg/L entered above)
If your lab reports in Milli Equivalents enter Na, Ca, & Mg below:
�SAR= #DIV/0! (From ME entered below)
Na (ME1 Ca (ME) M ME
Exchangeable Sodium Percentage (FOR SOIL SAMPLE RESULTS)
ESP = Na (Milli Equivalents) / CEC X 100
ESP = #DIV/0!
Na on NC soil test is expressed as meq.
The percentage of sodium ions occupying the

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
MeritechWork Order lt 022218102 Sample: Digester Sludge Grab
Parameter
Results Analysis Date
Report Date: 3/6/2018
Project: Sludge
Date Sample Rcvd: 2/22/2018
2/22/18
Reporting Urnit Method
%Total Solids
2.83 %
2/23/2018
0-100 %
SM 2540B
Ammonia, Nitrogen
678 mg/kg
2/26/2018
10 mg/kg
EPA 350.1
,rKN
43500 mg/kg
2/27/2018
0,20 mg/l(g
EPA 351.1
Nitrate/Nitrite, Nitrogen
548 mgll<g
2/23/2018
31.3 mg/kg
EPA 353.2
Aluminum, total
7770 mg/l(g
2/28/2018
2,5 mg/kg
EPA 200.7
Arsenic, total
6.08 mg/lcg
2/28/2018
2.44 mg/kg
EPA 200.7
Cadmium, total
<0.353 mg/kg
2/28/2018
0.353 mg/lcg
EPA 200.7
Calcium, total
9540 mg/kg
2/28/2018
10.0 mg/l(g
EPA 200.7
Copper, total
417 mg/kg
2/28/2018
1.00 mg/l<g
EPA 200.7
Lead, total
8.41 mg/kg
2/28/2018
0.500 Ing/1%
EPA 200.7
Magnesium, total
2600 mg/kg
2/28/2018
10.0 mg/kg
EPA 200.7
Mercury, total
0.636 mg/kg
2/27/2018
0.100 mgllcg
EPk245.1
Molybdenum, total
<0.8B3 mg/kg
2/28/2018
0,883 mg/kg
EPA 200.7
Nickel, total
5.27 mg/lcg
2/28/2018
2.0 mg/lcg
EPA 200.7
Phosphorus, total
2160 mg/lcg
2/28/2018
2.00 mg/kg
EPA 200.7
Potassium, total
2560 mg/lcg
2/28/2018
20.0 mg/]<g
EPA 200.7
Selenium, total
<1.77 mg/kg
2/28/2018
1.77 mg/kg
EPA 200.7
Sodium, total
1170 mg/l(g
2/28/2018
20.0 mg/kg
EPA 200.7
Zinc, total
116 ing/l(g
2/28/2018
0.500 mg/kg
EPA 200.7
70
All lresull-s we dw
r.5,91ids
I hereby certify th( A
Car(
tel.[phone] fax.[phone]

CLIENT: JEFFERSON 1
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,13ANNER ELK, NC 28604
[phone]
LOGIN TIME: 10:45 AM
SAMPLER:
COLLECTED DATE: 7-Feb-I8
REPORTED DATE: 2-Mar-18
:ANALYSIS.:::.:.: ::.:::::::::::.:. ::::::•:;::::.::ANALYS,IS::MQL%%::::UNITS:::
_::SAMPLE.:::;:ANALY'.SIS:�Y-::SAMPLE:::
S.U.LT,S.
>::::::.<:::::::::::::::::::::LOCATIQN
.CO.MP, '.ETE0
.:::._::CODE<:.:.•.:.
TOTAL SOLIDS
2.7
%
SLUDGE
FECAL COLIFORM
13347
1
CFU's
1
8-Feb-18
SM-9222D
WPS
V1-11 LU u 1 . IN\, UCr%1 Ir-I CU LHD hf Z)44
PAUL ISENHOUR, SUPERVISOR
2-7./9
13,3Y7
z .13. /0
il, Rs-Z
z. a /9
1q, S /9
.14.19
l8,67
z.a./9
/0,0W
z.zI. g
10,3g5
f z(b. S
iz, 309
LOG
�! /7
Y27
oo
/Y,o1
6T

WATER QUALITY SERVICES, INC.
P.O. •BOX 1102, BAN�.rE-R ELK, NC. 28604
(828)-898-6277
fax [phone]
CHAIN OF CUSTODY
SAIMPLETYPE: %VAS1'E\VATEI: *PRESERVATION' COD
LOCATION: I- 1-12SO-3, 2- H 103, 3- HCL,
FACILITY IDS;: Jefferson Wastewater Treatment Plant 1 . NA01-I, 5 - NONE, 6 - COOL ICE
SAMPLER NAME: Tim Church 7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE: START TIME: STOP TIMF:
SA,4iPLE tiA✓tiSE:
--
COLLECTION
DELIV
"FEItP
SAMPLE TYPE
PRESERVATION•
PFi
lverii'r�YES
CL2•D•CL. , L..%B SA...1i";-i�
[O
DATE
TIME
-T CMP
GRAF3
COh1P
F-FIEi_Q
--._..__�
L Lr�B
130D - INF.
TSS - INF.
_
EOD - EFF.
ITSS - EFF.
N1-13 as IN
L-1
OIL & GR_EASE
ILI
TOTAL N111'.
__
11
L
TOTAL PHOS.-r
L!
FECAL -UP
FECAL - EFF.
FECAL - DOWN
�il�
L7
F_7
IL7
I
l
_
I _ (,-
I
CONDUCT
CONDUCT - EFF.
11-2
Lead 5 1
1
TJ2
Copper
•
L2Cyanide
M l_ V S S -�—
tii L V S S
LOW Level Me- rcury,-
OT H E 1i
—`�
`�j
I
i
I
-�
�•___ _
_ _ _ _
IIN 1s>D B
2ELI140,!SHED BY
ATE'
DATE"
TI I :
T1N1E
R I IIc�UISIII�n BY r,, I>-r-- l_,®`t1_
ftEt QUIS1.1E- D 131' t7:' �l/"•'t
Laboratory preservation is ensured by addition of preservatives TiridIr to sample
containers leaving the lab, unless otherwise noted.
CL3-D-CL2- Chlorine check and dechlorination verification.
PRESERVATION:
�) COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI. TURBIDIT"',
{) COOL 4C , PH<2H2SO4 : NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, l'O'i PFlO5.
{ } COOL 4C. PH<2 HN'03 : MIETALS except CR, Vl
{) NONE: CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
O1•H E•R:
( ) COOL 4C. NA2S203 . COL!FORNi BACTERIA
NOTIFICATION°

CLIENT: JEFFERQON2
ADDRESS:
CITY:
o/*/E:
|O#
WATER QUALITY LAB & OPERATION, INC.
P.O.BOX 11O7.BANNERELK, NC28OO4
LOGIN TIME: 1:25PM
SAMPLER
COLLECTED DATE: 13-Feb-18
REPORTED DATE: 2'Mop18
TOTAL SOLIDS
2.7
%
SLUDGE
PAUL|SBNHOUR.SUPERVISOR

5bNATER QUAL11 -Y SERVICES, INC. 1102. BANNE R ELK, NC. 2 860-4
(828)-898-6277
z fax [phone] CHAIN OF CUSTOD)
SAMPLE TYPE: WASI-EWAI'Ef*I1RI'-SERV,"'­I'I0N CODE
LOCA'FION: I - 1-12 S 04' 2 - '-INO 3, 3 - 1-1 C L.
FACILITY lDr"r: Jefferson Wastewater Treatment Plant
4 - NAOI-I, 5 - NONE, 6 -COOL [('I-:
SAMPLER NAME: Tim Church 7 - NIA2S203, 8 - OTHER
COMPOSITE SAMPLE; START TIME: STOPITIVIF..
FSANVLE NAME'
COLLECTION
rELI
T�V
I'ENIP
Lj�
P
�IA L E TYPE
_N#
PRESERVATIO
I PH
verify
1CL2 -D-CL--j_1_AB SAMPL!_'�
ID NUN I 1B i
DATE
'I'IME
Tc_mp
""
r
G RA B
.COMP
I F -FIELD
I L-LAB
'BOD -INF.
TSS - INF.
BOD - EFF.
I'SS - EFF.
NF13 as N
I L I
OIL & GREASE
TOTAL NIT.
FECAL
FECAL -EFF. 'j
Ll
L7
IL7
N-2 — -----
FECAL - DOWN
11-7
CONDUCT
M 2
caNDucT - EFF.
Lead ,
Copper
Cyapide
N-ILVSS
JT,2
I
r., 2
Lei
1,2
7
iNILVSS
Low Lr'_vG1­m1_C1'._GU_1-_)'_
_77
0'1' 1-1 E R
T7-7-
I
'WISHED BY:
]ME
RE1_ I'NQUISFIED BY:
D A TE T_ i
R1-:LI.NQUISFIED BY: IJA I L.
M I-
RELINQUISHED III)'. D,�\'I'I- TF I
-Z
-Laboratory preservation is ensured by addition of preservatives prior tov.. Pe
containers leaving the lab, unless otherwise noied-
CL2-D-CL2- Chlorine check and dechlorination verification,
PRLSERVATIOIN':
COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
COOL 4C, PH<2)H2SO4 NH3, NO2-NO 3. TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PROS
COOL 4C, PH<2 IIN03 111AETALS except CR, VI
NO'NE :CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
OTHER:
( ) COOL 4C. NAM03: COLIFORPA BACTERIA
NOTIFICATION
t

CLIENT: JEFFERSC)N3
ADDRESS:
CITY:
STATE:
|D#
WATER QUALITY LAB & OPERATION, INC.
P.O.BOX 11G7.BANNERELK, NC286O4
[phone]
LOGIN TIME: 12:00PM
SAMPLER:
COLLECTED DATE: 14Feb-18
REPORTED DATE: 2'Mar-18
TOTAL SOLIDS
2.7
%
SLUDGE
REPORTED BY: NCCERTIFIED LAB #544
PAUL|SENH0UR.SUPERV8OR

WATER QUALITY SERVICES, INC.
13.0. -BOX 1102, BANNER ELK, NC. 28604
. (828)-898-6277
3
�fax [phone]
CHAIN OF CUSTODY
SAi'vtPLE TYPE: WASTEWATEit •11RESERV T]O'.' C01)1:
LOCATION: - I - H2SO4, 2 - HNO3, 3 - HCL,
FACILITY IDn: Jefferson. Wastewater Treatment Plant a - NIA01-1, 5 -,NONE, 6 - COOL €t: rE
SAMPLER NAME: Tim Church 7 - NA2S203, S - OTHER �
COMPOSITE SAMPLE: START TIME: STOP TIME:
SAMPLE NAME:
COLLECTION
DELIV
TEIMPI
SAMPLE'f-YPE
PRESERVATION"
I PH
verif
CL2•1)-CL ; LAG SANIPLF.
YES
- -
D.t fE
TI►vtE
TEMP
GRAB
I COMP
F-FIELD
E.•LAE3
BOD - INF.
-
TS S - IN F.
BOD - EFF.
TSS - EFF.
N'H3 as N
L I
I
OIL h GREASE—
TO-fAL NIT.
`I'O'r?VL PROS.
FECALT
FECAL - EFF.
19
-67N
1 V
ILI
IL7
JL,7
IL. I-
FECAL - DOWN
C014DUCT
CONDUCT - EFF.
-F
1_ --
T.9
Lead,
rJ2
—T--
Copper
•
a
r� 2
Cyanide
�TF
ML VSS
r 2
,LVSS
I
__
Low Levef--Mcrcuiyt__-
O'E'H E P,
1
�i-
1N(j��JISHE BY:
RELINQUISHED BY:
�-1"
DATE
T ME
T ItvSE
RELINQUISHED 13}' I D,a,"I E i !'€\II:
L.IN�C,)U€ `f f €`) BY'.
V, u-'�r� I MTY - 0--
*-Laboratory preservation is ensured by addition of preservatives priollo sample
containers leaving the lab, unless otherwise noted.
CL2-L)-CL2= Chlorine check and dechlorination verification.
PRESERVA'1ION:
() COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI. TURBIDITY
{ } COOL 4C , PIi<-2H2SO4 : NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
{) COOL 4C, PH,2 I-IN03 : METALS except CR, VI
{) NONE: CHLORIDE, PH, FLUORIDE SAMPLE DEVIA'rioN:
OTH ER:
() COOL aC. NA2S203 COLIFORM BACTERIA --�--
N'OTIFICATION
r�

CLIENT: JEFFERSON4
ADDRESS:
C|TY�
STATE:
|O#
WATER QUALITY LAB & OPERATION, INC.
P.O.BOX 11O7.BANNERELK, NC28OO4
LOGIN TIME: 11:00AM
SAMPLER:
COLLECTED DATE: 19-Fnb-18
REPORTED DATE: 2-Mar-18
-
ES
TOTAL SOLIDS
3.0
%
SLUDGE
PAUL|GENHOUR.SUPERVISOR

WATER QUALITY SERVICES, INIC.
RO.'BOX 1102, BANNER ELK, NC. 28604
(828)-898-6277
lax (828)-898-6255
CHAR' OF CUSTODY
SAMPLE TYPE: WAS1-EWATER 'PRESERVATION CODE
LOCATION: I - 1-12SO", 2 - HNO3, 3 - 1-ICL,
FACILITY ID#: Jefferson Wastewater Treatment Plant 4 - NAOH 5 - NONE, 6 - COOL IC1
SAMPLER NAME: Tim Church 7 - NA2S203, 8 - OTHER 1
(-nI`vfPr)CIT7CAMPT F• CTART TIME STnP "TIME:
�11%iPLE NAME:
EBOD
COLLECTION �DELIV
TEMP
SAMPLE TYPE
i PRESERVATION'
I'H
verify
IDNl.M;i;;R
DATE
TIME
TEMP
GRAB
COMP
F•FIELD
L•LAB
YES
N:0
- INF.
TSS - IN
_
� --
DOD - EFF.
TSS - EFF.
NH3 as N
LI
OIL & GREASE
'ILI
'TOTAL NIT.
_
LI
TOTAL PHOS.
FECAL - UP
FECAL - EFF.
FECAL - DOMN
CONDUCT
CONDUCT - EFF.
Lcad
1
Q ��
---�
�Lr-?---���
L 7
L7
i_
72
-------'--®
_ �r?-.�Nt5��_
_
ICopper
I
�-
Cyanide
Zinc
r
_
NILVSs
Logy Level Mercui•nr
OT H E R
'L rISH D B1':
:
(�(
t ,-
AT ;
DATE
-t
TIME
rli:
��
I ELFNIQUI ED E3Y:
D
N3 �,�
Di,\TE
I`D; rltC_-LINQUISHED
I{r5? i 1 J
'-Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless othenvise noted.
CL2-D-CI?= Chlorine check and dechlorination verification.
PRESERVATION;
{) COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
() COOL 4C , PH<'-)H2SO4 : NH3, NO2-NO3, TKN, 0&G, TOC. COD, HARDNESS, PHENOLS, TOT PROS.
(} COOL ,-C, PH< HNO3 : METALS except CR, VI
(} NONE: CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
OTHER: T
(} COO!_ -1C. NA2S203 : COLIFORM BACTERIA
NOTIFICATION:
a_.

CLIENT: JEFFERSON 5
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME: 9:30 AM
SAMPLER:
COLLECTED DATE: 20-Feb-18
REPORTED DATE: 2-Mar-18
:ANALYSIS ..' .::::; `.:..: ' ::::. .::.:::.:::ANALYSIS:
;NiQL?s:
;;`UNITS:';'::
%SAMPLE::
;::ANALYSIS;::::.:
;.;:NIETH.OD:;;::<
: ':INT::::;
.. ;:::�
...... . .. .. ... .. .....
..
:::
... ... ....
:�:�:�;�:�:�:�::<
.... ..... ...
a.00ATIORf
.......... .......
C.OMPL`I=T�ED
...................
� ; �:•:�`:.CbDE=::;:::.:
.
TOTAL SOLIDS
3.0
%
SLUDGE
FECAL COLIFORM
10000
1
CFU's
5
21-Feb-18
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
IrAmp
'F-W�ffl'wm,

WATER QUALITY SERVICES, INC.
P.O. -BOX 1102, BANNER ELK, NC. 28604
"s (8,28)-898-6277
fax [phone]
7 CHAIN OF CUSTODY
SAMPLE TYPE: W. AS TEWAT E R *PRESERVATION CODE
LOCATION:yT I - H2SO4, 2 - I-f NO3, 3 - HCL,
FACILITY ID#: Jefferson Wastewater Treatment Plant 4 - NAOH, 5 . NONE, 6 - COOL ICE
SAMPLER NAME: Tim Church 7 - NA2S203, 8 - OTHER I
COMPOSITE SAMPLE: START TIME: i STOP,ritmE:
SAMPLE NAME:
COLLECTION
ID-CLIVI
TEMP
SAIiPLETYPE
PRESERVATION'
PH
verify
CL2.D.C[.---
LAB SANIPL;'•
IDNU,\1BF'R'
TIME
'1--EMP
GRAB
COMP
F-FIELD-1
L-LAB
YES
NO
B 0 D - INF.
TSS - [NF,
BOD - EFF.
TSS - EFF.
NH3 as N
Ll
OLL & GREASE
E-1
TOTAL NIT
L I
TOTAL PHOS.
LI
FECAL - UP
z 12 8
1 Zro
L7
q_:1 5 f __7 2 5
FECAL - EFF.
IL7
FECAL - DOWN
11-7
CONDUCT
CONDUCT - EFF
Lead
T, 2
Copper
F—i
cyallide
Zinc
,\iLVSS
Low Level Mercur
01' FI Elk
77-1
HEq BY:
D TE'
r�; �e
TI M E
EUNQUISHED
L11 B
L—t—
—QUI&IED
T r
I IATE
T; N, I E,
, o
Y-LjNQ)P(SHED 0 B
DATE
TIME
EONI07T_
Q D-A
-Laboraior�preservation is ensured by addition orpreservatives(r)Aor to sarnple 61141t4-
c6mainers leaving the lab, unless otherwise noted.
CL2-D-CL2- Chlorine check- and dechlorinition verification.
PRESERVATION:
COOL 4C: BOD, RESIDUE, CONDUCTIVITY, IvIBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
COOL 4C, PH<2H2SO4 NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
U)COOL 4C. PH<? HNO3 METALS except CR, VI
( ) NONE : CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
OTHER:
COOL 4C, NA2S203 : COLIFORM BACTERIA
NOTIFICATION

CLIENT: JEFFERS(3NO
ADDRESS:
CITY:
STATE:
|O#
WATER QUALITY LAB & OPERATION, INC.
P.O.BOX 1107.BANNERELK, NC288O4
(828)898'0277
LOGIN TIME: 1115AM
SAMPLER:
COLLECTED DATE: 21-Feb'18
REPORTED DATE: 2-Mar18
TOTAL SOLIDS
2.9
%
SLUDGE
REPORTED BY: NC, CERTIFIED LAB;l 544
PAUL\SENHDUR,SUPERVISOR

WATER QUALITY SERVICES, INC.
P.O.BOX I I 02,13ANNNER ELK, NC, 28604
(828)-898-6277
fax [phone]
CHAIN OF CUSTODY
SAMPLE TYPE: WAS'I'EWATE R
LOCATION,: 1-1-12SO4,2 - HNO3,3 - FICL.
FACILITY IN: Jefferson Wastewater Treatment Plant 4 - NAOH, 5 - NONE, 6 - COOL 10E.
SAMPLER NAME: Tim Church 7 - NIA2S203, 8 - OTHER
COMPOSITFSAMPLE: START TIME: STOP TIME:
SAMPLE NAME-
Es
ECTION
SAMPLE
PRESERVA TION'
PH
veri Id
11) N UN 1B L
'r I M E
TLM P
CQmr'
.-LAB
YES I
NO I
BOD - INF.
__:_mE
TSS - INF.
BOD - EFF.
'I'SS - EFF.
NH3 as N
---------------
F
OIL L' GREASE
Ll
TOTAL NIT.
ILI
TOTAL PROS.
FECAL - @V,�Jtk��
I
Ll
L7
FECAL - EFF. - 0
-
jj�7
FECAL - DOWN
IL7
CON'DUCT
FT9_
CONDUCT- EFF.
Lezid;
T, 2
Copper
Cyanide
r, 2
L4-1
Zinc
r.2
NILVSS
Low Level Nicrciiryr
OTHER
L UISIJED BY:
Dr T
TIME
(min
U NQUISHED BY: DATE Ti 1;:'
W4
I�f_- L INQ U I S I -I E D 8
DATE
TINIE
E N I '1iID 13Y I.
•-Laboratory preservation is ensured by addition orpreservativescorior to sample
containers leaving the lab, unless otherwise noted.
CL2-D-CL2= Chlorine check and dechlorination verification.
PRFSERVA'noN:
COOL C : BOD, RESIDUE, CONDuuriVITY, MBAS, COLOR, ALKALINI*j'1(, CR, VI, TU11 BIDI*I'Y
COOL 4C , PH,-2H2SO4 NH3, N024,103. TKN, O&G, TOC, COD. HARDNESS, PHENOLS, TOT PROS
)COOL 4C, PH< HNO3 IMETALS except CR, VI
) NO'NE: CHLORIDE, PH, FLUORIDE SAMPLE DEVIA'1'10,1,':
OTHER:
( )COOL _!C.NA2S2O3 : COLIFORM BACTERIA
NOTIFICATIOIN'

CLIENT: JEFFERS<]NT
ADDRESS:
CITY:
o/*/E:
|D#
WATER QUALITY LAB & OPERATION, INC.
P.O.BOX 11O7.BANNERELK, NC288O4
(828)888'6277
LOGIN TIME: 10:30AM
SAMPLER
COLLECTED DATE: 26-Fab'18
REPORTED DATE: 2'KAo+18
TOTAL SOLIDS
2.6
%
SLUDGE
uLruK|LuBY: wU UEH||MEDLAB#b44
PAUL|SENHOUR.SUPERVISOR
\�

'WATER QUALITY SERVICES, INC.
P.O. 1102, BANNER ELK, NC. 28604
- (828)-898-6277
fax [phone]
CHAIN OF CUSTOMir
SANIPLE TYPE: WASTEWATER 11RESE'RVATION CODE_
LOCATION: I - 1-12SO4, 2 - H3111:03, 3 - HCL.
FACILITY JD#: Jefferson 'Wastewater Treatment Plant 4 - NAOIA, 5 - NONE, 6 - COOL ICE
SAINIPLER NAME: Tim Church 7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE: START TIME: STO 13 1'1 M E:
SAMPLE NA
COLLECTION
DELIVI
SMAPLETYPE
PRESERVA1'ION'F1P—H—CL2-D-
verifV
C L
LABSAMPLIE,
If)NLJ1MBI:!*'
TIME
Taip
F-FIELD
I L-LAB
;V-
�a
�Njo
NO
80D - INF.
TSS - INF.
BOD - EFF.
TSS - EFF.
N113 as N
OIL &, GREASE
ILI
L I
........
TOTAL MT.
ILI
TOTAL PROS.
Ll
FECAL - '' SWAP_
FECAL-EFF. %j
FECAL - DOWN,
Z.
DZ3-.S
L7
1-7
L7
CONDUCT
T.1
CONDUCT - EFF.
Lead,
i1,2
Copper
L2
.gj �nidc
—77
Zinc
NILVSS
Low Level Mercuiy,
-
OTHER
F-77
' .t, rt" ISHE BY:
-
DATP'
TIME
ELFNIQUISHED13 DATE-
E
J' L I INI Q U I S H E 1) B
I
DATE
I- I pvt 1:
EI(V Q U I � Y-1 171 D y.Tr E
Z 20[1�1
N5D
I -Laboratory preservation is ensured by addition of preservatives pwor to sample
c6ritainers leaving the lab, unless otherwise rioted.
CL2-D-CI-2= Chlorine check- and dechlorinition verification.
PRESERVA1*10;N:
COOL 4C: DOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINII'Y, CR, VI, TURBIDI'I'Y
COOL 4C, PH<21`12SO4 NH3, NO2-NO3. TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
COOL 4C, PH HNO3 METALS except CR, V1
NO,',,E: CHLORIDE, PH, FLUORIDE SANIPLE DEVIATION:
OTH ER:
( ) COOL aC. N,\2S203 : COLIFORM BACTERIA
NOTIFICATION-

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON
ADDRESS: SAMPLER: TIM CHURCH
CITY: JEFFERSON COLLECTED DATE: 30-May-18
STATE: NC REPORTED DATE: 17-Jul-18
I D#:
ANALYSIS
ANALYSIS
MQL's
UNITS
SAMPLE.
ANALYSIS .
INT
RESULTS-
LOCATION
COMPLETED
30 DAY BENCH SCALE
START
VOLITILE SOLIDS
68.60
0.1
%
SLUDGE
5-Jun-18
PI
END
VOLITILE SOLIDS
67.20
0.1
%
SLUDGE
5-Jul-18
PI
VOLITILE SOLIDS REDUCTION:
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
1.40%

WATER QUALITY LAB &OPERATIONS, INC.
LAB No.544
30 DAY BENCH SCALE VAR OPTION 3
SM 2540 E
ANALYST: START DATE:
DIGESTER VOLUME: I_rr a e^ 1 $
DAY
TIME
VOLUME
CONFIRMED
SCRAPED
SOLIDS
TEMP
DO
TARE
WET
DRY
ASH
RESULT
Start
100e
v
v
11.1
2-1
1-72. 572 7 9- -11
1 517
3• -7
11"?•9
70
1
as
✓
%.-1
11.1
2
1 10-11
-Lo. i
3
4,30
2. 0.
4
20 3
5
6
7
/()06
1-=7
3 2 "L
1712 15
1
8
10)n
9
S4K'
10
11
12
13
14
9 I11147.
55fl
t 4 1
17 0.
15
13P
16
z
17
I n
v
25,1'
18
Z/)
v
s
22,5
19
20
21
rooms
(2- 2-
22
23
To
v
24
v
25
5 tfp
20.3
26
27
28
g70
21.1
7-4
7.7- 7- 7 2.
76�I. 7 7?7
29
1 00.>
30
0 c"->
Ll/
7,
7. 3J / Lf 171,
7 11
70
VOLITILE SOLIDS REDUCTION: 1,1%

%VATER'
INN P.O. B 0 X 02, B i". N NIE"-'� E—, L K, N C 8 60
R" 2 8's- S9 6— C 2 7
W.,
C
C-7 i i A I
SANIPLE TYPE: WASTEVWriii.,
LOCATION'.
17--%CILITY [D#: Jefferson Wastew ater Treatm c tit Plant
4 NA0H. 5 - 6 - COOL 1t E
S A M P L E R M E: Tim Church 7 - IN. S'-) 0 f
CONVOSITE SAMPLE; START TI iM E: STOP :,IME
COLLECTION ffET" - I Zl--d —P -r —I-Em= 7; r = p K E: S I
Mm
D �,I I ?- �'T'
A,% i P L F N'A,'., I
L ATE -11ME I TEw) TEMP All CO,,.'P I F. F!::! D t t. -!.A B r'T T,
B 0 D - INI F,
TSS - INF.
BOD - EFF
. ........ .....
TSS - LFF.
OIL & GREASE
,ro,rA L NIT.
TOTAL PHOS. 7L I
FECAL - UP
FECAL - EFF.
FECAL - DOWN
I I A R' f)'NF SS UI)
HAR'DINESS F.H.L.
2
H-1 I I
011PER ZINIC
C i d
F'AD NICKEL V0hItflC S01idS mustmustdrat be reduced by
> 15% in 30 days.
rs I L v F., R
1% Volatile Solids
30 Day Bench SnIc
NUISIT) BY.
Dt , NU- TTIMI' RF L 0 U 1 S
T
'(, 7k--c
is-- 3019-i (9
preservation is clisured by a ddition prilof to sans; flc
cont3irerl leaving the lab. unless otherN%ke 11-aled
clica- and
P RE S F R VA T i 0,,.
C001. 4 C 130D. RESIDUE:, CONDUCTIVITY. N I B AS. Cj 1. U i .Ai A L:'.. COOI -C, PH,-21-12SO4, NH3. NO2-NO3, TKN, 0-a"G. TOC. CO), HARD ,:SS.
COOL JC, PH<2 )IN03 iviE't-ALS exccpi CR. VI
NO."ZI: CHLORIDE. Pit. FLUORIDE L;—: D V A7
0 T
CI
A
ITI

Meritech, Inc.
A LaboratoryEnvironment
Laboratory Certification No. 165
Page 1
Report Date: 9/11/2018
Client: Town of Jefferson WWTP
P.O. Box 67 Project: Sludge
Jefferson, NC 28640 Date Sample Rcvd: 8/23/2018
4eritech Work Order # 082318132 Sample: Digester Sludge Grab 8/23/18
13.1 P Meta
P—go-m—e-e—rs esul AalysiS Date Pet. LimitRey.Hinit Meth
Arsenic
<0.100 mg/L
8/31/18
0,100 5.0
EPA 200.7
Barium
0.196 mg/L
8/31/18
0.050 100i0
EPA 200.7
Cadmium
<0.020 mg/L
8/31/18
0.020 1.0
EPA 200.7
Chromium
<0.050 mg/L
8/31/18
0.050 5.0
EPA 200.7
Lead
<0,100 mg/L
8/31/18
0.100 5.0
EPA 200.7
Mercury
<0.02 mg/L
9/4/18
0.02 0.2
EPA 245.1
Selenium
<0.100 mg/L
8/31/18
0.100 1.0
EPA 200.7
Silver
<0.050 mg/L
8/31/18
0.050 5.0
EPA 200.7
TCLP Organics
Parameter
Results
Analysis Date
Reporting Limit
Method
Volatiles 8260
Attached
8/28/18
8260
Semi Vol. 8270
Attached
9/6/18
8270
Other Tests
Earametei
Reaults
Analysis Date
Reporting Liml
Method
% Total Solids
1.5 %
8/29/18
0-100 %
SM. 2540B
Corrositivity (pH)
6.4 S.U.
9/4/2018
1.0 - 14.0 S.U.
SM 4500 HB
Cyanide, total
0.54 mg/kg
8/24/18
0.500 mg/kg
EPA 335.4
Ignitability
>140 OF
8/24/18
-
EPA 1030
Sulfide, total
<10.0 mg/kg
8/24/18
10.0 mg/kg
SM 4500 SD
OF.
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc:
Environmental Laboratory
Laboratory Certification No.165
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Aeritech Work Order # 082318132 Sample: Digester Sludge Grab
Page 2
Report Date: 9/11/2018
Project: Sludge
Date Sample Rcvd: 8/23/2018
13 11 - TCLF ]Pesticides &. Herbicides
Pesticide - SW-846 8081A
Parameter Results
8/23/18
Analysis DatC pet. Limit RVZ Limit Dilution Factor
Endrin
<0.002 mg/L
9/5-6/18
0.002
0,02 1
Chlordane
<0.003 mg/L
9/5-6/18
0.003
0.03 1
Toxaphene
<0.05 mg/L
9/5-6/18
0.05
0.5 1
Methoxychlor
<1.00 mg/L
9/5-6/18
1.00
10.0 1
Heptachlor
<0.0008 mg/L
9/5-6/18
0.0008
0.008 1
Lindane
<0.040 mg/L
9/5-6/18
0.040
0.4 1
Herbicides - SW-846 8151A
Parameter
Results
Analysis Date
Det, Limit
Reg. Limit
Dilution Factor
2,4-D
<1.00 mg/L
9/5-6/18
1.00
10.0
1
2,4,5-TP (Silvex)
<0.100 mg/L
9/5-6/18
0.100
1.0
1
I hereby certify thatl have reviewed and approve these data.
Laborato epresentative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

N
MERITECH, INC;.
Environmental Laboratories
Laboratory Certificate #k165
Client: Jefferson WWTP
Project: Sludge
Client Sample ID: Digester Sludge
Sample Collection: 08/23/18
Meritech Sample ID: 082318132
1311 - T GLP Oroan[cs
olatiles: SW-846 8260
Analysis: 08/28/18
Extraction:
08/27/18
Analyst: vv v
Report Date:
09/04/18
Parameter
Result
Units
Det. Limit
Reg. Limit
Dilution Factor
Benzene
< 0.0100
mg/L
0.0100
0.50
10
Carbon Tetrachloride
< 0.0100
►ng/L
0.0100
0.50
10
Chlorobenzene
< 0.0100
mg/L
0.0100
100
10
Chloroform
< 0.0100
mg/L
0.0100
6.0
10
1,2-Dichloroethane
<0.0100
mg/L
0.0100
0.50
10
1, 1 -Dichloroethene
< 0.0100
mg/L
0.0100
0.70
10
Methyl Ethyl Ketone
< 0.100
mg/L
0.100
200
10
Tetrachloroethylene
< 0.0100
mg/L
0.0100
0.70
t0
Trichloroethene
<0.0100
mg/L
0.0100
0.50
10
Vinyl Chloride
<0.0200
mg/L
0.020
0.20
10
Semi-Volatiles: SW-8468270
Analysis: 09/06/18
Extraction:
08/27/18
Analyst: PM
Report Date:
09/10/18
Parameter
Result
Units
Dot. Limit
Reg. Limit
Dilution Factor
1,4-Dichlorobenzene
<0.100
mg/L
0.100
7.5
10
Hexachlorobenzenc
<0.100
mg/L
0.100
0.13
10
1lexachloro-1,3-butadiene
<0.100
mg/L
0.100
0.5
10
Hexachloroethane
<0.100
mg/L
0.100
3.00
10
o-cresol
<0.100
mg/L
0.100
200
10
m&p-cresol
<0.200
mg/L
0.200
200
10
Total cresols
<0.300
mg/L
0.300
200
10 .
Nitrobenzene
<0.100
mg/L
0.100
2.00
10
Pentachlorophenol
<0.500
mg/L.
0.500
100
10
Pyridine
<0.100
mg/L
0.100
5.0
10
2,4,5-Trichlorophenol
<0.100
mg/i.
0.100
400
10
2,4,6-Trichlorophenol
<0.100
mg/L
0.100
2.00
10
2',4-Dinitrotoluene
<0.100
mg/L
0.100
0.13
10
data.
f
� tau Z'
I hereby certify that I have reviewed and approve these
� r
Laboratory Representative
642 Tamco Road * Reidsville, NC 27320
[phone] * [e-mail]

5�. Chain of Custody Record (COC)
NPDEs#: �_T
I ` i YS�/h,^7VY VV I t Phone: - ���
Address: P n Roy 6 l� Fax: Z 6-
P.t'Son, 11i1� G.tt[nY[l Email: /
Projec : JI
P.O.#:
Attention: Turn around Time*
How would you like your report sent? *RUSH work needs prior approval.
Circle all that apply: Email preferred), Fax, Mail 5d (10 days) s 24-48Hrs
INC.lient:
r, M ERITECH! 6r
ka ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
zw
{!�� %• Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www.meritechlabs.com
Sample Location and/or ID #
Sampling Dates &Times
Person Taking Sample (Sign/Print):
Lab Use Only
Start
End
Comp?
Grab?
# of
Cont.
Test(s)
Required
on ice? Yes:-
, No
pH OK?
CI OK?
Date
Time
Date
Time
CA e
i Jqpz
BA
0730
Gr
Temperature Jppn Receipt.
Method of
Shipment:
*** Dechlorination (<0.5 ppm) of Ammonia, Cyanide, Phenol and TKN samples must be done in the field prior to preservation.
Comments:
Compositor #•
( UPS
1jug #
1 Fed EX
Are ese s Its for regulatory purposes? yes allo
Report results in: mg/L m g ED ug/L
Hand Delivery
Dater
Relinquished by: Time: /�
4a�D
v Time:
i
Other
R mq by; Time:
ceived y: D e: Time:
RelinqAhedby. Date: Time:
Receive Lay-Q tg: l�r� Time: y

ANNUAL PATHOGEN AND VECT0K A'1-1'RAC 10N 1kU)UC:11UN 14 VIUvl t.u,4t tcutcs)
Facility Name: Town of Jefferson
WWTP Name: Jefferson WWTP
Monitoring Period: From 1/D2018
To
WQ Permit Number:
NPDES Number:
1213112018
WQ0004166
NCO021709
D. +T ....., n .i....l 114 A Nr A r MT 11 nf.1 - Plancn indiegth level achieved and alternative performed:
Class A: 7AIt. A (time/temp) ,❑
Alt B (Alk Treatment)❑
Alt. C (Prior Testing)❑
Alt.D (No Prior Test) I Process to Further Reduce Pathogengs ❑
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑ Heat Drying ❑ Heat Treatment ❑ Thermophiiic ❑
Beta Ray El Gamma Ray ❑ Pasteurization ❑
Class B: Alt. (1) Fecal Density Alt. (2) Process to Significantly Reduce Pathogens ❑
If applicable to alternative performed (Class B only) indicate i'Process to Significantly Reduce Pathogens":
Lime Stabilization ❑
Air Drying' C7 Composting ❑
Aerobic Digestion
Anaerobic Digestion ❑
If applicable to alternative perforttted (Class A or Class B) complete the following
monitoring data:
Allowable Level
Pathogen Density
Number of
Frequency
Sample
Analytical
Parameter
in Sludge
Lxcec
of Analysis
'type
1'cch-
Minimun
Gea. Mean
MaximumUnits
2 x 10 to the
iViPN
6th po%ver
CFIJ
10,000
12,714
18,667
CFU
0
Daily
Grab
;M-9222E
Fecal Coliform
per gram of
total solids
1000 mpn per gram
of total solid (dry
weight)
Salmonella bacteria
3 MPN per 4 grams
(in lieu of fecal
total solid (dry
coliform)
weight)
a2r.T.t•FjW".6TSIG MEN 1111IA0MUTILYtll Aif[[WI[ii111[N air. U\'/y QN WI/l!IMP
AIt.I (VS reduction) ❑
Alt. 2 (40-day bench) ❑
Alt. 3 (30-day bench) ❑
Alt. 4 (Spec. 02 uptake) ❑
Alt. 5 (14-Day Aerobic) ❑
Alt. 6 (Alk. Stabilization ❑
Alt 7 (Drying - Stable) ❑
JAIt. 8 (Drying - Unstable) ❑
Alt. 9 (Injection) ❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed ❑
CERTIFICATION STATEMENT (please cltecl: ttte appropriate statement)
0 "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 have been met."
❑ "I certify, under penalty of law, that the pathogen requirements in 15A NCAC 02T .1106 and the
vector attraction reduction requirement in 15A NCAC 02T .1107 have not been met." (Please note
if you check this statement attach an explanation why you have not met one or both of the
requirements.)
"This determination has been made under my direction and supervision in accordance with the system
designed to ensure that qualified personnel properly gather and evaluate the information used to determine
that the pathogen and vector attraction reduction requirements have been met. I am aware that there are
significant penalties for false certification including fine and. imprisonment."
'rim Church, Water Resources Director
Preparer Name and Title (type or print)
�r� c � 1 5
Signature of Preparer* Date
Land Applier Name and Title (if applicable)(type or print)
Signature of Land Applier (if applicable) Date
"Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .l 102 (26)
DENR FORM PVRF 02T (1212006)

NCDA&CS Agronomic Division Phone: [phone]
Website: www.ncagr.gov/agronomit
ReportNo. FY19-SL013061
-
Client:
Town of Jefferson
Advisor: James Young
%`:� 'i; Predictive
302 East Main St / PO Box 67
Ashe CES - House
r M,
Jefferson, NC 28640
700 Sussex
�K Mehlich-3 Extraction
1 S o i I Report
Grassy Creek, NC 28631
-` r- y`M1"
Sampled County :Ashe
!! - Links to Helpful Information
Client ID: 88367
Advisor ID: 396894
Sampled:11/01/2018 Received: 11/05/2018 Completed: 11/28/2018
Farm:
Sample ID: FRED1
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre)
N P2O5
K2O
Mg S
Mn
Zn
Cu
B
Information
Lime History:
1 - Fescue/OGrass/Tim, E 0.7
50-70 40
20
0 0
0
0
0
0
Note: 12
2- Fescue/OGrass/Tim, M 0.0
120-200 20
60
0 0
0
0
0
0
Note: 12
Test Results [units - WN in glcrr-P; CEC and Na in meq/100 cm3; NO3-N in mg/dO]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1
Ca% Mg%
S-1
Mn-I
Mn-All Mn-AI2
Zn-I
Zn-AI
Cu-I
-Na ESP SS-1 NO3-N
0.51 0.80 12.6 89 1.4 6.4 51 39
61 27
63
192
125 126
348
348
353
0.2 2
Sample ID: FREW
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre)
N P2O5
K2O
Mg S
Mn
Zn
Cu
B
Information
Lime History:
1 -Fescue/OGrass/Tim, E 0.0
50-70 60
30
0 0
pH$
0
0
0
Note: 12 Note:
2 - Fescue/OGrass/Tim, M 0.0
120-200 50
70
0 0
pH$
0
0
0
Note: 12 Note:
Test Results [units - WN in g/cr&; CEC and Na in meq/100 cm3; NO3-N in mg/dO]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1
Ca% Mg%
S-1
Mn-I
Mn-All Mn-Al2
Zn-I
Zn-AI
Cu-I
Na ESP SS-1 NO3-N
0.41 0.85 13.4 90 1.3 6.6 38 33
59 31
58
284
179 179
380
380
253
0.2 1
Sample ID: JWALT
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre)
N P2O5
K2O
Mg S
Mn
Zn
Cu
B
Information
Lime History:
1 - Fescue/OGrass/Tim, E 0.0
50-70 80
30
0 0
pH$
0
0
0
Note: 12 Note:
1.00 tons/acre; 11/2017
2 - Fescue/OGrass/Tim, M 0.0
120-200 60
70
0 0
pH$
0
0
0
Note: 12 Note:
Test Results [units - WN in g/cO; CEC and Na in meq/100 cm3; NO3-N in mg/dm3]:
Soil Class:
Mineral
HM% WN CEC BS% Ac pH P-1 K-1
Ca% Mg%
5-1
Mn-I
Mn-All Mn-AI2
Zn-I
Zn-AI
Cu-1
Na ESP SS-1 NO3-N
0.36 0.89 12.5 89 1.4 6.5 31 35
60 28
47
528
326 326
226
226
161
0.1 1
North Carolina
V)113cco istM Numl C'i��i tai:S�S
Reprogramming of the laboratory -information -management system that makes this report possible is being funded
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxler. Commissioner of Agriculture