NC0081825_Renewal (Application)_20231115

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Joe Estridge
Town of Ansonville
PO Box 437
Ansonville, NC 28007-0437
Subject: Permit Renewal
Application No. NCO081825
Ansonville WWTP
Anson County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
November 15, 2023
The Water Quality Permitting Section acknowledges the November 15, 2023 receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//deq nc gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely,
474r, o�-�-�
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Division of Water Resources
Fayetteville Regional Office 1 225 Green Street, Suite 714 1 Fayetteville, North Carolina 28301

NC4 0 81 V ;-5
EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03/05/19
Ansonville WWTP OMB No.2040-0004
Form
U.S. Environmental Protection Agency
2A
V/EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION•N
INFORMATION FOR i
Facility name
1.1
Town of Ansonville
Mailing address (street or P.O. box)
p.o. Box 437
City or town
State
ZIP code
o
Ansonville
NC
28007
E
Contact name (first and last)
Title
Phone number
Email address
o
Jason Mullis
Public Works Director
[phone]
jmullis@townofansoville@yah
c
w
Location address (street, route number, or other specific identifier) ❑✓ Same as mailing address
U
R
City or town
State
ZIP code
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission 0 No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑✓ No 4 SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
City or town
State
ZIP code
0
c
Contact name (first and last)
Title
Phone number
Email address
.Q
a
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
0 Owner ❑ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑ Facility 0 Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
N
number for each.
E
a�
Existing Environmental Permits
0 NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
2
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
w
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
E]Other (specify)
w
404)
EPA Form 3510-2A (Revised 3-19) Page 1

/Ve-o09(VAS
EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105119
1 —ftc"T8215—
T Ansonville WWTP
OMB No. 2040-0004
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percentage)
100 % separate sanitary sewer
El Own ❑ Maintain
d
0 % combined storm and sanitary sewer
❑ Own ❑ Maintain
it
❑ Unknown
❑ Own ❑ Maintain
_
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own ❑ Maintain
R
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer ❑ Own ❑ Maintain
>,
% combined storm and sanitary sewer ❑ Own ❑ Maintain
`"
❑ Unknown ❑ Own ❑ Maintain
Total
Population
c0
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
°
�°
�° °
sewer line in miles)100
o
?-'
1.8
Is the treatment works located in Indian Country?
o
❑ Yes 0 No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes 0 No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
.120 mgd
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
cc
= 30
.053 mgd
.078 mgd
.060 mgd
y "
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
.550 mgd
.400 mgd
.210 mgd
1.11
Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Dischar a Points by Type
a d
CL
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Constructed
Emergency
Overflows
Overflows
1
0
0
0
0
EPA Form 3510-2A (Revised 3-19) Page 2

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO01825
Ansonville WWTP
OMB No. 2040-0004
Outfalls Other Than to Waters of the United States
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
1.14
Is wastewater applied to land?
❑ Yes S No 4 SKIP to Item 1.16.
0
1.15
Provide the land application site and discharge data requested below.
y
Land Application Site and Discharge Data
o
Continuous or
Location
Size
Average Daily Volume
Intermittent
Applied
check one
L
acres
d
gpd
❑ Continuous
o
❑ Intermittent
El Continuous
acres
d
gpd
❑ Intermittent
acres
❑ Continuous
gpd
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes ❑✓ No 4 SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ❑r No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NC001825
Ansonville W WTP
OMB No. 2040-0004
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving IF
cillity Data
Facility name
Mailing address (street or P.O. box)
d
City or town
State
ZIP code
0
v
Contact name (first and last)
Title
0
d
Phone number
Email address
aNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
0
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
❑ Yes 0 No 4 SKIP to Item 1.23.
U
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
R
Description
Volume
_
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
o
Contractor name
Jason Edward Kizer
(company name
o
Mailing address
street or P.O. box
p0 Box 437
o
City, state, and ZIP
Ansonville
code
Contact name (first and
v
last)
Jason Kizer
Phone number
[phone]
Email address
Townofansonville V1 `yqA
Ce vv�,
Operational and
Daily Operations and general
maintenance
responsibilities of
maintenance greasing
contractor
blowers,changingfllters ,etc.
EPA Form 3510-2A (Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
NCO01825 Ansonvil le W WTP
SECTIONDD• •' •
o Outfalls to Waters of the United States
0
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
LM
y
d
❑✓ Yes ❑ No 4 SKIP to Section 3.
0
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
.010 gpd
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration.
The Town has contacted a smoke test and inflow and infiltration inspection with North Carolina Rural Water Association
A
3
and have already begun performing minor repairs such as replacing broken cleanouts and repair of damaged manholes.
0
A CIP has been adopted for five and ten year repairs of sewer liens and manholes that require greater repairs.
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
ca a
specific requirements.)
o
o
Yes ❑ No
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
E
o2
(See instructions for specific requirements.)
cn
LV
3
0
❑✓ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑✓ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1. Complete Replacement of wastewater treatment plant and blowers system.
c
a�
E:
am
a
2. Install new Effluent Disk Filter
E
0 0
H
3. Install Sodium Hypochlorite Bleach disinfection system.
a�
4)
a>
4.
N
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled
or Actual Dates of Completion for Im rovements
E
Scheduled
Affected
Outfalls
Begin
g
End
Begin
g
Attainment of
Operational
o
Improvement
(list outfall
Construction
Construction
Discharge
C
_
(from above)
number
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MMIDDIYYYY
-a
1.
001
06/01/2024
06/01/2025
v
m
2.
001
06/01/2024
06/01/2025
N
3.
001
06/01/2024
06/01/2025
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑✓ Yes ❑ No ❑ None required or applicable
Explanation:
The construction has been approved and drawings submitted.
EPA Form 3510-2A (Revised 3-19) Page 5

EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03105/19
OMB No.2040-0004
NCO01825
Ansonville WWTP
SECTION•-
• ON r
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number 001
Outfall Number
Outfall Number
State
North Carolina
w
County
Anson
0
City or town
Ansonville
w
0
Distance from shore
ft.
ft.
ft.
.Q
Depth below surface
ft.
ft.
ft.
0
Average daily flow rate
-063 mgd
mgd
mgd
Latitude
35' 06' 55" N
°
Longitude
80' 04' 15" wCa
°
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
M
❑ Yes ✓❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
U)
Outfall Number
Outfall Number
Outfall Number
0
0
Number of times per year
s
discharge occurs
a
Average duration of each
o
discharge (specify units
oAverage
flow of each
mgd
mgd
mgd
y
discharge
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser pe at each applicable outfall.
F
Outfall Number
Outfall Number
Outfall Number
d
y
w
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
0 vi
3.6
discharge points?
w
❑✓ Yes ❑ No 4SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO01825
Ansonville WWTP
OMB No.2040-0004
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Yadkin -Pee-Dee
Name of watershed, river,
WS V,B 03 07 10
0
or stream system
Q-
U.S. Soil Conservation
N
Service 14-digit watershed
o
code
L
°'
Name of state
management/river basin
Yadkin PeeDee River Basin RN
a�
U.S. Geological Survey
Z
8-digit hydrologic
HUC : 03040104
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
El Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
QDesign
Removal Rates by
Outfall
d
BOD5 or CBOD5
85 %
%
%
E
m
L
TSS
85 %
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
OMB No. 2040-0004
NCO01825
Ansonville W WTP
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Current practice is to utilize calcium Hypochlorite tablets and then utilze Vita D chlor tablets for dechlorination.
a�
c
0
U
Outfall Number 001
Outfall Number
Outfall Number
0
Q
Disinfection type
Calcium Hypochlorite
m
0
Seasons used
All Seasons
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
~
Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
El Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑✓ No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
water
Number of tests of receiving
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No 4 SKIP to Item 3.16.
0
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
CD
❑ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
w
❑ Yes ❑ No
3.16
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
❑ Yes 4 Complete Tables C, D, and E as 0 No 4 SKIP to Section 4.
applicable.
3.17
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑ Yes ❑ No
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
FNCO01825
Ansonville WWTP
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ No + Complete tests and Table E and SKIP to
❑ Yes Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ No 4 Provide results in Table E and SKIP to
❑ Yes Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting aut ority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MWDD
d
c
0
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority. did any of the tests result in
o
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
d
3.23
Describe the cause(s) of the toxicity:
LU
W
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Not applicable because previously submitted
❑ Yes information to the NPDES permittin authority.
4. INDUSTRIAL
DISCHARGES AND i
HAZARDOUSSECTION
Does the POTW receive discharges from SIUs or NSCIUs?
4.1
0 Yes ❑ No 4 SKIP to Item 4.7.
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs
Number of NSCIUs
1
0
4.3
Does the POTW have an approved pretreatment program?
❑ Yes 0 No
4.4
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
application or (2) a pretreatment program?
N
0
❑ Yes ❑✓ No 4 SKIP to Item 4.6.
R
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
4.6
Have you completed and attached Table F to this application package?
M Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 9

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO01825
Ansonville W WTP
OMB No. 2040-0004
4.7
Does the POTW receive, or has it been noted that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ❑ No 4 SKIP to Item 4.9.
4.8
If yes, provide the foliowin information:
Annual
Hazardous Waste
Waste Transport Method
Amount of
Units
Number
(check all that apply)
Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
c
c
0
U
4)❑
Truck ElRail
❑ Dedicated pipe ❑ Other (specify)
0
v
N
❑ Truck ❑ Rail
_
❑ Dedicated pipe ❑ Other (specify)
R
d
4.9
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
y
including those undertaken pursuant to CERCI-A and Sections 3004(7) or 3008(h) of RCRA?
❑ Yes ❑ No 4 SKIP to Section 5.
y
4.10
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ❑ No
4.11
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewaters hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION•
OVERFLOWS (40
Does the treatment works have a combined sewer system?
5.1
E
❑ Yes 0 No +SKIP to Section 6.
R
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
i°
❑ Yes ❑ No
a
0
5.3
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
0
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 10

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO01825
Ansonville WWTP
OMB No. 2040-0004
5.4
For each CSO outfall, provide
the following information. Attach additional sheets as necessary.)
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
City or town
=
0
Q
State and ZIP code
U
N
o
County
o
:5
Latitude
o
0
0
N
Longitude
o
o
o
U
Distance from shore
ft.
ft.
ft.
Depth below surface
ft.
ft
ft.
5.5
Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number _
CSO Outfall Number
CSO Outfall Number
Rainfall
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
o
CSO flow volume
El Yes ❑ No
El Yes ❑ No
❑Yes El No
CSO pollutant
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0
concentrations
Receiving water quality
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO frequency
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Number of storm events
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5.6
Provide the following information for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Number of CSO events in
events
events
events
N
the past year
Average duration per
hours
hours
hours
event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
million gallons
million gallons
million gallons
o
Average volume per event
�
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
Minimum rainfall causing
inches of rainfall
inches of rainfall
inches of rainfall
a CSO event in last year
❑ Actual or ❑ Estimated
I ❑ Actual or ❑ Estimated
1 ❑ Actual or ❑ Estimated
EPA Form 3510-2A (Revised 3-19) Page 11

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO01825
Ansonville WWTP
OMB No.2040-0004
5.7
Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Receiving water name
Name of watershed/
streams stem
N
d
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
Service 14-digit
watershed code
>
if known
Name of state
management/river basin
�
U.S. Geological Survey
❑ Unknown
❑ Unknown
❑ Unknown
8-Digit Hydrologic Unit
Code if known
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam-1-1
SECTIONr,
CERTIFICATION STATEMENT (40
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
D Section 1: Basic Application
❑ w/ variance request(s) ❑ wl additional attachments
Information for All Applicants
Section 2: Additional
w/ topographic map 0 w/ process flow diagram
Information
❑ wl additional attachments
wl Table A ❑ w/ Table D
0 Section 3: Information on
F/1 w/ Table B ❑ w/ Table E
Effluent Discharges
❑ w/ Table C ❑ wl additional attachments
w
Section 4: Industrial
0 wl SIU and NSCIU attachments 0 w/ Table F
0 Discharges and Hazardous
❑
o
Wastes
w/ additional attachments
Section 5: Combined Sewer
❑
❑ w/ CSO map ❑ w/ additional attachments
Overflows
❑ w/ CSO system diagram
U
0 Section 6: Checklist and
❑ w/ attachments
Certification Statement
6.2
Certification Statement
U
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
lawvl �r-e6v-
Signature
sign d
Date
EPA Form 3510-2A (Revised 3-19) Page 12

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
NCO01825
Ansonville WWTP
Form Approved 03/05119
OMB No. 2040-0004
t] zog R mg]
Maximum Daily Discharge Average Daily Discharge
Analytical
Methods
ML or MDL
include units
( )
Pollutant
Value
Units
Value
Units
Number of
Samples
Biochemical oxygen demand
o BOD5 or ❑ CBOD5
(report one
22.0
mg/1
3.04
mg/l
28
❑ ML
❑ MDL
Fecal coliform
4700
#/100 ml
55.67
#/100ml
132
❑ ML
❑ MDL
Design flow rate
.500
mgd
0.064
mgd.
36
32
pH (minimum)
6.25
Std Unts
pH (maximum)
7.80
Std Unts
Temperature (winter)
25.0
celcius
18.79
Celcius
Temperature (summer)
28.1
Celcius
25.0
celcius
32
Total suspended solids JSS)
45.0
mg/I
5.27
mg/I
115
❑ ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 GFK 13b for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 13

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name I Outfall Number Form Approved 03/05/19
NCO01825 Ansonville WWTP OMB No.2040-0004
•' '• • • • •' 1 1
Maximum Dail Discharge ga Average Dai----- yisc Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Methods
include units
( )
Samples
❑ ML
Ammonia (as N)
❑ MDL
Chlorine
49
ug/I
16.88
ug/I
231
OML
❑ MDL
total residual, TRC 2
_
❑ ML❑
Dissolved oxygen
MDL
❑ MI
Nitrate/nitrite
29.84
mg/I
18.58
mg/1
7
❑ MDL
LIML
Kjeldahl nitrogen
7.24
mg/I
3.18
mg/I
7
❑ MDL
❑ ML
Oil and grease
❑ MDL
❑ ML
Phosphorus
8
mg/I
2.57
mg/I
g
❑ MDL
❑ ML
Total dissolved solids
❑ MDL
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19) Page 15

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name uuttau Numoer
rorm mpproveu oatooi 1 v
OMB No.2040-0004
W
NCO01825 Ansonville WTP
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Metals, Cyanide, and Total Phenols
❑ ML
Hardness (as CaCO3)
❑ MDL
❑ ML
Antimony, total recoverable
❑ MDL
❑ ML
Arsenic, total recoverable
❑ MDL
❑ ML
Beryllium, total recoverable
❑ MDL
❑ ML
Cadmium, total recoverable
❑ MDL
❑ ML
Chromium, total recoverable
❑ MDL
❑ ML
Copper, total recoverable
❑ MDL
❑ ML
Lead, total recoverable
❑ MDL
❑ ML
Mercury, total recoverable
❑ MDL
❑ ML
Nickel, total recoverable
❑ MDL
❑ ML
Selenium, total recoverable
❑ MDL
❑ ML
Silver, total recoverable
❑ MDL
❑ ML
Thallium, total recoverable
❑ MDL
❑ ML
Zinc, total recoverable
❑ MDL
❑ ML
Cyanide
❑ MDL
❑ ML
Total phenolic compounds
❑ MDL
Volatile Organic Compounds
❑ ML
Acrolein
❑ MDL
❑ ML
Acrylonitrile
❑ MDL
jBromoform
❑ ML
Benzene
❑ MDL
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outtall Number
rorm Hpprovea uxuoi is
OMB No. 2040-0004
NC001825 Ansonville WWTP
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units Samples
❑ ML
Carbon tetrachloride
❑ MDL
❑ ML
Chlorobenzene
❑ MDL
❑ ML
Chlorodibromomethane
❑ MDL
❑ ML
Chloroethane
❑ MDL
❑ ML
2-chloroethylvinyl ether
❑ MDL
❑ ML
Chloroform
❑ MDL
❑ ML
Dichlorobromomethane
❑ MDL
❑ ML
1,1-dichloroethane
❑ MDL
❑ ML
1,2-dichloroethane
❑ MDL
❑ ML
trans-1,2-dichloroethylene
❑ MDL
❑ ML
1,1-dichloroethylene
❑ MDL
❑ ML
1,2-dichloropropane
❑ MDL
❑ ML
1,3-dichloropropylene
❑ MDL
❑ ML
Ethylbenzene
❑ MDL
❑ ML
Methyl bromide
❑ MDL
❑ ML
Methyl chloride
❑ MDL
❑ ML
Methylene chloride
❑ MDL
❑ ML
1,1,2,2•tetrachloroethane
❑ MDL
❑ ML
Tetrachloroethylene
❑ MDL
❑ ML
Toluene
❑ MDL
❑ ML
1,1,1-trichloroethane
1 ❑ MDL
❑ ML
1,1,2-trichloroethane
1 ❑MDL
EPA Form 3510-2A (Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 031ub/19
OMB No.2040-0004
NCOO1825 Ansonville WWTP
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units Samples
❑ ML
Trichloroethylene
❑ MDL
❑ ML
Vinyl chloride
❑ MDL
Acid -Extractable Compounds
❑ ML
p-chloro-m-cresol
❑ MDL
❑ ML
2-chlorophenol
❑ MDL
❑ ML
2,4-dichlorophenol
❑ MDL
❑ ML
2,4-dimethylphenol
❑ MDL
❑ ML
4,6-dinitro-o-cresol
❑ MDL
❑ ML
2,4-dinitrophenol
❑ MDL
❑ ML
2-nitrophenol
❑ MDL
❑ ML
4-nitrophenol
❑ MDL
❑ ML
Pentachlorophenol
❑ MDL
❑ ML
Phenol
❑ MDL
❑ ML
2,4,6-trichlorophenol
❑ MDL
Base -Neutral Compounds
❑ ML
Acenaphthene
❑ MDL
❑ ML
Acenaphthylene
❑ MDL
❑ ML
Anthracene
❑ MDL
❑ ML
Benzidine
❑ MDL
❑ ML
Benzo(a)anthrace ne
❑ MDL
❑ ML
Benzo(a)pyrene
❑ MDL
❑ ML
3,4-benzofluoranthene
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03105119
OMB No.2040-0004
NC001825 Ansonville WWTP
gj N1 W 4 1 R••�
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
iBenzo(k)fluoranthene
Method' (include units)
Value Units Value Units
Samples
❑ ML
Benzo(ghi)perylene
❑ MDL
OML
❑ MDL
❑ ML
Bis (2-chloroethoxy) methane
❑ MDL
❑ ML
Bis (2-chloroethyl) ether
❑ MDL
❑ ML
Bis (2-chloroisopropyl) ether
❑ MDL
❑ ML
Bis (2-ethylhexyl) phthalate
❑ MDL
❑ ML
4-bromophenyl phenyl ether
❑ MDL
❑ ML
Butyl benzyl phthalate
❑ MDL
❑ ML
2-chloronaphthalene
❑ MDL
❑ ML
4-chlorophenyl phenyl ether
❑ MDL
❑ ML
Chrysene
❑ MDL
❑ ML
di-n-butyl phthalate
❑ MDL
❑ ML
di-n-octyl phthalate
❑ MDL
❑ ML
Dibenzo(a,h)anthracene
❑ MDL
❑ ML
1,2-dichlorobenzene
❑ MDL
❑ ML
1,3-dichlorobenzene
❑ MDL
❑ ML
1,4-dichlorobenzene
❑ MDL
❑ ML
3,3-dichlorobenzidine
❑ MDL
❑ ML
Diethyl phthalate
❑ MDL
❑ ML
Dimethyl phthalate
❑ MDL
❑ ML
2,4-dinitrotoluene
❑ MDL
❑ ML
2,6-dinitrotoluene
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
-F--
Form Approved 03/05/19
OMB No.2040-0004
NCO01825 Ansonville WWTP
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
O ML
1,2-diphenylhydrazine
❑ MDL
❑ ML
Fluoranthene
❑ MDL
El ML
Fluorene
L
El MDL
❑ ML
Hexachlorobenzene
❑ MDL
❑ ML
Hexachlorobutadiene
❑ MDL
❑ ML
Hexachlorocyclo-pentadiene
❑ MDL
O ML
Hexachloroethane
❑ MDL
❑ ML
Indeno(1,2,3-cd)pyrene
❑ MDL
❑ ML
Isophorone
❑ MDL
❑ ML
Naphthalene
❑ MDL
❑ ML
Nitrobenzene
❑ MDL
❑ ML
N-nitrosodi-n-propylamine
❑ MDL
❑ ML
N-nitrosodimethylamine
❑ MDL
❑ ML
N-nitrosodiphenylamine
❑ MDL
❑ ML
Phenanthrene
❑ MDL
❑ ML
Pyrene
❑ MDL
❑ ML
1,2,4-trichlorobenzene
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 0310b119
OMB No. 2040-0004
NCOO1825 Ansonville WWTP
�� •• •gag= lolcwxljlvij'�
Maximum Dail Discharge Avera a Dail Dischar a
Analytical ML or MDL
Pollutant Number of
(list) Value Units Value Units
Method' (include units)
Samples
No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 23

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03105119
NC001825 Ansonville WWTP OMB No.2040-0004
MONITORINGTABLE E. EFFLUENT O• WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Information
Test Number
Test species
Test Number
Test Number
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one:
❑ Grab
❑ 24-hour composite
❑ Grab
❑ 24-hour composite
❑ Grab
❑ 24-hour composite
Sample Location
Check one:
❑ Before Disinfection
❑ After Disinfection
❑ After Dechlorination
❑ Before Disinfection
❑ After Disinfection
❑ After Dechlorination
❑ Before disinfection
❑ After disinfection
❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test,
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response.)
❑ Acute
❑ Chronic
❑ Both
❑ Acute
❑Chronic
❑ Both
❑ Acute
Chronic ❑
❑ Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO01825 Ansonville WWTP OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number
Test Number
Test Number
Test Type
Indicate the type of test performed. (check one
response.)
❑ Static
❑ Static -renewal
❑ Flow -through
❑ Static
❑ Static -renewal
❑ Flow -through
❑ Static
❑ Static -renewal
❑ Flow -through
Source of Dilution Water
Indicate the source of dilution water. (check
one response.)
❑ Laboratory water
❑ Receiving water
❑ Laboratory water
❑ Receiving water
❑ Laboratory water
❑ Receiving water
If laboratory water, specify type.
If receiving water, specify source.
Type of Dilution Water
Indicate the type of dilution water. If salt
water, specify "natural' or type of artificial
sea salts or brine used.
❑ Fresh water
❑ Salt water (specify)
❑ Freshwater
El Salt water (specify)
❑ Freshwater
❑Salt water (specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. ❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑ Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑ Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑ Dissolved oxygen
Acute Test Results
Percent survival in 100% effluent
%
%
%
LC50
95% confidence interval
%
%
%
Control percent survival
%
%
I %
EPA Form 3510-2A (Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO01825 Ansonville WWTP OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
e table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number
i
Test Number
Test Number
Acute Test Results Continued
Other (describe)
Chronic Test Results
NOEC
%
%
%
IC25
%
%
%
Control percent survival
%
%
%
Other (describe)
Quality Control/Quality Assurance
Is reference toxicant data available?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Was reference toxicant test within
acceptable bounds?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
What date was reference toxicant test run
(MMIDDIYYYY)?
Other (describe)
EPA Form 3510-2A (Revised 3-19) Page 27

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Form Approveo uJivana
OMB No.2040-0004
NCO01825 Ansonville WWTP
TABLE1 INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU 001
SIU
SIU
Name of SIU
Premiere Fibers
Mailing address (street or P.O. box)
10056 Highway 52 N
City, state, and ZIP code
Ansonville , NC 28007
Description of all industrial processes that affect
�ves,Fibers &Oils
or contribute to the discharge.
List the principal products and raw materials that
Produce partially oriented yarns Fully Drwan
affect or contribute to the SIU's discharge.
Yarns and Highly Tenacity Fibers.
Nylon 6, 6PPT,and
PET, Polyp ropylene,Recycled Polyester,
Thermoplastic Polyuethane, Low Melt
Indicate the average daily volume of wastewater
o.oi9s gpd
gpd
gpd
discharged by the SIU.
How much of the average daily volume is
oleo gpd
gpd
gpd
attributable to process flow?
How much of the average daily volume is
0019 gpd
gpd
gpd
attributable to non -process flow?
Is the SIU subject to local limits?
El Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Is the SIU subject to categorical standards?
21 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 29

EPA Identification Number
NPDES Permit Number Facility Name rorm Hpprovea W/UDI I
OMB No. 2040-0004
NCO01825 Ansonville WWTP
TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU
SIU
SIU
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems (e.g.,
upsets, pass -through interferences) in the past 4.5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
ears that are attributable to the SIU?
If yes, describe.
EPA Form 3510-2A (Revised 3-19) Page 30