WQ0004166_Residual Annual Report 2021_20220204

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnWrvnmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
If not an application what is the submittal type?*
Annual Report
Residual Annual Report
Additional Information
Other
Annual Report Year* 2021
Permit Number (IR) * WQ0004166
Applicant/Permittee Town of Jefferson
Email Notifications
Does this need review by the hydrogeologist?* Yes • No
Regional Office
CO Reviewer
Admin Reviewer
Winston-Salem

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name*
Tim Church
Email Address* Phone Number*
[e-mail] 13362462165
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deg.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: * WQ0004166
Has Current Existing permit number
Applicant/Permittee Address*
Facility Name*
P.O. Box 67 Jefferson, NC 28640
Town of Jefferson Class B Residuals Program
Please provide comments/notes on your current submittal below.
High -Rate Infiltration
Reclaimed Water
Residuals
Other
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here. *
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
Residuals Report B 202120220204_14580583.pdf 16.87MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 2/4/2022

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0004166 County:
Facility Name (as shown on permit):
Land Application Operator:
Ashe
Year: 2021
Town of .lefferson
Tim Church
Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
Yes LJ No - If No, skip Part A, and Part B and proceed to Part C. Also, If residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A -Residuals Application Summary:
Total number of application fields in the •ermit:
2
Total number of fields utilized for land application during the year:
2
Total amount of dry tons applied during the year for all application sites:
50.5
Total number of acres utilizes for land application during the year:
35
Part B - Annual Compiance Statement:
Facility was compliant during calendar year 2021 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. 0 Yes LI 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 Resources.
10) No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of violations are
attached to include appropriate actions and remediations.
11) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified in the permit.
12) No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
13) All buffer requirements as specified on the permit were maintained during each application of residuals.
Part C - Certification:
"I certify, under penalty of law, that the above information is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations."
Tim Church, Water Resources Director
Permittee Name and Title (type or print) Signature of Permittee
2/V/2z
Date
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)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Town of Jefferson
Facility Name:
NC0021709
z
Jefferson WWTP
Sample or Composite Date
2/11/21
1.74
2.87 1
SLY()
420 1 1
2.07 1
4.79 1
1 22500
1210
00
N
pc
O
o
oc
in
in
O. I, CI
Conc.
Limit
(mg/kg)a
NA
0
4,300 1
¢
z
840
SL
420
0zzz
1 NA
NA
mumuuai hua.y,1
Parameter
(mg/kg)
Percent Solids (%)
Arsenic 1
Cadmium
Copper
Chromium
Lead 1
Mercury
o
>,z
0
U
Selenium
0
• —
N
Total Phosphorus
TKN
Ammonia -Nitrogen
Nitrate and Nitrite
-a
cd
C
bA
z u C �+
'C e%
u
C
> a
Clu
z
3 0
L
Y C
E v S .O
- C 0
ca .b O
L ,..+
u u bA
L.
II II
P C II o
0- o =
.0•y it L.
-0 > -
>_ L y
adO G iv, U
C
L c C
.Q o
C vCi 'L ��2
�, u
L.�- N
JD 0
L C
n. CI) 0)L:,
Ct = r.+ O
s_ '
o = t,
-� y
I.
O L^, CC v
L Id CA
C.
_ C., ..0
C I.)tS RS -I...
a.)+ a"Cl bA
.� C L. C
z v u "7
E i O
O C� U
u bA 0
O "I C
L. o
a.)4.. O CC
u �, L. =ct
o L.
u =
u CC
c 3 C C 'w
C
C.O.' 0
U Id
° c``� .
bA
ca u , c
C=
u • —
O _
v0 v. O
"o z
n C C� L.
0 O
u J w
,c 4. L. u
0 1..
z
u z, :s
o CO CI 0
Signature of Preparer
DENR FORM RSSF (12/2006)
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)

Meritech, Inc.
Town of Jefferson WWTP
Facility Name:
NC0021709
Residual Source
NPDES # or WQ#:
Jefferson WWTP
Sample or Composite Date
2.11.21
16200
5200
2490 1
3940 1
E
O
Q
r
U
C/
Maenesium
-d
C0
IPotassium
C..
Q
C.-
Q
C/1
1
DENR FORM RSSF - B (12/2006)
N
N
U
z
r-
Cd

Facility Name:
Permit #:
Operator:
Acres Used:
ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Town of Jefferson WWTP Total Dry Tons Applied (Annual): 33.20
Cation Exchange Capacity (non 503 only): 14.6
Predominant Soil Series: Watauga
WQ0004166
Tim Church Owner: Fred Walters
26 Acres Permitted: 26 Site it: Fred Walters Field #: 1
7y Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
1_i
2.11.21
2J
3 1 _4_,
_5,
6_:[
7)
8.1
9 1
10]
11
12 j
% Solids
1.74
Arsenic
2.87
Cadmium
0.57
Copper
420
Chromium
0
Lead
11.1
Mercury
2.07
Molyb-
denum
4.79
Nickel
17.5
Selenium
2.87
Zinc
684
Total
Phos-
phorus
22500
�n Ias/acre s:
Total
DT/Ac./
App.
Event
_1 ±
1.27
2 l
3]
4i
5
6]
7]
8
9 1
10 1
11 j
12_
1 r
0
Totals: o
0
Arsenic
0.007
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Cadmium
0.001
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.001
Copper
1.067
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.067
Chromium
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Lead
0.028
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.028
Mercury
0.005
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.005
Molyb
denum
0.012
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.012
Nickel
0.044
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
' 0.000
0.000
0.000
0.044
Selenium
0.007
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.007
Zinc
1.737
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.737
Total
Phos-
57.150
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
57.150
phorus
"I certify, under penalty of law, that this document was prepared under my a�rect�on or superv�s�on in accor ance
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
DENR FORM MFLSF (12/2006)

D. Tons
�Sf
NI
N
NO
M
c:.
—1'
M
'p
(,)
"„-:
N.
C>
Cot
Loads 1 Gallons
Sf
g:..S).
JC
.g.
,
M
.
8
csrj
�9
o<3
(8
---
,
.,
(>‹:
N
,...,..)
....--
-�
'''q
�'
.e
(:4),
.z.-
'''-
„4"-",
',
7
d
bC
cc
o
March
L.
May
>,
September
October
November
December
TOTAL

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.
N
Acres Utilized:
.10
WQ Permit #: WQ0004166
Facility Name: Town of Jefferson WWTP
Acres Permitted: 26
Site #: Fred Walters
Annual Dry Tons Applied: 33.6959
Land Owner: Fred Walters
Cation Exchange Capacity (non 503): 14.8
Predominant Soil Series: Watau
Operator: Tim Church
E
a
U
Name of Crop Type
Receiving Residual
Application
N
0
U
I Lime Applied
0
Ct
cn
—
o.
U
d
w
0CI0
=
w
c
w
o
w
0
c�
0
o
w
0
o
ea.?,
0
w
N
Q
PAN Applied
( lbs/acre)
N
0,
2O
i�
Q
z
<
z
Q
z
<
z
<
z
Q
z
<
z
<
z
O
O
O
O
O
O
O
O
0
O
:-
IC
V7
0,
O
(�
,.D
00
M
N
o
7
00
---
,,O
N
N
7
ON
O
-
4,
7
,n
O
v,
00
00
M
ON
O
et
O
e1'
0
N
M
O
0
O
O
O
0
O
O
O
0
O
O
O
0
O
O
N
00
,n
e~
eei
0 .0 Y
o
0
0
0
0
0
0
0
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form): I
0
Ammonia rn
Nitro en E
B
N
'r'
'^
N
"'
"'
N
"'
'^
"'
'^
c
N
m0
•
~
Vi
•v
00
M
et
00
00
o,
N
Z .
rn
E-E
O
N
00
O
N
0o
O
N
00
O
N
00
O
N
00
O
N
00
O
N
00
O
N
00
y
(A
00
0
0
s
O
~
pop
O
~
0.,,yf
0p
Mineralization
Rate***
o
o
m
o
o
M
a
O
M
o
O
M
0
O
M
0
O
M
0
O
m
0
O
M
Z
"Er
o
0
en
,__,
,;
r`
M
Volatilization
Rate**
o
0
0
0
�,
0
�,
0
.
0
.n
0
o
o
M
0
eh
0
'o
Application
Method*
N
N
N
y
N
N
N
by
x
o
0
o
v..,M
0
0
0
0
•.. N vi m
y �. L
a
C
C
O
O
O
c)O
c)
iao
00
O
,1
`.D
N
ro 8 A " 8
0
�
�
�
�
�
�
�
I. U
0
o
o
0
0
Z
Residual Sources
(NPDES #, WQ#,
Fert., Animal
Waste, etc)
0
0
0
z
0
0
0
z
0
0
0
z
0
0
0
z
0
0
0
z
0
0
0
z
0
0
0
z
0
0
0
z
U
o
o
N
00
VD
N
00
M
'O
U
O
Q
0
7
0
0
M
.:.
N U
CI a a
b C
d V 0
>ad L-00
Q 1
11
M
M •
0
0.080
O
000
N
O
0.236
0
00
0
0.000
0
O
¢000
O
OO
b
M
N
o
too
Annual lbs/acre
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R. * * * *
Permit PAN Limit lst/2nd Crop
Volume applied
(enter one) Solids/
Liquid
Cu. Yds Gallons
63000
48600
0
28800
14400
102600
10800
84600
464400
0
10otea
¢-�
�zQ
F
.0
Ec
O OD
p c
w
'C
c �
OD
.0
C.
d an
v
OD
c
O
cu
c
O
et
Q
* *
Signature of Land Applier
DENR FORM FSF (12/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
Town of Jefferson Total Dry Tons Applied (Annual):
WQ0004166
17.30
Cation Exchange Capacity (non 503 only): 12.4
Tim Church Owner: Johnny Walters Predominant Soil Series: Watauga
9 Acres Permitted: 9 Site #: Johnny Walters Field #: 5
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or
Com-
posite
Date
,_ 1!
2.11.21
_ 2
3 1
4 1
5 1
61
7J
8 j
91
10 j
111
12]
% Solids
1.74
Arsenic
2.87
Cadmium
0.57
Copper
420
Chromium
0
Lead
11.1
Mercury
2.07
Molyb-
denum
4.79
Nickel
17.5
Selenium
2.87
Zinc
684
Total
Phos-
phorus
22500
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
DT/Ac./
App.
Event
1
1.90
2
3 1
4'
5"
6
7
8
9
10 j
11 I
12
o
y
Arsenic
0.011
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.011
Cadmium
0.002
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.002
Copper
1.596
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.596
Chromium
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Lead
0.042
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.042
Mercury
0.008
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.008
Molyb-
denum
0.018
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.018
Nickel
0.067
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.067
Selenium
0.011
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.011
Zinc
2.599
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
2.599
Total
Phos-
phorus
85.500
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
85.500
"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".
2/Y122
Signature of Land Applier
Date
DENR FORM MFLSF (12/2006)

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.
Acres Utilized: 9
w
Acres Permitted: 9
L
a)
0
Annual Dry Tons Applied: 17.3704
ti
u
a0
Predominant Soil Series: Watau
Operator: Tim Church
z
a
V)
E
z
U
Name of Crop Type
Receiving Residual
Application
N
o.
U
Lime Applied 1
()
an
.o
OO
0
m
w
y
w
lig
A
PAN Applied
( lbs/acre)
N
o.
U
Q
z
Q
z
o
o
o
0
O
0
0
0
O
0
0
0
O
0
0
0
O
0
0
0
0
0
0
0
0
0
0
0
0
0
0
o
0
0
0
c>
0
0
0
o
0
0
0
o
155
a
o
,
o_
-„
-)
0
0.0.......
O
0
O
0
O
0
O
0
O
0
O
0
C
0
O
0
O
0
O
°`
N
2 rn
z z
co
coO
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
a
tri
ao
—
'•'•'•
..
Ammonia a'
Nitrogen E""
N
a
N CN
~
so
~
a
00
ON
N:
.x
0
0
,-4N
000
Mineralization
Rate***
o
m
o
M
"
O
0
O
"
O
M
Volatilization
Rate**o
to
O
v1
O
0
0'°
co
coO
0
0
-
Application
Method*
N
N
On
x
0
0
o
0
0
0
0,
0
C.4, N• fS
N V .6
O
o. .__
O
O
N
O,D
00O
M
V'')l
er
N-
N
0
Residual Sources
(NPDES #, WQ#,
Pert., Animal
Waste, etc)
O
N
0
0
z
O
N
0
0
z
O
h
00
7
M
U
0
0
O
0
O
0
M
Volume
Applied per
Acre
(Dry Tons/Ac)
M
—_
00
0
N
.-+
O
O
o
O
O
o
O
0
0.000
0.000
o
O
O
O
0
O
too
0
0
O
C
0
o
o
0
0
0
O
0
0
0
o
0
---
o
0
0.455 I
' O
so
7
O
�O
M
o 'C
O
C7
s.
r.
239400
Annual lbs/acre
Prior Years Cumulative lbs/ac
Current Cumulative lbs/ac
Permitted C. P. L. R.****
Permit PAN Limit 1 st/2nd Crop
Volume applied
(enter one) Solids/
Liquid
Cu. Yds I Gallons
0
00
0
0
138600
0
tpuow
zo a;EQ
.o:
¢
cn
0
F
DENR FORM FSF (12/2006)

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Report Date:
NPDES #:
Project:
P.O.#:
Date Sample kcvd:
Page 3
3/8/2021
NC0021709
Class B Sludge
2165
2/11/2(721
Meritech Work Order # 02112190
Parameters
0/0 Total Solids
Ammonia, Nitrogen
TKN
Nitrate/Nitrite, Nitrogen
Aluminum, total
Arsenic, total
Cadmium, total
Calcium, total
Copper, total
Lead, total
Magnesium, total
Mercury, total
Molybdenum, total
Nickel, total
Phosphorus, total
Potassium, total
Selenium, total
Sodium, total
Zinc, total
Results
Sample: Sludge Digester Grab
1.74 %
<575 mg/kg
18,200 mg/kg
1210 mg/kg
8,680 mg/kg
<2.87 mg/kg
<0.575 mg/kg
16,200 mg/kg
420 mg/kg
11.1 mg/kg
5,200 mg/kg
2.07 mg/kg
4.79 mg/kg
17.5 mg/kg
22,500 mg/kg
3,940 rng/kg
2.87 mg/kg
2,490 mg/kg
684 mg/kg
Analysis Date
2/15/2021
2/15/2021
2/16/2021
2/17/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/16/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
Reporting Limit
0-100
575
20
10.6
2.50
2.87
0.575
10.0
1.00
0.500
10.0
0.02
0.500
2.0
2.00
20.0
2.87
20.0
0.500
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
rng/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
mg/kg
2/11/2021
Method
SM 2540B
EPA 350.1
EPA 351.1.
EPA 353.2
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 245.1
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
EPA 200.7
1 hereby certify that 1 have reviewed and approve these data.
LIL
r" j<3
estAlls
75.
< ,g7
_AL_
Cu. LI, sop.
412,o .
Pb 8,'10.
11. 1
a
57.
Z.
75
A4.
,
Liz°.
17 5__._--_
,Ni
,Se i00.
C Z. ?7
642 Tamco Road, Reidsville, North (Z_11 7500 . (D
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Report Date:
NPDES #:
Project:
P.O. #:
Date Sample Rcvd:
Page 1
3/8/2021
NC0021709
Class B Sludge
2/11/2021
Meritech Work Order # 02112190
Sample: Sludge Digester Grab
2/11/2021
1311 - TCLP Metals
Parameter
Arsenic
Barium
Cadmium
Chromium
Lead
Mercury
Selenium
Silver
Results
<0.100 mg/L
0.155 mg/L
<0.020 mg/L
<0.050 mg/L
<0.100 mg/L
<0.02 mg/L
<0.100 mg/L
<0.050 rng/L
Analysis Date Det. Limit Reg. Limit Method
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/25/2021
2/23/2021
2/25/2021
2/25/2021
0.100 5.0 EPA 200.7
0.050 100.0 EPA 200.7
0.020 1.0 EPA 200.7
0.050 5.0 EPA 200.7
0.100 5.0 EPA 200.7
0.02 0.2 EPA 245.1
0.100 1.0 EPA 200.7
0.050 5.0 EPA 200.7
Parameter
Volatiles 8260
Semi Vol. 8270
Results
Attached
Attached
TCLP Organics
Analysis Date
2/23/2021
2/25/2021
Reporting Limit
Method
8960
8270
Other Tests
Parameter Results
Cyanide, total <0.005 ing/kg
Sulfide <1.00 mg/kg
Flash Point >140 °F
Corrositivity (pH) 6.0 S.U.
Analysis Date Reporting Limit
2/15/2021
2/17/2021
2/12/2021
3/2/2021 1.0 - 14.0 S.U.
0.005 mg/kg
1.00 mg/kg
Method
EPA 335.4
SM4500S2DB
EPA 1020B
SM 4500 i-iB
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Contact: Tim Church
Client: Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640
Report Date:
NPDES #:
Project:
P.O. #:
Date Sample Rcvd:
Page 2
3/8/2021
NC0021709
Class B Sludge
�2165
2/11/2021
Meritech Work Order # 02112190
Sample: Sludge Digester Grab
6/30/20
1311 - TCLP Pesticides & Herbicides
Pesticide - SW-846 8081A
Parameter
Endrin
Chlordane
Toxaphene
Methoxychlor
Heptachlor
Lindane
Herbicides - SW-846 8151A
Parameter
2,4-D
2,4,5-TP (Silvex)
Results
Attached
Attached
Attached
Attached
Attached
Attached
Results
Attached
Attached
Analysis Date Det. Limit Reg. Limit Dilution Factor
Analysis Date Det. Limit Reg. Limit Dilution Factor
642 Tamco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

www.encolabs,com
Description: 02:121-65
Matrix: Waste
Project: TCLP Pest/Herb
Lab Sample ID:AE0128S-01
Sa m pled: 02/11/21 10:45
Sampled By:
Received: 02/17/21 10:15
Work Order: AE01285
Solids:
TCLP Pesticides by GC
5;70 crane:: doJ ,ce 424)
Analyte ICAS Number.'
Chlordane (tech) [12789.03.6)^
Entlru� (72.20-8)^
gamma-8HC (58-89.9)^
Heptachlor [76-44-81^
Heptachlor epoxide [1024.57.3)^
Methoxyctdor (72-43.5)^
Toxaohene [8001.35.2j^
Resull5 Flag Unirs DF h1P1 l3 Oat ch Method Ar„i•/_zrd EY
0.00036 U mg/i. 1 0.00036 0.00050 1817045 EPA 80818 03;'.5 :: 14:37 .05
0.000014 U mg/L 1 0.0000140.000050 1817045 EPA 80818 03/05/21 14:37 ))8
0.000021 U mg/L 1 0.000021 0.000050 1817045 EPA 80816 03/05/21 14:37 ))6
0.000026 V mg/L 1 0.000026 0.000050 1817045 EPA 80818 03/05/21 14:37 1)8
0.000018 U mg/L 1 0.000018 0.000050 1817045 EPA 80818 03/05/21 14:37 128
0.000020 U mg/l 1 0.0000200.000050 1817045 EPA608:8 03/05/21 14:37 233
0.00048 U mg/L 1 0.00048 0.00050 1817045 EPA 80618 03/05/21 14:37 JJ8
Surrogates Results ff. Spike Lv/ 910 Rec % Rec Limits Batch Method Analyzed ¢y Notes
2,4,5,5-T ct.r 0.0032 1 0.00.500 65 46 38-142 1117045 EPA 50623 03/05/21 14.'37 J.18
L%ecychlorabryhen), 00046 1 0.00500 91 % 34.159 151/045 EPA 80815 03105/21 14:37 J'S
TCLP Herbicides by GC
fNCO c;. • :,) cnr:Wed..,mire:NC 424'
Analyte fCAS Nurnberg Re.lyc Flag y"Si DF r1Qj PQJ. Batch MethQ i Analyzed Ex Hates
2,4,5-TP(Silvex)[93-72-11" 0.00044 U my/1. 1 0.00044 0.00050 11323035 EPA 3151/. 02/26/21 17:50 FCV
2,4-0 [94-75-7)^ C.00027 U Nil 1 0.00027 0.00050 1823035 EPA 8151A 02/26/21 17.30 FCv
Surrogates
2, 4-0CAa
Results
0.012
QF Spike L v/ 4e Rec % Rec Limits Batch Method
0.0100 119 46 37.134 1823035
EP.t 5I51.1
AnalvzeQ
01/16, 21 17.-50
li1' Note3
FCl
Description: O2-1-124-94- rJ 2 1 i z t- ci 0
Matrix: 'Waste
Project: TCLP PestlHerb
TCLP Pesticides by GC
^ - EACO 0 a.oeo c. ^ux d an,»t a [NC 434/
Analyte 1SA5 Number.'
Chlordane (tech) (12789-03-61^
Endrrn (72-20-8j^
gamma-BHC (58.89-91^
Heptachlor (76-44-8)^
Heptachlor epoxide [1024-57.3)^
Methexychior[72-43.5j^
Toxahene [5001.35.2)^
Lab Sample ID: AE0128S-02
Sa m pled: 02/11121 10:05
Sampled By:
Received: 02/17i21
Work Order: AE01285
0/0 Solids:
Results F11g vjLiu DF dQL 129.1, Batch Method Analyzed 8
0.00036 ❑ mg/L 1 0.00036 0.00050 1817045 EPA 80818 03/ 05/21 14 50 135
0.000014 U 1n0/L l 0.0000140.000050 1817045 EPA 8081E 03/0512114'50 115
0.000021 U mg/L 1 0.000021 0.000050 1817045 EPA 80810 03;05/21 14.50 318
0.000026 U mg/L 1 0.000026 0.000050 1817045 EPA 80818 03/05/21 14:50 1)B
0.000018 U mgjl. 1 0.0000180.000050 11317045 EPA 80818 03/05/21 14:50 2J8
0.000020 U mg/L 1 0.0000200.000050 1817045 EPA 80818 03/05;21 14:50 1)8
0.00048 U mrl,'i 1 0.00048 0.00050 1817045 EPA 80818 03/05/21 14:50 103
Note'
Surrogates Results OF Spike L vl 4S Rec 4%0 Rec Limits 0atch Method An;rlv?Pd 0y Notes
2, a S, 6-TCMx 0.0060 I 0. 00500 120 46 36.142 1517045 EPA 80815 03/0 +, 2.
Oecechio,obiphenn 0.0055 1 a005.00 : /1 46 34-: 9 153/7-15 EPA 50 8:5
TCLP Herbicides by GC
Analyte !CAS Number]
2,4,5-TP (Srlvex) (93.72.1J^
2.4-D [94-75.71^
Results flag yni pf_ M.DI f, J. 5ateh Methoc) Analyzed By Notes
0.00044 U rng/L 1 0.00044 0.00050 1823035 EPA 8151A 02/26/21 18:15 FCV
0.00027 U mg'L 1 0.00027 0.00050 1823035 EPA 81511 02/26/21 18:15 rCd
,Surrogates Resw/tf QF Spike Lvl 9¢ Rec °:• Rec Limits /latch Method Anal):ed $y Notes
Z, 1-DC-14 0.011 1 0.0100 111 44- 37-134 1813035 EPA 8151A 02/26/11 1515 FCV
FINAL This report reta:es only to me sample as recerved by iv Utxuet y, VICE maY o, lY be ,eproltxesl,n tul.
Cale 4 cl 10

Client:
Project:
Client Sample ID:
Sample Collection:
Meritech Sample ID:
Volatiles: SW-846 8260
Analysis: 02/23/21
Analyst: VWV
Parameter
ITECH, INC.
Environmental Laboratories
Laboratory Certificate #165
Town of Jefferson
Class B Sludge
Sludge Digester
02/ 1 1 /21
02112190
1311 - TCLP Organics
Extraction: 02/15/21
Report Date: 02/25'21
Result Units pet. Limit Rea. Limit Dilution Factor
Benzene <0.0100 mg/L 0.0100 0.50
Carbon Tetrachloride < 0.0100 mg/L 0.0100 0.50
Chlorobenzene < 0.0100 mg/L 0.0100 100
Chloroform < 0.0100 mg/L 0.0100 6.0
1,2-Dichloroethane < 0.0100 mg/L 0.0100 0.50
1,1-Dichloroethene <0.0100 mg/L 0.0100 0.70
Methyl Ethyl Ketone < 0.100 mg/L 0.100 20U
Tetrachloroethylene < 0.0100 mg/L 0.0100 0.70
Trichloroethene <0.0100 mg/L 0.0100 0.50
Vinyl Chloride < 0.0200 mg'L 0.020 0.20
Semi-Volatiles: SW-346 8270
Analysis: 02/25/21
Analyst: PM
Parameter
1,4-Dichlorobenzene
Hexachlorobenzene
Hexachloro-1,3-butadiene
Hexachloroethane
o-cresol
m&p-cresol
Total cresols
Nitrobenzene
Pentachlorophenol
Pyridine
2,4,5-Trish l oroph enol
2.4.6-Tri ch lorophenol
2.4-Dinitrotoluene
Extraction: 02/15/21
Report Date: 02/26/21
Result Units Det. Limit Rea. Limit
<0.100 mg/L 0.100 7.5
<0.100 mg/L 0.100 0.13
<0.100 mo/L 0.100 0.5
<0.100 mg/L 0.100 3.00
<0.100 mg/L 0.100 200
<0.200 me/L 0.200 200
<0.300 m_/L 0.300 200
<0.100 m g/L 0.100 2.00
<0,500 ma/L 0.500 100
<0.100 i g/L. 0.100 5.0
<0.100 mg/L 0.100 400
<0.100 rng/L 0.100 2.00
<0.100 mg'1. 0.100 0.13
1 hereby certify that 1 have reviewed and approve these data.
10
10
10
10
10
10
10
10
10
10
Dilution Factor
10
10
10
10
10
10
10
10
10
10
10
10
10
Laboratory Representative
642 Tamco Road ' Reidsville, NC 27320
[phone] ' [e-mail]

-- Fed Ex Are these results for regulatory purposes? Yes 14 No I_ ' Report results in: mg/1 I_
Relinquished by: — �._.._
Hand Delivery 'al ll' /2 t Time: /03 % R:ivEr y; /f Date: Time
0,7
Chain of Custody Record (COC)
EfiTECH INC.
ENVIRONMENTAL LABORATORIES
642 Tamco Rd. Phone: [phone]
P 'Idehi
i• Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
WVtJW.merilecliLibs.corn
n
ter_
—
(.
E ma i It t"f.j>
Project: (�uLISS l) ‘gtdt('
`acs
77
z
..
0—
Std(10days) I ?_-` Day h
Turn Mound Time•
*RUSH work needs prior approval,
Lh,,1,=es, nunly
On Ice?
Y.es/ No
r
0
C
-
n =
0
x o
0
Z

Sam/zl
SAR Calculator 2,021
Adjusted SAR Calculator
EC
Ca
Mg
Na
HCO3
1
1281.8
90.4
[43.3
1
µS
mg/1 or ppm
nlg/1 or pp
mg/1 or ppm
mg/1 or ppm
SAR 0.6
adj SAR 0.2
Use the larger of the two
Reset
0.6
2.1
o!�
adj Classification Nlanagement Considerations
SAR
< 1 Excellent None
1-2 Good Little concern, add pelletized gypsum periodically
2-4 Fair
Aerify soil, sand topdress, apply pelletized gypsum, monitor soil
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 specialist
> 15 Unacceptable Do not use
© 2021 - Oklahoma State University j All rights reserved

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE: 19-Jan-21
REPORTED DATE: 8-Feb-21
PSRP
zozi
ANALYSIS
ANALYSIS
RESULTS
MQL's:
;: UNITS
SAMPLE .
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
1.4
43000
1
CFU's
1
20-Jan-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
DATE
C f= U' s
LOG
I. 19.21
'4 3, Oc0
14 . (331-}
1.20. 21
58100O
1-1.
7634
1.214.2,1
25,000
14.397q
z.zz.zI
6i,o00
1-1,7853
3.121
/41-000
9.693
3.2.2P
341,0130
i4-9az_
3. 8.21
46, ooc)
11.6623
32.2103 = 4.6371
7
G eome i 'bleat\ = Lig, 661

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
I D #:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
20-Jan-21
8-Feb-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
1.3
58000
1
%
CFU's
2
21-Jan-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE: 26-Jan-21
REPORTED DATE: 8-Feb-21
I LJh.
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
1.2
25000
1
%
CFU's
3
27-Jan-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY-
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
24-Feb-21
5-Mar-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
1.4
61000
1
9/0
CFU's
4
25-Feb-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
nu.
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK. NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
1-Mar-21
7-Apr-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLIDS
FECAL COLIFORM
1.2
44000
1
%
CFU's
5
3-Mar-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
I D#:
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
2-Mar-21
7-Apr-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
TOTAL SOLID
FECAL COLIFORM
1.3
84000
1
%
CFU's
6
4-Mar-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
f111.
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE.
8-Mar-21
7-Apr-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
SAMPLE
LOCATION
ANALYSIS
COMPLETED
METHOD
CODE
INT
FECAL COLIFORM
1.3
46000
1
CFU's
E
9-Mar-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
CLIENT: JEFFERSON SLUDGE
ADDRESS:
CITY:
STATE:
1 J .
WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
LOGIN TIME:
SAMPLER:
COLLECTED DATE:
REPORTED DATE:
8-Mar-21
7-Apr-21
ANALYSIS
ANALYSIS
RESULTS
MQL's
UNITS
.SAMPLE:
LOCATION
ANALYSIS
COMPLETED
METHOD
. CODE •
INT
FECAL COLIFORM
1.3
46000
1
CFU's
E
9-Mar-21
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB &OPERATIONS, INC.
LAB No. 544 f
VC�'�.
3 Dio,Y, BENCH SCALE VAR OPTION 3
pt` . 1SM2540E
START DATE 2 - 2d1- Z 1
v :nit
R cluc
DIGESTER VOLUME: 1 pno ,j_,S______
DAY
TIME
VOLUME
CONFIRMED
SCRAPED
SOLIDS
TEMP
DO
TARE
WET
DRY
ASH
RESULT
I•I7./7r.II
Start
Son
—
!I."
7.4`1
7a Li Lik-1
li_7 7211
(t z3
70. 75-7(
1
—
I d. 1
3- k
,lL
2
VC
30
r-
..-
ld.5-
1,6)-
3
4
5 3 4
Li Z
1.0
7
S 10
-
,--
) 7
3
7'1
70. 0 c 1 1
. NI i
71, oZZ 1
7 0. 3 o l
1. p7-/`7' 1
8
1 zo
/-•
t1-_`1
3.27
10
11
12
1og9
.-
✓
1'-7
)• 1Z
13
q .4,5".
4. (!r-
3.1..1
osA-Z/74,to
14
S 0
,
—
1,f-i:
3,)1
%7-(43.se
1O.S1f2c
73.3`1c3
72.21J'
15
9)o
,-
1I-5
JL(
16
ei " o
/ cf.1
3, ZS
17
18
19
5'ls
-
.-
4----)
,i
20
:5-9
_.
f
(.r. i
.
3.211
1. I o�7,�'.
21
(9c7
i
•-•
/F-`7
3•(3"
/2.73 .4-2
16yd5-1'1
73.3606
72 �06'S-
22
ci ZP
—
.- -'a-
5
;• 2J
23
S 30
/-
4.-3'
S.`1'-
24
25
26
9 9
f9.t
Z..77
27
"
c
111.2
1.7S
28
1 f
,
0,7
7. 73
29
et 0
/
15.1
'271.
30
1Oor
lc? 2,
7.b171.J3`i5-
I{S. 6(21
7nao2.3
7).o9(-ia-
1,07p/7).
VOLITILE SOLIDS REDUCTION:
.rftas-k fit.

WATER QUALITY SERVICES, INC.
P.O. BOX 1102, BANNER c,l.l: `c-7-2 60
SLUb&E�U(S2S)-S98.027 % VECTOR, ATtRHCT1UN ReP\UC*6\-
iax (S?S)-S9S-625S aO _ ILmc/n,5C(,it
rHAi . (v c?..:7-(t'.o) VDuds reduc#ion 15
ol.S
S.•\MAPLE TYPE: \VAS•1'1j\,..A1- t ;:1- �. i�r..:.�`-i.c4'�•-C"� •,''
LOCATION: • H2SO4. : • i i (_.3• • • iii L.
FACILITY IN: feffersoll Wastewater Treatment Plant .; . N,\0H, 5 • NO:.. 6 - COCtl R .
SAMPLER NAME: Tim Church ; • N'A2S203. S • OTi iER i
COMPOSITE SAMPLE; START TIME: . SLOP :'IN1E
COLLECTION (DE ;vl SAMPLE T' _ E ; 1 . ' ,., -
DATE I TIME I TEMP TEMPI GRAB 1 CO _ -.--_ __-�•._
�s—i ,,ac Sip jC�'� � -Cl. •D•
'r' j f•rlrl.D,i l.•i..l!i i<<. �I-5 ��
z. r-_,-........ .,�
BOO • INF. I I l I
UOD • E:r F I I F---- 1 —
_
rss FF. 1
1 —1 i
i ► IL
SAMPLE NAME:
NH3 asN
TOIL u GREASE
!TOTAL NIT.
(TOTAL PHOS.
(I E'2AE. • EFF.
rEC At. • DOWN
HARDNESS CUPS..
HARDNESS EH ,.
YQ Ia ; • 0 i, s t2 j2UJ f Z!
COPPER ZINC
C, ;untie
I.LA\L) NICKEL
1 SLL\'tiR
IL.
1 1 IL_
r T
I i
•
6,?-- -
I i I il,?
ILQ.
:1I
t.7
j CI iRbm1Ut\•1
i-i
`zfz'tJ/ / 075C
I DATE. '.'•' Il:
4-,4,i-A( /P50
•L3boraiory p:csc rvation is cnsvrcd by a�,',�,',itio❑ U1 pres cr.at:ycs or w sa:r,)Ic
cont3incrs lcsvIny the I3b. unless other-,0,c r'•''C:
C'• _ •il•. L?- Chlorins chcc't. 2nJ Li chlorination vcririca:.,,.
:'i:ES k.A!!O•
10001.:C . UOD. RESIDUE, CONDUCTIVITY. ML'AS. C•J1.UR
COOL =C . PH•2H?SO4 : NH3, NO?.-N0), TRh:. O::G. ' OC. COD. ll:.'r.7.',ESS, P!U. .;r..S. .•:)° • .
CU01. 4C. I'II<2 HNO3 : `.1E1'ALS caccpt CI:. VI
t ! t,O`t: CHLOR:DL. P11, FLUORIDE
OTHER
CC)O. �A'_S.'0) COLI'rC#IC.l :SAC , LRIA
-J_Yri - ATICE•

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
Facility Name:
WWTP Name:
Town ofJefferson WWTP
Jefferson WWTP
WQ Permit Number: WQ0004166
NPDES Number: NC0021709
Monitoring Period: From
1/1/2021
To
12/31/2021
- Please indicate level achieved and alternative performed:
Class A:
Alt. A (time/temp) ■
Alt B (Alk Treatment)❑
Alt. C (Prior Testing)*
Alt.D (No Prior Test) Cl
Process to Further Reduce Pathogengs Li
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying ❑
Heat Treatment ❑
Thermophilic L J
Beta Ray ❑
Gamma Ray ❑
Pasteurization
■
Class B:
Alt. (1) Fecal Density Cl
Alt. (2) Process to Significan ly Reduce Pathogens ❑ I
If applicable to a ternative performed (Class B only) indicate "Process to Sigi ificantly Reduce Pathogens":
Lime Stabilization ❑
Air Drying ❑
Composting C7
Aerobic Digestion l
Anaerobic Digestion ❑
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Analytical
Tech -
rliaue
Parameter
Allowable Level
in Sludge
Pathogen Density
Nurnber of
Excee-
dences
Frequency
y' of Analysis
Sample
Type
Minimum
Geo. Mean
Maximum
Units
Fecal Coliform
2 x 10 to the
6th power
per gram of
total solids
MPN
CFU
25000
48661
84000
CFU
0
Daily
Grab
SM9222D
1000 mpn per gram
of total solid (dry
weight)
Salmonella bacteria
(in lieu of fecal
coliform)
3 MPN per 4 grams
total solid (dry
weight)
tion (15A NCAC 02T .1107) - Please indicate alternative performed:
Alt.1 (VS reduction)
■
Alt. 2 (40-day bench) ❑
Alt. 3 (30-day bench) J
Alt. 4 (Spec. 02 uptake)
❑
Alt. 5 (14-Day Aerobic)
Alt. 6 (Alk. Stabilization 0
Alt 7 (Drying - Stable) ❑
Alt. 8 (Drying - Unstable)
0
■
Alt. 9 (Injection)
❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed
❑
CERTIFICATION STATEMENT (please check the appropriate statement)
t✓7 "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."
lam aurch Wtrerhse rrfs Afredb-
Preparer Name and Title (type or print) Land Applier Name and Title (if applicable)(type or print)
1A,Y 44 AL
Signature of Preparer* 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)

NCDA&CS Agronomic Division
Phone: [phone] Website: www.ncagr.gov/agronomi/
Report No. FY22-SL006967
x• Predictive
'.► , Soil
Ki• .
_ Links
s.mpied:09/30/2021 Received-
Report Mehlich-3 Extraction
to helpful int rrnat:on
Client: Town of Jefferson
302 East Main St / PO Box 67
Jefferson, NC 28640
Sampled County Ashe
Client W: 88367
Advisor Micah Orfieid
Ashe CES HOUSE ACCT
134 Gov. Cir. / PO Box
1032
Jefferson, NC 28640
Advisor ID: 396894
10/05,2021 Completed: 10/15/2021 Farm
( J
Sample ID: F1h'ALT
Lime History:
Recommendations: Lime
Nutrients (ib/acre)
More
Information
Note 12 NM i
Crop (tons/acre) N P2O5
1-Fescue/OGrass/T+m, E 0.0 50-70 0
2 -Fescue/OGrass/Tim, E 0.0 50-70 0
K2O Mg S Mn Zn
20 0 0 pHS 0
20 0 0 pH$ 0
Cu 8
0 0
0 0
Note 12 Note: €
Test Results [units • WN in glcnit: CEC and Na in meq/100 cm3; NO3-N in mg/dnt3J:
HM% WN CEC BS% Ac pH Pd K4 Ca% Mg%
0.46 0.83 14.8 91 1.4 6.5 80 39 63 27
S-1
52
Soil Class: Mineral
Mnd Mn-All Mn-Al2 Zn-I Zn-Al
219 140 140 771 771
Cu-i Na ESP SS -I NO3-N
514 0.1 1
NCDA&CS Agror'omlcDlv`son A Phone: [phone] Website: www.ncagr.goviagronomi/
Sample ID: JWALT
Lime History:
1.20 Eons/acxe. 10/2020
Report No. FY22-SL006967
Page 2 of 3
Recommendations: Lime Nutrients (lb/acre)
Crop (tons/acre) N P2O5 K2O Mg S Mn Zn Cu B
1-FPccue/OGrass7Tim, F 0.7 50-70 40 30 0 0 0 0 0 0
2-Fescue/OGrass/Tim. E 0.0 50-70 40 30 0 0 0 0 0 0
More
Information
Nole 12
Note 12
Test Results [units - WN in g/cnt1; CEC and Na in meq/100 cm3; NO3-N In mg/dm;J: Soli Class: Mineral
HM% WN CEC BS% Ac pH P4 K4 Ca% Mg% S-I Mn-1 Mn-AI1 Mn-AI2 Zn-I Zn-Al Cu-I Na ESP SS -I NO3-N
0.46 0.86 12.4 88 1.5 6.4 53 34 58 28 47 566 349 349 261 261 246 0.1 1