NC0081426_Renewal (Application)_20210511

`1,s STArE o-
4�, M^'."
ROY COOPER cy
Governor 1 0 `�
: i-'
DIONNE DELLI-GATTI «x*„�.,•
Secretary �rz=; f
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
May 11, 2021
City of Greensboro
Attn: Dell Harney, Water Supply Manager
PO Box 3136
Greensboro, NC 27402-3136
Subject: Permit Renewal
Application No. NC0081426
N.L. Mitchell WTP
Guilford County
Dear Applicant:
The Water QualityPermittingSection acknowledges the May11, 2021 receipt ofyourpermit renewal application and
9 P PP
supporting documentation. Your application will be assigned to apermit writer within the Section's NPDES WW permitting
9 PP 9 P 9
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-quidance/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, i II
Lf:
Wren Thedforw
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Q_J/ North Carolina Department of Environmental Quality Division of Water Resources m Winston-Salem Regional Office 450 West Hanes Mill Road.Suite 300 Winston-Sale North Carolina 27105
336.7769800

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 $%EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 12
treatment works? 1. . treating domestic sewage?
If yes,STOP. Do NOT complete No If yes, STOP. Do NOT No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial, mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
oYes 4 Complete Form 1 ❑✓ No Yes 4 Complete Form p✓ No
a and Form 2B. 1 and Form 2C.
0 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
o ❑ Yes 4 Complete Form 1 E✓ No Yes 4 Complete Form No
and Form 2D. 1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose
' discharge is composed entirely of stormwater Set oW&cL wv t- c
associated with industrial activity or whose RECEIVED
discharge is composed of both stormwater and
non-stormwater?
Yes 4 Complete Form 1 ❑✓ No MAY 11 2021
and Form 2F
unless 40 CFR exempted by NCDEQ/DWR/NPDES
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
N.L Mitchell Water Treatment Plant
2.2 EPA Identification Number
U
O NCR000013078
2.3 Facility Contact
Name(first and last) Title Phone number
-o Dell Harney Water Supply Manager [phone]
a
a) Email address
dell.harney@ greensboro-nc.gov
2.4 Facility Mailing Address
co
a Street or P.O.box
PO Box 3136
City or town State ZIP code
Greensboro NC 27402-3136
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
, 2.5 Facility Location
Street,route number,or other specific identifier
tc
Q o 1041 Battleground Avenue
ca
o County name County code(if known)
Guilford
o
E City or town State ZIP code
co z R Greensboro NC 27408
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
4941 water supply
a
a)
0
0
U
N
3.2 NAICS Code(s) Description(optional)
U
N
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
City of Greensboro
0 4.2 Is the name you listed in Item 4.1 also the owner?
o ❑✓ Yes ElNo
4.3 _Operator Status
❑ Public—federal El Public—state ❑✓ Other public(specify)municipal
❑ Private El Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
E 0 1041 Battleground Avenue
o g
City or town State ZIP code
0 o Greensboro NC 27408
is U
fl Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
5.1 Is the facility located on Indian Land?
as
C ❑ Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
Tts
a m NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
o water) fluids)
NC0081426 Small Generator NCR000013078
w a ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
a)
.y
r or fill(CWA Section 404) ❑ Other(specify)
'x Ocean dumping(MPRSA) ❑ Dredge
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
2
❑✓ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Water Supply-Conventional Water Treatment Facility that provides potable water for the City of Greensboro and
some Guilford County residents.
m
N
C
.N
O
a)
td
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
d ElYes 0No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
a, , 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
c �' NPDES permitting authority to determine what specific information needs to be submitted and when.)
°'
O Y
U
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
CO when.)
CD
C ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
cc Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and(g))
❑✓ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 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:Activities Requiring an NPDES Permit ❑✓ w/attachments
❑✓ Section 2: Name, Mailing Address,and Location ❑ w/attachments
❑✓ Section 3: SIC Codes ❑ w/attachments
❑✓ Section 4:Operator Information ❑ w/attachments
❑ Section 5: Indian Land ❑ w/attachments
❑✓ Section 6: Existing Environmental Permits ❑ w/attachments
w/topographic
Section 7: Map ❑✓ map ❑
❑✓ w/additional attachments
o ❑✓ Section 8: Nature of Business Elw/attachments
❑ Section 9: Cooling Water Intake Structures/0 ❑ w/attachments
a
El Section 10:Variance Requests N/4 El w/attachments
I �
17') ❑✓ Section 11: Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
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
Dell Harney Water Supply Manager
Signature Date signed
oniavoc2 /
EPA Form 3510-1(revised 3-19) Page 4

EPA FORM 3510-1,ATTACHMENT 1(FOR SECTION 1.0)
This NPDES permit(NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro(PWSID 0241010). The process waste system influent flow is composed of Filter
backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent
to either a Sanitary Sewer collection system or the NPDES permitted outfall. All process waste system
discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This
has been due to hydraulic restraints inherent to the process waste system that can limit water
treatment plant production and also to ongoing capital improvement construction projects on the site.
Improvements to the process waste system are in the design phase which,when constructed,will make
NPDES discharge possible again. Construction of the new system is planned to begin June of 2022 with
an expected duration of 18 months.
This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit
without having discharged to the designated outfall for the previous permit cycle and thus having no
discharge analysis data to provide. Instructions from our regional NCDEQ office for renewal of the
Mitchell NPDES permit are to complete:
• EPA form 1
• EPA form 2E
• Tables A&C of EPA form 2C, as well as table B if applicable
N.L. Mitchell WTP process waste system line drawing
-- Ex.Waste Clarifier
A. With Decanter&
NPR& Ex.Backwash Hydraulic im•rovernenb
Waste PS
• ( HPDES
iD ' D ' E.
iF
C . r
Settled Solids > - r 1 Sardtary Sewer

EPA FORNI 3510-1, ATTACHMENT 2 (I:()I SECTION 7.0)
Permit NC0081426
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City of Greensboro \ Mgr ilio 'Wit 1
N.1..Mitchell WTP et lirtil Ira 1 9 119fft Nei cy
NPDES Permit NC0081426
A yr Sowilf iiii,wi V,ift&V V
Facility L lkocatiol 411 mti,
Receiving Stream:North Buffalo Creek Stream Ciaas:WS V,NSW sc..11e nut shuven ai
Stream Segment:16 11 1.1 1 Sub Basin#:93 06 02 ,
River Basin:Cape Fear trUC:0303000201 SCALE 36.081389', -79.803333"
County:Guilford 1.24.000 USGS Quad G re ensboro
1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 R/EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
1.1.1 Is the facility a new or existing publicly owned 1 1 2 Is the facility a new or existing treatment works
treatment works? treating domestic sewage?
If yes,STOP. Do NOT complete ❑✓ No If yes.STOP. Do NOT 0✓ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial, mining,or silvicultural facility that is
Zr) production facility? currently discharging process wastewater?
o Yes 4 Complete Form 1 ❑✓ No ❑ Yes 4 Complete Form �✓ No
z and Form 2B. 1 and Form 2C.
c 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial, mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
d Yes 4 Complete Form 1 ❑✓ No 0 Yes-4 Complete Form 0✓ No
ce and Form 2D. 1 and Form 2E.
(4))°' 1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater 5e,e, occt,cLt►ANttAlk" '4.
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
El Yes 4 Complete Form 1 0 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b(15 .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
N.L Mitchell Water Treatment Plant
2.2 EPA Identification Number
0 NCR000013078
2.3 Facility Contact
i Name(first and last) Title Phone number
-o Dell Harney Water Supply Manager [phone]
Email address
dell.harney@ greensboro-nc.gov
2.4 Facility Mailing Address
Street or P.O.box
PO Box 3136
City or town State ZIP code
Greensboro NC 27402-3136
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
13 2.5 Facility Location
a Street,route number,or other specific identifier
Q 0 1041 Battleground Avenue
U
o County name County code(if known)
Guilford
E _1 City or town State ZIP code
R Greensboro NC 27408
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
4941 water supply
0
0
0
U
co
U
z 3.2 NAICS Code(s) Description(optional)
U
N
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
I 4.1 I Name of Operator
City of Greensboro
4.2 Is the name you listed in Item 4.1 also the owner?
❑✓ Yes ❑ No
= 4.3 Operator Status
0 Public—federal ❑ Public—state EZ Other public(specify)municipal
o ❑ Private 0 Other(specify)
4.4 Phone Number of Operator
[phone]
= 4.5 Operator Address
Street or P.O. Box
>` 0 1041 Battleground Avenue
`0 0
= w City or town State ZIP code
0 0 Greensboro NC 27408
7,4 U
a Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.210)(5))
@ -a 5.1 Is the facility located on Indian Land?
co ❑Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
y water) fluids)
o NC0081426 Small Generator NCR000013078
E
w a ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CAA)
x ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
2
❑✓ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Water Supply-Conventional Water Treatment Facility that provides potable water for the City of Greensboro and
some Guilford County residents.
U)
a)
0
a>
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
L ❑ Yes ❑✓ No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
2 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
o Y NPDES permitting authority to determine what specific information needs to be submitted and when.)
o ra
U
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
CO ❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
co Section 301(c)and(g))
❑✓ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are endosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1 Column 2
❑✓ Section 1:Activities Requiring an NPDES Permit ❑✓ w/attachments
❑✓ Section 2:Name, Mailing Address,and Location ❑ wl attachments
❑✓ Section 3: SIC Codes ❑ w/attachments
❑✓ Section 4:Operator Information ❑ wl attachments
❑ Section 5: Indian Land ❑ w/attachments
c
❑✓ Section 6: Existing Environmental Permits ❑ w/attachments
w/❑ topographic✓ Section 7: Map ❑✓ map ❑ w/additional attachments
rtSo ElSection 8: Nature of Business 0 wl attachments
03
❑ Section 9:Cooling Water Intake Structures/VA ❑ wl attachments
❑ Section 10:Variance Requests 04 ❑ w/attachments
❑✓ Section 11: Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
U
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
Dell Harney Water Supply Manager
Signature Date signed
(-71 /1/
EPA Form 3510-1(revised 3-19) Page 4

EPA FORM 3510-1,ATTACHMENT 1 (FOR SECTION 1.0)
This NPDES permit(NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter
backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent
to either a Sanitary Sewer collection system or the NPDES permitted outfall. All process waste system
discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This
has been due to hydraulic restraints inherent to the process waste system that can limit water
treatment plant production and also to ongoing capital improvement construction projects on the site.
Improvements to the process waste system are in the design phase which,when constructed,will make
NPDES discharge possible again. Construction of the new system is planned to begin June of 2022 with
an expected duration of 18 months.
This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit
without having discharged to the designated outfall for the previous permit cycle and thus having no
discharge analysis data to provide. Instructions from our regional NCDEQ office for renewal of the
Mitchell NPDES permit are to complete:
• EPA form 1
• EPA form 2E
• Tables A&C of EPA form 2C, as well as table B if applicable
N.L. Mitchell WTP process waste system line drawing
Ex.Waste Clarifier
A With Decanter &
Fitter Backwash EX. Backwash Hydraulic[m rovernents
- Waste PS _.....
HPDES
> .
F
c
Settled Solids ~,' sanitary Sewer

EPA FORM 3510-1, ATTACHMENT 2 (FOR SECTION 7.0)
Permit NC0081426
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City of Greensboro N
NI.Mitchell WTP
NPDES Permit NC0081426 A •
Facility Locetici
Receiving Stream:North Buffalo eicok Stearn Class:WS•V,NSW irnut sl,awri
Stream Segment:1E,11 14 1 Sub Basin g:$3 06 02
River Basin:Cape Fear HUC:$3Uj0002U1 SCALE 36.081383 . 79.eO3333"
County:Guilford 1.24.O00 usOsQuad.Greensboro

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C 'irk EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
O Numbelr Receiving Water Name Latitude Longitude
0
001 North Buffalo Creek 36° 0813' 89" -79° 8033' 33"
O
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
p, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
. balance?(See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
o ❑✓ Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1,provide average flow and treatment information.Add additional sheets if
necessary. 5 e r c, C.ck e
**Outfall Number**o01
Operations Contributing to Flow
Operation Average Flow
FILTER BACKWASH o mgd
E FILTER TO WASTE(REWASH) o mgd
io
mgd
N mgd
3
LL Treatment Units
a, Description Final Disposal of Solid or
Code from
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
DECHLORINATION 2E
CLARIFICATION 1U SANITARY SEWER
DISCHARGE TO SURFACE WATER 4A
DISCHARGE TO SANITARY SEWER
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
3.1 "Outfall Number"
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
•0
d
c
C
0
U
c
N
io
0 **Outfall Number**
Operations Contributing to Flow
0 Operation Average Flow
mgd
d
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
CD n ❑ Yes ❑✓ No- SKIP to Section 4.
co) 3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Fre.uency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
30 days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION(40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ❑✓ No 4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
ELG Category ELG Subcategory Regulatory Citation
Q
Q
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑ No SKIP to Section 6.
0
co 5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Unit of
Operation,Product,or Material Quantity per Day
-0 Number Measure
U)
co
co
0
O
a`
EPA Form 3510-2C(Revised 3-19) Page 3

•
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
SECTION 6.IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑✓ No 4 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
o Project (list outfall Discharge Required Projected
number)
E
N
fd
a)
Cl _ _
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑✓ Yes ❑ No ❑ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete.Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ❑✓ No 4 SKIP to Item 7.3.
7.2 If yes,indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
y requested and attached the results to this application package?
El Yes n/4 5-ee itc�c h�ti�e�� � ❑ No;a waiver has been requested from my NPDES
permitting authority for all pollutants at all outfalls.
Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ❑✓ No 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes ❑ No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid ❑Base/Neutral ❑Pesticide
❑Volatile 0 Acid 0 Base/Neutral ❑ Pesticide
0 Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
7.7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑ Yes El No
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B,pollutants that you have
indicated are"Believed Present"in your discharge?
❑ Yes ❑✓ No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑ No
then SKIP to Item 7.12.
7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
o determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
c.' pollutants you have indicated are"Believed Present"in your discharge?
❑ Yes ElNo
4) Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
-c for all outfalls?
ElYes ❑ No
C 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
° "Believed Present"? 11
❑ Yes ElNo See G.1 t C`c 4, Ens-
w Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?❑ Yes /'/4 ❑✓ No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑ Yes /� ElNo
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ElNo 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes ❑✓ No 4 SKIP to Section 9.
3 u) 8.2 List the pollutants below.
1. 4. 7.
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
SECTION 9.BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
❑ Yes ❑✓ No 4 SKIP to Section 10.
fA 'i
9.2 Identify the tests and their Durposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
o ❑ Yes ❑ No
0
_O
'
❑ Yes ❑ No
❑ Yes ❑ No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
D Yes ❑✓ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm
m
Laboratory address
c
a
O Phone number
Pollutant(s)analyzed
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 4 SKIP to Section 12.
O
11.2 List the information requested and attach it to this application.
o
1. 4.
0
a 2. 5.
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C 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 complete all sections or provide attachments.
Column 1 Column 2
✓❑ Section 1:Outfall Location ❑ w/attachments
❑ Section 2: Line Drawing ✓❑ wl line drawing ❑ w/additional attachments
171 Section 3:Average Flows and w/list of each user of
Treatment ❑✓ w/attachments El privately owned treatment
works
❑ Section 4: Intermittent Flows 0 w/attachments
❑ Section 5:Production !v A. ❑ wl attachments
w/optional additional
❑✓ Section 6: Improvements ❑✓ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ wl request for a waiver and ❑ w/explanation for identical
supporting information outfalls
❑ w/small business exemption ❑✓ w/other attachments
a, request
is Section 7: Effluent and Intake
✓❑ Characteristics ❑✓ w/Table A El w/Table B
0
❑✓ w/Table C ❑ w/Table D
w/Table E w/analytical results as an
0 ❑ ❑ attachment
1-7 Section 8:Used or Manufactured ❑ wl attachments
NTeccs �A RECEIVED
❑ Section 9: Biolo ical Toxicity ❑ w/attachments
Tests N r4'
U
❑ Section 10: Contract Analyses, 14 ❑ w/attachments MAY 11 2021
❑ Section 11:Additional Information,, ❑ w/attachments NCDEQIDWRINPDES
Section 12: Checklist and ❑ w/attachments
Certification Statement
12.2 Certification Statement
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
Dell Harney Water Supply Manager
Signature Date signed
I2/(f7 Offigui (901
EPA Form 3510-2C(Revised 3-19) Page 7

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EPA Identification Number NPDES Permit Number FacilityN me Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP 001 OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(if applicable) (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration mg/I 0 0
1 El(BOD5) Mass lbs 0 0
Chemical oxygen demand Concentration mg/I 0 0
2' (COD) ID
lbs 0 0
Concentration mg/I 0 0
3. Total organic carbon(TOC) ❑
Mass lbs 0 0
Concentration mg/I 0 0
4. Total suspended solids(TSS) ❑
Mass lbs 0 0
Concentration mg/I 0 0
5. Ammonia(as N) ❑
Mass lbs 0 0
6. Flow ❑ Rate mgd 0 0
Temperature(winter) ❑ °C °C NA 0
7 - -
Temperature(summer) ❑ °C °C NA 0
pH(minimum) 0 Standard units S.U. NA o
8.
pH(maximum) ❑ Standard units S.U. NA 0
-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
tinstructionns�s and 40 CFR 122.21(e)(3).
5cc ai}act IAA ei•L1 02
EPA Form 3510-2C(Revised 3-19) Page 9

This page intentionally left blank.

1
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
[\,1
Pollutant/Parameter Testing Units Maximum Maximum Long-Term Long-
(and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number Term Number
Present Absent Daily of of
D(requi edge D(f ava labs)ischarg De isc A
harge Analyses Value Analyses
I (if available)
❑ Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
1.1 Antimony,total Concentration
(7440-36-0) Mass
1 2 Arsenic,total Concentration
(7440-38-2) Mass
1.3 Beryllium,total Concentration
0 0 0
(7440-41-7) Mass
Cadmium,total Concentration
1.4 (7440-43-9) Mass
1.5 Chromium,total Concentration
(7440-47-3) Mass
1.6 Copper,total Concentration
0 0 0
(7440-50-8) Mass
1.7 Lead,total Concentration
(7439-92-1) Mass
1.8 Mercury,total Concentration
0 0 0
(7439-97-6) Mass
1.9 Nickel,total Concentration
0 El El
(7440-02-0) Mass
1.10 Selenium,total Concentration
(7782-49-2) Mass
1.11 Silver,total Concentration
0 0 0
(7440-22-4) Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
AI
Pollutant/Parameter Testing Units Long-Term
I J' (and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
Present Absent Daily Monthly Daily of Term of
Dreq fired) ifavalabe) DDischare ischarge Analyses AValuee Analyses
(if available)
Thallium,total Concentration
1.12 (7440-28-0) Mass
1.13 Zinc,total Concentration
0 0 0
(7440-66-6) Mass
1.14 Cyanide,total Concentration
(57-12-5) Mass _
1.15 Phenols,total 0 0 0
Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
21 Acrolein Concentration
(107-02-8) Mass
2.2 Acrylonitrile ❑ Concentration
(107-13-1) Mass
Benzene Concentration
2.3 (71-43-2) Mass
2 4 Bromoform Concentration
(75-25-2) Mass
2.5 Carbon tetrachloride 0 ElConcentration
0
(56-23-5) Mass
2.6 Chlorobenzene ❑ ❑ Concentration
(108-90-7) Mass
2.7 Chlorodibromomethane ❑ ❑ Concentration
(124-48-1) Mass
2.8 Chloroethane Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
\ A (and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
D(eq(required)harge D(if available) Diischarge scharge Analyses AverageValue Analyses
(if available)
2.9 2-chloroethylvinyl ether Concentration
(110-75-8) Mass
2.10 Chloroform(67-66-3) 0 0 0
Concentration
Mass
2.11 Dichlorobromomethane ❑ El Concentration
(75-27-4) Mass
212 1,1-dichloroethane Concentration
(75-34-3) Mass
2.13 1,2-dichloroethane 0 Concentration
(107-06-2) Mass
2.14 1,1-dichloroethylene ❑ � Concentration
(75-35-4) Mass
2.15 1,2-dichloropropane 0 0 Concentration
(78-87-5) Mass
1,3-dichloropropylene Concentration
2.16 (542-75-6) Mass
2.17 Ethylbenzene Concentration
(100-41-4) Mass
2.18 Methyl bromide 0 0 Concentration
(74-83-9) Mass
2.19 Methyl chloride Concentration
(74-87-3) Mass
2.20 Methylene chloride Concentration
(75-09-2) Mass
2.21 1,1,2,2-tetrachloroethane 0 ❑ Concentration
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
rn I A Present Absent Daily Monthly Daily of Term of
1`J D(req h edge Discharge
available)g Discharge Analyses AValuee Analyses
(if available)
2.22 Tetrachloroethylene ❑ ❑ Concentration
(127-18-4) Mass
2.23 Toluene Concentration
(108-88-3) Mass
2.24 1,2-trans-dichloroethylene El ❑ Concentration
(156-60-5) Mass
2.25 1,1,1-trichloroethane El ❑ Concentration
(71-55-6) Mass
2.26 1,1,2-trichloroethane ❑ 0 Concentration
(79-00-5) Mass
2.27 Trichloroethylene 0 0 Concentration
(79-01-6) Mass
2.28 Vinyl chloride 0 Concentration
El 0(75-01-4) Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol Concentration
(95-57-8) Mass
3.2 2,4-dichlorophenol Concentration
(120-83-2) Mass
2,4-dimethylphenol Concentration
3.3 (105-67-9) Mass
3.4 4,6-dinitro-o-cresol 0 0 Concentration
(534-52-1) Mass
3.5 2,4-dinitrophenol Concentration
(51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
N f Present Absent Daily Monthly e Daily of
DischargeTerm of
Dischargerequie (ifavalabe) Analyses AverageValue Analyses
(required) ( (if available)
3.6 2-nitrophenol Concentration
CI CI 0
(88-75-5) Mass
3.7 4-nitrophenol Concentration
El 0 CI
(100-02-7) Mass
3.8 p-chloro-m-cresol Concentration
CI 0 CI
(59-50-7) Mass
3.9 Pentachlorophenol CI C7 Concentration
(87-86-5) Mass
Phenol Concentration
3.10 CI 0 CI
(108-95-2) Mass
3.11 2,4,6-trichlorophenol ❑ 0 Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GC/MS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene Concentration
0 CI CI
(83-32-9) Mass
4.2 Acenaphthylene Concentration
(208-96-8) Mass
4.3 Anthracene Concentration
(120-12-7) Mass
4.4 Benzidine Concentration
(92-87-5) Mass
4.5 Benzo(a)anthracene El El ❑ Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene CIConcentration
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
Maximum Maximum Long-
1N (and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number
Term Number
Present Absent Daily of of
Discharge D De ischarge Analyses Average
Value
Analyses
(required) (if available) (if available)
4.7 3,4-benzofluoranthene Concentration
0 0 0
(205-99-2) Mass
4.8 Benzo(ghi)perylene Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene Concentration
(207-08-9) Mass
Bis(2-chloroethoxy)methane Concentration
4.10 (111-91-1) Mass
Bis(2-chloroethyl)ether Concentration
4.11 (111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether 0 Concentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate ElConcentration
(117-81-7) Mass
4-bromophenyl phenyl ether Concentration
4.14 (101-55-3) Mass
4.15 Butyl benzyl phthalate ❑ Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene ❑ ❑ Concentration
(91-58-7) Mass
4.17 4-chlorophenyl phenyl ether El ❑ Concentration
(7005-72-3) Mass
Chrysene Concentration
4.18 (218-01-9) Mass
4.19 Dibenzo(a,h)anthracene 0 0 Concentration •
(53-70-3) Mass
EPA Form 3510.2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
Long-
(and CAS Number,if available) Required Believed Believed Maximum Maximum
(specify) Daily Monthly Average Number Term Number
Present Absent Daily of of
Discharge Dischargef available) Discharge Analyses AverageValue Analyses
(required) ( ) (if available)
4.20 1,2-dichlorobenzene ❑ ❑ Concentration
(95-50-1) Mass
4.21 1,3-dichlorobenzene ❑ ❑ Concentration
(541-73-1) Mass
1,4-dichlorobenzene Concentration
4.22 (106-46-7) Mass
4.23 3,3-dichlorobenzidine 0 Concentration
(91-94-1) Mass
4.24 Diethyl phthalate El 0 Concentration
(84-66-2) Mass
4.25 Dimethyl phthalate El ❑ Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate ElConcentration
(84-74-2) Mass
2,4-dinitrotoluene Concentration
4.27 (121-14-2) Mass
4.28 2,6-dinitrotoluene ❑ ❑ Concentration
(606-20-2) Mass
4.29 Di-n-octyl phthalate ❑ Concentration
(117-84-0) Mass
4.30 1,2-Diphenylhydrazine ❑ Concentration
(as azobenzene)(122-66-7) Mass
Fluoranthene Concentration
4.31 (206-44-0) Mass
4.32 Fluorene Concentration
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
A (and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
C 1 Present Absent Daily Monthly Daily of Term of
Discharge Discharge Average
9 9
(if available) Discharge Analyses Analyses
(required) Value
if available
4.33 Hexachlorobenzene ❑ ❑ ❑ Concentration
(118-74-1) Mass
4.34 Hexachlorobutadiene ❑ ❑ ❑ Concentration
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene ❑ ❑ 0
Concentration
(77-47-4) Mass
4.36 Hexachloroethane ❑ 0 0
Concentration
(67-72-1) Mass
Indeno(1,2,3-cd)pyrene Concentration
4.37 (193-39-5) ❑ ❑ ❑ Mass
Isophorone Concentration
4.38 0 ❑ 0
(78-59-1) Mass
4.39 Naphthalene ❑ ❑ ❑ Concentration
(91-20-3) Mass
4.40 Nitrobenzene 0
0
0
Concentration
(98-95-3) Mass
4.41 N-nitrosodimethylamine ❑ ❑ ❑ Concentration
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine El ❑ ❑ Concentration
(621-64-7) Mass
4.43 N-nitrosodiphenylamine ❑ ❑ ElConcentration
(86-30-6) Mass
4.44 Phenanthrene ❑ ❑ ❑ Concentration
(85-01-8) Mass
Pyrene Concentration
4.45 0 0 0
(129-00-0) Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
' Present Absent Daily Monthly Daily of Term of
Discharge
req(required) (if available) Discharge Analyses AverageValue Analyses
(if available)
•
1,2,4-trichlorobenzene Concentration
4.46 (120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
5.1 Aldrin 0 Concentration
(309-00-2) Mass
5.2 a-BHC 0 Concentration
(319-84-6) Mass
13-BHC 0 Concentration
5.3 0 0
(319-85-7) Mass
y-BHC Concentration
5.4 (58-89-9) El 0 0 Mass
i-BHC Concentration
5.5 0 0 0
(319-86-8) Mass
5.6 Chlordane Concentration
(57-74-9) Mass
4,4'-DDT Concentration
5.7 (50-29-3) Mass
4,4'-DDE Concentration
5.8 (72-55-9) Mass
5.9 4,4'-DDD Concentration
(72-54-8) Mass
5.10 Dieldrin Concentration
(60-57-1) Mass
5.11 o-endosulfan Concentration
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
n Maximum Maximum Long-
'(�I (and CAS Number,if available) Required Believed Believed (specify)
Daily Monthly Average Number Number
Present Absent Daily of Term of
D(required)arge Df a(iva labharge s) Discharge Analyses AValuee Analyses
(if available)
13-endosulfan Concentration
5.12 (115-29-7) Mass
Endosulfan sulfate Concentration
5.13 El(1031-07-8) El 0 Mass
5.14 Endrin Concentration
(72-20-8) Mass
Endrin aldehyde Concentration
5.15 0 0 0
(7421-93-4) Mass
5.16 Heptachlor Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) ❑ 0 0 Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0 0 Mass
PCB-1254 Concentration
5.19 (11097-69-1) 0 0 0 Mass
PCB-1221 Concentration
5.20 (11104-28-2) 0 0 0 Mass
PCB-1232 Concentration
5.21 (11141-16-5) 0 0 0Mass
PCB-1248 Concentration
5.22 (12672-29-6) 0 ❑ 0
Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 0 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) ❑ 0 ❑ Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long•Term
lv (and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long. Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge
Discharge Analyses AValuee Analyses
(required) (if available)
(if available)
Toxaphene Concentration
5,25 (8001-35-2) 0 ❑ 0
Mass
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 3510-2C(Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Units '
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1 Bromide ❑ ❑ Concentration o 0
(24959-67-9) Mass o 0
Chlorine,total Concentration o 0
2' residual 0El Mass o o
Concentration o o
3. Color ❑✓ 0
Mass o 0
Concentration o 0
4. Fecal coliform ❑✓ 0
Mass o o
5 Fluoride 0 0 Concentration o o
(16984-48-8) Mass 0 0
Concentration o 0
6 Nitrate-nitrite ❑✓ ❑
Mass o 0
Nitrogen,total Concentration o 0
7. organic(as N) 0 Mass o 0
Concentration o o
8. Oil and grease 0 0 Mass o 0
9 Phosphorus(as ❑ ❑ Concentration o 0
P),total(7723-14-0) Mass o o
10. Sulfate(as SO4) 0 0 Concentration o o
(14808-79-8) Mass o 0
Concentration o 0
11. Sulfide(as S) 0 0 Mass \\ o 0
EPA Form 3510-2C(Revised 3-19) See ;�Ttahu,�
Cc—"1' -It Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
12. Sulfite(as S03) ❑ ❑✓ Concentration o 0
(14265-05-3) Mass 0 0
Concentration o 0
13. Surfactants ❑ L Mass o o
14. Aluminum,total
Concentration o 0
(7429-90-5) Mass 0 0
15. Barium,total ❑ ❑ Concentration o 0
(7440-39-3) Mass 0 0
16. Boron,total ❑ El
Concentration o 0
(7440-42-8) Mass 0 0
17. Cobalt,total Concentration o o
El l
(7440-48-4) ✓ Mass o o
Concentration o o
18 Iron,total 2 ❑ _
(7439-89-6) Mass 0 0
19 Magnesium,total 00 Concentration o 0
(7439-95 4) Mass o o
Molybdenum, Concentration o 0
20. total 0 ❑✓ Mass o o
(7439-98-7)
21. Manganese,total Concentration o 0
(7439-96-5) Mass 0 o
22. Tin,total 0 0 Concentration o 0
(7440-31-5) Mass o 0
23. Titanium,total 0 El
Concentration o 0
(7440-32-6) Mass 0 0
Sew ( CI\ 1.\F',CV' -40,
EPA Form 3510-2C(Revised 3-19) Page 24

r
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON C• VENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum DailyLong-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
1 (if available) (if available)
24. Radioactivity
Concentration o
Alpha,total 0 ❑✓
Mass o 0
Concentration o 0
Beta,total 0 0 Mass o 0
Concentration o 0
Radium,total 0 0 Mass o o
Concentration o 0
Radium 226,total 0 0 Mass o 0
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).
See_ OC 14-
QC� .
�C�
EPA Form 3510-2C(Revised 3-19) Page 25

«o
cs
co
o'
c�
cr

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
/� Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
N Present Absent
1. Asbestos ❑ 0
2. Acetaldehyde ❑ ❑
3. Allyl alcohol 0 ❑
4. Allyl chloride 0 0
5. Amyl acetate 0 0
6. Aniline ❑ 0
7. Benzonitrile ❑ 0
8. Benzyl chloride 0 0
9. Butyl acetate ❑ 0
10. Butylamine 0 0
11. Captan 0 0
12. Carbaryl 0 0
13. Carbofuran 0 0
14. Carbon disulfide 0 ❑
15. Chlorpyrifos 0 0
16. Coumaphos 0 0
17. Cresol 0 0
18. Crotonaldehyde 0 0
19. Cyclohexane 0 ❑
EPA Form 3510-2C(Revised 3-19) Page 27

r•
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))'
Presence or Absence
Pollutant (check one) Available Quantitative Data Believed Believed Reason Pollutant Believed Present in Discharge
I Y 4 (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) ❑ ❑
21. Diazinon ❑ ❑
22. Dicamba ❑ 0
23. Dichlobenil 0 0
24. Dichlone ❑ 0
25. 2,2-dichloropropionic acid 0 0
26. Dichlorvos 0 0
27. Diethyl amine 0 0
28. Dimethyl amine 0 0
29. Dintrobenzene ❑ 0
30. Diquat 0 0
31. Disulfoton 0 0
32. Diuron 0 0
33. Epichlorohydrin 0 0
34. Ethion 0 0
35. Ethylene diamine 0 ❑
36. Ethylene dibromide 0 0
37. Formaldehyde 0 0
38. Furfural ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Discharge Reason Pollutant Believed Present in Available Quantitative Data
WA- Believed Believed g (specify units)
Present Absent
39. Guthion El0
40. Isoprene 00
41. Isopropanolamine El 0
42. Kelthane
43. Kepone 00
44. Malathion ❑
45. Mercaptodimethur El 0
46. Methoxychlor 0
47. Methyl mercaptan 0 0
48. Methyl methacrylate ❑
49. Methyl parathion
50. Mevinphos 0
51. Mexacarbate D 0
52. Monoethyl amine ❑
53. Monomethyl amine El 0
54. Naled
55. Naphthenic acid
56. Nitrotoluene ❑
57. Parathion 0 El
EPA Form 3510-2C(Revised 3-19)
Page 29
I

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge
(specify units)
Present Absent
4 58. Phenolsulfonate ❑ 0
(�/ 59. Phosgene ❑ 0
60. Propargite ❑ ❑
61. Propylene oxide ❑ 0
62. Pyrethrins ❑ ❑
63. Quinoline ❑ 0
64. Resorcinol ❑ ❑
65. Strontium ❑ 0
66. Strychnine ❑ 0
67. Styrene ❑ 0
68 2,4,5-T(2,4,5-trichlorophenoxyacetic ❑ ❑
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ ❑
70 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑
propanoic acid]
71. Trichlorofon ❑ ❑
72. Triethanolamine ❑ ❑
73. Triethylamine ❑ ❑
74. Trimethylamine ❑ ❑
75. Uranium ❑ ❑
76. Vanadium 0 ❑
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L.Mitchell WTP OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
,(j Believed
Present Believed
Absent Reason Pollutant Believed Present in Discharge
(specify units)
77. Vinyl acetate
78. Xylene 0 El
79. Xylenol 0 El
80. Zirconium
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 3510-2C(Revised 3-19) Page 31

F
This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCR000013078 NC0081426 N.L. Mitchell WTP OMB No.2040-0004
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant Used or (check one) Results of Screening Procedure
(V Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 33

EPA FORM 2C,ATTACHMENT 1
(LINE DRAWING FOR SECTION 2.0)
N.L. Mitchell WTP process waste system
line drawing
Ex.Waste Clarifier
iiiip460: A With Decanter&
Ex. Backwash
Waite P9 Hydraulic Improvements
HPDES
1r E
F
X-C
I ' Sanitary Sewer
This NPDES permit(NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter
backwash and filter rewash streams. The process waste system has a binary discharge, sending
effluent to either a Sanitary Sewer collection system or the NPDES permitted outfall. All process waste
system discharge has gone to the Sanitary Sewer collection system during the current NPDES permit
cycle.
This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit
without having discharged to the designated outfall for the previous permit cycle and thus having no
discharge analysis data to provide. Instructions from our regional NCDEQ office for renewal of the
Mitchell NPDES permit are to complete:
• EPA form 1
• EPA form 2E
• Tables A& C of EPA form 2C, as well as Table B if applicable

1
EPA FORM 2C,ATTACHMENT 2
(EXPLANATION FOR SECTIONS 3.0, 7.3,7.13,Table C)
This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro(PWSID 0241010). The process waste system influent flow is composed of Filter
backwash and filter rewash streams. The process waste system has a binary discharge, sending
effluent to either a Sanitary Sewer collection system or the NPDES permitted outfall.
All process waste system discharge has gone to the Sanitary Sewer collection system during the current
NPDES permit cycle. This puts the City of Greensboro in the unusual position of renewing the Mitchell
site NPDES permit without having discharged to the designated outfall for the previous permit cycle
and thus having no discharge flow or analysis data to provide on the application.
(Section 7.3) The applicant cannot answer YES due to the fact that there has been no discharge at the
outfall to sample and analyze. The applicant cannot answer NO due to the fact that a waiver has not
been requested. Our current permit requires:
o Continuous monitoring discharge dischar a flow
o 2X monthly testing for
• TSS
• pH
• Total Chlorine Residual
• Turbidity
o Quarterly testing for
• Aluminum
• Total Iron
• Total Copper
• Manganese
• Fluoride
• Hardness
• Upstream Hardness
• Total Nitrogen
• Total Phosphorus
• Whole Effluent Toxicity Monitoring

1
EPA FORM 2C,ATTACHMENT 3
(DESCRIPTION OF PLANNED IMPROVEMENTS FOR SECTION 6.3)
This NPDES permit(NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter
backwash and filter rewash streams.
There are hydraulic restraints within the process waste system at this water treatment plant that have
led to discharging to Sanitary Sewer instead of the NPDES outfall for the entirety of the current permit
cycle. Improvements to the process waste system are in the design phase which,when constructed,
will make NPDES discharge possible again without limiting production. Construction of the new
1 system is planned to begin June of 2022 with an expected duration of 18 months.
The new system will include Equalization/Clarification
Y q /Clarification of intermittent
backwashes, Mixing,
Dechlorination, pH adjustment, Flocculation and Settling. Dishcharge options will include: Recycle
back to the treatment plant, NPDES to permitted outfall and Sanitary Sewer.
N.L. Mitchell WTP New Process Waste System
f- -<P

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0081426 N.L.Mitchell WTP OMB No.2040-0004
W
U.S. Environmental Protection Agency
FORM Application for NPDES Permit to Discharge Wastewater
2E NPDES 4;EPA MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURAL FACILITIES WHICH
DISCHARGE ONLY NONPROCESS WASTEWATER
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(h)(1))
1.1 Provide information on each of the facilit 's outfalls in the table below.
o
Outfall Receiving Water Name Latitude Longitude
— Number
0 001 North Buffalo Creek 36° 0813' 89" -79° 8033' 33"
J
w0 " ° , „
Y
0
SECTION 2.DISCHARGE DATE(40 CFR 122.21(h)(2))
d 2.1 Are you a new or existing discharger?(Check only one response.)
Ea
CO La) 0 New discharger ❑✓ Existing discharger 4 SKIP to Section 3.
N 2.2 Specify your anticipated discharge date:
0
SECTION 3.WASTE TYPES(40 CFR 122.21(h)(3))
3.1 What types of wastes are currently being discharged if you are an existing discharger or will be discharged if you are a
new discharger?(Check all that apply.)
❑ Sanitary wastes ❑✓ Other nonprocess wastewater(describe/explain
❑ Restaurant or cafeteria waste directly below)
n El Non-contact cooling water WTP Filter Backwash Wastewaters
I- 3.2 Does the facility use cooling water additives?
R ❑ Yes ❑✓ No 4 SKIP to Section 4.
3.3 List the cooling water additives used and describe their com.osition.
Cooling Water Additives Composition of Additives
(list) (if available to you)
SECTION 4.EFFLUENT CHARACTERISTICS(40 CFR 122.21(h)(4))
4.1 Have you completed monitoring for all parameters in the table below at each of your outfalls and attached the results to
this application package? SFe Ct*c.Ll,t,,,, ,,,r- t 1
No;a waiver has been requested from my NPDES permitting authority
ElYes nitq ❑ (attach waiver request and additional information) -4 SKIP to Section 5.
4.2 Provide data as requested in the table below., (See instructions for specifics.)
u) Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
.� (if actual data (specify units) (speci units) per
o reported) Mass Conc. Mass Conc. instructions)
2
6,3 Biochemical oxygen demand(BOD5) o
o Total suspended solids(TSS) o
c
°'
a) Oil and grease 0
w
Ammonia(as N) 0
Discharge flow 0 0 mgd NA
pH(report as range) o NA NA
Temperature(winter) 0 NA NA
Temperature(summer) 0 NA NA
'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 3510-2E(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0081426 N.L.Mitchell WTP OMB No.2040-0004
4.3 Is fecal coliform believed present,or is sanitary waste discharged(or will it be discharged)?
❑ Yes ❑✓ No 3 SKIP to Item 4.5.
4.4 Provide data as requested in the table below.1 (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (Use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. Instructions.)
Fecal coliform
- E. coli
Enterococci
U4.5 Is chlorine used(or will it be used)?
❑ Yes ❑✓ No 4 SKIP to Item 4.7.
4.6 Provide data as requested in the table below.1 (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
- (if actual data __ (specify units) (specify units) per
reported) Mass Conc. Mass Conc. instructions)
c -
3 Total Residual Chlorine
4.7 Is non-contact cooling water discharged(or will it be discharged)?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.8 Provide data as requested in the table below.1 (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. instructions)
Chemical oxygen demand(COD)
Total organic carbon(TOC)
SECTION 5.FLOW(40 CFR 122.21(h)(5))
5.1 Except for stormwater water runoff. leaks.or spills. are any of the discharges you described in Sections 1 and 3 of this
application intermittent or seasonal?
❑✓ Yes 4 Complete this section. ❑ No 4 SKIP to Section 6.
0 5.2 Briefly describe the frequency and duration of flow.
Intermittent discharge flow from filter backwash waste.
SECTION 6.TREATMENT SYSTEM(40 CFR 122.21(h)(6))
6.1 Briefly describe any treatment system(s)used(or to be used).
dFilter backwash waste stream is dechlorinated with sodium thiosulfate and sent to a decant clarifier prior to discharge
cointo North Buffalo Creek.
m
E
m
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 3510-2E(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0081426 N.L.Mitchell WTP OMB No.2040-0004
SECTION 7.OTHER INFORMATION(40 CFR 122.21(h)(7))
7.1 Use the space below to expand upon any of the above items. Use this space to provide any information you believe the
reviewer should consider in establishing permit limitations.Attach additional sheets as needed.
Due to on-going construction at the Mitchell plant,all plant discharges were sent to the sanitary sewer.There has been
no discharge to North Buffalo Creek under the current permit. Improvements to the process waste system are in the
0 design phase which,when constructed,will make NPDES discharge possible again. Construction of the new system is
planned to begin June of 2022 with an expected duration of 18 months.
a`>
t
O
SECTION 8.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
8.1 In Column 1 below, mark the sections of Form 2E 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: Outfall Location ❑ w/attachments(e.g.,responses for additional outfalls)
❑ Section 2: Discharge Date /VA ❑ w/attachments
0 Section 3:Waste Types ❑ w/attachments
_ ❑✓ Section 4: Effluent Characteristics 0 w/attachments
❑✓ Section 5: Flow ❑ w/attachments
o ❑✓ Section 6:Treatment System ❑ w/attachments
cci
❑✓ Section 7: Other Information ❑ w/attachments
❑✓ Section 8:Checklist and Certification Statement ❑ w/attachments
N 8.2 Certification Statement
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
Dell Harney Water Supply Manager
Signature Date signed
y otidl
EPA Form 3510-2E(revised 3-19) Page 3

EPA FORM 2E,ATTACHMENT 1 (FOR SECTION 4.0)
Sections 4.1 and 4.2 of form 2E could not be completed because all process wastes have been
discharged to a Sanitary Sewer connection during the current permit cycle. With no NPDES discharge
to the permitted outfall,the facility has no data to complete section 4.2 and is not requesting a waiver.
This NPDES permit(NC0081426) is for a conventional filtration water treatment plant operated by the
City of Greensboro (PWSID 0241010).
Instructions from our regional NCDEQ office for renewal of the Mitchell NPDES permit are to complete:
• EPA form 1
• EPA form 2E
• Tables A&C of EPA form 2C, as well as table B if applicable