NC0047759_Renewal (Application)_20220128

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�y
ROY COOPER
Governor ` i :,:i@
6
ELIZABETH S.BISER
Secretary
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
January 28, 2022
Pruitthealth- Sea Level, LLC
Attn: Nena Hancock, Administrator
1626 Jeaurgens Ct
Norcross, GA 30093-2219
Subject: Permit Renewal'
Application No. NC0047759
PruittHealth at Sealevel WWTP
Carteret County
Dear Applicant:
The Water Quality Permitting Section acknowledges the January 18, 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,
.gapin 11! ic:\,
Wren Thed ord
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_ECw NorthWilm CarobnaingtonRegional DepartmentOffice o1 f127 EnvironmentaCardinal lDrive QuExalitytension I DivisionWil ofmington.Water North Resources
CV) I Carolina 28405
910.796.7215

•
North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
JAN 2 7 2022
NCDEQ/DWR/NPDES
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
NC0047759 PRUITT HEALTH AT SEALEVEL 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 may 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
PRUITT HEALTH AT SEALEVEL
Mailing address(street or P.O.box)
468 HWY 70 EAST
City or town State ZIP code
SEALEVEL NC 28577
Contact name(first and last) Title Phone number Email address
NENA HANCOCK ADMINISTRATOR [phone] [e-mail]
w Location address(street,route number,or other specific identifier) ❑✓ Same as mailing address
w
468 HWY 70 EAST
City or town State ZIP code
SEA LEVEL NC 28577
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 0 No 4 SKIP to Item 1.4.
Applicant name
a Applicant address(street or P.O.box)
0
0 City or town State ZIP code
co
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.)
❑r Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
El Facility ❑ 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
number for each.)
Existing Environmental Permits
a ❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
E
❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CM)
rn
0 Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

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NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
%separate sanitary sewer ❑ Own ❑ Maintain
Z %combined storm and sanitary sewer 0 Own ❑ Maintain
d 0 Unknown ❑ Own 0 Maintain
_ %separate sanitary sewer ❑ Own 0 Maintain
g %combined storm and sanitary sewer 0 Own ❑ Maintain
❑ Unknown 0 Own ❑ Maintain
a %separate sanitary sewer 0 Own ❑ Maintain
a %combined storm and sanitary sewer El Own 0 Maintain
a0 Unknown 0 Own 0 Maintain
0 %separate sanitary sewer ❑ Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
❑ Unknown ❑ Own ❑ Maintain
0
Total
°' Population
u Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) % %
?' 1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes El No
c)
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.014 mgd
w Annual Average Flow Rates(Actual)
a Two Years Ago Last Year This Year
a ce
c
tti
o .006 mgd .006 mgd .007 mgd
Maximum Daily Flow Rates(Actual)
cn Two Years Ago Last Year This Year
.01.0 mgd .012 mgd .012 mgd
. 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
a- 0 Constructed
° a Combined Sewer
Tre ted Effluent Untreated Effluent Bypasses Emergency
YP 9 Y
ver Oflows Overflows
V
o
— -� — i
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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 2 No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
0 Continuous
gpd ❑ Intermittent
0 Continuous
gpd 0 Intermittent
2 1.14 Is wastewater applied to land?
El Yes 0 No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
o I Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
acres d 0 Continuous
gp 0 Intermittent
acres d 0 Continuous
gip' 0 Intermittent
0 acres d 0 Continuous
gp 0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ 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

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NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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
a Facility name Mailing address(street or P.O.box)
d
•= City or town State ZIP code
0
C.)
Contact name(first and last) Title
0
Phone number Email address
2
aNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
U,
1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
❑ Yes 0 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
Disposal Annual Average
o Location of Size of Continuous or Intermittent
Method Daily Discharge
Disposal Site Disposal Site (check one)
Description Volume
acres gpd 0 Continuous
❑ Intermittent
acresgpd 0 Continuous
❑ Intermittent
acresgpd 0 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.
CD an Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
e, ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑✓ Yes ❑ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name) PATRICIA DAVIS
Mailing address
0 289 NELSON NECK ROAD
(street or P.O.box)
o City,state,and ZIP SEA LEVEL NC 28577
m code
Contact name(first and PATRICIA DAVIS
U
Phone number [phone]
Email address [e-mail]
Operational and
maintenance OPERATE PLANT COLLECT
responsibilities of TRANSPORT SAMPLES,
Contractor PERFORM LIGHT
Page 4

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NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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?
❑ Yes ❑r No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
m and infiltration.
o gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
PLANT HAS LITTLE TO NO INFLOW OR INFILTRATION.THE FACILITY IS SUPPORTED BY ONE SEWAGE PUMP STATION.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
specific requirements.)
o
0
0.
❑✓ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
o
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.
1.
2.
0
3.
cu
cu
4
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled- in Begin End Be p
Outfalls g Operational
o Improvement Construction Construction Discharge
n - (list outfal( Level
(from above) (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)
number) (MM/DD/YYYYL
1.
2
cn
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

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NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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 o01 Outfall Number Outfall Number
State NORTH CAROLINA
(13
County CARTERET
o City or town SEALEVEL
0
o Distance from shore zs ft. ft. ft.
a
Depth below surface 2 ft. ft. ft.
0
Average daily flow rate .003 mgd mgd mgd
Latitude 34* 52' 59" N "
Longitude 76` 23' 46" W
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
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
6
Number of times per year
0 discharge occurs
ri Average duration of each
discharge(specify units)
Average flow of each
discharge mgd mgd mgd
co
u, 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 pe at each applicable outfall.
Outfall Number Outfall Number Outfall Number
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?
w ❑ Yes ❑ No-*SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name NELSON BAY,NC
Name of watershed,river, H33NW/LONG BAY,NC
0 or stream system
0- U.S.Soil Conservation
u) Service 14-digit watershed
o code
== Name of state management/river basin WHITE OAK RIVER BASIN
cn
U.S.Geological Survey
CO 8-digit hydrologic 03020105
ce 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 col I Outfall Number Outfall Number
Highest Level of ID Primary ❑ Primary ❑ Primary
Treatment(check all that El Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
Ill Secondary ❑ Secondary ❑ Secondary
❑ Advanced 0 Advanced 0 Advanced
0 Other(specify) 0 Other(specify) 0 Other(specify)
c TERTIARY FILTERS
0
'a Design Removal Rates by
0 Outfall
U,
d
ca BOD5 or CBOD5 90 % % %
tu
m TSS 90 % %
t=
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus % % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
% % %
i
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below.If disinfection vanes by
season,describe below.
12.5%SODIUM HYPOCHLORITE
U
0
Outfall Number 001 Outfall Number Outfall Number
Disinfection type
SODIUM HYPOCHLORITE
(13
Seasons used
YEAR ROUND
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
❑r 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?
0 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
Number of tests of discharge
cri
water
Number of tests of receiving
water
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 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?
0 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?
No additional sampling required by NPDES
ID Yes
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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?
El 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
(MMODNYYY)
m
0
3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
c' El Yes ❑ No-3 SKIP to Item 3.26.
F3.23 Describe the cause(s)of the toxicity:
C
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
El Yes E Not applicable because previously submitted
information to the NPDES permittin. authori .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 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 M Column 2
Section 1:Basic Application w/variance❑ request(s)Information for All Applicants ❑ ❑ w/additional attachments
Section 2:Additional ❑ wl topographic map ❑ w/process flow diagram
❑ Information ❑ wl additional attachments
e
r❑ w/Table A ❑ wl Table D
Section 3: Information on ❑ wl Table B ❑ w/additional attachments
Effluent Discharges
0 w/Table C
Section 4:Not Applicable
Section 5:Not Applicable
a Section 6:Checklist and
❑ Certification Statement ❑ wl attachments
6.2 Certification Statement
d .
s , 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 submitted is,to the best of my knowledge and belief,true,accurate,and
6 r, complete.I am 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
NENA HANCOCK ADMINISTRATOR
Signa ure Date signed
01/24/2022\tia/A
CAS, LA/84
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 001 Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of (include units)
Value Units Value Units Method
Samples
Biochemical oxygen demand ❑ML
❑BOD5 or❑CBOD5 67 MG/L 7.55 MG/L 4 SM 5210 B ❑MDL
re.ort one
Fecal coliform ❑ML
❑MDL
Design flow rate .012 MGD .003 MGD 30
pH(minimum) 7.62 SU
pH(maximum) 8.66 SU
Temperature(winter) 18 C 12 C 30
Temperature(summer) 30 C 28 C 30
CI ML
Total suspended solids(TSS) 12 MG/L 2.5 MG/L 4 SM 2540 D ❑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
NC0047759 PRUITT HEALTH AT SEALEVEL 001 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 Analytical ML or MDL
Pollutant Number of units
Value Units Value Units Samples Methods (include )
1:1 ML
Ammonia(as N) 11.5 MG/L .133 MG/L 2 SM 4500 NH3D-199i 0 MDL
Chlorine CI ML
48 UG/L 30 UG/L 30 SM 4500-CI G-2011
(total residual,TRC)2 ❑MDL
❑ML
Dissolved oxygen 0 MDL
0 ML
Nitrate/nitrite ❑MDL
❑ML
Kjeldahl nitrogen ❑MDL
❑ML
Oil and grease ❑MDL
❑ML
Phosphorus ❑MDL
❑ML
Total dissolved solids o 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
I NC0047759 PRUITT HEALTH AT SEALEVEL 001 Modified March 2021 .
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant — --
Value Units Value Units Number of Method1 (include units)
Sam les
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) 0 MDL
❑ML
Antimony,total recoverable 0 MDL
❑ML
Arsenic,total recoverable 0 MDL
❑ML
Beryllium,total recoverable 0 MDL
❑ML
Cadmium,total recoverable ❑MDL
❑ML
Chromium,total recoverable ❑MDL
❑ML
Copper,total recoverable ❑MDL
❑ML
Lead,total recoverable 0 MDL
❑ML
Mercury,total recoverable 0 MDL
Nickel,total recoverable ❑ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
❑ML
Silver,total recoverable 0 MDL
❑ML
Thallium,total recoverable ❑MDL
Zinc,total recoverable ❑ML
❑MDL
❑ML
Cyanide 0 MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
❑ML
Acrolein ❑MDL
O ML
Acrylonitrile I 0 MDL
❑ML
Benzene ❑MDL
❑ML
Bromoform 0 MDL
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
•
NC0047759 PRUITT HEALTH AT SEALEVEL 001 Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value I Units Number of Methods (include units)
Samples
❑ML
Carbon tetrachloride ❑MDL
❑ML
Chlorobenzene ❑MDL
❑ML
Chlorodibromomethane ❑MDL
❑ML
Chloroethane ❑MDL
❑ML
2-chloroethylvinyl ether 0 MDL
❑ML
Chloroform ❑MDL
0 ML
Dichlorobromomethane ❑MDL
❑ML
1,1-dichloroethane 0 MDL
❑ML
1,2-dichloroethane 0 MDL
❑ML
trans-1,2-dichloroethylene 0 MDL
- ❑ML
1,1-dichloroethylene ❑MDL
❑ML
1,2-dichloropropane 0 MDL
❑ML
1,3-dichloropropylene ❑MDL
❑ML
Ethylbenzene 0 MDL
❑ML
Methyl bromide ❑MDL
❑ML
Methyl chloride ❑MDL
0 ML
Methylene chloride 0 MDL
1,1,2,2-tetrachloroethane El ML
❑MDL
❑ML
Tetrachloroethylene ❑MDL
Toluene ❑ML
❑MDL
❑ML
1,1,1-trichloroethane 0 MDL
1,1,2-trichloroethane 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name 0utfall Number Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 001 Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant —
Value Units Value Units Number of Methods (include units)
Sam_ples
ML
Trichloroethylene ❑MDL
❑ML
Vinyl chloride ❑MDL
Acid-Extractable Compounds
❑ML
p-chloro-m-cresol ❑MDL
❑ML
2-chlorophenol ❑MDL
❑ML
2,4-dichlorophenol ❑MDL
❑ML
2,4-dimethylphenol ❑MDL
❑ML
4,6-dinitro-o-cresol ❑MDL
❑ML
2,4-dinitrophenol 0 MDL
❑ML
2-nitrophenol ❑MDL
❑ML
4-nitrophenol ❑MDL
❑ML
Pentachlorophenol ❑MDL
❑ML
Phenol ❑MDL
❑ML
2,4,6-trichlorophenol ❑MDL
Base-Neutral Compounds
❑ML
Acenaphthene ❑MDL
❑ML
Acenaphthylene ❑MDL
❑ML
Anthracene ❑MDL
❑ML
Benzidine ❑MDL
❑ML
Benzo(a)anthracene 0 MDL
❑ML
Benzo(a)pyrene ❑MDL
❑ML
3,4-benzofluoranthene ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
•
NC0047759 PRUI T'HEALTH AT SEALEVEL 001 Modified March 2021
T
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Method' (include units)
Samples
❑ML
Benzo(ghi)perylene ❑MDL
❑ML
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane ❑MDL
ML
Bis(2-chloroethyl)ether ❑MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
0 ML
Bis(2-ethylhexyl)phthalate ❑MDL
ML
4-bromophenyl phenyl ether ❑MDL
ML
Butyl benzyl phthalate ❑MDL
ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether ❑MDL
❑ML
Chrysene ❑MDL
0 ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
0 ML
Dimethyl phthalate ❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
❑ML
2,6-dinitrotoluene ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0047759 PRUITT HEALTH AT SEALEVEL 001 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
ML
1,2-diphenylhydrazine ❑MDL
Fluoranthene ❑ML
_ ❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
❑MDL
Hexachlorobutadiene ❑ML
❑MDL
0 ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane ❑ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene ❑MDL
❑ML
Isophorone ❑MDL
0 ML
Naphthalene ❑MDL
Nitrobenzene ❑ML
❑MDL
0 ML
N-nitrosodi-n-propylamine ❑MDL
0 ML
N-nitrosodimethylamine ❑MDL
N-nitrosodiphenylamine ❑ML
❑MDL
Phenanthrene ❑ML
❑MDL
❑ML
Pyrene ❑MDL
1,2,4-trichlorobenzene ❑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).
EPA Form 3 1 - A(Revised 3 19) Page 17

NPDES Permit Number Facility Name 1 Outfall Number Modified Application Form 2A Modified March 2021 .
NC0047759 PRUITT HEALTH AT SEALEVEL
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Dail Discharge Analytical ML or MDL
Pollutant — — Y y
(list) Value Units Number of ,
Value Units Samples Method (include units)
❑ No additional sampling is required by NPDES permitting authority.
ENTEROCOCCI 2420/100 ML 6.25 ML 4 ENTEROLERT IDEXX( O ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
0 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

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Pruitt Health at Sea Level
Ai Facility
Pruitt Healtb.WWTP Location *
State Grid/Ouacl: H33NW/Long Bay,NC Stream Segment! 21-35-7-1041) 14 not to scale
Latitude: 34°52'59"N bonzitude: 76°23'46"W
Receiviny,Stream: Nelson Bay Stream Class: SC
Drainage Basin: White Oak River Basin Sub-Basin: 03-05-04 North NPDES Permit NC0047759
HUC: 03020105 Carteret County
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