NC0085481_Renewal Application_20220207

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Faci9itoes < Oo`
and No Pretreatment Program
NPDES Permitting Program
j
Note: Complete this fonn if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
1A/1 AM)
Modified Application Form 2A
Modified March 2021
Form
NPDES
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
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))
Facility Information
1.1
Facility name
Penderlea Elementary School WWTP
Mailing address (street or P.O. box)
925 Penderlea Hwy
City or town
Burgaw
State
NC
ZIP code
28425
Contact name (first and last)
Steven Hill
Title
Superintendent
Phone number
[phone]
Email address
[e-mail]. Lit
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
82 Penderlea Hwy
City or town
Burgaw
State
NC
ZIP code
28425
1.2
Is this application for a facility that has yet to commence
❑ Yes + See instructions on data submission
requirements for new dischargers.
discharge?
v No
Applicant Information
1.3
Is applicant different from entity listed under Item
❑ Yes
1.1 above?
Item 1,4.
✓ No 4 SKIP to
Applicant name
Pender County School
Applicant address (street or P.O. box)
925 Penderlea Hwy
City or town
Burgaw
State
NC
ZIP code
28425
Contact name (first and last)
Steven Hill
Title
Superintendent
Phone number
[phone]
Email address
[e-mail]
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
❑ Facility ❑ Applicant
only
one response.)
Facility and applicant
(they are one and the same)
✓
Existing Environmental Permits
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
✓ NPDES
(discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
control)
water)
NC0085481
❑ PSD (air emissions)
❑ Nonattainment program (CM)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
404)
❑ Other (specify)
Page 1

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
\Ai%AJTf7
Modified Application Form 2A
Modified March 2021
Collection System and Population Served
0
U
ro
0
1.7 Provide the collection system information requested below for the treatment works.
1.8
Municipality
Served
NA - School
System
Population
Served
530
Collection System Type
(indicate percentage)
100 % separate sanitary sewer
% combined storm and sanitary sewer
0 Unknown
Ownership Status
O Own
O Own
O Own
0
0
Maintain
Maintain
Maintain
% separate sanitary sewer
% combined storm and sanitary sewer
Unknown
O Own
❑ Own
❑ Own
❑ Maintain
❑ Maintain
❑ Maintain
% separate sanitary sewer
% combined storm and sanitary sewer
0 Unknown
❑ Own
❑ Own
O Own
❑ Maintain
❑ Maintain
❑ Maintain
Total
Population
Served
530
Total percentage of each type of
sewer line (in miles)
% separate sanitary sewer
combined storm and sanitary sewer
Unknown
Separate Sanitary Sewer System
Is the treatment works located in Indian Country?
❑ Yes
E No
100
O Own
O Own
O Own
❑ Maintain
❑ Maintain
❑ Maintain
Combined Storm and
Sanitary Sewer
NA %
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes El No
rct
ro
ro
c 0
CO
1.10 Provide design and actual flow rates in the designated spaces.
Two Years Ago
Design Flow Rate
0.01 mgd
Annual Average Flow Rates (Actual)
Last Year
This Year
0.0036 mgd
0.0029 mgd
0.0027 mgd
Two Years Ago
Maximum Daily Flow Rates (Actual)
Last Year
This Year
0.0080 mgd
0.0172 mgd
0.0142 mgd
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Treated Effluent
Total Number of Effluent Discharge Points by Type
Untreated Effluent
Combined Sewer
Overflows
Bypasses
Constructed
Emergency
Overflows
1
Page 2

NPDES Permit Number
NC008S481
Facility Name
Penderlea Elementary School
lA/1A/Tn
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds,
for discharge to waters of the State of North Carolina?
❑ Yes
or other
surface impoundments that do not have outlets
+ SKIP to Item 1.14.
v No
1.13
1.14
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Location
Average Daily Volume
Discharged to Surface
Impoundment
Continuous or Intermittent
(check one)
gpd
❑ Continuous
❑ Intermittent
gpd
❑ Continuous
❑ Intermittent
Is wastewater
❑ Yes
gpd
❑ Continuous
0 Intermittent
applied to land?
3 SKIP to Item 1.16.
v No
1.15
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Location
Size
Average Daily Volume
AppliedIntermittent
Continuous or
(check one)
acresgpd
0 Continuous
0 Intermittent
acres
gp d
❑ Continuous
0 Intermittent
acres
g13 d
0 Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment
❑ Yes
prior to discharge?
+ SKIP to Item 1.21.
V No
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
NC0085481
Facility Name
Penderlea Elementary School
\AMA/TD
Modified Application Form 2A
Modified March 2021
utfalls and Other Discharge or Disposal Methods Continued
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 iliPPROMPIIIMI
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
NPDES number of receiving facility (if any) 0 None
Average daily flow rate mgd
1.21
Is the wastewater disposed of in a manner other than
not have outlets to waters of the State of North Carolina
❑ Yes
✓
those a
(e.g.,
No
ready mentioned in Items 1.14 through 1.21 that do
underground percolation, underground injection)?
4 SKIP to Item 1.23.
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods IP
Disposal
Method
Description
Location of
Disposal Site
_
Size of
Disposal Site
Annual Average
Daily Discharge
Volume
Continuous or Intermittent
(check one)
_.
acres
gpd
❑ Continuous
❑ Intermittent
acres
gpd
❑ Continuous
• Intermittent
acresgpd
0 Continuous
❑ Intermittent
Variance
Requests
1.23
Do
Consult
❑
v
you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
Not applicable
Contractor Information
1.24
Are
the
✓
any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
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
Contractor name
(company name)
Envirolink, Inc
Mailing address
(street or P.O. box)
4700 Homewood Court
City, state, and ZIP
code
Raleigh, NC 27609
Contact name (first and
last)
Michael Myers
Phone number
[phone]
Email address
[e-mail]
Operational and
maintenance
responsibilities of
contractor
Operate and maintain the
WWTP
Page 4

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
IA/IA/TO
Modified Application Form 2A
Modified March 2021
SECTION
c
rn
o
2. ADDITIONAL INFORMATION
(40 CFR 122.21(j)(1)
the State of North Carolina
works have a design
and
flow greater
(2))
than or equal to 0.1 mgd?
No + SKIP to Section 3.
Outfalls
2.1
to Waters of
Does the treatment
❑ Yes
✓
Inflow and Infiltration
2.2
Provide the treatment works' current average daily volume of inflow
and infiltration.
Average Daily Volume of Inflow and Infiltration
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Topographic
Map
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
❑ Yes ❑ No
E
o tv
LL o
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.)
❑ Yes ❑ No
Scheduled Improvements and Schedules of Implementation
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 3 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
2.
3,
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvemen
Scheduled
Improvement
(from above)
Affected
Outfalls
(list outfall
number)
Begin
Construction
(MM/DD/YYYY)
End
Construction
(MM/DD/YYYY)
Begin
Discharge
(MM/DDIYYYY)
Attainment of
Operational
Level
(MMIDDIYYYY)
1.
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federaVstate requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
1 Af1AT[)
Modified Application Form 2A
Modified March 2021
Description of Outfalls
N 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 001
Outfall Number
Outfall Number
State
NC
County
Pender
City or town
Burgaw
Distance from shore
NA ft.
ft.
ft.
Depth below surface
NA ft•
ft.
ft.
Average daily flow rate
mgd
mgd
mgd
Latitude
35' 45 34.4" NC
"
°
Longitude
79° 1' 9.s" vQ
"
Seasonal or Periodic Discharge Data
3.2
Do any of the outfalls described
❑ Yes
under Item 3.1 have seasona
or
periodic
✓
discharges?
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
Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
discharge
mgd
mgd
mgd
Months in which discharge
occurs
Diffuser Type
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes
✓
No 3 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Waters of
the U.S.
3.6
Does
one
✓
the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
or more discharge points?
Yes ❑ No -*SKIP to Section 6.
Page 6

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
1 AJlArTn
Modified Application Form 2A
Modified March 2021
Receiving Water Description
3.7
Provide the receiving water and related information (if known for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Crooked Run Creek
Name of watershed, river,
or stream system
Cape Fear
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
low flow
mg/L of
CaCO3
mg/L of
CaCO3
mg/L of
CaCO3
Treatment Description
3.8
Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
0 Primary
t] Equivalent to
secondary
❑ Secondary
❑ Advanced
❑ Other (specify)
0 Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
0 Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
Design Removal Rates by
Outfall
BOD5 or CB0D5
85
TSS
85 %
ok
0/0
Phosphorus
0 Not applicable
0 Not applicable
0 Not applicable
Nitrogen
0 Not applicable
0 Not applicable
❑ Not applicable
Other (specify)
0 Not applicable
%
0 Not applicable
0 Not applicable
Page 7

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
IMIA/TD
Modified Application Form 2A
Modified March 2021
Treatment Description Continued
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.
Outfall Number
001
Outfall Number
Outfall Number
Disinfection type
Ultraviolet
Seasons used
All
Dechlorination used?
✓
Not applicable
❑ Not applicable
❑ Not applicable
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
Effluent Testing Data
3.10
Have you completed
monitoring for all Table A parameters and attached the results to the app ication package?
❑ No
v Yes
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
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 4 Complete Table B, including chlorine.
✓ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed
package?
monitoring for all applicable Table B pollutants and attached the results to this application
❑ No
v Yes
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?
❑ Yes
No
sampling required by NPDES
authority.
✓ additional
permitting
Page 8

NPDES Permit Number
NC0085481
Facility Name
Penderlea Elementary School
1A/1A/Tf]
Modified Application Form 2A
Modified March 2021
Effluent Testing Data Continued
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 our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
(MMIDD/YYYY)
Summary of Results
NA
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
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
❑ Yes
Table E for all applicable outfalls and attached the results to the application package?
❑ Not applicable because previously submitted
information to the NPDES •ermittin. authori .
Page 9

NPDES Permit Number
NC0085481
Facility Name t
Penderlea Elementary School
Modified Application Form 2A
Modified March 2021
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
Checklist and Certification Statement
0.10
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 aI ilicants are re•uired to'rovide attachments.
Column 1
Column 2
❑r
Section 1: Basic Application
Information for All Applicants
Section 2: Additional
Information
wl variance request(s)
❑ w/ topographic map
❑ w/ additional attachments
wl additional attachments
❑ wl process flow diagram
• Section 3: Information on
Effluent Discharges
• w/TableA
• w/ Table B
❑ w/ Table C
❑ w/ Table D
❑ w/ additional attachments
Section 4: Not Applicable
Section 5: Not Applicable
• Section 6: Checklist and
Certification Statement
❑ w/ attachments
6.2
Certification Statement
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
complete. 1 am aware that there are significant pe • ties for submitting false information, including the possibility of fine
and imprisonment for knowing violat. ns.
Name (print or type first and I e)
Steven Hill
i
Official title
Superintendent
Signature
rN
Dat/VzI
'ned
Page 10

Total suspended solids (TSS)
Temperature (summer)
Temperature (winter)
2
x
c
pH (minimum)
Design flow rate
co
v
o
o
IBiochemical oxygen demand
u BOD5 or ❑ CBODs
(report one)
W
'r
29.2
N
Q)
O
7.8
6.8
0
b
N
A
N
2020
I--`
A
O
RS FOR ALL POTWS
Maximum Daily Discharge
Value Units
mg/L
Degrees C
Degrees C
I'
c
d
C
mgd
0
O
o
O
0
3
3
w
r
0.54
N
14.0
0.0027
A
N.)
0)
C
co
Average Daily Discharge
mg/L
Degrees C
Degrees C
mgd
n
o
o
0
F.
in
N
O
O
3
3
00
r
C
=
Pi:
N
N
A
N
Q1
26
-
W
a)
Cn
24
NJ
A
Number of
Samples
SM 2540 D 2.5 mg/L OML
MDL I
SM 9222 D ies/100 ml MDL
SM 5210 B 2.0 mg/LEl ML
O MDL
Analytical
Method1
ML or MDL
(include units)
I8tS800JN
JagwnN puled S3OdN
1
0
0
0
lagwnN Repo

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n n it) 0
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(D • 0 (j
0
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CCD N
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0 0
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(7)'
0
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0
0
0_
0
n)
v
n)
CD
0
(D
0
Total dissolved solids NA
Phosphorus NA
Oil and grease NA
Kjeldahl nitrogen NA
Nitrate/nitrite NA
Dissolved oxygen 11.3
IChlorine
(total residual, TRC)2 NA
Ammonia (as N) 3.0
•0
O_
c
7
rt
EPA Idenlifica:ion Number NPDES Permit Number Facility Name
NC0085481 Penderlea Elementary School
lAI AITD
TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THA
0
c
0
Maximum Daily Discharge
NA
NA
Z
D
NA
NA
mg/L
NA
r
C7
r«
(n
NA
NA
NA
Z
D
NA
oo
N
NA
w
w
0
0
i
Average Daily Discharge
VN
NA
NA
NA
NA
mg/L
NA
mg/L
Units
Outfall Number
001
0.1 MGD
NA NA
NA NA
NA NA
NA NA
NA NA
24 SM 1500 0 G-2016
NA NA
24 EPA 350.1
Number of
Samples
Analytical
Method
Modified Application Form 2A
Modified March 2021
❑ ML
NA 0 MDL
❑ ML
NA ❑ MDL
❑ ML
NA ❑ MDL
LJ ML
NA ❑ MDL
❑ ML
NA ❑ MDL
ML I0.1 mg/L ❑ MDL
❑ ML
NA ❑ MDL
0.1 mg/L O MDL
ML or MDL
(include units)

EPA Form 3510-2A (Revised 3-19)
-10
I,
CD
OM

EPA Form 3510-2A (Revised 3-19)
S
SO
1,1,2-trichloroethane
▪ 1,1,1-trichloroethane
-I
0
m
(D
-1
0
CD
O
O
co
CD=
1,1,2,2-tetrachloroethane
Methylene chloride
Methyl chloride
Methyl bromide
Ethylbenzene
1,3-dichloropropylene
1,2-dichloropropane
▪ 1,1-dichloroethylene
trans-1,2-dichloroethylene
1,2-dichloroethane
1,1-dichloroethane
Dichlorobromomethane
▪ Chloroform
2-chloroethylvinyl ether
Chloroethane
Chlorodibromomethane
▪ Chlorobenzene
Carbon tetrachloride
NPDES Permit Number Facility Name Outfall Number
NC0085481 Penderlea Elementary School
AI A/TD
:-S FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Value Units Value Units Number of
Samples
Modified Application Form 2A
Modified March 2021
Analytical ML or MDL
Methods (include units)
❑ ML
0 MDL
❑ ML
❑ MDL
❑ ❑
r
❑ ML
0 MDL
❑ ML
0 MDL
❑ ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
❑ ML
0 MDL
❑ ML
0 MDL
❑ ML
0 MDL
O ML
❑ MDL
0 ML
0 MDL
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NPDES Permit Number Facility Name Outfall Number
NC0085481 Penderlea Elementary School
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S FOR SELECTED POTWS
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