NC0043788_Renewal (Application)_20211118

ROY COOPER
Governor ,f513
ELIZABETH S.BISER . ,.. .
Secretary .° "
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
November 19, 2021
Columbus County
Attn: Amanda Davis, Executive Assistant
608 Washington St
Whiteville, NC 28472
Subject: Permit Renewal
Application No. NC0043788
Acme Delco Middle School WWTP
Columbus County
Dear Applicant:
The Water Quality Permitting Section acknowledges the November 18, 2021 receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
SCRIA
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North Carolina De artment of Environmental ualit I Division of Water Resources
D_EQ� P Q Y
Wllmlrtgton Regional OfFlce 1127 Cardinal Drive Extension'Wtlming[on.North Carolina 28405
910.796.7215

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0043788 Acme Delco Middle School OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 r2vEPA 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 treatment works? 1.1.2 treating domestic sewage?
If yes, STOP. Do NOT complete El No If yes, STOP. Do NOT El 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
production facility? currently discharging process wastewater?
oYes + Complete Form 1 0 No Ej Yes 4 Complete Form No
z 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,
Cr) mining,or silvicultural facility that has not yet commercial, mining,or silvicultural facility that
5
commenced to discharge? discharges only nonprocess wastewater?
❑ Yes . Complete Form 1 E✓ No EI Yes 4 Complete Form No
and Form 2D. 1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose RECEIVED
'— discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and NOV 1.8 2021
non-stormwater?
Yes 4 Complete Form 1 E✓ No
and Form 2F NCDEQ/DVVkJNI'[)tS
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
Columbus County-Acme Delco Middle School
0 2.2 EPA Identification Number
U
0
2.3 Facility Contact
Name(first and last) Title Phone number
Amanda Davis Executive Assistant [phone]
Email address
[e-mail]
o 2.4 Facility Mailing Address
Street or P.O.box
608 North Thompson Street
City or town State ZIP code
Whiteville NC 28472
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0043788 Acme Delco Middle School OMB No.2040-0004
2.5 Facility Location
Street,route number,or other specific identifier
Q o 26133 Andrew Jackson Hwy
a)(3
o County name County code(if known)
•
8 Columbus
0
a) J City or town State ZIP code
z Delco NC 28436
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
W
a)
•0
O
U
N
3.2 NAICS Code(s) Description(optional)
co
N
SECTION 4.OPERATOR INFORMATION (40 CFR 122.21(f)(4))
4.1 Name of Operator
Amanda Davis
0 4.2 Is the name you listed in Item 4.1 also the owner?
0 ❑ Yes ❑✓ No
4.3 Operator Status
o
14 ❑ Public—federal ✓❑ Public—state ❑ Other public(specify)
El Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
R
608 North Thompson Street
o
•� City or town State ZIP code
`o o Whiteville NC 28472
a U
o Email address of operator
[e-mail]
SECTION 5. INDIAN LAND(40 CFR 122.21(f)(5))
0 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
NC0043788 Acme Delco Middle School 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)
m NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
o N water) fluids)
L Y
a_ ElPSD(air emissions) ElNonattainment program(CM) ❑ NESHAPs(CAA)
rn
x ❑ Ocean dumping(MPRSA) 0 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.)
❑✓ Yes ❑ No 0 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.
y
m
i C
y
O
to
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑✓ No 4 SKIP to Item 10.1.
03 9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
s,
, 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
co
o Y NPDES permitting authority to determine what specific information needs to be submitted and when.)
0 ,a
U C
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.)
CD
a' ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Ce d 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
NC0043788 Acme Delco Middle School 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
0 Section 2:Name, Mailing Address,and Location ❑ w/attachments
0 Section 3: SIC Codes ❑ w/attachments
0 Section 4:Operator Information ❑ w/attachments
0 Section 5: Indian Land ❑ w/attachments
0 Section 6: Existing Environmental Permits ❑ w/attachments
0 Section 7:Map w/topographic
❑ map ❑ wl additional attachments
0 0 Section 8: Nature of Business Elw/attachments
474
0 Section 9:Cooling Water Intake Structures ❑ w/attachments
as
0 Section 10:Variance Requests ❑ wl attachments
0 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
Amanda Davis Executive Assistant
Signature Date signed
Amanda Day. 10/04/2021
47i.."td.s.. ZVI/34
EPA Form 3510-1(revised 3-19) Page 4

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NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NP�es MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result In denial of the...Iication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Acme Delco Middle School
Mailing address(street or P.O.box)
608 North Thompson Street
City or town State ZIP code
o Whiteville NC 28472
Contact name(first and last) Title Phone number Email address
Amanda Davis Executive Assistant [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
26133 Andrew Jackson Hwy
u City or town State ZIP code
Delco NC 28436
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes-3 See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑✓ Yes ❑ No 3 SKIP to Item 1.4.
Applicant name
County of Columbus
Applicant address(street or P.O.box)
608 North Thompson Street
City or town State ZIP code
Whiteville NC 28472
ra Contact name(first and last) Title Phone number Email address
n Amanda Davis Executive Assistant [phone] [e-mail]
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑ Operator ❑� Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility and applicant
El Facility Applicant ❑✓ (they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a ✓❑ NPDES(discharges to surface 0 RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
NC0043788
❑ PSD(air emissions) 0 Nonattainment program(CAA) 0 NESHAPs(CAA)
0)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

1
NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
192 x %separate sanitary sewer 0 Own ElMaintain
%combined storm and sanitary sewer ❑ Own 0 Maintain
D Unknown 0 Own 0 Maintain
co %separate sanitary sewer 0 Own 0 Maintain
o
%combined storm and sanitary sewer ❑ Own 0 Maintain
to
0 Unknown ❑ Own ❑ Maintain
a %separate sanitary sewer 0 Own El Maintain
-o %combined storm and sanitary sewer 0 Own 0 Maintain
es ❑ Unknown 0 Own 0 Maintain
d %separate sanitary sewer ❑ Own 0 Maintain
?, %combined storm and sanitary sewer D Own 0 Maintain
co ❑ Unknown 0 Own 0 Maintain
0 Total 192
0 Population
Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of /a o 0/o
sewer line(in miles)
Z' 1,8 Is the treatment works located in Indian Country?
a
o' ❑ Yes ❑✓ No
a 1,9 Does the facility discharge to a receiving water that flows through Indian Country?
co
c 0 Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.ol mgd
y Annual Average Flow Rates(Actual)
v Two Years Ago Last Year This Year
.002 mgd .002 mgd .002 mgd
o
t" Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
.008 mgd .008 mgd .008 mgd
co 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
a Total Number of Effluent Discharge Points by Type
a n. Constructed
1- Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
s .o Overflows Overflows
V
co
0 1
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im_poundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
❑ Continuous
gpd ❑ Intermittent
V
.c 1.14 Is wastewater applied to land?
❑ Yes ❑ No 4 SKIP to Item 1.16,
0 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
rn Applied (check one)
0 Continuous
acres gpd 0 Intermittent
0
acres gpd 0 Continuous
0 Intermittent
acres gpd 0 Continuous
0 Intermittent
7, 1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes m No 4 SKIP to Item 1.21.
1,17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ✓❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
1.20 In the table below,indicate the name,address,contact information,NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
v Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
2
a NPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
L 0 Yes ❑ No+SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acres gpd ❑ Continuous
0 Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acresgpd 0 Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
,u2, Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
c a ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
Section 301(h)) 302(b)(2))
0 Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑✓ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
0
Contractor name
(company name)
0 Mailing address
(street or P.O.box)
City,state,and ZIP
code
0 Contact name(first and
c> last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122,21(j)(1)and(2))
o Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
rn
o ❑ Yes p No 9 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
co
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
a
CO
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
mi O. specific requirements.)
0
❑ Yes ❑ No
ti
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o (See instructions for specific requirements.)
o ❑ Yes 0 No
2.5 Are improvements to the facility scheduled?
0 Yes 0 No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
0)
1.
d
E
d
0. 2.
0
3.
v
L 4.
a
g 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
E Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
Improvement Construction Construction Discharge
(from above) (list outfall Level
(MM/DD/YYYY) (MM/DD1YYYY) (MM/DD/YYYY)
number) (MM/DDNYYY)
a
ai
1.
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.210)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number 1 Outfall Number Outfall Number
State
o County
o City or town
w
0
c
s Distance from shore ft. ft. ft.
c
d Depth below surface ft. ft. ft.
0
Average daily flow rate mgd mgd mgd
L ° " ° °Latitude
Longitude ° °
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
co
o 0 Yes 0 No 4 SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
L
N Outfall Number Outfall Number Outfall Number
o
,a Number of times per year
o discharge occurs
a Average duration of each
`o discharge(specify units)
c Average flow of each mgd mgd mgd
to discharge
un Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
a, 3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number Outfall Number Outfall Number
Ql
N
7
0
o Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
e = 3.6 one or more discharge points?
❑✓ Yes 0 No 4SKIP to Section 6.
Page 6

FacilityName Modified Application Form 2A
I( NPDES Permit Number PP
NC0043788 Acme Delco Middle School Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number Outfall Number Outfall Number
Receiving water name Lindscomb Branch
Name of watershed,river,
0 or stream system
E. U.S.Soil Conservation
N Service 14-digit watershed
o code
Name of state
management/river basin
a)
•5 U.S.Geological Survey
0 8-digit hydrologic
te cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number Outfall Number Outfall Number
Highest Level of 0 Primary ❑ Primary ❑ Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced ❑ Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
e
0
Q Design Removal Rates by
O Outfall
m
o BOD5 or CBOD5 % % ok
a
t
a) TSS % %
t—
❑Not applicable ❑Not applicable 0 Not applicable
Phosphorus % % %
0 Not applicable 0 Not applicable El Not applicable
Nitrogen % % %
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below, If disinfection varies by
season,describe below,
cu Dual UV Disinfection System
V
_
0
= Outfall Number Outfall Number Outfall Number
0
a Disinfection type
yU
N
0
d
Seasons used
d Dechlorination used? 0 Not applicable 0 Not applicable 0 Not applicable
❑ Yes ❑ Yes 0 Yes
❑ No 0 No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes 0 No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Po Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
= water
FNumber of tests of receiving
water
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. ✓❑ No -4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Applicafion Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26,
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM1DDNYYY)
C)
m
p
3.22 Regardless of howyouprovidedyour WET testingdata to the NPDES permittingauthority,did anyof the tests result in
9
o toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23 Describe the cause(s)of the toxicity:
ai
W
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES rmittin authori .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
❑✓ Section 1: Basic Application ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
❑ Section 2:Additional ❑ w/topographic map ❑ w/process flow diagram
Information ❑
w/additional attachments
w/Table A ❑ w/Table D
❑ Section 3: Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
E ❑ w/Table C
cn Section 4:Not Applicable
0
Section 5:Not Applicable
Section 6:Checklist and
El Certification Statement ❑ wl attachments
6.2 Certification Statement
U
l 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
Amanda Davis Executive Assistant
Signature Date signed
Amanda Davis 10/29/2021
a�a GLUv)
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number m of Method1 (include units)
SBiochemical oxygen demand
C1 BODS or❑CBOD5 Summer 7.5 Winter Summer 5.0 Winter ML
❑MDL
resort one © ML
Fecal coliform 400 200 ■_-.-. p MDL
Design flow rate
pH(minimum) 6 ,f
pH (maximum) 9
Temperature(winter)
Temperature(summer)
0 ML
Total suspended solids(TSS) 45 30 0 MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 1,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method' (include units)
Samples
o ML
Ammonia(as N) ❑MDL
Chlorine
❑ML
(total residual,TRC)2 ❑MDL
Dissolved oxygen ❑ML
❑MDL
Nitrate/nitrite 0 ML
o MDL
Kjeldahl nitrogen ❑ML
❑MDL
Oil and grease ❑ML
❑MDL
Phosphorus ❑ML
❑MDL
Total dissolved solids ❑ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 1,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number of Methods (include units)
Samples
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) ❑MDL
Antimony,total recoverable 0 ML
❑MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable ❑ML
❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
0 ML
Copper,total recoverable ❑MDL
Lead,total recoverable ❑ML
❑MDL
❑ML
Mercury,total recoverable ❑MDL
Nickel,total recoverable 0 ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
❑ML
Thallium,total recoverable ❑MDL
Zinc,total recoverable ❑ML
0 MDL
Cyanide °ML
❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
0 ML
Acrylonitrile ❑MDL
0 ML
Benzene 0 MDL
Bromoform 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
•
NC0043788 Acme Delco Middle School Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Methods (include units)
Samples
Carbon tetrachloride o ML
❑MDL
Chlorobenzene 0 ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane o ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
ML
trans-1,2-dichloroethylene ❑MDL
0 ML
1,1-dichloroethylene 0 MDL
0 ML
1,2-dichloropropane ❑MDL
ML
1,3-dichloropropylene o MDL
❑ML
Ethylbenzene 0 MDL
ML
Methyl bromide 0 MDL
0 ML
Methyl chloride ❑MDL
ML
Methylene chloride ❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
❑ML
Tetrachloroethylene ❑MDL
❑ML
Toluene ❑MDL
❑ML
1,1,1-trichloroethane o MDL
❑ML
1,1,2-trichloroethane ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
❑ML
Trichloroethylene ❑MDL
❑ML
Vinyl chloride ❑MDL
Acid-Extractable Compounds
❑ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol ❑MDL
❑ML
2,4-dichlorophenol ❑MDL
❑ML
2,4-dimethylphenol ❑MDL
❑ML
4,6-dinitro-o-cresol ❑MDL
❑ML
2,4-dinitrophenol ❑MDL
❑ML
2-nitrophenol ❑MDL
❑ML
4-nitrophenol ❑MDL
❑ML
Pentachlorophenol 0 MDL
❑ML
Phenol ❑MDL
❑ML
2,4,6-trichlorophenol 0 MDL
Base-Neutral Compounds
❑ML
Acenaphthene ❑MDL
❑ML
Acenaphthylene ❑MDL
❑ML
Anthracene ❑MDL
❑ML
Benzidine ❑MDL
❑ML
Benzo(a)anthracene ❑MDL
❑ML
Benzo(a)pyrene ❑MDL
❑ML
3,4-benzofluoranthene ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfaf Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Method, (include units)
Samples
❑ML
Benzo(ghi)perylene ❑MDL
❑ML
Benzo(k)fluoranthene ❑MDL
❑ML
Bis(2-chloroethoxy)methane ❑MDL
❑ML
Bis(2-chloroethyl)ether ❑MDL
❑ML
Bis(2-chioroisopropyl)ether ❑MDL
❑ML
Bis(2-ethylhexyl)phthalate ❑MDL
❑ML
4-bromophenyl phenyl ether ❑MDL
❑ML
Butyl benzyl phthalate ❑MDL
❑ML
2-chloronaphthalene ❑MDL
❑ML
4-chlorophenyl phenyl ether ❑MDL
❑ML
Chrysene ❑MDL
❑ML
di-n-butyl phthalate ❑MDL
❑ML
di-n-octyl phthalate ❑MDL
❑ML
Dibenzo(a,h)anthracene ❑MDL
❑ML
1,2-dichlorobenzene ❑MDL
❑ML
1,3-dichlorobenzene ❑MDL
❑ML
1,4-dichlorobenzene El MDL
❑ML
3,3-dichlorobenzidine ❑MDL
❑ML
Diethyl phthalate ❑MDL
❑ML
Dimethyl phthalate ❑MDL
❑ML
2,4-dinitrotoluene ❑MDL
❑ML
2,6-dinitrotoluene ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number of Methods (include units)
Samples
ML
1,2-diphenylhydrazine ❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene 0 ML
❑MDL
Hexachlorobenzene ❑ML
o MDL
Hexachlorobutadiene ❑ML
❑MDL
0 ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane ❑ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene ❑MDL
❑ML
Isophorone ❑MDL
0 ML
Naphthalene ❑MDL
Nitrobenzene 0 ML
❑MDL
ML
N-nitrosodi-n-propylamine ❑MDL
1 ML
N-nitrosodimethylamine 0 MDL
❑ML
N-nitrosodiphenylamine 0 MDL
Phenanthrene ❑ML
❑MDL
0 ML
Pyrene 0 MDL
1,2,4-trichlorobenzene ❑ML
❑MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0043788 Acme Delco Middle School Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discha e Pollutant Analytical ML or MDL
Number of
(list) Value Units Value Units Samples Method.' (include units)
❑ No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 18