NC0083470_Regional Office Historical File Pre 2016

Pr
North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
October 15, 2015
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr. Church:
A Compliance Evaluation Inspection was performed on the subject facility on October 9, 2015 by George
Smith. Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of an overall
evaluation of the facilities equipment, capability to meet effluent limits, and compliance with the NPDES
permit.
Permit
Your NPDES permit became effective on July 1, 2011 and expires on March 31, 2016.
It is recommended that the Town register for eDMR. It will be a permit requirement in your next permit
cycle.
Please remember to submit your NPDES permit renewal application EPA Short Form C- WTP. Send to:
Division of Water Resources
WQ Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Records & Reports
The Town maintains all records for three years as required. The daily monitoring reports are submitted in a
timely manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
450 W Hanes Mill Rd., Suite 300, Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Fmmi nnnnrfunity t Affirmative Antinn Fmninver— Made in nart by recycled oaoer

The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by calculating the
flow based on the number of batch discharges from the backwash filter water. The flow can also be estimated
by measuring the inches of water level drained from the lagoon.
Laboratory
Performs the following tests on the effluent and reports them on the monitoring report: pH, Total Residual
Chlorine, and Temperature. The Town has obtained field certification #5206.
The field calibrations are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC, and Rick Ballou is the Back-up ORC.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2015 through July 2015 did not show any
limit violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary to Naked
Creek, Class C waters, which is adjacent to the gravel driveway on Don Walters Road.
The compliance evaluation inspection is satisfactory. Mr. Church operates the facility in an excellent
manner. If you have any questions please contact George Smith or me at [phone].
Sincerely,
4aU4�����
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
Cc: WSRO files

1;
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 L 2 15 I 3 I N00083470 111 12 15/10/09 17 18 [ � j 19 L G r! 201 1
2111111111111111111111111111111111IIIII1IIII 166
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA -----------------Reserved -------------
671
70 I, I 71 72 �, 731 I 174 75
_Ljj
L_l
JData LJ
80
Section B: Facility
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
12:05PM 15/10/09
11/07/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
12:15PM 15/10/09
16/03/31
Jefferson NC 28640
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Timothy Church,PO Box 67 Jefferson NC 286400067//336-246-9368/3362462165
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Records/Reports E Facility Site Review E Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S Smith WSRO WQ//336-776-9700/� ,' /•S �'!5
0
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

Permit NCO083470
Inspection Date: 10/09/2015
Owner - Facility: Jefferson WTP
Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
M
❑
❑
application?
Is the facility as described in the permit?
M
❑
❑
❑
# Are there any special conditions for the permit?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
M
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: permit renewal notice given with this report.
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
0
❑
❑
❑
Is all required information readily available, complete and current?
0
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
M
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
0
❑
❑
❑
Is the chain -of -custody complete?
0
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
0
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
0
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
0
❑
on each shift?
Is the ORC visitation log available and current?
M
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
M
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
0
❑
❑
❑
Is a copy of the current NPDES permit available on site?
M
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
0
❑
❑
❑
Comment:
EffluentPipe Yes No NA NE
Is right of way to the outfall properly maintained? M ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? M ❑ ❑ ❑
Page# 3

PV
Permit: NC0083470 Owner - Facility: Jefferson WTP
Inspection Date: 10/09/2015 Inspection Type: Compliance Evaluation
Effluent -Pipe
If effluent (diffuser pipes are required) are they operating properly?
Comment:
Yes No NA NE
tir
,W
Page#

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Regional Operations Section
Pat McCrory John E. Skvarla, III
Governor Secretary
November 3, 2014
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr, Church:
A Compliance Evaluation Inspection was performed on the subject facility on October 31, 2014 by
George Smith. Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of
an overall evaluation of the facilities equipment, capability to meet effluent limits, and compliance
with the NPDES permit.
Permit
Your NPDES permit became effective on July 1, 2011 and expires on March 31, 2016.
It is recommended that the Town register for eDMR. This office appreciates your attending the
eDMR training on October 22, 2014.
Records & Reports
The Town maintains all records for three years as required. The daily monitoring reports are
submitted in a timely manner.
The chain of custody forms and certified laboratory reports are fled and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
450 W. Hanes Mill Road: Suite 300, North Carolina 27105
Phone: [phone]
Wtemet.: www.ncwaterouality.org
An Eoual O000rtunitvtAffirrnative Action Ernolover

Compliance Evaluation Inspection
November 3, 2014
Page 2 of 2
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by
calculating the flow based on the number of batch discharges from the backwash filter water. The
flow can also be estimated by measuring the inches of water level drained from the lagoon.
Laboratory
Performs the following tests on the effluent and reports them on the monitoring report: pH, Total
Residual Chlorine, and Temperature. The Town has obtained field certification #5206.
The field calibrations are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC, and Rick Ballou is the Back-up ORC.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2014 through July 2014 did not show
any limit violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary
to Naked Creek, Class C waters, which is adjacent to the gravel driveway on Don Walters Road.
The compliance evaluation inspection is satisfactory. If you have any questions please contact
George Smith or me at [phone].
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
Cc: WSRO files
11

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expiresB-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 1 2 14 1 3 1 NC0083470 111 12 1 14/10/31 117 18 [ � j 19 1 G i 201 I
211111 1 1 j I I I II I I I I I I I I I I I J I I I I I I I I I I I II I I I I I �6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----- -----------Reserved-----------
67 70 1d 1 71 it��, 1 72 ti 73 �74 751 1 1 1 1 1 I 180
LJ LJ _L_1
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:OOAM 14/10/31
11/07/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
P
879 Don Walters Rd
Jefferson NC 28640
12:15PM 14/10/31
16/03/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Timothy Church,PO Box 67 Jefferson NC 286400067//336-246-9368/3362462165 Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenance 0 Records/Reports Self -Monitoring Program
Facility Site Review 0 Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S Smith WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
i�-� -- raL&J2.- Web
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES
yr/mo/day
31 NCO083470 I11 12 14/10/31 117
Inspection Type
18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#
11

pr
Permit: NC0083470 Owner -Facility: Jefferson WTP
Inspection Date: 10/31/2014 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ 0 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
❑
❑
❑
# Are there any special conditions for the permit?
❑
❑
❑
Is access to the plant site restricted to the general public?
❑
❑
❑
Is the inspector granted access to all areas for inspection?
❑
❑
❑
Comment:
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
0
❑
❑
❑
Is all required information readily available, complete and current?
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
Is the chain -of -custody complete?
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
M
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
❑
on each shift?
Is the ORC visitation log available and current?
M
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
M
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
❑
❑
❑
Is a copy of the current NPDES permit available on site?
❑
❑
❑
Page# 3

Permit: NCO083470 Owner - Facility: Jefferson VVTP
Inspection Date: 10/31/2014 Inspection Type: Compliance Evaluation
Record Keeping Yes No NA NE
Facility has copy of previous year's Annual Report on file for review? 0❑ ❑ ❑
Comment:
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
representative)?
Comment:
Yes No NA NE
N ❑ ❑ ❑
Page# 4

PV
Pat McCrory
Governor
"PA
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Regional Operations Section
Thomas A. Reeder John E. Skvarla, III
Director Secretary
October 21, 2013
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr. Church:
A Compliance Evaluation Inspection was performed on the subject facility on October 16, 2013 by
George Smith. Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of
an overall evaluation of the facilities equipment, capability to meet effluent limits, and compliance
with the NPDES permit.
Permit
Your NPDES permit became effective on July 1, 2011 and expires on March 31, 2016.
Records & Reports
The Town maintains all records for three years as required. The daily monitoring reports are
submitted in a timely manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
585 Waughtown Street„ North Carolina 27360
Phone: [phone] Fax: [phone]
Internet:: www wwateraualitv.ora
An Eaual O000rtunitv\Affirmative Action Emalover

Compliance Evaluation Inspection
10/21/2013
Page 2 of 2
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by
calculating the flow based on the number of batch discharges from the backwash filter water. The
flow can also be estimated by measuring the inches of water level drained from the lagoon.
Laboratory
Performs the following tests on the effluent and reports them on the monitoring report: pH, Total
Residual Chlorine, and Temperature. The Town has obtained field certification #5206.
The field calibrations are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC, and Rick Ballou is the Back-up ORC. Please make sure he is registered
as a back-up with the Technical Assistance & Certification Unit. You can call Gary Hudson at 336-
771-4954.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2013 through July 2013 did not show
any limit violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary
to Naked Creek, Class C waters, which is adjacent to the gravel driveway on Don Walters Road.
The compliance evaluation inspection is satisfactory. If you have any questions please contact
George Smith or me at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Cc: WSRO files

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCs)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 JA 2 I 31 NCO083470 111 121 13/10/16 117 181 C I 191 s I 20 LJ
!J !J
Remarks
211111111111111111 IIII III 11111 11111111 111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA -----------Reserved--------
67 I 169 70 14 I 71 U 72 73Iu_I I 174 751 I I. I I I I 180
LJ
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
Jefferson WTP
10:40 AM 13/10/16
11/07/01
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
Jefferson NC 28640
10:55 AM 13/10/16
16/03/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Timothy Church,PO Box 67 Jefferson NC 286400067//336-246-9368/3362462165 Contato
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Records/Reports Self -Monitoring Program
Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Georqp Smith � WSRO WQ//336-771-5000/ e
r
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

Permit: NCO083470
Inspection Date: 10/16/2013
Owner - Facility: Jefferson WTP
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ■ ❑
Judge, and other that are applicable?
Comment:
�.�w...:4 V.. Mn MA MG
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑ ■
❑
Is the facility as described in the permit?
■
❑ ❑
❑
# Are there any special conditions for the permit?
❑
■ ❑
❑
Is access to the plant site restricted to the general public?
■
❑ ❑
❑
Is the inspector granted access to all areas for inspection?
■
❑ ❑
❑
Comment:
Record Keeping
Yes
No NA
NE
Are records kept and maintained as required by the permit?
■
❑ ❑
❑
Is all required information readily available, complete and current?
■
❑ ❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
❑ ❑
❑
Are analytical results consistent with data reported on DMRs?
■
❑ ❑
❑
Is the chain -of -custody complete?
■
❑ ❑
❑
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
11110
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑ ■
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
❑ ■
❑
Is the ORC visitation log available and current?
■
❑ ❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
■
❑ ❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑ ❑
❑
Is a copy of the current NPDES permit available on site?
■
❑ ❑
❑
11
Page # 3

FV
Permit: NC0083470 Owner - Facility: Jefferson WTP
Inspection Date: 10/16/2013 Inspection Type: Compliance Evaluation
Record Keeping
Facility has copy of previous year's Annual Report on file for review?
Comment:
Yes No NA NE
❑ 0 ■ Q
Page # 4

FV
Beverly Eaves Perdue
Governor
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
A
VA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
October 16, 2012
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr. Church:
Dee Freeman
Secretary
A Compliance Evaluation Inspection was performed on the subject facility on October 10, 2012 by George Smith.
Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of an overall evaluation of the
facilities equipment, capability to meet effluent limits, and compliance with the NPDES permit.
Permit
Your NPDES permit became effective on July 1, 2011 and expires on March 31, 2016.
Records & Reports
The Town maintains all records for three years as required. The daily monitoring reports are submitted in a timely
manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by calculating the flow
based on the number of batch discharges from the backwash filter water. The flow can also be estimated by
measuring the inches of water level drained from the lagoon.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
Nne
orthCarohna
Natumll,ff

CEI
October 16, 2012
Page 2 of 2
Laboratory
Performs the following tests on the effluent and reports them on the monitoring report: pH, Total Residual Chlorine,
and Temperature. The Town has obtained field certification #5206.
The field calibrations are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC, and Rick Ballou will be the Back-up operator after attending the school for a Physical
Chemical Grade 1.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2012 through August 2012 did not show any limit
violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary to Naked
Creek, Class C waters, which is adjacent to the gravel driveway on Don Walters Road.
The compliance evaluation inspection is satisfactory. If you have any questions please contact George Smith or me
at [phone].
Sincerely,
v
W. Corey Basinger
Regional Supervisor
Cc: WSRO files

United States Environmental Protection Agency
Form Approved.
E PA Washington, D.C. 20460
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
c 201 I
1 I N I 2 I s I 31 NCO083470 111 121 12/10/10 117 181 C I 19II !J
!J !J -1
Remarks
2111 II 111111111111111111111111111111II I I I I I I I I I116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 61 QA --- --------- ----Reserved------------
67 I 169 70 tJ 71 72 UN 73 W 74 751 I I I I I I 180
�L----
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:00 AM 12/10/10
11/07/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
Jefferson NC 28640
11:15 AM 12/10/10
16/03/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Timothy Church,PO Box 67 Jefferson NC 286400067//336-246-9368/3362462165 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance E Records/Reports Self -Monitoring Program
Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S Smith WSRO WQ//336-771-5000/
N-r �0/v2,
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
/"&7L'4t _` O cam" ZvCZ_ .
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
31 NCO083470 111 121 12/10/10 117
Inspection Type
18L _I
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

Permit: NCO083470
Inspection Date: 10/10/2012
Owner - Facility: Jefferson WTP
Inspection Type: Compliance Evaluation
Operations $ Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ■ ❑
Judge, and other that are applicable?
Comment:
n.... 16
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
Yes No NA NE
Page # 3

pr
Beverly Eaves Perdue
Governor
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P. E.
Director
February 2, 2012
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr. Church:
Dee Freeman
Secretary
A Compliance Evaluation Inspection was performed on the subject facility on January 24, 2012 by George Smith.
Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of an overall evaluation of the
facilities equipment, capability to meet effluent limits, and compliance with the NPDES permit.
Permit
Your NPDES permit became effective on July 1, 2011 and expires on March 31, 2016. Please make yourself familiar
with the new permit.
Records & Reports
The Town maintains all records for three years as required. The daily monitoring reports are submitted in a timely
manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by calculating the flow
based on the number of batch discharges from the backwash filter water. The flow can also be estimated by
measuring the inches of water level drained from the lagoon.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
One
NorthCarohna
Natura!!rf

CEI
February 2, 2012
Page 2 of 2
Laboratory
C
Performs the following tests on the effluent and reports them on the monitoring report: pH, Total Residual Chlorine,
and Temperature. The Town .has obtained field certification #5206.
The field calibrations are well documented.
Effluent/Receivin'g Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC, and Rick Ballou will be the Back-up operator after attending the school for a Physical
Chemical Grade 1. Please notify the Technical Assistance & Certification Unit at 919-733-0026.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2011 through November 2011 did not show any limit
violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary to Naked
Creek, Class C waters, which is adjacent to the gravel driveway on Don Walters Road.
The compliance evaluation inspection is satisfactory. If you have any questions please contact George Smith or me
at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor

F
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I N I 2 5I 31 NCO083470 111 121 12/01 /24 117 181 C I 19I S I 20Il _ I
Remarks
211III IIIIIIIIIIII Illlllllllllllllllll 1111111JIJJ6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----- —---------------- --Reserved-------------
67I 169 70I 3 I 71 I D I 721 NJ 73 LU 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:00 AM 12/01/24
11/07/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
Jefferson NC 28640
11:30 AM 12/01/24
16/03/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Timothy Church,PO Box 67 Jefferson NC 286400067//336-246-9368/3362462165 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Records/Reports E Self -Monitoring Program
Facility Site Review Compliance Schedules Effluent/Receiving Waters 0 Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S Smith WSRO WQ//336-771-5000/
D
, /
Signature of Management Q A Reviewer, Agency/Office/Phone and Fax Numbers Date
— 0"0&7e�7�� rlrG7)0`t,,t- -�t/J' -'-JS-;1,) 2" Z.
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
11
3I NCO083470 11 12 12/01/24 117
18I Cl
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

Or
Permit: NCO083470
Inspection Date: 01/24/2012
Compliance Schedules
Is there a compliance schedule for this facility?
Owner -Facility: Jefferson WTP
Inspection Type: Compliance Evaluation
Is the facility compliant with the permit and conditions for the review period?
❑ ❑ ■ ❑
❑❑■❑
Comment:
Operations $ Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ❑ ■
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑
■
❑
Is the facility as described in the permit?
■
❑
❑
❑
# Are there any special conditions for the permit?
❑
■
❑
❑
Is access to the plant site restricted to the general public?
■
❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
❑
❑
Cl
Comment:
Record Keeping
Yes No
NA
NE
Are records kept and maintained as required by the permit?
■
❑
❑
❑
Is all required information readily available, complete and current?
■
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
■
❑
❑
❑
Is the chain -of -custody complete?
■
❑
❑
❑
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
■
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
Cl
■
❑
Page # 3

Permit: NCO083470 Owner - Facility: Jefferson WTP
Inspection Date: 01/24/2012 Inspection Type: Compliance Evaluation
Record Keeping
Is the ORC visitation log available and current?
Is the ORC certified at grade equal to or higher than the facility classification?
Is the backup operator certified at one grade less or greater than the facility classification?
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Comment:
11
Yes No NA NE
■ ❑ ❑ ❑
■❑❑❑
■❑❑❑
■ ❑ ❑ ❑
❑❑■❑
Page # 4

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: ii-pf"50 wl P Permit/Pi e No.: NC oa 8-?Y?0
P Month/Year �unc. zo//
Monthly Average Violations
Para_ Permit DMR Value % Over Limit
Weekly/Daily Violations
Date
Parameter
Permit Lin t/Tv )e DMR Value
%Over Limit
Monitoring
Frequency Violations
Date
Parameter
rRc
Permit Frequencv Values Reported
# of Violations
!:kiy �—
y P Ro /
Q �
he
d wf j CAi i
G /18
p tt�144 S./I'A
Other Violations
Completed by: vti
v
Regional Water Quality
Supervisor Signoff: JNAN�_e -.1
Date: i© A j? It i
Date: f 95 d &T 21b ,
�. ro(tgl tl

FV
Beverly Eaves Perdue
Governor
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
January 24, 2011
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dear Mr. Church:
Dee Freeman
Secretary
A Compliance Evaluation Inspection was performed on the subject facility on January 22, 2011 by George Smith.
Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of an overall evaluation of the
facilities equipment, capability to meet effluent limits, and compliance with the NPDES permit.
Permit
Your NPDES permit became effective on April 1, 2006 and expires on March 31, 2Q11.
Records & Reports
The Town maintains all records for three years as required.
The daily monitoring reports are submitted in a timely manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by calculating the flow
based on the number of batch discharges from the backwash filter water. The flow can also be estimated by
measuring the inches of water level drained from the lagoon.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org �JdA(ra //�
An Equal Opportunity 1 Affirmative Action Employer "

CEI
January 24, 2011
Page 2 of 2
Laboratory
III
Performs the following tests on the effluent and reports them on the monitoring report: pH, Settleable Solids, Total
Residual Chlorine, and Temperature. The Town has obtained field certification #5206.
The field calibration documents are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC and Mr. John Bowers is the back-up ORC.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2010 through December 2010 did not show any
monitoring or limit violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary to naked
creek, which is adjacent to the gravel driveway.
The compliance evaluation inspection is satisfactory. If you have any questions please contact George Smith or me
at [phone].
Sincerely,
'_44a) At'14
W. Corey Basinger
Interim Regional Supervisor
cc: WSRO Files

P!7
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 15I 31 N00083470 111 121 11/02/22 117 181 CI 19I sl 20� I
!_! -!
Remarks
2111111111111111111111111111111111111111111III1H6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------------Reserved ----- --- —
67I 169 70 13 I 711 NJ 721 NJ 73 L_U 74 751 III I I 1180
Section B. Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:32 AM 11/02/22
06/04/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
Jefferson NC 28640
10:45 AM 11/02/22
11/03/31
Name(s) of Onsite Rep resentative(s)fTitles(s)/Phone and Fax Number(s)
Other Facility Data
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
•
Timothy Church, PO Box 67 Jefferson NC Contacted
No
286400067//336-246-9368/3362462165
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance 0 Records/Reports Self -Monitoring Program
Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Georg SS Smith v/ WSRO WQ//336-771-5000/
G�� 0 �l/iW" �f l�
Signatur of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
31 NCO083470 1
11 121 11/02/22 117
Inspection Type
18l C l
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

FV
Permit: NCO083470
Inspection Date: 02/22/2011
Owner - Facility: Jefferson IMP
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ 0 ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ E ■
Judge, and other that are applicable?
Comment:
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted anew application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
■000
■000
n■nn
■❑00
■ ❑ 0 0
Page # 3

Ti�la
NCDENR
A LT -W* WA
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 3, 2010
Mr. D. E. Hightower
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640-0067
Subject: Renewal Notice
NPDES Permit NCO083470
Jefferson WTP
Ashe County
Dear Permittee:
RECEIVED
N.C. Deot. of E41
SEP 0 9 2010
Winston -Sale,
Regional Office
Dee Freeman
Secretary
Your NPDES permit expires on March 31, 2011. Federal (40 CFR 122.41) and North Carolina (15A
NCAC 2H.0105 (e)) regulations state that permit renewal applications must be filed at least 180 days prior
to expiration of the current permit. If you have already mailed your renewal application, you may
disregard this notice.
Your renewal package must be sent to the Division postmarked no later than October 2, 2010.
Failure to request renewal by this date may result in a civil penalty assessment. Larger penalties may be
assessed depending upon the delinquency of the request.
If any wastewater discharge will occur after March 31, 2011, the current permit must be renewed.
Discharge of wastewater without a valid permit would violate North Carolina General Statute 143-215.1;
unpermitted discharges of wastewater may be assessed civil penalties of up to $25,000 per day.
If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact
me at the telephone number or address listed below.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you
must submit with the permit renewal application. If you have any questions, please contact me at the
telephone number or e-mail address listed below.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
Winston-Salem Regional Office, Surface Water Protection
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarofina
Phone: [phone] / FAX [phone] / [e-mail] Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

NPDES PERMIT NCO083470
JEFFERSON WTP
ASHE COUNTY
The following items are REQUIRED for all renewal packages:
➢ A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit. Submit one signed original and two copies.
➢ The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
➢ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, written documentation must be provided showing the authority delegated to any
such Authorized Representative (see Part II.B.1 Lb of the existing NPDES permit).
➢ A narrative description of the sludge management plan for the facility. Describe how sludge (or other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following items must be submitted by anv Municipal or Industrial facilities discharp-in
process wastewater:
Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal
Regulations, Part 122) and ALL Municipal facilities with a permitted flow >_ 1.0 MGD must submit a
Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21.
The above requirement does NOT apply to privately owned facilities treating 100%
domestic wastewater, or facilities which discharge non process wastewater (cooling
water, filter backwash, etc.)
Send the completed renewal package to:
Mrs. Dina Sprinkle
NC DENR / DWQ / Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

Pr
DENR/DWQ
FACT SHEET FOR NPDES PERMIT DEVELOPMENT
NPDES No. NCO021709
Facility Information
Applicant/Facility Name:
Town of Jefferson WWTP
Applicant Address:
P.O. Box 67, 303 E. Main St.; Jefferson, NC 28640
Facility Address:
1233 Hwy 16 South; Jefferson, NC 28640
Permitted Flow
0.6 MGD
Type of Waste:
8 1 % Domestic
19% Industrial
Facility/Permit Status:
Active, renewal
County:
Ashe
BACKGROUND:
Jefferson WWTP is a 0.6 MGD wastewater treatment plant serving 1,400 customers in the Town
of Jefferson. The plant has completed an expansion and upgrade from 0.3 MGD to 0.6 MGD.
The facility discharges to Naked Creek, which is classified as a C+ waters in the New River
Basin. Because of the supplemental "+" symbol on the classification, Naked Creek is subject to
a special management strategy in 15A NCAC 2B .0225, the Outstanding Resource Waters
(ORW) rule to protect the downstream waters South Fork New and New Rivers designated
ORW area. The stream is listed on the 2010 North Carolina impaired stream 303(d) list for
degraded ecologicalfbiological integrity within the fish community.
The permit will continue to require the City to implement its pretreatment program. Jefferson has
a pretreatment program with a short term monitoring plan, because it has a permitted flow of less
than 2 MGD and/or less than four (4) significant industrial users (SICs). Significant industrial
users include American Emergency Vehicles and Gates Rubber Company.
REASONABLE POTENTIAL ANALYSIS:
The following parameters are monitored through the existing permit: Cd, CN, Cu, Pb, Zn, Hg,
Ag.
The following parameters are monitored through the modified pretreatment program with short
term monitoring program (STMP): As, Cd, Cr, Cu, CN, Pb, Hg, Mo, Ni, Se, Zn, Ag. In the
STMP, 4 samples are taken in one year, then none for the next four years, then repeat.
Fact Sheet
NPI)ES N00021709 Renewal
Page 1

Data submitted in discharge monitoring reports and PPAs from 2009 through 2010 were
evaluated and a reasonable potential analysis (RPA) was done to determine whether effluent
limitations or monitoring should be included in this permit renewal. Because of the C+
classification and the strategy to protect the ORW area downstream, one half the NC standard
was used to develop the allowable concentrations for all metals except for mercury. For mercury,
because of the statewide mercury impairment, the EPA recommended procedure of allowing no
dilution for development of Hg limits was maintained, and therefore the NC standard of 12 ng/1
was applied, instead of halving the Hg standard to 6 ng/l.
The RPA and effluent data is attached to the factsheet and the results are summarized below:
o Monthly average and daily maximum limits for cadmium, cyanide and lead,
will be recommended based on the results of the reasonable potential analyses.
The analyses indicated the reasonable potential for these parameters to exceed
the North Carolina water quality standard in the receiving stream. These
parameters will be limited and monitored monthly in accordance with DWQ
guidance.
o The daily maximum limit for mercury will be dropped from the permit based
on the results of the reasonable potential analysis. However, quarterly
monitoring for mercury will remain in the permit, based on the evaluation of
the submitted data.
o Silver monitoring will be dropped from the permit. There was no reasonable
potential shown to exceed the water quality action level standard instream.
All submitted silver data was below the laboratory detection level. Division
guidance recommends that silver monitoring be continued in the pretreatment
monitoring plan.
o Copper and zinc monitoring will remain in the permit based on the results of
the reasonable potential analyses. There was reasonable potential shown to
exceed the water quality action level standard instream. These parameters
will be monitored quarterly in conjunction with the whole effluent toxicity
test.
TOXICITY TESTING:
Type of Toxicity Test: Chronic Ceriodaphnia Pass/Fail (Quarterly)
Existing Limit: 001: Chronic P/F @ 30%
Recommended Limit: 001: Chronic P/F @ 30%
Monitoring Schedule: February, May, August, and November
The facility has consistently passed its WET tests during this permit cycle. Since February 2007,
the quarterly test has been passed 17 times, with two invalid tests in 2009.
It is recommended that the chronic pass/fail test be renewed in this permit.
COMPLIANCE SUMMARY:
While overall compliance appeared to be good, the Jefferson WWTP did have violations of the
lead limit in 2006, 2007 and 2009. DWQ actions included enforcement cases and notices of
violation because of these violations.
Past compliance evaluations of the facility have found the plant to be compliant with no major
problems, reported.
Fact Sheet
NPDES NCO021709 Renewal
Nwe 2

WFr
INSTREAM MONITORING:
Upstream: 50 feet upstream
Downstream: 250 feet downstream
Parameters: Temperature and dissolved oxygen
Reviewed instream data from 2008-2010 for the months of June through September. The review
indicated that there were no DO stream standard violations downstream of the discharge for the
past 3 years. Monthly downstream DO values ranged from 7.8 mg/1 to 9.6 mg/1. Recommend
continuation of instream monitoring for temperature and dissolved oxygen.
PROPOSED CHANGES:
• Silver monitoring deleted because of RPA results and will continue to be monitored in
STMP.
• Mercury limit deleted because of RPA results, however quarterly monitoring will remain in
the permit.
• Monitoring for copper and zinc will be modified from 2/monthly to quarterly based on the
results of the RPA and DWQ guidance for metals monitoring.
• Limits for cadmium, lead, and cyanide will be in the permit and the monitoring frequency
will be monthly based on the results of the RPA which indicated potential to exceed the NC
standard instream and DWQ guidance for metals monitoring.
Existing vermit limits and recommended limits/monitorinLy are summarized in the table be
t�
Li
�" , j
�,9;�
a e •
C.M03
•
M'na,..
•
• .
PROPOSED SCHEDULE FOR PERMIT ISSUANCE:
Draft Permit to Public Notice: June 8, 2011
Permit Scheduled to Issue: August 2, 2011 (est.).
low:
STATE CONTACT:
If you have any questions on any of the above information or on the attached permit, please
contact Jackie Nowell at 919-807-6386 or jackie.nowell(c�ncdenngov
NAME: ORIGINAL SIGNED BY JACQUELYN M. NOWELL DATE: 6/8/2011
Fact Sheet
NPDES NCO021709 Renewal
Page 3

REGIONAL OFFICE COMMENT:
R,,CO,n$W AJ MvlrM e
"IN
YV
7
NAME: 4z� Te "--A DATE:
Fact Sheet
NPDES NCO021709 Renewal
Page 4

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
TIM CHURCH
WATER RESOURCES DIRECTOR
Coleen H. Sullins
Director
Dee Freeman
Secretary
I RECEIVED
September 20, 2010 N , Dept. of ENR
TOWN OF JEFFERSON WATER RESOURCES
PO BOX 67
JEFFERSON NC 28640
Dear Mr. Church:
SEP 2 3 2010
Yvinstcn-aaP,
Regional C f-,,�E
Subject: Receipt of permit renewal application
NPDES Permit NCO083470
Jefferson WTP
Ashe County
The NPDES Unit received your permit renewal application on September 20, 2010. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to complete
your permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing
permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Jeff Poupart at
[phone].
Sincerely,
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
Equal Opportunity, Affirmative Action Employer
ole
NorthCaroiina
Naturally

Jefferson -:A
' ew~aroeew
1233 Highway 16 P.O. Box 67 Jefferson, NC 28640
September 17, 2010
Mrs. Dina Sprinkle
NC DENR / DWQ / Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
SUBJECT: Renewal Request for NPDES Permit
Jefferson Water Plant NC0083470
Ashe County
Dear Mrs. Sprinkle:
[phone]
RECEIVED
�. Dect, of �N4
SEP Z 3 2010
'�"rics!c�Jaler,
R�y'CnaI Off',cB
The Town of Jefferson Water Resources hereby requests the renewal of NPDES permit
NC0083470 for the Jefferson Water Plant. This permit regulates the discharge of backwash
lagoons at the facility. No changes have occurred in the treatment process since the issuance of
the last permit.
If additional information is required please call Tim Church, Water Resources Director, at (336)
246-2165.
Respectfully,
Tim Church
Water Resources Director
[e-mail]

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number INCOO R 3q 7
If you are completing this form in computer use the TAB key or the up - down arrows to moue from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Facility Name
Mailing Address
city
' - State / Zip Code
Telephone Number
Fax Number
e-mail Address
TOWR-4 Se�fe_fS0R,
_Te�efs o n 1nt fer 21(4
�Te�erson
... N c 2_gGlo
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road
City
State % Zip Code
County
3. Operator Information:
179 Don us R�
JTe'ffers0n.
Ash
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name IOW(1 J je;650r1
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
4. Ownership Status:
Federal ❑
State ❑
Private ❑
Public 9
Page I of 3 C-GW 03105

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
5. Products recovered: �Q_L
Gasoline ❑ Diesel fuel ❑ Solvents ❑ Other WDS
6. Number of separate discharge points: I
Outfall Identification number(s) 21
7. Frequency of discharge: Continuous ❑
If intermittent:
Days per week discharge occurs:
8. Treatment System Design flow 0.OS MGD
Intermittent 12
Duration: 16
9. Name of receiving stream(s) (Provide a map shouring the exact location of each outfall, including
latitude and longitude 3(� 25 00 2/26 - 41q (MG,� I-S DhC6�)
10. Please list all additives to the treatment systen:', including chemicals or nutrients, that have -
the potential to be discharged.
(one,
11. Is this facility located on Indian country? (check one)
Yes ❑ No [T�
12. Additional Information
All applicants (including renewals):
> A USGS topographical map (or copy of the relevant portion) which shows all outfalls
> A summary of the most recent analytical results (effluent data, if available) containing the
maximum values for each chemical detected
NEW Applicants only:
> Engineering Alternative Analysis
> Description of remediation treatment system components, capacities, and removal efficiency
for detected compounds.
> If the treatment system will discharge to a storm sewer, written approval from the
municipality responsible for the sewer.
> A list of any chemicals found in detectable amounts at the site, with the maximum observed
m
concentration reported for each chemical (the most recent sample must be collected less
than one year prior to the date of this application)
> For petroleum -contaminated sites - Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
> For sites contaminated with solvents or other contaminants - EPA Method 624/625
analysis should be performed.
Page 2 of 3 C-GW 03105

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
13. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed name of Person Signing
Signature of Applicant
Title
Date
North Carolina General Statute 143-215.6 (b)(2) provides that: Any person who knowingly makes any false
statement representation, or certification in any application, record, report, plan, or other document files or
required to be maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section
1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
Sludge Management Plan
Due to the nature of flow entering the lagoons, the removal
of sludge or solids has yet to be required. When that need
arises this will be accomplished by a mobile beltpress.
Jefferson Water Plant Lagoons
Average Discharge for Previous 12 Months
Flow.....................................0.040 mgd (for day discharge occurs)
Residual Chlorine ......................<20 ug/L
TSS.......................................14.2 mg/L
Settleable Matter ..................... <0.1 ml/L
Aluminum ..............................1 148.ug/l
Iron.......................................458. ug/I
Maximum Discharge for Previous 12 Months
Flow......................................0.040 mgd (for day discharge occurs
Residual Chlorine ......................27. ug/L
TSS....................................... 31 mg/L
Settleable Matter ........................<0.1 ml/L
Aluminum...............................2330. ug/L
Iron........................................2960. ug/L
Maximum pH .... 8.05 SU
Minimum pH .... 6.31 SU

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PV
Beverly Eaves Perdue
Governor
Mr. Tim Church
Town of Jefferson
P.O. Box 67
Jefferson, NC 28640
AdWWA
- f
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
SUBJECT:
Dear Mr. Church:
November 30, 2009
Compliance Evaluation Inspection (CEI)
Town of Jefferson WTP
NPDES Permit # NCO083470
Ashe County
Dee Freeman
Secretary
A Compliance Evaluation Inspection was performed on the subject facility on November 19, 2009 by George Smith.
Mr. Tim Church, ORC was present for the inspection. The inspection is comprised of an overall evaluation of the
facilities equipment, capability to meet effluent limits, and compliance with the NPDES permit.
Permit
Your NPDES permit became effective on April 1, 2006 and expires on March 31, 2011.
Records & Reports
The Town maintains all records for three years as required.
The daily monitoring reports are submitted in a timely manner.
The chain of custody forms and certified laboratory reports are filed and kept in order.
Facility Site Review
The three lagoons and grounds appeared to be in excellent condition.
The lagoons are structurally sound, and no leaks or tears in the liner were noticed.
Flow Measurement
The permit requires an estimate of the effluent flow. The facility meets this requirement by calculating the flow
based on the number of batch discharges from the backwash filter water. The flow can also be estimated by
measuring the inches of water level drained from the lagoon.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
Nne
orthCarolina
Natulully

CEI
November 30, 2009
Page 2 of 2
Laboratory
Performs the following tests on the effluent and reports them on the monitoring report: pH, Settleable Solids, Total
Residual Chlorine, and Temperature. The Town has obtained field certification #5206.
The field calibration documents are well documented.
Effluent/Receiving Waters
The unnamed tributary to Naked Creek did not appear to have any environmental impacts.
Operations & Maintenance
Mr. Tim Church is the ORC and Mr. John Bowers is the back-up ORC.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2009 through September 2009 did not show any
monitoring or limit violations.
Grab samples are collected from the end of the culvert just before it enters the unnamed tributary to naked
creek, which is adjacent to the gravel driveway.
The compliance evaluation inspection is satisfactory. If you have any questions please contact George Smith or me
at [phone].
Sincerely,
' / r��
Steve W. Tedder
Regional Supervisor
cc: WSRO Files

P!7
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C.20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCO083470 111 121 09/11/19 117 181CI 191 SI 201
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved --- ------------------
67 I 169 701 31 71 I N I 721 N I 731I I 174 711 I I I I I( 180
I
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:20 AM 09/11/19
06/04/01
Jefferson WTP
Exit Time/Date
Permit Expiration Date
879 Don Walters Rd
Jefferson NC 28640
11:40 AM 09/11/19
11/03/31
Name(s) of Onsite Rep resentative(s)/Tities(s)/Phone and Fax Number(s)
Other Facility Data
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Timothy Church,PO Box 67 Jefferson NC
No
286400067//336-246-9368/3362462165
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenance 0 Records/Reports Facility Site Review
Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S SmithWSRO WQ//336-771-5000/
*ee -L
Signature yManeme�nt Q A R/eview Agency/Office/Phone and Fax Numbers Date
—
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yrlmo/day
31 NCO083470 111 12, 09/11/19 117
Inspection Type
181 1
Section D Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

PV
Permit: NCO083470
Inspection Date: 11/19/2009
Owner - Facility: Jefferson VVTP
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n n n ■
Judge, and other that are applicable?
Comment:
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
nn■n
■nnn
n■nn
■ n n n
■nnn
Page # 3

FV
Beverly Eaves Perdue
Governor
Mr. Tim Church
Town of Lansing
P.O. Box 266
Lansing, NC 28643
A A -a
�v�.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
November 30, 2009
SUBJECT: Compliance Evaluation Inspection (CEI)
Town of Lansing WWTP
NPDES Permit # NCO066028
Ashe County
Dear Mr. Church:
Dee Freeman
Secretary
On November 19, 2009 a CEI was performed by George Smith. Mr. Tim Church, ORC, was present for the
inspection. The inspection is comprised of an overall evaluation in order to document compliance and
noncompliance of facilities equipment, capability to meet effluent limits, and terms & conditions with the NPDES
permit.
Permit
Your NPDES permit became effective April 1, 2006 and expires March 31, 2011.
Records & Reports
An activity log was also kept in the building, which logs operator visitation and plant operations. All certificates of
analytical analysis were kept on file along with chain of custody forms.
Calibration records for pH, total residual chlorine, and temperature were documented.
In summary, the records and reports documentation by Mr. Church is considered to be excellent.
Facility Site Review
The influent barscreen is maintained.
The two influent pumps work on alternating cycles and appeared to operating properly, and there was no evidence of
overflows.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
;Vaturalltf

CEI
November 30, 2009
Page 2 of 3
Both blower pumps were operational, and delivering a gentle rolling action in the aeration basin.
199
The aeration basin was a brown color with white colored foam covering less than 5% of the surface of the basin.
There was no evidence of straggler flock or solids from the up -flow clarifier cone unit. The discharge was clear. The
backwash system was functioning properly.
The Sanuril tablet chlorination unit was installed in the final effluent contact tank. One of the four tubes is used for
disinfection. The unit is satisfactory.
A sodium bisulfite tablet dechlorination tube was placed after the effluent weir in order to meet the total residual
chlorine limit of 28 ug/L. This treatment may be functioning properly because the facility only receives 20% of the
permitted flow. In the future, the facility may need a dechlorination box after the effluent weir. This will be
evaluated in future inspections.
Flow Measurement
The recording flow chart is operating, and measures the height of water measured in inches passing through a 60' V-
notch weir. The instantaneous flow at the time of inspection was 12,000 gpd.
The flow calibration log and charts were kept on -site for at least 3-years, and were well documented.
The flow meter was calibrated by BW Allen and documented on November 16, 2009.
Laboratory
Total Residual Chlorine (TRC), Temperature, and pH are performed and recorded on the Daily Monitoring Report
(DMR). The field parameters (TRC, Temp, pH) are currently performed under field parameter certification #5419.
The pH is performed with a Hach Sension 1 meter using a two -point calibration (pH 4 & 10) and a mid -range check
(pH 7), which is considered satisfactory.
Mr. Church performs a temperature calibration against a NIST traceable thermometer.
Total Residual Chlorine (TRC) is measured with a Hach DR2500, which is capable of detection to permit limit
of 28 ug/L. The annual 5-point calibration was performed.
Effluent/Receiving Waters
The effluent was clear with no color or solids present at the time of inspection. Big Horse Creek, Class C-trout,
HQW waters, appeared to be clean with no visible impacts.

CEI
November 30, 2009
Page 3 of 3
Operations & Maintenance
Mr. Tim Church is a grade IV operator and is the current ORC. Mr. Fred Walters is the Grade II back-up operator.
The facility and grounds are maintained in excellent condition.
Plant -Pro (Chlorine 68%) is used for disinfecting, and Plant -Pro (Sodium bisulfite) is used for dechlorination. They
appear to work well.
Settleability test is periodically performed as process control to judge the operational performance of this facility.
For the most part, operation & maintenance is judged by observing plant performance.
Self -Monitoring Program
A review of the monthly self -monitoring reports from January 2009 through September 2009 showed no monitoring
or limit violations.
The effluent composite sample is collected with an Isco Model 2910 using the time composite method at 150 mL/ hr.
This method, as defined in the permit Part II, Section A, Composite Sample (A)(4), cannot be used unless it is
approved by this office.
You must do one of the following:
1. Composite sample per a flow proportion technique, Part II, Section A, Composite Sample (A)(3), or
2. Submit seven (7) days of flow chart records to this office in order to for us to evaluate a flow
variance of < 15%.
Sludge Disposal
The aerated digester was approximately 50% full at the time of the inspection. The sludge removal is contracted
through Doug Cox septic service and hauled to the Town of Jefferson WWTP.
The compliance evaluation inspection is considered satisfactory._ Please respond to composite sample method as
explained in the Self -Monitoring Program of this report, within fifteen (15) days of receipt of this letter. If you have
any questions please contact George Smith or me at [phone].
Sincerely,
Steve W. Tedder
Regional Supervisor
cc: WSRO Files

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 ( 51 3I NCO066028 111 121 09/11/19 117 18I CI 19I SI 201
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CA ---- ---- ----- --------- — Reserved ----------------- ----
67 I 169 70I 3 I 71 I N I 72 I N I 73'W I 174 751 I I I I I Li 80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:00 AM 09/11/19
06/04/01
Lansing WWTP
Exit Time/Date
Permit Expiration Date
173 a St
Lansing NC 28643
11:20 AM 09/11/19
11/03/31
Name(s) of Onsite Representative (s)TTitles(s)/Phone and Fax Number(s)
Other Facility Data
Timothy Church/ORC/336-246-2165/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Dayna Brown,PO Box 266 Lansing NC 28643//336-384-3938/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance E Records/Reports
Self -Monitoring Program Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
George S Smith WSRO WQ//336-771-5000/
Signature Ma bgement Q A R Agency/Office/Phone and Fax Numbers Date
W
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
31 NCO066028 Ill 121 09/11/19 117
Inspection Type
18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

pr
Permit: NC0066028
Inspection Date: 11/19/2009
Owner - Facility: Lansing WVVfP
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ n
Judge, and other that are applicable?
Comment:
-____ . Vac Nn NG Mr -
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
n
Is the facility as described in the permit?
■
n
n
n
# Are there any special conditions for the permit?
n
■
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector granted access to all areas for inspection?
■
n
n
n
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
n
n
Is flow meter calibrated annually?
■
n
n
n
Is the flow meter operational?
■
n
n
n
(If units are separated) Does the chart recorder match the flow meter?
■
n
n
n
Comment:
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
00
Are the tablets the proper size and type?
■
n
n
n
Number of tubes in use?
1
Is the level of chlorine residual acceptable?
n
n
n
■
Is the contact chamber free of growth, or sludge buildup?
■
n
n
n
Is there chlorine residual prior to de -chlorination?
❑
❑
❑
■
Comment:
De -chlorination
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
■
n
n
n
Is storage appropriate for cylinders?
❑
❑
■
❑
# Is de -chlorination substance stored away from chlorine containers?
00
■
0
Page # 3

Permit: NCO066028
Inspection Date: 11/19/2009
Owner - Facility: Lansing WWTP
Inspection Type: Compliance Evaluation
Comment:
Are the tablets the proper size and type?
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
Comment: Need to sample by flow proportion or submit 7 days od flow chart data to
WSRO for evaluation.
C
Page # 4

December 19, 2008
5206
Mr. Tim Church
Town of Jefferson WWTP
P.O. Box 67
Jefferson, NC 28640-
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
SUBJECT: Wastewater/Groundwater Laboratory Certification Renewal
FIELD PARAMETERS ONLY
Dear: Mr. Church
Coleen H. Sullins, Director
Division of Water Quality
RECEIVED
N.C. Deot. of ENR
JAN 0 6 2009
Winston-Salem
Regional Office
The Department of Environment and Natural Resources, in accordance with the provisions of NC GS 143-215-
.3 (a) (10), 15 NCAC 2H .0800, is pleased to renew certification for your laboratory to perform specified
environmental analyses required by EMC monitoring and reporting regulations 15 NCAC 26 .0500, 2H .0900 and
2L .0100, .0200, .0300, and 2N .0100 through .0800.
Enclosed for your use is a certificate describing the requirements and limits of your certification. Please review
this certificate to insure that your laboratory is certified for all parameters required to properly meet your
certification needs.
Please contact us at 919-733-3908 if you have questions or need additional information.
Sincerely,
Pat Donnelly
Certification Branch Manager
Laboratory Section
Enclosure
cc: Ramon L. Cook
Dana Satterwhite
Winston-Salem Regional Office
No ihCarolina
Naturally
Laboratory Section 1623 Mail Service Center; Raleigh, NC 27699-1623 Phone [phone]
Location: 4405 Reedy Creek Road; Raleigh, NC 27607 FAX [phone]
Intemet: wwwAnIab.ong Customer Service 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

STATE OF NORTH CAROLINA DEPARTMENT OF THE
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
LABORATORY CERTIFICATION PROGRAM
In accordance with the provisions of N.C.G.S. 143-215.3 (a) (1), 143-215.3 (a)(10) and NCAC 2H.0800:
Field Parameter Only
•
j
QUAM Vl
TOWN OF JEFFERSON WWTP
Is hereby certified to perform environmental analysis as listed on Attachment I and report monitoring data to DWQ for
compliance with NPDES effluent, surface water, groundwater, and pretreatment regulations.
By reference 15A NCAC 2H .0800 is made a part of this certificate.
This certificate does not guarantee validity of data generated, but indicates the methodology, equipment, quality control procedures,
records, and proficiency of the laboratory have been examined and found to be acceptable.
This certificate shall be valid until December 31, 2009
Certificate No. 5206 /"�
Pat Donnelly

Attachment
North Carolina Wastewater/Groundwater Laboratory Certification
Certified Parameters Listing
FIELD PARAMETERS ONLY
Nn of Jefferson WWTP
). Box 67
__.ferson, NC 28640-
Certificate Number: 5206
Effective Date: 01/01/2009
Expiration Date: 12/31/2009
Date of Last Amendment:
The above named laboratory, having duly met the requirements of 15A NCAC 21-1.0800, is hereby certified for the measurement of the parameters listed below.
CERTIFIED PARAMETERS
INORGANICS
RESIDUAL CHLORINE
Std Method 4500 Cl G
DISSOLVED OXYGEN
Std Method 4500 O G
pH
Std Method 4500 H B
RESIDUE SETTLEABLE
Std Method 254OF
TEMPERATURE
Std Method 2550E
This certification requires maintance of an acceptable quality assurance program, use of approved methodology, and satisfactory performance on evaluation samples. Laboratories are
subject to civil penalties and/or decertification for infractions as set forth in 15A NCAC 21-1.0807.