NCG110013_COMPLETE FILE - HISTORICAL_20180501

i
STORMWATER DIVISION CODING SHEET
� NCG PERMITS
PERMIT NO.
/V
DOC TYPE
C9"HISTORICAL FILE
❑ MONITORING REPORTS
i OOC DATE
❑ A01 tY(�U�
YYYYMMDD

Permit Coverage
Renewal Apolication Form �!DES rmit Number
NCDENR National Pollutant Discharge Elimination System Stormwater Individual Permit s 110000
Please provide your permit number in box in the upper right hand corner, complete the information in the space provided
below and return the completed renewal form along with the required supplemental information to the address indicated.
Owner Information Address to which permit correspondence will be mailed
Owner / Organization Name: City of Winston-Salem, Archie Elledge, WWTP
Owner Contact: ..J.--Frank Crump -
Mailing Address: 2799 Griffith Road
Winston-Salem, NC 27103
Phone Number: -7625 _ _._...
Fax Number:336-659-4320
E-mail address: n it ofws . or
Facilitv Information
Facility Name:
Facility Physical Address:
Facility Contact:
Mailing Address:
Phone Number:
Fax Number:
E-mail address:
Permit Information
Permit Contact:
Mailing Address:
Phone Number:
Fax Number:
E-mail address:
Discharge Information
Receiving Stream:
Stream Class:
Basin:
Sub -Basin:
Number of Outfalls:
Archie Elledge, WWTP
_ RECEIVED
Winston-Salem, NC 27103
Jon Southern -- _ - - MAY 012010
2801 Griff1th Road
W' n-Salem NC 27103 DENR.LAh'D
36-397-7600 QUALITY
PERMITTING
T
J. Frank C
W-inst_an-Salem, NC 27103 V
336-:397-7625
336-659-4320
f ��CIVFD
MAY .9 9
19
Facility/Aciivity Chances Please describe below any changes to your facility or activities since issuance of your permit. Attached a
separate sheet if necessary.
Added two Equalization Tanks 2m each for process flows
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 ' true, com fete a ccurate.
Signature Date Aril. 17 2018
Jon Southern Seni,or_Ilti1ity Plant Supervisor
Print or type name of person signing above Title
Please return this completed application form SW Individual Permit Coverage RenewalStormwater Permitting Program
and requested supplemental information to: 1612 Mail Service Center
Raleigh, North Carolina 27699-1612

SUPPLEMENTAL INFORMATION REQUIRED FOR RENEWAL OF INDIVIDUAL
NPDES STORMWATER PERMIT
Two copies of each of the following shall accompany this submittal in order for the application
to be considered complete:
(Do not submit the site Stormwater Pollution Prevention Plan)
Initials
J I. A current Site Map from the Stormwater Pollution Prevention Plan. The location of
industrial activities (including storage of materials, disposal areas, process areas and
loading and unloading areas), drainage structures, drainage areas for each outfall,
building locations and impervious surfaces should be clearly noted.
N/A . 2. A summary of Analytical Monitoring results during the term of the existing permit
(if your permit required analytical sampling). Do not submit individual lab reports.
The summary can consist of a table including such items as outfall number,
parameters sampled, lab results, date sampled, and storm event data.
See
Attached 3. A summary of the Visual Monitoring results. Do not submit individual monitoring
reports. The summary can consist of a table including such items as outfall number,
parameters surveyed, observations, and date monitoring conducted.
Sec
Attached 4. A summary ofthe Best Management Practices utilized at the permitted facility.
Summary should consist of a short narrative description of each BMP's in place at
the facility. If the implementation of any BMP's is planned, please include
information on these BMP's.
See
Attached 5. A short narrative describing any significant changes in industrial activities at the
permitted facility. Significant changes could include the addition or deletion of
work processes, changes in material handling practices, changes in material storage
/ practices, and/or changes in the raw materials used by the facility.
�l 6. Certification of the development and implementation of a Stormwater Pollution
Prevention Plan for the permitted facility (Sign and return attached form).
If the final year analytical monitoring of the existing permit term has not been completed
prior to tiling the renewal submittal, then the last years monitoring results should be submitted
within 30 days of receipt of the laboratory reports. (i.e. do not withhold renewal submittal
waiting on lab results)

Question #3- Outfalls are monitored (visual) once per quarter, 2 times during rain events, 2 times during
dry weather. The outfalls are numbered 1-20, #3 outfall was omitted during an upgrade in2008.
Question #4- Outfalls are monitored for erosion and any debris buildup, spill kits are located throughout
plant for spill control.
Question #5- Plant added 2 equalization tanks 2MG each for process flows in 2017.

- -STOR,M, ,AT , R RO f U. ON PREVENTION PLAN : z
JDEVEIIOPM-ENT�AND YIV�{PLENiENTATION;
CER�T=IFICATION
`--
1.
North Carolina Division of Energy, Mineral, and Land Resources - Stormwater Permitting
Facility Name: Archie Elledge, WWTP
Permit Number: NCG 110000
Location Address: 2801 Griffith Road
Winston-Salem, NC_ 27103
County: Forsvth ~
"I certify, under penalty of law, that the Stormwater Pollution Prevention Plan (SPPP) document and all
attachments were developed and implemented under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information required by the SPPP.
Based can my inquiry.of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information gathered is, to the best of my knowledge and belief, true,
accurate and complete."
And
"I certify that the SPPP has been developed, signed and retained at the named facility location, and the SPPP
has been fully implemented at this facility location in accordance with the terms and conditions of the
stormwater discharge permit."
And
"I am aware that there are significant penalties for falsifying information, including the possibility of fines and
imprisonment for knowing violations."
Sign (according to permit signatory requirements) and return.this Certification. DO.:NOT. .
'SEND,STORMWATER POLLUTION PREVENTION PLAN WITH THIS CERTIFICATION.
Signature
on Southern
Print or type name of person signing above
Date Aril 17 201
Senior Utility Plant Supervisor
Title
SPPP Certification 10/13

CERTIFICATION OF NON-STORMWATER DISCHARGES
FORM 3
I certify, under penalty of law,, that the stormwater outfalls covered by this Permit have been
tested or evaluated for the presence of non-stormwater discharges 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 those persons, to the best
of my knowledge and belief, no non-pennitted discharges of non-stormwater enter the
stormwater outfalls covered by this Permit because of activities occurring at this facility [as
specified in Part 1I, Section A, Paragraph l (e) of the Permit].
Print Name and Official Title:
Jon Southern
Senior Utility Plant Supervisor
Signat rre:
/V (Pa,�
We Signed:
2-24-2018
Representing:
Archie Elledge WWTP
2799 Griffith Road
Winston-Salem, North Carolina 27103
Methods of Evaluation Used:
R) Review of building and site plans.
P Visual inspection of storm drainage system components (e.g., catch basins, manholes).
If Observation of outfalls on a dry day that was preceded by at least 72 hours of dry weather.
C Interview with facility personnel.
E] Flow tests using water, tracers, dyes, or smoke.
The Permittee is aware of the upset or bypass notification procedures as specified in the facility's NPDES Permit and
will act accordingly (See Part III, Sections C and E of the Permit).

LEGEND
A SODIUM HYPOCHLORITE
F
GASOLINE
& SODIUM BISULFITE
G
AMMONIUM NITRATE (EFF)
B CAUSTIC (MAIN TANK)
H
AMMONIUM NITRATE (PTB)
C CAUSTIC & POLYMER (GBT)
I
POLYMER & FERRIC
D FUEL OIL (GENERATORS)
J
CAUSTIC & HYPOCHLORITE
E FUEL OIL (MANSON-MEADS)
K
MISC. CHEMICAL STORAGE
1— 19 ARE STORMWATER OUTFALL LOCATIONS
NOTE: 3 WAS REMOVED DURING THE 1992 UPGRADE
18 WAS ADDED FALL 2004 WITH BS CAKE STORAGE
19 WAS ADDED FALL 2007 WITH DRYER FACILITY
do uufk-1 Aacke& Wwwr o-' hero i+gadworgs uf1r-i4

Winston-Salem r Forsyth County
ttti'l'i0tuien's'
Wate( - Sewer - Solid Waste Dispoul
Monday, June 21, 2016
Utilities
Division of Water Quality
Administration
Attn: DWQ Central Files
1617 Mail Service Center
City of
Raleigh, NC 27699-1617
110. Box 2511
Winston-Salem, NC 27102
City Link 311 {336.727.8000
r-xx 336-727-8432
To whom it may concern:
u•rrWrhynjrua.oil
-
V1CG 11 od l3
RECEIVED
DEC 2 9- 2017
CENTRAL FILES
DWR SECTION
Pursuant to our SWPPP Compliance Schedule, we are in a period of establishing
baseline levels for our storm water monitoring and sampling criteria. Our original
compliance schedule calls for four (4) quarterly samples begirming with the third
quarter of 2015 before moving to the full compliance phase for sampling and
monitoring, which would have been the third quarter of 2016, Because we had a `no
flow' report for the fourth quarter of 2015, we have only sampled three Q3) times over
the past year. Therefore, we are modif}ing our compliance schedule and extending our
baseline sampling period by one (1) additional quarter to get a full four quarters of data
from which to establish baseline criteria. This would make the last quarter of 2016,
ending December 2016, our first full compliance sampling event. if you have any
questions regarding this compliance schedule modification, please feel free to call or
email me at (;66) 747-7320 or waynet rQcitvol`ws_or , respectively.
Best
CC:" Jan McHargue, City of Winston-Salem
Ed Gibson, City of Winston-Salem
Rachacl Kirkman, Golder and Associates
City C until: Stapor Allo, Ininei: Vivian H. ]lurk, ,4Lvur 11 '10nlarre, Nanhe", WY rd: l lcn'rrc 1). Ad,-, North Ward; 040 15 v ,k+uthwtu Ward; Rvkrrn C. (AA, Wev W rd;
Molly Leigh;. Soudr WA; Jdf Alaelnuwh. Nurdr t %Vard; Derwin L \lontgurnegs L: L WA: Ja ne "1 a}Ivr, l t., Suodtcnt Uf Yd; Ciq .huger: La M (iarriey
Forsyth C unty COFWII i� Uaviel R. Plylco Chairman; D. dwin. Vicr Chair. T d K,plain: Richard V. Linvillt- WAter litmh l: (Aarij 1), Whi+cnhune E%crvt a %`ithrnp u ;
Call 311 or 336-727-8000 Cnuncy Manager. 1)udlq Watts. Jr,
Clt link Cl O1NS.DE GtylCounty IJtilia3 Comm scions J?irid i�cill (:haic rue; kandall S. Tunir.''t efiair:IX4le S unis, Jr.; Han ld £ 1)ar'li m GriR n; Handd K }l,dn a i3uaru R.ntg
y 1y Paul S. ?64,Gdl: Clwi, Parka; Jim Ruffin: Al H. Sc; n m,

A
ML �
MCDEN 1y �i
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
City of Winston-Salem
Attn: Ron Hargrove, Director Utilities
P.O. Box 2511
Winston-Salem, NC 27107-9998
Division of Water Quality
Charles Wakild, P. E.
Director
May 15, 2013
John E. Skvarla, III
Secretary
Subject: Compliance Evaluation Inspections
Archie Elledge Wastewater Treatment Plant, NPDES Permit NCO037834 & Stormwater
Permit NCG110013; and
Muddy Creek Wastewater Treatment Plant, NPDES Permit NCO050342 & Stormwater
Permit NCG110133
City of Winston-Salem
Forsyth County
Dear Mr. Hargrove:
Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ or the
Division) conducted wastewater and stormwater compliance evaluation inspections (CEI) of the Archie
Elledge Wastewater Treatment Plant (NC0037834 & NCG110013) and the Muddy Creek Wastewater
Treatment Plant (NC0050342 & NCG110133) on May 10, 2013. The assistance and cooperation of Jon
Southern, Keith Jones, Chris Shame], Frank Crump, and Carol Bell, during these inspections, was greatly
appreciated. Inspection checklists are attached for your records and inspection findings are summarized
below.
Archie Elledge Wastewater Treatment Plant, NPDES Permit NCO037834
General Information
The WWTP is located at 2801 Griffith Road in Winston Salem, Forsyth County, NC. The permit
authorizes the City to operate this 30 MGD WWTP, which consists of bar screens, grit basins, primary
clarifiers, aeration basins, final clarifiers, sodium hypochlorite and bisulfite feed for disinfection and
dechlorination, lime/magnesium hydroxide blend and caustic feed for alkalinity control, centrifuges with
screw conveyors, sludge digestion, polymer and iron salt feed, odor control systems, a sludge drying
facility, waste sludge lagoons and instrumented flow measurement. The permit authorizes the City to
discharge treated effluent from the plant via outfall 001 into Salem Creek, this section of which is currently
classified as Class C waters in the Yadkin Pee -Dee river basin.
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
fntemet: www.ncwaterqualdy.org
An Equal Opportunity L Affirmative Action Employer
Nor`rthCarolina
AAtlll all,lf

City of Winston-Salem, Attn: Ron Hargrove, utilities Director
Wastewater & Stormwater Compliance Evaluation Inspections
Archie Elledge WWTP NC0037834 & NCG110013; and,
Muddy Creek WWTP NCO050342 & NCG110133
May 15, 2013, Page 2 of 4
Site Review
As was also the case during the previous inspection in April, 2012, Mr. Southern and his crew
continue to do an outstanding job operating and maintaining the plant. The only issue noted during the
2012 inspection, constant time/constant volume composite influent sampling, has been corrected according
to Mr. Southern, and all influent composite samples are now taken flow proportionally as required by the
permit. This site review revealed no additional problems.
❑ocumentation Review
All documentation was reviewed. Mr. Southern and his staff, as well as Carol Bell and the
laboratory staff, have done an excellent job of documenting the operation and maintenance of the plant and
laboratory operations, as required by the permit, this includes operations/maintenance and operator
visitation logs, discharge monitoring reports, laboratory and field laboratory records, chains of custody, etc.
Archie Elledge Wastewater Treatment Plant, Stormwater Permit NCG110013
Site Review
No stormwater related issues were noted during the site inspection.
Documentation Review
The Stormwater Pollution Prevention Plan (SP3) and all associated records were reviewed. A new
SP3 has been written for 2013, No deficiencies or violations were noted. Mr. Southern has done an
excellent job of implementing the SP3 and conducting and recording all required monitoring, inspections,
etc.
Muddy Creek Wastewater Treatment Plant, NPDES Permit NCO050342
General Information
The WWTP is located at 4561 Cooper Road in Winston Salem, Forsyth County, NC. The permit
authorizes the City to operate this 21 MGD WWTP, which consists of bar screens, grit chambers, primary
clarification, three aeration basins with fine bubble diffusers, a hydrated lime silo, secondary clarification,
chlorination, dechlorination, instrumented flow measurement, anaerobic sludge digesters, a gravity
thickener, sludge storage lagoons, a belt filter press, a carbon pellet odor scrubber, two emergency
generators, an effluent/flood control pump station, and solids blending tanks. The permit authorizes the City
to discharge treated effluent from this facility into the Yadkin River (outfall 001) or, under flood conditions,
into Muddy Creek (outfall 002). Both receiving waters are currently classified as WS-IV (water supply)
waters in the Yadkin Pee -Dee River Basin.
N

-r
City of Winston-Salem, Attn: Rory Hargrove, Utilities Director
Wastewater & Stormwater Compliance Evaluation Inspections
Archie Elledge VVWTP NCO037834 & NCG110013; and,
Muddy Creels WWTP NCO050342 & NCG110133
May 15, 2013, Page 3 of 4
It is noted that the plant has undergone significant construction for upgradelmodification, and more
is yet to come, some of which will result in elimination/modification/replacement of select treatment
processes. The City is reminded that the plant description in the permit should be modified accordingly
during the permit renewal process. Also, please be mindful of the requirement for other permits, such as
Authorizations to Construct (AtC), construction stormwater permits, erosion control permits, etc. Please
notify this office immediately upon construction completion of each project so that we may perform a site
visit, if needed, to inspect the new units/processes.
Site Review
As was the case during the previous inspection in April, 2012, Mr. Jones and his crew continue to
do an outstanding job operating and maintaining the plant. The only issue noted during the 2012 inspection,
constant time/constant volume composite influent sampling, has. been corrected, according to Mr. Jones,
and all influent composite samples are now taken flow proportionally as required by the permit. This site
review revealed no additional problems.
Documentation Review
All documentation was reviewed. Mr. Jones and his staff, as well as Carol Bell and the laboratory
staff, have done an excellent job of documenting the operation and maintenance of the plant and laboratory
operations, as required by the permit; this includes operations/maintenance and operator visitation logs,
discharge monitoring reports, laboratory and field laboratory records, chains of custody, etc.
Muddy Creek Wastewater Treatment Plant, Stormwater Permit NCG110133
Site Review
No stormwater related issues were noted during the site inspection.
Documentation Review
The Stormwater Pollution Prevention Plan (SP3) and all associated records were reviewed. A new
SP3 has been written for 2013. No deficiencies or violations were noted. Mr. Jones has done an excellent
job of implementing the SP3 and conducting and recording all required monitoring, inspections, etc.
Other Issues
No other issues were noted during the inspections.
The Division greatly appreciates the City's efforts to effectively and efficiently operate and maintain
the Elledge and Muddy Creek WWTPs. Mr. Southern and Mr. Jones, and their crews, as well as Carol Bell
and the laboratory staff, have done an excellent job and should be commended for their efforts.

City of Winston-Salem, Attn: Ron Hargrove, Utilities Director
Wastewater & Stormwater Compliance Evaluation Inspections
Archie Elledge WWTP NCO037834 & NCG110013; and,
Muddy Creek WWTP NCO050342 & NCG110133
May 15, 2013, Page 4 of 4
If you have any questions regarding the inspection or this letter, or if we may be of any further
assistance to you, please feel free to call Mr, Boone or me at [phone]. Thank you for your attention
to this matter.
Sincerely,
/ YY Corey Basinger
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. BIMS Inspection Report, Archie Elledge NPDES Permit NCO037834
2. BIMS Inspection Report, Archie Elledge Stormwater Permit NCG110013
3. BIMS Inspection Report, Muddy Creek NPDES Permit NCO050342
4. BIMS Inspection Report, Muddy Creek Stormwater Permit NCG110133
CC: WSRO - SWP
Central Files
NPDES Unit
City of Winston-Salem
Attn: Jon Southern — ORC Archie Elledge WWTP
2801 Griffith Road
Winston-Salem, NC 27103
City of Winston-Salem
Attn: Keith Jones — ORC Muddy Creek WWTP
2801 Griffith Road
Winston-Salem, NC 27103

Permit: NCG110013
SOC:
County: Forsyth
Region: Winston-Salem
Compliance Inspection Report
Effective: 06/01/08 Expiration: 05/31/13 Owner: City of Winston-Salem
Effective: Expiration: Facility: City of Winston-Salem - Archie Elledge WWTP
2801 Griffith Rd
Contact Person: Norman Lee Byerly
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Winston Salem NC 271036417
Title: Phone: [phone]
Certification: Phone:
Inspection Date: 05/10/2013 - E Time: 09:00 AM Exit Time: 11:00 AM
Primary Inspector: Ron Boone Phone: [phone]
Secondary Inspector(s): /_?
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal WWTP > 1MGD, Stormwater Discharge, COC
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCG110013 Owner - Facility: City of Winston-Salem
Inspection pate: 05l1012013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to the attached inspection summary letter.
Page: 2

Permit: NCG1 IOO13 Owner - Facility: City of Winston-Salem
Inspection Date: 05/10/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan? ■ Cl ❑ Q
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment: Please refer to the attached inspection summary letter.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment: Please refer to the attached inspection summary letter.
Permit and Qutfalls
# Is a copy of the Permit and the Certificate of Coverage available at the site?
# Were all outfalls observed during the inspection?
# If the facility has representative outfall status, is it properly documented by the Division?
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: Please refer to the attached inspection summary letter.
■❑❑n
m0010
0000.
®❑ Ell ❑
E 0 0 0
B000
®Q❑❑
■n❑❑
Yes No NA NE
m C 01 0
Yes No NA NE
❑❑®❑
❑❑N0
Yes No NA NE
®❑00
®❑❑❑
®0DEj
■00D
Page: 3

Division of Water Quality 1 Surface Water Protection
r
National Pollutant Discharge Elimination System
NCDENR
NOl1Tn Q71RC —DEP ,R .Tp PERMIT NAME/OWNERSHIP CHANGE FORM
EwvIRO..ME.T - N.Ty FEZ0 -R 9
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
L Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C $'0 i N C G 1 I 1 10 O I 1 13
11. Permit status Lrior to requested change.
a. Permit issued to (company name): City of Winston Salem — Archie Elledge WWTP
b. Person legally responsible for permit: TT Norman L Byerly
First M i last
Superintendent
Title T
2799 Griffith Road
Permit Holder Mailing Address
Winston-Salem NC 27103
City State Zip
[phone], [phone]
Phone t'a.\
c. Facility name (discharge): Archie Elledge WWTP
d. Facility address: 2801 Griffith Road
Address
Winston-Salem NC 27103
City State Zip
c. Facility contact person: Norman L Byerly [phone]
First l MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
X Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
City of Winston-Salem — Archie Elledge WWTP
c. Person legally responsible for permit:
James F Crump
_
First MI Last
Superintendent of Wastewater
Title
2801 Griffith Road
Permit Holder Mailing Address
Winston-Salem NC 27103
City Slate Zip
[phone] frankc @cit aRvs.or
Phone E-mail Address
d. Facility name (discharge):
Archie Elledge WWTP
e. Facility address:
2801 Griffith Road
Address
Winston-Salem NC 27103
City State Zip
f Facility contact person:
Jon M Southern
first Ml Last
336) 397-7600 ions a cit ofws.or
Phone E-mail Address
I
Revised 2012Apr23

NPDES PENMIT NAME/OWNERSHIP CHANGE FORM
Page 21bf 2
IV. Permit contact information (d'different from the person legally responsible for the permit)
Permit contact: Same
First N4I Last
Title
Mailing Address
City State Zip
{
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
® This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
/ - 7 - /3
ignature Date
....................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,.North Carolina 27699-1617
Revised 712008

V.
Elk�I�f
North Carolina Department of Environment and Natural Resources
Division of Water Quality -
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
April 30, 2012
City of Winston-Salem
Attn: David K. Saunders
P1071B5x 251-1
Winston-Salem, NC 27107
Subject: Compliance Evaluation Inspections
NPDES individual Wastewater and General Stormwater Permits
Archie Elledge Wastewater Treatment Plant, NCO037834 & NCG110013 & Muddy
Creek Wastewater Treatment Plant, NCO050342 & NCG110133
City of Winston-Salem
Forsyth County
Dear Mr. Saunders:
Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ
or the Division) conducted wastewater and stormwater compliance evaluation inspections (CEI) of
the Archie Elledge Wastewater Treatment Plant (NC0037834 & NCG1.10013) on April 26, 2012, and
the Muddy Creek Wastewater Treatment Plant (NC0050342 & NCG110133) on April 24, 2012. The
assistance and cooperation of Jon Southern, Keith Jones, Chris Shamel, Frank Crump, and Carol
Bell, during these inspections, was greatly appreciated. Inspection checklists are attached for your
records and inspection findings are summarized below.
Archie Elledge Wastewater Treatment Plant
Individual NPDES Wastewater Permit NCO037834
General NPDES Stormwater Permit NCG110013
General Information
The WWTP is located at 2801 Griffith Road in Winston Salem, Forsyth County, NC. The
permit authorizes the City of Winston-Salem to operate this 30 MGD WWTP, which consists of bar
screens, grit basins, primary clarifiers, aeration basins, final clarifiers, sodium hypochlorite and
bisulfite feed for disinfection and dechlorination, lime/magnesium hydroxide blend and caustic feed
for alkalinity control, centrifuges with screw conveyors, sludge digestion, polymer and iron salt feed,
odor control systems, a sludge drying facility, waste sludge lagoons and instrumented flow
measurement. The permit allows the city to discharge treated effluent from the plant via outfall 001
into Salem Creek, this section of which is currently classified as Class C waters in the Yadkin Pee
Dee river basin.
Site Review
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location:585 Waughtown Street, Winston-Salem, North Carotin 27107
Phone; 336-771-50001 FAX: 336-771A6301 Customer Service 1-877-623-6748
Internet: www.ncwaterguality.org
An Equal Opportunity 1 Affirmative Action Employer
One
NofthCarolina
Naturally

City of Winston-Salem
Attn: David K. Saunders
compliance Evaluation inspections & Notices of Deficiency
Archie Elledge and Muddy Creek wastewater Treatment Plants
Page 2 of 4, April 30, 2D12
Mr. Southern and his crew have done an excellent job operating and maintaining the plant.
The only issue noted is that the influent sampler is set to draw samples on a constant time/constant
volume basis (85 milliliters/20 minutes), rather than flow proportionally, as required by the permit.
This issue is discussed in further detail below under "Other Issues". Other than that the site review
revealed no problems, deficiencies, or violations.
Documentation Review
All documentation was reviewed. Mr. Southern and his staff, as well as Carol Bell and the
laboratory -staff, -.have -done -an -excellent -job -of -documenting -the -operation -and -maintenance -of -the -- -
plant, and laboratory operations, as required by the permit. This includes operations/maintenance
and operator visitation logs, discharge monitoring reports, laboratory and field laboratory records,
chains of custody, etc. .
The only issue noted during the documentation review was that holidays are not being
properly annotated on discharge monitoring reports (DMR), as per written policy. This issue is also
discussed in further detail below under "Other Issues".
Stormwater Review
The Stormwater Pollution Prevention Plan (SP3) and all associated records were reviewed.
No deficiencies or violations were noted. Mr. Southern has done an excellent job of implementing
the SP3 and conducting and recording all required monitoring, inspections, etc.
Muddy Creek Wastewater Treatment Plant
Individual NPDES Wastewater Permit NCO050342
General NPDES Stormwater Permit NCG110133
General Information
The WWTP is located at 4561 Cooper Road in Winston Salem, Forsyth County, NC. The
permit authorizes the City of Winston-Salem to operate this 21 MGD WWTP, which consists of bar
screens, grit chambers, primary clarification, three aeration basins with fine bubble diffusers, a
hydrated lime silo, secondary clarification, chlorination, dechlorination, instrumented flow
measurement, anaerobic sludge digesters, a gravity thickener, sludge storage lagoons, a belt filter
press, a carbon pellet odor scrubber, two emergency generators, an effluent/flood control pump
station, and solids blending tanks. The permit authorizes the city to discharge treated effluent from
this facility into the Yadkin River (outfall 001) or, under flood conditions, into Muddy Creek (outfall
002). Both receiving waters are currently classified as WS-IV (water supply) waters in the Yadkin
Pee Dee River Basin.
Site Review
Mr. Jones and his crew have done an excellent job operating and maintaining the plant. The
only issue noted is that the influent sampler is set to draw samples on a constant time/constant
volume basis, rather than flow proportionally, as required by the permit. This issue is discussed in
further detail below under "Other Issues". Other than that the site review revealed no problems,
deficiencies, or violations.

City of Winston-Salem
Attn: David K. Saunders
Compliance Evaluation Inspections & Notices of Deficiency
Archie Elledge and Muddy Creek Wastewater Treatment Plants
Page 3 of 4, April 30, 2012
Documentation Review
All documentation was reviewed. Mr. Jones and his staff, as well as Carol Bell and the
laboratory staff, have done an excellent job of documenting the operation and maintenance of the
plant, and laboratory operations, as required by the permit. This includes operations/maintenance
and operator visitation logs, discharge monitoring reports, laboratory and field laboratory records,
chains of custody, etc.
The only issue noted during the documentation review was that holidays are not being
properly annotated on discharge monitoring reports (DMR), as per written policy_This issue is also
discussedfii further detail below under .Other Issues".
Stormwater Review
The Stormwater Pollution Prevention Plan (SP3) and all associated records were reviewed.
No deficiencies or violations were noted. Mr. Jones has done an excellent job of implementing the
SP3 and conducting and recording all required monitoring, inspections, etc.
Other Issues
During the inspection on April 24, there were a few issues that were brought up and
discussed. These issues are summarized below:
Influent samplers at both the Elledge and Muddy Creek plants are currently set to
draw constant time/constant volume (CT/CV) samples. As required by Part II,
Section A, of the permits, these samplers need to be set to draw flow proportional
samples on one of three methods as specified.in the permit and enumerated below:
a. Continuous: a single, continuous sample collected over a 24-hour period
proportional to the rate of flow.
b. Constant Urnelvariable volume: a series of grab samples collected at equal time
intervals over a 24 hour period of discharge and combined proportional to the
rate of flow measured at the time of individual sample collection, or
c. Variable time/constant volume" a series of grab samples of equal volume
collected over a 24 hour period with the time intervals between samples
determined by a preset number of gallons passing the sampling point. Flow
measurement between sample intervals shall be determined by use of a flow
recorder and totalizer, and the preset gallon interval between sample collection
fixed at no greater than 1124 of the expected total daily flow at the treatment
system
The use of CT/CV sampling requires prior approval from the Director and is only
permitted when effluent flow rates vary less than 15%.
2. Holidays are not being properly annotated on Discharge Monitoring Reports (DMR)
as per Division policy. This has resulted in invalid monitoring violations for the
Muddy Creek plant in recent months. Please review the attached policy memo titled
"Discharge Monitoring Reports (DMR) — HOLIDAYS,° and begin annotating holidays
on DMRs for both plants as specified in the policy memo.

City of Winston-Salem
Attm David K. Saunders
Compliance Evaluation inspections & Notices of Deficiency
Archie Elledge and Muddy Creek Wastewater Treatment Plants
Page 4 of 4, April 30, 2012
3. During the 'inspection, Ms. Bell inquired as to whether the Division wanted the
"mathematically corrected" average, or just the average, reported on the DMRs for
the Fluoride parameter's weekly and monthly averages for the Elledge plant. Please
note that, in accordance with the Part I, Section A.(1) and Part ll, Section A, of the
Elledge permit, the simple arithmetic mean is required to be reported for both the
weekly and monthly averages. Please review those sections of the permit for further
details. A "mathematically corrected" average is NOT required.
Please correct the issues noted above in #1 and #2 of "Other Issues" as soon as practical. If
-you-have-any-questionsregarding-the inspection -this -letter, or -the -issues -noted -during -the -- -
inspection, please feel free to call Mr. Boone or me at [phone]. Thank you for your
cooperation in this matter.
Sincerely,
W. Corey Basinger
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. BIMS Inspection Report
2. Policy Memo - "Discharge Monitoring Reports (DMRs) - Holidays
CC: WSRO - SWP
Central Files
NPDES Unit
City of Winston-Salem
Attn: Jon Southern - ORC Archie Elledge WWTP
2801 Griffith Road
Winston-Salem, NC 27103
City of Winston-Salem
Attn: Keith Jones - ORC Muddy Creek WWTP
2801 Griffith Road
Winston-Salem, NC 27103

Compliance Inspection Report
Permit: NCG110013 Effective: 06/01/08 Expiration: 05/31/13 Owner: City of Winston-Salem
SOC: Effective: Expiration: Facility: City of Winston-Salem - Archie Elledge WWTP
County: Forsyth 2801 Griffith Rd
Region: Winston-Salem
Winston Salem NC 27103
Contact Person: Norman Lee Byerly Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 04/26/2012 Entry Time: 09.00 AM Exit Time:.11:00 AM
Primary Inspector: Ron Boone /A, Yf ` .-Z Phone: [phone]
Secondary Enspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal WWTP > 1MGD, Stormwater Discharge, COC
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCG110013 Owner - Facility: City of Winston-Salem
Inspection Date: 04/26/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to the attached inspection summary letter.
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
®n
n
Q
# Does the Plan include a General F_ocation'(USGS) map?
El
❑
❑
n
# Does the Plan include a "Narrative Description of Practices"?
®❑
Q
11
# Does the Plan include a detailed site map including outfall locations and drainage areas?
®0-0-0--
# Does the Plan include a list of significant spills occurring during the past 3 years?
®
n
n
n
# Has the facility evaluated feasible alternatives to current practices?
®
n
n
n
# Does the facility provide all necessary secondary containment?
®❑
0
n
# Does the Plan include a BMP summary?
®
n
n
n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
®
n
n
n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
®
n
n
# Does the facility provide and document Employee Training?
®
Cl
n
n
# Does the Plan include a list of Responsible Party(s)?
®
Cl
❑
# Is the Plan reviewed and updated annually?
®❑
❑
n
# Does the Plan include a Stormwater Facility Inspection Program?
®
❑
n
Has the Stormwater Pollution Prevention Plan been implemented?
®
Q
n
n
Comment: Please refer to the attached inspection summary letter.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment: Please refer to the attached inspection summary letter.
Permit and Outfalls
# Is a copy of the Permit and the Certificate of Coverage available at the site?
# Were all outfalls observed during the inspection?
# If the facility has representative outfall status, is it properly documented by the Division?
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: Please refer to the attached inspection summary letter.
Yes No NA NE
0000
Yes No NA NE
Page: 2

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 22" d, 2011
City of Winston-Salem
Attn: David K. Saunders
P.O. Box 2511
Winston-Salem, NC 27107
Subject: Compliance Evaluation Inspection
NPDES General Stormwater Permit NCG110000
Certificate of Coverage NCG110013
Archie Elledge Wastewater Treatment Plant Stormwater Permit
Forsyth County
Dear Mr. Saunders:
1. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (D1NQ)
conducted a compliance evaluation inspection (CEI) at the subject facility on February 10t�', 2011.
The assistance and cooperation of Jon Southern, Operator in Responsible Charge (ORC) during
the inspection, was greatly appreciated. An inspection checklist is attached for your records and
the inspection findings are summarized below.
2. The WWTP is located at 2801 Griffith Road in Winston Salem, Forsyth County, NC. Stormwater
related to industrial activity is discharged from the site to Salem Creek, which is currently
classified as Class C waters in the Yadkin Pee Dee River Basin.
Documentation & Monitoring Review
3. The Stormwater Pollution Prevention Plan (SP3) is complete, current and has been implemented.
All qualitative monitoring (QM) has been accomplished as required and records are available.
There is no vehicle maintenance activity on site which would require analytical monitoring as
required by the permit.
Site Review
4. The site was very clean and well maintained. Mr. Boone noted no violations or discrepancies. It
is believed that you have minimized exposure of industrial activities to the maximum extent
practical.
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: 1-877-823-6748
Internet: www.ncavaterquality.org
An Equal Opportunity 4 Affirmative Action Employer
NothCarolina
Naturally

City of Winston-Salem
Attu: David K, Saunders
Archie Elledge Wastewater Treatment Plant Stormwater Permit
Compliance Evaluation Inspection, NCG110113
2/22f2011
Page 2 of 2
5. You are reminded that violations of the NCG110000 general permit are subject to civil penalty
assessments not to exceed $25,000 per day, per violation. Thank you for your cooperation in
this matter. Should you have any questions, please feel free to contact Mr. Boone or me at (336)
771-5000,
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section
Attachments:
1. BIMS Inspection Checklist
cc: S,WP W..SRO
Central Files
Stormwater Permitting Unit
i

Compliance Inspection Report
Permit: NCG110013 Effective: 06/01/08 Expiration: 05/31/13 Owner: City of Winston-Salem
SOC: Effective: Expiration: Facility: City of Winston-Salem -Archie ElledgeVWWTP
County: Forsyth 2801 Griffith Rd
Region: Winston-Salem
Wnston Salem NC 27103
Contact Person: Norman Lee Byerly Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 02110/2011 Entry Time: 08:30 AM Exit Time: 11:00 AM
Primary Inspector: Ron Lr
L Phone: [phone]
Secondary Inspector(s): Ext.2202
6 21 2 Z /j7
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal WVVTP > 1MGD, Stormwater Discharge, COC
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
E Storm Water
(See attachment summary)
Page: 1

Permit: NCG110013 Owner - Facility: City of Winston-Salem
Inspection Date: 02110/2014 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to the attached inspection summary letter.
Page: 2

Permit: NCG110013 Owner - Facility: City of Winston-Salem
Inspection Date: 02/10/2011 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes
No
NA
NE
Does the site have a Stormwater Pollution Prevention Plan?
■
n
n
Cl
# Does the Plan include a General Location (USGS) map?
■
n
n
n
# Does the Plan include a'Narrative Description of Practices'?
■
n
n
n
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■
n
n
n
# Does the Plan include a list of significant spills occurring during the past 3 years?
■
In
n
n
# Has the facility evaluated feasible alternatives to current practices?
■
n
n
n
# Does the facility provide all necessary secondary containment?
m
n
n
n
# Does the Plan include a BMP summary?
■
n
n
❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■
n
n
n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
®❑
n
n
# Does the facility provide and document Employee Training?
■
n
0
Cl
# Does the Plan include a list of Responsible Party(s)?
■
n
n
n
# Is the Plan reviewed and updated annually?
■
n
n
n
# Does the Plan include a Stormwater Facility Inspection Program?
o
n
n
n
Has the Stormwater Pollution Prevention Plan been implemented?
■
n
n
n
Comment: Please refer to the attached inspection summary letter
Qualitative Monitoring
Yes
No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■
n
n
n
Comment: Please refer to the attached inspection summary letter.
Analytical Monitoring
Yes
No
NA
NE
Has the facility conducted its Analytical monitoring?
n
0
■
n
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
n
n
■
n
Comment: Please refer to the attached inspection summary letter.
Permit and Outfalls
Yes
No
NA
NE
# 1s a copy of the Permit and the Certificate of Coverage available at the site?
■
n
n
n
# Were all outfalls observed during the inspection? -
■
n
n
n
# If the facility has representative outfall status, is it properly documented by the Division?
Cl
n
■
n
# Has the facility evaluated all illicit (non stormwater) discharges?
®
n
n
n
Comment: Please refer to the attached inspection summary letter
Page: 3

RI=GEaV�D
Winston-Salem - Forsyth County N.C. Dept_ of ENR
= it / County Utilities I MAY 1 12009
Winston-Salem
Water - Sewer - Solid Waste Disposal ResionalOfrire
Manson Meads Complex - 2799 Grif{ich Road - Winton -Salem. NC 27103 - Tel [phone] - Fax [phone]
May 8, 2009
Mr. Steve W. Tedder
Water Quality Regional Manager
Winston-Salem Region/ DWQ
585 Waughtown St.
Winston- Salem, NC 27107
Dear Mr. Tedder:
This letter is in response to the Notice of Deficiency for Permit No. NCG 110013 for
the Archie Elledge Wastewater Treatment Plant received from the Compliance Inspection
on March 241h, 2009. The Elledge Plant received a new storm water permit effective June
1`7, 2008 about the same time the Storm Water Dept- within the City of Winston-Salem
hired a consultant Jewell Engineering and Storm Water Services Group to totally rewrite
the Storm Water Pollution Prevention Plans (SWPPP) for our Wastewater Treatment
Plants. This resulted in some of the deficiencies that were noted during the inspection
being completed (most were in our files) but not incorporated in the new manual. The
storm water team has completed the noted deficiencies and is in the process of updating
all the S WPPP manuals and listing the documents in Appendix F as required. The
following is a list of deficiencies that were noted during the inspection and corrected
documentation is attached for your review.
• Location of past spills and leaks.( see significant spills sheet Ref#1)
• List of significant spills or leaks reported to National Response center. (* NRC
report dated 5/20/07 Ref # 2)
a Corrective actions to mitigate spill impacts. ( see -Sanitary Sewer Spill response
Evaluation Forms Ref #3)

• Certification statements signed in accordance with Part l 11 Standard Conditions,
Section b Paragraph 5. ( Certification form with signature Ref # 4)
• Facility personnel (or team) responsible for implementing the SPRP identified.
(SWPPT Members Ref # 5)
• Spill response team - Team had been identified by position but not listed by name.
(see corrected sheet Ref # 6)
• Spill response equipment and locations. ( Spill kit contents and locations Ref # 7)
• Facility personnel responsible for implementing the training identified. (SWPPT
leader -Jon Southern ReF# 6)
• Annual training provided on spill response and cleanup. ( Training sign -in sheet
Ref # 8)
• Responsibilities assigned and documented. (SWPPT organizational chart Ref #9/
SDO Reports Ref # 10)
The Plants are using a training video developed by the City's Storm Water group to train
employees on storm water requirements and follow-up actions. We are committed to
prevent storm water pollution at our facilities and abide by the permit requirements to
protect the States receiving waters. If there are questions or concerns or additional
documentation is required please do not hesitate to contact myself, Jon Southern at (336)
659-4322 or N. Lee Byerly at (336)-765-0130. Thank You for your help and cooperation
in this matter.
Sincerely,
Jon M. Southern
Sr. Utility Plant Supervisor
Cc: David Saunders, Utilities Director
Ron Hargrove, Deputy Director Utilities
Lee Byerly, Wastewater Treatment Superintendent
Frank Crump, Wastewater Treatment Superintendent

f
Ref #1
1.5 Significant Spills
' There have been significant spills of hazardous substances at this facility in the three (3) years
prior to the effective date of this Plan. 'rhe spill incidents are designated as:
• E03-05-06 dated 1-01-07
• E05-05-06 dated 3-16-06
• E06-06-07 dated 6-11-07
• E07-07-09 dated 10-05-07
• E08-07-08 dated 4-25-08
• E09-08-09 dated 10-16-08
• E09-07-08 dated 12-12-08
• * NRC Report dated 5-20-07
A spill report for these spills is located in Appendix F.
Significant spills are defined as those spills that have at least one of the following characteristics:
• The spilled material enters Salem Creek,
• The spilled material flows off the property,
• The spilled material causes injury to personnel
• The spilled material contaminates the soil, adjacent wetlands, or waters of the State, or
• The spilled quantity exceeds a regulatory reporting limit.
A summary of significant spill incidents are noted in_Table 5 below. The detailed spill report
1 (use Form 8 or similar) is filed in Appendix F.
TABLE 5 - SIGNIFICANT SPILLS
DATE
SPILLED MATERIAL
QUANTITY
CORRECTIVE ACTION
1-01-07
Grit and Grease
600 gallons
Opened drain valve
3-16-07
Grit and grease
300 gallons
Added gravity drain line back to wet well
5-20-07
* NRC REPORT
Hypochlorite
107 pounds
Line repaired
6-11-07
Raw wastewater
50,000 gallons
Back up switch gear in stock
10-05-07
Centrate
—600 gallons
Line repaired
4-25-08
Centrate
—3600 gallons
Line repaired
10-10-08
Final clarifier water
—300 gallons
New hoses installed
12-12-08
Centrate
2500 gallons
Line repaired
Archie Elledge W[PTP Stormwater Pollution Prevention Plan
A'PDES Permit No. NCG110013 Page 13

12f12/08 Centrate 25GO gallons Line repaired
Archie Elledge WWTP Stormwater Pollution Prevention Plan
NPDES Permit No. NCG310013 Page 14

Ref #4 (2)
NCG110013
SWPPP CERTIFICATION
FORM 1
"I 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" [see Part-fil, Section A, Paragraph 2
of the Permit].
Authorized Signature'
Title
Phone No.
Date
✓Ll
Sr Utility Plant
Supervisor
336-659-4322
4-21-09
SWPPT MEMBERS
The Plant Superintendent will appoint the Stormwater Pollution Prevention "beam (SWPPT)
leader and members each year. Write the names of the team members in the chart below.
City of Winston-Salem
Stormwater Division
[phone]
Keith Huff
Andrew Allen
SWPPT Leader
Jon Southern
Office:336-659-4322
Celt.336-240-5738
SWPPT Members
Consultants
Jewell Engineering
Consultants, PC
[phone]
Stormwater Services
Group, LLC
[phone]
1. Chris ShamellAsst. Spt. 2.Sherry Bagwell/IWC Super. 3. Diane GodfreylBio. Super.
4. Byron TeshlMaint Super._ 5.Bruce Casey/Dryer Super. 6. Bob Mcmannen
Danny Hartley/Sr.Operators
1 Certification and all documents requiring a signature shall be signed by the most senior municipal official at the facility or
authorized designee.
Archie Elledge WWTP Stormwater Pollution Prevention Pin
Appendix A Form I

----_`_---__------_---- _��___—__—__ Ref ilk
CERTIFICATION OF NON-STORMWATER DISCHARGES
I. certify, under penalty of law, that the stormwater outfalls covered by this Permit have been
tested or evaluated for the presence of non-stormwater discharges 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 those persons, to the
best of my knowledge and belief, no non -permitted discharges of non-stormwater enter the
stormwater outfalls covered by this Permit because of activities occurring at this facility [as
specified in Part H, Section A, Paragraph 1(e) of the Permit].
Print Name and Official Title:
Jon Southern/ Sr. Utility Plant Su ervisor
Signature:
ate Signed:
4/28/09
Representing:
Archie lE:lledge WW'IP
2799 Griffith Road
Winston-Salem, North Carolina 27103
Methods of Evaluation Used:
0 Review of building and site plans.
H Visual inspection of storm drainage system components (e.g., catch basins, manholes).
® Observation of outfalls on a dry day that was preceded by at least 72 hours of dry weather.
® Interview with facility personnel.
❑ Flow tests using water, tracers, dyes, or smoke.
The Permittee is aware of the upset or bypass notification procedures as specified in the facility's
NP.DES Permit and will act accordingly (See Part III, Sections C and E of the Permit).
Archie Elledge WWTP Stormwater Pallution Prevention Plan
NPDES Permit No. NCGI10013 Page 16

Ref #5/#6
Storm Water Response Team/ Storm Water Pollution Prevention Team
SWPPT Leader/Training- Archie Elledge Wastewater Treatment Plant:
Senior Utility Plant Supervisor ----Jon M. Southern
SWPPT Members:
Assistant Utility Plant Superintendent--- Christopher S. Shamel
Utility Plant Supervisor/Industrial Waste--- Sherry B. Bagwell
Utility Plant Supervisor/ Residuals ---Diane A. Godfrey
Utility Plant Supervisor/Dryer Facility ---Bruce M, Casey
Utilities Supervisor/Maintenance---Byron A. Tesh
Senior Utility Plant Operators ---Daniel R. Hartley
Bobby R. McMannen Jr.
Management/Advisors
Waste Treatment Plant Superintendents ---- N. Lee Byerly
J. Frank Crump

Ref #7 _----_�-.___-- —
SPILL KIT CONTENTS AND LOCATION
CONTROL BUILDING — 2 SPELL KITS, ABSORBENT AND DRAIN MATS
N 36 02.232
W 080 180.551 ,
TRUCK SHED- SPILL KIT, ABSORBENT AND ABSORBENT SOCKS
N 36 02.100
W 080 18.712
FLOOD CONTROL HOUSE- SPILL KIT, ABSORBENT AND ABSORBENT SOCKS
N 36 02.062
W 080 18.811
BLOWER BUILDING- SPELL KIT, ABSORBENT AND ABSORBENT SOCKS
N 36 02.218
W 080 18.717
CAUSTIC BUILDING- ABSORBENT AND ABSORBENT SOCKS,
N 36 02.149
W080. 18.613
OLD RESIDUAL STORAGE- SPELL KIT, ABSORBENT AND BALES OF STRAW
N 36. 02.303
W 080. 18.208
PTB PUMP HOUSE- SPILL KIT, ABSORBENT AND ABSORBENT SOCKS
N 36 02358
W 080 17.985
DRYER FACILITY- SPELL KIR, ABSORBENT SOCKS AND DRAIN MATS
N 36 02.246
W 080 18.450

Ref #8
JYCG_f 10013­
--,
TRAINING SIGN -IN SHEET
FORM 4
My signature below certifies that I have attended a Stormwater Pollution Prevention Training
workshop. Also, I have read the sections of the Stormwater Pollution Prevention Plan that apply to my
work area and clearly understand my, responsibilities concerning the prevention of pollutants from
entering this facility's storm drainage 'system -and the company's dedication to improving the quality of
stormwater which discharges from this facility. This training meets the intent of the Employee Training
requirement described in the General Penrnit NCG110013 Part II Section A.S.
PRINT NAME
Jor, So U i
[dG.C[�,,,
W egA e.-ry-i"
Archie Elledge WWTP
Appendix A
SIGNATURE DATE
ROOM
�-Zo -07
,Stormwater Pollution Prevention Plan
Form 4

Ref 118
(51612009) Byron Tesh-_Document.pdf - - :_ _ -- - ___ _ _ -Page 1
NC G 110013
TRAINING SIGN -IN SHEET
FORM 4
My signature below certifies that I have attended a Stormwater Pollution Prevention Training
workshop. Also, I have read the sections of the Stormwater Pollution Prevention Plan that apply to my
work area and clearly understand my responsibilities concerning the prevention of pollutants from
entering this facility's storm drainage system and the company's dedication to improving the quality of
stormwater which discharges from this facility. This training meets the intent of the Employee Training
requirement described in the General Permit NCGI 10013 Part II Section A5.
PRINT NAME
rpn �S
:4 ) _Ci U - La=S __10-b �n
- - _ SIGNATURE - -- - --
� 1/L•�aP�l 1114Lb%� L /N7yt�lRl��,�
11
tj
DATE
Y'z Y'
t4z�4,,
Archie F_lledge W47P Stormwaeer Pollution Prevention Plan
AppendixA Form 4

'1RA,WFNG SIGN -IN SHEET
FORM 4
My signature below certifies that I have attended a Stormwater Pollution Prevention Training
workshop. Also, I have read the sections of the Storrnwater Pollution Prevention Plan that apply to my
work area and clearly understand my responsibilities concerning the prevention of pollutants from
entering this facility's storm drainage system and the company's dedication to improving the quality of
stormwater which discharges from this facility. This training meets the intent of the Employee Training
requirement described in the General Permit WCG110013 Part II Section A.S,
PRINT NAME A SIGNATURE DATE
AxiW a �7 ripe IY.fYf 5tnrrmeerQr �aufiation Prea =F�nn 'ltu,
Appev&rA Frnm 4

N%G i 10013
Tl1tAIMG SIGN -IN SHEET
t FORM 4
My signature below certifies that I have attended. a Stormwater Pollution Prevention Training
workshop. Also, I have read the sections of the Stormwater Pollution Prevention Plan that apply to my
work area and clearly understand my responsibilities concerning the prevention of pollutants from
entering this facility's storm drainage system and the company's dedication to improving the quality of
stormwater which discharges from this facility. This training meets the intent of the Employee Training
requirement described in the General Permit NCG110013 Part II Section A.5.
��11 PRINT NAME SIGNATURE DATE,urvcL e46e AL�/3 0
IVo,J Q41tc,Y -1 (� _
5 e O Ct
R
rz 1/ 7"1% . S n,_ os
Archie Elledge MP7P Stormwarer Pollution Prevention Plan
Appendix A Form 4

n
Ref #9
0
7. RESPONSIBLE PARTY
The responsibilities of the Stormwater Pollution Prevention Team (SWPPT) are to:
• Schedule the actions to be performed as directed in the SWPPP;
• Monitor stormwater discharges as specified in the Permit;
• Conduct semi-annual site inspections;
• Implement best management practices;
• Perform record keeping and documentation as required by the SWPPP;
• Perform the annual updating and certifications as required by the SWPPP;
• Evaluate the adequacy of the SWPPP; and
• Modify the SWPPP as necessary to achieve reasonable pollutant reductions at the facility.
The SWPPT Leader will designate the SWPPT Leader and Members. The organizational arrangement
of the SWPPT is presented schematically in Section 7.1. A chart showing actual names, areas of
responsibility, and telephone numbers is provided in Appendix F. The SWPPT will meet at least
annually to evaluate the effectiveness of the BMPs and determine if additional BMPs need to be
incorporated at the facility. A series of BMP checklists are included in Appendix A to assist the team
in the evaluation of their assigned areas. The SWPPT is required to make revisions to the Plan
where changes to the facility affect the potential risks to stormwater quality. These revisions can
be simple and brief narratives inserted as amendments to the original Plan (Use Record of
Amendments form provided in Appendix A). The Plan may need to be updated or re -written
when the Permit is renewed.
7.1 SWPPT Organization Chart
Utility Plant Superintendent
Consultants SWPPT Leader
Jewell Engineering Utility Plant Supervisor
Consultants, PC of Operations
Stormwater Services
Group, LLC
SWPPT Members
Assistant Superintendent Supervisor/ Industrial Waste
Supervisor/ Maintenance Supervisor/ Dryer
City of Winston-
Salem
Stormwater
Division
Supervisor/ Residuals
General Plant Worker
Archie Elledge WTfTP Stormwater Pollution Prevention Plan
NPDES Permit No. NCG110013 Page 36

-- - — --- ---------- ---- — _ _— _ - _ ---- -Ref #9 - --- --- —�._
3.4 Notification of Releases
Facility personnel will be notified of a spill that could pose an immediate threat to their health
through the telephone system, PA system or word of mouth where practical.
The SWPPT Leader will be notified by telephone or voice of all spills of oil or hazardous
substances immediately. The SWPPT Leader will be responsible for notifying off -site agencies of
reportable spills. Only the SWPPT Leader or his designee will contact off -site agencies. Refer to
Table C.2 below:
TABLE 9- EMERGENCY RESPONSE AGENCIES AND TELEPHONE NUMBERS
1. On -Site
On -site Security..............................................................................................................
Initial Notification/ Emergency Response................................................................911
Facility SWPPT Leader Jon Southern ................. ......... __.................... [phone]
Jon Southern's cellphone .....................................................................[phone]
Frank Crump's cell phone. . ............. ................ ___ .... ......................... [phone]
IL Off -Site (use these numbers only as required
Fire, Medical, Police and Emergency .........................
City Stormwater Division
Keith Huffs office .................................................
Keith Huffs cell phone ................ .---------- ..............
Andy Alien's office ...............................................
Andy Alien's cell phone .......................................
...........................................911
..........................[phone]
........................_(336) 406-3332
..........................(3W) 747-6%8
-----------------------_ [phone]
Shamrock Environmental (spill response & clean-up).........................[phone]
Fire Marshall (Non -Emergency) ....................... ................................ _.[phone]
Local Emergency Management Agency (office hours).......................[phone]
State Emergency Response Coordinator . .................................. ....... [phone]
North Carolina DENR (during office hours).........................................[phone]
(after normal office hours)..............................(800) 85M368
National Response Centers..................................................................[phone]
USEPA Region 1V................................................................................[phone]
CHEMTREC (24-hours, Information Only) ........................................... [phone]
National Poison Control Center ......... .......................... ......................-[phone]
8. Call this number only if spill is an extremely hazardous substance > RQ or any spill reaches waters of the State.
s- Call this number only if the spill is a CERCLA hazardous substance > RQ and has entered waters of the State
The NRC will notify the USEPA.
Archie Elledge WWTP Stannwater Pollution Prevention Plan
NPDES Permit No. NCG110013 Page 29

NCDENR
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
April 9, 2009
Norman Lee Byerly
City of Winston-Salem
2799 Griffith Rd
Winston Salem NC 271036417
SUBJECT: . Notice of Deficiency
March 24, 2009 Compliance Evaluation Inspection
City of Winston Salem- Archie Elledge WWTP
Permit No: NCG110013
Forsyth County
Dear Mr. Byerly:
Resources
Dee Freeman
Secretary
Enclosed please find a copy of the Compliance Evaluation Inspection farm from the inspection conducted on March 24, 2009. The
Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem Regional Office of the Division of Water
Quality -
The facility was found to be Not in Compliance with permit NCG030240.
1. Permit
The current Certificate of Coverage NCG 110013 for the City of Winston Salem- Archie Elledge WWTP facility became effective
June 1, 2008 and will expire on May 31, 2013. The permitted facility is authorized to discharge stormwater from a facility located at
2801 Griffith Road, Winston Salem, North Carolina to receiving waters designated as Salem Creek, a 303d listed and class C stream
in the Yadkin -Pee Dee River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in General Permit No. NCG 110000.
The permittee is authorized to discharge stormwater to the surface waters of North Carolina or separate storm sewer system which has
been adequately treated and managed in accordance with the terms and conditions of this general permit. All discharges shall be in
accordance with the conditions of this permit.
Any other point source discharge to surface waters of the state is prohibited unless it is an allowable non-stormwater discharge or is
covered by another permit, authorization or approval.
The permit identifies one of two potential monitoring requirements that apply to this facility:
➢ Qualitative Monitoring of Stormwater Discharge Outfalls per Section B.
➢ There is no on -site vehicle maintenance activity at this site so Analytical Monitoring for On -Site Vehicle Maintenance is not
required.
Copies of the NCG 1 10000 general permit documents can be accessed from the following web page:
http://h2o.enr.state.nc.tistsu/Forms Documents.hnn#StormwaterGP
IL Records/Reports
General Permit NCG110000 requires certain monitoring to be documented and the records maintained at the facility.
North Caroiina 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 Nofth Caxolina
Internet mvw.nmaterpality.org ' Vatuy,a y
An Equal Opportunity 4 Affirmative Action Employer �/ L "

Part III Section D: Monitoring and Records, part (6) Records Retention: requires Qualitative monitoring shall be documented and
records maintained at the facility along
with the Stormwater Pollution Prevention Plan. Copies of analytical monitoring results
shall also be maintained on -site. The permittee shall retain records of all monitoring
information, including all calibration and maintenance records and all original strip chart
recordings for continuous monitoring instrumentation, and copies of all reports required
by this general permit for a period of at least S years from the date of the sample,
measurement, report or application. This period may be extended by request of the
Director at any time.
In addition Part III Section D: Monitoring and Records, part (2) Recording Results states: For each measurement, sample; inspection
or maintenance activity performed or collected pursuant to the requirements of this general permit, the permittee shall record the
following information:
a. . The date, exact place, and time of sampling, measurements, inspection or maintenance activity;
b. The individual(s) who performed the sampling, measurements, inspection or maintenance activity,-
c. The date(s) analyses were performed;
d. The individuals) who performed the analyses;
e, The analytical techniques or methods used; and
f. The results ofsuch analyses.
The following records are required at this site per the NPDES permit:
l . Stormwater Pollution Prevention Plan as specified per.Part II, Section A.
2. Stormwater Discharge Outfalls (SDO)' shall have Qualitative monitoring performed as described in Part 11, Section B and
Table 1.
A review was made of the available records and reports for this facility for the period through March 2009.
This review found some deficiencies in the records.
+ The Stormwater Pollution Prevention Plan was incomplete, Please see attached inspection report for details.
Ili. Facility Site Review
Mr. Jon Southern, ORC of Archie Elledge WWTP was present when the inspector toured the facility. Vehicle maintenance activities
for this facility are conducted off site at the City of Winston Salem Fleet Maintenance facilities. At the time of the inspection the
facility appeared well maintained and Mr Southern was well prepares} for the inspection. This facility is currently undergoing an
upgrade and is an active construction site. At the time of the inspection no adverse impacts to the stream were noted from
construction activities. A separate inspection of the NCG010000 Stormwater Permit associated with construction activities was
conducted on this date.
IV. Effluent /Receiving Stream
The facility storm -water discharges to receiving waters designated as Salem Creek, a 303d listed and class C stream in the Yadkin -Pee
Dee River Basin. On the date of the inspection the receiving stream and outfalls were clear and free of foam or debris. At the time of
the inspection no adverse impacts to the stream were noted from construction activities.
V. Self -Monitoring Program
There are currently eighteen (18) stormwater discharge outfalls being monitored.
The qualitative monitoring as required in Part II, Section B, and Table I was recorded on a semi-annual basis as required by the
permit.

Analytical Monitoring for On -Site Vehicle Maintenance is not required at this time.
VI. Pollution Prevention
The permittee is required to develop a Stormwater Pollution Prevention Plan as identified in Part 11, Section A of the General Permit.
The Plan should include, at a minimum the following items:
• A Site Plan containing the following: a General Location Map, a Narrative Description, a Site Map, a list of Significant
Spills and Certification of Stormwater Outfalls.'
• A Stormwater Management Plan incorporating the following: a Feasibility Study, a Secondary Containment Schedule and a
BMP Summary.
• A Spill Preventiori and Response Plan.
• A Preventative Maintenance and Good Housekeeping Program.
• Employee Training.
• A Responsible Party.
• Any Plan Amendments.
• A Facility Inspection Program.
• Implementation records for a period of five years.
There were deficiencies found in the facility's Stormwater Pollution Prevention Plan.
• Please see attached checklist for details.
Please refer to the enclosed Inspection Report and Stormwater Inspection Checklist far any additional observations and comments
Your continued oversight at this facility is very important. This office appreciates your efforts to bring your facility into
compliance. Please forward copies of your missing documentation as noted on the checklist to this office at the address below
within the next 30 days.
If you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
*",WYT
.er
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments
Cc: SWP-Central Files
WSRO
NPS Assistance and Compliance Oversight
Jon Southern, Archie Elledge WWTP, 2799 Griffith Rd, Winston Salem, NC 27103

------------
i
4
\ Stormw ater Inspection (SP3 Checklist)
Facility Name Archie Elledge WWTP
Permit Number—NCG110013_Activity_WWTP_
Facility Address_2801 Griffith Road, Winston Salem, North Carolina
County Forsyth
Industrial Activity Treatment Works_
SIC Code— Size of Facility_ _# Employees_ _
Facility Contact —Jon Southern_
Title ORC
Telephone Number240-5738
Inspection Date March 24, 2009 Time
Entry Time 08:30 am Exit Time
Inspector(s)_Rose Pruitt —
Facility Representative(s)Jon Southern
Other Agencies_Representatives_
08:30 am
_12:00pm

Part II Monitoring, Controls and Limitations for Permitted Discharge
Section A: Stormwater Pollution Prevention Plan. Incomplete_
1. Site Plan —shall provide a description of the physical facility and the potential pollutant sources which may be
expected to contribute to contamination of stormwater discharges. The site plan shall contain the following:
M
. General Location a— USGS quadrangle ma ore equivalent showing:_
Yes.
Facility location in relation to transportation routes and surface waters.
Yes
The name of the receiving water(s) to which the stormwater outfall(s) discharges:
Salem Creek- 303d listed
N/A
OR if the discharge is to a municipal separate storm sewer system, the name of the municipality and the
ultimate receiving waters: _
Accurate latitude and longitude of -tic points) of discharge.
Yes
b. Narrative description of:
Yes
Storage practices (rave materials, fuels, intermediate: products, byproducts. waste materials, finished
products)
Yes
Loading and unloading activities.
Yes.,
Outdoor'process areas (types of processes and equipment used).
N/A
Dust or particulate generating or control processes (crushing, mixing, burning, drying operations).
Yes
Waste disposal operations (solids, liquids, residuals/sludges).
c. Site map drawn to scale with distance legend indicating:
Yes
Location of industrial activities (including storage of materials, disposal areas, process areas, loading and
unloadin areas
Yes
Drainage structures (outfalls, stormwater conveyance system, retention ponds, diversion structures,
ditches, culverts, swales, porus pavement, sediment traps, erosion control, storm drain inlets).
Yes
Drainage areas for each outfall (flow pattern).
Yes
Activities occurring in the drainage area.
Yes
Building locations.
Yes
Existing BMP's and impervious surfaces.
Yes
% of each drainage area that is impervious.
Yes
For each outfall; a narrative description of potential pollutants which could be expected to be present.
Yes -
Location of exposed significant materials.
No
Location of past spills and leaks.
Yes
Fueling stations.
N/A
Vehicle and equipment maintenance.
Yes
Vehicle and equipment washing.
Yes
Loading and unloading areas.
Yes
Above ground liquid storage tanks.
Yes
Industrial waste management areas and outside manufacturing.
N/A j
Outside storage of raw materials, by-products or finished products.

d. List of significant spills or leaks of pollutants that have occurred at the facility during the 3
revious ears:
No
List of significant spills or leaks (includes hazardous substances in excess of reportable quantities reported
to National Response Center/ Appendix H).
No
Corrective actions to mitigate spill impacts.
e. Certification that the stormwater outfalls have been evaluated for the presence of non-
stormwater discharges.'
No
Certification statement signed in accordance with Part 11I, Standard Conditions, Section B, Paragraph 5.
N/A
Discharge tested (dye tracing, chemical analyses) for presence of non-stormwater discharge (process Nvater,
vehiclele ui ment wash water, sanitary waste, etc). [disconnect or apply for,`PDES ermit].
2. Stormwater Management Plan. The stormwater management plan shall contain a narrative description of
the materials management practices employed which control or minimize the exposure of significant materials to
stormwater, including structural and non-structural measures. The stormwater management plan, at a minimum,
shall incorjporate the follovvin
a. Feasibility study. A review.of the technical and economic feasibility of changing the methods of operations
and/or storage practices to eliminate or reduce exposure of materials and processes to stormwater. Wherever
practical the permittee shall;
Yes
Prevent exposure of all storage areas. (roof, enclose, drainage diversion, move materials inside, pallets)
YES
Material handling operations.
N/A
Manufacturing operations.
Yes
Fueling operations.
Yes
Loading and unloading areas. (roof, berms, grading)
Yes
Outdoor process areas. ( street sweeping, structural devices)
N/A
Dust or particulate control.
Yes
Waste disposal practices. (lids, roof)
b. Secondary Containment Schedule. for bulk storage of liquid materials, storage of Section 313 of Title III
of the SARA water priority chemicals (appendix 1), or storage of hazardous substances to prevent leaks and spills
from contaminating stormwater runoff.
Yes
Secondary Containment - spill containment for the contents of the single largest tank within the
containment structure plus sufficient freeboard to allow for 25 r, 24 hr storm event 5-6 in ). -
Yes
Bulk storage of liquids (single above ground container with capacity greater than 660 gallons or Multiple
containers in close proximity with combined storage capacity greater than 1,320 gallons). [ex. More than
24, 55 gallon drums]
Yes
Manually activated valves w/ locks- If secondary containment devices are connected directly to stormwater
conveyance systems, connection must be controlled by manually activated valves or similar devices [which shall
be secured with locking devices]
WA
Records documenting stormwater release from secondary containment (5 years) -- any stormwater that
accumulates in the containment area shall be at a minimum visually observed for color, foam, outfall staining,
visible sheens and dry weather Bow, prior to release of the accumulated stormwater. Accumulated stormwater
shall be released if found to be uncontaminated by the material stored within the containment area. Records
documenting the individual making the observation, the description of the accumulated stormwater and the date
and time of the release shall be ke t fora period of five years.
c. BMP
SummatT.
Yes
A narrative description shall be provided of BMP's to be considered such as, but not limited to, oil and grease
separation, debris control, vegetative filter strips, infiltration and stormwater detention or retention, where
necessary. The need for structural BMP's shall be based on the assessment of potential sources to contribute
significant quantities of pollutants to stormwater discharges and data collected through monitoring of stormwater
discharges.

d. Inspection Schedule
Yes Schedules for inspection of stormwater conveyances, controls, and measures to be taken to limit or prevent
erosion associated with the stormwater systems.
3. Spill Prevention and Response Plan. The Spill Prevention and Response Plan (SPRP) shall incorporate
an assessment of potential pollutant sources based on a materials inventory of the facility.
Yes
Materials inventory
No
Facility personnel (or team) responsible for implementing the SPRP identified.
Yes
A responsible person — shall be on site at all times during facility operations that might have the potential to
contaminate stormwater runoff through spills or exposure of material associated with the facility operations.
Yes
SPRP must be site stormwater specific. SPCC may be a component of SPRP.
Yes
Areas where spills can occur and their discharge points.
No
Spill response team
No
Spill response equipment and locations.
Yes
Spill containment, diversion, isolation, and cleanup.
Yes
Reporting procedures along with names and numbers.
Yes
Material handling and storage procedures.
Yes
Safety measures.
4. Preventative Maintenance and Good Housekeeping Program. A preventative maintenance program
shall be developed. The program shall document:
Yes
Schedules of inspections of stormwater _control systems.
Yes
Schedules of maintenance activities of stormwater control systems.
Yes
Schedules of inspections and maintenance of plant equipment and systems.
Yes
Inspection of material handling areas.
Yes
Regular cleaning schedules of material handling areas.
5. Employee Training. Training schedules shall be developed and training provided at a minimum of an
annual basis on proper spill response and cleanup procedures and preventative maintenance activities for all
personnel involved in any of the facility's operations that have the potential to contaminate stormwater runoff
No
Facility personnel (or team) responsible for implementing the training identified.
Yes
Training schedules developed.
No
Annual training provided on spill response and cleanup.
6. Responsible Party. The SPPP shall identify a specific position(s) responsible for the overall coordination,
development, implementation, and revision to the Plan. Responsibilities for all components of the Plan shall be
documented and position assignments provided.
Yes IPosition identified.
11 No f Responsibilities assigned and documented. 11
7. Plan Amendment. The permittee shall amend the plan whenever there is a change in design, construction,
operation, or maintenance which has a significant effect on the potential for the discharge of pollutants to surface
waters. 11
N/A I Plan is current. (design, operation, construction, maintenance)
NIA I SWPP reviewed and updated on an annual basis.

$. Facility Inspections. Inspections of the facility and all stormwater systems shall occur at a minimum on a
semi-annual schedule; 5 ears
Yes
Fall Inspection (September -November)
Yes
Spring Inspection (April -June)
N/A
Maintenance activities documented. (date and time of inspection, individual making the inspection, and a
narrative descri tion of the facility's stormwater control systems, plant e ui ment and systems).
Yes
Inspection records incorporated into SPPP
9.. Implementation. Implementation of the plan shall include documentation of all monitoring, measurements,
inspections and maintenance activities taken to implement BMP's associated with the industrial activities, including
vehicle maintenance activities. Such documentation shall be kept on -site for a period of five years and made
available to the Director or his authorized representative immediately upon request.
Wes .
Monitoring
Yes
Inspections
Yes
Maintenance activities
Yes
Documentation (5 years)
Additional Comments:

Compliance Inspection Report
Permit: NCG110013 Effective: 06/01/08 Expiration: 05/31/13 Owner: City of Winston-Salem
SOC: Effective: Expiration: Facility: City of Winston-Salem - Archie Elledge WWTP
F 2801 Griffith Rd
County, orsyt
Region: Winston-Salem
Contact Person: Norman Lee Byerly Title:
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03124/2009 Entry Time: 08:3d AM
Primary Inspector: Rose Pruitt
Secondary Irispector(s):
Certification:
Winston Salem NC 27103
Phone: [phone]
Phone:
Exit Time: 11:30 AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Municipal WWTP > 1MGD, Stormwater Discharge, CQC
-Facility Status: fl Compliant 0 Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCG110013 Owner - Facility: City of Winston-Salem
Inspection Date: 03/24/2009 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Met with Jon Southern at site. Facility undergoing upgrade and is an active construction site. Some info missing from
SP3, see checklist. Qualitative monitoring available at time of inspection.
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
■
fl
n n
# Does the Plan include a General Location (USGS) map?
■
n
n n
# Does the Plan include a "Narrative Description of Practices"?
■
on
n
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■
n
n n
# Does the Plan include a list of significant spills occurring during the past 3 years?
n
■
n n
# Has the facility evaluated feasible alternatives to current practices?
■
❑
n n
# Does the facility provide all necessary secondary containment?
■
❑
n n
# Does the Plan include a BMP summary?
■
n
n n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■
n
n n
# Does the Plan include a. Preventative Maintenance and Good Housekeeping Plan?
n
n n
# Does the facility provide and document Employee Training?
n
■
n n
# Does the Plan include a list of Responsible Party(s)?
n
®
n
# Is the Plan reviewed and updated annually?
n
n
n
# Does the Plan include Stormwater Facility Inspection Program?
■
n
n n
Has the Stormwater Pollution Prevention Plan been implemented?
■
n
n n
Comment: Information on spills missing. Employee training info not provided.
Responsible parties not named.
Qualitative Monitoring
Yes
No
NA NE
Has the facility conducted its Qualitative Monitoring semi-annually?
Is
n
n n
Comment:
Permit and Outfalls
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
®
n
n
n
# Were all outfalls observed during the inspection?
Is
n
n
n
# If the facility has representative outfall status, is it properly documented by the Division?
n
n
■
n
# Has the facility evaluated all illicit (non Stormwater) discharges?
n
n
n
■
Comment: Need signed certification statement
Page: 2

A-7-F9 --- - -- - - - -
I �Q0
Michael F. Easley, Governor
- - - - - - - -- -- - — - - _ _ William G..Ross Jr., Secretary _
North Carolina Department of Environment and Natural Resources V--
April 28, 2003
N Lee Byerly
City of Winston-Salem - Archie Elledge WWTP
2799 Griffith Rd
Winston Salem, NC 27103
Dear Permittee:
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: NPDES Stormwater Permit Renewal
City of Winston-Salem - Archie Elledge WWTP
COC Number NCG110013
Forsyth County
In response to your renewal application for continued coverage under general permit NCG110000, the
Division of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This
permit is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection
Agency, dated December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of General Stormwater Permit NCG110000
• A copy of the Analytical Monitoring Form (DMR)
• A copy of the Qualitativel Monitoring Form
A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division
may require modification or revocation and reissuance of the Certificate of Coverage. This permit does
not affect the legal requirements to obtain other permits which may be required by the Department of
Environment and Natural Resources, or relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
If you have any questions regarding this permit package please contact Mack Wiggins of the Central
Office Stormwater and General Permits Unit at [phone], ext. 542.
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Winston-Salem Regional Office
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
��&
NCDENR
Customer Service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG110000
CERTIFICATE OF COVERAGE No. NCG110013
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
City of Winston-Salem
is hereby authorized to discharge stormwater from a facility located at
City of Winston-Salem - Archie Elledge WWTP
2801 Griffith Road
Winston Salem
Forsyth County
to receiving waters designated as Salem Creek, a class C stream, in the Yadkin - Pee Dee
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, II, III, IV, V, and VI of General Permit No. NCG110000 as
attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
b,2,tel Ze r��y
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Michael F. Easley, Governor
- -� l-------- - ----- —William G.-Ross.Jr., Secretary
North Carolina Department of Environment and Natural Resources
r
0 �
September 4, 2002
N LEE BYERLY
WINSTON SALEM CITY OF
2799 GRIFFITH RD
WINSTON SALEM, NC 27103
Alan W. Klimek, P.E., Director
Division of Water Quality
Subject: NPDES Stormwater Permit Coverage Renewal
Winston Salem City Of
COC Number NCG 110013
Forsyth County
Dear Permittee:
Your facility is currently covered for stormwater discharge under General Permit NCGI 10000. This permit expires
on March 31, 2003. The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by early spring of 2003. Once the permit is reissued, your facility would be eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit coverage will be expiring. Enclosed you will find a Permit Coverage Renewal
Application Form. The application must be completed and returned by October 2, 2002 in order to assure
continued coverage under the general permit. Due to staff and budget constraints, letters confirming our receipt of
the completed application will not be sent.
Failure to request renewal within the time period specified, may result in a civil assessment of at least $250.00.
Larger penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your
facility without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-2I5.1
and could result in assessments of civil penalties of up to $10,000 per day.
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the I I categories of "storm water discharges associated with industrial activity," (except
construction activities). If you feel your facility can certify a condition of "no exposure", i.e. the facility industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http:llh2o.enr.state.ne.us/su/stormwater.htmI
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Corey Basinger of the
Winston-Salem Regional Office at 336-771-4600 or Mack Wiggins of the Central Office Stormwater Unit at (919)
733-5083, ext- 542
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater and General Permits Unit Files
Winston-Salem Regional Office ©BAN
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7748

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
April 30, 1998
N. LEE BYERLY
WINSTON-SALEM, CITY OF
2799 GRIFFITH ROAD
WINSTON-SALEM, NC 27103
f �9; TA
ID F
Subject: Reissued Stormwater General Permit for Certificate of Coverage No. NCG l 10013
Forsyth County
Dear Permittee:
In response to your renewal application for continued coverage under the subject permit, the Division
of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit
is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency
dated December 6, 1983.
The following information is included with your permit package:
■ A copy of the stormwater general permit.
■ A Stormwater Pollution Prevention Plan Certification Form. This form certifies that you have -
developed and implemented the Stormwater Pollution Prevention Plan (SPPP) required in your
permit. 'This form must be completed and returned to the Division within 30 days of receipt of
this letter. DO NOT send the SPPP with the signed form.
■ Five copies of Analytical Monitoring forms.
Five copies of Qualitative Monitoring forms.
A copy of a Technical Bulletin on the stormwater program which outlines program components
and addresses frequently asked questions.
■ A corrected Certificate of Coverage if you indicated a name or address change on the Renewal
Form returned to the Division.
Your certificate of coverage is not transferable except after notice to DWQ. The Division of Water
Quality may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
DWQ or permits required by the Division of Land Resources, Division of Air Quality, Coastal Area
Management Act or any other Federal or Local governmental permits that may be required.
If you have any questions concerning this permit or other attached documents, please contact the
Stormwater and General Permits Unit at telephone number [phone]
Sincerely,
foA. Preston Howard, Jr., P. E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer - 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor
March 19, 1993
N. Lee Byerly
POBox2511
Winston-Salem, NC 27102
Jonathan B. Howes, Secretary
Subject: General Permit No. NCG110000
Archie Elledge WWTP
COC NCG 110013
Forysth County
Dear Mr. Byerly:
In accordance with your application for discharge permit received on September 29, 1992, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215 .1 and the Memorandum of Agreement between North Carolina and the
US Environmental Protection agency dated December 6, 1983,
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and
binding.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Environmental Management. The Division of Environmental Management may
require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Environmental Management or permits required by the Division of
Land Resources, Coastal Area Management Act or any other Federal or Local governmental
permit that may be required.
Pollution Prevention Pays
P.O. Bar 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirn alive Action Employer

If -you have any questions concerning this permit, please contact Mr. Steve Ulmer at telephone
number 9191733-5083.
Sincerely,
Original Signed BY
Coleen H. Sullins
A. Preston Howard, Jr.
Acting Director
cc: Winston-Salem Regional Office

4
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL IERMiT O,- M'T M00
C RTLFICATE OF COVERAGE NO, NCG110013
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCIjARQE.ELI�MATION-. YUIEM
In compliance with the provision of North Carolina General Statute I43-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
City of Winston-Salem
is hereby authorized to discharge stormwater from a facility located at
Archie Elledge Wastewater Treatment Plant
2801 Griffith Rd., SR 2972 from intersection W. Clemmonsville Rd. (SR 1120)
Winston-Salem
Forsyth County
to receiving waters designated as Salem Creek in the Yadkin -Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, II1
and IV of General Permit No. NCG 110000 as attached.
This certificate of coverage shall become effective March 19, 1993.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 19, 1993,
Original Signed BY
Coleen H. Sullins
A. Preston Howard, Jr., P.E., Acting Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor
March 19, 1993
N. Lee Byerly
P O Box 2511
Winston-Salem, NC 27102
Jonathan B. Howes, Secretary
Subject: General Permit No. NCG110000
Archie Elledge WWTP
COC NCG 110013
Forysth County
Dear Mr. Byerly:
In accordance with your application for discharge permit received on September 29, 1992, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215 .1 and the Memorandum of Agreement between North Carolina and the
US Environmental Protection agency dated December'6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and
binding.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Environmental Management. The Division of Environmental Management may
require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Environmental Management or permits required by the Division of
Land Resources, Coastal Area Management Act or any other Federal or Local governmental
permit that may be required.
Pollution Prevention Pays
P.O. Bax 29535. Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

If you have any questions concerning this permit, please contact Mr. Steve Ulmer at telephone
number 919/733-5083.
Sind Sig, -led S
een H. Sullins
A. Preston Howard, Jr.
Acting Director
cc. Winston-Salem Regional Office

i
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO, NCG110000
CERTIFICATE QF COVERAGE NO. 1YCG•IIQ013
STORMWATER DISCHARGES
]NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215,1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
City of Winston-Salem
is hereby authorized to discharge stormwater from a facility located at
Archie Elledge Wastewater Treatment Plant
2801 Griffith Rd., SR 2972 from intersection W. Clemmonsville Rd. (SR 1120)
Winston-Salem
Forsyth County
to receiving waters designated as Salem Creek in the Yadkin -Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV of General Permit No. NCG110000 as attached.
This certificate of coverage shall become effective March 19, 1991
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 19, 1993.
Original Signed By
Careen H. Sullins
A. Preston Howard, Jr., P.E., Acting Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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