NC0024236_Renewal (Application)_20220801 (2)

sTATi"
ROY COOPER ‘4,4i
Governor ' f
ELIZABETH S.BISER
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
August 01, 2022
9
City of Kinston
Attn: Kenneth Stevens, Jr.
207 E King St
PO Box 339
Subject: Permit Renewal
Application No. NC0024236
Johnnie Mosley Regional WRF
Lenoir County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 1, 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.
4/A/4
Sincerely,
Wren he edford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
ENorthWashin CarogtonlinaRegional DepartmentOffice of E 943nvironmentWashinal gton QualitySquare Mall I DivisionWashingto of Watern.ResourcesNorth 1 Carolina 27889
252.946.6481

Kinston
K'U9DN PIWLI.0 SERVICEt
al
IIII.
Buildings&Grounds,Business Office,Electric,Engineering,Environmental Services, ze
Fleet Maintenance,Meter Reading,Stormwater.Streets,Wastewater,and Water
009
_ Kinston. the right place... Kinston Public Services, the right choice.
July 26,2022
NCDENR/DWQ RECEIVED
Attn: Wren Thedford
A U G 0 l 2022
1617 Mail Service Center
Raleigh,North Carolina 27699-1617 NCDEQ/DWR/NPDES
Re: Request for Permit Renewal
#NC0024236
Dear NPDES Unit:
Enclosed are three copies of our NPDES Form 2A Application, along with the necessary attachments to
complete a permit renewal package.
Please feel free to contact me at 252-939-3375 or email at [e-mail] if you have any
questions.
The toxicity reports have been previously submitted during the permit period and effluent pollutant scans are
attached to the permit application. The last required fathead minnow testing will be completed the week of
September 12,2022, and those results will be forwarded upon receipt.
Thanks for your considerations.
Sincerely,
Kenneth Stevens,Jr.
Kinston RWRF Superintendent
C: Benjamin Overton-Environmental Compliance Supervisor
File
Johnnie Mosley Regional Water Reclamation Facility
2101 Becton Farm Rd Kinston,North Carolina 28501 Phone[phone] Fax[phone]

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WRF
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 , D
Johnnie Mosley Regional Water Reclamation Facility
Mailing address(street or P.O.box) AUG 0 1 ZOZ2
2101 Becton Farm Road `�D aAuGDW
Cityor town State R/NPDES
o Kinston North Carolina 28501
R -
Contact name(first and last) Title Phone number Email address
Kenneth R.Stevens Superintendent
p [phone] [e-mail].n
Location address(street,route number,or other specific identifier) © Same as mailing address
City or town State ZIP code
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 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)
•
City or town State ZIP code
Contact name(first and last) Title Phone number Email address
a
a 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.)
❑ Facility ❑ Applicant 0 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
th
number for each.)
Existing Environmental Permits
ar❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
E NC0024236
❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
y ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 0Other(specify)
404)
LA-WQ0003919,Class A Dist
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No.2040-0004
NA NC0024236 30hnhie frws\ty 491,44t
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
100 %separate sanitary sewer ID Own ❑ Maintain
'a City of Kinston 19900 %
2 combined storm and sanitary sewer 0 Own 0 Maintain
d ❑ Unknown 0 Own 0 Maintain
c 100 %separate sanitary sewer <] Own 0 Maintain
Town of Dover 334 %combined storm and sanitary sewer 0 Own 0 Maintain
3 0 Unknown ❑ Own 0 Maintain
0 100 %separate sanitary sewer 0 Own 0 Maintain
tea Cutter Creek 250
. %combined storm and sanitary sewer 0 Own 0 Maintain
CU Subdivision ❑ Unknown ❑ Own 0 Maintain
d %separate sanitary sewer 0 Own 0 Maintain
>, %combined storm and sanitary sewer 0 Own 0 Maintain
c 0 Unknown 0 Own 0 Maintain
0 Total 20484
to Population
o Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 0 0
sewer line(in miles) 100 0 /°
?' 1.8 Is the treatment works located in Indian Country?
ci
0 ❑ Yes ❑ No
R1.9 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
11.85 mgd
_ Annual Average Flow Rates(Actual)
in
a Two Years Ago Last Year This Year
re
0 5.96 mgd 5.56 mgd 3.96 mgd
m" Maximum Daily Flow Rates(Actual)
cm Two Years Ago Last Year This Year
17.99 mgd 19.04 mgd 6.35 mgd
. 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
a a Constructed
o) Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
s Overflows Overflows
ca
0
0 1
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WLRF
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 (check one)
Impoundment
O Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
s 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.
Land Application Site and Discharge Data
to
o Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
s 0 Continuous
w WRF Property 38.45 acres 4429.1 gpd p Intermittent
acresgpd 0 Continuous
0 Intermittent
acres gpd 0 Continuous
R 0 Intermittent
a 1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ Yes No4SKIPtoItem1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
NA
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
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WRF
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
-0 Facility name Mailing address(street or P.O. box)
w Johnnie Mosely Regional WRF 2101 Becton Farm Road
rz City or town State ZIP code
o Kinston NC 28501
ca Contact name(first and last) Title
c Benjamin Overton Environmental Compliance Supervisor
m Phone number Email address
[phone] [e-mail]
o NPDES number of receiving facility(if any) 0 None Average daily flow rate 5.56 mgd
w NC0024236
6 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
m have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
s ❑ Yes El No->SKIP to Item 1.23.
u
0 1.22 Provide information in the table below on these other disposal methods.
m Information on Other Disposal Methods
L Disposal Annual Average
o Location of Size of Continuous or Intermittent
a Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
R 0 Continuous
acres gpd 0 Intermittent
o 0 Continuous
acres gpd ❑ Intermittent
acresgpd ❑ 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.
U ca y Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
c 3 ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
cc cp
Section 301(h)) 302(b)(2))
D 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?
0 Yes ❑r 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
c Contractor name
•R (company name)
E Mailing address
c (street or P.O. box)
o City,state,and ZIP
code
Contact name(first and
c_i last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o 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?
rn
0 Yes ❑ No 4 SKIP to Section 3.
e 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration. 3889960 gpd
47.
Indicate the steps the facility is taking to minimize inflow and infiltration.
Smoke testing of the Lower Neuse Outfall performed. Areas of concern located. CCTV inspections help locate areas and
repair in the downtown area of Kinston,710'repaired of 8"sewer main. Another 545'and 14 new service laterals.
Barrus lift station rehabbed as well. Monies for 4 more major improvements projects have been funded.
r 2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
RI CL specific requirements.)
:5) to
0
o E Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
19 (See instructions for specific requirements.)
o rn
o 1 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
is 1.
•
E
C)
a 2.
E
0
H 3.
0 4.
U,
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
d Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge
(from above) (fist outfall (MM/DDIYYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
61 1.
s
2.
rn
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:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional 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 1 Outfall Number Outfall Number
State North Carolina
County Lenoir
0 City or town Kinston
.s Distance from shore o ft. ft. ft.
y Depth below surface o ft. ft. ft.
Average daily flow rate 5.57 mgd mgd mgd
Latitude 35* 17' 15" N o
Longitude 77" 30' 41" W ot
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
Ti ❑ Yes No+SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
a Number of times per year
0 discharge occurs
n Average duration of each
discharge(specify units)
cAverage flow of each mgd mgd mgd
y discharge
en Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number Outfall Number Outfall Number
En
En' 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
(13
discharge points?
0 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
NC0024236 Johnnie Mosley Regional OMB No.2040-0004
wRF
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 1 Outfall Number Outfall Number
Receiving water name Neuse River
Name of watershed,river,
0
Neuse River Basin
or stream system
U.S.Soil Conservation
y Service 14-digit watershed not known
o code
Name of state management/river basin Neuse Sub Basin 03-04-05
U.S.Geological Survey
8-digit hydrologic 03020202
cataloging unit code
Critical low flow(acute) NA cfs cfs cfs
Critical low flow(chronic) NA cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow NA CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number I Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary 0 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
O Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
0
Design Removal Rates by
Outfall
N
0E BOD5 or CBOD5 >85
c
m
E
m TSS >85 %
❑ Not applicable 0 Not applicable ❑ Not applicable
Phosphorus >85
❑ Not applicable 0 Not applicable 0 Not applicable
Nitrogen >85 % o 0
/o /o
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
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WRF
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.
a
0
c�
0 Outfall Number 1 Outfall Number Outfall Number
Disinfection type
Ultraviolet light
H
co
0
Seasons used
all year
m Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
~ ❑ Yes ❑ Yes ❑ Yes
0 No ❑ No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
CI 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?
2 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
Number of tests of discharge 21
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?
❑� 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. ❑ No 4 Complete Table B,omitting chlorine.
E. 3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑✓ Yes ❑ 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. ❑ 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?
❑
No additional sampling required by NPDES Yes permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
N� NC0024236 Johnnie Mosley Regional OMB No.2040-0004
wRF
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?
0 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?
0 Yes ❑ No-3' 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)
2018 Jan.Toxicity-Pass
02/28/2018 2018 April Toxicity-Pass,submitted-05/10/2018
2018 July Toxicity-Pass,submitted-08/28/2018
2018 October Toxicity-Pass,submitted-11/28/2018
2019 Jan.Toxicity-Pass,submitted-02/26/2019
va 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 0 No 4 SKIP to Item 3.26.
3.23 Describe the cause(s)of the toxicity:
a)
uJ
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?
Not applicable because previously submitted
❑ Yes 0 information to the NPDES permitting authority.
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?
ElYes 0 No 4 SKIP to Item 4.7.
m 4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
en Number of SIUs Number of NSCIUs
en 7 5
4.3 Does the POTW have an approved pretreatment program?
El Yes 0 No
2 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
m 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?
s
❑ Yes El No 4 SKIP to Item 4.6.
R 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
a
4.6 Have you completed and attached Table F to this application package?
El Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
Nib NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WRF
4.7 Does the POTW receive,or has it been notified that it will receive,bytruck,rail,or dedicated pipe,any wastes that are
PP
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes 0 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 ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
U
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
H
0
T2
❑ Truck ❑ Rail
f0
_ ❑ Dedicated pipe ❑ Other(specify)
-0
N
m
4.9 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?
tn
❑ Yes No 4 SKIP to Section 5.
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 ❑ No
SECTION 5.COMBINED SEWER OVERFLOWS(40 CFR 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
❑ Yes 0 No 4SKIP to Section 6.
5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
El Yes ❑ No
5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
`" ❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional OMB No.2040-0004
WRF
5.4 For each CSO outlet',provide the following information. (Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
2- State and ZIP code
0
ca
o County
Latitude
0
o ° °
CU
Longitude °
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 ❑ No ❑ Yes ❑ No
c)
c
`o CSO flow volume ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
CSO pollutant 0 Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No
o concentrations
E
0 Receiving water quality ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
CSO frequency ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No
Number of storm events ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Numberci
Number of CSO events in>- events events events
the past year
a)
c Average duration per hours hours hours
event 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
m
w million gallons million gallons million gallons
o Average volume per event
LI 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 0 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
NC0024236 I Johnnie Mosley Regional OMB No.2040-0004
WRF
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
d U.S.Soil Conservation 0 Unknown ❑ Unknown ❑ Unknown
Service 14-digit
watershed code
_> (if known)
Name of state
cu
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.les
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
Information for All Applicants ❑ w/variance request(s) Elw/additional attachments
• Section 2:Additional ❑ w/topographic map El w/process flow diagram
Information w/additional attachments
❑ w/Table A ❑ w/Table D
• Section 3:Information on ✓❑ w/Table B ❑ w/Table E
d Effluent Discharges
� ❑ w/Table C ❑ w/additional attachments
co
Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑ w/Table F
(13 0 Discharges and Hazardous
Wastes ❑ w/additional attachments
❑ Section 5:Combined Sewer 0 w/CSO map ❑ w/additional attachments
Overflows
❑ w/CSO system diagram
12 1 12 Section 6:Checklist and
❑ Certification Statement El w/attachments
I N
Y 6.2 Certification Statement
/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
Kenneth Stevens Plant Superintendent
Signature Date signed
07/26/2022
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
v
,1 I/L1-- NC0024236 Johnnie Mosley Regional
WRF 001 OMB No.2040-0004
A
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant - Number of Include units
Value Units Value Units Samples Methods ( )
Biochemical oxygen demand
ElBOD5 or❑CBOD5 142 mg/L 1.35 mg/L 1055 SM5210B 2.0 mg/L rJ ML
❑MDL
(report one)
Fecal coliform >2419.6 MPN/100mL 58.49 MPN/100mL 1055 Colilert 18,Quanti tr N/100mL El ML
❑MDL
Design flow rate 21.43 mgd 5.58 mgd 1551
pH(minimum) 5.71 s.u.
pH(maximum) 8.14 s.u.
Temperature(winter) 19.9 C 15.2 C 281
Temperature(summer) 29 C 25.8 C 267
Total suspended solids(TSS) 12817 mg/L 26.2 mg/L 1074 SM2540 D-2011 2.5 mg/L ❑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

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional WRF 001 OMB No.2040-0004
L
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 units)
Value Units Value Units Samples
Ammonia(as N) 13.84 mg/L 0.2 mg/L 1055 SM 4500 NH3 D-201 0.1 mg/L ❑MDL
Chlorine ❑ML
NA NA NA NA NA NA NA
(total residual,TRC)2 0 MDL
❑ML
Dissolved oxygen 15.00 mg/L 8.72 mg/L 1087 SM 4500 0 G NA ❑MDL
Nitrate/nitrite 4.92 mg/L 1.28 mg/L 222 SM 4500 NH3 E ).04 mg/L 0 ML
0 MDL
Kjeldahl nitrogen 43.34 mg/L 1.18 mg/L 222 'A 351.2 Rev 2.0,199: ).20 mg/L El',ML
0 MDL
ML
Oil and grease <5.0 mg/L <5.0 mg/L 3 EPA 1664 A 5.0 mg/L 0 MDL
0 ML
Phosphorus 31.8 mg/L 0.97 mg/L 231 SM 4500 P E-2011 ).01 mg/L 0 MDL
Total dissolved solids 602 mg/L 431 mg/L 3 SM 2540-B,2015 10 mg/L Ei ML
0 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

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OA- NC0024236 Johnnie Mosley Regional WRF 001 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 Methods (include units)
Samples
Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) 80 mg/L 56.2 mg/L 17 SM 2340 C 1 mg/L J ML
❑MDL
0 ML
Antimony,total recoverable <3 ug/L <3 ug/L 3 EPA 200.8 3 ug/L 0 MDL
Arsenic,total recoverable <5 ug/L <5 ug/L 17 SM 3113 B 5 ug/L LI ML
0 MDL
ri ML
Beryllium,total recoverable <1 ug/L <1 ug/L 3 EPA 200.7 1 ug/L 0
❑MDL
0 ML
Cadmium,total recoverable <1 ug/L <1 ug/L 3 SM 3113 B 1 ug/L 0 MDL
ML
Chromium,total recoverable <5 ug/L <5 ug/L 17 EPA 200.7 5 ug/L 0 MDL
.77 ML
Copper,total recoverable 3 ug/L <2 ug/L 17 EPA 200.7 2 ug/L ❑MDL
ML
Lead,total recoverable 5 ug/L <5 ug/L 17 SM 3113 B 5 ug/L 0 MDL
1 Mercury,total recoverable <1 ng/L <1 ng/L 17 EPA 1631 E 1 ng/L 0 ML
❑MDL
Nickel,total recoverable <10 ug/L <10 ug/L 17 EPA 200.7 10 ug/L 0 MDL
ML
Selenium,total recoverable <10 ug/L <10 ug/L 17 SM 3113 B 10 ug/L 0 MDL
Silver,total recoverable <1 ug/L <1 ug/L 17 EPA 200.7 1 ug/L 0 ML
❑MDL
D ML
Thallium,total recoverable <1 ug/L <1 ug/L 3 EPA 200.8 1 ug/L ❑MDL
Li mL
Zinc,total recoverable 44 ug/L 27.53 ug/L 17 SM 3111 B 3 ug/L ❑MDL
0 ML
Cyanide <0.005 mg/L <0.005 mg/L 17 SM 4500 CN-E 0.005 mg/ 0 MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
3 EPA 624.1 100 ug/L
J ML
u
Acrolein <100.00 ug/L <100.00 ug/L g 0 MDL
Acrylonitrile <50.00 ug/L <50.00 ug/L 3 EPA 624.1 50 ug/L E ML
❑MDL
<5.00 ug/L <5.00 ug/L 3 EPA 624.1 5 ug/L Li ML
Benzene ❑MDL
Bromoform <5.00 ug/L <5.00 ug/L 3 EPA 624.1 5 ug/L I'D ML
❑MDL I
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
i NC0024236
Johnnie Mosley Regional WRF 001 0MB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
1 Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
- -I
Carbon tetrachloride <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L El ML MDL
3 EPA 624.1 5 ug/L 0 ML
Chlorobenzene <5.00 ug/L <5.00 ug/L MDL
El ML
Chlorodibromomethane <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ugh 0 MDL
3 EPA 624.1 10 ug/L ML
Chloroethane <10.00 ug/L <10.00 ug/L ❑MDL
Ed ML
2-chloroethylvinyl ether <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L 0 MDL
Fil ML
Chloroform <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
r3ML
Dichlorobromomethane <5.00 ug/L <5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
r.D ML
1,1 dichloroethane <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
D ML
1,2 dichloroethane <5.0o ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
3 EPA 624.1 5 ug/L D ML
trans-1,2-dichloroethylene <5.00 ug/L <5.00 ug/L ❑MDL
3 EPA 624.1 5 ug/L ❑'ML
1,1-dichloroethylene <5.00 ug/L <5.00 ug/L 0 MDL
OWL
1,2-dichloropropane <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
3 EPA 624.1 5 ug/L O ML
1,3-dichloropropylene <5.00 ug/L <5.00 ug/L ❑MDL
ML
Ethylbenzene <5.00 ug/L <5.00 ug/L 3 EPA 624.1 5 ug/L El MDL
Methyl bromide <10.0o ug/L
<10.00 ug/L 3 EPA 624.1 10 ug/L 0 MDL
10 ug/L cr.ML
Methyl chloride <10.00 ug/L <10.00 ug/L 3 EPA 624.1 ❑MDL
3 EPA 624.1 10 ug/L DML
Methylene chloride <10.00 ug/L <10.00 ug/L ❑MDL
5 ug/L OWL
1,1,2,2-tetrachloroethane <5.00 ug/L <5.00 ug/L 3 EPA 624.1 ❑MDL
3 EPA 624.1 5 ug/L ML
Tetrachloroethylene <5.00 ug/L <5.00 ug/L ❑MDL
3 EPA 624.1 5 ug/L O ML
Toluene <5.00 ug/L <5.00 ug/L 0 MDL
1,1,1-trichloroethane <5.00 ug/L
<5.00 ug/L 3 EPA 624.1 5 ug/L ❑MDL
3 EPA 624.1 5 ug/L ML
1,1,2-trichloroethane <5.00 ug/L <5.00 ug/L ❑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
Nd NC0024236 Johnnie Mosley Regional WRF 001 OMB No.2040-0004
f
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
I ' Maximum DailyAverage DailyDischar
Dischar 9a vera9 9e Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
3 EPA 624.1 5 ug/L G ML
Tnchloroethylene <5.00 ug/L <5.00 ug/L ❑MDL
Vinyl chloride <10.00 ug/L
<10.00 ug/L 3 EPA 624.1 10 ug/L 0 MDL
Acid-Extractable Compounds
ML
p chloro m cresol <20.00 ug/L <20.00 ug/L 3 EPA 625.1 20 ug/L 0 MDL
2-chlorophenol
<10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
10 ug/L E2ML
2,4-dichlorophenol <10.00 ug/L <10.00 ug/L 3 EPA 625.1 0 MDL
3 EPA 625.1 10 ug/L E§ML
2,4-dimethylphenol <10.00 ug/L <10.00 ug/L ❑MDL
3 EPA 625.1 50 ug/L El ML
4,6 dinitro o cresol <50.00 ug/L <50.00 ug/L ❑MDL
2,4-dinitrophenol <50.00 ug/L
<50.00 ug/L 3 EPA 625.1 50 ug/L ❑IML
3 EPA 625.1 10 ug/L [3 ML
2-nitrophenol <10.00 ug/L <10.00 ug/L ❑MDL
a ML
4-nitrophenol <50.00 ug/L <50.00 ug/L 3 EPA 625.1 50 ug/L ❑MDL
a ML
Pentachlorophenol <50.00 ug/L <50.00 ug/L 3 EPA 625.1 50 ug/L ❑MDL
ML
Phenol <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
10 ug/L ❑'ML
2,4,6-trichlorophenol <10.00 ug/L <10.00 ug/L 3 EPA 625.1 ❑MDL
Base-Neutral Compounds
<10.00 ug/L 3 EPA 625.1 10 ug/L J ML
IAhth
ene <10.00 ug/L El MDL
3 EPA 625.1 10 ug/L J ML
Acenaphthylene <10.00 ug/L <10.00 ug/L ❑MDL
�J ML
Anthracene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ❑MDL
3 EPA 625.1 100 ug/L 0 ML
Benzidine <100.00 ug/L <100.00 ug/L ❑MDL
<10.00 ug/L 3 EPA 625.1 10 ug/L ML
Benzo(a)anthracene <10.00 ug/L ❑MDL
3 EPA 625.1 10 ug/L ❑3ML
Benzo(a)pyrene <10.00 ug/L <10.00 ug/L ❑MDL
3,4-benzofluoranthene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L iIl ML
0 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
N)k NC0024236 Johnnie Mosley Regional WRF 001 0MB 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
0 ML
Benzo(ghi)perylene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ❑MDL
Benzo(k)fluoranthene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L G ML
❑MDL
Bis(2-chloroethoxy)methane <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ❑ML
0 MDL
Ei ML
Bis(2-chloroethyl)ether <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
M ML
Bis(2-chloroisopropyl)ether <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
Bis(2-ethylhexyl)phthalate <20.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 ML
❑MDL
4-bromophenyl phenyl ether <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ML
0 MDL
D ML
Butyl benzyl phthalate <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
2-chloronaphthalene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
ML
4-chlorophenyl phenyl ether <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
Chrysene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 ML
❑MDL
di-n-butyl phthalate <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L Er ML
❑MDL
n ML
di-n-octyl phthalate <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ❑MDL
0 ML
Dibenzo(a,h)anthracene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
0 ML
1,2-dichlorobenzene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
1,3-dichlorobenzene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L QML
❑MDL
1,4-dichlorobenzene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
0 ML
3,3-dichlorobenzidine <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L •
❑MDL
Diethyl phthalate <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
Dimethyl phthalate <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0ML
MDL
ML
2,4-dinitrotoluene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
2,6-dinitrotoluene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L El 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
NA NC0024236 Johnnie Mosley Regional WRF 001 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 Method' (include units)
Samples
3 EPA 625.1 10 ug/L 0ML
1,2-diphenylhydrazine <10.00 ug/L <10.00 ug/L 0 MDL
El ML
Fluoranthene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
3 EPA 625.1 10 ug/L ❑ML
Fluorene <10.00 ug/L <10.00 ug/L g ❑MDL
<10.00 ug/L 3 EPA 625.1 10 ug/L W ML
Hexachlorobenzene <10.00 ug/L 0 MDL
D ML
Hexachlorobutadiene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
0 ML
Hexachlorocyclo-pentadiene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L
0 MDL
/L ❑'10 ML
ug
Hexachloroethane <10.00 ug/L <10.00 ug/L 3 EPA 625.1 0 MDL I
ML
Inden0(1,2,3-cd)pyrene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L El
MDL
0 ML
Isophorone <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 MDL
' Naphthalene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L r ML
0 MDL
<10.00 ug/L 3 EPA 625.1 10 u /L Ci.'ML
Nitrobenzene <10.00 ug/L g 0 MDL
N-nitrosodi-n-propylamine <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L G ML
0 MDL
3 EPA 625.1 10 ug/L [}ML
N nitrosodimethylamine <10.00 ug/L <10.00 ug/L 0 MDL
N-nitrosodiphenylamine <lamug/L <10.00 ug/L 3 EPA 625.1 10 ug/L ❑'ML
0 MDL
Phenanthrene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L Ei•ML
0 MDL
Pyrene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L 0 ML
0 MDL
1,2,4-trichlorobenzene <10.00 ug/L <10.00 ug/L 3 EPA 625.1 10 ug/L '❑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 21

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional WRF OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge Pollutant Analytical ML or MDL
Number of
(list) Value Units Value Units Method1 (include units)
Samples
ElNo additional sampling is required by NPDES permitting authority.
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
0 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 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 23

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NA NC0024236 Johnnie Mosley Regional WRF 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 ❑ Grab ❑ Grab
❑ 24-hour composite ❑ 24-hour composite ❑ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
❑After Disinfection ❑After Disinfection ❑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 ❑Acute ❑Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑Chronic CI Chronic CI 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
NA NC0024236 Johnnie Mosley Regional WRF 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 0 Static 0 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
sea salts or brine used. ❑ Salt water(specify) ❑ Salt water(specify) ElSalt water(specify)
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
0 Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen
❑ Temperature ❑ Temperature ❑ Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC50
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
NA NC0024236 Johnnie Mosley Regional WRF 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
IC25 % %
iyo
Control percent survival
Other(describe)
Quality ControllQuality Assurance
Is reference toxicant data available? ❑ Yes 0 No ❑ Yes ❑ No ❑ Yes 0 No
Was reference toxicant test within ❑ Yes 0 No 0 Yes 0 No ❑ Yes ❑ No
acceptable bounds? _
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
EPA Form 3510-2A(Revised 3-19) . Page 27

This page intentionally left blank.

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0024236 Johnnie Mosley Regional WRF OMB No.2040-0004
.4
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU 1 SIU 2 SIU 3
Name of SIU Alsco Crown Equipment Company Domestic Fabrics and Blankets
Mailing address(street or P.O.box) P.O.Box 958 2000 Dobbs Farm Road 2002 W.Vernon Ave.
City,state,and ZIP code Kinston,NC 28501 Kinston,NC 28504 Kinston,NC 28501
Description of all industrial processes that affect Domestic,non-contact cooling water Domestic and Process(vibratory Domestic,Process and Boiler
or contribute to the discharge. and boiler blowdown finisher and five stage washer) blowdown
List the principal products and raw materials that Chemicals used for washing linens and Industrial Fork lift trucks. Knit fabirc
affect or contribute to the SIU's discharge. garments
Steel,powder and liquid paint, Cotton,ployester,nylon
pretreatment chemicals,welding
wire,batteries,steel shot,coolants
and hydraulic oil.
Indicate the average daily volume of wastewater
discharged by the SIU. 67008 gpd 14402 gpd 20845 gpd
How much of the average daily volume is I
attributable to process flow? 65592 gpd 3843 gpd 20645 gpd
How much of the average daily volume is
attributable to non-process flow? 1416 gpd 10559 gpd zoo gpd
Is the SIU subject to local limits?
Yes ❑ No 0 Yes 0 No ,❑ Yes 0 No
Is the SIU subject to categorical standards?
0 Yes 0 NoEi Yes ❑ No ❑ Yes ❑'Ne
Page 29
EPA Form 3510-2A(Revised 3-19)

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
A) / NC0024236 Johnnie Mosley Regional WRF 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 1 SIU 2 SIU 3
Under what categories and subcategories is the NA 40 CFR 433(Metal finishing) NA
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 El Yes 0 No 0 Yes �No ❑ Yes El No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30
1