NC0058378_Fact Sheet_20220915

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require full Fact
Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile home parks, etc)
that can be administratively renewed with minor changes, but can include facilities with more complex
issues (Special Conditions, 303(d) listed water, toxicity testing, instream monitoring, compliance
concerns).
Basic Information for Expedited Permit Renewals
Permit Writer / Date
Siying Chen 4/6/2022
Permit Number
NC0058378
Facility Name / Facility Class
Elk River WWTP/ WW-2
County / Regional Office
Avery / ARO
Basin Name / Sub -basin number
Watauga / 04-02-01
Receiving Stream / HUC
Elk River / 060101030201
Stream Classification / Stream Segment
C-Trout / 8-22-(3)
Does permit need Daily Maximum NH3 limits?
No
Does permit need TRC limits/language?
Already present
Does permit have toxicity testing? IWC (%) if so
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
Four NOVs during the permit cycle
Any permit mods since last permit?
Added WWTP classification
Updated eDMR requirements
Updated outfall map
New expiration date
9/30/2027
Comments on Draft Permit?
No comment received
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters List. Addressing
impaired waters is a high priority with the Division, and instream data will continue to be
evaluated. If there is noncompliance with permitted effluent limits and stream impairment can
be attributed to your facility, then mitigative measures may be required".
Fact Sheet for Permit Renewal
April 2022 -- NPDES Permit NC0058378 - Page 1

Section 1. Facility Overview:
This facility is a minor facility (flow < 1 MGD) discharging 100% domestic wastewater with a design
capacity of 0.08 MGD. This WWTP utilizes the following treatment components:
• effluent flow meter
• flow splitter box
• two (2) parallel contact stabilization package treatment plants
• two (2) reaeration chambers
• two (2) clarifiers
• two (2) aerobic digesters
• chlorination
• dechlorination
Section 2. Compliance History (October 2017 — June 2022):
• One NOV for TRC and flow monitoring frequency violations in January 2018.
• One NOV for flow monitoring frequency violation in March 2018.
• One NOV for BOD5, fecal coliform, flow, ammonia nitrogen, dissolved oxygen, and TSS
monitoring frequency violations in June 2018.
• One NOV for BOD5 limit violation in May 2022.
Section 3. Changes from previous permit to draft:
• Added facility grade in A. (1).
• Updated eDMR footnote in A. (1) and language in A. (2).
• Updated outfall map.
Section 4. Comments received on draft permit:
• No comment received on draft permit.
Section 5. Changes from draft to final:
• No change to final permit.
Fact Sheet for Permit Renewal
April 2022 -- NPDES Permit NC0058378 - Page 2

STATE OF NORTH CAROLINA
AVERY COUNTY
DEQ - DIVISION OF WATER
RESOURCES
1617 Mail Service Ctr
Raleigh, NC 276991617
AFFIDAVIT OF PUBLICATION
Before th dersigned, a Notary Public of said County and State, duly commissioned,
qualified, d authori
no/it
by law to administer oaths, personally appeared
171yj/-i who being first duly sworn, deposes and says: that
he (she) is an employee of ADAMS PUBLISHING GROUP, LLC, engaged in the publication
of a newspaper known as The Avery Journal, published in the city of NEWLAND in said
County and State, that he (she) is authorized to make this affidavit and sworn statement; that the
notice or other legal advertisement, a true copy of which is attached hereto, was published in
The Avery Journal, a newspaper meeting all of the requirements and qualifications of Section
I-597 of the General Statues of North Carolina on the following dates:
Wastewater Permit NC0058378 Elk River
07/20/22
„Sworn to
^Aver
au rnal
(!tmpg
Public Notice
North Carolina Environmen-
tal Management Commis-
sion/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
NC0058378 Elk River WWTP
The North Carolina Environmen-
tal Management Commission
proposes to issue a NPDES
wastewater discharge permit to
the person(s) listed below. Writ-
ten comments regarding the
proposed permit will be ac-
cepted until 30 days after the
publish date of this notice. The
Director of the NC Division of
Water Resources (DWR) may
hold a public hearing should
there be a significant degree of
public interest. Please mail com-
ments and/or information re-
quests to DWR at the above
address. Interested persons may
visit the DWR at 512 N. Salis-
bury Street, Raleigh, NC to re-
view information on file.
Additional information on
NPDES permits and this notice
may be found on our website:
http://deq.nc.gov/aboutldivi-
sion s/water-resources/water-
resources-permits/wastewate
r-branch / n p d e s-
wastewater/public-notices, or
by calling [phone]. Car-
olina Water Service Inc. of North
Carolina has applied to renew
NPDES permit NC0058378 for
the Elk River WWTP, Hwy 194
west of the Town of Banner Elk,
Avery County, discharging
treated wastewater into Elk
River, Watauga River Basin.
Currently, TRC and fecal col-
iform are water -quality limited.
This discharge may affect future
wasteload allocations in this por-
tion of the watershed.
`,..1111IrfI��
M.
•
N O T,q
nd subscribed before me on this 21st day of July, 2022 •
�D As
ublic
P.O. BOX 1815, BOONE, NC 28607
828-264-6397
This 21st day of,July, 2022
Signature of person making affidavit
My Commission expires:
''9CO
OUN .‘

NH3/TRC WLA Calculations
Facility: Elk River WWTP
PermitNo. NC0058378
Prepared By: Siying Chen
Enter Design Flow (MGD):
Enter s7Q10 (cfs):
Enter w7Q10 (cfs):
0.08
6
8
Total Residual Chlorine (TRC)
Daily Maximum Limit (ug/I)
s7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (UG/L)
Upstream Bkgd (ug/I)
IWC (%)
Allowable Conc. (ug/I)
Fecal Coliform
Monthly Average Limit:
(If DF >331; Monitor)
(If DF<331; Limit)
Dilution Factor (DF)
6
0.08
0.124
17.0
0
2.02
840
Ammonia (Summer)
Monthly Average Limit (mg NH3-N/I)
s7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (MG/L)
Upstream Bkgd (mg/I)
IWC (%)
Allowable Conc. (mg/I)
Ammonia (Winter)
Monthly Average Limit (mg NH3-N/I)
w7Q10 (CFS)
200/100m1 DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (MG/L)
49.39 Upstream Bkgd (mg/I)
IWC (%)
Allowable Conc. (mg/I)
Total Residual Chlorine
1. Cap Daily Max limit at 28 ug/I to protect for acute toxicity
Ammonia (as NH3-N)
1. If Allowable Conc > 35 mg/I, Monitor Only
2. Monthly Avg limit x 3 = Weekly Avg limit (Municipals)
3. Monthly Avg limit x 5 = Daily Max limit (Non-Munis)
If the allowable ammonia concentration is > 35 mg/L, no limit shall be imposed
6
0.08
0.124
1.0
0.22
2.02
38.7
8
0.08
0.124
1.8
0.22
1.53
103.7
Fecal Coliform
1. Monthly Avg limit x 2 = 400/100 ml = Weekly Avg limit (Municipals) = Daily Max limit (Non -Muni)

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22 Page 1 01 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor:
PERMIT: NC0058378
FACILITY: Carolina Water Service Inc of North Carolina - Elk River COUNTY: Avery
WWTP
REGION: Asheville
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
05 -2022 001 Effluent BOD, 5-Day (20 Deg. C) - 05/31/22 Weekly mg/I 30 34.15 13.8 Monthly Average Proceed to NOV
Concentration Exceeded
10 - 2018 001 Effluent Chlorine, Total Residual 10/15/18 2 X week ug/I 28 34 21.4 Daily Maximum No Action, BPJ
Exceeded
11-2018 001 Effluent Chlorine, Total Residual 11/12/18 2 X week ug/I 28 49 75 Daily Maximum No Action, BPJ
Exceeded
11-2018 001 Effluent Chlorine, Total Residual 11/19/18 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
11-2018 001 Effluent Chlorine, Total Residual 11/29/18 2 X week ug/I 28 47 67.9 Daily Maximum No Action, BPJ
Exceeded
01-2019 001 Effluent Chlorine, Total Residual 01/23/19 2 X week ug/I 28 33 17.9 Daily Maximum No Action, BPJ
Exceeded
01-2019 001 Effluent Chlorine, Total Residual 01/30/19 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
02-2019 001 Effluent Chlorine, Total Residual 02/04/19 2 X week ug/I 28 42 50 Daily Maximum No Action, BPJ
Exceeded
02-2019 001 Effluent Chlorine, Total Residual 02/05/19 2 X week ug/I 28 43 53.6 Daily Maximum No Action, BPJ
Exceeded
03-2019 001 Effluent Chlorine, Total Residual 03/11/19 2 Xweek ug/I 28 39 39.3 Daily Maximum No Action, BPJ
Exceeded
04 - 2019 001 Effluent Chlorine, Total Residual 04/04/19 2 X week ug/I 28 46 64.3 Daily Maximum No Action, BPJ
Exceeded
04 - 2019 001 Effluent Chlorine, Total Residual 04/09/19 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
06-2019 001 Effluent Chlorine, Total Residual 06/07/19 2 X week ug/I 28 49 75 Daily Maximum No Action, BPJ
Exceeded
06 - 2019 001 Effluent Chlorine, Total Residual 06/14/19 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
06 - 2019 001 Effluent Chlorine, Total Residual 06/17/19 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22 Page 2 of 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0058378 FACILITY: Carolina Water Service Inc of North Carolina - Elk River
WWTP
COUNTY: Avery REGION: Asheville
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
07 - 2019 001 Effluent Chlorine, Total Residual 07/02/19 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
07 - 2019 001 Effluent Chlorine, Total Residual 07/17/19 2 X week ug/I 28 47 67.9 Daily Maximum No Action, BPJ
Exceeded
07 - 2019 001 Effluent Chlorine, Total Residual 07/22/19 2 X week ug/I 28 41 46.4 Daily Maximum No Action, BPJ
Exceeded
08 - 2019 001 Effluent Chlorine, Total Residual 08/15/19 2 X week ug/I 28 39 39.3 Daily Maximum No Action, BPJ
Exceeded
08 - 2019 001 Effluent Chlorine, Total Residual 08/19/19 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
09-2019 001 Effluent Chlorine, Total Residual 09/03/19 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded
09-2019 001 Effluent Chlorine, Total Residual 09/05/19 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
09-2019 001 Effluent Chlorine, Total Residual 09/12/19 2 X week ug/I 28 35 25 Daily Maximum No Action, BPJ
Exceeded
09-2019 001 Effluent Chlorine, Total Residual 09/20/19 2 X week ug/I 28 43 53.6 Daily Maximum No Action, BPJ
Exceeded
10-2019 001 Effluent Chlorine, Total Residual 10/15/19 2 X week ug/I 28 33 17.9 Daily Maximum No Action, BPJ
Exceeded
10-2019 001 Effluent Chlorine, Total Residual 10/22/19 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
10-2019 001 Effluent Chlorine, Total Residual 10/25/19 2 X week ug/I 28 32 14.3 Daily Maximum No Action, BPJ
Exceeded
11-2019 001 Effluent Chlorine, Total Residual 11/05/19 2 X week ug/I 28 42 50 Daily Maximum No Action, BPJ
Exceeded
01-2020 001 Effluent Chlorine, Total Residual 01/02/20 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded
01-2020 001 Effluent Chlorine, Total Residual 01/16/20 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
02-2020 001 Effluent Chlorine, Total Residual 02/05/20 2 X week ug/I 28 42 50 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22 Page 3 of 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0058378 FACILITY: Carolina Water Service Inc of North Carolina - Elk River
WWTP
COUNTY: Avery REGION: Asheville
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
03 - 2020 001 Effluent Chlorine, Total Residual 03/31/20 2 X week ug/I 28 44 57.1 Daily Maximum No Action, BPJ
Exceeded
05-2020 001 Effluent Chlorine, Total Residual 05/07/20 2 X week ug/I 28 43 53.6 Daily Maximum No Action, BPJ
Exceeded
08 - 2020 001 Effluent Chlorine, Total Residual 08/11/20 2 X week ug/I 28 44 57.1 Daily Maximum No Action, BPJ
Exceeded
08 - 2020 001 Effluent Chlorine, Total Residual 08/18/20 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
09 - 2020 001 Effluent Chlorine, Total Residual 09/16/20 2 X week ug/I 28 49 75 Daily Maximum No Action, BPJ
Exceeded
09-2020 001 Effluent Chlorine, Total Residual 09/25/20 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
02 - 2021 001 Effluent Chlorine, Total Residual 02/17/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
03 - 2021 001 Effluent Chlorine, Total Residual 03/16/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
04 - 2021 001 Effluent Chlorine, Total Residual 04/13/21 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
04 - 2021 001 Effluent Chlorine, Total Residual 04/26/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
05 - 2021 001 Effluent Chlorine, Total Residual 05/20/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
06 - 2021 001 Effluent Chlorine, Total Residual 06/02/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
06 - 2021 001 Effluent Chlorine, Total Residual 06/24/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
07 - 2021 001 Effluent Chlorine, Total Residual 07/07/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
07 - 2021 001 Effluent Chlorine, Total Residual 07/09/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
07 - 2021 001 Effluent Chlorine, Total Residual 07/29/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22 Page 4 of 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0058378
FACILITY: Carolina Water Service Inc of North Carolina - Elk River
WWTP
COUNTY: Avery REGION: Asheville
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
08 - 2021 001 Effluent Chlorine, Total Residual 08/03/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
08 - 2021 001 Effluent Chlorine, Total Residual 08/20/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
08 - 2021 001 Effluent Chlorine, Total Residual 08/25/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
09 - 2021 001 Effluent Chlorine, Total Residual 09/10/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
09 - 2021 001 Effluent Chlorine, Total Residual 09/16/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
12 - 2021 001 Effluent Chlorine, Total Residual 12/06/21 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
12-2021 001 Effluent Chlorine, Total Residual 12/21/21 2 Xweek ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
01-2022 001 Effluent Chlorine, Total Residual 01/13/22 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
03 -2022 001 Effluent Chlorine, Total Residual 03/29/22 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
Monitoring Violation
MONITORING VIOLATION UNIT OF CALCULATED
REPORT OUTFALL LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE Over VIOLATION TYPE VIOLATION ACTION
06-2018 001 Effluent BOD, 5-Day (20 Deg. C) - 06/09/18 Weekly mg/I Frequency Violation Proceed to NOV
Concentration
01-2018 001 Effluent Chlorine, Total Residual 01/13/18 2 X week ug/I Frequency Violation Proceed to NOV
06-2018 001 Effluent Coliform, Fecal MF, MFC 06/09/18 Weekly #/100m1 Frequency Violation Proceed to NOV
Broth, 44.5 C
01 -2018 001 Effluent Flow, in conduit or thru 01/06/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/07/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22 Page 5 of 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0058378 FACILITY: Carolina Water Service Inc of North Carolina - Elk River
WWTP
COUNTY: Avery REGION: Asheville
Monitoring Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
01 -2018 001 Effluent Flow, in conduit or thru 01/13/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/14/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/17/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/20/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/21/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/27/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/28/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/30/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
03 -2018 001 Effluent Flow, in conduit or thru 03/07/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
03 -2018 001 Effluent Flow, in conduit or thru 03/14/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
03-2018 001 Effluent Flow, in conduit or thru 03/31/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
06 -2018 001 Effluent Flow, in conduit or thru 06/30/18 Continuous mgd Frequency Violation Proceed to NOV
treatment plant
06-2018 001 Effluent Nitrogen, Ammonia Total (as 06/09/18 Weekly mg/I Frequency Violation Proceed to NOV
N) - Concentration
06-2018 001 Effluent Oxygen, Dissolved (DO) 06/09/18 Weekly mg/I Frequency Violation Proceed to NOV
06-2018 001 Effluent Oxygen, Dissolved (DO) 06/16/18 Weekly mg/I Frequency Violation Proceed to NOV
06-2018 001 Effluent Oxygen, Dissolved (DO) 06/23/18 Weekly mg/I Frequency Violation Proceed to NOV

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/30/22
Page 6 o1 6
Permit: nc0058378 MRs Betweei 0 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region:
County: %
Violation Category:%
Subbasin:%
Program Category: %
Violation Action: %
PERMIT: NC0058378
FACILITY: Carolina Water Service Inc of North Carolina - Elk River
WWTP
COUNTY: Avery
REGION: Asheville
Monitoring Violation
MONITORING
REPORT OUTFALL
LOCATION
PARAMETER
VIOLATION UNIT OF
DATE FREQUENCY MEASURE
LIMIT
CALCULATED
VALUE
Over
VIOLATION TYPE
VIOLATION ACTION
06-2018 001
06-2018 001
01-2018 001
03-2018 001
03-2018 001
Effluent
Effluent
Effluent
Effluent
Effluent
Oxygen, Dissolved (DO)
Solids, Total Suspended -
Concentration
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
06/30/18 Weekly
06/09/18
01/20/18
03/10/18
03/17/18
Weekly
5 X week
5 X week
5 X week
mg/I
mg/I
deg c
deg c
deg c
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Proceed to NOV
Proceed to NOV
No Action, Facility
Reporting Error
No Action, BPJ
No Action, BPJ

From:
To:
Cc:
Subject:
Date:
Attachments:
Tony Konsul
Chen, Siying
Boss, Daniel J; Davidson, Landon; Weaver, Charles
[External] RE: NPDES Permit Issuance - Elk River WWTP NC0058378
Thursday, September 15, 2022 1:31:18 PM
image001.png
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Received, thank you.
Tony Konsul
Director, State Operations
From: Chen, Siying <[e-mail]>
Sent: Thursday, September 15, 2022 1:29 PM
To: Tony Konsul <[e-mail]>
Cc: Boss, Daniel J <[e-mail]>; Davidson, Landon <[e-mail]>;
Weaver, Charles <[e-mail]>
Subject: NPDES Permit Issuance - Elk River WWTP NC0058378
CAUTION: This email originated from outside of the organization. Do not click links or open
attachments unless you recognize the sender and verify that the content is safe.
Hi Mr. Konsul,
Attached is the final NPDES permit renewal for Elk River WWTP (NC0058378). The permit will be
effective on November 1, 2022.
Please respond to this email confirming that you received the attached document, were able to
open and view the document and have saved/printed a copy for your records.
Thank you!
Siying (Sylvia) Chen (She/Her/Hers)
Environmental Specialist, Division of Water Resources
North Carolina Department of Environmental Quality
Office: [phone]
[e-mail]

E QNORTH CAROLINA
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Carolina Water Service Inc of North Carolina
Attn: Tony Konsul, Director of State Operations
4944 Parkway Plaza Blvd., Ste 375
Charlotte, NC 28217
Subject: Permit Renewal
Application No. NC0058378
Elk River WWTP
Avery County
NORTH CAROLINA
Environment& Quality
March 17, 2022
Dear Applicant:
The Water Quality Permitting Section acknowledges the March 17, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-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: / Jdeq . nc.govioermits-regu lationsioerm it-g uidancelenvi ronmental-aDpl ication-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.
ec: WQPS Laserfiche File w/application
Sincerely
f.fi.
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Qualay I tllvislan of Water Resources
nshrvlle Regional Office 12090 U.S. Nlghway 70 I Swamanoa. north Carolina 28178
828.296.4500

!!I Carolina Water Service
MIK of North CarolinaTM
March 16, 2022
Mr. Wren Thedford
NC DENR
Division of Water Resources
NPDES Unit
1617 Mail Service Center
Raleigh NC 27699-1617
Re: Elk River WWTP
NPDES NC0058378
Renewal Request
Dear Mr. Thedford
RECEIVED
MAR 17 2022
NCDEQIDWRINPDES
Please find enclosed Application and attachments and consider this letter as our official request to
renew the NPDES permit for the facility referenced above.
If you should have any questions or need any additional information, please do not hesitate to call me at
704-319-0523 or by email at [e-mail] .
Thank you in advance for your attention.
Sincerely,
�y�ehsul
Director, State Operations
• 4944 Parkway Plaza Blvd. Ste 375
• Charlotte, North Carolina 28217 • 800-525-7990

AFT‘11 Carolina Water Service
11111i1 of North CarolinaTM
March 16, 2022
Mr. Wren Thedford
NC DENR
Division of Water Resources
NPDES Unit
1617 Mail Service Center
Raleigh NC 27699-1617
Elk River WWTP
NPDES NC0058378
Sludge Management Plan
Dear Mr. Thedford,
As sludge and other solids are generated at this facility, they are periodically removed by the licensed
contractor below.
A-1 Appalachian Pumping, Inc.
301 Clay Hodges Rd
Boone, NC 28607
Phone: [phone]
If you should have any questions or need any additional information, please do not hesitate to call me at
704-319-0523 or by email at [e-mail]
Thank you in advance for your attention.
Sincerely,
ul
Director, State Operations
• 4944 Parkway Plaza Blvd. Ste 375
• Charlotte, North Carolina 28217 • 800-525-7990

United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-1
Revised March 2019
Water Permits Division
&EPA Application Form 1
General Information
NPDES Permitting Program
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 1. 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."

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS
CONTENTS OF FORM 1 PACKAGE
The application forms for individual National Pollutant Discharge
Elimination System (NPDES) permits include the following:
Form 1—General Information (included in this package).
Form 2—Forms Based on Facility or Activity Type (not included
in this package)
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
2C. Existing Manufacturing, Commercial, Mining, and
Silvicultural Operations
2D. New Manufacturing, Commercial, Mining, and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
2E. Manufacturing, Commercial, Mining, and Silvicultural
Facilities Which Discharge Only Nonprocess Wastewater
2F. Stormwater Discharges Associated with Industrial Activity
2S. New and Existing Treatment Works Treating Domestic
Sewage
Form 1—General Instructions
Form 1—Line-by-Line Instructions
Form 1—Activities That Do Not Require Permits
Form 1—Glossary
Form 1—Application
FORM 1--GENERAL INSTRUCTIONS
Who Must Apply for an NPDES Permit?
With the exceptions described in "Form 1—Activities That Do Not
Require Permits," the federal Clean Water Act (33 U.S.C. 1251 et
seq.) prohibits any person from discharging pollutants into waters
of the United States without first having been issued a permit
under the NPDES program.
Who Must Complete Form 1?
All applicants, other than publicly owned treatment works
(POTWs) and treatment works treating domestic sewage
(TWTDS), must submit Form 1. If you operate one of the
following facilities, you must submit Form 1: concentrated animal
feeding operations and aquatic animal production facilities;
manufacturing, commercial, mining, and silvicultural operations;
or other industrial facilities.
At the state level, either the U.S. Environmental Protection
Agency (EPA) or an approved state agency administers the
NPDES permit program. If you are located in a jurisdiction in
which an EPA regional office administers the NPDES permit
program, you should use Form 1 and all other applicable forms
described in these instructions. If you are located in ajurisdiction
where a state administers the NPDES permit program, contact
the state to determine the forms you should complete. States
often develop their own application forms rather than use the
federal forms. See http:llwww.epa.govinpdeslnpdes-state-
program-information for a list of states that have approved
NPDES permit programs and those that do not.
Exhibit 1-1 (see end of this section) provides contact information
for each of EPA's 10 regional offices. Since the exhibit's content is
subject to change, consult EPA's website for the latest information:
http://www.epa . go vla bo u to pa#regional.
1-1
Upon your request, and based on information supplied by you,
EPA or the authorized NPDES state will determine whether you
are required to obtain a permit fora particular facility or activity.
Be sure to contact EPA or your state if you have a question.
Form 1 collects general information only. You must also complete
a more detailed application based on your proposed discharge
activity, as follows:
▪ If your facility is a concentrated animal feeding operation
or a concentrated aquatic animal production facility, you
must also complete Form 23.
• If your facility is an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges
process wastewater, you must also complete Form 2C.
• 1f your facility is a new manufacturing, commercial, mining,
or silviculture! facility that has yet to commence discharge of
process wastewater, you must also complete Form 2D.
• If your facility is a new or existing facility (including
manufacturing, commercial, mining, and silvicultural
facilities) that discharges only nonprocess wastewater,
you must also complete Form 2E.
• If your facility is a new or existing facility whose discharge
is composed entirely of stormwater associated with industrial
activity —excluding discharges from construction activity
under 122.26(b)(14)(x) or (b)(15)—you must also complete
Form 2F. If the discharge is composed of stormwater and
non-stormwater, you must complete Form 2F and you must
also complete Forms 2C, 2D, andlor 2E, as appropriate. See
Form 2F's instructions for further details.

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Whereto File Your Completed Form
• If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the state
forms.
• If you are in a jurisdiction where EPA is the NPDES
permitting authority (i.e., the state is not an NPDES-
authorized state), mail the completed application forms to the
EPA regional office that covers the state in which your facility
is located (see Exhibit 1-1).
When to File Your Completed Form
Because of statutory and regulatory requirements, the deadlines
for filing applications vary according to your facility or activity type
and the type of permit you need. The various permit application
deadlines are listed in Exhibit 1-2 at the end of this section.
Fees
EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES
permit program may charge fees. Consult with state officials for
further information.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request.
You may not claim any information on Form 1 (or related
attachments) as confidential.
You may make a claim of confidentiality for any information that
you submit to EPA that goes beyond the information required by
Form 1. if you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency's business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations (CFR).
Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
The NPDES permitting authority could consider your application
incomplete if you do not provide an answer (or indicate "NA" for
"not applicable) for all questions on Form 1 and the applicable
Form 2.
Provide your EPA Identification Number from the Facility Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 1 and any attachments. If your facility is new
(i.e., not yet constructed), write or type "New Facility° in the space
provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number, contact your
NPDES permitting authority. See Exhibit 1-1 for contact
information.
Do not leave any response areas blank unless the form directs
you to skip them. If the form directs you to respond to an item that
does not apply to your facility or activity, enter 'NA' for not
applicable" to show that you considered the item and determined
a response was not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received
and completed according to the authority's satisfaction. The
NPDES permitting authority will judge the completeness of any
application independently of the status of any other permit
application or permit for the same facility or activity.
1-2

FORM 1---GENERAL INSTRUCTIONS CONTINUED
Exhibit 1-1. Addresses of EPA Regional Contacts and Covered States
REGION 1
U.S. Environmental Protection Agency, Region 1
5 Post Office Square, Suite 100, Boston, MA 02109-3912
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: httpJlwww.epa.00vlaboutepalepa-region-1-new-england
REGION 6
U.S. Environmental Protection Agency, Region 6
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: http:llwww.ena.govlaboutepalepa-region-6-south-central
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
REGION 2
U.S. Environmental Protection Agency, Region 2
290 Broadway, New York, NY 10007-1866
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: httpJlwww.eoa.00vlaboutepaleoa-region-2
REGION 7
U.S. Environmental Protection Agency, Region 7
11201 Renner Boulevard, Lenexa, KS 66219
Phone: [phone]; toll free: [phone]
Website: htto:llwww.epa.govfaboutepalepa-region-7-midwest
Covered states: lows, Kansas, Missouri, and Nebraska
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rico
REGION 3
U.S. Environmental Protection Agency, Region 3
1650 Arch Street, Philadelphia, PA 19103-2029
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: http:IMrww.epa.govlabouteoaleoa-region-3-mid-atlantic
REGION 8
U.S. Environmental Protection Agency, Region 8
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: http_lhorAv.eoa.covlaboutepaleoa-region 8-mountains-and-plains
Covered states: Delaware, Distnct of Columbia, Maryland, Pennsylvania, Virginia,
and West Virginia
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming
REGION 4
U.S. Environmental Protection Agency, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: http:1www.epa.govlabouteralabout-eoa-region-4-southeast
REGION 9
U.S. Environmental Protection Agency, Region 9
75 Hawthorne Street, San Francisco, CA94105
Phone: [phone]; toll free: (866) EPA -WEST
Fax: [phone]
Website: httollwww.ecia.aovlaboutepalepa-region-9-pacific-southwest
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
and Trust Tenitones
Covered states: AUabeme, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee
REGION 5
U.S. Environmental Protection Agency, Region 5
77 West Jackson Boulevard, Chicago, IL 60604.3507
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: httpJlwww.eca.povfaboutepafeoa-revion-5
REGION 10
U.S. Environmental Protection Agency, Region 10
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: [phone]; toll free: [phone]
Fax: [phone]
Website: httcJlwrvw.epa.vovlaboutepa/epa-region-10-uadfc-northwest
Covered states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
Covered states: Alaska, Idaho, Oregon, and Washington
Exhibit 1-2. Filing Dates for NPDES Permit Applications
Permit Application
When to File
180 days before your present NPDES permit expires or, if you are a
new discharger, 180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
2B
180 days before your present NPDES permit expires or 180 days
prior to startup if you area new facility.
2C
180 days before your present NPDES permit expires.
20
180 days prior to startup.
2E
180 days before your present NPDES permit expires, or 180 days
prior to startup if you are a new facility.
2F
Construction: 90 days prior to date construction is to commence.
Noncanstruction: 180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
2S
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
1-3

FORM 1--LINE-BY-LINE INSTRUCTIONS
Section 1. Activities Requiring an NPDES Permit
Item 1.1. Review the questions in Item 1.1 to determine if you are
required to submit Form 1. Be sure to check the Form 1—
Glossary for the legal definitions of any key terms.
If you answer "Yes" to a question in Item 1.1, then you do not
need to complete Form 1, but you must comply with the
application requirements specified.
Item 1.2. Respond to the questions in Items 1.2.1 to 1.2.5. If you
answer "Yes" to any question, you must complete Form 1 and the
Form 2 application specified. See Exhibit 1-2 for filing deadlines.
If you answer "No' to every question in Items 1.1 and 1.2, then
you do not need an NPDES permit, and you do not need to
complete and return any of the NPDES application forms.
Section 2. Name, Mailing Address, and Location
Item 2.1. Enter the facility's official or legal name. Do not use a
colloquial name.
Item 2.2. Provide your EPA identification Number from the
Facility Registry Service if you have an existing facility. If you do
not know your EPA Identification Number, contact your NPDES
permitting authority. If your facility is new (i.e., not yet
constructed), write or type "New Facility."
Item 2.3. Give the name (first and last), title, work telephone
number, and email address of the person who is thoroughly
familiar with the operation of the facility and with the facts
reported in this application. The NPDES permitting authority will
contact the person listed if they have questions on the material
submitted.
Item 2.4. Give the complete mailing address of the office to which
the NPDES permitting authority should send correspondence.
This often is not the address used to designate the location of the
facility or activity.
Item 2.5. Give the address or location of the facility identified
under Item 2.1. If the facility lacks a street name or route number,
give the most accurate, alternative geographic information (e.g.,
section number or quarter section number from county records or
"at intersection of Routes 425 and 22"). Also provide the county
name, county code (if known), city or town, state, and zip code.
For concentrated aquatic animal production facilities, provide the
address or location of the production area (i.e., the location where
the animals are contained, grown, or held).
Section 3. SIC and NAICS Codes
Items 3.1 and 3.2. List, in descending order of significance, up to
four 4-digit standard industrial classification (SIC) codes and
North American Industrial Classification System (NAICS) codes
that best describe your facility in terms of the principal products or
services it produces or provides. If the SIC or NAICS codes do
not adequately describe your facility's products or services, you
have the option to provide additional descriptive information.
You can find SIC code numbers and descriptions in the
1987 Standard Industrial Classification Manual, prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the Government Printing
Office, Washington, D.C. An online version of the manual is also
available courtesy of the Occupational Safety and Health
Administration at http:Ilwww.osha.govlplslimislsic manual.html.
You can find NAICS code numbers and descriptions in the North
American Industrial Classification System Manual prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the National Technical
Information Service (NTIS) in Alexandria, Virginia. It is also
available online at http:llwww.census.00vleoslwwwlnaicsl.
Use the latest edition of the manuals. If you have any questions
about the appropriate SIC or NAICS codes for your facility,
contact your NPDES permitting authority.
Section 4. Operator Information
Item 4.1. Give the legal name of the person, firm, public
organization, or other entity that operates the facility described in
this application. This may or may not be the same as the facility's
name. The operator of the facility is the legal entity that controls
the facility's operation rather than the plant or site manager. Do
not use a colloquial name.
Item 4.2. Indicate whether the entity listed in response to Item 4.1
also owns the facility by marking the appropriate box.
Item 4.3. Indicate the ownership status of the operator of the
facility by marking the appropriate box. If the facility is a federal
facility (i.e., owned by the U.S. government), check the box for
"Public —federal." If the facility is awned by a state government,
check the box for "Public —state." If the facility is owned by a
county government, municipal (e.g., city or town) government,
tribal government, school district, water district, or other local
government entity, check the box for "Other public" and specify
the type of government entity. If the facility is owned by a
corporation or other private entity, check the box for "Private." If
the facility has mixed ownership (e.g., public/private) or is not
owned by an entity of the types previously listed, check the box
for "Other" and specify the type of entity.
Items 4.4 to 4.6. Enter the telephone number, address, and email
address of the operator identified in Item 4.1.
Section 5. Indian Land
Item 5.1. Indicate whether the facility is located on Indian Land.
Section 6. Existing Environmental Permits
Item 6.1. Check the appropriate boxes and provide the permit
numbers for all relevant federal, state, and local environmental
permits or construction approvals received or applied for under
any of the programs listed below. If you have more than one
currently effective permit under a particular permit program for
your facility, list the additional permit numbers on the application
form or on a separate sheet of paper.
1-4

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
• Hazardous waste management program under the Resource
Conservation and Recovery Act (RCRA).
• Underground Injection Control (UIC) program under the Safe
Drinking Water Act (SDWA).
• NPDES program under the Clean Water Act (CWA).
• Prevention of Significant Deterioration (PSD) program under
the Clean Air Act (CAA).
• Nonattainment program under the CAA.
• National Emission Standards for Hazardous Pollutants
(NESHAPs) preconstruction approval under the CAA.
• Ocean dumping permits under the Marine Protection
Research and Sanctuaries Act (MPRSA).
• Dredge or fill permits under Section 404 of the CWA.
• Other federal, state, or local environmental permits.
Section 7. Map
Unless the facility is a concentrated animal feeding operation,
provide a topographic map(s) of the area extending at least one
mile beyond the property boundaries of the facility that clearly
shows the following:
• The legal boundaries of the facility.
• The location and serial number of each of your existing and
proposed intake and discharge structures.
• All hazardous waste management, storage, and disposal
facilities.
• Each well where you inject fluids underground.
• All wells, springs, surface water bodies, and drinking water
wells that are in the public record or otherwise known to you
and that are located in the map area.
If the facility has associated water intakes, discharge structures,
hazardous waste disposal sites, or injection wells and these items
are located more than one mile from the facility, include them on
the map if possible. If you cannot, attach additional sheets
describing the location of the structures, disposal site(s), or well(s)
and identify the U.S. Geological Survey (USGS) or other map
corresponding to the iocation(s).
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS).
On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS's National Map
website at http //nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
1-5
(e.g., residential, commercial). An example of an acceptable
location map is shown as Exhibit 1-3 at the end of these
instructions. Note: Exhibit 1-3 is provided for illustration only; it
does not show an actual facility.
If the facility is a concentrated animal feeding operation, you are
not required to provide the topographic map required by this
section of Form 1. Instead, you are required to provide a
topographic map as specified in Section 4 of Form 2B.
Item 7.1. Note that you have completed your topographic map
and attached it to the application.
Section 8. Nature of Business
Briefly describe the nature of your business (e.g., products
produced or services provided). See Examples 1 and 2.
Example 1
Facilities Subject to 40 CFR 426, Subparts F and G
Industry A is an auto tempered and auto laminated glass
manufacturing facility subject to effluent limitation guidelines
(ELGs) for the 'Automotive Glass Tempering" and 'Automotive
Glass Laminating" subcategories of the 'Glass Manufacturing"
point source category at 40 CFR 426, subparts F and G. At the
facility, glass is cut and then passed through a series of
processes that grind and polish the edges, bend the glass, and
then temper the glass to produce side and back windows for
automobiles. Tempering involves heating the glass near the
melting point, then rapidly cooling it to increase its mechanical
and thermal endurance. The facility also produces automobile
windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass far
lamination (e.g., cutting, bending, and washing).
Example 2
Facility Not Subject to ELGs
Industry B undertakes batch -type resin manufacturing operations.
It has aboveground storage tanks for raw materials and finished
goods, resin loading operations, and warehouses for 55-gallon
drums of finished product. Industry B manufactures alkyd,
saturated and unsaturated polyester resins in batches using
reactor vessels and mix tanks. Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
piping system. Additional feedstocks are added manually as
solids from bags and sacks via manways, which are located on
top of the kettles. The resin is then chemically reacted in the
kettles. After the reaction step finishes, the resin is transferred
from the kettles to the mix tanks, where solvents are added to
thin it. The primary byproduct of the reaction is water vapor
containing condensed soluble organics. The byproduct flows to
an isolation tank where the vapors are directed to an onsite
thermal oxidizer. The finished resin is then pumped through one
of three types of filtration systems into finished goods storage
tanks, 55-gallon drums, 350-gallon intermediate bulk container
totes, or directly into tanker trucks. A typical batch takes about 30
hours to complete.

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Section 9. Cooling Water Intake Structures
Item 9.1. Indicate whether the facility uses cooling water. If yes,
continue to Item 9.2. If no, skip to Item 10.1.
Item 9.2. Identify the source of the cooling water. For example,
indicate whether the cooling water is from a surface water,
groundwater well, public water system, or treated effluent that
would otherwise be discharged to a water of the U.S.
If the facility uses a cooling water intake structure as described in
40 CFR 125, Subparts I and J, the facility may have additional
application requirements under 40 CFR 122.21(r). Note that the
information required by 40 CFR 122.21(r) is not requested as part
of Form 1. Contact your NPDES permitting authority to determine
the specifics of what you should provide and when.
Section 10. Variance Requests
An applicant (other than a POTW) may request a variance from
otherwise applicable effluent !imitations under certain conditions
described at 40 CFR 122.21(m).
Item 1 0.1. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note that
you are not being asked to submit any other information at this
time. Contact your NPDES permitting authority to determine the
specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and an
applicant may request a variance consistent with statutory and
regulatory requirements.
Section 11. Checklist and Certification
Item 11.1. Review the checklist provided. In Column 1, mark the
sections of Form 1 that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Item 11.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that, "Any person who knowingly makes any
false statement, representation, or certification in any application,
...shall upon conviction, be punished by a fine of no more than
$10,000 or by imprisonment for not more than six months, or
both."
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. Fora corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer
means: (1) a president, secretary, treasurer, or vice-president
of the corporation in charge of a principal business function,
or any other person who performs similar policy- or decision -
making functions for the corporation, or (2) the manager of
one or more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
1-6

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Exhibit 1-3. Example Topographic Map
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FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge
is in one of the following categories, as provided by the CWA and
NPOES regulations at 40 CFR 122 to 125. (However, under CWA
Sections 510 and 312, some discharges exempted from the
federal NPDES requirements may still be regulated by a state
permitting authority.)
• Any discharge of sewage from vessels and any effluent from
properly functioning marine engines, laundry, shower, and
galley sink wastes, or any other discharge incidental to the
normal operation of a vessel, including vessels of the Armed
Forces within the meaning of section 312 of the CWA and
recreational vessels within the meaning of section 502(25) of
the CWA. None of these exclusions apply to rubbish, trash,
garbage, or other such materials discharged overboard; nor
to other discharges when the vessel is operating in a
capacity other than as a means of transportation such as
when used as an energy or mining facility, a storage facility
or a seafood processing facility, or when secured to a
storage facility or a seafood processing facility, or when
secured to the bed of the ocean, contiguous zone or waters
of the United States for the purpose of mineral or oil
exploration or development.
■ Discharges of dredged or fill material into waters of the
United States that are regulated under CWA Section 404.
■ The introduction of sewage, industrial wastes, or other
pollutants into publicly owned treatment works by indirect
dischargers. Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the
obligation to have and comply with permits until all
discharges of pollutants to waters of the United States are
eliminated. (See also 40 CFR 122.47(b).) This exclusion
does not apply to the introduction of pollutants to privately
owned treatrnent works or to other discharges through pipes,
sewers, or other conveyances owned by a state, municipality,
or other party not leading to treatment works.
• Any discharge in compliance with the instructions of an On -
Scene Coordinator pursuant to 40 CFR 300 (The National Oil
and Hazardous Substances Pollution Contingency Plan) or
33 CFR 153.10(e) (Pollution by Oil and Hazardous
Substances).
• Any introduction of pollutants from non paint -source
agricultural and silvicultural activities, including stormwater
runoff from orchards, cultivated crops, pastures, range lands,
and forest lands, but not discharges from concentrated
animal feeding operations as defined in 40 CFR 122.23,
discharges from concentrated aquatic animal production
facilities as defined in 40 CFR 122.23, discharges from
concentrated aquatic animal production facilities as defined
in 40 CFR 122 24, discharges to aquaculture projects as
defined in 40 CFR 122.25, and discharges from silvicultural
point sources as defined in 40 CFR 122.27. Note: Per 40
CFR 122.26(b)(14)(ii), facilities classified within SIC 24,
Industry Group 241, that are rock crushing, gravel washing,
log sorting, or log storage facilities operated in connection
with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)
and Industry Groups 242 through 249; 26 (except 265 and
267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441,
and 373 (not included are all other types of silviculture
facilities) are considered stormwater discharges associated
with industrial activity, and are required to obtain an NPDES
permit.
• Return flows from irrigated agriculture.
• Discharges into a privately owned treatment works, except as
the NPDES permitting authority may otherwise require under
40 CFR 122.44(m).
• Discharges from a water transfer. "Water transfers means an
activity that conveys or connects waters of the United States
without subjecting the transferred water to intervening
industrial, municipal, or commercial use. This exclusion does
not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
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FORM 1—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 1. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPt7ES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
• Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained fora total of 45 days or
more in any 12-month period; and
a Crops, vegetation, forage growth, or post -harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit, including any additions, revisions, or modifications to the
forms; or forms approved by EPA for use in approved states, including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants, and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single -pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFD) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows, whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
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FORM 1—GLOSSARY CONTINUED
6. 500 horses;
7. 10,000 sheep or Iambs;
8. 55,000 turkeys;
9. 30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
10. 125,000 chickens (other than laying hens), if the AFC uses other than a liquid manure handling system;
11. 82,000 laying hens, if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks (if the AFO uses other than a liquid manure handling system); or
13. 5,000 ducks (if the AFO uses a liquid manure handling system).
MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more,
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses,
g. 3,000 to 9,999 sheep or Iambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens, if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); ore
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar man-
made device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) means a hatchery, fish farm, or other facility which
contains, grows, or holds aquatic animals in either of the following categories, or which the Director designates as such on a case -by -case
basis:
A. Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge at least 30 days per year but does not include
1. Facilities which produce less than 9,090 harvest weight kilograms (approximately 20,000 pounds) of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms (approximately 5,000 pounds) of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including, but not limited to, the Ameiuridae, Cetrarchiclae, and
Cyprrnidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1. Closed ponds which discharge only during periods of excess runoff; or
2. Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year.
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FORM 1--GLOSSARY CONTINUED
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92-500, as amended by Public Law 95-217, Public Law 95-576, Public Law 96-483 and Public Law
97-117, 33 U.S.C. 1251 of seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the "discharge of a pollutant" measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the "daily discharge" is
calculated as the total mass of the pollutant discharged aver the day. For pollutants with limitations expressed in other units of
measurement, the "daily discharge' is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the "discharge of a pollutant."
DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no "approved State program," and there is an EPA administered program, "Director" means the Regional Administrator. When there is
an approved State program, "Director' normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
"Director" means the Regional Administrator and not the State Director.
DISCHARGE (OF A POLLUTANT} means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any "indirect discharger".
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self -monitoring results by permittees. DMRs must be used by "approved States" as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue ar deny, modify, revoke
and reissue, terminate, or reissue a 'permit." A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of "draft permits." A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a "draft permit." A "proposed permit" is not a "draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of "pollutants"
which are 'discharged" from "point sources" into "waters of the United States," the waters of the "contiguous zone," or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of the CWA to adopt or
revise "effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES "point source" ar any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES "permit" issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights -of -way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
• All Indian allotments, the Indian titles to which have not been extinguished, including rights -of -way running through the same.
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FORM 1—GLOSSARY CONTINUED
INOIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing "pollutants" to a "publicly owned treatment works."
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; and
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held in self-contained bodies of water (mill ponds or
log ponds) or stored on land where water is applied intentionally on the logs (wet decking). (See 40 CFR 429, subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES "facility or activity" classified as such by the Regional Administrator, or, in the case of "approved
State programs," the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable "daily discharge"
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix i of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
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FORM 1—GLOSSARY CONTINUED
(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii) of this section.
MUNICIPALITY means a city, town, borough, county, parish, district, association, or other public body created by or under State law and
having jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
• Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
• Designed or used for collecting or conveying stormwater.
■ Which is not a combined sewer; and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE (see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) means the national program for issuing, modifying, revoking
and reissuing, terminating, monitoring and enforcing permits, and imposing and enforcing pretreatment requirements, under sections 307,
402, 318, and 405 of the CWA. The term includes an "approved program."
NEW DISCHARGER means any building, structure, facility, or installation
▪ From which there is or may be a "discharge of pollutants;"
• That did not commence the 'discharge of pollutants" at a particular 'site" prior to August 13, 1979:
■ Which is not a "new source;" and
▪ Which has never received a finally effective NPDES permit for discharges at that "site."
This definition includes an "indirect discharger" which commences discharging into "waters of the United States" after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
"site" for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a "site" under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a new discharger' only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a "discharge of pollutants," the
construction of which commenced-.
■ After promulgation of standards of performance under section 306 of the CWA which are applicable to such source, or
• After proposal of standards of performance in accordance with section 306 of the CWA which are applicable to such source, but only
if the standards are promulgated in accordance with section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any "facility or activity subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an -'approved State" to implement the
requirements of this part and parts 123 and 124. "Permit" includes an NPDES "general permit" (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a `draft permit" or a "proposed permit."
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
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FORM 1—GLOSSARY CONTINUED
agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(1); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other Floating craft from which pollutants are ar may be discharged. This term does not include return flows from irrigated agriculture ar
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 of seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
• Sewage from vessels; or
• Water, gas, or other material which is injected into a well to facilitate production of oil or gas, or water derived in association with oil
and gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located, and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources. Note Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator -produced isotopes. See Train v. Colorado Public Interest Research Group, inc., 426 U.S. 1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a "POTW."
PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the
production or use of any raw material, intermediate product, finished product, byproduct, or waste product.
PROPOSED PERMIT means a state NPDES "permit" prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A "proposed permit" is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and riprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a 'permit", including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the CWA, except that with respect to commercial
vessels on the Great Lakes this term includes graywater. For the purposes of this definition, "graywater" means galley, bath, and shower
water.
SEWAGE SLUDGE means any solid, semi -solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
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FORM 1—GLOSSARY CONTINUED
SILVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non -point source silvicultural activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and fire control,
harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some of these
activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
SITE means the land or water area where any "facility or activity" is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE -ONLY FACILITY means any "treatment works treating domestic sewage" whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an "approved program," or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, "State Director"
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in "industrial activity" for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non —coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17,1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located an the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable awnerloperator; inactive mining sites do not include sites
1-15

FORM 1-GLOSSARY CONTINUED
where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities, including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221-25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) ar, in the case of "sludge use or disposal practices," any
pollutant identified in regulations implementing section 405(d) of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, 'domestic sewage" includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a "treatment works treating domestic sewage,' where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET (defined at § 122.41(n)) means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does not include
noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of
preventive maintenance, or careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable 'effluent
limitations guidelines" which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
1-16

EPA Identification Number
NPDES Permit Number
NC0058378
Facility Name
Elk River
Form Approved 03/05/19
OMB No.2040-0004
Form
NPDES
-.EPA
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
GENERAL INFORMATION
SECTION
1. ACTIVITIES REQUIRING AN NPDES PERMIT
(40 CFR 122.21(f) and (f)(1))
Foram 1
Activities Requiring an NPDES Permit
1.1
Applicants Not Required to Submit
1.1.1
Is the facility a new or existing publicly
treatment works?
If yes, STOP. Do NOT complete
Form 1. Complete Form 2A.
owned
1..
12
Is the facility a new or existing treatment works
treating domestic sewage?
If yes, STOP. Do NOT ❑ No
complete Form 1. Complete
Form 2S.
12 No
1.2
Applicants Required to Submit Fonn 1
1.2.1
Is the facility a concentrated animal
operation or a concentrated aquatic
production facility?
❑ Yes 3 Complete Form 1
and Form 2B.
feeding
animal
1.2.2
Is the facility an existing
commercial, mining,
currently discharging
D Yes 4 Complete
1 and
manufacturing,
or silvicultural facility that is
process wastewater?
p No
Forrn p No
Form 2C.
1.2.3
Is the facility a
mining, or silvicultural
commenced to
new manufacturing, commercial,
facility that has
discharge?
Complete Form 1
and Form 2D.
not yet
1.2.4
Is the facility a new
commercial, mining,
discharges only nonprocess
❑ Yes 4 Complete
1 and
or existing manufacturing,
or silvicultural facility that
wastewater?
• Yes +
p No
Form p No
Form 2E.
1.2.5
Is the facility a
discharge is composed
associated with
discharge is composed
non-stormwater?
new or existing facility whose
entirely of stormwater
industrial activity or whose
of both stormwater and
Complete Form 1 0 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b 15
• Yes 4
2. NAME,
MAILING ADDRESS, AND LOCATION (40 CFR 122.21(f)(2))
7
I Name, Mailing Address, and Location
2.1
Facility Name
Eik River wastewater Treatment Plant
2.2
EPA Identification Number
2.3
Facility Contact
Name (first and last)
Tony Konsul
Title
❑irector, State Operations
Phone number
[phone]
Email address
[e-mail]
2.4
Facility Mailing Address
Street or P.O. box
P.O. Box 240908
City or town
Charlotte
State
NC
ZIP code
28224-0908
EPA Form 3510-1 (revised 3-19)
Page 1

EPA Ident4ication Number
NPDES Permit Number
NC0058378
Facility Name
Elk River
Form Approved 03l05l19
OMB No. 2040-0004
Name, Mailing Address,
and Location Continued
2.5
Facility Location
Street, route number, or other specific identifier
NC Highway 194, West of Banner Elk
County name
Avery
County code (if known}
City or town
Banner Elk
Stake
NC
ZIP code
28604
3. SIC
AND NAICS CODES (41 CFR 122.21(f)(3))
Operator Information-n- SIC and NAICS Codes
3.1
SIC Code(s)
Description ((optional}
3.2
NAICS Code(s)
Description (optional)
N 4. OPERATOR
INFORMATION (40 CFR
122.21(f)(4))
4.1
Name of Operator
Carolina Water Service of North Carolina
4.2
Is the
name
Yes
you listed in Item 4.1 also the owner?
■No
4.3
Operator Status
❑ Public —federal ❑ Public —skate
•
Other public (specify)
❑✓ Private
• Other (specify)
4.4
Phone Number of Operator
[phone]
4.5
Operator Address
Operator Information
Continued
Street or P.O. Box
4944 Parkway Plaza Blvd Suite 375
City or town
Charlotte
State
NC
ZIP code
28217
Email address of operator
[e-mail]
N 5. INDIAN
LAND (40 CFR 122.21(f)(5))
5.1 Is
the
■
facility located on Indian Land?
Yes O No
EPA Farm 3510.1 (revised 3-19}
Page 2

EPA Identification Number
NPDES Permit Number
NC0058378
Facility Name
Elk River
Form Approved 03/05/19
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)
❑ NPDES (discharges to surface
water)
NC0022985
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
fluids)
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ 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.)
E Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 26.)
SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(f)(8))
8.1
Nature of Business
Describe the nature of your business.
Private waster utility company providing domestic water and wastewater service to the Elk River subdivision located
in Avery County NC.
SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(f)(9))
9.1
9.2
Does your facility use cooling water?
❑ Yes 0 No4SKIPtoItem10.1.
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(f)(10))
10.1
es
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122 21(m)? (Check all that
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
CC
c
R
.F
co
a
Section 301(n))
❑ Non -conventional pollutants (CWA
Section 301(c) and (g))
❑ Not applicable
302(b)(2))
❑ Thermal discharges (CWA Section 316(a))
EPA Form 3510-1 (revised 3-19)
Page 3

EPA Identification Number
NPDES Permit Number
NC0058378
Facility Name
Elk River
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 11. CHECKLIST AND
CERTIFICATION STATEMENT (40
CFR 122.22(a) and (d)}
you have completed and are submitting with your application.
that you are enclosing to alert the permitting authority. Note
Checklist and Certification Statement
11.1
In Column 1 below, mark the sections of Form 1 that
Far each section, specify in Column 2 any attachments
that not all applicants are required to provide attachments.
Column i
Column 2
1: Activities Requiring an NPDES Permit
❑ wl attachments
l7 Section
2: Name, Mailing Address, and Location
v Section
■ wl attachments
3: SIC Codes
• Section
• wl attachments
4: Operator Information
✓ Section
• wl attachments
5: Indian Land
D wl attachments
IS Section
6: Existing Environmental Permits
❑ wl attachments
GI Section
7: Map
0 watpopagraphic
TS Section
• wl additional attachments
El Section 8: Nature of Business
• w/ attachments
9: Cooling Water Intake Structures
• Section
! wl attachments
10: Variance Requests
❑ w/ attachments
• Section
11: Checklist and Certification Statement
❑ wl attachments
v Section
11.2
Certification Statement
l 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)
Tony Konsul
Official title
Director, State Operations
Signaturbk
Date signed
3 rL Z
EPA Form 3510-1 {revised 3-19)
Click to go back to the beginning of Form
Page t

Print All Pages
Print Form Only
North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Form 2A
Modified March 2021
Form
NPOES
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to fuilow
the instructions ma result in denial of the application.
SECTION 1. BASIC
APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9))
Facility name
Elk River Wastewater Treatment Plant
Facility Information
1.1
Mailing address (street or P.O. box)
P.O. Box 240908
City or town
Charlotte
State
NC
ZIP code
28224-0908
Contact name (first and last)
Tony Konsul
Title
Director, State Operations
Phone number
(704} 319-0523
Email address
tony.konsul@carotinawaterser
Location address (street, route number, or other specific identifier)
NC Highway 194
❑ Same as mailing
address
City or town
Banner Elk
State
NC
ZIP code
28504
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* See instructions on data submission
requirements for new dischargers.
r
No
Is applicant different from entity listed under Item 1.1 above?
❑✓ Yes •
No4SKIPtoItem1.4.
Applicant name
Carolina Water Service of North Carolina
Applicant address (street or P.O. box)
P.O. Box 240908
City or town
Charlotte
State
NC
ZIP code
28224-0908
Contact name (first and last)
Tony Konsul
Title
Director, State Operations
Phone number
[phone]
Email address
tony.konsul@carolinawaterser
Is the
•
applicant the facility's owner, operator,
Owner
•
or both? (Check only one response.)
Operator El Both
1.5
To
■
which entity should the NPDES permitting
Facility
MI
authority send correspondence? (Check
Applicant
•
only one response.)
Facility and applicant
(they are one and the same)
Existing Environmental Permits
Indicate
number
below any existing environmental permits. (Check all that apply and print or
for each.)
type
the corresponding permit
Existing Environmental Permits
•
NPDES (discharges to surface
water)
NC0058378
❑ RCRA (hazardous waste)
•
UIC (underground injection
control)
PSD (air emissions)
❑ Nonattainment program (CM)
❑ NESHAPs (CAA)
f Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
404)
•
Other (specify)
Page 1

NPDES Permit Number
NC0058378
Fadlity Name
Elk River
Modified Application Form 2A
Modified March 2021
Collection System and Population Served
Provide the collection system information requested below for the treatment works.
Municipality
Served
Population
Served
Collection System Type
(indicate percentage)
Ownership Status
100 % separate sanitary sewer
0 Own CI Maintain
129.2.5=323
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
❑ Unknown
0 Own 0 Maintain
0 Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
❑ Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
0 Unknown
0 Own 0 Maintain
Total
Population
Served
323
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
100 %
%
Is the treatment works located in Indian
0 Yes
Country?
Ei No
Indian Country
1.8
1.9
Does the facility discharge to a receiving
❑ Yes
water that flows through Indian Country?
❑ No
Design and Actual
Flow Rates
1.10
Provide design and actual flow rates
in the designated spaces.
Design Flow Rate
0.080 mgd
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
.009 mgd
.009 mgd .0026 mgd
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
0.140 mgd
0.120 mgd I 0.007 mgd
Discharge Points
by Type
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points by Type
Treated Effluent
Untreated Effluent
Combined Sewer
Overflows
Constructed
Bypasses 1 Emergency
Overflows
1
Page 2

NPOES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Forth 2A
Modified March 2021
r
i
0
0.
co
6
8
En
ra
�'
O
S
co
3
a
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds,
for discharge to waters of the State of North Carolina?
❑ Yes
or other
surface impoundments that do not have outlets
4 SKIP to Item 1.14.
0 Na
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Location
Average Daily Volume
Discharged to Surface
Impoundment
Continuous or Intermittent
check one)
91:ld
❑ Continuous
0 Intermittent
gpd
❑ Continuous
❑ Intermittent
gpd
❑ Continuous
❑ Intermittent
1.14
Is wastewater applied to land?
❑ Yes
4 SKIP to Item 1.16.
0 No
1.15
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Location
Site
Average Daily Volume
Applied
Continuous or
Intermittent
(sled[ one)
acres
d
gp
Continuous
0 Intermittent
acres
gpd
0 Continuous
0 Intermittent
acres
gpd
0 Continuous
0 Intermittent
1.16
Is effluent transported to another
facility for treatment prior to discharge?
0 No 4 SKIP to Item 1.21.
• Yes
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No -4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page3

NPDES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Form 2A
Modified March 2021
Ouffalls and Other Discharge or Disposal Methods Continued
N N IV
N � 0
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name
Mailing address (street or P.C. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
NPDES number of receiving facility (if any) 0 None
Average daily flow rate mgd
Is the
not
•
wastewater disposed of in a manner other than
have outlets to waters of the State of North Carolina
Yes r
those already mentioned in Items 1.14 through 1.21 that do
(e.g., underground percolation, underground injection)?
No + SKIP to Item 1.23.
Provide
information in the table below on these other dis osal methods.
Information on Other Dial Methods
Description
Disposal
Method
Location of
Disposal Site
Size of
Disposal Site
Annual Average
Daily Discharge
Volume
Continuous or Intermittent
(check one)
acres
gpd
❑ Continuous
❑ Intermittent
acres
gPd
❑ Continuous
p Intermittent
acres
gPd
❑ Continuous
❑ Intermittent
=g
g3
1.23
Do
Consult
•
•
you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters (CWA ❑ Water quality related effluent [imitation (CWA Section
Section 301(h)) 302(b)(2))
Not applicable
Contractor Information
1.24
Are any operational or maintenance aspects (related to
the responsibility of a contractor?
❑ Yes [J
wastewater treatment and effluent quality) of the treatment works
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
Contractor name
(company name)
Mailing address
(street or P.C. box)
City, state, and ZIP
code
Contact name (first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Form 2A
Modified March 2021
SECTION 2. ADDITIONAL INFORMATION
(40 CFR122.21(j)(1)
and
(2))
o
c
c
Outfalls to Waters of the State of North Carolina
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑ Yes 0No + SKIP to Section 3.
Inflow and Infiltration
2.2
Provide the treatment works' current average daily volume of inflow
and infiltration.
Average Daily Volume of Inflow and Infiltradon
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Wastewater sewer main replacement, manhole rehabilitation, smoke testing of sewer mains, lift station rehabilitation,
CCTV of sewer mains.
0
0
$
r
2.3
Have you attached
specific requirements.)
a topographic map to this application that contains all the required information? (See instructions for
❑ No
t7 Yes
E
1 °
" n
2.4
Have you attached
(See instructions
a process flow diagram or schematic to this application that contains all the required information?
for specific requirements.)
❑ No
17 Yes
0
w
d
E
,.
E
'
m
d
0
cn
g
c
p1
�
E
E
d
w
r
rn
2.5
Are improvements
to the facility scheduled?
No 3 SKIP to Section 3.
r Yes
■
Briefly list and describe the scheduled improvements.
1.
2.
3.
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Scheduled
Improvement
(from above)
L_
Affected
Outfalls
(lnumber)ll
Begin
Construction
(MM/DDIYYYY)
End
Construction
(MMIDDIYYYY)
Begin
Discharge
(MMIDDIYYYY)
Attainment of
Operational
(MM/DD Level
1.
2.
3.
4.
2.7
Have appropriate permitslclearances concerning other federal/state
response.
❑ Yes ❑ No
requirements been
obtained? Briefly explain your
None required or applicable
•
Explanation:
Preliminary engineering only completed at this time for budgeting purposes.
Page 5

NPDES Permit Number Facility Name
NC0058378 Elk River
Modified Application Form 2A
Modified March 2021
SECTION 3. INFORMATION
ON EFFLUENT DISCHARGES (40 CFR 122.21(0(3)
top))
sheets if you have more than three outfalls.)
3.1
Provide the following information for each outfall. (Attach additional
Outfall Number 001
Outfall Number
Outfall Number
State
North Carolina
County
Avery
a
Q
City or town
[Banner Elk
o
E.
Distance from shore
5 ft.
ft.
ft.
0
Depth below surface
3 ft.
ft.
ft.
im
Average daily flow rate
.009 mgd
mgd
mgd
Latitude
36' 15 94" N
"
Longitude
81° 9Cf 44" W
o "
Seasonal or Periodic Discharge Data
3.2
Do
•
any of the outfalls described
Yes
under Item 3.1 have seasonal or periodic discharges?
1:1 No+ SKIP to Item3.4.
3.3
If so, provide the following information
for each applicable outfall.
Outfall Number
Outfall Number
Outiap Number
Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
discharge
mgd
mgd
mgd
Months in which discharge
occurs
Diffuser Type
3.4
Are
•
any of the outfalls listed under Item 3.1 equipped with a diffuser?
Yes
51
No + SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Waters of
the U.S.
3 6
Does the treatment works discharge or plan to discharge wastewater
one or more discharge points?
51 Yes
•
to waters of the State of North Carolina from
No +SKIP to Section 6.
Page 6

NPQES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Form 2A
Modified March 2021
Receiving Water Descripti❑n
3.7 Provide the receiving water and related information (if known) for each outfall.
Outfall Number oat
Outfall Number
Outfall Number
Receiving water name
Elk River
Name of watershed, river,
or stream system
Watauga
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
managementlriver basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
low flow
mglL of
CaCO3
mglL of
CaCO3
mglL of
CaCO3
Treatment Description
w
eo
Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number
Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
0 Primary
0 Equivalent to
secondary
❑ Secondary
❑ Advanced
❑ Other (specify)
❑ Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
0 Primary
0 Equivalent to
secondary
❑ Secondary
0 Advanced
0 Other (specify)
Design Removal Rates by
Outfall
NR
BODs or CBOD5
%
ok
°lo
TSS
%
%
%
Phosphorus
❑ Not applicable
ok
0 Not applicable
%
0 Not applicable
,k
Nitrogen
❑ Not applicable
%
0 Not applicable
ok
0 Not applicable
%
Other (specify)
0 Not applicable
%
0 Not applicable
%
0 Not applicable
%
Page 7

NPDES Permit Number
NC0058378
Facility Name
Elk River
Modified Application Form 2A
Modified March 2021
Effluent Testing Data Treatment Description Continued
3.10
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Chlorine tablets are used for disinfection and Sodium bi-sulfite tablets for de -chlorination.
Outfall Number
001
Outfall Number
Outfall Number
Disinfection type
Calcium Hypo -chlorite (Tablets}
Seasons used
All
Dechlorination used?
❑ Not applicable
e Yes
❑ No
❑ Not applicable
• Not applicable
• Yes
■ Yes
• No
■ No
Have you completed monitoring for all Table A parameters and attached the results to the app
[l Yes ❑ No
ication package?
3.11
Have you conducted any WET tests during the 4.5 years prior to
discharges or on any receiving water near the discharge points?
❑ Yes
the date of the
application on any of the facility's
SKIP to Item 3.13.
12 No 4
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
water
Number of tests of receiving
water
3.14
Does the POTW
reasonable potential
use chlorine far disinfection, use chlorine elsewhere
to discharge chlorine in its effluent?
Complete Table B, including chlorine.
in the treatment
process, or otherwise have
Complete Table B, omitting chlorine.
• Yes 4
0 No 4
3.15
Have you completed
package?
monitoring for all applicable Table B pollutants
and attached
the results to this application
MI Yes
■ No
3.18
Have you completed
attached the results
monitoring for all applicable Table D pollutants
to this application package?
required by
No additional
your NPDES permitting authority and
sampling required by NPDES
authority.
III Yes
0
permitting
Page 8

NPDES Permit Number
NC0058378
Facility Name
Eik River
Modified Application Foram 2A
Modified March 2021
Effluent Testing Data Continued
3.19
Has
or (2)
•
the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
at least four annual WET tests in the past 4.5 years?
Yes • No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have
III
you previously submitted the results of the above tests to your NPDES permitting authority?
Yes ❑ No + 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
(MMIDIJNYYY1
Summary of Results
3.22
Regardless
toxicity.
•
of how you provided your WET testing data to the NPDES
Yes
•
permitting authority, did any of the tests result in
No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes
• No 4 SW 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
❑ Yes
the results to the application package?
Not applicable because previously submitted
information to the NPDES 'ermittin, authori
Page 9

NPDES Permit Number
NC0058378
Facility Name Modified Application Form 2A
Elk River Modified March 2021
SECTION 6. CI-ECKLIST
AND CERTIFICATION STATEMENT
(40 CFR 122.22(a) and (d))
of Form 2A that you have completed and are submitting with your application. For
attachments that you are enclosing to alert the permitting authority. Note that not
m
E
i
aSection
0
m
cI
-a
R
+,
Y
=
6.1
In Column 1 below, mark the sections
each section, specify in Column 2 any
all applicants are required to provide attachments.
Column 1
Column 2
Section 1 Basic Application
wl variance request(s) ❑ wi additional attachments
Information for All Applicants
Section 2: Additional
• w/ topographic
map
attachments
• wl process flow diagram
0
Information
• w/ additional
Section 3 information
E wf Table A ❑ wf Table D
❑ wl Table B ❑ wf additional attachments
0 wl Table C
on
0
Effluent Discharges
4: Not Applicable
Section 5: Not Applicable
Section 6: Checklist
❑ wl attachments
and
■
Certification Statement
6.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. l 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)
Tony Konsul
Official title
T 1 R- 15'VsNc CC"
Signatu
Date signed
Page 10

NPDES Fermi! Number
NC0058378
Facility Name
Elk River
0utfall Number
001
Modified Application Form 2A
Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Average Daily Discharge
Analytical
ML or MDL
Maximum Da
ly Discharge
Pollutant
Value
Units
Value
Units
Number of
Method'
include units)
)
Biochemical oxygen demand
El BODs or ❑ CBOD5
resort one
44.7
mg/I
13.4
mg/I
(156) 2019-2021
❑ ML
❑ MDL
Fecal coliform
240
#/100m1
19.4
#/100m1
(156) 2019-2021
0 ML
❑ MDL
Design flow rate
.140
MGD
.009
MGD
(156) 2019-2021
pH (minimum)
7.1
s.0
pH (maximum)
7.9
s.0
7.8
°C
(156) 2019-2021
Temperature (winter)
16.0
"C
Temperature (summer)
26.0
°C
18.0
°C
(156) 2019-2021
Total suspended solids (TSS)
40.0
mg/I
3.6
mg/I
(156) 2019-2021
n 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 O. See instructions and 40 CFR 122.21(e}{3).
Page 11

EPA Identification Number
NPDES Permit Number
NC0058378
Facility Name
Elk River
outtall Number
001
Modified Application Form 2A
Modified March 2021
TABLE B. EFFLUENT PARAMETERS
Pollutant
FOR ALL POTWS WITH A FLOW EQUAL
Maximum Daily Discharge
TO OR GREATER THAN 0.1 MGD
Average Daily Discharge
Analytical
Method'
ML or MDL
(include units)
)
Value
Units
Value
Units
Number of
Ammonia (as N)
16.8
mg/I
1.5
mg/I
(156) 2019-2021
0 ML
❑MDL
Chlorine
total residual, TRC)2
49.0
ugJl
10.4
ug/I
(312) 2019-2021
❑ ML
❑ MDL
Dissolved oxygen
N/A
N/A
5.1
mg/I
(156) 2019-2021
❑ ML
❑ MDL
Nitrate/nitrite
4.59
mg/I
4.41
mg/I
(2) 2021
CI ML
❑ MDL
Kjeldahl nitrogen
10.3
mg/I
9.7
mg/I
(2) 2021
El ML
❑ MDL
Oil and grease
N/A
N/A
N/A
N/A
N/A
0 ML
❑MDL
Phosphorus
5.0
mg/I
2.7
mg/I
(2) 2021
0
0 ML
❑MDL
Total dissolved solids
N/A
N/A
N/A
N/A
El 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 12221(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19)
Page 12

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NCflDS$37$
FOR SELECTED POTWS
Facility Name
Elk River
OutfaII Number
001
Modified Application Forrn 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical ML or MDL
Pollutant
Value
Units
Value I
Units
Number of
Samples
Method1 (include units)
Metals, Cyanide, and Total Phenols
, 4 F=ir
Hardness (as CaCO3)
❑ML
o MDL
Antimony, total recoverable
ML
0 MDL
Arsenic, total recoverable
❑ ML
0 MDL
Beryllium, total recoverable
0 ML
o MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑MDL
Mercury, total recoverable
0 ML
❑ MDL
Nickel, total recoverable
❑ ML
❑ MDL
Selenium, total recoverable
❑ ML
❑ MDL
Silver, total recoverable
❑ ML
0 MN_
Thallium, total recoverable
0 ML
❑ MDL
Zinc, total recoverable
❑ ML
❑MDL
Cyanide
El ML
❑ MDL
Total phenolic compounds
0 ML
❑ MDL
Volatile Organic Compounds
Acrolein
ID ML
❑ MDL
Acrylonitrile
CI ML
❑ MDL
Benzene
0 ML
❑ MDL
Bromoform
0 ML
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 13

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
Pollutant
NPDES PermiiNumber
NC0058378
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Elk River
Average
Outfall Number
001
Daily Discharge
Modified
Analytical
Methods
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
I: ML
❑ MDL
Chlorodibromomethane
0 ML
❑ MDL
Chloroethane
0 ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
ID ML
❑ MDL
Dichlorobromomethane
0 ML
0 MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
0 MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2-dich4oropropane
0 ML
❑ MDL
1,3-dichloropropylene
0 ML
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML
0 MDL
1,1,2,2-tetrachloroethane
❑ ML
{7 MDL
Tetrachloroethylene
0 ML
❑ MDL
Toluene
_
❑ ML
❑ MDL
1,1,1-trichloroethane
❑ ML
0 MDL
1,1,2-trichloroethane
❑ ML
❑MDL
EPA Form 3510-2A (Revised 3-19)
Page 14

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0058378
FOR SELECTED POTWS
Facility Name
Elk River
Outfal! Number
001
Modified
Analytical
Method!
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Value
Units
Value
Units
Number of
Samples
0 ML
_ ❑ MDL
Trichloroethylene
Vinyl chloride
ML
o MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
0 Mt
❑MDL
2,4-dichlorophenol
0 ML
❑MQL
2,4-dimethylphenol
0 ML
p MDL
4,6-dinitro-o-cresol
El ML
❑MDL
2,4-dinitrophenol
0 ML
❑MQL
2-nitrophenol
El ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
0 ML
0 MDL
Phenol
0 ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
0 ML
❑ MDL
Acenaphthylene
_
0 ML
0 MDL
Anthracene
❑ ML
❑ MDL
Benzidine
El ML
❑ MDL
Benzo(a)anthracene
❑ ML
0 MDL
Benzo(a)pyrene
0 ML
0 MDL
3,4-benzofluoranthene
El ML
❑MQL
EPA Fomi 3510-2A (Revised 3-19)
Page 15

EPA Identifleation Number
TABLE C. EFFLUENT PARAMETERS
Pollutant
NPDES Permit Number
NC0058378
FOR SELECTED POTWS
Maximum Daily Discharge
Facility Name
Elk River
Average
Outfall Number
Opt
Daily Discharge
Modthed
Analytical
Methods
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
Benzo(ghi)perylene
❑ ML
❑ MDL
Benzo(k)tluoranthene
❑ ML
❑MDL
as (2-chl0roethoxy) methane
❑ ML
❑ MDL
Bis (2-chloroethyl) ether
0 ML
❑ MDL
Bis (2-chloroisopropyl) ether
❑ ML
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ ML
❑ MDL
4-bromophenyi phenyl ether
❑ ML
❑ MDL
Butyl benzyl phthalate
0 ML
❑ MDL
2-chloronaphthalene
❑ ML
❑ MDL
4-chlorophenyl phenyl ether
❑ ML
❑ MDL
Chrysene
C ML
0 MDL
di-n-butyl phthalate
0 ML
❑ MDL
di-n-octyl phthalate
C ML
❑ MDL
Dibenzo(a,h)anthracene
ML
❑MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
1,3-dichlorobenzene
❑ ML
0 MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑MDL
Diethyl phthalate
❑ ML
❑ MDL
Dimethyl phthalate
❑ ML
❑ MDL
2,4-dinitrotoluene
❑ ML
0 MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Reused 3-19)
Page 16

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC005837E
Facility Name
Elk River
Outfall Number
001
Modified Application Form 2A
Modified March 2021
Analytical ML or MDL
Method' (include units)
FOR SELECTED POTWS
Maximum Daily Discharge
Average Daily Discharge
Value
Units
Value
Units
Number of
Samples
❑ ML
u MDL
1,2-diphenylhydrazine
❑ ML
❑ MDL
Fluoranthene
Fluorene
❑ ML
❑ MDL
0 ML
fl MDL
Hexachlorobenzene
Hexachlorobutadiene
El ML
❑ MDL
Hexachlorocyclo-pentadiene
L
o MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd}pyrene
ML
o MDL
Isophorone
❑❑ MDL
Naphthalene
0 ML
0 MDL
Nitrobenzene
0 ML
C] MDL
N-nitrosodi-n-propylamine
CI ML
❑ MDL
N-nitrosodimethylarnine
0 ML
❑ MDL
N-nitrosodiphenylamine
17 ML
❑ MDL
Phenanthrene
❑ ML
❑ MDL
Pyrene
0 ML
0 MDL
❑ ML
❑ MDL
1,2,4-trichlorobenzene
1 Ramnlinn shall hA nond&irtad arrn Jinn to RIiffiriantly sensitive test nrnradrxes
fi P methnds1 annrnved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19)
Page 17

NPDES Permit Number
NC0058378
Facility Name
Elk River
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE D. ADDITIONAL POLLUTANTS
AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge
Average Daily Dlschar_e
Analytical
ML MDL
Pollutant
(kb
Value
I Units
Value
Units
Number of
Samples
Methods
or
(include units)
0 No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
❑ ML
0 MOL
0 ML
❑ MOL
0 ML
0 MDL
0 ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
0 ML
❑ MOL
❑ ML
❑ MDL
0 ML
0 MDL
0 ML
❑ MDL
❑ ML
❑ MDL
0 ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ML
0 MCI
❑ ML
❑ MDL
1 4amnlinn shall he rnndurtad anon Jinn to suffniently sensitive test procedures ti.e.. methnds) annrnved under 40 CFR 136 for the analysis of pollutants or Pollutant parameters or required
under 40 CFR chapter I, subchapter N or O. See instructions and 40 CFR 122.21(03).
Page 18

St °54' 1 VW 67 ° 41' 5"W
6t°5413"YY 61.53:51M
� p j "CONFItENTIAJ 4 PROPRIETARY INFORMATION'.
▪ Elk River r V p �Y Y V �l ~~ DISCLAIMER; This map not a su very.
crd:a n �a T° '� la CWSNC makes no guarantee, implicit or
w.t service P▪ asses impfed, about the accuracy of this data.
N
Map Produced By: SP4 A
Date: 3/8/2022

Permit NC0058378
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Carolina Water Service, Inc. of North Carolina
is hereby authorized to discharge wastewater from a facility located at the
Elk River WWTP
NC Highway 194, West of Banner Elk
Avery County
to receiving waters designated as the Elk River in the Watauga River Basin in accordance with effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective October 1, 2017.
This permit and authorization to discharge shall expire at midnight on September 30, 2022.
Signed this day July 21, 2017.
S. Jay Zimmerman, P. G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NC0058378
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
Carolina Water Service, Inc. of North Carolina
is hereby authorized to:
1. Continue to operate an existing 0.080 MGD wastewater treatment system utilizing:
• effluent flow meter
• flow splitter box
• two (2) parallel contact stabilization package treatment plants
• two (2) reaeration chambers
• two (2) clarifiers
• two (2) aerobic digesters
• chlorination
• dechlorination
Located west of Banner Elk at Elk River WWTP off of NC Highway 194 in Avery County, and
2. Discharge from said treatment works via Outfall 001, a location specified on the attached map, into
the Elk River [Stream Segment: 8-22-(3)], a waterbody currently classified C-Trout waters within
subbasin 04-02-01 [HUC: 0601010302] of the Watauga River Basin.
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Permit NC0058378
Part I.
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning on the effective date of this permit and lasting until expiration, the
Permittee is authorized to discharge from Outfall 001. Such discharges shall be limited and monitored'
by the Permittee as specified below:
EFFLUENT CHARACTERISTICS
(PARAMETER CODES)
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample
Type
Sample
Location
Flow
50050
0.080 MGD
Continuous
RecordingInfluent
or
Effluent
Temperature (°C)
00010
Daily
Grab
Effluent
Total Residual Chlorine
50060
28 pg/L 2
2/Week
Grab
Effluent
pH
00400
Not < 6.0 or > 9.0
standard units
Weekly
Grab
Effluent
Dissolved Oxygen
00300
Weekly
Grab
Effluent
Fecal Coliform
(geometric mean)
31616
200/100 ml
400/100 ml
Weekly
Grab
Effluent
BOD, 5-day (20°C)
C0310
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
Ammonia (NH3 as N)
C0610
Weekly
Composite
Effluent
Total Nitrogen
(NO2+NO3+TKN)
C0600
Semi -Annually
Composite
Effluent
Total Phosphorus
C0665
Semi -Annually
Composite
Effluent
Footnotes:
1. The permittee shall submit discharge monitoring reports electronically using the NC DWR's eDMR
application system [see A. (2)].
2. The Division shall consider all effluent TRC values reported below 50 µg/1 to be in compliance with the
permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina
certified laboratory (including field certified), even if these values fall below 50 µg/1.
Condition:
The Permittee shall discharge no floating solids or foam in other than trace amounts.
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Permit NC0058378
A. (2) ELECTRONIC REPORTING OF MONITORING REPORTS
[NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program
reports. The final NPDES Electronic Reporting Rule was adopted and became effective on December
21, 2015.
NOTE: This special condition supplements or supersedes the following sections within Part II of this
permit (Standard Conditions for NPDES Permits):
• Section B. (11.)
• Section D. (2.)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reporting Requirements [Supersedes Section D. (2.) and Section E. (5.) (a)l
The permittee shall report discharge monitoring data electronically using the NC DWR's Electronic
Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and
submitted electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring
data and submit DMRs electronically using the internet. Until such time that the state's eDMR
application is compliant with EPA's Cross -Media Electronic Reporting Regulation (CROMERR),
permittees will be required to submit all discharge monitoring data to the state electronically using
eDMR and will be required to complete the eDMR submission by printing, signing, and submitting one
signed original and a copy of the computer printed eDMR to the following address:
NC DEQ / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility
being physically located in an area where less than 10 percent of the households have broadband access,
then a temporary waiver from the NPDES electronic reporting requirements may be granted and
discharge monitoring data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms
approved by the Director. Duplicate signed copies shall be submitted to the mailing address above. See
"How to Request a Waiver from Electronic Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the month following the
issuance of the permit or in the case of a new facility, on the last day of the month following the
commencement of discharge.
Starting on December 21, 2020, the permittee must electronically report the following compliance
monitoring data and reports, when applicable:
• Sewer Overflow/Bypass Event Reports;
• Pretreatment Program Annual Reports; and
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Permit NC0058378
• Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to Request a
Waiver from Electronic Reporting" section below).
2. Electronic Submissions
In accordance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at the time of
each electronic submission. The permittee should use the EPA's website resources to identify the initial
recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated facilities means the entity
(EPA or the state authorized by EPA to implement the NPDES program) that is the designated entity for
receiving electronic NPDES data [see 40 CFR 127.2(b)].
EPA plans to establish a website that will also link to the appropriate electronic reporting tool for each
type of electronic submission and for each state. Instructions on how to access and use the appropriate
electronic reporting tool will be available as well. Information on EPA's NPDES Electronic Reporting
Rule is found at: http://www2.epa.gov/compliance/final-national-pollutant-discharge-elimination-
system-npdes-electronic-reporting-rule.
Electronic submissions must start by the dates listed in the "Reporting Requirements" section above.
3. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an
electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to the
Division. Requests for temporary electronic reporting waivers must be submitted in writing to the
Division for written approval at least sixty (60) days prior to the date the facility would be required
under this permit to begin submitting monitoring data and reports. The duration of a temporary waiver
shall not exceed 5 years and shall thereupon expire. At such time, monitoring data and reports shall be
submitted electronically to the Division unless the permittee re -applies for and is granted a new
temporary electronic reporting waiver by the Division. Approved electronic reporting waivers are not
transferrable. Only permittees with an approved reporting waiver request may submit monitoring data
and reports on paper to the Division for the period that the approved reporting waiver request is
effective.
Information on eDMR and the application for a temporary electronic reporting waiver are found on the
following web page:
http://deq.nc.gov/about/divisions/water-resources/edmr
4. Signatory Requirements [Supplements Section B. (11.) (b) and Supersedes Section B. (11.) (d)1
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part II,
Section B. (11.)(a) or by a duly authorized representative of that person as described in Part II, Section
B. (11.)(b). A person, and not a position, must be delegated signatory authority for eDMR reporting
purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user account
and login credentials to access the eDMR system. For more information on North Carolina's eDMR
system, registering for eDMR and obtaining an eDMR user account, please visit the following web
page:
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Permit NC0058378
http://deq.nc.gov/about/divisions/water-resources/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall make the
following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL
BE ACCEPTED:
"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
fines and imprisonment for knowing violations."
5. Records Retention [Supplements Section D. (6.)1
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions.
These records or copies shall be maintained for a period of at least 3 years from the date of the report.
This period may be extended by request of the Director at any time [40 CFR 122.41].
Page 6 of 6