NC0088099_Renewal (Application)_20220809

ROY COOPER }~ ,.,, y
Governor
11� ,;
ELIZABETH S.BISER "*any
Secretary i .�:
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
August 09, 2022
Town of Beech Mountain
Attn: Daniel Davis, Utilities Director
403 Beech Mtn Pkwy
Beech Mountain, NC 28604-8012
Subject: Permit Renewal
Application No. NC0088099
Buckeye Lake WTP
Watauga County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 9, 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,
Xfiiin
/w
. /4
Wren T edfor•
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
EQ14) North Carolina Department of Fm'vorunental QualityIDivisionof Water Resources Wnston-Salem RegionalOfflce 11soWestHanesMIIIRoadsuite300 I Winston-Salem.North Carolina 27105
+ u a.o\ 336.77691300

United States Office of Water EPA Form 3510-1
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
PIEPA Application Form 1
General Information
NPDES Permitting Program
RECEIVED
AUG 0 9 2022
NCDEQIDWRINPDES
Note: All applicants to the National Pollutant Discharge Elimination System (NPDES)permits
program,with the exception of publicly owned treatment works and other treatment works treating
domestic sewage,must complete Form l. Additionally,all applicants must complete one or more of the
following forms: 2B,2C, 2D,2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions"for this form.

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

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Lake WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 V./EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 treatment works? 1.1.2 treating domestic sewage?
If yes,STOP.Do NOT complete ❑✓ No If yes,STOP. Do NOT ❑✓ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial,mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
o ❑ Yes 4 Complete Form 1 ❑✓ No Yes 4 Complete Form ❑ No
z and Form 2B. 1 and Form 2C.
1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
d ❑ Yes 4 Complete Form 1 No Yes 4 Complete Form No
ce and Form 2D. 1 and Form 2E.
�; 1.2.5 Is the facility a new or existing facility whose
'— discharge is composed entirely of stormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 ❑✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME, MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
Buckeye Lake Water Treatment Plant
2.2 EPA Identification Number
NC0088099
-a
co 2.3 Facility Contact
Name(first and last) Title Phone number
Daniel Davis Utilities Director [phone]
Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O.box
403 Beech Mountain Parkway
City or town State ZIP code
Beech Mountain North Carolina 28604
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Lake WTP OMB No.2040-0004
d 2.5 Facility Location
48 . Street,route number,or other specific identifier
Q v 1400 Pine Ridge Rd
rn
c County name County code(if known)
2 47.
Watauga
Gi 0
City or town State ZIP code
z Beech Mountain North Carolina 28604
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
d,
d
0
o
U
N
U
3.2 NAICS Code(s) Description(optional)
16 221310 Water Supply and Irrigation Systems
U_
v7
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Town of Beech Mountain
4.2 Is the name you listed in Item 4.1 also the owner?
c ✓❑ Yes ❑ No
4.3 Operator Status
❑ Public—federal ❑ Public—state ❑✓ Other public(specify)Municipal
o ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
E 403 Beech Mountain Parkway
o
c City or town State ZIP code
o v Beech Mountain North Carolina 28604
1 co a Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
c -a 5.1 Is the facility located on Indian Land?
cu
c ❑Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Lake WTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
d m NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
2 •en NC0088099
a ❑ PSD(air emissions) ❑ Nonattainment program(CM) ElNESHAPs(CM)
rn
w ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
❑✓ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NA7URE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Treatment of surface water to supply municipal distribution system.
U)
w
d
c
N
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O
N
a
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
d ElYes ❑✓ No 4 SKIP to Item 10.1.
Ra 9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
a, 2 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
c Y NPDES permitting authority to determine what specific information needs to be submitted and when.)
U
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
co) apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
ra Section 301(c)and(g))
❑✓ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

1+`` • - J
F �; - Beech Creek
_ - �,i ` � [flows north
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Buckeye Creek ':.'c>
(flows north] �: r
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- - = Approximate
i '�` ' - J ,. Outfall 001 Facility Boundary'' ` Pine Ridge Rd
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j f J �J copyr�grht 2013:National-Georaphic_ aciet�y� i-cubed
Town of Beech Mountain - Buckeye Lake W'I'P N *
NPUES Permit NC0088099
1400 Pine Ridge Road, Beech Mountain 28604 15000000
Receiving Stream: Buckeye Creek Stream Class: C;Tr
Stream Segment: 8-20-3-(2.5) Sub-Basin#:04-02-01 36.2208°N. -81.9075°W
River Basin: Watauga HUC:060101030305 tit \I I NC Grid:Cl INW
County: Watauga I '-t.0oo USGS Quad: Elk Park,NC

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Lake WTP OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1 Column 2
❑✓ Section 1:Activities Requiring an NPDES Permit 0 w/attachments
❑✓ Section 2:Name,Mailing Address,and Location 0 wl attachments
❑✓ Section 3:SIC Codes 0 w/attachments
O Section 4:Operator Information ❑ w/attachments
❑✓ Section 5:Indian Land 0 w/attachments
.- ❑✓ Section 6:Existing Environmental Permits 0 w/attachments
c
II 0 Section 7:Map ❑ w/topographic 1-1 w/additional attachments
co ma
P
1co
c 0Section 8:Nature of Business 0 wl attachments
w
A
67 ❑✓ Section 9:Cooling Water Intake Structures 0 w/attachments
cc
o ❑✓ Section 10:Variance Requests 0 wl attachments
-c
c
7 0 Section 11:Checklist and Certification Statement 0 w/attachments
Y
L 11.2 Certification Statement
U
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible for gathering the information,the information submitted is,to the best of my knowledge and
belief,true,accurate,and complete.I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Daniel Davis Utilities Director
Signature..,(2,_____c)
Date signed
a...R:1_ .
/ 3 3-62-z
EPA Form 3510-1(revised 3-19) Page 4

United States Office of Water EPA Form 3510-2C
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
:.EPA Application Form 2C
Existing Manufacturing,
Commercial , Mining , and
Si Ivicu Itu ral Operations
NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or silvicultural facility that currently discharges process wastewater.

Paperwork Reduction Act Notice
The U.S.Environmental Protection Agency estimates the average burden to collect information and
complete Form 2C to be 32.5 hours. This estimate includes time for reviewing instructions, searching
existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. Send comments about the burden estimate or any other aspect of this
collection of information to the Chief, Information Policy Branch (PM-223),U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue,NW, Washington,DC 20460, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street,NW,
Washington,DC 20503,marked"Attention: Desk Officer for EPA."

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C vr.EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL, MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
o Numbelr Receiving Water Name Latitude Longitude
001 Buckeye Creek 36° 13' 14" N 81° 54' 27" W
is
0
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
a, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
3 balance?(See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J �
o ❑✓ Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation Average Flow
Water Treatment 0.0120 mgd
mgd
is
d
mgd
mgd
LL
Treatment Units
a, Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C•1 Liquid Wastes Other Than
retention time,etc.) by Discharge
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
3.1 **Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
a,
cu
z
.2
o
0)
E
d
**Outfall Number**
Operations Contributing to Flow
Operation Average Flow
L
a, mgd
a' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time.etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
E
Na) SKIP to Section 4.
tr.) Yes Elo 4❑
rn n 3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frequency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION 40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ❑✓ No 4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
I
ELG Category ELG Subcategory Regulatory Citation
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑✓ No.4 SKIP to Section 6.
O
5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Unit of
Operation,Product,or Material I Quantity per Day
Number Measure
O
0
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
SECTION 6. IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
0 Yes ❑✓ No 4 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
Project (list outfall Discharge Required Projected
number)
E
N
d
a)
Q
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes 0 No ✓❑ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete. Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ❑✓ No 4 SKIP to Item 7.3.
7.2 If yes,indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number _
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
N requested and attached the results to this application package?
❑✓ Yes 1-1 No;a waiver has been requested from my NPDES
permitting authority for all pollutants at all outfalls.
6 Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
Y 7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
0 Yes ✓❑ No 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes 0 No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GCIMS Fraction(s)
(Check applicable boxes.)
D Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile ❑Acid 0 Base/Neutral 0 Pesticide
0 Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
7.7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
ElYes ❑ No
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B,pollutants that you have
indicated are"Believed Present"in your discharge?
✓❑ Yes ❑ No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑✓ No
then SKIP to Item 7.12.
7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
pollutants you have indicated are"Believed Present"in your discharge?
✓❑ Yes ❑ No
d Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
for all outfalls?
Y ❑✓ Yes ❑ No
c 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
° "Believed Present"?
3 ❑✓ Yes ❑ No
W Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
❑ Yes ElNo
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑ Yes ❑✓ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑✓ No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ✓❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes ❑✓ No 4 SKIP to Section 9.
N 8.2 List the pollutants below.
n 0 1. 4. 7.
0
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
SECTION 9.BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
❑✓ Yes ❑ No 4 SKIP to Section 10.
cu
9.2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
7a Aquatic pass/fail toxicity Quarterly monitoring ✓❑ Yes ❑ No 01/19/2021
0
m Aquatic pass/fail toxicity Quarterly monitoring ✓❑ Yes ❑ No 07/06/2021
Aquatic ass fail toxicity Q
uarterl monitoring
rin
g ✓ 10 19 2021
❑ Yes ❑ No / /
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑Q Yes ❑ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm Water Tech Labs Inc.
5 Pinewood Plaza Drive
Granite Falls,NC 28630
Laboratory address Mailing address:
P.O.Box 1056
Granite Falls,NC 28630
0 Phone number
[phone]
Pollutant(s)analyzed Chlorine,pH,TSS,Turbidity,
NH3 as N,Influent and
effluent total hardness,NO2
+NO3,TKN,T.Nitrogen,T.
Phosphorus,Aluminum,Zinc
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 4 SKIP to Section 12.
0
E11.2 List the information requested and attach it to this application.
1. 4.
0
2. 5.
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C 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 complete all sections or provide attachments.
Column 1 Column 2
O Section 1:Outfall Location ❑ w/attachments
O Section 2:Line Drawing ❑ wl line drawing ❑ wl additional attachments
Section 3:Average Flows and w/list of each user of
0 Treatment ❑ w/attachments 0 privately owned treatment
works
O Section 4: Intermittent Flows ❑ w/attachments
O Section 5:Production ❑ w/attachments
w/optional additional
0 Section 6:Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
w/small business exemption w/other attachments
0 request El
co 0 Section 7: Effluent and Intake 0 w/Table A 0 w/Table B
Characteristics
0
0 w/Table C 0 w/Table D
d w/Table E w/analytical results as an
0 ❑ ❑ attachment
Section 8:Used or Manufactured
0 Toxics ❑ w/attachments
.Y Section 9: Biological Toxicity
0 ❑ w/attachments
Tests
c)
O Section 10:Contract Analyses ❑ w/attachments
O Section 11:Additional Information 0 w/attachments
0
Section 12:Checklist and ❑ w/attachments
Certification Statement
12.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly
responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,
accurate,and complete.I am aware that there are significant penalties for submitting false information,including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Daniel Davis Utilities Director
Signature Date signed
S Izozr_-
EPA Form 3510-2C(Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0088099 Buckeye Water Treatment Plant 001
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(if applicable) (spay) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
0 Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration
1' El(BOD5) Mass
Chemical oxygen demand Concentration
2' El(COD) Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration mg/I 42 23.9 39 72
4. Total suspended solids(TSS) ❑
Mass
Concentration mg/I <1 <1 <1 12
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate mgd 0.216 0.0312 0.0120 15840
Temperature(winter) ❑ °C °C
7.
Temperature(summer) ❑ °C °C
pH(minimum) ❑ Standard units S.U. 6.4 6.4 6.0 72
8.
pH(maximum) 0 Standard units s.u. 6.8 6.8 8.4 72
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 3510-2C(Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Maximum Maximum Long-Term Long-
(and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number Term Number
Present Absent of of
Discharge Discharge Discharge a Analyses Average Analyses
(required) (if available) 9 Value
(if available) i
Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table.Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
Antimony,total Concentration
1.1 (7440-36-0) Mass
Arsenic,total Concentration
1.2 (7440-38-2) 0 0 0 Mass
Beryllium,total El 0 ❑ Concentration
1.3 (7440-41-7) Mass
Cadmium,total Concentration
1.4 (7440-43-9) 0 El � Mass
Chromium,total Concentration
1.5 (7440-47-3) 0 El0 _Mass
Copper,total Concentration
1.6 El 0 El
(7440-50-8) Mass
Lead,total Concentration
1.7 (7439-92-1) 0 0 0 Mass
Mercury,total1=1 Concentration
1.8 (7439 97 6) ❑
Mass
Nickel,total Concentration
1'9 (7440-02-0) 0 � 0 Mass
1.10 Selenium,total 1=1 Concentration
0 El
(7782-49-2) Mass
Silver,total Concentration
1.11 (7440-22-4) 0 0 � Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant ow. OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
Present Absent Daily Monthly Term
of of
Discharge Discharge DisDchar a An lyses Average Analyses
(required) (if available) g Value
(if available)
Thallium,total Concentration
1.12 (7440 28 0) ❑ ❑ ❑
Mass
1.13 Zinc,total ✓❑ ❑ 0 Concentration ug/I 38 7.65 12
(7440-66-6) Mass
1.14 Cyanide,total Concentration
(57-12-5) Mass
1.15 Phenols,total El 0
Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
Acrolein 0 Concentration
2.1 0 0(107-02-8) Mass
2.2 Acrylonitrile El 0 0Concentration
(107-13-1) Mass
2.3 Benzene Concentration
(71-43-2) Mass
2.4 Bromoform ❑� Concentration
0 El
(75-25-2) Mass
2.5 Carbon tetrachloride C3 0 Concentration
(56-23-5) Mass
Chlorobenzene Concentration
2.6 (108-90-7) Mass
Chlorodibromomethane 0 Concentration
2.7 (124-48-1) Mass
2.8 Chloroethane 0Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of of
Discharge Discharge DisDchar a An lyses Average Analyses
(required) (if available) g Value
(if available)
2.9 2-chloroethylvinyl ether El ❑✓ Concentration
(110-75-8) Mass
2.10 Chloroform(67-66-3) Concentration
Mass
Dichlorobromomethane ❑ El Concentration
2.11 (75-27-4) Mass
1,1-dichloroethane ❑ ❑ ❑ Concentration
2.12 (75-34-3) Mass
2.13 1,2-dichloroethane 0 ❑✓ Concentration
(107-06-2) Mass
2.14 1,1-dichloroethylene ElE✓ Concentration
El
(75-35-4) Mass
2.15 1,2-dichloropropane ❑✓ Concentration
El 0
(78-87-5) Mass
2.16 1,3-dichloropropylene 0 ❑✓ Concentration
(542-75-6) Mass
2.17 Ethylbenzene ❑ El Concentration
(100-41-4) Mass
2.18 Methyl bromide ✓❑ Concentration
El 0
(74-83-9) Mass _
2 19 Methyl chloride Concentration
El El 0
(74-87-3) Mass
2.20 Methylene chloride ❑✓ Concentration
El El
(75-09-2) Mass
2.21 1,1,2,2-tetrachloroethane ❑ El ❑✓ Concentration
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (speci Maximum Maximum Long-
Present Absent
) Daily Monthly Average Number Term Number
Discharge Discharge Daily of Average of
(required) (if available) Dischar(ifge Analyses Value Analyses
available)
2.22 Tetrachloroethylene Concentration
(127-18-4) Mass
2.23 Toluene Concentration
(108-88-3) Mass
2.24 1,2-trans-dichloroethylene 0 Concentration
(156-60-5) Mass
2.25 1 1,1-trichloroethane 0 Concentration
(71-55-6) Mass
2.26 1,1,2-trichloroethane El ❑ Concentration
(79-00-5) Mass
2.27 Trichloroethylene 0 El0Concentration
(79-01-6) Mass
2.28 Vinyl chloride 0 0 Concentration
(75-01-4) Mass
Section 3.Organic Toxic Pollutants(GCIMS Fraction—Acid Compounds)
3.1 2-chlorophenol Concentration
El El El
(95-57-8) Mass
3.2 2,4-dichlorophenol ❑ ❑ 1=1
Concentration
(120-83-2) Mass
3.3 2,4-dimethylphenol 0 0 Concentration
(105-67-9) Mass _
4,6-dinitro-o-cresol Concentration
3.4 El 0 El
(534-52-1) Mass
3.5 2,4-dinitrophenol ❑ Concentration
(51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
and CAS Number,if available) Required Believed Believed Maximum Maximum Long-
( q (specify) Daily Monthly Average Number Term Number
Present Absent
Discharge Discharge Daily of Average of
(required) (if available) Dischar(ifavailablge)e Analyses Value Analyses
3.6 2-nitrophenol Concentration 1
El El El
(88-75-5) Mass
3.7 4-nitrophenol El ElConcentration
El
(100-02-7) Mass
3.8 p chloro m cresol El Concentration
(59-50-7) Mass
3.9 Pentachlorophenol 121 ❑ 0Concentration ,
(87-86-5) Mass
3.10 Phenol ❑✓ Concentration
(108-95-2) Mass
3.11 2,4,6-trichlorophenol ❑ El0Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GCIMS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene ❑ ❑ Concentration
(83-32-9) Mass
Acenaphthylene Concentration
4.2 1:1 El El
(208-96-8) Mass
4.3 Anthracene Concentration
(120-12-7) Mass
4.4 Benzidine 0Concentration
El El
(92-87-5) Mass
4.5 Benzo(a)anthracene El El0Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene ❑ El0Concentration
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
aily of of
Discharge Discharge Di D har a An lyses Average Analyses
(required) (if available) 9 Value
(if available)
4 7 3,4-benzofluoranthene El Concentration
El 0
(205-99-2) Mass
4.8 Benzo(ghi)perylene Concentration
(191-24-2) Mass
Benzo(k)fluoranthene Concentration
4.9 El 0 El
(207-08-9) Mass
4.10 Bis(2-chloroethoxy)methane Concentration
(111-91-1) Mass
4.11 Bis(2-chloroethyl)ether 0 0Concentration
(111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether ElConcentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate 0 El ❑✓ Concentration
(117-81-7) Mass
4.14 4-bromophenyl phenyl ether ❑ 0 0 Concentration
(101-55-3) Mass
4.15 Butyl benzyl phthalate ❑� Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene Concentration
(91-58-7) Mass
4-chlorophenyl phenyl ether Concentration
4.17 (7005-72-3) Mass
Chrysene 1:1Concentration
4.18 0 0
(218-01-9) Mass
4.19 Dibenzo(a,h)anthracene El ElConcentration
(53-70-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Discharge Discharge Daily °f Average of
(required) (if available) Discharge Analyses Value Analyses
(if available)
4.20 12-dichlorobenzene 0 Concentration
0 0
(95-50-1) Mass
4.21 1,3-dichlorobenzene 0Concentration
El El
(541-73-1) Mass
4.22 1,4-dichlorobenzene 0Concentration
El 0
(106-46-7) Mass
4.23 3,3-dichlorobenzidine ✓❑ Concentration
0 0
(91-94-1) Mass
4.24 Diethyl phthalate © Concentration
0 0
(84-66-2) Mass
4.25 Dimethyl phthalate El ❑ 0Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate ❑ ❑ © Concentration
(84-74-2) Mass
4.27 2,4-dinitrotoluene ✓❑ Concentration
0 0(121-14-2) Mass
4.28 2,6-dinitrotoluene 0Concentration
El 0
(606-20-2) Mass
Di-n-octyl phthalate 0 Concentration
4.29 (117-84-0) Mass
4.30 1,2-Diphenylhydrazine El El Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene ❑ Concentration
El El
(206-44-0) Mass _
4.32 Fluorene Concentration
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0088099 Buckeye Water Treatment Plant 001
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant]Parameter Testing Units Maximum Maximum Long-Term Long-
(and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number Term Number
Present Absent
Discharge Discharge Daily of Average of
(required) (if available) Discharge Analyses Analyses
Value
(if available)
Hexachlorobenzene Concentration
4.33 0 CI(118-74-1) ✓ Mass
Hexachlorobutadiene Concentration
4.34 0 Cl(87 68 3) ✓ Mass
4.35 Hexachlorocyclopentadiene 0 Concentration
(77-47-4) Mass
Hexachloroethane � 0 Concentration
✓
4.36 (67-72-1) Mass
Indeno(1,2,3-cd)pyrene 0 Concentration
4.37 ✓ •
(193-39-5) Mass
4.38 Isophorone Concentration
(78-59-1) Mass
Naphthalene Concentration
4.39 El 0(91-20-3) ✓ Mass
4.40 Nitrobenzene Concentration .
(98-95-3) Mass
•
N-nitrosodimethylamine ❑ ✓ Concentration
4.41 (62-75-9) Mass
N-nitrosodi-n-propylamine 0 0 Concentration
4.42 ✓(621-64-7) Mass
N-nitrosodiphenylamine ❑ ❑ Concentration
✓
4.43 (86-30-6) Mass
Phenanthrene Concentration
4.44 0 0(85-01-8) ✓ Mass
Pyrene Concentration
4.45 (129-00-0) Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0088099 Buckeye Water Treatment Plant 001
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
and CAS Number,if available) Required Believed Believed s Maximum Maximum Long-
(and q ( Pegh) Average Number Number
Present Absent Daily Monthly Term
Daily °f of
Discharge Discharge Average
(required) (if available) Discharge Analyses Value Analyses
(if available)
4.46 1,2,4-trichlorobenzene 0Concentration
(120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides) _
51 Aldrin 0Concentration
(309-00-2) Mass
a-BHC 0 Concentration
5.2 (319-84-6) Mass
p-BHC Concentration
5.3 (319857) ❑ ❑✓
Mass
y-BHC ✓ Concentration
5.4 (58-89-9) El ❑ Mass
b-BHC Concentration
5.5 (319-86-8) Mass
5.6 Chlordane 0Concentration
El 0
(57-74-9) Mass
5.7 4,4'-DDT ❑✓ Concentration
(50-29-3) Mass
5.8 4 4'-DDE ❑✓ Concentration
(72-55-9) Mass
5.9 4,4'-DDD Concentration
(72-54-8) ✓ Mass
5.10 Dieldrin Concentration
(60-57-1) ✓ Mass
5.11 a-endosulfan Concentration
(115-29-7) ✓ Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
and CAS Number,if available) Required Believed Believed Maximum Maximum Long-
( q (specify) Average Number Number
Present Absent Daily Monthly Term
Discharge Discharge Daily °f Average of
(required) (if available) Discharge Analyses Value Analyses
(if available)
13-endosulfan Concentration
5.12 (115-29-7) Mass
Endosulfan sulfate Concentration
5.13 (1031-07-8) Mass
5.14 Endrin Concentration
El El El
(72-20-8) Mass
Endrin aldehyde Concentration
5.15 (7421-93-4) Mass
5.16 Heptachlor Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) ❑ 0 0 Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0 Mass
PCB-1254 Concentration
5.19 (11097-69-1) ❑ 0 0 Mass
PCB-1221 Concentration
5.20 (11104-28-2) ❑ ❑ El Mass
PCB-1232 Concentration
5.21 (11141-16-5) 0 ❑ ❑ Mass
PCB-1248 Concentration
5.22 (12672-29-6) ❑ 0 0 Mass
PCB-1260 Concentration
5.23 (11096-82-5) ❑ 0 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) ❑ 0 E Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily of of
Discharge Discharge Average
(required) (if available) Discharge Analyses Value Analyses
(if available)
Toxaphene Concentration
5.25 (8001-35-2) ❑ ❑ ❑
Mass
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 3510-2C(Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant onOMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Units '
Pollutant Maximum Lon Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) (if available) Value
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1-1 Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the`Presence or Absence"column of Table C for
each pollutant.
1 Bromide ❑ 0 Concentration
(24959-67-9) Mass
Chlorine,total Concentration mg/I <17 <17 72
2. ❑
residual 0 Mass
3. Color 0 ElConcentration
Mass
Concentration
4. Fecal coliform 0 0 Mass
5 Fluoride ❑ 0 Concentration
(16984-48-8) Mass
Concentration mg/I 3.60 0.945 12
6 Nitrate-nitrite 0 0 Mass
Nitrogen,total Concentration mg/I 6.80 1.95 12
7' organic(as N) 0 0 Mass
Concentration
8. Oil and grease 0 0 Mass
Phosphorus(as Concentration mg/I 0.72 0.249 12
9' P),total(7723-14-0) 0 ❑ Mass
Sulfate(as SO4) El Concentration
10. (14808-79-8) 0
Mass
Concentration
11. Sulfide(as S) 0 0
Mass
EPA Form 3510-2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant 001 OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) Value
(if available) (if available)
12. Sulfite(as SO3) 0 0 Concentration
(14265-45-3) Mass
13. Surfactants 12 El
Concentration
Mass
Aluminum,total 0 Concentration ug/I 5510 1592 12
14. (7429-90-5) Mass
15. Barium,total ❑ ❑✓ Concentration
(7440-39-3) Mass
16. Boron,total 0 ❑✓ Concentration
(7440-42-8) Mass
17. Cobalt,total Concentration
(7440-8-4) ✓ Mass
18 Iron,total ❑ ✓❑ Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ ✓� Concentration
(7439-95-0) Mass
Molybdenum, Concentration
20. total 0 ❑✓ Mass
(7439-98-7)
21 Manganese,total ❑ ✓� Concentration
(7439-96-5) Mass
22 Tin,total Concentration
(7440-31-5) Mass
23. Titanium,total ❑ ❑✓ Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24

r
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088099 Buckeye Water Treatment Plant ow. OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent
(Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
(if available) (if available)
24. Radioactivity
Alpha,total ❑ Concentration
Mass
Concentration
Beta,total ❑ ✓❑ Mass
Radium,total El 0 Concentration
Mass
Radium 226,total El ID
Concentration
Mass
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 3510-2C(Revised 3-19) Page 25

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Buckeye Lake Water Treatment Plant Line Drawing
Buckeye Lake
Buckeye Lake WTP Basin Splitter
Sed. Basin 1 Sed. Basin 2
Dissolved Air
Flotation
Discharge
Flowmeter
Filter 1 Filter 2 Filter 3
Discharge
Backwash Backwash to Buckeye
Creek