NC0021326_Renewal (Application)_20230705

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Jeff Sedlacek
Town of Dobson
PO Box 351
Dobson, NC 27017-0351
Subject: Permit Renewal
Application No. NCO021326
Dobson WWTP
Surry County
Dear Permittee:
NORTH CAROLINA
Environmental Quality
July 05, 2023
The Water Quality Permitting Section acknowledges the July 5, 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. 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://deg.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.
ec: WQPS Laserfiche File w/application
Sincerel ,
'i
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
D QV
North Carolina Department of Environmental Quality 1 Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road Suite 300 i Winston-Salem. North Carolina 27105
336.776 9800

PHONE
[phone]
June 30, 2023
\RTH caao�%
TOWN OF DOBSON
307 NORTH MAIN STREET • POST OFFICE BOX 351
DOBSON, NORTH CAROLINA 27017
NC Division of Water Resources
NPDES Permitting
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Town of Dobson WWTP
NPDES Permit No. NC 00021326
To whom it may concern,
JUL 0 5 2023
FAX
[phone]
NCDEQ/DWR/NPDES
Enclosed for your review is a NPDES Permit renewal package for the Dobson Wastewater Treatment
Plant. Our existing permit expires on December 31, 2023. We are requesting the Division to renew our
NPDES Permit. There are no changes at our facility since the issuance of the last permit. Attachment I is a
topographic map of the locations. Attachment II is a plant flow schematic. Attachment III is a narrative
description of the sludge management plan for the facility.
If you have any questions concerning the information provided, please feel free to give me a call.
Sincerely,
Jeff Sedlacek
Town Manager

ATTACHMENT I
RECEIVED
JUL 0 5 2023
NCDEQ/DWR/NPDES

51�
Ne Hops" 1
_ o�
um
41
�J`:' �\;� � • tom• �• �~�%-1 1i,��1 V
ub
• `: Dobson �T der/'
W.
lant
It
Air j6
� � P �-= �: � •� �=" e •fir'
;,-s
1 pasa
.�
SCALE 1: 24 0 0 0 Facility
Latitude: 36'22'50- Sub -Basin: 03-07-02 Location
Longitude: -W43.25"
ad #: B16NrW
Stream Class: C
} .� f „
Rereirm ine Stream: Cod}v Creek �L/L AICOo_ To�ca of Don
obsobs
Permitted Flom': 0.35 IMGD c� Dobson Trcatmcnt Fadlitc

ATTACHMENT II

INFLUENT
r
z
c ROTOMAT
U
m
TRASH
INFLUENT
WET
WELL
INFLUENT
PUMPING
STATION
DOBSON WASTEWATER TREATMENT PLANT
LAERAPON(l
f�
CODY
CREEK
DISINFEC11ON
LIME
SLUDGE MIXING 100,000 GALI
HOLDING SECTION ,,..;,� DIGESTER
TANK
)11 SLUDGE
LOAD LIMED' PUMPS
—
TRUCKS
AIRLINES
SPUTTER
BOX
ANOXIC
SOME
.............}...;........
RETURN
' SLUDGE RAS
PIT " PUMPS
ANOXIC
SONE
200,000
CAPACITY
AERATION
BASIN
cn
w
Z
q
BLOWER I I BL02 ER I I BLOWER

DIAGRAM NARRATIVE DESCRIPTION
The Town of Dobson owns and operates a 0.350 MGD wastewater treatment
plant. The unit treatment processes in the plant include influent screening and a
influent pump station. The influent waste stream is split between two extended
aeration activated sludge plants, with integral clarifiers. The treated effluent from
the two plants is then combined, and disinfected with UV disinfection. The
existing chlorination system was-` test in -prace as a back up to the UV system.
The treated effluent stream is discharged into Cody Creek, a Class C stream in
the Yadkin -Pee Dee River Basin.

ATTACHMENT III

DESCRIPTION OF SLUDGE MANAGEMENT
The sludge that is generated by the wastewater plant is wasted into dual
. 100 MGD basins. The basins are supernated back to the influent of the
plant. The finished sludge is mixed with hydrated lime and sampled to meet
requirements of our land application permit No. WQ0003796. The sludge is
then land applied by Southern Soil Builders on approved sites.

United States
Environmental Protection Agency
Office of Water EPA Form 3510-2A
Washington, D.C. Revised March 2019
Water Permits Division
VEP�A Application Form 2A
New and Existing Publicly
Owned Treatment Works
NPDES Permitting Program
Note: Complete this form if your facility is a new or existing publicly owned treatment works.

EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03/05/19
NCO021326
Town of Dobson WWTP OMB No.2040-0004
Form
U.S. Environmental Protection Agency
2A Id%
Application for NPDES Permit to Discharge Wastewater
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION•N
INFORMATION FOR i
Facility name
1.1
Town of Dobson WWTP
Mailing address (street or P.O. box)
P.O. Box 351
City or town
State
ZIP code
o
Dobson
NC
27017
€
Contact name (first an�Iast)
Title
Phone number
Email address
Michael FrazierORC/Public
Works Director
[phone]
[e-mail]
'
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
R
U-
500 Vineyard Lane
City or town
State
ZIP code
Dobson
NC
27017
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
Town of Dobson
Applicant address (street or P.O. box)
cc
P.O. Box 351
R
o
City or town
State
ZIP code
w
5
Dobson
NC
27017
Contact name (first and last)
Title
Phone number
Email address
a
Jeff Sedlacek
Town Manager
[phone]
[e-mail]
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
0 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
Y
number for each.)
Existing Environmental Permits
r❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO021326
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
W
C1
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Collection WQCS00215
Land App. WQ0003796
EPA Form 3510-2A (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
Town of Dobson
1391
100 % separate sanitary sewer
❑ Own 0 Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
cc
❑ Unknown
❑ Own ❑ Maintain
m%
separate sanitary sewer
❑ Own ❑ Maintain
N%
combined storm and sanitary sewer
❑ Own ❑ Maintain
c
❑ Unknown
❑ Own ❑ Maintain
Total
Population
0
0
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
sewer line in miles
100 %
%
1.8
Is the treatment works located in Indian Country?
C
0
0
ElYes ❑ No
v
R
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
.350 mgd
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c
204 mgd
196 mgd
212 mgd
_0
d"
Maximum Dail Flow Rates Actual
c
Two Years Ago
Last Year
This Year
.584 mgd
.487 mgd
.565 mgd
y
1.11
Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Dischar a Points by Type
0.. c
a,
Combined Sewer
Constructed
F
Treated Effluent
Untreated Effluent
Bypasses
Emergency
wOverflows
Overflows
0
1
EPA Form 3510-2A (Revised 3-19) Page 2

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NC0021326
Town of Dobson WWTP
OMB No. 2040-0004
Outfalls Other Than to Waters of the United States
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 United States?
❑ 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 Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
gpd
❑ Continuous
a
❑ Intermittent
w
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.
I
Land Application Site and Discharge Data
`o
Average Daily Volume
Continuous or
a,
Location
Size
Applied
Intermittent
check one
acres
d
gpd
❑ Continuous
c
❑ Intermittent
4)
acres
d
gpd
❑ Continuous
o
❑ Intermittent
acres
d
gpd
❑ Continuous
cc
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
El 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 -* SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter 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
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving F cility Data
Facility name
Mailing address (street or P.O. box)
a�
c
City or town
State
ZIP code
0
v
Contact name (first and last)
Title
0
s
d
Phone number
Email address
c
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate m d
9 Y 9
0.,
Ma
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
0
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
cm
❑ Yes © No 4 SKIP to Item 1.23.
0
c
1.22
Provide information in the table below on these other disposal methods.
m
Information on Other Disposal Methods
0
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Descri tion
Volume
w
acres
gp d
❑ Continuous
❑ Intermittent
ElContinuous
acres
gpd
❑ Intermittent
acres
gp d
El 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.
0 w
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
C
❑ Discharges into marine waters (CWA ElWater quality related effluent limitation (CWA Section
Cr
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
0
Contractor name
(company name
Mailing address
0
street or P.O. box
o
City, state, and ZIP
code
cContact
name (first and
c�
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A (Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO021326 Town of Dobson WWTP OMB No. 2040-0004
SECTION•D• •• • 1
% Outfalls to Waters of the United States
0
=
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o
❑r Yes ❑ No 4 SKIP to Section 3.
2.2
Provide the treatment works' current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
.�
L
and infiltration.
N/A gpd
1:
w
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
N/A
R
3
0
c�
s
2 3
ma to this application that contains all the required information? See instructions for
Have you attached a topographics
yP PP q (
M Q
specific requirements.)
� R
O �
❑✓ Yes ❑ No
Fo
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
o R
(See instructions for specific requirements.)
�
� R
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.
E
n.
2.
E
0
3.
d
L
U
4.
U)
R
Provide scheduled or actual dates of completion for improvements.
2.6
Scheduled or Actual Dates of Completion for Im rovements
E
0
>
Affected
Scheduled
Out
Begin
End
Begin
Attainment of
Operational
o
CL
Improvement
(list outfall
Construction
Construction
Discharge
Level
E
(from above)
numbers
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
U
N
2
3
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
EPA Form 3510-2A (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO021326 Town of Dobson WWTP OMB No. 2040-0004
SECTION•' • ON 1 1
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 1
Outfall Number
Outfall Number
State
North Carolina
County
Surry
42
o
City or town
Dobson
0
c
Distance from shore
N/A ft.
ft.
ft.
0_
Depth below surface
N/a ft.
0
Average daily flow rate
.196 mgd
mgd
mgd
Latitude
3e 22' 50"
Longitude
80 41 25"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o
c
❑ Yes r❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
N
Outfall Number
Outf ill Number
Outfall Number
c
Number of times per year
0
L
discharge occurs
a
Average duration of each
0
discharge (specify units
r-
Average flow of each
mgd
mgd
mgd
0
discharge
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes © No —> SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
n
Outfall Number
Outfall Number
Outfall Number
d
(6
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
�
discharge points?
CD
w
❑✓ Yes ❑ No -*SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
3.7 Provide the receiving water and related information if known for each outfall.
Outfall Number
Outfall Number
i Outfall Number
Receiving water name
Cody Creek
Name of watershed, river,
0
or stream system
N/A
•L
U.S. Soil Conservation
Service 14-digit watershed
N/A
o
code
L
Name of state
management/river basin
Yadkin Pee Dee
U.S. Geological Survey
8-digit hydrologic
N/A
cataloging unit code
Critical low flow (acute)
N/A cfs
cfs
cfs
Critical low flow (chronic)
N/A cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
N/A CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr
vided for discharges from each outfall.
Outfall Number
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
0 Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
Design Removal Rates by
Outfall
BOD5 or CBOD5
TSS
Phosphorus
Nitrogen
Other (specify)
85 %
85 %
0 Not applicable
• Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number
NCO021326
Name
Town of Dobson WWTP
Form Approved 03/05/19
OMB No. 2040-0004
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
3
C
•C
O
c
Outfall Number 1
Outfall Number
Outfall Number
Q
Disinfection type
UV Disinfectin System
H
d
Seasons used
All/Continuous
i d
E
cc
Dechlorination used?
Not applicable
❑ Not applicable
❑ Not applicable
F-
❑ 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?
El 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
Number of tests of discharge
water
Number of tests of receiving
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No 4 SKIP to Item 3.16.
0
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine. ✓❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
3
package?
w
❑✓ Yes ❑ No
3.16
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
Yes 4 Complete Tables C, D, and E as
❑ `'❑ No 4 SKIP to Section 4.
applicable.
3.17
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑ Yes ❑ No
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
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 ❑ 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
v
m
c
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.
3.23
Describe the cause(s) of the toxicity:
' c
d
w
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 permittinq authority.
SECTION•D•
i -
4.1
Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes 0 No + SKIP to Item 4.7.
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
ca
Number of SIUs
Number of NSCIUs
0
"
4.3
Does the POTW have an approved pretreatment program?
_
❑ Yes ❑ No
a
4.4
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
sapplication
or (2) a pretreatment program?
❑ Yes ❑ No 4 SKIP to Item 4.6.
0
R
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
0
c
—
4.6
Have you completed and attached Table F to this application package?
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 9

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
4.7
Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes 0 No 4 SKIP to Item 4.9.
4.8
If yes, provide the following information:
Annual
Hazardous Waste Waste Transport Method
Amount of
Units
Number (check all that apply)
Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
_
0
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
N
3
O
N
❑ Truck ❑ Rail
_
❑ Dedicated pipe ❑ Other (specify)
v
R
d
4.9
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
0
❑ Yes ❑ No 4 SKIP to Section 5.
4.10
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
❑ Yes + SKIP to Section 5. ❑ No
4.11
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater's hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION•
i
Does the treatment works have a combined sewer system?
E
5.1
rn
R
❑ Yes ❑ No +SKIP to Section 6.
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
c
Q
❑ Yes ❑ No
0
5.3
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
"'
U
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 10

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
5.4
For each CSO outfall, proviiide the following information. Attach additional sheets as necessary.)
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
City or town
a
State and ZIP code
M
o
County
O
Latitude
°
W
y
Longitude
Distance from shore
ft.
Depth below surface
ft.
5.5
Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Rainfall
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
a�
c
o`
CSO flow volume
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO pollutant
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0
concentrations
v
Receiving water quality
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO frequency
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Number of storm events
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5.6
Provide the following information for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Number of CSO events in
events
events
events
the past year
a
_
Average duration per
hours
hours
hours
event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
oAverage
volume per event
million gallons
million gallons
million gallons
c>
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
Minimum rainfall causing
inches of rainfall
inches of rainfall
inches of rainfall
a CSO event in last year
❑ Actual or ❑ Estimated 1
❑ Actual or ❑ Estimated I
❑ Actual or ❑ Estimated
RECEIVED
JUU G 5 '---'3
EPA Form 3510-2A(Revised 3-19) ' `CDEQ/ " " R/NPDES Page 11

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO021326
Town of Dobson WWTP
OMB No. 2040-0004
5.7
Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Receiving water name
Name of watershed/
streams stem
0
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
Service 14-digit
0
watershed code
'5 ;
if known
Name of state
management/river basin
U.S. Geological Survey
❑ Unknown
❑ Unknown
❑ Unknown
8-Digit Hydrologic Unit
Code if known
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
examples)
SECTION•
6.1
i d (d
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/ variance requestEl w/ additional attachments
Informationforfor All A Iicants
❑ Section 2: Additional
0 wl topographic map ❑ w/ process flow diagram
Information
❑r w/ additional attachments
0 w/ Table A ❑ w/ Table D
0 Section 3: Information on
0 w/ Table B ❑ w/ Table E
c
Effluent Discharges
E
❑ w/ Table C ❑ w/ additional attachments
o
Section 4: Industrial
❑ wl SIU and NSCIU attachments ❑ w/ Table F
('
❑ Discharges and Hazardous
❑
Wastes
wl additional attachments
:~
ElSection 5: Combined Sewer
El w/ CSO map ❑ wl additional attachments
�
Overflows
❑ wl CSO system diagram
Section 6: Checklist and
0
❑ w/attachments
Certification Statement
y
Y
6.2
Certification Statement
ca
L)
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
Jeff Sedlacek
Town Manager
Signature
Date signed
I
06/30/2023
EPA Form 3510-2A (Revised 3-19)/ \ Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO021326 I Town of Dobson WWTP OMB No.2040-0004
Maximum Daily Discharge
Average Daily Discharge
Pollutant
—
7� — {
Number of
Analytical
ML or MDL
Value Units
Value Units I
Method'
(include units)
Samples
Biochemical oxygen demand
Ri BOD5 or ❑ CBOD5
3.1
mg/I
.357
mg/I
52 SM5210B
2.0 mg/I
(report one
❑ MDL
Fecal coliform
<1.0
#/100ml
1.0
#/100m1
52 SM9222D
cfy/100m1 OML
❑ MDL
Design flow rate
.487
mgd
.196
mgd
365
1.0 mg/I OML
❑ MDL
pH (minimum)
6.2
su
pH (maximum)
6.8
su
13.22
deg c
43
Temperature (winter)
20.2
deg c
Temperature (summer)
26.0
deg c
21.66
deg c
61
Total suspended solids JSS)
3.855
mg/I
0.34
mg/I
52 SM4540D
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 13

This page intentionally left blank.

Number NPDES Permit Number Facility Name Outtall Number
NCO021326 I Town of Dobson WWTP
Form Approved 03105/19
OMB No. 2040-0004
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical
ML or MDL
Numbers
Value
Units
Value
Units
Samples
Method'
(include units)
Ammonia (as N)
1.96
mg/I
0.35
mg/I
52
SM4500WH3F
0 ML
0.1 mg/I ❑ MDL
Chlorine
total residual, TRC 2
N/A
N/A
N/A
N/A
N/A
N/A
El ML
N/A MDL
Dissolved oxygen
9.4
mg/I
7.4
mg/I
104
45000C
OML
0 mg/I MDL
Nitrate/nitrite
4.8
mg/I
2.975
mg/I
12
SM450ONO3E
OML
.05 mg/I 0 MDL
Kjeldahl nitrogen
2.24
mg/I
1.24
mg/I
12
SM4500WORGC
OML
1.0 mg/I MDL
Oil and grease
N/A
N/A
N/A
N/A
N/A
N/A
DML
N/A MDL
Phosphorus
.9
mg/I
.317
mg/I
12
SM450OPE
.01 mg/I OML
❑ MDL
Total dissolved solids
N/A
N/A
N/A
N/A
N/A
N/A
DML
N/A 0 MDL
I 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 15