WQ0022155_Renewal Application_20210223

Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0022155
Applicant/Permittee Town of Jefferson
Applicant/Permittee Address P.O. Box67 Jefferson, NC 28640
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Municipal
Facility Name Town of Jefferson DCAR
County Ashe
Fee Category Minor Fee Amount $0
Is this a complete
application?*
r Yes r No Complete App Date 02/23/2021
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by N B Staff
Name * Tim Church
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ ......... ....................................................................................................................................... .
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
336 246-2165
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation r High -Rate Infiltration
r Other Wastewater r Reclaimed Water
r Closed -Loop Recycle r Residuals
r Single -Family Residence Wastewater r Other
Irrigation
Permit Number:*
W00022155
Fbs Current Existing perrrit number
Applicant/Permittee *
Town of Jefferson
Applicant/Permittee Address*
P.O. Box 67 Jefferson, NC28640
Facility Name *
Town of Jefferson DCAR
Please provide comments/notes
on your current submittal below.
I inadvertently sent this as a hard copy on January 25, 2021 before I was aware electronic
filing was required.
Please pardon the inconvenience.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Specifications, Calculations, Bc.)
Renewal Class A Permit20210223_14031780.pdf 2.05MB
Locad only 1 RDFdocurrent (less than 250 W). NLfliple documents rust be corrbined into one RDFfile unless file is larger than
upload limit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
�c� Cyr

Submission Date 2/23/2021

'OR State of North Carolina
Department of Environmental Quality
DW Division of Water Resources
Division of Water Resources 15A NCAC 02T.1100 — DISTRIBUTION OF CLASS A RESIDUALS
FORM: DCAR 06-16
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Jefferson WWTP
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State X Municipal ❑ County
Signature authority's name per I SA NCAC 02T.0106: Tim Church Title: Water Resources Director
Applicant's mailing address: P. O. Box 67
City: Jefferson State: NC Zip: 28640
Telephone number: [phone] Email Address: ,centurylink.net
2. Consultant's name: n/a License Number (for P.E.):
Affiliation: ❑ On Staff ❑ Retained (Finn:.
Consultant's mailing address. -
City: — State: Zip:
Telephone number: (_) Email Address:
3. Fee submitted: _nla (See Instruction B)
H. PERMIT ]INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified, X renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: W00022155
Date of most -recently issued permit: July 28, 2016
Date of most -recently certified Attachment A (if different than the permit)-, n/a
III. FACILITY INFORMATION:
1. Name of residuals processing facility: Town of Jefferson WWTP
City: Jefferson State: NC Zip: 28640
Coordinates: Latitude-, 36' 24'37" Longitude: 81' 25'37"
Datum: Level of accuracy:
Method of measurement:
County where facility is located: Ashe
1 Facility contact (person familiar with residuals preparation):
Name: Tim Church Title: -Water Resources Director
Mailing address: P. O. Box 67
City: Jefferson State: NC Zip: 28640
Telephone number: [phone] E-mail address: o,centurylink.net
FORM: DCAR 06-16 Pagel of

3. Is the residual process facility also the generator? X Yes; El No
If No, please specify delivery frequency and quantity of residual to be processed:
4. Length of residuals storage at facility: 50 days (Note: the Division requires minimum 30 days storage in units that are separate
from treatment system, i.e. not in clarifiers, aeration basins, etc,)
IV. RESIDUALS QUALITY INFORMATION:
1. Specify how these residuals will be distributed:
R sold or given away in bags or other containers; X lawn (bulk); F-1 home garden (bulk);
X other (explain); hay fields, bulk
Note: Bulk residuals shall mean residuals that are transported and not sold or giving away in a bag or other receptacles with a
load capacity of one metric ton or less.
2. Complete the following if residuals are to be mixed with other materials:
Type of Materials Amounts to be added
I P per 1.0 dry ton of residuals (dry ton)
3. Approximate amounts of the residuals received and processed at the facility: 16 dry tons per year.
4. Approximate amounts of the final product (processed residuals) to be distributed: 16 dry tons per year.
5. Provide a description of the onsite storage management plan for the treated residuals (including estimated average and
maximum storage times prior to distribution): Approximately 1000 sq. ft. of covered storage is available on site but this facility
has never stored dry residuals on site.
6. Does the facility have a stormwater management plan? X Yes-, n No
Explain whether the treatment and storage areas are under roof or how stormwater runoff will be handled: The belt press and
sludge dryer are enclosed. Dry sludge is conveyed outside to a spreader truck and is disposed as it is produced. The spreader
truck is parked under the shed which has sub -&Lade drains that flow to the influent wet well of the WWTP.
V. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the attached Residuals Source Certificatioti and all associated documentation.
RSC 06-16.doc
FORM: DCAR 06-16
r-
Page 2 of 3

Professional Engineer's Certification: (Application Involving New or Changes to Treatment or Storage Units)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best of my knowledge
the proposed design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal pack -age
may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I have reviewed
this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
Applicant's Certification:
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T.0105.
X Yes ❑ No, Explain;
1, Tim Church Water Resources Director
(Signature Authority's Name — PLEASE PRINT) (Tide)
attest that this application for Town of Jefferson WWTP
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes §143-215,6A and §143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: r,,"CLL Date: January 20, 202
FORM: DCAR 06-16 Page 3 of 3

- ' S LOP\]
1111100k. in State of North Carolina
nw 0 Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Pease use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
Far more information, visit the Water Quality Permitting Section's lion-Discharye Permitting Unii
General — This certification provides detailed information of residuals source generating facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 02T .1100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 11-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the `Map Guidance for
Residuals Land Application Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16
Page 1 of 1

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Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
L RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Town of Jefferson WWTP
1 Facility permit holder is: ❑ Federal, n State, X Local Government or ❑ Private.
Facility permit issued by: Div. of Water Resources, ❑ Div. of Environmental Health,
or ❑ Other (explain: _).
3. Facility contact person and title: Tim Church, Water Resources Director
Complete mailing address: P.O. Box 67
City: Jefferson State: NC Zip: 28640
Telephone number: [phone] E-mail address: _jeffwns@centujylink.n
4. Facility physical address: .1233 Highway 16 S
City: Jefferson State: NC Zip: 28640
Coordinates: Latitude-. 361124'37" Longitude: 81' 25'37"
Datum: Level of accuracy:
Method of measurement:
5. Purpose of the facility:
X treatment of municipal wastewater, n treatment of 100% domestic wastewater,
n treatment of potable water, F] treatment of 100% industrial wastewater,
El treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: _ % industrial and - % domestic)
❑ other (explain: _ ).
& Does the facility have an approved pretreatment program: X Yes No
7. Facility permitted/design flow: 0.600 MGD and facility average daily flow: 0.240 MGD
8. Average amount of residuals being generated at this facility 60. dry tons per year,
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: Aerobic digesters 205,000 gallons
Type and volume of residuals storage (i.e., outside of residuals treatment units): 200,000 gallons
H. RESIDUALS QUALITY INFORMATION (See Instruction C.):
1. Specify if residuals are regulated under:
X 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T. 1102(6 as:
X Biological E] Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes X no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: ❑ yes X no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: Meritech Inc. and Date of analysis: 7/9/2020
Passed corrosivity test: X yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: X yes ❑ no. Flashpoint: > 140°F (> 140°F)
Passed reactivity test: Xyes ❑no. HCN: < 10. mg/kg (<250) & H2S: mg/kg (<500)
TCLP parameter
Limit
(mg/1)
Result
(mS/V
TCLP Parameter
Limit
(mg/7)
Result
(mgfl)
Arsenic
5.0
<0.100
Hexachlorobenzene
0.13
<0.100
Barium
100.0
1.23
Hexachloro-1,3-Butadiene
0.5
<0,100
Benzene
0.5
<0.01
Hexachloroethane
3.0
<0.100
Cadmium
1.0
<0.020
Lead
5.0
<0.100
Carbon Tetrachloride
0.5
<0.010
Lindane
0.4
<0.040
Chlordane
0.03
<0.003
Mercury
0.2
<0.02
Chlorobenzene
100.0
<0.0100
Methoxychlor
10.0
<1.000
Chloroform
6.0
<0.0100
Methyl Ethyl Ketone
200.0
<0.100
Chromium
5.0
0.060
Nitrobenzene
2.0
<0.100
m-Cresol
200.0
0.253
Pentachlorophenol
100.0
<0.500
o-Cresol
200.0
<0.100
Pyridine
5.0
<0.100
p-Cresol
200.0
0.253
Selenium
1.0
<0.100
Cresol
200.0
0.253
Silver
5.0
<0.050
2,4-D
10.0
<1.
Tetrachloroethylene
0.7
<0.0100
1,4-Dichlorobenzene
7.5
<0.100
Toxaphene
0.5
<0.05
1,2-Dichloroethane
0.5
<0.0100
Trichloroethylene
0.5
<0.0100
l,l-Dichloroethylene
0.7
<0.0100
2,4,5-Trichlorophenol
400.0
<0.100
2,4-Dinitrotoluene
0.13
<0.100
2,4,6-Trichlorophenol
2.0
<0.100
Endrin
0.02
<0.002
2,4,5-TP (Silvex)
1.0
<0.100
Heptachlor and its Hydroxide
0.008
<0.0008
Vinyl Chloride
0.2
<0.0200
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15 A NCAC 02T .1105.
a. For DishibutionlLandApp Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Meritech, Inc. and Date of analysis: 71912020
Parameter
Ceiling
Concentration Limits
(Class.4 & ClassB)
(mglkg)
Monthly Average
Concentration Limits
(Class A Only)
(mg1kg)
Result
(mg1kg)
Arsenic
75
41
<0.531
Cadmium
85
39
0.683
Copper
4,300
1,500
425
Lead
840
300
119
Mercury
57
17
2.176
Molybdenum
75
n/a
5.1
Nickel
420
420
19.1
Selenium
100
100
<0,531
Zinc
7,500
2,800
548
b. For Surface Disposal Unit (landfill) Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: - and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(meters, check one)
Arsenic
(mg1kg)
Chromium
(mg/kg)
Nickel
(M949)
❑ > 0 but < 25
30
200
210
❑ > 25 but < 50
34
220
240
El ? 50 but < 75
39
260
270
❑ >75 but< 100
46
300
320
100but < 125
53
360
390
125
62
450
420
Result (mg1kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 94.2%.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Meritech. Inc and Date of analysis: July 15, 2020
Parameter
Result
(mg49)
Aluminum
8,310
Ammonia -Nitrogen
2,260
Calcium
10,800
Magnesium
3,300
Nitrate -Nitrite Nitrogen
<10.6
pH (Standard Unit)
6.5
Phosphorus
17,600
Potassium
1,990
Sodium
513
Total Kjeldahl Nitrogen
13,300
c. Using the results listed in Item H. Bb above, calculate the Sodium Absorption Ratio (SAR ): 1.1
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30%. This
rate is a (check one): X default value, or ❑ actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals:
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (i') Year PAN
Five -Year
Maximum Adjusted PAN
N949)
Nglkg)
Surface
4,452.6
5,030.6
Injection/Incorporation
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7, Pathogen Reduction: Per 15A NCAC 02T, 1106, specify how residuals will meet the pathogen reduction requirements:
a. For DisitibutionlLand Application of Class A or Equivalent.
X A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
F] A salmonella sp. density that is demonstration to be less than 3 WN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
X Alternative I [ 15A NCAC 02T. I 106(b)(3)(A)] - Time/Temperature Compliance.
0 Alternative 2 [15A NCAC 02T. I 106(b)(3)(B)] - Alkaline Treatment.
❑ Alternative 3 [15A NCAC 02T. I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
❑ Alternative 4 [15A NCAC 02T. I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Heiminth Ova.
E] Alternative 5 [15A NCAC 02T. I 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP),
Specify one: rl composting, R heat drying, R heat treatment,
thermophilic aerobic digestion, ❑ beta ray irradiation,
❑ gamma ray irradiation, or ❑ pasteurization,
b. For Land Application of Gass B.-
0 Alternative I [ 15A NCAC 02T. I 106(c)(1)] - Fecal Coliforin Density Demonstration,
El Alternative 2 [15A NCAC 02T. I 106(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: E] aerobic digestion, ❑ air drying, n anaerobic digestion,
n composting, or ❑ lime stabilization.
c. For Surface Disposal:
[0 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item II. 7a. above,
F1 Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item H. 7b. above.
❑ Exempt -If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.1 106(a)(2)].
Not Applicable -Non-Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T. 1107 ' specify how residuals will meet the VAR requirements.-
❑ Alternative I [15A NCAC 02T.1 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic/Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T. I 107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
M Alternative 3 [15A NCAC 02T. I 107(a)(3)] - 3 O-Day Bench Scale Test (Aerobic Digestion).
R Alternative 4 [15A NCAC 02T. I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
F-1 Alternative 5 [15A NCAC 02T, I 107(a)(5)] - 14-Day Aerobic Processes.
E] Alternative 6 [15A NCAC 02T. I 107(a)(6)] - Alkaline Stabilization.
X Alternative 7 [15A NCAC 02T. I 107(a)(7)] - Drying of Stabilized Residuals.
M Alternative 8 [15A NCAC 02T. I 107(a)(8)] - Drying of Unstabilized Residuals.
M Alternative 9 [15A NCAC 02T. I 107(a)(9)] - Injection.
R Alternative 10 [15A NCAC 02T. I 107(a)(10)] - Incorporation.
El Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T. I 107(b)(2)].
EJ Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

Town of Jefferson Water Resources
DISTRIBUTION OF CLASS A RESIDUALS
(Renewal Applicatio►► for Permit Number WQ0022155)
Ashe County
TABLE OF CONTEjVTS for Sup orting Docume►►tatio►r
I - Form DCAR Parts D and H Narrative
Marketability Statement & Information Sheet for Recipients
Sampling Plan
2. Form RSC Part B. Residuals Source -Generating Facility Information
Vicinity Map
Process Flow Diagram
Quantitative Justification for Residuals Production Rate
Residuals Production Record
Residuals Tracking Record
3. Form RSC Part C. Residuals Quality Information
Laboratory Certificates of Analysis
Documentation of Compliance with PSRP and VAR Requirements

Town of Jefferson Class A Residuals Permit Renewal Application
Permit Number WQ0022155
Supportit,`Documentation
Form DCAR 11-13
D. Program Information
Liquid residuals are pumped from the final digester by a positive displacement pump located on
the Phoenix Belt Press. Prior to the wet residual flowing onto the press a dose of polymer is
applied and mixed into the flow. Dewatering occurs immediately and the resulting water is
captured in a tray under the belt and flows a trough that encircles the belt press and flows to the
influent wet well at the head of the WWTP, Water for the belt washing operation and for the
cooling of the dryer is normally supplied by a 2 inch potable city water line, although a system
for re -use of the WWTP plant effluent for this purpose is available.
From the end of the belt press the cake is moved by a screw conveyer into a hopper and then fed
in a batch process into the drum of the sludge dryer. As each batch is dried, the material is
discharged from the drum and conveyed by auger to the outside of the processing building. The
Class A residual falls into a spreader truck and distributed. Class A residuals are typically
distributed immediately after production and not stored at the WWTP. PAN and SAR
calculations are completed to ensure protection of soil quality. (See the attached process flow
diagram)
A marketability statement and information sheet is attached that the records the name and
address of the Town of Jefferson WWTP as the preparer, the name and address of the person
receiving the residuals, a statement that application shall be made according to the attached
information, no residuals should be applied to any site that is flooded, frozen, or snow-covered,
along with a reminder to observe all set -backs and avoid allowing any residuals to be carried by
run-off into surface waters. A11 application is to be done at agronomic rates according to this
sheet.
I1. Operation and Maintenance Plan
See Attachment on following page.

Operation and Maintenance Plan
Multiple original factory Operation and Maintenance Plans for the Phoenix Belt Press and the
Fenton Sludgemaster RK Dryer are onsite at the Wastewater Treatment Plant. However each are
contained in a binder format that is well over 100 pages in length. These manuals include all
maintenance schedules, safety precautions, and daily inspection schedules. Due to their volume
we are reluctant to include them in this application, but will certainly make them available upon
request.
The plant's ORC as well as the lead operator and maintenance superintendent are knowledgeable
of exercising the on -going maintenance and operation of the units. The sludge dryer is connected
by computer modem to the manufacturer in Brownwood. Texas and almost any operational
malfunction can be diagnosed and corrected via phone line.
A spill response plan for this operation is accomplished by the fact that the entire dewatering and
drying operation is self-contained in one building dedicated for this use alone. All units are
encircled by a pre -cast trough poured into the floor that collects any spillage or wash water and
returns it by gravity to the influent wet -well at the head of the WWTP.
Each unit is inspected every day of use prior to operation by the WWTP operator/maintenance
technician, Fred Walters, and / or the Water Resources Director and WWTP ORC, Tim Church.
Two documents (both are attached) allow operators to verify compliance with Class A
requirements.
* "Production Record" is used to verify that the Thermal Fluid temperature recommended by
the manufacturer has been achieved. The actual discharge temperature of the residual is also
recorded along with the length of drying time, thus demonstrating compliance with Pathogen
Reduction, Alternative 1 - Time / Temperature Compliance. Also a certificate of analysis is
attached that verifies compliance with Vector Attraction Reduction criteria Alternative 7,
Drying of Stabilized Residuals.
* "Tracking Record" is used to record the name and address of recipients as well as the date of
distribution. We are in the process a making a change to this format that will record residuals
volumes in dry tons rather than batches.
Sampling is conducted as per conditions set forth within the permit. The person responsible for
this activity is the Water Resources Director.

Class A Dry Biosolids Production Record
OzIPathogen Reduction Alternative 1
(Complete a line for each batch produced, not just a line for each day.)
DATE
Thermal Fluid
1 Discharge Temperature
Drying
Time of
Degrees F
i Degrees F
Time, hrs.
Discharge
q5Q
ZR7
1130
I. lq- 2-1
450
I
—1
1,530
1. 15. z'I
SO
Z17
ZI
L 2A, bi
q 5' 0
U211
4
4SO
2,97

Town of Jefferson NNANIT
Trackinay Record for Class A Residuals
Date Distr1hUted
Recipictit Nnnic
R,:cipient Address
Residual� VOIL1111C. dr-\ tons
Use of Residuals
PAN
Mar (.0, 2=,
�;pd WatftA,4
767J)Dr, \)Jak-A-
3 PI),Z41,11,-
9�4f- 15, W2.6
Fr-rd
F
4 It It
I&. & z26
Fred WIC-
7�70on Wkx 0
rra S1,4r,
j c, Jc
r, v
Ji:�

SOUTH FORK 6-1-0 Biosolids Fertilizer
Produced by Town of Jefferson
P.O. Box 67 Jefferson, NC 28640
South Fork 6-1-0 (SF 610) is a high organic content fertilizer manufactured by the Town of Jefferson Wastewater
Treatment Facility. This material produces superior results•on lawns, Christmas trees, flower beds, and shrubs
providing nutrients at the rates indicated below.
GUARANTEED ANALYSIS
Total Nitrogen.........................................6
%
Water Insoluble Nitrogen ..........................3.5%
Available Phosphoric Acid.........................1
%
Soluble Potash.........................................0
%
Iron...........................................................I %
RECOMMENDED APPLICATION RATES
Lawn -Sod Establishment: Apply SF 610 at a rate of 30 lbs./1000 square feet at time of planting
Turf Maintenance: Apply SF 610 at a rate,of 10-15 lbs./1000 square feet every 3 months
Plant Bed Establishment: Apply SF 610 at a rate of 2 lbs. / 100 square feet and mix into the soil
Plant Bed Maintenance: Apply SF 610 at a rate of 2 lbs. / 100 square feet in the Spring and Fall
WARNINGS: SF 610 is environmentally safe when used as directed, but can become a hazard if mismanaged. This product
should not be used on soils intended for food crop production. This product should not be used as a starting medium for
germinating seeds other than grasses. Cover SF 610 with a tarp or plastic during transport. Store SF 610 in a dry area away from
wells or surface waters where it could be washed into streams: keep bulk product away from areas where children may play or pets
may wander.
LIMITED WARRANTY AND DISCLAIMER: The Town of Jefferson warrants that SF 610 meets the specifications stated
above, and that the heavy metals content is less than or equal to the limitations specified in EPA and NC DENR sludge quality
criteria for land application. There are no warrantees expressed or implied that extend beyond the description contained herein.
Specifically, there are no warrantees of merchantability or fitness for a particular purpose. If SF 610 fails to meet its specifications
the buyer's sole remedy shall be the recovery of the purchase price. Under no circumstances shall the Town of Jefferson be liable
for any other damages, including direct, indirect, consequential or special damages.
ACKNOWLEDGEMENT: The undersigned Buyer acknowledges that he/she has read this brochure and is familiar with its
contents. The undersigned Buyer agrees to abide by the following restrictions:
1. SF 610 shall not be applied to land except in accordance with the instructions contained herein.
2. SF 610 shall not be applied to any site that is flooded, frozen, or snow-covered.
3. SF 610 shall not be applied within 25 feet of any water supply, stream, or lake.
4. Adequate measures shall be provided to prevent surface runoff from carrying this product into surface waters.
Buyer Signature
Name (print)
Address
Date
Quantity:
Intended Use
Amount Collected $
Lbs Tons

Town of Jefferson WWTP
Class A Residuals Permit Number WQ0022155
Sampling Plan for Class A Residuals
Samples for the analysis of the following parameters will be collected at the final aerobic
digester which supplies liquid sludge to the belt press:
Arsenic
Cadmium
Copper
Lead
Mercury
Molybdenum
Nickel
Selenium
Zinc
Aluminum
Ammonia- nitrogen
Calcium
Magnesium
Nitrate- Nitrite nitrogen
%Total Solids
pH
Phosphorus
Potassium
Sodium
TKN
PAN and SAR calculation
Toxicity Characteristics
Leaching Procedure
Samples for the purpose of demonstrating compliance with PSRP and VAR requirements
including %Total Solids and Fecal coliform will be collected at the discharge end of the
screw conveyor which moves the dry product from the dryer drum to the spreader truck.

4 e _
6
0
4.
r
w
"rl
Ix
:J% � cn _��`t� ..._-� f� •!i' }�.t, �- '� ,! _"`, +. J;� !.� 7 ��, ��i1`\v�� 'f? f7.� , t ` I i r .i= I � '
Z n Oz ` �C • n�' �.
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ty O
z
go
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o N .•,
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rn
to
o ,. i r , �C o• n x •'
;
��r^ '�ti It f} .%//f 1•�(�� // - `t� jj/j • L' i� 4( /( t 'y
� - � s �� �,•- : , i� � �- " � ii fly- -
i
r

11
ns
ro
vi

Town of Jefferson WWTP
CLASS A RESIDUALS PERMIT WQ0022155
Quantitative Justification of Residuals Production Rate I
This justification is based upon the most recent five years of production and the
production rates found in previous permits.
The five year average shows the Town of Jefferson WWTP producing approximately 16
dry tons of Class A residuals annually, in addition to the Class B program.
The proposed maximum of 120 dry tons per year suggested in this request is based
upon the proven record of this facility to produce additional volumes of Class A
residuals should the need arise to become more reliant upon the Class A program.
The original permit issued in 2002 allowed 133 dry tons of production.

Jefferson WWTP
BELT PRESS FLOW

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Meritech Work Order # 07092022 Sample: Class A dry residuals Grab
Revised Date:
Report Date:
NPDES #:
Project:
P.O. #:
Date Sample Rcvd:
Page 3
712912020
7/27/2020
NCO042269
Class A Residuals
2165
7/9/2020
7/8/2020
Parameters Results Analysis Date Reporting Limit Method
%Total Solids
94.2 %
7/10/2020
0-100 %
SM 2540B
Ammonia, Nitrogen
2,260 mg/kg
7/10/2020
10 mg/kg
EPA 350.1
TKN
13,300 mg/kg
7/15/2020
20 mg/kg
EPA 3 51 .1
Nitrate/Nitrite, Nitrogen
<10.6 mg/kg
7/9/2020
10.6 mg/kg
EPA 353.2
Aluminum, total
8,310 mg/kg
7/15/2020
2.50 mg/kg
EPA 200.7
Arsenic, total
c0.531 mgjkg
711512020
0,531 mgjkg
EPA 200.7
Cadmium, total
0.683 mg/kg
7/15/2020
0.200 mg/kg
EPA 200.7
Calcium, total
10,800 mg/kg
7/15/2020
10.0 mg/kg
EPA 200.7
Copper, total
425 mgjkg
7/15/2020
1.00 mg/kg
EPA 200.7
Lead, total
13.9 mg/kg
7/15/2020
0.500 mg/kg
EPA 200.7
Magnesium, total
3,300 mg/kg
7/1S/2020
10.0 mg/kg
EPA 200.7
Mercury, total
2.176 mg/kg
7/14/2020
0.02 mg/kg
EPA 245.1
Molybdenum, total
5.10 mg/kg
7/15/2020
0.500 mg/kg
EPA 200.7
Nickel, total
19.1 mg/kg
7/15/2020
2.0 mg/kg
EPA 200.7
Phosphorus, total
17,600 mg/kg
7/15/2020
2.00 mg/kg
EPA 200.7
Potassium, total
1,990 mg/kg
7/15/2020
20.0 mg/kg
EPA 200.7
Selenium, total
<0.531 mg/kg
7/15/2020
0.531 mg/kg
EPA 20M
Sodium, total
S13 mg/kg
7/15/2020
20.0 mgjkg
EPA 200.7
Zinc, total
548 mg/kg
7/15/2020
0.500 mg/kg
EPA 200.7
pH
6.5 S.U.
7/9/2020
1.0 - 14.0 S.U.
SM 4500-HB
1 hereby certify that 1 have reviewed and approve these data.(/Will
Laboratory Representative
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

MERITECH, INC.
.ea Environmental Laboratories
Laboratory Certificate #165
Client: Town of Jefferson WWTP
Project: Class A Residuals
Client Sample ID: Class A Dry Residuals
Sample Collection: 07'O8/20
Meritech Sample ID: 070420222
1311 - TCLP Organics
Volatiles: S1N'-846 8260
Analysis: 07116/20
Extraction:
0713/20
Analyst: VNVV
Report Date:
07t20/20
Parameter
Result
Units
Det. Limit
Reg. Limit
Dilution Factor
Benzene
< 0.0100
miz L
0.0100
MO
10
Carbon Tetrachloride
< 0.0100
rm8 L
0.0100
0.50
10
Chlorobenzene
< 0.0100
mg'L
0.0 1Ora
100
10
Chloroform
< 0.0100
❑ie/L
0.0100
6.0
10
1.2-Dichloroethane
< 0.0100
mP'L
0.4140
0.50
10
1. 1 -Dichloroethenc
<0.0100
m&I.
0.0100
0.70
I
tileth)i Ethyl KetUne
<0.I00
ma:'L
0.10u
200
10
TetrachloroethN lene
< 0.0100
me,1.
0.0100
0.70
10
Trichloroethene
<0.0100
me;l.
0.0100
0.50
10
Vinvl Chloride
< 0.0200
mwl-
0.020
0.21)
l t)
Semi-Volatiles: SW-846 8270
Analysis: 07117/20
Extraction:
07/13/20
Analyst: PM
Report Date:
07/20/20
Parameter
Result
Units
Det. Limit
Reg. Limit
Dilution Factor
1.4-Dichlorobenzene
<0.100
ntg,L
0.100
7.5
10
Hexachlorobenzene
<0.100
m&L
0.100
0.13
10
Hexachloro-l.3-butadiere
<0.100
mgil-
0.100
0.5
10
Hexachloroethane
<0.100
meiL
0.100
3.40
14
o-cresol
<0.100
mg;L
0.100
200
10
m&p-cresol
U53
rng/L
0.200
200
10
Total cresols
0.253
m2it.
(1.300
200
10
Nitrobenzene
<O.100
ma•L
U.I(if
2.00
10
Pentachloropheno�
<u.SUU
ma�L
0.5()(,,
101)
10
P\ridine
<U.100
m61,
0.100
5.0
10
2.4.5-Trichlorophenol
<0.100
nu,'L
0.100
400
10
2.4,6-Triehlorophenol
<0.100
mgil.
0.100
2.00
10
2A-Dinitroioluenc
<0.100
mcf1,
0.100
0.13
10
I hereh)• certify, that I hove reviewed and
approve
these dala.
Laboratorl, Representative
642 Tamco Road * Reidsville, NC 27320
[phone] * [e-mail]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Page 1
Report Date:
7/27/2020
NPDE5 #:
NCO042269
Project:
Class A Residuals
P.O. #:
2165
Date Sample Rcvd:
7/9/2020
Meritech Work Order # 07092022 Sample: Class A dry residuals Grab 7/8/2020
1311 - TCLP Metals
Parameter
Results
Analvsis Date
Det, Limit
Re;. Limit
Method
Arsenic
<0.100 mg/L
7/22/2020
0.100
5.0
EPA 200.7
Barium
1.23 mg/L
7/22/2020
0.050
100.0
EPA 200.7
Cadmium
<0.020 mg/L
7/22/2020
0.020
1.0
EPA 200.7
Chromium
0.060 mg/L
7/22/2020
0.050
5.0
EPA 200.7
Lead
<0.100 mg/L
7/22/2020
0.100
5.0
EPA 200.7
Mercury
<0.02 mg/L
7/21/2020
0.02
0.2
EPA 245.1
Selenium
<0.100 mg/L
7/22/2020
0,100
1.0
EPA 200.7
Silver
<0.05o mg/L
7/22/2020
0.050
5.0
EPA 200.7
TCLP Organics
Parameter
Results
Analysis Date
Reporting Limit
Method
Volatiles 8260
Attached
7/16/2020
8260
Semi Vol. 8270
Attached
7/17/2020
8270
Other Tests
Parameter
Cyanide, total
1.29 m-/kg
7/16/2020 0.500 mg/kg
EPA 335.4
Sulfide
<10 mg/kg
7/15/2020 10.0 mg/kg
SM4500S2DB
Flash Point
>140 °F
7/16/2020 -
EPA 1020B
Corrositivity (pH)
6.5 S.U.
7/9/2020 1.0 - 14.0 S.U.
SM 4500 HB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

REsF-ARch & ANAlyTicAt
F Q UbOIrwoRksr INC.
Analyticai/Process Consultations
Toxiciq Characteristic Leachate Procedure CLP) Analysis for Meritech, Inc., collected 08 July 2020)
07092022
EPA HW Quentitation Results Characteristic
Number Contaminant Limit(metL) (rnQJL) Level(,m /L} EPA Method Analvst
1. TCLP PESTICIDESIHERBICIDES
D-020
Chlordane
D-01 b
2,4-D
D-012
Endrin
D-031
Heptachlor
D-013
Lindane
D-014
Methoxychlor
D-015
Toxaphene
D-017
2,4,5-TP(Silvex)
Sample Number
Sample Date
Sample Time (brs)
Sample Matrix
Date Analyzed
0.003
BQL
0.030
8081
MG
1.000
BQL
10.0
8151
MG
0.002
BQL
0.020
8081
MG
0.0008
BQL
0.008
8081
MG
0.040
BQL
0.400
8081
MG
1.000
BQL
10.0
8081
MG
0.05
BQL
0.500
8081
MG
0.100
BQL
1.00
8151
MG
84584-01
07/08/20
1130
Sludge
07/2020
mg/kg - milliga= per kilogmaln - parts per million (ppm) BQL - Below Quantitation Limits

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Page 2
Report Date: 7/27/2020
Contact: Tim Church NPDES#: NCO042269
Client: Town of Jefferson WWTP Project: Class A Residuals
P.O. Box 67 P.O. #: 2165
Jefferson, NC 28640 Date Sample Rcvd: 7/9/2020
Meritech Work Order# 07012037 Sample: NCC Building/Solar Panel 6/30/20
1311 - TCLP Pesticides & Herbicides
Pesticide - SW-846 8QaIA
Parameter Results Analysis Date Det. Urni Reg. Limit Dilution Facto
Endrin Attached
Chlordane Attached
Toxaphene Attached
Methoxychlor Attached
Heptachlor Attached
Lindane Attached
Herbicides - SW-846 8151A
Parameter Results Analysis Date Det. Limit Reg. Limit Dilution Facto
2,4-D Attached
2,4,5-TP (Silvex) Attached
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax,[phone]

Chain of Custody Record (COC)
NPDESW
o-qL ' Affsorl_Y1CYV 1 L Phone: t,
� � �lient:_
% INC..
Address: P 0.Rox 7 Fax:
ENVIRONMENTAL LABORATORIES
L y
i)��yOLIT EmailJkTw SreII__Cl�'.
642 Tamco Rd. Phone: [phone]
Project:
t7' Reidsville NC 27320 Fax: [phone]
i
P.Cf.#:LlIJ
Email: [e-mail]
Attention: 1 C. , Turn Around Time`
Now would you like your report sent? *RUSH work needs prior approval.
www.CT eritec 1 r1�).`:;.( ()ii-I
_
stdLioda s} S 17ays a ntstlrt
Circle all that apply: Email prelerred) , Fax, Mail r— �1---
.
Sampling Dues & Times
Person Taking Sample (Sign/Print)�i
Lab Use Only
Sample Location and/or ID It
Start End
Comp? u of
Test(s) Rz�,',u(red
On Ice? Yes pl-I 00
Date
Time
Date
Time
Grab? Cont.
/ No Cl OK?
resin
_
1
7%© Olids MV3
_
cadmii0m, C CI Lend,
_
d 1 _W f kZ . pi
y p � L T
' wm. TkH.
Zinc-,.
6RI fe-sic6als
A
Temperature Upon Receipt,
Method Of
*** Dechlorination (<O.5 ppm) of Ammonia, Cyan ide, Phenol and TKN sine les nxrst be done in the field prior to preservation,—'
Shipment:
Comments:
Compositor fl
Jul It
/ UPS
E.J Fed Ex
Are ese cults for regulatory purposes? Yes i_..I No '
Report results in: mg/L _„J mg/kg ug/L I
Hand Delivery
Relinquished by: , au. Time:
Received by: Date: Time:
— Outer
Relinquished by: Date: Time:
Received by. Date: lime:
Rehnritn5hed by: Date: Time:
fteetTived L b: _- ;» f Date:
l

CLIENT: JEFFERSON
ADDRESS:
CITY. -
STATE:
ID#:
WATER QUALITY LAB & OPERATION, INC.
P.O, BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME: 1:50 PM
SAMPLER:
COLLECTED DATE: 6-Apr-20
REPORTED DATE: 6-May-20
ANALYSIS
ANALYSIS
MQL's
UNITS
SAMPLE
ANALYSIS
METHOD
INT
RESULTS
LOCATION
COMPLETED
CODE
TOTAL SOLIDS
93,1
01111
CLASS A
FECAL COLIFORM
220
1
MPN
SLUDGE
7-Apr-20
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB ft 544
PAUL ISENHOUR, SUPERVISOR
��

SAR Calculator — Oklahoma State University Tudgrass Science
SAR Calculator
Adjusted SAR Calculator
EC 1 PS
Ca 11.0206j mg/l or ppm
Mg 13102 1 mg/l or ppm
Na 482.�) mg/l or ppm
HCO3 I mg/l or ppm
SAR
adj SAR 0.6
Use the larger of the two 1.1
Reset
adj Classification SAR Management Considerations
< I Excellent None
1-2 Good Little concern, add pelletized gypsum periodically
Aerify soil. sand topdress, apply pelletized gypsum, -1
2-4 Fall' g. psurn, monitor sot
salinity
4-8 Poor Aerify soil, sand topdress, apply pelletized gypsum, leach soil
regularly, monitor soil salinity closely
8-15 Very Poor Requires, special attention; consult water quality specialis
t
ist
> 15 Unacceptable Do not use
C;2021 - Oklahoma State University I All rights reserved
turf.okstate.edu/water-quality/-,ar-cair-Litator 1il