NC0021709_Renewal (Application)_20160115

Town of Jefferson Water Re OU.Yce�
P.O. Box 67 1233 NC Highway 16 South Jefferson, NC 28640 [phone]
Cathy Howell, Town Manager Tim Church, Director
January 12, 2016
RECEIVED/NCDEQ/D11VR
NC DEQ JAN 1 5 1016
Attn: NPDES Unit Permitting
a ptai
1617 Mail Service Unit
Raleigh, North Carolina 27699-1617
SUBJECT: Renewal Application for NPDES NC0021709
Town of Jefferson WWTP : Ashe County
Dear Staff:
Please find enclosed the renewal application for NPDES Permit NC0021709 held
by the Town of Jefferson WWTP. If you have questions or require additional
information please call me at(336) 246-2165 or contact by e-mail at
jeffwns(aicenturylink.net.
Repectfully,
(1110/CAL
Tim Church
Water Resources Director
Town of Jefferson
[e-mail]

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Je-cf ecs'0 i/00021704 Renewal New
FORM -F_
2A S FORM 2A APPLICATION OV , - -
NPDES
-
APPLICATION OVERVIEW
Form 2A has been developed in a modular format and consists of a "Basic Application Information" packet
and a "Supplemental Application Information" packet. The Basic Application Information packet is divided
into two parts. All applicants must complete Parts A and C. Applicants with a design flow greater than or
equal to 0.1 mgd must also complete Part B. Some applicants must also complete the Supplemental
Application Information packet. The following items explain which parts of Form 2A you must complete.
BASIC APPLICATION INFORMATION:
A. Basic Application Information for all Applicants. All applicants must complete questions A.1 through A.8. A treatment works
that discharges effluent to surface waters of the United States must also answer questions A.9 through A.12.
B. Additional Application Information for Applicants with a Design Flow>0.1 mgd. All treatment works that have design flows
greater than or equal to 0.1 million gallons per day must complete questions B.1 through B.6.
C. Certification. All applicants must complete Part C (Certification). RECEIVED/NCDEQ/DWR
SUPPLEMENTAL APPLICATION INFORMATION: JAN 1 5 2016
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waterwit >1ed States and meets
one or more of the following criteria must complete Part D(Expanded Effluent Testing Data):p ,jpj Section
1. Has a design flow rate greater than or equal to 1mgd,
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)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22 Page 1 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
3effe r. NCo02.17e Renewok, Nt.vJ
BASIC APPLICATION INFORMATION
PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatment works must complete questions A.1 through A.8 of this Basic Application Information Packet.
A.1. Facility Information. T
Facility Name IOWIC of Jef{ erson WWTP
Mailing Address PO jOX. '`
S,f f erson ) NC 2 (A0
Contact Person Tm Church,
Title \/lakes Resources DireG- or
Telephone Number 1336 2!410 - 2,1(05 L RECEIVED/NCD�DwR
Facility Address 12,33 1419hw ICo S k JAN I 5 1016
(not P.O. Box) e rstsn NC Z,9410
Water Quality
A.2. Applicant Information. If the applicant is different from the above, provide the following: Permitting Section
Applicant Name Vasdl 1Qi
Mailing Address
Contact Person
Title
Telephone Number ( )
Is the applicant the owner or operator(or both)of the treatment works?
owner operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
❑ facility applicant
A.3. Existing Environmental Permits. Provide the permit number of any existing environmental permits that have been issued to the treatment works
(include state-issued permits).
NPDES NCOO 3'1?Q PSD
UIC Other
RCRA Other
A.4. Collection System Information. Provide information on municipalities and areas served by the facility. Provide the name and population of each
entity and,if known, provide information on the type of collection system(combined vs.separate)and its ownership(municipal, private,etc.).
Name Population Served Type of Collection System Ownersh.
JP_Wer SW. FCC, SAr;kavy Yo
r'eccersor, Lardin5 yoo Sari-k-ary LT. L. Golf
Total population served IS co
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 2 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Oe.-cf-ecsoy, t tC o02.170q Renew0 Neta)
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
Title
Telephone Number j )
For each treatment works that receives this discharge, provide the following:
Name
Mailing Address
Contact Person
Title
Telephone Number j
If known,provide the NPDES permit number of the treatment works that receives this discharge
Provide the average daily flow rate from the treatment works into the receiving facility. mgd
e. Does the treatment works discharge or dispose of its wastewater in a manner not included
in A.B.through A.8.d above(e.g., underground percolation,well injection): ❑ Yes [E(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:
Is disposal through this method ❑ continuous or ❑ intermittent?
EPA Form 3510-2A(Rev. 1-99). Replaces EPA forms 7550-6&7550-22. Page 4 of 22

[ACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jcccsor.
N COc2,170q Renevic X 1Je.W
A.5. Indian Country.
a. Is the treatment works located in I dian 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 CJ No
A.6. Flow. Indicate the design flow rate of the treatment plant(i.e.,the wastewater flow rate that the plant was built to handle). Also provide the
average daily flow rate and maximum daily flow rate for each of the last three years. Each year's data must be based on a 12-month time period
with the 12th month of"this year"occurring no more than three months prior to this application submittal.
a. Design flow rate 0. 700 29 mgd
Two Years Ago Last Year This Year
b. Annual average daily flow rate O. 306 mgd. 0. MI/ m,94 0.210 mgd.
c. Maximum daily flow rate 0. '130 filth 0_3118, t 0.31405d-
A.7.
.3YQ 05(A..
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. //y�
Separate sanitary sewer / Il LI(
❑ Combined storm and sanitary sewer °k
A.8. Discharges and Other Disposal Methods.
a. Does the treatment works discharge effluent to waters of the U.S.? E Yes ❑ No
If yes, list how many of each of the following types of discharge points the treatment works uses:
i. Discharges of treated effluent 1
ii. Discharges of untreated or partially treated effluent 0
iii. Combined sewer overflow points 0
iv. Constructed emergency overflows(prior to the headworks) 0
v. Other 0
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.? 0 Yes No
If yes,provide the following for each surface impoundment:
Location:
Annual average daily volume discharge to surface impoundment(s) mgd
Is discharge 0 continuous or ❑ intermittent?
c. Does the treatment works land-apply treated wastewater? [Jf Yes ❑ No
If yes, provide the following for each land
application site:
/ 1 SI�d9�
Location: 7� ( Dbn1 Wci+ers Dd.
Number of acres:
Annual average daily volume applied to site: U. 06 21 mgd
Is land application ❑ continuous or Tr
intermittent?
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works? 0 Yes dNo
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 3 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jef[erso NC , 3ZI7CA � Rer e.Wat New
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
A.8.a,go to Part B,"Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 mgd."
A.9. Description of Outfall.
a. Outfall number Obi
b. Location SeSk('SOR, 2,200
(City or town,if applicable) (Zip Code)
Ashe WC/
(County) (State)
3(.1109 8/. 12g
(Latitude) /] (Longitude)
c. Distance from shore(if applicable) N//n1 ft.
d. Depth below surface(if applicable) N'/'t ft.
e. Average daily flow rate 0.210 mgd
f. Does this outfall have either an intermittent or a periodic discharge'? ❑ Yes 1/No (go to A.9.g.)
If yes, provide the following information:
Number f times per year discharge occurs:
Average duration of each discharge:
Average flow per discharge: mgd
Months in which discharge occurs:
g. Is outfall equipped with a diffuser'? ❑ Yes I2(No
A.10. Description of Receiving Waters. ,,,� LL Greek
a. Name of receiving water Nc ke .
b. Name of watershed(if known)
United States Soil Conservation Service 14-digit watershed code(if known):
c. Name of State Management/River Basin(if known): NeW
United States Geological Survey 8-digit hydrologic cataloging unit code(if known):
d. Critical low flow of receiving stream(if applicable)
acute cfs chronic cfs
e. Total hardness of receiving stream at critical low flow(if applicable): mg/I of CaCO3
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 5 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jed-cc-KS(Sy NM:2_170 Re.r‘ k.k
A.11. Description of Treatment
a. What level of treatment are provided? Check all that apply.
❑ Primary ❑ Secondary
[✓(Advanced ❑ Other. Describe:
b. Indicate the following removal rates(as applicable): (,1
Design BOD5 removal or Design CBOD5 removal 5 %Q1
Design SS removal /�t5 %
Design P removal 4S %
Design N removal
I `
Other
c. What type of disinfection is used for the effluent from this outfall? If disinfection varies by season, please describe:
C.hltt I(It s
If disinfection is by urination is dechlorination used for this outfall? /Yes ❑ No
Does the treatment plant have post aeration? [P"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 data must comply with QA/QC requirements of
40 CFR Part 136 and other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a
minimum,effluent testings� data must be based on at least three samples and must be no more than four and one-half years apart.
Outfall number OD
MAXIMUM DAILY VALUE AVERAGE DAILY VALUE
PARAMETER
Value Units Value Units Number of Samples
pH(Minimum) •q s.u.
pH(Maximum) 7 0 S.U.
Flow Rate 0.570 m' - 0.250 m9ct 1.030•
Temperature(Winter) /7. Ci 10.2 OG 1003,
Temperature(Summer) 2S C O C lq.lp 0c l(03
•For pH please report a minimum and a maximum daily value
MAXIMUM DAILY AVERAGE DAILY DISCHARGE
DISCHARGE • ANALYTICAL
POLLUTANT METHOD MUMDL
Conc. Units Conc. Units Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN BOD5 G.(0 TY1,9/L 3.0 "1/i 4112. SA 521013
DEMAND(Report one) CBOD5 /
FECAL COLIFORM .328 /boo ml. 31. //OO SI t'AA`• 1(�'.9' T
v u
TOTAL SUSPENDED SOLIDS(TSS) '7 /L < 5. ^''9/4, ; 4-11z, SM z 10
END OF PART A.
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 6 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Je ecsol, N CoC12,1709 Re ne wckk Nem/
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>Od must answer questions B.1 through B.6. All others go to Part C(Certification).
B.1. Inflow and Infiltration. Estimate the average number of gallons per day that flow into the treatment works from inflow and/or infiltration.
15,QOD gpd
Briefly explain any steps underway or planned to minimize inflow and infiltration.
Linse * Camera Fo iden1-t y I/I Sources.
Se,alln3 ►n+er►or walls of problem manholes.
B.2. Topographic Map. Attach to this application a topographic map of the area extending at least one mile beyond facility property boundaries. This
map must show the outline of the facility and the following information. (You may submit more than one map if one map does not show the entire
area.)
a. The area surrounding the treatment plant, including all unit processes.
b. The major pipes or other structures through which wastewater enters the treatment works and the pipes or other structures through which
treated wastewater is discharged from the treatment plant. Include outfalls from bypass piping,if applicable.
c. Each well where wastewater from the treatment plant is injected underground.
d. Wells,springs,other surface water bodies,and drinking water wells that are: 1)within V.mile of the property boundaries of the treatment
works, and 2)listed in public record or otherwise known to the applicant.
e. Any areas where the sewage sludge produced by the treatment works is stored,treated,or disposed.
f. If the treatment works receives waste that is classified as hazardous under the Resource Conservation and Recovery Act(RCRA)by truck,rail,
or special pipe,show on the map where the hazardous waste enters the treatment works and where it is treated,stored,and/or disposed.
B.3. Process Flow Diagram or Schematic. Provide a diagram showing the processes of the treatment plant,including all bypass piping and all
backup power sources or redunancy in the system. Also provide a water balance showing all treatment units,including disinfection(e.g.,
chlorination and dechlorination). The water balance must show daily average flow rates at influent and discharge points and approximate daily flow
rates between treatment units. Include a brief narrative description of the diagram.
B.4. Operation/Maintenance Performed by Contractor(s).
Are any operational or maintenance aspects(relaVd to wastewater treatment and effluent quality)of the treatment works the responsibility of a
contractor? ❑ Yes m No
If yes,list the name.address,telephone number,and status of each contractor and describe the contractor's responsibilities(attach additional
pages if necessary).
Name:
Mailing Address:
Telephone Number: ( )
Responsibilities of Contractor:
8.5. 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.
b. Indicate whether the planned improvements or implementation schedule are required by local,State, or Federal agencies.
❑ Yes ❑ No
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6 8 7550-22. Page 7 of 22

B.2. Topographic Map
a. Quad Map included
b. indicated
c. No injection wells
d. Naked Creek is the receiving stream and lies adjacent to WWTP.
No wells or springs within 1/4 mile of this site.
e. Land Application sites are indicated on the Quad map
f No RCRA wastes involved RECEIVED/NCDEQ/DWR
JAN 1 5 2016
B.3. Process Flow Diagram
Water QuillIty
Permitting secfion
An automatic bar screen precedes a wet well serviced by 4 influent pumps. Biological
treatment is provided by an oxidation ditch where a MLSS level of approximately 2500
mg/I is routinely maintained. From the oxidation ditch, flow is split between two circular
clarifiers by a divider box. A duplex pump station receives sludge flow from the two
clarifiers and is designed to allow return sludge to the oxidation ditch, or waste sludge to
twin sludge basins. The clarifiers discharge to dual traveling bridge multimedia tertiary
filters. The backwash water from the filters flows by gravity to the influent wet well.
From the filters, flow continues to the chlorination basin and disinfection is
accomplished by Chlorine gas. The effluent flow measurement device is located prior to
a 90 degree v-notch weir at the end of the disinfection process. A dechlorination
solution of sodium thiosulfate enters just behind the weir. Flow passing over the weir
enters a final aeration basin, allowing enhanced dechlorination and increased dissolved
oxygen content for the final effluent.
Biosolids management is provided under both Class A dry and Class B liquid programs.
The bulk of the plant's sludge is disposed by trucking liquid sludge to 43 acres of hay and
pasture land located approximately 2 miles from the WWTP. When freezing and/or wet
conditions prevent access to farmland, dry sludge is produced using a belt press and
propane sludge dryer.
Waste sludge is pumped to twin sludge basins 120,000 gallons in capacity. Each is
equipped with telescopic valves that allow gravity thickening/dewatering of the sludge.
The decant water from the sludge basins flows by gravity to the influent wet well.
From these basins sludge is pumped to another aerobic digester 65,000 gal. in capacity.
It also has dewatering capability. Sludge from that unit flows by gravity to a truck
loading station that holds 25,000 gallons. From the station, sludge can either be pumped
directly into the tanker truck, or to the belt press in the solids processing building.

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FACILITY NAME AND PERMIT NUMBER: I I PERMIT ACTION
TIION REQUESTED: RIVERBASIN:
II ' iii. Coo2ReMAI70(�l -- i I Ne
c. If the answer to B.5.b is"Yes,"briefly describe, including new maximum daily inflow rate(if applicable).
H/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 MM/DD/YYYY MM/DD/YYYY
-Begin Construction / / / /
-End Construction / / / /
-Begin Discharge / / / /
-Attain Operational Level / I / /
e. Have appropriate permits/clearances concerning other Federal/State requirements been obtained'? ❑ Yes ❑ No
Describe briefly:
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 analytes not addressed by 40 CFR Part 136. At a minimum effluent testing data must be
based on at least three pollutant scans and must be no more than four and on-half years old.I
Outfall Number: 001
MAXIMUM DAILY AVERAGE DAILY DISCHARGE •
DISCHARGE ANALYTICAL
POLLUTANT Number METHOD ML/MDLConc. I Units Conc. Units Samples
f
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA(as N) 0.5 " /L < 0.2, 3,L 141 I S/1050o F o.
CHLORINE
RESIDUAL,TRC)AL 417 P•5/1.., 22,, /1/t 112, Sp e k 20
DISSOLVED OXYGEN f (- a/L 7.g M9/j. j1 Z sM 4z,,2 F 0.t
NITROGENTOTAL (TDKN)AHL ('7p•�•w m!/� g.3 1/19/L Co SM I q11.503 N o•
NITRATE PLUS NITRITE 13.Coci�L 6. 5, '"9/L 0o SMjg4SOo N o. o?
NITROGEN J 5r�
OIL and GREASE 2. ms/L 1•g mg/` 3 sjigsSzo a 1 .
PHOSPHORUS(Total) 1.2 MI jL 2.3 'II IL_ Co EPA z.0o.7 0. 0Z _
TOTAL DISSOLVED SOLIDS Zi12 Mi/L MI NI Sit-
3 SM`p 51(13 G
OTHER
END OF PART B.
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 8 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
,TfftisTE\ N C00 ai701 Renewal Nell)
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 Suppl mental Application Information packet:
art D(Expanded Effluent Testing Data)
LI! 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.
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who
manage the system or those persons directly responsible for gathering the information,the information is,to the best of my knowledge and belief,true,
accurate,and complete. I am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment
for knowing violations.
Name and official title `Tim (k1J Wait( Resoiirc ..s
Signature .Tynr` 4 /
Telephone number (3) 2i, 'i t0 E
Date signed 111/t
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 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 9 of 22

FACILITY NAME AND PERMIT NUMBER: PE IT ACTION REQUESTED: RIVER BASIN:
jefiffSerN WO ' CO 2,I70R eta Ntw
SUPPLEMENTAL APPLICATION INFORMATION
PART D. EXPANDED EFFLUENT TESTING DATA
Refer to the directions on the cover page to determine whether this section applies to the treatment works.
Effluent Testing: 1.0 mgd and Pretreatment Works. If the treatment works has a design flow greater than or equal to 1.0 mgd or it has(or is required
to have)a pretreatment program,or is otherwise required by the permitting authority to provide the data,then provide effluent testing data for the following
pollutants. Provide the indicated effluent testing information and any other information required by the permitting authority for each outfall through which
effluent is discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data collected
through analyses conducted using 40 CFR Part 136 methods. In addition,these data must comply with QA/QC requirements of 40 CFR Part 136 and
other appropriate QA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. Indicate in the blank rows provided below
any data you may have on pollutants not specifically listed in this form. At a minimum,effluent testing data must be based on at least three pollutant
scans and must be no more than four and one-half years old.
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL MUMDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
METALS(TOTAL RECOVERABLE),CYANIDE,PHENOLS,AND HARDNESS. /y�y
ANTIMONY < 01
M3 f <0/ WL 3 EPA 2UJ
/
ARSENIC (..01 JL1•• x.01 mVA. 3 FPA 2(0.7
BERYLLIUM < 02 )) <. Qz, mg/L 3 EPA 2.0o.7
CADMIUM < .05D2., )) < .000Z 9'/L I 3G EPA Z00'7
I
CHROMIUM <.001 " C W1 m9/z, 3 EPA Z50.7
COPPER .006 )) .005 rn9/L N EPA al
LEAD ‹.01 ') < 0/ k, 360 EPi4 ,CAN/
MERCURY ( .0001 )9 (. 000/ l"'lL 8 EPR 245.1
NICKEL •001 fl W( tri-g/L 3 EPA 203.7
SELENIUM <.01 " <.of "le//L 3 EPA 2,0a7
SILVER .001, n <. YJ PI// 3 EPAzOO.7
THALLIUM <.of )) <00/ m9/,(, 3 EPA Z40.7
ZINC • 071 » :.0''/2L 5/t IA/ EPR 2110.7
CYANIDE .008 " <.005 J// 36 gm 19 ilso]I t
COMPOUNDS
TOTAL
PHENOLIC I.01 1f <.01 /j 3 EPA '20.1
HARDNESS(as CaCO3)
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 22

FACILITY rrINAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
JCSMA M NcOOZ I70q Renewal Nein
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL MUMDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
VOLATILE ORGANIC COMPOUNDS
ACROLEIN <MAL ''g/. <AL 3/L 3 FPA. (oz'I
ACRYLONITRILE <AL /I L1 r/, 3 EPA Coe
BENZENE )1 1f 1✓ ), r 0 EPA i
BROMOFORM f ff 1f 1) 11 fl
CARBON )' )1 )� )' )) ))
TETRACHLORIDE
CHLOROBENZENE )1 pp 1f )1 ))
CHLORODIBROMO-
METHANE )) )f » 1) )f ))
CHLOROETHANE )1 f) » )1 )f )P
2-CHLOROETHYLVINYL )) )) 0 » )) ff
ETHER
CHLOROFORM •013 " 4 11 4 1)
DICHLOROBROMO-
METHANE /JtQL�,IAI ') f1 )) » 1'
1,1-DICHLOROETHANE )) )1 )) 11 f) 11
1,2-DICHLOROETHANE )) )) 1 1) )) )I I)
TRANS-I2-DICHLORO- )) )) ') » )) ))
ETHYLENE
1,1-DICHLORO- ►) >s )) » H f1
ETHYLENE
1,2-DICHLOROPROPANE )) )) H )1 ft P)
1,3-DICHLORO- )) )) » )) )) ')
PROPYLENE
ETHYLBENZENE f) )f f) )1 0 ))
METHYL BROMIDE ft 11 f) ft f) f)
METHYL CHLORIDE )) 0 » )) ff 0
METHYLENE CHLORIDE f) 1) 12 )) ff »
1,1,2,2-TETRA- )) to f) f1 f) f)
CHLOROETHANE
TETRACHLORO- )) 11 I/ )) )) ))
ETHYLENE
TOLUENE )) 1) f) 0 33 f)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22 Page 11 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Je elcson NCUc 2 1704 Rerie,uo . NEW
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL ML/MDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples .(/�
TRICHLOROETHANE <�t�1 L h13 ., <HJL 3 EPA 62
TRICHLOROETHANE (MQ' 113/1. <MIL 3 EPrq 62y
TRICHLOROETHYLENE <Ml. - I < a, 3 EPA £2Y
VINYL CHLORIDE (/ Id "3/L <MQL 3 LPA or
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 <MQL 5IL (btu_ I 3 EPA 66
2-CHLOROPHENOL )3 )) </tIQL, 3 EPA 64
2,4-DICHLOROPHENOL )) f <MQL 3 EPA 1625
2,4-DIMETHYLPHENOL 1h )) 1) 3 »
4,6-DINITRO-O-CRESOL )) f) )) 3 !,)
2,4-DINITROPHENOL )) )3 PI 3 ,,
2-NITROPHENOL $) )) )) 3 ))
4-NITROPHENOL sl )) )) 3 ),
PENTACHLOROPHENOL )) ), ,, 3 ))
PHENOL •010 n/L )) 3 )!
2,4,6-
)) )0 )) 3 0)
TRICHLOROPHENOL
Use this space(or a separate sheet)to provide information on other acid-extractable compounds requested by the permit writer
BASE-NEUTRAL COMPOUNDS
ACENAPHTHENE (/L m9/II..
(MQL 3 EPACZ
ACENAPHTHYLENE J )) (moi, 3 EPA42-5
ANTHRACENE )J )) <M . 3 EPA 6Z5
BENZIDINE )) )) (/ )L 3 EPA 6Z
BENZO(A)ANTHRACENE » H (WL 3 FPA 62.5
BENZO(A)PYRENE ,, ), CMQL 3 EPA 616
EPA Form 3510-2A(Rev. 1-99). Replaces EPA forms 7550-6&7550-22. Page 12 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jeersoy . NC002170 9 Resiiat NEW
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL
ML/MDL
Conc. Units Mass Units Conc. Units Mass Units of METHOD
Samples
3,4 FLUORANTHENE ZL /� 19/L 3 EM &z5
BENZO(GHI)PERYLENE <MQL114, m /L 3 EPR 6
BENZO(K) )) np 3
FLUORANTHENE
BIS(2-CHLOROETHOXY) )) 5) )) 3 )!
METHANE
BIS(2-CHLOROETHYL)- !) 5, !f 3 ))
ETHER
BIS(2-CHLOROISO- )) )) !) 3 )f
PROPYL)ETHER
BIS(2-ETHYLHEXYL) f!
PHTHALATE �� !� b 3
4-BROMOPHENYL )i !) ))
PHENYL ETHER 3 !)
BUTYL BENZYL ff !) f! 3 f)
PHTHALATE
2-CHLORO- !) If 1 )!
NAPHTHALENE 3 8
4-CHLORPHENYL V !f » 3 w
PHENYL ETHER
CHRYSENE !t !p !) 111 3 h
DI-N-BUTYL PHTHALATE A )) P) 3 4
DI-N-OCTYL PHTHALATE » )) f'1 3 ”
DIBEANTHRZO(A,H)ACENE
)) » )1 3 n
1,2-DICHLOROBENZENE » if --- „ !!
1,3-DICHLOROBENZENE )! )) III !f ”
1,4-DICHLOROBENZENE P! VI )) !)
3,3-DICHLORO- )) !) '! IS
BENZIDINE
DIETHYL PHTHALATE )) !! » H
DIMETHYL PHTHALATE )) )) )51 3 !)
2.4-DINITROTOLUENE )) » f! 3 ))
2,6-DINITROTOLUENE » P )y 3 !!
1,2-DIPHENYL- )) H )) 3 n
HYDRAZINE
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 13 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Je F Sc N00021 Toa Rt,e-vot.Q Nw.)
Outfall number: _ (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
POLLUTANT Number ANALYTICAL ML/MDL
Conc. Units • Mass Units Conc. Units Mass Units of METHOD
Samples
FLUORANTHENE <MRL n19// <XL 11//, 3 EPA 625
FLUORENE <P L I J/��, <MQL ' /L 3 EPA (045
HEXACHLOROBENZENE )f !f 99 )f 3 !f
HEXACHLORO- f) f' » ft 3 )f
BUTADIENE
HEXACHLOROCYCLO- )f f1 ff ff 3 »
PENTADIENE
I
HEXACHLOROETHANE ff U )) 1' 3 Pt
INDENO(1.2,3-CD) H f1 f, )) 3 >>
PYRENE
ISOPHORONE ff ft ,) ff .3
rj
NAPHTHALENE ff 1f ff ff 3 )f
NITROBENZENE f) 7f )f )f 3 py
N-NITROSODI-N-
PROPYLAMINE
$$ JP, )f » H
3
N-NITROSODI- f) )) 7) f) 3 f)
METHYLAMINE
N-NITROSODI- ff fp
PHENYLAMINE » ff 3 ff
PHENANTHRENE ff )) ff n 3 ft
PYRENE Il )f ,f PS
3. 97
1.2,4 f, V f, f, 3 I »
TRICHLOROBENZENE
Use this space(or a separate sheet)to provide information on other base-neutral compounds requested by the permit writer
Use this space(or a separate sheet)to provide information on other pollutants(e.g.,pesticides)requested by the permit writer
I
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 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
affersrnV. NCo62.170q RenewciL NEw
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility's discharge points: 1)POTWs with a design flow rate greater than or equal to 1.0 mgd;2)POTWs with a pretreatment program(or those that are
required to have one under 40 CFR Part 403);or 3)POTWs required by the permitting authority to submit data for these parameters.
• At a minimum,these results must include quarterly testing for a 12-month period within the past 1 year using multiple species(minimum of two
species),or the results from four tests performed at least annually in the four and one-half years prior to the application,provided the results
show no appreciable toxicity,and testing for acute and/or chronic toxicity, depending on the range of receiving water dilution. Do not include
information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted
using 40 CFR Part 136 methods. In addition,this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
requirements for standard methods for analytes not addressed by 40 CFR Part 136.
• In addition,submit the results of any other whole effluent toxicity tests from the past four and one-half years. If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity,provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation,if one was conducted.
• If you have already submitted any of the information requested in Part E,you need not submit it again. Rather,provide the information
requested in question E.4 for previously submitted information. If EPA methods were not used,report the reasons for using alternate methods.
If test summaries are available that contain all of the information requested below,they may be submitted in place of Part E.
If no biomonitoring data is required,do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. Required Tests. p
Indicate the
number of whole effluent toxicity tests conducted in the past four and one-half years. 1g
l 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 I Test number: 2, Test number: 3
a. Test information. r, r,, (� p
odaphnla Rz
Test Species&test method number A eZ1
CeriP $zi 0 C r+od lhlo.. Z 0l3 Ce-1odcxp 11c1 Rrot Ora
Age at initiation of test
<21 hrs. < 2"4 hrs. < hrs.
Outfall number /VII M I 00
Dates sample collected IL ZC/,� I1.4I.I5 g Il•I5 8.13.15 5.5.15
Date test started IN. IS 8.12,.IS d.(0, 15
Duration '7 dams 7 da-t G'1 '7 dop-
b. Give toxicity test methods followed. dams
Manual title Ne Modicxdi y, NC Mod ilkC 'It1. NCMoctificakt6yr
Edition number and year of publication Dec, zb io Vers. 3.0 DK. VA 0 Vera. 3•b Der-ZO10 Vers.3.0
Page number(s)
c. Give the sample collection method(s)used. For multiple grab samples,indicate the number of grab samples used.
24-Hour composite Zy 2,41 Zu
Grab l
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection I
After dechlorination ✓ /
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 15 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
je et'soyn NCDOZI70Q
RtheJJ
Test number: Test number: Test number: 3,
e. Describe the point in the treatment process at which the sample was collected. E41uex4ovifall
Sample was collected:
f. For each test,include whether the test was intended to assess chronic toxicity,acute toxicity,or both
Chronic toxicity V/ ✓
Acute toxicity
g. Provide the type of test performed.
Static
Static-renewal (/ ✓
Flow-through
h. Source of dilution water. If laboratory water,specify type; if receiving water,specify source.
Laboratory water
Receiving water V
i. Type of dilution water. If salt water,specify"naturae'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.
30 30 3D
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH 763 7 SI/ '7. 1q
Salinity
Temperature 2i/ e C
Ammonia d !a
Dissolved oxygen 7. l 7"g '7. Q
I. Test Results. O
Acute:
Percent survival in 100%
effluent
LC50
95%C.I.
Control percent survival % %
Other(describe)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6 8 7550-22. Page 16 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jelcrersoy\ N C00 z l 70 q Rene eW
Chronic:
NOEL 30 % 30 % 30%
IG5
Control percent survival 100 % l 00 % 1 CO
Other(describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test
run(MM/DD/YYYY)?
Other(describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation'?
❑ YesD(iNo If yes,describe:
E.4. 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: / / (MM/DD/YYYY)
Summary of results: (see instructions)
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 8 7550-22. Page 17 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Jeers m NC0i52,170q Rentwa H Ew
- -
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
meeting One or more or the folio-wing coter.a must cri.u,icto the. resuits•-rf elflueut h•hicly!es:S(C• acute chronic toxic,ty for each or the
facility s discharge points It POTWs with a design flew-rate gi eater than or aquai to l mod 2i Prli-RIVs with a pretreatment prOdiancl(or Mose that arh
required to have one under 40 CFR Pal 4031 or 31 POTVVo ret1U,it, the petmitirng authority to uomit data for Mese parameters
• At a minimum.these results must inctude quarterly testr.g to'-a 12-monto period with n the past 1 year using multiple species(minimum of two
species),or the results from four tests performed it least annually in the four and one-half years Pr1.7.,to the application provided the results
show no appreciable toxicity and testing for acute and/or onion-c•tux:city depending on the ii3nde of receiving water criluticm Do not include
information on combiner'sewer overflows in this seilior All nrurroaeut;reported .coat be based un data collected throiJuh analysis condo,ter;
using 40 CFR Part 1`..lb methods :n addition th:s data must C-,rriC,i or 4: ;:ri. Part 1.:tr-1 a:•-t nt,ef a(Drrnor e
requirements to' standacd methods for arialytes not tiv 4°:•;:--; Pail
• !rt.additior submrt tne results of any nicer 4,ehnie effluent ,Pie pas:fry,;(;Ind oce had years it a,.;!••••••.. 'enl
conducted during the past tour attic ode-nalf years ite any imicurraticr cc toe
toxicity reduction evaluation. if one was concluded
• If you have already submitted any of the Information requested in Part 0 you need not submit it aga.n Ratner promde toe loformatr4r,
requested in question E 4 for previously submitted information d EPA methods were not used report the reasons for using alternate ri,ethods
If test summaries are available that contain air of the information requested below they may t,e,submitted in place of Part E
If no biornonitoring data is required. do riot COMOr't Par!F Rek f tru::,Aopi.catlan.:)vers.oe,v frrl -.4lecr.OeS On whi., orner sec ofine lorry to
complete
E.1. Required Tests.
Indicate the number of whole effluent toxicity tests conducted WI the Past tour and one-half yeas ig
5,7r, chronic :71 acute
E.2. Individual Test Data. CornpR•ite 1hp Inhowinu chart for each]whole effluent toxicity test oraucted in the uast fC.-tUr and one;half_yeacs Allow One
column per test!where ecti scecces constitutes a test) TThrty this tr::' it oorfct than throe tests arc:brrird recihrted
Ts! OUrnbef
lest info-mation.
. ETA SZA
Test Species test method number
leer ltdafhilick R 02, 013 •
. . .
Aga at initiation of test < 2.41 hatt.h.A.
Outfall number 1001
.•..
shate-.;sample collected 2.3.15 .1 5
Date test started 2.tti IS
Dicirdvon '7 064s
. .
h
c::rixe toxicity fest metriodt.•
. . _
t;:le NC Malico-fics—
.
Edition number and year of puChcation
Dec.2,010 Verso, 3.0
numbersi
c Gr.e the Sar^pi, "(0,er-,on method,s•..used -)i ;-,. c;.,)
','4-Hour composite
ie,4(
. .
Grab
; • .
ci
indicate where the sampie was taCen in'elation to oisintetior) .r_Eec):,ail app;, :-•a:-c-)
Llof,re rfection
. .
Alter disinfection
After dechlorination
• -
EPA, t-99) R,,'iace-E EPA fcv Ms 1

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Je,c-i-efstyr, NCO02170Q Rrok Nem
Test number: Test number
':
J� Test number
r• hest ibe the:,o of r,t IN t'eatl r oro„< a' ht, S.V.t,.. :.;S:• 4c 'r' E 1 iu n+ out`i`irL l �a- I�
ami•re was collected
f For each test :nctude whether the test was Intended to assess ohronnc tO..:c:ty abide toxicity or hot'
_:'Hnn,C toxicity •,
if
Acute t,cxicity YY
g Provide the type of test perforr+ed
State:
_ _ -
"Stats-renews- - - / - - ---
Flaw✓,throuy^rr
h Sour(:,of dilution water It laboratory water specify type If receiving water spe::!v sour:re
• Laboratory water
• .
Rer:eiving:rater
I .yce of diiution water If sa.".water oec:••y n.O'cra or;y:_ .k c_',` :3 = ... ,aL'c, bin,,.. .,....
Fresh water
:got'water
f (.3'1Ve the percentage etfll•r r:t,.dseh frit 9 I _ i atit ns rl l',,; .. ,:1,-,s
30
M. Parameters measured riorir.g the test i..-it. ;,! I.ror parameter rr,ets'.asr.rner,red err.`“cat.or;,
750
.
.=:rrperature Z.4./
. `q O C
.
a.rrn;.;•ia
7.5
rest Re.U'..
Ac i t e
Percent survival In t0O% % % 0
effluent
Control percent survival %
Other r desc DeI
icr'0'3 i',, . L .Air;e, .ab, ,:,:k-pacer-'.If- .. . - 3.

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN.
Je e,rson NC 02,170Q Rtne.wd New
chron!,
30 °
ic .
{•On?r.;j peicenl Surwva; % %
)the ,describe;
rr: Ass;.:.,-r cc
.]atrt.r,nr,:-]Jle
rt.(•..,, ff!it'E;S:
3C.:eritan,h0und5'?
Ahat date was refererce to,1c.ant test
run rMM/CD''r YY)?
7theer 1de5rn ti F.,
E.3. Toxicity Reduct1:4(.1
on Evaluation. ncr trr f r;•- . .._, '. r.:.,
(es if sea cescNbe
E.4. Summary of Submitted Biomonitoring lest informationnn,,r rl err:?r, �, r ,,i.�, tau a�:,:; 1,1E
• t
_e'P llyr Of tr?Y ri,y V.'�;f'�Rr th,, past fC J: a'.� I �. e iil� vJ r"'qr .. _.i7^ r�"-�v?t". y,l.c .i.h. ,_. dlJ i,'1,.'Ity can. ��„r •;,lr.
t the results
•
Cate submitted MM;'JC;'
a,;r"7rary - 'esults 15tw ., ;i::;•cc
END OF PART E.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
Fr:A r;rn 35t0-'A.Rev I.99) Replaces

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Nco0z7oq RericJ
New
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.1. Pretreatment program. Does the treatment works have, or is subject ot, an approved pretreatment program?
Yes ❑ No
I �
F.2. Number of Significant Industrial Users(SIUs)and Categorical Industrial Users(CIOs). Provide the number of each of the following types of
industrial users that discharge to the treatment works.
a. Number of non-categorical SIUs. 0
b. Number of CIUs.
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.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: AmPiNA, �fria P� Ve 1 es
Mailing Address: I(05 Arnext.cam. sp,-2rso- NG 29 YJ
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
C,hf mic:kpfeporo koh of aluminurn COT111 UP Led;PS ccr Primer aro,
F.5. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw materials that affect or contribute to the SIU's
discharge.
Principal product(s): / I mLUl Q NC,E 5
Rawmaterial(s): Aluminum / S el
F.6. 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 Jwhether the discharge is continuous or intermittent.
a) gpd ( 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.t.
iC�Cl gpd ( continuous or y/ intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a Local limits [>7�Yes ❑ No
b. Categorical pretreatment standards V Yes ❑ No
If subject to categorical pretreatment standards,which category and subcategory?
_ � f inishi 3eco CFR 4133
EPA Form 3510-2A(Rev. 1-99). Replaces EPA forms 7550-6&7550-22. Page 18 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
JeAceiri_.CE12.1 0• Rtn ci NEW
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems(e.g.,
upsets,interference)at the treatment works in the past three years'?
O Yes [iNo If yes,describe each episode.
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL, OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatmentpipe'?
2/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. Remediation Waste. Does the treatment works currently(or h s it been notified that it will)receive waste from remedial activities?
❑ Yes(complete F.13 through F.15.) No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates(or is excepted to origniate in
the next five years).
•
F.14. Pollutants. List the hazardous constituents that are received(or are expected to be received). Include data on volume and concentration,if
known. (Attach additional sheets if necessary.)
F.15. Waste Treatment.
a. Is this waste treated(or will be treated)prior to entering the treatment works?
❑ Yes ❑ No
If yes,describe the treatment(provide information about the removal efficiency):
b. Is the discharge(or will the discharge be)continuous or intermittent?
❑ Continuous ❑ Intermittent If intermittent,describe discharge schedule.
END OF PART F.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
EPA Form 3510-2A(Rev. 1-99). Replaces EPA forms 7550-6&7550-22. Page 19 of 22

FACILITY NA��M(rE AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
ee na NCO& Oc Re_nemoi eA)3
SUPPLEMENTAL APPLICATION INFORMATION
PART G. COMBINED SEWER SYSTEMS
If the treatment works has a combined sewer system,complete Part G.
G.1. System Map. Provide a 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.1 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 G.6 once for each CSO discharge point.
G.3. Description of Outfall.
a. Outfall number
b. Location
(City or town, if applicable) (Zip Code)
(County) (State)
(Latitude) (Longitude)
c. Distance from shore(if applicable) ft
d. Depth below surface(if applicable) ft
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?
G.4. CSO Events.
a. Give the number of CSO events in the last year.
events (❑actual or❑approx.)
b. Give the average duration per CSO event.
hours (❑actual or❑approx.)
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22. Page 20 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
NCcoz 1769 Rexoi New
c. Give the average volume per CSO event.
million gallons(❑actual or❑approx.)
d. Give the minimum rainfall that caused a CSO event in the last year
Inches of rainfall
G.5. Description of Receiving Waters.
a. Name of receiving water:
b. Name of watershed/river/stream system:
United State Soil Conservation Service 14-digit watershed code(if known):
c. Name of State Management/River Basin:
United States Geological Survey 8-digit hydrologic cataloging unit code(if known):
G.6. CSO Operations.
Describe any known water quality impacts on the receiving water caused by this CSO(e.g., permanent or intermittent beach closings,permanent or
intermittent shell fish bed closings,fish kills,fish advisories,other recreational loss,or violation of any applicable State water quality standard).
END OF PART G.
REFER TO THE APPLICATION OVERVIEW(PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A(Rev.1-99). Replaces EPA forms 7550-6&7550-22 Page 21 of 22

PAT MCCRORY
cove,,,or
DONALD R. VAN DER VAART
Sec refa-v.
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
January 20, 2016
Tim Church
Town of Jefferson WWTP
PO Box 67
Jefferson,NC 28640
Subject: Acknowledgement of Permit Renewal
Application No. NC0021709
Jefferson WWTP
Ashe County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on January
195,2016. A member of the NPDES Unit will review your application. They will contact you if additional
information is required to complete your permit renewal. Per G.S. 150B-3 your current permit does not
expire until permit decision on the application is made. Continuation of the current permit is contingent on
timely and sufficient application for renewal of the current permit. Please respond in a timely manner to
requests for additional information necessary to complete the permit application.
If you have any additional questions concerning renewal of the subject permit, please contact Tom
Belnick at 919-807-6390 or [e-mail].
Sincerely,
W cue cti Tk-P-O rOU
Wren Thedford
Wastewater Branch
cc: Central Files
Winston Salem Regional Office, Water Quality Regional Operations Section
NPDES Unit
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300