NC0021709_Renewal (Application)_20220520

i . .
ROY COOPER `* 2
Governor - !t^::?
ELIZABETH S.BISER �`• "�.
Secretary _7:00,-,'
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
May 19, 2022
Town of Jefferson
Attn: Tim Church, Water Resources Dir.
PO Box 67
Jefferson, NC 28640-0067
Subject: Permit Renewal
Application No. NC0021709
Jefferson WWTP
Ashe County
Dear Applicant:
The Water Quality Permitting Section acknowledges the May 19, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincere)
4!, ,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Central Files w/application
ec: WQPS Laserfiche File w/application
North Carolina Department of Environmental Quality I Division of Water Resources
n., DEW) Winston-Salem Regional Office 1450 West Hanes Mill Road,Suite 300 I Winston-Salem,North Carolina 27105
336.776.9800

Town of Jefferson
ALDERMEN 302 East Main Street MAYOR
Charles Caudill PO Box 67 Bluferd Eldreth
Mark Johnston Jefferson, NC 28640 TOWN MANAGER
Max Yates Dan McMillan
Wes Williams Phone [phone] FINANCE OFFICER
Cathy Ballou Fax [phone] Kayla Jones
Tax ID # 56-0896625
May 16, 2022
NCDEQ/ DWR/ NPDES RECEIVED
ATTN: Wren Thedford
1617 Mail Service Center
Raleigh, NC 27699-1617 MAY 2 0 2022
Dear Ms. Thedford; NCDEQIDWRINPDES
Please find enclosed the renewal application for NPDES Permit NC0021709 held by the Town of
Jefferson WWTP. If you have questions or require additional information please call me at
[phone] or contact me by email at [e-mail].
Respectfully,
Tim Church, Water Resources Director
Town of Jefferson

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A &2&EPA Application for NPDES Permit to Discharge Wastewater
NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Jefferson WWTP
Mailing address(street or P.O.box)
PO Box 67
City or town State ZIP code
o Jefferson NC 28640
Contact name(first and last) Title Phone number Email address
Tim Church Water Resources Director [e-mail]
Location address(street,route number,or other specific identifier) ❑Same as mailing address
ti 1233 NC Highway 16 South
City or town State ZIP code
Jefferson NC 28640
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission El No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes El No 4 SKIP to Item 1.4.
Applicant name
= Applicant address(street or P.O. box)
0
City or town State ZIP code
0 Contact name(first and last) Title Phone number Email address
n
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ElOperator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
ElFacility ❑ Applicant ❑ Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
P. Existing Environmental Permits
❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
m water) control)
E
_
a ❑ PSD(air emissions) ❑ Nonattainment program(CM) 0 NESHAPs(CM)
ao
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 0 Other(specify)
w 404)
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
Jefferson 1400 100 %separate sanitary sewer 0 Own 0 Maintain
o %combined storm and sanitary sewer 0 Own 0 Maintain
❑ Unknown 0 Own ❑ Maintain
cn
c %separate sanitary sewer 0 Own 0 Maintain
combined storm and sanitary sewer 0 Own 0 Maintain
co
fl ❑ Unknown ElOwn ElMaintain
a %separate sanitary sewer ❑ Own 0 Maintain
c %combined storm and sanitary sewer 0 Own El Maintain
E co 0 Unknown 0 Own 0 Maintain
separate sanitary sewer ❑ Own ❑ Maintain
y %combined storm and sanitary sewer ❑ Own El
o 0 Unknown El Own 0 Maintain
t Total 1400
°' Population
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 100 % %
sewer line(in miles)
1.8 Is the treatment works located in Indian Country?
c
o
0 ❑ Yes 0 No
c..0
m 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
la
c ❑ Yes ❑ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.700 mgd
Ti
= Annual Average Flow Rates(Actual)
Two Years Ago Last Year This Year
c
c _0 0.220 mgd 0.249 mgd 0.251 mgd
d Maximum Daily Flow Rates(Actual)
cl Two Years Ago Last Year This Year
0.62 mgd 0.62 mgd 0.55 mgd
co, 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
•o Total Number of Effluent Discharge Points by Type
°' a Constructed
Combined Sewer
2'1-- Treated Effluent Untreated Effluent Bypasses Emergency
o T Overflows yp g y
.o Overflows
0 1 0 0 0 0
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes 0 No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
0 Continuous
gpd ❑ Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No)SKIP to Item 1.16.
c 1.15 Provide the land application site and discharge data requested below.
0.y Land Application Site and Discharge Data
Continuous or
o Location Size Average Daily Volume Intermittent
a, Applied (check one)
cL acresgpd CI Continuous
❑ Intermittent
43
t acres d CI Continuous
9p ❑ Intermittent
- ❑ Continuous
acres gpd ❑ Intermittent
0 1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes 0 No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ✓❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
EPA Form 3510-2A(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
oNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
O 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
0 have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
rn
s ❑ Yes ❑r No 4 SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Dis osal Site Dis osal Site Daily Discharge
Description p p Volume (check one)
co
acresgpd ❑ Continuous
o 0 Intermittent
acres d ❑ Continuous
glo ❑ Intermittent
acres gpd ❑ Continuous
0 Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
n Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
as
❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
0
Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP
code
O Contact name(first and
c� last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

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Narrative for Process Flow Diagram
Jefferson Wastewater Treatment Plant
NC0021709
Influent flows enters the facility at the automatic bar screen. The headworks includes a manual screen as
well to accommodate a by-pass of the unit in the event of repairs. Four influent pumps are located in the
basement of the process building and are controlled by a float system in the wet well.
Influent is pumped to the Oxidation Ditch where about 60%of the flow enters the outside ring of the ditch
and the remaining flow goes to the second ring. The oxidation ditch has two sets of rotors in each ring.
One rotor operates continuously in each ring and the two are manually rotated as necessary to avoid
excessive wear. Adjustment of flow and aeration to the first ring results in conditions that enhance nutrient
removal.
From the Oxidation ditch,flow enters the splitter box through which it may be directed and rate controlled
to each clarifyer. A third compartment exists to accommodate a third clarifyer in the future. It is at this
point where samples are taken for measuring settleability and MLSS.
Two circular clarifyers operate in a parallel design. Return sludge from each enters the pump station
located between clarifyer#1 and the circular digester. The pump station is valved to allow RAS to flow
back to the Oxidation Ditch or it may be wasted to the twin sludge basins or the circular digester.
After leaving the clarifyers,flow enters the dual tertiary filters,operating in parallel sequence. Backwash
water from the filters flows by gravity back to the influent wet well.
Disinfection is accomplished using chlorine gas fed to the front end of the chlorine contact chamber. This
unit has around the end baffling for maximum contact time. At the end of the chlorine contact chamber a
sodium thiosulfate solution is fed as a dechlorinating agent. This area also features a post aeration basin
just prior to the outfall to the receiving stream.
(Also attached to this narrative is the "Sludge Management Plan which should be helpful in interpreting
the flow diagram)

Plant Flow
Backwash --------- Town of Jefferson WWTP
Return Sludge — Headworks Short-Term Monitoring PlanBar Scree
Waste Sludge Sample Point 1 Well
Cooling for Dryer
_4___ 1
Sludge Sludge
Basin Basin
Belt Sludge Clarifyer
Press Dryer
. # 1
•
mp Station
#40.
Final WAS
Digester
� RAS
Sample Point 4 .-'�,. r
1111110.
Divider Box
Digester
I7.........
jrnpieE!t3 I 1
Oxidation Ditch
rTOFI rsnno
ryNO ChioLDech10r.
Clarifyer
• Sample Point 2
#2
i1

r
Town of Jefferson Water Resources
Sludge Management Plan for Jefferson WWTP
I. Sludge Storage Capacity
Two sludge storage basins retrofitted with new headers and diffusers in 2004 115,000 gallons
Round digester 65,000 gallons
Loading station 25,000 gallons
Total sludge storage capacity 205,000 gallons
II. Sludge Transfer through the Facility
Sludge collected from the two clarifyers enters a pump station. Wasting is accomplished by
diverting return activated sludge flow to the dual sludge storage basins. When the basins are
filled,the aerators are turned off and the solids settle,allowing clear supernatant to be decanted
using telescopic valves in each basin. The supernatant flows by gravity to the influent
headworks of the WWTP At the completion of the dewatering procedure aeration is resumed
and the thickened sludge is transferred to the round digester using a submersible pump located in
each basin. The round digester has the same dewatering capability. Upon dewatering the round
digester,thickened sludge is transferred by gravity flow to the loading station. Supernatant from
the round digester enters the sludge pump station where it is transferred to the oxidation ditch.
The thickened sludge from the round digester is transferred by gravity to the truck loading station
for disposal to land application sites or to the belt press and sludge dryer.
This plan allows a 2%total solids value for the sludge and results in a maximum detention time.
III. Class B Liquid Sludge
Permit WQ 0004166 regulates Class B liquid sludge disposal. Jefferson has forty two acres
permitted for liquid sludge disposal. All the acreage is located within a two mile radius of the
WWTP. The facility uses a military style ten wheel drive truck fitted with a tank capacity of
1800 gallons. Sludge leaves the tank through a spreader bar six feet in length,controlled by a
pneumatic valve operated from the cab of the truck.
Procedures to Significantly Reduce Pathogens is demonstrated by analysis of seven annual
sludge samples for coliform bacteria,having a geometric mean<2,000,000 MPN. Vector
Attraction Reduction is demonstrated by volatile solids analysis of sludge in a thirty day bench
scale shown to produce<15%volatile solids reduction.
IV. Class A Dry Sludge
Permit WQ 0022155 regulates Class A dry sludge production.This facility operates a Phoenix
belt press with a capacity of 35 gpm. The cake from the belt press is augered to a Fenton sludge
dryer. This unit generates a granular product with total solids>90%and coliform bacteria are
eliminated. This sludge is distributed on hay fields using an"eezee flow"drop spreader. (see
the back of this page for details regarding Class A compliance under the 503 rules)

•
Fenton Environmental Technologies, Inc.
RK Series Municipal Biosolids Dehydrator.
1(800) 777-1371
Class A Compliance Under the 503 Rules
The SludgeMASTER RK series automatic batch style biosolids dehydrator is uniquely suited to
i
insure compliance with the 40 CFR 503 regulations pertaining to achieving Class "A" biosolids.
The RK dehydration chamber is loaded automatically with a predetermined amount of dewatered
biosolids which starts the batch cycle.
The total sludge load is subjected to a minimum temperature of 212 degrees F for a minimum of
two and one-half hours which exceeds the time and temperature requirements of the 503
regulations pertaining to pathogen reduction. This complianc is shown as follows using Regime
A under Alternative 1 which requires that solids be heated at 50 degrees C or higher for 20
minutes or longer.
Time (in days) = 131.700.000
10A 0.14 (temperature)gr, for the RK dehydrator at 212 degrees F (=100 C)
Time= 131.700.000 sr Time= 131.700.000 Qr Time= less than 1.3/10^6 day.
10A 0.14(100) 10^14
The time required in the RK for pathogen reduction would be less than 1 minute. Therefore, the
minimum time requirement of 20 minutes specified in the 503 Rules must be followed. Following
the 20-minute requirement,the RK dehydrator exceeds the time requirement by about 700%.
• Total cycle time is determined by achieving the desired sludge dryness. We normally recommend a
minimum of 90 % dry solids for a finished product to qualify under 503.33 "Option-8" regarding
vector attraction reduction. (Fully digested sludges need be dried to 75%- 503.33 "Option 7".)
The SludgeMASTER RK patented process automatically adjusts the time and temperature regime
foi the varying incoming wet sludge solids content. This feature is very important since dewatering
operations will vary from time to time in solids consistency yet we must maintain consistent Class
A bioso lids at all times. Conversely, automatic flow through systems cannot adjust to varying
conditions without disrupting their normal operation and compromising the finished Product
Class "A" parameters.
Please refer to 40 CFR 503.32 Pathogens- (a)(3) (ii) (9) for pathogen reduction requirements and
to 40 CFR 503.33 (b) (7) and (8) for vector attraction reduction requirements.
Fenton Environmental Technologies, Inc. guarantees Class A compliance on a continued basis
with each SludgeMASTER RK Dehydration System.
In choosing Class A biosolids thermal dehydration Ionizing SludgeMASTER RK technology, your
utility will be assured of an environmentally correct sludge handling solution for many years in the
future.

Town of Jefferson WWTP
Operation and Maintenance Plan
This document is a supplement to the"Narrative for Process Flow Diagram"which has been
included in earlier submittals in the permit renewal application.
The Jefferson WWTP was last expanded in 2005. This project included the construction of a
new laboratory and office, allowing the older laboratory area to be converted to storage and filing
space. The previous laboratory now stores the following information for each major piece of
equipment in the facility, as well as spare parts.
* Start-Up Reports, including service technician contacts
* Operation and Maintenance Manuals
* Maintenance schedules
* Warranties as applicable
* Suggested lubrication intervals and lubricants
* Spare parts and suppliers
The current laboratory carries out in-plant quality control analyses. This information is logged in
a binder in the lab and is labeled "Process Control Data". It contains the following information
on two separate forms. An in-plant QC series as described in Item I below is conducted
approximately weekly.
I. Mixed Liquor Suspended Solids Inventory and Conditions
A. Sludge settleability graph (minutes vs. %settled volume)
B. Mixed Liquor Suspended Solids calculations
C. Sludge Volume Index
D. Oxidation Ditch pH
E. Depth of sludge blanket in each clarifier.
F. Observation of Microscopic activity and operational strategies.
II. Sludge Handling Activities
A. Daily volume of sludge wasted to round digester
B. Daily volume of sludge wasted to basins
C. Daily volume of dewatering from round digester
D. Daily volumes of dewatering from basins
E. Return sludge rates
A daily log for the WWTP is also maintained in the form of a narrative that describes any
significant operational activities or noteworthy events of the day. This log is maintained on the
desk of the Water Resources Director.
Tim Church, Water Resources Director

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_ __. __ C2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION (40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the United States
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
m
c ❑ Yes ❑ No 4 SKIP to Section 3.
c 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration. 1500 gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Engineering study to determine specific areas of collection system with greatest volume of I/I.
Use of sewer camera/video recording/smoke testing in collection mains.
Polymer lining of manholes showing large amounts of infiltration.
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0 0 specific requirements.)
o)2
0
0'
0 ✓❑ Yes ❑ No
t—
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
v3 al:° (See instructions for specific requirements.)
13,
o ❑✓ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
= Briefly list and describe the scheduled improvements.
0
w
d
E
d
2.
E
0
3.
TS
a
ac
rn
4.
-c
v 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
> Outfalls Operational
2 Improvement Construction Construction Discharge p
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
-0
2.
cn
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
NC0021709 Jefferson WWTP OMB No.2040-0004
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number 1 Outfall Number Outfall Number
State North Carolina
To
County Ashe
0 City or town Jefferson
0
Distance from shore n/a ft. ft. ft.
a
Depth below surface n/a ft. ft. ft.
Average daily flow rate 0.251 mgd mgd mgd
Latitude 36° 24 37" "
Longitude si 2.5' 37' °
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o 0 Yes ❑ No 4 SKIP to Item 3.4.
d
3.3 If so,provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
0
Number of times per year
discharge occurs
a Average duration of each
discharge(specify units)
Average flow of each
R discharge mgd mgd mgd
Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number Outfall Number Outfall Number
U)
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
d discharge points?
3 w 0 Yes ❑ No 4SKIP to Section 6.
EPA Form 3510-2A(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 1 Outfall Number Outfall Number
Receiving water name Naked Creek
Name of watershed,river, South Fork New River
c or stream system
o
�- U.S.Soil Conservation
d Service 14-digit watershed
o code
w 3 Name of state
management/river basin North Carolina/New River
a)
c U.S.Geological Survey
0 8-digit hydrologic n/a
CD
cataloging unit code
Critical low flow(acute) n/a cfs cfs cfs
Critical low flow(chronic) n/a cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow n/a CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 1 Outfall Number Outfall Number
Highest Level of ❑ Primary ❑ Primary ❑ Primary
Treatment(check all that ❑ Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
0 Secondary 0 Secondary ❑ Secondary
❑ Advanced 0 Advanced ❑ Advanced
0 Other(specify) 0 Other(specify) 0 Other(specify)
c
0
a Design Removal Rates by
0 Outfall
ar
im BOD5 or CBOD5 95 % % %
d
E
w TSS 95 % %
1-
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus
% % %
0 Not applicable ❑ Not applicable 0 Not applicable
Nitrogen % a
/o
Other(specify) 0 Not applicable ❑Not applicable 0 Not applicable
%
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below.If disinfection varies by
season,describe below.
C)
d
c
c
0
v
c Outfall Number Outfall Number Outfall Number
Disinfection type Chlorine gas
•U
N1
= Seasons used 4
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
O Yes ❑ Yes ❑ Yes
❑ No 0 No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑r Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑✓ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number 1 Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water 16
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
El Yes ❑ No 4 SKIP to Item 3.16.
0 3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
w ❑✓ Yes ❑ No
3.16 Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C,must
sample other additional parameters(Table D),or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls(Table E).
Yes 4 Complete Tables C,D,and E as
CI applicable. ElNo 4 SKIP to Section 4.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑✓ Yes ❑ No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes 0 No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑� Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
ID Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
z. 9. 202 All passed
S: 5. ZOzl
g. 2. .2DZI
-a 11/03/2021
am
0
c
c
0
o 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
❑ Yes ❑✓ No 4 SKIP to Item 3.26.
t 3.23 Describe the cause(s)of the toxicity:
c
0
a
LU
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes 0 No—I SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
Not applicable because previously submitted
EYes ❑ information to the NPDES .ermittin. authorit .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES (40 CFR 122.21(j)(6)and(7))
4.1 Does the POTW receive discharges from Skis or NSCIUs?
❑ Yes ❑ No 4 SKIP to Item 4.7.
d 4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
cn Number of SIUs Number of NSCIUs
1
'2 4.3 Does the POTW have an approved pretreatment program?
14
N
El Yes ❑ No
4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F:(1)a pretreatment program annual report submitted within one year of the
application or(2)a pretreatment program?
-o
❑✓ Yes ❑ No 4 SKIP to Item 4.6.
0
7) 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
Annual Pretreatment Report 2020
-a
c
4.6 Have you completed and attached Table F to this application package?
✓❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
4.7 Does the POTW receive,or has it been notified that it will receive,by truck,rail,or dedicated pipe,any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ❑ No 4 SKIP to Item 4.9.
4.8 If yes,provide the following information:
Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
c.0
❑ Truck ❑ Rail
3 ❑ Dedicated pipe ❑ Other(specify)
0
'2
N ❑ Truck ❑ Rail
to
_ ❑ Dedicated pipe ❑ Other(specify)
-0
U,
m
s 4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
❑ Yes ❑✓ No 4 SKIP to Section 5.
3 4.10 Does the POTW receive(or expect to receive)less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d)and 261.33(e)?
❑ Yes-4 SKIP to Section 5. ❑ No
4.11 Have you reported the following information in an attachment to this application:identification and description of the
site(s)or facility(ies)at which the wastewater originates;the identities of the wastewater's hazardous constituents;and
the extent of treatment,if any,the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION 5. COMBINED SEWER OVERFLOWS(40 CFR 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
❑ Yes ❑ No+SKIP to Section 6.
a 5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
a ❑ Yes ❑ No
!o
2 5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
cn
❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
5.4 For each CSO outfall,provide the following information.(Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
0. State and ZIP code
U
in
0 County
T,
o o o
= Latitude
0
0 II o
rn Longitude '
1 11
c)
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Rainfall ❑ Yes ❑ No 0 Yes 0 No ❑ Yes 0 No
GP
C
0 CSO flow volume 0 Yes 0 No ❑ Yes 0 No ❑ Yes ❑ No
CSO pollutant ❑Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
o concentrations
Cl,
c.' Receiving water quality ❑ Yes 0 No ❑ Yes 0 No ❑Yes ❑ No
CSO frequency ❑ Yes 0 No ❑ Yes 0 No 0 Yes ❑ No
Number of storm events 0 Yes 0 No ❑ Yes ❑ No ❑ Yes ❑ No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number_
} Number of CSO events in events events events
y the past year
a
c Average duration per hours hours hours
c II event ❑Actual or❑Estimated ❑Actual or❑ Estimated ❑Actual or❑Estimated
CU
W million gallons million gallons million gallons
o Average volume per event
`)c ❑Actual or❑ Estimated ❑Actual or❑ Estimated 0 Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year ❑Actual or❑ Estimated ❑Actual or❑ Estimated 0 Actual or❑ Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Receiving water name
Name of watershed/
stream system
U.S.Soil Conservation ❑Unknown 0 Unknown ❑Unknown
Service 14-digit
watershed code
"> (if known)
CI
Name of state
cc management/river basin
coU.S.Geological Survey ❑Unknown ❑Unknown ❑Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam•les
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1 Column 2
Section 1:Basic Application
Information for All Applicants ❑ w/variance request(s) ❑ w/additional attachments
❑ Section 2:Additional ❑ w/topographic map ❑ w/process flow diagram
Information ❑ wl additional attachments
✓❑ wl Table A ✓❑ wl Table D
a Section 3:Information on ❑ wl Table B ❑✓ wl Table E
Effluent Discharges
E ❑ wl Table C ❑ wl additional attachments
Section 4: Industrial r
❑ wl SIU and NSCIU attachments ❑ w/Table F
t ❑✓ Discharges and Hazardous
s Wastes ❑ w/additional attachments
❑ Section 5:Combined Sewer ❑ w/CSO map ❑ w/additional attachments
Overflows
sis ❑ w/CSO system diagram
Section 6:Checklist and
❑ Certification Statement ❑ w/attachments
.Y 6.2 Certification Statement
0
d
/certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information,the information submitted is, to the best of my knowledge and belief,true,accurate,and
complete. I am aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Tim Church Water Resources Director
Signature Date signed
7
SM/22-d
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facifty Name Outfall Number Form Approved 03/05/19
N00021709 Jefferson WWTP 1 OMB No.2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Method+ (include units)
Samples
Biochemical oxygen demand
o ML
IDBODs or o CBODs 9.6 mg/I mg/I 432 SM-5210B mg/I O MDL
(report one)
El ML
Fecal coliform 6000 CFU's/100 ml 34. CPU's/100m1 432 SM-9222D cfu/100ml MDL
Design flow rate 0.620 mgd 0.240 mgd Continuous
pH(minimum) 6.4 su
pH(maximum) 7.7 su
Temperature(winter) 14.9 Degrees C 11.9 Degrees C 72
Temperature(summer) 23.1 Degrees C 18.5 Degrees C 72
Total suspended solids(TSS) 13. mg/I 0.5 mg/I 432 5M-2540 D mg/I MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPOES Permit Number Facility Name OutfaII Number Form Approved 03/05/19
NC0021709 Jefferson W WTP 001 0MB No.2040-0004
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Methods (include units)
Samples
Ammonia(as N) 0.68 mg/I 0.05 mg/I 52 SM-4500F 0 ML
❑MDL
Chlorine ❑ML
(total residual,TRC)2 38.0 ug/I 17.1 ug/I 156 SM4500CI G2011 Aq 0 MDL
ML
Dissolved oxygen 8.9 mg/I 8.2 mg/I 156 SM4500 G2016Aque 0 MDL
Nitrate/nitrite 3.7 mg/I 3.3 mg/I 2 SM 19 4500 N ❑ML
❑MDL
0 ML
Kjeldahl nitrogen 7.8 mg/I 7.6 mg/I 2 SM 19 4500 N 0 MDL
0 ML
Oil and grease <5 mg/I <5 mg/I 12 EPA 1664 A ❑MDL
Phosphorus 2.7 mg/I 2.7 mg/I 2 200.7 1994 ❑ML
❑MDL
Total dissolved solids 179 mg/I 179 mg/I 1 SM 2540 C ML
0 MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 349) Page 15

EPA Identification Number NPDES Permit Number Facitty Name Duffel Number Form Approved 03/05/19
NC0021709 Jefferson WWTP 001 OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) 60 mg/I 51 mg/I 4 5M 2340 C 0 ML
❑MDL
0 ML
Antimony,total recoverable <0.025 mg/I <0.025 mg/I 3 EPA 200.7 0 MDL
Arsenic,total recoverable <0.01 mg/I <0.01 mg/I 3 EPA 200.7 ❑ML
❑MDL
0 ML
Beryllium,total recoverable <0.005 mg/I <0.005 mg/I 3 EPA 200.7 0 MDL
Cadmium,total recoverable <0.002 mg/I <0.002 mg/I 3 EPA 200.7 0 ML
❑MDL
0
Chromium,total recoverable <0.005 mg/I <0.005 mg/I 3 EPA 200.7 ML
❑MDL
Copper,total recoverable 63.6 ug/I 14.6 ug/I 16 EPA 200.7 0 ML
❑MOL
Lead,total recoverable <0.01 mg/I <0.01 mg/I 3 EPA 200.7 ❑ML
❑MDL
Mercury,total recoverable 5.79 net 3.4 ng/I 3 EPA 1631 0 ML
0 MDL
Nickel,total recoverable <0.01 mg/I <0.01 mg/I 3 EPA 200.7 0 ML
❑MDL
Selenium,total recoverable <0.01 mg/I <0.01 mg/I 3 EPA 200.7 ❑ML
0 MDL
Silver,total recoverable <0.005 mg/I <0.005 mg/I 3 EPA 200.7 0 ML
0 MDL
Thallium,total recoverable <0.02 mg/I <0.02 mg/I 3 EPA 200.7 ML
0 MDL
0
Zinc,total recoverable 522 ug/I 92.8 ug/I 16 EPA 200.7 ML
❑MDL
1 Cyanide 12 ug/I <5 ug/I 16 EPA 335.4 ❑ML
0 MDL
Total phenolic compounds 0.022 mg/I 0.022 mg/I 3 EPA 420.1 El ML
❑MDL
Volatile Organic Compounds
❑ML
Acrolein <50 ug/I <50 ug/I 3 EPA 624.1 0 MDL
Acrylonitrile <10. ug/I <10 ug/I 3 EPA 624.1 ❑ML
❑MDL
•
Benzene <1.00 ug/I <1.00 ug/I 3 EPA 624.1 El ML
❑MDL
Bromoform <1.0o ug/I <1.00 ug/I 3 EPA 624.1 ❑ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 17

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EPA Identification Number NPDES Permit Number Facility Name DudaII Number Form Approved 03/05/19
NC0021709 Jefferson WWTP 001 OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Methods (include units)
Samples
ML
Trichloroethylene cl ug/I <1 ug/I 3 EPA 624.1 o MDL
0 ML
Vinyl chloride <5 ug/I <5 ugh 3 EPA 624.1 0 MDL
Acid-Extractable Compounds
0 ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol <10 ug/I <10 ug/I 3 EPA 625.1 0 MDL
0 ML
2,4-dichlorOphen0l <10 ug/I <10 ug/I 3 EPA 625.1 ID MDL
0 ML
2,4-dimethylphenol <10 ug/I <10 ugh 3 EPA 625.1 0 MDL
4,6-dinitro-o-cresol 0 ML
O MDL
0 ML
2,4-dinitrophenol <50 ug/I <50 ug/I 3 EPA 625.1 0 MDL
2-nitrophenol <10 ug/I <10 ug/I 3 EPA 625.1 o ML
0 MDL
4-nitrophenol <50 ug/I <50 ug/I 3 EPA 625.1 0 MDL
Pentachlorophenol <50 ugh <50 ug/1 3 EPA 625.1 ❑ML
0 MDL
Phenol <10 ug/I <50 ug/I 3 EPA 625.1 ❑ML
❑MDL
0 ML
2,4,6-trichl0rophenol <10 ug/I <50 ug/I 3 EPA 625.1 0 MDL
Base-Neutral Compounds
Acenaphthene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
_ ❑MDL
0 ML
Acenaphthylene <10 ug/I <10 ug/I 3 EPA 625.1 0 MDL
Anthracene <10 ugh <10 ug/1 3 EPA 625.1 ML
0 MDL
Benzidine <50 ugh <50 ug/1 3 EPA 625.1 ❑ML
❑MDL
Benzo(a)anthracene <10 ug/I <10 ug/l 3 EPA 625.1 0 ML
0 MDL
0 ML
Benzo(a)pyrene <10 ug/I <10 ug/l 3 EPA 625.1 0 MDL
3,4-benzofluoranthene <i0 ug/I <10 ugh 3 EPA 625.1 ❑ML
0 MDL
EPA Form 3510.2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfal Number Form Approved 03/05/19
NC0021709 Jefferson WWTP 001 OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
Benzo(ghi)perylene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Benzo(k)fluoranthene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Bis(2-chioroethoxy)methane <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
0 MDL
Bis(2-chioroethyl)ether <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
Bis(2-chioroisopropyl)ether <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
❑MDL
Bis(2-ethyihexyl)phthalate <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
4-bromophenyi phenyl ether <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Butyl benzyl phthalate <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
2-chloronaphthalene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
0 ML
4 chiorophenyi phenyl ether <10 I ug/I <10 I ug/I 3 EPA 625.1 0 MDL
Chrysene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
di-n-butyl phthalate <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
di-n-octyl phthalate <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Dibenzo(a,h)anthracene <10 ug/I <10 ug/I 3 EPA625.1 ❑ML
❑MDL
1,2-dichlorobenzene <10 ugh! <10 ug/I 3 EPA 625.1 0 ML
0 MDL
1,3-dichlorobenzene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
1,4-dichlorob <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
enzene
0 MDL
3,3-dichlorobenzidine <So ug/I <50 ug/I 3 EPA 625.1 ❑ML
❑MDL
Diethyl phthalate <10 ug/I <10 ug/I 3 EPA 625.1 D ML
❑MDL
Dimethyl phthalate <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
2,4-dinitrotoluene <10 ug/I <10 ugh' 3 EPA 625.1 ❑ML
❑MDL
2,6-dinitrotoluene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Faciity Name Oulfal Number Form Approved 03/05 19
OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
I
Pollutant Number of Method+ (include units)
I-
Value Units Value Units Samples
0 ML
1,2-diphenylhydrazine <10 ug/I <10 ug/I 3 EPA 625.1 0 MDL
Fluoranthene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Fluorene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Hexachlorobenzene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Hexachlorobutadiene <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
❑MDL
Hexachlorocyclo-pentadiene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
©MDL
Hexachloroethane <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
0 MDL
Indeno(1,2,3-cd)pyrene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Isophorone <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
0 MDL
Naphthalene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
Nitrobenzene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
N-nitrosodi-n-propylamine <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
0 ML
N-nitrosodimethylamine <10 ug/I <10 ug/I 3 EPA 625.1 ❑MDL
0 ML
N-nitrosodiphenylamine <10 ug/I <10 ug/I 3 EPA 625.1 0 MDL
Phenanthrene <10 ug/I <10 ug/I 3 EPA 625.1 0 ML
0 MDL
Pyrene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
1,2,4-trichlorobenzene <10 ug/I <10 ug/I 3 EPA 625.1 ❑ML
❑MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 21

EPA Identification Number NPDES Permit Number Facility Name Outfat Number Forrn Approved 03/05/19
NC0021709 Jefferson WWTP 001 OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge Pollutant Analytical ML or MDL
(ist) Value Units Value Units I Samples Method' (include units)
ElNo additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
'Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 12221(e)(3).
EPA Form 3510-2A(Revised 3.19) Page 23

EPA Identification Number NPDES Permit Number Fadlty Name Outfal Number Form Approved 03/05/10
NC0021709 Jefferson WWTP 001 DNB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 1 Test Number 2 Test Number 3
Acute Test Results Continued
Other(describe) - -Chronic Test Results
NOEC
ICzs %
Control percent survival too % 1o0%% 100%%
Other(describe) Pass Pass Pass
Quality ControUQuality Assurance
Is reference toxicant data available? ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No
Was reference toxicant test within 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
acceptable bounds?
What date was reference toxicant test run
(MM,DD/YYYY)? --
Other(describe)
EPA Form 3510.2A(Revised 3-19) Pape 27

EPA Identification Number NPOES Permit Number Faalty Name Oulfal Number Form Approved 03/05/19
NC0021709 Jefferson WWTP ow. OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 1 Test Number 2 Test Number 3
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static ❑Static
response.)
❑r Static-renewal ❑r Static-renewal ❑✓ Static-renewal
❑ Flow-through ❑ Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑Laboratory water ❑ Laboratory water 0 Laboratory water i
one response.)
0 Receiving water El Receiving water 0 Receiving water
If laboratory water,specify type.
If receiving water,specify source.
Type of Dilution Water
Indicate the type of dilution water.tf salt ✓❑Fresh water ElFresh water ❑✓ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. ❑Salt water(specify) ❑ Salt water(specify) El water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 30% 30% 30%
Parameters Tested
Check the parameters tested. 0 pH 0 Ammonia 0 pH ❑Ammonia 0 pH 0 Ammonia
El Salinity ❑✓ Dissolved oxygen ❑ Salinity El Dissolved oxygen 0 Salinity CI Dissolved oxygen
0 Temperature ❑Temperature 0 Temperature
Acute Test Results
Percent survival in 100%effluent o/ %
LCso
95%confidence interval % %
Control percent survival % %
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Raab,.Name Outfal Number Form Approved 03/05119
NC0021709 Jefferson WWTP 001 OMB No.20400004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 1 Test Number 2 Test Number 3
Test species Ceriodaphnia dubia Ceriodaphnia dubia Ceriodaphnia dubia
Age at initiation of test <24 hours <24 hours <24 hours
Outfall number 001 001 001
Date sample collected 02/22/2022 11/03/2021 08/04/2021
Date test started 02/22/2022 11/03/2021 08/04/2021
Duration 48 hours 48 hours 48 hours
Toxicity Test Methods
Test method number EPA 821R02-013 Method 1002.0 EPA 821R02-013 Method 1002.0 EPA 821R02-013 Method 1002.0
Manual title NC Modification NC Modification NC Modification
Edition number and year of publication December 2010 Version 3.0 December 2021 Version 3.0 December 2021 Version 3.0
Page number(s)
Sample Type
Check one: ❑Grab ❑ Grab ❑ Grab
El 24-hour composite El 24-hour composite ❑r 24-hour composite
Sample Location
Check one: ❑Before Disinfection ❑ Before Disinfection ❑Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
❑r After Dechlorination ❑r After Dechlorination 0 After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent outfall Effluent outfall Effluent outfall
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute ❑Acute ❑Acute
performed to asses acute or chronic toxicity, ❑✓ Chronic ID Chronic ❑✓ Chronic
or both.(Chedk one response.)
❑Both ❑Both ❑Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021709 Jefferson WWTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SlUs.Copy the table to report information for additional SIUs.
SIU o4 SIU SIU
Name of SIU American Emergency Vehicles
Mailing address(street or P.O.box) 165 American Way
City,state,and ZIP code Jefferson,NC 28640
Description of all industrial processes that affect Preparation of aluminum ambulance bodies
or contribute to the discharge. for priming and painting.
List the prindpal products and raw materials that Aluminum patient compartments
affect or contribute to the SIU's discharge. Alodine
Alumiprep
Indicate the average daily volume of wastewater
discharged by the SIU. 3000 gpd gpd gpd
How much of the average daily volume is
attributable to process flow? 2000 gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? 100o gpd gpd gpd
Is the SIU subject to local limits?
❑r Yes 0 No ❑Yes 0 No 0 Yes 0 No
Is the SIU subject to categorical standards?
0 Yes 0 No 0 Yes ❑No ❑Yes 0 No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Fadity Name Fonn Approved 03/05/19
N00021709 Jefferson WWTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three Sills.Copy the table to report information for additional SIUs.
SIU o4 SIU SIU
Under what categories and subcategories is the 40 CFR 433.17
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 ❑Yes El No ❑Yes ❑ No ❑Yes ❑No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30