NC0071773_Renewal (Application)_20230828

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Donald Hawks
Yadkin County Board of Education
121 Washington St
Yadkinville, NC 27055-7725
Subject: Permit Renewal
Application No. NCO071773
Forbush High School WWTP
Yadkin County
Dear Permiee:
NORTH CAROLINA
Environmental Quality
August 28, 2023
The Water Quality Permitting Section acknowledges the August 28, 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://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.
ec: WQPS Lasefiche File w/application
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
D Q-
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road Suite 300 1 Winston-Salem. North Carolina 27105
336.776.9800

Yadkin County Board of Education
Renewal request for discharge wastewater
treatment facility:
Forbush High School WWTP
1525 Falcon Road,
East Bend, NC 27018
Permit # NCO071773
RECEIVED
AUG 2 8 2023
NCDEQ/DWR/NPDES

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO071773
Froebush High School
Modified March 2021
NC Department of Environmental Quality- Application for NPDES Permit to Discharge Wastewater
Form
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the instructions may result in denial of the application.)
SECTION•N
INFORMATION FOR i
Facility name
1.1
Forbush High School
Mailing address (street or P.O. box)
121 Washington St
City or town
State
ZIP code
o
Yadkinville
NC
27055
Contact name (first and last)
Title
Phone number
Email address
o
Mitchell T Long
ORC
[phone]
Mitchell. long@yadkin. k12.nc.t
c
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
M
1525 Falcon Road
u_
City or town
State
ZIP code
East Bend
NC
27018
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* See instructions on data submission 0 No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes 0 No SKIP to Item 1.4.
i
Applicant name
Applicant address (street or P.O. box)
_
0
is
E j
City or town
State
ZIP code
0
c
Contact name (first and last)
Title
Phone number
Email address
.Q
i
CL
a
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.)
0 ❑ Facility and applicant
❑ Facility Applicant (they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
Existing Environmental Permits
a
✓❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO071773
c
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
X
404)
w
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO071773
Froebush High School
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percenta a
1
1'599
100 °o separate sanitary sewer
ID Own 171 Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
CL
% separate sanitary sewer
❑ Own ❑ Maintain
combined storm and sanitary sewer
❑ Own ❑ Maintain
CU
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer
❑ Own ❑ Maintain
combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
rTotal
1,599
d
Population
c°�
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
100 %
°
sewer line in miles)��
z7
1.8
Is the treatment works located in Indian Country?
o
❑ Yes 0 No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes No
1.10
i
Provide design and actual flow rates in the designated spaces.
Design Flaw Rate
0.026 mgd
Annual Average Flow Rates Actual
,c
Two Years Ago
Last Year
This Year
o
0.010 mgd
0.010 mgd
0.010 mgd
LM u
Maximum Daily Flow Rates Actual
j Two Years Ago
Last Year
This Year
0.010 mgd
0.010 mgd
0.010 mgd
r„
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points b Type _.....
o___.._.
d a
Combined Sewer
Constructed
a
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
n
Overflows
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO071773
Froebush High School
Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface 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 -
1.14
Is wastewater applied to land?
❑ Yes ❑ No 4 SKIP to Item 1.16.
1.15
Provide the land application site and discharge data requested below.
C
Land Application Site and Discharge Data
a
`
Average Daily Volume
Continuous or
o
m
Location
Size
Applied
Intermittent
F
check one
t°
acres
gpd
❑ Continuous
❑ Intermittent
C3
❑ Continuous
m
s
acres
gpd
❑ Intermittent
0
acres
gpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
42
o
El Yes 0 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 0 No 4 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
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
F NCO071773 Froebush High School Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
facility.
-receiving
Receiving F cility Data
a
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
0
y
Contact name (first and last)
Title
a
0
d
Phone number
Email address
g
NPDES number of receiving facility (if any) El None
Average daily flow rate mgd
CL
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
❑ Yes ❑ No 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
_
El Continuous
acres
9P d
❑ Intermittent
0
❑ Continuous
acres
gpd
❑ Intermittent
acres
gp d
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
3
❑ 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?
0 Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
o
Contractor name
Lentz Septic Tank Service
name
E
`0
-(company
Mailing address
418 Lentz Road,
street or P.O. box
w
City, state, and ZIP
Statesville, NC 28625
Q
code
La
Contact name (first and
Jason Lentz
0ast
Phone number
[phone]
Email address
[e-mail]
Operational and
Clean Sludge Storage Tanks at
maintenance
the end of School Year.
responsibilities of
Usually in June.
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO071773 Froebush High School Modified March 2021
SECTION11 • •• • 1
0 _
3 Outfalls to Waters of the State of North CarolinaLL
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
rn
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.
M
3
0
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
R
specific requirements.)
C
0
0
❑ Yes ❑ No
r0
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
12
o
(See instructions for specific requirements.)
" o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
d
m
a
2.
1=
0 a
3.
4.
M
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
m
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
operational
>
o
a
Improvement
( list outfall
Construction
Construction
Discharge
Level
(from above)
number
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
a
d
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:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NCO071773 Froebush High School Modified March 2021
SECTION•' • ON I 1
3.1 Provide the following information for each ouffall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number ool Outfall Number
Outfall Number
NC
State
2
Yadkin
County
.r
3
0
0
0
City or town
East Bend
Distance from shore
2640
c,.
Depth below surface
3
Average daily flow rate
.010 mgd
mgd
mgd
Latitude
36� 09 2Y'
I
Longitude
so° 31 44"
°
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
0
0 Yes ❑ No 4SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
N
Outfall Number 001
Outfall Number
Outfall Number
Number of times per year
170
o
discharge occurs
a-
Average duration of each
20 hours
`o
discharge (specify units
oAverage
flow of each
.010 mgd
mgd
mgd
y
discharge
4n
Months in which discharge
Jan. - May Aug. -Dec.
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5
BriOf describe the diffuser type
at each applicable outfall.
—[--Outfall
CL
Outfall Number_ Number
Outfall Number
I I
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
ui
3 6
one or more discharge points?
»�
❑ Yes ElNo 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NCO071773 Froebush High School Modified March 2021
3.7 Provide the receiving water and related information if known for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Forbush Creek
Name of watershed, river,
Sub Basin 03 07 02
0
or stream system
Q
U.S. Soil Conservation
!
y
Service 14-digit watershed
o
code
w
Name of state
management/river basin
Yadkin Pee Deer River
m
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
I
I
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
0 Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
Q
Design Removal Rates by
Q
Outfall
d
BODs or CBODs
70 %
%
%
E
w
TSS
70 %
%
%
r=
© Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
ova
0 Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
93 %
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
%
%
%
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO071773
Froebush High School
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Ultra Violet disinfection is used through all seasons.
m
c
c
0
Outfall Number 1
Outfall Number
Outfall Number
0
n
•�
Disinfection e
tyP
Ultraviolet Light
U
t/f
41
Q
Seasons used
all
0
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
~
❑ Yes
❑ Yes
❑ Yes
Q No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
21 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
by outfall number or of the receiving water near the discharge points. _
—discharges
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
R
R
Number of tests of discharge
rn
water
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. 0 No -+ 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?
R 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
permittingauthority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO071773
Froebush High School
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes O 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 ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DDNYYY
c
c
0
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?
CO
c
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
c
m
W
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 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 0 Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number
Facility Name Modified Application Form 2A
NCO071773
Froebush High School Modified March 2021
SECTION
6. CHECKLIST
1 1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
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
❑ wl variance request(s) ❑ wl additional attachments
Information for All Applicants
❑ Section 2: Additional
❑ wl topographic map ❑ w/ process flow diagram
Information
❑ wl additional attachments
0 w/ Table A ❑ wl Table D
❑ Section 3: Information on
© wl Table B ❑ wl additional attachments
Effluent Discharges
E
❑ wl Table C
m
A
C
Section 4: Not Applicable
c
or_
R
?
Section 5: Not Applicable
m
ca
Section 6: Checklist and
0
❑ wl attachments
Certification Statement
N
Ac
6.2
Certification Statement
1 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. 1 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
Mitchell Thomas Long
ORC
Signature
Date signed
_
08/21/2023
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO071773
Froebush High School
1
Modified Application Form 2A
Modified March 2021
Maximum Daily
Discharge
Average Daily Discharge______
Pollutant
Analytical
ML or MDL
Value
Units
Value Units
Number of
Method'
(include units)
Samples
Biochemical oxygen demand
o BODs or ❑ CBODs
45.0
mg/L
4.64
mg/I
36
sm5210b-2016
U ElMDL-
(report one
Fecal coliform
400/100
#/100ml
0
#/100ml
36
Colilert-18
L7 PAL
El ^IDL
Design flow rate
0.026
MGD
standard
standard
c
c
mg/I
n.010 jMGD 36
5.26 mg/I 36
i
SM 254OD-2015
V MiL
❑ MDL
pH (minimum)
>6.0
pH (maximum)
<9.0
Temperature (winter)
No limit
Temperature (summer)
No limit
Total suspended solids (TSS)
45.0
' 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
NCO071773 Froebush High School 1 Modified March 2021
Average Daily Discharge
Maximum Daily
Discharge
Analytical
ML or MDL
Value
Units
Pollutant
Value Units Number of
Method'
(include units)
Samples
Ammonia (as N)
No Limit
0.06
mg/l
36
o ML
❑ MDL
Chlorine
❑ ML
total residual, TRC 2
❑ MDL
Dissolved oxygen
OML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
No Limit
47.8
mg/I
12
OML
❑ MDL
Oil and grease
OML
❑ MDL
Phosphorus
No Limit
13.5
mg/I
12
21 ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
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 T NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO071773 Froebush High School
Modified March 2021
3
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
Hardness (as CaCO3)
OML
❑ MDL
Antimony, total recoverable
OML
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
0 MIL
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
0 MIL
❑ MDL
Lead, total recoverable
El 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
0 ML
❑ MDL
Volatile Organic Compounds
Acrolein
El ML
❑MDL
Acrylonitrile
El ML
❑ MDL
Benzene
El ML
❑ MDL
Bromoform
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO071773 Froebush High School
I
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units Samples
❑ ML
Carbon tetrachloride
❑ MDL
❑ ML
Chlorobenzene
❑ MDL
❑ ML
Chlorodibromomethane
❑MDL
❑ ML
Chloroethane
❑ MDL
2-chloroethylvinyl ether
OML
❑ MDL
❑ ML
Chloroform
❑ MDL
❑ ML
Dichlorobromomethane
❑ MDL
❑ ML
1,1-dichloroethane
❑ MDL
❑ ML
1,2-dichloroethane
❑ MDL
trans-1,2-dichloroethylene
C1 ML
❑ MDL
1,1-dichloroethylene
OML
❑ MDL
0 ML
1,2-dichloropropane
❑ MDL
1,3-dichloropropylene
0 ML
❑ MDL
❑ ML
Ethylbenzene
❑ MDL
Methyl bromide
El ML
❑ MDL
0 ML
Methyl chloride
❑ MDL
OML
Methylene chloride
❑ MDL
❑ ML
2,2-tetrachloroethane
❑ MDL
OML
❑ MDL
❑MLoluen
[Tetrachloroethylene
lu e
❑ MDL
❑ ML
-trchloroethane
❑ MDL
❑ML
-trichloroethane2
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO071773 Froebush High School
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
[Trichloroethylene
Method' (include units)
Value Units Value Units
Samples
L1 ML
❑ MDL
Vinyl chloride
El ML
❑ MDL
Acid -Extractable Compounds
11 ML
p-chloro-m-cresol ❑ MDL
2-chlorophenol
11 ML
❑ MDL
2,4-dichlorophenol
El ML
o MDL
2,4-dimethylphenol
El ML
❑ MDL
El ML
❑ MDL
4,6-dinitro-o-cresol
2,4-dinitrophenol
0 ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
0 ML
❑ MDL
Pentachlorophenol
11 ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-tdchlorophenol
D ML
❑ MDL
Base -Neutral Compounds
ccneetnnhaarpahceneyenlApthe
Ll ML
❑MDL
Ahthene
OML
❑ MDL
A
❑ ML
El MDL
❑ ML
Bezidine
❑ MDL
oBenz(a)anthracene
El ML
❑ MDL
)PyrOML
e
❑ MDL
34-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name T Outfall Number
NCOO71773 Froebush High School
Modified Application Form 2A
Modified March 2021
•' 1 i
Maximum Daily Discharge
Average Daily Discharge
Analytical ML or MDL
Pollutant
Method' (include units)
—
Number of
Value
Units
Value
Units
Samples
Benzo(ghi)perylene
OML
❑ MDL
Benzo(k)fluoranthene
El ML
❑ MDL
Bis (2-chloroethoxy) methane
EJ ML
❑ MDL
Bis (2-chloroethyl) ether
Cl ML
❑ MDL
Bis (2-chloroisopropyl) ether
El ML
❑ MDL
Bis (2-ethylhexyl) phthalate
OML
❑ MDL
4-bromophenyl phenyl ether
OML
❑ MDL
Butyl benzyl phthalate
11 ML
❑ MDL
2-chloronaphthalene
El ML
❑ MDL
4-chlorophenyl phenyl ether
I-] ML
❑ MDL
Chrysene
❑ ML
❑ MDL
di-n-butyl phthalate
❑ ML
❑ MDL
di-n-octyl phthalate
0 ML
❑ MDL
Dibenzo(a,h)anthracene
0 ML
❑ MDL
1,2-dichlorobenzene
El ML
❑ MDL
1,3-dichlorobenzene
El ML
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
El ML
❑ MDL
Diethyl phthalate
C:1 ML
❑ MDL
Dimethyl phthalate
El ML
❑ MDL
2,4-dinitrotoluene
El ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCOO71773 Froebush High School
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Method' (include units)
_
_ _ _
Number of
Value
Units
Value
Units
Samples
1,2-diphenylhydrazine
El ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
0 ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
OML
❑ MDL
Isophorone
❑ ML
❑ MDL
Naphthalene
❑ ML
❑ MDL
Nitrobenzene
El ML
❑ MDL
N-nitrosodi-n-propylamine
OML
❑ MDL
N-nitrosodimethylamine
OML
❑ MDL
N-nitrosodiphenylamine
0 ML
❑ MDL
Phenanthrene
❑ ML
❑ MDL
Pyrene
OML
❑ MDL
1,2,4-trichlorobenzene
❑ ML
❑ MDL
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 17

AIPr1FC Pnrmif Nnmhnr Corlllr„ Al— 0.tfnll KI—hnr KA— ifinrl Annli--inn Fnrm U
., ., �....,,,, ,......, ,ate, ,.y ...,,., ,,,. •,..., ,...,,....i
,..,,.,,,.... ,rr..,,...,.,,,,.., ,�,.
NCO071773 Froebush High School
Modified March 2021
�I • • • • •'
Maximum DailyDischarge Avera a Dail Discharge
Pollutant
Analytical ML or MDL
Numbers
(list) Value Units Value Units
Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ ML
- -
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
O ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
-
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18

NCO071773 - Forbush High School WWTP
County:
Yadkin
Latitude:
Mo08129"
Longitude
80o33144"
Sub -Basin:
03-07-02
Stream Class:
WS-IV
Receiving Stream: Forbush Creek
Facility
��_
Location X
(not to scale)