NC0034452_Renewal (Application)_20231103

AQUA.
6 Essential
November 1, 2023
Division of Water Resources
Water Quality Permitting Section — NPDES KLQ%xq%
1617 Mail Service Center (�
Raleigh, North Carolina 27699-1617 NU wY 3
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Willow Creek Wastewater Treatment Plant
NPDES No. NCO034452
Davidson County
Good Afternoon:
n ►,_ i ,n�,
Enclosed are three (3) copies of the completed application Form 2A. This submittal includes the
necessary attachments for your office to renew the subject permit.
Should you need any additional information or assistance, please feel free to contact me via phone (919-
653-6977) or by email at [e-mail].
Sincerely,
Lauren Raup-Plummer
Engineering Manager
Aqua North Carolina, Inc.
Enc: NPDES Application, Form 2A
Cc: Christopher Collins
Joseph Pearce
Shannon Becker
NOV 0 3 2023
NrDFn,/nWP/NPDES
202 MacKenan Court, Cary, NC, 27511 0 919.467.8712 • AquaAmerica.com

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
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
Willow Creek Subdivision WWTP
Mailing address (street or P.O. box)
Dorado Drive
City or town
State
ZIP code
o
High Point
INC
27265
EContact
name (first and last)
Title
Phone number
Email address
w
c
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaameric
Location address (street, route number, or other specific identifier) ❑✓ Same as mailing address
R
uL
SW of Willow Creek Country Club
City or town
State
ZIP code
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes + See instructions on data submission ❑ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
0 Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Aqua North Carolina
=
Applicant address (street or P.O. box)
w
.g
202 MacKenan Court
E
State
ZIP code
City or town
12
Cary
NC
27511
cc
Contact name (first and last)
Title
Phone number
Email address
CL
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaameric
n
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.)
❑ Facility ❑r Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
€
Existing Environmental Permits
a
0 NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO034452
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
Ocean dumping (MPRSA)
E] Dredge or fill (CWA Section
❑ Other (specify)
w❑
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 percentage)
High Point, NC
429
100 % separate sanitary sewer
I] Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own El Maintain
Z
d
❑ Unknown
❑ Own ❑ Maintain
CO)
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a
a
% separate sanitary sewer
ElOwn ElMaintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
EElUnknown
ElOwn ElMaintain
% separate sanitary sewer
❑ Own ❑ Maintain
y%
combined storm and sanitary sewer
❑ Own ElMaintain
c
1
❑ Unknown
❑ Own ❑ Maintain
Total 429
Population
Served
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
100 %
%
z'
1.8
Is the treatment works located in Indian Country?
c
'o
0
❑ Yes No
R
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.08 mgd
y
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c
0.062 mgd
0.035 mgd
0.036 mgd
`L
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.12 mgd
0.09 mgd
0.09 mgd
U)
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
15-
Total Number of Effluent Discharge ointsbyType
a n
Constructed
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Emergency
L
Overflows
Overflows
N_
0
1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 ❑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 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
ElContinuous
gpd
❑ Intermittent
r
1.14
Is wastewater applied to land?
❑ Yes 0 No 4 SKIP to Item 1.16.
c
1.15
Provide the land application site and discharge data requested below.
CL y
Land Application Site and Discharge Data
o
Continuous or
c
Location
Size
Average Daily Volume
Intermittent
Applied
check one
cc
acres
d
gpd
❑ Continuous
o
❑ Intermittent
❑ Continuous
sacres
o
gp d
❑ Intermittent
acres
❑ Continuous
gpd
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes ❑✓ 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.
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
NCO034452
Willow Creek WWTP
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facilit .
Receiving F cility Data
a
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
0
U
(n
Contact name (first and last)
Title
0
L
Phone number
Email address
2
0
NPDES number of receiving facility (if any) ❑ None
Average flail flow rate m d
9 Y 9
Q
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
0
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
EP
❑ Yes 0 No -* SKIP to Item 1.23.
U
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
oDisposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
cc
Description
Volume
w
acres
gp d
❑ Continuous
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
ElContinuous
acres
gpdl
❑ 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.)
ElDischarges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑� Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes D 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
R
(company name
E
0
Mailing address
street or P.O. box
w
City, state, and ZIP
code
15
Contact name (first and
o
U
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO034452 Willow Creek WWTP Modified March 2021
SECTION11 • •• • 1
c Outfalls to Waters of the State of North Carolina
=
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
m
c
❑ 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
.2
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
v
3
0
w
c
s
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
R
specific requirements.)
0
0
CL
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
3 1°
0
(See instructions for specific requirements.)
0,
� m
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.
c
0
E
M
c
2.
E
0 0
y
as
3.
4)
d
4.
N
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
E
0
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
CL
Improvement
Outfalls
(list outfal
Construction
Construction
Discharge
Operational
Level
E
(from above)
number)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
d
o
d
s
W
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
NC0034452
Willow Creek WWTP Modified March 2021
SECTION•'
• ON • 1
3.1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 001
Outfall Number
Outfall Number
State
NC
rA
County
Davidson
O
w
City or town
High Point
0
c
Distance from shore
0 ft.
n
Depth below surface
5 ft.
ft.
ft.
c
Average daily flow rate
0.04 mgd
mgd
mgd
Latitude
35° 58' 04" N
Longitude
80 06 02" W
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
C3
❑ Yes 0 No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
L
y
Outfall Number
Outfall Number
Outfall Number
c
Number of times per year
o
discharge occurs
a
Average duration of each
o
discharge (specify units
Average flow of each
mgd
mgd
mgd
H
discharge
R
Months 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 pe at each applicable outfall.
CL
>
Outfall Number
Outfall Number
Outfall Number
d
y
0
v�
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
d
❑ Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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
Abbotts Creek
Name of watershed, river,
Abbotts Creek
c
or stream system
a
U.S. Soil Conservation
y
Service 14-digit watershed
In
code
°'
cc
3
as
Name of state
management/river basin
Yadkin Pee Dee
U.S. Geological Survey
CD
8-digit hydrologic
CD
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number oot
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)
c
0
n
Design Removal Rates by
Outfall
H
N
BOD5 or CBOD5
85 %
%
c
d
E
a1Oi
TSS
85 %
%
%
0 Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
0 Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
0 Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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.
v
d
0
U
c
Outfall Number 001
Outfall Number
Outfall Number
•�
Disinfection type
YP
Tablet Chlorination w/contact
c.�
y
m
tank
O
Seasons used
All
d
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
0 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?
0 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 0 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
o
Number of tests of discharge
=
water
Number of tests of receiving
►°
water
d
0
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?
0 Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
0 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 0 No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No + 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/DD/YYYY
v
m
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?
c
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
c
d
LU
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 outfalis and attached the results to the application package?
❑ Yes 0 Not applicable because previously submitted
information to the NPDES permittin authority.
Page 9

NPDES Permit Number
Facility Name Modified Application Form 2A
NC0034452
Willow Creek WWTP Modified March 2021
SECTION•
1
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/ variance request(s) El w/ additional attachments
Informationforfor All A licants
❑ Section 2: Additional
El w/ topographic map 0 w/ process flow diagram
Information
❑ w/ additional attachments
10 w/ Table A ❑ w/ Table D
❑ Section 3: Information on
✓❑ w/ Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ w/ Table C
d
R
Section 4: Not Applicable
c
Section 5: Not Applicable
d
U
Section 6: Checklist and
❑
❑ w/ attachments
Certification Statement
VJ
6.2
Certification Statement
d
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Lauren Raup-Plummer
Engineering Manager
Signature oocusigoea by.
Date signed
"by,
C
11/01/2023
9C8BE0960A7B49B..
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO034452
Willow Creek WWTP
001
Modified Application Form 2A
Modified March 2021
Pollutant
Maximum Daily Discharge
Average Daily Discharge
Analytical
Method'
ML or MDL
(include units)
Value
Units
Value
Units
Samb lest
Biochemical oxygen demand
o BOD5 or o CBOD5
(report one
8.8
mg/L
< 1
mg/L
235
SM5210B
OML
2.0 0 MDL
Fecal coliform
93
mg/L
< 1
mg/L
223
SM9222D (MF)
1.0 0 ML
MDL
Design flow rate
148,467
gallons
35,732
gallons
1575
pH (minimum)
6.8
units
pH (maximum)
8.5
units
Temperature (winter)
20
degrees Celsius
10.69
degrees Celsius
320
Temperature (summer)
28
degrees Celsius
26.0
degrees Celsius
419
Total suspended solids (TSS)
5.4
mg/L
0.80
mg/
235
ML
SM2540D 2.5 ID 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).
Page 11

,ES Permit Number Facility Name Outfall Number Modified Application Form 2A
NCO034452 Willow Creek WWTP 001 Modified March 2021
•' '• • •
• •' 1 •
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Methods
Include units
( )
Samples0
Ammonia (as N)
2.14
mg/L
0.15
mg/L
229
SM4500NH3D
MIL
0.2 0 MDL
Chlorine
total residual, TRC 2
35
u /L
g
7.48
ug/L
456
Field -Hach DPD
❑ ML
❑MDL
Dissolved oxygen
11.6
mg/L
8.21
mg/L
234
Field -Hach DPD
❑ MIL
❑ MDL
Nitrate/nitrite
38.4
mg/L
19.58
mg/L
53
SM450ONO3E
❑ MI
❑ MDL
Kjeldahl nitrogen
6.4
mg/L
1.53
mg/L
53
SM45000RGB,NH3C
❑ ML
❑ MDL
Oil and grease
❑ MIL
❑ MDL
Phosphorus
5.61
mg/L
2.88
mg/L
55
SM450OPE
❑ 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 NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek W WTP
Modified March 2021
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)
❑ ML
❑ MDL
Antimony, total recoverable
El ML
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ MI
❑ MDL
Copper, total recoverable
❑ ML
❑ 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
El ML
❑ MDL
tile Organic Compounds
Acrolein
❑ ML
❑ MDL
Acrylonitrile
I
❑ ML
❑ MDL
Benzene
❑ ML
❑ MDL
Bromoform
El 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
NC0034452 Willow Creek WWTP
Modified March 2021
•' 1 '•
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Number of
Value Units Value Units
Method' (include units)
Sam les
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1 dichloroethane
❑ ML❑MDL
1,2 dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
❑ MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2 dichloropropane
El ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ 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
1, 1, 1 -trichloroethane
❑ ML
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek WWTP
Modified March 2021
NP1117917111 NIB=
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Trichloroethylene
El ML
❑ MDL
Vinyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
0 ML
❑ MDL
2,4-dimethyl phenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
El MI
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
❑ ML
❑ MDL
Benzidine
I-
❑ ML
❑ MDL
Benzo(a)anthracene
❑ ML
❑ MDL
Benzo(a)pyrene
❑ ML
❑ MDL
3,4-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
Method' (include 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
❑ 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
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Number of
Value Units Value Units
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
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyre ne
❑ 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
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).
EPA Form 3510-2A (Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form ZA
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Dail Dischar a Average 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
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ 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).
Page 18

DocuSign Envelope ID AC8A639F-116E-4FBC-97Qs-E9C3E7372A37
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NCO034452 — Willow Creek Subdivision WWTP
Latitude: 350 58' 04" N Longitude: 80' 06' 02" W
Sub -Basin: 03-07-07 Stream Class: C
Receiving Stream: Abbotts Creek
CRAVEN RU
Facility.
Location
North Davidson County
Map not to scale

E
Influent
Bar and
Fine
Screens
Flow Aeration Basins
Equalization (3)
Tank
Secondary Gravity Sand
Clarifiers (3) Filters
Chlorine Contact
Sludge Holding Chamber (Tablet
Tank 0
Chlorinator)
Sludge Hauler
(off -site disposal)
Abbotts Creek;
Yadkin -Pee Dee River
Basin

Willow Creek Data 2019 - 2023
Row Labels
Count of RESULT
Ammonia as N
229
Biological Oxygen Demand (BOD)
235
Chlorine Residual, Total
456
Dissolved Oxygen
477
Fecal Coliform (number)
223
Fecal Coliform (P/A)
1
Flow
1575
Nitrate + Nitrite
53
pH, Field
233
Temperature, Field
493
Total Kjeldahl Nitrogen (TKN)
53
Total Nitrogen
55
Total Phosphorous
55
Total Suspended Solids
235
Grand Total
4373
Row Labels
Average of RESULT
Ammonia as N
0.150436681
Biological Oxygen Demand (BOD)
0.672340426
Chlorine Residual, Total
7.475877193
Dissolved Oxygen
8.21106383
Fecal Coliform (number)
5.825112108
Fecal Coliform (P/A)
1
Flow
42167.55048
Nitrate + Nitrite
19.5754717
pH, Field
7.453648069
Temperature, Field
16.83757962
Total Kjeldahl Nitrogen (TKN)
1.533207547
Total Nitrogen
20.96909091
Total Phosphorous
2.883090909
Total Suspended Solids
0.803404255
Grand Total
16167.68306

AQUA.
6 Essential
November 1, 2023
Division of Water Resources
Water Quality Permitting Section — NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Willow Creek Wastewater Treatment Plant
NPDES No. NCO034452
Davidson County
Good Afternoon:
Enclosed are three (3) copies of the completed application Form 2A. This submittal includes the
necessary attachments for your office to renew the subject permit.
Should you need any additional information or assistance, please feel free to contact me via phone (919-
653-6977) or by email at [e-mail].
Sincerely,
Lauren Raup-Plummer
Engineering Manager
Aqua North Carolina, Inc.
Enc: NPDES Application, Form 2A
Cc: Christopher Collins
Joseph Pearce
Shannon Becker
202 MacKenan Court, Cary, NC, 27511 9 919.467.8712 9 AquaAmerica.com

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
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
Willow Creek Subdivision WWTP
Mailing address (street or P.O. box)
Dorado Drive
City or town
State
ZIP code
o
High Point
NC
27265
Ecc
Contact name (first and last)
Title
Phone number
Email address
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaamerica
Location address (street, route number, or other specific identifier) ❑✓ Same as mailing address
uL
SW of Willow Creek Country Club
City or town
State
ZIP code
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
0 Yes ❑ No + SKIP to Item 1.4.
Applicant name
Aqua North Carolina
Applicant address (street or P.O. box)
w
.;
202 MacKenan Court
€
City or town
State
ZIP code
0
Cary
NC
27511
Contact name (first and last)
Title
Phone number
Email address
n
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaamerica
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.)
❑ Facility 0 Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
€
Existing Environmental Permits
❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO034452
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
High Point, INC
429
100 % separate sanitary sewer
El Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
c
% separate sanitary sewer
❑ Own ❑ Maintain
C
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
c
o
a
% separate sanitary sewer
❑ Own ❑ Maintain
_
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
m%
separate sanitary sewer ❑ Own ❑ Maintain
% combined storm and sanitary sewer ❑ Own ❑ Maintain
co
c
1 ❑ Unknown ❑ Own ❑ Maintain
Total 429
°—'
Population
C.)
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
sewer line in miles)100
o 0
/o /a
Z'
1.8
Is the treatment works located in Indian Country?
c
'o
U
❑ Yes El No
C
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes El No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.08 mgd
ca
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
0.062 mgd
0.035 mgd
0.036 mgd
c _0
U"
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.12 mgd
0.09 mgd
0.09 mgd
H
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
15
Total Number of Effluent Discharge Points by Type
a a
o)
Combined Sewer
Constructed
P
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
r
W
Overflows
y
�
1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 ❑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 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
❑ Continuous
gpd
,a
El Intermittent
sue.
1.14
Is wastewater applied to land?
2
❑ Yes ❑� No SKIP to Item 1.16.
c
1.15
Provide the land application site and dischar a data requested below.
C
Land Application Site and Discharge Data
o
Continuous or
`o
Location
Size
Average Daily Volume
Intermittent
Applied
check one
L
acres
d
gpd
❑ Continuous
o
❑ Intermittent
❑ Continuous
s
o
acres
gpd
❑ Intermittent
o
❑ Continuous
cc
gpd
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
❑ Yes ❑✓ No + 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.
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
NCO034452
Willow Creek WWTP
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving IF cility Data
Facility name
Mailing address (street or P.O. box)
d
City or town
State
ZIP code
0
U
Contact name (first and last)
Title
0
L
iv
Phone number
Email address
c
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate m d
a
y
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)?
0
s
❑ Yes 0 No 4 SKIP to Item 1.23.
U
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
oDisposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
w
acres
gp d
❑ Continuous
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gp d
❑ 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.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑✓ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
0
Contractor name
R
(company name
E
`0
Mailing address
street or P.O. box
o
City, state, and ZIP
code
o
Contact name (first and
c�
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO034452 Willow Creek WWTP Modified March 2021
SECTION11I I IUNAL INFORMATION1
c Outfalls to Waters of the State of North Carolina
C
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
%
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
ea
3
0
c
r
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
CL
specific requirements.)
C
Co
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?
c 2
(See instructions for specific requirements.)
LL-2
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
is
1.
c
m
m
c.
2.
E
0
y
d
3.
-o
d
U
4.
N
R
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
E
d
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
CL
Improvement
Outfalls
(list o
Construction
Construction
Discharge
Operational
Level
E
(from above)
number)
(MM/DD/YYYY)
(MM/DDIYYYY)
(MM/DDIYYYY)
MM/DD/YYYY
v
3
d
L
in
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
NC0034452
Willow Creek WWTP Modified March 2021
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 001
Outfall Number
Outfall Number
State
NC
1'
Davidson
ccCounty
w
City or town
High Point
0
c
Distance from shore
0 ft.
ft.
ft.
a
Depth below surface
5 ft.
ft.
ft.
0
Average daily flow rate
0.04 mgd
mgd
mgd
Latitude
35' 58' 04" IN
Longitude
80° 06' 02" W
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o
❑ Yes ❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
r
y
Outfall Number
Outfall Number
Outfall Number
C3
o
Number of times per year
discharge occurs
a
Average duration of each
o
discharge (specify units
C
0
Average flow of each
mgd
mgd
mgd
discharge
M
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number
Outfall Number
Outfall Number
d
tll
0
c
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
a =
one or more discharge points?
�
❑✓ Yes ❑ No •SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0034452
Willow Creek WWTP
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
Abbotts Creek
Name of watershed, river,
c
or stream system
Abbotts Creek
.2-
U.S. Soil Conservation
H
Service 14-digit watershed
o
code
==
�
a>
Name of state
management/river basin
Yadkin Pee Dee
U.S. Geological Survey
8-digit hydrologic
CD
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
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
❑ 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)
c
0
a
Design Removal Rates by
Outfall
N
BOD5 or CBOD5
85 %
%
%
c
d
E
TSS
85 %
%
%
0 Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
°
0 Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
la Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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.
v
d
c
w
0
t�
=
Outfall Number 001
Outfall Number
Outfall Number
0
Disinfection type
Tablet Chlorination w/contact
y
m
tank
G
Seasons used
All
d
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
E 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?
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
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
R
w
o
Number of tests of discharge
rn
=
water
Number of tests of receiving
water
d
0
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 -* Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑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
permitting authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 0 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 + 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/DD/YYYY
-c
m
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?
a'
c
❑ Yes ❑ No SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
d
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 0 Not applicable because previously submitted
information to the NPDES ermAk"
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NCO034452 Willow Creek WWTP Modified March 2021
SECTION. CHECKLIST AND CERTIFICATION STATEMENT (40
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
❑ wl variance request(s) Elw/additional attachments
Information for All A licants
❑ Section 2: Additional
w/ topographic map w/ process flow diagram
Information
❑ w/ additional attachments
Q wl Table A ❑ wl Table D
❑ Section 3: Information on
✓❑ w/ Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ w/ Table C
d
is
w
N
Section 4: Not Applicable
c
0
v
Section 5: Not Applicable
~C
d
U
Section 6: Checklist and
❑
❑ w/ attachments
Certification Statement
Mn
Y
6.2
Certification Statement
CD
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
Lauren Raup-Plummer
Engineering Manager
Signature oocuSigned by:
Date signed
C �A.l�—P�WlV
11/01/2023
9CBBE09BOA78498
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO034452
Willow Creek WWTP
001
Modified Application Form 2A
Modified March 2021
Pollutant
Maximum Daily Discharge
Average Daily Discharge
Analytical ML or MDL
Method' (include units)
Value
Units
Value
Units
Sam lest
Biochemical oxygen demand
O BOD5 or ❑ CBOD5
(report one
8.8
mg/L
< 1
mg/L
235
OML
SM5210B 2.0 O MDL
Fecal coliform
93
mg/L
< 1
mg/L
223
SM9222D (MF) 1.0 OML
O MDL
Design flow rate
148,467
gallons
35,732
gallons
1575
pH (minimum)
6.8
units
pH (maximum)
8.5
units
Temperature (winter)
20
degrees Celsius
10.69
degrees Celsius
320
Temperature (summer)
28
degrees Celsius
26.0
degrees Celsius
419
Total suspended solids (TSS)
5.4
mg/L
0.80
mg/L
235
5M2540D
2.5 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).
Page 11

EPA Identification Number I NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0034452 Willow Creek WWTP 001 Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number
Pollutant
Methods
(include units)
Samples
Ammonia (as N)
2.14
mg/L
0.15
mg/L
229
SM4500NI
0.2 1211
Chlorine
total residual, TRC)2
35
ug/L
7.48
ug/L
456
Field -Hach I
O ML
❑ MDL
Dissolved oxygen
11.6
mg/L
8.21
mg/L
234
Field -Hach DPD
OML
❑ MDL
Nitrate/nitrite
38.4
mg/L
19.58
mg/L
53
SM450ONO3E
❑ ML
❑ MDL
Kjeldahl nitrogen
6.4
mg/L
1.53
mg/L
53
SM4500CRGB,NH3C
El MIL
❑ MDL
Oil and grease
❑ MDL
Phosphorus
5.61
mg/L
2.88
mg/L
55
SM450OPE
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑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 12

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek WWTP
Modified March 2021
• • 1 • ri
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)
❑ ML
❑ 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
Copper, total recoverable
❑ ML
❑ 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 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
•• 1 ••
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
El ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
❑ MI
❑ MDL
2-chloroethylvinyl ether
El ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1-dichloroethane
❑ MI
❑ MDL
1,2-dichloroethane
❑ M
MDL
❑ I
trans-1,2-dichloroethylene
OML
❑ MDL
1,1-dichloroethylene
OML
❑ MDL
1,2-dichloropropane
El ML
❑ MDL
1,3-dichloropropylene
❑ MI
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
OML
❑ MDL
Methyl chloride
OML
❑ MDL
Methylene chloride
OML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
T0
etrachloroethylene
ML
❑ MDL
Toluene
❑ MI
❑ MDL
1, 1, 1 -trichloroethane
❑ MI
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Number of
Method' (include units)
Value Units Value Units
Samples
Trichloroethylene
❑ ML
❑ MDL
Vinyl chloride7
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimeth ylphenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
❑ ML
❑ MDL
Benzidine
❑ ML
❑ MDL
Benzo(a)anthracene
❑ ML
❑ MDL
Benzo(a)pyrene
❑ ML
❑ MDL
3,4 benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Number of
Method' (include units)
Value units Value Units
Samples
Benzo(ghi)perylene
❑ ML
❑ MDL
Benzo(k)fluoranthene
❑ ML
❑ MDL
Bis (2-chloroethoxy) methane
El 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
❑ 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
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number
NPDES Permit Number Facility Name Cutfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
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
11 MIL
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
El ML
❑ MDL
Hexachlorobenzene
El ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
0 MIL
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ ML
❑ MDL
Isophorone
El ML
❑ MDL
Naphthalene
❑ ML
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi-n-propylamine
El 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 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek W WTP
Modified March 2021
1 11 • '•
• I '1 •'
Affau
Maximum Dail Dischar a Avera a Dail Discharge
Pollutant
Analytical ML or MDL
Number of
(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
❑ 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).
Page 18

JocuSign Envelope ID: AC8A639F-116E-4FBC-9703-E9C3E7372A37
Vallburg
00G PARK DR
PRESTWICK OR
V
L D pZ pFFC�R
- W ''AEE RO
4
Y
v
ti
DR -
DOaADd �
'0+
it
01-
FI O
NCO034452 - Willow Creek Subdivision WWTP
Latitude: 35° 58' 04" N Loneitude: 80° 06' 02" W
Sub -Basin: 03-07-07 Stream Class: C
Receiving Stream: Abbotts Creek
i
CRAvEn RD
FQ
4
0
Facility
Location
North � Davidson County
Map not to scale

•
Influent
Fine
Screens
Flow Aeration Basins
Equalization (3)
Tank
Secondary Gravity Sand
Clarifiers (3) Filters
Chlorine Contact
Sludge Holding Chamber (Tablet
Tank 0
Chlorinator)
Sludge Hauler
(off -site disposal)
Abbotts Creek;
Yadkin -Pee Dee River
Basin

Willow Creek Data 2019 - 2023
Row Labels
Count of RESULT
Ammonia as N
229
Biological Oxygen Demand (BOD)
235
Chlorine Residual, Total
456
Dissolved Oxygen
477
Fecal Coliform (number)
223
Fecal Coliform (P/A)
1
Flow
1575
Nitrate + Nitrite
53
pH, Field
233
Temperature, Field
493
Total Kjeldahl Nitrogen (TKN)
53
Total Nitrogen
55
Total Phosphorous
55
Total Suspended Solids
235
Grand Total
4373
Row Labels
Average of RESULT
Ammonia as N
0.150436681
Biological Oxygen Demand (BOD)
0.672340426
Chlorine Residual, Total
7.475877193
Dissolved Oxygen
8.21106383
Fecal Coliform (number)
5.825112108
Fecal Coliform (P/A)
1
Flow
42167.55048
Nitrate + Nitrite
19.5754717
pH, Field
7.453648069
Temperature, Field
16.83757962
Total Kjeldahl Nitrogen (TKN)
1.533207547
Total Nitrogen
20.96909091
Total Phosphorous
2.883090909
Total Suspended Solids
0.803404255
Grand Total
16167.68306

AQUA,.
6 Essential
November 1, 2023
Division of Water Resources
Water Quality Permitting Section — NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Willow Creek Wastewater Treatment Plant
NPDES No. NCO034452
Davidson County
Good Afternoon:
Enclosed are three (3) copies of the completed application Form 2A. This submittal includes the
necessary attachments for your office to renew the subject permit.
Should you need any additional information or assistance, please feel free to contact me via phone (919-
653-6977) or by email at [e-mail].
Sincerely,
Lauren Raup-Plummer
Engineering Manager
Aqua North Carolina, Inc.
Enc: NPDES Application, Form 2A
Cc: Christopher Collins
Joseph Pearce
Shannon Becker
202 MacKenan Court, Cary, NC, 27511 0 919.467.8712 • AquaAmerica.com

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
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
Willow Creek Subdivision WWTP
Mailing address (street or P.O. box)
Dorado Drive
City or town
State
ZIP code
o
High Point
NC
27265
EContact
name (first and last)
Title
Phone number
Email address
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaameric
Location address (street, route number, or other specific identifier) ❑✓ Same as mailing address
R
LL
SW of Willow Creek Country Club
City or town
State
ZIP code
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* See instructions on data submission ❑r No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑� Yes ❑ No SKIP to Item 1.4.
Applicant name
Aqua North Carolina
Applicant address (street or P.O. box)
w
202 MacKenan Court
City or town
State
ZIP code
Cary
INC
27511
cc
Contact name (first and last) 7Title
Phone number
Email address
c-
Lauren Raup-Plummer
Engineering Manager
[phone]
laraupplummer@aquaameric
a
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.)
El Facility ❑� Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
€
Existing Environmental Permits
a
❑✓ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO034452
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
3
c
w
rn
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 percentage)
High Point, NC
429
100 % separate sanitary sewer
0 Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
c%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
n
a
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer ❑ Own ❑ Maintain
% combined storm and sanitary sewer ❑ Own ❑ Maintain
c
❑ Unknown ❑ Own ❑ Maintain
Total 429
Population
U
Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles)
loo /o o /o 0
z'
1.8
Is the treatment works located in Indian Country?
c
'o
U
❑ Yes El No
r-
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes 0 No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.08 mgd
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
o
0.062 mgd
0.035 mgd
0.036 mgd
c
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.12 mgd
0.09 mgd
0.09 mgd
y
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 ointsbyType
a c
Constructed
a
Treated Effluent
Untreated Effluent
Combined Sewer
Emergency
Overflows
Overflows
0
r 1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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 ❑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 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
El Continuous
gpd
H
❑ Intermittent
s
1.14
Is wastewater applied to land?
2
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
c
1.15
Provide the land application site and discharge data requested below.
Q
Land Application Site and Discharge Data
o
c
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
o)
check one
acres
d
gpd
El Continuous
0
❑ Intermittent
El Continuous
CD
acres
gp d
❑ Intermittent
acres
❑ Continuous
gpd
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
El Yes ❑✓ No + 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
Page 3

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving IF cility Data
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
0
0
v
Contact name (first and last)
Title
0
L
Phone number
Email address
c
NPDES number of receiving facility (if any) ❑ None
�Average dail flow rate m d
Y 9
y
'c
`o
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)?
d
rn
s
❑ Yes ❑ No 4 SKIP to Item 1.23.
0
1.22
Provide information in the table below on these other disposal methods.
d
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
acres
gpd
❑ Continuous
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
acres
d
gpd
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
y
❑ 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 0 No 4SKIP 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
0
City, state, and ZIP
0
e
code
c
Contact name (first and
0
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO034452 Willow Creek WWTP Modified March 2021
SECTION•1 • •• • I
c Outfalls to Waters of the State of North Carolina
C
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
aM
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
%
Y
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
-o
c
�v
3
0
c
t
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
CL
W
specific requirements.)
tM C
0
CL
0
0
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
c e
— cm
(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
v
1.
d
E
aT
c.
2.
E
w
0
y
a�
3.
CD
CD
Q
4.
-c
M
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Com letion for Improvements
E
m
>
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
c
CL
Improvement
(list outfal
Construction
Construction
Discharge
Level
E
(from above)
number)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
d
-o
d
rn
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
NC0034452
Willow Creek WWTP Modified March 2021
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 001
Outfall Number
Outfall Number
State
NC
�
County
Davidson
0
w
City or town
High Point
0
c
.Q
Distance from shore
0 ft.
ft.
ft.
d
Depth below surface
5 ft.
ft.
ft.
0
Average daily flow rate
0.04 mgd
mgd
mgd
Latitude
35' 58' 04" IN
"
Longitude
80` 06' 02" W
o
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
c
❑ Yes ❑ No -* SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
L
H
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
discharge occurs
a
Average duration of each
o
discharge (specify units
c
0
Average flow of each
mgd
mgd
mgd
discharge
�v
in
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser t pe at each applicable outfall.
c.
Outfall Number
Outfall Number
Outfall Number
d
H
v�
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
12 �
one or more discharge points?
d
9 w
❑ Yes ❑ No -SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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
Abbotts Creek
Name of watershed, river,
Abbotts Creek
0
or stream system
a
U.S. Soil Conservation
N
Service 14-digit watershed
o
code
°'
cc
�
Name of state
management/river basin
Yadkin -Pee Dee
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
at critical
mg/L of
mg/L of
mg/L of
7Totalohardness
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
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
El Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
Q
Design Removal Rates by
Outfall
d
BOD5 or CBOD5
85 %
%
%
c
d
E
TSS
85 %
%
%
0 Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
® Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
0 Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
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.
o
d
_
0
c�
c
Outfall Number 001
Outfall Number
Outfall Number
Q-
Disinfection type
Tablet Chlorination w/contact
c.�
�+
a�
tank
G
Seasons used
All
d
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
0 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?
0 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 -* 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
R
Number of tests of discharge
rn
=
water
U)
Number of tests of receiving
water
d
Ui
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?
❑r Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑✓ Yes ❑ 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 0 No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO034452
Willow Creek WWTP
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No + 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 + 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
as
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?
a'
❑ Yes No SKIP to Item 3.26.
U)c
3.23
Describe the cause(s) of the toxicity:
c
m
LU
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 0 Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0034452 Willow Creek WWTP Modified March 2021
SECTION. CHECKLIST AND CERTIFICATION STATEMENT (40
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/ variance request(s) El w/ additional attachments
Informationforfor All A licants
❑ Section 2: Additional
❑r w/ topographic map ❑✓ w/ process flow diagram
Information
❑ w/ additional attachments
❑ w/ Table A ❑ w/ Table D
❑ Section 3: Information on
✓❑ w/ Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ w/ Table C
a�
�o
c
Section 4: Not Applicable
0
;2
Section 5: Not Applicable
a�
U
a
Section 6: Checklist and
❑
❑ wl attachments
Certification Statement
N
2
6.2
Certification Statement
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. 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
Lauren Raup-Plummer
Engineering Manager
Signature oocu3igned by:
Date signed
E �d1A�—P(UMKA V�
11/O1/2023
9CBBE0980A7B49B..
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO034452
Willow Creek WWTP
001
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical ML or MDL
Value
Units
Value Units Method' (include units)
Samb lest
Biochemical oxygen demand
2 BOD5 or ❑ CBOD5
8.8
mg/L
< 1
mg/L
235 SM5210B 2.0 2 MDL
(report one
Fecal coliform
93
mg/L
< 1
mg/L
223 SM9222D (MF) 1.0 0 MIL
2 MDL
Design flow rate
148,467
gallons
35,732
gallons
1575
pH (minimum)
6.8
units
pH (maximum)
8.5
units
Temperature (winter)
20
degrees Celsius
10.69
degrees Celsius
320
Temperature (summer)
28
degrees Celsius
26.0
degrees Celsius
419
Total suspended solids (TSS)
5.4
mg/L
0.80
mg/L
235 SM2540D 2.5 El
2 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).
Page 11

Identification Number I NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NCO034452 Willow Creek WWTP 001 Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Method'
(include units)
Samples
Ammonia (as N)
2.14
mg/L
0.15
mg/L
229
SM4500NH3D
El ML
0.2 2 MDL
Chlorine
total residual, TRC 2
35
ug/L
7.48
ug/L
456
Field -Hach DPD
El ML
❑MDL
Dissolved oxygen
11.6
mg/L
8.21
mg/L
234
Field -Hach DPD
❑ ML
❑ MDL
Nitrate/nitrite
38.4
mg/L
19.58
mg/L
53
SM450ONO3E
❑ ML
❑ MDL
Kjeldahl nitrogen
6.4
mg/L
1.53
mg/L
53
SM45000RGB,NH3C
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
5.61
mg/L
2.88
mg/L
55
SM450OPE
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑ 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 12

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Value
Units Value
Units
Number of
Method' (include units)
Samples
—
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑ MDL
❑ ML
Arsenic, total recoverable
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ 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
❑ ML
Thallium, total recoverable
—_
❑ 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 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
.1-2,291211141 •�
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
El ML
❑ MDL
2-chloroethylvinyl ether
El ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ MI
❑ MDL
1,1-dichloroethane
❑ MI
❑ MDL
1,2-dichloroethane
❑ MI
ElMDL
trans-1,2-dichloroethylene
0 ML
❑ MDL
1,1-dichloroethylene
0 ML
❑ MDL
1,2-dichloropropane
0 ML
❑ MDL
1,3-dichloropropylene
0 ML
❑ MDL
Ethylbenzene
0 ML
❑ MDL
Methyl bromide
0 ML
❑ MDL
Methyl chloride
0 ML
❑ MDL
Methylene chloride
13 ML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
❑ MDL
Toluene
❑ ML
❑ MDL
1,1,1-trichloroethane
❑ ML
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Value Units Value Units Number of
Method' (include units)
Samples
Trichloroethylene
❑ ML
❑ MDL
Vinyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethylphenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
❑ ML
❑ MDL
Benzidine
❑ ML
❑ MDL
Benzo(a)anthracene
❑ ML
❑ MDL
Benzo(a)pyrene
❑ ML
❑ MDL
3,4-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0034452 Willow Creek WWTP I
Modified March 2021
7Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
Method' (include units)
Samples
Benzo(ghi)perylene
El ML
❑ MDL
Benzo(k)fluoranthene
- - --
El ML
❑ MDL
Bis (2 chloroethoxy) methane
El ML
❑ MDL
Bis (2 chloroethyl) ether
El ML
❑ MDL
Bis (2-chloroisopropyl) ether
❑ ML
❑ MDL
Bis (2 ethylhexyl) phthalate
El ML
❑ MDL
4-bromophenyl phenyl ether
❑ ML
❑ MDL
Butyl benzyl phthalate
❑ 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
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
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
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ ML
❑ MDL
Isophorone
❑ ML
❑ MDL
Naphthalene
❑ ML
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi n propylamine
El ML
❑ MDL
N-nitrosodimethylamine
❑ ML
❑ MDL
N-nitrosodiphenylamine
❑ ML❑
MDL
Phenanthrene
❑ ML
❑ MDL
Pyrene
❑ ML
❑ MDL
0 1,2,4-trichlorobenzene
❑ ML
❑ 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).
EPA Form 3510-2A (Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO034452 Willow Creek WWTP
Modified March 2021
1 11 • '• • 1 '1 •'
Maximum Dail Discharge Average 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
❑ 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).
Page 18

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NCO034452 — Willow Creek Subdivision WWTP
Latitude: 35058' 04" N Longitude: 80° 06' 02" W
Sub -Basin: 03-07-07 Stream Class: C
Receiving Stream: Abbotts Creek
i,
CRAVEN RD
' 04
Facility
Location AA
North Davidson County
Map not to scale

Influent
Barand
Fine
Screens
Flow Aeration Basins
Equalization (3)
Tank
Secondary Gravity Sand
Clarifiers (3) Filters
Chlorine Contact
Sludge Holding Chamber (Tablet
Tank 0
Chlorinator)
Sludge Hauler
(off -site disposal)
Abbotts Creek;
Yadkin -Pee Dee River
Basin

Willow Creek Data 2019 - 2023
Row Labels
Count of RESULT
Ammonia as N
229
Biological Oxygen Demand (BOD)
235
Chlorine Residual, Total
456
Dissolved Oxygen
477
Fecal Coliform (number)
223
Fecal Coliform (P/A)
1
Flow
1575
Nitrate + Nitrite
53
pH, Field
233
Temperature, Field
493
Total Kjeldahl Nitrogen (TKN)
53
Total Nitrogen
55
Total Phosphorous
55
Total Suspended Solids
235
Grand Total
4373
Row Labels
Average of RESULT
Ammonia as N
0.150436681
Biological Oxygen Demand (BOD)
0.672340426
Chlorine Residual, Total
7.475877193
Dissolved Oxygen
8.21106383
Fecal Coliform (number)
5.825112108
Fecal Coliform (P/A)
1
Flow
42167.55048
Nitrate + Nitrite
19.5754717
pH, Field
7.453648069
Temperature, Field
16.83757962
Total Kjeldahl Nitrogen (TKN)
1.533207547
Total Nitrogen
20.96909091
Total Phosphorous
2.883090909
Total Suspended Solids
0.803404255
Grand Total
16167.68306