NC0020559_Renewal Application_20161028

NPDES DOCU ENT SCANNING COVER SHEET
NC0020559
Henderson WWTP
NPDES Permit:
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File
- Historical
Renewal Application
Instream Assessment (67b)
Environmental
Assessment (EA)
Permit
History
Document Date:
October 28, 2016
Thus document is printed on reuse paper - more and
content an the reYermse wide

1,4
Water Resources
ENVIRONMENTAL QUALITY
October 28, 2016
Mr. Frank Frazier, City Manager
City of Henderson
PO Box 1434
Henderson, NC 27536
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Sec rerro:I•
S. JAY ZIMMERMAN
Director
Subject: Current Permit Renewal
Application No. NC0020559
Henderson WRF
Vance County
Dear Mr. Frazier:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on October 03, 2016. The primary reviewer for this renewal application
is Ron Berry.
The primary reviewer will review your application, and he will contact you if additional information
is required to complete your permit renewal. Per G.S. 150B-3 your current permit does not expire until
permit decision on the application is made. Continuation of the current permit is contingent on timely and
sufficient application for renewal of the current permit.
Please respond in a timely manner to requests for additional information necessary to complete the
permit application. If you have any additional questions concerning renewal of the subject permit, please
contact Ron Berry at 919-807-6389 or [e-mail].
cc: Central Files
NPDES
Raleigh Regional Office
Sincerely,
Vs a 74e4msd
Wren Thedford
Wastewater Branch
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6300

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,NC0020559
FORM
2A
NPDES
PERMIT ACTION REQUESTED: RIVER BASIN:
Permit Renewal Roanoke
NPDES FORM 2A APPLICATION OVERVIEW
.011
APPLICATION OVERVIEW
Form 2A has been developed in a modular format and consists of a "Basic Application Information" packet
and a "Supplemental Application Information" packet. The Basic Application Information packet is divided
into two parts. All applicants must complete Parts A and C. Applicants with a design flow greater than or
equal to 0.1 mgd must also complete Part B. Some applicants must also complete the Supplemental
Application Information packet. The following items explain which parts of Form 2A you must complete.
BASIC APPLICATION INFORMATION:
A. Basic Application Information for all Applicants. All applicants must complete questions A.1 through A.8. A treatment works
that discharges effluent to surface waters of the United States must also answer questions A.9 through A.12.
B Additional Application Information for Applicants with a Design Flow z 0.1 mgd. All treatment works that have design flows
greater than or equal to 0.1 million gallons per day must complete questions B.1 through B.6.
C Certification. All applicants must complete Part C (Certification).
SUPPLEMENTAL APPLICATION INFORMATION:
RECEIVED/ ODEUDV
OCT 0 3 2016
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waters of the United States and meets
one or more of the following criteria must complete Part D (Expanded Effluent Testing Data):
1. Has a design flow rate greater than or equal to 1 mgd,
2. Is required to have a pretreatment program (or has one in place), or
3. Is otherwise required by the permitting authority to provide the information.
Toxicity Testing Data. A treatment works that meets one or more of the following criteria must complete Part E (Toxicity Testing
Data):
1. Has a design flow rate greater than or equal to 1 mgd,
2. Is required to have a pretreatment program (or has one in place), or
3. Is otherwise required by the permitting authority to submit results of toxicity testing.
Industrial User Discharges and RCRAICERCLA Wastes. A treatment works that accepts process wastewater from any
significant industrial users (SlUs) or receives RCRA or CERCLA wastes must complete Part F (Industrial User Discharges
and RCRA/CERCLA Wastes). Sills are defined as:
1. All industrial users subject to Categorical Pretreatment Standards under 40 Code of Federal Regulations (CFR) 403.6 and
40 CFR Chapter I, Subchapter N (see instructions); and
2. Any other industrial user that:
a. Discharges an average of 25,000 gallons per day or more of process wastewater to the treatment works (with certain
exclusions); or
b. Contributes a process wastestream that makes up 5 percent or more of the average dry weather hydraulic or organic
capacity of the treatment plant; or
c. Is designated as an SIU by the control authority.
. Combined Sewer Systems. A treatment works that has a combined sewer system must complete Part G (Combined Sewer
Systems).
ALL APPLICANTS MUST COMPLETE PART C (CERTIFICATION)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 1 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
BASIC APPLICATION INFORMATION
PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatment works must complete questions A.1 through A.8 of this Basic Application Information Packet.
A.1. Facility Information.
Facility Name Henderson Water Reclamation Facility
Mailing Address P.O. Box 1434
Henderson NC 27536
Contact Person H. Lamont Allen
Title Director of Henderson Water Reclamation
Telephone Number ([phone])
Facility Address 1646 West Andrews Avenue
(not P.O. Box) Henderson NC 27536
A.2. Applicant Information. If the applicant is different from the above, provide the following:
Applicant Name "Same As Above"
Mailing Address
Contact Person
Title
Telephone Number ( )
Is the applicant the owner or operator (or both) of the treatment works?
❑ owner ® operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
❑ facility ® applicant
A.3. Existing Environmental Permits. Provide the permit number of any existing environmental permits that have been issued to the treatment works
(include state -issued permits).
NPDES NC0020559 PSD
UIC Other Storm Water NCG110075
RCRA Other
A.4. Collection System Information. Provide information on municipalities and areas served by the facility. Provide the name and population of each
entity and, if known, provide information on the type of collection system (combined vs. separate) and its ownership (municipal, private, etc.).
Name Population Served Type of Collection System Ownership
Henderson 16.000 separate City of Henderson
Part of Vance County 1,400 separate City of Henderson
Total population served 17,400
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 2 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
A.5. Indian Country.
a. Is the treatment works located in Indian Country?
❑ Yes ® No
b. Does the treatment works discharge to a receiving water that is either in Indian Country or that is upstream from (and eventually flows
through) Indian Country?
❑ Yes ® No
A.6. Flow. Indicate the design flow rate of the treatment plant (i.e., the wastewater flow rate that the plant was built to handle). Also provide the
average daily flow rate and maximum daily flow rate for each of the last three years. Each year's data must be based on a 12-month time period
with the 12th month of "this year' occurring no more than three months prior to this application submittal.
a. Design flow rate 4.14 mgd
b. Annual average daily flow rate
c. Maximum daily flow rate
Two Years Ago
Last Year This Year
2.298 1.918 2.393
9.630 5.905 6.691
A.7. Collection System. Indicate the type(s) of collection system(s) used by the treatment plant. Check all that apply. Also estimate the percent
contribution (by miles) of each.
x❑ Separate sanitary sewer 100
❑ Combined storm and sanitary sewer
A.8. Discharges and Other Disposal Methods.
a. Does the treatment works discharge effluent to waters of the U.S.? 0 Yes ® No
If yes, list how many of each of the following types of discharge points the treatment works uses:
i. Discharges of treated effluent 1
ii. Discharges of untreated or partially treated effluent 0
iii. Combined sewer overflow points 0
iv. Constructed emergency overflows (prior to the headworks) 0
v. Other N/A
b. Does the treatment works discharge effluent to basins, ponds, or other surface impoundments
that do not have outlets for discharge to waters of the U.S.? ❑ Yes
If yes, provide the following for each surface impoundment:
Location: N/A
® No
Annual average daily volume discharge to surface impoundment(s)
Is discharge
0 continuous or 0 intermittent?
c. Does the treatment works land -apply treated wastewater?
If yes, provide the following for each land application site:
Location: N/A
O Yes
mgd
® No
Number of acres: NIA
Annual average daily volume applied to site:
Is land application 0 continuous or
N/A mgd
0 intermittent?
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works?
❑ Yes ® No
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 3 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
e.
If yes, describe the mean(s) by which the wastewater from the treatment works is discharged or transported to the other treatment works
(e.g., tank truck, pipe).
N/A
If transport is by a party other than the applicant, provide:
Transporter Name N/A
Mailing Address
Contact Person N/A
Title
Telephone Number j )
following:
For each treatment works that receives this discharge, provide the
Name N/A
Mailing Address
Contact Person
Title
Telephone Number ( )
If known, provide the NPDES permit number of the treatment works
Provide the average daily flow rate from the treatment works into
Does the treatment works discharge or dispose of its wastewater
in A.8. through A.8.d above (e.g., underground percolation, well
If yes, provide the following for each disposal method:
that receives this discharge N/A
the receiving facility. N/A mgd
in a manner not included
injection): ❑ Yes ® No
Description of method (including location and size of site(s) if applicable):
N/A
Annual daily volume disposed by this method: N/A
Is disposal through this method ❑ continuous or ❑ intermittent?
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 4 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Fc��;lAdc>f,:
WASTEWATER DISCHARGES:
If you answered "Yes" to question A.8.a, complete questions A.9 throuqh A.12 once for each outfall (including bypass points) through
which effluent is discharged. Do not include information on combined sewer overflows in this section. If you answered "No" to question
A.8.a, go to Part B, "Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 mgd."
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 5 of 22

A.9. Description of Outfall.
a. Outfall number 001
b. Location City of Henderson 27536
(City or town, if applicable)
Vance
(Zip Code)
NC
(County)
36°21'01"N
(State)
78° 24' 40" W
(Latitude) (Longitude)
c. Distance from shore (if applicable) N/A ft.
d. Depth below surface (if applicable) N/A ft.
e. Average daily flow rate 1.99 mgd
f. Does this outfall have either an intermittent or a periodic discharge? ❑ Yes X❑ No (go to A.9.g.)
If yes, provide the following information:
Number f times per year discharge occurs: N/A
Average duration of each discharge: N/A
Average flow per discharge: N/A mgd
Months in which discharge occurs: N/A
g. Is outfall equipped with a diffuser? ❑ Yes ® No
A.10. Description of Receiving Waters.
a. Name of receiving water Nutbush Creek
b. Name of watershed (if known) Nutbush arm of Kerr: Roanoke River Basin
United States Soil Conservation Service 14-digit watershed code (if known):
c. Name of State Management/River Basin (if known): Roanoke
United States Geological Survey 8-digit hydrologic cataloging unit code (if known): 03010102
d. Critical low flow of receiving stream (if applicable)
acute cfs chronic 0.2 CFS cfs
e. Total hardness of receiving stream at critical low flow (if applicable): N/A mg/I of CaCO3
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 6 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCOO2O559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
A.11. Description of Treatment
a. What level of treatment are provided? Check all that apply.
❑ Primary ❑ Secondary
® Advanced ❑ Other. Describe: Oxidation Ditch
b. Indicate the following removal rates (as applicable):
Design BOD5 removal or Design CBOD5 removal 99.1 ok
Design SS removal 98.9 6/0
Design P removal 92.9
Design N removal 73.4 %
Other %
c. What type of disinfection is used for the effluent from this outfall? If disinfection varies by season, please describe:
Ultra Violet Light Disinfection System
If disinfection is by chlorination is dechlorination used for this outfall? 0 Yes N/A❑ No
Does the treatment plant have post aeration? ® Yes 0 No
A.12. Effluent Testing Information. All Applicants that discharge to waters of the US must provide effluent testing data for the following
parameters. Provide the indicated effluent testing required by the permitting authority for each outfall through which effluent is
discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data
collected through analysis conducted using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of
40 CFR Part 136 and other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a
minimum, effluent testing data must be based on at least three samples and must be no more than four and one-half years apart.
Outfall number: 001
PARAMETER
MAXIMUM DAILY VALUE
AVERAGE DAILY VALUE
Value
Units
Value
Units
Number of Samples
pH (Minimum)
6.2
s.u.i
pH (Maximum)
7.6
s.u.
��//�
Flow Rate
7.493
MGD
2.300
MGD
366
Temperature (Winter)
20.8
C°
15.5
C°
100
Temperature (Summer)
26.8
C°
22.6
C°
152
For pH please report a minimum and a maximum daily value
POLLUTANT
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMDL
Conc.
Units
Conc.
Units
Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN
DEMAND (Report one)
BOD5
156
mg/L
1.8
mg/L
250
SM 52106
2001
2.0 mg/L
CBOD5
FECAL COLIFORM
10100
#/100 mL
4.4
#/ 100
mL
250
SM 9222 D-
1997
1 #! 100 mL
TOTAL SUSPENDED SOLIDS (TSS)
645
mg/L
3.1
Mg/L
249
SM 2540 D-
1997
2.5 mg/L
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 8 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
BASIC APPLICATION INFORMATION
PART B. ADDITIONAL APPLICATION INFORMATION FOR APPLICANTS WITH A DESIGN FLOW GREATER THAN OR
EQUAL TO 0.1 MGD (100,000 gallons per day).
All applicants with a design flow rate Z 0.1 mgd must answer questions B.1 through B.6. All others go to Part C (Certification).
B.1. Inflow and Infiltration. Estimate the average number of gallons per day
125 000 gpd
that flow into the treatment works from inflow and/or infiltration.
by completing some of the I&I projects. The City also
Briefly explain any steps underway or planned to minimize inflow and infiltration.
The City of Henderson has reduced I&I over the past 3 years
received a Technical Assistance Grant to help model the sewer system which will aid in this process.
B.2. Topographic Map. Attach to this application a topographic map of the area extending at least one mile beyond facility property boundaries. This
map must show the outline of the facility and the following information. (You may submit more than one map if one map does not show the entire
area.)
a. The area surrounding the treatment plant, including all unit processes.
b. The major pipes or other structures through which wastewater enters the treatment works and the pipes or other structures through which
treated wastewater is discharged from the treatment plant. Include outfalls from bypass piping, if applicable.
c. Each well where wastewater from the treatment plant is injected underground.
d. Wells, springs, other surface water bodies, and drinking water wells that are: 1) within Y. mile of the property boundaries of the treatment
works, and 2) listed in public record or otherwise known to the applicant.
e. Any areas where the sewage sludge produced by the treatment works is stored, treated, or disposed.
f. If the treatment works receives waste that is classified as hazardous under the Resource Conservation and Recovery Act (RCRA) by truck, rail,
or special pipe, show on the map where the hazardous waste enters the treatment works and where it is treated, stored, and/or disposed.
B.3. Process Flow Diagram or Schematic. Provide a diagram showing the processes of the treatment plant, including all bypass piping and all
backup power sources or redunancy in the system. Also provide a water balance showing all treatment units, including disinfection (e.g.,
chlorination and dechlorination). The water balance must show daily average flow rates at influent and discharge points and approximate daily flow
rates between treatment units. Include a brief narrative description of the diagram.
B.4. Operation/Maintenance Performed by Contractor(s).
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a
contractor? El Yes ❑ No
If yes, list the name, address, telephone number, and status of each contractor and describe the contractor's responsibilities (attach additional
pages if necessary).
Name: Andy Smith
Mailing Address: Granville Farms, Inc
PO Box 1396, Oxford, NC 27565
Telephone Number: 1919) 690-8000
Responsibilities of Contractor: Hauls digested sludge from the plant and land applies at agronomic rates
B.S. Scheduled improvements and Schedules of Implementation. Provide information on any uncompleted implementation schedule or
uncompleted plans for improvements that will affect the wastewater treatment, effluent quality, or design capacity of the treatment works. If the
treatment works has several different implementation schedules or is planning several improvements, submit separate responses to question B.5
for each. (If none, go to question B.6.)
a. List the outfall number (assigned in question A.9) for each outfall that is covered by this implementation schedule.
N/A
b. Indicate whether the planned improvements or implementation schedule are required by local, State, or Federal agencies.
❑ Yes El No
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 10 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility,
NC0020559
PERMIT ACTION REQUESTED: RIVER BASIN:
Permit Renewal Roanoke
c. If the answer to B.5.b is "Yes,' briefly describe, including new maximum daily inflow rate (if applicable).
N/A
d. Provide dates imposed by any compliance schedule or any actual dates of completion for the implementation steps listed below, as
applicable. For improvements planned Independently of local, State, or Federal agencies, indicate planned or actual completion dates, as
applicable. Indicate dates as accurately as possible.
Implementation Stage
- Begin Construction
Schedule
MM/DD/YYYY
Actual Completion
MM/DD/YYYY
/ /
- End Construction / / / /
- Begin Discharge / / / /
- Attain Operational Level / / / /
e. Have appropriate permits/clearances concerning other Federal/State requirements been obtained? • Yes • No
Describe briefly: N/A
B.6. EFFLUENT TESTING DATA (GREATER THAN 0.1 MGD ONLY).
Applicants that discharge to waters of the US must provide effluent testing data for the following parameters. Provide the indicated
effluent testing required by the permitting authority for each outfall through which effluent is discharged. Do not indude information
on combine sewer overflows in this section. Ail information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate
QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At -a minimum effluent testing data must be
based on at least three pollutant scans and must be no more than four and on -half years old.
Outfall Number: • .
• . .
POLLUTANT
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY. DISCHARGE
ANALYTICAL
•
Cont.
Units
Conc.
Units
Number of
Samples
METHOD
ML/MDL
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA (as N)
16.6
mg/L
0.5
mg/L
Y51
SM 4500 D-
1997
0.1 mg/L
CHLORINE (TOTAL
RESIDUAL, TRC)
ND
pg/L
ND
Ieg/L
3
SM 4500 CL G-
2000
15 Irg/L
DISSOLVED OXYGEN
11.1
mg/L
8.4
mglL
250
SM 4500 O G- 2001
0.1 mglL
TOTAL KJELDAHL
NITROGEN (TKN)
1.8
mg/L
0.5
mg/L
12
SM 4500 N ORG
C-1997, EPA
351.1
0.5, 0.2 mg/L
NITRATE PLUS NITRITE
NITROGEN
11.0
mg!L
5.4
mg/L
12
EPA 353.2
0.1 mg/L
OIL and GREASE
ND
mg/L
ND
mg/L
3
EPA 1664B
5.0 mglL
PHOSPHORUS (Total)
1.6
mg/L
0.3
mg/L
61
EPA 365., EPA
2p0.7
0.1 , 0.020 mg/L
TOTAL
(TDS)
DISSOLVED SOLIDS
478
mg/L
318
mg/L
3
SM2540C
10 mg/L
OTHER
END OF pART B.
REFER TO THE APPLICATION OVERVIEW (PAGE 'I) :TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 11 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
BASIC APPLICATION INFORMATION
PART C. CERTIFICATION
All applicants must complete the Certification Section. Refer to instructions to determine who is an officer for the purposes of this
certification. All applicants must complete all applicable sections of Form 2A, as explained in the Application Overview. Indicate below which
parts of Form 2A you have completed and are submitting. By signing this certification statement, applicants confirm that they have reviewed
Form 2A and have completed all sections that apply to the facility for which this application is submitted.
Indicate which parts of Form 2A you have completed and are submitting:
El Basic Application Information packet Supplemental Application Information packet:
® Part D (Expanded Effluent Testing Data)
® Part E (Toxicity Testing: Biomonitoring Data)
® Part F (Industrial User Discharges and RCRA/CERCLA Wastes)
0 Part G (Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
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 is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment
for knowing violations.
Name and official title F rr a-.lK- PraT e e_ 4 C , - - A 4 s m t e
Signature �l ` J
Telephone number ( 25?.) 4-'b O 5 i O
Date signed q -242 - I L.
Upon request of the permitting authority, you must submit any other information necessary to assure wastewater treatment practices at the treatment
works or identify appropriate permitting requirements.
SEND COMPLETED FORMS TO:
NCDENRI DWQ
Attn: NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 12 of 22

9/22/2016
Map Filter
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City of Henderson
Henderson Water Reclamation Facility
State Grid/Quad:
Receiving Stream:
Drainage Basin:
Stream Class:
B 25 SW / Henderson
Nutbush Creek
Roanoke
C
Latitude:
Longitude:
Sub -Basin:
36° 21' 01 " N
78° 24' 40" W
03-02-06
NORTH
Facility
Location
(map not to scale)
NPDES Permit NC0020559
Vance County

Go ogle Earth meters

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART D. EXPANDED EFFLUENT TESTING DATA
Refer to the directions on the cover page to determine whether this section applies to the treatment works.
Effluent Testing: 1.0 mgd and Pretreatment Works. If the treatment works has a design flow greater than or equal to 1.0 mgd or it has (or is required
to have) a pretreatment program, or is otherwise required by the permitting authority to provide the data, then provide effluent testing data for the following
pollutants. Provide the indicated effluent testing information and any other information required by the permitting authority for each outfall through which
effluent is discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data collected
through analyses conducted using 40 CFR Part 136 methods. In addition, these data must comply with QA/QC requirements of 40 CFR Part 136 and
other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. Indicate in the blank rows provided below
any data you may have on pollutants not specifically listed in this form. At a minimum, effluent testing data must be based on at least three pollutant
scans and must be no more than four and one-half years old.
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
METALS (TOTAL RECOVERABLE), CYANIDE, PHENOLS, AND HARDNESS.
ANTIMONY
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
EPA 200.7
25 pg/L
ARSENIC
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
12
SM 3113B-
2004/ EPA
200.7
10 pg/L
BERYLLIUM
ND
pg/L
ND
lbs
ND
pg/L
ND
Ibs
3
EPA 200.7
5 pg/L
CADMIUM
ND
pg/L
ND
lbs
ND
pg/L
ND
Ibs
12
SM 3113B-
2004/ EPA
200.7
1/2 pg/L
CHROMIUM
ND
pg/L
ND
lbs
ND
pg/L
ND
Ibs
12
SM 3113B-
2004/ EPA
200.7
1/5 pg/L
COPPER
7
pg/L
0.136
Ibs
3.2
pg/L
0.061
Ibs
12
SM 3113B-
2004/ EPA
200.7
2 pg/L
LEAD
ND
pg/L
ND
lbs
ND
pg/L
ND
Ibs
12
SM 3113B-
2004/ EPA
200.7
5/10 pg/L
MERCURY
0.00699
pg/L
000174
lbs
0.00309
pg/L
000058
lbs
12
EPA 1631
0.001 pg/L
NICKEL
6
pg/L
0.089
Ibs
0.8
pg/L
0.011
Ibs
8
SM 3113B-
2004/ EPA
200.7
5/ 10 pg/L
SELENIUM
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
12
SM 3113B-
2004/ EPA
200.7
10 pg/L
SILVER
ND
pg/L
ND
lbs
ND
pg/L
ND
lbs
8
SM 3113B-
2004/ EPA
200.7
2/5 pg/L
THALLIUM
ND
pg/L
ND
lbs
ND
pg/L
ND
lbs
3
EPA 200.7
10/ 20
pg/L
ZINC
40
pg/L
1.014
lbs
27.7
pg/L
0.513
Ibs
12
EPA 200.7
10 pg/L
CYANIDE
ND
mg/L
ND
lbs
ND
mg/L
ND
Ibs
3
SM 4500-CN-
E/ EPA 335.4
0.005
mg/L
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 13 of 22

TOTAL PHENOLIC
COMPOUNDS
0.020
mg/L
0.247
Ibs
0.013
mg/L
0.181
Ibs
3
420.4
5/10 mg/L
HARDNESS (as CaCO3)
234
mg/L
3570
Ibs
175
mg/L
2555
Ibs
3
EPA 200.7/
SM2340C
1 mg/L
SM2340C
Use this space (or a separate sheet) to provide information on other metals requested by the permit write
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 14 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
VOLATILE ORGANIC COMPOUNDS
ACROLEIN
NDpg/L
ND
Ibs
NDpg/L
ND
Ibs
3
624
100/500/50
pg/L
ACRYLONITRILE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
50/100/10
p9/L
BENZENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/1011 pg/L
BROMOFORM
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
100r50p9/Lr5o
CARBON
TETRACHLORIDE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
CHLOROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5110.!1 pgrL
CHLORODIBROMO-
METHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
CHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
10/50/5 pg/L
2-CHLOROETHYLVINYL
ETHER
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
10/50/5 pgrL
CHLOROFORM
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
DICHLOROBROMO-
METHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
1,1-DICHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
1,2-DICHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
TRANS-1,2-DICHLORO-
ETHYLENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
1,1-DICHLORO-
ETHYLENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
1,2-DICHLOROPROPANE
ND
pg/L
ND
Ibs
ND
pg/L.
ND
Ibs
3
624
5/10/1 pgrL
1,3-DICHLORO-
PROPYLENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
ETHYLBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
METHYL BROMIDE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
10/50/5 pgrL
METHYL CHLORIDE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pgrL
METHYLENE CHLORIDE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
624
5.'101 pgrL
1,1,2,2-TETRA-
CHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
TETRACHLORO-
ETHYLENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5.,10,1 pg/L
TOLUENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10,1 pgrL
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 15 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
1,1,1
TRICHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
1,1,2
TRICHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
TRICHLOROETHYLENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/10/1 pg/L
VINYL CHLORIDE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
624
5/50/5 pg/L
Use this space (or a separate sheet) to provide information on other volatile organic compounds requested by the permit writer
ACID -EXTRACTABLE COMPOUNDS
P-CHLORO-M-CRESOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
2-CHLOROPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 ugiL
2,4-DICHLOROPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
2,4-DIMETHYLPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
10r10/10
ugll
4,6-DINITRO-0-CRESOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
20/50/50
uglL
2,4-DINITROPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
50 ug/L
2-NITROPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 u9/L
4-NITROPHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
PENTACHLOROPHENOL
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5110/10 pg/L
PHENOL
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
50 pg/L
2,4,6-
TRICHLOROPHENOL
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
10 pg/L
-extractable compounds requested by the permit writer
ACENAPHTHENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
ACENAPHTHYLENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
ANTHRACENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pglL
BENZIDINE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
50 pg/L
BENZO(A)ANTHRACENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
BENZO(A)PYRENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 16 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
3,4 BENZO-
FLUORANTHENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
BENZO(GHI)PERYLENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5./10/10 pg/L
BENZO(K)
FLUORANTHENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/ion 0 pg/L
BIS (2-CHLOROETHOXY)
METHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
10 pg/L
BIS (2-CHLOROETHYL)-
ETHER
ND
pg /L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
BIS (2-CHLOROISO-
PROPYL) ETHER
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5i10/10 pg,L
BIS (2-ETHYLHEXYL)
PHTHALATE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5/10/10 pg/L
4-BROMOPHENYL
PHENYL ETHER
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
BUTYL BENZYL
PHTHALATE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5.,10/10 pg'L
2-CHLORO-
NAPHTHALENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5.o1o/10 pg/L
4-CHLORPHENYL
PHENYL ETHER
ND
p9 /L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
CHRYSENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
soon pg/L
DI-N-BUTYL PHTHALATE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
DI-N-OCTYL PHTHALATE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
DIBENZO(A,H)
ANTHRACENE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5/10/10 pg/L
1,2-DICHLOROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
1,3-DICHLOROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
1,4-DICHLOROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
3,3-DICHLORO-
BENZIDINE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
25/50/50
pg/L
DIETHYL PHTHALATE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
DIMETHYL PHTHALATE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
2,4-DINITROTOLUENE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5/10/10 pg/L
2,6-DINITROTOLUENE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5/10/10 pg/L
1,2-DIPHENYL-
HYDRAZINE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 17 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
FLUORANTHENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
FLUORENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 p9'L
HEXACHLOROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg1
HEXACHLORO-
BUTADIENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
HEXACHLOROCYCLO-
NDpg/L
ND
Ibs
ND
L
!L
pg/
ND
Ibs
3
625
10/50/50
pg/L
HEXACHLOROETHANE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
INDEN0(1,2.3 CD)
PYRENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
ISOPHORONE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
10 pg/L
NAPHTHALENE
ND
pg/L
ND
Ibs
ND
pglL
ND
Ibs
3
625
5'10/10 pg/L
NITROBENZENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
N-NITROSODI-N-
PROPYLAMINE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5110/10 pg/L
N-NITROSODI-
METHYLAMINE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
N-NITROSODI-
PHENYLAMINE
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
10 pg/L
PHENANTHRENE
ND
pg/L
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
PYRENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
1,2,4
TRICHLOROBENZENE
ND
pglL
ND
Ibs
ND
pg/L
ND
Ibs
3
625
5/10/10 pg/L
Use this space (or a separate sheet) to
provide information
on
other base -neutral compounds
requested
by the permit
writer
Use this space (or a separate sheet) to provide information on other pollutants (e.g , pesticides) requested by the permit writer
END OF PART D.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 18 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using altemate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
® chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 1 Test number: 2 Test number: 3
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
1/10/12, 1/12/16
4/10/12,4/12/12
7/10/12,7/12/12
Date test started
1 /11 /12
4/11/12
7/11/12
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Short -Term Methods for Estimating the Chronic
Toxicity of Effluents and Receiving Waters to
Freshwater Organisms 1002.0
Short -Term Methods for Estimating the Chronic
Toxicity of Effluents and Receiving Waters to
Freshwater Organisms 1002.0
Short -Term Methods for Estimating the
Chronic Toxicity of Effluents and Receiving
Waters to Freshwater Organisms 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
1-335
1-335
1-335
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 19 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 1 Test number: 2 Test number: 3
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Soft Synthetic
Soft Synthetic
Soft Synthetic
Receiving water
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
45,67.5,90,95,100
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
n/a
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
n/a
n/a
n/a
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCso
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 20 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
100 %
100 %
100 %
IC25
>100 %
>100 %
>100 %
Control percent survival
100 %
100 %
100 %
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Yes
Yes
Yes
Was reference toxicant test within
acceptable bounds?
Yes
Yes
Yes
What date was reference toxicant test
run (MM/DD/YYYY)?
01/10/12
4/10/12
7/10/12
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information, or information regarding the
the information was submitted to the permitting authority and a summary
for all three samples was =100%
Summary of results: (see instructions)
Tests conducted on1/11/12, 4/11/12. 7/11/12. The NOEC
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 21 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using altemate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
ID chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 4 Test number: 5 Test number: 6
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
10/2/12,10/4/12
1/8/13, 1/10/13
4/2/13, 4/4/13
Date test started
10/3/12
1/9/13
4/3/13
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Short -horn M.lhod. for Estimating tbs. Cf,onlc Tocklry of
Entu.nt..rMR.c.IvinoWaists loFrss0wat.,O,O0n0 .
1002.0
Shor1•T.,m M.M,od. for (*Mingling th. Chronic Toxicity o1
Effluents and R.c.MnoW.lenloFreshwater Organisms
1002.0
Mhorl.T.rm Methods lur Estimating M,. Chronic Toxicity
ofEMwnioAnd R.c.NhgWaters toFreshwater
Organisms 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
1-335
1-335
1-335
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 22 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCOO2O559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 4 Test number: 5 Test number: 6
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whethe the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Soft Synthetic
Soft Synthetic
Soft Synthetic
Receiving water
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test senes.
45,67.5,90,95,100
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
n/a
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
n/a
n/a
n/a
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCso
95% C.I.
Control percent survival
%
%
iyo
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 23 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
100 %
100 %
100 %
IC25
>100 %
>100 %
>100 %
Control percent survival
100 %
100 %
100 %
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Yes
Yes
Yes
Was reference toxicant test within
acceptable bounds?
Yes
Yes
Yes
What date was reference toxicant test
run (MM/DDM'YY)?
10/2/12
1/8/13
4/2/13
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information, or information regarding the
the information was submitted to the permitting authority and a summary
all three samples was =100%
Summary of results: (see instructions)
Tests conducted on 10/3/12, 1/9/13. 4/3/13. The NOEC for
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 24 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using altemate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
D chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half Years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 7 Test number: 8 Test number: 9
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
7/9/13,7/11/13
10/8/13, 10/10/13
1/7/14, 1/9/14
Date test started
7/10/13
10/9/13
1/8/14
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Short -Term Methods to E.Omaling the Chronic Toxicity of
Effluent* and Receiving Water. to Fr..ho.l.r Orgenlem.
1002.0
Shot -Term Method. for E.hmalhg the Chronic To.lcily of
Monts end Receiving Water. to F,.hwal.r Org.nieme
1002.0
Short -Term Method. for Estimating the Chronic Toxicity
of Effluents and Receiving Water. lc Fraahwal.r
0,ganlenm 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
1-335
1-335
1-335
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite '
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 25 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 7 Test number: 8 Test number: 9
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Soft Synthetic
Soft Synthetic
Soft Synthetic
Receiving water
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
45,67.5,90,95,100
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during he test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
n/a
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
n/a
n/a
n/a
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCso
95% C.I.
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 26 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
100 %
100 %
100 %
IC2s
>100%
>100%
>100%
Control percent survival
100 %
100 %
100 %
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Y
Y
Y
Was reference toxicant test within
acceptable bounds?
Y
Y
Y
What date was reference toxicant test
run (MM/DD/YYYY)?
7/9/13
10/8/13
1/7/14
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information,
the information was submitted to the
all three samples was =100%
or information regarding the
permitting authority and a summary
Summary of results: (see instructions)
Tests conducted on 7/10/13, 10/9/13. 1/8/14. The NOEC for
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 27 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using alternate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the foram to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
D chronic ❑ acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 10 Test number: 11 Test number: 12
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
4/15/14, 4/17/14
7/8/14,7/10/14
10/7/14, 10/9/14
Date test started
4/16/14
7/9/14
10/8/14
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Shom.T.om M•dwde for E.Om.ling On Chronic To0ktty of
ERW.nband Revolving W.l.r•lolnehreletChganMm.
10020
Shorl.T.rm Y.II,oal. for E•hm.l. , ln• Chronic To.lcuy of
Effluents and R.c.rrinoWawa toFr..hr.M1rO,0.nlem•
1002 0
5h61 T.rm Method. for E.Om.tlrq Ma Chronic To.k11y
ofcmu•,.and R.c..°W.l.ntofr..hr0.r
Organisms 10020
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
1-335
141-196
141-196
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 28 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 10 Test number: 11 Test number: 12
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Soft Synthetic
Receiving water
Lake Brandt
Lake Brandt
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
45,67.5,90,95,100
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
n/a
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
n/a
n/a
n/a
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
LC50
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 29 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
100 %
100 %
100 %
IC25
>100 %
Control percent survival
100 %
100 %
100
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Y
Y
Y
Was reference toxicant test within
acceptable bounds?
Y
Y
Y
What date was reference toxicant test
run (MM/DD/YYYY)?
4/8/14
7/2/14
10/1/14
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information, or information regarding the
the information was submitted to the permitting authority and a summary
all three samples was =100%
Summary of results: (see instructions)
Tests conducted on 4/6/14, 7/9/14. 10/8/14. The NOEC for
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 30 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using alternate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
❑ chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 13 Test number: 14 Test number: 15
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
1/27/15, 1/29/15
4/7/15, 4/9/15
7/14/16, 7/16/15
Date test started
1/28/15
4/8/15
7/15/15
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Short -Term Methods for Estimating the Chronic ft/skit, of
Effluents and Receiving Waters to Freshwater Organisms
1002.0
Shod.Term Mslhode for Estimating the Chronic Toxicity of
Effluents and Receiving Waters to Freshwater Organisms
1002.0
Slwd•Term Methods for Estlmeling the Chronic loxkih
of Effluent* and Receiving%dors TOFreshwater
Organisms 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
141-196
141-196
141-196
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 31 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Test number: 13 Test number: 14 Test number: 15
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Receiving water
Lake Brandt
Lake Brandt
Lake Brandt
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
90
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
n/a
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
n/a
n/a
n/a
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
LC50
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 32 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
%
100 %
100 %
IC25
%
%
Control percent survival
91.67 %
100 %
100 %
Other (describe) P/F
PASS
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Y
Y
Y
Was reference toxicant test within
acceptable bounds?
Y
Y
Y
What date was reference toxicant test
run (MM/DD/YYYY)?
1/21/15
3/8/15
7/29/15
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information, or information regarding the
the information was submitted to the permitting authority and a summary
result was PASS. NOEC for others was =100%
Summary of results: (see instructions)
Tests conducted on 1/28/15, 4/8/15. 7/15/15. FOR 1/28/15
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 33 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using alternate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
❑ chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 16 Test number: 17 Test number: 18
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
<24 hrs
Outfall number
001
001
001
Dates sample collected
10/20/15, 10/22/15
1/12/16, 1/14/16
4/5/16, 4/7/16
Date test started
10/21/15
1/13/16
4/6/15
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Manual title
Shori.lrrm M.U, ds for Erinmsnny the Chronic Toxicity of
Eftlnsnts and Receiving Views to f rashwstrr Organism*
1002 0
•hart -Tern. Msdpds for E.Om-tlrp MS Chronic Toxicity of
Mo n e and Receiving Welsn b fnshw•M OrpNsms
1002.0
•hurl -Term Methods for Eel/meting Ow Chronic Toskiry
of Effluents end Receiving Yen to Frrhr.ln
Or•.wem. 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page number(s)
141-196
141-196
141-196
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
X
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
X
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 34 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO02O559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 16 Test number: 17 Test number: 18
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Receiving water
Lake Brandt
Lake Brandt
Lake Brandt
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
X
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
45,67.5,90,95,100
45,67.5,90,95,100
45,67.5,90,95,100
k. Parameters measured during he test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
n/a
nla
n/a
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
nla
n/a
nla
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
LC50
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 35 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
95%
95%
100%
IC25
%
%
%
Control percent survival
100 %
100 %
100 %
Other (describe) P/F
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Y
Y
Y
Was reference toxicant test within
acceptable bounds?
Y
Y
Y
What date was reference toxicant test
run (MM/DD/YYYY)?
10/28/15
1/26/16
3/30/16
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information, or information regarding the
the information was submitted to the permitting authority and a summary
NOEC = 100%
Summary of results: (see instructions)
Tests conducted on 10/21/15, 1/13/16 NOEC= 95%, 4/6/16
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 36 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1) POTWs with a design flow rate greater than or equal to 1.0 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) POTWs required by the permitting authority to submit data for these parameters.
• At a minimum, these results must include quarterly testing for a 12-month period within the past 1 year using multiple species (minimum of two
species), or the results from four tests performed at least annually in the four and one-half years prior to the application, provided the results
show no appreciable toxicity, and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition, submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity, provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation, if one was conducted.
• If you have already submitted any of the information requested in Part E, you need not submit it again. Rather, provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used, report the reasons for using altemate methods.
If test summaries are available that contain all of the information requested below, they may be submitted in place of Part E.
If no biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests.
Indicate the number of whole effluent
0 chronic 0 acute
E.2. Individual Test Data. Complete the
column per test (where each species
toxicity tests conducted in the past four and one-half years.
following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
constitutes a test). Copy this page if more than three tests are being reported.
Test number: 19 Test number: Test number:
a. Test information.
Test Species & test method number
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
Outfall number
001
Dates sample collected
7/19/16, 7/21/16
Date test started
7/20/16
Duration
7 days
b. Give toxicity test methods followed.
Manual title
shod.T..,n Method. io. E•w,,,t,,,v th. Chronic folic,' or
Ertlwnt. wet R•cNWp Waters m il..hw.ter Orosnhm.
1002 0
Edition number and year of publication
Fourth, 2002
Page number(s)
141-196
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
X
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
X
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 37 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 19 Test number: Test number:
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Receiving water
Lake Brandt
i. Type of dilution water. If salt water, specify "natural" or type of artificial sea salts or brine used.
Fresh water
X
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
90
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Salinity
n/a
Temperature
Meets Specifications
Ammonia
n/a
Dissolved oxygen
Meets Specifications
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
0/0
LCso
95% C.I.
%
%
%
Control percent survival
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 38 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic:
NOEC
%
%
%
IC25
Control percent survival
100 %
%
0/0
Other (describe) P/F
PASS
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Y
Was reference toxicant test within
acceptable bounds?
Y
What date was reference toxicant test
run (MM/DD/YYYY)?
7/26/16
/ /
/ /
Other (describe)
E.3. Toxicity Reduction Evaluation.
❑ Yes ® No
Is the treatment works involved in a Toxicity Reduction Evaluation?
If yes, describe:
E.4. Summary of Submitted Biomonitoring Test Information. If you have
cause of toxicity, within the past four and one-half years, provide the dates
of the results.
Date submitted: / / (MM/DD/YYYY)
submitted biomonitoring test information,
the information was submitted to the
permitting
or information regarding the
authority and a summary
Summary of results: (see instructions)
Test 7/20/16 Pass at 90%
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 39 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART F. INDUSTRIAL USER DISCHARGES AND RCRAICERCLA WASTES
All treatment works receiving discharges
complete part F.
GENERAL INFORMATION:
F.1. Pretreatment program. Does the treatment
® Yes ❑ No
F.2. Number of Significant Industrial Users
industrial users that discharge to the
a. Number of non -categorical Sills.
b. Number of CIUs.
SIGNIFICANT INDUSTRIAL USER
from significant industrial users or which receive RCRA,CERCLA, or other remedial wastes must
works have, or is subject ot, an approved pretreatment program?
(SIUs) and Categorical Industrial Users (ClUs). Provide the number
treatment works.
2
of each of the following types of
1
INFORMATION:
discharges to the treatment works, copy questions F.3 through F.8 and
Supply the following information for each SIU. If more than one SIU
provide the information requested for each SIU.
F.3. Significant Industrial User Information. Provide the name and address of each SIU discharging to the treatment works. Submit additional pages
as necessary.
Name: The lams Company
Mailing Address: 845 Commerce Drive
Henderson, NC 27537
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
Facility and Manufacturing Equipment Cleaning
F.5. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw materials that affect or contribute to the SIU's
discharge.
Principal product(s): Pet Food
Raw material(s): Grains, meats
F.6. Flow Rate.
a. Process wastewater flow rate. Indicate the average daily volume
day (gpd) and whether the discharge is continuous or intermittent.
3300 gpd ( X continuous
volume
following:
subcategory?
of process wastewater discharge into
or intermittent)
the collection system in gallons per
into the collection system
b. Non -process wastewater flow rate. Indicate the average daily
in gallons per day (gpd) and whether the discharge is continuous
3700 gpd ( X continuous
of non -process wastewater flow discharged
or intermittent.
or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the
a. Local limits ® Yes
b. Categorical pretreatment standards ❑ Yes
If subject to categorical pretreatment standards, which category and
❑ No
® No
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 40 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems (e.g.,
upsets, interference) at the treatment works in the past three years?
D Yes ® No If yes, describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck, rail or dedicated pipe?
❑ Yes 0 No (go to F.12)
F.10. Waste transport. Method by which RCRA waste is received (check all that apply):
❑ Truck 0 Rail 0 Dedicated Pipe
F.11. Waste Description. Give EPA hazardous waste number and amount (volume or mass, specify units).
EPA Hazardous Waste Number Amount Units
CERCLA (SUPERFUND) WASTEWATER, RCRA REMEDIATION/CORRECTIVE ACTION
WASTEWATER, AND OTHER REMEDIAL ACTIVITY WASTEWATER:
F.12. Remediation Waste. Does the treatment works currently (or has it been notified that it will) receive waste from remedial activities?
❑ Yes (complete F.13 through F.15.) 0 No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates (or is excepted to origniate in
the next five years).
F.14. Pollutants. List the hazardous constituents that are received (or are expected to be received). Include data on volume and concentration, if
known. (Attach additional sheets if necessary.)
F.15. Waste Treatment.
a. Is this waste treated (or will be treated) prior to entering the treatment works?
❑ Yes ❑ No
If yes, describe the treatment (provide information about the removal efficiency):
b. Is the discharge (or will the discharge be) continuous or intermittent?
❑ Continuous ❑ Intermittent If intermittent, describe discharge schedule.
END OF PART F.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 41 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART F.INDUSTRIAL USER DISCHARGES AND RCRA/CERCLA WASTES
All treatment works receiving discharges from significant industrial users or which receive RCRA,CERCLA,
complete part F.
GENERAL INFORMATION:
F.1. Pretreatment program. Does the treatment works have, or is subject ot, an approved pretreatment program?
® Yes ❑ No
F.2. Number of Significant Industrial Users (SIUs) and Categorical Industrial Users (ClUs). Provide the number
industrial users that discharge to the treatment works.
c. Number of non -categorical Skis. 2
or other remedial wastes must
of each of the following types of
questions F.3 through F.8 and
d. Number of ClUs. 1
SIGNIFICANT INDUSTRIAL USER INFORMATION:
to the treatment works, copy
Supply the following information for each SIU. If more than one SIU discharges
provide the information requested for each SIU.
F.3. Significant Industrial User Information. Provide the name and address of each SIU discharging to the treatment
as necessary.
works. Submit additional pages
Name: Wal-Mart Stores East, LP, DBA Wal-Mart Distribution Center #6091
Mailing Address: 680 Vanco Mill Road
Henderson, NC 27537-7503
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
None- Cold Food Storage
F.5. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw materials that affect
discharge.
or contribute to the SIU's
Principal product(s): Refrigeration and distribution of food includes truck maintenance facility
Raw material(s):
F.6. Flow Rate.
c. Process wastewater flow rate. Indicate the average daily volume of process wastewater discharge into
day (gpd) and whether the discharge is continuous or intermittent.
N/A gpd ( continuous or intermittent)
the collection system in gallons per
discharged into the collection system
d. Non -process wastewater flow rate. Indicate the average daily volume of non -process wastewater flow
in gallons per day (gpd) and whether the discharge is continuous or intermittent.
7800 gpd (X continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes 0 No
b. Categorical pretreatment standards 0 Yes ® No
If subject to categorical pretreatment standards, which category and subcategory?
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 42 of 22

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems (e.g.,
upsets, interference) at the treatment works in the past three years?
❑ Yes ® No If yes, describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck, rail or dedicated pipe?
❑ Yes 0 No (go to F.12)
F.10. Waste transport. Method by which RCRA waste is received (check all that apply):
❑ Truck 0 Rail 0 Dedicated Pipe
F.11. Waste Description. Give EPA hazardous waste number and amount (volume or mass, specify units).
EPA Hazardous Waste Number Amount Units
CERCLA (SUPERFUND) WASTEWATER, RCRA REMEDIATION/CORRECTIVE ACTION
WASTEWATER, AND OTHER REMEDIAL ACTIVITY WASTEWATER:
F.12. Remediation Waste. Does the treatment works currently (or has it been notified that it will) receive waste from remedial activities?
❑ Yes (complete F.13 through F.15.) 0 No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates (or is excepted to origniate in
the next five years).
F.14. Pollutants. List the hazardous constituents that are received (or are expected to be received). Include data on volume and concentration, if
known. (Attach additional sheets if necessary.)
F.15. Waste Treatment.
c. Is this waste treated (or will be treated) prior to entering the treatment works?
❑ Yes ❑ No
If yes, describe the treatment (provide information about the removal efficiency):
d. Is the discharge (or will the discharge be) continuous or intermittent?
❑ Continuous 0 Intermittent If intermittent, describe discharge schedule.
END OF PART F.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2AYOU MUST COMPLETE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 43 of 22

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART F.INDUSTRIAL USER DISCHARGES AND RCRA/CERCLA WASTES
All treatment works receiving discharges
complete part F.
GENERAL INFORMATION:
F.1. Pretreatment program. Does the treatment
® Yes ❑ No
F.2. Number of Significant Industrial Users
industrial users that discharge to the
e. Number of non -categorical SIUs.
f. Number of ClUs.
SIGNIFICANT INDUSTRIAL USER
from significant industrial users or which receive RCRA,CERCLA, or other remedial wastes must
works have, or is subject ot, an approved pretreatment program?
(SIUs) and Categorical Industrial Users (ClUs). Provide the number
treatment works.
2
of each of the following types of
questions F.3 through F.8 and
1
INFORMATION:
to the treatment works, copy
Supply the following information for each SIU. If more than one SIU discharges
provide the information requested for each SIU.
F.3. Significant Industrial User Information. Provide the name and address of each SIU discharging to the treatment works. Submit additional pages
as necessary.
Name: Semprius, Inc
Mailing Address: 145 Technology Lane, B
Henderson NC 27537
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
Wafer fabrication, surface mount technology processing (solder screening and reflow) and silicone molding .
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw materials that affect or contribute to the SIU's
discharge.
Principal product(s): Concentrated Photovoltaic Solar Modules
Raw material(s): Bare silicone wafers and various metals and plating bath chemicals.
F.6. Flow Rate.
e. Process wastewater flow rate. Indicate the average daily volume of process wastewater discharge into
day (gpd) and whether the discharge is continuous or intermittent.
3100 gpd (X continuous or intermittent)
the collection system in gallons per
into the collection system
f. Non -process wastewater flow rate. Indicate the average daily volume of non -process wastewater flow discharged
in gallons per day (gpd) and whether the discharge is continuous or intermittent.
3750 gpd ( X continuous or _ intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes 0 No
b. Categorical pretreatment standards ® Yes 0 No
If subject to categorical pretreatment standards, which category and subcategory?
469.18
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 44 of 22

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems (e.g.,
upsets, interference) at the treatment works in the past three years?
❑ Yes ® No If yes, describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck, rail or dedicated pipe?
❑ Yes 0 No (go to F.12)
F.10. Waste transport. Method by which RCRA waste is received (check all that apply):
❑ Truck 0 Rail 0 Dedicated Pipe
F.11. Waste Description. Give EPA hazardous waste number and amount (volume or mass, specify units).
EPA Hazardous Waste Number Amount Units
CERCLA (SUPERFUND) WASTEWATER, RCRA REMEDIATIONICORRECTIVE ACTION
WASTEWATER, AND OTHER REMEDIAL ACTIVITY WASTEWATER:
F.12. Remediation Waste. Does the treatment works currently (or has it been notified that it will) receive waste from remedial activities?
❑ Yes (complete F.13 through F.15.) 0 No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates (or is excepted to origniate in
the next five years).
F.14. Pollutants. List the hazardous constituents that are received (or are expected to be received). Include data on volume and concentration, if
known. (Attach additional sheets if necessary.)
F.15. Waste Treatment.
e. Is this waste treated (or will be treated) prior to entering the treatment works?
❑ Yes ❑ No
If yes, describe the treatment (provide information about the removal efficiency):
f. Is the discharge (or will the discharge be) continuous or intermittent?
❑ Continuous ❑ Intermittent If intermittent, describe discharge schedule.
END OF PART F.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 45 Of 22

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART G. COMBINED SEWER SYSTEMS
If the treatment works has a combined sewer system, complete Part G.
G.1. System Map. Provide a
a. All CSO discharge
b. Sensitive use areas
outstanding natural
c. Waters that support
G.2. System Diagram. Provide
includes the following information.
a. Location of major sewer
b. Locations of points
c. Locations of in -line
d. Locations of flow -regulating
e. Locations of pump
CSO OUTFALLS:
map indicating the following: (may be included with Basic Application Information)
points.
potentially affected by CSOs (e.g., beaches, drinking water supplies, shellfish beds, sensitive aquatic ecosystems, and
resource waters).
threatened and endangered species potentially affected by CSOs.
a diagram, either in the map provided in G.1 or on a separate drawing, of the combined sewer collection system that
trunk lines, both combined and separate sanitary.
where separate sanitary sewers feed into the combined sewer system.
and off-line storage structures.
devices.
stations.
G.6 once for each CSO discharge point.
Complete questions G.3 through
G.3. Description of Outfall.
a. Outfall number
b. Location
(City or town, if applicable) (Zip Code)
(County) (State)
(Latitude)
c. Distance from shore
d. Depth below surface
e. Which of the following
❑ Rainfall
❑ CSO flow
f. How many storm events
G.4. CSO Events.
a. Give the number of
(Longitude)
(if applicable) ft.
(if applicable) ft.
were monitored during the last year for this
0 CSO pollutant concentrations
volume 0 Receiving water quality
were monitored during the last year?
CSO events in the last year.
events (0 actual or 0 approx.)
CSO?
0 CSO frequency
b. Give the average duration per CSO event.
hours (0 actual or 0 approx.)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22.
Page 46 of 22

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
c. Give the average volume per CSO event.
million gallons (0 actual or 0 approx.)
d. Give the minimum rainfall that caused a CSO event in the last year
Inches of rainfall
G.5. Description of Receiving Waters.
a. Name of receiving water:
b. Name of watershed/river/stream system:
United State Soil Conservation Service 14-digit watershed code (if known):
c. Name of State Management/River Basin:
United States Geological Survey 8-digit hydrologic cataloging unit code (if known):
G.6. CSO Operations.
Describe any known water quality impacts on the receiving water caused by this CSO (e.g., permanent or intermittent beach closings, permanent or
intermittent shell fish bed closings, fish kills, fish advisories, other recreational loss, or violation of any applicable State water quality standard).
END OF PART G.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 47 of 22

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SIGNAGE AND
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JOB NO.: 1201100
DATE: AUGUST. 2012
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