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HomeMy WebLinkAboutNC0051713_Renewal (Application)_20240603ROY COOPER Governor ELIZABETH S. BISER Secretary RICHARD E. ROGERS, JR. Director Walter Craven, Jr Lakeview MHP LLC 420 Marion Dr #31 Wilmington, NC 28412 Subject: Permit Renewal Application No. NCO051713 Lakeview Mobile Home Park WWTP Forsyth County Dear Applicant: NORTH CAROLINA Environmental Quality June 03, 2024 The Water Quality Permitting Section acknowledges the June 3, 2024 receipt of your permit renewal application and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting branch. Per G.S. 15OB-3 your current permit does not expire until permit decision on the application is made. Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a timely manner to requests for additional information necessary to allow a complete review of the application and renewal of the permit. Information regarding the status of your renewal application can be found online using the Department of Environmental Quality's Environmental Application Tracker at: https://www.deg.nc.Rov/permits-rules/environmental-application-tracker If you have any additional questions about the permit, please contact the primary reviewer of the application using the links available within the Application Tracker. ec: WQPS Laserfiche File w/application Sincerely, 6r kL Cynthia Demery Administrative Assistant Water Quality Permitting Section North Carolina Department of Environmental Quality I Division of Water Resources Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 1 Winston-Salem. North Carolina 27105 336.776.9800 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 HECENED JUN 03 R4 ®EQI1DWR/NPDE.S 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 NCO051713 Lakeview Mobile Home Park 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 insbuc Lions mly result in denial of the application.) SECTION•N INFORMATION FOR 1.1 Facility name Lakeview Mobile Home Park WWTP !1;1�1, d 3 20%4 Mailing address (street or P.O. box) P.O. Box 3421 City or town State o Wilmington NC 28406-3421 EContact name (first and last) Title Phone number Email address 0 c Walter Craven Owner (910) 777-1998 Location address (street, route number, or other specific identifier) ❑ Same as mailing address w 5186 High Point Rd. City or town State ZIP code High Point NC 27260 1.2 Is this application for a facility that has yet to commence discharge? ❑ Yes 4 See instructions on data submission ✓❑ No requirements for new dischargers. 1.3 Is applicant different from entity listed under Item 1.1 above? ❑ Yes El No SKIP to Item 1.4. Applicant name Applicant address (street or P.O. box) 0 `o City or town State ZIP code w c Contact name (first and last) Title Phone number Email address Q CL < 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 R ✓❑ NPDES (discharges to surface ❑ RCRA (hazardous waste) ❑ UIC (underground injection water) control) E 0 ❑ PSD (air emissions) ❑ Nonattainment program (CAA) ❑ NESHAPs (CAA) 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 NCO051713 Lakeview Mobile Home Park 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 175 100 % separate sanitary sewer 0 Own I] Maintain % combined storm and sanitary sewer ❑ Own ❑ Maintain ❑ Unknown ❑ Own ❑ Maintain _ % separate sanitary sewer ❑ Own ❑ Maintain ° % combined storm and sanitary sewer ❑ Own ❑ Maintain ❑ Unknown ❑ Own ❑ Maintain a o % separate sanitary sewer ❑ Own ❑ Maintain (L % combined storm and sanitary sewer ❑ Own ❑ Maintain f° ❑ Unknown ❑ Own ❑ Maintain d% separate sanitary sewer ❑ Own ❑ Maintain N% combined storm and sanitary sewer ElOwn ElMaintain c ElUnknown ElOwn ❑ Maintain Total 175 Population L) Served Combined Storm and Separate Sanitary Sewer System Sanitary Sewer Total percentage of each type of 100 % % sewer line in miles z' 1.8 Is the treatment works located in Indian Country? o ❑ Yes 0 No U 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 015 mgd 'AAnnual Average Flow Rates Actual Two Years Ago Last Year This Year o mgd mgd mgd `L Maximum Daily Flow Rates Actual Two Years Ago Last Year This Year mgd mgd 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 by Type a c. Combined Sewer Constructed Treated Effluent Untreated Effluent Overflows Bypasses Emergency Overflows � 1 Page 2 NPDES Permit Number Facility Name Modified Application Form 2A NCO051713 Lakeview Mobile Home Park 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 Z 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) Im oundment ❑ Continuous gpd ❑ Intermittent ❑ Continuous gp d ❑ Intermittent ❑ Continuous gpd y ❑ Intermittent 1.14 Is wastewater applied to land? ❑ Yes 0 No 4 SKIP to Item 1.16. 0 1.15 Provide the land application site and discharge data requested below. H Land Application Site and Discharge Data o 0 Average Daily Volume Continuous or Location Size Applied Intermittent check one acres 9p d El Continuous o ❑ Intermittent _ El Continuous L o acres gpd ❑ Intermittent a acres gpd ❑ Continuous ❑ 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 -* 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 NCO051713 Lakeview Mobile Home Park Modified March 2021 1.20 In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the facility. -receiving Receiving IF cility Data Facility name Mailing address (street or P.O. box) d 3 City or town State ZIP code 0 Contact name (first and last) Title 0 d Phone number Email address aNPDES number of receiving facility (if any) ❑ None Average daily flow rate mgd N 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)? ❑ Yes 0 No -+ SKIP to Item 1.23. c 1.22 Provide information in the table below on these other disposal methods. Information on Other Disposal Methods o Disposal Location of Size of Annual Average Continuous or Intermittent R Method Disposal Site Disposal Site Daily Discharge (check one) Description Volume ❑ Continuous acres gpd ❑ Intermittent 0 ❑ Continuous acres gp d ❑ 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.) d Discharges into marine waters (CWA Water quality related effluent limitation (CWA Section ❑ Cr❑ Section 301(h)) 302(b)(2)) Not applicable 1.24 Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a contractor? ❑ Yes ❑ No +SKIP to Section 2. 1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational and maintenance responsibilities. Contractor Information Contractor 1 Contractor 2 Contractor 3 0 Contractor name Bell Enterprises LLC A (company name oMailing address c street or P.O. box P.O. Box 1291 w City, state, and ZIP Clemmons, NC 27012 i0 code cContact name (first and U last)y Rand Bell Phone number (336) 399-8243 Email address Belir83161@yahoo.com Operational and All operations and maintenance maintenance responsibilities of contractor Page 4 NPDES Permit Number Facility Name Modified Application Form 2A NCO051713 Lakeview Mobile Home Park Modified March 2021 SECTION 2. ADDITIONAL INFORMATION (40 CFR 122.21(j)(1) and (2)) o 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? o ❑ Yes 0 No 4 SKIP to Section 3. 0 2.2 Provide the treatment works' current average daily volume of inflow Average Daily Volume of Inflow and Infiltration w and infiltration. gpd Indicate the steps the facility is taking to minimize inflow and infiltration. c 3 0 r_ c 2.3 Have you attached a topographic map to this application that contains all the required information? (See instructions for s R specific requirements.) a> C 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? cM (See instructions for specific requirements.) rn " 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. d d 2. E w 0 y d 3. d 4. U ) v v 2.6 Provide scheduled or actual dates of completion for improvements. Scheduled or Actual Dates of Completion for Improvements d > Scheduled Affected Outfalls Begin End Begin Attainment of Operational o Improvement l (list outfanumber) Construction Construction Discharge Level E (from above) ) (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) MM/DD/YYYY d ,3 d n 2. 3. 4. 2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your response. ❑ Yes ❑ No ❑ None required or applicable Explanation: Page 5 NPDES Permit Number Facility Name Modified Application Form 2A NCO051713 Lakeview Mobile Home Park Modified March 2021 SECTION•' • ON I 1 to 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 North Carolina County Forsyth O w City or town High Point 0 gDistance from shore NA ft. Depth below surface NA ft. d 0 Average daily flow rate NA mgd mgd mgd Latitude 36 of 30" o" Longitude so od 00" 3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges? R o ❑ Yes ❑ No 4 SKIP to Item 3.4. a R 3.3 If so, provide the following information for each applicable outfall. L y Outfall Number Outfall Number Outfall Number Number of times per year discharge occurs o Average duration of each `o discharge (specify units oAverage flow of each mgd mgd mgd discharge u, Months in which discharge occurs 3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser? ❑ Yes 0 No + SKIP to Item 3.6. m 3.5 Briefly describe the diffuser t pe at each applicable outfall. CL Outfall Number Outfall Number Outfall Number m 0 0 vi 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? ❑ Yes ❑ No +SKIP to Section 6. Page 6 NPDES Permit Number Facility Name Modified Application Form 2A NCO051713 Lakeview Mobile Home Park Modified March 2021 3.7 Provide the receiving water and related information if known for each outfall. Outfall Number Outfall Number Outfall Number Receiving water name Name of watershed, river, `o or stream system s U.S. Soil Conservation H Service 14-digit watershed c code Name of state 3 management/river basin rn U.S. Geological Survey 8-digit hydrologic unit code —cataloging 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 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 ❑ Secondary ❑ Secondary ❑ Secondary ❑ Advanced ❑ Advanced ❑ Advanced ❑ Other (specify) ❑ Other (specify) ❑ Other (specify) c 0 EL Design Removal Rates by 0 Outfall fA N BOD5 or CBOD5 % % % d E cc m TSS % % % ❑ Not applicable ❑ Not applicable ❑ Not applicable Phosphorus % % % ❑ Not applicable ❑ Not applicable ❑ Not applicable Nitrogen % % % Other (specify) ❑ Not applicable ❑ Not applicable ❑ Not applicable Page 7 NPDES Permit Number Facility Name Modified Application Form 2A NCO051713 Lakeview Mobile Home Park 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. _ 0 Outfall Number Outfall Number Outfall Number 0 Disinfection type U N d 0 Seasons used d E d Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable ❑ Yes ❑ Yes ❑ Yes ❑ No ❑ No ❑ No 3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package? ❑ 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 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? ❑ Yes 4 Complete Table B, including chlorine. ❑ No -+ Complete Table B, omitting chlorine. 3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application package? ❑ 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 NCO051713 Lakeview Mobile Home Park 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 MM/DD/YYYY v m c i c p co 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in c toxicity? c w ❑ Yes ❑ No 4 SKIP to Item 3.26. 3.23 Describe the cause(s) of the toxicity: c m a W 3.24 Has the treatment works conducted a toxicity reduction evaluation? ❑ Yes ❑ No SKIP to Item 3.26. 3.25 Provide details of any toxicity reduction evaluations conducted. 3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package? ❑ Yes ❑ Not applicable because previously submitted information to the NPDES permitting authority. Page 9 NPDES Permit Number Facility Name Modified Application Form 2A NC0051713 Lakeview Mobile Home Park Modified March 2021 SECTION. CHECKLIST AND 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 ❑ wi variance request(s) 0 wl additional attachments Information for All Applicants ❑ Section 2: Additional ❑ wl topographic map ❑ wl process flow diagram Information ❑ wl additional attachments ❑ wl Table A ❑ wl Table D ❑ Section 3: Information on ❑ wl Table B ❑ wl additional attachments Effluent Discharges E ❑ wl Table C d (n Section 4: Not Applicable 0 Section 5: Not Applicable d U ❑ Section 6: Checklist and ❑ wl attachments Certification Statement Y 6.2 Certification Statement U 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 Walter B. Craven _-r—zA Y� Owner Y Signature Date signed V'�� -C�- /J­2 /'� /-/ RECEIVED JUN 0 3 L324 NCDEQ/DWR/NPDES Page 10 n .,z; ., Cm, l n., in. cnr_179nQ AC47 AnAr) QOA7 rMMr)7GRnO0nO ti. I . i S ' \ lie r oil S � of � � �, � � � � � �� � ��' ' � ■ � `,' ildi �� � � .r•f� �� - ' � ` drip c - l Discharge Point / i . I C; i — W. ti '\.�- - Ott .�. � r �t.- t,' .. • j i [� � 1) • i. !),f _ .. � f `�`, 4 �i� i , � .s�� � , � • .. yr. . • M ...._ _.,, .,,ass.; Orne 13 q • k6 , or 14 ,� ` '�/ • 1, t. ;lA �- I I • Lakeview Mobile Home Park - NCO051713 Facility • Location USGS Quad: Kernersville, N.C. Latitude: Receiving Stream: UT to Cuddybum Creek 36001'20" Stream Class: WS-III Subbasin: Yadkin -Pee Dee - 03-07-07 Longitude: Ar� 1Q Forsyth County 80°04'00" JV (�l�l� Map not to scale NPDES Permit Number Facility Name Outfall Number NCO051713 Lakeview Mobile Home Park 001 Modified Application Form 2A Modified March 2021 Maximum Daily Discharge Average Daily Discharge Pollutant Analytical ML or MDL Number of Value Units Value Units Methods (include units) Samples Biochemical oxygen demand ❑ BODs or ❑ CBODs 27.3 MG/I <2 MG/L 52 SM5210 B-2016 MG/L OML (report one ❑ MDL Fecal coliform 365.4 MPN/100 <1 MPN/100 52 IDEXX Coilert 18 MPI MPN/100 OML ❑ MDL Design flow rate 0.018 MGD 0.006 MGD 52 SM2540 D-2015 MG/L pH (minimum) 6.6 pH (maximum) 7.7 Temperature (winter) 24 Celcius 6 Celcius 52 Temperature (summer) 29 Celcius 11 Celcius 52 Total suspended solids (TSS) 233 MG/L <1 MG/L 52 ❑ MDL Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3). Page 11 EPA Identification Number NPDES Permit Number Facility Name I Outfall Number NCO051713 Lakeview Mobile Home Park Modified Application Form 2A Modified March 2021 Maximum Daily Discharge Average Daily Discharge Pollutant Analytical ML or MDL Number of Value Units Value Units Method' (include units) Samples Ammonia (as N) ❑ ML ❑ MDL Chlorine ❑ ML total residual, TRC 2 ❑ MDL Dissolved oxygen ❑ ML ❑ MDL Nitrate/nitrite ❑ ML ❑ MDL Kjeldahl nitrogen ❑ ML ❑ MDL Oil and grease ❑ ML ❑ MDL Phosphorus ❑ 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 NCO051713 Lakeview Mobile Home Park Modified March 2021 •' 11261 Maximum Daily Discharge Average Daily Discharge Pollutant Analytical I ML or MDL Value Units Value Units Number of Method' 1 (include 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 ❑ 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 in ❑ ML ❑ MDL ❑ ML nitrile LBenzene ❑ MDL ❑ ML ❑ MDL oform ❑ 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 NCOO51713 Lakeview Mobile Home Park Modified March 2021 Maximum Daily Discharge Average Daily Discharge � Pollutant Analytical ML or MDL iValue Units Value Units Number of Method' (include 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 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 NCOO51713 Lakeview Mobile Home Park Modified March 2021 •• 1 •• Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL Pollutant �— — -- y 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)anthrace ne ❑ 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 NCOO51713 Lakeview Mobile Home Park Modified March 2021 Maximum Daily Discharge Average Daily Discharge Pollutant Analytical ML or MDL Value Units Value Units Number of Method' (include units) Samples Benzo(ghi)perylene ❑ ML ❑ MDL Benzo(k)fluoranthene El MI ❑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 NCO051713 Lakeview Mobile Home Park Modified March 2021 Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL Pollutant Number of Method' (include units) Value Units Value Units Sam les 1,2-diphenylhydrazine ❑ ML ❑ MDL Fluoranthene El ML ❑ MDL Fluorene ❑ ML ❑ MDL Hexachlorobenzene ❑ ML ❑ MDL Hexachlorobutadiene ❑ ML ❑ MDL Hexachlorocyclo-pentadiene ❑ ML ❑ MDL Hexachloroethane El ML ❑ MDL lndeno(1,2,3-cd)pyrene El 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 ' 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 NCOO51713 Lakeview Mobile Home Park Modified March 2021 a Maximum Dail Dischar Average Dail Discharge Pollutant Analytical ML or MDL Value Units Value Units Number of (list) 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