WQ0022155_2023 Residual Annual Report_20240213 (2)

Initial Review
Reviewer
nathaniel.thorn burg
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* 2023
Permit Number (IR) * WQ0022155
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 Wanda Gerald

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:*
WQ0022155
Has Current Existing permit number
Applicant/Permittee Address*
1233 NC Highway 16 South, P.O. Box 67, Jefferson, NC 28640
Facility Name*
Town of Jefferson Class A 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 A 2023.pdf 11.6MB
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.1i
Submission Date 2/13/2024

Town of Jefferson WWTP
Class A Residuals
2023
1.14 Dry Tons of Class A Residuals were produced in 2022. The material was
distributed on Christmas Trees owned by various farmers who have received and
completed an information form regarding application rates, areas/crops to avoid,
and that the Town provided the residuals at no cost to the farmer.
FILE NAME:
Residuals Report A 2023
Submitted electronically 211312024

ANNUAL LAND APPLICATION CERTIFICATION FORM
Facility Name (as shown on permit):
Land Application Operator:
Town ofJefferson
Tim Church Phone: [phone]
Land application ofresiduals amallowed bvthe permit occurred during the past calendar year?
RJ Yes 0 No -%7No, skip Part A,and Part Band proceed boPart C. Also, Ifresiduals 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:
n/a
Total number of fields utilized for land application during the year:
n/a
Total amount of dry tons applied during the year for all application sites:
1.14
Total number of acres utilizes for land application during the year:
n/a
Facility was compliant during calendar year 2023 with all conditions ofthe land application permit
(including but not limited tnitems 1-13 below) issued by the ------ Division ofWater Resources. 0 Yes [] No
If no please, provide u vvrdtoo description vvby the facility was not compliant, the dates, and explain corrective action
taken.
l) Only residuals approved for this permit were applied to the permitted sites.
2) Soil pH was adjusted as opcciD#j in the permit and lime was applied (if needed) iuachieve usoil nK of at least 6.0ox
the limit specified in the permit.
3) Annual soils analysis were performedoneach site receiving residuals during the past calendar year and three (3) copies
uflaboratory 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 ofcertified laboratory results are attached.
S) The facility did not exceed any ofthe Pollutant Concentration Limits in 15/\YQC8CO2T .l\O5(u)orthe Pollutant
Loading Rates in 15A Y4[ACO2T.l |O5(b)(applicable Lo40CP& Part50] regulated facilities).
7) All general requirements in on specified inthe Land Application Permit were complied with (applicable tn40[FR Part
503 regulated facilities).
8) All monitoring and reporting requirements in 15&Y4C/\CO2T.\l}l were complied with (applicable tw4OCFRPart
503 regulated facilities).
g) All operations and maintenance requirements in the permit were complied with or, inthe case ofmdeviation, 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 10include appropriate actions and rcmodiations.
!l) Vegetative cover was maintained and proper crop management was performed on each site receing residuals, as
specified inthe 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 perinit were maintained during each application of residuals.
Part C - Certification:
"Icertify, under penalty n[law, that the above information is, tothe best of my knowledge and belief, true, accurate,
and complete. Iomoaware that there are significant penalties for submitting false information, including the
possibility oyfines and imprisonment for knowing violations."
llm(hurch, Water Resources Director
Pormi1teeName and Title (type orprint)
Signature of Permittee Date
Signature of Date Signature ofLand App|ier Date
(if different from Permittee) (if different from Pemoitteeand P
*9rcpurorindefined io40[PKPart 50].V(r)and \5Ay4C/\[O2T.1102(2h) DENRFORM ACF(12/2OOO)

CLASS A ANNUAL DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0022155 FACILITY NAME:
PHONE: [phone] COUNTY: Ashe
Town of Jefferson WWTP
OPERATOR:
Tim Church
FACILITY TYPE (please check one): &I Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C)
Distribution and Marketing (complete Parts A, B, and C)
uithn in nnnr�tinn Atirina the nact rnlPnrlar veer? Yes -F] No L1 0 If No skip parts A, B, C and certify form below
Part A*:
Part B*:
Month
Sources(s) (include NPDES # if
applicable)
Volume
(dry tons)
Recipient Information
Amendment)
Bulking Agent
Residual In
Product Out
Name(s)
Volume (dry tons)
Intended use(s)
January
NCO021709
1.1
1.1
Eric Hamilton
1.1
Christmas trees
February
March
April
May
June
July
August
September
October
November
December
Total from FORM DMSDF (sup)
Totals:
Annual (dry tons):
0
L1
1.1
1.1
Amendment(s) used: Bulking Agent(s) used:
* If more mace is required_ attach additional information sheets (FORM DMSDF (supp)): Total Number of Form DMSDF (Supp)
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit 121 Yes
(including but not limited to items 1-3 below) issued by the Division of Water Resources: No 1, If No, Explain in Narritive
1. All monitoring was done in accordance with the permit and reported for the year as required and three (3) copies of certified laboratory results are attached.
2. All operation and maintenance requirements were compiled with or, in the case of a deviation, prior authorization was received from the Division of Water Resources.
No contravention of Ground Water Quality Standards occurred at a monitoring well.
"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."
Signature of Permitteof Permittee Date
**Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Signature of Preparer**
(if different from Permittee)
Date
DENR FORM DMSDF (12/2006)

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ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM (503 Rules)
Facility Name: Town of Jefferson WWTP
WWTP Name: Jefferson WWTP
WQ Permit Number:
NPDES Number:
WQ0022155
NCO021709
Monitoring Period: From 1.1.23 To 12,31.23
Pathollen Reduction (40 CFR 503.32) - Please indicate level achieved and alternative performed:
Class A:
Alternative 1 21
Alternative 2
Alternative 3
A -iiati
Itet ve 4 L1
Alternative 5 El
Alteniative 6
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost El
Heat Drying :K�'
Heat Treatment 0
Thermophillic L'J
Beta Ray Ll
Gamma Ray [J
Pasteurization [1
Class B:
Alternative I Ll
Alternative 2 El
If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization
Air Dryings
Composting 0
jAerobic Digestion 0
...... ... . ..
Anaerobic Digestion 11
If applicable to alternative performed (Class A or Class B) complete the following monitoring data
Parameter
Allowable Level
in Sludge
Pathogen Density
Numt)er of-
d
Frequency
of Analysis
I -
Sample
Type
Analytical
I' . ech-
pioue
Mini rnum
Geo. Mean
Maximum
Units
Fecal Coliforin
2 x 10 to the
6th power
per gram of
total solids
MPN
244
244
244
MPN
0
1
Grab
SM9222D
CFU
1000 mpn per grant
oftotal solid (dry
weight)
Salmonella bacteria
(in lieu of fecal
coliform)
3 WIN per 4 grams
total solid (dry
weight)
Vector Attraction Reduction (40 CFR 503.33) - Please indicate option performed:
Alt. I (VS reduction) El
Alt. 2 (40-day bench) D
Alt. 3 (30-day bench) 0
1Alt. 4 (Spec. 02-uptake) ---L1
Alt. 5 (14-Day Aerobic) Ll
Alt. 6 (Alk. Stabilization El
Alt 7 (Drying - Stable) Rl
JAR. 8 (Drying - Unstable) 13
Alt. 9 (Injection) 0-
Alt. 10 (Incorporation) EI
No vector attraction reduction alternatives were performed D
CERTIFICATION STATEMENT (please check the appropriate statement)
Ed "I certify, under penalty of law, that the pathogen requirements in 40 CFR 503.32 and the vector
attraction reduction requirement in 40 CFR 503.33 have been met."
0 "1 certify, under penalty of law, that the pathogen requirements in 40 CFR 503.32 and the vector
attraction reduction requirement in 40 CFR 503.33 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)
ILAMM4L
Signature of Preparer* Date
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 503 (12/2006)

Town of Jefferson WWTP
Class A Residuals WQ0022155
K!m
MONTH
GALLONS
DRY TONS
January, 2023
20,600
11.14
0.01,33 Y
N -T

4
Class A Dry Biosolids Production Record
Pathogen Reduction Alternative I
(Complete a line for each batch produced, not just a line for each day.)
DATE
Thermal Fluid
Degrees F
Discharge Temperature
Degrees F
Drying
Time, hrs.
Time of-7
Discharge
(7
23
'T -
211
"7
- ----------

Fenton Environmental Tecbnologics, Inc.
RK Series Municipal Biosolids, Dehydmtor
1(800) 777-1371
Class A Compliance Under the 503 Rules
The Sludge"TER RK scries automatic betch style biosolids dehydrator is uniquely suited to
insure compliance with the 40 CFR 503 regulations rA:rtaining to achieving Class "A" biosobds.
Tbc RK dehydration chamber is loaded automatically with a predetermined amount of dewatered
biosobds which starts the batch cycle.
The total sludge load is subjected to a Wi&iMWXtcmp=t,urc of 212 degrtes F for a miaun-oLof
two and ow -half hours which exceeds the time and ternpe-rlture requirements of the 503
regulations pertaining toh9ycn lion. This cornpliancb is shown as follows using Regime
p41��uq
A under Alternative I whicE requires that solids be heated at 50 degrees C or higher for 20
minutes or longer.
Time (in days) JJLJQ9,M
10,", 0.14 (temperature) gr, for the I.K. dehydrator at 212 degrees F (- 100 C)
Time= 13JMQN— or Ti== 12iJ-QQM .9 r Timc = less than 1.3/1 (Yfi dray.
I DA 0.14(100) IOA14
e.
The titheb,
e required in the RK for pathogen reduction would less than I minute, Therefore, the
minimum time requirement of 20 minutes specifled in the 503 Rules must be fOIIO%%'W. Fotlo%�ing
the 20-minute requirement, the RK dehydrator cxccc6 the time requirement by about 700%.
Total cycle time is determined by achieving the desired sludge dryness. We normally rocommcnd a
miairnJIM-of 90 % dry solids for a finished product to qualify under 503.33 "Option-8" regarding
vector affie6tion re&6:tl6ri (Fully digested sludges r=d be dried to 7511/6- 503.33 -Option 7-.)
The SludgeMASTER RK patented process automatically adjusts the time and temperature regime
for the -,w*g incoming wet sludge solii
solids content. This feature s very important since dev,-aterin',t, '
operations will vary from time to time in solids consistency yet we must maintain consistent CL-Lss
A biosolids at ail times. Con4scly, automatic flow through systems cannot adjust to varying
conditions without disrupting their norrml operation and compromising the finished Product
CLiss "A" parameters.
Plcas-e refer to 40 CFR 503.32 Pathogens - (a) (3) (ii) (9) for pathogen reduction requirements and
to 40 CFR 503.33 (b) (7) and (8) for vector attraction reduction requirements.
Fenton Environmental Technologies, Inc. gun=tcrs Class A compliance on a continued besis
with each SludgeNWTER RK Nhydration System.
In choosing Class A biosolids the=] dehydration utilizing SludgeNAASl-ER RK technology, your
utility will be ass=d of an environmentally correct sludge: haMling solution for many years in the
future.

Contact: Tim [hunch
client: Town u[)effermQoVVW7P
P0.Box 67
/eKcrson'NCZ864U
K4critochVVorkUnJcr# 12122370
��_111tLQ1
Y67ota| Solids
Amnnoniz'Mitu/grn
TKN
Mirra\c/Nitrike,Nkrogcn
Numioom.\u\a|
A:scnic.tolu\
�udmium.tnta|
� |cioin, to:a\
Copper, total
iead.urta|
Mzgncximn.to<n|
Mcrcury.imta|
k4o|ybdcnun\tntx|
Nickel, total
Ph*sphoruy.toti|
Potaosixm.total
Sc\enium'tora|
Sudiom.k/(a|
linc.\uua|
pH
���� ~����~D� Inc.^.=~~==�~~-~�=v �~~~~
Environmental Laboratory
Laboratory Certification No. 165
Simple: MryRpsidua|sCrab
90.6 Y6
1'310 nno/ku
2.340rn&/kA
1.210 nnm/k*
5.760nng/km
<0.500 mg/kg
<0.100 mg/k%
10.900 mg/kg
417 mg/kg
\O.O mg/kg
1.310 mg/kg
Z.4] mg/kg
3,11 mg/kA
I63 mg/kg
I3.000rnQ/kg
2^010 nng/kA
<0.500 nog/kg
64S rng/kg
766 mg/kg
i2/l3/23
l2/2l/Z3
l2/27/23
l2/22/23
l2/l4/23
l3/I4/23
12/l4/2]
13/14/2D
12/14/23
\2/|4/2]
l2/l4/2]
l2/}9/23
iZ/l4/23
l2/l4/23
l2/14/23
\2/14/23
\Z/I4/Z3
l3/\4/23
l2/\1/2]
\Z/20/Z3
: 11-1 ' hereby rerbfvthat / have reviewed and approve these data.
Page
Report Date: 1/8/2034
NPD8S#: NC0021709
RO.#: 2165
Date Sample 0cvd: 12/12/2023
O'lOO 96
10 me/km
20 mg/kg
10.0 roe/ke
2.50 mg/kg
0.500rng/kg
O.\OO mg/kg
10.0 rng/kg
1.00 nng/kg
0.500 nng/kg
10.0 nug/kg
0.02 mg/kg
0.500 mg/kg
2.0 mg/kg
2.00 mg/kg
20.0 mg/kg
0.500 mg/kg
20.0 nng/kA
0.500 mg/kg
12/l2/2023
SK4Z54UB
EPA ]58.l
EPA2Sl]
CPA353.3
EPAZOU7
EPA20U,7
EPA2OOJ
CPA2O0J
EPA2OU.7
EPA2OOJ
EPA20OJ
EP8Z45.)
6PA2OO7
6PAZOO7
LKA20U.7
[PA2OO7
EPA2AO7
[PAZ00.7
CPA2O87
3h045uO'HB
Laboratory Representative
642TomncoRoad, Reidsville, North Carolina 27320
ieL(336)342'47480mx.[phone]

����U�~1���K"�� Inc..'~~~~~�-�~~~� ~~~.~
Environmental Laboratoi-y
-
Laboratory Certification No. 165
Page
Report Date:
1/8/2024
Contaci:Tim Church
NPD2S#:
NCO03I709
Client: Tovvnuf/effersooVVVVTP
P.O. Boz67
P.O.
2165
jefferyon.NC2O64O
Date Sample Rcvd:
12/12/2023
K4critcchVVorkUrder# 12122369 Sample: Dry Residua|eGrab
12/12/2023
1311 - TCLP Metals
Parameter
Results
Analysis Pate
��Linii Reg. Linii
Method
Arsenic
<0,10011ug/L
12/28/23
O.lUO 5.0
CPAZOU
Barium
1.56mg/L
12/26/23
0,05O l0O.O
SP&20U.7
Cadmiu/n
<0.020 ong/[
12/26/23
0.020 1�0
EP&ZOO.7
Chro/niun/
<0.050 noA/|.
12/26/23
0,050 5.0
bPA2OO.7
Lcad
<0100 mg/L
12/26/23
0,100 5.0
EPA2OO.7
Mercury
<O.OZOO /ng/L
12/26/23
0.0200 0.2
EPA24S.l
Se|eoiunn
8.327nug/L
I2/26/23
0.100 1.0
CPA20U,7
Silver
<0.050 rng/L
12/26/23
0.050 5.0
�PA2Q0.7
7~(~T lJ Organics
Parameter
—R t.� t��
Method
Vo|atiles836O
Attached
12/28/23'
8260
S*ndVol. 8Z7O
Attached
1/2/24
-
8270
Other Tests
Parameter
Results
Analysis Date,
Reporting Limit
Method
Cyaoide. total
0.740 mg/kg
12/28/33
0.500 mg/kg
EPA 335.4
Sulfide
lO mg/kg
12/28/23
10.0 mg/kg
Sk1450062DS
8as|)Point
>I400F
12/27/23
-
EpAl()2U8
642 TarucoRoad, Reidsville, North Carolina 27320
beL(336)342-4748bau.(336)342'1522

Me~ ~0-eK~h Inc.
Environmental Laboratory
~
Laboratory Certification No. 165
Page
-�~-
Report Date:
1/8/2024
Contact: TinnChurch
NPDES#:
NC0021709
Client: Town of' |ehermonVVVV1P
P.O.Box 67
P.U.#:
2I65
jeftecson'NC2864D
Date Sample Rcvd:
12/12/2023
k3eritachVYorkOrder# l2I22369
Sample: Dry R,yidua|sGrab
12/12/2023
Paratntj!�j Results Analysis Date Det. LiLni Reg. Limit Dilution Factor
�ndrin
Attached
Chlordane
Attached
Toxaphene
Attached
NeLboxych|ur
Attached
Heptachlor
Attached
Lindone
Attached
Parameter Resull
2.4-D Attached
2.4'5'711 Biivexl Attached
Analysis Dat Det. Limil Reg. Linlit Dilution Factor
--K4A�L��
64%1[anm(oRoad, Reidsville, North Carolina 27320
be|.[phone]tax]336)342'1522

� 11.1-1 111. �%1'11
SUMMU1, S ........
WO#:
23121528
ie
3310 Win Sr.
D'ate Reported:
12/29/2023
ENVIRONMENTAL TECHNOLOGIES, INC
Clowhoga Falls. Ohio 44223
4oAlyth'al TEL: (33Q) 253-8211 FAX. [phone]
Company
Meritech l'"nvironmental
Laboratories
Address:
642 'famco 1W.
1ieidsville NC
27320
Received:
121120/2023
Pro.ject4:
TCL11 Pesticides
Client H)#
Lab 1D#
Collected Analyte
Rep Lnit Result Units
Matrix
Nletbod DF
Reglvl
Run
Analyst
001
12/1212023 Chlordane, total
0.0250 NO mg/L
Solid
EPA 8081 B 10
0,0300
12/24/2023
JOB
121223-0,
001
12/12/2023 Toxaphene
0.0500 NO rng/l.
Solid
EPA 8081 B 10
0,500
12/24/2023
JOB
;121223-69
001
12112/2023 Endrin
0.00500 NO rng/L
Solid
EPA 8081 B 10
0.0200
12/24/2023
JOB
I
,1 2 i '22i»6
001
12/12/2023 gamma-BI-IC
0.00500 NO mg/L
Solid
EPA 80816 10
0.400
12/24/2023
JOB
12122340
001
12/12/2023 Heptachlor
0.00500 NO mg/L
Solid
EPA 80816 10
0.00800
12/24/2023
JOB
1 21221-'df0
001
12112/2023 Heptachlor epoxide
0M500 NO mg/t.
Solid
EPA 8081 B 10
0.00800
12/24/2023
JOB
121
Doi
12112/2023 Metiioxychlor
0.00500 NO mg/L
Solid
EPA 8081 B 10
10.0
12/24/2023
JOB
TC L P Herbicides
Client 110
Lab 1D#
Collected Analyte
Rep Lint Result Units
Matrix
Method DF
RcgLvl
Run
Analyst
121223-69
001
12/12/2023 2,4-D
0.500 NO f-ng/L
Solid
EPA 8321 B 50
10.0
12,122/2023
MTG
121223-69
001
12/1212023 2,4,5-TP
0.500 NO mg/L
Solid
EPA 8321 B 50
1.00
12122/2023
MI G
TCLP Pesticides
Client ]D# Lab 1,D# Collected Analyte Rep Lout Result Units Matrix Method DF RegL0 Ron Analyst
121423-158
002
12/14/2023 Chlordane, total
0,0250
NO mg/L
Solid
EPA 8081 B
10
0.0300
12/28/2023
JOB
121423-158
002
12/14/2023 Toxaphene
0,0500
NO mg/L
Solid
EPA 8081 B
10
0.500
12/28/2023
JOB
121423-158
002
12/14/2023 Endrin
0.00500
NO mg/L
Solid
EPA 8081 B
10
0.0200
12/28/2023
JOB
121423-158
002
12/14/2023 gamma-BFiC
0,00500
NO mg/L
Solid
EPA 8081 B
10
0.400
12/28/2023
JOB
121423-158
002
12/14/2023 Heptachlor
0.00500
NO mg/L
Solid
EPA 80818
10
0.00800
12/28/2023
JDB
121423-158
002
12/1412023 Heptachlor epoxide
0.00500
NO mg/L
Solid
EPA 8081 B
10
0.00800
12/28/2023
JOB
121423-158
002
12/14/2023 Methoxychlor
0.00500
NO mg/L
Solid
EPA 8081 B
10
IM
12/28/2023
JOB
TCLP Herbicides
Client 110 Lai) 1139 Collected %nahte Rep Lrut Result Units Matrix Nlethod DF Regl,vt Run Analyst
121423-158 002 12/14/2023 2,4-D 0,500 NO ryig/L Solid EPA 8321 B 50 10.0 12/22/2023 MTG
121423-158 002 12/14/2023 2,4,5-TP 0,500 NO mg/L Solid EPA 8321B 50 1.00 12/22/2023 MTG
Page of 17

INC.
MERITECH,
Environmental Laboratories
'0 Laboratory Certificate #1G5
-- Client: Town ofJefferson Water Resources
PJcct: TIC LP
0cro Sample |D: Dry Residuals
Sample Collection: 12/12/23
McritechSample |11 12122309
AnaySiu: 12/28/23
Exuvcioo:
12/28/23
Analyu: Vu/V
Report Date:
01m5/21
Parameter
Result
.1111its
Det. LAITIR
�L. l'infit Dilution ador
Benzene
< 0.O|O8
mw|,
0.0100
0,50 \O
CurhonTe/mch\orido
<0u\UO
mQ/L
0,0100
0,50 |U
Ch|orobcnzroc
<0.0|VO
m8/L
0.0100
100 |U
Ch!omR`nn
/0.0100
mA/L
0.0100
8.0 10
1.2'Dich\opouhunc
0.0100
Im"L
U.U\0O
8,50 )O
|.\-Dich|omcthcnc
<O.0\0O
nlgl.
0.0100
070 |O
��udhy|Elhy|Kcmnc
«u�|OU
mQ/L
o.|UO
ZOO |U
Turachi^neffiy|cnc
/00UO
mg/L
0.0100
070 |o
Trich|umoUhonn
100
mg"L
0.0100
0.50 |o
Viny|CNohdc
<0.02O8
mg/L
0.020
0.20 10
Analysis: 01m2/24
Cxuucionr
|�2*23
Analyst: I'm
KcpmrtDate:
010524
Parameter
Result
Units
De1Limit
�Li. Limit Dilution Factor
|.4'Dichiombcoxcne
«0]00
mg/L
0]O0
7.5 |O
Hcxu h|omhunzcoc
<0]08
nIg/L
0.|80
0]3 N
Urxuchoro-|.34mtudione
<0,108
xqg/L
U]00
0.5 10
Hcxuch|onoedmic
<0]00
n)g/L
O]00
3.00 N
n-Cosu|
<l}08
nIL-/L
O.|00
200 |0
m&p-cresol
<8.200
280 |0
Tom|cnso|o
<0300
m8/L
280 |U
Ni`mhcnzcnn
<0.100
mg/|
2.00 |0
Pen/ach|omphcno|
<0.500
m@/|
8.500
108 |O
Pyridine
<0'100
UO
5/0 \O
2,4.5liich|umphcnn|
<0.100
()()
400 |O
2�.6lrichkxupbcno|
~0.|08
mg/L
|UO
Z]m |U
2.4'Dinitrou|umc
<0.100
mg/L
100
0]3 N _
}herebrcertifj, that / have reviewed and
approve
theadatu.
labvn/m'yxpv,vxcvmti,,
842TarDco Road ° Reidsville, NC2732O

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Wigation - Sodium Adsorption Ratio (SAR)
Note: A water SAR below 4 minimizes soil hardening.
mg/L as ion pprn / mg/L as
(unless checked) CaCO3
Calcium - Ca+2 9875
Magnesium - Mg+2 2979
Sodium - Na+ 580
Calculate
SAR: 1.31

-- WATER QUALITY LAB & OPERATIONS, INC.
PD.BOX 11S7
BANNER ELK, NC28GO4
[phone]
CLIENT: JEFFER3ON
CLASS SAMPLER:
RESIDUALS RECEIVED DATE:
REPORTED DATE:
|D#: NCO021709
T|MCHURCH
See analysis date below
5-Jan-24
�/& 143 1 -
ANALYSIS
ANALYSff
MQL's
UNITS
SAMPLE
ANALYSIS
METHOD
INT
RESULTS
LOCATION
STARTED
CODE
TOTAL SOLIDS
91.2
%
SLUDGE
PAUL|SENHOUR.SUPERVISOR

WATER QUALITY LAB & OPERATIONS, INC.
P,O. BOX 1167, BANNER ELK, NC 28604
[phone]
fax [phone]
Class A CHAIN OF CUSTODY
01 C,", T 10 N J c' f (e r s 0 (1 WVVT P . H2 S Cl 4 2 � 1 NO 3 3 - H C L
-
FACILITY ID NCO02 1709 cla'("S A Rts'lxlis NACH 5 NONE 6 , COOL ICE
SANIPLEIR NAt,,',E T Church 7 - N"12S203 6 OTHER
COMPOSITE SANIPLE START 'rfmc- 800 800
SAMPLE NAME I COLLECTION JDELIV.jSAMPLE
-TYPE
FP R E S E RVTTTO W
PH
CL2 D
2
LAB SAMPLE
7
DATE TILlf1yPF EMP[qR7B
MP F=E7ELD
L LAB
EL
NO
ID NUMBER
_
1300/-rss
_-
X �-6
Efkuen� BOD/TSS
X G
Effl,;enl NH3 hj
X 6
EHluenl I collforn) X
X
6-1
61
41
!Copper 21ric
C,
2
X
X
'JISHED BY
DA T E
TIP.1E
RECEIVED BY
DATE
T I t l
��
t'E"JOUISHED BY
DATE
Tl�,�E
0
RECEIVED BY
DATE I T I M F
preservalion is P!)sj(e(,' by zidd�f on of preserw f ri r I p I c-s ) o (:) s o rn ! e
ka av,r0 the Iab !1'2ss
Ch�r� -r - , c VF- If -a
E—D RES:DILE
CO'1DUCTIV Tv
CO�OR Y C r -,
V, ','UREIDITY
C P! -" -QSO-.
NH3 NO2-NO3 'I KN (-l�"'C,
T()C SS
PHE,':Cl S TOT �i-C)F)
C-I L C P H': 2 H Nl 03'
m - T I\,_ S
ON E CIa;•O;?!DE PII
FLUORIDE:
0 T H E P
COL IFOR( ,A DACTERI:,
f`lli0'I*IFI(--lATION

SOUTH FORK 6-1-013iosolids Fertilizer
Produced by Town of Jefferson
P.O. Box 67 Jefferson, NC 28640
South Fork 6-1-0 (SF 610) is a high organic content fertilizer manufactured bythe Town of,"Jefferson Wastewater
Treatment Facility. This product produces superior results on lawns, Christmas trees, flower'Nds, and shrobs,
providing nutrients at the rates indicated below.
GUARANTEED ANALYSIS
Total Nitrogen ......................................... 6%
Water Insoluble Nitrogen .......................... 3.5%
Available Phosphoric Acid ......................... I %
Soluble Potash. ..................................... 0%
Iron...,,..... ..... I %
RECOMMENDED APPLICATION RATES
Lawn -Sod Establishment: Apply SF 610 at a rate of 30 lbs.11000 square feet at time of planting
Turf Maintenance: Apply SF 610 at a rate of 10-1$ lbsJIOOO square feet every 3 months
Plant Bed Establishment: Apply SF 610 at a rate of 2 lbs. / 100 square feet and mix into the soil
Plant Bed Maintentince: Apply SF 610 at a rate 42 lbs. / 100 square feet In the Spring and Fall
WARNINGS: HC 610 is crivironinentally safe when used as directed, but can become a hazard if mismanaged. This product
should not be used on soils intended for food crop production. This product should not be used as a starting medium for
germinating seeds other than grasses. Cover SF610 with a tarp or plastic during transport. Store SF 610 in a dry area away from
wells or surface waters where it could be washed into streams: keep bulk product away from areas where children may play or pets
may wander.
LIMITED WARRANTY AND DISCLAIMER: The Town of Jefferson warrants that SF 610 meets the specifications stated
above, and that the heavy metals content is less than or equal to the limitations specified in EPA and NC DENR sludge quality
criteria for land application, fliere are no warrantees expressed or implied that extend beyond the description contained herein.
Specifically, there are no warrantees of merchantability or fitness for a particular purpose. If SF 610 fails to incet its specifications
the buyer's sole remedy shall be the recovery of the purchase price. Under no circumstances shall the Town of Jefferson be liable
for any other damages, including direct, indirect, consequential or special damages.
ACKNOWLEDGENI EN,r: I'he undersigned Buyer acknowledges that he/she has read this brochure and is familiar with its
contents, The undersigned Buyer agrees to abide by the following restrictions:
1. SF 610 shall not be applied to land except in accordance with the instructions contained herein.
2. SF 610 shall not be applied to any site that is flooded, frozen, or snow-covered,
3. SF 610 shall not be applied within 25 feet of any water supply, stream, or lake.
4. Adequate measures shall be provided to prevent surface runoff from carrying this product into surface waters.
/VBuyer Signature ?
Date
/�4ame (print) 71 NO Quantity: Lbs Tons
/Address Intended Use ?Z
V
C
22
Amount Collected S