NC0075612_Renewal (Application)_20221031

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0. 1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
O C T 2 8 2022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.
i

NPDES Permit Number Facility Name Modified Application Form 2A
NCOD . C0I Z. Wildcat- C1i WWII' Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result in denial of the ay•ication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Wi IdCat c c VvvuTQ
Mailing address(strpkt or P.O.box)
1 L I
��` Club fir.
City or town State ZIP code
c FYI k n k c .. aS -11
dC nt - ame(first and last) Title Phone number Email address
e -51ctes Gcnerut rytume 8?.8.5W'-21K w;Idu,cltcc
Location ad ss(street,route number,or other specific ide tifier) dame as mailingad��
ress
La.
City or town State ZIP code
1.2 Is this application for a facility that has yet to commence discharge?
D Yes 4 See instructions on data submission Lad" No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O.box)
0
€ City or town State ZIP code
Contact name(first and last) Title Phone number Email address
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
[Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
VFacility and applicant
❑ Facility ❑ Applicant (they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
MUD 1tDI 2-
o ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 0 Other(specify)
404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
N t t ( 1Z VV(idcth C 11(� , , n�J ��'_ , ,r(� Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
fits jop %separate sanitary sewer V'Own ❑ Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
CUINKNUAc11) 0 Unknown 0 Own 0 Maintain
co
c etit6"1 ir104 %separate sanitary sewer 0 Own 0 Maintain
o
-% 701- AJ %combined storm and sanitary sewer 0 Own 0 Maintain
a 0 Unknown 0 Own 0 Maintain
o %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
E0 Unknown 0 Own 0 Maintain
; %separate sanitary sewer 0 Own 0 Maintain
N %combined storm and sanitary sewer 0 Own ❑ Maintain
a 0 Unknown 0 Own 0 Maintain
o
Total nt-iya,
Population
✓ Served ��.XY�itty11
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of o j�V 0
sewer line(in miles) I CO /o k
z' 1.8 Is the treatment works located in Indian Country?
c
a 0 Yes V No
c1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c 0 Yes V No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
O. mgd
Ti
Annual Average Flow Rates(Actual)
vTwo Years Ago 0Last Year 'Thiiss-Yeear�r
CO i e �) d mgd • W J mgd
Maximum Daily Flow Rates(Actual)
a Two Years Ago Lastr- Year This
�Year
D• O"p. mgd 0 'v'a� mgd O •Dlg9- mgd
N 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
o
a.. a Constructed
*V '' Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
.o rn r.o Overflows Overflows
v
m i
0
Page 2
1

NPDES Permit Number ' Facility Name Modified Application Form 2A
n `Cry�r ^ti 1 n P 1 Ici ^i �` w. n, r'P Modified March 2021
Outfalls Other Than to'Waters Wof the State of North Carolina/`J ( {�-t �J�/�J
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
0 Yes kr No 4 SKIP to Item 1.14. 1
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
D Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
to gpd ❑ Intermittent
mac 1.14 Is wastewater applied to land?
1 2 ❑ Yes 12 No 4 SKIP to Item 1.16.
u 1.15 Provide the land application site and discharge data requested below.
0
PP 9
Land Application Site and Discharge Data
ca
El Continuous or
Ci Average Daily Volume
Location Size Intermittent
Applied (check one)
As
acres gpd ❑ Continuous
❑ Intermittent
Zu acres gpd El Continuous
❑ Intermittent
0
❑ Continuous
o es acres gpd 0 Intermittent
(11
74 74 1.16 Is effluent transported to another facility for treatment prior to discharge?
O 0 Yes No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
1
Page 3

i NPDES Permit Number I Facility Name Modified Application Form 2A
Modified March 2021
NG bu�5(.oiz WitchAt Gt WWW
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
,a Facility name Mailing address(street or P.O.box)
0
0
c City or town State ZIP code
0
vContact name(first and last) Title
0
t Phone number Email address
M
QNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
a not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
co ❑ Yes V No 4 SKIP to Item 1.23.
v
o 1.22 Provide information in the table below on these other disposal methods.
d Information on Other Disposal Methods
Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
0 Description Volume
'O acres d El Continuous
5 gp ❑ Intermittent
0 ❑ Continuous
acres gpd ❑ Intermittent
acres d ❑ Continuous
gp 0 Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
Oi ) Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
a Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
y ❑ Section 301(h)) 302(b)(2))
le Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
V Yes 0 No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name) EntAn.v mewl l i t 1r1C.
`o Mailing address
C (street or P.O.box) P 1;? ')C "t
511
Co ,state,and ZIP `
II' codde C wltc�,tlhe2 t`,
Contact name(first and Matt-
co> last)
14-t--
Phone number VS'G�p
Email address er `r_,✓�-c"`A�rv�p„. A,nCO 001,CC,)''�
Operational and /ti A tV q " ,.1' 1
maintenance NA
responsibilities of
contractor 4- rupu i r.
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
N — qS1 I Z ' it
J CI c 1!1 AA alp Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o 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 rer No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
a. a specific requirements.)
0
io ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o :° (See instructions for specific requirements.)
m
c Cl Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
5
E
m
2.
i o
3.
d
v 4.
U)
R 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
°' Affected Attainment of
Scheduled Outfalls Begin End Begin Operational
o Improvement Construction Construction Discharge Level
E (from above) (list ouff ll (MM/DDIYYYY) (MM/DD/YYYY) (MM/DDIYYYY)
number) (MM/DD/YYYY)
.
C,
m
to2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

I i NPDES Permit Number�, Facility Name Modified Application Form 2A
Modified March 2021
O. 5 .o I 2- (0 C/ C I ;VO t�
rr
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number Outfall Number Outfall Number
State 1\10A4ACOrek'r
Tv County \io..c r
o City or town V1/4`n N\
a Distance from shore `� ft. ft. ft.
fl
0
Depth below surface ft. ft. ft.
o
Average daily flow rate mgd mgd mgd
Latitude 35 L' 1 ' u`1tk" N ° "" ° „
Longitude ir`° 01-' \C " tn) ° " °
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c ❑ Yes IV No 4 SKIP to Item 3.4.
m
ri 3.3 If so,provide the following information for each applicable outfall.
w Outfall Number Outfall Number Outfall Number
0
Number of times per year
c discharge occurs
a Average duration of each
`o discharge(specify units)
7.o Average flow of each mgd mgd mgd
0 discharge
n Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes V No 4 SKIP to Item 3.6.
a, 3.5 Briefly describe the diffuser tjpe at each applicable outfall.
n.
4-- Outfall Number ___ Outfall Number Outfall Number
v
.
0
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
N = 3.6 one or more discharge points?
CO
CO Yes 0 No 4SKIP to Section 6.
Page 6

' NPDES Permit Number Facility Name Modified Application Form 2A
i Modified March 2021
I Nam�(.o IZ 'W i d Ca+ CAI s Ww-TP
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number COI Outfall Number Outfall Number
Receiving water name I
Name of watershed,river {.�p kg\,
or stream system It i Y Qr t9a5i h
r- U.S.Soil Conservation
H Service 14-digit watershed
o code 1
co
Name of state u- C.1 err 5 L
management/river basin r.`(v t,v- 1501 V1
m
U.S.Geological Survey
75 8-digit hydrologic
cecataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 01,1 Outfall Number Outfall Number
Highest Level of V Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to ❑ Equivalent to
apply per outfall) secondary secondary secondary
O Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0
Q Design Removal Rates by
'5 Outfall
co
o BODE or CBOD5 % % %
c
m
E
n ok
i TSS
L
❑Not applicable 0 Not applicable 0 Not applicable
Phosphorus % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen % % ok
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
i
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below.If disinfection varies by
season,describe below.
c
Outfall Number CiCA Outfall Number Outfall Number
Disinfection type (G((,,.m
CD
pothl(xi
Seasons used il h i(,r
'(ec r10
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
2/Yes ❑ Yes 0 Yes
❑ No ❑ No ❑ No
3.10 Have ou completed monitoring for all Table A parameters and attached the results to the application package?
Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?�E
❑ Yes No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
water
pr�Ocli. camel.
3.14 Does the-PeTtruse chlorine ford' fection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. V No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package? /
❑ Yes Lfld" No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
coA ,� ^^ ()(Z 1 l i'd , , Modified March 2021
3.19 Has the POTW conductedl_iJl either(1)minimum of four quarterly WET tests for one year� preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑ Yes Er/No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
0
ttt 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
a' ❑ Yes ❑ No 4 SKIP to Item 3.26.
g3.23 Describe the cause(s)of the toxicity:
m
uJ
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes 0 No-4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes Not applicable because previously submitted
information to the NPDES.ermittin. authorit
Page 9

DocuSign Envelope ID: D9544EEA-61DD-47AE-B493-808E224C195C
IIIIIIIIIIII ..�
NPOES Pennrt Number Facility Name.,- ' . I , I. .��M1odSed Application Fo{m 2A
�v l l Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and Id))
r: 6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority Note that not
all applicants are required to provide Ott v ie:'ls
` Column t Column2
Section 1_Basic Application
r
Information for All Applicants ❑ wf variance requests} 0 wt additional attachments
v Section 2_Additional 0 wt topographic map 0 a`process flow diagram
Information 0 w/additional attachments
w`Table A ❑ wl Table D
4,' �/ Section 3:Information on ❑ wt Table B 0
n Effluent Discharges 'hi additional attachments
> . =" 0 wl Table C
>s
,' Section 4:Not Applicable
v,
,,„:y:4..:
Section 5 Not Applicable
'� Section 6:Checklist and
Certification Statement ❑ wi attachments
''',4 6.2 Certification Statement
f 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
f '' r4 for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and
44 complete,f am aware that there are significant penalties for submitting false information.including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Jeffery Blais CEO
Signature Date signed
�o«usqee ey
10/17/2022
Page 10
I

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
(\ rC ,` Y,r U)1 12 `V�f r f t cleat
(__ 1 L, 00`` Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS �
Maximum Daily Discharge Average Daily Discharge
_�._.._T___ _ __.. __ Analytical MI or MDL
Pollutant
Value Units Value Units Number of Methodt (include units)
Samples
Biochemical oxygen demand ❑
p OD5 or❑CBOD5 � �
report one) .g ` L- Q •� m IL 54 5 15110 D- Zi ii
Fecal coliform m Z�D�laC(
I V� Ccu 1(WM( •S c Eloovi 6 a oL
Design flow rate 0.0 1q 4 O.0. rl o(o�
pH(minimum) `-w vI
LO•3 su .
pH(maximum) .5 5LA
Temperature(winter) I cj 0, O a 0 C a .
Temperature(summer) a(4.5 0 G 18. 'o a (_o
Total suspended solids(TSS) 'g.( I ��I 5 _q M Olt�I--- �� sm 25 C.(o�Zp I, 4L
I Sampling shall be conducted according to sufficiently sensitive tes procedures(i.e.,methods)approved untl CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 11

�
ROY COOPER I
Governor
ELIZABETH S.BISER `. ,.11
Secretary Y ^" r"
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
October 31, 2022
Wildcat Community Services, Inc.
Attn: Jeffrey Blais, CEO
770 Country Club Dr
Highlands, NC 28741
Subject: Permit Renewal
Application No. NC0O75612
Wildcat Cliffs WWTP
Macon County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 24, 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. 1506-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
Wren The ord
Administrative Assistant
Water Quality Permitting Section
cc: Mark Teague- Environmental, Inc.
ec: WQPS Laserfiche File w/application
E Q North Carolina Department of En lronmental Quality I Division of Water Resources
Asheville Regional Office 12090 US.Highway 70 Swannanoa.North Carolina 28778
^++� 828.296 4500

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0. 1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
O C T 2 8 2022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number Facility Name Modified Application Form 2A
1 N F c .� Modified March 2021
IVCUo �-5Cv�z_ V�f 1 I 11 w `'(
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
NPDES the instructions : result in denial of the a,•ication.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
W i Idcct-+ C1►WS wwTP
Mailing address(str t or P.O.box)
—11y totAililetj
Club Dr.
City or town State ZIP code
0
Firms j n 1\S c, on7S -11
1 C nt ame(first and last) Title Phone number Email address
Je lc s Gcnerlal rYrirne WS'5511e-2Q VI idcufecc .ctw4
Location address(street,route number,or other specific ide tifier) dame as mailing ad resd s
0
b
aL
City or town State ZIP code
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission Lid No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O.box)
0
m
� City or town State ZIP code
c
Ti.—CIS
Contact name(first and last) Title Phone number Email address
a.
`t 1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
[Owner 0 Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
VFacility and applicant
0 Facility 0 Applicant (they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
V% number for each.)
€ Existing Environmental Permits
a QC NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
c water) control)
E MLWD 5toI2-
2 ❑ PSD(air emissions) ❑ Nonattainment program(CAA) 0 NESHAPs(CAA)
0
W
m
y
❑ Ocean dumping(MPRSA) El Dredge or fill(CWA Section El Other(specify)
1 404)
I
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
n NC-Up-�1Z W'(dcth % , , f_ , �.ri) Mod'rfiedMarch 2021
1.7 Provide the collection system information requested below for thetreatment works. uJ 11'
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
war,. per` 100 %separate sanitary sewer (, Own ❑ Maintain
'�' i1 ' %combined storm and sanitary sewer 0 Own 0 Maintain
Sa�y� CUIVAUnc Unknown 0 Own 0 Maintain
co (,A.V 1 noi- %separate sanitary sewer 0 Own 0 Maintain
o
To—r J %combined storm and sanitary sewer 0 Own 0 Maintain
n 0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
iv c %combined storm and sanitary sewer 0 Own 0 Maintain
E0 Unknown 0 Own 0 Maintain
; %separate sanitary sewer 0 Own 0 Maintain
li
%combined storm and sanitary sewer 0 Own 0 Maintain
c 0 Unknown 0 Own 0 Maintain
a Total
1va:4p
Population
v Served CLITmIV.lYl1
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of ° °/0 sewer line(in miles) I C '0
ZZ" 1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes No
U
0 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c D Yes V No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0• mgd
To 1
Annual Average Flow Rates(Actual)
as Two Years Ago 0Last Yearar� ((�� `�Thiisys--Year
CO Co mgd 'mil./ mgd lJ • Vu mgd
I cm r`di Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
mgd mgd 0 •O`q mgd
o. oa � a �-
�, 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
c Total Number of Effluent Discharge Points by Type
./ m
m aa. Combined Sewer Constructed
2'I-- Treated Effluent Untreated Effluent Bypasses Emergency
c
a Overflows Overflows
U
N_ t
c :_

NPDES Perm Number Facility Name Modified Application Form 2A
NC r O I 12- V 1 td �„1 di
Ws`- r,, �-{) Modified March 2021
Dutfalls Other Than to Waters ofthe State of North Carolina1/`J ( L t 1 �J V�/I
1.12 Does the POTW discharge wastewater to basins.ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
0 Yes V No 4 SKIP to Item 1.14. '
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gPd ❑ Intermittent
❑ Continuous
gPd ❑ Intermittent
❑ Continuous
t gPd ❑ Intermittent
s 1.14 Is wastewater applied to land?
2 0 Yes V No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
ca. Land Application Site and Discharge Data
a Continuous or
`o Average Daily Volume
Location Size Intermittent
Applied
(check one)
Nacres gpd ❑ Continuous
o 0 Intermittent
rri acres gpd 0 Continuous
o ❑ Intermittent
acres
to gp d 0 Continuous
❑ Intermittent
UI
1.16 Is effluent transported to another facility for treatment prior to discharge?
o 0 Yes No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
NC,
^ W-I.5lt2- w`tCknt /�1` \`I WV Modified March 2021
1.20 In the table below,indicate the name,address,contact information,NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
-o Facility name Mailing address(street or P.O.box)
a>
City or town State ZIP code
0
o Contact name(first and last) Title
0
ts
Phone number Email address
m
0 NPDES number of receiving facility(if any) ❑None Average daily flow rate mgd
N
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
d not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
1 co 0 Yes IV No 3 SKIP to Item 1.23.
0
0 1.22 Provide information in the table below on these other disposal methods.
d Information on Other Disposal Methods
L Disposal Annual Average
2S Location of Size of Continuous or Intermittent
Method Daily Discharge
c Description Disposal Site Disposal Site Volume (check one)
w
1° acres ❑ Continuous
gpd ❑ Intermittent
o ❑ Continuous
acres gpd ❑ Intermittent
acresgpd 0 Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
H Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
.c ❑
Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
co Section 301(h)) 302(b)(2))
Er Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
V Yes ❑ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name1 TO _y,_
(company name) EnVlrCfrreev IiI 1 t nC
Mailing address
c (street or P.O.box) PO s_ Q
O. City,state,and ZIP f ,1
R code Cu.Llu, te.INC, Mb
m (first and
� Contact name
ci last) f1 L -rw-
Phone number gat-G{s g.,
Email address en`f,rCINM► p„ ',rlCO Ool1C(
Operational and /� k C �I v -1i1 5
maintenance 1.�1M - µ
responsibilities of Y Q� �C
contractor P 1 J
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
— iZ , +�d C ( . Modified March 2021
Ai
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c Outfalls to Waters of the State of North Carolina
c 2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
Q ❑ Yes Lid' No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
to
gpc
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
R
0
w
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
co a specific requirements.)
rn `a
o 2
�o ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
ovo (See instructions for specific requirements.)
m
ii r3
o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
d
: 2.
3.
a,
d
4.
vs
V
R 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
a' Affected Attainment of
d Scheduled Outfalls Begin End Begin Operational
o Improvement Construction Construction Discharge Level
a. (from above) (list outfall (MM/DDIYYYY) (MM/DD/YYYY) (MMIDDIYYYY)
number) (MM/DD/YYYY)
1.
43
am
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

i
NPDES Perm.t Number Facility Name Modified Application Form 2A
" �1 Z 'n 'i�. I c. 1 I J. r , ,�/�J, ' �, Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5)) �/
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number(DCA Outfall Number Outfall Number_
State MOrk111 Crirehrti
County
‘NCIaux1
o City or town high\Ckir&°
c Distance from shore ft. ft. ft.
w
a
Depth below surface ft. ft. ft.
Average daily flow rate U`1 " mgd mgd mgd
Latitude 35 L41 ' L`c N °
Longitude Cj`° 01" \C "
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
❑ Yes No 4 SKIP to Item 3.4.
R 3.3 If so,provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
Number of times per year
discharge occurs
a Average duration of each
discharge(specify units)
oAverage flow of each mgd mgd mgc
discharge
c; Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes [V No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser t/pe at each applicable outfall.
Outfall Number Outfall Number Outfall Number
tel
6
N ui 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more points?
discharge
CD
g Yes ❑ No-3SKIP to Section 6.
Page 6

NPDES Permit Number i Facility Name Modified Application Form 2A
Modified March 2021
(�((_)�5(.oiZ W►la Gt s Wu-n9
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number COOS Outfall Number Outfall Number
Receiving water name 214Ceattles• VA
Name of watershed,river, Witt 1
e or stream system v iv er5)h
V. U.S.Soil Conservation
+w Service 14-digit watershed
• c3; code
co •
Name of state 1..A.itt.Tent5I5 L•
3" management/river basin rt v Q." 9I h
t U.S.Geological Survey
8-digit hydrologic
te cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number GOt Outfall Number Outran Number
Highest Level of V Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
O Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
Design Removal Rates by
g Outfall
V
BOD5 or CBOD5
F
TSS
❑Not applicable 0 Not applicable 0 Not applicable
Phosphorus
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen % %
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
%
Page 7
I

i NPDES Permit Number Facility Name Modified Application Form 2A
n CADO '2— t,,,r`idCat ^ It f Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below.If disinfection varies by
season,describe below.
la
c
.c
0
c Outfall Number DCA Outfall Number Outfall Number
0
Disinfection type Seasons used •
tpcoVortit
lr�hi(,�,��j
P '(eur IrCO
cu.�'
E
67
t—
Dechlorination used? El Not applicable ❑ Not applicable 0 Not applicable
l"Yes 0 Yes 0 Yes
0 No 0 No 0 No
3.10 Have ou completed monitoring for all Table A parameters and attached the results to the application package?
t^/Yes 0 No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
0 Yes V No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
.a Acute Chronic Acute Chronic Acute Chronic
R
o Number of tests of discharge
m
c water
rNumber of tests of receiving
water
m
w 91(10C - ai-,C.11
3.14 Does the-Pefotl'use chlorine for chi.nfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. V No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes 0 No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
No additional sampling required by NPDES
❑ Yes permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC^^ /w'� 1 r''da l Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑ Yes /No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MMIDD/YYYY)
0
0
co 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
a' ❑ Yes ❑ No-4 SKIP to Item 3.26.
cr
S 3.23 Describe the cause(s)of the toxicity:
m
Lu
W
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes Not applicable because previously submitted
information to the NPDES•ermittin. authorit .
Page 9

DocuSign Envelope ID:D9544EEA-61DD-47AE-B493-808E224C195C
NPDES Permit Number Feel5ity Name _____ Modified Application Form 2A
Matt Mardi 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
t 6.1 In Column 1 below.mark the sections of Form 2A that you have completed and are submitting with your application.For
, each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority Note that not
all applicants are required o provide attachments
` ,.. - Cotumt�
r EeSectmn 1.Basic Application ❑ we variance requests} 0 wi additional attachments
f' Information for All Applicants
tSection 2_Additional ❑ wl topographic map 0 wl process flow diagram
f` Information ❑ wl additional attachments
wl Table A 0 w(Table D
K-/' Section 3:Information on 0 wi Table B 0 wl additional attachments
— Effluent Discharges
❑ wl Table C
Section 4:Not Applicable
a Section 5 Not Applicable
r
Section 6:Checklist and 0 wt attachments
Certification Statement
$ :; 6.2 Certification Statement
s;, 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 property gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
I >y / for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and
complete.I am aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
,,� Jeffery Blais CEO
Signature
Date signed
s,""ey 10/17/2022
Page 0

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
A r/+ 12 Y,^V(I I d cat-_(;�[L CA,a 001 Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant __ Number of Analytical NIL or MDL
Value Units Value Units Method1 (include units)
Samples —
Biocnemical oxygen demand
ODe or❑CBOD5 ' A q I _
(report one) �/. 0 r` L .Q •� m I L 5 c 5n�5/1 O Dy 2 V i(
Fecal coliform 1 eCu 6(4 1 Ia. wd O C�''�e.100i+►1 59 InZ1.1l),(Qq 7 0 ML
IiiIclDL
Design flow rate _____C),b,Q o
pH minimum - V I 0. ' d 3ts-w .
( ) lo.3 su .
pH(maximum) "1,.. `3 5ut
Temperature(winter) I Q 0 C. O a 0 C r1 ( „
Temperature(summer) a 14.5 0 r 1 8'.E '0 � a1 �Yr ^
Total suspended solids(TSS) S,L' mq I L. 5 -- I (Y'I bi 59, Sm 2r)L op_Z 01 1 iDL
1 Sampling shall be conducted according to sufficiently sensitive to procedures(i.e.,methods)approved and CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 11