NC0021946_Renewal (Application)_20201008

SfA sJ
. ' a 00• " r
ifig
r 3 r y
ROY COOPER - "
Governor
MICHAEL S. REGAN -'
Secretary
S. DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
October 08, 2020
Town of Rosman
Attn: Brian Shelton, Mayor
PO Box 636
Rosman, NC 28772
Subject: Permit Renewal
Application No. NC0021946
Rosman WWTP
Transylvania County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 5, 2020 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
ren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
�� North is ro r Deps rtrrent of Envuonmenta'Qua ty I Dyson of W ter Fes:q roes
D_E C�, Ash=v ?Raganai DfRoe 12094 U.S.7D►f gtr ay I Spar c anoe,North Ce ro rs i&??a
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TOWN OF ROSMAN
MAYOR POST OFFICE BOX 636 ALDERMEN
Brian Shelton ROSMAN, NC 28772 Jared Crowe
ATTORNEY 828-884-6859 Mark Miller
Donald Barton [e-mail] Larry Bullock
TOWN CLERK Tricia Hendricks
Angela Woodson Deedra Shelton
September 30, 2020
RECEIVED
0C1 0 5 2020
Ms. Wren Thedford
NCDENR/DWR/NPDES Unit NCDSQ/DWR/NPDSS
1617 Mail Service Center
Raleigh,NC 27699-1617
Re: Permit Renewal Application—NC0021946
Dear Ms. Thedford,
Enclosed,please find the permit renewal application for the Town of Rosman.
There have been no changes to the facility since the issuance of our last permit. Therefore I, on
behalf of the town, am requesting the renewal of said permit.
Furthermore,the town does not have a sludge management plan, all sludge processed is taken to
the Transylvania County landfill site for disposal.
Sincerely,
TOWN OF ROSMAN
Brian Shelton
Mayor/Town Administrator

•
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A 8 EPA Application for NPDES Permit to Discharge Wastewater
NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
TOWN OF ROSMAN
Mailing address(street or P.O.box)
POST OFFICE BOX 636
City or town State ZIP code
o ROSMAN NC 28772
Contact name(first and last) Title Phone number Email address
c
BRIAN SHELTON MAYOR [phone] rosmantowncomporium.net
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
6 MAIN STREET
w City or town State ZIP code
ROSMAN NC 28772
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 ❑✓ No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O.box)
0
City or town State ZIP code
c
Contact name(first and last) Title Phone number Email address
.a
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.)
El Facility El 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)
FRENCH BROAD
2 ❑ PSD(air emissions) ❑ Nonattainment program(CAA) 0 NESHAPs(CM)
cn
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
75 %separate sanitary sewer 0 Own 0 Maintain
ROSMAN 780 %combined storm and sanitary sewer 0 Own 0 Maintain
d 0 Unknown 0 Own 0 Maintain
Cl) %separate sanitary sewer ❑ Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer El 0 Maintain
_ %combined storm and sanitary sewer 0 Own 0 Maintain
t6 0 Unknown 0 Own 0 Maintain
E %separate sanitary sewer ❑ Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
cn
c 0 Unknown 0 Own 0 Maintain
c Total
Population 780
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of ° °
sewer line(in miles) no /0 o �0
z' 1.8 Is the treatment works located in Indian Country?
c
o 0 Yes ❑✓ No
U
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.250 mgd
= Annual Average Flow Rates(Actual)
T.;
Two Years Ago Last Year This Year
ca
Ta ce
c
RI
c o .1154 mgd .1029 mgd .101 mgd
7•" Maximum Daily Flow Rates(Actual)
rm Two Years Ago Last Year This Year
.230 mgd .156 mgd .277 mgd 1
N 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
c Total Number of Effluent Discharge Points by Type
o
a Constructed
P.'1— Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
s .o Overflows Overflows
U
H
b 1
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd 0 Intermittent
.2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
c 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
acresgpd 0 Continuous
y ❑ Intermittent
d 0 Continuous
acres
L g13 0 Intermittent
-0 0 Continuous
R acres gpd 0 Intermittent
Ti 1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ Yes m No 4 SKIP to Item 1.21.
0
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
EPA Form 3510-2A(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
n Facility name Mailing address(street or P.O.box)
°D TOWN OF ROSMAN POST OFFICE BOX 636
City or town State ZIP code
o ROSMAN NC 28772
Contact name(first and last) Title
o BRIAN SHELTON MAYOR
d Phone number Email address
[phone] [e-mail]
aNPDES number of receiving facility(if any) ❑ None Average daily flow rate 101 mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
T.
❑ Yes ❑✓ No 4 SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
= Method Disposal Site Disposal Site Daily Discharge (check one)
03 Description Volume
acres gpd ❑ Continuous
0 Intermittent
0 Continuous
acres gpd ❑ Intermittent
acres gpd 0 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.
w 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
ca 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+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
(company name)
Mailing address
(street or P.O. box)
City,state,and ZIP
code
Contact name(first and
O last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

r
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c Outfalls to Waters of the United States
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
as
❑✓ 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. 5,000
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
as
CORRECT ISSUES AS NEEDED
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
I
a specific requirements.)
om
a. ❑✓ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
13 (See instructions for specific requirements.)
0 a,
" ❑ 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.
d
E
a,
2.
E
0 0
3.
a
d
co
4.
-o
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
Improvement Construction Construction Discharge
a. (from above) (list outtall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
1.
d
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number o01 Outfall Number Outfall Number
State NORTH CAROLINA
1 County TRANSYLVANIA
0 City or town ROSMAN
Distance from shore 50 ft. ft. ft.
Depth below surface o ft. ft. ft.
0
Average dailyflow rate .101 mgd mgd mgd
9 9
Latitude 35° 08' 10" N ° 0 "
Longitude 82° 49' 15" W
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
Fa ❑ Yes ✓❑ No 4 SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
y Outfall Number Outfall Number Outfall Number
Number of times per year
0 discharge occurs
a Average duration of each
discharge(specify units)
c Average flow of each mgd mgd mgd
discharge
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.
Q
Outfall Number Outfall Number Outfall Number
c vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
3 ❑ Yes ❑✓ No+SKIP to Section 6.
EPA Form 3510-2A(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name FRENCH BROAD
Name of watershed,river, FRENCH BROAD BASIN
c or stream system
U.S.Soil Conservation
H Service 14-digit watershed 04-03-01/06010105
code
Name of state FRENCH BROAD RIVER
management/river basin
a
U.S.Geological Survey
8-digit hydrologic
cc cataloging unit code
Critical low flow(acute) N/A cfs cfs cfs
Critical low flow(chronic) N/A cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow N/A CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number Outfall Number Outfall Number
Highest Level of ❑ Primary ❑ Primary 0 Primary
Treatment(check all that 0 Equivalent to ❑ Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary ❑ Secondary 0 Secondary
❑ Advanced ❑ Advanced 0 Advanced
O Other(specify) ❑ Other(specify) ❑ Other(specify)
0
Design Removal Rates by
a.
'c Outfall
N
BOD5 or CBOD5 85
ai TSS 85
r=
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
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below.If disinfection varies by
season,describe below.
d
.c
0
Outfall Number o01 Outfall Number Outfall Number
0- Disinfection type
5 uv
z Seasons used
Tel
Dechlorination used? 0 Not applicable 0 Not applicable ❑ Not applicable
❑ Yes 0 Yes 0 Yes
❑ No 0 No 0 No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes 0 No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑✓ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
0 Yes ❑ No 4 SKIP to Item 3.16.
0 3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. p 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 0 No
3.16 Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C,must
sample other additional parameters(Table D),or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls(Table E).
Yes 4 Complete Tables C,D,and E as
O applicable. 0No 4 SKIP to Section 4.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
O Yes ❑ No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Method1 (include units)
Samples
Biochemical oxygen demand
o BOD5 or 0 CBOD5 45 MG/L 30 MG/L 4 SM5210 ©ML
❑MDL
(report one)
Fecal coliform 400 100ML 200 100ML 4 SM92220 ❑ML
0 MDL
Design flow rate .250 MGD
pH(minimum) 6 SU
pH(maximum) 9 SU
Temperature(winter) 13.5 C 6 C 4
Temperature(summer) 22.5 C 21 C 4
Total suspended solids(TSS) 45 MG/L 30 MG/L 4 ❑ML
0 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 O.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 13
L

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
El 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?
ID Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
-a
m
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?
❑ Yes El No 4 SKIP to Item 3.26.
F 3.23 Describe the cause(s)of the toxicity:
C,
a�
Ui
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?
El Yes ❑ Not applicable because previously submitted
information to the NPDES .ermittin. authorit .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.21(j)(6)and(7))
4.1 Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes ❑✓ No 4 SKIP to Item 4.7.
j 4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs Number of NSCIUs
4.3 Does the POTW have an approved pretreatment program?
uzi
= El Yes ❑ No
-a
5 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
d identical to that required in Table F:(1)a pretreatment program annual report submitted within one year of the
application or(2)a pretreatment program?
❑ Yes ❑ No 4 SKIP to Item 4.6.
o 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
-a
4.6 Have you completed and attached Table F to this application package?
El Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
4.7 Does the POTW receive,or has it been notified that it will receive,by truck,rail,or dedicated pipe,any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ❑✓ No 4 SKIP to Item 4.9.
4.8 If yes, provide the following information:
Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
O
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
N ❑ Truck ❑ Rail
as
❑ Dedicated pipe ❑ Other(specify)
as
as 4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
❑ Yes ❑✓ No-)SKIP to Section 5.
y 4.10 Does the POTW receive(or expect to receive)less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d)and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ❑ No
4.11 Have you reported the following information in an attachment to this application:identification and description of the
site(s)or facility(ies)at which the wastewater originates;the identities of the wastewater's hazardous constituents;and
the extent of treatment,if any,the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION 5.COMBINED SEWER OVERFLOWS(40 CFR 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
T.
El Yes ❑� No+SKIP to Section 6.
03
5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
1d ❑ Yes ❑ No
a
R
O 5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
5.4 For each CSO outfall,provide the following information.(Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
a State and ZIP code
0
o County
3 Latitude 1 II ° °
0
II
cn Longitude °
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Rainfall 0 Yes 0 No ❑ Yes 0 No 0 Yes 0 No
0)
0 CSO flow volume 0 Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No
CSO pollutant 0 Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
o concentrations
CO
c3 Receiving water quality 0 Yes ❑ No 0 Yes ❑ No ❑ Yes 0 No
CSO frequency 0 Yes 0 No ❑ Yes ❑ No 0 Yes 0 No
1 Number of storm events ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Al Number of CSO events in events events events
H the past year
a.
Average duration per hours hours hours
c event ❑Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
m
W million gallons million gallons million gallons
o Average volume per event
co
c.) 0 Actual or 0 Estimated 0 Actual or 0 Estimated ❑Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall , inches of rainfall
a CSO event in last year 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number_ CSO Outfall Number_ CSO Outfall Number
Receiving water name
Name of watershed/
y stream system
U.S.Soil Conservation ❑Unknown ❑Unknown ❑ Unknown
Service 14-digit
watershed code
'> (if known)
Name of state
management/river basin
U.S.Geological Survey 0 Unknown 0 Unknown 0 Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam i les
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
❑ Section 1: Basic Application ❑ w/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 ❑ w/Table B ❑ w/Table E
• Effluent Discharges
❑ w/Table C ❑ w/additional attachments
w Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑ w/Table F
❑ Discharges and Hazardous
s Wastes ❑ w/additional attachments
Section 5:Combined Sewer ❑ wl CSO map ❑ w/additional attachments
❑ Overflows
❑ w/CSO system diagram
❑ Section 6:Checklist and ❑ w/attachments
Certification Statement
Y 6.2 Certification Statement
cu
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
BRIAN SHELTON MAYOR
Signature Date signed
09/30/2020
EPA Form 3510-2A(Revised 3-19) Page 12
1

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include
Value Units Value Units Samples units)
0 ML
Ammonia(as N) 6.3 MG/L 4.5 MG/L 4 SM4500NH 3-F 0 MDL
Chlorine ❑ML
(total residual,TRC)2 ❑MDL
0 ML
Dissolved oxygen ❑MDL
Nitrate/nitrite 22 MG/L 19 MG/L 2 EPA353.2 ❑ML
❑MDL
0 ML
Kjeldahl nitrogen 1.0 MG/L 1.0 MG/L 2 EPA351.2 0 MDL
0 ML
Oil and grease ❑MDL
❑ML
Phosphorus 4 MG/L 4 MG/L 2 EPA365.1 0 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 15

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
o ML
Hardness(as CaCO3) ❑MDL
0 ML
Antimony,total recoverable ❑MDL
Arsenic,total recoverable ❑ML
❑MDL
0 ML
Beryllium,total recoverable ❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDLML
Copper,total recoverable ❑MDL
Lead,total recoverable ❑ML
❑MDL
0 ML
Mercury,total recoverable ❑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
❑ML
Cyanide ❑MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
Acrolein ❑ML
_ ❑MDL
0 ML
Acrylonitrile ❑MDL
Benzene 0 ML
❑MDL
Bromoform ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Carbon tetrachloride ❑ML
_ ❑MDL
Chlorobenzene ❑ML
0 MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane El ML
❑MDL
ML
2-chloroethylvinyl ether ❑MDL
Chloroform 0 ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
0 ML
trans-1,2-dichloroethylene 0 MDL
ML
1,1-dichloroethylene ❑MDL
0 ML
1,2-dichloropropane ❑MDL
ML
1,3-dichloropropylene 0 MDL
ML
Ethylbenzene 0 MDL
ML
Methyl bromide ❑MDL
ML
Methyl chloride ❑MDL
0 ML
Methylene chloride ❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
El ML
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 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
ML
Trichloroethylene 0 MDL
ML
Vinyl chloride ❑MDL
Acid-Extractable Compounds
ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol ❑MDL
0 ML
2,4-dichlorophenol ❑MDL
0 ML
2,4-dimethylphenol 0 MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
0 ML
2,4-dinitrophenol ❑MDL
0 ML
2-nitrophenol ❑MDL
❑ML
4-nitrophenol ❑MDL
0 ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
0 ML
2,4,6-trichlorophenol ❑MDL
Base-Neutral Compounds
ML
Acenaphthene o MDL
ML
Acenaphthylene ❑MDL
Anthracene ❑ML
❑MDL
Benzidine ❑ML
❑MDL
0 ML
Benzo(a)anthracene ❑MDL
0 ML
Benzo(a)pyrene ❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
ID ML
Benzo(ghi)perylene 0 MDL
0 ML
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane ❑MDL
0 ML
Bis(2-chloroethyl)ether ❑MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
0 ML
Bis(2-ethylhexyl)phthalate 0 MDL
0 ML
4-bromophenyl phenyl ether ❑MDL
0 ML
Butyl benzyl phthalate 0 MDL
0 ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether ❑MDL
0 ML
Chrysene ❑MDL
0 ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate 0 MDL
❑ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ID ML
❑MDL
1,4-dichlorobenzene ID ML
❑MDL
3,3-dichlorobenzidine ID ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
ID ML
Dimethyl phthalate ❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ID ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
o ML
1,2-diphenylhydrazine ❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
❑MDL
Hexachlorobutadiene ❑ML
❑MDL
ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane El ML
❑MDL
ML
Indeno(1,2,3-cd)pyrene o MDL
ML
Isophorone ❑MDL
ML
Naphthalene ❑MDL
Nitrobenzene ❑ML
❑MDL
0 ML
N-nitrosodi-n-propylamine 0 MDL
0 ML
N-nitrosodimethylamine ❑MDL
ML
N-nitrosodiphenylamine ❑MDL
Phenanthrene ❑ML
❑MDL
0 ML
Pyrene ❑MDL
1,2,4-trichlorobenzene ❑ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 21

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03105/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar e
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method1 (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
o 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).
EPA Form 3510-2A(Revised 3-19) Page 23

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number Test Number Test Number
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one: ❑ Grab ❑ Grab 0 Grab
❑ 24-hour composite ❑ 24-hour composite ❑ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection 0 Before Disinfection ❑ Before disinfection
❑After Disinfection 0 After Disinfection 0 After disinfection
❑ After Dechlorination 0 After Dechlorination 0 After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 0 Acute 0 Acute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑ Chronic ❑ Chronic El Chronic
O Both ❑ Both 0 Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0021946 TOWN OF ROSMAN
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static ❑ Static
response.)
❑ Static-renewal ❑ Static-renewal ❑ Static-renewal
❑ Flow-through ❑ Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water ❑ Laboratory water
one response.)
❑ Receiving water 0 Receiving water ❑ Receiving water
If laboratory water,specify type.
If receiving water,specify source.
Type of Dilution Water
Indicate the type of dilution water.If salt 0 Fresh water ❑ Fresh water ❑ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. 0 Salt water(specify) ElSalt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. ❑ pH ❑ Ammonia 0 pH ❑ Ammonia 0 pH 0 Ammonia
❑ Salinity ❑ Dissolved oxygen 0 Salinity ❑ Dissolved oxygen ❑ Salinity 0 Dissolved oxygen
❑ Temperature ❑ Temperature ❑ Temperature
Acute Test Results
Percent survival in 100%effluent
LCso
95%confidence interval
Control percent survival
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC
IC25 % %
Control percent survival %
Other(describe)
•
Quality ControllQuality Assurance
Is reference toxicant data available? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
Was reference toxicant test within
acceptable bounds? El Yes El No El Yes El No ❑ Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
EPA Form 3510-2A(Revised 3-19) Page 27

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU_ SIU SIU
Name of SIU
Mailing address(street or P.O.box)
City,state,and ZIP code
Description of all industrial processes that affect
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU. gpd gpd gpd
How much of the average daily volume is
attributable to process flow? gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? gpd gpd gpd
Is the SIU subject to local limits?
❑ Yes ❑ No 0 Yes 0 No 0 Yes 0 No
Is the SIU subject to categorical standards?
0 Yes 0 No 0 Yes ❑ No 0 Yes 0 No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0021946 TOWN OF ROSMAN OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU SIU_ SIU
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 0 Yes 0 No ❑ Yes ❑ No ❑ Yes 0 No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30