NC0066991_Renewal (Application)_20221021

3,Cf'c SCATF o
i i�� Nr'a)1�
ROY COOPER ;
Governor
ELIZABETH S.BISER -`
Secretary Qum.,,--
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
October 24, 2022
Watauga County BOE
Attn: Eric R. Bolick
175 Pioneer Trial
Boone, NC 27607
Subject: Permit Renewal
Application No. NC0066991
Bethel Elementary School
Watauga County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 21, 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,
6C
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North Carolina Department of Environmental Quality i Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road Suite 300 I Winston-Salem.North Carolina 27105
aksk9 336.776.9800

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
MC.
C OC) /Dcl1 � � ` 5 G Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result in denial of the application.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
:JETHEt. �LEvt iEMT6Il2`l .SGLkv
Mailing address(street or P.O.box)
�75- P2 e rie.4rZ
City or town State ZIP code
Contact name(first and last) Title OR C -/a sms-rdkotrPhone number Email address
0
6z:u- Botitcy. iMAIF1.rErrAatct DLr2* 3et3 bokcke %wALletT>c.hcsas.or
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
3 BerktEc Sc 2p •
City or town State ZIP code
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission [,/ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
WATAMCAA- Coue.ivrt & D OF GDuc.4J:1 it/
Applicant address(street or P.O.bd)
0
75 /9«l EEi2 7744 zL
oCity or town State ZIP code
3c5e,cue-
Contact name(first and last) Title ai2e - a$R5 rA44rPhone number Email address c ��� Ltl� /1AI�vtE✓s/aK�E flr,Az- sz3)2co9 •�439 3 bo/ e *wc / , cols
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.) -m re2,
❑ Owner 0' 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
water) control)
E
o ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
07
y ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC. OOL co 9 I, 7 r 44 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)
I 60 %separate sanitary sewer Erawn ❑ Maintain
d ,26 O %combined storm and sanitary sewer 0 Own ❑ Maintain
CCD Unknown El Own ❑ Maintain
co %separate sanitary sewer ❑ Own 0 Maintain
g %combined storm and sanitary sewer ❑ Own 0 Maintain
0
3 0 Unknown ❑ Own El Maintain
n
O %separate sanitary sewer ❑ Own 0 Maintain
a
c %combined storm and sanitary sewer ID Own ❑ Maintain
E 0 Unknown ❑ Own 0 Maintain
0 %separate sanitary sewer ❑ Own ❑ Maintain
co %combined storm and sanitary sewer ❑ Own ❑ Maintain
c ❑ Unknown 0 Own ❑ Maintain
.0 Total
CO Population a 1-0
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of °
sewer line(in miles) — `/iws.'.Ie ° /°I O0 �°
1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes [r No
U
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes Er No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
. 0 CD Cp$ mgd
= Annual Average Flow Rates(Actual)
1 Two Years Ago Last Year This Year
03
w CO mgd mgd mgd
Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
mgd mgd mgd
01.11 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
Q. a Constructed
Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
t Overflows Overflows
0
N_
d O CD O
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
A r� OD4 co e 1 8� � `�� 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 12-----No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
(I) gpd ❑ Intermittent
. 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.
N Land Application Site and Discharge Data
6 Continuous or
Location Size j Average Daily Volume Intermittent
Applied (check one)
acres d 0 Continuous
o gp ❑ Intermittent
s acresgpd El Continuous
o ❑ Intermittent
acres d ❑ Continuous
gp 0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes Er No4SKIPtoItem1.21.
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
Al C. 006G9 t 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
73 Fja5ility name Mailing address(.street or P.O.box
CD
FrbiL eie-r?• 5GN-oac, 13R 6crtke- Sc.Hant. lZc.7.
City town State ZIP cod
U
c iCii4Iz C'7gov6 n/c zwCT i
N Conta name(first ��an st) Title �"
o •PJ c- (C)C.ZGI� d RC- ' Ass - Am (JZ12..
s
Ph a number Email address tt
TV Z Ca A - Ca3 q 3 bo/;c,ke ® l�Je u sclools . o r cA.
o N S number of receiving facility(if any) ❑ None
Q- Al C. (''O( ,Ca \ Average daily flow rate mgd
C')
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
L
d not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
❑ Yes Er No 4 SKIP to Item 1.23.
U
0 1.22 Provide information in the table below on these other disposal methods.
- Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
R Method Dis osal Site Dis osal Site Daily Discharge
Description p p Volume (check one)
❑ Continuous
acres gpd ❑ Intermittent
0
acres d 0 Continuous
go 0 Intermittent
acres gpd ❑ 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.
a) y Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
CCSc 3 ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
n71 co 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 0 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)
a Mailing address
c (street or P.O.box)
`o City,state,and ZIP
ns code
0 Contact name(first and
c.) last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
NC- ooco cock l ET-E` Fern .
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
0 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?
m
a) ❑ Yes ❑-----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
.� and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
w
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0 . specific requirements.)
R
0
0 ❑ Yes 0 No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
30 E (See instructions for specific requirements.)
`L o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
= Briefly list and describe the scheduled improvements.
0
1.
a)
d
E
d
fl. 2.
3.
d
a)
v7
4.
Fa 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
o Scheduled Begin End Begin
Outfalls Operational
2 Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
C)
number) (MM/DD/YYYY)
1.
t
2.
U)
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
0 Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
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 l Outfall Number Outfall Number
State
::town
o (SUCiA'Z (kove
s Distance from shore ft. ft. ft.
.Q
d Depth below surface 1/ ft. ft. ft.
0
Average daily flow rate D0(.5. mgd mgd mgd
Latitude 3 (Q (s ' a$ „
Longitude s i ° m 1 '
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
❑ Yes t' 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
o discharge occurs
a Average duration of each
discharge(specify units)
Average flow of each g mgdg
discharge an d an d
co
rn Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number Outfall Number Outfall Number
U)
o I
o vi 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
(Q(Qe1` n74et �Gt4 Modified March 2021 I NIL
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number I Outfall Number Outfall Number
Receiving water name
B64yEK DA,vi Cr4o4
Name of watershed,river,
c or stream system WA'tA460 gtvE,2- /345 c/
0. U.S.Soil Conservation
H Service 14-digit watershed
o code
63 R Name of state
ca management/river basin OprT1(46.1A i.vG - ,cf.N
0)
.- U.S.Geological Survey
co 8-digit hydrologic
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
1 low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number l Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced ❑ Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0 -'FL Design Removal Rates by
.� Outfall
N
N
o BOD5 or CBOD5 % % %
c f—
d
E
73
TSS it _—
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus % % °/o
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen % o/o °
/o
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
%
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
n'C 6O(62q l OeT EL ae 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.
d
o C. l�t.o�L'1mc TASL�S
= Outfall Number I Outfall Number Outfall Number
0
0_ Disinfection type
C14c,oR1- Tiers
Seasons used
Y6Ap_
d Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
EP--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?
❑ 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 [1]— 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
CD 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?
Er Yes 4 Complete Table B,including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes 12— 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
❑ Yes permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
r C occD cDc\ �,er1�E C�ft` 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 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 Ia.- 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/DDIYYYY)
0
R 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.
4, 3.23 Describe the cause(s)of the toxicity:
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. authori .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
C0 p(7 Cp`\l a r✓nt e� �E Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d)) GG
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
_❑ Information for All Applicants ❑ w/variance request(s) ❑ wl additional attachments
❑ Section 2:Additional ❑ wl topographic map ❑ w/process flow diagram
Information ❑ wl additional attachments
❑ w/Table A ❑ w/Table D
❑ Section 3: Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
d
❑ wl Table C
c' Section 4: Not Applicable
0
a,
Section 5: Not Applicable
U
Section 6:Checklist and
co Certification Statement ❑ w/attachments
Y 6.2 Certification Statement
a)
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 of c.- A-bs-ksraur
R • U o i_ioc Af.4s-#i„.Y.itivc� per•
Signature ,� Date signed
L a /D/ / 772,0 z z
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
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 ❑ML
0 BOD5 or❑CBOD5 ❑MDL
re.ort one
❑ML
Fecal coliform ❑MDL
Design flow rate � r
pH(minimum) .. *�
pH(maximum)
Temperature(winter)
Temperature(summer) ML
Total suspended solids(TSS) ■_ ❑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 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
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 Methods include units
Value Units Value Units Samples Methods (
)
❑ML
Ammonia(as N) ❑MDL
Chlorine ❑ML
(total residual,TRC)2 ❑MDL
❑ML
Dissolved oxygen ❑MDL
❑ML
Nitrate/nitrite ❑MDL
❑ML
Kjeldahl nitrogen ❑MDL
❑ML
Oil and grease ❑MDL
❑ML
Phosphorus ❑MDL
❑ML
Total dissolved solids
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) 0 MDL
0 ML
Antimony,total recoverable 0 MDL
❑ML
Arsenic,total recoverable 0 MDL
❑ML
Beryllium,total recoverable 0 MDL
❑ML
Cadmium,total recoverable 0 MDL
❑ML
Chromium,total recoverable 0 MDL
❑ML
Copper,total recoverable ❑MDL
❑ML
Lead,total recoverable 0 MDL
❑ML
Mercury,total recoverable 0 MDL
❑ML
Nickel,total recoverable 0 MDL
Selenium,total recoverable ❑ML
❑MDL
❑ML
Silver,total recoverable
0 MDL
❑ML
Thallium,total recoverable 0 MDL
❑ML
Zinc,total recoverable
0 MDL
❑ML
Cyanide ❑MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
❑ML
Acrolein ❑MDL
❑ML
Acrylonitrile 0 MDL
❑ML
Benzene ❑MDL
0 ML
Bromoform ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 13

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

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
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
❑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 ❑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 ❑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
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
0 ML
Benzo(ghi)perylene ❑MDL
0 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
0 ML
Butyl benzyl phthalate ❑MDL
0 ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether ❑MDL
❑ML
Chrysene ❑MDL
ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
0 ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
0 ML
Diethyl phthalate ❑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
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)
Samples
❑ML
1,2-diphenylhydrazine ❑MDL
0 ML
Fluoranthene ❑MDL
❑ML
Fluorene ❑MDL
0 ML
Hexachlorobenzene ❑MDL
❑ML
Hexachlorobutadiene ❑MDL
❑ML
Hexachlorocyclo-pentadiene ❑MDL
❑ML
Hexachloroethane ❑MDL
❑ML
Indeno(1,2,3-cd)pyrene ❑MDL
❑ML
Isophorone ❑MDL
❑ML
Naphthalene ❑MDL
❑ML
Nitrobenzene ❑MDL
❑ML
N-nitrosodi-n-propylamine ❑MDL
ML
N-nitrosodimethylamine ❑MDL
❑ML
N-nitrosodiphenylamine ❑MDL
❑ML
Phenanthrene ❑MDL
❑ML
Pyrene ❑MDL
❑ML
1,2,4-trichlorobenzene ❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Pollutant Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
(list) Value Units Value Units Number of Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
El 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).
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