NC0086291_Renewal (Application)_20221229

1
ROY COOPER
Governor 0
ELIZABETH S.BISER
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
January 03, 2023
Town of Edenton
Attn: Corey Gooden, Town Manager
PO Box 300
Edenton, NC 27932
Subject: Permit Renewal
Application No. NC0086291
Beaver Hill WTP
Chowan County
Dear Applicant:
The Water Quality Permitting Section acknowledges the December 29, 2022, receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
httos://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,
,.,-"fttv
V0
Wren The ford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Q0 North GrolIna Department of honmental Quality I Division of Water Resources
Washington Regional Office 943Eno Washington Square Mall Washington.North Carolina 27
889
252.946.6481

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RECEIVED
December 21, 2022 DEC 2 9 Z022
NCDEQIDWRINPDES
NC Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh,NC 27699-1617 Laserfirho
Subject: NPDES Permit Renewal
Town of Edenton WTPs
NPDES Permit#NC0007552 Freemason
#NC0086291 Beaver Hill
Chowan County
Dear Permitting Unit:
The Town of Edenton is submitting the renewal application for NPDES permit #NC0007552 1
(Freemason WTP) and permit#NC0086291 (Bever Hill WTP) which both are scheduled to expire
on July 31, 2023. The permit application package consists of one Cover Letter and the following
for both plants:
- EPA Form 1
- EPA Form 2E
- Table "A"from EPA Form 2C
- Table "C" from EPA Form 2C
- Topographic Map
Printed on Recycled Paper
P.O. BOX 300, Edenton N.C. 27932 -[phone]
[phone] -FAX

The Town of Edenton would like to request that the Total Chloride limit be replaced with Monitor
&Report for both treatment facilities. In Section A. (2) 1-5 calls out a timeline for the Compliance
Schedule. During the first year of the permit a Corrective Action Plan summarizing the actions to
be taken to achieve compliance was to be submitted. The town requested, on several occasions,
technical assistance from the regional office for guidance on this schedule but sees no logical
option to meet this permit limit within our water system. Also, in Section A. (2) it states, "Upon
approval of the Corrective Action Plan by the Division, the report and actions become an
enforceable part". Although the town has requested assistance, a Corrective Action Plan has not
been submitted to the Division for approval and therefore is not enforceable.
The town conducts Acute "WET" Testing on a quarterly basis as per the current permit. During
this permit cycle neither of the water treatment facilities have failed this testing.The primary goal
of WET testing is to ensure that the effluent discharged into surface waters does not negatively
impact aquatic ecosystems. The town meets this requirement.
The town has recently conducted testing on the upstream receiving waters and found chloride
levels of 1270 mg/L. This result is higher than the annual average at the Freemason WTP at 895
mg/L and only slightly below the annual average of 1325 mg/L at the Beave Hill WTP. As stated
in my December 6th, 2022, letter to Mr. Hennessy, we have exhausted all options. Also as stated
in the letter we have received funding for two (2) well sites and an interconnect between the two
(2) raw water tanks at each facility. Once this project is complete, we feel the raw water supply
will be of better quality but may still not achieve a limit of 230 mg/1 for Total Chloride.
In closing the Town request the Total Chloride be monitored and report only for both facilities and
a remission on all NOV and assessment of Civil Penalties regarding Total Chloride. If you have
any additional questions or comments, please call my office at#252-482-2155 ext. 201.
Sincerely,
i
rey Gooden
Town Manager
Town of Edenton

United States Office of Water EPA Form 3510-1
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
*SEPA Application Form 1 !,
General Information
Program
NPDES Permitting Pro g
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 Form 1—General Instructions
Elimination System(NPDES)permits include the following: Form 1—Line-by-Line Instructions
Form 1—General Information (included in this package). Form 1—Activities That Do Not Require Permits
Form 2—Forms Based on Facility or Activity Type(not included Form 1—Glossary
in this package): Form 1—Application
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
2C. ExistingManufacturing,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
Who Must Apply for an NPDES Permit? Upon your request,and based on information supplied by you,
With the exceptions described in"Form 1—Activities That Do Not EPA or the authorized NPDES state will determine whether you
Require Permits,"the federal Clean Water Act(33 U.S.C. 1251 et are required to obtain a permit for a particular facility or activity.
seq.)prohibits any person from discharging pollutants into waters Be sure to contact EPA or your state if you have a question.
of the United States without first having been issued a permit Form 1 collects general information only.You must also complete
under the NPDES program. a more detailed application based on your proposed discharge
Who Must Complete Form 1? activity,as follows:
All applicants,other than publicly owned treatment works •
If your facility is a concentrated animal feeding operation
(POTWs)and treatment works treating domestic sewage or a concentrated aquatic animal production facility,you
(TWTDS),must submit Form 1. If you operate one of the must also complete Form 2B.
following facilities,you must submit Form 1:concentrated animal • If your facility is an existing manufacturing,commercial,
feeding operations and aquatic animal production facilities; mining,or silvicultural facility that currently discharges
manufacturing,commercial,mining,and silvicultural operations; process wastewater,you must also complete Form 2C.
or other industrial facilities. • If your facility is a new manufacturing,commercial,mining,
At the state level,either the U.S. Environmental Protection or silvicultural facility that has yet to commence discharge of
Agency(EPA)or an approved state agency administers the process wastewater,you must also complete Form 2D.
NPDES permit program. If you are located in a jurisdiction in • If your facility is a new or existing facility(including
which an EPA regional office administers the NPDES permit manufacturing,commercial,mining, and silvicultural
program,you should use Form 1 and all other applicable forms facilities)that discharges only nonprocess wastewater,
described in these instructions. If you are located in a jurisdiction you must also complete Form 2E.
where a state administers the NPDES permit program,contact • If your facility is a new or existing facility whose discharge
the state to determine the forms you should complete. States is composed entirely of stormwater associated with industrial
often develop their own application forms rather than use the activity—excluding discharges from construction activity
federal forms. See http://www.epa.00v/npdes/npdes-state- under 122.26(b)(14)(x)or(b)(15)—you must also complete
program-information for a list of states that have approved Form 2F.If the discharge is composed of stormwater and
NPDES permit programs and those that do not. non-stormwater,you must complete Form 2F and you must
Exhibit 1-1 (see end of this section)provides contact information also complete Forms 2C, 2D,and/or 2E,as appropriate.See
for each of EPA's 10 regional offices.Since the exhibit's content is Form 2F's instructions for further details.
subject to change,consult EPA's website for the latest information:
htto://www.eoa.00v/aboutepa#regional.
1-1

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form Completion of Forms
• If you are in a jurisdiction with an approved state NPDES Print or type in the specified areas only. If you do not have enough
permit program,file according to the instructions on the state space on the form to answer a question,you may continue on
forms. additional sheets,as necessary, using a format consistent with the
• If you are in a jurisdiction where EPA is the NPDES form.
permitting authority(i.e.,the state is not an NPDES- The NPDES permitting authority could consider your application
authorized state), mail the completed application forms to the incomplete if you do not provide an answer(or indicate"NA"for
EPA regional office that covers the state in which your facility "not applicable")for all questions on Form 1 and the applicable
is located(see Exhibit 1-1). Form 2.
When to File Your Completed Form Provide your EPA Identification Number from the Facility Registry
Because of statutory and regulatory requirements,the deadlines Service, NPDES permit number,and facility name at the top of
for filing applications vary accordingtoyour facilityor activitytype
each page of Form 1 and any attachments. If your facility is new
YP
and the type of permit you need.The various permit application (i.e.,not yet constructed),write or type"New Facility"in the space
deadlines are listed in Exhibit 1-2 at the end of this section. provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number,contact your
Fees NPDES permitting authority. See Exhibit 1-1 for contact
EPA does not require applicants to pay a fee for applying for information.
NPDES permits. However,states that administer the NPDES Do not leave any response areas blank unless the form directs
permit program may charge fees.Consult with state officials for you to skip them. If the form directs you to respond to an item that
further information. does not apply to your facility or activity,enter"NA"for"not
Public Availability of Submitted Information applicable"to show that you considered the item and determined
a response was not necessary for your facility.
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request. The NPDES permitting authority will consider your application
You may not claim any information on Form 1 (or related complete when it and any supplementary material are received
attachments)as confidential. and completed according to the authority's satisfaction.The
NPDES permitting authority will judge the completeness of any
You may make a claim of confidentiality for any information that application independently of the status of any other permit
you submit to EPA that goes beyond the information required by application or permit for the same facility or activity.
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).
1-2

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Exhibit 1-1.Addresses of EPA Regional Contacts and Covered States
REGION 1 REGION 6
U.S.Environmental Protection Agency,Region 1 U.S.Environmental Protection Agency,Region 6
5 Post Office Square,Suite 100,Boston,MA 02109-3912 1445 Ross Avenue,Suite 1200,Dallas,TX 75202-2733
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:htb://www.epa.gov/abouteoa/epa-reqion-1-new-england Website:http:/Miww.epa.gov/abouteOaleoa-reaion-6-south-central
Covered states:Connecticut,Maine,Massachusetts,New Hampshire,Rhode Covered states:Arkansas,Louisiana,New Mexico,Oklahoma,and Texas
Island,and Vermont
REGION 2 REGION 7
U.S.Environmental Protection Agency,Region 2 U.S.Environmental Protection Agency,Region 7
290 Broadway,New York,NY 10007-1866 11201 Renner Boulevard,Lenexa,KS 66219
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Website:htte://www.eoa.qov/aboutepa/epa-region-7-midwest
Website:http://www.epa.gov/abouteva/epa-region-2 Covered states:Iowa,Kansas,Missouri,and Nebraska
Covered states:New Jersey,New York,Virgin Islands,and Puerto Rico
REGION 3 REGION 8
U.S.Environmental Protection Agency,Region 3 U.S.Environmental Protection Agency,Region 8
1650 Arch Street,Philadelphia,PA 19103-2029 1595 Wynkoop Street,Denver,CO 80202-1129
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.qov/aboutepa/epa-region-3-mid-atlantic Website:http://www.epa.qov/aboutepa/epa-region-8-mountains-and-plains
Covered states:Delaware,District of Columbia,Maryland,Pennsylvania,Virginia, Covered states:Colorado,Montana,North Dakota,South Dakota,Utah,and
and West Virginia Wyoming
REGION 4 REGION 9
U.S.Environmental Protection Agency,Region 4 U.S.Environmental Protection Agency,Region 9
Sam Nunn Atlanta Federal Center 75 Hawthorne Street,San Francisco,CA 94105
61 Forsyth Street,SW,Atlanta,GA 30303-8960 Phone:[phone];toll free:(866)EPA-WEST
Phone:[phone];toll free:[phone] Fax:[phone]
Fax:[phone] Website:http://www.epa.qov/aboutepa/epa-reaion-9-oaafic-southwest
Website:http://www.epa.qov/aboutepa/about-epa-region-4-southeast Covered states:Arizona,California,Hawaii,Nevada,Guam,American Samoa,
Covered states:Alabama,Florida,Georgia,Kentucky,Mississippi,North Carolina, and Trust Territories
South Carolina,and Tennessee
REGION 5 REGION 10
U.S.Environmental Protection Agency,Region 5 U.S.Environmental Protection Agency,Region 10
77 West Jackson Boulevard,Chicago,IL 60604-3507 1200 Sixth Avenue,Suite 900,Seattle,WA 98101
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax'[phone] Fax'[phone]
Website:http://www.epa.aov/aboutepa/epa-region-5 Website:http://www.eoa.qov/abouteroa/eoa-region-10-pacific-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
2A 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 are a new facility.
2C 180 days before your present NPDES permit expires.
2D 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.
Construction:90 days prior to date construction is to commence.
2F Nonconstruction: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 You can find SIC code numbers and descriptions in the
Item 1.1.Review the questions in Item 1.1 to determine if you are 1987 Standard Industrial Classification Manual, prepared by the
required to submit Form 1. Be sure to check the Form 1— Executive Office of the President, Office of Management and
Glossary for the legal definitions of any key terms. Budget.This document is available from the Government Printing
Office,Washington, D.C.An online version of the manual is also
If you answer"Yes"to a question in Item 1.1,then you do not available courtesy of the Occupational Safety and Health
need to complete Form 1,but you must comply with the Administration at http:J/www.osha.gov/pls/imis/sic manual.html.
application requirements specified.
You can find NAICS code numbers and descriptions in the North
Item 1.2.Respond to the questions in Items 1.2.1 to 1.2.5. If you American Industrial Classification System Manual prepared by the
answer"Yes"to any question,you must complete Form 1 and the Executive Office of the President, Office of Management and
Form 2 application specified.See Exhibit 1-2 for filing deadlines. Budget.This document is available from the National Technical
If you answer"No"to every question in Items 1.1 and 1.2,then Information Service(NTIS)in Alexandria,Virginia. It is also
you do not need an NPDES permit,and you do not need to available online at http:/9www.census.gov/eos/www/naics/.
complete and return any of the NPDES application forms. Use the latest edition of the manuals.If you have any questions
Section 2.Name,Mailing Address,and Location about the appropriate SIC or NAICS codes for your facility,
Item 2.1.Enter the facility's official or legal name.Do not use a contact your NPDES permitting authority.
colloquial name. Section 4.Operator Information
Item 2.2. Provide your EPA Identification Number from the Item 4.1.Give the legal name of the person,firm,public
Facility Registry Service if you have an existing facility. If you do organization,or other entity that operates the facility described in
not know your EPA Identification Number,contact your NPDES this application.This may or may not be the same as the facility's
permitting authority. If your facilityis new(i.e., not yet name.The operator of the facility is the legal entity that controls
P 9 ty
constructed), the facility's operation rather than theplant or site manager. Do
t ucted ,write ortype"New Facility." 9
ty
not use a colloquial name.
Item 2.3.Give the name(first and last),title,work telephone
Item 4.2.Indicate whether the entity listed in response to Item 4.1
number,and email address of the person who is thoroughly
familiar with the operation of the facility and with the facts also owns the facility by marking the appropriate box.
reported in this application.The NPDES permitting authority will Item 4.3.Indicate the ownership status of the operator of the
contact the person listed if they have questions on the material facility by marking the appropriate box. If the facility is a federal
submitted. facility(i.e.,owned by the U.S.government),check the box for
Item 2.4.Give the complete mailing address of the office to which "Public—federal."If the facility is owned by a state government,
the NPDES permitting authority should send correspondence. check the box for"Public—state."If the facility is owned by a
This often is not the address used to designate the location of the county government,municipal(e.g.,city or town)government,
facility or activity. tribal government,school district,water district,or other local
government entity,check the box for"Other public"and specify
Item 2.5.Give the address or location of the facility identified the type of government entity. If the facility is owned by a
under Item 2.1. If the facility lacks a street name or route number, corporation or other private entity,check the box for"Private."If
give the most accurate,alternative geographic information(e.g., the facility has mixed ownership(e.g., public/private)or is not
section number or quarter section number from county records or owned by an entity of the types previously listed,check the box
"at intersection of Routes 425 and 22").Also provide the county for"Other"and specify the type of entity.
name,county code(if known),city or town,state,and zip code.
Items 4.4 to 4.6.Enter the telephone number,address,and email
For concentrated aquatic animal production facilities,provide the address of the operator identified in Item 4.1.
address or location of the production area(i.e.,the location where
the animals are contained,grown,or held). Section 5.Indian Land
Section 3.SIC and NAICS Codes Item 5.1.Indicate whether the facility is located on Indian Land.
Items 3.1 and 3.2.List, in descending order of significance,up to Section 6.Existing Environmental Permits
four 4-digit standard industrial classification(SIC)codes and Item 6.1.Check the appropriate boxes and provide the permit
North American Industrial Classification System(NAICS)codes numbers for all relevant federal,state,and local environmental
that best describe your facility in terms of the principal products or permits or construction approvals received or applied for under
services it produces or provides. If the SIC or NAICS codes do any of the programs listed below. If you have more than one
not adequately describe your facility's products or services,you currently effective permit under a particular permit program for
have the option to provide additional descriptive information. 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 (e.g.,residential,commercial).An example of an acceptable
Conservation and Recovery Act(RCRA). location map is shown as Exhibit 1-3 at the end of these
• Underground Injection Control(UIC)program under the Safe instructions. Note: Exhibit 1-3 is provided for illustration only; it
Drinking Water Act(SDWA). does not show an actual facility.
• NPDES program under the Clean Water Act(CWA). If the facility is a concentrated animal feeding operation,you are
Prevention of Significant Deterioration(PSD)program under not required to provide the topographic map required by this
• the Clean Air Act(CAA). section of Form 1. Instead,you are required to provide a
topographic map as specified in Section 4 of Form 2B.
• Nonattainment program under the CAA.
Item 7.1.Note that you have completed your topographic map
• National Emission Standards for Hazardous Pollutants and attached it to the application.
(NESHAPs)preconstruction approval under the CAA.
Section 8.Nature of Business
• Ocean dumping permits under the Marine Protection Briefly describe the nature of your business(e.g.,products
Research and Sanctuaries Act(MPRSA).
produced or services provided).See Examples 1 and 2.
• Dredge or fill permits under Section 404 of the CWA.
Example 1
• Other federal,state,or local environmental permits.
Facilities Subject to 40 CFR 426,Subparts F and G
Section 7.Map Industry A is an auto tempered and auto laminated glass
Unless the facility is a concentrated animal feeding operation, manufacturing facility subject to effluent limitation guidelines
provide a topographic map(s)of the area extending at least one (ELGs)for the"Automotive Glass Tempering"and"Automotive
mile beyond the property boundaries of the facility that clearly Glass Laminating"subcategories of the"Glass Manufacturing"
shows the following: point source category at 40 CFR 426,subparts F and G.At the
• The legal boundaries of the facility. facility,glass is cut and then passed through a series of
processes that grind and polish the edges,bend the glass,and
• The location and serial number of each of your existing and then temper the glass to produce side and back windows for
proposed intake and discharge structures. automobiles.Tempering involves heating the glass near the
• All hazardous waste management,storage,and disposal melting point,then rapidly cooling it to increase its mechanical
facilities. and thermal endurance.The facility also produces automobile
• Each well where you inject fluids underground. windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass for
• All wells,springs,surface water bodies,and drinking water lamination(e.g.,cutting,bending,and washing).
wells that are in the public record or otherwise known to you
and that are located in the map area. Example 2
Facility Not Subject to ELGs
If the facility has associated water intakes,discharge structures,
hazardous waste disposal sites,or injection wells and these items Industry B undertakes batch-type resin manufacturing operations.
are located more than one mile from the facility, include them on It has aboveground storage tanks for raw materials and finished
the map if possible. If you cannot, attach additional sheets goods,resin loading operations,and warehouses for 55-gallon
describing the location of the structures,disposal site(s),or well(s) drums of finished product. Industry B manufactures alkyd,
and identify the U.S.Geological Survey(USGS)or other map saturated and unsaturated polyester resins in batches using
corresponding to the location(s). reactor vessels and mix tanks.Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
On each map, include the map scale,a meridian arrow showing piping system.Additional feedstocks are added manually as
north,and latitude and longitude to the nearest second. Latitude solids from bags and sacks via manways,which are located on
and longitude coordinates may be obtained in a variety of ways, top of the kettles.The resin is then chemically reacted in the
including use of hand held devices(e.g.,a GPS enabled kettles.After the reaction step finishes,the resin is transferred
smartphone),internet mapping tools(e.g., from the kettles to the mix tanks,where solvents are added to
httos://mynasadata.larc.nasa.qov/latitudelongitude-finder/), thin it.The primary byproduct of the reaction is water vapor
geographic information systems(e.g.,ArcView),or paper maps containing condensed soluble organics.The byproduct flows to
from trusted sources(e.g., USGS). an isolation tank where the vapors are directed to an onsite
On all maps of rivers,show the direction of the current. In tidal thermal oxidizer.The finished resin is then pumped through one
waters,show the directions of ebb and flow tides. of three types of filtration systems into finished goods storage
tanks,55-gallon drums,350-gallon intermediate bulk container
You may develop your map by going to USGS's National Map totes,or directly into tanker trucks.A typical batch takes about 30
website at http://nationalmap.gov/.(For a map from this site,use hours to complete.
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

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

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1-7

FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge • Any discharge in compliance with the instructions of an On-
is in one of the following categories,as provided by the CWA and Scene Coordinator pursuant to 40 CFR 300(The National Oil
NPDES regulations at 40 CFR 122 to 125.(However, under CWA and Hazardous Substances Pollution Contingency Plan)or
Sections 510 and 312,some discharges exempted from the 33 CFR 153.10(e)(Pollution by Oil and Hazardous
federal NPDES requirements may still be regulated by a state Substances).
permitting authority.) • Any introduction of pollutants from non point-source
• Any discharge of sewage from vessels and any effluent from agricultural and silvicultural activities, including stormwater
properly functioning marine engines,laundry,shower,and runoff from orchards,cultivated crops,pastures,range lands,
galley sink wastes,or any other discharge incidental to the and forest lands, but not discharges from concentrated
normal operation of a vessel,including vessels of the Armed animal feeding operations as defined in 40 CFR 122.23,
Forces within the meaning of section 312 of the CWA and discharges from concentrated aquatic animal production
recreational vessels within the meaning of section 502(25)of facilities as defined in 40 CFR 122.23,discharges from
the CWA. None of these exclusions apply to rubbish,trash, concentrated aquatic animal production facilities as defined
garbage,or other such materials discharged overboard; nor in 40 CFR 122.24,discharges to aquaculture projects as
to other discharges when the vessel is operating in a defined in 40 CFR 122.25,and discharges from silvicultural
capacity other than as a means of transportation such as point sources as defined in 40 CFR 122.27. Note: Per 40
when used as an energy or mining facility,a storage facility CFR 122.26(b)(14)(ii),facilities classified within SIC 24,
or a seafood processing facility,or when secured to a Industry Group 241,that are rock crushing,gravel washing,
storage facility or a seafood processing facility,or when log sorting,or log storage facilities operated in connection
secured to the bed of the ocean,contiguous zone or waters with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)
of the United States for the purpose of mineral or oil and Industry Groups 242 through 249;26(except 265 and
exploration or development. 267),28(except 283),29,311,32(except 323),33,3441,
Discharges of dredged or fill material into waters of the and 373(not included are all other types of silviculture
• United States that are regulated under CWA Section 404. facilities)are considered stormwater discharges associated
with industrial activity,and are required to obtain an NPDES
• The introduction of sewage,industrial wastes,or other permit.
pollutants into publicly owned treatment works by indirect • Return flows from irrigated agriculture.
dischargers. Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the • Discharges into a privately owned treatment works,except as
obligation to have and comply with permits until all the NPDES permitting authority may otherwise require under
discharges of pollutants to waters of the United States are 40 CFR 122.44(m).
eliminated.(See also 40 CFR 122.47(b).)This exclusion • Discharges from a water transfer."Water transfer"means an
does not apply to the introduction of pollutants to privately activity that conveys or connects waters of the United States
owned treatment works or to other discharges through pipes, without subjecting the transferred water to intervening
sewers,or other conveyances owned by a state,municipality, industrial,municipal,or commercial use.This exclusion does
or other party not leading to treatment works. not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
1-8

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 NPDES 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 for a total of 45 days or
more in any 12-month period;and
• 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 CAFO)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;
1-9

FORM 1—GLOSSARY CONTINUED
6. 500 horses;
7. 10,000 sheep or lambs;
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 AFO 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).
B. 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 lambs;
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
Cyprinidae 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.
1-10

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 et 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 over 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 or 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"or 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.
1-11

•
FORM 1—GLOSSARY CONTINUED
INDIAN 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
1-12

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
1-13

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 or may be discharged.This term does not include return flows from irrigated agriculture or
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 et 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.
1-14

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 on the site of such operations;(inactive mining operations are
mining sites that are not being actively mined,but which have an identifiable owner/operator;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 POLLU
TANT means any pollutant listed as toxic under section 307(a)(1)or,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 Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 ..EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 12
treatment works? 1. . treating domestic sewage?
If yes,STOP. Do NOT complete No If yes,STOP. Do NOT ❑✓ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing.
operation or a concentrated aquatic animal commercial, mining. or silvicultural facility that is
a production facility? currently discharging process wastewater?
w ❑ Yes 4 Complete Form 1 ❑✓ No ❑ Yes 4 Complete Form 0 No
a and Form 2B. 1 and Form 2C.
1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
co
rn mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
= commenced to discharge? discharges only nonprocess wastewater?
cE1 Yes 4 Complete Form 1 ❑� No ❑ Yes 4 Complete Form No
and Form 2D. 1 and Form 2E.
▪ 1.2.5 Is the facility a new or existing facility whose
'— discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
Yes 4 Complete Form 1 0✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
Beaver Hill WTP
2.2 EPA Identification Number
J
110009120622
2.3 Facility Contact
Name(first and last) Title Phone number
43 Roy Alons Superintendent [phone]
rn Email address
[e-mail]
-
(6 2.4 Facility Mailing Address
ro Street or P.O.box
P.O. Box 300
City or town State ZIP code
Edenton NC 27932
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
13 2.5 Facility Location
• c Street,route number,or other specific identifier
c( v Dr.Martin Luther King,Jr.Avenue
c o County name County code(if known)
19 Chowan
M
E J City or town State ZIP code
z m Edenton NC 27932
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3 1 SIC Code(s) LDescription (optional) J
4941 Water treatment
ai
0
U
C
3.2 j NAICS Code(s) Description(optional)
2213 Water Treatment
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Roy Alons
4.2 Is the name you listed in Item 4.1 also the owner?
E ❑ Yes 0No
`0 4.3 Operator Status
ta ❑ Public—federal ❑ Public—state ✓❑ Other public(specify)Municipal
❑ Private 0 Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
P.O. Box 300
o
•c City or town State ZIP code
col Edenton NC 27932
to
Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
W 5.1 Is the facility located on Indian Land?
3 ❑ Yes ❑ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6 1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
d NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
o w water) fluids)
NC0086291
w a ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
rn
0 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.)
2
❑✓ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Water Treatment Plant sourced by groundwater.A Ion Exchange filter is used to soften the water.The water is
(f) chlorinated prior to distribution.
m
c
N
CO
0
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑✓ No 4 SKIP to Item 10.1.
R . 9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
a, 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.)
O
U 1°
c
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
c ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
ce d Section 301(n)) 302(b)(2))
❑CCI Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
co Section 301(c)and(g))
❑� Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004 •
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1 Column 2
O Section 1:Activities Requiring an NPDES Permit ❑ w/attachments
O Section 2:Name, Mailing Address,and Location ❑ w/attachments
O Section 3:SIC Codes ❑ w/attachments
O Section 4:Operator Information ❑ w/attachments
O Section 5: Indian Land ❑ w/attachments
0 Section 6:Existing Environmental Permits ❑ w/attachments
El Section 7: Map w/topographic
❑ map
cn ❑ w/additional attachments
0 0 Section 8:Nature of Business ❑ w/attachments
❑ Section 9:Cooling Water Intake Structures ❑ w/attachments
❑ Section 10:Variance Requests ❑ w/attachments
y 0 Section 11:Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is,to the best of my knowledge and
belief, true, accurate,and complete.I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
( riarci c'JOGe/'1 1.0(A)n / L et
SS
Signature Date signed
12 2/ /zaz
EPA Form 3510-1(revised 3-19) Page 4

United States Office of Water EPA Form 3510-2E
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
6EPA Application Form 2E
Manufacturing , Commercial ,
Mining , and Silvicultural
Facilities Which Discharge
Only Nonprocess Wastewater
NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is a new or existing manufacturing, commercial,
mining, and silvicultural facility that discharges only nonprocess wastewater.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect and complete
Form 2E to be 13.5 hours. This estimate includes time for reviewing instructions, searching existing data
sources, gathering and maintaining the needed data, and completing and reviewing the collection of
information. Send comments about the burden estimate or any other aspect of this collection of
information to the Chief, Information Policy Branch (PM-223), U.S. Environmental Protection Agency,
1200 Pennsylvania Avenue,NW, Washington, DC 20460, and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, 725 17th Street, Washington, DC 20503, marked
"Attention: Desk Officer for EPA."

FORM 2E—INSTRUCTIONS
General Instructions
Who Must Complete Form 2E? Follow-up Requirements for New Dischargers
You must complete Form 2E if you answered"Yes"to Item 1.2.4 on Note that no later than 24 months after commencement of
Form 1—that is, if you are a new or existing facility(including discharge from the proposed facility,you must complete and
manufacturing,commercial,mining, and silvicultural facilities)that submit Section 4 of this form.At that time you must test and report
actual rather than estimated data for the pollutants or parameters
discharges only non process wastewater. listed,unless waived by the NPDES permitting authority.
Where to File Your Completed Form
Submit your completed application package(Forms 1 and 2E)to Line-by-Line Instructions
your National Pollutant Discharge Elimination System(NPDES) If you have multiple outfalls, you must submit a separate Form 2E
permitting authority.Consult Exhibit 1-1 of Form 1's"General for each(Sections 1,3,and 4 only).
Instructions"to identify your NPDES permitting authority. Section 1.Outfall Location
Public Availability of Submitted Information Item 1.1.Complete sections 1 through 6 for each outfall.Provide
The U.S. Environmental Protection Agency(EPA)will make the latitude and longitude to the nearest 15 seconds for the outfall.
information from NPDES permit application forms available to the Latitude and longitude coordinates may be obtained in a variety of
public for inspection and copying upon request.You may not claim ways,including use of hand held devices(e.g.,a GPS enabled {'
any information on Form 2E(or related attachments)as smartphone),internet mapping tools(e.g.,
confidential. httP s://mY nasadata.larc.nasa.gov/latitudelongitude-finder/),
You may make a claim of confidentiality for any information that you geographic information systems(e.g.,ArcView),or paper maps
submit to EPA thatgoes beyond the information required byForm from trusted sources(e.g., U.S.Geological Survey or USGS).The
Y q
2E. Note that NPDES permitting authorities will deny claims for location of each outfall(i.e.,where the coordinates are collected)
treating any effluent data as confidential. If you do not assert a shall be the point where the discharge is released into a water of
claim of confidentiality at the time you submit your information to the United States. If you need further guidance in responding to
the NPDES permitting authority, EPA may make the information Item 1.1,refer to http:llwww.epa.govlgeospatial/latitudelonoitude-
available to the public without further notice to you. EPA will handle data-standard.
claims of confidentiality in accordance with the Agency's business Section 2.Discharge Date
confidentiality regulations at Part 2 of Title 40 of the Code of
Federal Regulations(CFR). Item 2.1.Indicate whether you are a new or an existing discharger.
Completion of Forms If you are an existing discharger,skip to Section 3 after completing
this item.
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 Item 2.2.Indicate the date on which the facility will or is estimated
additional sheets,as necessary, using a format consistent with the to commence discharge.
form. Section 3.Waste Types
Provide your EPA Identification Number from the Facility Registry Item 3.1.Indicate the general type(s)of wastes being discharged or
Service, NPDES permit number, and facility name at the top of to be discharged,depending on whether you are an existing or new
each page of Form 2E and any attachments. If you do not know discharger. If you mark the response"Other Nonprocess
your EPA Identification Number,contact your NPDES permitting Wastewater,"specify the nature of your discharge.
authority.See Exhibit 1-1 of Form 1's"General Instructions"for
contact information. Item 3.2.Indicate if the facility uses cooling water additives.If yes,
Do not leave any response areas blank unless the form directs you continue. If no,skip to Section 4.
to skip them. If the form directs you to respond to an item that does Item 3.3.List the cooling water additives being used(or to be used)
not apply to your facility or activity,enter"NA"for"not applicable"to and specify the composition of the additives,if such information is
demonstrate that you considered the item and determined a available to you.You can generally find composition information on
response was not necessary for your facility. product labels or from manufacturers'data sheets.
The NPDES permitting authority will consider your application Section 4.Effluent Characteristics
complete when it and any supplementary material are received and Items 4.1 to 4.8.These items require you to collect and report data
completed according to the authority's satisfaction.The NPDES for the parameters and pollutants listed in Section 4.The
permitting authority will judge the completeness of any application instructions are distinct for applicants with existing discharges
independently of the status of any other permit application or permit
for the same facility or activity. versus applicants that are new.
Definitions Important note: Read the"General Instructions for Reporting,
Sampling,and Analysis"on pages 2E-3 and 2E-4 before
The legal definitions of all key terms used in these instructions and completing Section 4.
Form 2E are in the"Glossary"at the end of the"General
Instructions"in Form 1.
2E-1

FORM 2E—INSTRUCTIONS CONTINUED
Item 4.1.Indicate whether you have completed monitoring for all limitations. If you wish to demonstrate your eligibility for a"net"
parameters in the table under Item 4.2 and attached it to the effluent limitation(i.e.,an effluent limitation adjusted to provide
application package. If you answer"No"because you have credit for the pollutant(s)present in your intake water)add a short
requested a waiver from your NPDES authority,skip to Section 5. If statement as to why you believe you are eligible.See also 40 CFR
"Yes,"continue to Item 4.2. 122.45(g).You will be contacted by the NPDES permitting authority
Item 4.2.Provide the sampling data requested in the table per the with further instructions.
"General Instructions for Reporting,Sampling,and Analysis"for Section 8.Checklist and Certification Statement
biochemical oxygen demand (BOD),total suspended solids(TSS), Item 8.1.Review the checklist provided on the application. In
oil and grease,ammonia(as N),flow,pH,and temperature(winter Column 1, mark the sections of Form 2E that you have completed
and summer). and are submitting with your application. For each section in
Item 4.3.Answer whether you believe fecal coliform to be present Column 2,indicate whether you are submitting attachments.
in your discharge or whether sanitary waste is discharged(or will be Item 8.2.The Clean Water Act(CWA)provides for severe penalties
discharged). If you answer"No,"skip to Item 4.5.Otherwise, for submitting false information on this application form.CWA
continue to Item 4.4. Section 309(c)(2)provides that"Any person who knowingly makes
Item 4.4.Provide the sampling data requested in the table per the any false statement,representation,or certification in any
"General Instructions for Reporting,Sampling,and Analysis"for application, ...shall upon conviction,be punished by a fine of no
fecal coliform,Escherichia coli(E. col!),and enterococci. more than$10,000 or by imprisonment for not more than six
Item 4.5.Indicate whether chlorine is used(or will be used). If no, months,or both."
skip to Item 4.7.Otherwise,continue to Item 4.6. FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
Item 4.6.Provide the sampling data requested in the table per the APPLICATION TO BE SIGNED AS FOLLOWS:
"General Instructions for Reporting,Sampling,and Analysis"for A. For a corporation, by a responsible corporate officer. For the
total residual chlorine. purpose of this section,a responsible corporate officer means:
Item 4.7.Answer whether non-contact cooling water is(or will be) (1)a president,secretary,treasurer,or vice-president of the
discharged from your facility. If no,skip to Section 5. If yes, corporation in charge of a principal business function,or any
continue to Item 4.8. other person who performs similar policy-or decision-making
Item 4.8.Provide the sampling data requested in the table per the functions for the corporation,or(2)the manager of one or
"General Instructions for Reporting,Sampling,and Analysis"for more manufacturing, production,or operating facilities,
chemical oxygen demand(COD),and total organic carbon(TOC). provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
Section 5.Flow including having the explicit or implicit duty of making major
Item 5.1.Indicate whether any of the discharges that you described capital investment recommendations,and initiating and
in Sections 1 and 3(except for stormwater runoff,leaks,or spills) directing other comprehensive measures to assure long term
are intermittent or seasonal. If yes,continue to Item 5.2. If no,skip environmental compliance
with environmental laws and
to Section 6. regulations;the manager can ensure that the necessary
Item 5.2.Describe the average frequency of flow and duration of systems are established or actions taken to gather complete
any intermittent or seasonal discharge(except for stormwater and accurate information for permit application requirements;
runoff,leaks,or spills)in gallons or million gallons per day(gpd or and where authority to sign documents has been assigned or
mgd),whichever is appropriate.The frequency of flow is the delegated to the manager in accordance with corporate
number of days or months per year there is an intermittent procedures.
discharge. Duration is the number of days or hours per discharge. B. For a partnership or sole proprietorship,by a general partner
For new dischargers,report your best estimate. or the proprietor,respectively.
Section 6.Treatment System C. For a municipality,state,federal,or other public facility,by
Item 6.1.Briefly describe any treatment system(s)used(or to be either a principal executive officer or ranking elected official.
used for new dischargers), indicating whether the treatment system For purposes of this section,a principal executive officer of a
is physical,chemical,biological,sludge and disposal,or other.Also federal agency includes:(1)The chief executive officer of the
give the particular type(s)of process(es)used(or to be used). For agency,or(2)a senior executive officer having responsibility
example,if a physical treatment system is used(or will be used), for the overall operations of a principal geographic unit of the
specify the processes applied(or to be applied),such as grit agency(e.g., Regional Administrators of EPA).
removal,ammonia stripping,dialysis,etc. END
Section 7.Other Information Submit your completed Form 1,Form 2E,and
Item 7.1.OPTIONAL ITEM. Report any additional information or all associated attachments
data(such as sampling results)that you believe the NPDES (and any other required NPDES application forms)
permitting authority should consider when establishing permit to your NPDES permitting authority.
2E-2

Analysis
I
General Instructions for Reporting,Sampling,and An a y
Important note: Read these instructions before completing Section If you have sampling and analysis questions,direct them to your
4 of Form 2E. NPDES permitting authority.The authority may request that you do
General Items additional testing,if appropriate,on a case-by-case basis under
CWA Section 308.
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number,NPDES permit number, New Dischargers
facility name,and applicable outfall number at the top of each page You must provide maximum daily and average daily discharge
of any associated attachments. estimates for the parameters or pollutants listed in Section 4,unless
You may report some or all of the required data by attaching specifically indicated on the form. Note that if you have the results
separate sheets of paper instead of completing Section 4 for each of actual analyses for the listed parameters or pollutants,you are
of your outfalls so long as the sheets contain all of the required required to report those results rather than submit estimates.
information and are similar in format to Section 4. Report or estimate all parameter or pollutant levels as concentration
Reporting of Effluent Data and as total mass,except for flow,pH,and temperature.Indicate
Report pollutant levels for all pollutants in Section 4 as the source of all estimates in the appropriate column in the
concentration and total mass,with the exception of flow,pH,and
Section 4 tables using the engineering study codes below. Note
temperature.Total mass is the total weight of pollutants that you are required to conduct follow-up testing and reporting no
discharged over a day. later than two years once your facility commences discharge.
Engineering Report Codes
Flow,temperature,pH,and fecal coliform organisms must be g g p
n
reported as mgd,degrees Celsius( C),standard units,and most Actual data from pilot plants 1
probable number per 100 milliliters(MPN/100 mL),respectively. Estimates from other engineering reports 2
Use the following abbreviations in the columns requiring"units"in Data from other similar plants 3
Section 4. Best professional estimates 4
Concentration Mass Others specify on the form
ppm=parts per million lbs=pounds Base your determination of whether a pollutant will be present in
mg/L=milligrams per liter ton=tons(English tons) your discharge on your knowledge of the proposed facility's use of
ppb=parts per billion mg=milligrams maintenance chemicals and any analyses of your effluent or of any
similar effluent.You may also provide the estimates based on
pglL=micrograms per liter g=grams available in-house or contractor engineering reports or any other
MPN=most probable number per kg=kilograms studies performed on the proposed facility.
100 milliliters T=tonnes(metric tons)
Pollutants Solely in Intake Water
Existing Dischargers If you expect a pollutant to be present solely because of its
You must provide at least one analysis for each parameter or presence in your intake water,you must still provide an estimate or
pollutant,including the following:BOD,TSS,oil and grease, analytical result in Section 4;however,you should indicate in
ammonia(as N),fecal coliform including E.coil and enterococci(if Section 7 in Item 7.1 that you believe the pollutant or parameter to
believed present or if sanitary waste is or will be discharged),total be present only due to its presence in your source water.See the
residual chlorine(if chlorine is or will be used),COD,and TOC(if instructions under Item 7.1.
non-contact cooling water is or will be discharged),discharge flow, Testing Waivers
pH,and temperature(winter and summer).
You may report quantitative data that you have collected over the The NPDES permitting authority may waive the testing and
past 365 days if they are representative of your current operations. reporting requirements for flow or any of the pollutants listed in
The data reported must include maximum daily discharge,average Section 4 if you submit a written request for such a waiver before
daily discharge,and number of analyses.Most existing facilities or with your application.Contact your NPDES permitting authority
routinely monitor the pollutants and parameters listed in Section 4 for more information.
as part of their existing NPDES permit requirements. Sampling
You must collect and analyze samples in accordance with 40 CFR The collection of samples for the reported analyses should be
136.Grab samples must be used for analyses of pH,temperature, supervised by a person experienced in performing sampling of
total residual chlorine,oil and grease,fecal coliform(including E. industrial wastewater.You may contact your NPDES permitting
coli),and enterococci(previously known as fecal streptococcus) authority for detailed guidance on sampling techniques and for
and volatile organic compounds.Twenty-four-hour composite answers to specific questions.See Exhibit 1-1 of Form 1 for
samples must be used for all other pollutants,using at least four contact information.Any specific requirements in the applicable
grab samples unless otherwise specified at 40 CFR 136.For a analytical methods—for example,sample containers,sample
composite sample,only one analysis of the composite of aliquots is preservation,holding times,and the collection of duplicate
required. samples—must be followed.
2E-3

General Instructions for Reporting,Sampling,and Analysis Continued
The time when you sample should be representative of your normal • The method has the lowest ML of the analytical methods
operation,to the extent feasible,with all processes that contribute approved under 40 CFR 136 or required under 40 CFR
wastewater in normal operation,and with your treatment system chapter I,subchapter N or 0 for the measured pollutant or
operating properly with no system upsets.Collect samples from the pollutant parameter.
center of the flow channel,where turbulence is at a maximum,at a
site specified in your present NPDES permit,or at any site Consistent with 40 CFR 136,you may provide matrix-or sample
specific MLs rather than the published levels. Further,where you
adequate for the collection of a representative sample.
can demonstrate that,despite a good faith effort to use a method
Analysis that would otherwise meet the definition of"sufficiently sensitive,"
Except as specified below,all required quantitative data shall be the analytical results are not consistent with the quality assurance
collected in accordance with sufficiently sensitive analytical (QA)/quality control(QC)specifications for that method,then the
methods approved under 40 CFR 136 or required under 40 CFR NPDES permitting authority may determine that the method is not
chapter I,subchapter N or 0.A method is"sufficiently sensitive" performing adequately and the NPDES permitting authority should
when: select a different method from the remaining EPA-approved
methods that is sufficiently sensitive consistent with 40 CFR
• The method minimum level(ML)is at or below the level of the 122.21(e)(3)(i).Where no other EPA-approved methods exist,you
applicable water quality criterion for the measured pollutant or must select a method consistent with 40 CFR 122.21(e)(3)(ii).
pollutant parameter. When there is no analytical method that has been approved under
• The method ML is above the water quality criterion,but the 40 CFR 136;required under 40 CFR chapter I,subchapter N or 0,
amount of the pollutant or pollutant parameter in the facility's and is not otherwise required by the NPDES permitting authority,
discharge is high enough that the method detects and you may use any suitable method but shall provide a description of
quantifies the level of the pollutant or pollutant parameter in the method.When selecting a suitable method,other factors such
the discharge. as a method's precision,accuracy,or resolution,may be
considered when assessing the performance of the method.
2E-4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
U.S.Environmental Protection Agency
FORM = EPA Application for NPDES Permit to Discharge Wastewater
2E
NPDES MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURAL FACILITIES WHICH
DISCHARGE ONLY NONPROCESS WASTEWATER
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(h)(1))
1.1 Provide information on each of the facility's outfalls in the table below. 1
o
Outfall Receiving Water Name Latitude Longitude
— Number
U
0 001 UT to Filbert Creek 36° 06 65 N -76° 61' 42" W
I J
a) ° , u ° , „
7
0
SECTION 2.DISCHARGE DATE(40 CFR 122.21(h)(2))
w 2.1 Are you a new or existing discharger?(Check only one response.)
CO
a' 0 New discharger 0 Existing discharger 4 SKIP to Section 3.
h 2.2 Specify your anticipated discharge date:
0
SECTION 3.WASTE TYPES(40 CFR 122.21(h)(3))
3.1 What types of wastes are currently being discharged if you are an existing discharger or will be discharged if you are a
new discharger?(Check all that apply.)
❑ Sanitary wastes ❑✓ Other nonprocess wastewater(describe/explain
❑ Restaurant or cafeteria waste directly below)
n ❑ Non-contact cooling water Backwash from Ion Exchange Filter
3.2 Does the facility use cooling water additives?
❑ Yes 0 No 4 SKIP to Section 4.
3.3 List the cooling water additives used and describe their composition.
Cooling Water Additives Composition of Additives
(list) (if available to you)
SECTION 4.EFFLUENT CHARACTERISTICS(40 CFR 122.21(h)(4))
4.1 Have you completed monitoring for all parameters in the table below at each of your outfalls and attached the results to
this application package?
❑✓ Yes ❑ No;a waiver has been requested from my NPDES permitting authority
(attach waiver request and additional information)4 SKIP to Section 5.
4.2 Provide data as requested in the table below.' (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
H Parameter or Pollutant Analyses Discharge Discharge (use codes
'� (if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. instructions)
E.
Biochemical oxygen demand(BOD5) N/A N/A N/A N/A N/A N/A
r Total suspended solids(TSS) 24 N/A 2.8 mg/L N/A 0.12 mg, N/A
tu
Oil and grease N/A N/A N/A N/A N/A N/A
w Ammonia(as N) 12 N/A 0.23 mg/L N/A 0.05 mg/ N/A 1
Discharge flow Continuous 0.13 mgd N/A
pH(report as range) 24 7.36-8.25 su N/A
Temperature(winter) 4 19 deg.c N/A
Temperature(summer) 4 23.3 deg.c N/A
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 I
parameters or required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2E(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
4.3 Is fecal coliform believed present,or is sanitary waste discharged(or will it be discharged)?
❑ Yes ❑✓ No 4 SKIP to Item 4.5.
4.4 Provide data as requested in the table below.' (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (Use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. Instructions.)
Fecal coliform
d
E.coli
c
c_ Enterococci
0 4.5 Is chlorine used(or will it be used)?
,w El 0 No 4 SKIP to Item 4 7
y 4.6 Provide data as requested in the table below.' (See instructions for specifics.)
5 Number of Maximum Daily Average Daily Source
o Parameter or Pollutant Analyses Discharge Discharge (use codes
- (if actual data (specify units) (speci units) per
.E. reported) Mass Conc. Mass Conc. instructions)
= Total Residual Chlorine 24 N/A 105 ug/L N/A 17.6 ug/ N/A
w 4.7 Is non-contact cooling water discharged(or will it be discharged)?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.8 Provide data as requested in the table below.1 (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. instructions)
Chemical oxygen demand(COD)
Total organic carbon(TOC)
SECTION 5.FLOW(40 CFR 122.21(h)(5))
5 1 Except for stormwater water runoff,leaks,or spills,are any of the discharges you described in Sections 1 and 3 of this
application intermittent or seasonal?
❑ Yes 4 Complete this section. ❑✓ No. SKIP to Section 6.
c 5.2 Briefly describe the frequency and duration of flow.
SECTION 6.TREATMENT SYSTEM(40 CFR 122.21(h)(6))
6.1 Briefly describe any treatment system(s)used(or to be used).
E
NWater Treatment Plant sourced by groundwater.An Ion Exchange filter is used to soften the water.The water is
cn chlorinated prior to distribution.
c
a>
E
io
m
I
'Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant
parameters or required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2E(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP OMB No.2040-0004
SECTION 7.OTHER INFORMATION(40 CFR 122.21(h)(7))
7.1 Use the space below to expand upon any of the above items. Use this space to provide any information you believe the
reviewer should consider in establishing permit limitations.Attach additional sheets as needed.
' c
0
0
a�
O
SECTION 8.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
8.1 In Column 1 below,mark the sections of Form 2E that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that
not all applicants are required to provide attachments.
Column 1 Column 2
❑✓ Section 1:Outfall Location 0 w/attachments(e.g.,responses for additional outfalls)
0 Section 2:Discharge Date 0 w/attachments
❑✓ Section 3:Waste Types ❑ w/attachments
❑✓ Section 4: Effluent Characteristics ❑ w/attachments
❑ Section 5:Flow ❑ w/attachments
co
o ❑✓ Section 6:Treatment System ❑ w/attachments
`—' ❑ Section 7:Other Information ❑ w/attachments
❑✓ Section 8:Checklist and Certification Statement ❑ w/attachments
-0
° 8.2 Certification Statement
0 /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(pCe))rt
int or type first and last name) Official title
aa,k, /D(.)n /'1 na`/er
Signature Date signed
lZ 2 I /2„,
22
EPA Form 3510-2E(revised 3-19) Page 3

EPA Idenuficaton Number NPDES Permit Number Fac4ty Name Oudall Number Form Approved 03/05/19
OMB No.2040-0004
110009720622 NC0086291 Beaver Hill WTP 001
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
(Optonall
I Waiver Pollutant Requested Units Maximum Maximum ! Long-Term Number of Lon Term Number of
(if applicable)
Daily Monthly Average Daily AnalysesAverage Value
Discharge Discharge Discharge 9 Analyses
(required) (it available) I (if available) I ( .._
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration N/A
1. ❑
(BOD5) Mass N/A
Chemical oxygen demand Concentration N/A
2. ❑
(COD) Mass N/A
Concentration N/A
3. Total organic carbon(TOC) 0
Mass N/A
Concentration mg/L 2.8 N/A 0.12 24
4. Total suspended solids(TSS) 0
Mass N/A
Concentration mg/L 0.23 N/A 0.05 12
5. Ammonia(as N) ❑
Mass N/A
6. Flow ❑ Rate mgd 0.13 N/A 0.021 Continous
Temperature(winter) 0 °C °C 19 N/A 16.9 4
7.
Temperature(summer) 0 °C °C 23.3 N/A 22.6 4
pH(minimum) ❑ Standard units s.u. 7.36
8.
pH(maximum) ❑ Standard units s.u. 8.25
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 9

EPA Identficafon Number NPDES Permit Number Facility Name Outfall Number 1 Form Approved 03105119
OMB No.2040-0004
110009720622 NC0086291 Beaver Hill WTP 001
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optimal)
Units Maximum Long-Term
Pollutant Believed Believed (specify) Maximum Daily) Maximum Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
—_.�f available) Of available)
❑
Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence column of Table C for
each pollutant.
❑
Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the Presence or Absence column of Table C for
each pollutant.
1
Bromide ❑ ❑ Concentration
(24959-67-s) Mass
Chlorine,total Concentration ug/L 105 N/A 17.6 24
2. residual ❑ 0 Mass
3. Color ❑ ❑�
Concentration
Mass
Concentration
4. Fecal coliform ❑ ❑� Mass
6 Fluoride ❑ ❑ Concentration mg/L 0.9 N/A 0.55 12
(1698448-8) Mass
Concentration
6 Nitrate-nitrite ❑ 0 Mass
7 Nitrogen,total ❑ ❑ Concentration
organic(as N) Mass mg/L 2.26 N/A 1.3 4
Concentration
8. Oil and grease 0 0 Mass
9 Phosphorus(as Concentration mg/L 0.0 N/A 0.0 4
El 0
P),total(7723-14-0) Mass
10 Sulfate(as SO4) ❑ ❑ Concentration
(14808-79 8) Mass
11. Sulfide(as S) 0 Concentration
0
Mass
EPA Form 3510.2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Fadlity Name Outfall Number Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill TP 001 OMB No.2040-0004
W
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))t
Presence or Absence
(check one) Effluent Intake
(Op/anal)
Pollutant Units Maximum Long-Term
Believed Believed (speciry) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
(if available) (if available)
12 Sulfite(as S03) ❑ 0 Concentration
(14265.45-3) Mass i
13. Surfactants ❑ 0
Concentration
Mass
14. Aluminum,total ❑ 0
Concentration
(7429-90-5) Mass
15. Barium,total ❑ Concentration
(7440-39-3) Mass
16. Boron,total ❑ ❑ Concentration
(7440-42-8) Mass
17 Cobalt,total ❑ O Concentration
(744048-4) Mass
Iron,total ❑ ❑ Concentration
18. (7439-89-6) Mass
19 Magnesium,total ❑ 0Concentration
(7439-95-4) Mass
Molybdenum, Concentration
20. total 0 0
(7439-98-7) Mass
21 Manganese,total ❑ ❑ Concentration
(7439-96-5) Mass
22 Tin,total El ❑ Concentration
(7440-31-5) Mass
23 Titanium,total ❑ ❑ Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19)
Page 24

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009720622 NC0086291 Beaver Hill WTP 001 OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))'
Presence or Absence Intake
(check one) Effluent optimal)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required)) Discharge Discharge Analyses l Value Analyses
(if available) (if available)
24. Radioactivity
Concentration
Alpha,total 0 0
Mass
Concentration
Beta,total 0 2 Mass
Concentration
Radium,total ❑ 0 Mass
Concentration
Radium 226,total ❑ ElMass
'Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 25

" 4- I
_
•
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_...--__ Outfall001 1 J" shop,-
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- Edenton Bay -
- Dr. Martin Luther King Jr.Ave
' -' (W.Albemarle St)
' Boundary Between - _ ! '
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Town of Edenton - Beaver Hill WTP N
NPDES Permit NC0086291
Dr. Martin Luther King, Jr. Ave., Edenton 27932 "'°°°°°°
Receiving Stream: UT"Filbert Creek"to Edenton Bay
Stream Segment: 26-1 Stream Class: C:NSW 36.0665°N, -76.6142°W
River Basin: Chowan Sub-Basin#: 03-01-04 SCALE NC Grid:C32SE
County: Chowan HUC: 030102050101 1:24.000 USGS Quad: Edenton,NC