NC0078271_Renewal (Application)_20220114

ROY COOPER d~,,,
Governor _ i
ELIZABETH S.BISER .� .:,t,.
Secretary
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
January 14, 2022
NC State University
Attn: Jeffery Johnson, Maintenance Supervisor
804 Cedar Lane
Reidsville, NC 27320
Subject: Permit Renewal
Application No. NC0078271
Betsy Jeff Penn 4H Education
Rockingham County
Dear Applicant:
The Water Quality Permitting Section acknowledges the January 12, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit.The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,ac. pc.g,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road,Suite 300 I Winston-Salem North Carolina 27105
DEW)
336 776.9800

North Carolina Modified Application Form 2A
Department of Environmental Quality Revised March 2021
Division of Water Resources
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
I A N 12 2022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result in denial of the application.
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and (9))
1.1 Facility name
Betsy-Jeff Penn 4-H Educational Center
Mailing address(street or P.O. box)
804 Cedar Lane
City or town State ZIP code
o Reidsville NC 27320
Contact name(first and last) Title Phone number Email address
c Jeffery Johnson Maintenance Supervisor 336-349-9445 [e-mail]
Location address(street,route number,or other specific identifier) ® Same as mailing address
f6
LL
City or town State ZIP code
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O. box)
0
o City or town State ZIP code
Contact name(first and last) Title Phone number Email address
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
® Facility El Applicant
❑ Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
E number for each.)
Existing Environmental Permits
a76 NPDES(discharges to surface El RCRA(hazardous waste) UIC(underground injection
water) control)
NC0078271
❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
(I) ElOcean dumping(MPRSA) ElDredge or fill(CWA Section ElOther(specify)
LL, 404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
o Betsy Jeff AVG. 175 100 %,separate sanitary sewer m Own 0 Maintain
°' %Penn 4-H combined storm and sanitary sewer 0 Own 0 Maintain
m C:antar ISI ❑ Unknown 0 Own 0 Maintain
co
c %separate sanitary sewer 0 Own 0 Maintain
combined storm and sanitary sewer 0 Own 0 Maintain
(13
0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own ElMaintain
%combined storm and sanitary sewer ❑ Own 0 Maintain
ca 0 Unknown 0 Own 0 Maintain
E %separate sanitary sewer 0 Own 0 Maintain
cn . %combined storm and sanitary sewer 0 Own 0 Maintain
C 0 Unknown 0 Own 0 Maintain
Total 175
°' Population
ci Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 100 % °/°sewer line(in miles)
1.8 Is the treatment works located in Indian Country?
c
o 0 Yes ❑ No
c)
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
co
c El Yes ❑ No
c
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.0131 mgd
= toAnnual Average Flow Rates(Actual)
a2 Two Years Ago Last Year This Year
C• O 0.0031 mgd 0.0013 mgd .0028 mgd
Maximum Daily Flow Rates(Actual)
0 Two Years Ago Last Year This Year
0.0078 mgd 0.0071 mgd 0.018 mgd
u) 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
o Total Number of Effluent Discharge Points by Type
n O. Constructed
rn Combined Sewer
Treated Effluent Untreated Effluent Bypasses Emergency
t Overflows Overflows
U
N
0 1 0 0 0 0
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins, ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes ❑ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd ❑ Intermittent
-D
2 1.14 Is wastewater applied to land?
2 ❑ Yes ❑ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
H Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
ea
-=
acresgpd ❑ Continuous
❑ Intermittent
acres d 0 Continuous
0 9P 0 Intermittent
acresgpd 0 Continuous
❑ Intermittent
Wi 1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes ❑ No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O. box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
-0 Facility name Mailing address(street or P.O. box)
City or town State ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
3
NPDES number of receiving facility{if any) 0 None Average daily flow rate mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
dnot have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
❑ Yes ❑ No 4 SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
= Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
co
acresgpd 0 Continuous
0 Intermittent
0 Continuous
acres gpd ❑ Intermittent
acresgpd ❑ Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
d Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
C cy ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
Section 301(h)) 302(b)(2))
VI Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name)
Mailing address
(street or P.O.box)
o City,state,and ZIP
code
cContact name(first and
c.) last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
SECTION 2.ADDITIONAL INFORMATION (40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o ❑ Yes ❑ No Ht SKIP to Section 3.
c 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
-0
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
• O. specific requirements.)
o 2
O ❑ Yes
o ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o (See instructions for specific requirements.)
o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
R 1.
d
E
2.
E
0
3.
V
C)
in 4.
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
> Outfalls Operational
2 Improvement Construction Construction Discharge p
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
2
co
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 1 Outfall Number Outfall Number
State North Carolina
County Rockingham
City or town Wentworth
0
g Distance from shore 2 ft. ft. ft.
Q
Depth below surface 0 ft. ft. ft.
Average daily flow rate .0021 mgd mgd mgd
Latitude 36 23 35' N
Longitude 7g 42 1g' W °
3.2 Do anyof the outfalls described under Item 3.1 have seasonal orperiodic discharges?
9
o ❑ Yes ❑ No 4 SKIP to Item 3.4.
3.3 If so, provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
3
Number of times per year
0 discharge occurs
Average duration of each
Lo _discharge(specify units)
•
Average flow of each
0 discharge mgd mgd mgd
03 Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number Outfall Number Outfall Number
d
U)
0
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
® Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 1 Outfall Number Outfall Number
Receiving water name Carroll Creek
Name of watershed, river, Roanoke river
o or stream system
fl U.S.Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
U.S.Geological Survey
CO 8-digit hydrologic
cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 1 Outfall Number Outfall Number
Highest Level of m Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
0 - -
Q Design Removal Rates by
U,
Outfall
BOD5 or CBOD5 80 %
E
TSS 80 % ok
F-
1 Not applicable 0 Not applicable 0 Not applicable
Phosphorus % % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen 65 % % %
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
ok
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below.
We use a Trojan UV2000 Ultraviolet disinfection system
_
0
Outfall Number 1 Outfall Number Outfall Number
0
Disinfection type Ultraviolet
co
d
Seasons used 4
Dechlorination used? 0 Not applicable ❑ Not applicable ❑ Not applicable
❑ Yes ❑ Yes ❑ Yes
❑ No ❑ No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
VI Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
co
Number of tests of discharge
•= water
Y
Number of tests of receiving
water
w
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
• Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
El Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MMIDD/YYYY)
v
m
c
c
w 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
o toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
F 3.23 Describe the cause(s)of the toxicity:
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES •ermittin• authorit .
Page 9

NPDES Permit Number Fadity Name Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application. For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
0 Section 1:Basic Application ❑ w/variance request(s) ❑ wi additional attachments
Information for All Applicants
❑ Section 2:Additional ❑ w/topographic map ❑ w/process flow diagram
Information ❑ wl additional attachments
❑ w/Table A ❑ wl Table D
Section 3:Information on ❑ w/Table B ❑ wl additional attachments
m ❑ Effluent Discharges
❑ wl Table C
m
Section 4:Not Applicable
0
Section 5:Not Applicable
Section 6:Checklist and
❑ ❑ wi attachments
Certification Statement
6.2 Certification Statement
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information, the information submitted is,to the best of my knowledge and belief,true, accurate,and
complete. lam aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Jeffery Johnson Maintenance Supervisior
Signa7ttr Date signed
,. ' 01/12/2022
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method1 (include units)
Sam•les
Biochemical oxygen demand
0 ML
0 BODE or o CBOD5 ,5.0 mg/I 30.0 mg/I 2/month SM 5210B-2016 mg/I l MDL
retort one
Ill ML
Fecal coliform ,00/100 ml 00/100 ml 2/month Colilert-18 MPN/100❑MDL
Design flow rate 4.0131 MGD MGD Weekly
pH(minimum) >6.0 standard
pH(maximum) <9.0 standard
Temperature(winter) MS=(summer) MIIM
O ML
Total suspended solids(TSS) 45.0 mg/I c0.0 mg/I 2/month SM 2540D-2015 mg/Ivi MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical ML or MDL
Value Units Value Units Method (include units)
Samples
o ML
Ammonia(as N) 35.0 mg/I 12.0 mg/I 2/month EPA 350.1 mg/I m MDL
Chlorine ❑ML
(total residual,TRC)2 ❑MDL
❑ML
Dissolved oxygen ❑MDL
❑ML
Nitrate/nitrite ❑MDL
❑ML
Kjeldahl nitrogen ❑MDL
❑ML
Oil and grease ❑MDL
❑ML
Phosphorus ❑MDL
❑ML
Total dissolved solids ❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
❑Hardness(as CaCO3) M
❑MLDL
— - - ❑ML
Antimony,total recoverable ❑MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable ❑ML
❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
Copper,total recoverable ❑ML
❑MDL
Lead,total recoverable ❑ML
❑MDL
Mercury,total recoverable ❑ML
❑MDL
Nickel,total recoverable ❑ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
Acrolein o ML
❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples rt
Carbon tetrachloride ❑ML
❑MDL
❑ML
Chlorobenzene
❑MDL
❑ML
Chlorodibromomethane
❑MDL
❑ML
Chloroethane
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
0 ML
Chloroform ❑MDL
❑ML
Dichlorobromomethane
❑MDL
❑ML
1,1-dichloroethane
❑MDL
1,2-dichloroethane 0 ML
❑MDL
0 ML
trans-1,2-dichloroethylene ❑MDL
0 ML
1,1-dichloroethylene ❑MDL
II ML
1,2-dichloropropane ❑MDL
0 ML
1,3-dichloropropylene ❑MDL
0 ML
Ethylbenzene ❑MDL
0 ML
Methyl bromide ❑MDL
ID ML
Methyl chloride ❑MDL
0 ML
Methylene chloride ❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
0 ML
Tetrachloroethylene ❑MDL
Toluene ❑ML
❑MDL
1,1,1-trichloroethane ❑ML
❑MDL
1,1,2-trichloroethane ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Trichloroethylene °ML
❑MDL
Vinyl chloride ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol o ML
❑MDL
2-chlorophenol ❑ML
❑MDL
2,4-dichlorophenol ❑ML
❑MDL
2,4-dimethylphenol ❑ML
❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
2,4-dinitrophenol ❑ML
❑MDL
2-nitrophenol ❑ML
❑MDL
4-nitrophenol ❑ML
0 MDL
❑ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
2,4,6-trichlorophenol ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene ❑ML
❑MDL
Acenaphthylene ❑ML
❑MDL
Anthracene ID ML
❑MDL
Benzidine ❑ML
0 MDL
Benzo(a)anthracene ❑ML
0 MDL
Benzo(a)pyrene ❑ML
❑MDL
3,4-benzofluoranthene ID ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Method1 (include units)
Samples
0 ML
Benzo(ghi)perylene ❑MDL
0 ML
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane ❑MDL
0 ML
Bis(2-chloroethyl)ether ❑MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
0 ML
Bis(2-ethylhexyl) phthalate ❑MDL
0 ML
4-bromophenyl phenyl ether ❑MDL
0 ML
Butyl benzyl phthalate ❑MDL
0 ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether 0 MDL
0 ML
Chrysene ❑MDL
0 ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
0 ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene CI ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
0 ML
Dimethyl phthalate ❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
1,2-diphenylhydrazine o ML
❑MDL
Fluoranthene ❑ML
o MDL
Fluorene 0 ML
o MDL
❑ML
Hexachlorobenzene o MDL
Hexachlorobutadiene ❑ML
❑MDL
Hexachlorocyclo-pentadiene ❑ML
❑MDL
Hexachloroethane 0 ML
❑MDL
Indeno(1,2,3-cd)pyrene ❑ML
❑MDL
Isophorone ❑ML
❑MDL
Naphthalene ❑ML
❑MDL
Nitrobenzene ❑ML
❑MDL
N-nitrosodi-n-propylamine ❑ML
❑MDL
N-nitrosodimethylamine ❑ML
❑MDL
N-nitrosodiphenylamine ❑ML
❑MDL
Phenanthrene ❑ML
❑MDL
Pyrene ❑ML
❑MDL
1,2,4-trichlorobenzene ❑ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0078271 Betsy-Jeff Penn 4-H Center Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar e
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method1 (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ML
D MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18