NC0089478_Renewal (Application)_20220615

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
N c r)c Q()") Li 1Q� n/�ni a w Modified March 2021
Form iP
NC Department of Environmental Quality-Apil VVication 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 a••ication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name"
Wahck w w
Mailing address(street or .0.box)
40 N. Nlerrinetn P t. , Sut4e, 3 =1
City or town State ZIP code
PtShev l ite Nc.) anoi
Contact name(first and last) Title—Di rocky— of Phone number Email address
(YIQSSi -rat t 2$-515 .2%9 brnesss nyeymceivwc 429
Locati address(street,rot umbe or other specific identifier) El Same as mailing address
507)0 Via tu. t 1
City or town State ZIP code
ryas G NC.
1.2 Is this appcation for a facil hat has yet to commence discharge?
❑ Yes 4 See instructions on data submission No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O. box)
0
City or town State ZIP code
Contact name(first and last) Title Phone number Email address
0
n.
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
IV Facility ❑ Applicant ❑ Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a.
�v NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
w t�er) control)
OD
;? ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
w
rn
y ' ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
Nc Isq`rilj c 34 " (c� �� w �) Modified March 2021
1.7 Provide the collection system information requested below for e treatmentW works.
J�`r
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
I DO %separate sanitary sewer 1lAwn 0 Maintain
Z � %combined storm and sanitary sewer 0 Own 0 Maintain
n wcl a ❑ Unknown 0 Own 0 Maintain
oe %separate sanitary sewer ❑ Own 0 Maintain
_---cc;
%combined storm and sanitary sewer 0 Own 0 Maintain
0..
0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
Eo
0 Unknown 0 Own 0 , Maintain
w: %separate sanitary sewer 0 Own 0 Maintain
co %combined storm and sanitary sewer 0 Own 0 Maintain
o 0 Unknown 0 Own 0 Maintain
Total
o Population P wet
LI Served i(i
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) 1 OD % none. %
Z' 1.8 Is the treatment works located in Indian Country?
c
0 0 ❑ Yes V No
U
c 1.9 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
115 .61� mgd
Annual Average Flow Rates(Actual)
v - Two Years Ago Last Year This Year
c
CO , f .y,1 r mgd9
c o t�a' � mgd �/�/ t • mgd
CO LL _
o Maximum Daily Flow Rates(Actual)
Two Years Ago Last Year This Year
mgd {{��V•OO (0 mgd 0•(YOU mgd
co 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
o Total Number of Effluent Discharge Points by Type
°" a Constructed
0 l- Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
a Overflows g y
.a Overflows
1 a 1
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
w `( ( )c q�1c ( , ___ p \�� O Modified March 2021
Outfalls Other Than to Waters of the Stateof Carolina r
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?
0 Yes 1EV- 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
Impoundment (check one)
❑ Continuous
gPd ❑ Intermittent
O Continuous
9Pd 0 Intermittent
O Continuous
gpd ❑ Intermittent
w 1.14 Is wastewater applied to land?
2 ❑ Yes V No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
a Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
°' _ Applied
(check one)
yacres d 0 Continuous
a gp ❑ Intermittent
acres d 0 Continuous
o gp 0 Intermittent
acres d GI Continuous
gp 0 Intermittent
7, 1.16 Is effluent transported to another facility for treatment prior to discharge?
o 0 Yes V 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
i I
Page

NPDES Permit Number Facility Name Modified Application Form 2A
A r c_/inciLi�0/ ( . .p
Wahci In)
Modified March 2021
1.20 In the table below,indiccat�e the name,adddrress,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
1g Facility name Mailing address(street or P.O.box)
0
c
City or town State ZIP code
0
0
g Contact name(first and last) Title
0
t Phone number Email address
QNPDES number of receiving facility(if any) ❑ None Average daily flow rate mgd
co
r5 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
dnot have outlets to waters of the State of North Carolina(e.g., underground percolation. underground injection)?
0 ElYes V No 4 SKIP to Item 1.23.
V
a 1.22 Provide information in the table below on these other disposal methods.
r Information on Other Disposal Methods
g Disposal Annual Average
Method Location of Size of Daily Discharge Continuous or Intermittent
R Description Disposal Site Disposal Site Volume (check one)
N .
acres gpd Tit ❑ Continuous
GI Intermittent
0
acres gpd ElContinuous
❑ Intermittent
acres gpd 111
Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
4) w Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
N
C 0 ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
CO 40 Section 301(h)) 302(b)(2))
IV 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?
V Yes ❑ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name • t
E (company name) GhV1Y'(Y, n'U„ nC
e Mailing address
c (street or P.O.box) Po (' y '(-1
o City,state,and ZIP 13' d ( ',E W t�ap
cti
Tabcoe
o
Contact name(first and
c,> last) MAY I(, �'tql?-Q,,
Phone number %1c6, J Ott—
Email address env
ir f��11�,�.l.�.linGga0I.Cr en
Operational and �yS WU 1`�L Cu en
1
maintenance Z l
responsibilities of
contractor ., trienet OL
Page 4

NPDES Permit Number I Facility Name Modified Application Form 2A
n (C/ to :4 4 Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
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?
03
o ❑ Yes Eg No 4 SKIP to Section 3.
O 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.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
41 o. specific requirements.)
rn
o 2
0
o Yes❑ ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
a :° (See instructions for specific requirements.)
rn
W. 0
c ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1.
E
2.
0
N 3.
co
w
4.
v
= 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
w Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge
(from above) Level
(list outfall (MM/DDIYYYY) {MM/DDIYYYY} (MM/DD/YYYY)
number) (MM/DD/YYYY)
0
d
1.
0
co2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
0 Yes ❑ No 0 None required or applicable
Explanation:
Page 5

NPDES Permit Number 1 Facility Name Modified Application Form 2A
Modified March 2021
NS� (� �,.. U 1. Ll.� L�f� l.1►
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 COI Outfall Number Outfall Number
State I r h CL tri
to
w County SwAin ,vn,.,t
s
t City or town Ad 1n 6+11
wDistance from shore ft. ft. ft.
a
d Depth below surface ft. ft. ft.
n
Average daily flow rate mgd mgd mgd
Latitude ' " c, '
Longitude " "
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
to
o ❑ Yes V No 4 SKIP to Item 3.4.
d
R 3.3 If so.provide the following information for each applicable outfall.
y Outfall Number Outfall Number Outfall Number
c
`S Number of times per year
o discharge occurs
'C
a Average duration of each
`o discharge(specify units)
To c Average flow of each
R discharge mgd mgd mgd
cow Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes V No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
cil
Outfall Number Outfall Number Outfall Number
u)
0
ai 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
d = one or more discharge points?
4 L �/
-- Ll� Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number I Facility Name Modified Application Form 2A
N�/iSnU7� r `�r,��(„ # N 1 Iir� Modified March 2021
3.7 Provide the receiving water and related information(ifknown f r each outfall. uW 17
Outfall Number I Outfall Number Outfall Number
Receiving water name Tou&xlhlt,U.5e
Name of watershed,river, L 41-14. 17' .)
0 or stream system river ?eosin
,E U.S.Soil Conservation
co
Service 14-digit watershed
o code
L
Name of state 1 I
ol
management/river basin
c U.S.Geological Survey
al 8-digit hydrologic
cc cataloging unit code UP DI oab1D5ol.p .
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 VPrimary ❑ Primary E Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) ❑ Other(specify) ❑ Other(specify)
0
0
Q Design Removal Rates by
Outfall
fA _.___._._.,
a,
o BOD5 or CBODs % % ok
a'
d
i
CD TSS % % %
L
❑Not applicable 0 Not applicable 0 Not applicable
Phosphorus % %
ok
❑Not applicable 0 Not applicable 0 Not applicable
Nitrogen %
Other(specify) ❑Not applicable 0 Not applicable 0 Not applicable
%
Page 7

NPDES Permit Number Facility Name I _ Modified Application Form 2A
MC, `)Qny�� \ r �j11„ Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each (thhe tableabl below.If disinfection varies
YPby
season,describe below.
_ dd
oOutfall Numberft1 Outfall Number Outfall Number
Disinfection type
a ChkUr1�{.
Seasons used v LMA5
Me o ct urd
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
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?
Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes [ No SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
qs Acute Chronic Acute Chronic Acute Chronic
co
co
rn
Number of tests of discharge
water
Number of tests of receiving
water
rivcriC
3.14 Does th se chlorine for disinf tion,use chlorine elsewhere in the treatment process,or otherwise have
reasogable potential to discharge chlorine in its effluent?
4V Yes 4 Complete Table B,including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
El Yes •No additional sampling required by NPDES
'-�+' permitting authority.
Page 8

NPDES Permit Number Facility Name Modified
r Modified Application Form 2A
N c. cx ciL g earn n
C nn /��y c , Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET{ests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
KJ
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?
El Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
m 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.
3.23 Describe the cause(s)of the toxicity:
3.24 Has the treatment works conducted a toxicity reduction evaluation?
0 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. authorit .
Page 9

DocuSign Envelope ID:47E97B07-6411-4A78-B725-C328AE946EA1
NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(do)
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 at ach arts
.1 Column 2
Section 1:Basic Application
❑ Information for All Applicants ❑ wi variance request(s) ❑ wi additional attachments
❑ Section 2:Additional ❑ wi topographic map ❑ w/process flow diagram
Information ❑ w/additional attachments
❑ wi Table A ❑ wl Table D
❑ Section 3:Information on ❑ w/Table B ❑ wi additional attachments
Effluent Discharges
❑ wi Table C
Section 4:Not Applicable
Section 5:Not Applicable
❑ Section 6:Checklist and ❑ wi attachments
Certification Statement
6.2 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
Bryan Messing Director Facilities and rusk
Signature
Date signed
v. � 6/14/2022
1 f�au.Iftrssiw�
,�. CJ1�9Fi<0.43z
Page 16

NPDES Permit Number CFacility Name Outfall Number Modified Application Form 2A aine \Mci4! ct.
Modified March 2021
NC. CtC6C1 L c it C33 I
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of MethodT (include units)
Samples
Value Units Value Units
Biochemical oxygen demand ❑ ML
V30D5 or ❑ CBOD5a (.4 CI ❑ MDL
resort one qirs') 1 L aci rr . L
Fecal coliform $ .. El ML
I � ' frill
rIMEILIMIll ❑ MDL
Design flow rate 0. OLo 11 •00t) MGD11E2M
•
pH (minimum) .
pH (maximum)
4"--1 . Lico
. .- . `er\\���ti4`�"+}:`4\�" `i�\�?` �l`,.\.. : \\t.�\�� � ` `t?4 � �\\r y \ , �\
Temperature (winter) • 3 Cop O Cm)
Temperature (summer) Mill
MIMI
Oc)
& s
(4) ,.„
. ..
❑ ML
Total suspended solids (TSS) aa % MIMEIIMIIIIIIIEIEIE & ❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e. , methods) approved unde A 0 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