NC0064726_Renewal (Application)_20231031

.0..STATE a„
ROY COOPER _
Governor
IZABETH S.BISE "^t�" ,•EL R ' r
Secretary -
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
October 31, 2023
Town of East Bend
Attn: James Dunn, Mayor
108 W Main St
East Bend, NC 27018
Subject: Permit Renewal
Application No. NC0064726
East Bend Industrial Park WWTP
Yadkin County
Dear Applicant:
The Water Quality Permitting Section acknowledges the September 26, 2023 receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deb.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.
Sincerely,
5c1
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Jeff Jones, ORC
ec: WQPS Laserfiche File w/application
Q North Cae Environmental Quality r
Winston-Salemrolina D Regionalpartment OffIceof 450 West Hanes Mill RDivisionoad.Suiteof 300Wate Winston-SResourcesalem.North Carolina 27105
a�'r.`raer�ra.m� r" 336.7769800

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A a 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
East Bend Industrial Park Wastewater Treatment Plant
Mailing address(street or P.O.box)
NC HWY 67 East
City or town State ZIP code
o East Bend NC 27018
E Contact name(first and last) Title Phone number Email address
w Jeff Jones ORC [phone] [e-mail]
P Location address(street,route number,or other specific identifier) ❑ Same as mailing address
ci 299 Salem Trail
uL
City or town State ZIP code
East Bend NC 27018
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑✓ No ,�
requirements for new dischargers. � �
1.3 Is applicant different from entity listed under Item 1.1 above? C I �02
❑ Yes ❑✓ No 4 SKIP to Item 1.4.
Applicant name CpE�pw�IT
Jeff Jones r N
c Applicant address(street or P.O. box)
w 404 Williams St.
€ City or town State ZIP code
Boonville NC 27011
03 Contact name(first and last) Title Phone number Email address
c- Jeff Jones orc [phone] [e-mail]
Q
a 1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑✓ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
0 Facility ❑✓ Applicant 0 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.)
d Existing Environmental Permits
a ❑✓ NPDES(discharges to surface El RCRA(hazardous waste) ❑ UIC(underground injection
mwater) control)
E
2 ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
> i I
c
u.,
an
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ 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
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
loo %separate sanitary sewer ID Own ❑ Maintain
East Bend 50 %combined storm and sanitary sewer ❑ Own ❑ Maintain
z 0 Unknown ❑ Own 0 Maintain
c %separate sanitary sewer ❑ Own 0 Maintain
%combined storm and sanitarysewer 0 Own 0 Maintain
'�
a ❑ Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
ro El Unknown 0 Own ❑ Maintain
; %separate sanitary sewer ❑ Own ❑ Maintain
15›, %combined storm and sanitary sewer ❑ Own ❑ Maintain
co ❑ Unknown 0 Own ❑ Maintain
Total
d Population 50
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) 100% ° o.o
1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes ❑✓ No
U
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.010 mgd
w Annual Average Flow Rates(Actual)
u N
a V' Two Years Ago Last Year This Year
c
MI
o .0033 mgd .0038 mgd .0053 mgd
U u_ Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
.004 mgd .005 mgd .0141 mgd
u) 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
c Total Number of Effluent Discharge Points by Type
a a- Constructed
a� Combined Sewer
co T Treated Effluent Untreated Effluent Overflows Bypasses Emergency
c .n Overflows
0 1 0 0 0 0
EPA Form 3510-2A(Revised 3-19) Page 2
1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
O Continuous
gpd 0 Intermittent
❑ Continuous
gpd 0 Intermittent
-o
_2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
a Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
acresgpd 0 Continuous
0 Intermittent
acres d 0 Continuous
0 9p ❑ Intermittent
acresgpd 0 Continuous
❑ Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ Yes m 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
NC0064726 East Bend Industrial Park wwtf 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) ❑ None Average dailyflow rate mgd
0 9 9
0 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
8 have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
s ❑ Yes ❑✓ No 4 SKIP to Item 1.23.
0
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
oDisposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acres gpd 0 Continuous
❑ Intermittent
0 Continuous
acres gpd 0 Intermittent
acresgpd 0 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.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
o CD ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
cr
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
c Contractor name
(company name) Jeff Jones
Mailing address 404 Williams St
(street or P.O.box)
City,state,and ZIP Boonville NC 27011
code
oContact name(first and Jeff Jones
c� last)
Phone number [phone]
Email address [e-mail]
Operational and
maintenance Blower Maintenance
responsibilities of Minor Electrical
contractor Routine diffuser maintenance
EPA Form 3510-2A(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number I Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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?
rn
❑ Yes ❑✓ No 4 SKIP to Section 3.
= 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration. ooi gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Wooten Engineering is set to perform an AIA on system,performing smoke test,and camera work.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0.
R specific requirements.)
0
Fo ❑✓ Yes El No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
3
o to., (See instructions for specific requirements.)
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
1. Most improvements will be based upon AIA
_
E
E2.Tentative Plan for plant expansion based on future expansion of local Industrial Park Factory
0
3.
4.
N
-O
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
o Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
0 2.
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 03/05/19
NC0064726 East Bend Industrial Park wwtf 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 001 Outfall Number Outfall Number
State NC
o County Yadkin
O City or town East Bend
0
wDistance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
Average daily flow rate .0043 mgd mgd mgd
Latitude 36° 12' 38" N
Longitude 80° 27' 30" E
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
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
Number of times per year
c discharge occurs
o Average duration of each
discharge(specify units)
cAverage flow of each mgd mgd mgd
Ch discharge
in 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.
c, 3.5 Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number Outfall Number Outfall Number
c us Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
3.6 discharge points?
w ❑✓ Yes ❑ No 4 SKIP 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
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Unnamed Tributary
Name of watershed,river,
0 or stream system Yadkin Pee Dee
fl U.S. Soil Conservation
Service 14-digit watershed
o code
Name of state management/river basin Yadkin Pee Dee River Manage
rn
U.S.Geological Survey
8-digit hydrologic 03040101
cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 001 Outfall Number Outfall Number
Highest Level of ❑ Primary 0 Primary ❑ Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
O Secondary ❑ Secondary ❑ Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0
0. Design Removal Rates by
Outfall
N
BOD5 or CBOD5 70 IV° iyo
TSS 70 %
I Not applicable 0 Not applicable ❑Not applicable
Phosphorus
0 Not applicable ❑ Not applicable ❑Not applicable
Nitrogen 92 %
Other(specify) 0 Not applicable 0 Not applicable ❑Not applicable
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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.
The system utilizes Ultra Violet light UV system for final treatment
cOutfall Number o01 Outfall Number Outfall Number
Disinfection type
0 UV-Ultra Violet
u►
Seasons used
Annually
Dechlorination used? 0 Not applicable 0 Not applicable 0 Not applicable
0 Yes 0 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?
O 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?
O Yes 0 No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑ Yes 0 No 4 SKIP to Item 3.16.
o 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?
m ❑ Yes 4 Complete Table B,including chlorine. la 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?
❑ 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 ✓❑ No 4 SKIP to Section 4.
applicable.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑ Yes 0 No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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?
El 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/DDNYYY)
C
a7
C
as 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
o toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
ra 3.23 Describe the cause(s)of the toxicity:
C
U
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES .ermittin• authorit .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.210)(6)and(7))
4.1 Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes ❑✓ No 4 SKIP to Item 4.7.
4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
1-4 Number of SIUs Number of NSCIUs
U)
0
2 4.3 Does the POTW have an approved pretreatment program?
_ ❑ Yes ❑✓ No
2 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?
❑ Yes ❑✓ No 4 SKIP to Item 4.6.
I o
o 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
�L
U)
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
NC0064726 East Bend Industrial Park wwtf 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 0 Rail
❑ Dedicated pipe ❑ Other(specify)
.40
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
N ❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
co 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.
•C
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. 0 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?
cn ❑ Yes ❑✓ No 4 SKIP to Section 6.
5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
0 Yes 0 No
5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
cr' ❑ Yes ❑ No
U
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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
ti
•fl State and ZIP code
0
t
o County
R
oLatitude " " °
0 °
co Longitude '
o
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 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
a,
c
o CSO flow volume 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO pollutant 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
o concentrations
U)
0 Receiving water quality 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO frequency 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
Number of storm events 0 Yes 0 No 0 Yes 0 No 0 Yes 0 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
the past year
R
a
C Average duration per hours hours hours
c event 0 Actual or 0 Estimated ❑Actual or❑ Estimated ❑Actual or❑ Estimated
d
"-' million gallons million gallons million gallons
o Average volume per event
0 ❑Actual or❑ Estimated ❑Actual or 0 Estimated ❑Actual or❑ Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year ❑Actual or❑ Estimated I ❑Actual or❑ Estimated ❑Actual or❑Estimated
EPA Form 3510-2A(Revised 3-19) Page 11
i

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004 I
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/
CI) stream system
a; U.S.Soil Conservation 0 Unknown 0 Unknown 0 Unknown
3 Service 14-digit
c watershed code
> (if known)
d Name of state
management/river basin
cnU.S.Geological Survey 0 Unknown 0 Unknown 0 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 ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
❑ Section 2:Additional ✓❑ w/topographic map ❑ w/process flow diagram
Information ❑ w/additional attachments
✓❑ w/Table A ❑ w/Table D
O Section 3: Information on 0 w/Table B 0 w/Table E
Effluent Discharges
g ❑ w/Table C 0 w/additional attachments
Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑ w/Table F
c' 0 Discharges and Hazardous
s Wastes 0 w/additional attachments
cci
❑ Section 5:Combined Sewer ❑ w/CSO map 0 w/additional attachments
Overflows ❑ w/CSO system diagram
❑ Section 6:Checklist and El attachments
co Certification Statement
en
l' 6.2 Certification Statement
U
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
o
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(pi
rint o,ty a first and last name) Official title
Signature Date signed
,;.-...ytq...._ ...>1.---4 a-- (€.,./ 3ap 7i- zez
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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-1 (include units)
Sam Iles
Biochemical oxygen demand
El BOD5 or❑CBOD5 32.5 mg/I 6.14 mg/I 120 ❑ML
❑MDL
resort one
Fecal coliform 2420 #/100 ml 98.36 #/100 ml 121 Li ML
❑MDL
Design flow rate 0.141 MGD .004 MGD. 1,008
pH(minimum) 5.26 Std Unts
pH(maximum) 8.80 Std Unts
Temperature(winter) 14.06 Celcius 9.27 Celcius 160
Temperature(summer) 25.65 Celcius 15.48 Celcius 195
Total suspended solids(TSS) 194 mg/I 15.08 mg/I 126 El ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 1,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 13

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB 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 Number of Methods (include
Value Units Value Units Samples units)
❑ML
Ammonia(as N) mg/I mg/I ❑MDL
Chlorine ug/I ug/I ❑ML
(total residual,TRC)2 ❑MDL
CI ML
Dissolved oxygen mg/I mg/I ❑MDL
Nitrate/nitrite mg/I mg/I ❑ML
❑MDL
0 ML
Kjeldahl nitrogen mg/I mg/I ❑MDL
O ML
Oil and grease mg/I mg/I ❑MDL
0 ML
Phosphorus mg/I mg/I ❑MDL
Total dissolved solids mg/I mg/I ❑ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 15

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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 Method, (include units)
f Samples
Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) ❑ML
0 MDL
Antimony,total recoverable ❑ML
❑MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable o ML
0 MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
0 ML
Copper,total recoverable ❑MDL
Lead,total recoverable ❑ML
❑MDL
0 ML
Mercury,total recoverable ❑MDL
Nickel,total recoverable ❑ML
_ ❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
0 MDL
Zinc,total recoverable ❑ML
❑MDL
❑ML
Cyanide ❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method, (include units)
Value Units Value Units
Samples
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
0 MDL
Chloroethane ❑ML
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
ML
1,1-dichloroethylene _ ❑MDL
ML
1,2-dichloropropane ❑MDL
1,3-dichloropropylene ❑ML
❑MDL
❑ML
Ethylbenzene ❑MDL
ML
Methyl bromide ❑MDL
ML
Methyl chloride ❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
Tetrachloroethylene ❑ML
❑MDL
Toluene ❑ML
❑MDL
1,1,1-tichloroethane ❑ML
❑MDL
1,1,2-tichloroethane ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
o ML
Trichloroethylene ❑MDL
❑ML
Vinyl chloride 0 MDL
Acid-Extractable Compounds
o ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol ❑MDL
0 ML
2,4-dichlorophenol ❑MDL
0 ML
2,4-dimethylphenol ❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
0 ML
2,4-dinitrophenol ❑MDL
0 ML
2-nitrophenol ❑MDL
❑ML
4-nitrophenol ❑MDL
0 ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
0 ML
2,4,6-trichlorophenol ❑MDL
Base-Neutral Compounds
ML
Acenaphthene ❑MDL
0 ML
Acenaphthylene ❑MDL
Anthracene 0 ML
❑MDL
Benzidine ❑ML
❑MDL
ML
Benzo(a)anthracene ❑MDL
0 ML
Benzo(a)pyrene ❑MDL
3,4-benzofluoranthene 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
0 ML
Benzo(ghi)perylene ❑MDL
Benzo(k)fluoranthene ❑ML
_ ❑MDL
ML
Bis(2-chloroethoxy)methane ❑MDL
Bis(2-chloroethyl)ether ❑ML
❑MDL
Bis(2-chloroisopropyl)ether ❑ML
❑MDL
Bis(2-ethylhexyl)phthalate ❑ML
❑MDL0 ML
4-bromophenyl phenyl ether ❑MDL
Butyl benzyl phthalate ❑ML
❑MDL
2-chloronaphthalene ❑ML
❑MDL
4-chlorophenyl phenyl ether ❑ML
❑MDL
0 ML
Chrysene ❑MDL
di-n-butyl phthalate ❑ML
❑MDL
di-n-octyl phthalate 0 ML
❑MDL
Dibenzo(a,h)anthracene 0 ML
❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ❑ML
❑MDL
Dimethyl phthalate ❑ML
❑MDL
2,4-dinitrotoluene ❑ML
_ ❑MDL
2,6-dinitrotoluene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
n ML
1,2-diphenylhydrazine 0 MDL
Fluoranthene ❑ML
❑MDL
❑ML
Fluorene ❑MDL
Hexachlorobenzene ❑ML
❑MDL
Hexachlorobutadiene ❑ML
❑MDL
0 ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane ❑ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene ❑MDL
0 ML
Isophorone ❑MDL
0 ML
Naphthalene ❑MDL
Nitrobenzene 0 ML
❑MDL
0 ML
N-nitrosodi-n-propylamine ❑MDL
0 ML
N-nitrosodimethylamine ❑MDL
0 ML
N-nitrosodiphenylamine 0 MDL
Phenanthrene ❑ML
❑MDL
0 ML
Pyrene ❑MDL
1,2,4-trichlorobenzene 0 ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 21

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EPA Identification Number NPDES Permit Number Facility Name Outlet!Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
gist) Value Units Value Units Samples Method1 (include units)
❑ No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 23

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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 Information
Test Number Test Number Test Number
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one: ❑ Grab ❑ Grab ❑ Grab
❑ 24-hour composite ❑ 24-hour composite ❑ 24-hour composite
Sample Location
Check one: 0 Before Disinfection 0 Before Disinfection ❑ Before disinfection
❑After Disinfection ❑After Disinfection ❑ After disinfection
❑ After Dechlorination ❑ After Dechlorination ❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute ❑Acute ❑ Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑Chronic ❑ Chronic ❑ Chronic
❑ Both ❑ Both 0 Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Test Type
Indicate the type of test performed.(Check one ❑ Static ElStatic 0 Static
response.)
❑ Static-renewal 0 Static-renewal ❑ Static-renewal
O Flow-through ❑ Flow-through , ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water 0 Laboratory water
one response.)
❑ Receiving water ❑ Receiving water ❑ Receiving water
If laboratory water,specify type.
If receiving water,specify source.
Type of Dilution Water _
Indicate the type of dilution water. If salt 0 Fresh water ❑ Fresh water 0 Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. 0 Salt water(specify) ElSalt water(specify) ElSalt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. ❑ pH ❑ Ammonia 0 pH ❑ Ammonia 0 pH 0 Ammonia
❑ Salinity 0 Dissolved oxygen ❑ Salinity 0 Dissolved oxygen 0 Salinity ❑ Dissolved oxygen
O Temperature ❑ Temperature ❑ Temperature
Acute Test Results
Percent survival in 100%effluent ok
LCso
95%confidence interval
Control percent survival
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC
IC25
Control percent survival
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? 0 Yes 0 No 0 Yes ❑ No 0 Yes ❑ No
Was reference toxicant test within
acceptable bounds? ElYes ❑ No ElYes ❑ No ❑ Yes ❑ No
What date was reference toxicant test run
(MMIDD/YYYY)?
Other(describe)
EPA Form 3510-2A(Revised 3-19) Page 27

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf 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 SIU SIU
Name of SIU
Mailing address(street or P.O.box)
City,state,and ZIP code
Description of all industrial processes that affect
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU. 9Pd gpd gpd
How much of the average daily volume is
attributable to process flow? gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? gpd gpd gpd
Is the SIU subject to local limits?
❑ Yes 0 No El Yes ❑ No ❑ Yes 0 No
Is the SIU subject to categorical standards?
❑ Yes 0 No ❑ Yes 0 No ❑ Yes 0 No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0064726 East Bend Industrial Park wwtf OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU SIU SIU
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19), Page 30

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East Bend Industrial Park WWTP Facility *
II Location
State Grid/USGS Quad: C16NE/East Bend
Receiving Stream: UT to Yadkin River
Lat.: 36°12'38"
North
Stream Class: WS-IV
Long.: 80°27'30" N P D E Yadkin
aPdekr mi n i County
0 6 4 7 2 6
Subbasin: 03-07-02