NC0043974_Renewal (Application)_20221006

ROY COOPER ig
Governor
ELIZABETH S.BISER
Secretary QtaAt4 '`
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
October 06, 2022
Public Schools of Gates County
Attn: Dr. Phillip Barry Williams, ED
PO Box 125
Gatesville, NC 27938-0125
Subject: Permit Renewal
Application No. NC0043974
Buckland Elementary School
Gates County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 6, 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
��AQ.Ati
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_EQ.., North Carolina Department of Environmental Quality I Division of Water Resources
Qs Washington Regional Office 1943 Washi gton Square Mall Washington.North Carolina 27889
d�.,w.+ `.s.AZons. 252946 6481

Office of the Superintendent BOARD MEMBERS
P.O.Box 125 Chairman
205 Main Street Ray Felton
Gatesville,NC 27938 Vice-Chairman
[phone] Sallie J.Ryan
Dr.Phillip Barry Williams Members
Superintendent Glendale Boone
Leslie Byrum
Amanda Heimbecker
9irAeo C SO
LI
October 3, 2022
lit‘/1/4‘111.
To: Division of Water Resources
Water Quality Permitting Section-NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: NPDES Permit Renewals for Buckland, TS Cooper, & Gatesville Elem Schools
Gates County, NC
Dear Permit Application Reviewer:
Please find attached the Permit Renewal Applications (EPA Modified Form 2A) for the above referenced
facilities. The forms have been prepared with the assistance of our Engineer Mr.John R. Harman, PE. Please
include him on any correspondence to us for any and all requests for additional information if needed @
[e-mail].
Regards,
o
Dr. PhillipBWi ams ED
arry
Superintendent Ga es Co Public Schools
Gates County Schools is an equal opportunity provider and employer

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
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
NC0043974 Buckland Elementary School 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 a,'ication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Buckland Elementary School WWTP
Mailing address(street or P.O.box)
Gates Co Public Schools;P.O.Box 125
City or town State ZIP code
0 Gatesville NC 27938-0125
Contact name(first and last) Title Phone number Email address
Phillip Williams Superintendent [phone] roundtreelj@gatescountyscho
Location address(street,route number,or other specific identifier) ❑Same as mailing address
cva 448 NC Hwy 37 North
LL
City or town State ZIP code
Gates NC 27937
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
•
co Contact name(first and last) Title Phone number Email address
0.
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 ❑ 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
d water) control)
E NC0043974
o ❑ PSD(air emissions) ❑ Nonattainment program(CAA) 0 NESHAPs(CM)
w
i rn
N ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ElOther(specify)
w 404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School 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
100 %separate sanitary sewer ❑ Own 0 Maintain
Z305 %combined storm and sanitary sewer 0 Own El Maintain
d 0 Unknown 0 Own 0 Maintain
co %separate sanitary sewer 0 Own 0 Maintain
g %combined storm and sanitary sewer 0 Own 0 Maintain
❑ Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own ID
-cs_ %combined storm and sanitary sewer 0 Own El Maintain
E ❑ Unknown 0 Own 0 Maintain
d %separate sanitary sewer 0 Own 0 Maintain
N %combined storm and sanitary sewer ID Own 0 Maintain
c 0 Unknown 0 Own ❑ Maintain
Total
d Population 305
o Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) no % %
1.8 Is the treatment works located in Indian Country?
o ❑ Yes 0 No
U
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
co
c 0 Yes 0 No
c
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.006 mgd
= Annual Average Flow Rates(Actual)
c
ti Two Years Ago Last Year This Year
`6 2019 0.002251 mgd 2020 0.001699 mgd 2021 0.001733 mgd
c o
a)LL
d Maximum Daily Flow Rates(Actual)
cn Two Years Ago Last Year This Year
0.006537 mgd 0.006461 mgd 0.005776 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_ T Constructed
E'1— Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
s .o Overflows Overflows
U
N
a 1 0 0 0 0
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School 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
Impoundment (check one)
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd
to ❑ Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes ❑ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
0 Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
a, Applied (check one)
acres gpd 0 Continuous
o 0 Intermittent
acresgpd 0 Continuous
o 0 Intermittent
acresgpd 0 Continuous
0 Intermittent
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
NC0043974 Buckland Elementary School 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
-to
0
Phone number Email address
o NPDES number of receiving facility(if any) 0 None Average dailyflow rate mgd
CL 9 9
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
not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
❑ Yes ❑ No 3 SKIP to Item 1.23.
0
U
0 1.22 Provide information in the table below on these other disposal methods.
iv Information on Other Disposal Methods
Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description _ Volume
`� ❑ Continuous
° acres gpd 0 Intermittent
0 Continuous
acres gpd ❑ Intermittent
acres gpd 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.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
co
3 ❑ 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)
o Mailing address
(street or P.O.box)
0 City,state,and ZIP
code
O Contact name(first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 8uckland Elementary School Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c 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?
rn
o 0 Yes ❑ No 4 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
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0 a. specific requirements.)
00a
o ❑ Yes ❑ No
3 E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
0 `o, (See instructions for specific requirements.)
iL !a
0 Yes 0 No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
a)
1.
d
E
2.
E
0
3.
a)
a�
U)
4.
v
2.6 Provide scheduled or actual dates of completion for improvements.
tn
Scheduled or Actual Dates of Completion for Improvements
E d Affected Attainment of Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
,3
1.
cn 2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes 0 No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School 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 001 Outfall Number Outfall Number
State North Carolina
County Gates
City or town Gates
Distance from shore ft. ft. ft.
.a
ta Depth below surface ft. ft. ft.
0
Average daily flow rate 0.0038 mgd mgd mgd
Latitude 36° 28' 10"
Longitude -76° 45' 44"
ns
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o ❑ Yes ❑ No SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
y Outfall Number Outfall Number Outfall Number
0
Number of times per year
G discharge occurs
a Average duration of each
discharge(specify units)
To c Average flow of each mgd mgd mgd
discharge
Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes 0 No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number Outfall Number Outfall Number
m
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?
3 w ❑ Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number ooi Outfall Number Outfall Number
Receiving water name Unnamed Trib to Cole Creek
Name of watershed,river,
or stream system Chowan River Basin
a U.S.Soil Conservation
•L
y Service 14-digit watershed
o code
Name of state
management/river basin
rn
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 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 001 Outfall Number Outfall Number
Highest Level of El Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
WI Secondary 0 Secondary 0 Secondary
0 Advanced 0 Advanced 0 Advanced
2 Other(specify) 0 Other(specify) 0 Other(specify)
UV Disinfection
'Q, Design Removal Rates by
Outfall
0 BOD5 or CBOD5
E
TSS
0 Not applicable ❑Not applicable ❑Not applicable
Phosphorus o 0 0
0 Not applicable 0 Not applicable ❑Not applicable
Nitrogen %
0/0
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
Page 7

•
NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School 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.
v
CO
c
c
0
Outfall Number ooi Outfall Number Outfall Number
Disinfection type
uv
•• Seasons used
5 All year
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
❑ Yes 0 Yes ❑ Yes
❑ No 0 No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes 0 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 0 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
co Acute Chronic Acute Chronic Acute Chronic
rn
Number of tests of discharge
water
FNumber 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. 0 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
NC0043974 Buckland Elementary School 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?
El Yes ❑ No 4 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
(MM/DD/YYYY)
y3.22 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.
111 3.23 Describe the cause(s)of the toxicity:
d
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?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES •ermittin. authorit .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043974 Buckland Elementary School 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
Section 1: Basic Application w/additional attachments
® Information for All Applicants ❑ w/variance request(s) 0
® Section 2:Additional ® w/topographic map 0 w/process flow diagram
Information 0 w/additional attachments
© w/Table A ❑ w/Table D
• Section 3:Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
❑ w/Table C
a)
Section 4:Not Applicable
0
Section 5:Not Applicable
c Section 6:Checklist and
° ® Certification Statement w/attachments
:Y 6.2 Certification Statement
0
d
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
Phillip Williams Superintendent
Signature Date signed
774
/674/1eI
Page 10

NPDES Permit Number Facility Name Dutfall Number Modified Application Form 2A
NC0043974 Buckland Elementary School Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include
Value Units Value Units Samples units)
Biochemical oxygen demand
®BOD5 or 0 CBOD5 23 mg/I 2.7 mg/I 72 Per State Cert.Lab ❑ML
❑MDL
(report one)
Fecal coliform 6000 colonies/100mI 867 colonies/100ml 72 Per State Cert.Lab ❑ML
❑MDL
Design flow rate 0.00508 MGD .001895 avg all data MGD 147
pH(minimum) 8.58 pH Units
pH(maximum) 8.70 pH Units
Temperature(winter) 15.53 max all values; degrees,C 12.40 degrees,C 60
Temperature(summer) 28.83 max all values; degrees,C 20.13 degrees,C 87
0 ML
Total suspended solids(TSS) 10.3 max all values mg/I 3.25 mg/I 72 Per State Cert.Lab ❑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 O.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
NC0043974 Buckland Elementary School 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
ML
Ammonia(as N) ❑MDL
Chlorine ❑ML
(total residual,TRC)2 ❑MDL
0 ML
Dissolved oxygen ❑MDL
Nitrate/nitrite ❑ML
❑MDL
0 ML
Kjeldahl nitrogen ❑MDL
0 ML
Oil and grease ❑MDL
❑ML
Phosphorus ❑MDL
Total dissolved solids ❑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).
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
NC0043974 Buckland Elementary School Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) ❑MDL
Antimony,total recoverable ❑ML
❑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
❑ML
Lead,total recoverable ❑MDL
Mercury,total recoverable ❑ML
0 MDL
❑ML
Nickel,total recoverable ❑MDL
❑ML
Selenium,total recoverable ❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
❑ML
Zinc,total recoverable ❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
❑ML
Acrolein ❑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
NC0043974 Buckland Elementary School Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
0 MDL
Chlorodibromomethane CI ML
0 MDL
0 ML
Chloroethane ❑MDL
2-chloroethylvinyl ether ❑ML
❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
0 MDL
1,1-dichloroethane CI ML
❑MDL
1,2-dichloroethane CI ML
❑MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
❑ML
1,1-dichloroethylene ❑MDL
1,2-dichloropropane ❑ML
❑MDL
❑ML
1,3-dichloropropylene ❑MDL
❑ML
Ethylbenzene 0 MDL
Methyl bromide ❑ML
0 MDL
❑ML
Methyl chloride ❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
Tetrachloroethylene 0 ML
❑MDL
Toluene ❑ML
❑MDL
❑ML
1,1,1-trichloroethane ❑MDL
❑ML
1,1,2-trichloroethane ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

U,
N N J J J J J J J J _J J J J J J J .J J J J J N
O J O J O J O J C] J O J O J O J O J O J O J O J O J O J O J O J O J O J O J O J O
E 0' J w 2222 M2222222M2 2222 22 2MMM22 222M22 22222M2 g
€� CIc ❑❑ ❑❑ ❑❑O❑❑❑ OO ❑❑ ❑❑❑OO❑ ❑❑ ❑❑ ❑❑ ❑DOODOO❑ ❑OO❑ O❑ o
L 0
as 0 -c
U Kp 7
c O 7.5
Pd
a)
3
m
YU C
_T-c
d
C m
Q
O N
L N
O T▪ x
co
- )
E Z
2
z
— a)
o)
ea
s
U
N_
0
T N
.>„
C
0
d
CO
O a)
o >
a
U,
a
Z
2
C a7
Ca,
Z` C TO
U
a) >
(D W
11 -o
C
U
7
fG
O y
En w
03 C
-C
CO U
N_
I-. 0
0 >,
v a
z_ rn o 0
E a Ili E
a O 0
upv wJ c
C] Z lJ.l X 7
z N 2 >
Ce
0
LL
U)
O!
W
H
W
N
C
C
11 Q o c a
E a = n o c a) a) r)
z f- co a) E o c c c 78
aci o c
c Z c O o _ a) a) 0 O a) L a a) m a) co s
O W a) 0 N O L L C L �- a) C C N
▪ D o >, a) a) t c Q n. �' a) a O 0 c a) a) o ce
3 -J a L -o a) O >> 9 Q c c 2 0 O a) >. a) c >,LL
0 m ❑ C o - 0 0 a) a) o t U y C m m n 0
c uJ O L "5 o o s a) '` a n. -c `0 -c-,,.- n. o.. 0 c m m c o
d (j U >. L -a 'D '� ... ... C N co N ac) ac) L C N N L M
w W c W c) c? v . cD st a C a) L v Z c) c.) c a) a) a) v:.
m F- > ,a d N N N V' C N V' O- O- N N < < < CO CO CO r) l0
Q U c Q
1— cc m W i

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043974 Buckland Elementary School 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
Benzo(ghi)perylene o ML
❑MDL
Benzo(k)fluoranthene ❑ML
❑MDL
Bis(2-chioroethoxy)methane ❑ML
❑MDL
Bis(2-chloroethyl)ether ❑ML
❑MDL
Bis(2-chloroisopropyl)ether ❑ML
❑MDL
Bis(2-ethyihexyl)phthalate ❑ML
❑MDL
4-bromophenyi phenyl ether ❑ML
❑MDL
Butyl benzyl phthalate ❑ML
❑MDL
2-chloronaphthalene ❑ML
❑MDL
4-chiorophenyl phenyl ether ❑ML
❑MDL
Chrysene ❑ML
❑MDL
di-n-butyl phthalate ❑ML
❑MDL
di-n-octyl phthalate ❑ML
❑MDL
Dibenzo(a,h)anthracene 0 ML
❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
❑ML
1,3-dichlorobenzene ❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ❑ML
❑MDL
❑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
Modified March 2021
NC0043974 Buckland Elementary School
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
1,2-diphenylhydrazine ❑ML
❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
0 MDL
Hexachlorobutadiene ❑ML
❑MDL
Hexachlorocyclo-pentadiene ❑ML
❑MDL
Hexachloroethane ❑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
'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
NC0043974 Buckland Elementary School 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
I Method'
Samples (include units)
❑ No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 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 18

ye
rw
aiii NI Mil
{ ; — - 4‘'
9
f • P;.N. '' kik
Ir 6
/ ....
hill
..,
1 .Pi ‘''''
, • -, ii i .. ' *VW'-...
I. , ,, ,, ., ., .
, , 4,4
:.
.! , 'A r•• .ii, 4 ..„
, 2.
- `• * , •... 0
I .e,. to-
»
ii .-- ) ,',.. Outfail001
i •
0` , I lr -,:ig it.
. tip1 1 arts / ' 4.. , i
1111
-
,r '') ... 0)1 Alx„" 1
11p101111111111111".9 4 . . Parh•ir
. : -1.111,-_," t_iii, f11,- ,
4 >>_J r,•
'ram "1�4.'1 ,° .,w s ,i. . . 1„
IIa
�.., f.
NC0043974 — Buckland Elementary Facility iiiiii,
School WWTP Location
Latitude:362 28' 11" Sub-basin:03-01-01
Longitude:762 45'44" Receiving Stream:Cole Creek Gates County
Stream Class:C;NSW NORTH Map not to scale