WQ0004166_2022 Residual Annual Report_20230202 (2)

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* 2022
Permit Number (IR) * WQ0004166
Applicant/Permittee Town of Jefferson
Email Notifications
Does this need review by the hydrogeologist? * Yes U No
Regional Office Winston-Salem
CO Reviewer
Admin Reviewer

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*
[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*
13362462165
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-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://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0004166
Has Current Existing permit number
Applicant/Permittee Address*
P.O. Box 67 Jefferson, NC 28640
Facility Name*
Town of Jefferson Class B Residuals Program
Please provide comments/notes on your current submittal below.
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 2022.pdf 52.49MB
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
Pr G'?Aw-If
Submission Date 2/2/2023

ANNUAL LAND APPLICATION CERTIFICATION FORM
Ashe
Year: 2022
WQ Permit#: WQ0004166 County:
Facility Name (as shown on permit):
Land Application Operator:
Town of Jefferson
Tim Church Phone: [phone]
Land application of residuals as allowed by the permit occurred during the past calendar year?
21 Yes ❑ 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 ADDHCOtiOn Summarv:
Total number of application fields in the permitJ
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:
1 25.8
Total number of acres utilizes for land application during the year:
35
Part B - Annual Compiance Statement:
Facility was compliant during calendar year 2022 with all conditions of the land application permit
(including but not limited to items 1-13 below) issued by the Division of Water Resources. B Yes C7 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) Ali 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. I 105(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
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)

* CA `C K
co
�tD
CL
CD
tn' O
Q F
CDCD
CD
mLA
O
w.. C
P.O.
CL
a � �
P-0
o C �
PI
a �
F
o�
a A
� o
�o�o•
C � O
to "O
� C
A O
2 O et
� C ►�
'n v' t9
O w C-
�
r
N D �
n n
N K �
N Q.
O
C C
z>
o
CD
L
H�3-
CD
a'
CD
O
N
O
a
'
�NIZ
4
■
fD
co
.�
v'
O
✓
4
C
s
fi
z
z
z
z
;�„ C
N �1
v�
z
W
oo
J
z
r O
a
a
aa000�^�aao��a.�
m
�-
t!t
w
�-
cn
�-• N
w
p
-
N
r�-
4�1
t0
v
�
�' J
O
O
O
(71 C1
41
�
F—
N
CAD
0
n
0
O
d
CD
i
C
OOil
r
a•
lDk
C
pi
rD
�!
0
O
N_
v
O
110
r
5
ot
tz

F.
CD
� Yo
ro '0
Q.
.A
0
n
R�
!"T
0
W
".3
z
n
a
0
N
O
m
z
X
-n
O
Z'I
w
'n
W
N
K3
O
il+
ui
use
IINIIIIIIIAI
�IIIWIII
i
innuii
n
O
O
N
0
rr
UI A W N
CD
Co
p
n
EE
w
ro

odo
o
Co
o
�.
w
ao
a
V
Cx7
Co
W
O
ad
o
.1

ANNUAL METALS FIELD LOADING SUMMARY FORM*
Attach this form to the corresponding Field Loading Summary Form to be submitted in Annual Report
Facility Name:
Permit #:
Operator:
Acres Used:
Town of Jefferson WWTP Total Dry Tons Applied (Annual):
WQ0004166 Cation Exchange Capacity (non 503 only):
Tim Church Owner:
26 Acres .Permitted:
18.50
14.1
Fred Walters Predominant Soil Series: Watauga
26
Site #: Fred Walters Field #:
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
•
Com-
posite
Date
iD
WWI-
®
11.
FOR M-1
Total
Phos-
phorusMENEENEENEEN
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
3!
4_
5
6
71
8,
191
10-
11'
12
DT/Ac./
-
-
-
-
App.
Event
0.71
Arsenic
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
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
0.508
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.508
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
0.015
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.015
Mercury
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
Molyb-
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.003
denum
Nickel
1 0.016
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.000
0.016
Selenium
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.003
Zinc
0.790
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.790
Total
Phos-
16.756
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
16.756
horus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier Date
DENR FORM MFLSF (12/2006)

d
v
m
Z
X
O
9
W
O
O
D7
o
H
o
Date or
"
c
�*
�.
9-
Month
9�
El
a �
EL
w
u
.1�
w+
oo
N
w o
#CD
N
O
�
O
f�7
O
O
C
O
p
o b�
—
O
—
O
O—
Q
C
O=
O
—
O
w
"D
T
w
vi
5 5
0
0
0
�
0
n
n
n
n
:C9
__
r)
0E
00
V
C
b
b
b
b
O
y tz
v,
-4
"
w
rn
.oD
.oD
A
00
Oai
�
s
I.ja,ao
4����
O
PO�a
n
'TJ b
lb
V, o-
R a
PO
zCD
CL
CL
7 �
w
Cl
R
A
N qr
ao�c
z � �

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 Jefferson WWTP Total Dry Tons Applied (Annual):
Permit #: WQ0004166 Cation Exchange Capacity (non 503 only):
Operator: Tim Church Owner: Johnny Walters
Acres Used: 9 Acres Permitted: 9 Site #:
7.30
10.3
Predominant Soil Series: Watauga
Johnny Walters Field #: 5
Residual Analysis Data (Heavy Metals and Total Phosphorus use mg/kg, % Solids use Raw Percent #):
Com-
posite
ate
Total
Phos-
phor-us,MENEENEENEEN
Annual Heavy Metal Field Loadings (Calculated in lbs/acre):
Total
1
2
4
5
fi
7
8
9
10
11
12
DT/Ac./
_3j
App.
Event
0.81
Arsenic
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
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
0.580
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
1 0.000
0.580
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
0.017
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.017
Mercury
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
Molyb-
0.003
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
0.000
0.000
0.003
denum
Nickel
0.019
0.000
0.000
0.000
0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.019
Selenium
0.003
0.000
0.000
0.000
1 0.000
0.000
0.000
1 0.000
0.000
0.000
0.000
0.000
0.003
Zinc
0.901
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.901
Total
Phos-
19.116
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
19.116
phorus
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations".
Signature of Land Applier Date
DENR FORM MFLSF (1212006)

0
m
z
X
-n
0
0)
n
N
O
0
c�0 rdn p
a Date or
C ° Month
o < 2
. �. G o -Or-
GI
0CD
0
d 0 00 w 3 p, 'C
00 a N
0
O
O
O
0
n
w
o
0
0
�
0cad
NJ00
w
6
F�
yd
w
•>
.•i
bb
*POIROW
uouBozrddV
��
L�
aor;ezrtr�eroA
o
W
uoyszgeaau►yq
A
d
�o
x�
Q
U
ll
13
�
3 uaSou?K
Crr
EiUaUIIU�
rr
A
3 z z
o 0 0 0 0 o d dd _ _— n 2y a 'a �
'� I �JII IQ O O C C C o O O N O N, "AS
4 O O O A Q C
v
O
Q
O
N !Ey5
ci
z
p O
O
P
0
0
0
C7
O
C
>
0
WI
-lb
C
n
N
E
im

M[eritech, 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 # 02162289 Sample: Class B Residuals Grab
Page 3
Report Date-
3/4/2022
NPDES #:
NCO021709
Project:
Class B Residuals
P.O. #:
2165
Date Sample Rcvd:
2/16/2022
2/16/2022
Parameters Results Analysis Date Reporting Limit Method
% Total Solids
0.99 %
2/17/2022
0-100 %
SM 254013
Ammonia, Nitrogen
1690 mg/kg
2/17/2022
10 mg/kg
EPA 350.1
TKN
53,700 mg/kg
2/23/2022
20 mg/kg
EPA 351.1
Nitrate/Nitrite, Nitrogen
1760 mg/kg
2/18/2022
10.0 mg/kg
EPA 353.2
Aluminum, total
5,120 mg/kg
2/28/2022
2.50 mg/kg
EPA 200.7
Arsenic, total
<1.01 mg/kg
2/28/2022
1.01 mg/kg
EPA 200.7
Cadmium, total
0,700 mg/kg
2/28/2022
0.100 mg/kg
EPA 200.7
.alcium, total
12,900 mg/kg
2/28/2022
10.0 mg/kg
EPA 200.7
Copper, total
358 mg/kg
2/28/2022
1.00 mg/kg
EPA 200.7
Lead, total
10.6 mg/kg
2/28/2022
0.500 mg/kg
EPA 200.7
Magnesium, total
4,760 mg/kg
2/28/2022
10.0 mg/kg
EPA 200.7
Mercury, total
0.0064 mg/kg
2/18/2022
0.02 mg/kg
EPA 245.1
Molybdenum, total
2.06 mg/kg
2/28/2022
0.500 mg/kg
EPA 200.7
Nickel, total
11.6 mg/kg
2/28/2022
2.0 mg/kg
EPA 200.7
Phosphorus, total
11,800 mg/kg
2/28/2022
2.00 mg/kg
EPA 200.7
Potassium, total
5,950 mg/kg
2/28/2022
20.0 mg/kg
EPA 200.7
Selenium, total
1.79 mg/kg
2/28/2022
0.500 mg/kg
EPA 200.7
Sodium, total
6,170 mg/kg
2/28/2022
20.0 mg/kg
EPA 200.7
Zinc, total
556 mg/kg
2/28/2022
0S00 mg/kg
EPA 200.7
pH
6.3 S.U.
2/18/2022
1.0 - 14.0 S.U.
SM 4500-14B
bMIT, MYKG I ReSUI+S
I herehv certify that I have reviewed and approve these data.
642 Tamco Road, Reidsville, North Carolina N )
tel.[phone] fax.[phone]_SC,,
Zn
< 1.0
0.70
[us]
75. zo
goo. i.79
75ao. 5�G.--

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
R
f
Page 1
Report Date:
3/4/2022
Contact: Tim Church
NPDES #:
NCO021709
Client: Town of Jefferson WWTP
Protect:
cis, $ Resicu,a_:
P.O. Sox 67
P.O. #:
2165
Jefferson, NC 28640
Date Sample Rcvd:
2/16/2022
Meritech Work Order # 02162289
Sample: Class B Residuals Grab
2/16/2022
1311- TCLP Metals
Parameter
Rgesults
Analysis -Date
Qet. Limit
Reg. Limit
Method
Arsenic
<0.100 mg/L
3/2/2022
0.100
5.0
EPA 200.7
Barium
0.067 mg/L
3/2/2022
0.050
100.0
EPA 200.7
Cadmium
<0.020 mg/L
3/2/2022
0.020
1.0
EPA 200.7
Chromium
0.224 mg/L
3/2/2022
0.050
5.0
EPA 200.7
Lead
<0.100 mg/L
3/2/2022
0.100
5.0
EPA 200.7
Mercury
<0.02 mg/L
2/22/2022
0.02
0.2
EPA 245.1
Selenium
<0.100 mg/L
3/2/2022
0.100
1.0
EPA 200.7
Silver
<0.050 mg/L
3/2/2022
0.050
5.0
EPA 200.7
TCLP Organics
Parameter
ReLults
Analvsis Date
Reporting Limit
Method
Volatiles 6260
Attached
2/21/2022
-
8260
Semi Vol. 8270
Attached
2/28/2022
-
8270
Other Tests `
Parameter
Results
Analvsis Date
Reporting Limit
Method
Cyanide, total
<0.500 mg/kg
2/24/2022
0.500 mg/kg
EPA 335.4
Sulfide
<10.0 mg/kg
2/24022
10.0 mg/kg
SM450052DB
!.jsh Point
>140 °F
2/18/2022
EPA 1020R
Corrositivity (pH)
6.3 S.U.
2/18/2022
1.0 - 14.0 S.U.
SM 4500 HB
642 Tameo Road, Reidsville, North Carolina 27320
tei.[phone] fax.[phone]

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
-
Page 2
Report Date:
3/4/2022
Contact: Tim Church
NPDES #:
NCOO21709
Client: Town of Jefferson WWTP
Project:
Class a Residuals
P.O. Box 67
P.O. #:
2165
Jefferson, NC 28640
Date Sample Rcvd:
2/16/2022
Meritech Work Order# 02162289
Sample: Class B Residuals Grab
2/16/2022
1311 - TCLP Pesticides & Herbicides
Pesticide - SW-846 8081A
Parameter Results Analvsis Dat Det. Limit Reg lP imit Dilution Factor
Endrin
Chlordane
Toxaphene
kiethoxychlor
_ Heptachlor
Lindarle
Herbicides - SW-846 81-5-1-A-
Parameter
Attached -
Attached -
Attached
Attached
Attached
Attached
Results Analysis Date Det. Limit Reg. Limit Dilution Factor
2,4-D Attached - -
2,4,5-TP (Silver) Attached - -
642 Tarnco Road, Reidsville, North Carolina 27320
tel.[phone] fax.[phone]

I%-r
i
_ Environmental Laboratories
Laboratory C _ . 'sate # 165
Client:
Prt?ject:
Client Sample ID:
Sample Collection:
Meritech Sample ID
Jefferson WWTP
Class B Residuals
Class B Residuals
02/ 16, 22
U2162259
1311 - TCLP Oroanics
Volatiles: SW-846 8260
Analysis- 02. _' 1122
Extraction:
02Y 17'22
Analyst: v%VV
Report Date:
02122 22
Parameter
Recuit
Units
Det. Limit
Re0. Limit
Dilution Factor
Benzene
< U.0 l Uo
mg. L
0.01 UrJ
U.;()
Carbon Tetrachloride
<0.01UO
mgtL
0.0100
0.50
I!
Chlombcnzene
< 0.0100
mg/L
0.0100
NO
! t
Chloroform
< 0.0100
mgtL
0,0100
6.0
1 c
] 2-Dichloroethane
<0.0100
mzjl-
0.0100
0.50
1r,
1, 1 -Diehl oroethene
<0.01Ou
ingfL
0.rilon
0.70
1U
\•letk I Elhyl Ketone
<U.1 UU
mg L
0.100
_UU
I U
Tetrachluroetlt\•Ierle
< 0.0100
m "L
0 0100
070
10
.€.richloroethene
< 0.0100
rne'L
0.0100
Mo
10
Vinyl Chloride
< 0,020U
M&I
0.020
0.2U
10
Semi-Volatiles: SNP'-S46 5270
analysis: 02; 218'22
Lxiractiun:
02/17.'22
Analyst:
Report Date:
031032-1
Parameter
Result
Units
Det. Limit
Red. Limit
Dilution Factor
1.4-Dichlorobenzene
<0,I110
mLL
0.1OU
?
10
licxachloroh;nzene
<0.100
mC'�I,
O.100
0.1
111
Ile.achloro-I,-butadicnc
<0.160
m-L
0.1ui1
{r 5
i(1
Flesachloroethane
<U.100
mg!L
0.1110
3.U0
Icy
o-cresol
<0.100
nt-'L
0.100
200
l U
rnkp-cresol
<0 200
me'L
0.200
200
[)
Total cresols
<U.300
me/L
0.300
200
ku
Nhrobenzene
<0, [ OU
mq'L
0.1 CIO
2.00
I e.
Perttachloropheriul
<U.500
mg L
0.,q11
100
I r�
Nritline
<0.100
vial
i1.100
2.4.5-TrichlnmpheniA
<0.100
rns•"L
4' 100
400
2.4.6-Thchkirophenol
<0.100
rng'L
0.100
2.00
UI
2,4-Dinitrutoluene
<0.100
In%1
U_IIIO
(1.13
lU
I here .1 c4rlrfp that I have reviewed and approve these data. �� +•,.
Laborrrturs' Represenrrrtive
642 Tamco Road " Reidsville, NC 27320
[phone] � [e-mail]

Summit Enrvauncntal Ted:01a/t,,ver, 1rc
331(1 Win Sr.
Cio.whugu Falls. Ohio 4e7_'3
TEL. [phone]l i FAX (338, :53.4489
1Cehsire ! itp e4vwiv settel, cnm
W04: 22021304
Date Reported, 3/3/2022
Comp.uly Nleritech Environmental Laburawries
Address: 642 Talmo Rd.
Reidsville NC ''7;30
Rccelved 21812022
Project;
TCLP Pesticides .Analysis (SNi'131118081)
Client TW
Lab ID4
Collected .Analyte
Rep Lmt
Result UFlits
Matrix
Method
DF
ReeLvl
Run
Anal}sl
021522-218
004
211512022 Chlordane, lotai
250
NO pg)L
Sludge
EPA 8081B
10
30.0
2124/2022
CSS
021522-218
004
2115,12022 Toxaphene
500
NO pg1L
Sludge
EPA 8081B
10
500
2124/2022
CSS
021522-218
004
2115/2022 Endnn
5.00
NO pg/L
Sludge
EPA 8081B
10
20.0
2124/2022
CSS
021522-218
0C4
2/15/2022 gamma-BHC
5.00
NO pg/L
Sludge
EPA 80818
10
400
212412022
CSS
021522-218
004
2115f2022 Heptachlor
5.00
ND pglL
Sludge
EPA 80818
10
8,00
212412022
CSS
021522-218
004
2115/2022 Heptachlor epoxide 5.00
NO pg1t,
Sludge
EPA 8081E
10
800
2/2412022
CSS
021522-218
004
2/1512022 Melhoxychlor
5.00
ND lig1L
Sludge
EPA 9081 B
10
10000
2124 2022
GS—S
TCLP Herbicides by EPA 832IB
f
Client ID4
Lab 1D#
Collected Analyte
Rep Lint
Result Units
Matrix
Method
DF
RetgLsl
Run
Analyst
021522-218
004
?li512022 2,4-D
0.500
NO mg1L
Sludge
EPA8321B
50
10.0
311j2022
RIS
021522.21tt
004
2/1512022 2.4,5-TP
0 500
NO mg!L
Sludge
EPA 8321E
5c
1.Dtti
3I12022
P.t5
TCLP Pesticides ,Analysis (SNVI311/8081)
Client ID4
Lab 1D#
Collected Analyte
Rep Lmt
Result Units
Matrix
Method
DF
RcgLvI
Run
Analyst
021622-39
005
211612022 Chlordane, total
25.0
NO p91L
Sluoge
EPA 8081E
1C
3o 0
2.2.t12.022
C'S
021622-89
005
2116/2022 Toxaphene
50.0
NO pglL
Sludge
EPA E0815
10
500
2:24 2D22
ti.=S
021622-80
005
2/16/2022 Endrin
5.00
ND lig/L
Sludge
EPA 60816
10
20.0
212412G22
CSS
021622-84
005
21M2022 gamma-BHC
5.00
NO pg1L
Sludge
EPA 8081B
10
400
M412022
CSS
021622.89
005
2/16/2022 Heptachlor
5.00
NO lig/L
Sludge
EPA 80818
W
am
2J2412022
CSS
021622-89
005
2116/2022 Heptachlor epoxide
5.00
NO pg/L
Sludge
EPA 80815
10
8.00
2/24/2022
CSS
021622-89
005
2/1612022 M7ethpxyctl1or
5.00
1,40 y,g'L
Sludge
EPA 80818
10
10000
21'242_7s
S
TCLP Herbicides
by EPA 832113
Client IN
Lab ID9
Collected Analyte �
Rep Lmt
Result Llnits
:Matrix
Method
DF
Re-0,%1
Run
Analyst
021822 89
005
2J1612022 2,4-0
0,500
NO mglL
Sludge
EPA 8321E
50
10.0
3/1/2022
RIS
021622-89
005
2/16/2022 2,4,5-TP
0.500
NO mg/L
Sludge
EPA B321B
50
1.00
31112022
RtS
Page 5 of 15
P_Igt: ? ill 14

I
L
L
c
=
-n
`°
rD
X
ro
q
n
'-r
-
3
`7
Y
m
*�
s
O
3
_
N
3
_
{
D
m
A
I Z.
l
m
V)
rowrn
j ^ + CI !
C
CLr
nQ
T t ■®��'
0
3
�
r I
L7
6
©
l cr QI G1 b
3
B
O
0
o a O ==
�.
S
'"
m
-
L
1-
ti
�
NrD
n
�
C
Q
�o
n
3
io
rD
7
n
m
N
O
O
ro
t/I
`L
O
d C
Q
O
75
a
V
c
ri
tom
C()i 1
oLA
L
I ,
M
J
I�
O
y
zz
CL
V,
.-
Imo--
I
� O
('�
Ci
n
O
=
6-
Xr
JI
! r

SAR Calculator
Adjusted SAR Calculator
EC
Ca
Mg
Na
HCO3
11
127
47
61
1
SAR �1.2
adj SAR 0.4
Use the larger of the two
Reset
ad J
Classification
SAR
< 1
Excellent
1-2
Good
2-4
Fair
4-8 Poor
8-1 S Very Poor
> 15 Unacceptable
2- /16 /ZO&
PS ffi%� C, X 76 S 01 id S - M3/L
mg/I or ppm y ^�►
mg/1 or ppm t._l, �-.�� K �.� t�l-7
mg/l or ppm X 0.01 = W• I
mg/1 or ppm '
1.2 u
Management Considerations
None
Little concern, add pelletized gypsum periodically
Aerify soil, sand topdress, apply pelletized gypsum, monitor soil
salinity
Aerify soil, sand topdress, apply pelletized gypsum, leach soil
regularly, monitor soil salinity closely
Requires special attention; consult water duality specialist
Do not use
Contact Information

p PSRP
WATER QUALITY LAB & OPERATION, INC. /1�
P.D. BOX 116TBANNER ELK, NC 28604 a/O
Z/
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY: COLLECTED DATE: 8-Feb-22
STATE: REPORTED DATE: 8-Mar-22
mtt•
ANALYSIS
ANALYSIS
MQL's
UNITS
SAMPLE
ANALYSIS
METHOD
INT
RESULTS
LOCATION
COMPLETED
CODE
TOTAL SOLIDS
1.3
%
FECAL COLIFORM
46000
1
CFU's
SLUDGE
SM-9222D
WPS
REPORTED BY, NG GERTIFIED LAU * 544
PAUL ISENHOUR, SUPERVISOR
i
(D bZj
. 22�
5z,, Ox
q. 71 �o
,3-', OT-�
�' 53lq
2,.1(p•?-2--r.
-S 5, C--
�. 7y 0
z. z,� • 2z�
31, cx�
�.�R 1 �
Z. zi?- ZZ
q�, u-,
14. U131
32.577N
7
Gebrne,�, c, inean ,072

WATER QUALITY LAB 8, OPERATION, INC.
P,O. BOX 1167,BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY:
STATE:
I D #
ANALYSIS ANALYSIS MQ1
RESULTS
TOTAL SOLIDS 1.3
FECAL COLIFORM 52000 1
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
COLLECTED DATE: 9-Feb-22
REPORTED DATE: 6-Mar-22
UNITS SAMPLE ANALYSIS METHOD
LOCATION COMPLETED CODE
CFU's SLUDGE Srv1-9222D
ilm
WPS

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY:
STATE-,
I D#:
ANALYSIS ANALYSIS
RESULTS
TOTAL SOLIDS I. -
FECAL COLIFORM 34000
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR
COLLECTED DATE: 15-Feb-22
REPORTED DATE: 8-Mar-22
IL's UNITS SAMPLE ANALYSIS METHOD
LOCATION COMPLETED CODE
1 CFU's SUjDGE SM-9222D
Ivill
WPS

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,6ANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 'f
ADDRESS:
COLLECTED DATE:
16-Feb-22
CITY:
STATE:
REPORTED DATE:
8-Mar-22
I D#:
ANALYSIS ANALYSIS
MQL's UNITS SAMPLE
ANALYSIS METHOD 1NT
RESULTS
LOCATION
COMPLETED CODE
TOTAL SOLIDS
1.2
550QG
1
%
CFU's
SLUDGE
SM-9222D VVPS
FECAL COLIFORM
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NG 28604
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY: COLLECTED DATE: 22-Feb-22
STATE: REPORTED DATE: 8-Mar-22
Ir7��
ANALYSIS
ANALYSIS
MQL's
UNITS
SAMPLE
ANALYSIS
METHOD
INT
RESULTS
LOCATION
COMPLETED
CODE
TOTAL SOLIDS
1.3
%
FECAL COLIFORM
62000
1
CFU's
SLUDGE
SM-9222D
WPS
REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY: COLLECTED DATE: 23-Feb-22
STATE; REPORTED DATE: 8-Mar-22
I D#:
ANALYSIS
ANALYSIS
MQL's
UNITS I
SAMPLE
ANALYSIS
METHOD
INT
RESULTS
LOCATION
COMPLETED
CODE
TOTAL SOLIDS
1.3
%
FECAL COLIFORM
31000
1
CFU's
SLUDGE
$M-9222D
WPS
REPORTED BY- NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON 1
ADDRESS:
CITY: COLLECTED DATE: 28-Feb-22
STATE: REPORTED DATE: 8-Apr-22
I D#:
ANALYSIS
ANALYSIS
MQL's
iJNITS
SAMPLE
ANALYSIS
METHOD
1NT
RESULTS
LOCATION
COMPLETED
CODE
1.2
%
FECAL COLIFORM
44000
1
CFU's
SLUDGE
SM-9222D
WPS
REPORTED BY: NC CERTI>:IED LAB # 544
PAUL iSENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone]
7 CHAIN OF CUSTODY
LOCATION: Jefferson WWTP 1 - H2SO4, 2 - HNO3, 3 - HCL,
FACILITY ID #: NCO021709 4 - NAOH, 5 - NONE, 6 - COOL ICE
SAMPLER NAME: T. Church F. Walters 7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE; START TIME:_ 800 800
SAMPLE NAME: I
COLLECTION
DELIV.
TEMP I
SAMPLE
TYPEJ
PRESERVATION`
PH
CL2-D-CL2
LAB SAMPLE
ID NUMBER
DATE
TIME
TEMP
GRAB I
COMP JF
- FIELD
L - LAB IverifyiYES
NO
Influent SOD/TSS
X
6
Effluent 1300/TSS
X
6
Effluent NH3 N
X
6
f, coliform
2.9.
07,30
X
6
Cyanide
X
6
4
Copper, Zinc
X
i 61
2
_
Total Nitrogen
X
6
Total Phosphorus
X
6
Effluent Hardness
X
6
Upstr. Hardness
X
6
RELUJ 'UISHffED BY:
rVvv„{ •h�A�C 11/
�
PAT
�,8 7�i
TIME
0�5W
RECEIVED BY:
DATE
a
TIME
RELINQUISHED BY:
DATE
TIME
RECEIVED BY'
DATE
TIME
Laboratory preservation'is ensured by addition of servatives prior to sample .
containers leaving the lab, unless otherwise note .
CL2-D-CL2= Chlorine check and dechlorination verification.
PRESERVATION:
( ) COOL 4C : BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
( ) COOL 4C, PH<2 H2SO4: NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
( } COOL 4C, PH<2 HNO3 . METALS except CR, VI
{) NONE : CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
OTHER
t } COOL 4C, NA2S203 COLIFORM BACTERIA
NOTIFICATION:

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
Class
• ` fax [phone] of 701
PISp� CHAIN OF CUSTODY
LOCATION:
Jefferson WWTP 1 - H2SO4, 2 - HNO3, 3 - HCL,
a - NAOH, 5 - NONE, 6 - COOL ICE
FACILITY ID If:
SAMPLER NAME:
NC0021709
T. Church F. Walters 7 _ NA25203, 8 -OTHER
COMPOSITE SAMPLE,
START TIME:_ 800 800
TYPE RF ER
COLLECTION UV. SAMPL COMP
NO ID NUMBER
SAMPLE NAME:
DATE TIMETEMP TEMP GRAB F L7i-A--]verify BtYES
Influent BOD/TSS
X 6
6
Effluent BODITSS
X
X 6
Effluent NH3 N
f. coliform
2, 3 X 6
4
C anide
X 6
X 6 2
Copper, Zinc
--�
X
Total Nitro en
X 6
Total Phosphorus
EEj X
S
L=wuent Hardness 6
Uosir. Hardness X
'�ELIN DISHED BY: DATE TIME
RECEIVED BY: DATE TIME
?-,/q la- 0"00
RELINQUISHED BY: DATE TIME ECEIVED BY:GATE TIME
a-�
•- Laboratory preservation is ensured by addition of preservatives prior to sample
containers leaving the lab, unless otherwise noted.
CL2-D-CL2= Chlorine check and dechlorination verification.
PRESERVATION
( ) COOL 4C BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, Vl, TURBIDITY
{ } COOL 4C, PH<2 H2SO4 NH3, NO2-NO3, TKN, O&G, TOC COD. HARDNESS, PHENOLS TOT PHOS
t ) COOL 4C, PH<2 HNO3 , METALS except CR, VI SAMPLE DEVIATION'
( ) NONE • CHLORIDE, PH, FLUORIDE
OTHER.
( ) COOL 4C, NA2S203 COLIFORM BACTERIA NOTIFICATION

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone]�
CHAIN OF CUSTODY
LOCATION: Jefferson WWTP 1 - 1-12SO4, 2 - HNO3, 3 • HCL,
4 - NAOH, 5 - NONE, 6 • COOL ICE
FACILITY ID iF: NC0021709 SAMPLER NAME: T. Church F. Walters 7 _ NA2S203, 8 -OTHER
COMPOSITE SAMPLE: START TIME:_ 800 800
SAMPLE NAME: COLLECTION DCAB SAMPLE
ELIV. SA11111111:MPLE TOY -PP R� ELF �TIO B" VeH CYO © NO !D NUMBER
DATE TIME TEMP TEMP GRAB C
influent BOD/TSS X 6
Effluent BODITSS X 6
Effluent NH3 N X 6
�
V Effluent [ toliform is X 6 4
C anide X
6 2
Co er. Zinc X
Total Nitrogen X 6
Total Phosphorus X 6
Effluent Hardness X 6 �—
Upstr Hardness X 6
INQ ISHED BY: ATE TIME
RECEIVED BY: DATE TIME
��51Z� OS�J .1 `-2 0 � 16
f2 LINQUISHED B DATE TIME
R ElVED BY: DAT TIME
��- C�
' Laboratory preservation is ensured by addition of pr eroatives prior to sample
containers leaving the lab, unless otherwise noted.
CL2-D-CL2= Chlorine check and dechlorination verification
PRESERVATION
( ) COOL 4C 600, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, V1, TURBIDITY
( } COOL 4C. PH<2 H2SO4 NH3, NO2-NO3, TKN, O&G. TOC COD, HARDNESS. PHENOLS. TOT PHOS
COOL 4C, PH<2 HNO3 . METALS except CR, VI SAMPLE DEVIATION:
( ) NONE. CHLORIDE, PH, FLUORIDE
OTHER:
( ) COOL 4C, NA2S203 - COLIFORM BACTERIA NOTIFICATION:

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone]
slabb P150
LOCATION: Jefferson WWTP
FACILITY ID #. NCO021709
SAMPLER NAME: T. Church F. Walters
COMPOSITE SAMPLE: START TIME:_, 600
PLE NAME: COLLECTION
PATE ITIMEITEM
Influent BODITSS
Effluent BOD/TSS
Effluent NH3 N
f coliform
Cyanide
Copper, Zinc
Total Nitrogen
Total Phosphorus
CHAIN OF CUSTODY
t
1 - H2SO4, 2 - HNO3, 3 - HCL,
4 - NAOH, 5 - NONE, 6 - COOL ICE
7 - NA2S203, 8 - OTHER
M1111
DELIV. SAMPLE TYPE PRE EERVATION'
TEMP GRAB COMP F - rl LD L -LAB
px�6
XX
PH CL2-D-CL2 L A 6 SAMPLE
erifv YES NO ID NUMBER
Effluent Hardness X 6
Upslr Hardness X 6
I
�^ TIME
L1NQ ISHED BY: DAT TIME BY: DATE
Z'/11(:1' 2-1— 100D Pj —toe)
RELINQUISHED BY: DATE TIME BY' DATE TIME
?ii
z� I �27
Laboratory preservation is ensured by additron of pives prior to sample
containers leaving the lab, unless otherwise noted
CL2-0-CL2= Chlorine check and dechlorination verification.
PRESERVATION
( } COOL 4C: BOO, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
{ j COOL 4C, PH<2 H2SO4 - NH3, NO2-NO3, TKN, O'&G, TOC, COD, HARDNESS, PHENOLS. TOT PROS
( ) COOL 4C, PHe2 HNO3 . METALS except CR, V! SAMPLE DEVIA710N:
( } NONE: CHLORIDE, PH, FLUORIDE
OTHER
( ) COOL 4C, NA2S203 COLIFORM BACTERIA NOTIFICATION:

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
(-6277
Pr% fax828) (828)9898-6 55 Saf 7
�1iUV0
CHAIN OF CUSTODY
LOCATION: Jefferson WWTP 1 - H2SO4, 2 - HNO3. 3 - HCL,
FACILITY ID #: NCO021709 4 - NAOH, 5 - NONE, 6 - COOL ICE
SAMPLER NAME. T. Church F. Walters 7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE: START TIME,_ 800 800
SAMPLE NAME: COLLECTION DEl_IV, SAMPLE TYPE PRESERVATION' PH CL2-D-CL2 LAB SAMPLE
DATE TIME TEMP TEMP GRAB COMP F - FIELD L LAB verify YES NO ID NUMBER
--' X
Influent BODlTSS 6
Effluent SOD/TSS X 6
Effluent NH3 N X 6
—anwoldf coliform 2 Z"L 0750 X 6
Cyanide X 6 4
Copper, Zinc X 6 2
,-otal Nitrogen X 6 —
Jotal Phosphorus _ X 6
Eff'uew Hardness
Upstr Hardness
�,INQ ISHED BY. DAY TIME RECEIVED BY. DATE
� �-,�,,
ELINQUISHED BY.n DATE TIME CEIVED BYDATE
-- Laboratory preservation is ensured by addition of preervalives prior to sample
containers leaving the lab, unless otherwise noted. J
CL2-D-CL2= Chlorine check and dechlorinalion verification.
PRESERVATION:
( ) COOL 4C BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
( } COOL 4C, PH<2 H2SO4 • NH3, NO2-NO3. TKN, O&G. TOC, COD, HARDNESS. PHENOLS TOT PROS
{ ) COOL 4C, PH-:2 HNO3 : METALS except CR. VI SAMPLE DEVIATION
( ) NONE CHLORIDE, PH, FLUORIDE
OTHER:
( ) COOL 4C. NA2S203 COLIFORM BACTERIA NOTIFICATION.
TIME
TIME

WATER QUALITY LAB 8, OPERATIONS, INC.
P.O. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone] J
slkwle � p CHAIN
OF CUSTODY 1 J 7
LOCATION: Jefferson WWTP 1 - H2SO4, 2 - HNO3, 3 - HCL,
FACILITY ID # - NCO021709 4 - NAOH, 5 - NONE, 6. COOL ICE
SAMPLER NAME: T. Church F. Walters 7 - NA2S203, B - OTHER
COMPOSITE SAMPLE, START TIME:_, 600 800
DELIV.
TEMP TEMP
SAMPLE
TYPE PRESERVATION' PH CL2-D-CL2 LAB SAMPLE
COMP F --FIELD L -LAB verif YES NO ID NUMBER
X 6
SAMPLE NAME
COLLECTION
DATE
TIME
GRAB
Influent BODITSS
Effluent BODITSS
X
X
X 6
X 6
6
6 4
Effluent NH3 N
I�1aew f. coliform
CyF,nlde
n
Copper Zinc
Total Nilrogen
^—�
1
1
X 6 2
X 6
iota! Pho5oharus
_
6
_X
X 6 "—
Effluen! Hardness
Upstr Hardness
X fi
RE,LINQUISHED BY DATE
Z- /Z3- 7,
I IMr Kra
DATE
TIME
RELIraouisl-IED BY'
containers leaving the lab, unless otherwise noted
CL2-D-CL2= Chlorine check and dechlorination verification.
EIVED BY. DATE TIME
EIVED
Zf2- lot
servalives prior to sample
PRESERVATION
( j COOL 4C SOD, RESIDUE, CONDUCTIVITY. MBAS. COLOR, ALKALINITY, CR, VI, TURBIDITY
( } COOL 4C, PH<2 H2SO4 - NH3, NO2-NO3, TKN, 08G. TOC. COD HARDNESS, PHENOLS TOT PHOS
( ) COOL 4C, PH<2 HNO3 . METALS except CR, VI
( ) NONE, CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION
OTHER:
( ) COOL 4C, NA2S203 COLIFORM BACTERIA
NOTIFICATION

sl
e V1%
�
LOCATION. Jefferson WWTP
FACILITY ID 0 NCO021709
SAMPLER NAME. T. Church F. Walters
COMPOSITE SAMPLE; START TIME._ 800
WATER QUALITY LAB & OPERATIONS, INC.
p,0. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone]
CRAM OF CUSTODY ®-C
1 - H2SO4, 2 - HNO3, 3 - HCL,
4 - NAOH. 5 - NONE. 6 - COOL ICE
7 - NA2S203, 8 - OTHER
:iN
SAMPLE
SAMPLE NAME: COLLECTION DELIV. SAMPLE TYPE F R -FIELD LTIO VeH CYE S NO L IDNUMBER
DATE TIME TEMP TEMP GRAB COP
Influent BODITSS X ----- Effluent BOOITSS X 6
6
Effluent NH3 N X 6
f coliform X 6
X 6 a
Cyanide 6 2
Copper, Zinc X
Total Nitrogen X 6
Total Phosphorus X 6
6
Effluent Hardness X
Upstr Hardness X 6
1N UISHED 8Y, DATE TIME
RECEIVED BY: DATE TIME
R EIVED BY, DATE TIME
RELINQUISHI=D By' DATE TIME
O � t`1 /
D ti
' Laboratory preservation is ensured by addition of • eservatives prior to sample
containers leaving the lab, unless otherwise noted -
CL2-D-CL2= Chlorine check and dechlorination verification.
PRESERVATION
{ } COOL r+C BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, V1, TURBIDITY
( } COOL 4C PH<2 H2SO4 NH3, NO2-NO3. TKN O&G, TOC. COD. HARDNESS, PHENOLS, TOT PHOS
t COOL 4C. PH<2 HNO3 METALS except CR, V1 SAMPLE DEVIATION.
( ) NONE CHLORIDE, PH, FLUORIDE
OTHER:
( ) COOL 4C, NA2S203 ' COLIFORM BACTERIA NOTIFICATION

WATER QUALITY LAB & OPERATION, INC.
P.O. BOX 1167,BANNER ELK, NC 28604
Veciar Om4i6n Wa
m [phone]
CLIENT: JEFFERSON
ADDRESS: SAMPLER: TIM CHURCH
CITY: JEFFERSON COLLECTED DATE: 8-Feb-22
STATE: NC REPORTED DATE: 8-Apr-22
ID#1
ANALYSIS ANALYSIS
MQL's UNITS
SAMPLE ANALYSIS INT
ICOMPLETEDI
RESULTS
I I
LOCATION
30 DAY BENCH SCALE
START
VOLITILE SOLIDS
75.30
0.1
%
SLUDGE
9-Feb-22
PI
END
VOLITILE SOLIDS
73,80
0.1
%
SLUDGE
11-Mar-22
PI
VOLITILE SOLIDS REDUCTION: 1.50%
~— REPORTED BY: NC CERTIFIED LAB # 544
PAUL ISENHOUR, SUPERVISOR

WATER QUALITY LAB & OPERATIONS, INC.
BOX 1167 BANNER ELK NC 28604
P.O. I
A�mc,4;cn(828) 898-6277 V�or ` EduAm
Class fax [phone]eY)C� ResiJuftls� V�
CHAIN OF CUSTODY yol(rly � aids Rtjuam
,�wb-
LOCATION: Jefferson WWTP 1 - H2SO4, 2 - HNO3, 3 - HCL, {
FACILITY ID #. NCO021709 4 - NAOH, 5 - NONE, 6 - COOL ICE
SAMPLER NAME: T. Church F. Walters 7 - NA2S203, 8 - OTHER
COMPOSITE SAMPLE; START TIME:_ 800
1
SAMPLE N)
ECTION
DELIV.
TEMP
SAMPLE
GRAB
TYPE
COMP
PRESERVATION'
F -FIELD L -LAB
PH
verify
CL2-D-CL2
LAB SF
ID NU
DATE
TIME
TEMP
YES
NO
Influent BOD/TSS
X
6
Effluent BOD/TSS
X
6
Effluent NH3 N
X
6
Effluent f. coliform
X
6
Cyanide
X
61
4
Copper, Zinc
X
6
2
Total Nitrogen
X
6
Total Phosphorus
X
6
d
Effluent Hardness
X
6
Ups#r. Hardness
X
6
F,LINQ ISHED BY: DA7 TIME RECEIVED
ELINQUISHED BY:
A - F2 Z- 0 4 t30 L , �...,
Laboratory preservation is ensured by addition of F
containers leaving the lab, unless otherwise noted.
CL2-D-CL2= Chlorine check and dechlorination verification.
u
DATE
TIME
a
C Sly
DATE
TIME
prior to sample
PRESERVATION:
( } COOL 4C: BOD, RESIDUE, CONDUCTIVITY, MBAS, COLOR, ALKALINITY, CR, VI, TURBIDITY
( } COOL 4C, PH<2 H2SO4: NH3, NO2-NO3, TKN, O&G, TOC, COD, HARDNESS, PHENOLS, TOT PHOS.
( } COOL 4C, PH<2 HNO3 : METALS except CR, VI
( } NONE: CHLORIDE, PH, FLUORIDE SAMPLE DEVIATION:
OTHER
( ) COOL 4C, NA2S203 - COLIFORM BACTERIA
NOTIFICATION:

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (02T Rules)
Facility Name: Town of Jefferson WWTP
WWTP Name: Jefferson WWTP
Monitoring Period: From 1/l/2022 To
WQ Permit Number: WQ0004166
NPDES Number: NCO021709
12/31/2022
Pathogen Reduction (15A NCAC 02T .1106) - Please indicate level achieved and alternative performed:
Class A:
Alt. A (tiuieltemp) ❑ I
Alt B (Alk'freatnient) ❑
Alt. C (Prior Testing)[]
A1t.D (No Prior Test) ❑
Process to Further Reduce Pathogengs [3
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying, ❑
Heat Treatment ❑
-fhermophilic I-]
Beta Rav ❑
Gamma Ray ❑
Pasteurization EJ
Class B:
Alt. (1) Fecal Density Z
Alt. (2) Process to Significantly Reduce Pathogens ❑
If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization ❑
Air Drying ❑
Composting ❑
jAerobic Digestion 0
Anaerobic Digestion LJ
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Parameter
Allowable Level
in Sludge
Pathogen Density
um er o
Excee-
i s
Frequency
o1•Analysis
Sample
Type
na ytica
Tech-
moue
MinimumGeo.
Mean
Maximu
Units
Fecal Coliform
2 x 10 to the
6th power
per gram of
total solids
MPN
CFU
31000
45072
62,000
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
I weight)
Vector Attraction Reduction (15A NCAC 02T .1107) -Please indicate alternative performed:
AIt, l (VS reduction) ❑
Alt. 2 (40-day bench) ❑
Alt. 3 (30-day bench) T
Alt. 4 (Spec. O, uptake) ❑
Alt. 5 (14-Day Aerobic) ❑
Alt. 6 (Alk. Stabilization ❑
Alt 7 (Drying - Stable) ❑
I Alt. 8 (Drying - Unstable) ❑
Alt. 9 (injection) ❑
Alt. 10 (Incorporation) ❑
No vector attraction reduction alternatives were performed ❑
CERTIFICATION STATEMENT (please check the appropriate statement)
Z "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."
Tim Church, Water Resources Director
Preparer Name and Title (type or print)
Signature of Preparer* ate
Land Applier Name and Title (if applicable)(type or print)
Signature of Land Applier (if applicable) Date
*Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM PVRF 02T (12/2006)

.;D
CD
w
3
c0
s ?'
0 5-
CD
3
m
0 3
rn D
0 3
3
3 p']
C) 3
O_ go
Z m
N ..
O y
0�1 Q
O �
2 a
C Wp
a y.
O
a� 3
TT 1
�1 A H
� � ?
Z
m
O �e rfl
e n
r cn
V
� D
r
a6
1
CDS Vi
N � 3
h m
m
g
Z
'
CDN
e 0
r o)
+�
TI
� D
m -
i
o �•_t•._ •
N
.a
p cn
n C
0 CL
0. mow■ rr++
/z�
l
o
a
Yi
O
3
N (') ,'0
N �.,)
-,
A
� ! m
FA
r.� n m
3
-- a M
c 8 3
:.. n 0
co A
o0
m
aa
`a
O
o
Z
al m O
CL
Z
@ su O
N O O
cn is m
W m 3
O) 'a 0)w
T
m
o
3
3 3
3CD
3 3
v
m m
m m
v iT w
N C
a
W
e
a r
P
a r
O
co
aNi
O
o
toi Z
ry W
CD
O
O
Z
�
�
W
7
cn 0)
O O Z
m0 C) 7
N 9
G
7 z
X
+G
at3
to a
o o
a
a c
@
°
3
POm
m
N 10
W e
� e
0•
0 0 0
0 0 0
cn l
to
O i
to
�
0
0 0
IQ
3
N N
oa0
g
A l�
o00
10 A
�_
U,
i
.'.
C
C o o
p
cmo
o o
3 m N
m .303
3
w
is c
o
is Z
m Q.
w a
3
s
m
_
j
co'
-4 o z a 7
o
3 0
n m
C.)
b0
O CD co
a
N 3
o
O O N'n
Q
•� co (/}
h!
L1T
N UM,
T
N p
Q
v;
H
V
ro CD
V
a
i Ar
o ca�
x
co
N N
V >
0 0
W
O D
O O g
to C
0 c
a <
0 0�
o
m
a
;o
Zt
O
m
1 • •
Q . _.
fD
p
x
0 0
0 Co Im
N m
O
N
�
QS
QOi C
.a
Z nTC
T
0
O Z
C) _
o 0
O
i0
00
CA
J.
-+ m 0
Vi
J.
O
�I7
O W D
Cn
o
N N O
N O N
X
A
z
o
'
ODO
ca
w
Z