NC0088579_Renewal (Application)_20220314

1
ROY COOPER 44 '''11
Governor i 1
ELIZABETH S.BISER ' 751��
Csy QUMt vd'f +.
Secretary
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
March 15, 2022
JS North Land, LLC
Attn: Scott C. Sullivan
PO Box 3649
Wilmington, NC 28406-3649
Subject: Permit Renewal
Application No. NC0088579
Stone Bridge WWTP
Watauga County
Dear Applicant:
The Water Quality Permitting Section acknowledges the March 14, 2022 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.
Sincere) a
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
DE -' North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Offce 450 West Hanes Mill Road.Suite 300 Winston-Salem North Carolina 27105
*a=.....+:” 336.7769800

JS North Land, LLC
P.O. Box 3649
Wilmington, NC 28406
Wren Thedford RECEIVED
NC DENR/DWR/NPDES Unit
1617 Mail Service Center MAR 14 2022
Raleigh, NC 27699-1617
RE: NPDES Permit NC0088579 NCDEQIDWRINPDES
This is to request renewal of Permit NC0088579 (Stone Bridge WWTP) in Watauga County. No facilities
exist and there are none under construction at this time.
Sincerely,
Scott C. Sullivan
Manager,JS North Land, LLC

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088579 Stone Bridge WWTP 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 treatment works? 1.1.2 treating domestic sewage?
If yes,STOP. Do NOT complete E 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,
doperation or a concentrated aquatic animal commercial,mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
Yes 4 Complete Form 1 E No Yes 4 Complete Form 0 No
z and Form 2B. 1 and Form 2C.
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?
CD
❑ Yes 4 Complete Form 1 0 No El Yes 4 Complete Form 0 No
cc 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
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
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
Stone Bridge WWTP
0 2.2 EPA Identification Number
0
J
2.3 Facility Contact
Name(first and last) Title Phone number
-tea Scott Sullivan Owner [phone]
cn Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O.box
P.O. Box 3649
City or town State ZIP code
Wilmington NC 28406
EPA Form 3510-1(revised 3-19) Page 1

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088579 Stone Bridge WWTP OMB No.2040-0004
i7, 2.5 Facility Location
. Street,route number,or other specific identifier
Q V 950 Shulls Mill Rd.
rn
c c County name County code(if known)
.; Watauga
E o City or town State ZIP code
z Boone NC 28607
•ECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
d
U
co
3.2 NAICS Code(s) Description(optional)
c.)
•ECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Permit only. No facilities
0 4.2 Is the name you listed in Item 4.1 also the owner?
E ❑
w Yes ❑ No
4.3 Operator Status
❑ Public—federal ❑ Public—state ❑ Other public(specify)
o ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
4.5 Operator Address
Street or P.O. Box
E �
0 =
w City or town State ZIP code
C
0 0
U
0_ Email address of operator
0
SECTION 5.INDI N LAND(40 CFR 122.21(f)(5))
g 5.1 Is the facility located on Indian Land?
cJ ❑ Yes ONo
EPA Form 3510-1(revised 3-19) Page 2

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088579 Stone Bridge WWTP 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)
d ❑✓ NPDES(discharges to surface ❑ RCRA(hazardous wastes) 0 UIC(underground injection of
water) fluids)
o Discharge Wastewater
�+ a ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CM)
47.
x 0 Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section 404) ❑ Other(specify)
W
•ECTION 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
A specific requirements.)
❑r 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.
Real Estate
fA
co
fA
y
O
d
Z
•ECTION 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.
9.2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
YNPDES permitting authority to determine what specific information needs to be submitted and when.)
o 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
a when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
e 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

r
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088579 Stone Bridge WWTP 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 ❑ wl attachments
❑ Section 3:SIC Codes ❑ wl attachments
2 Section 4:Operator Information ❑ w/attachments
❑ Section 5: Indian Land ❑ w/attachments
E Section 6:Existing Environmental Permits I ❑ w/attachments
w/topographic
❑ map ❑
❑ Section 7:Map w/additional attachments
0 0 Section 8:Nature of Business 0 w/attachments
w ❑� Section 9:Cooling Water Intake Structures ❑ w/attachments
�-' Section 10:Variance Requests 0 wl attachments
c
N ❑� Section 11:Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible for gathering the information,the information submitted is.to the best of my knowledge and
belief,true,accurate,and complete.lam 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
Scott C.Sullivan Manager
Signature Date signed
4 AA a y--G k 1.-1)
EPA Form 3510-1(revised 3-19) Page 4

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0. 1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result in denial of the :'.lication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Stone Bridge WWTP(NO FACILITIES,PERMIT ONLY)
Mailing address(street or P.O.box)
P.O.Box 3649
City or town State ZIP code
Wilmington NC 28406
Contact name(first and last) Title Phone number Email address
Scott Sullivan Manager
= g [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
co 950 Shulls Mill Road
LL
City or town State ZIP code
Boone NC 28607
1.2 Is this application for a facility that has yet to commence discharge?
O Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes Q No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O.box)
0
City or town State ZIP code
Contact name(first and last) Title Phone number Email address
0
Q.
a 1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑✓ Owner ❑ Operator 0 Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
El 0 Applicant ❑ Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a 0 NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
E
❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1
1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
%separate sanitary sewer ❑ Own ❑ Maintain
Z %combined storm and sanitary sewer 0 Own 0 Maintain
w 0 Unknown ❑ Own 0 Maintain
c %separate sanitary sewer 0 Own 0 Maintain
4 a %combined storm and sanitary sewer 0 Own ❑ Maintain
n ❑ Unknown 0 Own ❑ Maintain
o %separate sanitary sewer 0 Own ❑ Maintain
1 its %combined storm and sanitary sewer 0 Own 0 Maintain
ia 0 Unknown 0 Own 0 Maintain
E CD °
%separate sanitary sewer 0 Own ❑ Maintain
rn %combined storm and sanitary sewer ❑ Own 0 Maintain
c ❑ Unknown ❑ Own 0 Maintain
Total
o
d Population
co Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) % %
z' 1.8 Is the treatment works located in Indian Country?
o ❑ Yes ElNo
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
03
iTs
❑ Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
mgd
ea I
• y Annual Average Flow Rates(Actual) 1
RS
Two Years Ago Last Year This Year
c
= c mgd mgd mgd
• `L Maximum Daily Flow Rates(Actual)
0
o Two Years Ago Last Year This Year
mgd mgd mgd
1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
.o Total Number of Effluent Discharge Points by Type
a 0- Constructed
a' Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
O Overflows
o
Overflows
N
Page 2
i

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP 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 Impoundment Location and Discharge Data
yr A e age Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
f/f
gpd ❑ Intermittent
w 1.14 Is wastewater applied to land?
2 ❑ Yes ❑ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
H Land Application Site and Discharge Data
Continuous or
° Location Size Average Daily Volume Intermittent
Applied (check one)
s 0 Continuous
y acres gpd ❑ Intermittent
acresgpd ❑ Continuous
0 ❑ Intermittent
acres d ElContinuous
9p 0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes ❑ 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
NC0088579 Stone Bridge WWTP 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
0 Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
U
Contact name(first and last) Title
15 Phone number Email address
c NPDES number of receiving facility(if any) ❑ None
Q, Average daily flow rate mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
° not have outlets to waters of the State of North Carolina(e.g., underground percolation,underground injection)?
d
❑ Yes ❑ No 4 SKIP to Item 1.23.
c 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
❑ Continuous
acres gpd El Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acres gpd ❑ 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.
a� w 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
CO Section 301(h)) 302(b)(2))
❑ Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractors operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
0
Contractor name
(company name)
8Mailing address
(street or P.O.box)
o 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
NC0088579 Stone Bridge WWTP 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?
❑ Yes ❑ No 4 SKIP to Section 3.
o
.171
71 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
w
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
co
0
c
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0.
specific requirements.)
0
0 ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o03 (See instructions for specific requirements.)
a,
co
o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
= Briefly list and describe the scheduled improvements.
0
1.
C
a,
E
c 2.
E
0 0
3.
0 4.
U)
cz 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
CD Scheduled Begin End Begin
o Outfalls Operational
Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
d i
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
NC0088579 Stone Bridge WWTP Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number Outfall Number Outfall Number
State
County
City or town
0 Distance from shore ft. ft. ft.
n
Depth below surface ft. ft. ft.
Average daily flow rate mgd mgd mgd
Latitude "
Longitude 0
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
17.3 ❑ Yes ❑ No 3 SKIP to Item 3.4.
g 3.3 If so, provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
0
Number of times per year
0 discharge occurs _
a Average duration of each
`o discharge(specify units)
Average flow of each
discharge mgd mgd mgd
cn Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
0
Outfall Number Outfall Number Outfall Number
N
0
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
ia �
❑ Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
3.7 Provide the receiving water and related information(if known for each outfall.
Outfall Number Outfall Number Outfall Number
Receiving water name
Name of watershed, river,
c or stream system
0- U.S.Soil Conservation
d Service 14-digit watershed
code
176
Name of state
management/river basin
a U.S.Geological Survey
8-digit hydrologic
cc 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 ❑ Primary ❑ Primary ❑ Primary
Treatment(check all that ❑ Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary ❑ Secondary ❑ Secondary
❑ Advanced 0 Advanced 0 Advanced
O Other(specify) 0 Other(specify) ❑ Other(specify)
0
Design Removal Rates by
Outfall
BOD5 or CBOD5
a>
E
I-
TSS
❑ Not applicable 0 Not applicable 0 Not applicable
Phosphorus % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen %
Other(specify) ❑ Not applicable 0 Not applicable ❑Not applicable
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below.
-0
C i
0
U
Outfall Number Outfall Number Outfall Number
2- Disinfection type
0
d
Seasons used
ro
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
El Yes ❑ Yes ❑ Yes
❑ No ❑ No El No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
El Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
R
a►
Number of tests of discharge
tr.;
Number 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 El No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0088579 Stone Bridge WWTP 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
(MM/DD/YYYY)
as
c
0
03 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
❑ Yes ❑ No -9 SKIP to Item 3.26.
1) 3.23 Describe the cause(s)of the toxicity:
•C
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 •ermittin• authori .
Page 9

NPDES Permit Number Facility Name Modred Application Form 2A
NC0088579 Stone Bridge WWTP 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 i Column 2
❑ Section 1: Basic Application ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
Section 2:Additional ❑ wl topographic map ❑ w/process flow diagram
❑ Information ❑ w/additional attachments
❑ wl Table A ❑ w/Table D
❑ Section 3:Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
❑ wl Table C
is
c' Section 4:Not Applicable
0
Section 5:Not Applicable
r I
Section 6:Checklist and
❑ j ❑ w/attachments
Certification Statement
6.2 I 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.lam 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
Scott Sullivan Manager
Signature ^- Date signed
,,V\ 21- 1v1 ci re.h ZvLr✓
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
•
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method' (include units)
Samples
Biochemical oxygen demand ❑ML
❑BOD5 or❑CBOD5 I ❑MDL
(report one)
Fecal coliform ❑ML
❑MDL
Design flow rate
pH(minimum)
pH(maximum)
Temperature(winter)
Temperature(summer)
Total suspended solids(TSS) ❑ML
❑MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP 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 Method1 (include units)
Samples
Ammonia(as N) ❑ML
0 MDL
Chlorine
❑ML
(total residual,TRC)2 0 MDL
Dissolved oxygen ❑ML
0 MDL
Nitrate/nitrite ❑ML
❑MDL
Kjeldahl nitrogen ❑ML
0 MDL
Oil and grease ❑ML
❑MDL
Phosphorus
❑ML
0 MDL
Total dissolved solids ❑ML
❑MDL
'Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) ❑MDL
0 ML
Antimony,total recoverable ❑MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable 0 ML
_ ❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
Copper,total recoverable ❑ML
❑MDL
❑ML
Lead,total recoverable ❑MDL
Mercury,total recoverable ❑ML
❑MDL
Nickel,total recoverable ❑ML
❑MDL
I Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds ❑ML
❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile
❑ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑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
NC0088579 Stone Bridge WWTP Modified March 2021
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
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
2-chloroethylvinyl ether ❑ML
0 MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
❑ML
1,1-dichloroethane ❑MDL
❑ML
1,2-dichloroethane 0 MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
1,1-dichloroethylene ❑ML
0 MDL
1,2-dichloropropane ❑ML
❑MDL
0 ML
1,3-dichloropropylene 0 MDL
Ethylbenzene ❑ML
0 MDL
Methyl bromide ❑ML
❑MDL
Methyl chloride ❑ML
0 MDL
❑ML
Methylene chloride 0 MDL
1,1,2,2-tetrachloroethane 0 ML
0 MDL
Tetrachloroethylene ❑ML
❑MDL
Toluene ❑ML
❑MDL
1,1,1-trichloroethane 0 ML
0 MDL
1,1,2-trichloroethane 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED PO?WS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Trichloroethylene ❑ML
❑MDL
Vinyl chloride ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
0 MDL
2-chlorophenol ❑ML
0 MDL
❑ML
2,4-dichlorophenol 0 MDL _
2,4-dimethylphenol ❑ML
0 MDL
❑ML
4,6-dinitro-o-cresol 0 MDL
❑ML
2,4-dinitrophenol ❑MDL
2-nitrophenol
❑ML
❑MDL
❑ML
4-nitrophenol ❑MDL
❑ML
Pentachlorophenol 0 MDL
Phenol ❑ML
0 MDL _
2,4,6-trichlorophenol ❑ML
0 MDL
Base-Neutral Compounds
Acenaphthene ❑ML
❑MDL
❑ML
Acenaphthylene ❑MDL
Anthracene ❑ML
❑MDL
Benzidine ❑ML
0 MDL
Benzo(a)anthracene ❑ML
0 MDL
Benzo(a)pyrene ❑ML
❑MDL
3,4-benzofluoranthene ❑ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
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
Benno hi a lene ❑ML
(9 )pry ❑MDL
Benzo(k)fluoranthene ❑ML
❑MDL
Bis(2-chloroethoxy)methane ❑ML
❑MDL
Bis(2-chloroethyl)ether ❑ML
0 MDL
❑ML
Bis(2-chloroisopropyl)ether 0 MDL
Bis(2-ethylhexyl)phthalate ❑ML
❑MDL
❑ML
4-bromophenyl phenyl ether ❑MDL
Butyl benzyl phthalate ❑ML
0 MDL
2-chloronaphthalene ❑ML
❑MDL
4-chlorophenyl phenyl ether ❑ML
❑MDL
Chrysene ❑ML
❑MDL
di-n-butyl phthalate ❑ML
❑MDL
di-n-octyl phthalate ❑ML
❑MDL
Dibenzo(a,h)anthracene ❑ML
0 MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ❑ML
❑MDL
Dimethyl phthalate ❑ML
❑MDL
0 ML
2,4-dinitrotoluene 0 MDL
2,6-dinitrotoluene 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
1,2-diphenylhydrazine ❑ML
❑MDL
0 ML
Fluoranthene
❑MDL
Fluorene 0 ML
❑MDL
Hexachlorobenzene 0 ML
0 MDL
Hexachlorobutadiene 0 ML
❑MDL
Hexachlorocyclo-pentadiene ❑ML
0 MDL
0 ML
Hexachloroethane ❑MDL
Indeno(1,2,3-cd)pyrene 0 ML
❑MDL
Isophorone ❑ML
0 MDL
❑ML
Naphthalene
❑MDL
Nitrobenzene ❑ML
❑MDL
N-nitrosodi-n-propylamine ❑ML
❑MDL
N-nitrosodimethylamine ❑ML
❑MDL
N-nitrosodiphenylamine ❑ML
❑MDL
Phenanthrene 0 ML
❑MDL _
Pyrene 0 ML
❑MDL
1,2,4-trichlorobenzene 0 ML
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0088579 Stone Bridge WWTP Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar e
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method1 (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
0 ML
0 MDL
❑ML
❑MDL
0 ML
0 MDL
0 ML
❑MDL
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or O.See instructions and 40 CFR 122.21(e)(3).
Page 18