xvEPA
                                United States
                                Environmental Protection
                                Agency
                                Health Effects Research
                                Laboratory
                                Cincinnati OH 45268
                                Research and Development
                                EPA-600/S1-81-030 May 1981
Project Summary
                                Evaluation of  the Health Risks
                               Associated with the Treatment
                               and  Disposal  of  Municipal
                               Wastewater  and  Sludge
                               C. S. Clark, H  S  Bjornson, J. W Holland, V. J. Elia, V A Majeti, C. R. Meyer,
                               W. F. Balistreri, G. L. Van Meer, P. S. Gartside, B. L. Specker, C. C.
                               Lmnemann, Jr., R. Jaffa, P. V. Scarpino, K. Brenner, W. J. Davis-Hoover,
                               G. W. Barrett, T. S. Anderson, and D. L. Alexander
                                 Since 1975 a major research pro-
                               gram has been underway at the Uni-
                               versity of Cincinnati to determine
                               some of the potential human health
                               risks associated with the collection,
                               treatment and land disposal of munic-
                               ipal wastes. The first phase of this
                               effort focused on occupational expo-
                               sure to viruses and bacteria associated
                               with sewer maintenance and conven-
                               tional activated sludge wastewater
                               treatment. The second phase of this
                               effort, starting in 1977, included
                               study of exposure to different agents:
                               organic chemicals, fungi and endo-
                               toxins; and different processes: com-
                               posting of wastewater plant sludges,
                               hazardous waste disposal, the spray
                               irrigation of wastewater, and the land
                               application of sludge. The various
                               projects carried out during the second
                               phase of the program are described in
                               this report.
                                 A study of workers  involved in
                               composting of wastewater treatment
                               plant sludge by the aerated pile method
                               was initiated to evaluate the potential
                               health effects of exposure toAspergil-
                               lus fumigatus and other viable and
                               nonviable components of sludge in
                               Camden, N.J., Washington, D.C. and
                               Beltsville, MD. The study consisted of
                               clinical and serologic evaluation of
                               workers four times a year, physical
                               examinations, and environmental mon-
                               itoring.
                                 A health study was conducted of the
                               residents of a small community in
                               Hardeman County, Tennessee, who
                               were exposed to carbon tetrachloride
                               and other toxic chemicals in their
                               drinking water as a result of contami-
                               nation of their domestic wells by a
                               nearby hazardous waste dump. The
                               study consisted of analysis of blood
                               specimens for liver and kidney function
                               parameters, determination of serum
                               and urine bile acid concentrations,
                               physical examinations, interviews and
                               air and water monitoring.
                                 Workers exposed to chlorinated in-
                               secticide substances discharged  to
                               the sewer by a pesticide formulator
                               were studied at the North Wastewater
                               Treatment Plant, Memphis, Tennessee.
                               The study was undertaken to determine
                               if evidence of exposure to hexachloro-
                               cyclopentadiene (HEX), hexachlorobi-
                               cycloheptadiene (HEX-BCH), hepta-
                               chlorobicycloheptene, and chlordene
                               could be detected by analysis of urine
                               specimens from the workers.
                                 In order to assess the potential for
                               health risks associated with the spray
                               irrigation of wastewater, a clinical and
                               virus serologic evaluation of workers

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and wastewater and air monitoring for
viruses, pathogenic bacteria, and vol-
atile organic chemicals was conducted
in Muskegon County, Michigan.
  A field ecosystem study was carried
out at Miami University, Oxford, OH,
to evaluate the effects of land applica-
tion of heat dried municipal waste-
water treatment plant sludge (Milor-
ganite) on vegetation, insects and
meadow voles.
  Reports have been prepared from an
evaluation of pertinent literature on
potential health effects from viable
and nonviable emissions (EPA-600/1 -
81 -006) and persistent organics (EPA-
600/1 -80-025) associated with waste-
water treatment plants and land appli-
cation sites. The potential health effects
associated with sludge incineration
and  pyrolysis are presented in this
report.
  This Project Summary  was devel-
oped by EPA's Health Effects Research
Laboratory, Cincinnati, OH, to an-
nounce key findings  of the research
project that is fully documented in a
separate report of the same title (see
Project Report ordering information at
back.)

Introduction
  Contact with wastewater, wastewater
sludge,  and waters  receiving such
discharges have long been regarded as
a public health risk. Assumptions con-
cerning these risks have served as a
basis for the promulgation of standards
for recreational waterqualityand for the
construction and operation of facilities
for wastewater and wastewater sludge
treatment. However, there is a paucity
of documented evidence concerning the
nature and extent of the risks involved.
The  increased pace of construction of
new wastewater and sludge treatment
facilities in recent years, the improve-
ment of existing facilities and the em-
phasis on the land application  of the
residuals produced, lend impetus to the
need to evaluate the risks involved. One
approach is to investigate the health
conditions of individuals engaged in
wastewater   and  wastewater  sludge
treatment and disposal  activities. Among
the other approaches are the examina-
tions of populations exposed through
contamination of drinking water sup-
plies and the investigation of the effects
of sludge applications on the vegetation,
insects and mammals  in semi-enclosed
grassland ecosystems. Each of these
approaches was utilized in one or more
of the investigations included in this
project.

Sewage Sludge Compost
Worker Study
   Sewage sludge  composting by the
windrow method has been practiced for
a  number of years by the Los Angeles
County Sanitation District. More recently
the development of the aerated  pile
composting method by the U.S. Depart-
ment of Agriculture, Agricultural Re-
search Station at  Beltsville, MD,  has
resulted  in considerable expansion of
the use of sludge composting. Currently,
Philadelphia, PA, Camden, N.J., Wash-
ington, D.C., Windsor, Ontario, Bangor
and Portland, ME, as well as other cities
are engaged in municipal sludge com-
posting. Many other cities are actively
considering this method. A  number of
factors are apparently responsible for
the expansion in  the  use  of sludge
composting. Among them are the prohi-
bition of ocean dumping of sludge after
1981, the increase in  the amount of
sludge being  produced nationally  and
the growing emphasis on the land
application of wastewater and waste-
water sludges. Composting is a thermo-
philic process and  the heat  generated
helps inactivate the microorganisms
present in sludge. However, the heat
generated during composting also en-
courages proliferation  of thermophilic
fungi, in particular,Aspergillus fumigatus,
and actinomycetes. Aspergillus fumi-
gatus. an opportunistic pathogen, is one
of the most prevalent fungi  during the
sludge composting process. Because
they are heat  resistant,  bacterial endo-
toxins are also present in composted
sludge. A prospective health study was
initiated in 1979 to determine if workers
at municipal sludge composting facilities
are subjected loan increased health risk
from exposure to viable fungal particles,
actinomycetes, and endotoxins in addi-
tion to the pathogenic microorganisms
that are normally present in municipal
wastewater and sludge. The clinical and
serologic evaluation of workers exposed
to dust at the composting site included:
1) comprehensive history and physical
examination; 2) health questionnaires;
3) illness monitoring; 4) liver and kidney
function profiles; 5) anterior nares  and
oropharyngeal swab cultures; 6) chest
X-ray;  7) complete blood count with
differential; 8) determination of anti-
bodies directed against A. fumigatus; 9)
determination  of  antibodies  directed
against lipopolysaccharide (LPS) present
in compost samples; 10) skin testin
with A. fumigatus antigen; 11)pul--
monary function tests; 12) quantitation
of total IgG, IgM, IgA, and IgE; and 13)
determination of C-reactive protein,
levels of C3 and CH5o. Health question-
naires, anterior nares and oropharyngeal
swab cultures and sera for each of the
serologic tests were obtained five times
during 1979, the first year  of the in-
vestigation. Statistical comparisons
among the groups were made by means
of the chi-square, Fisher's  Exact and
Mann-Whitney one-tailed ranking tests.
Environmental monitoring for fungi and
bacteria using six-stage Andersen sam-
pler was also conducted several times
during the first year.


Pesticide Waste  Dump Health
Study
  Improper disposal of hazardous chem-
ical waste is increasingly being recog-
nized as a source of a potential human
health hazard. A health  study of the
residents of a small  community in
Hardeman County, TN, exposed to toxic
chemicals in drinking water  as a result
of contamination of their domestic wells
was initiated in 1978. The residents
were exposed to carbon tetrachloridej
(CCU) and other chlorinated organil
contaminants from their private wate™
supply wells and possibly in ambient air^
The  source of these contaminants i
groundwater was probably from leachates
from a chemical waste landfill formerly
used  by a Memphis,  TN, pesticide for-
mulator which manufactured chlorinated
insecticides. A study to determine if the
residents showed any detectable health
effects from exposure to toxic organic
chemicals in their drinking  water was
conducted during the Fall and Winter of
1978-1979. The protocol  included the
analysis of blood specimens  for several
parameters of liver and kidney function;
determination of concentrations of the
bile acids, sulfated conjugates of litho-
cholate (SLCC), and cholyglycine (CG) in
urine and serum samples; physical
examinations; health questionnaires
and air and water monitoring. The data
were checked for normality  and trans-
formed where necessary. Statistical
comparisons among the groups were
made using analysis of covariance and
with contingency tables. Air samples
were collected  on  chromosorb  102
Analyses of air, water and urine samples
for organic chemicals were  performes
by electron capture gas chromatography

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 Exposure to Pesticide
 Chemicals at a Wastewater
 Treatment Plant
   During a prospective seroepidemio-
 logical study of the bacterial and viral
 disease risks associated with municipal
 wastewater treatment, an opportunity
 developed to investigate exposure to
 toxic organic chemicals emitted from
 the wastewater  during the treatment
 process at one of the plants in the study.
 Workers at this plant, the Memphis
 North Wastewater Treatment Plant, had
 been complaining in early 1978 of acute
 symptoms of respiratory distress that
 they associated with periods of intense
 chemical odor at the plant. Other symp-
 toms noted were dizziness, headache,
 and  irritation of the eyes,  nose, throat,
 lungs and skin. The treatment plant is
 located near a manufacturer that pro-
 duces and utilizes several chlorinated
 organic intermediates for  the formula-
 tion of flame retardants and chlorinated
 insecticides (notably isodrm, endrm,
 chlordane  and heptachlor). Chemical
 waste from this  manufacturer is dis-
 charged into a sewer that flows to the
 Memphis North Wastewater Treatment
 Plant. During 1978 exposure to several
 chlorinated organic compounds including
 HEX and HEX- BCH at this treatment
 plant was assessed by evaluating urinary
 excretion, illness symptoms and air and
 wastewater contamination. Chemical
 analyses were performed by electron
 capture gas chromatography.  The data
 were checked for normality and trans-
 formed where necessary. Statistical
 comparisons among the groups were
 made using analysis of covariance.

Exposure of Wastewater Spray
Irrigation System Workers to
 Viruses, Bacteria and Organic
Chemicals
  As a result of legislative actions, such
as the 1972 Clean Water Act and its
 1977 Amendments, land application of
 municipal wastewater and sludge after
 pretreatment is becoming  increasingly
 popular as an alternative means to the
 more conventionally used disposal
 methods, such as ocean and surface
water dumping, and incineration. Spray
or sprinkler application is one of the
commonly  used  methods of  land ap-
plication of wastewater. The volatile
organic chemicals and microorganisms
present in  wastewater may become
airborne during spray  application and
are a potential  risk to the  workers
 involved  with  the operation of the
 facility. In order to assess the potential
 health risks of workers from exposure to
 volatile organic chemicals and viruses
 in aerosols, the ambient air environ-
 ment and the workers at the Muskegon
 County Wastewater Management Sys-
 tem,  Ml,  were evaluated. Air  samples
 for animal virus and coliphage assay
 were collected with an Army prototype
 XM2  Biological  Sampler/Collector. Air
 sample filtrates were inoculated into
 BGM cells derived from primary African
 green monkey kidney cells. Coliphage
 assay of air and water samples was by
 the soft agar overlay method. Six-stage
 viable particle Andersen samplers were
 used for the collection of air samples for
 the determination of total bacteria, total
 and fecal  coliforms and for the identi-
 fication of gram-negative and gram-
 positive bacteria. The concentration of
 chloroform, carbon tetrachloride, tri-
 chloroethane, trichloroethylene and
 tetrachloroethylene in air samples
 collected on chromosorb 102 and char-
 coal tubes and in water samples were
 determined by use  of electron capture
 gas chromatography. Blood samples,
 throat and rectal swabs and illness
 symptom data  were collected on a
 monthly basis from June through Octo-
 ber. Antibodies to poliovirus types 1, 2
 and 3, coxsackievirus types B2 and B5
 and echovirus types 7 and 11  were
 determined using a  microneutralization
 technique. Comparisons between the
 groups for the virus serology results
 were accomplished by contingency
 tables and chi-square analyses. Viral
 cultures from throat and rectal swabs
 were  inoculated into cell cultures of
 African green monkey kidney, vero
 monkey kidney and WI-38. Viruses,
 including those recovered from waste-
 water, were identified by neutralization
 with Lim-Benyesh-Melnick antisera
 pools.


 Effects of Wastewater
 Treatment  Plant Sludge  on
 Two Grassland  Ecosystems
  A field  ecosystem study was carried
 out at Miami University, Oxford, OH, to
 evaluate  the effects over a two-year
 period of  land application of heat dried
 municipal sludge (Milorganite) on vege-
 tation, insects and  meadow voles in
sixteen one quarter acre semi-enclosed
plots.  Eight of the plots were initially in
the fourth year of grassland succession
(perennial field) and eight had previously
 been sowed to winter wheat (annual
 field). Six of the plots received surface
 application of Milorganite  monthly for
 five months during the growing season,
 six  received a commercial fertilizer
 containing equivalent amounts of nitrogen-
 phosphorus  and potassium and four
 were controls. Five breeding pairs of the
 meadow vole Microtus pennsylvanicus
 were placed inside  each enclosure in
 the  Spring of each year.
  The study focused on three aspects of
 the grassland ecosystems which maybe
 affected by sludge deposition: structure
 and energetics of the total ecosystems,
 population dynamics of small mammals,
 and population dynamics of arthropods.
 Comparison between control and exper-
 imental plots in each grassland type
 provided  information regarding the
 effects of sludge on the ecosystem as a
 whole. Comparison of the experimental
 plots between the two grassland types
 provided information as to which eco-
 system is better able to process sludge
 most efficiently. The effects of sludge on
 vegetative community structure was
 considered by comparison of species
 diversity between control and exper-
 imental plots. Productivity was mea-
 sured by the short-term harvest method.
 Diversity was determined by the number
 of species per 0.25 m~2, Margalef's
 richness  index, Shannon-Weaver's
 function, and Pielou's  evenness index.
 Vole population dynamics in the control
 and experimental systems were compared
 on the basis of age structure, turn-over
 rate, population growth rate, and carry-
 ing capacity. Vole population densities
 were related to vegetation nutrient
 content  in a test of Pitelka and Shultz
 theories of nutrient-recovery and nutri-
 ent cycling effects Arthropod response
 to treatment was evaluated for all major
 orders in terms of density and biomass.
 One order (Homoptera) was analyzed in
 detail regarding species richness and
 apportionment.  During November of
 each year the voles were sacrificed for a
 complete autopsy and for histopathology
 of liver, lungs, kidney and testes  or
 ovaries. These organs were also analyzed
for  cadmium, lead, copper and  zinc
 content.


Potential Health Effects From
 Viable and Nonviable Emissions
Associated With Sludge Incin-
eration and Pyrolysis
  A  literature review of chemical, bio-
 logical, and environmental literature

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was initiated in 1978 to evaluate the
potential health effects of emissions
from wastewater and sludge treatment
operations including land application
from agents such as viruses, pathogenic
microorganisms, toxins and persistent
organics. Individual reports have been
prepared from the  literature evaluation
on  viable and nonviable emissions
(EPA-600/1 -81 -006) and persistent
organics (EPA-600/1-80-025). Poten-
tial health effects  of incineration and
pyrolysis of sludge are discussed in this
report.

Conclusions
  Some of the conclusions of the various
investigations involved in this project
are as follows.

Sewage Sludge Compost
Workers Study
    1. Results of  the environmental
      monitoring demonstrated that
      workers at each of the compost
      sites were exposed to markedly
      elevated numbers of A. fumigatus
      spores. This  observation was
      further supported by the compar-
      atively high frequency of isolation
      of A. fumigatus from oropharyn-
      geal and anterior nares cultures
      of compost  workers when com-
      pared to the intermediate-exposed
      and control  groups.
    2. Preliminary  analyses of the high-
      est results obtained for each
      participant on tests for the enzymes
      serum glutamic oxaloacetic trans-
      aminase (SCOT), serum glutamic
      pyruvic transaminase (SGPT),
      measures of liver function; abso-
      lute eosinophil count; total IgG,
      IgE, and  IgM  antibodies; and
      specific IgG antibody directed
      towards A. fumigatus, determined
      by the enzyme-linked immuno-
      sorbent assay, did not reveal any
      differences among exposure groups
      at any of the sites.
    3. The only significant difference in
      an examination of C-reactive
      protein (CRP) was  found among
      Beltsville workers. Four of nine
      compost workers had positive
      CRP values  compared to none of
      eight   intermediate-exposed
      workers.
    4. Levels of antibody directed against
      lipopolysaccharide (LPS) prepared
      from site-specific compost as
      determined  by the enzyme-linked
      immunosorbent assay were not
     found to be higher among Camden
     compost workers than in control
     workers. However, in Beltsville
     and Blue Plains antibody liters
     among  compost workers were
     higher than in their correspond-
     ing lower exposure groups.

   5. One worker in the study, em-
     ployed at  a compost site, was
     found to have a local infection
     involving his right ear.  This in-
     fection caused by/4, niger grad-
     ually progressed over a period of
     several months. Despite treat-
     ment, there was erosion of 70%
     of the right tympanic membrane.
   6. Chest X-rays were obtained from
     74 participants and reviewed by a
     radiologist at the University  of
     Cincinnati. Of these, one compost
     worker's X-ray exhibited an ab-
     normality compatible with an
     occupationally-related disorder.
Pesticide Waste Dump Health
Study
   7. Concentrations of CCU in the
      contaminated wells were of the
      order of 5000 A/g/L. Assuming a
      consumption of one liter per day,
      the individuals using thecontam-
      inated water had a dose of about
      5 mg/day, CCU.
   8. Results from the initial screening
      in November 1978 after almost
      all potable use of the contami-
      nated water had ceased, revealed
      that the concentrations of the
      serum  enzymes alkaline phos-
      phatase, SGPT and SGOT  were
      elevated in the group of residents
      who had  previously consumed
      the  contaminated water when
      compared to the control group.
      The differences appear to be
      associated with the ingestion of
      well water contaminated by.leach-
      ate from  a toxic waste landfill.
      Two months later many of the
      persons with abnormal test results
      had results in the normal range.
   9. During the January 1979 survey,
      six individuals from the exposed
      group  and one from the interme-
      diate-exposed were found to have
      enlarged livers.
  10. The mean nonfasting serum bile
      acid, sulfated conjugates of SLCC,
      was significantly  lower in the
      exposed group  than  in the con-
      trol.
  11. For those persons in the exposec
      group who  were tested in both
      November  1978 and January
      1979 nonfasting serum concen-
      trations of  SLCC and CG were
      significantly higher in November
      1978 than in January 1979.
  12. The potential long-term  health
      effects of exposure to these chem-
      icals in drinking water is not
      known.

Exposure to Pesticide Chemicals
at  a Wastewater  Treatment
Plant
  13. Influent wastewater from the
      North Plant, and air samples
      collected at  the wet well and grit
      chamber of the North  Plant in
      Memphis, TN, contained several
      contaminants  including HEX,
      HEX-BCH,   heptachlorobicyclo-
      heptene and chlordene.
  14. Influent wastewater and air sam-
      ples obtained at the grit chamber
      of the Maxson Plant, the control
      plant in Memphis,  TN,  did not
      contain  the type of substances
      found in the samples obtained at
      the North Plant.
  15. Urinary  excretion of HEX-BCH
      was found to increase during the
      work shift  for workers at the
      North (exposed) plant in the June
      1978 survey, whereas it de-4
      creased  during the work shift at™
      the  Maxson (control) plant. The
      percent  of exposed plant urine
      samples with HEX-BCH concen-
      trations  greater than 3/L/g/L in-
      creased  from 7 to 41 during the
      work shift while in control plant
      samples the percent decreased
      from 9 to 0, during the June 1978
      screening.
  16. The significance of the presence
      of these chlorinated organic
      chemicals in the urine of workers
      and the potential long-term health
      effects of exposure to these chem-
      icals is not known.

Exposure of Wastewater Spray
irrigation System Workers to
Viruses, Bacteria and Organic
Chemicals
  17. No animal viruses were detected
      in air samples collected at the
      Muskegon  County Wastewater
      Management System  using the
      Army prototype XM2 Biological)
      Sampler/Collector.
i

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18. Animal viruses were detected in
    raw influent samples but de-
    creased in concentrations as the
    wastewater was aerated and
    stored in the lagoons. None were
    detected in wastewater at the
    pump station just prior to distri-
    bution to the spray irrigation rigs.
19. Using the centrifugation-filtration
    method all raw influent samples
    were found to contain viruses,
    ranging  from 50 to 400 plaque-
    forming  units/liter.
20. Coliphage were removed from air
    samples at the aeration basins in
    concentrations ranging from 0-9
    per cubic meter of air.  E. coli
    13706 coliphage was recovered
    more often than the other two
    tested, 15597 and 11303.
21. Illness and virus isolation rates
    were not significantly different in
    the study group of workers en-
    gaged in the  spray irrigation of
    wastewater compared to a control
    group of road commission workers.
22. Antibody titers to coxsackievirus
    B5 were significantly higher for
    one  subgroup  of  wastewater
    workers, the spray irrigation noz-
    zle cleaners, when  compared to
    either other wastewater workers
    or to the road commission work-
    ers. This suggests that there may
    be a risk of viral infection only in
    those with the greatest and most
    direct exposure to wastewater.
23. The  prevalence  of Hepatitis A
    antibody correlated with age, as
    would  be expected in normal
    populations, and there was no
    increase in the prevalence of
    Hepatitis A antibody in those
    exposed to spray irrigation.
24. Antibody titers to poliovirus 1, 2
    and  3,  coxsackievirus B2 and
    echovirus 7 and 11  were not dif-
    ferent between  the wastewater
    and  road commission worker
    groups.
25. The quantity of bacteria in the air
    downwind of treatment sources
    at the Muskegon wastewater site
    contained higher total numbers
    of bacteria and higher percent-
    ages of gram-negative bacilli,
    fecal-indicator bacteria, and
    pathogenic bacteria than upwind
    air.
26. The mean respirable concentra-
    tion of the total airborne bacteria
      found one  meter  downwind of
      the aeration basin at the Muskegon
      wastewater site was 2800 Colony
      Forming Units (CPU) per m3
      which was significantly higher
      than that found 1 8 meters down-
      wind of  the spray irrigation rigs
      (i.e., 700 CPU per m3). Concentra-
      tions one meter upwind of the
      aeration basin and 18 meters
      upwind of the field rigs were 490
      CFU/m3 and 660 CFU/m3, re-
      spectively.
  27. Relatively high airborne levels of
      respirable Klebsiella spp. were
      found downwind of wastewater
      operation compared to most other
      recent studies.
  28. Concentrations of tnchloroethane,
      trichloroethylene and tetrachloro-
      ethylene at the Muskegon County
      Spray Irrigation System at the
      downwind edge of the aeration
      basins ranged up to 90 ng/L, 73
      fjg/L and 46 /t/g/L, respectively.
      Adjacent to the spray irrigation
      rigs  the highest concentrations
      reached for the same compounds
      were 2.7,  9.3 and 8.6, respec-
      tively. All of these concentrations
      were well  below the 8-hour oc-
      cupational standards of 45,000
      //g/L, 535,000 A/g/L and 670,000
         L, respectively.
  29. Chloroform was not detected in
      the air adjacent to the spray
      irrigation rigs but was detected
      downwind of the aeration basins
      at concentrations  ranging up to
      202 fjg/m3 (8-hour occupational
      limit 50,000 A
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Potential Health  Effects From
Viable and Nenviable
Emissions Associated With
Sludge Incineration and
Pyrolysis
  39. A literature evaluation indicated
      that incineration and pyrolysis
      processes may lead to air pollu-
      tion from volatilization of heavy
      metals  and incomplete combus-
      tion of organic chemicals, respec-
      tively. The air  pollution can be
      controlled by the use  of appro-
      priate control  measures  in both
      incineration and pyrolysis processes
      and also  by afterburning in the
      case of pyrolysis.

Recommendations
   1. Compost  workers should be ob-
      served over an extended period of
      time to reveal abnormalities which
      may be related to the length  of
      exposure.
   2. The preliminary data on antibody
      response  of the compost workers
      to  lipopolysaccharide  prepared
      from compost samples suggests
      that it may be  advisible to take
      precautions to reduce exposure,
      such as the use of respirators by
      compost  workers and periodic
      water  spraying of the compost
      sites to reduce dust.
   3. A method should be developed to
      quantify the presence of endo-
      toxin in compost and in the air.
   4. Long-term medical follow-up  of
      the residents of Toone-Teague
      Road,  Hardeman County, TN,
      should be initiated.
   5. Necessary precautions should be
      taken, if possible, to prevent the
      contamination  by these toxic
      chlorinated organic chemicals of
      the artesian aquifer below the
      Hardeman County dump site,
      since it  is used as a water supply
      for the City of Memphis.
   6. The closure plan for this  dump
      site should be designed to prevent
      an increased exposure to nearby
      residents and to those downstream
      and downwind  to contaminants
      associated with the dump.
   7. Industrial discharge of toxic chemi-
      cal waste into municipal sewerage
      systems should be controlled and
      monitored.
   8. A follow-up study of the workers
      involved at the Memphis North
      Treatment Plant should be con-
    ducted to determine if urinary
    excretion of HEX and HEX-BCH
    remains at the  low levels
    detected in September 1978 and
    if any health effects are apparent.
 9. The XM2 Biological Sampler/
    Collector should be used for a
    sampling period of at least sever-
    al days to determine if animal vi-
    ruses can be detected in aerosols
    sampled  by this  method at the
    Muskegon, Ml spray irrigation
    site.
10. The virus  content of  solid material
    at the bottom of the lagoons and
    aeration basins at the Muskegon,
    Ml spray irrigation site should be
    determined to see if future disposal
    of the solid material would be a
    problem.
11. The Kott's MPN method is recom-
    mended for use when coliphage
    levels are expected to  be very
    low.
12. Because  of problems with  the
    XM2 sampler and  sterilization
    and arcing problems in other
    large volume samplers, an  im-
    proved large  volume biological
    air sampler should be developed.
13. Resistant aerosolized bacteria
    such as  Klebsiella should be
    explored as possible indicators of
    bacterial air contamination from
    fecal sources.
14. An examination of the serum of
    workers at the Muskegon spray
    irrigation site for antibodies to
    Klebsiella should be initiated.
15. Routine air monitoring for selected
    organic compounds should be
    performed downwind of the aera-
    ration basins and in the scrubber
    house at the Muskegon spray
    irrigation  site.
16. The observation of  an apparent
    increased risk in nozzle cleaners
    at Muskegon should  be confirmed.
    The number of available nozzle
    cleaners is small, but a serologic
    survey of former nozzle cleaners
    could be conducted.
17. The hypothesis that wastewater
    workers may be at risk of Legion-
    narie's disease could be evaluated
    further by testing for antibody to
    Legionella pneumophila which
    has been related to blue green
    algae. Wastewater irrigation work-
    ers may be exposed to wastewater
    with higher algae content than
    ordinary  wastewater treatment
    plant workers.
18. For minimizing effects on smal
    mammal populations mid-suc-
    cessional old-fields should be
    used as sites for the land application
    of sludge, rather than early suc-
    cesessional stages or  agricultural
    fields.
19. Research should continue to
    more completely characterize the
    effect of sewage sludge application
    on mammal populations, especially
    to evaluate if Cd concentrations
    tend to increase in the kidneys
    and livers of animals functioning
    within sludge-treated  plant com-
    munities.
20. Afterburning should be used in
    the pyrolysis process to assure
    complete combustion of organic
    chemicals in sludge.
                                 i
                                 4

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C.  S Clark. H. S. Bjorson. J.  W. Ho/land, V. J Elia,  V. A. Majeti, C. R. Meyer.
  W. F. Balistreri, G. L Van Meer. P. S. Gartside, B. L Speaker, C. C. Linnemann.
  Jr., R. Jaffa,  P. V. Scarpino, K.  Brenner,  W J. Davis-Hoover, and D. L.
  Alexander are with the University of Cincinnati, Cincinnati, OH 45267, G. W.
  Barrett and T. S. Anderson are with Miami University, Oxford, OH 45056.
Herbert R. Pahren is the EPA Project Officer (see below).
The complete report, entitled "Evaluation of the Health Risks Associated with
  the Treatment and Disposal of Municipal Wastewater andSludge, "(Order No.
  PB 81-175 945; Cosf $20.00, subject to change} will be available only from.
        National Technical Information Service
        5285 Port Royal Road
        Springfield, V'A 22161
        Telephone: 703-487-4650
The EPA Project Officer can be contacted at:
        Health Effects Research Laboratory
        U.S. Environmental Protection Agency
        Cincinnati, OH 45268
 5 US GOVERNMENT PRINTINOOFFICE' 1961 -757-012/1186

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Environmental Protection
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Information
Cincinnati OH 45268
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