NC0052043_Renewal (Application)_20220620

ROY COOPER _ c
Governor
ELIZABETH S.BISER '^^„^
Secretary „_
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
June 20, 2022
Toxaway Falls POA, Inc.
Attn: Thomas Moholias
PO Box 270
Lake Toxaway, NC 28747-0270
Subject: Permit Renewal
Application No. NC0052043
Toxaway Falls WWTP
Transylvania County
Dear Applicant:
The Water Quality Permitting Section acknowledges the June 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. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely
Wren T edford
Administrative Assistant
Water Quality Permitting Section
cc: William Royal, ORC
ec: WQPS Laserfiche File w/application
D E Q^ North Carolina Department of Environmental Quality I Division of Water Resources
`/P7J(/� Asheville Regional Office I2090 U.S.Highway 70 I Swannanoa.North Carolina 28778
828.296 4500

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A &EPA Application for NPDES Permit to Discharge Wastewater
NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
TOXAWAY FALLS WWTP
Mailing address(street or P.O.box)
PO BOX 270
City or town State ZIP code
o LAKE TOXAWAY NC 28747
Contact name(first and last) Title Phone number Email address
o WESLELY ROYAL ORC [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑✓ Same as mailing address
TOXAWAY RIVER RD
w
City or town State ZIP code
LAKE TOXAWAY NC EC EIY ED
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No JUN 17 2022
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above? NCDEQIDWRINPDES
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
TOXAWAY FALLS WWTP
Applicant address(street or P.O.box)
PO BOX 270
City or town State ZIP code
c LAKE TOXAWAY NC 28747
Contact name(first and last) Title Phone number Email address
n TOM MAHOLIAS PRESIDENT(POA) [phone] [e-mail]
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
O Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility ❑ Applicant 0Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a 0 NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
E NC0052043
❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CM)
a)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/D5/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
NA NA %separate sanitary sewer 0 Own 0 Maintain
Z %combined storm and sanitary sewer 0 Own ElMaintain
-
0 Unknown 0 Own 0 Maintain
cl
o NA NA %separate sanitary sewer 0 Own 0 Maintain
:r; %combined storm and sanitary sewer ❑ Own 0 Maintain
m 0 Unknown ID Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
a NA NA
_ %combined storm and sanitary sewer 0 Own ❑ Maintain
0 Unknown 0 Own 0 Maintain
E
d NA NA %separate sanitary sewer 0 Own 0 Maintain
>, %combined storm and sanitary sewer 0 Own ❑ Maintain
c 0 Unknown 0 Own 0 Maintain
Total
°' Population
c) Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of o/° /°p
sewer line(in miles)
1.8 Is the treatment works located in Indian Country?
'o ❑ Yes ❑ No
CU
g 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
El Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.010 mgd
Ti
y Annual Average Flow Rates(Actual)
a2 Two Years Ago Last Year This Year
c o .004 mgd .004 mgd .004 mgd
Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
.006 mgd .006 mgd .004 mgd
w 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
o Total Number of Effluent Discharge Points by Type
a a Constructed
°'1- Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
r -0 ver Oflows Overflows
V
G 001 NA NA NO NA
I
EPA Form 3510-2A(Revised 3-19) Page 2

Permit NC0052043
Part I.
A. 41) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15 NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginningon the effective date of thispermit and lastinguntil expiration, the Permittee
P
is authorized to discharge from outfall 001. Such discharges shall be limited and monitored' by the
Permittee as specified below:
PARAMETER LIMITS MONITORING REQUIREMENTS
[PCS Code] Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location
[50050]Flow ent
0.010 MGD Continuous Recording I Effluent or
BOO,5-day(20°C) 30.0 mg/L 45.0 mg/L Weekly Grab Effluent
[00310]
Total Suspended Solids 30.0 mg/L 45.0 mg/L Weekly Grab Effluent
[00530]
NH3 as N Monitor&Report 2/Month Grab Effluent
[00610[
pH
>6.0 and<9.0 standard units Weekly Grab Effluent
[0
[00400] -
Fecal Coliform (geometric
mean) 200/100 mL 400/100 mL Weekly Grab Effluent
[31616]
Total Residual Chlorine2 28 fig/L 2/Week Grab Effluent
[50060]
Footnotes:
1. The permittee shall submit discharge monitoring reports electronically using the Division's eDMR
system [see A. (4)].
2. The Permittee shall report all effluent TRC values reported by a NC-certified laboratory [including
field-certified]. Effluent values < 50 ug/L will be treated as zero for compliance purposes.
All samples much be collected from a typical discharge event.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER
THAN TRACE AMOUNTS.
A. (2) PHASED CONSTRUCTION CONDITION
If this facility is built in phases, plans and specifications for the next phase shall be submitted
when the flow to the existing units reaches 80% of the design capacity of the facilities on line.
At no time may the flow tributary to the facility exceed the design capacity of the existing units.
Furthermore, this facility will need to justify the need for specific design flows prior to a request
for expansion.
Page 3 of 8

Permit NC0052043
A. (3) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
115 NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning on the effective date of this permit and lasting until expiration, the Permittee
is authorized to discharge from outfall 001. Such discharges shall be limited and monitored' by the
Permittee as specified below:
PARAMETER LIMITS MONITORING REQUIREMENTS
[PCS Code] Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location
Flow 0.12 MGD Continuous Recording Influent or
[50050] Effluent
BOO,5-day(20°C) 30.0 mg/L 45.0 mg/L Weekly Composite Effluent
[003101_
Total Suspended Solids 30.0 mg/L 45.0 mg/L Weekly Composite Effluent
[00530]
NH3 as N(April 1 -October 31) 11.0mg/L 35.0 mg/L Weekly Composite Effluent
[00610]
NH3 as N(November 1 -March
31) 22.0 mg/L 35.0 mg/L Weekly Composite Effluent
[00610]
Fecal Coliform(geometric mean) 200/100 m/L 400/100 m/L Weekly Grab Effluent
[31616] _ —
Total Residual Chlorine2 28 Og/L 2/Week Grab Effluent
[50060]
Temperature(°C) Daily Grab Effluent
[00010]
Total Nitrogen(N01+NO3+TKN) —
j006001 Semi-Annually Composite Effluent
Total Phosphorus Semi-Annually Composite Effluent
.j00665jpH
>6.0 and<9.0 standard units Weekly Grab Effluent
[00400] -
Footnotes:
1. The permittee shall submit discharge monitoring reports electronically using the Division's eDMR
system [see A. (4)].
2. The Permittee shall report all effluent TRC values reported by a NC-certified laboratory [including
field-certified]. Effluent values < 50 mg/L will be treated as zero for compliance purposes.
All samples much be collected from a typical discharge event.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER
THAN TRACE AMOUNTS.
A. (4) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Page 4 of 8

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
Outfalls Other Than to Waters of the United States
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 United States?
❑ 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 k
Impoundment (check one)
TOXAWAY RIVER 0 Continuous
003 gpd ❑ Intermittent
❑ Continuous
gpd Cl Intermittent
❑ Continuous
gpd ❑ Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes ❑ No 4 SKIP to Item 1.16.
c 1.15 Provide the land application site and discharge data requested below.
w Land Application Site and Discharge Data
b Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
r 0 Continuous
acres d
gP 0 Intermittent
acresgpd 0 Continuous
0 Intermittent
acresgpd ❑ Continuous
0 Intermittent
CO 1.16 Is effluent transported to another facility for treatment prior to discharge?
0 ❑ 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
EPA Form 3510-2A(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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
Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
o Contact name(first and last) Title
0
Phone number Email address
aNPDES number of receiving facility(if any) ❑None Average daily flow rate mgd
1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
o` have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
❑ Yes ❑ No 4 SKIP to Item 1.23.
N
' 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
0 Continuous
acres gpd 0 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.
0 w Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
o ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
co cy Section 301(h)) 302(b)(2))
0 Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
✓❑ Yes ❑ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
c Contractor name
ROYAL WATER WORKS
(company name)
Mailing address PO BOX 778
(street or P.O.box)
o City,state,and ZIP PISGAH FOREST,NC 28768
code
Contact name(first and
v last) WILLIAM ROYAL
Phone number [phone]
Email address [e-mail]
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

EPA Identification Number I NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c Outfalls to Waters of the United States
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o ❑ Yes ❑ No 4 SKIP to Section 3.
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.
c
0
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
specific requirements.)
C)
o
eL
✓❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
cf° (See instructions for specific requirements.)
rn
o ❑it 0
Yes 0 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
d
2.
E
3.
U
d
U,
4.
-o
gs 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
E Affected Attainment of
Scheduled Outfalls Begin End Begin Operational
Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
a
1.
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ID None required or applicable
Explanation:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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 001 Outfall Number Outfall Number
State NORTH CAROLINA
County TRANYSLVANIA
is
City or town LAKE TOXAWAY
...
Distance from shore o ft. ft. ft.
a
d Depth below surface 0 ft. ft. ft.
Average daily flow rate .003 mgd mgd mgd
Latitude
Longitude "
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o ❑ Yes ❑ No+SKIP to Item 3.4.
d
3.3 If so,provide the following information for each applicable outfall.
y Outfall Number Outfall Number Outfall Number
0
Number of times per year
0 discharge occurs
a Average duration of each
`o discharge(specify units)
a Average flow of each
0
discharge mgd mgd mgd
N Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes 0 No+SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number Outfall Number Outfall Number
N
3
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
d • discharge points?
71,
3 - ❑ Yes ❑ No+SKIP to Section 6.
EPA Form 3510-2A(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number o01 Outfall Number Outfall Number
Receiving water name TOXAWAY RIVER
Name of watershed,river,
c or stream system SAVANNAH
U.S.Soil Conservation
Service 14-digit watershed
c code
' L
Name of state
management/river basin
U.S.Geological Survey
8-digit hydrologic 03060101
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 oo, Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary 0 Primary
Treatment(check all that El Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
O Other(specify) 0 Other(specify) 0 Other(specify)
0
Q Design Removal Rates by
Outfall NA
BOD5 or CBOD5 ok
f4 TSS ok
I—
fa Not applicable 0 Not applicable 0 Not applicable
Phosphorus
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen %
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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.
CHLORINE TABLET FEEDER
m
c
Outfall Number 001 Outfall Number Outfall Number
Disinfection type CHLORINE TABLETS
tq
G
c Seasons used
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
El 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 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
co ❑ Yes ✓❑ No 4 SKIP to Item 3.16.
0 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. 0 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
cu
package?
w ❑ Yes 0 No
3.16 Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C,must
sample other additional parameters(Table D),or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls(Table E).
Yes 4 Complete Tables C,D,and E as
❑ applicable. 0 No 4 SKIP to Section 4.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑ Yes ❑ No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

Permit NC0052043
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NPDES Permit NC0052043
Toxaway Falls W{NTPA lam ;,,
Fi-m.Location
Receiving Stream.Toaaway River Stream Class.C LakeTci akag NC -
Stream Segment 4-(4) Sub-Basin At 03-13-02
River Basin:Savannah HUC:03060101 STALE 1.1535 Qued Reid,NC
County Transylvania 1:24,033
Page 8 of 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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• 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
C
0
CO 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.
w3.23 Describe the cause(s)of the toxicity:
c
d
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES permittin. authori .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.21(j)(6)and(7))
4.1 Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes ElNo 4 SKIP to Item 4.7.
a; 4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs Number of NSCIUs
CO
O
2 4.3 Does the POTW have an approved pretreatment program?
_ ❑ Yes ❑ No
R 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F:(1)a pretreatment program annual report submitted within one year of the
application or(2)a pretreatment program?
cu
❑ Yes 0 No 4 SKIP to Item 4.6.
o 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
H
7
4.6 Have you completed and attached Table F to this application package?
❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
4.7 Does the POTW receive,or has it been notified that it will receive, by truck,rail,or dedicated pipe,any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
0 Yes ❑ No 4 SKIP to Item 4.9.
4.8 If yes,provide the following information:
Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck 0 Rail
❑ Dedicated pipe ❑ Other(specify)
0
C)
❑ Truck 0 Rail
❑ Dedicated pipe 0 Other(specify)
0
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
m
as
s4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
0 Yes 0 No 4 SKIP to Section 5.
rn 4.10 Does the POTW receive(or expect to receive)less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d)and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ❑ No
4.11 Have you reported the following information in an attachment to this application:identification and description of the
site(s)or facility(ies)at which the wastewater originates;the identities of the wastewater's hazardous constituents;and
the extent of treatment,if any,the wastewater receives or will receive before entering the POTW?
❑ Yes El No
SECTION 5.COMBINED SEWER OVERFLOWS(40 CFR 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
❑ Yes ❑ No+SKIP to Section 6.
5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
0 Yes 0 No
co
0 5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
cn
❑ Yes 0 No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
5.4 For each CSO outfall,provide the following information.(Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
.a State and ZIP code
0
y
CD
County
m
0
Latitude ° -, ° „
o °
Longitude ° 0
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Rainfall ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes ❑ No
e
o CSO flow volume 0 Yes ❑ No ❑ Yes ❑No ❑ Yes ❑ No
CSO pollutant 0 Yes ❑ No ❑ Yes ❑No 0 Yes ❑ No
o concentrations
`.) Receiving water quality 0 Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
CSO frequency 0 Yes ❑ No ❑ Yes 0 No ❑ Yes ❑ No
•
Number of storm events 0 Yes ❑ No ❑ Yes ❑No ❑ Yes 0 No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
ai
tu
Number of CSO events in events events events
w the past year
co
a
c Average duration per hours hours hours
to
event 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
o Average volume per event million gallons million gallons million gallons
CC.) 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year 0 Actual or 0 Estimated 0 Actual or 0 Estimated ❑Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Receiving water name
Name of watershed/
stream system
U.S.Soil Conservation 0 Unknown 0 Unknown 0 Unknown
Service 14-digit
= watershed code
: (if known)
CD
Name of state
management/river basin
U.S.Geological Survey 0 Unknown 0 Unknown 0 Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam Iles
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application. For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
❑ Section 1: Basic Application ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
❑ Section 2:Additional ❑ w/topographic map ❑ w/process flow diagram
Information ❑ w/additional attachments
❑ w/Table A ❑ w/Table D
❑ Section 3: Information on ❑ w/Table B ❑ wl Table E
d Effluent Discharges
❑ w/Table C ❑ w/additional attachments
w Section 4: Industrial 0 w/SIU and NSCIU attachments ❑ w/Table F
❑ Discharges and Hazardous
c Wastes
0 w/additional attachments
Section 5:Combined Sewer ❑ wl CSO map ❑ w/additional attachments
❑ Overflows ❑ w/CSO system diagram
= Section 6:Checklist and
❑ Certification Statement ❑ w/attachments
Y 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. lam aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
WILLIAM WESLEY ROYAL ORC
Signature Date signed
bli\l/1711 klf64/9 - d-
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method1 (include units)
Samples
Biochemical oxygen demand
0 BOD5 or❑CBOD5 45 MG/L 30 MG/L 52 C0130 ❑ML
(report one) ❑MDL
Fecal coliform 400 GEOMEAN 200 GEOMEAN 52 31616 ❑ML
❑MDL
Design flow rate .010 MGD
pH(minimum) 6 SU
pH(maximum) 9 SU
Temperature(winter) NA
Temperature(summer) NA
Total suspended solids(TSS) 45 MG/L 30 MG/L 52 C0530 E ML
MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of
Value Units Value Units Samples Method' (include units)
Ammonia(as N) ❑ML
❑MDL
Chlorine ❑ML
(total residual,TRC)2 28 UGL 0 MDL
Dissolved oxygen NA ❑ML
❑MDL
Nitrate/nitrite NA 0 ML
❑MDL
Kjeldahl nitrogen NA ❑ML
❑MDL
Oil and grease NA ❑ML
❑MDL
Phosphorus NA 0 ML
❑MDL
Total dissolved solids NA ❑ML
❑MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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
1 Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) NA ❑ML
❑MDL
Antimony,total recoverable NA ❑ML
❑MDL
Arsenic,total recoverable NA ❑ML
❑MDL
❑ML
Beryllium,total recoverable NA ❑MDL
Cadmium,total recoverable NA ❑ML
❑MDL
Chromium,total recoverable NA ❑ML
❑MDL
Copper,total recoverable NA ❑ML
❑MDL
Lead,total recoverable NA ❑ML
❑MDL
Mercury,total recoverable NA ❑ML
❑MDL
Nickel,total recoverable NA ❑ML
— -- ❑MDL
Selenium,total recoverable NA ❑ML
❑MDL
Silver,total recoverable NA El ML
❑MDL
❑ML
Thallium,total recoverable NA ❑MDL
Zinc,total recoverable NA ❑ML
O MDL _
Cyanide NA O ML
❑MDL
Total phenolic compounds NA ❑ML
❑MDL
1 Volatile Organic Compounds
1 ❑ML
Acrolein NA ❑MDL
- ❑ML
Acrylonitrile NA ❑MDL
Benzene NA ❑ML
_ ❑MDL
Bromoform NA ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant —
Value Units Value Units Number of Method1 (include units)
Samples
Carbon tetrachloride NA ❑ML
❑MDL
Chlorobenzene NA ❑ML
❑MDL
Chlorodibromomethane NA ❑ML
❑MDL
Chloroethane NA 0 ML
❑MDL
2-chloroethylvinyl ether NA ❑ML
❑MDL
Chloroform NA ❑ML
❑MDL
Dichlorobromomethane NA ❑ML
❑MDL
1,1-dichloroethane NA ❑ML
❑MDL
1,2-dichloroethane NA ❑ML
❑MDL
trans-1,2-dichloroethylene NA ❑ML
❑MDL
1,1-dichloroethylene NA ❑ML
❑MDL
1,2-dichloropropane NA ❑ML
❑MDL
1,3-dichloropropylene NA ❑ML
❑MDL
Ethylbenzene NA ❑ML
❑MDL
Methyl bromide NA ❑ML
❑MDL
Methyl chloride NA ❑ML
❑MDL
Methylene chloride NA ❑ML
❑MDL
1,1,2,2-tetrachloroethane NA ❑ML
❑MDL
Tetrachloroethylene NA ❑ML
❑MDL
Toluene NA ❑ML
❑MDL
1,1,1-trichloroethane NA ❑ML
❑MDL
1.12-trichloroethane NA ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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
Trichloroethylene NA ❑ML
_ _ _ ❑MDL
Vinyl chloride NA ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol NA ❑ML
❑MDL
2-chlorophenol NA ❑ML
❑MDL
2.4-dichlorophenol NA ❑ML
❑MDL
2.4-dimethylphenol NA ❑ML
❑MDL
4.6-dinitro-o-cresol NA ❑ML
_ _ ❑MDL
2.4-dinitrophenol NA ❑ML
❑MDL
2-nitrophenol NA ❑ML
❑MDL
4-nitrophenol NA ❑ML
❑MDL
Pentachlorophenol NA ❑ML
❑MDL
Phenol NA ❑ML
0 MDL
2.4.6-trichlorophenol NA ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene NA ❑ML
❑MDL
Acenaphthylene NA ❑ML
❑MDL
Anthracene NA ❑ML
❑MDL
Benzidine NA ❑ML
❑MDL
Benzo(a)anthracene NA ❑ML
❑MDL
Benzo(a)pyrene NA ❑ML
❑MDL
3,4-benzofluoranthene NA ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units
Samples
Benzo(ghi)perylene NA ❑ML
❑MDL_
Benzo(k)fluoranthene NA ❑ML
❑MDL
Bis(2-chloroethoxy)methane NA ❑ML
❑MDL
Bis(2-chloroethyl)ether NA ❑ML
❑MDL
Bis(2-chloroisopropyl)ether NA ❑ML
❑MDL
Bis(2-ethylhexyl)phthalate NA ❑ML
❑MDL
4-bromophenyl phenyl ether NA ❑ML
❑MDL
Butyl benzyl phthalate NA ❑ML
❑MDL
2-chloronaphthalene NA ❑ML
❑MDL
4-chlorophenyl phenyl ether NA ❑ML
❑MDL
Chrysene NA ❑ML
❑MDL_
di-n-butyl phthalate NA ❑ML
❑MDL
di-n-octyl phthalate NA ❑ML
❑MDL
Dibenzo(a,h)anthracene NA ❑ML
0 MDL
1,2-dichlorobenzene NA ❑ML
❑MDL
1,3-dichlorobenzene NA ❑ML
❑MDL
1,4-dichlorobenzene NA ❑ML
❑MDL
3,3-dichlorobenzidine NA ❑ML
❑MDL
Diethyl phthalate NA ❑ML
❑MDL
Dimethyl phthalate NA ❑ML
❑MDL
2,4-dinitrotoluene NA ❑ML
❑MDL
2,6-dinitrotoluene NA ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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
1,2-diphenylhydrazine NA ❑ML
❑MDL
Fluoranthene NA CI ML
❑MDL
Fluorene NA Cl ML
❑MDL
Hexachlorobenzene NA ❑ML
❑MDL
Hexachlorobutadiene NA CI ML
❑MDL
Hexachlorocyclo-pentadiene NA ❑ML
❑MDL
Hexachloroethane NA CI ML
❑MDL
Indeno(1,2,3-cd)pyrene NA CI ML
❑MDL
Isophorone NA ❑ML
❑MDL
Naphthalene NA CI ML
❑MDL
Nitrobenzene NA ❑ML
❑MDL
N-nitrosodi-n-propylamine NA 0 ML
❑MDL
N-nitrosodimethylamine NA Cl ML
❑MDL
N-nitrosodiphenylamine NA ❑ML
❑MDL
Phenanthrene NA ❑ML
0 MDL
Pyrene NA ❑ML
❑MDL
1,2,4-trichlorobenzene NA ❑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).
EPA Form 3510-2A(Revised 3-19) Page 21

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
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' (include units)
Samples
El No additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑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 O.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number Test Number Test Number
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one: ❑ Grab 0 Grab 0 Grab
❑ 24-hour composite ❑ 24-hour composite ❑ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection 0 Before disinfection
❑After Disinfection ❑After Disinfection 0 After disinfection
❑ After Dechlorination ❑ After Dechlorination ❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute 0 Acute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) Li Chronic ❑ Chronic ❑ Chronic
❑ Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Test Type
Indicate the type of test performed.(Check one ❑ Static ❑ Static ❑ Static
response.)
❑ Static-renewal ❑ Static-renewal ❑ Static-renewal
❑ Flow-through ❑ Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water ❑ Laboratory water
one response.)
❑ Receiving water ❑ Receiving water ❑ Receiving water
If laboratory water,specify type.
If receiving water,specify source.
Type of Dilution Water
Indicate the type of dilution water.If salt ❑ Fresh water ❑ Fresh water ❑ Fresh water
water,specify"natural"or type of artificial CI Salt water(specify) CI Salt water(specify) ❑ Salt water(specify)
sea salts or brine used.
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. ❑ pH ❑ Ammonia ❑ pH ❑ Ammonia ❑ pH ❑ Ammonia
❑ Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen
❑ Temperature ❑ Temperature ❑ Temperature
Acute Test Results
Percent survival in 100%effluent %
LCso
95%confidence interval % %
Control percent survival
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number Test Number Test Number
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC 0/0
IC25 % % %
Control percent survival "/o % %
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? 0 Yes 0 No 0 Yes 0 No ❑ Yes 0 No
Was reference toxicant test within ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
acceptable bounds?
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
1 EPA Form 3510-2A(Revised 3-19) Page 27
I

EPA Identfication Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU SIU SIU
Name of SIU
Mailing address(street or P.O.box)
City,state,and ZIP code
Description of all industrial processes that affect
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU. gpd gpd gpd
How much of the average daily volume is
attributable to process flow? gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? gpd gpd gpd
Is the SIU subject to local limits?
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
Is the SIU subject to categorical standards?
❑ Yes ❑ No ❑ Yes ❑ No El Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0052043 TOXAWAY FALL WWTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional Sills.
SIU SIU SIU
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30