NC0026921_NPDES Permit Renewal_20131119

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
November 19, 2013
Attn: Larry G. Hagin
Town of Parkton
PO Box 55/28 West David Parnell St
Parkton, NC 28371
Subject: Receipt of permit renewal application
NPDES Permit NC0026921
Roberson County
Dear Mr. Hagin,
John E. Skvarla, III
Secretary.
RECEIVED
NOV 26 2013
DENR -FAYETTEWLLE REGIONAL OFRC
E
The NPDES Unit received your permit renewal application on October 28th, 2013. This
permit renewal has been assigned Joe Corporon (919-807-6394) who will contact you if any
additional information is required to complete your permit renewal. Due to current backlog, you
should continue to .operate under terms of your current permit, until a new permit is issued. If
you have any questions, please contact the assigned permit writer.
Sincerely,
GA, KP4/0
�/
(11`Jeff Poupart
Point Source Branch Program Supervisor IV
-Cc: Central Files
ayetteville Regional Office
NPDES
1601 Mail Service Center, Raleigh, North Carolina 27699-1601 '
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity \ Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper
horthCarolina
aturaI/

Mayor,
Larry G. Hagin
Finance Director / Town Clerk
Debra McNeill
Chief of Police
Ronald Starling
Public Works Director
Roy Lowder
October 30, 2013
TOWN OF PARKTON
Post Office Box 55 / 28 West David Parnell St
Parkton, North Carolina 28371
Office: 910-858-3360
Fax: [phone]
NC Department ofEnvironment and Natural Resources
Division of Water Rcsources/NPDES Unit
R16alie7M,NC
cServoce9!..Ce11
1-§t167r
igh Subject:
NPDES
Perrmt-Renewal
Town
f Parkton
S-Pcellilloun ffN, C0 02
Robeson6921
lE@R OWIE
OCT 2 8 2013
DENR-WATER QUALITY
POINT SOURCE BRANCH
ear Permitting Unit:
Alderman
Al McMillan
Alf Parnell
Robin Hill
Benton Finley
Fran Meinert
The Town of Parkton is submitting the renewal application package for:, Npl3ES permit
#NC0026921. The permit application consists of:
- Cover letter
- One original ‘offonn 2A —I•TF'DES Application for Permit Renewal
- Topographic Map
- Process Flow Schematic and Narrative
- Two additional copies of Renewal Package
The Town would like to request the:fbllowing c angeS.to the'permit.
A. The permit currently contains a monthly monitoring requirement and daily maximum
limit for mercury. We are requesting that monitoring/limit be removed from the permit.
Effluent monitoring over the past three years shows that, with one exception, mercury
levels are fairly consistent. The wastewater 'flow to the plant is entirely

domestic/commercial with no known contributors of mercury, such as dental offices. We
expect mercury levels to remain in the same range unless affected by any new industrial
or commercial development. We have no explanation for the one high mercury level,
except that it is such an anomaly that it must be due to sampling errors. We ask that this
number not be used in the reasonable potential analysis.
B. We request that quarterly toxicity testing requirement be removed from the permit. As
stated above, the flow to the wastewater treatment plant is domestic in nature and does
not meet the definition as a discharger of "complex" wastewater as defined in the
Department's August 1999 memo which was written to clarify the application of WET
limits in permits.
C. It is requested that the upstream and downstream monitoring requirements for Dissolved
Oxygen and Temperature be removed from the permit. The receiving stream flows
through swampland/woodland that is bordered by farmland. The testing of DO and
Temperature at the two monitoring sites has no correlation to the discharge from the
wastewater plant. DO in the stream is more likely to be affected by agricultural runoff,
natural decay, rainfall, etc and any increase or decrease in DO cannot be definitely
attributed to the treatment plant. Again, since the wastewater flow is domestic in nature
with no industrial dischargers that could potentially discharge high temperature waste it is
improbable that the discharge will affect stream temperature.
D. It is requested that conductivity monitoring be removed from the permit. A review of test
results shows that the conductivity of the effluent is consistently in the range for domestic
wastewater. As the wastewater is purely domestic, any changes in the conductance of
the water would be attributable either to temperature or potable water characteristics.
Current permit required testing for BOD5, TSS, and NH3 are sufficient to determine
effluent clarity.
If you have any questions or comments, please contact Roy Lowder, Public Works Director, at
252/245-6632.
Sincerely,
a704( )01, Al*
Larry G. Hagin, Mayor
Town of Parkton

Town of Parkton WWTP
Receiving Stream: Dunns Marsh Drainage Basin: Lumber River
Latitude: 34° 53' 02" N Longitude: 78° 59' 59" W
Permitted Flow: 0.200 MGD Sub -Basin: 03-07-53
State Grid / USGS Quad: H 23NW / Hope Mills, N.C. Stream Class: C; Sw
Upstream Monitoring Point
atNCSR.1725_
North
NPDES Permit NC0026921
Robeson County

Influent Pump Station
FIGURE I-2 MAIN PROCESS FLOW PATTERN
Sludge
Drying Beds
Post '
Aeration
Steps
Chlorine
Contact Tank
Aerobic Digester
Operations
Building
Clarifier #2
Oxidation
Ditch #2
Recycle Sludge
Pumping
Splitter Box
Oxidation
Ditch #1

Town of Parkton WWTP
Treatment Plant Narrative
NPDES NC0026921
The Town of Parkton WWTP consists of the following units:
• Barscreen
• Two parallel operating oxidation ditches
• Two parallel operating secondary clarifiers
• Two sludge recirculation and waste pump stations
• Parshall flume and flow meter
• Chlorine contact basin
• Post aeration
• Aerobic sludge digester
• Sludge drying beds
The Parkton WWTP is an activated sludge system using oxidation ditches for aeration and
conventional clarifiers for sedimentation. Each clarifier is equipped with a sludge pumping
station which can be used to recycle the activated sludge to the aeration process or waste the
sludge to the aerobic digester. Effluent from the activated sludge process is disinfected in the
chlorine contact basin. After disinfection, post aeration is accomplished by cascade steps to
insure maintenance of minimum dissolved oxygen levels.

FACILITY NAME AND PERMIT NUMBER:
Pai 1U.IJI i V V v vri 1 NC002692
PERMIT ACTION REQUESTED:
Rcnn.vval
RIVER BASIN:
.CambT.R
OGr
FORM
2A NPDES
NPDES
APPLICATION OVERVIEW
Form 2A has been developed in a modular format and consists of a "Basic Application Information" packet
and a "Supplemental Application Information" packet. The Basic Application Information packet is divided
into two parts. All applicants must complete Parts A and C. Applicants with a design flow greater than or
equal to 0.1 mgd must also complete Part B. Some applicants must also complete the Supplemental
Application Information packet. The following items explain which parts of Form 2A you must complete.
BASIC APPLICATION INFORMATION:
A. Basic Application Information for all Applicants. All applicants must complete questions A.1 through A.8. A treatment works
that discharges effluent to surface waters of the United States must also answer questions A.9 through A.12.
B. Additional Application Information for Applicants with a Design Flow z 0.1 mgd. All treatment works that have design flows
greater than or equal to 0.1 million gallons per day must complete questions B.1 through B.6.
C. Certification. All applicants must complete Part C (Certification).
SUPPLEMENTAL APPLICATION INFORMATION:
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waters of the United States and meets
one or more of the following criteria must complete Part D (Expanded Effluent Testing Data):
1. Has a design flow rate greater than or equal to 1 mgd,
2. Is required to have a pretreatment program (or has one in place), or
3. Is otherwise required by the permitting authority to provide the information.
E. Toxicity Testing Data. A treatment works that meets one or more of the following criteria must complete Part E (Toxicity Testing
Data):
1. Has a design flow rate greater than or equal to 1 mgd,
2. Is required to have a pretreatment program (or has one in place), or
3. Is otherwise required by the permitting authority to submit results of toxicity testing.
F. Industrial User Discharges and RCRA/CERCLA Wastes. A treatment works that accepts process wastewater from any
significant industrial users (SIUs) or receives RCRA or CERCLA wastes must complete Part F (Industrial User Discharges
and RCRA/CERCLA Wastes). SlUs are defined as:
1. All industrial users subject to Categorical Pretreatment Standards under 40 Code of Federal Regulations (CFR) 403.6 and
40 CFR Chapter I, Subchapter N (see instructions); and
2. Any other industrial user that:
a. Discharges an average of 25,000 gallons per day or more of process wastewater to the treatment works (with certain
exclusions); or
b. Contributes a process wastestream that makes up 5 percent or more of the average dry weather hydraulic or organic
capacity of the treatment plant; or
c. Is designated as an SIU by the control authority.
G. Combined Sewer Systems. A treatment works that has a combined sewer system must complete Part G (Combined Sewer
Systems).
ALL APPLICANTS MUST COMPLETE PART C (CERTIFICATION)

FACILITY NAME AND PERMIT NUMBER:
Parkton WV4ITF NC0026021
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber River
BASIC APPLICATION INFORMATION
PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatment works must complete questions A.1 through A.8 of this Basic Application Information Packet.
A.1. Facility Information.
Facility Name PART:TON AIM
Mailing Address PO Pc:: 55
Parkton. NC 28371
Contact Person Roy Lowder
Title Public Works Director
Telephone Number [phone]
Facility Address NCSR 1724 (south of Parkton
(not P.O. Box)
A.2. Applicant Information. If the applicant is different from the above, provide the following:
Applicant Name
Mailing Address
Contact Person
Title
Telephone Number ( )
Is the applicant the owner or operator (or both) of the treatment works?
0 owner ® operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
® facility 0 applicant
A.3. Existing Environmental Permits. Provide the permit number of any existing environmental permits that have been issued to the treatment works
(include state -issued permits).
NPDES PSD
UIC Other Parkton Coiiection System: Vkr0CSuutoa
RCRA Other
A.4. Collection System Information. Provide information on municipalities and areas served by the facility. Provide the name and population of each
entity and, if known, provide information on the type of collection system (combined vs. separate) and its ownership (municipal, private, etc.).
Name Population Served Type of Collection System Ownership
Total population served

FACILITY NAME AND PERMIT NUMBER:
Parkton WW1?, NCOO26921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber Rive;
A.S. Indian Country.
a. Is the treatment works located in Indian Country?
❑ Yes ®No
b. Does the treatment works discharge to a receiving water that is either in Indian Country or that is upstream from (and eventually flows
through) Indian Country?
❑ Yes ® No
A.6. Flow. Indicate the design flow rate of the treatment plant (i.e., the wastewater flow rate that the plant was built to handle). Also provide the
average daily flow rate and maximum daily flow rate for each of the last three years. Each year's data must be based on a 12-month time period
with the 12th month of "this year" occurring no more than three months prior to this application submittal.
a. Design flow rate 0.200 mgd
Two Years Ago
b. Annual average daily flow rate 0.007 mqd
c. Maximum daily flow rate 0.295 mq
Last Year This Year
0.072 m d 0.149 mqd
0.198 ma 0.506 mq
A.7. Collection System. Indicate the type(s) of collection system(s) used by the treatment plant. Check all that apply. Also estimate the percent
contribution (by miles) of each.
® Separate sanitary sewer 100
❑ Combined storm and sanitary sewer
A.B. Discharges and Other Disposal Methods.
a. Does the treatment works discharge effluent to waters of the U.S.? Ei Yes 0 No
If yes, list how many of each of the following types of discharge points the treatment works uses:
i. Discharges of treated effluent
ii. Discharges of untreated or partially treated effluent
iii. Combined sewer overflow points
iv. Constructed emergency overflows (prior to the headworks)
v. Other
b. Does the treatment works discharge effluent to basins, ponds, or other surface impoundments
that do not have outlets for discharge to waters of the U.S.? 0 Yes
If yes, provide the following for each surface impoundment:
Location: NA
100
❑ No
Annual average daily volume discharge to surface impoundments) NA mgd
Is discharge ❑ continuous or 0 intermittent?
c. Does the treatment works land -apply treated wastewater? 0 Yes ❑c No
If yes, provide the following for each land application site:
Location: NA
Number of acres: NA
Annual average daily volume applied to site:
N a mgd
Is land application ❑ continuous or 0 intermittent?
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works?
0 Yes 0 No

FACILITY NAME AND PERMIT NUMBER:
Parkton VVVUTP, NCOO26921
PERMIT ACTION REQUESTED
Renewal f�
RIVER BASIN:
Lumber River
If yes, describe the mean(s) by which the wastewater from the treatment works is discharged or transported to the other treatment works
(e.g., tank truck, pipe).
na
If transport is by a party other than the applicant, provide:
Transporter Name
Mailing Address
Contact Person
Title
Telephone Number ( )
For each treatment works that receives this discharge provide the following:
Name
Mailing Address
Contact Person
Title
Telephone Number ( )
If known, provide the NPDES permit number of the treatment works that receives this discharge
Provide the average daily flow rate from the treatment works into the receiving facility. mgd
e. Does the treatment works discharge or dispose of its wastewater in a manner not included
in A.B. through A.8.d above (e.g., underground percolation, well injection): 0 Yes ® No
If yes, provide the following for each disposal method:
Description of method (including location and size of site(s) if applicable):
Annual daily volume disposed by this method:
Is disposal through this method 0 continuous or 0 intermittent?

FACILITY NAME AND PERMIT NUMBER:
Parkton WUUTP, NCOO26921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber River
WASTEWATER DISCHARGES:
If you answered "Yes" to question A.8.a, complete questions A.9 through A.12 once for each outran (including bypass points) through
which effluent is discharged. Do not include information on combined sewer overflows in this section. If you answered "No" to question
A.8.a, go to Part B. "Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 mgd."
A.9. Description of Outfall.
a. Outfall number 001
b. Location Town of Parkton 28371
(City or town, if applicable)
Robeson
(Zip Code)
NC
(County)
34°53'02"N
(State)
78°59'59'11J
(Latitude) (Longitude)
c. Distance from shore (if applicable) NA ft.
d. Depth below surface (if applicable) NA ft.
e. Average daily flow rate
0.149 mgd
f. Does this outfall have either an intermittent or a periodic discharge? ❑ Yes ® No (go to A.9.g.)
If yes, provide the following information:
Number f times per year discharge occurs: NA
Average duration of each discharge: NA
Average flow per discharge: NA mgd
Months in which discharge occurs: NA
g. Is outfall equipped with a diffuser? ❑ Yes -El No
A.10. Description of Receiving Waters.
a. Name of receiving water Dunn's Marsh Swamo
b. Name of watershed (if known)
United States Soil Conservation Service 14-digit watershed code (if known):
c. Name of State Management/River Basin (if known):Lumber River
United States Geological Survey 8-digit hydrologic cataloging unit code (if known):
d. Critical low flow of receiving stream (if applicable)
acute cfs chronic cfs
e. Total hardness of receiving stream at critical low flow (if applicable): mg/l of CaCO3

FACILITY NAME AND PERMIT NUMBER:
Parkton VVWTP, NC00026921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber River
A.11. Description of Treatment
a. What level of treatment are provided? Check all that apply.
❑ Primary El Secondary
❑ Advanced ❑ Other. Describe: -
b. Indicate the following removal rates (as applicable):
Design BOD5 removal or Design CBOD5 removal 90 %
Design SS removal 90 %
Design P removal NA %
Design N removal NA %
Other %
c. What type of disinfection is used for the effluent from this outfall? If disinfection varies by season, please describe:
Chlorine Gas
If disinfection is by chlorination is dechlorination used for this outfall? ❑3 Yes ❑ No
Does the treatment plant have post aeration? fiL4 Yes ❑ No
A.12. Effluent Testing Information. All Applicants that discharge to waters of the US must provide effluent testing data for the following
parameters. Provide the indicated effluent testing required by the permitting authority for each outfall through which effluent Is
discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data
collected through analysis conducted using 40 CFR Part 136 methods. In addition, this data must comply with QAIQC requirements of
40 CFR Part 136 and other appropriate CIA/QC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a
minimum, effluent testing data must be based on at least three samples and must be no more than four and one-half years apart
Outfall number. 001
PARAMETER
MAXIMUM DAILY VALUE
AVERAGE DAILY VALUE
Value
Units
Value
Units
Number of Samples
pH (Minimum)
6.2
, s.u.
<<
pH (Maximum)
8.0
s.u.
Flow Rate
0.506
nig
0.102
mgd
33
Temperature (Winter)
14
C
13
C
5
Temperature (Summer)
26
C
24
C
5
• For pH please report a minimum and a maximum daily value
POLLUTANT
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
MLIMDL
Conc.
Units
Conc.
Units
Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN
DEMAND (Report one)
BOD5
25
Mgil
9
Mgll
12
S:MA52101B
2.0
CBOD5
FECAL COLIFORM
102
Cot/100ml
6
Co1/100m1
12
SM9222D
1
TOTAL SUSPENDED SOLIDS (TSS)
21
Mgli
9
Ma/i
12
Silii2540D
25.0
END OF PART A.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE

FACILITY NAME AND PERMIT NUMBER:
Parkton WWTP, NC0026921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber ever
BASIC APPLICATION INFORMATION
PART B. ADDITIONAL APPLICATION INFORMATION FOR APPLICANTS WITH A DESIGN FLOW GREATER THAN OR
EQUAL TO 0.1 MGD (100,000 gallons per day).
All applicants with a design flow rate z 0.1 mgd must answer questions B.1 through B.6. All others go to Part C (Certification).
B.1. Inflow and Infiltration. Estimate the average number of gallons per day
40.000 gpd
that flow into the treatment works from inflow and/or infiltration.
connections to the sewer main.
Briefly explain any steps underway or planned to minimize inflow and infiltration.
Smoke test to locate inflow sources. Repair/replace all sewer
B.2. Topographic Map. Attach to this application a topographic map of the area extending at least one mile beyond facility property boundaries. This
map must show the outline of the facility and the following information. (You may submit more than one map if one map does not show the entire
area.)
a. The area surrounding the treatment plant, including all unit processes.
b. The major pipes or other structures through which wastewater enters the treatment works and the pipes or other structures through which
treated wastewater is discharged from the treatment plant. Include outfalls from bypass piping, if applicable.
c. Each well where wastewater from the treatment plant is injected underground.
d. Wells, springs, other surface water bodies, and drinking water wells that are: 1) within'/. mile of the property boundaries of the treatment
works, and 2) listed in public record or otherwise known to the applicant
e. Any areas where the sewage sludge produced by the treatment works is stored, treated, or disposed.
f. If the treatment works receives waste that is classified as hazardous under the Resource Conservation and Recovery Act (RCRA) by truck, rail,
or special pipe, show on the map where the hazardous waste enters the treatment works and where it is treated, stored, and/or disposed.
B.3. Process Flow Diagram or Schematic. Provide a diagram showing the processes of the treatment plant, including all bypass piping and all
backup power sources or redunancy in the system. Also provide a water balance showing all treatment units, including disinfection (e.g.,
chlorination and dechlorination). The water balance must show daily average flow rates at influent and discharge points and approximate daily flow
rates between treatment units. Include a brief narrative description of the diagram.
B.4. OperationfMaintenance Performed by Contractor(s).
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a
contractor? ❑ Yes © No
If yes, list the name, address, telephone number, and status of each contractor and describe the contractor's responsibilities (attach additional
pages if necessary).
Name:
Mailing Address:
Telephone Number. ( )
Responsibilities of Contractor.
B.S. Scheduled Improvements and Schedules of Implementation. Provide information on any uncompleted implementation schedule or
uncompleted plans for improvements that will affect the wastewater treatment, effluent quality, or design capacity of the treatment works. If the
treatment works has several different implementation schedules or is planning several improvements, submit separate responses to question B.5
for each. (If none, go to question B.6.)
a. List the outfall number (assigned in question A.9) for each outfall that is covered by this implementation schedule.
b. Indicate whether the planned improvements or implementation schedule are required by local, State, or Federal agencies.
0 Yes ❑ No

FACILITY NAME AND PERMIT NUMBER:
Parkton WWTP, NC0026921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber River
c. If the answer to B.5.b is "Yes," briefly describe, including new maximum daily inflow rate (if applicable).
d. Provide dates imposed
applicable. For improvements
applicable. Indicate
Implementation Stage
- Begin Construction
- End Construction
- Begin Discharge
- Attain Operational
e. Have appropriate
Describe briefly:
by any compliance schedule
planned independently
dates as accurately as possible.
Level
pennitslclearances conceming other
or any actual dates of completion for the implementation steps listed
of local, State, or Federal agencies, indicate planned or actual completion
Schedule Actual Completion
MM/DD/VYYY MM/DD/YYYY
below, as
dates, as
Yes ❑ No
/ / / /
/ / / /
/ / / /
/ / / /
Federal/State requirements been obtained? 0
B.6. EFFLUENT TESTING DATA (GREATER THAN 0.1 MGD
Applicants that discharge to waters of the US must
effluent testing required by the permitting authority
on combine sewer overflows in this section. Ali information
using 40 CFR Part 136 methods. In addition, this data
QA/QC requirements for standard methods for analytes
based on at least three pollutant scans and must be
Outfall Number: 001
ONLY).
provide effluent testing data for the following parameters. Provide
for each outfall through which effluent is discharged. Do not include
the indicated
information
conducted
other appropriate
data must be
reported must be based on data collected through analysis
must comply with QA/QC requirements of 40 CFR Part 136 and
not addressed by 40 CFR Part 136. At a minimum effluent testing
no more than four and on -half years old.
POLLUTANT
MAXIMUM DAILY
DISCHARGE
AVERAGE DAILY DISCHARGE
•
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Conc.
Units
Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA (as N)
11.8
Mg/I
7.5
Mg/I
4
SM4500
0.1
CHLORINE (TOTAL
RESIDUAL, TRC)
42
Ugli
29
Ugl1
4
4500 cl-g
<17
DISSOLVED OXYGEN
9.7
Mg/1
36
Nig/I
4
4500-O-C
TOTAL KJELDAHL
NITROGEN (TKN)
8.32
Mg/I
7.3
Mg/I
4
SM4500
0.25
NITRATE PLUS NITRITE
NITROGEN
2.8
Mg/1
1.63
Mg/l
4
EPA300.0
0.05
OIL and GREASE
PHOSPHORUS (Total)
1.01
118g.1
0.78
Mg/l
4
EPA200.8
0.02
TOTAL DISSOLVED SOLIDS
(TDS)
OTHER
END OF PART B.
REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE

FACILITY NAME AND PERMIT NUMBER:
Parkton WWTP, NC0026921
PERMIT ACTION REQUESTED:
Renewal
RIVER BASIN:
Lumber River
BASIC APPLICATION INFORMATION
PART C. CERTIFICATION
All applicants must complete the Certification Section. Refer to Instructions to determine who is an officer for the purposes of this
certification. All applicants must complete all applicable sections of Foram 2A, as explained in the Application Overview. Indicate below which
parts of Form 2A you have completed and are submitting. By signing this certification statement, applicants confirm that they have reviewed
Form 2A and have completed all sections that apply to the facility for which this application is submitted.
Indicate which parts of Form 2A you have completed and are submitting:
0 Basic Application Information packet Supplemental Application Information packet:
❑ Part D (Expanded Effluent Testing Data)
❑ Part E (Toxicity Testing: Biomonitoring Data)
❑ Part F (Industrial User Discharges and RCRA/CERCLA Wastes)
❑ Part G (Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
I certify under penalty of law that this document and at 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 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 and official title Larry G. Hagin, Mayor
a
Signature aA.711 . grbit,
Telephone number [phone]
Date signed
Upon request of the permitting authority, you must submit any other information necessary, to assure wastewater treatment practices at the treatment
works or identify appropriate permitting requirements.
SEND COMPLETED FORMS TO:
NCDENR/ DWQ
Attn: NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617