NC0075515_Renewal (Application)_20230629

ATE
"`ST 4-
46,
ROY COOPER - _ r
Governor A'
ELIZABETH S.BISER "" a s
=_
Secretary Q �ar" ~
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
June 29, 2023
Wilkes County Schools
Attn: Thomas J. Spicer, ORC
613 Cherry St
North Wilkesboro, NC 28659
Subject: Permit Renewal
Application No. NC0075515
Boomer Ferguson Elementary School
Wilkes County
Dear Applicant:
The Water Quality Permitting Section acknowledges the June 29, 2023, 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. 150B-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,
Wren Thed rd
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Q Narolina n Environmental Quality Water Resources
Winston-SalemorthC Departme
Regional OftFlofce 450 West Hanes Mill Road.Division Suiteof 300 Winston-Salem,North Carolina 27105
33b.7769800

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
RECEIVED
NPDES Permitting Program JUN 2 9 2023
NCDEQIDWRINPDES
Boomer-Ferguson
NC - 0075515
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
Boomer Ferguson NC0075515 Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions may result in denial of the application.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Boomer Ferguson Elementary School
Mailing address(street or P.O.box)
556 Boomer-Ferguson School Rd
City or town State ZIP code
o Boomer NC 28606
Contact name(first and last) Title Phone number Email address
Thomas James Spicer ORC p [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
556 Boomer Ferguson School Rd
City or town State ZIP code
Boomer NC 28606
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
Wilkes County Schools
= Applicant address(street or P.O.box)
613 Cherry Street
City or town State ZIP code
North Wilkesboro NC 28659
ci Contact name(first and last) Title Phone number Email address
n Thomas Spicer ORC [phone] [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 only one response.)
❑ Facility 0 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
w number for each.)
Existing Environmental Permits
a.
NPDES(discharges to surface El RCRA(hazardous waste) UIC(underground injection
water) control)
NC0075515
o ❑ PSD(air emissions) ❑ Nonattainment program(CM) 0 NESHAPs(CM)
❑ Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section 0 Other(specify)
404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 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)
215 100 %separate sanitary sewer 0 Own El Maintain
4) %combined storm and sanitary sewer ❑ Own ❑ Maintain
in CI Unknown CI Own ❑ Maintain
c %separate sanitary sewer IDOwn ❑ Maintain
'1 %combined storm and sanitary sewer 0 Own ❑ Maintain
0. 0 Unknown 0 Own ElMaintain
a %separate sanitary sewer ❑ Own ❑ Maintain
c %combined storm and sanitary sewer ❑ Own 0 Maintain
E ❑ Unknown El Own ❑ Maintain
; %separate sanitary sewer 0 Own ❑ Maintain
co
%combined storm and sanitary sewer 0 Own ❑ Maintain
cn
c 0 Unknown ElOwn 0 Maintain
Total 215
°' Population
ci Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) 05
1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes ❑✓ No
0
U
a 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
cu
c ❑ Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.0030 mgd
Ti
= Annual Average Flow Rates(Actual)
ea Two Years Ago Last Year This Year
C
CO c c .0017 mgd .0020 mgd .0022 mgd
w LL Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
.0026 mgd .0030 mgd .0028 mgd
u) 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
aTotal Number of Effluent Discharge Points by Type
Combined Sewer Constructed
a'1- Treated Effluent Untreated Effluent Bypasses Emergency
CO >, Overflows yp g y
-a Overflows
U)
o X
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 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 ❑ Intermittent
O Continuous
gpd ❑ Intermittent
_ 1.14 Is wastewater applied to land?
❑ Yes No 4 SKIP to Item 1.16.
c 1,15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Continuous or
° Location Size Average Daily Volume Intermittent
cp Applied (check one)
0 Continuous
acres gpd 0 Intermittent
0 Continuous
acres gpd ❑ Intermittent
= acresgpd ❑ Continuous
❑ Intermittent
Tu 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
Boomer Ferguson NC0075515 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
Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
a Contact name(first and last) Title
0
Phone number Email address
0Q NPDES number of receiving facility(if any) ❑None Average daily flow rate mgd
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
dnot have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
� I
D Yes ❑✓ No 4 SKIP to Item 1.23.
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
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
❑ Continuous
acres gpd ❑ Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acres gpd ❑ Continuous
El 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.
w Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
c ❑ 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
0
Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP
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
Boomer Ferguson NC0075515 Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
0 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
0
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
R Q specific requirements.)
� R
o 2
CL ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
1° (See instructions for specific requirements.)
o a,
u
o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
0 Yes 0 No 4 SKIP to Section 3.
= Briefly list and describe the scheduled improvements.
0
CO 1.
c
E
d
2.
E
0 0
3.
CO
3
CO
4.
R 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
P p
Scheduled
Affected
Begin End Begin Attainment of
Outfalls Operational
2 Improvement Construction Construction Discharge P
(list outfall Level
(from above) number) (MM/DD/YYYY) (MM/DD/YYYY M/MDD/YYYY
( ) (MM/DDM(YY)
1.
2•
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
0 Yes 0 No 0 None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number o01 Outfall Number Outfall Number
State North Carolina
County Wilkes
City or town Boomer
0
Distance from shore 1 ft. ft. ft.
0_
Depth below surface 0 ft. ft. ft.
Average daily flow rate .0018 mgd mgd mgd
Latitude 36° 10a " NE
Longitude -81 .2 , v❑ °
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o ❑✓ Yes ❑ No 4 SKIP to Item 3.4.
d
R 3.3 If so,provide the following information for each applicable outfall.
o Outfall Number o01 Outfall Number Outfall Number
Number of times per year
discharge occurs 180
a Average duration of each
8 discharge(specify units) 8 min.
cAverage flow of each .0016 mgd mgd mgd
discharge
in Months in which discharge
occurs Aug-May
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser pe at each applicable outfall.
Outfall Number Outfall Number Outfall Number
d
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
a one or more discharge points?
w ❑✓ Yes 0 No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Applicafion Form 2A
Boomer Ferguson NC0075515 Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number ow Outfall Number Outfall Number
Receiving water name Warrior Creek
Name of watershed,river,
c or stream system Yadkin River
Q- U.S.Soil Conservation
co
Service 14-digit watershed
o code
_
Name of state Yadkin River
management/river basin
rn _
c U.S.Geological Survey
4) 8-digit hydrologic
ix cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mglL 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 ow Outfall Number Outfall Number
Highest Level of 0 Primary ❑ Primary 0 Primary
Treatment(check all that ❑ Equivalent to ❑ Equivalent to ❑ Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced ❑ Advanced ❑ Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
0
.Q Design Removal Rates by
0 Outfall
N
0
o BOD5 or CBOD5 30 mg/L % % %
d
E
0 TSS 30 mg/L %
it.
0 Not applicable ❑Not applicable 0 Not applicable
Phosphorus a/a
0 Not applicable ❑Not applicable ❑Not applicable
Nitrogen % o/Q
Other(specify) 0 Not applicable 0 Not applicable ❑Not applicable
% % %
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 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.
=
C
c
_
0
U
= Outfall Number 001 Outfall Number Outfall Number
0. Disinfection type Chlorine
c Seasons used Sept_May
co
Dechlorination used? 0 Not applicable 0 Not applicable 0 Not applicable
❑✓ Yes 0 Yes ❑ Yes
❑ No ❑ No 0 No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
✓❑ Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑✓ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
rn
Number of tests of discharge
= water
4) Number of tests of receiving
water
w
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. E 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?
❑ Yes No additional sampling required by NPDES
permitting_authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 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+ 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 0 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)
a>
c
w
c
0
w 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
o toxicity?
❑ Yes ❑✓ No 4 SKIP to Item 3.26.
al3.23 Describe the cause(s)of the toxicity:
d
3
W
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑✓ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
El Yes Not applicable because previously submitted
information to the NPDES .ermittin. authorit .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
Boomer Ferguson NC0075515 Modified March 2021
SECTION 6.CFECKLIST 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
EI Section 1: Basic Application
Information for All Applicants ❑ w/variance request(s) ❑ wl additional attachments
❑ Section 2:Additional ❑✓ w/topographic map ❑ w/process flow diagram
Information
❑ w/additional attachments
© w/Table A ❑ w/Table D
❑ Section 3:Information on © w/Table B ❑ w/additional attachments
Effluent Discharges
❑ wl Table C
is
Section 4:Not Applicable
0
0
Section 5:Not Applicable
U
Section 6:Checklist and
0 Certification Statement ❑ wl attachments
N
Y 6.2 Certification Statement
ci)
v
i 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.lam 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
Thomas James Spicer ORC
Signature Date signed
Please see attached
documents!!!
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Number of Analytical ML or MDL
Pollutant Method (include
Value Units Value Units Sam•les units)
Biochemical oxygen demand
0 ML
©BOD5 or❑CBOD5 N/A 6-9 mg/L N/A N/A 2 per month Grab 30 MDL
resort one
o ML
Fecal coliform 200/100 ml 400/100 200/ 1 2 per month Grab 30 MDL
Design flow rate 0.0030 mgd .0015 .0015 mgd .0015 2 per month
pH(minimum) 6.0
pH(maximum) 9.0
Temperature(winter) N/A
Temperature(summer) N/A
Total suspended solids(TSS) 30 30 30 ❑2 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).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 001 Modified March 2021
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method1 (include units)
Samples
❑ML
Ammonia(as N) ❑MDL
Chlorine
0 ML
(total residual,TRC)2 ❑MDL
❑ML
Dissolved oxygen 0 MDL
Nitrate/nitrite
❑ML
0 MDL
❑ML
Kjeldahl nitrogen 0 MDL
❑ML
Oil and grease 0 MDL
Phosphorus
❑ML
0 MDL
❑ML
Total dissolved solids 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).
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
Boomer Ferguson NC0075515 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
0 MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable ❑ML
❑MDL
Cadmium,total recoverable 0 ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
Copper,total recoverable ❑ML
❑MDL
❑ML
Lead,total recoverable ❑MDL
❑ML
Mercury,total recoverable ❑MDL
❑ML
Nickel,total recoverable 0 MDL
Selenium,total recoverable ❑ML
0 MDL
❑ML
Silver,total recoverable ❑MDL
❑ML
Thallium,total recoverable ❑MDL
Zinc,total recoverable ❑ML
0 MDL
Cyanide ❑ML
❑MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile 0 ML
0 MDL
Benzene ❑ML
❑MDL
❑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
Boomer Ferguson NC0075515 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
Carbon tetrachloride ❑ML
0 MDL
Chlorobenzene ❑ML
0 MDL
Chlorodibromomethane ❑ML
0 MDL
Chloroethane ❑ML
0 MDL
2-chloroethylvinyl ether ❑ML
0 MDL
Chloroform ❑ML
0 MDL
Dichlorobromomethane ❑ML
0 MDL
1,1-dichloroethane ❑ML
0 MDL
1,2-dichloroethane ❑ML
0 MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
1,1-dichloroethylene ❑ML
0 MDL
1,2-dichloropropane ❑ML
0 MDL
1,3-dichloropropylene ❑ML
❑MDL
Ethylbenzene ❑ML
0 MDL
Methyl bromide ❑ML
❑MDL
❑ML
Methyl chloride ❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
❑ML
Tetrachloroethylene ❑MDL
Toluene ❑ML
❑MDL
❑ML
1,1,1-trichloroethane 0 MDL
1,1,2-trichloroethane 0 ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 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
Trichloroethylene ❑ML
❑MDL
Vinyl chloride ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
❑MDL
2-chlorophenol ❑ML
0 MDL
❑ML
2,4-dichlorophenol ❑MDL
2,4-dimethylphenol ❑ML
❑MDL
❑ML
4,6-dinitro-o-cresol ❑MDL
2,4-dinitrophenol ❑ML
❑MDL
2-nitrophenol ❑ML
❑MDL
4-nitrophenol ❑ML
❑MDL
❑ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
2,4,6-trichlorophenol ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene o ML
o MDL
Acenaphthylene ❑ML
❑MDL
Anthracene ❑ML
❑MDL
Benzidine ❑ML
❑MDL
Benzo(a)anthracene ❑ML
❑MDL
Benzo(a)pyrene ❑ML
❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 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
Benzo(ghi)perylene ❑ML
0 MDL
Benzo(k)fluoranthene ❑ML
0 MDL
Bis(2-chloroethoxy)methane ❑ML
0 MDL
Bis(2-chloroethyl)ether ❑ML
0 MDL
Bis(2-chloroisopropyl)ether ❑ML
0 MDL
Bis(2-ethylhexyl)phthalate ❑ML
O MDL
4-bromophenyl phenyl ether CI ML
O MDL _
Butyl benzyl phthalate ❑ML
❑MDL
2-chloronaphthalene ❑ML
0 MDL
4-chlorophenyl phenyl ether ❑ML
0 MDL
Chrysene ❑ML
0 MDL
di-n-butyl phthalate ❑ML
❑MDL
di-n-octyl phthalate ❑ML
0 MDL
Dibenzo(a,h)anthracene ❑ML
0 MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
0 MDL
1,4-dichlorobenzene ❑ML
0 MDL
3,3-dichlorobenzidine ❑ML
0 MDL
Diethyl phthalate ❑ML
❑MDL
❑ML
Dimethyl phthalate 0 MDL
❑ML
2,4-dinitrotoluene 0 MDL
2,6-dinitrotoluene ❑ML
o MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 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
1,2-diphenylhydrazine ❑ML
❑MDL
Fluoranthene 0 ML
❑MDL
Fluorene 0 ML
o MDL
Hexachlorobenzene 0 ML
❑MDL
Hexachlorobutadiene 0 ML
o MDL
Hexachlorocyclo-pentadiene 0 ML
o MDL
Hexachloroethane 0 ML
❑MDL
Indeno(1,2,3-cd)pyrene ❑ML
❑MDL
Isophorone ❑ML
❑MDL
Naphthalene ❑ML
❑MDL
Nitrobenzene 0 ML
❑MDL
N-nitrosodi-n-propylamine ❑ML
❑MDL
N-nitrosodimethylamine ❑ML
0 MDL
❑ML
N-nitrosodiphenylamine ❑MDL
Phenanthrene 0 ML
❑MDL
Pyrene ❑ML
0 MDL
1,2,4-trichlorobenzene ❑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).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Boomer Ferguson NC0075515 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 Method1 (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
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑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).
Page 18

DocuSign Envelope ID:4181978A-874B-4976-BCAC-52438394451E
NPDES Permit NC0075515 '-
Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 02B.0500 et seq.]
Grade I Biological WPCS [15A NCAC 08G .0302]
During the period beginning on the effective date of the permit and lasting until
expiration, the Permittee is authorized to discharge from outfall 001. Such discharges
shall be limited and monitored' by the Permittee as specified below:
PARAMETER LIMITS MONITORING REQUIREMENTS
[eDMR Code] Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location
Flow ] 0.003 MGD Weekly Instantaneous Influent Effluent or
50050
BOD,5 day,20°C 30.0 mg/L 45.0 mg/L 2/Month. Grab Effluent
[C0310]
Total Suspended Solids 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent
[C0530]
NH3 as N [C0610] 12.7 mg/L 35.0 mg/L 2/Month Grab Effluent
(April 1 to October 31)
NH3 as N [C0610] Monthly Grab Effluent
(November 1 to March 31)
Fecal Coliform [31616] 200/100 ml 400/100 ml 2/Month Grab Effluent
(geometric mean)
Total Residual Chlorine(TRC)2 28 pg/L 2/Week Grab Effluent
[50060]
Temperature Weekly Grab Effluent
[00010]
Total Nitrogen Quarterly Grab Effluent
[C0600]
Total Phosphorus Quarterly Grab Effluent
[C0665]
pH
>6.0 and<9.0 standard units 2/Month Grab Effluent
[0
[00400] —
- -
1 The permittee shall submit discharge monitoring reports electronically using the Division's
eDMR system [see A. (3)].
2 The Permittee shall report all effluent TRC values reported by a NC-certified laboratory
[including field-certified]. Effluent values < 50 µg/L will be treated as zero for compliance
purposes.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2) NUTRIENT REOPENER FOR HIGH ROCK LAKE
[NCGS 143.215.1 (b)]
This permit may be reopened and modified to implement nutrient requirements in
accordance with any future TMDL and / or nutrient management strategy for High Rock
Lake.
3 of 6

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NPDES Permit NC0075515A ..„_,
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Receiving Stream: UT to Warrior Creek Stream Class: WS-IV
Stream Segment: 12-29-(0.7) Sub-Basin#:03-07-01 ``
River Basin:Yadkin-Pee Dee HUC:30401010206 SCALE 36.1003°N, -81.2964° W
County: Wilkes 1:16,000