NC0051373_Renewal (Application)_20220816

It .
ROYCOOPER II
'•' '�
Governor o
ELIZABETH S.BISER
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
August 16, 2022
Perquimans County
Attn: Nick Lolies
PO Box 45
Hertford, NC 27944-0045
Subject: Permit Renewal
Application No. NC0051373
Perquimans County WTP #2 - Winfall
Perquimans County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 16, 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,
&-iviQbqn,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North Carolina Department of Environmental Quality DNision of Water Resources
Washington Regional Office 943 Washington Square Mall Washington,North Carolina 27889
252 946 6481

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 12
treatment works? 1. . treating domestic sewage?
If yes,STOP. Do NOT complete El No If yes,STOP. Do NOT ❑ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial, mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
o ❑ Yes 4 Complete Form 1 ID No ❑ Yes 4 Complete Form 0 No
a and Form 2B. 1 and Form 2C.
c 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
c mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
O Yes 4 Complete Form 1 2 No El Yes 4 Complete Form © No
re and Form 2D. 1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
El Yes 4 Complete Form 1 ElNo
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2. NAME, MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
Perquimans County WTP#2-Winfall
O 2.2 EPA Identification Number
0
0
2.3 Facility Contact
Name(first and last) Title Phone number
Nick Lolies Water Dept Supervisor [phone]
-a
e Email address
F- [e-mail]
2
2.4 Facility Mailing Address
Street or P.O.box
PO BOX 45
City or town State ZIP code
I I I Hertford INC 127944
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
2.5 Facility Location
.D ` Street,route number,or other specific identifier
a v 109 Melton Grove Road
CO
c g County name County code(if known)
Perquimans
City or town State ZIP code
Hertford NC 27944
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
U
0
0
U
Cl)
3.2 NAICS Code(s) Description(optional)
c.)
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Christopher Wharton
4.2 Is the name you listed in Item 4.1 also the owner?
❑ Yes ❑ No
4.3 Operator Status
g
A ❑ Public—federal ❑ Public—state ID Other public(specify)Municipul
o ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
E 0 PO Box 45
o =
• w City or town State ZIP code
o v Hertford NC 27944
co
o Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
g c 5.1 Is the facility located on Indian Land?
c " ❑ Yes 0No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
❑✓ NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
o u,
w d ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
SECTION 7. MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
R specific requirements.)
z
❑ Yes El No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Water Treatment Plant
d
co
"6
a..
<II
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑ No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
a,w 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
o NPDES permitting authority to determine what specific information needs to be submitted and when.)
o ,a
U c
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
a- ❑ Fundamentally different factors(CWA ❑✓ Water quality related effluent limitations(CWA Section
ce Section 301(n)) 302(b)(2))
d
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and (g))
❑ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 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
❑✓ Section 1:Activities Requiring an NPDES Permit ❑ w/attachments
❑✓ Section 2: Name,Mailing Address,and Location 0 wl attachments
❑ Section 3:SIC Codes ❑ w/attachments
© Section 4:Operator Information ❑ wl attachments
❑✓ Section 5: Indian Land ❑ wl attachments
ElSection 6: Existing Environmental Permits ❑ w/attachments
w/topographic
❑ Section 7:Map ❑ map ❑ wl additional attachments
c ❑✓ Section 8: Nature of Business ❑ wl attachments
0 Section 9:Cooling Water Intake Structures ❑ wl attachments
U El Section 10:Variance Requests ❑ w/attachments
-0
w ❑✓ Section 11:Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
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 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
Nick Lolies Water Dept Supervisor
Signat Date signed
08/11/2022
EPA Form 3510-1(revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C 'ay EPA Application for NPDES Permit to Discharge Wastewater
NPDES GG EXISTING MANUFACTURING, COMMERCIAL,MINING,AND SILVICULTURE OPERATIONS
SECTION 1. OUTFALL LOCATION (40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
Outfa° Nu ber Receiving Water Name Latitude Longitude
001 Unnamed tributary to Mill C 36° 12' 50" N 76° 26' 15" W
Co
O
SECTION 2. LINE DRAWING(40 CFR 122.21(g)(2))
co 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
J R
o ❑ Yes El No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1,provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** o01
Operations Contributing to Flow
Operation Average Flow
sedimentation,dechlorination .045 mgd
mgd
o
mgd
mgd
a Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
250,000 tank,.045mgd,5.5 days 1-U/5-P Land applied by permitted site b
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
3.1 **Outfall Number** 001
cont. Operations Contributing to Flow
Operation _L Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
d
C
r
0
c
as
—
Co
F— -
**Outfall Number**
y Operations Contributing to Flow
Operation Average Flow
cn mgd
co
d
' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
d a El Yes ElNo 4 SKIP to Section 4.
N 3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frequency I Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
months/year mgd mgd days
u_
m months/year mgd mgd days
months/year mgd mgd days
months/year mgd mgd days
months/year mgd mgd days
months/year mgd mgd days
..ys/week months/year mgd mgd days
months/year mgd mgd days
SECTION 5. PRODUCTION (40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ❑✓ No.4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
ELG Category ELG Subcategory Regulatory Citation
co
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑ No 4 SKIP to Section 6.
0
5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J Outfall Operation, Product,or Material Quantity per Day Unit of
-o Number Measure
C,
y
co
0
'C
2
a
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 6.IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑ No 4 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
o Project (list outfall Discharge Required Projected
a number)
a,
as
Q.
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes No ❑ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete.Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ElNo 4 SKIP to Item 7.3.
7.2 If yes, indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
requested and attached the results to this application package?
No;a waiver has been requested from my NPDES
CIYes ❑ permitting authority for all pollutants at all outfalls.
5 Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ❑✓ No 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
w ❑ Yes ❑✓ No
7.6 List the applicable primary industry categories and check the boxes indicating the required GCIMS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GCIMS Fraction(s)
(Check applicable boxes.)
❑Volatile ❑Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile ❑Acid ❑ Base/Neutral ❑Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
7.7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes El No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑ Yes © No
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B, pollutants that you have
indicated are"Believed Present"in your discharge?
❑ Yes ❑r No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, © No
then SKIP to Item 7.12.
c 7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
c determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
cc) pollutants you have indicated are"Believed Present"in your discharge?
`—' ❑ Yes D No
a) Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
co
for all outfalls?
❑ Yes ❑✓ No
CO 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
"Believed Present"?
❑ Yes ❑✓ No
w Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
❑ Yes El No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑ Yes ❑✓ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑ No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
d an intermediate or final product or byproduct?
0 Yes 0 No 4 SKIP to Section 9.
8.2 List the pollutants below.
cco x
2 1. 4. 7.
0
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 9. BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
❑✓ Yes ❑ No 4 SKIP to Section 10.
9.2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permittin. Authorit ?
0 --
~ Chronic Toxicity Required by NPDES Permit
0 Yes ❑ No
0
El Yes No
El Yes El No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
Yes ❑ No + SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm Meritech Labs
a), Laboratory address 642 Tamco Rd
= Reidsville,NC 27320
%o
co
Phone number
[phone]
Pollutant(s)analyzed
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 4 SKIP to Section 12.
0
6 11.2 List the information requested and attach it to this application.
1. 4.
C
0
:0 2. 5.
3. 6.
EPA Form 3510-20(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
SECTION 12. CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C 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 complete all sections or provide attachments.
Column 1 Column 2
❑ Section 1:Outfall Location ❑ w/attachments
❑ Section 2:Line Drawing ❑ wl line drawing ❑ wl additional attachments
.171 Section 3:Average Flows and w/list of each user of
❑
11-1 Treatment wl attachments ❑ privately owned treatment
works
❑✓ Section 4: Intermittent Flows ❑ w/attachments
❑✓ Section 5: Production ❑ w/attachments
w/optional additional
❑✓ Section 6:Improvements ❑ wl attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
...
supporting information outfalls
d w/small business exemption w/other attachments
❑ request ❑
❑ Section 7: Effluent and Intake ❑ w/Table A ❑ w/Table B
Characteristics
❑ w/Table C ❑ w/Table D
d ❑ w/Table E ❑ w/analytical results as an
c� attachment
e Section 8:Used or Manufactured
H
Toxics ❑ w/attachments
Section 9: Biological Toxicity ❑ w/attachments
Tests
❑✓ Section 10:Contract Analyses ❑ w/attachments
❑✓ Section 11:Additional Information ❑ w/attachments
© Section 12:Checklist and ❑ w/attachments
Certification Statement
12.2 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. 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
Nick Lolies Water Dept Supervisor
Signature Date signed
08/11/2022
EPA Form 3510-2C(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 001 OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
(Optional)
Waiver Units Maximum Maximum Long-Term
Pollutant Requested (specify) Daily Monthly Average Daily Number of Long-Term Number of
(if applicable) Discharge Discharge Discharge Analyses Average Value Analyses
(required) Of available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration
1' (BOD5) ❑ Mass
Chemical oxygen demand Concentration
2' (COD) ❑ Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration
4. Total suspended solids(TSS) ❑
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate
Temperature(winter) ❑ °C °C
7.
Temperature(summer) 0 °C °C
pH(minimum) ❑ Standard units s.u.
8.
pH(maximum) ❑ Standard units s.u.
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 O.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0051373 Perquimans County WTP#2 OMB No.2040-0004
TABU B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term -Lon
Maximum Maximum Long
-
(and CAS Number,if available) Required Believed Believed (specify) Average Number Term Number
Present Absent Daily Monthly Daily of of
Discharge Discharge Average
(required) (if available) Discharge Analyses Value Analyses
Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table.Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
1.1 Antimony,total ❑ Concentration
(7440-36-0) Mass
1.2 Arsenic,total ❑ Concentration
(7440-38-2) Mass
1.3 Beryllium,total o Concentration
(7440-41-7) Mass
1.4 Cadmium,total ❑ Concentration
0 0
(7440-43-9) Mass
1.5 Chromium,total ❑ Concentration
El El
(7440-47-3) Mass
1.6 Copper,total 0 Concentration
0 El
(7440-50-8) Mass
1.7 Lead,total o Concentration
0 0
(7439-92-1) Mass
1.8 Mercury,total 0Concentration
El El
(7439-97-6) Mass
1 9 Nickel,total ❑ Concentration
0 El
(7440-02-0) Mass
1.10 Selenium,total ❑ Concentration
El 0
(7782-49-2) Mass
1.11 Silver,total ❑ Concentration
(7440-22-4) Mass
P e11
EPA Form 3510-2C(Revised 3-19) �