NC0075027_Renewal (Application)_20220620

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North Carolina
Department of Environmental Quality
Division of Water Resources
IPrint Form Only
Modified Application Form 2A
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
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Form
NPDES
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
the instructions may result in denial of the application.)
Facility Information
N
I
IC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9))
Facility name
Cainsway
Mailing address (street or P.O. box)
P.O. Box 846
City or town
Walkertown
State
NC
ZIP code
27051
Contact name (first and last)
Daryl Cain
Title
HOA President
Phone number
[phone]
Email address
[e-mail]
Location address (street, route number, or other specific identifier)
Pinehall Road
❑ Same as mailing
address
City or town
North of Walkertown
State
NC
ZIP code
27051
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission
requirements for new dischargers.
✓
No
Applicant Information
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)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
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
❑ Facility ❑ Applicant
..1Facility
only one response.)
and applicant
(they are one and the same)
Existing Environmental Permits
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
water)
❑ RCRA (hazardous waste)
❑ UIC (underground injection
control)
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
404)
❑ Other (specify)
Page 1

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Collection System and Population Served
1.7
Provide the collection system information requested below for the treatment works.
Municipality
Served
Population
Served
Collection System Type
(indicate percentage)
Ownership Status
100 % separate sanitary sewer
0 Own 0 Maintain
125
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
0 Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
0 Own ❑ Maintain
% separate sanitary sewer
0 Own ❑ Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own ❑ Maintain
Total
Population
Served
125
❑ Unknown
Separate Sanitary Sewer System
❑ Own ❑ Maintain
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
100 %
0
/o
Indian Country
1.8
Is the treatment works located in Indian
❑ Yes
Country?
I
No
1.9
Does the facility discharge to a receiving
❑ Yes
water that flows through
✓
Indian Country?
No
Design and Actual
Flow Rates
1.10
Provide design and actual flow rates
in the designated spaces.
Design Flow Rate
.0432 mgd
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
mgd
mgd
mgd
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
mgd
mgd
mgd
Discharge Points
by Type
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
Treated Effluent
Untreated Effluent
Combined Sewer
Overflows
Bypasses
Constructed
Emergency
Overflows
1
Page 2

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds,
for discharge to waters of the State of North Carolina?
❑ Yes
or other
surface impoundments that do not have outlets
4 SKIP to Item 1.14.
✓ No
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Location
Average Daily Volume
Discharged to Surface
Impoundment
Continuous or Intermittent
(check one)
gpd
❑ Continuous
❑ Intermittent
gpd
❑ Continuous
0 Intermittent
gpd
❑ Continuous
0 Intermittent
1.14
Is wastewater applied to land?
❑ Yes
4 SKIP to Item 1.16.
I No
1.15
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Location
Size
Average Daily Volume
Applied
Continuous or
Intermittent
(check one)
acresgpd
❑ Continuous
❑ Intermittent
acresgpd
❑ Continuous
❑ Intermittent
acresgpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for
❑ Yes
treatment prior to discharge?
4 SKIP to Item 1.21.
✓ No
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
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods Continued
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
Contact name (first and last)
Title
Phone number
Email address
NPDES number of receiving facility (if any) 0 None
Average daily flow rate mgd
1.21
Is the wastewater disposed of in a manner other than
not have outlets to waters of the State of North Carolina
❑ Yes
✓
those a ready mentioned in Items 1.14 through 1.21 that do
(e.g., underground percolation, underground injection)?
No 4 SKIP to Item 1.23.
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal
Method
Description
Location of
Disposal Site
Size of
Disposal Site
Annual Average
Daily Discharge
Volume
Continuous or Intermittent
(check one)
acres
gpd
0 Continuous
0 Intermittent
acres
gpd
0 Continuous
0 Intermittent
acres
gpd
0 Continuous
0 Intermittent
Variance
Requests
1.23
Do
Consult
❑
✓
you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
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
Section 301(h)) 302(b)(2))
Not applicable
Contractor Information
1.24
Are
the
✓
any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
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
Contractor name
(company name)
Bradley Flynt
Mailing address
(street or P.O. box)
8467 southard Road
City, state, and ZIP
code
Stokesdale, NC 27357
Contact name (first and
last)
Bradley Flynt
Phone number
[phone]
Email address
bradley.flynt@greensboro-nc.€
Operational and
maintenance
responsibilities of
contractor
All operations and some
mantenance
Page 4

SECTION
c
2. ADDITIONAL INFORMATION
Outfalls to Waters of
NPDES Permit Number
NC0075027
(40 CFR 122.21(j)(1) and
the State of North Carolina
Facility Name
Cainsway HOA
(2))
Modified Application Form 2A
Modified March 2021
2.1
Does the treatment works have a design
❑ Yes
flow greater
than or equal to 0.1 mgd?
No 4 SKIP to Section 3.
✓
Inflow and Infiltration
2.2
Provide the treatment works' current average daily volume of inflow
and infiltration.
Average Daily Volume of Inflow and Infiltration
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Topographic
Map
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
❑ Yes ❑ No
Flow
Diagram
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
❑ Yes ❑ No
Scheduled Improvements and Schedules of Implementation
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
2.
3.
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Scheduled
Improvement
(from above)
Affected
Outfalls
(list outfall
number)
Begin
Construction
(MM/DD/YYYY)
End
Construction
(MM/DD/YYYY)
Begin
Discharge
(MM/DD/YYYY)
Attainment of
Operational
Level
(MM/DD/YYYY)
1.
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Description of Outfalls
ORMATION ON EFFLUENT DISCHARGES (40 CFR 122.21(j)(3) to (5))
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number o01
Outfall Number
Outfall Number
State
North Carolina
County
Forsyth
City or town
Walkertown
Distance from shore
5 ft.
ft.
ft.
Depth below surface
o ft.
ft.
ft.
Average daily flow rate
.007 mgd
mgd
mgd
Latitude
°
Longitude
°
"
Seasonal or Periodic Discharge Data
3.2
Do any of the outfalls described
❑ Yes
under Item 3.1 have seasonal or
periodic
✓
discharges?
No 4 SKIP to Item 3.4.
3.3
If so, provide the following information
for each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
discharge
mgd
mgd
mgd
Months in which discharge
occurs
Diffuser Type
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes
✓
No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser t pe at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Waters of
the U.S.
3.6
Does
one
✓
the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
or more discharge points?
Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Receiving Water Description
3.7
Provide the receiving water and related information (if known) for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Ader Creek
Name of watershed, river,
or stream system
Roanoke
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
low flow
mg/L of
CaCO3
mg/L of
CaCO3
mg/L of
CaCO3
Treatment Description
3.8
Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
0 Primary
0 Equivalent to
secondary
0 Secondary
❑ Advanced
❑ Other (specify)
0 Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
❑ Primary
❑ Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
Design Removal Rates by
Outfall
BODs or CBOD5
85
TSS
93 %
%
ok
Phosphorus
l Not applicable
0 Not applicable
0 Not applicable
Nitrogen
0 Not applicable
0 Not applicable
0 Not applicable
Other (specify)
0 Not applicable
0 Not applicable
0 Not applicable
Page 7

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Treatment Description Continued
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.
Outfall Number
001
Outfall Number
Outfall Number
Disinfection type
Hypochlorite Tablets
Seasons used
all
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
✓
Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
Effluent Testing Data
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
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
✓ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes
✓ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
❑ Yes
No
sampling required by NPDES
authority.
✓ additional
permitting
Page 8

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
Effluent Testing Data Continued
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above
❑ Yes
tests to your NPDES permitting
No 4 Provide
authority?
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
(MM/DD/YYYY)
Summary of Results
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?
❑ 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
❑ Yes
and attached the results to the application
Not
package?
because previously submitted
NPDES permittin. authorit .
applicable
information to the
Page 9

NPDES Permit Number
NC0075027
Facility Name
Cainsway HOA
Modified Application Form 2A
Modified March 2021
cn
Checklist and Certification Statement
0
rn rncr,
n
2
ECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
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
❑ wl variance request(s) ❑ w/ additional attachments
Information for All Applicants
❑ Section 2: Additional
Information
❑ w/ topographic map ❑ wl process flow diagram
❑ w/ additional attachments
❑ Section 3: Information on
Effluent Discharges
❑ wl Table A ❑ w/ Table D
❑ w/ Table B ❑ wl additional attachments
❑ w/ Table C
Section 4: Not Applicable
Section 5: Not Applicable
❑ Section 6: Checklist and
Certification Statement
❑ w/ attachments
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)
Bradley T. Flynt
Official title
ORC
Signature
Date signed
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NC0075027
Cainsway HOA
001
Modified Application Form 2A
Modified March 2021
TABLE A. EFFLUENT PARAMETERS
Pollutant
FOR ALL POTWS
Maximum Daily
Discharge
Average Daily Discharge
Analytical
Methods
Methods(
ML or MDL
include units )
Value
Units
Value
Units
Number of
Samples
Biochemical oxygen demand
IllBOD5 or ❑ CBOD5
(report one)
22
mg/I
3.2
mg/I
36
❑ ML
❑MDL
Fecal coliform
200/100m1
#/100m1
0
#/100
36
❑ ML
❑ MDL
Design flow rate
.0432
mgd
.009
mgd
36
pH (minimum)
6
su
AL —
Mr
pH (maximum)
9
su
Temperature (winter)
deg. c
14.1
deg. c
21
Temperature (summer)
deg. c
23.2
deg. c
15
Total suspended solids (TSS)
30
MG/I
4.8
mg/I
36
❑ 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
NC0075027
Facility Name
Cainsway HOA
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE B. EFFLUENT PARAMETERS
FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Pollutant
Maximum Daily Discharge
Average Daily Discharge
Analytical
Methods
ML or MDL
(include
units)
Value
Units
Value
Units
Number of
Samples
Ammonia (as N)
❑ ML
❑ MDL
Chlorine
(total residual, TRC)2
❑ ML
❑ MDL
Dissolved oxygen
❑ ML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 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

TABLE
EPA Identification Number
C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0075027
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Cainsway HOA
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
Metals,
Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
0 MDL
Antimony, total recoverable
❑ ML
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑ MDL
Mercury, total recoverable
❑ ML
❑ MDL
Nickel, total recoverable
0 ML
❑ MDL
Selenium, total recoverable
0 ML
❑ MDL
Silver, total recoverable
0 ML
❑ MDL
Thallium, total recoverable
0 ML
❑ MDL
Zinc, total recoverable
0 ML
❑ MDL
Cyanide
0 ML
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ ML
❑ MDL
Acrylonitrile
❑ ML
❑ MDL
Benzene
❑ ML
❑ MDL
Bromoform
0 ML
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 13

TABLE
EPA Identification Number
C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0075027
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Cainsway HOA
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
0 ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
❑ MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2-dichloropropane
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
❑ ML
❑ 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

TABLE
EPA Identification Number
C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0075027
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Cainsway HOA
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
Trichloroethylene
❑ ML
❑ MDL
Vinyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethylphenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
❑ ML
❑ MDL
Benzidine
❑ ML
❑ MDL
Benzo(a)anthracene
❑ ML
❑ MDL
Benzo(a)pyrene
❑ ML
❑ MDL
3,4-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 15

TABLE
EPA Identification Number
C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0075027
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Cainsway HOA
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
Benzo(ghi)perylene
❑ ML
❑ MDL
Benzo(k)fluoranthene
❑ ML
❑ MDL
Bis (2-chloroethoxy) methane
❑ ML
❑ MDL
Bis (2-chloroethyl) ether
❑ ML
❑ MDL
Bis (2-chloroisopropyl) ether
❑ ML
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ ML
❑ MDL
4-bromophenyl phenyl ether
❑ ML
❑ MDL
Butyl benzyl phthalate
❑ ML
❑ MDL
2-chloronaphthalene
❑ ML
❑ MDL
4-chlorophenyl phenyl ether
❑ ML
❑ MDL
Chrysene
❑ ML
❑ MDL
di-n-butyl phthalate
❑ ML
❑ MDL
di-n-octyl phthalate
❑ ML
❑ MDL
Dibenzo(a,h)anthracene
❑ ML
❑ MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
1,3-dichlorobenzene
❑ ML
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
❑ ML
❑ MDL
Dimethyl phthalate
❑ ML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 16

TABLE
EPA Identification Number
C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0075027
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Cainsway HOA
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
1,2-diphenylhydrazine
❑ ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
❑ ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ 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
1,2,4-trichlorobenzene
❑ ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19)
Page 17

TABLE D. ADDITIONAL POLLUTANTS
NPDES Permit Number
NC0075027
AS REQUIRED BY NPDES PERMITTING
Maximum Daily Discharge
Facility Name
Cainsway HOA
AUTHORITY
Average
Outfall Number
Daily Dischar e
Modified
Analytical
Method
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
(list)
Value
Units
Value
Units Number of
Samples
•
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
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
E ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
1Sampling 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