NC0022900_Renewal (Application)_20220317

c lROY COOPER L4)
THSBISER er
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
March 17, 2022
Carolina Water Service Inc of North Carolina
Attn: Tony Konsul, Director of State Operations
4944 Parkway Plaza Blvd, Ste 375
Charlotte, NC 28217
Subject: Permit Renewal
Application No. NC0022900
Sugar Mountain WWTP
Avery County
Dear Applicant:
The Water Quality Permitting Section acknowledges the March 17, 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. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regardingthe status ofyour renewal application can be found online usingthe Department of Environmental
PP P
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,
t((z) II
Wren Thedford
Administrative Assistant
Water Quality Permitting Section 1
ec: WQPS Laserfiche File w/application
ODE $) North Carolina Department of Environmental Quality Division of Water Resources
Asheville Regional Office 12090 US Highway 70 I Swannanoa.North Carolina 28778
"o+�' 828 296 4500

"PM
Carolina Water Service
110111 of North Carolina"
March 16, 2022
Mr. Wren Thedford
NC DENR RECEIVED
Division of Water Resources
NPDES Unit MAR 17 2022
1617 Mail Service Center
Raleigh NC 27699-1617 NCDEQ/DWR/NPDES
Re: Sugar Mountain WWTP
NPDES NC0022900
Renewal Request
Dear Mr.Thedford
Please find enclosed Application and attachments and consider this letter as our official request to
renew the NPDES permit for the facility referenced above.
If you should have any questions or need any additional information, please do not hesitate to call me at
704-319-0523 or by email at [e-mail] .
Thank you in advance for your attention.
Sincere
Tony Kon.ul
e. - . ,State Operations
•4944 Parkway Plaza Blvd.Ste 375 • Charlotte, North Carolina 28217 •800-525-7990

!WM Carolina Water Service
�� of North CarolinaTM
March 16, 2022
Mr. Wren Thedford
NC DENR
Division of Water Resources
NPDES Unit
1617 Mail Service Center
Raleigh NC 27699-1617
Re: Sugar Mountain WWTP
NPDES NC0022900
Sludge Management Plan
Dear Mr.Thedford,
As sludge and other solids are generated at this facility,they are periodically removed by the licensed
contractor below.
A-1 Appalachian Pumping, Inc.
301 Clay Hodges Rd
Boone, NC 28607
Phone: [phone]
If you should have any questions or need any additional information, please do not hesitate to call me at
704-319-0523 or by email at [e-mail] .
Thank you in advance for your attention.
Sincerely,
Tony K ul
Director,State Operations
•4944 Parkway Plaza Blvd.Ste 375 • Charlotte, North Carolina 28217 •800-525-7990

Print All Pages
Print Form Only
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
NC0022900 Sugar Mountain 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 application.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.210)(1)and(9))
1.1 Facility name
Sugar Mountain Wastewater Treatment Plant
Mailing address(street or P.O.box)
P.O.Box 240908
City or town State ZIP code
o Charlotte NC 28224-0908
Contact name(first and last) Title Phone number Email address
Tony Konsul Director,State Operations [phone] tony.konsul@carolinawatersei
Location address(street,route number,or other specific identifier) ❑Same as mailing address
291 Norwood Hollow Road
w
City or town State ZIP code
Sugar Mountain NC 28604
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission 0 No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
r❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Carolina Water Service of North Carolina
Applicant address(street or P.O.box)
47.o P.O.Box 240908
€ City or town State ZIP code
= Charlotte NC 28224-0908
Contact name(first and last) Title Phone number Email address
Q. Tony Konsul Director,State Operations [phone] tony.konsul@carolinawatersei
n
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑ Operator ElBoth
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility and applicant
❑ 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
❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
:3
water) control)
NC0022985
❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
y ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section El Other(specify)
404)
WQCS0o227
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain 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
100 %separate sanitary sewer 0 Own 0 Maintain
v 1103*2.5=2757 %
Z i combined storm and sanitary sewer 0 Own ❑ Maintain
co ❑ Unknown 0 Own ❑ Maintain
c %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
cg
0 Unknown 0 Own ❑ Maintain
o %separate sanitary sewer 0 Own ❑ Maintain
a.
_ %combined storm and sanitary sewer 0 Own 0 Maintain
❑ Unknown 0 Own 0 Maintain
E %separate sanitary sewer 0 Own ❑ Maintain
N %combined storm and sanitary sewer ❑ Own ❑ Maintain
0 Unknown ❑ Own 0 Maintain
0 Total 2757
m
Population
o Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 100
sewer line(in miles)
z' 1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes El No
c1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes ❑ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.500 mgd
w Annual Average Flow Rates(Actual)
aTwo Years Ago Last Year This Year
eti
0 0.208 mgd 0.192 mgd 0.230 mgd
'1"' Maximum Daily Flow Rates(Actual)
0 Two Years Ago Last Year This Year
1.22 mgd 0.800 mgd 0.670 mgd
o, 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points by Type
a c. Constructed
rn Combined Sewer
en T Treated Effluent Untreated Effluent Overflows Bypasses Emergency
U Overflows
In ,
6 ' 1
Page 2
I

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain 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
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
0 Continuous
gpd ❑ Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes 0 No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
y Land Application Site and Discharge Data
oAverage Daily Volume Continuous or
Location Size Applied Intermittent
(check one)
co
d 0 Continuous
acres
a gp ❑ Intermittent
-0acresgpd 0 Continuous
o ❑ Intermittent
0 Continuous
acres gpd ❑ 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
NC0022900 Sugar Mountain 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
o Facility name Mailing address(street or P.O.box)
2 City or town State ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
aNPDES number of receiving facility(if any) ❑None 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)?
❑ Yes 0 No 4 SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
oDisposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acres gpd ❑ Continuous
❑ Intermittent
0 Continuous
acres gpd 0 Intermittent
acresgpd 0 Continuous
0 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.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters(CWA Water quality related effluent limitation(CWA Section
co 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 ElNo+SKIP 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
= Contractor name
0
.rz (company name)
Mailing address
(street or P.O.box)
w 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
NC0022900 Sugar Mountain Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c 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
d ❑✓ Yes ❑ No 4 SKIP to Section 3.
`0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Wastewater sewer main replacement,manhole rehabilitation,smoke testing of sewer mains,CCTV of sewer mains.
0
0
z 2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
M specific requirements.)
0
0
ElYes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
c e (See instructions for specific requirements.)
u
co
o ❑✓ Yes ❑ No
2.5 Are improvements to the facility scheduled?
ElYes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1 Preliminary Engineering of wastewater treatment plant filters,UV,new head works screen,new influent lift station
2.
3.
co
4.
v
2.6 Provide scheduled or actual dates of completion for improvements.
cn
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge
(from above) (list l (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
numberber)) (MM/DD/YYYY)
v i
1. 1 06/01/2022 03/30/2023
v
0 2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes 0 No ❑ None required or applicable
Explanation:
Preliminary engineering only completed at this time.
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain 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 on Outfall Number Outfall Number
State North Carolina
v) Avery
To County
U
0 City or town Sugar Mountain
w
0
4 Distance from shore 2 ft. ft. ft.
:.
Q.
. Depth below surface 3 ft. ft. ft.
0
Average daily flow rate 0.127 mgd mgd mgd
Latitude 36' 07 56" N ,.
Longitude 81° 51' 07' w "
as
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c ❑ Yes 0 No 4 SKIP to Item 3.4.
d
3.3 If so,provide the following information for each applicable outfall.
s
y Outfall Number Outfall Number Outfall Number
0
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
0 discharge
co
in Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ElNo 4 SKIP to Item 3.6.
4, 3.5 Briefly describe the diffuser type at each applicable outfall.
C
1- Outfall Number Outfall Number Outfall Number
H
7
0
N y 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.
:' N
3 w ❑✓ Yes 0 No+SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number o01 Outfall Number Outfall Number
Receiving water name Flattop Creek
Name of watershed,river, Watauga
0 or stream system
;i U.S.Soil Conservation
y Service 14-digit watershed
o code
d
R Name of state
management/river basin
rn
U.S.Geological Survey
4) 8-digit hydrologic
CD 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 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to j
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
aDesign Removal Rates by NR
Duffel!
d
E BOD5 or CBOD5 %
c
d
E
d TSS
f-
❑Not applicable 0 Not applicable 0 Not applicable
Phosphorus % % ok
0 Not applicable 0 Not applicable 0 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
NC0022900 Sugar Mountain 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.
Liquid sodium hypo-chlorite(12.5%)is used for disinfection and liquid sodium bi-sulfite for de-chlorination.
= Outfall Number 001 Outfall Number Outfall Number
0
Disinfection type (Liquid)Sodium Hypochlorite
= Seasons used All
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
0 Yes ❑ Yes ❑ Yes
❑ No ❑ No ❑ 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?
El 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 001 Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
o
Number of tests of discharge 21
water
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?
El 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 0 No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain 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?
El 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
frMM]DDIYYYY)
,
as
c
c
0 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 4 SKIP to Item 3.26.
CD 3.23 Describe the cause(s)of the toxicity:
c
d
LU
W
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
El Yes ❑ Not applicable because previously submitted
information to the NPDES ermittin authori .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0022900 Sugar Mountain 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 ❑ wl process flow diagram
Information ❑ w/additional attachments
❑ w/Table A ❑ w/Table D
Section 3: Informationo
❑r n ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
❑ w/Table C
iv
cn Section 4:Not Applicable
0
Section 5:Not Applicable
c.)
0 Section 6:Checklist and
❑ Certification Statement El w/attachments
Y 6.2 Certification Statement
CD
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
Tony Konsul Director,State Operations
Signature Date signed
\--1/4>‘42 3I 1262Z.
Page 10

NPDES Permit Number Facility Name Ouffall Number Modified Application Form 2A
NC0022900 Sugar Mountain 001 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 of Method1 (include units)
Samples
Biochemical oxygen demand
t7 BODE or 0 CBODE 58.0 mg/I 12.9 mg/I (468)2019-2021 ❑ML
❑MDL
(report one)
Fecal coliform 6400 #/100m1 3.7 #/100m1 (468)2019-2021 CI ML
0 MDL
Design flow rate 1.220 MGD 0.200 MGD 2019-2021
pH(minimum) 6.0 s.0
pH(maximum) 7.5 s.0
Temperature(winter) 18.0 °C 11.0 °C (774)2019-2021
Temperature(summer) 24.0 °C 17.2 °C (774)2019-2021
Total suspended solids(TSS) 42.0 mg/I 5.2 mg/I (468)2019-2021 ❑ML
0 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).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0022900 Sugar Mountain 001 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 Methods (include
Value Units Value Units Samples units)
Ammonia(as N) 38.6 mg/I 3.6 mg/I (468)2019-2021 0 MDL
Chlorine 0 ML
(total residual,TRC)2 49.0 ug/I 10.5 ug/I (468)2019-2021 ❑MDL
Dissolved oxygen 12.6 mg/I 8.8 mg/I (468)2019-2021 ID ML
0 MDL
Nitrate/nitrite 4.23 mg/I 4.1 mg/I (2)2021 0 ML
0 MDL
0 ML
Kjeldahl nitrogen 9.94 mg/I 9.3 mg/I (6)2021-2022 0 MDL
0 ML
Oil and grease N/A N/A N/A N/A N/A 0 MDL
Phosphorus 3.14 mg/I 2.2 mg/I (6)2021-2022 ❑ML
0 MDL
Total dissolved solids N/A N/A N/A N/A 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).
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
NC0022900 Sugar Mountain 001 Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols Not Applicable
❑ML
Hardness(as CaCO3) ❑MDL
0 ML
Antimony,total recoverable 0 MDL
Arsenic,total recoverable ❑ML
❑MDL
0 ML
Beryllium,total recoverable ❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
0 ML
Copper,total recoverable ❑MDL
Lead,total recoverable ❑ML
❑MDL
0 ML
Mercury,total recoverable ❑MDL
Nickel,total recoverable ❑ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
0 ML
Cyanide ❑MDL
0 ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile ❑ML
0 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
NC0022900 Sugar Mountain ow. Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
0 MDL
1,2-dichloroethane ❑ML
❑MDL
ML
trans-1,2-dichloroethylene 0 MDL
0 ML
1,1-dichloroethylene ❑MDL
0 ML
1,2-dichloropropane 0 MDL
0 ML
1,3-dichloropropylene ❑MDL
ML
Ethylbenzene ❑MDL
❑ML
Methyl bromide ❑MDL
0 ML
Methyl chloride ❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
ML
Tetrachloroethylene ❑MDL
Toluene ❑ML
❑MDL
1,1,1-trichloroethane ❑ML
❑MDL
1,1,2-trichloroethane ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0022900 Sugar Mountain 001 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
ML
Trichloroethylene ❑MDL
❑ML
Vinyl chloride ❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
❑MDL
❑ML
2-chlorophenol ❑MDL
0 ML
2,4-dichlorophenol ❑MDL
2,4-dimethylphenol ❑ML
❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
2,4-dinitrophenol ❑ML
❑MDL
2-nitrophenol ❑ML
❑MDL
4-nitrophenol 0 ML
❑MDL
ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
2,4,6-trichlorophenol ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene ❑ML
❑MDL
Acenaphthylene ❑ML
❑MDL
Anthracene 0 ML
❑MDL
Benzidine ❑ML
❑MDL
0 ML
Benzo(a)anthracene ❑MDL
0 ML
Benzo(a)pyrene ❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0022900 Sugar Mountain 001 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
0 ML
1 Benzo(ghi)perylene ❑MDL
0 ML
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane ❑MDL
0 ML
Bis(2-chloroethyl)ether 0 MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
0 ML
Bis(2-ethylhexyl)phthalate ❑MDL
0 ML
4-bromophenyl phenyl ether ❑MDL
0 ML
Butyl benzyl phthalate ❑MDL
0 ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether 0 MDL
0 ML
Chrysene ❑MDL
0 ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
0 ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ID ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine 0 ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
ID ML
Dimethyl phthalate 0 MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ❑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
001 NC0022900Sugart Mountain Modified March 2021
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
1,2-diphenylhydrazine ❑ML
❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
❑MDL
Hexachlorobutadiene ❑ML
❑MDL
Hexachloroc clo entadiene El ML
Y p
❑MDL
Hexachloroethane ❑ML
❑MDL
Indeno(1,2,3-cd)pyrene El ML
❑MDL
Isophorone ❑ML
❑MDL
Naphthalene ❑ML
❑MDL
Nitrobenzene ❑ML
❑MDL
N-nitrosodi-n-propylamine ❑ML
❑MDL
N-nitrosodimethylamine ❑ML
❑MDL
N-nitrosodiphenylamine ❑ML
❑MDL
Phenanthrene ❑ML
❑MDL
Pyrene ❑ML
❑MDL
❑ML
1,2,4-trichlorobenzene ❑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).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0022900 Sugar Mountain 001 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 Method
Samples (include units)
MI No additional sampling is required by NPDES permitting authority.
o ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑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 18

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Print All Pages
Print Form Only
United States Office of Water EPA Form 3510-1
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
.w.EPA Application Form 1
General Information
NPDES Permitting Program
Note: All applicants to the National Pollutant Discharge Elimination System(NPDES)permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D,2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions"for this form.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information
and complete Form 1 to be 2.9 hours for new applicants and 0.9 hours for applicants renewing
existing permits. This estimate includes time to review instructions, search existing data sources,
gather and maintain the needed data, and complete and review the collection of information.
New respondents must also prepare a topographic map. Send comments about the burden
estimate or any other aspect of this collection of information to the Chief, Information Policy
Branch(PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue,NW,
Washington, DC 20460, and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, 725 17th Street,NW,Washington,DC 20503,marked"Attention:
Desk Officer for EPA."

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS CONTENTS OF FORM 1 PACKAGE
The application forms for individual National Pollutant Discharge Form 1—General Instructions
Elimination System(NPDES)permits include the following: Form 1—Line-by-Line Instructions
Form 1—General Information(included in this package). Form 1—Activities That Do Not Require Permits
Form 2—Forms Based on Facility or Activity Type (not included Form 1—Glossary
in this package): Form 1—Application
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
2C. Existing Manufacturing,Commercial,Mining,and
Silvicultural Operations
2D. New Manufacturing,Commercial,Mining,and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
2E. Manufacturing,Commercial,Mining,and Silvicultural
Facilities Which Discharge Only Nonprocess Wastewater
2F. Stormwater Discharges Associated with Industrial Activity
2S. New and Existing Treatment Works Treating Domestic
Sewage
FORM 1—GENERAL INSTRUCTIONS
Who Must Apply for an NPDES Permit? Upon your request,and based on information supplied by you,
EPA or the authorized NPDES state will determine whether you
With the exceptions described in"Form 1—Activities That Do Not
Require Permits,"the federal Clean Water Act(33 U.S.C. 1251 et are required to obtain a permit for a particular facility or activity.
seq.) prohibits any person from discharging pollutants into waters Be sure to contact EPA or your state if you have a question.
of the United States without first having been issued a permit Form 1 collects general information only.You must also complete
under the NPDES program. a more detailed application based on your proposed discharge
Who Must Complete Form 1? activity,as follows:
All applicants,other than publicly owned treatment works •
If your facility is a concentrated animal feeding operation
(POTWs)and treatment works treating domestic sewage or a concentrated aquatic animal production facility,you
(TWTDS),must submit Form 1. If you operate one of the must also complete Form 2B.
following facilities,you must submit Form 1:concentrated animal • If your facility is an existing manufacturing,commercial,
feeding operations and aquatic animal production facilities; mining,or silvicultural facility that currently discharges
manufacturing,commercial,mining,and silvicultural operations; process wastewater,you must also complete Form 2C.
or other industrial facilities. • If your facility is a new manufacturing,commercial,mining,
At the state level,either the U.S. Environmental Protection or silvicultural facility that has yet to commence discharge of
Agency(EPA)or an approved state agency administers the process wastewater,you must also complete Form 2D.
NPDES permit program. If you are located in a jurisdiction in • If your facility is a new or existing facility(including
which an EPA regional office administers the NPDES permit manufacturing,commercial,mining,and silvicultural
program,you should use Form 1 and all other applicable forms facilities)that discharges only nonprocess wastewater,
described in these instructions. If you are located in a jurisdiction you must also complete Form 2E.
where a state administers the NPDES permit program,contact • If your facility is a new or existing facility whose discharge
the state to determine the forms you should complete.States is composed entirely of stormwater associated with industrial
often develop their own application forms rather than use the activity—excluding discharges from construction activity
federal forms.See http://www.epa.qov/npdes/npdes-state- under 122.26(b)(14)(x)or(b)(15)—you must also complete
program-information for a list of states that have approved Form 2F. If the discharge is composed of stormwater and
NPDES permit programs and those that do not. non-stormwater,you must complete Form 2F and you must
Exhibit 1-1 (see end of this section)provides contact information also complete Forms 2C,2D,and/or 2E,as appropriate.See
for each of EPA's 10 regional offices.Since the exhibit's content is Form 2F's instructions for further details.
subject to change,consult EPA's website for the latest information:
http://www.epa.gov/aboutepa#regional.
1-1

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form Completion of Forms
• If you are in a jurisdiction with an approved state NPDES Print or type in the specified areas only. If you do not have enough
permit program,file according to the instructions on the state space on the form to answer a question,you may continue on
forms. additional sheets,as necessary,using a format consistent with the
• If you are in a jurisdiction where EPA is the NPDES form.
permitting authority(i.e.,the state is not an NPDES- The NPDES permitting authority could consider your application
authorized state),mail the completed application forms to the incomplete if you do not provide an answer(or indicate"NA"for
EPA regional office that covers the state in which your facility "not applicable")for all questions on Form 1 and the applicable
is located(see Exhibit 1-1). Form 2.
When to File Your Completed Form Provide your EPA Identification Number from the Facility Registry
Because of statutory and regulatory requirements,the deadlines Service,NPDES permit number,and facility name at the top of
for filing applications vary according to your facility or activity type each page of Form 1 and any attachments. If your facility is new
and the type of permit you need.The various permit application (i.e.,not yet constructed),write or type"New Facility"in the space
deadlines are listed in Exhibit 1-2 at the end of this section. provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number,contact your
Fees NPDES permitting authority.See Exhibit 1-1 for contact
EPA does not require applicants to pay a fee for applying for information.
NPDES permits. However,states that administer the NPDES Do not leave any response areas blank unless the form directs
permit program may charge fees.Consult with state officials for you to skip them.If the form directs you to respond to an item that
further information. does not apply to your facility or activity,enter"NA"for"not
Public Availability of Submitted Information applicable"to show that you considered the item and determined
a response was not necessary for your facility.
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request. The NPDES permitting authority will consider your application
You may not claim any information on Form 1 (or related complete when it and any supplementary material are received
attachments)as confidential. and completed according to the authority's satisfaction.The
NPDES permitting authority will judge the completeness of any
You may make a claim of confidentiality for any information that application independently of the status of any other permit
you submit to EPA that goes beyond the information required by application or permit for the same facility or activity.
Form 1. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency's business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations(CFR).
1-2

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Exhibit 1-1.Addresses of EPA Regional Contacts and Covered States
REGION 1 REGION 6
U.S.Environmental Protection Agency,Region 1 U.S.Environmental Protection Agency,Region 6
5 Post Office Square,Suite 100,Boston,MA 02109-3912 1445 Ross Avenue,Suite 1200,Dallas,TX 75202-2733
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.00v/aboutepa/epa-region-1-new-enqland Website:http://www.epa.gov/aboutepalepa-region$-south-central
Covered states:Connecticut,Maine,Massachusetts,New Hampshire,Rhode Covered states:Arkansas,Louisiana,New Mexico,Oklahoma,and Texas
Island,and Vermont
REGION 2 REGION 7
U.S.Environmental Protection Agency,Region 2 U.S.Environmental Protection Agency,Region 7
290 Broadway,New York,NY 10007-1866 11201 Renner Boulevard,Lenexa,KS 66219
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Website:http:l/www.epa.qov/aboutepa/epa-reqion-7-midwest
Website:http:/lwww.epa.gov/aboutepa/epa-reqion-2 Covered states:Iowa,Kansas,Missouri,and Nebraska
Covered states:New Jersey,New York,Virgin Islands,and Puerto Rico
REGION 3 REGION 8
U.S.Environmental Protection Agency,Region 3 U.S.Environmental Protection Agency,Region 8
1650 Arch Street,Philadelphia,PA 19103-2029 1595 Wynkoop Street,Denver,CO 80202-1129
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/aboutepa/epa-reqion-3-mid-atlantic Website:http:l/www.epa.00v/aboutepa/epa-region-8-mountains-and-plains
Covered states:Delaware,District of Columbia,Maryland,Pennsylvania,Virginia, Covered states:Colorado,Montana,North Dakota,South Dakota,Utah,and
and West Virginia Wyoming
REGION 4 REGION 9
U.S.Environmental Protection Agency,Region 4 U.S.Environmental Protection Agency,Region 9
Sam Nunn Atlanta Federal Center 75 Hawthorne Street,San Francisco,CA 94105
61 Forsyth Street,SW,Atlanta,GA 30303-8960 Phone:[phone];toll free:(866)EPA-WEST
Phone:[phone];toll free:[phone] Fax:[phone]
Fax:[phone] Website:http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Website:http:/Iwww.epa.govlabouteoa/about-epa-region-4-southeast Covered states:Arizona,California,Hawaii,Nevada,Guam,American Samoa,
Covered states:Alabama,Florida,Georgia,Kentucky,Mississippi,North Carolina, and Trust Territories
South Carolina,and Tennessee
REGION 5 REGION 10
U.S.Environmental Protection Agency,Region 5 U.S.Environmental Protection Agency,Region 10
77 West Jackson Boulevard,Chicago,IL 60604-3507 1200 Sixth Avenue,Suite 900,Seattle,WA 98101
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.00v/aboutepa/epa-reqion-5 Website:http:llwww.epa.qov/aboutepalepa-region-10-pacific-northwest
Covered states:Illinois,Indiana,Michigan,Minnesota,Ohio,and Wisconsin Covered states:Alaska,Idaho,Oregon,and Washington
Exhibit 1-2.Filing Dates for NPDES Permit Applications
Permit Application When to File
180 days before your present NPDES permit expires or,if you are a
2A new discharger,180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
26 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
2C 180 days before your present NPDES permit expires.
2D 180 days prior to startup.
2E 180 days before your present NPDES permit expires,or 180 days
prior to startup if you are a new facility.
Construction:90 days prior to date construction is to commence.
2F Nonconstruction:180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
2S 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
1-3

FORM 1—LINE-BY-LINE INSTRUCTIONS
Section 1.Activities Requiring an NPDES Permit You can find SIC code numbers and descriptions in the
Item 1.1.Review the questions in Item 1.1 to determine if you are 1987 Standard Industrial Classification Manual, prepared by the
required to submit Form 1.Be sure to check the Form 1— Executive Office of the President, Office of Management and
Glossary for the legal definitions of any key terms. Budget.This document is available from the Government Printing
Office,Washington, D.C.An online version of the manual is also
If you answer"Yes"to a question in Item 1.1,then you do not available courtesy of the Occupational Safety and Health
need to complete Form 1,but you must comply with the Administration at htto://www.osha.gov/pls/imis/sic manual.html.
application requirements specified.
You can find NAICS code numbers and descriptions in the North
Item 1.2.Respond to the questions in Items 1.2.1 to 1.2.5. If you American Industrial Classification System Manual prepared by the
answer"Yes"to any question,you must complete Form 1 and the Executive Office of the President,Office of Management and
Form 2 application specified. See Exhibit 1-2 for filing deadlines. Budget.This document is available from the National Technical
If you answer"No"to every question in Items 1.1 and 1.2,then Information Service(NTIS)in Alexandria,Virginia. It is also
you do not need an NPDES permit,and you do not need to available online at http://www.census.gov/eos/www/naics/.
complete and return any of the NPDES application forms. Use the latest edition of the manuals.If you have any questions
Section 2.Name,Mailing Address,and Location about the appropriate SIC or NAICS codes for your facility,
Item 2.1.Enter the facility's official or legal name.Do not use a contact your NPDES permitting authority.
colloquial name. Section 4.Operator Information
Item 2.2. Provide your EPA Identification Number from the Item 4.1.Give the legal name of the person,firm,public
Facility Registry Service if you have an existing facility. If you do organization,or other entity that operates the facility described in
not know your EPA Identification Number,contact your NPDES this application.This may or may not be the same as the facility's
permitting authority. If your facility is new(i.e.,not yet name.The operator of the facility is the legal entity that controls
constructed),write or type"New Facility." the facility's operation rather than the plant or site manager. Do
not use a colloquial name.
Item 2.3.Give the name(first and last),title,work telephone
number,and email address of the person who is thoroughly Item 4.2. Indicate whether the entity listed in response to Item 4.1
familiar with the operation of the facility and with the facts also owns the facility by marking the appropriate box.
reported in this application.The NPDES permitting authority will Item 4.3. Indicate the ownership status of the operator of the
contact the person listed if they have questions on the material facility by marking the appropriate box. If the facility is a federal
submitted. facility(i.e.,owned by the U.S.government),check the box for
Item 2.4.Give the complete mailing address of the office to which "Public—federal."If the facility is owned by a state government,
the NPDES permitting authority should send correspondence. check the box for"Public—state."If the facility is owned by a
This often is not the address used to designate the location of the county government, municipal(e.g.,city or town)government,
facility or activity. tribal government,school district,water district,or other local
government entity,check the box for"Other public"and specify
Item 2.5.Give the address or location of the facility identified the type of government entity. If the facility is owned by a
under Item 2.1. If the facility lacks a street name or route number, corporation or other private entity,check the box for"Private."If
give the most accurate,alternative geographic information(e.g., the facility has mixed ownership(e.g.,public/private)or is not
section number or quarter section number from county records or owned by an entity of the types previously listed,check the box
"at intersection of Routes 425 and 22").Also provide the county for"Other"and specify the type of entity.
name,county code(if known),city or town,state,and zip code.
Items 4.4 to 4.6.Enter the telephone number,address,and email
For concentrated aquatic animal production facilities,provide the address of the operator identified in Item 4.1.
address or location of the production area(i.e.,the location where
the animals are contained,grown,or held). Section 5.Indian Land
Item 5.1. Indicate whether the facility is located on Indian Land.
Section 3.SIC and NAICS Codes
Items 3.1 and 3.2.List, in descending order of significance,up to Section 6.Existing Environmental Permits
four 4-digit standard industrial classification(SIC)codes and Item 6.1.Check the appropriate boxes and provide the permit
North American Industrial Classification System(NAICS)codes numbers for all relevant federal,state,and local environmental
that best describe your facility in terms of the principal products or permits or construction approvals received or applied for under
services it produces or provides. If the SIC or NAICS codes do any of the programs listed below. If you have more than one
not adequately describe your facility's products or services,you currently effective permit under a particular permit program for
have the option to provide additional descriptive information. your facility, list the additional permit numbers on the application
form or on a separate sheet of paper.
1-4

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
• Hazardous waste management program under the Resource (e.g.,residential,commercial).An example of an acceptable
Conservation and Recovery Act(RCRA). location map is shown as Exhibit 1-3 at the end of these
• Underground Injection Control(UIC)program under the Safe instructions.Note: Exhibit 1-3 is provided for illustration only;it
Drinking Water Act(SDWA). does not show an actual facility.
• NPDES program under the Clean Water Act(CWA). If the facility is a concentrated animal feeding operation,you are
Prevention of Significant Deterioration(PSD)program under not required to provide the topographic map required by this
• the Clean Air Act(CAA). section of Form 1. Instead,you are required to provide a
topographic map as specified in Section 4 of Form 2B.
• Nonattainment program under the CAA.
Item 7.1.Note that you have completed your topographic map
• National Emission Standards for Hazardous Pollutants and attached it to the application.
(NESHAPs)preconstruction approval under the CAA.
Section 8.Nature of Business
• Ocean dumping permits under the Marine Protection Briefly describe the nature of your business(e.g., products
Research and Sanctuaries Act(MPRSA).
produced or services provided).See Examples 1 and 2.
• Dredge or fill permits under Section 404 of the CWA.
Other federal,state,or local environmental permits. Example 1
• Facilities Subject to 40 CFR 426,Subparts F and G
Section 7.Map Industry A is an auto tempered and auto laminated glass
Unless the facility is a concentrated animal feeding operation, manufacturing facility subject to effluent limitation guidelines
provide a topographic map(s)of the area extending at least one (ELGs)for the"Automotive Glass Tempering"and"Automotive
mile beyond the property boundaries of the facility that clearly Glass Laminating"subcategories of the"Glass Manufacturing"
shows the following: point source category at 40 CFR 426,subparts F and G.At the
The legal boundaries of the facility. facility,glass is cut and then passed through a series of
• processes that grind and polish the edges, bend the glass,and
• The location and serial number of each of your existing and then temper the glass to produce side and back windows for
proposed intake and discharge structures. automobiles.Tempering involves heating the glass near the
• All hazardous waste management,storage,and disposal melting point,then rapidly cooling it to increase its mechanical
facilities. and thermal endurance.The facility also produces automobile
• Each well where you inject fluids underground. windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass for
• All wells,springs,surface water bodies,and drinking water lamination(e.g.,cutting,bending,and washing).
wells that are in the public record or otherwise known to you
and that are located in the map area. Example 2
Facility Not Subject to ELGs
If the facility has associated water intakes,discharge structures,
hazardous waste disposal sites,or injection wells and these items Industry B undertakes batch-type resin manufacturing operations.
are located more than one mile from the facility, include them on It has aboveground storage tanks for raw materials and finished
the map if possible. If you cannot,attach additional sheets goods,resin loading operations,and warehouses for 55-gallon
describing the location of the structures,disposal site(s),or well(s) drums of finished product. Industry B manufactures alkyd,
and identify the U.S.Geological Survey(USGS)or other map saturated and unsaturated polyester resins in batches using
corresponding to the location(s). reactor vessels and mix tanks.Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
On each map,include the map scale,a meridian arrow showing piping system.Additional feedstocks are added manually as
north,and latitude and longitude to the nearest second.Latitude solids from bags and sacks via manways,which are located on
and longitude coordinates may be obtained in a variety of ways, top of the kettles.The resin is then chemically reacted in the
including use of hand held devices(e.g.,a GPS enabled kettles.After the reaction step finishes,the resin is transferred
smartphone),Internet mapping tools(e.g., from the kettles to the mix tanks,where solvents are added to
https://mynasadata.larc.nasa.gov/latitudelonqitude-finder/), thin it.The primary byproduct of the reaction is water vapor
geographic information systems(e.g.,ArcView),or paper maps containing condensed soluble organics.The byproduct flows to
from trusted sources(e.g.,USGS). an isolation tank where the vapors are directed to an onsite
On all maps of rivers,show the direction of the current. In tidal thermal oxidizer.The finished resin is then pumped through one
waters,show the directions of ebb and flow tides. of three types of filtration systems into finished goods storage
tanks,55-gallon drums, 350-gallon intermediate bulk container
You may develop your map by going to USGS's National Map totes,or directly into tanker trucks.A typical batch takes about 30
website at http://nationalmap.gov/.(For a map from this site,use hours to complete.
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.)You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
1-5

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Section 9.Cooling Water Intake Structures FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
Item 9.1.Indicate whether the facility uses cooling water.If yes, APPLICATION TO BE SIGNED AS FOLLOWS:
continue to Item 9.2. If no,skip to Item 10.1. A. For a corporation,by a responsible corporate officer.For the
Item 9.2. Identify the source of the cooling water.For example, purpose of this section,a responsible corporate officer
indicate whether the cooling water is from a surface water, means:(1)a president,secretary,treasurer,or vice-president
groundwater well,public water system,or treated effluent that of the corporation in charge of a principal business function,
would otherwise be discharged to a water of the U.S. or any other person who performs similar policy-or decision-
making functions for the corporation,or(2)the manager of
If the facility uses a cooling water intake structure as described in one or more manufacturing,production,or operating facilities,
40 CFR 125,Subparts I and J,the facility may have additional provided the manager is authorized to make management
application requirements under 40 CFR 122.21(r).Note that the decisions which govern the operation of the regulated facility
information required by 40 CFR 122.21(r)is not requested as part including having the explicit or implicit duty of making major
of Form 1.Contact your NPDES permitting authority to determine capital investment recommendations,and initiating and
the specifics of what you should provide and when. directing other comprehensive measures to assure long term
Section 10.Variance Requests environmental compliance with environmental laws and
An applicant(other than a POTW)may request a variance from regulations;the manager can ensure that the necessary
otherwise applicable effluent limitations under certain conditions systems are established or actions taken to gather complete
described at 40 CFR 122.21(m). and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
Item 10.1.If known at the time of application,check all of the delegated to the manager in accordance with corporate
authorized variances that you plan to request or renew.Note that procedures.
you are not being asked to submit any other information at this B. For a partnership or sole proprietorship,by a general partner
time.Contact your NPDES permitting authority to determine the or the proprietor,respectively.
specifics of what you should provide and when.The ability to
request a variance is not limited to the time of application,and an C. For a municipality,state,federal,or other public facility,by
applicant may request a variance consistent with statutory and either a principal executive officer or ranking elected official.
regulatory requirements. For purposes of this section,a principal executive officer of a
federal agency includes:(1)The chief executive officer of the
Section 11.Checklist and Certification agency,or(2)a senior executive officer having responsibility
Item 11.1.Review the checklist provided. In Column 1,mark the for the overall operations of a principal geographic unit of the
sections of Form 1 that you have completed and are submitting agency(e.g.,Regional Administrators of EPA).
with your application.In Column 2,indicate for each section
whether you are submitting attachments.
Item 11.2.The Clean Water Act provides for severe penalties for
submitting false information on this application form.CWA Section
309(c)(2)provides that,"Any person who knowingly makes any
false statement,representation,or certification in any application,
...shall upon conviction,be punished by a fine of no more than
$10,000 or by imprisonment for not more than six months,or
both."
1-6

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1-7

FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge • Any discharge in compliance with the instructions of an On-
is in one of the following categories,as provided by the CWA and Scene Coordinator pursuant to 40 CFR 300(The National Oil
NPDES regulations at 40 CFR 122 to 125.(However, under CWA and Hazardous Substances Pollution Contingency Plan)or
Sections 510 and 312,some discharges exempted from the 33 CFR 153.10(e)(Pollution by Oil and Hazardous
federal NPDES requirements may still be regulated by a state Substances).
permitting authority.) • Any introduction of pollutants from non point-source
• Any discharge of sewage from vessels and any effluent from agricultural and silvicultural activities,including stormwater
properly functioning marine engines,laundry,shower,and runoff from orchards,cultivated crops, pastures,range lands,
galley sink wastes,or any other discharge incidental to the and forest lands,but not discharges from concentrated
normal operation of a vessel,including vessels of the Armed animal feeding operations as defined in 40 CFR 122.23,
Forces within the meaning of section 312 of the CWA and discharges from concentrated aquatic animal production
recreational vessels within the meaning of section 502(25)of facilities as defined in 40 CFR 122.23,discharges from
the CWA. None of these exclusions apply to rubbish,trash, concentrated aquatic animal production facilities as defined
garbage,or other such materials discharged overboard;nor in 40 CFR 122.24,discharges to aquaculture projects as
to other discharges when the vessel is operating in a defined in 40 CFR 122.25,and discharges from silvicultural
capacity other than as a means of transportation such as point sources as defined in 40 CFR 122.27.Note: Per 40
when used as an energy or mining facility,a storage facility CFR 122.26(b)(14)(ii),facilities classified within SIC 24,
or a seafood processing facility,or when secured to a Industry Group 241,that are rock crushing,gravel washing,
storage facility or a seafood processing facility, or when log sorting,or log storage facilities operated in connection
secured to the bed of the ocean,contiguous zone or waters with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)
of the United States for the purpose of mineral or oil and Industry Groups 242 through 249;26(except 265 and
exploration or development. 267),28(except 283),29,311,32(except 323),33,3441,
Discharges of dredged or fill material into waters of the and 373(not included are all other types of silviculture
• United States that are regulated under CWA Section 404. facilities)are considered stormwater discharges associated
with industrial activity,and are required to obtain an NPDES
• The introduction of sewage,industrial wastes,or other permit.
pollutants into publicly owned treatment works by indirect • Return flows from irrigated agriculture.
dischargers. Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the • Discharges into a privately owned treatment works,except as
obligation to have and comply with permits until all the NPDES permitting authority may otherwise require under
discharges of pollutants to waters of the United States are 40 CFR 122.44(m).
eliminated.(See also 40 CFR 122.47(b).)This exclusion • Discharges from a water transfer."Water transfer"means an
does not apply to the introduction of pollutants to privately activity that conveys or connects waters of the United States
owned treatment works or to other discharges through pipes, without subjecting the transferred water to intervening
sewers,or other conveyances owned by a state,municipality, industrial, municipal,or commercial use.This exclusion does
or other party not leading to treatment works. not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
1-8

FORM 1—GLOSSARY
Note:This glossary includes terms used in the various NPDES application forms, including Form 1.The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms,contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at§ 122.23)means a lot or facility(other than an aquatic animal production facility)where the
following conditions are met;
• Animals(other than aquatic animals)have been,are,or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period;and
• Crops,vegetation,forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit,including any additions, revisions,or modifications to the
forms;or forms approved by EPA for use in approved states,including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT(defined at§122.25)means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater,estuarine,or marine plants or animals.DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species,using a method or plan or operation(including, but not limited to,physical confinement)which,on the basis of reliable
scientific evidence,is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants,and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES(BMPs)means schedules of activities,prohibitions of practices, maintenance procedures,and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements,operation
procedures,and practices to control plant site runoff,spillage or leaks,sludge or waste disposal,or drainage from raw material storage.
BIOSOLIDS(see sewage sludge).
BYPASS(defined at§ 122.41(m))means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW(CSO)means a discharge from a combined sewer system(CSS)at a point prior to the Publicly Owned
Treatment Works(POTW)Treatment Plant(defined at§403.3(r)).
COMBINED SEWER SYSTEM(CSS)means a wastewater collection system owned by a State or municipality(as defined by section
502(4)of the CWA)which conveys sanitary wastewaters(domestic,commercial and industrial wastewaters)and storm water through a
single-pipe system to a Publicly Owned Treatment Works(POTW)Treatment Plant(as defined at§403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION(defined at§ 122.23)means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of(A)or(B)below,or that is designated as a CAFO in accordance with 40 CFR 122.23(c).Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation,if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION(LARGE CAFO)means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows,whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves.Cattle includes but is not limited to heifers,steers,bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
1-9

FORM 1—GLOSSARY CONTINUED
6. 500 horses;
7. 10,000 sheep or lambs;
8. 55,000 turkeys;
9. 30,000 laying hens or broilers,if the AFO uses a liquid manure handling system;
10. 125,000 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
11. 82,000 laying hens, if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks(if the AFO uses other than a liquid manure handling system);or
13. 5,000 ducks(if the AFO uses a liquid manure handling system).
B. MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION(MEDIUM CAFO)means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO.An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows,whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers,steers,bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers,if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens,if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks(if the AFO uses other than a liquid manure handling system);ore
m. 1,500 to 4,999 ducks(if the AFO uses a liquid manure handling system);and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch,flushing system,or other similar man-
made device;or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over,across,or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY(defined at§ 122.24)means a hatchery,fish farm,or other facility which
contains,grows,or holds aquatic animals in either of the following categories,or which the Director designates as such on a case-by-case
basis:
A. Cold water fish species or other cold water aquatic animals including, but not limited to,the Salmonidae family of fish(e.g.,trout and
salmon)in ponds,raceways,or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms(approximately 20,000 pounds)of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms(approximately 5,000 pounds)of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including,but not limited to,the Ameiuridae, Cetrarchiclae,and
Cyprinidae families of fish(e.g.,respectively,catfish,sunfish,and minnows)in ponds,raceways,or other similar structures which
discharge at least 30 days per year,but does not include;
1. Closed ponds which discharge only during periods of excess runoff;or
2. Facilities which produce less than 45,454 harvest weight kilograms(approximately 100,000 pounds)of aquatic animals per year.
1-10

FORM 1—GLOSSARY CONTINUED
CWA means the Clean Water Act(formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972)Public Law 92-500,as amended by Public Law 95-217,Public Law 95-576, Public Law 96-483 and Public Law
97-117,33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act(CWA)and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the"discharge of a pollutant"measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass,the"daily discharge"is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement,the"daily discharge"is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the"discharge of a pollutant."
DIRECTOR means the Regional Administrator or the State Director,as the context requires,or an authorized representative.When there
is no"approved State program,"and there is an EPA administered program,"Director"means the Regional Administrator.When there is
an approved State program,"Director"normally means the State Director. In some circumstances,however,EPA retains the authority to
take certain actions even when there is an approved State program.(For example,when EPA has issued an NPDES permit prior to the
approval of a State program,EPA may retain jurisdiction over that permit after program approval,see§123.1.) In such cases,the term
"Director"means the Regional Administrator and not the State Director.
DISCHARGE(OF A POLLUTANT)means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source;or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from:surface runoff which is collected or channelled by man;
discharges through pipes,sewers,or other conveyances owned by a State,municipality,or other person which do not lead to a treatment
works;and discharges through pipes,sewers,or other conveyances,leading into privately owned treatment works.This term does not
include an addition of pollutants by any"indirect discharger".
DISCHARGE MONITORING REPORT means the EPA uniform national form,including any subsequent additions,revisions,or
modifications for the reporting of self-monitoring results by permittees.DMRs must be used by"approved States"as well as by EPA. EPA
will supply DMRs to any approved State upon request.The EPA national forms may be modified to substitute the state agency name,
address, logo,and other similar information,as appropriate,in place of EPA's.
DRAFT PERMIT means a document prepared under§124.6 indicating the Director's tentative decision to issue or deny,modify,revoke
and reissue,terminate,or reissue a"permit."A notice of intent to terminate a permit,and a notice of intent to deny a permit,as discussed
in§124.5,are types of"draft permits."A denial of a request for modification,revocation and reissuance,or termination,as discussed in
§ 124.5,is not a"draft permit."A"proposed permit"is not a"draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities,discharge rates,and concentrations of"pollutants"
which are"discharged"from"point sources"into"waters of the United States,"the waters of the"contiguous zone,"or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b)of the CWA to adopt or
revise"effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY(EPA)means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES"point source"or any other facility or activity(including land or appurtenances thereto)that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES"permit"issued under§122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY(or INDAN LANDS)means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government,notwithstanding the
issuance of any patent,and,including rights-of-way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof,and whether within or without the limits of a state;and
• All Indian allotments,the Indian titles to which have not been extinguished,including rights-of-way running through the same.
1-11

FORM 1—GLOSSARY CONTINUED
INDIAN TRIBE means any Indian Tribe, band,group,or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing"pollutants"to a"publicly owned treatment works."
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§122.26(b)(4))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census(Appendix F of 40 CFR 122);or
(ii)Located in the counties listed in appendix H of 40 CFR 122,except municipal separate storm sewers that are located in the
incorporated places,townships or towns within such counties;or
(iii)Owned or operated by a municipality other than those described in paragraphs(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs(i)or(ii). In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;and
(E)Other relevant factors;or
(iv)The Director may,upon petition,designate as a large municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i),(ii),(iii).
LOG SORTING AND LOG STORAGE FACILITIES(defined at§ 122.27)means facilities whose discharges result from the holding of
unprocessed wood,for example,logs or roundwood with bark or after removal of bark held in self-contained bodies of water(mill ponds or
log ponds)or stored on land where water is applied intentionally on the logs(wet decking).(See 40 CFR 429,subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES"facility or activity"classified as such by the Regional Administrator,or,in the case of"approved
State programs,"the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable"daily discharge."
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§122.26(b)(7))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 100,000 or more but less than 250,000,as determined by the 1990 Decennial
Census by the Bureau of the Census(appendix G of 40 CFR 122);or
(ii)Located in the counties listed in appendix I of 40 CFR 122,except municipal separate storm sewers that are located in the incorporated
places,townships or towns within such counties;or
(iii) Owned or operated by a municipality other than those described in paragraph(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph(i)or(ii). In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;or
(E)Other relevant factors;or
1-12

FORM 1—GLOSSARY CONTINUED
(iv)The Director may,upon petition,designate as a medium municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i), (ii),(iii)of this section.
MUNICIPALITY means a city,town, borough,county,parish,district,association,or other public body created by or under State law and
having jurisdiction over disposal of sewage,industrial wastes,or other wastes,or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER(defined at§ 122.26(b)(8))means a conveyance or system of conveyances(including roads
with drainage systems, municipal streets,catch basins,curbs,gutters,ditches, man-made channels,or storm drains):
• Owned or operated by a State,city,town,borough,county,parish,district,association,or other public body(created by or pursuant to
State law)having jurisdiction over disposal of sewage,industrial wastes,stormwater,or other wastes,including special districts under
State law such as a sewer district,flood control district or drainage district,or similar entity,or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
• Designed or used for collecting or conveying stormwater.
• Which is not a combined sewer;and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE(see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES)means the national program for issuing,modifying,revoking
and reissuing,terminating,monitoring and enforcing permits,and imposing and enforcing pretreatment requirements, under sections 307,
402,318,and 405 of the CWA.The term includes an"approved program."
NEW DISCHARGER means any building,structure,facility,or installation:
• From which there is or may be a"discharge of pollutants;"
• That did not commence the"discharge of pollutants"at a particular"site"prior to August 13, 1979;
• Which is not a"new source;"and
• Which has never received a finally effective NPDES permit for discharges at that"site."
This definition includes an"indirect discharger"which commences discharging into"waters of the United States"after August 13, 1979. It
also means any existing mobile point source(other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig)such as a seafood processing rig,seafood processing vessel,or aggregate plant,that begins discharging at a
"site"for which it does not have a permit;and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979,at a"site"under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern,the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1)through(10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a"new discharger"only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building,structure,facility,or installation from which there is or may be a"discharge of pollutants,"the
construction of which commenced:
• After promulgation of standards of performance under section 306 of the CWA which are applicable to such source,or
• After proposal of standards of performance in accordance with section 306 of the CWA which are applicable to such source,but only
if the standards are promulgated in accordance with section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any"facility or activity"subject to regulation under the NPDES program.
PERMIT means an authorization, license,or equivalent control document issued by EPA or an"approved State"to implement the
requirements of this part and parts 123 and 124."Permit"includes an NPDES"general permit"(§ 122.28).Permit does not include any
permit which has not yet been the subject of final agency action,such as a"draft permit"or a"proposed permit."
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides,and the application of chemical pesticides that leave a residue,from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application,this does not include
1-13

FORM 1—GLOSSARY CONTINUED
agricultural storm water discharges and return flows from irrigated agriculture,which are excluded by law(33 U.S.C. 1342(1);33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application,means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible,confined,and discrete conveyance, including but not limited to,any pipe,ditch,channel,tunnel,
conduit,well,discrete fissure,container,rolling stock,concentrated animal feeding operation,landfill leachate collection system,vessel or
other floating craft from which pollutants are or may be discharged.This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff.(See§ 122.3).
POLLUTANT means dredged spoil,solid waste, incinerator residue,filter backwash,sewage,garbage,sewage sludge,munitions,
chemical wastes, biological materials,radioactive materials(except those regulated under the Atomic Energy Act of 1954,as amended(42
U.S.C.2011 et seq.)),heat,wrecked or discarded equipment,rock,sand,cellar dirt and industrial,municipal,and agricultural waste
discharged into water. It does not mean:
• Sewage from vessels;or
• Water,gas,or other material which is injected into a well to facilitate production of oil or gas,or water derived in association with oil
and gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located,and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources.Note:Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source,byproduct,or special nuclear materials. Examples of materials not covered include radium
and accelerator-produced isotopes.See Train v. Colorado Public Interest Research Group, Inc.,426 U.S. 1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement(Natural Resources Defense
Council et al.v. Train,8 E.R.C.2120(D.D.C. 1976),modified 12 E.R.C. 1833(D.D.C. 1979));also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is(1)used to treat wastes from any facility whose
operator is not the operator of the treatment works and(2)not a"POTW."
PROCESS WASTEWATER means any water which,during manufacturing or processing,comes into direct contact with or results from the
production or use of any raw material,intermediate product,finished product,byproduct,or waste product.
PROPOSED PERMIT means a state NPDES"permit"prepared after the close of the public comment period(and,when applicable,any
public hearing and administrative appeals)which is sent to EPA for review before final issuance by the State.A"proposed permit"is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW(defined at§403.3)means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality(as defined by CWA Section 502(4)).This definition includes any devices or systems used in the
storage,treatment, recycling,and reclamation)of municipal sewage or industrial wastes of a liquid nature.This definition also includes
sewers, pipes,and other conveyances only if they convey wastewater to a POTW.The term also means the municipality as defined in
CWA Section 502(4),which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES(defined at§122.27)means facilities which process crushed and broken
stone,gravel,and riprap(See 40 CFR 436,subpart B,including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a"permit",including an enforceable sequence of
interim requirements(for example,actions,operations,or milestone events)leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the CWA,except that with respect to commercial
vessels on the Great Lakes this term includes graywater. For the purposes of this definition,"graywater"means galley,bath,and shower
water.
SEWAGE SLUDGE means any solid,semi-solid,or liquid residue removed during the treatment of municipal waste water or domestic
sewage.Sewage sludge includes,but is not limited to,solids removed during primary,secondary,or advanced waste water treatment,
scum,septage,portable toilet pumpings,type III marine sanitation device pumpings(33 CFR 159),and sewage sludge products.Sewage
sludge does not include grit or screenings,or ash generated during the incineration of sewage sludge.
1-14

FORM 1—GLOSSARY CONTINUED
SILVICULTURAL POINT SOURCE(defined at§ 122.27)means any discernible,confined,and discrete conveyance related to rock
crushing,gravel washing,log sorting,or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States.This term does not include non-point source silvicultural activities such as
nursery operations,site preparation,reforestation and subsequent cultural treatment,thinning,prescribed burning,pest and fire control,
harvesting operations,surface drainage,or road construction and maintenance from which there is natural runoff. However,some of these
activities(such as stream crossing for roads)may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit(see 33 CFR 209.120 and part 233).
SITE means the land or water area where any"facility or activity"is physically located or conducted,including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any"treatment works treating domestic sewage"whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d)of the CWA and is required to obtain a permit under§122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d)of the CWA
which govern minimum requirements for sludge quality, management practices,and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States,the District of Columbia,Guam,the Commonwealth of Puerto Rico,the Virgin Islands,American
Samoa,the Commonwealth of the Northern Mariana Islands,the Trust Territory of the Pacific Islands,or an Indian Tribe as defined in
these regulations which meets the requirements of§ 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an"approved program,"or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies,"State Director"
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER(or STORM WATER)(defined at§122.26(b)(13))means stormwater runoff,snow melt runoff,and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY(defined at§122.26(b)(14))means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing,processing or raw materials
storage areas at an industrial plant.The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section,the term includes,but is not limited to,stormwater discharges
from industrial plant yards;immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material,or by-products used or created by the facility; material handling sites;refuse sites;sites used for the application or disposal
of process waste waters(as defined at 40 CFR 401);sites used for the storage and maintenance of material handling equipment;sites
used for residual treatment,storage,or disposal;shipping and receiving areas;manufacturing buildings;storage areas(including tank
farms)for raw materials,and intermediate and final products;and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading,transportation,or conveyance of any raw material,intermediate product,final product,by-product or waste product.The
term excludes areas located on plant lands separate from the plant's industrial activities,such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities(including industrial facilities that are federally,State,or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below)include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v).The
following categories of facilities are considered to be engaging in"industrial activity"for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines,new source performance standards,or toxic pollutant effluent standards
effluent standards which are exempted underparagraph 11
under 40 CFR Subchapter N (except facilities with toxicpollutant o ue i p below);
P ( P
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing,gravel washing,log sorting,or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)and Industry Groups 242
through 249;26(except 265 and 267),28(except 283),29, 311,32(except 323),33,3441,373;(not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14(mineral industry)including active or inactive mining
operations(except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released,or except for areas of
non—coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990)and oil and gas exploration, production, processing,or treatment operations,or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with,any overburden,raw material,intermediate
products,finished products,byproducts or waste products located on the site of such operations;(inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator;inactive mining sites do not include sites
1-15

FORM 1-GLOSSARY CONTINUED
where mining claims are being maintained prior to disturbances associated with the extraction,beneficiation,or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment,storage,or disposal facilities,including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills,land application sites,and open dumps that receive or have received any industrial wastes(waste that is received from any
of the facilities described under this subsection)including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials,including metal scrapyards,battery reclaimers,salvage yards,and automobile
junkyards,including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities,including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40,41,42(except 4221-25),43,44,45,and 5171 which have
vehicle maintenance shops, equipment cleaning operations,or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance(including vehicle rehabilitation,mechanical repairs,painting,fueling,and lubrication),
equipment cleaning operations,airport deicing operations,or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system,used in the
storage treatment, recycling,and reclamation of municipal or domestic sewage,including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility,with a design flow of 1.0 mgd or more,or required to have an approved
pretreatment program under 40 CFR 403.Not included are farm lands,domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility,or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing,grading and excavation,except operations that result in the disturbance of less than five acres
of total land area.Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20,21,22,23,2434,25,265,267,27,283,285,30,31 (except 311),323,34
(except 3441),35,36,37(except 373), 38,39,and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1)or,in the case of"sludge use or disposal practices,"any
pollutant identified in regulations implementing section 405(d)of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE(TWTDS)means a POTW or any other sewage sludge or waste water
treatment devices or systems,regardless of ownership(including federal facilities),used in the storage,treatment,recycling,and
reclamation of municipal or domestic sewage,including land dedicated for the disposal of sewage sludge.This definition does not include
septic tanks or similar devices. For purposes of this definition,"domestic sewage"includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f)of the CWA,the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a"treatment works treating domestic sewage,"where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling,use or disposal
practices,or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET(defined at§122.41(n))means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee.An upset does not include
noncompliance to the extent caused by operational error,improperly designed treatment facilities,inadequate treatment facilities,lack of
preventive maintenance,or careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125,or in the applicable"effluent
limitations guidelines"which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA.This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c),301(g),301(h),301(i),or 316(a)of the CWA.
WATERS OF THE UNITED STATES as defined at§122.2.
WHOLE EFFLUENT TOXICITY(WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
1-16

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0022900 Sugar Mountain OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 \-/EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 12
treatment works? 1. . treating domestic sewage?
If yes,STOP. Do NOT complete 0 No If yes,STOP.Do NOT No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial,mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
o0 Yes 4 Complete Form 1 0 No Yes 4 Complete Form 0 No
a and Form 2B. 1 and Form 2C.
c1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
d 0 Yes 4 Complete Form 1 2 No ❑ Yes 4 Complete Form E No
and Form 2D. 1 and Form 2E.
tq
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 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
Sugar Mountain Wastewater Treatment Plant
2.2 EPA Identification Number
w
A
0
0
J
2.3 Facility Contact
Name(first and last) Title Phone number
v
Tony Konsul Director,State Operations [phone]
rn Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O. box
P.O.Box 240908
City or town State ZIP code
Charlotte NC 28224-0908
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0022900 Sugar Mountain OMB No.2040-0004
u 2.5 Fudlity Location
• . Street,route number,or other specific identifier
Q coi 291 Norwood Hollow Road
C.)
0 County name County code(if known)
(73
Avery
o
E City or town State ZIP code
Z co Sugar Mountain NC 28604
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
N
61
0
O
3.2 NAICS Code(s) Description(optional)
U
(73
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Carolina Water Service of North Carolina
0 4.2 Is the name you listed in Item 4.1 also the owner?
❑ Yes ❑ No
4.3 Operator Status
❑ Public—federal ❑ Public—state ❑ Other public(specify)
❑r Private ❑ Other(specify)
. 4.4 Phone Number of Operator
[phone]
4.5 Operator Address
w Street or P.O.Box
m 4944 Parkway Plaza Blvd Suite 375
o
City or town State ZIP code
o c- 0 Charlotte NC 28217
)
Email address of operator
O [e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
c 5.1 Is the facility located on Indian Land?
3 ❑Yes ❑ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0022900 Sugar Mountain OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
❑ NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
o .• w NC0022900
a0 PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
w ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
0. specific requirements.)
2
❑� Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Private waster utility company providing domestic water and wastewater service to the Sugar Mountain area
subdivisions located in Avery County NC.
N
N
N
y
m
w
O
E.)7
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes 0 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
o,�• 2 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
C
O �p
U �
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
y apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
ce 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
NC0022900 Sugar Mountain 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 I Column 2
❑✓ Section 1:Activities Requiring an NPDES Permit ❑ wl attachments
❑� Section 2:Name,Mailing Address,and Location ❑ w/attachments
❑ Section 3:SIC Codes ❑ w/attachments
ElSection 4:Operator Information ❑ w/attachments
❑✓ Section 5:Indian Land ❑ wl attachments
❑✓ Section 6:Existing Environmental Permits ❑ w/attachments
w/topographic
A 0 Section 7:Map ❑ map ❑ wl additional attachments
c ❑r Section 8:Nature of Business ❑ wl attachments
w ❑ Section 9:Cooling Water Intake Structures ❑ wl attachments
C.' ❑ Section 10:Variance Requests ❑ wl attachments
n ElSection 11:Checklist and Certification Statement ❑ w/attachments
.X
m 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
Tony Konsul Director,State Operations
Sign re + \ \ Date signed
Click to go back to the beginning of Form
EPA Form 3510-1(revised 3-19) Page 4

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