NC0089052_Renewal (Application)_20240212

Laserflctlts
North Carolina Modified Application Form 2A
Department of Environmental Quality Revised March 2021
Division of Water Resources
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
FEB 12 2024
NCDEQ/DWR/NPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Appkation Form 2A
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 instrucdons. Failure to idlow
NPDES
the instructions may result in denial of the a llcatlon.)
SECTION•N
INFORMATION FORr
Facility name
1.1
Mailing address (street or P.O. box)
City or town
State
ZIP code
c
0
EContact
name (first and last)
Title
Phone number
Email address
0
c
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
R
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?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
c
Applicant address (street or P.O. box)
.Q
City or town
State
ZIP code
w
c
Contact name (first and last)
Title
Phone number
Email address
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 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.
E
m
Existing Environmental Permits
is
NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
=°
c
wat r)
control)
E
ov U
a
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
W
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

Zooland Family WWTP 4eiA ✓Kevq4-� NC 0089052 K�J"
Annual Average Effluent Flow Rates (MGD)
2 Yr ago
2021
Jan
0.001930
Feb
0.002168
March
0.002323
April
0.002583
May
0.002319
June
0.002930
July
0.002943
August
0.002197
Sept
0.002133
Oct
0.001755
Nov
0.001740
Dec
0.000893
Ave
0.002160
Lasy Yr
1
This Yr
1
2022
2023
0.001224
0.001846
0.001432
0.001405
0.001997
0.001785
0.002400
0.002917
0.002407
0.002111
0.002607
0.002793
0.002793
0.003423
0.002184
0.002045
0.001932
0,001872
0.002490
0.002442
0.001963
0.002263
0.001419
1 0.002294
0.002071
0.002266

+h 6mr,,t a
Zooland Family WWTP
NC 0089052
Maxium Daily Effluent Flow Rates Actual (MGD)
2 Yr ago
2021
Jan
0.00530
Feb
0.00380
March
0.00410
April
0.00540
May
0.00450
June
0.00550
July
0.00520
August
0.00490
Sept
0.00420
Oct
0.00460
Nov
0.00340
Dec
0.00130
Ave
0.00435
Mf
Lasy Yr
2022
This Yr
2023
0.00230
0.00300
0.00400
0.00320
0.00370
0.00380
0.00500
0.00810
0.00810
0.00480
0.00410
0.00490
0.00580
0.00570
0.00480
0.00360
0.00520
0.00405
0.00520
0.00405
0.00430
0.00460
0.00320
0.00395
0.00464
0.00448

NPDES Permit Number
Facility Name
Modified Application Form 2A
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
% separate sanitary sewer
❑ Own ❑ Maintain
Z%
combined storm and sanitary sewer
❑ Own ❑ Maintain
m
❑ Unknown
❑ Own ❑ Maintain
%separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
CL
o
% separate sanitary sewer
❑ Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own ❑ Maintain
E
❑ Unknown
❑ Own ❑ Maintain
m
% separate sanitary sewer
❑ Own ❑ Maintain
N%
combined stone and sanitary sewer
❑ Own ❑ Maintain
c
1 ❑ Unknown
❑ Own ❑ Maintain
Total
Population
0
Served
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
z'
1.8
Is the treatment works located in Indian Country?
c
o
0
ElYes ❑ No
U
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes ❑ No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
D, ®0 mgd
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
mgd
l�, 0 O o2.0? t mgd
d. 00 a 7o mgd
m"
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0. 00q_3 mgd
Q. d O 67 mgd
�
Q• U�%��T mgd
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
m
Constructed
L T
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Emergency
r
ra
Overflows
Overflows
0
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
Modified March 2021
Outfalis 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 &3" 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 Discha a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
w
❑ Intermittent
0
1.14
Is wastewater applied to land?
❑ Yes L"J No 4 SKIP to Item 1.16.
1A
1.15
Provide the land application site and discharge data requested below.
C
Land Application Site and Discharge Data
In
0
Average Daily Volume
Continuous or
�'
Location
Size
Applied
Intermittent
check one
acres
gpd
El Continuous
y
c
❑ Intermittent
❑ Continuous
m
r
0
acres
gpd
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment pri r to discharge?
0
❑ 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.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

NMES Permit Number
Facility Name
Modified Application Form 2A
i
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 fac lity.
Receivin F cility Data
Facility name
Mailing address (street or P.O. box)
d
3
City or town
State
ZIP code
0
U,
Contact name (first and last)
Title
0
m
Phone number
Email address
0
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate mgd
CL
0
1.21
is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina .g., underground percolation, underground injection)?
d
s
❑ Yes No 4 SKIP to Item 1.23.
c1.22
Provide information in the table below on these other disposal methods.
Information on Other Dis osal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
check one
( )
Description
Volume
❑ Continuous
acres
gpd
0 Intermittent
O
❑ Continuous
acres
gpd
❑ Intermittent
acres
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.)
Q, w
Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
.r Cr
econ
302(b)(2))VNot
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
Mailing address
street or P.O. box
c
City, state, and ZIP
code
cContact
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
Modified March 2021
SECTION••
• •' •
Clutfalls to Waters of the State of North Carolina
o
c
2.1
n or equal to 0.1 mgd?
Does the treatment works have a design flow g;�No
rn
0
El Yes + SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
gpd
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration.
o
c
so
3
0
r-
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
CL
o,
specific requirements.)
`Os `c
❑ Yes ❑ No
0
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
s f
(See instructions for specific requirements.)
" c
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No SKIP to Section 3.
Briefly list and describe the scheduled improvements.
=
0
1.
m
E
m
c
2.
E
w
0
3.
m
4.
v
0
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled
or Actual Dates of Completion for Improvements
m
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
2
Improvement
(list outfall
Construction
Construction
Discharge
Level
CL E
(from above)
number
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
v
1.
m
L
CO)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
Modified March 2021
SECTION•' • ON
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number PO,
Z
Outfall Number
Outfall Number
State
County
0
City or town
h
c
S
Distance from shore
.Q
m
Depth below surface
�- a , Q ft.
ft.
ft.
0
Average daily flow rate
mgd
mgd
mgd
Latitude
-C .34 Or"A/
o
o
Longitude
e SQ s8 " W
'
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodi ischarges?
R
o
❑ Yes No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
'o
Number of times per year
S
discharge occurs
a
Average duration of each
o`
discharge (specify units
cAverage
flow of each
mgd
mgd
mgd
v,
discharge
CA
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
?
❑ Yes L►1 No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser rpe at each applicable outfall.
m
a
F
Outfall Number
Outfall Number
Outfall Number
m
N
c
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
3.6
one or ore discharge points?
3 w
Q�Yes ❑ No -*SKIP to Section 6.
Page 6

t
ReceivinR.Stream: Little River River Basin: Yadkin
Latitude; Sal Btr ON, N Lonpitude: 79` 50' 5S" YJ
Sub -Basin: 03-07-15
USG5Quad: Seagrove N.C. Strearn Class: G
Facility'"
Location
not to scale
Permit 52
NPDRa
�J���
dolki Co0099

NPDES Permit Number
Facility Name
Modified Application Form ZA
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 601
Outfall Number
WWI Number
Receiving water name
A, ,'�� Ve�
Name of watershed, river,
q a d Rd l Pe
g
or stream system
,Y e
U.S. Soil Conservation
y
Service 14-digit watershed
c
code
L
3
Name of state
management/river basin
C ��
/
rn
.:
U.S. Geological Survey
4)
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
0 cfs
cfs
cfs
Critical low flow (chronic)
0 cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
0 CaCO3
CaCO3
CaCO3
3.8
Provide the following information
descdbing the treatment pr vided for discharges from each outfall.
Outfall Number 00
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
econdary
[I Secondary
❑ Secondary
Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
n
Design Removal Rates by
Outfall
N
N
BOD5 or CBODs
9 %
%
%
c
d
E
L
�
TSS
} �� ,o`o
1
%
%
of applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
of applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
RNot applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Pemtit Number i Facility Name Modified Application Form 2A
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
�
3
season,
en IQ-� u ! -7L2cL 1 / Cl � e�
C
•C
c
Outfall Number
Outfall Number
Outfall Number
Disinfection type
d
v
0
m
Seasons used
^ u
f'�
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑l Yes
❑ Yes
❑ Yes
[�J No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
Gr Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
a'
c
water
Number of tests of receiving
water
d
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? —/
El Yes 4 Complete Table B, including chlorine. &T 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
attacho the results to this application package?
No additional sampling required by NPDES
Yes ❑ ermittin authori .
Page 8

Pertnif NCO099052
SUPPLEMENT TO PERMIT COVER, -SHEET
.Qll previous:WDES Permlo issued to Phis facility, whether foe opeitrtion. or` discharge are hereby revoked As of this
permit issuance, any previously issued permit bearing this number is no longer -effective- Therefore, the exclusive authortty
to operate and discharge from: thisA-Cility arises under the permit conditions, requirements, terms, rind provisions included
herein.
TRG Zoolan -, LP
is hereby authorized to:
L Continue; to operate a.0:006 Marl) wastewater treatment facility that includes, the following components:
8,0.00-gallon septic tank. influent receiving basin
21000-gaijotf flow equalization tank
Duplex submersible pumps
9,60.0-gallon Moving Bred Riofilm Reactor
4 3,50.0-gallon: clarifier
e Duplex. blower system
.1.,50"0-gallon filter feed tank
Onepressure sand filter
o 1,500-gallon clearwell with diffused post aeration
Alkalinity feed system
Two ultraviolet light disinfection systems
a Backup generator and transfer switch
2. Afterobtaining an Authorization to Construct permitfrom the Division, to construct, and after submittal
of an. Engineer's Certificate, to operate a 0.017 MOD wastewater treatment facility that inaluties the
following components:
10,OOt1-gallon septic tank influent receiving basin
4 3,000-gallon flow equalization tank interconnected: to existing flow equalization. tank
0 Duplex submersible pumps
4, 5000-gallon Moving. Bed Biofllm. Reactor
4. Duplex blower system
o Bioclere with integral clarifier
o 1,500-gaf on filter feed tank (existing)
4, One additional tertiary sand filter
® Ultraviolet light disinfection system
4� Effluent flow meter with recorder (existing)
0 Backup genomtor and transfer switch(axisting)
This facility is located. at the Zooland Family Campground WWTR, 3761 Pisgah Covered Bridge Road,.
near. Asheboro in Randolph County.
3. Discharge from said. treatment works at the location specified on the attached map into the Little River
(HUC: 0304010403011, currently classified C waters in the Yadkin River Basin.
Page 2 of 7

Permit NC0089052
PART I[
A. ("L) EFFLUEN UWTATIONS AND MOMTORING REQ>t IREWI+NTS
[15A NCAC 02B.0400 et.seq, 02B OSGO at.seq.1
Grade i Biological WPCS II SA NCAC 08G .0302j
During the period, begintAng on the effective date of -this permit and lasting until .expansion alcove
0.006 M- OD,, or expiration, the Perinittee is. authorized to discharge treated wastewater from outfall
001. Such discharges shall be limited and monitored" by the petrnittee as specified below:
OFFI IEW CHARACTERISTICS
LIMITS
MOWTORING REQUIREMENTS
eDMR bode
Monthly
Av"T B
Deily
MOXIMUm
a surenterrt
Frequenq
Sample
'F a
Sample
Locatlora2
t (ov1 5005E
0.006 MGD
Gantihuous
Recording
influent or
Effluent
_
BOD, 5-day(20110) (Apr. 1— Oct. 31') G0310
&0 mg&
7.5: mg/L
Weekly
Grab
Effluent
BOD, 5-day (201G) (Nov.1— Mar. 31) C0310
10.0. mg/L
15.0 mg/L.
Weetdy
Grab
Effluent
Total Suspended Solids; C0630
30,E mg/L
45.0 mg/L
weekly
Grab
Effluent
NHs as N (Apr.1---Oct. 31 _ C0610
3.5 mg/L
17.5 mg/L
21 Month
Grab
Effluent
NHs w N (Nov.1- Mar. 31) C0610
TO mg/L
35:0 mg/L
2/ Month
Grab
Effluent -
Dissolved Oxygen 00300
Daily average k 6.0 mg/L.
Weekly.
Grab
w irfttuent
~
Fpaal Conform (geometric mean) 3161'6.
200 f 100 rn
4UOJ 1.00 ml
Weekly
Grab
Effluent
Temperature CC) 00010
Monitor & Report
Weekly
Grab
Effluent,
pH 6G400
;� 6.0 and e. O.0 standard units
Weekly
Y
Grab
Effluent
Dissolved Oxygen 00300,
Monitor & Report
_
Weekly
Grab
Upstream &
Downstream
Temperature 00010
Monitor & Report
Weekly
Grab
Upstream &
Downstream
pH 00400
Monitor & Report
Weekly
Grab
Upstream &
Downstream
Foot -notes:
_
1. The permittee shall subrait'discharge monitoring reports electronically usin_g.the Division's eD.MR system.
Sea Condition A. ,(3:.).
2. Upstream -at least 100 feet upstreatn from the outfall. Downstream = at NCSR 112-7.
There ghall be no discharge of floating snlids. or foam visible in other than trace amounts,
Page 3 of 7

Permit NaCO089052
A. (1) EFFLUENT LIA41TAI"IONS AND MONITOMNG REQUIREMENTS
(l5A NCAC 0213.0400 et seq., 02&050.0 et:seq..].
Grade. l Biological WPC9 [15A NCA.0 08G .0-102]
Duri ng the period beginning on the submittalof an Engineer's Certification and lasting until
expiration, the Pertnfttee is authorized to discharge- treated. wastewater from outfall 001. Such
discharges shall be limited and: mouitared.t by the Permittee as specified below;
EFFLUENT .CI ARACTERISTICS
LIMITS
MONITORING REQUIRl:M NTS
eDMR.:Code
Monthly
Avera a
Daily
Maximum
Measurement
Ere. uen
82mp a
Type
Sample
"ort2
LoeatOr
Flow. 50050
0.017 MGD
Continuous
. Recordin 9
Influent Effluent
800 5-day. (20°C) (Apr.1— Oct.. 3) C0310r
5.0 mg/L
7.5 mg/L
Weekly
Grab.
Effluent
' B0D,.5-day (20°C) (Nov.1— Mar. 31) C0310
10.0 mg/L
15.0 mg/L
Weekly
Grab:
Effluent
Total Suspended Solids COS30
30.0 mg/L.
45.0-mg/L
Weekly
Grab
Effluent
NR3 as N (Apr. 1 — Oct. 3t) C0610
1.9 mg/L
9.3 mg/L
21 Month
Grab
Effluent
Wass N (Nov,1-- Mar. 34) C-0610
7.0 mgiL
35.0 mg/L
2/ Month
Grab
Effluent
Dissolved Oxygen 00300
Daily average ;� 6,0 mg/L.
Weekly
G*a
-Effluent
Fecal Coliform (geometric mean) 31616.
200 / 100 ml
400 / 1.00 ml
Weekly
Grab
Effluent
Temperature (°C) 0.0010
Monitor& Report
Weekly
Grab
Effluent
pH 00400
�t &0 ands 9.0 standard units
Weekly
Grab
Effluent
Dissolved Oxygen 003.00
Monitor & Report
Weekly
Grab
Upstream &
Downstream
Temperature 000t0
Monitor & Report
Weekly
Grab
Upstream &
Downstream
pN 00400
Monitor & Report
Weekly
Grab
Upstream
Downstream
Footnotes.
1. The permlttee shall submit discharge monitoring reportselectronically using ther Division's eD'MR system.
See Condition A. (3.).
2. Upstream = at least 100 feet upstream from -the outfall_ Downstream = at NCSR 1.127.
There shall be no discharge of floating solids or foam visible in other than trace amounts.
Page 4 of 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
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 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
MMW
7Z
c
.c
0
R
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?
e
❑ Yes ❑ No 4 SKIP to Item 3.26.
F
3.23
Describe the cause(s) of the toxicity:
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 outfalls and attached t *results to the application package?
❑ Yes 1_YI/ Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number FacilityName Modified Application Form 2A
Modified March 2021
SECTIONt+
CERTIFICATION STATEMENT (40
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
❑ w/ variance request(s) ❑ w/ additional attachments
Information for All Applicants
❑ Section 2: Additional
❑ w/ topographic map ❑ w/ process flow diagram
Information
❑ w/ additional attachments
❑ w/ Table A ❑ w/ Table D
❑ Section 3: Information on
❑ wl Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ w/ Table C
d
is
Section 4: Not Applicable
c
0
R
!�
Section 5: Not Applicable
d
U
Section 6: Checklist and
El❑
w/ attachments
Certification Statement
H
Y
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. 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
Signature
Date signed
Page 10

NPDES Permit Number I Facility Name
Modified Application Form 2A
Modified March 2021
Pollutant
Maximum Daily
Discharge
Average Daily Discharge
An.01
alytical
ML or MDL
Number of
Value
Units
Value
Units
Samples
Method'
(include units)
Bioc or oxygen demand
&PSOD5 or ❑ CBODs
/
!!
K
6
1 "
(report one
v-L :
Fecal coliform1%►e/ti�lc�0NML
A'y-
Design flow rate
G?, p©6
_
pH (minimum)
y
pH (maximum)
Temperature (winter)
dC;�
Temperature (summer)
d o 140
► ram' r `(�r
Total suspended solids (TSS)
'
�(�
�' -G
L .
ML
1 Sampling shall be conducted according to sufficiefitly sensitive test procedbres (i.e., methods) approved undef 40 CFR 136 for the analysil of pollutants or pollutant parametersbr
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). % 5,10
Page 11

EPA Identification Number NPDES Permit Number I Facility Name I Outfall Number Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Methods
include units
( )
Samples
Ammonia (as N)
--
❑ ML
❑ MDL
Chlorine
❑ ML
total residual, TRC z
O MDL
Dissolved oxygen
El ML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
0 ML
❑ MDL
Oil and grease
OML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19) Page 12

EPA Identification Number
NPDES Permit Number Faci ty Name Outtall Number
reoamea Hppucauon ram a+
Modified March 2021
• • N • •
0.
Maximum Daily Discharge Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
Number of
Value TSamples
Units
Value
Units
Metals, Cyanide, and Total Phenols
❑ ML
Hardness (as CaCO3)
❑ MDL
❑ ML
Antimony, total recoverable
❑ MDL
❑ ML
Arsenic, total recoverable
❑ MDL
❑ ML
Beryllium, total recoverable
❑ MDL
❑ ML
Cadmium, total recoverable
❑ MDL
❑ ML
Chromium, total recoverable
❑ MDL
❑ ML
Copper, total recoverable
❑ MDL
❑ ML
Lead, total recoverable
❑ MDL
❑ ML
Mercury, total recoverable
❑ MDL
❑ ML
Nickel, total recoverable
❑ MDL
❑ ML
Selenium, total recoverable
Z
❑ MDL
❑ ML
Silver, total recoverable
r
❑ MDL
❑ ML
Thallium, total recoverable
❑ MDL
❑ ML
Zinc, total recoverable
❑ MDL
❑ ML
Cyanide
❑ MDL
❑ ML
Total phenolic compounds
❑ MDL
Volatile Organic Compounds
❑ ML
Acrolein
❑ MDL
❑ ML
Acrylonitrile
❑ MDL
❑ ML
Benzene
❑ MDL
❑ ML
Bromoform
Cl
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identfication Number NPDES Permit Number Facility Name DuffaA Number Modified Application Form 2A
Modified March 2021
•- •
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
Number of
Value
Units
Value
Units
Samples
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
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethytbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
OML
❑ MDL
Toluene
❑ ML
❑ MDL
1,1,1-trichloroethane
❑ ML
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Fort 3510-2A (Revised 3-19) Page 14

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

EPA Identification Number NPDES Permit Number Facility Name Dudal Number Modified Appkation Form 2A
Modified March 2021
Maximum Daily Discharge
Pollutant
Value Units
Average Daily Discharge
Analytical
Method'
ML or MDL
(include units)
Value
Units
Number of
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
0 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
methyl phthalate
❑ ML
❑ MDL
t2A-dinitrotoluene
❑ ML
❑ MDL
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
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-diphenyihydrazine
111exachlorobutadiene
0 ML
❑ MDL
Fluoranthene
❑ ML
❑MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
A
1
❑ ML
❑ MDL
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
0 ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
0 ML
❑ MDL
❑ ML
Isophorone
❑ MDL
Naphthalene
0 ML
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi-n-propylamine
ML
o MDL
OML
N-nitrosodimethylamine
❑ MDL
0 ML
N-nitrosodiphenylamine
❑ MDL
❑ ML
Phenanthrene
❑ MDL
OML
Pyrene
❑ MDL
❑ ML
1,2,4-tdchiorobenzene
❑ 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 351D-2A (Revised 3-19) Page 17

NPDES Permit
Number / F cility �fG� Outfall Number Modified Application Form 2A
A • / IO©/ Modified March 2021
Maximum Dail Discharge Average Daily Discha e
Pollutant Analytical ML or MDL
Samples (fist) Value Units Value Units Numbers Mrli .N Method' (include units)
❑ No additional sampling is required by NPDES permitting authority.
SO
< 5 � 0 83
A�_) -;,
•C ; • 3 ?,1 (
M ' —
1 2.
5at a B
a, "f/= f�IOfDL
-r5.s
< 9.7466
rK C1a.._
A3 .57-76-
rn_ )';t-
� a.
a vo-D
z° 1
H 3 —IV
07
(n
�34 3,-)¢
0Jo ° ID
r—
l . ❑ M
KOM# VA
& DL
c..
a•
v N
< i ,
m �,v ,�
�.,
cd �, G1trig
L_°ILL
❑ 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

Zooland Family WWTP
NC 0089052
Year 2023
Pollutants per NPDES for 2023
Maxium Daily Effluent Discharge /
"/� / M4 /It- " ;. m one/101*1L
OD
SS
H3-N
Fecals
<2.0
<2.5
0.360
<1.0
<2.0
<2.5
<0.10
<1.0
4.200
7.200
0.250
<1.0
31.600
72.50
4.200
9.6
2.60
<2.5
<0.10
<1.0
<2.0
6.400
<0.10
<1.0
<2.0
6.500
0.120
<1.0
3.900
<2.5
<0.10
<1.0
4.200
<2.5
1.400
<1.0
5.400
<2.5
0.380
<1.0
4.000
7.100
0.920
<1.0
3.400
<2.5
<0.10
1550
<5.6083
<9.7666
<0.6775
0.34772
�Oa&Alvenf 3- �4m
Averagg Monthly / Daily Effluent Discharge
A /�- �. ryc %- /hPi✓ /dam Z-
BOD
TSS
NH3-N
Fecals
<2.0
<2.5
0.36
1.0
<2.0
<2.5
<0.10
1.0
0.84
2.26
0.051
1.0
11.075
18.125
1.05
1.760223
0.65
<2.5
<0.10
1.0
<2.0
1.28
<0.10
1.0
<2.0
1.625
0.03
1.0
0.78
<2.5
<0.10
1.0
2.333333
<2.5
0.466667
1.0
1.875
<2.5
0.175
1.0
1.50
1.421
0.204
1.0
1.40
<2.5
<0.10
27.041931
<2.37111
<3.5175
<0.236306
0.1397975

9800 Kincey Ave., Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ACKNOWLEDGMENT
Analyte List
Reporting
Customer Sample ID Method
Compound
Limit Units
Effluent 2540D Total Suspended Solids
Total Suspended Solids
2.5 mg/L
350.1 Ammonia EDN
Nitrogen, Ammonia
0.1 mg/L
5210B BOD, 5 day EDN
BOD, 5 day
2 mg/L
Colilcrt-18 Fecal Coliform EDN
Fecal Coliforms
1 MPN/100mL
Please contact your project manager if you recognize any discrepancy in this form or have any questions about your project.
Thank you for choosing Pace Analytical Services, LLC. Page 2 of 2
02/01/2024 05 35 PM