NC0089265_Renewal (Application)_20230710

445
ROY COOPER -�j/ `` 2
Governor
ELIZABETH S.BISER ` sic
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
July 10, 2023
Town of Dobson
Attn: Jeff Sedlacek,Town Manager
PO Box 351
Dobson, NC 27017
Subject: Permit Renewal
Application No. NC0089265
Dobson WTP
Surry County
Dear Applicant:
The Water Quality Permitting Section acknowledges the July 10, 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,
.acilibk)(QVD
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D Q"? North Carolina Department of Environmental Quality I DIv(Sion of Water Resourtts
Winston-Salem Regional OfFlce 1450 West Hanes MIII Road,State 300 Winston-Salem,North Carolina 27105
u+ w\ 336776.9800

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TOWN OF DOBSON
PHONE 307 NORTH MAIN STREET• POST OFFICE BOX 351 FAX
[phone] DOBSON,NORTH CAROLINA 27017 [phone]
July 6, 2023 RECEIVED
JUL 10 2023
NCDEQIDWRINPDES
NC Division of Water Resources
NPDES Permitting
1617 Mail Service Center
Raleigh,NC 27699-1617
RE: Dobson WTP
NPDES Permit No. NC0089265
To whom it may concern,
Enclosed for your review is a NPDES Permit renewal package for the Dobson Water 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. I have also enclosed the
required map (showing outfall), flow schematic, and solids handling plan for the town's water treatment
plant.
If you have any questions concerning the information provided, please feel free to give me a call.
Sincerely,
, 440....<......_„
Jeff Sedlacek
Town Manager

United States Office of Water EPA Form 3510-2A
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
.,EPA Application Form 2A
New and ExistingPublicly
Y
Owned Treatment Works
NPDES Permitting Program
Note: Complete this form if your facility is a new or existing publicly owned treatment works.
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Town of Dobson Facility
Dobson WTP Location
not to scale
Di aivaie Basin: Yadkin-Pee Dee Receiving Stream: Fisher River
Latitude: 36°24'49" N State Grid/USGS: B16NVi Dodson.'V.longitude: x0°43 16" V, Stream Segment: 12-63-191 NPDES Permit NCUOtSy_'():
Stream('lass: l III( 03040101 North
Sub-Basin: II,-u--(I
Sutry County

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TOWN OF DOBSON WATER TREATMENT PLANT OUTFALL
ANDERSON 36 24' 36" N, 80' 42' 09" W
-----.AC7A4c\A ND FROM USGS MAP DOBSON NC, 2010, SCALE: 1:24,000
ASSOCIATES, Inc. _ -

INTAKE (FISHER RIVER) T
RAW WATER PUMPS O O
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• • !
BACKWASH
REWASH FILTER
MIX BASIN • FLOC BASIN
DRAIN DRAIN
STORM
M•
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• —• •
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• OUTFALL
CLEARWELL
DRAIN
STORM
DRAIN
DOBSON WTP DISCHARGE SCHEMATIC
QnQ�AANDERSON
c AND N.T.S.
SSOCIATES, Inc.

DRAFT
RESIDUALS MANAGEMENT PLAN FOR
DOBSON WATER TREATMENT PLANT
DOBSON, NORTH CAROLINA
August 23, 2012
te�oese�essasr�i
,.,,Most CA% '".+,
00`e`4`tj •n` 74, jt•
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•
•• 41..0# 6 231I2 Prepared By:
Anderson & Associates, Inc.
Professional Design Services
Greensboro, North Carolina
NC Corporate License No. C-0867
JN 30078

Aa Residuals Management Plan for Dobson WTP
TABLE OF CONTENTS
PAGE
A. PLAN SUMMARY 2
1. Background 2
2. General 2
3. Residuals Generation and Treatment 2
4. Disposal Site 3
5. Transportation 3
6. Record Keeping 4
APPENDIX A Residuals Characteristics 1
APPENDIX B Disposal Site 2
APPENDIX C Hauling Route 3
IVWGSO1lPROJECTS\3 013 00 7 8130 0 7 8 ENGINEERING\STUDY1PER130078 RESIDUALS MGMT PLAN.DOCX 8/23/12
TABLE OF CONTENTS 1

e0e� Residuals Management Plan for Dobson WTP
APPENDIX A
Residuals Characteristics
1. Testing was performed on the raw and finished water as an indication of potential
constituents present in the combined residuals from the plant.
2. Upon concurrence with the DRAFT plan, each of the separate residual streams
will be sampled and mixed to form a representative combined residual sample for
further analysis. TCLP testing will be performed to confirm that the waste is non-
hazardous and suitable for landfilling.

ez Residuals Management Plan for Dobson WTP
A. PLAN SUMMARY
1. Background
The Town of Dobson is located in Surry County, North Carolina. The
Town operates a public water system which serves the community. Water is
supplied from a water treatment plant operated by the Town which draws water
from the Fisher River. The plant has a rated capacity of 1.5 mgd and was
originally constructed in 1967. There have been no significant upgrades to the
treatment plant since the original construction. The original design piped the
generated residuals and all basin drains to the storm sewer. This practice is
being discontinued at the plant.
2. General
The purpose of this Residuals Management Plan is to describe the new
procedure for disposal of the water treatment plant residuals from the Dobson
Water Treatment Plant. The residuals will be settled, dewatered, and then
hauled to the Surry County Landfill for ultimate disposal.
3. Residuals Generation and Treatment
The water treatment plant uses a conventional, coagulation, flocculation,
sedimentation, filtration, and disinfection process. As such, residuals are
generated from the removal of solids and the addition of chemicals during the
treatment process. The main sources of these residuals within the treatment
plant include:
1. Backwash from the filters
2. Rewash water from ripening of the filters
3. Accumulated solids from the sedimentation basins
While these sources consist mainly of dilute natural solids that have been
removed during treatment, chemicals added during the treatment process could
also occur within these sources. The chemicals added during treatment include:
4. Aluminum sulfate (alum), a coagulant
5. Lime, to raise pH lowered by alum
6. Chlorine, a disinfectant
7. Fluoride, a dental health supplement.
Other potential pollutants may occur in low concentrations in the raw
water and become more concentrated in the residuals. These might include any
elements that occur in an insoluble form. Testing conducted in July 2012
showed that iron, manganese, and copper are likely to be present in the
residuals.
The residuals will be treated at the water treatment plant in a settling tank
and dewatered through a belt press or filter container to reduce the volume of
residuals and ultimately the disposal cost. Water treatment plant residuals
11AAGS011PROJECTS13013007813007B ENGINEERINGISTUDYIPER130078 RESIDUALS MGMT PLAN.DOCX 8/23/12
PLAN SUMMARY 2

'I Residuals Management Plan for Dobson WTP
contain virtually no pathogens and therefore do not require stabilization before
settling and dewatering.
The settling tank used for treatment will serve several purposes. First, it
will act as an equalization tank allowing backwashing and sedimentation basin
cleaning to proceed when needed. Second, it will serve as a sedimentation tank,
allowing solids to settle out and the clear water to be decanted off. Third, it will
store the concentrated residual solids until they are drawn off for dewatering.
The concentrated solids (approximately 5%) will be dewatered in a belt press or
filter box to approximately 12-15%to pass the paint filter test. The volume of
water plant residuals anticipated to be generated is approximately 500 gallons
per day. Once this is dewatered, the weight of residuals to be disposed of in the
landfill is estimated to currently average 410 pounds per day, or 46 "wet"tons per
month. Without any significant changes in the treatment process, this could
increase to about 85 tons per month at the full 1.5 mgd water treatment plant
capacity.
Residuals will be sampled and analyzed to establish general
characteristics and also to analyze the potential for leaching toxic components.
These results are provided in Appendix A.
The Environmental Compliance Supervisor(the "gatekeeper") at the
municipal landfill (as defined by RCRA Subtitle D)will collect TCLP data to
determine whether the waste can be accepted into the facility. If TCLP analytical
results are below the TCLP D-list maximum contamination levels (MCLs), the
waste will be accepted. If they are above these levels, the waste must be taken
to a hazardous waste disposal facility.
4. Disposal Site
The dewatered residuals will be disposed of at the Surry County Landfill
located at 237 Landfill Road, Mt. Airy, North Carolina. Surry County operates
this Subtitle D landfill. Appendix B provides information on the landfill and a letter
of intent from the landfill to accept the residuals.
5. Transportation
Dewatered residuals will be hauled directly from the Dobson Water
Treatment Plant to the Surry County Landfill on a schedule defined by the water
treatment plant operator. Residuals will NOT be mixed with other solid wastes
from the Town. The Town will either haul the residuals using their own
equipment and personnel or retain the services of a hauling contractor. The
hauling truck will be covered and suitably water tight.
The route to be taken by the hauler from the Dobson Water Treatment
Plant to the landfill (approximately 12 miles) will be as follows: From Prison
Camp Road, turn left onto US-601 BUS N and go 1.4 miles. Turn left onto US-
601 N/ Rockford Street and go 4.4 miles. Turn right to merge onto I-74E and go
1.3 miles to Exit 13 (Park Drive) and turn left onto Park Drive. Take the first right
onto Sheep Farm Road and go 2.2 miles. Turn right onto Hiatt Road and go 0.8
miles. Turn right onto Landfill Road. Landfill is on the left. A map of the route is
included in Appendix C.
11AAGS011PROJECTS130U0078130078 ENGINEERINGISTUDYIPER130078 RESIDUALS MGMT PLAN.DOCX 8/23/12,
PLAN SUMMARY 3

eOefl Residuals Management Plan for Dobson WTP
6. Record Keeping
A manifest will be completed for each load of dewatered residuals from
the Town's water treatment plant delivered to the Surry County Landfill under
contract with Surry County. The County will use this manifest as a basis for
invoicing the Town for reimbursement of disposal fees. The County will be
invoiced by the Surry County Landfill as part of their total solid waste load under
the terms of their current contract with the landfill.
The contractor's driver will obtain weight ticket and landfill attendant's
signature at the time the load is delivered. Manifest and weigh ticket will then be
delivered to the Town office. The Town will then forward a copy of the weight
tickets to the County on a monthly basis so that an invoice can be prepared. The
Town will be invoiced at the current rate paid by the County (i.e., $38/ton as of
July 2012).
\AAGSO1lPROJECTS13 013 00 7 8130 0 7 8 ENGINEERINGISTUDYIPER130078 RESIDUALS MGMT PLAN.DOCX 8/23/12
PLAN SUMMARY 4

A Residuals Management Plan for Dobson WTP
APPENDIX B
Disposal Site

•
Dennis Bledsoe
•
Interim-birector � , ` 7 �� �' , Phone: 33b-401-8376
,�RM, d; r, Fax: 336�01 8380
COUNTY OF SURRY
PUBLIC WORKS DEPARTMENT
Solid Waste:Division
P.O. BOX 342
•
Dobson,NC 27017
Mr. Gary Crouch
Anderson 8,Associates, inc.
100 Ardmore Street
Blacksburg, VA 24060
•
•
Re: Town of Dobson
Water Treatment Residuals Disposal
JN 30078
Dear Mr. Crouch:
This letter of intent is provided as a follow-up to our telephone conversations regarding disposal
of dewatered water treatment plant residuals at the Surry County Landfill. We understand that these
residuals will be generated at the Town of DObson's municipal water treatment plant, and that the Town is
in the process of changing their current disposal methods. The residuals will consist of normal
concentrated solids removed during the treatment process and the residue of normal chemicals used in
the treatment process. The waste will be dewatered and is not anticipated to contain hazardous material.
• The Surry County Landfill can accept this type of waste. We would be willing to accept this waste
for disposal under the following conditions:
1. TCLP testing shows that the waste is classified as non-hazardous.
2. The dewaterediresiduals pass the paint filter test.
3_ The residuals are not mixed with other solid wastes.
4. The waste is being disposed: of under a plan acceptable to the North Carolina
Department of Environmental Health and Resources.
This letter of intent is provided to document our willingness to accept the waste. A final
agreement will be executed once we have documentation that the waste is acceptable. Please keep us
informed of your schedule and intentions. Let us know if we can be of further assistance.
Sincerely,
•
Dennis Bledsoe
Interim-Director of Public Works

curry �ounry i't_. rage i oz i
;
Surry 1 _-��
You511 Find It In Sorry County NC
-Elected Officials 9 5" ry x*( " r a€a
County Commrss[ryntrs F a r - • j $ 'i y.-' ua
Commissioners • 1 u .Y 1, i egg ;� .;
•
,Agenda
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Minutes Public Works
Ordinances
Clerk of Court Dennis Bledsoe,lntermin Director
RcgisterofSeeds P.O. Box 342
Sheriff Dobson, NC 27017
Administrti n Phone: [phone]
County Wanner
County Offices Office Hours: Office Hours:
Board of irfectiotts Monday- Saturday 8:00-4:00
Comrnunications
onptive g;:ensiors Landfill And Convenience Center Locations
Economic Development Recycling
Emergency Services
Environmental HealthWaste And Sewer Policy
Fat:jiff;.s Management nagem;nt Surry County Landfill
Finance
Fire Marshal Surry County operates a Subtitle D landfill located at 237 Landfill Road, Mt. Airy and is
fievlth and Rut:titian available for the disposal of residential and commercial waste. Waste from the transfer
station is delivered to the Subtitle D landfill for final disposal.This location has a construction
Hainan Resources and demolition disposal area. This is for the disposal of any building material (wood, metal,
Inspections drywall, vinyl, etc) or demolished buildings, plus cement and paving waste. An area is
- EIS provided at the Mt- Airy landfill for the disposal of tires (rims must be removed) and
appliances (white goods), and yard waste. Surry County operates thirteen
Parks a'd Res"rea:;en recycling/convenience centers. These centers are available for residential drop-off of
• canning and DevziC1h`tr( tst household waste and provide an outlet for recycling. These centers are not available to
-Public Works commercial business waste disposal. All centers accept household waste for disposal.
Purchasing Household waste consists of trash and food waste from the daily activities of a home.
Anything other than household waste such as wood, metal, or in general "spring or
StffifOr SenrkteS basement" cleaning must come to the landfill at Mt. Airy. Users of the centers are
• Social Services • discouraged from bringing pickup loads of bagged trash to the centers for disposal. The
Sail 9 cf Watercenters are not equipped to handle large loads. Large loads should be delivered directly to
• the landfill"or transfer station"for disposal. No liquids or hazardous waste is accepted at any
Tax of the County's disposal areas. Disposal methods of liquids and hazardous waste are
Tourisrtt; available from the source of purchase or the manufacturer of the product.Recycling facilities
Veterans cardboard,
each center are available for newspaper, magazines, aluminum cans, glass bottles,
cardboard, and auto batteries. Glass containers should be rinsed clean. Newspaper,
Job Openings magazines, and cardboard should be free of any foreign materials such as string, paper, or
.Find iithere plastic bags and should not be co-mingled with other paper types.
Search
The Mt. Airy center has facilities for all paper types. Paper such as envelopes, color paper,
plain paper, paper with black or color ink are considered mixed paper and do not have to be
sorted. Computer paper is acceptable, but must be segregated from other paper. Also, the
Mount Airy Center accepts computers, televisions, fax machines, copiers, and other
electronics.
"Notice"Email correspondence is subject to the North
Carolina Public Records Law(NCGS Chapter 132).
: ,
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Q&\ Residuals Management Plan for Dobson WTP
2
APPENDIX C
Hauling Route

- ---� raPP i of z
'. ,, o r� MAPS
A 2604 Prison Camp Rd, Dobson, NC 27017-8573
B 237 Landfill Rd, Mt Airy, NC 27030-6160
Total Distance: 11.65 miles—Total Time: 21 mins
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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105/19
NC0089265 Dobson WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A aEPA Application for NPDES Permit to Discharge Wastewater
NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Dobson WTP
Mailing address(street or P.O.box)
PO BOX 351
City or town State ZIP code
0 Dobson NC 27017
Contact name(first and last) Title Phone number Email address
w Michael Frazier ORC/Public Works Director [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
2604 Prison Camp Rd
City or town State ZIP code
Dobson NC 27017
1. Isthis application for a facilitythat hasyet to commence discharge?
2g
PP
❑ Yes-4 See instructions on data submission ❑ No
ers.
requirements for new dischargers.
9
1.3 Is applicant different from entity listed under Item 1.1 above?
❑r Yes 0 No 4 SKIP to Item 1.4.
Applicant name
Town of Dobson
Applicant address(street or P.O. box)
0
P.O.Box 351
City or town State ZIP code
Dobson NC 27017
Contact name(first and last) Title Phone number Email address
Jeff Sedlacek Town Manager [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 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
❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
Ts
water) control)
NC0021326-WWTP
2 ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 0 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 03/05/19
NC0089265 Dobson WTP OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served _ (indicate percentage) Ownership Status
Dobson 1391 100 %separate sanitary sewer ❑ Own ❑ Maintain
Z0 %combined storm and sanitary sewer ❑ Own ❑ Maintain
a, ❑ Unknown ❑ Own 0 Maintain
%separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer ❑ Own 0 Maintain
0 0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
combined storm and sanitary sewer 0 Own 0 Maintain
E ❑ Unknown _ 0 Own 0 Maintain_
e; %separate sanitary sewer 0 Own 0 Maintain
co
%combined storm and sanitary sewer 0 Own 0 Maintain
cn
o 0 Unknown 0 Own 0 Maintain
Total 1391
Population
0 Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 100 % 0 %
sewer line(in miles)
1.8 Is the treatment works located in Indian Country?
c
o 0 Yes 0 No
v
c 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
0.066 mgd
to i Annual Average Flow Rates(Actual)
< i 1 Two Years Ago Last Year This Year
co
" a .0098 mgd .008 mgd .010 mgd
co lI I
u) Maximum Daily Flow Rates(Actual)
ca Two Years Ago Last Year This Year
.057 mgd .025 mgd .018 mgd
u, 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
0 T Constructed
a"- Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
R a Overflows
v a 1 ! 1 Overflows
o _
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP 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 ❑r 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 0 Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes 0 No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
o Continuous or
Location Size Average Daily Volume Intermittent
a, I Applied (check one)
m
acres gpd 0 Continuous
o ❑ Intermittent
acres d 0 Continuous
0 9P 0 Intermittent
0 Continuous
acres gpd 0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ 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 S• tate ZIP code
Contact name(first and last) T• itle
•
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
NC0089265 Dobson WTP 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 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
0
t
Phone number Email address
o NPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
0.
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 United States(e.g.,underground percolation,underground injection)?
❑ Yes ❑r No 4 SKIP to Item 1.23.
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
a Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
`� ❑ Continuous
acres gpd 0 Intermittent
0 Continuous
acres gpd 0 Intermittent
acresgpd ❑ 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.
d 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
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
Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP
code
Contact name(first and
ci 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
NC0089265 Dobson WTP OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the United States _
c 2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o ❑ 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
.m 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
co 0. specific requirements.)
rn�
0
❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o (See instructions for specific requirements.)
o,
" 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
R 1.
E
w
Q 2.
E
0
3.
s
4.
g. 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
co
Affected I Attainment of
Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge
(list outfall Level
E (from above) (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)
number) (MM/DD/YYYY)
1.
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
NC0089265 Dobson WTP OMB No.2040-0004
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 ooi Outfall Number Outfall Number
State North Caroline
County Surry
o City or town Dobson
o _
g Distance from shore 4.0 ft. ft. ft.
Depth below surface N/A ft. ft. ft.
Average daily flow rate .008 mgd mgd mgd
Latitude 36' 24 49" Ns
Longitude 80 43' 3.6" 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.
3.3 If so, provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
Number of times per year
g discharge occurs
Average duration of each
discharge(specify units)
Average flow of each
0 discharge mgd mgd mgd
coMonths in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑r No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser t pe at each applicable outfall.
a
Outfall Number ( Outfall Number Outfall Number
r
c ,
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
0 Yes ❑ No 4SKIP 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
NC0089265 Dobson WTP OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Fisher River
Name of watershed,river, N/A
or stream system
0- U.S.Soil Conservation
y Service 14-digit watershed N/A
code
Name of state
is
management/river basin Yadkin-Pee-Dee
a,
U.S.Geological Survey
8-digit hydrologic N/A
cc 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 provided for discharges from each outfall.
Outfall Number 001 Outfall Number Outfall Number
Highest Level of ❑ 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 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
a Design Removal Rates by
Outfall
m
BOD5 or CBOD5
a i TSS
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP 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.
w
C
0
U
= Outfall Number 001 Outfall Number Outfall Number
0
Q Disinfection type N/A
cn
Seasons used All/Continuous
is -Dechlorination used? 0 Not applicable El Not applicable ❑ Not applicable
❑ 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?
O 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 0 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
CD package?
Lu w ElYes IDNo
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
❑ applicable. ❑ No SKIP to Section 4.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
El 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?
No additional sampling required by NPDES
ElYes ❑ permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105/19
NC0089265 Dobson WTP 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?
No 4 Complete tests and Table E and SKIP to
0 Yes 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)
All Pass
08/02/2022
co
c
11/01/22,02/07/23,05/02/23
(5 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?
0' ❑ Yes 0 No 4 SKIP to Item 3.26.
o 3.23 Describe the cause(s)of the toxicity:
d
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes El 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?
0 Yes ❑ Not applicable because previously submitted
information to the NPDES .ermittin. authorit .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.21(j)(6)and(7))
4.1 Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes El No 4 SKIP to Item 4.7.
4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
W Number of SIUs Number of NSCIUs
3
O
A 4.3 Does the POTW have an approved pretreatment program?
o ❑
= Yes ❑ No
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
application or(2)a pretreatment program?
to ❑ Yes ❑ No 4 SKIP to Item 4.6.
To 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
5
C
4.6 Have you completed and attached Table F to this application package?
O Yes 0 No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105/19
NC0089265 Dobson WTP 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 ❑ No 4 SKIP to Item 4.9.
4.8 If yes,provide the following information:
l Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
a
U _
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
t
� I
0
-0
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
a)
mi 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?
❑ Yes ❑ No 4 SKIP to Section 5.
•c
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 4 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 5.COMBINED SEWER OVERFLOWS(40 CFR 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
ea
rn 0 Yes ❑ No 4SKIP to Section 6.
• 5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
❑ Yes ❑ No
O 5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
cn
U ❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP OMB No.2040-0004
5.4 For each CSO outfall,provide the following information.(Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
2- State and ZIP code
0
C County
0
Latitude
0 °
o „
N Longitude °
c>
Distance from shore ft. ft. ft.
Depth below surface ft. ft. 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 0 Yes ❑ No ❑ Yes ❑ No
CD
C
`o CSO flow volume ❑ Yes ❑ No 0 Yes ❑ No 0 Yes 0 No
CSO pollutant ❑ Yes ❑ No ❑ Yes ❑ No 0 Yes 0 No
o concentrations
co
v Receiving water quality ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No
CSO frequency 0 Yes ❑ No 0 Yes 0 No 0 Yes 0 No
Number of storm events 0 Yes 0 No 0 Yes 0 No 0 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
y the past year
<O
n.
c Average duration per hours hours hours
d event El or 0 Estimated 0 Actual or 0 Estimated 0 Actual or❑ Estimated
Lu million gallons million gallons million gallons
o Average volume per event
cC.> 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year 0 Actual or❑ Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP 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/
N stream system
U.S.Soil Conservation 0 Unknown 0 Unknown 0 Unknown
Service 14-digit
= watershed code
> (if known)
°i Name of state
management/river basin
cn U.S.Geological Survey 0 Unknown 0 Unknown 0 Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam Iles
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 172.22(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) ❑
❑ Section 2:Additional 0 w/topographic map El w/process flow diagram
Information ❑ w/additional attachments
w/Table A 0 wl Table D
❑ Section 3: Information on w/Table B Elw/Table E
Effluent Discharges
✓❑ w/Table C ❑ w/additional attachments
o Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑ w/Table F
❑ Discharges and Hazardous
o ❑ w/additional attachments
Wastes
Section 5:Combined Sewer ❑ w/CSO map ❑ w/additional attachments
v ❑ Overflows ❑ w/CSO system diagram
Section 6:Checklist and
co ❑ Certification Statement ❑ wl attachments
17)
6.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information,the information submitted is, to the best of my knowledge and belief, true,accurate,and
complete.I am aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Jeff Sedlacek Town Manager
Signature Date signed
07/06/2023
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units NSamplesf Method1 (include units)
Biochemical oxygen demand ❑ML
❑BODs or❑CBOD5 ❑MDL
(report one)
Fecal coliform ❑ML
❑MDL
Design flow rate .025 mgd .008 mgd 365
pH(minimum) 6.20 Std Unts
pH(maximum) 8.30 Std Unts
Temperature(winter) 14.80 Celsius 8.25 Celsius 10
Temperature(summer) 27.70 Celsius 21.40 Celsius 14
D ML
Total suspended solids(TSS) 15.05 mg/I 2.35 mg/I 24 SM 2540D-2011 mg/I O 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 13
L

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 0MB No.2040-0004
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)
Sam les l
Ammonia(as N) ❑ML
0 MDL
Chlorine l7 ML
(total residual,TRC)2 14.0 ug/I 7.40 ug/I 24 SM4500 CL G-2011 ug/I 0 MDL
Dissolved oxygen ❑ML
0 MDL
0 ML
Nitrate/nitrite 1.30 mg/I 0.78 mg/I 4 SM4500E-2011 mg/I 0 MDL
ML
Kjeldahl nitrogen 1.68 mg/I 1.18 mg/I 4 SM4500NorgB-2011 mg/I 0 MDL
Oil and grease CI ML
❑MDL
0 ML
Phosphorus 0.25 mg/I 0.0625 mg/I 4 SM4500PE-2011 mg/I O 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 15

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
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 _
Metals,Cyanide,and Total Phenols
ML
Hardness(as CaCOs) 47.0 rng/I 25.75 mg/I 12 Calculation mg/I ❑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
ML
Copper,total recoverable 330.0 ug/I 98.60 ugh! 12 EPA 200.8 ug/I 0 MDL
Lead,total recoverable ❑ML
❑MDL
Mercury,total recoverable ❑ML
❑MDL
Nickel,total recoverable ❑ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
Acrolein ❑ML
_ _ ___ ❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 0MB No.2040-0004
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
Carbon tetrachloride ❑ML
_ ❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
2-chloroethylvinyl ether 0 ML
❑MDL
Chloroform 0 ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane 0 ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
1,1-dichloroethylene ❑ML
❑MDL
1,2-dichloropropane ❑ML
❑MDL _
❑ML
1,3-dichloropropylene ❑MDL
Ethylbenzene ❑ML
❑MDL
Methyl bromide ❑ML
❑MDL
Methyl chloride ❑ML
❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
Tetrachloroethylene ❑ML
❑MDL
Toluene ❑ML
❑MDL
❑ML
1,1,1-trichloroethane ❑MDL
1,1,2-trichloroethane 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
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
❑ML
Trichloroethy lene I ❑MDL
Vinyl chloride 1 ❑ML
I ❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
❑MDL
2-chlorophenol ❑ML
❑MDL
2,4-dichlorophenol ❑ML
❑MDL
2,4-dimethylphenol El ML
❑MDL
4,6-dinitro-o-cresol ❑ML
0 MDL
2,4-dinitrophenol ❑ML
❑MDL
2-nitrophenol ❑ML
0 MDL
4-nitrophenol ❑ML
❑MOL
❑ML
Pentachlorophenol 0 MDL
Phenol — — ❑ML
❑MDL
2,4,6-trichlorophenol ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene ❑ML
❑MDL
Acenaphthylene ❑ML
_ ❑MDL
Anthracene ❑ML
0 MDL
❑ML
Benzidine 0 MDL
❑ML
Benzo(a)anthracene ❑MDL
❑ML
Benzo(a)pyrene ❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 0MB No.2040-0004
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
__ ❑MDL
Benzo(k)fluoranthene ❑ML
❑MDL
Bis(2-chloroethoxy)methane ❑ML
❑MDL
Bis(2-chloroethyl)ether ❑ML
❑MDL
Bis(2-chloroisopropyl)ether ❑ML
❑MDL
Bis(2-ethylhexyl)phthalate ❑ML
❑MDL
4-bromophenyl phenyl ether ❑ML
❑MDL
Butyl benzyl phthalate 0 ML
❑MDL _
2-chloronaphthalene ❑ML
❑MDL
4-chlorophenyl phenyl ether ❑ML
❑MDL
Chrysene ❑ML
_ ❑MDL
di-n-butyl phthalate ❑ML
❑MDL
di-n-octyl phthalate ❑ML
❑MDL
Dibenzo(a,h)anthracene ❑ML
❑MDL
1,2-dichlorobenzene ❑ML
❑MDL _
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ❑ML
❑MDL
Dimethyl phthalate ❑ML
0 MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number of Method' (include units)
Samples
1,2-diphenylhydrazine ❑ML
❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
❑MDL _
Hexachlorobutadiene ❑ML
_ ❑MDL
Hexachlorocyclo-pentadiene ❑ML
❑MDL
Hexachloroethane 0 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
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 21

H
vD
CD
CD
C-

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge
Pollutant 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
L MDL
0 ML
Turbidity 12.70 NTU 3.60 NTU 24 EPA-180.1 NTU p 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
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 23

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number Qrt-4 Test Number Qrt-1 Test Number Qrt-2
Test species Ceriodaphnia dubia Ceriodaphnia dubia Ceriodaphnia dubia
Age at initiation of test 1-day 1day 1-day
Outfall number o01 o01 001
Date sample collected 11/01/2022 02/07/2023 05/02/2023
Date test started 11/02/2022 02/08/2023 05/03/2023
Duration 7 days 7days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Freshwater WET Freshwater Wet Freshwater Wet
Edition number and year of publication Short term Method 4th Edition-2002 Short Term Method 4Th Edition-2002 Short Term Method 4th Edition-2002
Page number(s) page 141-189 141-189 141-189
Sample Type
Check one: ✓❑ Grab © Grab ❑✓ Grab
0 24-hour composite 0 24-hour composite ❑ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
0 After Dechlorination 0 After Dechlorination _ 0 After dechlorination
Point in Treatment Process
Describe the point in the treatment process Sample is collected at the point of entry 001 Sample collected at outfall 001 Fisher River Sample collected at outfall 001 Fisher River
at which the sample was collected for each discharge to the Fisher River
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute ❑Acute ❑Acute
performed to asses acute or chronic toxicity, Chronic 0 Chronic El Chronic
or both.(Check one response.)
❑ Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Qr" Test Number Qrt-1 Test Number Qrt-2
Test Type
Indicate the type of test performed.(Check one ❑ Static Cl Static ❑ Static
response.)
0 Static-renewal 0 Static-renewal 0 Static-renewal
❑ Flow-through ❑ Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑r Laboratory water 0 Laboratory water 0 Laboratory water
one response.)
❑ Receiving water ❑ Receiving water ❑ Receiving water
If laboratory water,specify type. DI Water DI-Water DI-Water
If receiving water,specify source. Fisher River Fisher River Fisher River
Type of Dilution Water
Indicate the type of dilution water. If salt 0 Fresh water 0 Fresh water r❑ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. ❑ Salt water(specify) ❑ Salt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. [T pH d Ammonia 0 pH El Ammonia 0 pH Er Ammonia
❑ Salinity © Dissolved oxygen El Salinity El Dissolved oxygen ❑ Salinity © Dissolved oxygen
El Temperature El Temperature El Temperature
Acute Test Results
Percent survival in 100%effluent 100 % 100 % 100 %
LCso
95%confidence interval a/a a/a oho
Control percent survival ioo % 100 % 10o %
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0089265 Dobson WTP 001 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Qrt-4 Test Number art-1 Test Number Qrt-2
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC
IC25
Control percent survival
Other(describe)
Quality ControUQuality Assurance
Is reference toxicant data available? ❑r Yes ❑ No CI Yes ❑ No El Yes ❑ No
Was reference toxicant test within
acceptable bounds? El Yes ❑ No CI Yes ElNo El Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
EPA Form 3510-2A(Revised 3-19) Page 27

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIu
Name of SIU
Mailing address(street or P.O.box)
City,state,and ZIP code
Description of all industrial processes that affect
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU. gpd gpd gpd
How much of the average daily volume is
attributable to process flow? gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? gpd gpd gpd
Is the SIU subject to local limits?
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
Is the SIU subject to categorical standards?
❑ Yes ❑ No Cl Yes ❑ No ❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0089265 Dobson WTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU SIU_ SIU
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 0 Yes 0 No 0 Yes 0 No ❑ Yes ❑ No
years that are attributable to the SIU? _
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30