WQ0003992_Residual Annual Report 2014_20150205

MAYOR
Dale Baldwin
ATTORNEY
David Paletta Town of Nest Jefferson
TOWN MANAGER "Prosperity, Growth, Achievement
Brantley Price
February 4, 2015
DENR/DWQ
Water Quality Section
Non -Discharge Compliance Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Sir:
ALDERMEN
Calvin Green
Tom Hartman
John K Reeves
Stephen Shoemaker
Brett Summey
Enclosed please find three copies of the Town of West Jefferson's Annual Report for the Land
Application of Bio-solids for the calendar year 2014. If you have comments, questions, or
require additional information, please let me know.
Respectfully,
Charles Call
Town of West Jefferson
Ph.- 336-246-3558
Email- [e-mail]
Post Office Box 490 01 South Jefferson Avenue West Jefferson, NC 28694
Telephone: [phone] Fax Number: [phone] www.townofwj.com

S
i
I
TOWN OF WEST JEFFERSON
BIO-SOLIDS PROGRAM
ACTIVITY REPORT FOR
CALENDAR YEAR 2014
SLUDGE PERMIT #WQ0003992
NPDES #NC0020451
Town of West Jefferson
Po Box 490
West Jefferson, NC 28694
Charles Call, L.A.
(336-246-3558)

s ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ 0003992 County: ASHE Year: 2014
Facility Name (as shown on permit): Town of West Jefferson
Land Application Operator: Charles Call Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
0 Yes ❑ No - If No, slip Part A, and Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A - Residuals Annlication Summarv:
Total number of application fields in thepermit:
6
Total number of fields utilized for land application during the year:
3
Total amount of dry tons applied during the year for all application sites:
15.82
Total number of acres utilizes for land application during the,,year:
25.3
tart n - Annuai %-ompiance statement:
Facility was compliant during calendar year 2014 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Quality. 0 Yes ❑ No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
taken.
1) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pH was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pH of at least 6.0 or
the limit specified in the permit.
3) Annual soils analysis were performed on each site receiving residuals during the past calendar year and three (3) copies
of laboratory results are attached.
4) Annual TCLP analysis (if required) was performed and three (3) copies of certified laboratory results are attached.
5) All other monitoring was performed in accordance with the permit and reported during the year as required and three (3)
copies of certified laboratory results are attached.
6) The facility did not exceed any of the Pollutant Concentration Limits in 15A NCAC 02T .1105(a) or the Pollutant
Loading Rates in 15A NCAC 02T .1105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 15A NCAC 02T .1111 were complied with (applicable to 40 CFR Part
503 regulated facilities).
9) All operations and maintenance requirements in the permit were complied with or, in the case of a deviation, prior
authorization was received from the Division of Water Quality.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
11) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true,, accurate,
and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fines and"imprisonment for knowing violations."
Brantley Price / Town Manager Permittee Name and Title (type or print) Signatur Permittee Date
M
J -4
Signature of Preparer* Date Signature of Land Applier Date
(if different from Permittee) (if different from Permittee and Preparer)
* Preparer is defined in 40 CFR Part 503.9 (r) and 15A NCAC 02T .1102 (26) DENR FORM ACF (12/2006)

TOWN OF WEST JEFFERSON
BIO-SOLIDS PROGRAM
CERTIFICATION STATEMENT
I CERTIFY UNDER PENALTY OF LAW THAT THE Class B pathogen requirements
in 503.32 b and the Vector attraction in 503.33 b 6 have been met. This determination has
been made under my direction and supervision in accordance.with the system designed to
insure that qualified personnel properly gather and evaluate the information used to
determine that the pathogen requirements and vector attraction reduction requirements
have been met. I am aware that there are significant penalties for false certification,
including the possibility of fines and imprisonment.
" ede'
Charles Call
Town of West Jefferson

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SL DICIrE ANALYSIS .

rr,D/UJ/LUIJ/ iva 1L•U1 flue CRA N0, P. UU1
4:
1
Blue .Ridge Labs
PO Bax 2940
Lenoir, NC 28645
828-728-0149 [e-mail]
Client:
Water Quality Labs
P. 0. Box 1.167
Banner Elk, NC 2$604
Attention:
Mr. P. Xs hhdtir
Date Received;
06-Nov-14
Report bate:
09-Dec-14
Sample -Date:
03-Nov-14
.BRL'4:
BR L-2014-0786
LA Sample 1D:
LSID,2014-0470
Client Sample XD:
West S-effersbb Sludge
'Parameter
TCLP Bxiraction Metals
Ag
As
Ra
Cd
Cr
Pb
% by Cold Vapor AAS
R
Reported By:
Result
MQL•
—�
Ulait
Method
extracted
SW-846-1311.
#
0.5
mgn
sw-846-6010
*
0.5
mg/1
SW=846-16010
*
5
mg/1
SW-846-601.0
0.1
mg/1
8W-846-6010
*
0,2
mg/1
SW-946-6010
*
0,5
ing/1
SW-846-6010
........ _..... ...4 .___DS_......__.._.._._M-1
SW-846-6010 -
* 0.002. mgfl 5W-846-7411
Analysls Analysis
Time Date
Analyst
Summit
.11114/2014
Summit .
11/14/2014
-Sumrnit
11/14/20i4
Summit
11/1-412014
Summit
11/14/2014
Summit
11/1.4/2014
SUjnmit
_.. 11/14/22614
Summit
11/14/2014 Summit
S. J. Johnson, D.R. Wessinger
Concentrations are below Minifilum Quantification Limit except where noted.
NC Laboratory Certificate No, 215
- Rage 1 of 10

VLbl"JilZUIvIUh 1L,U/ fm
.Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
8..28-728-0149
Client ;
Water Quality Labs
P. O. $ox 1167
Banner F-1k N' C 28604
Attention;
Mr_ P. Isenhour
Date Received:
06 Nov-14
Report Date:
00-Dec-14
Sample Date:
'63-Nov-14
.URL 9,
13R1„2014-07g6
Lab Sample ID:
LSID-2014-03471
Client Sample ID.
West Jefferson SIudge
[e-mail]
Parameter
Result
MQL
Unit
Method
TCLP Semi-'VOC extraction
extracted
SW-846-1311
Cres6ls (Total)
w
5
tng/1
SW-••846-8270
1)iohlorobenzene, 1,4
w
0.1
mg/I
SW-846.8270
Dinitrotoluene, 2,4-
0.•i
►ngn
SW'1846-8270
Nexachloro-1,3-Butadiene
0.1
rng/]
S'l)I/-846-8270
Hexachlorobenzene
*
0.1
mg/1
8W-846-8270
Re eachloroethane
0,1
mg/1
SW-84642.70
....... _ i*litrob®ttz®ne--._.................-..----•
0.1
m I
SW-846-8270
Pentachlorophenol
0.25
mg/1
.SW- 846-8270
Pyridine.
0.25
ing/]
SW-846-8270
Trichlorophenol,.2,4,5
*
0,25
mg
SW-846-8270
Trichlorophehol,2,4,6-
6.25.
tng/1
SW-846-8270
Reported By:
Analysis Analysis
Time Date. Analyst
Summit
i 1 /] 4/2014
Summit
11/14/2014
Summit
I1/f4/2014
Summit
11/14/2014
Summit
11/14/2014
Summit
11/14/2014
Summit
11/14/2014
Summit
1-1114/2014
Sumxpit
11/14/2014
Snmmlt
11./14/2014
Sulmtriit
11/14/2014
'SUXnmi;
S. J. Johnson, D.R Wessinger
* Concehtratlons are below Minimum Quantificatioli U*A except where noted.
NC Laboratory Certificate No.11,5
page 2 of 10

rhblI jl'zuI v IUh 1L:U/ fivi
rAn No, P. 003
Blue Ridge .Lads
PO Box 2940
Lenoir, XC 28645
828-728-0149
Client :
Water Quality Labs
P. 0. Box 1167
Banner Elk, NC '28604
Attention:
Mr, P. henhour
Date Received:
66-Nov-14
Report Date:
09-Dec-14
Sample ,Date:
03-Nov-14
SRL 9:.
BkL-2014-0786
Lab Sample ID:
LSID-2014-63472
Client Sample ID:
Nest Jefferson Sludge
[e-mail]
Parameter
Result
MQL
Unit
Method
Analysis Analysis
'Time bate
Analyst
TCLI?21-IEVolatilesYEktraction
extracted
_
SW-.8:46-13'11
Summit
Benzene
*
0.1
mg/1
SW846-:8260.
11/14/7014
Summit
Carbon Twachloride
0.1
mgA
SW846-8260
11•A 2014
Summit
Chlorobenzene
0.1
mg/1
SW846::-$260
11114/.2014
Summit
Chloroform
0.1
mgil.
SW846-8260
11/14/2014
Summit
Dich'lproethane, 1,2-
*
0.1
mg/1
SW846-8260
I IA4/2014
Summit
Dichloroeth'ene, 1,1-
a
0.1
mg/l
SW846-8260
1III V2014
Stunmit
ME1C
....
.12
mgJ]
SW$46-8260
11414/2014
Summit
Tetrachloroethene
0.1
m=/1
SW846-8260•
11/14/2014
Summit
Triehloroeth.ene
*
0:1
mgA
SW$46-8260
11414/2014
Summit
Vinyl Chloride
0.2
mg/1
SW846-8260
11/14/2014
summit
Reported By:
S.• J. Tohnson, D.R. Wessinger
Concentrations are below Minimum Quanilficatlonx Limit except where noted,
NC Laboratory Certificate No. 275
Page 3 of "1.0

1"IUJ//U1J/11ib 1/—Ul 11P1
PNa 110. e. UU4
Blue Ridge Labs
PO Box 2940
Lenoir l YC 28646
•828-728-0149
Client.;
Water Quality Labs
P. O. Box 1167
Banner Elk, NO 19604
Attenti(5n;
Mr. P, Isenhour
Date Received:
r
06-Nov-I4
Report bat0b:
09-Dec-14
Sample Date:
03-Ndv-14
BPL t#:
BRL-2.014-0786
Lab Sample W-
LS11)-2014-03473
Client Sample ID:
West Jefferson Sludge
Parameter
Result
TCLP Semi-VOC Bxtiaction
-extracted
2,4,5-TP (Silve?O
2,4-D
Chlordane
1✓ddrin
Heptachlor
Heptachlor Epoxide
Lindane . ••• • •• •
"
Methoxychlor
Toxaphene
Reported By:
blueeidgela bslenofrOgma il.corh
Analysis Analysis
MQL
Unit
Method
time Date
Analyst.
SW-846-131.1
Summit
0.1-
mg/l
M-846-808.0
IV20/2014
Summit
0..1
:nig/l
SW-846-8080
11/20%2014
Summit
0.01
mg/1
SW-846-9080
11/14/2014
summit
0.002
1no/1
SW-846-8080
11/14/2014
-Summit
0.002
mg/1
SW-846-80$0
11414/2014
Sumrclit
0,002
mg/1.
S.W-846-8080
11/14/2014
Summit
O,OQ2„ •• .
•. rn�11
5W-846-80 q.
1.1/1412014
Summii'
0.002.
mg/1
SW-846-8080
I1/14/2014
Summit
0.1
tng4
SW-846•-8080
1111412014
Suntmit
S.• J. Johnson, D.R. Wessinger
* Concentrations are below Minimum Quantification Lidi t e3teopt where noted.
NC .Labarsiot y Certificat6 No. 2.75
.Page 4 of 10

16
rrD/UJ/LU10/1up, 1L;U0 rNl
PHA PIo, F. UU5
.flue .Ridge Labs
PO,Boz 2940
Lenoir, NC 28645
828-728-0149
Client :
Water Quality Labs
P. O. BOX 11.67
Banner Elk,14C 28604
Attention:
Mr-P. Isenhotit'
Date Received:
0644Q'V-1.4
Report. Date:
09-Dec-14
Sample Date:
03-NQu-14
BRL M
BRL-2014-0786
Lab Sample ID:
L91D-2014-03474
Client Sample IDS:
West Jef eT5Q11 Sludge
blueridgelabs.lenolrOgmail,com
.Analysis
Analysis
,Parameter
Result MQL
Unit Method
Time
Date
Analyst
JKCJ
lgnitability�
µ Not Ignitable 76
Deg., P. 1030 SW-846
15:25
11/10/2014
Corrosivity as pH
6,1 0.1
su 9045C SW-8
9:05
11l6/2014
KCJ
.Paint Filter Test
98.9 0.1
ml SW 846-9095
16:23
111101-2*614
KCJ
Reported By:
-S. J. Johnson, D.R.Wessinger
Coneentrations are below Minimum Qunntilication Limit except wh6re noted.
NC )Laboratory Certificate No. 275
page'$ of 10

11
1'1ii)/ Y UJ/ LUiJ/ 1UL' iL,UU ilvi PHA AO. f. UUb
Blue Midge .Labs
PO Box 2940
Lenoir, NC 28645
828-7.28-0149 blueridgelabslendr( dmail.com
Client*:
Water Quality Labs
P. 0. Box 1.167
Banner Elk, NC 2,8604
AttentioW
'Mr. P, lsenhoUr
Date Received:
06-Nov-)4
Report Date:
0.9-Dec-14
Sample Hate.
03 Nov-14
B'RL 4:
BRL-2014-0786'
Lab Sample ID:
LS 0-2014-0347.5
Client Saniple ID;
West Jefferson Sludge
Parameter
Reactivity as CN
Reactivity as Sulfide
Result MQL.
Reported By:
Analysis
Analysis
Unit Method Time
Date Analyst
Mg/1 SW B'46-7.3.3 16A5
11/11%2014 KCJ
mg/1 'SW-:846.7.3.3 l5:40
' VI V2014 'KCI
S. J. Johnson, D.R. Wessinger
toneentrations•are below Mininium Qaantiiica'tiott Limit except Wbere-noted.
NC Laboratory Certificate No.. 275
.Page 6 of 10

lk
rab/IUJ/LU13/1Ur Iz:UU rM PRA N0, P. U UY
Blue Ridg.eLabs
.Pb Box .2940
Lenoir, NC 28645
828.728-03-49 [e-mail]
Client;
Water Quality Labs
P. 0. $ox 1.167
Banner Elk, NC 28604
Attention:
Mr. P..Zserihour
Date Received:
06-Nov-14
I2,ep.ortDAie:
'09-Der,-14
'Sample Date:
03N.ov-14
BRL V:.
BI�1. 2014-0786.
Y.ab Sample ID:
LSID-2614-03476
Client Sample 1D:
West J'e'ffergon Sludge
Analysis Analysis
Parameter Result MQL, Unit Meih6a Time Date Analyst
AmmoniaNitro'ge.n - 13.4 1 mg1l Ammonia 10:24 i1/20/2014 kci
Reported By:
$, J. Johnson, D:R, Wessinger
x Concentrations are below Minimum Quantification. LiOt Mept W4v re noted.
NC Laboratory. Certificate No. 275
Pagb 7 of to

4
I'Lll/xUJ/LUIJ/ IUL 1L.Uo nvi PHA lvo. Y. UUd
Blue ,ridge Jabs
PO Box 2940
Lenoir, N. C 28645'
82&728-0149
Client : Water Quality 44
P. O. $ox 1167
Bander Ells, M 28.604
Attention: Mr. h1senh-mir.
[e-mail]
Date Aeeeived.
06-14ov-14
� Revised Report
Report Date;
28-1an-I5
Sample Date:
03,e1ov-,14
HP.L *
BRL,2434-a7$6
Lab;SampleID:
L,SID-201.4-03477
Client Sample ID:,
West Jefl`erson -Sludge
Parameter
Total Ph.osphoms
Ally ICP=AES.
As by ICP-AES
Ca by ICP-AES
Cd by JCP-AES
.Cr by ICP=AES-
Cu by .ICP-AES
.K by ICP-AES
Mg by ICP-AES
Mo, by ICP-AES
Na by 1Cp AES
Ni by rCP-A15
Pb, by 1CP-AES
Se by ICP-AFS
Zn. by .ICP-AES
H•g'by Cold Vapor AAS
MQL
Unit
riYetlrod'
Analysis
Time
Time
Analysis
Date
A,nalysi
84.3
2
mgll
EAA:200;7
I6.4S
-1/27/2015
KC)
106'
0:5
mg61
SW-846-6010
15:03
11/24/'4014
KG1
.0
1
moll
M-846-6010
15;03
1lf2412014
KCj
704
2.5
mg/I
SW-846-600
15;63
11/24TZt)'14
KG)
*
0.7
mg/1
8W-846-6010
15:03
11/24/20.14
KCJ
0.805
0.1
mg/I
'SW-846-60 10
15:03
11124/2014'
KCJ
9.69
0-1
zn;/1
SW=846-60I0
15:03
'lln4P2014
KCI
,2'82
0:,5
mg/1
W-846.6010
15:03
1124/2014
269
0.5
•mg/l
SW-846-b0a0
I5;63
11/34/2014
KCJ
1.87
0.1
1nq/l
SW-8=16-6610
15:03
11/202014
KCJ
$66
2.5
.mg/i
8W-946-6010
15:03
11/24/•?014
XCJ
0.1
mg/I
SW-846-6010
15:03
11/24/2014•
KCJ
1
mgn
5W-846-6aio
15:03
1124/.2014
IZC7
1
mg/1
SW-$46-6616
15:03
1 U24h014
ICCJ
2.01
01
mg/l
SW 84&6010
15:03
Y1J24/2b14
KCJ
O'.Ousi
0.001'
fth
SW-$46-T471
16.40
1•i/13/•2014
'KC3
Reported'By: .
S.. hrison,.DR. Wessinger=
Concentrations are below Mirdmam Quantification Mralt except W-h.ere noted.
N'�; Laborlifory Certificate No. 27.$
laaoe S, of 10

rDDiUD/LUIU/IUr, 1L:U0 rive PHA 110. Y, UH
Blue Ridge .dubs
PO Pok 2940
Lenoir, NC 28645
828-728-01.49
blueridgelabslenoir ftmaii.dom
Client; Water Quality Labs
P. 'O_ Box 1167
Banner Elk, ITC .28604
Attention: Mt. P. Isenhour,
Date Received: 06-NDv-.14
Report Date;. 09-Dec-14
Sample, Dnte: 03-Nov,14
IM #c $1R,-2014.-0786
Lab Sample W: ISID-2014-03478
Client SamplelD'- West Jefferson Sludge
Analysis '
Analysis
Parameter 'Result MQL
Unit 'Method Tints
bate
Analyst
Soll6ls-_.__._._,—•--•-------- "-0.63 01'r—
°`% %5alids ^� 16;20
11/612014 -,1CC7
Plt Available Nitrogen 17.5 1.6
mg/1 Plan.t Avatlabl 11:05
11/200014
KCJ
SAP, 39.2
SAR 16:44
11/24/2014
yCJ
'Reported By:
S. J. Johnson, D.R.''Wessinger
* Concentrations are below Minimum Quantification Limit except where natcd.
,NC Laboratory Certificate No. 275
Page 9 of IQ

rPD/;JJ/LU10/1UP, 1L;UO t'M
rRA AO.
Y. Ulu
Blue Ridge Labs
PO Box 2940
Lenodr,.JVC .28645
828-728-0140
Client :
'Water Quality Labs
P. O. Box 1I61
Banner llk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
06-Nov-14
Report Date:
09-Dec-14
Sample bate:
03-Nov-14
BRL #:
UL-2.0.14-M6
Lab Sample ID:
LSID-2014-0347.9
Client Sajnple• ID:
West Jefferson Sludge
parameter
Result: MQL
Nitrate +'Nitritc Nitrogen (K2+ 4.15 0.64
Total Kjeldahl Nitrogen (TKN) 26.6 0.5
Reported By:
blueridgelabslenoirOgmail.com
.Analysis Analysis
Unit Method Time .Plate Analyst
mg/1 SM•19 4500-N 15.:40 11/19/2014 � KCI•
mg/1 SM19.4500-N 14 :;-5 11/75120.14 KCI
s. J. Johnson, D.R.- 'Wessinger
a Concentrations are below Minimum Q6antifieation Lihiit eXcept Whete noted.
NC Laboratory Certificate No. 275
Page 10 of 10

f.
I Ui)/ UJ/ LU1J/ 1v1; UL. UJ iIn
SLUDGE
SAMPLE TYPE:
LOCATION: -'
FACILITY ID#:
SAMPLER NAME;
WASTEWATER
WESTIEFFERSON
NC002Q451
CHARLES CALL
PHA 110,
WATER QUALITY LAB & OPERATIONS, INC.
PO BOX 1167, BANNER ELK, NC 28604
8288986277
FAX [phone]
CHAIN OF CUSTODY
Y. UU1
ANNUAL RESIDUAL
SAMPLING
40 CFR PART 503
*PRESERVATION CODE
1— HiSOa, 2 — HNO3, 3 — HCL, ,
4 — NAOH, 5 — NONE, 6 — COOL ICE
7 — NAZSZ03, 8 — OTHER
COMPOSITE SAMPLE; START DATE:
SAMPLE COLLECTION
NAME:
START TIME:
DELIV SAMPLE
TYPE
STOP DATE:
PRESEION RVAT*
STOP TIME:
CL2-D- •
PH CI-2
LAB
SAMPLE
T1=1y P
DATE
TIME TEMP
GRAB COMP
F-FIELD . L-LAB
verify
YES NO
ID
NUMBER
% SOLIDS t
p o f3,
CORROSIVITY
IGNITASILITY
.r
REACTIVITY
NH3 as N
NO2 NO3
TKN
TOTAL PHOS
SODIUM
CALCIUM
POTASSIUM
MAGNESIUM
ARSENIC
CADMIUM
COPPER
LEAD
U
MERCURY
1
MOLYBDENUM (p
�3®
RELINQ (SHED Y:
DATEE-2�3
RECEIV�D BY:
DATE
TI
I'
E
RELINQUISHED BY:
ATd
RECEIVED BY:r
,
D TE
TIME
*Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
Cl2-D-CL2 = Chlorine check and dechlorination verification.
PRESERVATION: pH:
O COOL 40C: BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY Temp: I-3 4
0 COOL 40C, PH<2 H2SO4: NH3, NOz7NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS. COnd: 5-43
() COOL4°C, PH<2 HNO3: METALS EXCEPT CR, VI
() NONE- CHLORIDE, PH, FLUORIDE
OTHER:
'()COOL 4°C, NA2S203: COLIFORM BACTERIA

rZD/ UU/ LU1:J/ IUL UZ. UU "I PRA No, F. 002
♦,
WATER QUALITY LAB & OPERATIONS, INC.
PO BOX 1167, BANNER ELK, NC 28604
8288986277
SLUDGE- FAX [phone]
CHAIN.OF CUSTODY
SAMPLE TYPE:
LOCATION:
FACILITY ID#:
SAMPLER NAME:
WASTEWATER
WEST JEFFERSON
NCO0204SI
CHARLES CALL
COMPOSITE SAMPLE: START DATF!
CTAQT Tlfter.
ANNUAL RESIDUAL
SAMPLING
40 CFR PART 503 .
*PRESERVATION CODE
1— H2SO,, 2 — HN 03, 3 — HCL,
4 — NAOH; 5 — NONE, 6 — COOL ICE
.7 — NA2Sa03r 8 — OTHER
SAMPLE
NAME:
COLLECTION
D1=LIB/
TEMP
-- -------''--
-SAMPLE
TYPE
.r. Vr YP%I G.
PRESERVATION*
DATE
TIME
TEMP
GRAB
COMP
F-FIELD
L-LAB
RZ
RELI UI HED BY:
DAT
TIME
RECEIVED 1
vq
-
RECEIVED I
RELINQUISHED BY:
DATE
/r
TIME
2, G
PH
Verify
L
STOP TIME:
CL2-D- LAB
CL2 SAMPLE
- ID
:YIES;07 'NUMBER
3Y: DATE IMP
IY: �4DWTE TIME
LaboratOry preservation is ensured by addition of preservatives prior to sample
containers leaving the lab; unless otherwise noted.
CL2-D-CL2 = Chlorine check and dechlorination verification.
PRESERVATION:
().COOL 40C: BOD, RESIDUE, CONDUCTIVITY, MRAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
() COOL 4°C, PH<2 HISO4. NH3, NO,,-NO3, TKN, 08,6, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
() COOL 4°C, PH<2 HNO3: METALS EXCEPT CR, VI
() NONE: CHLORIDE, PH, FLUORIDE
OTHER:
0 COOL 4°C, NA25103. COLIFORM BACTERIA
pH: (o - I
Temp: {3. 1
COnd: S4

1/LV/ 1 I/ LU1 V VYLIJ UJ, LO I1A
41,
rHl, ivo, P. U13
Em
WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
fak (828) 89,8-6256
TYPE SAMPLE:. WASTEWATER
LOCATION•:
FACILITY ID #:
SAMPLER NAME:
.sMr c. GTAOY
CHAIN OF CUSTODY
" PRESERVATION •CODE
1 - 142SO4, 2 - HNO3, 3- HCL,
4 - NAOH, 5 - NONE. 6 - COOL
7 - NAMO3, 8 -'OTHER
'CTnP TIME: -
iiMMON�Iq
Gales
Tw
N#fWj
P-4iur FA NR
POP
TaP ;.
5-IR
SC13 + 679r5
'*97V
We -
MINIM
ME
rrrrrrrrrr1=11M
IME-Err■r
rrrrrrrrrrrr�rr��r�
rrrrrrrrr
rrME
M1
rrrr
rrii�ir�rir'
rrrrr�iir�rr
r0i�IN
M1rrrrEIMEMEN
err
IN
ME
rr�rrrrrrr11MMINIMEr■r
rr
rrrririr�irr�■r�
r■rrrrrrr�ir�ir�
irr�rrr■rrr
rrrrirrr
rrrrrurr■rrrrrrrr�it�rNi
ri
rrriririrrIrirr
rrrr
rrr�r�rrM1
HIMr�
Is
rrr
rr�rrr�rrrrrrrrrirrr■rr
■
11MIN
Irrrrrrrrr
rrrirrrrrrrrrrMIMM■
=M
rr�r11MIN
rrrrrr11MMIMME
11MIN
I rrrrrrMrrrrrrrrr
111ME
m1MMI1MrrINMEROC—SIVED
rr
BY,
RECEIVED Br.
-- .LaMfalffy preservamn Is ensureu oy 5aU1UtJn ur pratieivrauvra pnwi iu
containers leaving the lab, uriliess otherwise noted,
CL2-D-CL2= -Chlorine check and dechlorinatlon verification, ,
PRESERVATION:
( ) COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, V1, TURBICITY
( ). COOL4C, PH<2 H2SO4: NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS; YOT PHOS.
( ) COOL 4C, PH<2 HNO3, -METALS except CR. VI .
( ) NONE : CHLORIDE, P.H. FLUORIDE SAMPLE DEVIAVON.
OTHER:
( ) COOL 4C', NiA28203 : COLIFORM BACTERIA
NOTIFICATION:
Id A .
0It
q

Y
inn/,UJ/LU1J/ IUD 1L•UO iivi PHA 110. P. Ull
"' : • • : ,• "
Summit &wrohmenral I'Mmologim, 1pc
'Q(/
DateXeportcd:
14110691
:�a�ii1P►�N�lri>'aL:,:.....:dik: ale
cramhoar+l�a7ls o�'o•a4aZ3
12W014
1ls;p/y�ie .j 9 ra�g1 P#p :
7YL; (330) 253 I.I PAX (336) 233-V89
Cpmppy:
Blue Ridge Labs, Inc.
$t�ebaltet hire //www.s cover
Address:
P 0 Box 29.40
Letidir NC 29645
Received:
1.1/10/2014
.projcd t"
341onl./1703
TCLP Metals AhakyA (6010)
Client ID#
Lab ID# Collected Aualyte
Rep Lint Result Units
Matrix
Method
bF
RegLvl
Run Analyst
3470171/I2173
O0i
�?/*914 TCLP Arsenlc(Ais)
0.5o
NO mg1L
Solid
EPA 001.0 C
1
6.0
11/14/201.4
WK
3410(71l72/73
001
1nl?o1a Ti:F 0atlum(Ba)
5.o
NO mg/L
Solid
EPA6010C
1
100
1.1114120.14
WK
34T6f11/72f73
001
11/312014, TdLP Cadmibm jCd)
0.10
NO mg1L
Solid
EPA 6010 C
1
1.0
11/142014
WK
3470/71172r73
001
11/3/?o1;4 TCLP Chromlum(cr)
0.20
NO mgA..
Solid
EPA Go10 C
1
5.0
11/1412014
VVK
3470171(72173
001
11/3/20_14, TgLP LA9d(Pb)
0,50
NO m.9/L
Solid
EPA 8010 C
1
5.0
11/14/201.4.
WK
3470MRV73
001
11/3/2014' TCLP Selenlum(&a)
0.16
ND mg/L
Solid
EPA 6010 C
1
1,0
11/1.4/2014
WK
13470M/77J73
001
11/3/2014 'TCLP SiNer(Ag)
oso
NO. mg/L
Solid,
1=PA cold C
1
5-0
11/1$12014
WK
TCLI- Mercury Analysis (131117470)
Client 11W Lab.1DN CNieete4 AnAyte Rep Lint •Resuult UAW Matrix Method DF •RogLvl kim Analyst
347Wlf72/73 001 11/3/2014 TCLP Mercury 0.0020 ND mg1L Solid . EPA 7470 A 1 0,20 l Mk2014 i4LJ
S'Q•OC SW-846: 8081-TC1,P pesticides
Client ID#
Lab IM Collected Analyte
Rep Lmt Result Units
Matrix
Method
OF
1LeXLvl
Run Analyst
347W/ 172173
001
total
0.010
NO mg1L
Solid
EPA 80818
1
01130
11/14/2014
JBN
3470/71P 2/73
001
T&aphena
0.10
ND mg/L
'Solid
EPA60810
1
.0,50
11%14/Z014
JAN
3470/71/.72173
001..
11/3/2014,•Enddn
0.0020
'NO ng1L
Solid
EPA8g81 a
1
0.020
Vi42g14
JBN
3470171R2173
001
19/3/�, Q1a: •�8mma-BHC
0,0020
ND mg/L
Solid
EPA goal 0
1
0.40
11/14/2014
JUN
3470R1172R3
qo1
11/3/2014 •'Noptachlor
0-D02p
No mg/L
Solid
EPA 6081 A
1
0.086
11/14/2014
AN
34701TV72r73
001
c_ 1.11813Qj.44ptachlorepoAde
0.0020
ND mglL
Solid
EPA:8081 9
1
((.0080
11114204
JBN
3470/71i72/73 001 . 11/3/2014 (IQethoxychlor 0.0.020 NO mgfL Solid EPA 8081 6 1 10 11114/2014 JBN
SVOC S`1'tl 846: 8131,1ae6icjdes-TCLP
Client WO
Lab- ID# Collected A 4Alyte
Rep but Result Units
Matrix
Method
DF
Regtvl
Run •Awlyst
3470/7'ln2/73
001 1113414 ,A-D
0.40 ND mglL
Solid
EPA 8151 A
'1
10
11121i12614 JBN
347Wlf7W*
PQt j jl% /2014 .2,4,rrTP
0.10 ND rgglL
Solid
EPA 8151 A
1
1.0
11/2012014 JeN
Page 4 of 7
r

1 LL)/O,UJ/LUIJ/ IUL• 1L, UJ ttvi P11A 110. i. U12
• •yt� •, aitYsti.•'t���.136iG1`�6•`>�i.
S Omit Eny17onmeWal TeChnakeft, fire,
3310 win 3t.
Cuyahoga Falls Ohio d4223
TBZ: (33o) 233-821 t &ik 030) 2534489
Websi1¢- hV.'/. .settee
WOO, 14110691
Date Reported. 1215CO14
Company: Blue Mcige Labs, Inc,
A.ddiess: Y. O'box 2940
Lrnoir NC 28645
VOC by GC/MS (8260)-TCLP
Rcceived: I VIO12014
P11ojca-, 3470/71/72173
-Client Rw
Lob Mg Collected Amalyte
Rep Lot Itesoi4 lunits
MmY&
Method
DF .RegY,vl
•Run Analyst
34i0/71/72/73
001
11/5/201 a i,1-01c%btosthene
0.10
ND mg/L
Solid
EPA 0260 B
1
0.79
11/14/2014
ME5
$470nl/M73
Cal
1v3M...
- I�Z.Nchloroethans
0.10
ND MSIL
Solid
EPA 82608
1
0.50
1/114/2014
MES
3470OV721i3
001
' 11/31201,'4. -Bement
O.io
ND mg/L
Sclld
EPA 8260 B
1.
0,50
11/14/2014
MES
347.0#l'j,7?n3
001
11/312Q4 ':Carbon tetrachloride
OAQ
NO mg/L
Solld
EPA-8260 B
1
0.60
11/14/2014
MES
3470171I74/73
001
1IL3/2dR a ; Qhlomber¢ene
0.10
ND mg/I,
Solid
OA 8280 8
1
160
11/14/2014
MES
3470l71172/73
001
11( (2,Qj ^lablarofotm
0.10.
ND mg/L
Solid
EPA 826Q 8
1•
6.0
11I141204
MES
3470/71172/73
Ocki
1jf3/201'4.7etmotargethene
0.10
ND mg/L
S611Q
EPA8260B
1
0.70
1111412014
MESS
3470/71/72n3
A01
1 /3/20aa Itichloroathene
b.10
ND mg/L
Solid
EPA 8250B
1
0.60
11l.1412014
{NES
3470/71n2n3
001
.111V24,14_ Amyl chlorlde
0.20
ND mglL
solid
EPA 8260 a
1
020
11114/2014
:MES
3470f7V12/73
oar
11/3/2014 .MEK
2,6
NO mg/L
Solid
EPA 8260 B
1
200
111146'14.
MES
s'VOC 8276 -TeLP BNA List
Cltent ID#
Lab HW c0lettedAnalytt
Rep Lint Result Units
Muria
Method
DF
'RegLVI
Raw Auslyst
•347061/72173
001
11139o14, i:,d=bichloroben2ehe
0.10
ND mg1L
$ol-rd
EPA 8270 C
1
7.5
11/1412014
ET
347WI172173
001
113/,2014 ,4;4,5 TrkhloroOertol
0.25
ND mg/L
Solid
EPA 8270 C
1
400•
11/14/.2014
ET
$470/71172173
001
1.1131AQ1,� �2,4.8-Trichlordphennl
9.25
NO tdg11.
Solid
EPA 827o C
i
2.0
11114/2014
ET
3470171/72n9
001
11/3120;14•,:2;4-Dlnitrr lgluene
0.10
ND mg/L
Solid
EPA 8270 C
1'
0.11
1111412014
ET
3470/71172173
a01
° 1113/2014!-.Cj sals,Total
5.0
ND mg/L
Solid
EPA 8270C
1
200
11AV2014
ET
34709v72173
001
_r
1113120$}!e
'Xgc111oro-1,3-
010
ND /L
m8olid
S
EPA 8270C
1
0.50
't1114/2014
ET
bUlaOne
3470171/72/73
001
_
11l3(2Q1q Hb7taChl6iabenzene
0.10
ND mg/L
Salid.
EPA8270C
1
0.13
1111412014
tT
34 71/12/73
a01
1119fa914:tiexacnloraeu►�ne
O to
No moll
Solid
EPA e270 G
1
30
11l14/2ui4
ET
3470/71172n3
001
1V3320�4'Nkinbenone
0.10
ND mg/l.
Solid
EPA8270C
1
2A• '
i1/t4/201'4
tET
3470/71n2173
001
11/312014 FN-ntachlorophenot
6.25
Nb mg/L
Solid
EPA 0270 C
1.
100
11/14)2614
ET
34ION1 073
001
11/3/26-14 Pyddino
025
ND mg/L
Solid
EPA 8210 C
1
0.0
11/14/201.4
ET
Page.5 bf 7

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 - B
WQ Permit Number: WQ0003992
Facility Name: Town of West Jefferson
Residual Source WQ # or
NPDES #:
NCO020451
WWTP Name: Town of West Jefferson
Residual Analysis Data
Laboratory: 1) Water Quality Labs
2) Blue Ridge Labs
3) Summit Environmental Technologies
4)
5)
Parameter
(mg/kg)
FPpercent'Solids
Ceiling
Conc.
Limit
Sample or Composite Date
11/3/14
(%)
N/A
0.0063
Arsenic
75
158.7
Cadmium
85
31.7
Copper
4,300
1538
Chromium
NA
127.7
Lead
840
158.7
Mercury
57
0.8095
Molybdenum
75
296.8
Nickel
420
15.87
Selenium
100
158.7
Zinc
7,500
319
Total Phosphorus
NA
13381
TKN
NA
4222
Ammonia -Nitrogen
NA
2126.9.
Nitrate and Nitrite
NA
658.7
a For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits.
"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."
C,11
Signature of Preparer * Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
I?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: WQ0003992 Laboratory: 1) Water Qaulity Labs
Facility Name: , Town of West Jefferson
Residual Source
NPDES # or WQ#:
WWTP Name:
Residual Analvsis nntn
NC 0020451
Town of West Jefferson
2) Blue Ridge Labs
3) Summit Environmental Technologies
4)
5)
Parame ter
- -
-Sample or CompositeDate
Magnesium
----------
"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 Preparer *
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
J 11
✓ ,55
Date
DENR FORM RSSF - B (12/2006)

k,
CALCMATIONS WORK SHEET
•This work sheet is designed to assist the Division of Environmental Management in reviewing this application as expeditiously as
Possible. Its preparation in a complete and accurate manner is critical to this review. For permits that cove rmultiple sow= of
residuals or different residuals from the same source, use additional work sheets.,
A. List the specific residual that is coveted by these calculations (place. or process , of -origin)
What are the total dry tons "of this residual to he land applied each year?
Total Dry Tons = Hallows of Residuals * % SWidg * &34 lbsJgallon
produced anrui�y 1 A(�
2,0001bs./ton
Total Dry Tons = * --.:— * 8.341bsJgal%n
log
-2,000 lbs./ton
Dry Toms pee year
If the quantity of residual will vary significantly or if there will be a larger initial application; please attach a detailed
explanation and provide calculations for each va iatim
B . Complete the following calculations to establish the portion of Ahe residual that is made
tip of the various parameters:
% Total Solids
(PLEASE NOTE THAT ALL CONSTrrUENTS ARE TO BE IN TOTAL CONCENTRATIONS)

ANN UAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Town of West Jefferson Total Dry Tons Applied (Annual): �4.68 `"ry
Permit #: WQ0003992 Cation Exchange Capacity (non 503 only):
Operator: Charles Call Owner: Albertine Pennington Predominant Soil Series:
Acres Used: 9.9 Acres Permitted: 9.9 Site #: AP-1 Field #: 1
Residual Analvsis Data (Heavv Metals and Tntnl Phnenhnr„c 1100 .,,. /],_ of Q _,:a
posite
-Date,
Total
Phos-
_phoru
-
,
NONE
.
1•
1 110
4 111
/ 101
0 1/4
1 ell
1 111
1 0ll
1 111
1 ,.
1 1 1
1 0 1
1 ell
1 Ile
1 111
1 111
1 iil
1 ill
0 111
1 100
/ I/O
1 111
•••
��.
1 111
1 11!
1 111
1 101
/ !!0
1 011
1 111
1 111
1 011
1 0ll
! 101
��.
Zi.L'iLfiLiS!'
1 1
1 111
0 111
1 11
1 111
1 111
/ 111
1 111
a 111
! /11
1 11 !
1 1 11
1 1
0 ..
1 111
0 11!
i 111
1 1!1
1 111
1 110
fill
0 !10
1 111
0 111
4 104
1 ..
i�
1 11
1 11!
1 110
1 lil
1 lel
1 111
1 !1/
1 111
1 111
1 111
1 Oil
/Ile
1 10
•_• �
1 •
1 111
1 !11
1 111
1 0!1
0 111
1 010
1 111
! 110
0 110
i 11!
1 111
1 •
Nickel 0:015.. 0.000. 0 000 0;.000: 00 ;0 000 000 ; "",0.000 0 0 00 000 0 QO`0„
Selenium 0.1.49 0.000, 0-000", 0.�000. °:0,000.0000 0 000 - 0000 0 000 : ".� 0000� ; ,00000 000_; 0149
Zinc 0.0 O.OQO , :0:000 0:000 ,0.000 0' 0.00 - 0 000 0:000
30�0 "<""0:000,. 0J06, 0
Total
Phos- k2.578. ' 0.000 .`. 0 0004 0 OQ0 :; =;"0.000 0 000 - 0.000 0 000 0 000 0 000 O:U00 0 000 l2 578;
horus
"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".
C" detz
Signature of Land Applier
C� ✓y 15
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 West Jefferson
Land Owner: Albertine Pennington
Operator: Charles Call
WQ Permit #: WQ0003992 Field #: 1
Annual Dry Tons Applied: 4:67fr2 ":' n „• Site #: AP-1
Predominant Soil Series:
Crop 1 Name: Fescue Crop 1 Max. PAN: 187 Crop 2 Name:
Acres Utilized: 9.9
Acres Permitted: 9.9
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
0
QLiquid
Volume applied
(enter one) Solids/
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
Soil
Cond.
Wet'
Moist)
Precip.
Past 24
Hrs.
inches
y
ci '�
a
*
o
F,
* �•
o'
;v .,
*
0
TKN
mg/kg
Z
o
QQ w.
mg/kg
Nitrate
and
Nitrite
mg/kg
PAN Applied
(lbs/acre)
Name of CropType
Receiving Residual
Application
Crop 1
Crop 2
Crop 1
Crop 2
0:000
0:000
March
76000
0.63
..'•° .U:202b,,:
Moist
0
S
0.5
0.3
4222
2126.9
658.7-`:0:9„4s`"
April
60000
0.63
Moist
0
S
0.5
0.3
4222
2126.9
658.7
„ 0:749"°;.Oi749`:_
0:600 :
0 b6o
June
42000
0.630'1`1'1''°''
Dry
0
S
0.5
0.3
4222
2126.9
658.7
'.•0:524 °
�`�0:524.'�
0:000 .
0 600
q.000
r o 000 ' ..
0.000,:
0:000; ;
0.00
0.000,1
. a 06
-0.000
Residuals Applications totals on FORM
pp
F F
S su attach FORM
PP (
FSF su
to this form
PP ):
TOTALS:.v`o;:
:ias000
:::::::::::::.
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
2221; °�2:221`,
Lime Applied
Annual
lbs/acre.
,0149,.-;'»:::::>::
0.33163
,0 481:.:° '
36 I
0.02937
• .0:059 ;,
34
6.1449
7.5,9;1;
1338
0.36439
. •0.484 '
2677
0.52592
':; 0,075 ,.
267
0.26319
,0:264 ,.,
15
0.36315
.,0.642'
N/A
0.33091
; 0.346 ,
374
0.13329
.Or2`82_
89
7.6526
_
7:952=
2498
, .8 ... • • , . , ...... • • .. •
::
:' >::: ;`:::::: > `:;::::::::::::::::::::
Date
lbs/ac
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit lst/2nd Crop P
-
87
"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."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation -1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of Land Applier Date aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

na�airaa.a nyrvnvmIp utvialon rnone: (Ulu) fai-zdso vveusite: www.ncagngov/agronoml/ Report No. FY15-SL000527
:�alµ,troxa•l,b�r Client: Albertine Pennington Advisor: Bob Branch
�a Predictive 262 Pennington Farm Rd. Branch Residuals 8l
n Crumpler, NC 28617 Soils -Bob
} Soil Report Mehlich-3 Extraction 8646 W Market St Suite
Sampled County: Ashe 111
Greensboro, NC 27409
Sampled: Reeeived: 07/10/2014 Completed: 07/18/2014 Farm: Links to Helpful Information
Sample ID: AP1 Recommendations: Lime Nutrients (lb/acre) More
Crop (tonslacre) N P205 K20 Mg S Mn Zn Cu B information
Lime History: 1- Fescue/OGrassrrim, 1 0.0 120-200 0 90 0 0 0- 0 0 0 Note: 12
2- Fescue/OGrassrrim, 0.0 120-200 0 90 0 0 0 0 0 0 Note: 12
Test Results [units - WN in g/cd; CEC and Na in meq/100 CO- NO3-N in mg/drn?]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P4 K-1 Ca% Mg% S-1 Mn-I Mn All Mn-Al2 Zn-1 Zn-AI Cu-I Na ESP SS-1 NO3-N
0.46 0.94 14.4 93 1.0 6.4 97 25 64 28 50 205 134 134 523 523 285 0.1 1
North Carolina
RAwco Trust FwW CtKniw-%%kas
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 Trox/er, Commissioner of Agriculture
r

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Town of West Jefferson Total Dry Tons Applied (Annual):
Permit #: WQ0003992 Cation Exchange Capacity (non 503 only):
Operator: Charles Call Owners Tommy Barlow Predominant Soil Series:
Acres Used: 9 Acres Permitted: 9 Site #:. TB-1 Field #:
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg-/k2. % Solids use Raw Percent #t)-
Coni-
•.
000
Date,
Total
Phos-
phorus
Mai neavy ivietai rieia l,oaames lualculated in lhs/aerel:
..
0
0
0
a
oApp-
MENun0
on
veo
1 '.
1 111
1 111
1 111
1 111
1 111
1 111
0 ell
1 Ile
a ell
1 Ile
0 Ile
1 �.
�mj�
1 111
1 Ile
1 Ile
1 lel
1 Ill
1 Ill
0 101
1111
1 I11
1 lel
1 111
11�•
•••-
1 Ill
1 111
1 III
a III
0 Ill
1 111
1 I10
1 Ill
0 111
a lee
a IOe
1 •:
1 111
1 111
loll
1 110
a ell
1 111
1 lee
o 111
1 111
1 ell
a Ill
1 •:
l '.
1 111
1 111
o ell
1 111
0 110
1 Ill
I Ill
1 Iol
1 110
1 ell
1 ale
1 �.
1 11
1 III
1 Ile
1 Ill
1 Ill
1 111
1 111
1 Ilo
1 111
0 lee
1 111
a ell
1 el
.-' •
1 �.
1 111
a III
1 Ill
1 ell
1 111
9 110
0 111
l Ile
1 ell
1 e01
1 111
1 �.
1 1
1 OIQ
1 Ilo
1 111
1 ell
9 ell
1 Ill
1 lee
0 Ill
1 Ill
1 Ile
1 lee
1 1
1 '.
1 Ill
1 111
1 III
1 Ill
1 lee
1 lee
1 Ill
a Ile
I Ill
1 Ill
a III
1 �.
1 ..
1 111
1 111
1 Ill
1 Ill
1 eel
1 111
0 lea
1 11e
1 101
1 Ill
0 010
l ..
l
1.
1 lel
1 Ill
1 lel
1 ell
l ill
1 100
a ell
0 III
0 lee
1 lel
1 ole
_ ___ ___, , „a ..y,•, t-"L Luau UMA&MCm Wa, prepares unaer my airection or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
�&Z'a
Signature of Land Applier
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 West Jefferson
Land Owner: Tommy Barlow
Operator: Charles Call
Crop 1 Name:
Fescue
WQ Permit #: WQ0003992 Field M I
Annual Dry Tons Applied: '6:9881'.:.:;':=�;_'`" Site #: Z B-1
Predominant Soil Series:
Crop 1 Max. PAN: 187 Crop 2 Name:
Acres Utilized: "9
Acres Permitted: 9
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
+� o
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,
Wet
Moist)
Precip.
past 24
Hrs.
inches
a
0
°c m
°
°
o
*
°o
w
CD ?r
*
* "
TKN
mg/kg
Z
=�
o°o o
g w
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
122000
0.63
r°a03;56 ";`,,
NCO020451
Dry
0
S
0.5
0.3
4222
2126.9
658.7
.1.674',:'
June
56000
0.63
x:.: �0<163' -
NC0020451
Dry
0
S
0.5
0.3
4222
F 2126.9
658.7
:o ,0.760'
',0',**, .
August
88000
0.63
NC0020451
Dry
0
S
0.5
0.3
4222
2126.9
658.7
1.208; .
;;1.208"
00
.. ,.
Residuals Applications total
pp s_ on FORM
FSF supp (attach FORM
FSF supp to this form):
TOTALS:
04
As
Cd
Cu
Cr
Pb
Hg
Mo
Ni
Se
Zn
P
3.6T0::
s7650�
Lime A lied
Annual
lbs/acre
0 246'
0.22559
"'0:472F','-',.
36
„ 0 049 ,'
0.20494
;.0:254, .
34
2=387;
5.9921._
;.;:8:379..`
1338
0:19$
0.35452
2677
0.246:.
1.00478
1,251 :
267
,`.:0.00,1" :
0.35289
�'„0.354°•
15
0461 .
0.37749
` 0.83&
N/A
0.025=
0.42751
` 0:452 =,
374
; .0:246•.;
0.09898
> 0.3,45;,'
89
;: Q.495;<„t20
6.6933
2498
767 °::::::::::::::....:::::::::::::::
': ::
........ ..............
:.:::.>....:.....
Date
lbs/ac
Prior Years Cumulative lbs/ac
10/27/14
4413
Current Cumulative lbs/ac
Permitted C. P. L. R.****
p Permmt AN Limit 1 t/2nd Crop s
7
"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
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0..5, Injection/Incorporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobialty digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)

NCDA&CS Agronomic Division Phone: [phone]
Website: www.ncagr.gov/agronomi/
Report No. FY15-SL000529
atiWcfvar..ga
Client:
Thomas Barlow
Advisor: Bob Branch
Predictive
569 Greensboro Rd.
Branch Residuals &
Crumpler, NC 28617
Soils -Bob
_
x F Soil Report
p • Mehlich=3 Extraction
8646 W Market St Suite
a• ��
Sam pled County: Ashe
111
Greensboro, NC 27409
Sampled: Received: 07/10/2014
completed: 07/18/2014
Farm:
Links to Helpful Information
Sample ID: TB1
Recommendations: Lime
Nutrients (lb/acre)
More
Crop (tons/acre)
N P205
K20
Mg S
Mn
Zn
Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim, 1 0.0
120-200 20
80
0 0
0
0
0 0
Note: 12
2-Fescue/OGrass/Tim, 0.0
120-200 20
80
0 0
0
0
0 0
Note: 12
Test Results [units - WN in g/cd; CEC and Na in meq/100 cm3; NO3-N in mg/d1ff?1:
Soil Class:
Mineral
HM% W/V CEC BS% Ac pH P-1 K-1
Ca% Mg%
S-1 Mn4
Mn All Mn-AI2
Zn-I
Zn AI
Cu4 Na ESP SS-1 NO3-N
0.46 0.89 14.3 92 1.1 6.5 53 31
58 33
42 209
136 136
262
262
261 0.1 1
North Carolina
TL+:tctco Trust FuDd tbanmh*,.k*
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 Troxier, Commissioner of Agriculture

HALSEY'S FARM SERVICE INC.
P.J. BOX 53
MOUTH OF WILSON, VIR3INIA. 24363
276-579-4522 OR 1-800-370-2168
/oice: 195341
Name; TOWN OF WEST jEFFERSON!
jress: P.O. BOX 490
WEST JEFFERSON NC 2d694
------------------------------------------------
antity Unit Description Exempt
______________________
AMR
Drawer: 01
Date: 10127/2014
Time: 1:31
Employee: OWN
------------------------------
Price Extended Price
----------------------------
$32.00
------------
$635.52
Subtotal
52
Tax
$O10N
Total
$635.52
$635.52
Cash Tendered
$0.00
------------
Change
$0.00
Thank you - We appreciate your business!
— \u�
--'
=-= u� rux xLL /uux rHxn Ou14L/ WtuM
FERTILIZER, LIME, GYPSUM, CHEMICALS, FENCING, SEEDS,FEED, SPREADER SERVICE
STORE HOURS 8.00 - 5.00 M0VDAY-FRIDAY
>
-----------------------------------------------------------------------------
Payment due upon rsciept of invoice
ALL ACCOUNTS PAST DUE WILL BE CHARGED 11/2 PERCENT PER MONTH.
We accept Mastercard,VISA and Farm Plan
'

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 West Jefferson Total Dry Tons Applied (Annual):
WQ0003992 Cation Exchange Capacity (non 503 only):
Charles Call Owner: Willard Little Predominant Soil Series:
6.4 Acres Permitted: 25.5 Site #: WL-1 Field #:
6
Residual Analvsis Data (Heaw Metals and Total Phnsnhnrnc nce ma/ka of C'nlirlo non D.— -P --+ #l.
Com-
posite
@NONE
Non
Date
Total
..
v {.. ♦ 1.1\r."K 1'lO.LL LIUdU...Y\ ...Nu-u.i..ru ..■ ■al`/!1P.'P.'
©
©
o
©
o
0
0
0
�
i1
M%E
•
NMI
1 1•
illl
1111
1111
1111
1111
1110
e011
1110
1111
1111
1111
1 1.
�
I e-
/ lel
a lee
a eel
a ill
/oee
I lel
1 eoe
o ell
1 ell
1 lel
a oeo
1 0,
•••-
•••
a 011
1 lie
1 111
1 ill
1 ell
1 111
1 i00
0 111
1 101
1 ell
0 0e1
•••
1 ..
e111
1111
1111
e101
e111
1111
leel
1lle
lell
0111
/ell
a ..
1 1.
1 111
1 Ile
1111
1 111
1 111
1 111
1 011
1 111
1 111
1 Ill
1 Ili
1 e.
1 11
1 111
1 111
1 ell
1 Ili
1 ill
1 111
a 101
1 lil
1 911
1 Ile
1 eel
1 11
.-• •
1 :.
1 111
1 111
1 111
1 011
1 !11
1 Ile
1 111
1 100
0 111
1 111
a @1!
1 :.
My M
11
1111
loll
1011
1111
1lle
1111
e111
1111
e011
e111
011e
10
1 1.
1 ell
a eel
1 Ile
1 eli
a lil
1 oee
i ile
a eee
i ell
a lee
o eel
i 1.
1'
1 111
1 111
1 lee
1 lee
/eel
1 110
I I11
a 110
1 ell
1 111
1 010
1
Total
Phos-
1 111
1 Ila
a eel
a ill
I eoe
a oll
a eee
1 Ile
1 elo
a ale
o lee
•
phorus
�.
- - , __-_ _-_., .. µ- t.y IJV"A %,u {luLLGl AUY Ull MAILU11 WE JUpervlslon 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". -
($0
Signature of Land Applier
9
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 West Jefferson
Land Owner: Willard Little
Operator: Charles Call
Crop 1 Name: Fescue
WQ Permit #: WQ0003992
Annual Dry Tons Applied::4.1508
Predominant Soil Series:
Field #: 6 Acres Utilized:
Site #: WL-1 Acres Permitted:
Cation Exchange Capacity (non 503):
Crop 1 Max. PAN: 187 Crop 2 Name:
Crop 2 Max. PAN:
6.4
25.5
o�
�
QY ,
Volume applied
(enter one) Solids/
Li Liquid
9
Cu. Yds Gallons
%
Solids
Volume
Applied per
Acre
(Dry Tons/Ac)
Residual Sources
(NPDES #, WQ#,
Fert. Animal
Waste, etc)
Soil
Cond.
Moist)
Precip.
Past 24
Hrs.
inches
a
co ?
o w
* o
o
w °»'•
N'
*
�
7y C
F
* w
TKN
mglkg
Z
o El
c0°o
w.
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
,. 0.`000 ; _
0:000 .
0.000
0.000 -.
0.000,
0.000--
March
32000
0.63
; 0:131-
NCO020451
Moist
0
S
0.5
0.3
4222
2126.9
658.7
0.618,
- 6.6A
April
62000
0.63
0:2,55 ;'-':
NC0020451
Dry
0
S
0.5
0.3
4222
2126.9
658.7
1,1.96-
:;-`IA96.`
0:006
0.000'
0.000
; 0.000
0.006"
0.,060 :
::0.000,' �
October
64000
0.63
, .:. 0:263 : ,
NCO020451
Dry
0
S
0.5
0.3
4222
2126.9
658.7
1235 -t
1.235
0.000::
0.000
0:000
0.0.00. -.."
0:000
0000:
Residuals Applications totals on FORM
FSF supp ( attach FORM
FSF supp to this form):
TOTALS:
`;,',: :,-,.?.0
158000..:.:.:.:::::::
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
:.3.049,;..:;:3;049''
Lime Applied
Annual
lbs/acre1:999`-
.=0.166 - ,.0.206" ;;� 0.00-1 0.386 .,` '021° - 0.206`�'; 0.44-5: •17:395:.'•:::::::::....:::::
0.10614 0.00554 2.6465 0.10141 0.26839 0.23466 0.45357 0.12694 0.02734 3.097 ::
0:312,, 0:047 -; .:4,646 0.267 0,475 ,0.236 0.839; 0 148 ;.`0.234-, . 3.512 ,::<::`::`:::: <:::::: ::.......... .
36 34 1338 2677 267 15 N/A 374 89 2498
.1 87 .a
Date
lbs/ac
Prior Years Cumulative lbs/ac
1/2/14
2745
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit 1 t/2nd Cro
p o
p
"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
�ys
Date
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
*** 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)

NCDASCS Agronomic Division Phone: (919) 733=2655
Website: www.ncagr.gov/agronomcl
Report No. FY15-SL000528
P.(:L;41L.Ke" t"?,
Client:
Willard Little
Advisor: Bob Branch
-0
Predictive
1535 HWY 16 North
Branch Residuals &
Y
Crumpler, NC 28617
Soils -Bob
.,.1.
Soil Repo1 Mehlich-3 Extraction "
8646 W Market St Suite
Sampled County: Ashe
111
k .��IM,I
Greensboro, NC 27409
Sampled: Recelved: 07/10/2014
Completed: 07/18/2014
Farm:
Links to Helpful Information
Sample ID: WI-6
Recommendations: Lime
Nutrients (Ib/acre)
More
Crop (tons/acre)
N P2O5
K2O
Mg S
Mn,
Zn
Cu B
Information
Lime History:
1 - Fescue/OGrass/Tim,1 0.0
120-200 0
80
0 0
pH$
0
0 0
Note: 12 Note:
2 - Fescue/OGrassrrim, 0.0
120-200 0
80
0 0
"pH$
0
0 0
Note: 12 Note:
Test Results [units - W/V in g/crrr?; CEC and Na in meq/100 cm3; NO3-N in mg/dd]:
Soil Class:
Mineral
HIM% WN CEC BS% Ac pH P-1 K-1
Ca% Mg%
S-1 Mn-I
Mn-All Mn-Al2
Zn-I
Zn AI
Cu-1 Na ESP SS-1 NO3-N
0.32 0.92 16.4 95 0.8 6.5 281 30
70 25
55 99
68 68
645
645
491 0.1 1
North Carolina
v
Tubiccet Trust f uad Comirim H4
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

�
` .
'~
HALSEY`S FARM SERVICE INC.
`P.O. BOX 53
MOUS OF WILSOM, VIRGINIA. 24363
. 276-579-4522 OR 1-800-370-3168
HALSEY'S FARM SERVICE INC.
P.�. BOX 53
�[K|TH OF WILSON/ VIRGINIA. 24363
276-579-4522 OR 1-800-370-3168
�xvuicc: 192318
1535 HWY 16 NORTH
002PLE9 MC 28617
'-'--__------.......... '----- _-_____-___--___-____
Tuantity Unit Descriptiov,
--------------------------------'-------
Drawer: 01
Date: 01/02/201it
Time: 10:53
Employee: OWN
------------------------------------
Exempt Price Extexved Price
-------------------------------------
Yes $32.00
Subtotal
$1120.00
Tax �
$0 ��
.
L-^ �~` -----------
1P rota1
$1120.0�
&&�� /_/~7_, Cash Tendered
~~`-,~~' /—/ /-/ ��
^
$0 00
DATE
'APPROVED Change
$0.0@
Thank you --We appreciate your busitess!
SE�� US FOR ALL YOUR FARM SUPPLY NEEDS.
FERTILIZER, LIME, 8YPSUM,CHEMICALS, FENCING~SEEDS,FEED, SPREADER SERVICE
STORE 8.00 - 5.00 MONDAY-FRIDAY
__-_--_---__-_-_-______-______--_-_--_-____--__-_-____--__-_-_-_-______-_-____
Payment due upon reciept of invoice
FLL ACCOUNTS PAST DUE WILL BE CHARGED 1 1/2 PERCENT PER MONTH.
We accept Mastelcard,V}SA and Farm Plan

�
�.
1r+r
..
�A,
�_
�r
%
F
�
�
i
t

PATHOGEN & VECTOR ATTRACTION REDUCTION
PATHOGEN AND VECTOR REDUCTION AT THE WEST JEFFERSON WWTP IS
ACCOMPLISHED THROUGH AEROBIC DIGESTION AND UTILAZATION OF
FECAL DENSITY AND THE 30 DAY BENCH SCALE TEST.
AS INDICATED ON THE ATTACHED WWTP SCHEMATIC, THREE AEROBIC
DIGESTERS ARE USED FOR SLUDGE STORAGE AND ASSIMILATION.
MEASUREMENT OF PH IS PERFORMED USING A SENSION ONE PORTABLE
PH METER.
ONCE THE CONTENTS OF THIS DIGESTER MEET PSRP AND VECTOR
ATTRACTION CRITERIA, SLUDGE IS REMOVED FROM THE UNIT AND LAND
APPLIED BY SURFACE METHOD.

WATER QUALITY LAB & OPERATION,
PD.BOX 1187.BINC INC.
(828)808'6277
CLIENT:
VVESTJEFFERSON
ADDRESS:
CITY:
VVESTJEFFERSON
STATE:
NC
ANA
SAMPLER:
CHARELS CALL
COLLECTED DATE:
15-Jan'14
REPORTED DATE:
28'Fob'14
kA
30DAY BENCH SCALE
E8O
% SLUDGE
20-Jan-14
Pi
START
7 5.
0.1
% SLUDGE
20-Jan-14
p I
END
SLUDGE
21-Feb-14
PI
REPORTED BY: NCCERTIFIED LAB #544
PAUL|SENHOUR.SUPERVISOR
� 9\ � ��
1WVy/ � �f�/
@L �-�U-- �J1 ���° w`--^
U�7/\
[/
~
�
m

4.
LYlfll\/ IU/LUIVIVIViv UL•LL IIVI PRA INO. F. UU2
L
WATER QUALITY LAB & OPERATIONS, INC.
PO BOX 1167, BANNER ELK, NC 28604
_ 8288986277
�- 30Day Bench Scale, FAX[phone]
CHAIN OF CUSTODY
SAMPLE TYPE:
LOCATION:
FACILITY ID#:
SAMPLER NAME:
WASTEWATER
WEST JEFFERSON
N00020451
CHARLES CALL
COMPOSITE SAMPLE: START nATF-
STARTTIME- STOP
SAMPLE
NAME:
30 Day Bench
COLLECTION
DELIV
TEMP
SAMPLE
TYPE,
PRI=SER
DATE
TIME
TEMP
GRAB
f
COMP
F-FIELD
Scale
of l
IDOL
.Ip C
*PRESERVATION CODE
1— H2SO4, 2 HNO3, 3 — HCL,
4 — NAOH, S — NONE, 6 — COOL I CE
7 — NA2S203, 8 — OTHER
DATE: STOP TIME:
CL2•D- LAB
NATION* PH CL2 SAMPLE
verify, Ib
L-LAB YES NO NUMBER
``ll//!! �DAT
I RVtCRELINQUISHED BY:DqE[ TME RECEIVE BY; / UJ��/,UO E TIME
*Laboratory preservatlon is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
CL2-D-CL2 = Chlorine check and dechlorination verification.
PRESERVATION: pH: 7. I
() COOL 4°C: SOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY Temp.
() COOL 4°C, PH<2 H2SO4: NH3, NO2-NO3, TKN, 0&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS. Cond:
O COOL 4°C, PH<2 HNO3: METALS EXCEPT CR, VI
()NONE,: CHLORIDE, PH, FLUORIDE
OTHER:
0 COOL 40C, NA-,S,)Oz: COLIPORM BACTERIA

"L)l lY/ LUII/ rni Ul .II IV1 I PRA 110. Y. UU4/UU'/
CLIENT: WEST JEFFERSON (1)
ADDRESS;
CITY:
STATE:
I n#-
WATER. QUALITY LAB & OPERATION, INC.
P.O. BOX-1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME: 2:30 PM
SAMPLER:
COLLECTED DATE: 13-Jan-14
REPORTED DATE: 10-Feb-14
i NiQlkY l
ANALYSI&::MgL'
.:.:.
;
iT :::
: O.
ULT S::
O:CAT N
:CO M�:L�. .
TOTAL SOLIDS
1.0
MPN
DIG
I=ECAL COLI FORM
6200
1
/100 MIS
#3
16-Jan-14
SM-92221)
WPS�
.�" v��/,b-^Jvl../,,w vLl\Ilf-ILV LJIV "ft J`tY
PAUL ISENHOUR, SUPERVISOR
t

I . 1i 1%/1'2/LU1V 1'1%1 U1.11 1Rl PRA N0, ,
r, uuVuu'i
CLIENT: WEST JEFFERSON (1)
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
(828).898-6277
LOGIN TIME: 2:40 PM
SAMPLER:
COLLECTED DATE: 14-Jan-14
REPORTED DATE: 10-Peb=14
::::::::::::::::::::::::::::::::::::::i�TVR�YSIS:
adlQL`s
:;fdNtTs::
::5A111FAL1r:�cNieKILYSl3:
:R
CZN
�C�,�.
Q
TOTAL SOLIDS
'0.82
MPN
DIG
FECAL COLIFORM
4265
1
1100 MIS
#3
15-Jan=14
SM-9222D
WPS
RGDi1ATCh aV. IAIf% f1c: it CfI
1 AO Jl CAA
PAUL ISENHOUR, SUPERVISOR

3 L11/ 17/ LU1'S/ 1'1\1 U1 • Yi 11P1
r.Hn IN0• Y, UUb/UU'/
CLIENT: WEST JEFFERSON (1)
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NO 28604
[phone]
LOGIN TIME: 1:15 PM
SAMPLER:
COLLECTED DATE: - 15-Jan-14
REPORTED DATE: 10-Feb-14
: = ::
A`KIe4Y$iS::MQI::'8:::,:U:NIT3:;:;
>RIrSr U..: .
:;:SA'M:PLE :;
C. e4it6���.
N
:ANACY
.................
OTAi, s0bi S
0.9
MPN
DIG
FECAL COLIFORM
53333
1
/.100 MIS
#3
17-Jan-14
SM-92221)
WPS
REPOPTF() RY• Kin C.FRTipmr)
i na 4 CAA
_
PAUL ISENHOUR, SUPERVISOR

r
•""� 11/ LV 12/171V19 UJ-LU nevi TRA 11 U.
r. uul/UUl
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
• [phone]
CLIENT: WEST' JEFPERSON (1) LOGIN TIME: 2:30 PM
ADDRESS: SAMPLER:
CITY: COLLECTED DATE: 16-Jan-14
STATE: REPORTED DATE: 10-Feb-14
I D#:
:::'
AN�tf<YSIIS:
:. .
:R 41'S:
;iVJS�:::::UN1T5:::::::..
PL
... ::
T.11Qto
::i4f@it1 .
L....
.M� :.
TOTAL SOLIDS
0.9
MhN
DIG
FECAL COLIFORM
866666
1
J100 MIS
#3
17-Jan-14
SM-9222D
WPS
RI=PORTFD RV- mr r..FRYIFipn
1 4R A Rnn
PAUL ISENHOUR, SUPERVISOR

a
• ul, ''I LV 1 1/ • 41, V 1 . TZ 11V1 l RA 110, F. UU1/007
WAT.ER-QUAL.IT_Y_LAB-&DP-EPAT
ION,.INC.
P.O_ BOX 1167,13ANNER ELK, NC 28604
[phone]
CLIENT: WEST JEFFERSON (1) LOGIN TIME: 2:45 PM
ADDRESS: SAMPLER:
CITY: COLLECTED DATE: 21-Jan-14
STATE: REPORTED DATE: 10-Feb-14
I D#-
ANitIL'YSI$:; ::::=:.: , >::;::::::>::•::•:•:•;< ::: ;
SOLIDS
1-
A11X�!
::A'RN)I`%�t 1r5
.A:.::�:�YrTOTAL
:
::::MC
FECAL COLIFORM
REPORTED BY: NC CERTIFIED
1.07 MPN DIG.
5384 1 /100 MIS #3
LAB # 544
23-Jan-14
SM-9222D
WPS
��
PAUL ISENHOUR, SUPERVISOR

rLI%/ IV LUIV V A I UI I. Vf I VRA 110. T. UU2/007
CLIENT: WEST JEFFERSON (1)
ADDRESS:
CITY:
STATE:
I nft.
WATER4UALITY LAB_&-OP-ERATI.ON,.,.INC-,
P.O. BOX 1167,13ANNER ELK, NC 28604
(828) 89&6277
LOGIN TIME: 1:35 PM
SAMPLER:
COLLECTED bATE: 22-Jan-14
REPORTED DATE: 10-Feb-14
Af1A:R ...:
ANie>;tY61S:::,
�•E •
i•tOf7:'::::::::';::IWF::::;:
.CAT
.Q1ilIP��' LE•
TOTAL SOLIDS
1.09
MPN
DIG
FECAL COLIFORM
44037
1
/100 MIS
#3
23-Jan-14
SM-9222D
WPS
Pr:0n0TChl QV. n11- f MMrlMCn
1 A[ -U 11 A
PAUL ISENHOUR, SUPERVISOR

0-
1 *1/ L U I V I'R I U I . I I I IVI
F. UU3/007
-WAT.ER-QUALIT-Y-.LABAOPERATION,..INC.--
P.O. BOX 1167,13ANNER ELK, NC 28604
[phone],
CLIENT: WEST JEFFERSON (1) LOGIN TIME: 3-00 PM
ADDRESS:' SAMPLER:
CITY: COLLECTED DATE: 23-Jan-14
STATE: REPORTED DATE: 10-Feb,-14
100-
A NA
.. ..............
-'ANM X$14
R F- U LIT., 9- -
,N
`5
IfOTAL SOLIDS
1-04
-�A.
0 r 0 .
-
SM-9222D
FECAL COLIFORM
10140
1
MPN
/100 MIS
DIG
#3
24-Jan-14
RFPORTFr) PtV' KJ(- r.P:PT19=lr:r-%
I AD 4; CAA
PAUL ISENHOUR, SUPERVISOR
:m-
WPS

.Y

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
A
Facility Name: Town of West Jefferson WQ Permit Number: WQ0003992
WWTP Name: Town of West Jefferson NPDES Number: NCO020451
Monitoring Period: From 1/1/2014 To 12/31/2014
Pathogen Reduction (15A NCAC 02T .1106) - Please indicate level achieved and.alfernativP ppirfarrm-a•
Class A:
Alt. A (time/temp) ❑
Alt B (Alk Treatment) ❑ IFAlt.
C (Prior Testing)❑
A1t.D (No Prior Test) ❑
Process to Further Reduce Pathogengs [3
If applicable to alternative
performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying ❑
1 Heat Treatment ❑
Thermophilic ❑
Beta Ray ❑
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 "Process to Significantly Reduce Pathogens
Lime Stabilization ❑
Air Drying ❑
Cornposting ❑
Aerobic Digestion a
Anaerobic
obrc Digestion
If applicable to alternative performed (Class A or Class B) complete the following monitoring
data:
Parameter
Allowable Level
� Sludge
Pathogen Density
Number ot
Excee-
dencesg
Frequency
q y
of Analysis
Sample
p
Type
Analytical
Tech-
moue
Minimu
Geo. Mean
aximu
Units
Fecal Coliform
2 x 10 to the
6th power
per gam of
total solids
MPN
CFU
1000 mpn per gram
of total solid (dry
weight)
4.265
22521
866.666
Salmonella bacteria
(in lieu of fecal
coliform)
17nn+-r A+ta. ..+.,.
3 MPN per 4 grams
total solid (dry
Weight)
13..a..-4a! /1 c
A IkTdv ♦ r
n-
• a....,vl �«a aa.�ivii 1�GuuG1.1V11 11Jt1 1rl..Hl. UG I _ 1 1 U71 - YIPACP lnri�ratp altarn�tivn ►�nrfiwTMnrl. '
Alt.1 (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) ❑ Alt. 8 (Drying - Unstable) ❑
Alt. 9 (Injection) ❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed ❑
d- D'i'YVII' A'T7l%lkT CT A TTAT
.—TT /
-
�. a.i� 111' it.C11 1Vl\ .7 1 H 1 rA mA 1 kplease cnecK the appropriate statement)
❑ "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."
Charles Call Charles Call ORC
Pre�parer Name and Title (type or print)
p
Signature of Preparer*
Land Applier Name and Title (if applicable)(type or print)
1s
Date Signature of Land Applier (if applicable) Date.
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM PVRF 02T (12/2006)

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 - B
WQ Permit Number: WQ0003992
Facility Name: Town of West Jefferson
Residual Source WQ # or
NPDES #:
WWTP Name:
Residual Analysis Data
NCO020451
Town of West Jefferson
Laboratory: 1) Water Quality Labs
2) Blue Ridge Labs
3) Summit Environmental Technologies
4)
5)
Parameter
(mg/kg)
Ceiling
Conc.
Limit
Sam le or Composite Date
11/3/14
o.G
Percent Solids (%)
N/A
0.0063
Arsenic
75
158.7
Cadmium
85
31.7
Copper
4,300
1538
Chromium
NA
127.7
Lead
840
158.7
Mercury
57
0.8095
Molybdenum
75
296.8
Nickel
420
15.87
Selenium
100
158.7
Zinc
7,500
319
Total Phosphorus
NA
13381
TKN
NA
4222
Ammonia -Nitrogen
NA
2126.9
Nitrate and Nitrite
NA
658.7
a For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference the individual permit for metals limits.
"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 submitti g false information, including the possibility of fines and imprisonment for knowing violations."
t J ,
9&,f
reparer * Date
in 40 CFR 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: WQ0003992
Facility Name: Town of West Jefferson
Residual Source
NPDES # or WQ#:
NC-0020451
WWTP Name: Town of West Jefferson
Recidnnl Analvsic Data
Laboratory: 1) Water Qaulity Labs
2) Blue Ridge Labs
3) Summit Environmental Technologies
4)
5)
_
MEE
"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."
4
5
Date
in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF - B (12/2006)

CALCULATIONS WORK SHEET
_.Ibis work sheet is designed to assist the Division of Environmental Management in reviewing this E
possible. Its preparation in a complete and accurate manner is criticail to this.review. For don as �1timdy as
residuals or different residuals from the sate source, use adt clonal work sheets. penanits that cover multiple sources of
A . List the specific residual that is covered by these calculations '(plaee or process of origin),
What are the Itotal dry tons of this residual to be land applied each year?
Total Dry Tans = Gallons of Residuals * SLUM g,U lbsJgaft
MMuced annually, —A 00
Z,000 lbs.AM
Total Dry Tons 8.34 lbsJgalion
- inn
-2,0M lbs./ton
Dry Tons per year
If the quantity of residual will vary significantly or if there will be a larger initial application, please attach a detailed
explanation and provide calculations f6i each vaiia ,'
Complete the following calculations to establish ' the portion
up of the various parameters:
of the
residual that is ma de
% Total Solids
(PLEASE NOTE THAT ALL CONSTrrUENTS ARE To BE IN TOTAL, CONCENTRATIONS)
PARAMETER
CaCiiilllittl
m /L i- % SOUS Decimal
�. = m d
wt.
x
. A.,002
— ibs:/dr ton
Co er.
J
d a
_ y
= .
X
0.002
Ltad
/�/
D
�,
x
0.002
]Mickel
��
_
x
0.002.
= .
x
0.002
_ 39
{per mm5
Calcium
a DD
- a
-
x
'0.002
_.
iVla esium
V
—
x
'0.002.133
—
N43-NOZ-N
X
Phos horns
_
,
x
0.002
—
Potassium
X
0.002
_
sodium
-
x .
0.0.02
_ g
�KN
a.
X
0.002
�.
44
D� vl1
_-
.�
X
0.002
_
OTHER.
�a
y�
9 �GdCt{Y
o t? G9a U
—
0.002
= Dp
x
0.002
a.
x
O.W2
=
- �
x
0.002
U 9