NC0037834_Renewal (Application)_20131216

Winston-Salem, Forsyth County �@�� `/
�j
City/County
Ut�let'es NCDENER/DWR DEC 1 6 2013
Water•Sewer-Solid Waste Disposal Attn: NPDES Unit
1617 Mail Service Center nIKIT WATER QUALIT>'
POINT SOURCE BRANCH
Raleigh,North Carolina 27699-1617
Utilities
Administration
Re: NPDES Permit Renewal Application
City of Winston-Salem Archie Elled e WWTP C0037834
F.o.nor2511 g
Winston-Salem,NC 27102 City of Winston Salem; Forsyth County
City Link 311(336,72-8000)
Fax [phone]
www rityofivs,org
The City of Winston Salem is submitting its renewal application for the Archie Elledge
WWTP's NPDES Permit#NC0037834. Attached to this letter are the completed forms
"FORM 2A NPDES" including the basic application and supplemental applications as
required.
The City of Winston Salem request that you provide a written response confirming that
this application has been received and is complete. This response can be mailed to:
Mr. Ron Hargrove, City/County Utilities Director
P.O. Box 2511 Winston Salem,N.C. 27103
OR
Email at [e-mail]
The City of Winston Salem also request consideration of the following permit
modifications based on past plant performance and budgetary constraints.
1. Due to low concentrations of BOD and TSS in our past effluent samples and
budgetary constraints, we request that we be considered an "exceptional facility"
and have our sampling frequency for these pollutants reduced to twice/week.
2. Due to low concentrations of Fluoride in our past effluent samples and
budgetary constraints, we request that our sampling frequency be reduced from
weekly to quarterly with monitoring requirements only.
3. Due to low concentrations of Total Mercury in our past effluent samples and
budgetary constraints, we request that our sampling frequency be reduced from
2/month to quarterly with an annual average concentration limit of 47 ng/L
based on Technology Based Effluent Limits.
The City of Winston Salem also requests an"Owners" draft of the reissued permit prior
to public notice. This will provide staff sufficient time to review the information and
provide additional information in a timely manner.
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City(:o..dh M iyut Allen loine;V'rian f:,R,xke.Mnyor Nn rm,t Orr,Nni rheut Wtni;Manisa D,Ad um,Nonb V inG D,.,He r,�"ahwcar IX'.rrd,K"IX"(".('lark,Ik",\V, 1,
l \lolly Ix,tht.Shut,Ward;Jcd:l4acintoth No•rhwm wad;D) n L\lona}pnscn FA,(V-a-.d Jantt.,T,tyinr,Je.Vwrheaet Wird,Ciry M.-ger Lee D(;arnn•
Forsyth County Commissioners:Rrtha d V Linville Chairman,Glom D tVU—ihuna,V1cc Chaw Mark[Baker,W-dtcr Marshall;Dxnd R,Plrlcr,Bill%%achmt;E­ace
Call 311 or 338-727-8000 Widtenlxx n;(o uy Manag Dudley Ware,jr_
cit link a�clt OIVJ$.D� City/Co—tc Utility Commission•D,vid Ned,Chai,mm,(ones h.1.owe,Vit:C:.airn° ,•Ibrnko"t'oy"Gca};Irl—ld 1, D,Y;111 ld R.HoI,m,C6,..1)Jewdi 11;'an a I,hk
Y y 9 Paul S Md;r':,AI F) Scynoor.J 11.11 Srockun:,R.,adsll S.Tudt

2
In addition, the City of Winston Salem request an electronic copy of the Reasonable
Potential Analysis be sent to Ron- Hargrove at his email address of [e-mail]
Sinc ely, Ron Hargrove.

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
FORM
V.
2A E�SC3FZM 2 �PP< I�i�1l�, C Et��/J .�
NPDES
APPLICATION OVERVIEW
m
Form 2A heen„devepin a modular format and•consists ofa;"Basic Applicationlnformation" pac ket
.. -
anda=,Supplemental App�licat onylnformation.:packet: The Basic Applation,Informationzpacfket`stliv�ded
intoAwo partS All a"pplicanti must"complete Parts A and C. Applicants£wlth`a3deslgn flow greater than or<
equal.to�,l mgd,must5als�o�-complete Part'B. Some applicant ust also,complete,the Supplemental^ ;; \,
Apphcatio�n Information�p"a�ck�et: The,following<,i�tems explain h<parts`of Form:2Ayou•mustcomptete
BASIC APPLICATION INFORMATION:
A. Basic Application Information for all Applicants. All applicants must complete questions A.1 through A 8. A treatment works
that discharges effluent to surface waters of the United States must also answer questions A.9 through A.12.
B. Additional Application Information for Applicants with a Design Flow z 0.1 mgd. All treatment works that have design flows
greater than or equal to 0.1 million gallons per day must complete questions B 1 through B.6.
C. Certification. All applicants must complete Part C(Certification).
SUPPLEMENTAL APPLICATION INFORMATION:
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waters of the United States and meets
one or more of the following criteria must complete Part D(Expanded Effluent Testing Data)
1 Has a design flow rate greater than or equal to 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).
7 �� J}I,, , C'k!r3,, 3�2 �� �AC (CERTIFICTION}. .
..
...... Ei3; ••%•SEP:y:F-"a _,-._, ,- , ,3, ;_ ..,-. ,�• . �F: ..E.
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:
Archie Elledge WWTP NCO037834 Renewal Yadkin
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PARVA BASIC Nr FNW6F
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All treatment works must complete questions A.1 through A.8 of this Basic Application Information Packet
A.I. Facility Information.
Facility Name Archie Elledge Wastewater Treatment Plant
Mailing Address P 0.Box 2511
Winston-Salem,NC 27102
Contact Person Mr Ron Hargrove
Title City/County Utilities Director
Telephone Number [phone]
Facility Address 2801 Griffith Rd
(not P 0 Box) Winston-Salem, NC 27103
A.2. Applicant Information. If the applicant is different from the above,provide the following
Applicant Name City of Winston-Salem
Mailing Address P 0 Box 2511
Winston-Salem, NC 27102
Contact Person Mr Ron Hargrove
Title City/County Utilities Director
Telephone Number [phone]
Is the applicant the owner or operator(or both)of the treatment works?
x owner x operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
0 facility x 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 NC0037834/Stormwater 110013 DRYER WQ0029804
UIC Other Non Discharge WQ0000094
RCRA Other Air Quality 00817R7
A.4. Collection System Information. Provide information on municipalities and areas served by the facility. Provide the name and population of each
entity and,if known,provide information on the type of collection system(combined vs.separate)and its ownership(municipal,private,etc
Name Population Served Type of Collection System Ownership
Winston-Salem 161,109 Separate Municipal
Kernersville 16,000 Separate Municipal
Walkertown 2,100 Separate Municipal
Total population served 179,209
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:
Archie Elledge WWTP NC0037834, Renewal Yadkin
A.5. Indian Country.
a Is the treatment works located in Indian Country?
❑ Yes x 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 x 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 years data must be based on a 12-month time period
with the 12`"month of"this year"occurring no more than three months prior to this application submittal
a Design flow rate 30 mgd
Two Years Apo Last Year This Year
b Annual average daily flow rate 15.67 14.83 15.3
C. Maximum daily flow rate 27.5 27.3 33
A.7. Collection System. Indicate the type(s)of collection system(s)used by the treatment plant. Check all that apply. Also estimate the percent
contribution(by miles)of each
x Separate sanitary sewer 100 %
❑ Combined storm and sanitary sewer 0 %
A.8. Discharges and Other Disposal Methods.
a Does the treatment works discharge effluent to waters of the U S? x 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
u Discharges of untreated or partially treated effluent 0
in 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? ❑ Yes x No
If yes,provide the following for each surface impoundment
Location.
Annual average daily volume discharge to surface impoundment(s) mgd
Is discharge ❑ continuous or ❑ intermittent?
c Does the treatment works land-apply treated wastewater? ❑ Yes x No
If yes,provide the following for each land application site
Location
Number of acres:
Annual average daily volume applied to site mgd
Is land application ❑ continuous or ❑ intermittent?
d Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works? x Yes ❑ No
EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550-6&7550-22 Page 3 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP NC0037834, Renewal Yadkin
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)
Secondary digested sludge is pumped 5.2 miles via three 8"HDPE butt fused pipeline to mixing tanks from Muddy Creek WWTP to Archie
Elledge WWTP for centrifuging and Biosolids Dryer disposal Centrate is returned to Muddy Creek WWTP
If transport is by a party other than the applicant,provide
Transporter Name
Mailing Address
Contact Person
Title
Telephone Number ( )
For each treatment works that receives this discharge,provide the following
Name Muddy Creek Wastewater Treatment Plant
Mailing Address 4561 Cooper Road
Winston-Salem NC 27127
Contact Person Ozie Keith Jones
Title Senior Utility Plant Supervisor/ORC
Telephone Number [phone]
If known,provide the NPDES permit number of the treatment works that receives this discharge NCO050342
Provide the average daily flow rate from the treatment works into the receiving facility 0 163 mgd
e Does the treatment works discharge or dispose of its wastewater in a manner not included
in A 8 through A 8.d above(e g,underground percolation,well infection) ❑ Yes x 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
ethodIs disposal through this method ❑ continuous or ❑ intermittent?
EPA Form 3510-2A(Rev.1-99) Replaces EPA forms 7550-6&7550-22 Page 4 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP NC0037834, Renewal Yadkin
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 001
b Location Winston-Salem NC,27102 27103
(City or town,if applicable) (Zip Code)
Forsyth NC
(County) (State)
N36 DEG 1 8MIN west 80 degrees 18 868 MIN
(Latitude) (Longitude)
C. Distance from shore(if applicable) N/A ft
d Depth below surface(if applicable) N/A ft
.e Average daily flow rate 153 mgd
f Does this outfall have either an intermittent or a periodic discharge? ❑ Yes x No (go to A 9 g)
If yes,provide the following information
Number f times per year discharge occurs'
Average duration of each discharge
Average flow per discharge. mgd
Months in which discharge occurs
g Is outfall equipped with a diffuser? x Yes ❑ No
A.10. Description of Receiving Waters.
a. Name of receiving water Salem Creek
b. Name of watershed(if known) Yadkin River Basin
United States Soil Conservation Service 14-digit watershed code(if known) None
C Name of State Management/River Basin(if known) Yadkin
United States Geological Survey 8-digit hydrologic cataloging unit code(if known) 03040103
d Critical low flow of receiving stream(if applicable) 7Q10
acute 15 cfs chronic Cfs
e Total hardness of receiving stream at critical low flow(if applicable) None Available mg/I of CaCO3
EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550-6 8 7550-22 Page 5 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP NC0037834, Renewal Yadkin
A.11. Description of Treatment
a What level of treatment are provided? Check all that apply
x Primary x❑ Secondary
❑ Advanced ❑ Other. Describe'
b Indicate the following removal rates(as applicable)
Design BOD5 removal or Design CBOD5 removal 98 %
Design SS removal 97 %
Design P removal N/A %
Design N removal N/A %
Other N/A %
c What type of disinfection is used for the effluent from this outfall? If disinfection varies by season,please describe-
Chlorination using Sodium Hypochlorite No Seasonal Variation
If disinfection is by chlorination is dechlonnation used for this outfall? x Yes ❑ No
Does the treatment plant have post aeration? x 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 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
zr MAXIMUM'DAILY VALUE r- ?A1%ERAGE DAILY VALUE = _
.P PAMETER, s,l.
.,
Units
V e ;"tl'itS N mtiz Y.
Value` n er of Saiiiples
pH(Minimum) 6.0 s u
PH(Maximum) 7.7s.0
Flow Rate 45 MGD 16.31 MGD 1642
Temperature(Winter) 22 DEG C 16 DEG C 544
Temperature(Summer) 30 DEG C 24 DEG C 947
'For pH please report a minimum and a maximum daily value
�a> MAXIMUMIDAlLY:.
- - AVERAGEIDAILY DISCHARGE w
-. r DISCHARGE: ="" ANALYTICAL
• POLLUTANT:. ffM. _ .::...._ 'ML/MDL
°E ca_ "M_�...;�.. jr,' :,.,.>-. �r;�',,'3' , .f'' = ar?�":°•�1Num6WM&tH6nT< Yof:'.�'f q^'' �,=�;.
Cont. Units. Cont: Units
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN BOD5 19 mg/1 5 Mg/1 1131 SM5210B 2m /1
DEMAND(Report one) CBOD5
FECAL COLIFORM 3400 #100m1 30 #100 1129 SM9222D 1m1
TOTAL SUSPENDED SOLIDS(TSS) Y9 1 mg/1 1 7 1 Mg/1 1620 SM2540D 2.5m /1
yam{; -- - �.�t;,u• ....�-- ° -=.- � ,•:,�,�•.�t„-« � _ .��
`mmEND OF PARTiio►. = m€
3;:�f: ,.• fifi�r° w �” .. rC•':e <"" a..�;..._,
,REFER TO„THEAPPLlCATI®NE�OVER�1lIEW(�PAGE�1�)�TO„DETERMINE WHICyH=OTFiE PAR°T 3,
3�- s{E,a. ..
OF�FORM'2AYOIJ MUST'COMPLETE ,,3 '
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:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
A
HA ;N'T
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BASIC )RIVIATINQ%�-__ __�'
"Pw
�AR,T,B._N ADDITIONAL APPLICATION R APPLICANTS" ITH A DESIGN KMGREXTEWTHAN OR,
A,�kION INFQRMk�,'10N-FmC
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All applicants with a design flow rate�:0.1 mgd must answer questions BA through B.6. All others go to Part C(Certification).
B.I. Inflow and Infiltration. Estimate the average number of gallons per day that flow into the treatment works from inflow and/or infiltration
-1,600,000 gpd
Briefly explain any steps underway or planned to minimize inflow and infiltration
The CCUC has implemented a master plan to reduce I&I as well as maintain adequate service for our customers and to
protect the environment. It includes the rehabilitation of sewer linesreplacement of lines as needed, lines being
cleared of roots and debris both manually and by chemical treatment
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%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 reclunancy in the system Also provide a water balance showing all treatment units,including disinfection(e g.,
chlorination and dechlonnation) 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
BA. 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? D Yes x 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
Mailing Address-
Telephone Number.
Responsibilities of Contractor
B.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.
001
b Indicate whether the planned improvements or implementation schedule are required by local,State,or Federal agencies
El Yes x No
EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550-6&7550-22 Page 7 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
c If the answer to B.5.b is"Yes,"briefly describe,including new maximum daily inflow rate(if applicable).
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 07/01/2014
End Construction 07/31/2016
Begin Discharge
Attain Operational Level
e. Have appropriate permits/dearances concerning other Federal/State requirements been obtained? ❑ Yes x No
Describe briefly: Archie Elledge Plant is discussing the design of 2 day tanks that will be able to receive raw wastewater from Muddy
Creek WWTP This is being done to aid the Muddy Creek Wastewater Treatment Plant by reducing hydraulics and
organic loading on the plant.
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.
Outfall Number: 001
MAXIMUM•DAILY AVERAGE DAILL-Y•-.'•DISCHARGE
,;DISCHARGE ,• mow. ANALYTICALA'
POLLUTANT $" _ w MUMDL'
_3 e :Number of: METHOD 21 "
_ E
COnC.? 11111tS l < COItC ,b,UnItS, F,,yP: ;j
a.
MSampfes-r.,

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
4,
QBASlC4fAPRL1lC-ATAm
IOWNEORMATION7,
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:
x Basic Application Information packet Supplemental Application Information packet:
• Part D(Expanded Effluent Testing Data)
• Part E(Toxicity Testing Biomonitoring Data)
• Part F(Industrial User Discharges and RCRAICERCLA Wastes)
E] Part G(Combined Sewer Systems)
ALL APPLICANTS MU ,MPLET �
IE V�f G,CER*T
I�FF
,I PA70T=-5"-
,
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 Ron42rove.Citv/County Utilities Director
Signature PW
Telephone number Q 6)747-_7
V
Date signed Z-2 z/C.;Ii Z/3
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: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
'+�;.,ui - _ �
a
SUPPL
EMENT�tiL:APPL"ICAT>IQN-INF6RMATION
P_AR'T E PANDE EFFLUENT TESTING
;fie;ust�n c�'-r �� — .;- �, .°'��° w s` � •`4—.i&_.- 'z,�. � •"��,� -
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 10 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 followng
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•DAILYDISCHARGE AVERAGEDAILYI$ HARGE•.,:
.- a, , - $- ..
� Nm3er,; ANPOLL UTANT - (� MLIMDU
. m Cone. Units:. 'Mass, Unets`r` Cone.:. EUnits , Mass Units of ;
METH D
Samples
METALS(TOTAL RECOVERABLE),CYANIDE,PHENOLS,AND HARDNESS.
ANTIMONY <2 5 ug/I <2 5 ug/I 4 EPA 200 7 2.5
ARSENIC <10 ug/I <10 ug/I 4 EPA 200.7 10
BERYLLIUM <5 ug/I <5 ug/I 4 EPA 200 7 5
CADMIUM <2 ug/I <2 ug/I 3 EPA 2007 2
CHROMIUM <5 ug/I <5 ug/I 3 EPA 200.7 5
COPPER <2 ug/I <2 ug/I 3 EPA 200 7 2
LEAD <10 ug/I <10 ug/I 3 EPA 200 7 10
MERCURY 088 ug/I .004 ug/I 107 1631E 1
NICKEL <10 ug/I <10 ug/I 3 EPA 200 7 10
SELENIUM <10 ug/I <10 ug/I 4 EPA 200 7 10
SILVER <5 ug/I <5 ug/1 3 EPA 200 7 5
THALLIUM <20 ug/I <20 ug/I 4 EPA 200 7 20
ZINC 87 ug/I 68 ug/I 3 EPA 200 7 10
CYANIDE <5 ug/I <5 ug/I 4 EPA 335 4 5
TOTAL PHENOLIC 16 ug/I 10 ug/I 4 EPA 420 1 10
COMPOUNDS
HARDNESS(as CaCO3) 92 mg eq 85 mg eq 4 SM 23408 0 662
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 NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States.)
UM"6A'L"y""DISCHARGE ,,-; AVERAGE'Di41LY DISCHARGE.
4�if"�AMMPIM
�Mlll
POLLUTANT
Cont. -massUnits `Gone.' Units" Massy Uriits of.;
VOLATILE ORGANIC COMPOUNDS
ACROLEIN <50 ug/I <50 ug/I 4 EPA 624"
ACRYLONITRILE <10 Ug/I <10 ug/I 4 EPA 624 10
BENZENE <1 Ug/I <1 ug/I 4 EPA 624 1
BROMOFORM <1 Ug/I <1 ug/I 4 EPA 624 1
CARBON <1 Ug/I <1 ug/I 4 EPA 624 1
TETRACHLORIDE
CHLOROBENZENE <1 Ug/I <1 ug/I 4 EPA 624 1
CHLORODIBROMO- 10 Ug/I 4 ug/I 4 EPA 624 1
METHANE
CHLOROETHANE <5 Ug/I <5 ug/I 4 EPA 624 5
2-CHLOROETHYLVINYL <5 ug/I <5 ug/I 4 EPA 624 5
ETHER
CHLOROFORM 20 ug/I 10 ug/I 4 EPA 624 1
DICHLOROBROMO- 25 Ug/I 14 ug/I 4 EPA 624 1
METHANE
1,1-DICHLOROETHANE <1 Ug/I <1 ug/I 4 EPA 624 1
1,2-DICHLOROETHANE <1 Ug/I <1 ug/I 4 EPA 624 1
TRANS-1,2-DICHLORO- <1 ug/1 <1 ug/I 4 EPA 624 1
ETHYLENE
1,1-DICHLORO- <1 ug/I <1 ug/I 4 EPA 624 1
ETHYLENE
1,2-DICHLOROPROPANE <1 ug/I <1 ug/I 4 EPA 624 1
1,3-DICHLORO- <1 Ug/1 <1 ug/I 4 EPA 624 1
PROPYLENE
ETHYLBENZENE <1 ug/I <1 ug/I 4 EPA 624 1
METHYL BROMIDE <5 ug/I <5 ug/I 4 EPA 624 5
METHYL CHLORIDE <5 ug/I <5 ug/I 4 EPA 624 5
METHYLENE CHLORIDE <1 ug/I <1 ug/I 4 EPA 624 1
1,1,2,2-TETRA- <1 ugll <1 ug/I 4 EPA 624 1
CHLOROETHANE
TETRACHLORO- <1 ugh <1 ug/I 4 EPA 624 1
ETHYLENE
TOLUENE <1 ug/I <1 Ug/I 4 EPA 624 1
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:
Archie Elledge WWTP, NC0037834 Renewal Yadkin
Outfall number 001 (Complete once for each outfall discharging effluent to waters of the United States.)
MAXIMUM DAILY'DISGHARG 6'" :'AV E AILYRDISCHARGE - �
k .. .. -
s.E ;,�,.�Ei[36.-:-."-� .c.-. -.-res= ..ie ' wy:�' ;,t' �; ., y' °,"• :.'�,,s, .'^„ 0 ••-.
Numtler ANALYCAL
POLLUTANT ., L
Conc. Units• Mas Units. Conc. J Uriits Mass`: Units v;' of
'EAAETHOD MLlMD,
—4
SamPles^
,r.
<1 ug/I <1 ug/I 4 EPA 624 1
TRICHLOROETHANE
1,1,2 <1 ug/I <1 ug/1 4 EPA 624 1
TRICHLOROETHANE
TRICHLOROETHYLENE <1 ug/I <1 ug/I 4 EPA 624 1
VINYL CHLORIDE <5 ug/I <5 ug/I 4 EPA 624 5
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 <10 ug/I <10 ug/I 4 EPA 625 10
2-CHLOROPHENOL <10 ug/I <10 ug/I 4 EPA 625 10
2,4-DICHLOROPHENOL <10 ug/I <10 ug/I 4 EPA 625 10
2,4-DIMETHYLPHENOL <10 ug/I <10 ug/l 4 EPA 625 10
4,6-DINITRO-0-CRESOL <50 ug/I <50 ug/I 4 EPA 625 50
2,4-DINITROPHENOL <50 ug/I <50 ug/I 4 EPA 625 50
2-NITROPHENOL <10 ug/I <10 ug/I 4 EPA 625 10
4-NITROPHENOL <50 ug/1 <50 ug/l 4 EPA 625 50
PENTACHLOROPHENOL <50 ug/1 <50 ug/l 4 EPA 625 50
PHENOL <10 ug/1 <10 ug/I 4 EPA 625 10
2,4,6- <10 ug/1 <10 ug/I 4 EPA 625 10
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 <10 ug/I <10 ug/I 4 EPA 625 10
ACENAPHTHYLENE <10 ug/1 <10 ug/I 4 EPA 625 10
ANTHRACENE <10 ug/I <10 ug/I 4 EPA 625 10
BENZIDINE <50 ug/I <50 ug/I 4 EPA 625 50
BENZO(A)ANTHRACENE <10 ug/I <10 ug/I 4 EPA 625 10
BENZO(A)PYRENE <10 ug/I <10 ug/I 4 EPA 625 10
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:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
Outfall number 001 (Complete once for each outfall discharging effluent to waters of the United States
MAX'I'Mo�F64LN", IS
D POT
C
T1
------- zANALY, AL,
F"
zz N
.5 rill-, '�4kMETHO
yzz: zz f j7,
z 3
pUft.' Uy"nitts, JMUnts Conc. S
=. Samples
3,4 BENZO- <10 ug/l <10 ug/l 4 EPA 625 10
FLUORANTHENE
BENZO(GHI)PERYLENE <10 ug/l <10 ug/l 4 EPA 625 10
BENZO(K) <10 ug/1 <10 ug/l 4 EPA 625 10
FLUORANTHENE
BIS(2-CHLOROETHOXY) <10 ug/l <10 ug/l 4 EPA 625 10
METHANE
BIS(2-CHLOROETHYL)- <10 ug/l <10 ug/11 4 EPA 625 10
ETHER
BIS(2-CHLOROISO- <10 ug/1 <10 ug/l 4 EPA 625 10
PROPYL)ETHER
BIS(2-ETHYLHEXYL) 45 ug/l 18 ug/l 4 EPA 625 10
PHTHALATE
4-BROMOPHENYL <10 ug/l <10 ug/l 4 EPA 625 10
PHENYLETHER
BUTYL BENZYL <10 ug/l <10 ug/l 4 EPA 625 10
PHTHALATE
2-CHLORO- <10 ug/1 <10 ug/l 4 EPA 625 10
NAPHTHALENE
4-CHLORPHENYL <10 ug/l <10 ug/l 4 EPA 625 10
PHENYLETHER
CHRYSENE <10 ug/l <10 ug/l 4 EPA 625 10
DI-N-BUTYL PHTHALATE <10 ug/l <10 ug/l 4 EPA 625 10
DI-N-OCTYL PHTHALATE <10 ug/l <10 ug/1 4 EPA 625 10
DIBENZO(A,H) <10 ug/l <10 ug/l 4 EPA 625 10
ANTHRACENE
1,2-DICHLOROBENZENE <10 ug/l <10 ug/l 4 EPA 625 10
1,3-DICHLOROBENZENE <10 ug1l <10 ug/l 4 EPA 625 10
1,4-DICHLOROBENZENE <10 ug/1 <10 ug/l 4 EPA 625 10
3,3-DICHLORO-
BENZIDINE <50 ug/l <50 ug/l 4 EPA 625 50
DIETHYL PHTHALATE <10 ug/l <10 ug/l 4 EPA 625 10
DIMETHYL PHTHALATE <10 ug/I <10 ug/l 4 EPA 625 10
2,4-DINITROTOLUENE <10 ug/I <10 ug/l 4 EPA625 10
2,6-DINITROTOLUENE <10 ug/I <10 ug/1 4 EPA 625 10
1,2-DIPHENYL- <10 ug/I <10 ug/1 4 EPA 625 10
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:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
Outfall number: 001 (Complete once for each outfall discharging effluent to waters of the United States
MAXIMW6A '61�SCH41idt,]
ER S
H��_PE
M0
"' -
W, V Num brm MUMDL-
we
Cone:04
MaisF
�tjnit_q Ma Units =Cone. units, Unittt hof METHOD.. ,
_._-_
ii S p
M AW A&-
-;k NOW les
FLUORANTHENE <10 ug/I <10 ug/I 4 EPA 625 10
FLUORENE <10 ug/I <10 ug/I 4 EPA 625 10
HEXACHLOROBENZENE <10 ug/I <10 ug/I 4 EPA 625 10
HEXACHLORO- <10 ug/I <10 ug/I 4 EPA 625 10
BUTADIENE
HEXACHLOROCYCLO- <50 ug/I <50 ug/I 4 EPA 625 50
PENTADIENE
HEXACHLOROETHANE <10 ug/1 <10 Ug/I 4 EPA 625 10
INDENO(1,2,3-CD) <10 ug/1 <10 Ug/I 4 EPA 625 10
PYRENE
ISOPHORONE <10 ug/1 <10 Ug/I 4 EPA 625 10
NAPHTHALENE <10 ug/I <10 ug/I 4 EPA 625 10
NITROBENZENE <10 ug/I <10 ug/I 4 EPA 625 10
N-NITROSODI-N- <10 ug/I <10 ug/I 4 EPA 625 10
PROPYLAMINE
N-NITROSODI- <10 ug/1 <10 ug/I 4 EPA 625 10
METHYLAMINE
N-NITROSODI-
PHENYLAMINE <10 ug/I <10 ug/I 4 EPA 625 10
PHENANTHRENE <10 ug/I <10 ug/I 4 EPA 625 10
PYRENE <10 ug/I <10 ug/I 4 EPA 625 10
1.2.4- <10 ug/I <10 ug/I 4 EPA 625 10
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
VIM 16
z:i I
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EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550-6&7550-22 Page 14 of 22

�
� Test number: Test number Test number.
�

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge VVVVTP, NCO037834 Renewal Yadkin
Test number: Test number: Test number:
e Describe the point in the treatment process at which the sample was collected
Sample was collected
f For each test,include whether the test was intended to assess chronic toxicity,acute toxicity,or both
Chronic toxicity
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
i. Type of dilution water. If salt water,specify"natural"or type of artificial sea salts or brine used.
Fresh water
Salt water
Give the percentage effluent used for all concentrations in the test series
k Parameters measured during the test (State whether parameter meets test method specifications)
pH
Salinity
Temperature
Ammonia
Dissolved oxygen
I Test Results
Acute
Percent survival in 100% % % %
effluent
LC5o
95%C I % % %
Control percent survival % % %
Other(describe)
EPA Form 3510-2A(Rev.1-99) Replaces EPA forms 7550-6&7550-22 Page 16 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
Chronic
NOEC % % %
IC25 % % %
Control percent survival % % %
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(MWDD/YYYY)?
Other(describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ❑ No If yes,describe-
EA. Summa of Submitted Biomonitorin Test Information. If you have submitted biomonitorin test information,or information regarding the
Summary 9 Y 9
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)
Quarterly, as required by the permit. All passed except a failure due to low reproduction In April 2012;the retests
conducted according to permit requirements passed
1=
r :.;', riEND:OF MART E.- -
.
. _
REFEFN THE APPLICA °IOfV'OVE p�/IEVU( i4GE 1)TQ DE ERM_INE WHICH O TH^ER'PA►RTS,:
O' FC)RM 2AYOl1:IUIUSICOMPLETE
EPA Form 3510-2A(Rev.1-99) Replaces EPA forms 7550-6&7550-22 Page 17 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
=P%E�1��,"
AL�APPLICATION INFORMATION ,a,;..
-PART F.INDUSTRIAL-USER DfSCHARGES AND.RCRA/CERCLA
:. '', ,%,+ -.�:- '- �ias�cu.a�€N..�<__.�.. _=- �.. .�:, 3uau.............•.,,,.. F.amu_ ,3�. ,• •' ,
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?
x 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 Sl Us 10
b Number of CIUs 10
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* ""SEE ATTACHED""
Mailing Address
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the SIU's discharge.
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)
Raw material(s).
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 whether the discharge is continuous or intermittent.
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
gpd ( continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following-
a. Local limits ❑ Yes ❑ No
b Categorical pretreatment standards ❑ Yes ❑ No
If subject to categorical pretreatment standards,which category and subcategory?
EPA Form 3510-2A(Rev.1-99) Replaces EPA forms 7550-6 8 7550-22. Page 18 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge WWTP, NCO037834 Renewal Yadkin
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed to any problems(e g,
upsets,interference)at the treatment works in the past three years?
❑ Yes No If yes,describe each episode
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK, RAIL,OR DEDICATED PIPELINE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck,rail or dedicated pipe?
❑ Yes x 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 has it been notified that it will)receive waste from remedial activities?
❑ Yes(complete F 13 through F 15) x 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 ongniate 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 O_F RARTF. : > a,... .r,_ ,< 3
-
REFER,TO-THE APPLIC�►TION 01/ERVIEW,(,PAGE""1)TO DETERMINE-WHICH'OTHER''PARTS
' OF�FORM�2A"Y4U fVIU�ST"COMPLETE 9 �-
^' - _�
EPA Form 3510-2A(Rev.1-99) Replaces EPA forms 7550-6&7550-22 Page 19 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Archie Elledge VWVTP, NCO037834 Renewal Yadkin
AW
SUPPLEMENTALAPPLtCATIONINFORMATIO�N ::; "" -
" _
I UZ
ECMe,�u
-EBINEQ:SEWER_,SAPATOMS
�3
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 mayor 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?
GA. 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:
Archie Elledge VVVVfP, NCO037834 Renewal Yadkin
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 Sod 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)
ENDOE PART G. —
REEE'R TSO THE APPLICATION 01/ERViEVit'(P .1,)TO ®ETERMINE�INHICHOTHERP�#RTS
OFmFORMa2A Y:OU`Ml1ST COMPLETE':. f
-' -
EPA Form 3510-2A(Rev 1-99). Replaces EPA forms 7550-6&7550-22 Page 21 of 22

Additional information,if provided,will appear on the following pages.
NPDES FORM 2A Additional Information

PART F. INDUSTRIAL USER DISCHARGES
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.
Adele Knits,Inc.
3304 Old Lexington Road
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Manufactures polyester and nylon fabrics
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.
Manufacture synthetic circular knit fabrics
Nylon yarns, polyester yarns, powder dyes, machine oil, and dye,and auxiliary
chemicals.
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 70,000 gpd -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. 0 gpd at permitted discharge
point. Unknown.
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards, which category and subcategory? N/A
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.
SIU Info—Elledge—2013 NPDES

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.
B/E Aerospace,Inc.
1455 Fairchild Road
Winston-Salem,NC 27105
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing
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.
Manufacture parts for airline seating by machining and fabricating
Aluminum, steel, plastics,chromium, copper, lead, nickel,zinc, cleaners,acids,and
caustics
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Federal Regulations Apply to Process
Wastewater Only. Process Flow is 3,000 gpd -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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR 433 Subpart A
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
S IU Info—Elledge—2013 NPDES

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.
Bekaert Textiles USA,Inc.
240 Business Park Drive
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Textile-woven fabric finishing
F.S. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Manufacture mattress ticking
Rayon, polyester,cotton, acids,scouring compounds,and polymers
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 20,000 gpd - Continuous
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. 5,0000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards,which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Caterpillar Axle Manufacturing
2950 Temple School Road
Winston-Salem, NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing -Coating
Process includes machining of cast parts, metal preparation and painting.
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Manufacture axles,wheels,spindles and brakes for excavators
Steel, metal cleaning chemicals, paints, and machine oils.
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limits apply to Process
wastewater only. Process wastewater is batch operation of 20,000 gallons per
month—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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR 433 Subpart A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Dairy Fresh LLC
2221 Patterson Avenue
Winston-Salem,NC 27105
FA. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Dairy processing and plastic molding & forming
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Products include milk, ice cream, sherbert, frozen yogurt,flavored drinks
Raw milk, sugars, fruit concentrates, ice cream flavorings, bleach, caustic solutions,
and plastic
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 165,000 gpd - Continuous
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. 10,000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards, which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes © No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Deere-Hitachi Construction Machinery Corporation
1000 Deere-Hitachi Road
Kernersville,NC 27285
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing-Coating
Process includes cutting and welding of steel plates, metal preparation and painting.
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Manufacture hydraulic excavators
Steel, metal cleaning and etching chemicals, paints, oils, and hydraulic fluids
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limits apply to Process
wastewater only. Process wastewater is 3,300 gpd -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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 433 Subpart A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g.,upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Grass America,Inc.
1202 Hwy 66 South
Kernersville,NC 27284
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing -Coating
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Powder coat kitchen and bath cabinet hardware
Steel, powder paints, alkaline cleaner and iron phosphate cleaner
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limits apply to process
flow only. Process flow is batch discharge of 2,500 gallons twice(2)a year-
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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 433 Subpart A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g.,upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Hanes Dye and Finishing Company
600 Northwest Blvd.
Winston-Salem,NC 27102
FA. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Woven textile facility which dyes and finishes fabrics
F.S. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Woven textile
Acids, dyes, caustics, flame retardant, and fabric protection chemicals
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 160,000 gpd - Continuous
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. 6,000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards,which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Highland Industries,Inc.
215 Drummond Street
Kernersville,NC 27284
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Textile coating and finishing operation
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Produce tire products, rubber drive belt material and airbag material
Neoprene, nitrile, silicone, urethane, polyurethane,solvents, cleaners
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 8,000 gpd -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. 0 gpd at permitted discharge
point.
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards,which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES
L

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.
HOH Corporation
1701 Vargrave Street
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Centralized waste treatment
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.
Treat wastewater and solidify non-hazardous sludge& liquids
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical limit applies to process
flow only. Process flow is 35,000 gpd -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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 437 Subpart D
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Ingredion Incorporated
4501 Overdale Road
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Wet corn milling
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.
Produce corn feed,corn meal,corn germ, starch, liquid dextrose and high fructose
corn syrup
Corn, acids, caustics,and enzymes
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 600,000 gpd -Continuous
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. 6,000 gpd - Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards,which category and subcategory? N/A
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems(e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Johnson Controls Battery Group,Inc.
2701 Johnson Controls Drive
Kernersville,NC 27284
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Battery
F.S. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Lead-acid batteries for auto, marine and utility
Lead,sulfur acid, parts cleaner,oils and glycol
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limits apply to process
flow only. Process flow is 10,000 gpd -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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards,which category and subcategory?
40 CFR Part 461 Subpart C
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Kaba Ilco Corporation
2941 Indiana Ave.
Winston-Salem,NC 27105
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Push button and electronic locks
Chromium, copper, nickel,zinc, brass, cyanide,acids,caustics, bleach and
brighteners
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limit applies to process
flow only. Process flow is 27,000 gpd - Continuous
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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 433 Subpart A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference)at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Microfibres,Inc.
3821 Kimwell Drive
Winston-Salem,NC 27103
FA. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Textiles for nylon upholstery
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.
Produce flocked nylon upholstery fabric with dyeing
Nylon,surfactants, adhesive, flame retardants, dyes, and softeners
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 20,000 gpd - Continuous
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. 3,000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards,which category and subcategory? N/A
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Pepsi Bottling Ventures
3425 Myer Lee Drive
Winston-Salem,NC 27101
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Soft drinks and beverages
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.
Manufacture carbonated and non-carbonated beverages
Water, CO2,corn syrup,flavorings, colors, cleaners,and caustic solutions
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 122,000 gpd -Continuous
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. 6,000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards, which category and subcategory? N/A
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Piedmont Aviation Component Services
3817 North Liberty Street
Winston-Salem,NC 27105
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing
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.
Overhaul/repair aviation components
Cadmium, chromium, copper, cyanide, acids, caustics and cleaners
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical standards apply to process
flow only. Process flow is 2,500 gpd - Continuous
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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 433 Subpart A
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g.,upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Rexam Beverage Can Company
4000 Old Milwaukee Lane
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Coil coating -Aluminum cans
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Manufacture two-piece aluminum beverage cans.
Aluminum coils,coatings, inks,acids,caustics,and cleaners
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical Limits apply to process
flow only. Process flow is 130,000 gpd - Continuous
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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 465 Subpart D
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference)at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Sonoco CorrFlex
555 Aureole Street
Winston-Salem, NC 27117
FA. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Corrugated displays
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Corrugated Display and Packaging
Paper, borax, caustic,starch, inks,and glue
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 12,000 gpd - Continuous
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. 3,000 gpd - Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits N Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards, which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference) at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

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.
Stratford Metal Finishing
1681 S. Martin Luther King Jr. Dr.
Winston-Salem,NC 27107
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Metal finishing
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Metal and surface finishing
Cadmium,chromium, copper, nickel,zinc,silver, gold,cyanide, acids,caustic,and
cleaners.
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. Categorical limits only apply to process
flow. Process flow is batch operation of 24,000 gallons per month -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. Unknown
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits Yes No
b. Categorical Pretreatment Standards Yes No
If subject to categorical pretreatment standards, which category and subcategory?
40 CFR Part 433 Subpart A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SILT 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.
SIU Info—Elledge—2013 NPDES

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.
Unifirst
526 Piney Grove Road
Kernersville,NC 27284
F.4. Industrial Processes. Describe all the industrial processes that affect or contribute to the
SIU's discharge.
Industrial laundry
F.S. Principal Product(s) and Raw Material(s). Describe all of the principal processes and raw
materials that affect or contribute to the SIU's discharge.
Wash uniforms,aprons, mops and shop towels
Surfactant,water conditioner,caustic and degreaser/solvent
F.6. Flow Rate
a. Process wastewater flow rate. Indicates 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. 31,000 gpd - Continuous
b. Non-process wastewater now 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. 2,000 gpd -Continuous
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ® Yes No
b. Categorical Pretreatment Standards Yes ® No
If subject to categorical pretreatment standards, which category and subcategory? N/A
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the
SIU caused or contributed to any problems (e.g., upsets, interference)at the treatment
works in the past three years?
Yes ® No If yes, describe each episode.
SIU Info—Elledge—2013 NPDES

ELLEDGE WASTEWATER`TREATMENT PLANT FLOW SCHEME
S%1%j0RK PRELIMiNARY TREATMENT
BAR SCREE ANDFIEFt�tltl
gg ,LE�MM
RAKE M
O1;�rFALL � M
iltitlrlUENT Back-lap Power
PUMPs(6) Generaton by
T 3-25W KW
,,Generators,
1:000 HP" PRIMARY
BLOWERS(411 CLARIFIERS 141RAW
DGE
PUMPS (-0)
AIR DISTRIBLITION SYST
ACTIYATED.SLUDGE BASINS(8)
THICKENER DIGESTERS ( FINAL CLARIMERSK
I
DEWItATEFUNG'TREATMENT E HOLDING 1 CHL t1RINE DISINFECTION
SOUTH FORK.PRE-TREATMENT BASINS
1 CENTRIFUGE 'T�
'— FACILITY
Yj
DRYER
" FACILITY
DEWATERING FROM,CENTRIFUGE DECHLORINATION
Averae Plant FIt>rovs ;
South Fork 4, MGG DRIED SOLIDS
Satern 18.20 MW REMOVED FROM �► �
KImeI 087 O DRYER FACILITY
ARE LAND APPLIED
Effluent 14.03 NGD �
B.R I`1£i•f5nneti.7r.12Jj8
Plant Influent flow enters the,plant through three separate outfalls,_Kmel Outfall,Salem Outfall and South
Fork Outfall_Once flow enters the plant,it goes through Bar Screens and Grit Collectorsto Influent
Pumps.'Flow from Influent Pump Station area will then flow to•Primary Clarifiers to remove settleable
solids,scum,grease and.flgatables.-From Primary,area;flow will enter Activated Sludge tanks where-
Uiological actiuitY'takes place.After aproximately 241bours of detention time,mixed liquor will flaw into
:he-Final Clarifiers to settle solids.A portion of solids is washed out of the system with the remaining
volume of solids sent back to the head of the Activaled Sludge System.From the Final Clarifiers,
treated water is injected with Sodium Hypochlonte afthe flash Mixer and flows into the'Chlorine
Contact Chamber to provide,ample contact time for disinfection_Atthe,dischartge of the Contact
Chamber,flow is Injected with Sodium Bisulfite to remove residual Chlorine..Atthis point..effluent fow
is discharged to Salem Creek.

Archie Elledge
Wastewater Treatment Plant
r S b LEEN
Gravity Sewer
A
�",, `ter '-, „�.��••ry.!ryr -�ft,e .;,, 'f -, '. .kr' `; A°�:• "'. _ N
_�§6.� •}-t 'x;' _;rte-^5 t✓ �'L; 4 ,4� "'".;».""','-•,�. r, S; �, ,�v7 V
`':' 4 w''-m t"„mss .j ,. - �.. .9 ;" �i:.• :- S
FIYj # � SALEM O0 2,500 5,000
UTFALL
OUTFALL w Feet
1 inch=2,500 feet
ELLEDGE WWiP M"��4 0' ,
lid "^ '"' ,� -�-, ✓ ,¢ Data source
- -''* •- •+ " ,� -_ "�„ f ®2011 National Geographic Society,
i-cubed
Msuy Utmiuiti�.�ey
s
..
Sa,a W.-D.­1

IVA-
NICURR
wy war
North�Carolina Departrne'rit 6f)Environrh6h1t and NbWral;REispurtes
Division,of Water Resources
Water Quality'Programs
'Pat*drdry Tt omas,A.;Reeder J16hn El 81W4 III
Governor Dir6dtlbr Sbcretary
Atigpt 8,;:2013
Mr.Ron Hargrove-,
City/county=Uii'l'i-tids,'Directcit
City of Winston-Salem,
?.0.Box-25,11
Winston-Salem, 27
N' J
NG 102
RE'. Renewal of Yadkin Pee Dee'River,Basin Association Memorandum of'Agreement
NPDES Permit Modification for'ln-stream Monitoring,
K00,37834—Archie Elledge,W WTP-
Forsyth County
Dear Mr.-HO
grove:
For the Past 15,years,members=of the Yadkin Pee'Dee River Basin Association(YPDRB have
broadened ourco1leciive understanding of the Yadkin/Pee De6.bd§in through,wdter quality
'monitoring'. Tht,bivision,of Water Resources(OWR)greatly appTeciates.the Association's
continued support of themonitoring and­
thelime and expertise contributed`by its members.
,
By this,letter the,,T)WR confirms the waiver of in-stream monitoring requirements within.your
individual'NPDES,permit,in eichange-,&r the YPbRBA's monitoring of the basin as specified
within
thin the renewed Memorandum of Agreemejit,(MOA),effective-August 1,20,13. The
agreement identifies the,stations,parameters,and frequency,of monitoring required ofthd
as I sociati6n'in order t(i maintain the in-stream.,monitoTirfig waivers fqr,y9urjndividual permits.
Influent-and.effluent monitoring requirements,are not affected,bytfiiswaiVei. Should-your
membership in thel,associatl'On,b,etepninat&d,you rhust'n.otify DAR immediately and the;Iin-,
stream monitoring:requirement's in',yourpermitwill be,reinstati-d.
All other terns and conditions in the original permit remain unchanged andin f1ill:eff6ct. These,
modifications are i,s.§ued purs uanfto,thelequifemefits,of NorthEardlina General Statute 143-
215.1 and the Memoralndum.o.f-Agreement between'Norib Carolina and-the,US Environmental
Protection,Agency.
1617.Mail'S&Oca Center,Ralah,No*Catalina-278 99.1617
Locatbii,512 N.Sjlistti ry St Rafth,North Caollna 27041
Pi b,6`9'IUOTC 310D k Fax:915-607,6492
alty.cra
Aa Eqva: AOM Eroayer

Ar6hie E,116dgc-WWFP
August 8,2013
Page 2'of 2
If'you have any,qpestions,-kegdrding ihc,MOA,or any cither'OAlition matter,pleaso'coiitact Carrie
Ruhtman at'(91,9)74:3z4�41 I or via email at,cari-ie.rtilili,nati�i_ijicdenr.�o'v
Thomas A
homas A.Reeder
cc Corev Basinger,Winston-Salem Regioiial,'Offite,(corey.basintiei(t.'i,,iicdeiir.,qoy)
Carrie Ruhlman,'En,viropriiental-,Scidnces,,,$ecti'bn
Central Files

WFAA
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
December 17, 2013
Attn: Ron Hargrove
City of Winton-Salem
P.O.Box 2511
Winston-Salem,NC 27102
Subject: Receipt of permit renewal
Permit NCO037834
Forsyth County
i
Dear Mr. Hargrove:
The NPDES Unit received your permit renewal application on December 16, 2013. 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 pen-nit 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 [phone].
Sincerely,
* Aa
Wren Thedford
Point Source Branch
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location-512 N.Salisbury St Raleigh,North Carolina 27604
Phone:[phone] Fax:[phone]/Customer Service:1-877-623-6748
Internet:www.ncwater.orq
An Equal OpportunityWfiirmative Action Employer

r