WQ0022155_Residual Annual Report 2014_20150126

ANNUAL LAND APPLICATION CERTIFICATION FORM
Permitg: wQ DD ?2I �S County: Year: Z01
Facility Name (as shown on permit):
Land Application Operator: lm 01Ilt-01, , Phone: (p —LVW
and a placation of residual solids as allowed by the permit occurred during the past calendar year?
1Yes ❑ No If No, ship Part A, and Part B and proceed to the certification. Also, if residuals were
generated but not land applied, please attach an explanation on how the residuals were handled.
Part A:
Total number of application fields in permit:
1 N
Total number of fields land application occurred during the year:
Total amount of dry tons applied during the year for all application sites:
Total number of acres land application occurred during the year:
1-4 FA -
Pa B:
Facility was compliant during calendar year ?,01� with all conditions of' the land application permit
(including but not limited to items 1-12 below) issued by the Division of VYater Quality. 0 Yes ❑ No
If no please, provide a written description why the facilih, 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 pI-I was adjusted as specified in the permit and lime was applied (if needed) to achieve a soil pl-I 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 was performed and three (3) copies of certified laboratory results are attached.
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.
6. The facility did not exceed ally of the Pollutant Concentration Limits in Table I of'40 CFR Part 503.13 or the
Pollutant Loading Rates in Table 2 of 40 CFIt part 503.13 (applicable to 40 CFR Part 503 regulated facilities).
7. All general requirements in 40 CFR Part 503.12 and management practices in 40 CPR Part 503.14 were
complied with (applicable to 40 CFR Part 503 regulated facilities).
8. All operations and maintenance requirements in the permit were complied Nvith or. in the case of a deviation,
prior authorization was received from the Division of Water Quality.
9. No contravention of Ground Water Quality Standards occurred at a monitoring well or explanations of
violations are attached to include appropriate actions and remediations.
10. Vegetative cover as specified in the permit was maintained on this site and the crops grown were removed
in accordance with the crop management plan.
11. No runoff of residuals from the application sites onto adjacent property or nearby surface waters has occurred.
12. All buffer requirements as specified on the permit Mere maintained during each application of residuals.
"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 tines and imprisonment for knowing violations."
TM13111fC/1 w lYlmeL� 1►a4or
Permittee Name and Title (type or print)
Signature of Preparer* Date
(if'different from Permittee)
' Preparer is defined in 40 CFR Part 503.9 (r)
Signature of Permittee Date
Signature of Land Applier Date
(if'differew from Permittee and Preparer)
DENR FORM ACF (5/2003)

12-3 �Vrv'
17— yyk
Date
Starting
Freeboard, in.
Final
Freeboard, in.
Head, ft.
in./ 1 2= Hd. ft.
Gallons .
187xHd x 7.48
1,630
2,
ly.
CqZb
1620
3.9
7
1?,3(D
2.7
Sir 0
3
-1// ?CIO
36 Pj 3:00
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r
A'p 671S
(A bc' 3,-66
0
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919 3:00
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6 L,) 0 7 IS
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J4. 3
Cad l
Tis
(p I q 7 -SAI
7lb--
qzbg �j
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pro b1trAs
JAOImop

Date
Starting
Freeboard, in.
Final
Freeboard, in.
Head, ft.
in./12= Hd. ft.
Gallons
187xHd x 7.4-8
V is
q.1
v
69'-
S-(p-
ly f S4
60
14
43
A -I
0 1 q-
16"L 0
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7 LO
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Drm*
Class A Dry Biosolids PYo'r�cti® Record
I
Pathogen Reduction Alternative I Art
ZU/Y
DATE
Theripal Fluid
Temperature F
Discharge -
Temperature F
Drying Time, hrs.
(includes fill time)
# of batches
made today
z.
4150.
2? 7.
3
3. 6. ly
J/5710.
'397.
3
21
& 1,10.114
Zq 7.
3
3
,3
7
Z�7
-Z
A
23.1q
-qs()
?,q 7
qSO
?I q -/
3
A
47
ZI
ly
2,q -1
3

Town of Jefferson WWTP Tracking Record for Class A Residuals
Date Distributed
Recipient Name
Recipient Address
Residuals Volume
Use of Residuals
Nitrogen Rate
Z.3. lY
fed Wa/-krs
767 D. Wc�. lets Ad.
Z &Aches
pay %phs-hv ire.
3. 6. A /
Fred WO -Hers
»
2
.9.
3.16. Al
reef Ulal-IeCs
7)
3
�
Red WAIrS
fj
3
��
3. ,ZO. /I
'Te-�f W lr TP
/233 Hwy, 1 � S
2
Mecdow - Wesf cf t;JKK'
3. a.1-q
Tt�� WV TP
p'
21
9�
3.31-141
Je . WWTP
.»
3
r
14. Z. 1Y
Fri Wagers
767 D. Wt 14ers Pet
3
#Ay fps-W,re-
y 1a.1y
Fri S6 9AP� awe '
�
Newsod at fla y w,4-
q. / (. lq
PeA Wd ITEM
167
{f
I rok
Joe- L Pd-
A�
�a\ds
, lixi5mU
�• - ��
m %rd\-
,21 MRV-f n
Yar
ya
S.17, Iq
Ft-(tAdSA-p BApt ,
R tarn(
,51 R. ILI
Fern` MAJ-kys
V67 D . W s P-d
Z
)qa AS-N -

Town of Jefferson WWTP Tracking Record for Class A Residuals
Date Distributed
Recipient Name
Recipient Address
Residuals Volume
Use of Residuals
Nitrogen Rate
5, 30.111
dim Ourck
zo McIrbtt t by
Pay q rwnd--
�.� . l
Fred t 4ftka-
767D.Wa u-W.
ro ~_
Frwa 4eA,-
7&7Lb- �,lalersRd
Paste
&./6:� -Iq
r-ed GJa klys
767 P. VlOffs Rd
�Ie V- aiG AI. IVI

{
l p )r
r`h _ ertll
I�er."
s `
SOU7C1� FORK 6.` 1-0, BIa�a11d � .
-; Produced by Town of Jefferson
s p.0.ox:67:;JefTerSori, NC 28640
South 1, Fork 6 0" {SF 610) is a high organic tcc; iterat fertilizer manufactured by the Torun ofJefferson Wast®water
Treatment Facility:. This product produces,supea for results on lawns, Christmas trees, flower beds, ,and shrubs
providing' nutrients at the,rates indicated below, ,
77.
GVARAI\T.EED ANALYSIS.
Total Nitrol;cn.;..r.:......:, ; •••G
Water Insa(ubYe 1Vitrogeu., ... ..3.5%
: :.:....:..1 % .
v it A a I
b�blc l'taosphoric Acid:.. ,
o °�°
Solu l Plash .::.................:.. ..0
Iron..................................lr ° °
RECOMMENDED APPLICATION MATES
" Lawn Sod Establishinent: ' .. Apply-SF`610 at',a"rate of,30 Ibs./1000 square feet At
tiine'.of planting,
Turf Maintenance:, Apply SF 610 at a rate; of J04S lbs.IIUUO srl!iare feet every, 3 months'
Pi nt'Iied_Establishinerit 'Al�iply SF 610,at sa rate;of2'Ibs./;�1�00 square feet and inix into the sail
Plant B6d Maaantenance . Apply SF 61U at:a rate of 2=1Us.1100 square feet in the Spring and Fali
WARNINGS: HC 610 is environmentally safe when ase'd' as" directen,' but cola become a hazard of iatistaaanaged ,This product
should not be used on sails intended for food crop production. This product' should 'not: be used as,a starting niediuna for
germinatirit; seeds'other than grhsses. `Cover SF,'G10 with a tarp, ar plastic during iratasport. ° Store SF 610 tin a dry area away from
r wells or surface waters where it1could , areas where ehildren may play. or pets
be washed into -streams: 'keep bulk product away from a
r ,may, wander,
: R The Town of Jefferson wa J_ 10 me' e .
f r w wants that SF G�� is the specificatioias stated
LIMITEll WARRANTY A,ND:DISCLAIME
above, and that the heavy metals content.is less than or equal to the limitations specified. in ;EPA and NC ,DENIt'slud e qu ility
;criteria'for land ,applicatioir.;, T`here,are no.�yarrantees expressed or implied that extend beyond the description'contained Herein
;Specifically; there are,no warrahtees of ntercliantability or"fitness, fgx_a particular purpose. If SF 610 fails to "meet its, specifications
the buyer's sole reittedy^stiall`.be'the recovery of the purchase'pricc::Under no, circumstances shall the Towaa'of Jefferson be liable. '
far atlyotheramaest inclaadiy'1g direct;,indireet, consequential or special:damages,
' ACKNOWLEDGEMENT The undersl�ned iiuyer*ackn6wledges that he/she has read thus brochure and is familiar ►with its
contcnts.',The iinde rsign' d I3uycr.a reel to abide by doe follow `sra restriction
s:
1 SF-6 1,O shall not be applied tv land except in accordance avtth the instructions contained herein.
SF 61U shall not.l�e.applied,`to any site that is' flooded, frozen, or snow-covered.
3. , SF 61"Q shall not be;alaplied within 25 feet of any water supply,. stream;, or lake:.
q:' Adequate ineasures shall be provided' to, prevent surface runoff fr�na carrying this product into surface'waters ,
Buyer Sigiaature___�t ' Date
5.7:'�7
Qiaantity /triJ ' Tons' '
:Name print r[_ bs
Address.. InteiadedLTsei_
rcrn%;C g
Telephone:( i'r'I� Amount Collected S

5.
x SO_UTI ORK 6-'I O`Bibi bficis I�'ertili e>t
:` - 1'roduclday,; o�vti of 3effe�°;son #W
Bo,.,6 3effers(?n, NC. °?'86,4C? ;
Sown Fork. 64--t1 (Sir' 610) tz.a high orpilic c(miterit flertilizdr mahuiaclured by the 1riven df Jefferson i,,istewater
rcattrient Fat iii►�: ""fhi5 +c��l'uct pr'r3dtrc`e suptriar results of . awn�,�l lwistrt asirees.. t1�1��'nt° �cd5: anti shrubs
liraY ltiltr� i nrbt tits`:t t?�e rues indicated bel0li
G,,OA1b%N''[`i: 1) AINAL!SIS
1'otat4l Nrtr`'+agtrt..:............ .ta "u
"V4#rtter tasiiluhli Nifroren ..........::�,5';�a
Available PhOsphoric'Acid .....................
Soloble Potash— ........
s ` lrosr.. .. .... .1
IM
�I7h.Ca► " XIENDED A'.1?YL%C�A'f'[6 RA"TES
t.awn-,1)ci tit:ri,iisirinent:.` ippl, SF+ [l0 ilt a rate of34 1bs.f1000 square feet :it time of laiaioting
'11rrS Ivttt"t'nteriiirtee Apl l} SF 610, at a,"r,,ite of 10 5 1bs.r"1060, squat, feet.every 3 rnonttis
l iant reS;l Establisl►mel'i' ' :��1ap1y SF &l0 rrt a ratt•of 100 square feet and nij% ultu tide cUsl
)slant Heel ltintntent�ric a:..`. ' _ A p13, ,5b tA( ot'� a vsita.o'(2'1hS,,J.100.sq'ur�re feetill lc 51)•11i(I 1111d Vall.
11C: ti tO it Iyir6nnic►.ia^llyf Mafia when ust.d a� direr t'eel, but cmi b c o n€�'a hazard � isnut'nage'c l his proull t
slit,Uld tot be'�:=tael or, ss7ila int:ailded for food rota preI n Mott, a1n,,,priacauit;ltgtrtd n0c tae used as.te slartin! .All e',eim for
gerinina.ting seeds ciCnzr,tFtan r,r sses. Ctiyer Sk i; l,t) with.. a trlrp or° plastic during transport. Store'SF t;10 In a i:rr, awea a;+. V °;�rOM L °
:; vs,;clls or," ;urfacc'�vcl;r�"wh�rt. ,t tntlld lie washed i it<a streattls:.keep lat►ik pr0dtrct away+ trams°, -«Fc:r -?�,:.'r� is .ay flay.;Fr p` t>
a�, v wimder ;
LAN11T)Eq WiN:R12A:ti'I`V VXD 1yt'�C LAfIv11�R a _`,l"h� TOwrt cif 1efi� rs0n ,e�+alran=ts that Sl' o l t.1 era' pis �.lsr °.;sec3) t area,ls s4 :t� t�
I bone, and that this hE, vy ant"trtls,Con enCts,lesi thin tar"equal in•ifie lirnitaticins' sperifitd ,r 1;.1'A �trlc ti` t)t.ti:� 3uJ+ t �t satin'
criicriafc�r lanti,t7lat•ticati atl. "l'hclt ,in't r?0 �� rrrant�cs.e„>prts i tl t�. ntplied that exteria be-vond ti;e i. cr 4it it a�tiitned lade+:a.
Sciccifiratly: thexes„arm. rao �rair'iiiatces f merchzlrliaibility" or tltne�s fear a partietalar_pirtpost. If SF fi"1t'! �f�ai+ to t���a�.ct its sptctti a�,srs
the buyer's tiralt�� 'r n�edv, sflall,tie'ti.c re€owery"'t?foie laui h�ase�p s:e°.; Lnt e'r no i'ircurns'iance� haji.tlIC '11 tyr .
fOr.J[iV {_ather CiiiXllilt c dir t; lndi c't'°t, Conscgiienti pl, or ,}7LC.1a Lyrnar,�C� "
AC kl t) �i .:1',!J(y 1;)v1Fti"I f°rie undersigns d E iiyerr arckntiavlcd N c � t�.tat he'�la�: 17 1 te`a� l th{is'aruchu °:. �rrlcl t'ct+nth �� ► �t, its
conr�Xtts. "fhe uftdcrsier+cd Bu ,cr .iare rs to at+itle. by the,folloWnig Xtstri�ttt�7 ..
1..� ,F ut( shall.ttyt,�aw✓ al?rrlled'to ]nra 'ea;rt pt in rtccrarelala, (il trio yin truetitrns cGt.th'arled h: rtt� '
S' ti.l t1 shall °no"t, he applieat to stay site zlt;it- i , flooded. frr)rwn, or snow -covert
3. ,t ,i;'{I sha!,.', ndt-he alspp d ee�ithirr?5'f e t ofi+lad^ ��'°attt,stlpialy, str°eam or take.
4 AtiulJate.naeasurc.s 5hi3.?I be: ?r'r��"itieci to prelcnt s;iri;"Ce 1utloff.from �.ar ying thista e�ctuct' IVEO Su;°i; c water::.
j;7777
� _
'(lhint)_'Sl.i (�SaL t",`kilrtity": �.as
U..1�.� Q :inter- tezl i T ._1.1�C1QI1GPi. ; „
:�r= �1SQ-1ir1_e's'ctlls{,m.orins
TeiejAwnc -Anttiunt'Cea'lecteeJ+S

Denton Environmental Technologies, Inc.
RK Series P' uniciplal Blosolids Dehydrator.
1(800) 777-1371
Class A Comliance Under the 503 Rules
The SludgeMASTER RK series automatic batch style biosolids dehydrator is uniquely suited to
insure`compliance with the 40 CFR 503 regulations pertaining to achieving Class "A" biosolids.
The RK dehydration chamber is loaded automatically with a predetermined amount of dewatered
biosolids which starts the batch cycle.
The total sludge load is subjected to a minimum temperature of 212 degrees F for a m_ IDiM of
two and one -Half hours which exceeds the time and temperature requirements of tiic""'503
regulations pertain -Mg top ht eriw°ar , n ,This complian b is spawn as follows using Regime
A under Alternative 1 which requires that solids be heated at 50 degrees C or higher for 20
minutes or longer.
Time (in days) =131 700.QW
10" 0.14 (temperature) 9r, far the RK dehydrator at 212 degrees F (=100 C)
Time 13 LQQ.QQ,Q nx Time* 131,700,000 g,� Time — less -than 1.3/10" b day.
10^ 0.14(100) t 10^14
The time required in the RK for pathogen reduction°would be less than 1 minute. Therefore, the
.. _minimum time acquirement of 20 minutes spec Din the 503 Rules must be followed. Following
the 20-minute requirement, the RK dehydrator ° cc+ ids the time requirement by about 700%.
Total cycle time is determined by achieving the desired sludge dryness. We normally rccommend a
minimum of 90 % dry solids for a finished product to qualify under 503.33 "Option-$'" regarding
vectoratiraction,rcd46t i (Fully digested .sludges rid be dried to 75%- 503.33 "Option 7".)
The SludgeMA,STER RK patented process automatically adjusts the time and temperature regime
for the varying incoming wet sludge solids content. This featum is very important since dewatering
operations will vary from time to time in solids consistency yet we must maintain consistent Class
A biosolids at all times. Conversely, automatic flow through systems cannot adjust to varying
conditions without disrupting their normal operation and compromising the finished Product
Class "A" parameters.
Please refer to 40 CFR. 503.32 Pathogens 4 (a) (3) CH)'(9) for pathogen reduction requirements and
to 40 CFR 503.33 (b) (7) and (8) for vector attraction reduction requirements.
Fenton Environmental Technologies, Inc. guarantees Gass A compliance on a continued basis
with each SludgeMASTER RTC Dehydration System.
In choosing Class A blosolids thermal dehydration Vtilizing SludgeMASTER RK technology, your
utility will be assured of an environmentally correct sludge handling solution for many years in the
�� future

WATER QUALITY LAB & OPERATIONS, INC.
P.O. BOX 1167
BANNER ELK, NC 28604
[phone]
CLIENT: JEFFERSON
ADDRESS: SAMPLER:
CITY: RECEIVED DATE:
STATE: NC REPORTED DATE:
I D -tl rk NCO021709
TIM CHURCH
1 0-Mar-1 4
20-Mar-1 4
..............
........
.. §M-1 W�
'A NALY S
.......
� UN (T$'::' :
:WETH0134*'�S
'A, M.
ALY.
. .........
E UL A8.1.
Ed CAT 10. N
b'A"' r*-
TOTAL SOLIDS
94.5
%
SLUDGE FECAL
1
<2
2.00
MPN
SM9222D
SLUDGE
11-Mar-14
Pi
VeCu�r C\
T. KP�I6Yl
Paio9en R2du��im� __
REPORTED BY: NC CERTIFIED LAB # 544
/qa,I
PAUL ISENHOUR, SUPERVISOR

11
• OPERATIONS, f WATER QUALM' LAB C,.
P.O. BOX 1 167, BANNER ELK, NC. 28604
(828)•898.6277 --
fax (52S'-395.6255
PLA - CHAIN OF CUSTODY
SAMPLE TYPE: WASTEWATER
LOCATION: JefCersotti 5(udpei
FACILITY IDN: NCO021709
SAMPLER NAME: Tam Church
*PRESERVATION CODE
I . H2SO4, 2 • HNO3. 3 - HC4,
4 - NAOH, 5 • NONE, 6 - COOL ICE
7 - NA2S203, S - OTHER
n •rr%n Irn i n
LE NAME
COLLECTION
DELIV
SAMPLE TYPE
PRESERVATION•
PH
veri
L2-D-Cl:
YES
N0
LA S.kkiPL:
iD NLMBER
DATE
TIME
.TEMP
TAMP
C
MP'
F•F1ELD
L•LAB
FBODNF.
W.
HOD - EFF.
TSS • 9F.
NH3 as N
LI -
FECAL
L7
FECAL - EFF. 1j
L7
FECAL - DOWN
L7
CYANIO£
L
CONDUCT - D
�T LP
a
°
TUPW ED" - D
OIL k GREASE
L3
TOTAL MT.
L I
TOTAL PNOS.
LI
o
MLV5S
Lead
L�
ILL HQ 1631
T1�1E
"
TINIE
SIN ISH D BY:
RELINQUISHED BY:
AT
DATE
TIME
TIME
RECEIVED BY:
RECEIVED BY:
DATE
DATE
'-Laboratorypreiervation is ensured by addition of prescrv+civet prior to simple
cocuiners luvin= the lib, unitu othcMic noted,
CL2•D-CL2- Cblorioe cbcck and dechlorLudoo vMfiCA6011.
PRESERVATION:
() COOL 4C: BOD, RESmUE, CONDUCTIVITY, MBAS, COLOR, ALKALI; t1 T Y, CR, VI, TI, "MITY
() COOL 4C, t}Ic=SO4 : NX3, NO2•NO3, TXN, O&G, TOC, COD. HAR.DticSS. PHENOLS. TOT PHOS
() COOL 4C, ?H<2 HNO3 : METALS except CR, VI
() NONE: CHLORIDE, PH, FLUORIDE SAWLE DEVLkTION:
OT IR:
) COOL 4C, NA?5203 - COLIFOiti,i BAt-rro i

Blue Bilge Lolls
PO Box 2940
Letroir, NC 28645
828-728-0149
[e-mail]
Client:
Water Quality Labs
P.O. BOX 1167
Banner Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar-14
Report Date:
29-Mar-14
Sample Date:
10-Mar-14
--
BRL 4:
BRL-20'14-0132
Lab'Sample ID:
LSID-2014-00720
Client Sample ID:
Jefferson Sludge
Analysis
Analysis
Parameter
Result
_ .._
MQL
. _
Unit
Method
Time
Date
Analyst
% Solids
92.7
0.1~
o
/o
°
/o Solids
� 7:00
3/12/2014
KCJ
Ignitability
Not Ignitable
70
:Deg. F.
1030 SW-846
15:40
3/12/2014
KCJ
Corrosivity as pH
5.4
0.1
su
9045C SW-8
14:25
3112/2014
KCJ
Paint Filter Test
ass no free liq
0.1
nil
SW-846-9095
15:58
3/12/2014
KCJ
Reported By:
S. obnson, D.R. Wessinger
* Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 1 of 10 ' -

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
Client:
Water Quality Labs
P. O. Box 1167
Banner Elk. NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar-14
Report Date:
29-Mar-14
Sample Date:
I O-Mar- 14
BRL 4:
BRL-2014-0132
Lab Sample ID:
LSfD-2014-00721
Client Sample ID:
Jefferson Sludge
Parameter
Result
Plt Available Nitrogen
3229
SAR
143
[e-mail]
Analysis Analysis
MQL Unit Method Time Date Analyst
124 dryrng3-/kg Plant Availabl 12.10 3/2 1/20 14 KCJ
SAR 16:25 3/20/2014 KCJ
Reported By:
S. J.; 9 uson, D.R. Wessincrer
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 2 of 10

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
[e-mail]
Client: Water Quality Labs
P. O. Box 1167
Banner Elk, NC 28604
Attention: Mr. P. Isenhour
Date Received: 12-Mar-14
Report Date: 29-Mar-14
Sample Date: 10-Mar-14
BRL #: BRL-2014-0132
Lab Sample ID: LS1D-2014-00722
Client Sample ID: Jefferson Sludge
Analysis
Analysis
Parameter Result 1v1QL
Unit Method Time
Date Analyst
Reactivity as CN * I
mg1ka SW-846-7.3.3 16:15
3/18/2014 KCJ
Reactivity as Sulfide * 5
mg/kg SW-846-7.3.3 15:15
3/18/2014 KCJ
Reported By: r= >: e
S
..Y,r�ldbnson, D.R. Wessinger
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 3 of 10

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
Client:
Water Quality Labs
P. O. Box 1167
Banner Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-N1ar-14
Report Date:
29-1VIar-14
Sample Date:
I O-Mar- 14
BRL 4:
BRL-2014-0132
Lab Sample ID:
LSID-2014-00723
Client Sample ID:
Jefferson Sludge
Parameter
Ammonia Nitrogen
Result iNIQL
3020 92
[e-mail]
Analysis Analysis
Unit Method Time Date Analvst
dry mg/kg Ammonia I I - 15 3/21/2014
KCJ
-151 '0
Reported By:
S. J-11"Anson, D.R. Wessinger
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 4 of 10

Blue Ridge Labs
PO Box 2940
Let:oir, NC 28645
828-728-0149
[e-mail]
Client : Water Quality Labs
P.O. Box 1167
Banner Elk, NC 25604
Attention: Mr. P. Isenhour
Date Received: 12-Mar-14
Report Date: 29-Mar-14
Sample Date: 10-Mar-14
BRL 4: BRL-2014-0132
Lab Sample ID: LSID-2014-00724
Client Sample ID: Jefferson Sludge
Analysis
Analysis
Parameter Result MQL
Unit Method Time
Date Analyst
Nitrate + Nitrite Nitrogen (N12+ 209 31.6
dry tng/kg SM 19 4500-N 17:45
3P-0/2014 KCJ
Total Kjeldahl Nitrogen (�'KN) 45249 187
dry rnekg SM19 4500-N 13:42
3/20/2014 KCJ
Reported By:
S. J son,, D.R. Wessinger
' Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 5 of 10

Blue Ridge Labs
PO Box 2940
Lenoir, NC 28645
828-728-0149
[e-mail]
Client
Water Quality Labs
P. 0. Box 1167
Banner Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar- 14
Report Date:
29-tv1ar-14
Sample Date:
I O-Mar- 14
BRL #:
BRL-2014-0132
Lab Sample ID:
LSID-2014-00725
Client Sample ID:
Jefferson Sludge
Analysis
Analysis
Parameter
Result
MQI'
Unit
Method
Time
Date
Analyst
Total Phosphorus
35694
542
dry mg/kg
EPA 200.7
14:40
3/13/2014
KCJ
As by ICP-AES
41.9
2.1
dry mg kg
SW-846-6010
14:40
3/13/2014
KCJ
Ca by ICP-AES
2252
678
dry mg1ko
SW-846-6010
14:40
3111312014
KCJ
Cd by ICP-AES
1.36
0.042
dry mg/kg
SW-846-601 0
14:40
3113/220 14
KCJ
Cu by ICP-AES
538
27.1
dry mg/kg
SW-846-60 10
14:40
3/1312014
KCJ
K by ICP-AES
3497
115
dry mg/kg
SW-846-6010
14-40
3/13/2014
KCJ
Ma by ICP-AES
5580
135
dry mg/kg
SW-846-6010
14:40
3/13/2014
KCJ
Nlo by lCP-AES
0.21
dry nig/kc,
SW-846-6010
14:40
3/132014
KCJ
Na by ICP-AES
8977
678
dry mg/kg
SW-846-6010
14:40
3/13/2014
KCJ
Ni by ICP-AES
15.2
0.21
dry mg1ka
S4V-846-6010
14:40
3/1312014
KCJ
Pb by ICP-AES
17.7
2.1
dry mg/kc,
SW-846-6010
14;40
3/13/2014
K6
Se by ICP-AES
13.0
2.1
dry' mg/kg
0 "
SW-846-601 0
14:40
3/13/2014
KCJ
2n by ICP-AES
578
0.21
dry mg/kg
0 0
SW-846-6010
14:40
3/13/2014
KCJ
1-1gy by Cold Vapor AAS 0.154
0.0189
dry mg/kg
SW-846-7471
15:02
311712014
KCJ
Reported By:
S. inson, D.R. Wessinger
ger
Concentrations are below Minimum Quantification Unit except where noted.
NC Laboratory Certificate No. 275
Page 6 of 10

I
�- Blue Ridge Labs
PO Bov 2940
Lenoir, NC 28645
828-728-0149
[e-mail]
Client:
Water Quality Labs
P.O. Box 1167
Banner Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar-14
-
Report Date:
29-Mar-14
Sample Date:
10-Mar-14
BRL #:
BRL-20'14-0132
Lab Sample ID:
LSID-2014-00726
Client Sample ID:
Jefferson Sludge
Analysis Analysis
Parameter
Result
17QL Unit
Method
Time Date
Analyst
TCLP Extraction Metals
extracted
SW-846-1311
Summit
Ag
*
0.5 mgll
SW-846-6010
3/1912014
Summit
As
*
0.5 mgfl
SW-846-6010
3/19/2014
Summit
Ba
5.2
5 mg/l
SW-846-6010
3/19/2014
Summit
Cd
0.1 mg/I
SW-846-6010
3/19/2014
Summit
Cr
*
0.2 mg/I
SW-846-6010
3/19/2014
Summit
Pb
0.5 mg/1
SW-846-6010
3/19/2014
Summit
Se
*
0.5 mJl
S1V-846-6010
3/19/2014
Summit
I-lg by Cold Vapor AAS *
O.OU2 mgtl
SGV-846-7471
3l19f20111
Summit
Reported By:
,rF
mson, D.R. Wessinger
* Concentrations are
below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 7 of 10

Blue Ridge Labs
PO Box 2940
Lenoir, JVC 28645
828-728-0149
Client:
Water Quality Labs
11. O. Box 1167
Banner Elk-, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar- 14
Report Date:
29-Mar-14
Sample Date:
I 0-Mar-14
BRL #:
BRL-2014-0132
Lab Sample ID:
LSID-2014-00727
Client Sample ID:
Jefferson Sludge
Parameter
Result
IMQL
TCL.P Semi-VOC Extraction
extracted
Cresols (Total)
5
Dichlorobenzene, 1,4
0.1
Dinitrotoluene, 2,4-
0.1
Hexachloro- 1,3-BLIcadiene
0.1
Hexachlorobenzene
0.1
Hexachloroethane
OA
Nitrobenzene
0.1
Pentachloroplienol
0.25
Pyridine
0,25
Trichlorophenol, 2,4,5-
0.25
Trichlorophenol, 2,4,6-
0.25
[e-mail]
Unit
Method
SW-846-1311
mg/1
SW-846-8270
mg/l
SW-846-8270
mg/l
SW-846-8270
ing/l
SW-846-8270
mall
SW-846-8270
mall
SW-846-8270
rna/l
SW-846-8270
mall
SW-846-8270
mg/l
SW-846-8270
rn,atl
SW-846-8270
mall
0
SW-846-8270
Analysis Analysis
Time Date
Analyst
Summit.
3/20/2014
SLI111111it
3/20/2014
Summit
3/20/2014
Summit
3/20/2014
Summit
3/20,12014
Summit
3/20/2014
Summit
3/20/2014
Summit
3/20/2014
SI)yninit
3/2012014
Summit
3/20/2014
Summit
3/20/2014
Summit
Reported By:
S. �-�1/5�lrohnson, D.R. Wessinger
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 8 of 10

PO Box 2940
Lenoir, NC 28645
828-728-0149
[e-mail]
Client Water Quality Labs
P.O. Box 1167
Banner Elk, NC 28604
Attention: Mr. P. Isenhour
Date Received: 12-Mar-14
Report Date: 29-Mar- 14
Sample Date: I 0-TvIar- 14
BRL #: BRL-2014-01 32
Lab Sample ID: LSID-2014-00728
Client Sample ID: Jefferson Sludge
Analysis Analysis
Parameter Result
MQL Unit Method
Time Date
Analyst
TCLP ZHE Volatiles Extraction extracted
SW-846-1311
Summit
Benzene
0.1 mg/l SW846-8260
3/1912014
Sum=
Carbon Tetrachloride
0.1 ing/I SW846-8260
3/19/2014
Sun,111t
Chlorobenzene
0.1 mg/l SW846-8260
3/19/2014
sumult
Chloroform
0.1 mg/l SW846-8260
3/19/2014
Sumnit
Dichloroethane, 1,2-
0.1 mg/l SW846-8260
311912014
Sunimt
Dichloroethene, 1,1-
0.1 mall SW846-8260
311912014
SlImmt
MEK
2 mg/1 SW846-8260
3119/20111
sualint
Tetrachloroethene
0.1 mg/l SW846-8260
3/19/2014
Summt
Trichloroethene
0.1 mg/l SW846-8260
3119/2014
SUMnIt
Vinyl Chloride
0.2 mg/l SW846-8260
3/19/2014
SuMnit
-ley
Reported By:
S. I nson, D.R. Wessidger
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 9 of 10

Blue Riche Labs
PO Bo.1c 2940
Lenoir, NC 28645
828-728-0149
Client :
Water Quality Labs
P. O. Box 1167
Banner Elk, NC 28604
Attention:
Mr. P. Isenhour
Date Received:
12-Mar- 14
Report Date:
29-Mar- 14
Sample Date:
10- Mar- 14
BRL #:
BRL-2014-0132
Lab Sample ID:
LSID-2014-00729
Client Sample ID:
Jefferson Sludge
Parameter
Result
MQL
TCLP Semi-VOC Extraction
extracted
2,4,5-TP (Silvex)
0.5
2,4-D
5
Chlordane
#
0.01
Endrin
0.002
Heptachlor
0.002
Heptachlor Epoxide
0.002
Lindane
0.002
Methoxychlor
0.002
Toxaphene
0.1
[e-mail]
Analysis Analysis
Unit
Method
Time Date
Analyst
SW-846-1311
Summit
ing/I
SW-846-8080
3/25/2014
Sul-nj-nit
mg/1
SW-846-8080
3L25/2014
Summit
mo—JI
SW-846-8080
3/22/2014
Summit
mgII
SW-846-8080
3/22/2014
Summit
ma/I
SW-846-8080
3/22/2014
Summit
in-/]
SW-846-8080
3/22/2014
Summit
mg/1
MV-846-8080
3/2212014
Summit
me I
SW-846-8080
3/2212014
Summit
mIg/I
SW-846-8080
3/22/2014
Summit
Reported By:
S. k P hnson, D.R. Wessinger
Concentrations are below Minimum Quantification Limit except where noted.
NC Laboratory Certificate No. 275
Page 10 of 10

i
ANNUAL RESIDUAL SAMPLING SUMMARY FORM - B
Report all sampling analysis results for parameters not listed in FORM RSSF that are part of the WQ permit or were analyzed for over the past
calendar year. Use additional forms as needed.
WQ Permit Number: WQ},
Facility Name: a Tsm W%jTP
Residual Source
NPDES # or WQ#: K0 ZI 09
WWTP Name: j e- sure,
Laboratory:
4)
S)
Parameter
(mgtkg)
. l.lm M4 &Wlill loilMR1,0176 MM
- W-M
"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."
of Preparer *
Date
Prepa defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
DENR FORM RSSF - t )/2006)

CLASS A ANNUAL, DISTRIBUTION AND MARKETING/ SURFACE DISPOSAL CERTIFICATION AND SUMMARY FORM
WQ PERMIT #: WQ0022155 FACILITY NAME: Town of Jefferson, Class A WWTP Residuals Distribution Program
PHONE: [phone] COUNTY: Ashe OPERATOR: Tim Church
FACILITY TYPE (please check one):
Surface Disposal (complete Part A (Source(s) and "Residual In" Volume only) and Part C)
Distribution and Marketing (complete Parts A, B, and C)
Was the facility in operation during the past calendar year? Yes 153 No ❑ —► If No skip parts A, B, C and certify form below
9� t'
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
Q
Polyiner
February
60
March
gcm 217 Q
April
NUM Z1709
MayN
CLO 2170
June
July
August
September
October
November
December
Total from FORM 1)MSUF (sup)
Totals:
Annual (dry tons):
0
.. ' • . . ♦ . ' .
+ , ' .
Amendment()
If more space is required, additional information sheets Bulking Agent(s) used
* (FORM DMSDF (supp)): Total Number of Form DMSDF (Supp)l
Part C:
Facility was compliant during the past calendar year with all conditions of the land application permit ® Yes
(including but not limited to items 1-3 below) issued by the Division of Water Resources: ❑ No lo If No, Explain in Narritive
1. All monitoring 4vas 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."
IL 01wk _ l ("
Signature of Pemrittee Date
**Preparer is defined in 40 CFR Part 503.9(r) and 15A NCAC 2T .1102 (26)
Sigrnature of Preparer**
(if different from Permittee)
Date

ANNUAL PATHOGEN AND VECTOR ATTRACTION REDUCTION FORM
!p
Facility Name:
WWTP Name:. -5
Monitoring Period:
Permit Number: WO M 22155
NPDES Number: N(`MZj'70q
athogen Reduction (40 CFR 503.32) - Please indicate level achieved and alternative performed:
Class A:
L
Alternative 1 -05-7
Alternative 2 ❑
Alternative 3 ❑
Alternative 40
Alternative 5 ®
Alternative 6 ❑
If applicable to alternative performed (Class A only) indicate "Process to Further Reduce Pathogens":
Compost ❑
Heat Drying ®
Heat Treatment ❑
Thermophilic ❑
Beta Ray ❑
Gamma Ray ❑
Pasteurization ❑
..................................................
Class B:
Alternative 1 ❑
Alternative 2 ElAlternative
3 ❑
If applicable to alternative performed (Class B only) indicate "Process to Significantly Reduce Pathogens":
Lime Stabilization ❑
Air Drying ❑
Composting ❑ jAerobic,
Digestion ❑
i Anaerobic Destm o n
g
If applicable to alternative performed (Class A or Class B) complete the following monitoring data:
Parameter
Allowable Level
in Sludge
g
Pathogen Density
Number of
Excee-
Frequency
of
Sample
Type
Analytical
Tech-
Minimum
Geo. Mean
Maximums
Units
Fecal Coliform
2 x 10 to the 6th
power MPN per
gram of total
solids or 2 x 10 to
the 6th power
_
1000 mpn per
gram oFtotal solid
(dryweight)
,�' �
C� �
< �
p
���
�
�
rr
l��IAN
s%1�
VI �p
Salmonella bacteria
(in lieu of fecal
coliform)
3 MPN per a
grams total solid
dry weight
Vector Attraction Reduction (40 CFR 503.33) - Please indicate option performed:
Option 1 ❑ Option 2 ❑ Option 3 ❑ Option 4 ❑ Option 5 ❑
Option 6 ❑ Option 7 ❑ Option 8 ❑ Option 9 ❑ Option 10 ❑
No Yector p attraction reduction options were performed
CERTIFICATION STATEMENT (please check the appropriate statement)
❑ "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."
❑ "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 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."
r 3UAA _P. R9,39W s
Preparer Name and Title (type or print)
I �Lp�
Signature of Preparer Date
Land Applier Name and Title (if applicable)(type or print)
Signature of Land Applier (if applicable) Date
DENR FORM RF (512003)

i
ANNUAL RESIDUAL SAMPLING SUMMARY FORM
Please note that your permit may contain additional parameters to be analyzed. The parameters can be reported in FORM RSSF - B
WQ Permit Number:
Facility Name: JP-P
Residual Source WQ # or
NPDES #:
WWTP Name: Se%,Y'Srn,
Residual Analvsis Data
Laboratory: 1)
2)
3)
4)
5)
Parameter
(nig/kg)
Conc.
Limit
(mP/h )a
Sample or Composite Date
3
Percent Solids (%)
NA
Arsenic
75
11,9
Cadmium
85
1, 6
Copper
4,300
.5 .
C':hrornittm
NA
0
Lead
840
17.7
Mercury
57
0.1%-q
Molybdenum
75
<D.
N ickel
420
5. 7-./
Selenium
100
13.0
zinc
7.500
57
Total Phosphorus
NA
'5 60
TKN
NA
Ammonia -Nitrogen
NA
Nitrate and Nitrite
NA
For surface disposal facilities the ceiling concentration limits listed in this form are not applicable. Reference: the individual permit for metals limits.
"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."
L,= axr� % l
Signature of Preparer * bate
'Preparer : 4etined in 40 CFR Part 503.9(r) and 15A NCAC 2T .l 102 (26)
DENR FORM RSSF Y200t5)