WQ0006906_Residual Annual Report 2021_20220211

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
En.anmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
EADS\ndthornburg
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) * WQ0006906
Applicant/Permittee Town of Taylorsville
Email Notifications
Does this need review by the hydrogeologist?* Yes No
Regional Office
CO Reviewer
Admin Reviewer
Mooresville

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*
David Odom
Email Address*
[e-mail]
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
828-632-2218
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: *
Permit Number: *
Applicant/Permittee Address*
Facility Name*
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
WQ0006906
Has Current Existing permit number
67 Main Avenue Drive, Taylorsville, NC 28681
Town of Taylorsville 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.)
town of taylorsville 2021 annual report.pdf 889.12KB
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
eiDeekkieii5676e.orz
Submission Date 2/11/2022

2021
Town of Taylorsville
2021 Annual Report
Land Application Program
Permit No. WQ0006906

ANNUAL LAND APPLICATION CERTIFICATION FORM
WQ Permit#: WQ0006906 County: Alexander Year: 2021
Town ofTaylorsville
Facility Name (as shown on permit):
Land Application Operator:
US 13iosolids, Inc, 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 permit:
6
Total number of fields utilized for land application during the year:
4
Total amount of dry tons applied during the year for all application sites:
41.71
Total number of acres utilizes for land application during the year;
66.7
Part B - Annual Compianee 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, © Yes 0 No
If no please, provide a written description why the facility was not compliant, the dates, and explain corrective action
to ken.
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 .1 105(a) or the Pollutant
Loading Rates in 15A NCAC 02T .1 105(b) (applicable to 40 CFR Part 503 regulated facilities).
7) All general requirements in as specified in the Land Application Permit were complied with (applicable to 40 CFR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 1 SA NCAC 02T .1 1 1 1 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 cast 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. tam aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations."
vj a as CA...v.) ins t-e% 04)
Permittee Name and Title (type or print)
Signature of Perrnittee
Z- It-ZozZ
Date
Z arI�2a - p,.,,,i 7 v '�'� z0l
Signatur of Preparer* Date Signature of 1.,and 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)

te
1.1
ei ten -tr
Town of Taylorsville
a
Town of Taylorsville
)ate
Sample or Composite
N
ob
(--,a
ON
^
;
.-4
45.5 I
as
O
Cr;
p
O
do
—
en(NI
ri
N
c�
ty
--+
L_22I
N
�.j
(NI
rn
'r
t}"
ipn
�A
`40
o
O
4
163700 I
0606
N
N
v')
NA
75 I
NA
420
4
NA•
r vx
r ,__
Percent Solids (%)
IChromium
E
A
rt
Zinc
ITotal Phosphorus
IAmmonia -Nitrogen
Nitrate and Nitrite
ria 44
gra
el
ae w
it t si
C
u�'-0°
- 1tos11
g" r` . I.
o d °°
.4 a
....
....
o C os° g
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a o A
o 0 g i
0
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a I. A 5
di v
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c p� :d t,
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o 'T1
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R1:3 O
a .
te
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ocra
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die
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF (12/2006)

ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Waypoint Analytical
;17,, — _ r1 r.
Laboratory:
Town of Taylorsville
O
Cs
N
V
Town of Taylorsville
Sample or Composite Date 1
4
00
d,
63730
•
00
�
15200
22500
th
OD
tn
----
tri
l!1
Cr'
to
N
O
.--.
Parameter
(mg/kg)
Organic N
1
C.0
Aluminum
E
=
C_.)
�
w
Magnesium
v
ina)
=.�,
z
y
a
P
5
c.n
Sulfur 1
z
nQ.
4�
c¢
DENR FORM RSSF - B (12/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Town of Taylorsville Total Dry Tons Applied (Annual):
WQ006906 Cation Exchange Capacity (non 503 only):
8.96
Operator: Clyde Hendren Owner: Clyde Hendren Predominant Soil Series: Pc132
Acres Used:
23.4 Acres Permitted: 23.4 Site #: CH 01 Field #: CH 01
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
,Sample or
posite
Date
1 l
2.1
3.1
4J
- 5 i
6 1
7j
...8_1
._gs
'1. 0 f
11 j
12 1
9/28)21
% Solids
1.14
Arsenic
45.5
Cadmium
9.09
Copper
500
Chramiun‘
31.6
,
Lead
27.3
Mercury
1.27
Molyb-
denum
22.7
Nickel
22.7
Selenium
45.5
Zinc
605
Total
Phos-
phorus
34600
)
nnual Heavy Metal Field Loadings (Calculated in Iles/acre):
Total
D'tIA c.!
App.
Event
1J
0.38
4 [5i
6j
?J
8
9
10
11j
'121
-
,Si.
y
Arsenic
0.035
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.035
Cadmium
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
Copper
0.383
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.000
0.000
0.000
0.383
Chromium
0.024
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.024
Lead
0.021
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.021
Mercury
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
Molyb-
denum
0.017
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
T 0.000
_
0.017
Nickel
0.017
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.017
Selenium
0.035
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.035
Zinc
0.463
0.000
0,000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.463
Total
Phos-
phorus
II.
26.504
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
26.504
i ceri��y, unaer penalty or taw, 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",
atu of
Land
d A'plier
,- q• ]uaz
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: 23.4
Field #: CH (II
WQ Permit #: WQ0006906
Facility Name: Town of Taylorsville
Site #: CH 01
Cation Exchange Capacity (non 503):
Predominant Soil Series: PcB2
Operator: Clyde Hendren
Name of Crop Type
Receiving Residual
Application
N
a.
2
"O
6?
a.
Q
0
U
o
a. O
.-
F
01
4d
�
.2
_[,_
r'+
2op
t
Qo
a
0
0
0
0
0
0
0
a
0
0
oo
0
0
O
0$$
o
O
o
O
o
o
0
0
O
en
Q
a"
(.15
1/46
o
o
a
o
g
6
8
O
S
Q
o
C
0
o
8
0
o
o
S
C
a
O
�pg¢
sai
"J y
z z E
�`
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):1
N
c
N
o
M
M
n
a
04,
�,
Am nonia
Nitrogen E
=r
<
o
ea
e
eV
eeet
e-i
oo
k et
ppo
H E
0
2
o—
o
so—
d
,
ao
—
d
N
"'
Mineralization
Rate***
,�
"
0
=
O
o
0
0
a
J
0
Q
Volatilization
Rate**
k.,
e
o
o
c
0
—
0
'^
Application
Method*
a_
O
o
o•
N
0
N
W N c
Q
•r
thon'3
''
V
o
C
c
M
C7
m
m
C7
Q
2
V
m
o
.c
,-i
S
aC
M
Residual Sources
(NPDES #. WQ#.
Pert.. Animal
Waste. etc)
0
0'
0
3
U
$
c
o
o
o
0
ram,
Volume
Applied per
Acre
(Dry TonslAc)
'$
G
6
0.000
q
a�g�SS
0
0
0
©
0
0
0.000
0.000
sy
o0-
C
C
d
1 36
a'?
C rJ
(i�
-r
Annual lbs/acre
Prior Years Cumulative Ibs/ac
Current Cumulative lbslac
Permitted C. P. L. R.****
o
L
U
v
[V
;E
7
n
F
a
Volume applied
(enter one) Solids/
Liquid
Cu_ Yds 1 Gallons
v,
GO
$
m
o
�)UOjN
to OW]M
N
_
,".
Y.'W
<
0
t
etJ
i.,
IND
an
rn
R
0,3
00
.a
C7
01
a
s,
7-1
C,
Ob
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 Names
Permit #:
Town of Taylorsville Total Dry Tons Applied (Annual): 5,87
WQ006906
Cation Exchange Capacity (non 503 only):
Operators Clyde Hendren Owner: Clyde Hendren Predominant Soil Series: Fc82
Acres Used:
9.3 Acres Permitted: 9.3 Site #: CH 02 Field #: CH 02
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample or_..!
Com-
posite
Date
..
9128/21
21
ji
_4j
_5J
61
7]
8
9I
710
11i
12 '
% Solids
1.14
Arsenic
45,5
Cadmium
9.09
Copper
500
'Chromium
31.6
Lead
27.3
_
Mercury
1.27
,
Molyb-
denum
22 7
Nickel
22,7
F
Selenium
45.5
Zinc
605
Total
Phos-
phorus
34600
r
Annual Heavy Metal Field Loadings (Calculated in lbslacre):
Total
DTJAc.!
App.7
Event
4J
51
6
7 j
81
9 i
'10
11 J
12
1-1
so
__°_.!
0.63
Arsenic
0.057
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.057
Cadmium
0.011
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.01.1
0.631
Copper
0,631
0.000
0.000
0.000
0.000
0.000
0,000
0,000
0.000
0.000
0.000
0.000
Chromium
0.040
0.000
0.000
0.000
0,000
0.000
0.000
0,000
0.000
0.000
0,000
0.000
0.040
Lead
0.034
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.000
t
0.000
0.034
Mercury
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
Molyb-
denum
0.029
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0,029
Nickel
0,029
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0,000
0.000
0.000
0.029
Selenium
0,057
0.000
0,000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,057
Zinc
0,764
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,764
Total
Phos-
phorus
43.665
0.000
0.000
0,000
0.000
0,000
0.000
-
0.000
-
0.000
-
0.000
-
0.000
0.000
43,665
"1 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.
1 am aware that there are significant penalties for submitting false information, including the possibility alines and
imprisonment for knowing violations".
Signature of Land Applier
Date
DEW( FORM MFLSF (12/2006)

Acres Utilized: 9.3
Field it: CH 02
Acres Permitted: 9.3
Site #: CH 02
Cation Exchange Capacity (non 503):
Operator: Clyde Hendren
Crop 2 Max. PAN:
a
U
00
00
Crop
Cro
N
a
0
U
0
2
U
a
U
Q
0
Ammonia
Nitrogen
00
h
0
M
a
Q
0
0
0
0
0
0
Mineralization
Rate***
• o 0 0
0 0 0 0
O 0 0 0
0 Ci o 0
O 0 0 a
0 0 a o
O 0 a O
r-
N
rn
o VI o
--
� yj N
M 0
O 0
as
o
00
Volati fixation
Rate**
Application
Method*
.
v m
2• N L
a.
0
0
'0
0
a
r
t
0
0
0
0
0
0
0
a
0
0
0
0
0
O
0
0
�4^
rn
0
O 0 d
0 0
O
X
O co
0
a.
C
a
cC
in as
O 0
V
U
� O
N
b o r
N 00 00
^
00
v
U
0
0
mIlid•••=1111•1
LUOIN
xo ap3
0
N
F
a
Annual lbs/acre
0 0 M
0
M 0
c v0
O 0
a
a.
U
a
z
E
a
DENR FORM FSF 072/2006)

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name: Town of Taylorsville Total Dry Tons Applied (Annual): 16.38
Permit #: WQ006906 Cation Exchange Capacity (non 503 only):
Operator: Phillip Hoover Owner: Phillip Hoover Predominant Soil Series: PCB2
Acres Used: 14.7 Acres Permitted: i 4.7 Site #: PH 01 Field #: PH 01
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Sample orfJi 41 _5 I
Com-
posite
Date 9/28/21
a/o Solids
Arsenic
Cadmium
Copper
1.14
45,5
9.09
500
6]
8
_9]
o1
11
1z�
Chromium
Lead
31.6
27.3
Mercury
Mo1yb-
denurn
Nickel
Selenium
Zinc
1.27
22.7
22.7
45.5
605
Total
Phos- 34600
horns
Annual Heavy Metal Field Loadings (Calculated in Ibs/acre):
i 1 ?
Total
D'r1Ac.1
App.
Event
Arsenic
Cadmium
Copper
f1]
1.11
0.101
0.020
1.114
0.000
0.000
0.000
3
0.000
0.000
0.000
4
0.000
0.000
0.000
0.000
0.000
0.000
6f
0.000
0.000
0.000
0.000
0.000
0.000
81i
0.000
0.000
0.000
9i
0.000
0.000
0.000
10j
0.000
0.000
0.000
0.000
0.000
0.000
121
0.000
0.000
0.000
0.101
0.020
1.114
'Chromium
Lead
Mercury
Molyb-
denum
Nickel
0.070
0.061
0.003
0.051
0.000
0.000
0.000
Selenium
Zinc
0.051
0.101
1.348
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
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
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
0.000
0.000
0.000
0.070
0.061
0.003
0.051
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
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
0.000
0.000
0.000
0.000
0.000
0.000
0.051
0.101
1.348
Total
Phos-
phorus
"l 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.
l am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
77.089
0.000
0.000
12-".• 2"),
Signature of Land Applier
0.000
0.000
0.000
0.000
0.000
0.000
Date
0.000
0.000
0.000
77.089
DENR FORM MFLSF (1212006)

Acres Utilized: 14.7
Field #: PH 01
Facility Name: Town ofTaylorsville
Acres Permitted: 14.7
Site #: PH 01
Land Owner: Phillip Hoover
Cation Exchange Capacity (non 503):
Predominant Soil Series: PcB2
Phillip Hoover
z
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Lime Applied J
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Annual lbs/acre
Prior Years Cumulative lbs/ac
Current Cumulative Ibs/ac
Permit PAN Limit ]stl2nd Crop
Volume applied
(enter one) Solids/
Liquid
Cu. Yds 1 Gallons
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—
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 Taylor'sville Total Dry Tons Applied (Annual): 10.50
WQ006906 Cation Exchange Capacity (non 503 only):
Predominant Soil Series: CeB2
Owen lcenhouor Owner: Owen Icenhour
19.3 Acres Permitted:
19.3 Site
08 01 Field #:
08 01
Residual
Analysis
Data (Heavy
Metals and Total Phosphorus
use mg/kg,
% Solids
use
Raw Percent
#):
Sample or._1i
Com-
posite
Date
9/28121
_?_i
_LI
. `1 }
6i
W? 1
8
A...
1)
Ali
.
12J
°1° Solids
1.14
_
-
-
Arsenic
45.5
,
Cadmium
9.09
_
_
_
_
Copper
500
.
-
Chromiurn
31.6
Lead
27.3
- _
Mercury
1.27
Molyb-
denurn
22.7
Nickel
22.7
-
-
•
Selenium
45,5
Zinc
605
_
Total
Phos-
34600
-
_horus
Annual
Heavy Metal
Field Loadings (Calculated
in lbs/acre):
Total
DT/Ac,/
App.
Event
-1J
0.54
2 '3J
`4]
51
eJ
2_1
81
9J
19_1
111
12
1
w
Arsenic
0.050
0.000
0.000
0.000
0.000 i
0.000
0.000
0,000
0.000
0.000
0.000
0.000
0.050
Cadmium
0.010
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.010
Copper
0.544
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.544
1
Chromium
0.034
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
-
0.000
0,034
Lead
0.030
0,000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000 _
0.000
0.000
0.030
Mercury
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
Malyb-
denunm
0.025
0.000
0.000
0.000
0,000
,
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.025
Nicke]
_
0.025
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.025
Selenium
0.050
0.000
0.000
' 0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
+ 0.050
Zinc
0.658
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.658
Total
Phos-
_horus
37.645
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
37.645
I certify. under
penalty of law. that this document was prepared
under my
direction or supervision in accordance
with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.
I am aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
I 1 P: /1)/
Signature of Land Applier
2.4t• »")
Date
DENR FORM MFLSF (12/2006)

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PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Acres Utilized: 19.3
Field #: 08 01
Acres Permitted: 19.3
Site #: 08 01
Land Owner: Owen lcenhour
Cation Exchange Capacity (non 503):
Predominant Soil Series: CeB2
Operator: Owen lcenhour
Name of Crop Type
Receiving Residual
Application
Crop 2
f Lime Applied f
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Current Cumulative lbs/ac
*
*
*
Ci
0.
U
v
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!Permit PAN Limit 1 st/2nd Crop
Vol wile applied
(enter one) Solids/
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Cu. Yds I Gallons
221000
8
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4woW
14 ma
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F'
Signature of Land Applier
DENR FORM FSF (12/2006)

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
Facility Name: Town of Taylorsville WQ Permit Number: WQ0006906
WWTP Name: Town ofTaylorsville WWTP NPDES Number:
Monitoring Period: From 1/1 /2021 To 12/31/2021
Pathogen Reduction (1SA NCAC 02T .1106) - Please indicate level achieved and alternative performed:
Alt. A (titre/temp) ❑ 1 All,B (Mk Treatment)❑ Alt. C (Prior Testing)❑
Alt.D (No Prior Test) 0 Process to Further Reduce Pathogengs ❑
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑ Heat Drying 0 Heat Treatment ❑ Thermophilic 0
Pasteurization ❑
Class A:
Beta Ray ❑
Gamma Ray 0
Class B: Alt-:(1) Fecal Density ❑ I Alt, (2) Process to Significantly Reduce Pathogens 10
If applicable to a ternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization 1Ri Air Drying ❑ 1 Composting ❑ Aerobic Digestion ❑
Anaerobic Digestion Cl .
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Allowable Level Pathogen Density Number of
Excee-
in Sludge Minimum Geo. MeanMaximum Units deuces
Parameter
Fecal Coliform
Salmonella bacteria
(in lieu of fecal
coliform)
2 x 10 to the
6th power
per gram of
total solids
Frequency
of Analysis
MPN
Sample
Type
Analytical
Tech-
niau_e
Cl"11
1000 mpn per gram
of total solid (dry
weight)
3 MPN per 4 grams
total solid (dry
weight)
n Reduction (15A NCAC 02T .1107) - Please indicate alternative performed:
Alt,l (VS reduction)
❑
Alt. 2 (40-day bench) 0
Alt. 3 (30-day bench) 0
Alt. 4 (Spec. O, uptake)
I
Alt. 5 (14-Day Aerobic)
0
Alt. 6 (Alk. Stabilization 0
Alt 7 (Drying - Stable) ■
Alt. 8 (Drying - Unstable)
0
Alt. 9 (Injection)
❑
Alt, 10 (Incorporation) 0
No vector attraction reduction alternatives were performed
0
CERTIFICATION STATEMENT (please check the appropriate statement)
0 "1 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."
❑ "1 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 certificat on including fine and imprisonment."
ie „) etre,s
(Glt G 1.4A.4-t' Dennis Key US Biosolids, Inc.
Preparer Name and Title (type or print) Land Applier Name and Title (if applicable)(type or print)
-t &7ji2 L 17J,4• 10/7/ 1-4• 1:te3.
Date Signature of Land Applier (if applicable) Date
Signature of Preparer*
*Preparer is defined in 40 CPR Part 503.9(r) and I5A NCAC 2T .1102 (26)
DENR FORM PVRF 02T (12/2006)

Waypol nt.
ANALYTICAL
46381
US Rosolids Inc
Dennis Key
958 I -loots Road
Roaring River , NC 28669
Report Number : 21-277-0007
Lab No : 50023
Sample ID : Taylorsville
7621 White pine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypoi nta nalytitai,tom
Project Taylorsville
Information :
REPORT OF ANALYSTS
Report Date : 10/13/2021
Received : 10/04/2021
Iowa F1( (clear
Pauric Mc Groary Ph.O,, CPA
Agronomist
Matrix: Solids
Sampled: 9/28/2021 14:00
Test
Results
Units
M01_
DF Date / Time By Analytical
Analyzed Method
Moisture
Sulfur
Calcium
Aluminum
Manganese
Organic N
Nickel
Lead
Arsenic
Selenium
Test
98.9 H % 0.010
5990 mg/Kg - dry 909
15200 mg/Kg - dry 4550
80800 mg/Kg - dry 455
585 mg/Kg - dry 45,5
63730 mg/Kg - dry 22730
<22.7 mg/Kg - dry 22.7
<27.3 mg/Kg - dry 27.3
<45.5 mg/Kg - dry 45,5
<45.5 mg/Kg - dry 45.5
Results Units MOL.
1 10/07/21 17:02 FMM ,SM-2540G
1 10/12/2100:53 JTR 6010D
1 10/08/21 21:53 TJS 6010D
1 10/08/21 21:53 TJS 6010D
1 10/08/21 21:53 TJS 6010D
1 10/11/21 10:30 CALCULATION
1 10/08/21 21:53 TJS 6010D
1 10/12/21 21:30 JTR 6010D
1 10/08/21 21:53 TJS 6010D
1 10/08/21 21:53 TJS 60100
DF Date / lime By Analytical
Analyzed Method
Total Solids
Phosphorus
Copper
Total Kjeidahi Nitrogen
1,14 H
34600
500
mg/Kg ,. dry
mg/Kg - dry
63700 mg/Kg - dry
0.010
455
45.5
1 10/07/21 17:02 FMM
1 10/08/2121:53 TJS
1 10/08/21 21:53 TJS
SM-2540G
6010D
6010D
22700 1 10/11/21 10:30 ]PJ iM-4500-NH3C-TO
Qualifiers/
Definitions
8 Analyte detected in blank
H Beyond holding time
DF Dilution Factor
MQL Method Quantitdtion Limit

Waypoint.
ANALYTICAL
46381
US Biosolids Inc
Dennis Key
958 Hoots Road
Roaring River , NC 28669
Report Number : 21-277-0007
Lab No : 50023
Sample ID : Taylarsville
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Pak 804-271-6446
www.waypointanalytical.com
Project Taylorsvilie
Information
REPORT OFANAL YSZS
Report Date ; 10/13/2021
Received : 10/04/2021
Tawi 4
Pauric Mc Groary Ph,D., CPA
Agronomist
Matrix: Solids
Sampled: 9 / 28/ 2021 14:00
Potassium
Magnesium
Sodium
iron
Zinc
Ammonia Nitrogen
Nitrate+Nitrite-N
Cadmium
Chromium
Mercury
pH
Molybdenum
7450 mg/Kg - dry 909
3990 mg/Kg - dry 455
5150 mg/Kg - dry 2270
22500 mg/Kg - dry 909
605 mg/Kg - dry 114
<9090 mg/Kg - dry 9090
S22 mg/Kg - dry 425
<9.09 mg/Kg - dry 9.09
31.6 mg/Kg •- dry 22,7
<1.27 mg/Kg - dry 1,27
6.9 s.u.
<22.7 mg/Kg - dry 22.7
1 10/08/21 21:53 TJS
1 10/08/21 21;53 T3S
1 10/08/21 21:53 TJS
1 10/08/21 21:53 TJS
1 10/08/21 21:53 T1S
1 10/11/21 13:30 JPJ
1 10/11/21 14;25 ZBD
1 10/08/21 21;53 TJS
1 10/08/2121:53 TJS
1 10/08/21 13:08 1W2
1 10/11/21 14:50 DRS
1 10/08/21 21:53 TJS
6010D
6010D
60100
6010D
6010D
SM-4500-NH3C
4500NO3F-2011
6010D
60100
SW-7471B
9045D
60100
Qualifiers/
Definitions
B Analyte detected in blank
H Beyond holding time
DF Dilution Factor
MQL Method Quantitation Limit

SAR
Sodium Absorption Ratio
Na : Sodium (Mg/L) Equivalent weight: 23
Ca : Calcium (Mg/L) Equivalent weight: 20
Mg : Magnesium (MgIL) Equivalent weight: 12
Na(Mq/L) Ca(Mo/L) MQ(Mg/L)
58.71 173.28 45.48 !
Na (ME)
2.552609
Ca (ME)
8.664
Mg (ME)
3.79
Milli Equivalent = Mg/L / Equivalent weight
SAR= Na Milli Equivalentl10.5 X (Ca Milli Equivalent + Mg Milli equivalent))0.5 power
1 SAR = 1.022927,
(From Mg/L entered above)
SAR= 1.022046
Na (ME)
Ca (ME)
Mg (ME)
2.55
8.66
3.79
(From ME entered below)
The amour
amount of E
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810
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More
Information
Note: 12
Test Results [units - INN In gicrr?; CEC and Na in meg1100 cm3; NO3-N in mgldnl3]: Soil Class: Mineral
HM% WN CEC BS% Ac PH P-i K-I Ca% Mg% S-i Mn-1 Mn-AI1 Mn-AI2 Zn-I Zn-AI Cu-Ii Na ESP SS -I NO3-N
0.41 1.21 6.0 61 1-2 6.1 109 31 60 18 26 137 97 256 256 164 0.1 2
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Client: Clyde Hendren Advisc
PO Box 732
Taylorsville, NC 28581
Mehtich-3 Extraction
Sampled County : Alexander
Client ID: 438306 Advia
Id_ 01/07/2022 Farm:
Lime Nutrients (lb/acre)
Ionslacre) N P2O5 K2O Mg S Mn Zn Cu
0.0 120-200 0 80 0 0 0 0 0
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Lime History:
Sample ID: CH2
Lime History:
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NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomil Report No. FY22SL017967
Clyde Hendren Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
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Recommendations
Lime
If testing finds that soil pH is too low for the crop(s) indicated, a lime recommendation will be given in units of either
ton/acre or Ib/1000 sq ft, For best results, mix the lime into the top 6 to 8 inches of soil several months before planting.
For no -till or established plantings where this is not possible, apply no more than 1 to 1,5 ton/acre (50 lb/1000 sq ft) at on:
time, even if the report recommends more. You can apply the rest in similar increments every six months until the full rate
is applied. if MG is recommended and lime is needed, use dolomitic lime.
Fertilizer
Recommendations for field crops or other large areas are listed separately for each nutrient to be added (in units of
lb/acre unless otherwise specified). Recommendations for N (and sometimes for 6) are based on research/field studies
for the crop being grown, not on soil test results. K-1 and P-I values are based on test results and should ben 50. If they
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
an excellent source: 175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs, SS -I levels appear
only on reports for greenhouse soil or problem samples.
Farmers and other commercial producers should pay special attention to micronutrient levels. If $, pHs, $pH, C or Z
notations appear on the soil report, refer to $Note: Secondary Nutrients and Micronutrients In general, homeowners do not
need to be concerned about micronutrients. Various crop notes also address lime fertilizer needs; visit
ncagr.govlagronom iipubs.htm.
Recommendations for small areas, such as home lawns/gardens, are listed in units of lb/1000 sq ft . If you cannot find
the exact fertilizer grade recommended on the report, visit www.ncadr.doy/agronomi/obriart4.htrnfflind information that
may help you choose a comparable alternate. For more information, read A Homeowner's Guide to Fertilizer.
Test Results
The first seven values [soil class, HM%, W/V, CEC, BS%, Ac and pH] describe the soil and its degree of acidity. The
remaining 16 [P-I, K-I, Ca%, Mg%, Mn-I, Mn-All, Mn-AI2, Zn-1, Zn-Al, Cu-I, S-I, SS -I, Na, ESP. SS -I, NO3-N (not routinely
available)] indicate levels of plant nutrients or other fertility measurement. Visit w.ncagr_gov/aa_ronom;/uyrst.htm

FY22 SL017968
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Phone: [919) 733-2655
NCDA&CS Agronomic Division
Understanding the Soli Report: explanation of measurements, abbreviations and units
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