NC0020559_Historical_2011

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
October 5, 2011
THOMAS M SPAIN
DIRECTOR
HENDERSON WATER RECLAMATION FACILITY
PO BOX 1434
HENDERSON NC 27536
Dear Mr. Spain:
Dee Freeman
Secretary
Subject: Receipt of permit renewal application
NPDES Permit NCO020559
Henderson WRF
Vance County
The NPDES Unit received your permit renewal application on October 3, 2011. A member of the NPDES
Unit will review your application. They will contact you if additional information is required to complete your
permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing permit
expires.
If you have any additional questions concerning renewal of the subject permit, please contact Julie Grzyb at
[phone].
Sincerely,
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
Raleigh Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] Customer Service1877-623-6748 Nis Carolina
Internet: www.ncwaterqualq.org N� ����
An Equal Opportunity t Afamative Action Employer / `(

Nutbush Creek Wastewater Treatment Plant
Sludge Management Program
The primary, trickling filter secondary and aeration tank activated sludges are processed
through a dissolved air floatation unit and thickened to a range of 4% to 6% solids.
Approximately 9,000 gallons of sludge at 4% to 6% solids are produced daily.
The sludge is pumped to two pure oxygen aerobic digesters with an average detention time of
3.4 days.
The sludge is heated in these digesters to a range of 110 degrees F to 130 degrees F by an
autothermal biological reaction.
The sludge then enters a primary anaerobic digester with a boiler, recirculation and gas perth
mixing.
The sludge is digested at 95 degrees F to 99 degrees F for an average of 24.4 days in this
digester.
The sludge then enters a secondary anaerobic digester where supernatant is removed when
possible.
The sludge is further digested in this tank at 60 degrees F for an average of 19.3 days.
The sludge is then pumped to a 1,000,000 gallon sludge holding tank with an average detention
time of 75 to 100 days.
The stabilized sludge is land applied at agronomic rates to permitted farm land by a private
contractor, Granville Farms, Inc.
The sludge is analyzed periodically for total solids, total volatile solids and pH.
In addition, all of the required sludge permit analysis are performed quarterly and TCLP
annually.
Alum sludge from phosphorus removal may be generated in the final clarifiers but at present
Ferrous Sulfate added to the collection system is removing phosphorus.
If alum is used, this sludge will be digested in a new 1,000,000 gallon aerobic digester for
approximately 60 to 80 days and then it will be pumped to the 1,000,000 gallon sludge holding
tank and blended with the other sludges for land application.
The plant still has 31 sand drying beds that can be used to store sludge if needed. (`,

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FACILITY NAME AND PERMIT NUME_... I PERMIT ACTION RcmucSTED: I RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559 Permit Renewal
FORM
2A NPDES FORM 2A APPLICATION OVERVIEW
NPDES
APPLICATION OVERVIEW
Roanoke
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.
S. 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. CertNication. All applicants must complete Part C (Certification).
SUPPLEMENTAL APPLICATION INFORMATION:
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):
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.
E. 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.
F. Industrial User Discharges and RCRA/CERCLA Wastes. A treatment works that accepts process wastewater from any
significant industrial users (SIUs) or receives RCRA or CERCLA wastes must complete Part F (Industrial User Discharges
and RCRA/CERCLA Wastes). SIUs 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.
G. 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)
OCT 1 0 701) i OC 00 3 2011
EPA Form 3510-2A (Rev. 1-99). Replace EPA (arms 7550. _ ( I POINT SOURCE R;jA-"ge I of 44

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FACILITY NAME AND PERMIT NUMBI PERMIT ACTION RE iED: RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559 Permit Renewal Roanoke
BASIC APPLICATION INFORMATION
PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatinefit 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
Title Director of Henderson Water Reclamation Facility
Telephone Number (2521431-6081 Cell # (252) 4324547
Facility Address 1646 West Andrews Avenue
(not P O. Box) Hentlerson, NC 27536
A.2. Applicant Information. If the applicant is different from the above, provide the following:
Applicant Name
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 Pernms. Provide the permit number of any existing environmental permits that have been issued to the treatment works
(include state -issued permits).
NPDES NCO020559 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
entry 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
i6 DuDuO
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 44

FACILITY NAME AND PERMIT NUMB PERMIT ACTION RI RTED: RIVER BASIN:
Henderson Water Reclamation Facility, NCOO2O559 Permit Renewal I Roanoke
A.S. 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.S. 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 12'h month of "this year" occurring no more than three months prior to this application submittal.
a. Design flow rate 4.14 mgd
Two Years Ago Last Year This Year
b. Annual average daily flow rate 2.194 mqd 2.298 mqd 1,918 mqd
c. Maximum daily flow rate 7.410 mqd 9.630 mqd 5.905 mqd
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.
E] Separate sanitary sewer 100 %
❑ Combined storm and sanitary sewer 0 %
A.B. Discharges and Other Disposal Methods.
a. Does the treatment works discharge effluent to waters of the U.S.? Z Yes ❑ No
If yes, list how many of each of the following types of discharge points the treatment works uses-.
L Discharges of treated effluent
ii. Discharges of untreated or partially treated effluent
iii. Combined sewer overflow points
iv. Constructed emergency overflows (prior to the headworks)
0
V. Other NIA
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 No
If yes, provide the following for each surface impoundment:
Location: N/A
Annual average daily volume discharge to surface impoundments) mgd
Is discharge ❑ continuous or ❑ intermittent?
C. Does the treatment works land -apply treated wastewater? ❑ Yes No
If yes, provide the following for each land application she:
Location:
Number of acres:
Annual average daily volume applled to site: NIA mgd
Is land application ❑ continuous or ❑ intermittent?
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works? ❑ Yes �: No
EPA Forth 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 3 of 44

FACILITY NAME AND PERMIT NUME PERMIT ACTION R - _ _3TED: RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559 Permit Renewal Roanoke
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).
If transport is by a party other than the applicant, provide:
Transporter Name
Mailing Address
Contact Person N/A
Title
Telephone Number ( )
For each treatment works that receives this discharge, provide the following:
Name N/A
Mailing Address
Contact Person
Title
Telephone Number
If known, provide the NPDES permit number of the treatment works that receives this discharge N/A
Provide the average daily flow rate from the treatment works into the receiving facility. N/A mgd
e. Does the treatment works discharge or dispose of its wastewater in a manner not included
in A.8. through A.SA above (e.g.. underground percolation, well injection): ❑ Yes ® No
If yes, provide the following for each disposal method:
Description of method (including location and size of site(s) if applicable):
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 44

FACILITY NAME AND PERMIT NUME PERMIT ACTION R iTED: RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559 Permit Renewal Roanoke
WASTEWATER DISCHARGES:
If you answered "Yes" to question A.8.a, complete questions A.9 through 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
Aj,p go to Part B, "Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 mgd."
I A.9. Description of Outfall.
a. Outfall number
b. Location City of Henderson 27536
(City or town, ifapplicable) (➢p Code)
(County) (state)
360 21' 01" N 78° 24' 40" W
(Latitude) (Longitude)
C. Distance from shore (if applicable) N/A ft.
d. Depth below surface (if applicable)
e. Average daily flow rate
f. Does this oulfalt have either an intermittent or a periodic discharge?
If yes, provide the following information:
Number f times per year discharge occurs:
Average duration of each discharge:
Average flow per discharge:
Months in which discharge occurs:
g. Is oulfall equipped with a diffuser?
A.10. Description of Receiving Waters.
a. Name of receiving water
ft.
2.137 mgd
❑ Yes ® No (go to A.9.9.)
NIA
❑ Yes ® No
mgd
b. Name of watershed (f known) Nutbush Arm of Kerr Lake: Roanoke River Basin
United States Soil Conservation Service 14-digit watershed code (If known): 'NOTE: 14 Digit Code Not Assigned Yet.
C. Name of Stale 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 cis
e. Total hardness of receiving stream at critical low flow (if applicable):
rage of CaCO3
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 5 of 44

FACILITY NAME AND PERMIT NUMI
PERMIT ACTION F STED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
A.11. Description of Treatment
What level of treatment are provided? Check all that apply.
® Primary ® Secondary
2 Advanced i Other. Describe:
Indicate the following removal rates (as applicable)
Design SODS removal or Design CBOD5 removal 96.8 %
Design SS removal 85.0 %
Design P removal 90. %
Design N removal (convert NH-N to NOS 94.0 ^%
Other
What type of disinfection is used for the effluent from this outfall? If disinfection vanes by season, please describe:
Ultra Violet Liaht Disinfection System
_
If disinfection is by chlorination is dechlorination used for this oulfali? ❑ Yes N/A ❑ No
Does the treatment plant have Post aeration? ® Yes ❑ 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 date must comply with QA/QC requirements of
40 CFR Part 136 and other appropriate CA/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
MAXIMUM DAILY VALUE
AVERAGE DAILY VALUE
PARAMETER
Value
Units
Value
UnRs
Number of Samples
pH (Minimum)
6.3
S.U.
pH (Ma)dmum)
7.7
S.U.
Flow Rate
9.630
MGD
2.137
MGD
760
Temperature (Winter)
14.0
degrees C
16.4
degrees C
369
Temperature (Summer)
24.5
degrees C
22.7
degrees C
381
' For pH please report a minimum
and a maximum daily value
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY DISCHARGE
POLLUTANT
ANALYTICAL
ML/MDL
Conic.
Units
Cone.
Units
Number of
METHOD
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN
BOD5
5.4
mill
1.4
reign
760
Std. method 6210 B
2.0 mg/I
DEMAND( one)
CBOD5
FECAL COLIFORM
>23,100
Feca11100m9
6
FecaIr100m1
750
Std method 9222 D (MF)
1/100 ml
TOTAL SUSPENDED SOLIDS (rSS)
49.6
m /I
2.2
m a.
750
Sul method 2540 D
2.5 m ll
END OF PART A.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Fonn 3510-2A (Rev. 1.99). Replaces EPA forms 7550-6 8 7550.22. Page 6 cf 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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 2 0.1 mgd must answer questions B.1 through B.S. All others go to Part C (Certification).
B.1. Inflow and Infiltration. Estimate the average number of gallons per day that flow into the treatment works from inflow and/or infiltration.
250,000 gpd
Briefly explain any steps underway or planned to minimize inflow and infiltration.
The City of Henderson has spent approximate $1.0 million in the past two years repairing I & I problems and plans to
spend $1.0 million on I & I problems over the next 18 months.
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 outfalis from bypass piping, If applicable.
c. Each well where wastewater from the treatment plant is injected underground. N/A
d. Wells, springs, other surface water bodies, and drinking water wells that are: 1) within % 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.
I. 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. NIA
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.
SA. 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? Zi Yes ❑ No
If yes, list the name, address, telephone number, and status of each contractor and describe the contractors responsibilities (attach additional
pages if necessary).
Name: Andy Smith
Mailing Address: Granville Farms Inc.
PO Box 1396 Oxford, NC 27565
Telephone Number. [phone]
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 ❑ No
EPA Form 3510-2A (Rev. 1-9e). Replaces EPA forms 7550A & 7550-22. Page 7 of 44

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ENDERSON WATER RECLAMATION FACILITY
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FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
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.
Schedule Actual Completion
Implementation Stage MNVDD/YYYY MM/DDNYYY
- Begin Construction
- End Construction
- Begin Discharge
- Attain Operational Level
e. Have appropriate permihUclearances 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 include Information
on combine 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 analyles 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: 001
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY DISCHARGE
POLLUTANT
ANALYTICAL
MLIMDLits
Conc.
Units
Cone.
Un
Number of
METHOD
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA (as N)
1.7
mg/I
0.0
mg/I
750
Sid Meth 4500NH3L
0.1 mg/l
CHLORINE (TOTAL
RESIDUAL, TRC)
In priority pollutant scan but not run at any other time because we don't feed chlorine
.015 mg/I
DISSOLVED OXYGEN
14,0
mg/I
9.2
mg/I
750
Sid Meth 45000G
0.1 mgll
TOTAL KJELDAHL
20
mg/I
0.0
mg/I
72
Sid Meth 45000RG-C
0.5 mg/I
NITROGEN (TKN)
Sid Meth 4500 NHID
NITRATE PLUS NITRITE
NITROGEN
479
mg/1
36.2
mg/I
72
EPA353.2
0.02 mg/I
OIL and GREASE
Not required to run Oil and Grease by our permit
PHOSPHORUS (Total)
1.9
mg/I
07
mg/I
157
EPA 365.3
0.1 mg/I
TOTAL DISSOLVED SOLIDS
(TDS)
Not required to run TDS by our permit
OTHER COD
25
mg/I
0 0
^xq9
72
EPA 4104
25 mg/I
END OF PART B.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA For 3510-2A (Rev. 1-99). Replaces EPA fors 7550-6 & 7550-22. Page 8 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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:
❑ Basic Application Information packet Supplemental Application Information packet:
® Part D (Expanded Effluent Testing Data)
El Part E (Toxicity Testing: Biomonitoring Data)
® Part F (Industrial User Discharges and RCRA/CERCLA Wastes)
❑ Part G (Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the Information submitted. Based on my inquiry of the person or persons who
manage the system or those persons directly responsible for gathering the information, the information 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 Frank Fraziier. Assistant CityMana er
Signature 'AA,A' w41, ails
Telephone number [phone]
Date signed September 29, 2011
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:
NCDENR/ DWQ
Attn: NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
EPA Form 35104A (Rev. 1-99). Replaces EPA fortes 7550-6 s 7550-22, Page 9 of 44

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559 I Permit Rene I Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
I PART D. EXPANDED EFFLUENT TESTING DATA
I Refer to the dlreedons 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/OC 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 forth. 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.
Oudall number 001 (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE YUMLYTIC
DL
ANIETHOD L
Cone. Units Mass Units Cone. Units Mass Units N amolasf METHOD
Somglu
METALS (TOTAL RECOVERABLE), CYANIDE, PHENOLS, AND HARDNESS.
ANTIMONY
ND
mgL
ND
Ibs
NO
mgL
ND
Ibs
3
2008.
0.003
ARSENIC
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
36
31138
0.010
BERYLLIUM
ND
mgL
ND
Ibs
NO
mgL
NO
Ibs
3
200.8
0.002
CADMIUM
NO
mg1L
NO
Ibs
NO
mg/L
ND
Ibs
36
31136
0.001
CHROMIUM
NO
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
36
3113B
0.001
COPPER
0,013
mg/L
0.275
Ibs
0.007
mg/L
0.117
Ibs
156
3113B
0,002
LEAD
NO
mg/I
NO
Ibs
NO
mg/I
ND
Ibs
36
3113B
0.005
MERCURY
00000082
mg/L
0.000158
Ibs
00000022
mg/I
0000039
Ibs
156
EPPA1631
0.000001
NICKEL
0.007
mgL
0.095
Ibs
0.002
mg/1
0.032
Ibs
17
3113B
0.005
SELENIUM
ND
mgL
ND
Ibs
NO
mgL
NO
Ibs
36
3113B
0.010
SILVER
NO
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
16
3113B
0.004
THALLIUM
ND
mg/L
ND
Ibs
ND
mg/L
NO
Ibs
3
200.8
0.001
ZINC
0.057
mg/L
1,024
Ibs
0.021
mg/L
0.350
Ibs
156
3116/200.7
0.02510.010
CYANIDE
ND
mg/L
ND
Ibs
ND
mgL
ND
Ibs
3
335.3
0.005
TOTAL PHENOLIC
COMPOUNDS
0.0189
mg/L
0.3547
Ibs
0.0118
mg/L
0.2068
Ibs
3
SM510AB
0.005
HARDNESS (as CaCO3)
266
mg/L
4991
Ibs
199
mg/L
3513
Ibs
3
200.8
N/A
Use this space (or a separate sheet) to provide Information on other metals requested by the permit writer
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550.6 & 7550-22. Page 10 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
POLLUTANT
ANALYTICAL
MUMDL
Number
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
of
METHOD
Samples
VOLATILE ORGANIC COMPOUNDS
ND
mg/L
NO
Its
ND
mg/L
ND
Its
3
624
0.050
ACROLEIN
ND
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
624
0,050
ACRYLONITRILE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0.005
BENZENE
ND
mg/L
ND
Ibs
ND
mg/L
NO
Ibs
3
624
0.005
BROMOFORM
CARBON
ND
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
624
0.005
TETRACHLORIDE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Its
3
624
0.005
CHLOROBENZENE
CHLORODIBROMO-
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0.005
METHANE
NO
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
624
0.005
CHLOROETHANE
2-CHLOROETHYLVINYL
ND
mg/L
NO
Ibs
ND
mg/L
NO
lbs
3
624
0,010
ETHER
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
624
0,005
CHLOROFORM
DICHLOROBROMO-
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0,005
METHANE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0.005
1,1-DICHLOROETHANE
ND
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
624
0.005
1,2-DICHLOROETHANE
TRANS-I,2-DICHLORO-
ND
mg/L
ND
Ibs
NO
mg/L
NO
ibs
3
624
0.005
ETHYLENE
1,1-DICHLORO-
NO
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0.005
ETHYLENE
NO
mg/L
ND
Ibs
ND
mg/L
NO
Ibs
3
624
0.005
1,2-DICHLOROPROPANE
1,3-DICHLORO-
NO
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
624
0,005
PROPYLENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
624
0.005
ETHYLBENZENE
NO
mg/L
ND
Its
ND
mg/L
NO
Ibs
3
624
0.010
METHYL BROMIDE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
624
0.005
METHYL CHLORIDE
ND
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
624
0.005
METHYLENE CHLORIDE
1,1,2,2-TETRA-
NO
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
624
0.005
CHLOROETHANE
TETRACHLORO-
NO
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
624
0.005
ETHYLENE
ND
mg/L
ND
Ibs
NO
mg/L
NO
Its
3
624
0.005
TOLUENE
EPA Forrn 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 11 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:'
Roanoke
Outfall number. 001 (Complete once for each curtail discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILW36T24
YTICAL
MUMDL
Conc.
Units
Mass
Units
Conc.
Units
MassTHOD
1,1,1
TRICHLOROETHANE
ND
mg/L
NO
Ibs
ND
mg/L
ND624
0.010
TRICHLOROETHANE
TRIO
NO
mg/L
NO
Ibs
NO
mg/L
ND24
0.005
TRICHLOROETHYLENE
ND
mg/L
NO
Its
NO
mg/L
NO24
0,005
VINYL CHLORIDE
NO
mg/L
NO
be
NO
mg/L
ND
Ibs
3
624
0.005
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
mg/L
NO
Ibs
ND
mg/L
NO
Ibs
3
625
0.010
2-CHLOROPHENOL
NO
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
2,4-DICHLOROPHENOL
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0,010
2,4-DIMETHYLPHENOL
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
4,6-DINITRO-0-CRESOL
NO
mglL
ND
Ibs
ND
mg/L
NO
be
3
625
0.050
2,4-DINITROPHENOL
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0,050
2-NITROPHENOL
ND
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0,010
4-NITROPHENOL
NO
mg/L
ND
Ibs
NO
mg/L
ND
be
3
625
0.010
PENTACHLOROPHENOL
ND
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0.030
PHENOL
NO
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
2,4,6-
TRICHLOROPHENOL
NO
mg/L
ND
lbs
ND
mg/L
ND
Ibs
3
625
0.010
Use this space (or a separate sheet) to provide information on other acid -extractable compounds requested by the permit writer
SASE -NEUTRAL COMPOUNDS
ACENAPHTHENE
NO
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
ACENAPHTHYLENE
ND
mg/L
NO
Ibs
ND
mg/L
NO
Ibs
3
625
0.010
ANTHRACENE
ND
mg/L
ND
be
ND
mg/L
ND
Ibs
3
625
0.010
BENZIDINE
ND
mg/L
NO
Ibs
ND
mg/L
NO
Ibs
3
625
0.050
BENZO(A)ANTHRACENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
SENZO(A)PYRENE
NO
mg/L
NO
Ibs
NO
mg/L
NO
Ibs 1
3
625
0.010
EPA Form 3510-2A (Rev. 1-99) Replaces EPA forms 7550-6 & 7550-22. Page 12 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
Outlall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
POLLUTANT
Number
ANALYTICAL
MLIMDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
of
METHOD
Samples
RANT
FLUORANTHENE
ND
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0,010
BENZO(GHI)PERYLENE
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
BENZO(
FLUORANTHENE
ND
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
BIS (2-CHLOROETHOXY)
METHANE
NO
mg/L
NO
Ibs
NO
mg/L
8
NO
Ibs
3
625
0.010
BIS (2-CHLOROETHYL)-
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
ETHER
SIS(2-CHL-
PROPYL)ETHER
ETHER
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0,010
BIS (2-ETHYLHEXYL)
ND
mg/L
NO
Ibs
ND
mg/L
NO
Ibs
3
625
0.010
PHTHALATE
4-BROMOPHENYL
PHENYLETHER
ND
mglL
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
BUTYL BENZYL
PHTHALATE
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
2-CHLORO-
NAPHTHALENE
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
4-CHLORPHENYL
NO
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
PHENYLETHER
CHRYSENE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
DI-N-BUTYL PHTHALATE
ND
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0,010
DI-N-OCTYL PHTHALATE
ND
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0,010
DISENZO(A, H)
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
ANTHRACENE
1,2-DICHLOROBENZENE
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
1,3-DICHLOROBENZENE
ND
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
1,4-DICHLOROBENZENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
3,3-DICHLORO-
NO
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0.020
BENZIDINE
DIETHYL PHTHALATE
ND
mg/L
NO
Ibs
NO
mg/L
NO
Ibs
3
625
0.010
DIMETHYL PHTHALATE
NO
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
2,4-DINITROTOLUENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
2,6-DINITROTOLUENE
ND
mg/L
ND
tbs
ND
mg/L
ND
Ibs
3
625
0.010
1,2-DIPHENYL-
ND
mg/L
NO
Ibs
ND
mg/L
NO
Ibs
3
625
0.010
HYDRAZINE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 13 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMOL
Cone.
Units
Mass
Units
Cone.
Units
Mass
Units
Number
Of
Samples
FLUORANTHENE
NO
mg/L
ND
Ibs
ND
mg/L
NO
Ibs
3
625
0.010
FLUORENE
ND
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
HEXACHLOROBENZENE
NO
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
HEXA-
DIENE
BUTADIENE
ND
mg/L
NO
Ibs
NO
m g /L
ND
Ibs
3
625
0.010
HEXACHLOROCYCLO-
PENTADIENE
ND
mg/L
NO
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
HEXACHLOROETHANE
ND
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0.010
INDENO(1,2,3-CD)
PYRENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
ISOPHORONE
NO
mg/L
ND
Ibs
NO
mg/L
NO
Ibs
3
625
0,010
NAPHTHALENE
ND
mg/L
ND
Ibs
NO
mg/L
ND
lbs
3
625
0.010
NITROBENZENE
ND
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
N-NfTROSODI-N-
PROPYLAMINE
ND
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.020
N-NITROSODI-
METHYLAMINE
ND
mg
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0,010
N-NITROSODI-
PHENYLAMINE
NO
mg/L
ND
Ibs
ND
mg/L
ND
Ibs
3
625
0.020
PHENANTHRENE
NO
mg/L
NO
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
PYRENE
NO
mg/L
ND
Ibs
NO
mg/L
ND
Ibs
3
625
0.010
1,2,4
TRICHLOROBENZENE
ND
mg/L
ND
Ibs
ND
mg/L
NO
Ibs
3
625
0,010
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., pestici les) requested by the permh 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 14 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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 mild; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 401 or 3) POTWs required by the permitting authority to submit data for these parameters.
e 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 OA/OC 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-hait years revealed toxicity, provide any information on the cause of the toxicity or any results of a toxicity
reduction evaluation, if one was conducted.
e 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 EA for previously submitted information. If EPA methods were not used, report the reasons for using aftemate 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 forth to complete,
E.I. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
❑ chronic ❑ acute
E.L Individual Test Deft. Complete the following chart for each whole effluent toxicity test Conducted in the last four and one-half Years. Allow one
column per test (where each species constitutes a test). Copy this page it 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 di
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
< 24 hrs
< 24 hire
22 hrs
Otdfall number
001
001
001
Dates sample collected
01/09/07, 1/12107
4/10/07, 4/13/07
07110/07. 07/13/07
Date test started
01 /10/07
04/11 /07
07/11 /07
Duration
7 days
7 days
7 days
b. Gtve toxicity test methods followed.
Short -Term Methods for Estimating the
Short -Term Methods for Estimating the
Short Term Methods for Estimating the
Manual title
Chronic Toxicity of Effluents and Receiving
Chronic Toxicity of Effluents and Receiving
Chronic Toxicity W Effluents and Receiving
Waters to Freshwater Organisms 1002.0
Waters to Freshwater Organisms 1002 0
Waters to Freshwater Organisms 1002 0
Edition number and year of
Fourth, 2002
Fourth, 2002
Fourth, 2002
publication
Page numbers)
1-335
1-335
1-350
c. Give the sample collection methods) 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
X
X
X
After disinfection
After dechlodnation
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-5 & 7550-22. Page 15 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO02O559
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
I. 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
Yates Mill PoNd
Receiving water
i. Type of dilution water. If salt water, specify `naturar or type of artificial sea salts or brine used.
Fresh water
x
x
x
Safi water
j. Give the percentage effluent used for all concentrations in the test series.
15, 30, 45, 67.5, 90
15, 30, 45, 67.5, 90
15, 30, 45, 67.5, 90
k. Parameters measured during the test. (State whether parameter meets test method specificatiorrs)
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%
ef8uerd
%
%
%
LCss
95% C.I.
%
%
%
Control percent survival
%.
%
%
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 755M & 7550-22. Page 16 of 44

Other (describe)
FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
Chronic: Test 1 Test 2 Test 3
NOEC
>90 %
>90 %
>90 %
IC25
>90 %
>90 %
>90 %
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
Yes
Yes
Yes
acceptable bounds?
What date was reference toxicant test
01/09/07
04/03/07
07/18/07
run (MM/DD/YYYY)?
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes 0 No If yes, describe:
EA. Summary of Submitted Biomonitoring Test Information. If you have submitted biomonitoring test information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Date submitted: 09/29/2011 (MM/DD/YYYY)
Summary of results: (see instructions)
Tests conducted on 1 /10/07, 4/11_107 and 7/11/07. The NOEC for all three samples was >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 'arms 755D 6 & 7550-22 Page 17 of44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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 OA/OC requirements of 40 CFR Part 136 and other appropriate OA/OC
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 lt again. Rather, provide the information
requested in question EA 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 forth to
complete.
E.I. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
® chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half rears. Allow one
column per test (where each species 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 8 test method number
Ceriodaphnia dubia
Fathead Minnow
Ceriodaphnia dubla
Age at initiation of test
<24 hrs
22.25
< 24 fire
Outfall number
D01
001
001
Dates sample collected
1019/07, 10/12107
1018107, 10/10107, 10/12107
01115/08, 01118108
Date test started
10110/07
'10/09107
01116/08
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Short Term Method s for Estimating the Chronic
Short Term Methods for Estimating the
Chronic Toxicity of Effluents and
Shod -Term Methods far Estimating the
Chronic Toxicity of Effluents and Receiving
Manual floe
Toxicity Effluents and Receiving Waters to
Reca,ing Waters to Freshwater
waters to Freshwater Organisms 1 Ono 0
Freshwater Organisms 10e2 0
Organisms iD00.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 202
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
X
X
x
After disinfection
After dechlorination
EPA Form 3510-2A (Rev. 1-99), Repleoea EPA Arms 7550-6 8 7550-22. Par 19 Of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NC0020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 4 Test number. 6 Test number: 6
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
I. For each test, Include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
X
Acute toxicity
9. 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 saltwater, specify'natural° or type of artificial sea salts or brine used.
Fresh water
X
X
X
Sell 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
15, 30, 45, 67.5, 90
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specifications
Meets Specifications
Meets Specifications
Salinity
N/A
NIA
NIA
Temperature
Meets Specifications
Meets Specifications
Meets Specifications
Ammonia
N/A
NIA
NIA
Dissolved oxygen
Meets Specifications
Meets Specifications
Meets Specifications
I. Test Results.
Acute:
Percent survval in 100%
effluent
%
%
%
LCro
95%C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Forrn 3510-2A (Rev. 1-99)_ Replaces EPA forme 755OI 6 6 7550-22. Page 19 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NC0020559
Permit Renewal
Roanoke
Chronic: Test 4 Test 5 Test 6
NOEC
>100 %
>100 %
>90 %
ICE
>100 %
>100 %
>90 %
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
Yes
Yes
acceptable bounds?
What date was reference toxicant test
10/02/07
10/09/07
01/08/08
run (MM/DD/YYYY)?
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ® No If yes, describe:
EA. Summary of Submitted Biomonitoring Test Information. If you have submitted biomonitoring test information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Date submitted: 09/29/2011 (MM/DD/YYYY)
Summary of results: (see instructions)
Ceriodaphnia conducted 10/10/07, Fathead Minnow on 10/09/07 and Ceriodaohnia on 1/16/08 The NOEC results were
>100%. >100% and >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 20 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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
Part136 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 -halt 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 EA 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 biomonftoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the forth to Complete,
E.I. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
❑ chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
column per test (where each species 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
Fathead Minnow
Ceriodaphnia dubia
Age at initiation of test
<24
19.75
<24
Outfall number
001
001
001
Dates sample collected
04115108, 04/18/08
04114108, 04/16/08, 04/18/08
07/08/08, 07/11/08
Date test started
04116/08
04/15/08
07/09/08
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
ShortTomMethods for Estimating the
Short -Term Methods for Estimating the
shortTermMethods for Estimating the
Manual title
Chronic Toxicity of Effluents and Receiving
Chronic Toxicity of Effluents and Receiving
Chronic Toxicity of Effluents and Receiving
Waters to Freshwater Organisms 1002 0
Waters to Freshwater Organisms 10000
Waters to Freshwater Organisms 1002 0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page numbers)
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 rotation to disinfection. (Check all that apply for each.
Before disinfection
X
X
X
After disinfection
After dechlonnation
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550.22. Page 21 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCOO20559
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
I. For each test, include whether the test was Intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
X
X
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
X
X
Flow -through
h. Source of dilution water. If laboratory water, specify type; d receiving water, specify source.
Laboratory water
Soft Synthetic
Soft Synthetic
Soft Synthetic
Receiving water
i. Type of dilution water. If saltwater, specify 'natural" or type of artificial sea sags 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 Specification
Meets Specification
Meets Specification
Salinity
N/A
N/A
N/A
Temperature
Meets Specification
Meets Specification
Meets Specification
Ammonia
N/A
N/A
N/A
Dissolved oxygen
Meets Specification
Meets Specification
Meets Specification
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCW
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 9510-2A (Rev. 1-99). Replaces EPA forms 755M & 7550-22. Page 22 of 44

FACIUTY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
Chronic: Test 7
NOEC >100 %
Cz, >100 %
Control percent suMvai 100 %
PERMIT ACTION REQUESTED:
Permit Renewal
Test 8
>100 %
>100 %
100 %
RIVER BASIN:
Roanoke
Test 9
>100 %
>100 %
100 %
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Yes
Yes
Yes
Was reference toxicant test within
Yes
Yes
Yes
acceptable bounds?
What date was reference toxicant test
04/08108
04/15/08
07/08/08
nun (MM/DD/YYYY)?
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes a No If yes, describe:
EA. Summary of Submitted Btomonhoring Test Information. If you have submitted biomonitonng test information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Dale submitted: 09/29/2011 (MWDD/YYYY)
Summary of results: (see instructions)
Tests were Ceriodaohnia on 4/16/08, Fathead minnow on 4115108 and Ceriodaohnia on 7/9/08 NOEC were >100%
>100% and >100%
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. 149) Replaces EPA forms 7550-6 5 7550 22 Page 23 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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 poor 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.I. Required Tests.
Indicate the number of whole effluent toxicity tests Conducted in the past four and one-half years.
® chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
column per test (where each species 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
Fathead Minnow
Age at initiation of test
<24
<24
<24
Outfall number
001
001
001
Dates sample collected
1017108, 10/10108
1/12/09, 1116109
01/12/09, 01/14/09, 011/6/09
Date test started
10/08/08
1/14/09
01/13/09
Duration
7 days
7 days
7 days
b. Give toxicity test methods followed.
Short -Term Methods fort Estimating the
Chronic Toxicity of Effluents and
Shun -Term Methods for Estimating the
Chronic Toxicity of Effluents and
Shod -Term Methods for Estimating the Chronic
Manual titte
Receiving Waters to Freshwater
Receiving Waters to Freshwater
Toxmlty of Effluents and Receiving Waters to
Freshwater Organisms 10000
Organisms 1002.0
Organisms 10020
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
X
X
X
After disinfection
After dechlormation
EPA Form 3510.2A (Rev. 1-99). Replaces EPA forms 7550-6 6 7550-22. Page 24 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
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
I. 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 setts 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 Specification
Meets Specification
Meets Specification
Salinity
N/A
N/A
NIA
Temperature
Meets Specification
Meets Specification
Meets Specification
Ammonia
N/A
N/A
N/A
Dissolved oxygen
Meets Specification
Meets Specification
Meets Specification
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCw
96% C.I.
%
%
%
Control percent survival
%
%
%
Other(desaibe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 25 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NC0020559
Permit Renewal
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
Part136 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 blomonitoring 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 toxicity tests conducted in the past four and one-half years.
® chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half Years. Allow one
column per test (where each species 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
<24
<24
Outfall number
001
001
001
Dates sample collected
04/14/09, 04/17/09
7107/09, 7110109
10/06/09110/09109
Date test started
04/15/09
07/08/09
10/07/09
Duration
7 Days
7 Days
7 Days
b. Give toxicity test methods followed.
Short -Term Methods for Estimating the
Sham -Term Methods for Estimating the
Short -Term Methods for Estimating the
Manual title
Chronic Toxicity of Effluerns and Receiving
Chronic Toxicity of Efllllents and Receiving
Chronic Toxicity of Effluents and Receiving
Waters to Freshwater organisms 1 0020
Waters to Freshwater Organisms 1002 0
Waters to Freshwater 0r amsms 1002.0
Edition number and year of publication
Fourth, 2002
Page number(s)
1-335
1.335
1-335
c. Give the sample collection methods) 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
X
X
X
After disinfection
After dechlorination
EPA Form 3510.2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Pape 27 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
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 corrected
Efflulent
Effluent
Effluent
I. 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
Statio-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 metltod specifications)
pH
Meets Specification
Meets Specification
Meets Specitcation
Salinity
NIA
N/A
N/A
Temperature
Meets Specification
Meets Specification
Meets Specification
Ammonia
N/A
N/A
N/A
Dissolved oxygen
Meets Specification
Meets Specification
Meets Specification
i. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCw
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-8 & 7550-22. Page 28 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
Chronic:
NOEC
>100 %
>100 %
>100 %
ICs
>100 %
>100 %
>100 %
Control percent survival
100 %
100 %
100 %
Other (describe)
m. Quality ControVQuality, Assurance.
Is reference toxicant data available?
Yes
Yes
Yes
Was reference toxicant test within
Yes
Yes
Yes
acceptable bounds?
What date was reference toxicant test
04/14109
07/07/09
10/14/09
run (MM/DD/YYYY)?
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ® No If yes, describe:
EA. Summary of Submitted Biomontoring Test Information. If you have submitted biomonitodng test information, or information regarding the
cause of toxicity, within the past four and one -hat years, provide the dates the information was submitted to the permitting authority and a summary
Of the results.
Date submitted: 09/29/2011 (MM/DD/YYYY)
Summary of results: (see instructions)
Tests were run on Ceriodaphnia on 4/15/09 7/8 09 and 10/7/09 The NOEC results were >100% >100% and >100%.
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 fortes 7550-6 8 7550-22. Page 29 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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.
a 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 -had/ 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 EA for previously submitted information. If EPA methods were not used, report the reasons for using aflemale 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 bionnonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the torte to complete.
E.1. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
El chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half wears. Allow one
column per test (where each species 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
<24
<24
Outfall number
001
001
001
Dates sample collected
01/05/10, 01108/10
04/06110, 04/09/10
07120/11, 07/24/11
Date test started
01 /06/10
04/07/10
07/21110
Duration
7 days
7 days
6 days
It. Give toxicity test methods followed.
ShortTermMethods for Estimating the
Short-Tevo Methods for Estimating the
Shon-Term Mathode for Estimating the
Manual title
Chronic Toxicity of Effluents and Receiving
Chrome Toxicity of Effluents and Receiving
Chronic Toxicity of E10uerds and Receiving
waters to Freshwater Or anisms 1002.0
waters to Freshwater Organisms 1002.0
waters to Freshwater organisms 10020
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page nonber(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
X
X
X
After disinfection
After dechlonnation
EPA Form 3510-2A (Rev. 1-99). Replaces EPA fortes 7550-6 & 7550-22. Page 30 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Test number: 10 Test number: 17 Test number: 19
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
Ststicrrenewal
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
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 Method Specification
Meets Method Specification
Meets Method Specification
Salinity
N/A
NIA
NIA
Temperature
Meets Method Specification
Meets Method Specification
Meets Method Specification
Ammonia
NIA
NIA
N/A
Dissolved oxygen
Meets Method Specification
Meets Method Specification
Meets Method Specification
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
%
%
LCw
95% C.I.
%
%
%s
Control percent survival
%
%
%
Other (describe)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA fors 7550-6 d 7550-22, Page 31 of 44

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Henderson Water Reclamation Facility, NCO0200559 I Permit Renewal Roanoke
Chronic: Test 16 Test 17 Test 18
NOEC
>100 %
>100 %
>100 %
IC2s
>100 %
>100 %
>100 %
Control percent survival
100 %
100 %
100 %
Other (describe)
m. quality ControgOuallly, Assurance.
Is reference toxicant data available?
Yes
Yes
Yes
Was reference toxicant test within
Yes
Yes
Yes
acceptable bounds?
What date was reference toxicant test
01/05/10
04106/10
07/08110
run (MMIDD/YYYY)?
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ❑ No If yes, describe:
E.I. Summary of Submitted Biomonitoring Test Information. If you have submitted biomontoring lest information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Date submitted: 09/29/2011 (MMIDD/YYYY)
Summary of results: (see instructions)
Tests were run on Ceriodaohnia on 116110. 417/10, and 7/21/10%The NOEC results were >100%. >100% and >100%.
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Forth 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 8 7550-22. Page 32 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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 leafing 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
Part136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate CA/QC requirements for
standard methods for analyles 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 EA 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 biondonitoring data is required, do not Complete Part E. Refer to the Application Overview for directions on which other sections of the forth to Complete.
E.I. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
® chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half Years. Allow one
Column per test (where each species constitutes a test). Copy this page it more than three tests are being reported.
Test number: 19 Test number: 20 Test number. 21
a. Test information.
Test species &test method number
Fathead Minnow
Ceriodaphnia dubia
Ceriodaphnia dubia
Age at initiation of test
<24 hrs
<24 hrs
23.5
Outfall number
001
001
001
Dates sample collected
7120/10, 7/21110, 7123/10
10105110, 10/08/10
1111111, 1113111
Date test started
7120/10
1016110
1 /12/11
Duration
7 days
7 days
7 days
b. Give toxicity lest methods followed.
Short -Term Methods for Estimating this
ShortTermMethods for Estimating the
Chronic Toxicity of Effluents and Receiving
Short -Term Methods for Esnmatmg the
Chronic Toxicity of Effluents ad Receiving
MerUel title
Toxirify of EflWeMs and Receiving
Waters to Freshwater Organisms 1000 0
Waters to Freshwater Organisms 1002 0
Waters to Freshwater Organisms 1002 0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Fourth, 2002
Page numbers)
1-350
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
It
x
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
x
It
x
After disinfection
After dechiorinallon
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forma 7550.6 & 7550.22, Page 33 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Teat number: 19 Test number. 20 Tat number. 21
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
Effluent
I. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
x
x
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
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
Jordan Lake
Jordan Lake
I. Type of dilution water. If sah water, specify Inatural° or type of artftal sea salts or brine used.
Fresh water
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 Specification
Meets Specification
Meets Specification
Salinity
NIA
NIA
NIA
Temperature
Meets Specification
Meets Specification
Meets Specification
Ammonia
NIA
NIA
NIA
Dissolved oxygen
Meets Specification
Meets Specification
Meets Specification
I. Test Results.
Acute:
Percent survival in 100%
effluent
%
eye
%
Lceo
95% C.I.
%
%
%
Control percent survival
%
%
%
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550.E a 7550-22. Page 34 of 44

Other (describe)
FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
Permit Renewal
RIVER BASIN:
Roanoke
Chronic: Test 19 Test 20 Test 21
NOEC
>100 %
>100 %
>100 %
IC'
>100 %
>100 %
>100 %
Control percent survival
97.5 %
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)?
7/18/10
10/05/10
1/19/11
Other (describe)
E.3. Toxicityy Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ® No If yes, describe:
EA. Summary of Submitted Biomonitoring Test Information. If you have submitted bimmonitoring test information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Dale submitted: 09/29/2011 (MMIDD/YYYY)
Summary of results: (see Instructions)
Tests were run on Fathead minnow on 7/20/11 and Ceriodaohnia on 10/6/10 and 1 /12/11. The NOEC were >100%
>100% and >100%.
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 7550-8 8 755D-22. Page 35 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility. NCO020559
Permit Renewal
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 diluflon. 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 CWQC 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 EA for previously submitted information. If EPA methods were not used, report the reasons for using aflemate 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 forth to complete.
E.I. Required Tests.
Indicate the number of whole effluent toxicity tests conducted in the past four and one-half years.
❑ chronic ❑ acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half Years. Allow one column
per test (where each species constitutes a test). Copy this page If more than three tests are being reported.
Test number. 22 Test number. 23 Test number.
a. Test information.
Test Species Btest method number
Ceriodaphniaduble
Ceriodaphrlfadubia
Age at Initiation of test
<24 hours
<24 hours
Outfall number
001
001
Dates sample collected
4/06/11, 4109/11
7/12/11, 7/14111
Date test started
4/07111
7/13/11
Duration
7 days
7 days
b. Give toxicity test methods followed.
Shon-Term Methods for Estimating Me
Snort -Term Methods for Estimating the
Manual flg8
Chronic Toxicity of EfBuems and Receiving
Chronic Toxicity of Effluents and Receiving
Waters to Freshwater Organisms 1002 D
Waters to Freshwater Or nums 1002.0
Edition number and year of publication
Fourth, 2002
Fourth, 2002
Page number(s)
1-335
1-335
c. Give the sample milecflon method(s) used. For multiple grab samples, 'indicate the number of grab samples used.
24-Fburcomposfte
X
x
Grab
d. Indicate where the sample was taken in relation to dsinfecion. (Check all that apply for each.
Before disinfection
X
x
After disinfection
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 36 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED:
NCO020559
RIVER BASIN:
Roanoke
Test number. 22 Test number: 23 Tat number.
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
Effluent
Effluent
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
x
x
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
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
Receiving water
I. Type of dilution water. If sett water, specify "naturar or type of artificial sea salts or brine used.
Fresh water
x
x
San 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
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Meets Specification
Meets Specification
Salinity
NIA
NIA
Temperature
Meets Specification
Meets Specification
Ammonia
NIA
N/A
Dissolved oxygen
Meets Specification
Meets Specification
I. Test Results.
Acute:
Percent sur"I at in 100%
effluent
%
%
%
LGs
95% C.I.
%
%
%
Control percent survival
%
%
%
Other (describe)
EPA Fomr 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 37 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NC0020559
Permit Renewal
Roanoke
Chronic: Test 22 Test 23
NOEC
>100 %
>100
%
IC25
>100 %
>100
%
Control percent survival
100 %
100 %
%
Other (describe)
m. Quality ConlroliQuallty, Assurance.
Is reference toxicant data available?
Yes
Yes
Was reference toxicant test within
Yes
Yes
acceptable bounds?
What date was reference toxicant test
4/05111
7112111
I /
run (MWDD/YYYY)?
Other (describe)
E.A Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ® No If yes, describe:
E.A. Summary of Submitted Biomonitoring Test Information. If you have submitted biomonitoring test information, or information regarding the
cause of toxicity, within the past four and one-half years, provide the dates the information was submitted to the permitting authority and a summary
of the results.
Date submitted: 09/29/2011 (MM/DD/YYYY)
Summary of results: (see instructions)
Tests were run on Ceriodaphnia on 4/7/11 and 7/13/11. The NOEC results were >100% and >100%.
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 9510-2A (Rev. 1-99). Replaces EPA forms 7550-8 & 7550-22. Page 38 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
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, or other remedial wastes must
complete part F.
GENERAL INFORMATION:
F.I. Pretreatment program. Does the treatment works have, or is subject ot, an approved pretreatment program?
E Yes ❑ No
F.2. Number of Significant Industrial Users (SIUs) and Categorical Industrial Users (CIUs). Provide the number of each of the following types of
industrial users that discharge to the treatment works.
a. Number of non -categorical SIUs. 2
b. Number of CIUs. U
SIGNIFICANT INDUSTRIAL USER INFORMATION:
Supply the following Information for each SIU. N more than one SIU discharges to the treatment works, copy questions F.3 through F.8 and
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 dba Procter & Gamble Pet Care
Mailing Address: 845 Commerce Drive
Henderson, NC 27537
F.A. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
F.S. Principal Product(s) and Raw Malerlal(s). Describe all of the principal processes and raw materials that affect or contribute to the SIU's
discharge.
Pdncipal product(s): Pet Food
Raw material(s): Grains and meats
F.S. Flow Rate.
a. Process wastewater flow rate. Indicate the average daily volume of process wastewater discharge into the collection system in gallons per
day (gpd) and whether the discharge is continuous or intermittent.
38,000 gpd (X continuous or intermittent)
b. Non -process wastewater flow rate. Indicate the average daily volume of non -process wastewater flow discharged into the collection system
in gallons per day (gpd) and whether the discharge is continuous or intermittent.
19,000 gpd (X continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits E Yes ❑ No
b. categorical pretreatment standards ❑ Yes E 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 39 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
F.S. 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 ® No (go to F.12)
F.10. Waste transport Method by which RCRA waste is received (check all that apply):
❑ Truck ❑ Rail ❑ 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 activhies?
❑ Yes (complete F.13 through F.15.) ® No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLAIRCRAIor 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.1& 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 8 7550 22. Page 40 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART F.INDUSTRIAL USER DISCHARGES AND RCRAICERCLA WASTES
All treatment works reeelving discharges from significant industrial users or which receive RCRA,CERCLA, or other remedial wastes must
complete part F.
GENERAL INFORMATION:
FA. 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 (CIUS). Provide the number of each of the following types of
industrial users that discharge to the treatment works.
C. Number of non -categorical SIUs. 2
d. Number of CIUs. 0
SIGNIFICANT INDUSTRIAL USER INFORMATION:
Supply the following Information for each SIU. If more than one SIU discharges to the treatment works, copy questions F.3 through F.S and
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: Walmari Distribution Center
Mailing Address: 680 Vanco Mill Road
Henderson. NC 27537
FA. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
None — Cold Food Storage
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw matenals that affect or contribute to the SIU's
discharge.
Principal product(s): Refrigeration and distribution of food includes truck maintenance facility
Raw matenal(s): __..
F.S. Flow Rate.
C. Process wastewater flow rate. Indicate the average daily volume of process wastewater discharge into the collection system in gallons per
day (gpd) and whether the discharge is continuous or intermittent.
n1a gpd ( continuous or intermittent)
d. Non -process wastewater flow rate. Indicate the average daily volume of non -process wastewater flow discharged into the collection system
in gallons per day (gpd) and whether the discharge is continuous or intermittent.
23 2d0 gpd (X continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ❑1 Yes ❑ No
b. Categorical pretreatment standards ❑ Yes E No
If subject to categorical pretreatment standards, which category and subcategory?
EPA Form 3510-2A (Rev. 1-99). Replaces EPA fors 7550-6 d 7550-22. Page 41 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NCO020559
Permit Renewal
Roanoke
F.S. 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 E No If yes, describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.S. 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 E No (go to F.12)
F.10. Waste transport Method by which RCRA waste is received (check all that apply),
❑ Truck ❑ Rail ❑ 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. Remedlatlon Waste. Does the treatment works currently (or has I been notified that tt wig) receive waste from remedial activities?
❑ Yes (complete F.13 through F.15.) E 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 origniale in
the next five years).
F.14. Pollutants. List the hazardous constituents that are received (or are expected to be received). Indude data on volume and concentration, if
known. (Attach additional sheets if necessary.)
F.15. Waste TrsstmerM.
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 ❑ 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 42 of 44

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Henderson Water Reclamation Facility, NC0020559
Permit Renewal
Roanoke
SUPPLEMENTAL APPLICATION INFORMATION
PART G. COMBINED SEWER SYSTEMS
If the treatment works has a combined sewer system, complete Part G.
G.I. System Map. Provide a map indicating the following: (may be included with Basic Application Information)
a. All CSO discharge points.
b. Sensitive use areas potentially affected by CSOs (e.g., beaches, drinking water supplies, shellfish beds, sensitive aquatic ecosystems, and
outstanding natural resource waters).
C. Waters that support threatened and endangered species potentially affected by CSOs.
G.2. System Diagram. Provide a diagram, either in the map provided in G. i or on a separate drawing, of the combined sewer collection system that
includes the following information.
a. Location of major sewer trunk lines, both combined and separate sanitary.
b. Locations of points where separate sanitary sewers feed into the combined sewer system.
C. Locations of in -line and off-line storage structures.
d. Locations of flow -regulating devices.
e. Locations of pump stations.
CSO OUTFALLS:
Complete questions G.3 through GA once for each CSO discharge point.
G.3. Description of Outfall.
a. Outfall number N/A
b. Location N/A
(City or town, If applicable) (Zip Code)
N/A
(County) (State)
N/A
(Latitude) (Longitude)
C. Distance from shore (if applicable) N/A ft.
d. Depth below surface (if applicable) N/A R.
e. Which of the following were monitored during the last year for this CSO?
❑ Rainfall ❑ CSO pollutant concentrations ❑ CSO frequency
❑ CSO flow volume ❑ Receiving water quality
f. How many storm events were monitored during the last year? N/A
GAL CSO Events.
a. Glee the number of CSO events in the last year.
N/A events (❑ actual or ❑ approx.)
b. Give the average duration per CSO event.
N/A hours (❑ actual or ❑ approx.)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA fors 7550-8 & 7550-22. Page 43 of 44

FACILITY NAME AND PERMIT NUMBER:
Henderson Water Reclamation Facility, NCO020559
PERMIT ACTION REQUESTED: RIVER BASIN:
Permit Renewal Roanoke
C. Give the average volume per CSO event.
NA million gallons (❑ actual or ❑ appmx.)
d. Give the minimum rainfall that caused a CSO event in the last year
N/A Inches of rainfall
G.S. Description of Racetving 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).
NIA
END OF PART G.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Forth 3510-2A (Rev. 1-99). Replaces EPA forms 7550-5 & 7550-22. Page 44 of 44