NC0022730_Permit Issuance_20180820

ROY COOPER
lio,rnmr
MICHAEL S. REGAN
Seemlary
LINDA CULPEPPER
lmrr/m Dirrc'mr
NORTH CAROLINA
Environmental Quality
August 20, 2018
Mr. Robert Heaton
Public Utilities Director
403 Beech Mountain Parkway
Beech Mountain, NC 28604
Subject: Issuance of NPDES Permit NCO022730
Grassy Gap Creek W WTP
Watauga County
Grade II Biological WPCS
Dear Mr. Heaton:
Division personnel have reviewed and approved your application for renewal of the subject permit.
This permit renewal is issued pursuant to the requirements of North Carolina General Statute 143-215.1
and the Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency dated October 15, 2007 (or as subsequently amended).
This final permit includes no significant changes from the draft permit previously sent to
you on June 27, 2018.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles H. Weaver at telephone number (919)
707-3616.
cc: Central Files
NPDES files
in rely,
Linda Culpepper
Interim Director, Division of Water Resources
ACF�["J
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-707-3600

Permit NCO022730
Grade H Biological Water Pollution Control System [15A NCAC 08G.0302]
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other
lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission, and the Federal Water Pollution Control
Act, as amended, the
Town of Beech Mountain
is hereby authorized to discharge wastewater from a facility located at the
Grassy Gap Creek WWTP
204 Grassy Gap Creek Road
Beech Mountain
Watauga County
to receiving waters designated as Buckeye Creek in the Watauga River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV hereof.
This permit shall become effective October 1, 2018.
This permit and authorization to discharge shall expire at midnight on September 30, 2022.
Signed this day August 20, 2018
4
a Culpepper, 4inte Direct
Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NCO022730
Grade H Biological Water Pollution Control System [15A NCAC 08G.03021
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
The Town of Beech Mountain
is hereby authorized to:
1. Continue operation of an existing 0.08 MGD wastewater treatment system that
includes the following components;
♦ Influent bar screen
♦ Flow equalization
♦ Dual -path aeration basins and clarifiers
♦ Chlorine disinfection
♦ Dechlorination equipment
This facility is located at the Grassy Gap Creek WWTP (204 Grassy Gap Creek
Road, Beech Mountain) in Watauga County.
2. Discharge from said treatment works via outfall 002 at the location specified on
the attached map into Buckeye Creek (Stream Index 8-20-3-(2.5)), a waterbody
currently classified C-Trout waters in the Watauga River Basin.
Page 2 of 6

Permit NCO022730
Grade 11 Biological Water Pollution Control System [15A NCAC 08G.0302]
PART I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning on the effective date of this permit and lasting until expiration,
the Permittee is authorized to discharge via Outfall 002. Such discharges shall be limited
and monitored' by the Permittee as specified below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[eDMR Code]
Monthly
Weekly
Daily
Measurement
Sample
Average
Average
Maximum
Frequency
Type
Sample Location
Flow
[500501
0.08 MGD
Continuous
Recording
Influent or Effluent
BOD, 5-day (20'C)2
C0310
30.0 mg/L
45.0 mg/L
Weekly
Composite
Influent & Effluent
Total Suspended Solids2
[C05301
30.0 mg/L
45.0 mg/L
Weekly
Composite
Influent & Effluent
NH3 as N [CO610]
(April 1 - October 31
11.0 mg/L
33.0 mg/L
Weekly
Composite
Effluent
NH3 as N [CO610]
November 1- March 30
Monitor and Report [mg/L]
Weekly
Composite
Effluent
Fecal Coliform [31616]
(geometric mean
200/100 mt.400/100
mL
Weekly
Grab
Effluent
Total Residual Chlodne3
5W60
28 pg/L
2/Week
Grab
Effluent
Temperature (OC)
00010y
Dail
Grab
Effluent
Total Mercury^
COMER
Monitor and Report [rig/1-1
'/Permit
Grab
Effluent
Total Nitrogen [CO600]
NOz+NO3+TKN
Monitor and Report [mg/L]
po [ � 1
Semi -Annually
y
Composite
polite
Effluent
Total Phosphorus
[CC6651
Monitor and Report [mg/L]
Semi -Annually
Composite
Effluent
pH
00400
> 6.0 and < 9.0 standard units
- -
Weekly
Grab
Effluent
Notes:
1. The permittee shall submit discharge monitoring reports electronically using the
Division's eDMR system [see A. (3)].
2. The monthly average BODS and Total Suspended Solids concentrations shall not exceed
15% of the respective influent value (85% removal).
3. The Division shall consider all effluent TRC values reported below 50 µg/L to be in
compliance with the permit. However, the Permittee shall continue to record and submit
all values reported by a North Carolina certified laboratory (including field certified), even
if these values fall below 50 µg/L.
4. Total Mercury must be sampled once during the permit cycle [see A. (2)].
There shall be no discharge of floating solids or visible foam in other than trace amounts.
Page 3 of 6

Permit NCO022730
Grade II Biological Water Pollution Control System [15A NCAC 08G.03021
A. (2) EFFLUENT MERCURY ANALYSIS
[G.S. 143-215.66]
The Permittee shall provide one effluent mercury analysis, using EPA method 1631E,
in conjunction with the next permit renewal application. The analysis should be
performed within 12 months prior to the application date. Any additional effluent
mercury measurements conducted from the effective date of this permit and up to the
application date shall also be submitted with the renewal application.
If the result of the mercury analysis is not provided with the application, the
application may be returned as incomplete and the Permittee considered non-
compliant.
A. (3) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
[G.S. 143-215.1(b)]
Federal regulations require electronic submittal of all discharge monitoring reports
(DMRs) and program reports. The final NPDES Electronic Reporting Rule was
adopted and became effective on December 21, 2015.
NOTE: This special condition supplements or supersedes the following sections
within Part II of this permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. M.) and Section E. 15.) (a)]
The permittee shall report discharge monitoring data electronically using the NC
DWR's Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for
each month and submitted electronically using eDMR. The eDMR system allows
permitted facilities to enter monitoring data and submit DMRs electronically using
the internet. Until such time that the state's eDMR application is compliant with
EPA's Cross -Media Electronic Reporting Regulation (CROMERR), permittees will be
required to submit all discharge monitoring data to the state electronically using
eDMR and will be required to complete the eDMR submission by printing, signing,
and submitting one signed original and a copy of the computer printed eDMR to the
following address:
NC DEQ / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Page 4 of 6

Permit NCO022730
Grade II Biological Water Pollution Control System [15A NCAC 08G.03021
If a permittee is unable to use the eDMR system due to a demonstrated hardship or
due to the facility being physically located in an area where less than 10 percent of
the households have broadband access, then a temporary waiver from the NPDES
electronic reporting requirements may be granted and discharge monitoring data may
be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by
the Director. Duplicate signed copies shall be submitted to the mailing address
above. See "How to Request a Waiver from Electronic Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the
month following the issuance of the permit or in the case of a new facility, on the last
day of the month following the commencement of discharge.
Starting on December 21, 2020, the permittee must electronically report the following
compliance monitoring data and reports, when applicable:
• Sewer Overflow/Bypass Event Reports;
• Pretreatment Program Annual Reports; and
• Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to
Request a Waiver from Electronic Reporting'° section below).
2. Electronic Submissions
In accordance with 40 CFR 122.410)(9), the permittee must identify the initial
recipient at the time of each electronic submission. The permittee should use the
EPA's website resources to identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated facilities
means the entity (EPA or the state authorized by EPA to implement the NPDES
program) that is the designated entity for receiving electronic NPDES data [see 40
CFR 127.2(b)].
EPA plans to establish a website that will also link to the appropriate electronic
reporting tool for each type of electronic submission and for each state. Instructions
on how to access and use the appropriate electronic reporting tool will be available as
well. Information on EPA's NPDES Electronic Reporting Rule is found at:
http: / /www2.epa.gov/compliance/fmal-national-pollutant-discharge-elimination-
system-npdes-electronic-reporting-rule.
Electronic submissions must start by the dates listed in the "Reporting
Requirements" section above.
3. How to Request a Waiver from Electronic Reoortin¢
The permittee may seek a temporary electronic reporting waiver from the Division. To
obtain an electronic reporting waiver, a permittee must first submit an electronic
reporting waiver request to the Division. Requests for temporary electronic reporting
waivers must be submitted in writing to the Division for written approval at least
sixty (60) days prior to the date the facility would be required under this permit to
begin submitting monitoring data and reports. The duration of a temporary waiver
Page 5 of 6

Permit NCO022730
Grade II Biological Water Pollution Control System [15A NCAC 08G.0302]
shall not exceed 5 years and shall thereupon expire. At such time, monitoring data
and reports shall be submitted electronically to the Division unless the permittee re-
applies for and is granted a new temporary electronic reporting waiver by the
Division. Approved electronic reporting waivers are not transferrable. Only
permittees with an approved reporting waiver request may submit monitoring data
and reports on paper to the Division for the period that the approved reporting waiver
request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver
are found on the following web page:
https: / /deg.nc.gov/about/divisions/water-resources/edmr
4. Sianatory Requirements [Supplements Section B (11.1 (bl and Supersedes
Section B. (11.1 (d)]
All eDMRs submitted to the permit issuing authority shall be signed by a person
described in Part II, Section B. (11.)(a) or by a duly authorized representative of that
person as described in Part II, Section B. (11.)(b). A person, and not a position, must
be delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an
eDMR user account and login credentials to access the eDMR system. For more
information on North Carolina's eDMR system, registering for eDMR and obtaining an
eDMR user account, please visit the following web page:
http://deq.nc.gov/about/divisions/water-resources/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR
system shall make the following certification [40 CFR 122.22). NO OTHER
STATEMENTS OF CERTIFICATION WILL BE ACCEPTED:
"I certify, under penalty of law, that this document and all attachments were
prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
5. Records Retention [Supplements Section D. (6.11
The permittee shall retain records of all Discharge Monitoring Reports, including
eDMR submissions. These records or copies shall be maintained for a period of at
least 3 years from the date of the report. This period may be extended by request
of the Director at any time [40 CFR 122.411.
Page 6 of 6

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Ttaa;r Tnfnrmation for Expedited Permit Renewals
Permit Writer/Date
Charles H. Weaver — 6/14/2018
Permit Number
NC0022730
Facility Name
Grassy Gap Creek WWTP
Basin Name/Sub-basin number
04-02-01
Receiving Stream
Pond Creek
Stream Classification in Permit
C-Trout
Does permit need Daily Max NH3 limits?
No — already resent
Does permit need TRC limits/language?
No — already resent
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Yea - Effluent Mercury Anal sis
Does permit have instream monitoring9
No
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
No
Any permit modifications since last
permit?
None.
New expiration date
9/30/2022
Comments on Draft Permit
➢ Added parameter codes.
➢ Added eDMR footnote to the table.
➢ Added regulatory citations.
➢ eDMR language was added in A.
3.

Weaver, Charles
From: Weaver, Charles
Sent: Friday, August 17, 2018 2:20 PM
To: Mickey, Mike M
Cc: Graznak, Jenny
Subject. FW: DRAFT permit renewal for NCO022730 - now being finalized
Mike — this is a weird situation, and it makes this permit confusing.
The Grassy Gap Creek W WTP couldn't meet limits when they discharged to Grassy Gap Creek, so they relocated the
discharge to Buckeye Creek in 2004. That's why the facility discharges from outfall 002.
The correct receiving stream is for the Grassy Gap Creek WWTP is Buckeye Creek — and that's how it will appear in the
final permit.
CHW
From: Weaver. Charles
Sent: Thursday, June 21, 2018 2:29 PM
To: Mickey, Mike M <[e-mail]>
Subject: RE: DRAFT permit renewal for NCO022730
Thanks, Mike.
I didn't have an electronic copy of the last permit, so I adapted the Buckeye Creek permit for Grassy Gap Creek.
I'll fix those errors before it goes to Notice.
CH W
From: Mickey, Mike M
Sent: Thursday, June 21, 2018 12:44 PM
To: Weaver, Charles <[e-mail]>
Cc: Graznak, Jenny <[e-mail]>; Knight, Sherri <[e-mail]>; Park, Kelli A
<[e-mail]>
Subject: RE: DRAFT permit renewal for NCO022730
Charles— Noticed the following typos on the draft permit for Beech Mtn/Grassy Gap WWTP.
1) The topo map lists the outfall as #002 but the effluent limitations and monitoring requirements page says the
outfall is #001.
2) The cover page of the permit lists Buckeye Creek as the receiving stream. The supplement page lists Grassy Gap
Creek as the receiving stream.

\ 1 NlJ
Outfall 002
PART I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
j15A NCAC 02B .0400 et seq., 02B .0500 et seq.j
During the period beginning on the effective date of this permit and lasting until expiration,
the Permittee is authorized to discharge via Outfall 001. Such discharges shall be limited
and monitored' by the Permittee as speed below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[PCs Code]
Monthly
Weekly
Daily
Measurement
Sample
Sample Location
Average
Average
Maximum
Frequency
Type
Flow
15DO501
0.08 MGD
Continuous
Recording
Influent or Effluent
Town of Beech Mountain
is hereby authorized to discharge wastewater from a facility located at the
Grassy Gap Creek WWTP
204 Grassy Gap Creek Road
Beech Mountain
Watauga County
to receiving waters designated as Buckeye Creek in the Watauga River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV hereof.
This permit shall become effective
This permit and authorization to discharge shall expire at midnight on September 30, 2022.
3

The Town of Beech Mountain
is hereby authorized to:
1. Continue operation of an existing 0.08 MGD wastewater treatment system that
includes the following components;
♦ Influent bar screen
♦ Flow equalization
♦ Dual -path aeration basins and clarifiers
♦ Chlorine disinfection
♦ Dechlorination equipment
This facility is located at the Grassy Gap Creek WWTP (204 Grassy Gap Creek
Road, Beech Mountain) in Watauga County.
2. Discharge from said treatment works via outfall 002 at the location specified on
the attached map into Grassy Gap Creek (Stream Index 8-20-3-(2.5)), a waterbody
currently classified C-Trout waters in the Watauga River Basin.
Mike Mickey
Division of Water Resources
Department of Environmental Quality
336-776-9692 office
mike.mickev@ ncdenr.Rov
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Graznak, Jenny
Sent: Thursday, June 21, 2018 9:16 AM
To: Knight, Sherri <[e-mail]>
Cc: Mickey, Mike M <[e-mail]>
Subject: FW: DRAFT permit renewal for N00022730
Importance: High
3

From: Weaver, Charles
Sent: Wednesday, June 20, 2018 3:17 PM
To: Graznak, Jenny <[e-mail]>; Kinney, Maureen <[e-mail]>
Subject: DRAFT permit renewal for NCO022730
Importance: High
The attached draft will go to Public Notice on 6/27/2018. This is a class WW-2 facility in Watauga County.
Please send me any comments by July 2&.
As always, thanks for your help
Charles H. Weaver
Environmental Specialist
N.C. Division of Water Resources
N.C. Department of Environmental Quality
919-807-6391
ch arles.weaver(a) ncden r. gov
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties.

AFFIDAVIT OF PUBLICATION
Acct. Name: NORTH CAROLINA-WATAUGA COUNTY
DEQ - DIVISION OF WA Before the undersigned, a Notary Public of said County
and State, duly commissioned, qualified and authorized by the
Acct. # 265236 law to administer oaths, personally appeared:
COST OF PUBLICATION \\
`J G cC ,e7.- k1A 4p o e'
Total $274.40
Who being first duly sworn, deposes and says: that he (she) is
REPRESENTATIVE
of a newspaper known as THE WATAUGA DEMOCRAT, publishe
issued and entered as second class mail in City of Boone,
in said County and State; that he (she) is authorized to make
this affidavit and sworn statement; that the notice of other legal
advertisement, a true copy of which is attached hereto, was
published in THE WATAUGA DEMOCRAT the following dates
ver
WASTEWATER PERMIT
07/01 /2018
and that the said newspaper in which such notice, paper,
document or legal advertisement was published was, at the time
of each and every such publication, a newspaper meeting all of
the requirements and qualifications of Section 1-597 of the
General Statutes of North Carolina and was a qualified
newspaper within the meaning of Section 1-597 of the General
Statutes of North Carolina.
This 3rd day ofl/J1�
2Q� W RYd day ofuly, 2018
Sworn J 3d before me, this
Z_
_ z o
PV�J Notary Public
K,ihr�►M "a1
��''gTgUGAO'��'�, My Commission Expires: �%' -21

Public Notice
North Carolina
Environmental Management
Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environ-
mental Management. Commis-
sion proposes to issue a
NPDES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit will
be accepted until 30 days after
the publish date of this notice.
The Director of the NC Division
of Water Resources (DWR)
may hold a public hearing
should there be a significant de-
gree of public interest. Please
mail comments and/or informa-
tion requests to DWR at the
above address. Interested per-
sons may visit the DWR at 512
N. Salisbury Street, Raleigh,
NC to review information on file.
Additional information on
NPDES permits and this notice
may be found on our website:
http://deq.nc.gov/abouVdivi-
siona/water-resoumes/water-re-
sourcm-permits/wastewater-
branch/npdes-wastewater/pub-
lic-notices,or by calling (919)
807-6397. Town of Beech
Mountain requested renewal of
permit NC0022730/Grassy Gap
Creek WWTP/Watauga County.
Facility discharges to Buckeye
Creek/Watauga River Basin.
Currently, ammonia nitrogen,
fecal coliform, and total residual
chlorine are water quality limit-
ed. Water Resources Manage-
ment requested renewal of
NPDES permit NC0089036/pro-
posed NC Highway 105
WWTP/Watauga County. This
discharge would be to the
Watauga River/Watauga River
Basin. Currently BOD, total
suspended solids, ammonia ni-
trogen, dissolved oxygen, and
fecal colform are water -quality
limited. Smoketree lodge re-
quested renewal of permit
NC0049174/Watauge County.
Facility discharges to the
Watauga River/Watauga River
Basin. Currently BOD, ammonia
nitrogen, total suspended
solids, dissolved oxygen, fecal
coliform, and total residual chlo-
rine are water quality limited.

Grzyb, Julie
From: Grzyb, Julie
Sent: Tuesday, May 02, 2017 12:06 PM
To: 'Davis, Molly'
Subject: RE: permit applications from Beach Mountain
Molly,
We need both permits, appreciate your help on this. G) VA
Thanks, V
Julie f '�
Julie A Grzyb
Supervisor
NPDES Complex Permitting
NC DEQ / Division of Water Resources / Water Quality Permitting
New 919 807 6390 office
919 707 9000 main office
iulie.grzvb(a ncdenr.gov
Physical Address: 512 North Salisbury St., Raleigh, NC, 27604
Mailing Address: 1617 Mail Service Center, Raleigh, NC, 27699-1617
t:' /'Nothing Compares,
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Davis, Molly [mailto:[e-mail]]
Sent: Tuesday, May 02, 2017 9:34 AM
To: Grzyb, Julie <[e-mail]>
Subject: permit applications from Beach Mountain
JJc- owe. Jr-
ray-
i-iZ��
I received paper copies of permit renewal documents from Beach Mountain for their Grassy Gap W WTP (NC0022730) and
Pond Creek WWTP (NC0069761) facilities. I'm not sure why the facility sent these directly to us but wanted to make sure you
had them. Let me know if you need them and I'll pdf the files and then put the paper copies in the mail to you.
Molly Davis
Chief, NPDES Permitting Section
61 Forsyth St SW 15T37
Atlanta, GA 30303
404.562.9236 (office)
404.562.9772 (fax)

Council Members
E. 'R&A' lhlkq Mayor
Paul Piquet, Vice Mayor
Renee Castiglione
Wendel Sauer
Rick Owen
BEECH
MOUNTAIN
N O R T H CAROLINA
Eastern America's Highest Town
April 26, 2017
U.S. Environmental Protection Agency
Atlanta Federal Center
61 Forsyth Street, SW
Atlanta, GA 30303-3104
Attention: Permit Contact, Permits Section
Dear Permit Reviewer,
Town Manage
Tim H. Hoaorran
Town Attorney
Stacy C. Eggers W
On behalf of the Town of Beech Mountain,) respectfully submit to you permit renewal
documentation for NPDES Permit No. NC0022730, Grassy Gap Wastewater Treatment Plant for
your review and approval.
Please find enclosed the following:
1. EPA Application Form 1-General Information
2. NPDES Form 2A, Parts Al-Al2
3. NPDES Form 2A, Parts Bl-B6
4. Topographic Map
Please call me at 828-387-9368 if you have any questions. Thank you.
Sin pprjS.or6e,
DonalE.I.T.
403 Beech \lountain Parkway Beech Mountain North Carolina 28604-8012
elephone (828) 38- 4236 Fax (828) 38" 4862
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VI. FACILfTY LOCATION
Beech Mountain, North Carolina
dele of �y
11 POLLUTANTCHARACTERISTI
INSTRUCTIONS Compete A through J to delarmne whadier you need W submit any perm t application fame to the EPA. If you answer yes' m any glaations, you must
submt this form and the sagpblhrorWl form listed In the pererdhess following the question. Mar! in the boa in the MI Islumn a the supplemental form la attached If
you an"" -no' to each question, you need not submit any of these forme. You may answer -no' 9 your activity Is excluded from permit requlramarru; am Secllon C of the
imaouWona. See also. Sedaon D ol the mdiucaons for defnibons of bdd4i temis
Ain
-r
wv
A-
SPECIFICQUESTIONS
SPECIFIC OUESTa3NS
vex
No
AORRM
.act
MO
An�m
A. Is this facility a Publicly owned treatment works which
malts in a discharge to water of the U.S.? (FORM 2A)
�/
X
S Does or will mla fill (either eafsang c, pmposed)
Include a eoncentrted animal Fuming operation or
X
aquatic animal Production facility wtkch mults in a
r
discharge to water of the U.S.? (FORM 23)
C. Is this a faddy who culmntiy results in discharges tc
X
0. is this a proposed fa¢y, (other then moss desmoed in A
ulor
walars of the U.S. other than those described in A or B
B si which will msJt In a discharge to water o1
x
above? (FORM 2C)
1.the
U.S.? (FORM 2D)
E. Does or will this facility beat atom, or dispose of
F. Do you or war you Inject at this facility Industrial or
haxardoue wastes? (FORM 3)
X
municipal effluent below the lowermost eVelum
X
containing, whin ono quarter me of the ". bare,
underground sources of drinking water? (FORM 4)
s�
G. Do you or wdI you inject at this fadrty any Produced water
H. Do you or will you In)ad at the facility fluids for special
I other fluids which am bupm to the wrlace in
connschom wish conventional di or natural gob production,
X
processes such ore mining of sueur by the Fraech process.
solution craning of minerals. in situ mmbustidn of loam
X
Inject fluids used for alhanced recovery of dl or nests
fiat, or recovery of geothermal energy? (FORM 4)
gas, or Inject guide for storage of liquid hydrocarbons?
(FORM 4)
a
p
a
I. Is the facility, a proposed stationary source which M one
J. Is the facility a proposed source which sourwhich Is
ol the 2e industrial categories listed In the Imlrucl arc
�/
x
NOT one a the 25 Industrel calegorea freed In the
v
which wit ponoaay ems 100 tons per year of any str
e
:nsbuclions and which will polan:Mlly emit 25D lens pal
pollutant regulated under the Clean Air Act and may affect
I
I year of any air pollutant mgudmad under the Clem Ain Act
'>
u
or be located in an atMlnmanl arse? (FORM S)
and may effect or be located in an atlainni snail
(FORM 5)
Ill NAME OF FACILITY
sror Grassy Gap WWTP
n
a
n
+
IV FACILITY CONTACT
A NAME B TITLE (Imf.%roc h cad,)
B. PHONE (emu cork AinI
2
Hea on, Robert, ub13c Uti i
ies Director
n
e r r p
V FACILTY MAILING ADDRESS
A. STREET OR P O. BO%
c
3 4 3 Beech Mountain Parkway
ua
e
B. CITY OR TOWN
C STATE D. ZIP CODE
Beech Mountain
C 2116114
4
e
VI FACILITY LOCATION
A STREET, ROUTE NO OR OTHER SPECIFIC IDENTIFIER
c
5 2 4 Grassey Gap reek oad
o
S. COUNTY NAME
Watauga
A
C CITY OR TOWN
D STATE
E. ZIP CODE
F COUNTY CODE r ke mj
6
B e h M LI t i
C I
2 6 4
EPA Form 3510.1 (11.90) CONTINUE ON REVERSE

FIRST
T
C. THIRD D. FOURTH
hprd9 T (wr69
7
I
BIs Me lame bated In Item
VII-A situ the awnel7
a Gary Tipton
O YES m NO
r
C. STATUS OF OPERATOR (Ervirrhirrfruylunirka,11.0 rhramarrbar.
ID. PHONE errs adr6ea
F • FEDERAL M a PUBLIC (mhrr lbn/Nrrvl or rrdrl i+Mrl/9
M
() 387-9724
828
S•STATE
P a PRIVATE O-OTHER HPrch'1
e
E. STREET OR P O. BOX
TTF-I
4 3 Beech ountain Parkway
F CITY R T WN G STATE
H IP CORE
ILX INDIAN LAND
Ie na fadlay bated on IrMun IaMsv
B
Beech Mountain NC
2860I OYES I]NO
4 01
+
EXISTING ENVIRONMENTAL PERMITS ---
PSD An .ut4dam ' u +
A NPRES /Nub SmS claw
g
N
NCO022730
9 P
+
B. UIC (/exit Sandia amnr Fhudr
E. THER + r, J
*ch)
9
U
9
C. RORA Hapn njl'mral
E. OTHER f. c h)
(vrrh'1
9
R
9
XI MAP
Attach to dt a application a topographic map of Me area eMndhq to at least one mile beyond property boundaries. The map must Shoe the out 0 the facility. Me
location of each of in existing and proposed Intake end discharge structure. each of Ito hazardous stoch waste treatment. rage, or disposal facilities. and eawell when it
Injects fluids underground Include all springs. rims, and otter surface wets, bodies In the map sea See instructions for Precise requirements.
XII NATURE OF BUSINESS (provilbae4 dewd i
Municiple wastewater treatment via a wastewater treetement plant discharging eibeluent into Buckeye creek.
Xlll CERTIFICATION free Instructions)
I c,my under peneey of taw Met I hale pamonesy examined and am hMaar wtM she Mlommoon suhmitted in IMa appecsbon and all attachments end Metbased m my
inquiry of Moss persons immedsIsty resportnble for oMa4Yng the urbrmaaw eonblMd in Me, application, I befeva OW OW information is tow. accurats and eemplen. if
am awes the; then are significant penalties M wbmiIling Islas in Maim. iw-4,G nil Me P=Ib,2 of fine and mlonsonmend
A. NAME 8 OFF CIAL TITLE (p'A^ Nmr) 8 SIGNAT C DA ED
Tim H. Holloman, Town Manager
COMMENTS FOR OFFICIAL USE ONLY
I
C
EPA Form 3510-1 15.90)

FACILITY NAME AND PERMIT NUMBER:
3rassey Gap Creek WWTP, NC0022730
BASIC APPLICATION INFORMATION
Form Approved ln4W
OAe fAynbar 206404oee
I PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS: I
All flesh. fft worlu must complete clusetlons A.1 through A.S of this Sash; Appllestion Information packet
A.I. Facility Information.
Facility name
Melling Address
Contact person
Tito
Telephone number
Fadity Address
(rat P.O. Box)
A.Z. Applicant Information. If it* applicant Is diRerenl horn dme above, provide lie following:
•�.es .!r u• r =r
r u
Contact person Tin H. Holloman
Title Town Maneaer
Telephone number (8281387-4236
is the applicant the owner or operator (or both) of the traatmard works?
Xowner operator
Indicate whether correspondence regarding this permit should be directed to the facility or the applicant.
V hdley applicant
A.d. Existing Envhonmantal Pemilts. Provide the permit number of any existkp emim mental pemmis Oat have been issued to the healment
works (Ind ide steraAmed pumas).
NPUES NC0022730 PSD
UIC Other
RCRA
Other
A.a. Collection System Information. Provide information on municipalities and areas served by the fedhly. Provide the name and population of
each entity and, If known, provide Information on the type of collection system (combined vs, separale) and is ownership (muNcipal, pnvas,
etc.),
Name Population Served Type of Collection System Ownership
Total population served
EPA Form 3510-2A (Ray. 1-99) Replacer; EPA forms 7550-8 a 7550-22 Page 2 of 21

FACILITY NAME AND PERMrT NUMBER:
Grasaey Gap Creek WVV TP, NC0022730
A.G. Indian Country.
Foam Approved 1/1"If
Ohm NunWr 204600ae
a, is the treatment works located In Indian Country?
Yes V_ No
b. Does the treatment works discharge to a receiving water that is either in Indian Country or that Is upstream from (and eventually flows
through) Indian Country?
Yes No
A.6. Flow. Indicate the design flow rate of the treatment plant (I a., the wastewater flow rate that the plant was bust to handle). Also provide the
average daily flow rate and maximum dolly flow rate for each of the last three years. Each year's data must be based on a 12mwUn tine
period with the 12th month of 'this year' occumIng no more than three months prior to this application submittal.
a. Design flow rate 0.08 mgd
b. Annual average daily flow rate
C. Maximum daly flow rate
O.D3 0.07 mgd
0.3R 0 07 nqd
A.7. Collection 3ystenu Indicate the types) of Collodion system(s) used by the treatment plant. Check as that apply. Alva estimate the percent
contribution (by miles) of each.
✓ Separate sanitary eewer 100.00 %
Combined storm end sanitary sewer %
A.B. Discharges and Other Disposal Methods,
a. Does the treatment works discharge efsuent to waters of the U.S?
Yen No
If yes, IW how many of each of the following types of discharge points Me treatment works uses:
I. Discharges of treated effluent
1
li. Discharges of untreated or partially treated effluent
III. Combined sewer overflow points
Iv. Constructed emergency overflows (prior to the headworks)
v. Other
b. Does Ma treatment works discharge eMuent to basins, ponds, or other surface
✓
Impoundments that do not have outlets for discharge to "fare of the U.S.7
Yee No
If yes, provide the fclowin9 for each surface Impoundment,
Location:
Annual average daily volume discharged to surface Impoundrnent(s)
mod
Is discharge continuous or Intermittent?
C. Does hiss treatment works lend-appy treated wastewater?
Yee No
If yes, provide the following for each land aockat)on she:
Location:
Number of aces:
Annual average daly volume applied to sae: Mad
Is land application continuous or intermident7
d. Does the treatment works discharge or transport treated or untreated wastewater to another
treatment works?
Yes No
EPA Form 3510.2A (Rev. 1.99) Raplaose EPA tonne 755M 6 7550-22 Page 3 of 21

FACILITY NAME AND PERMIT NUMBER:
3rassey Gap Creek WWTP, N00022730
Fwm Awumd I114W
046 Nurribsr 204p00e8
If yea, describe the meanp) by which the wastewater from the treatment works Is discharged or trannponed to the other tealment
Mike (e.g.. tank truck, pipe).
B transport in by a party other than the applicant, provide
Transposer name:
MaN WAddress:
Contact person.
Tits:
Telephone number.
For each treatment works that receives this dtic write, provide the foeowtng
Name:
Meting Address:
Contact person:
Tole
Telephone number
If known, provide Me NPDES pemW number of the treatment works that receives this discharge.
Provide the average daily flow rate from Me treatment wofka Into the receiving facility. mgd
e. Does the treatment works discharge or dispose of its wastewater Ina manner not Included In
A.B.a through A-B.d above (e.g., underground percolation, well kfacaon)?
if yes, provide the ktAoWng for each disposal method:
Description of method (including location end We of ske(s) it applicable):
Annuel daily volume disposed of by this method:
Is dieposei through this method mmlnuoue or
Intermittent?
Yee 1( No
EPA Form 3510-ZA (Rev. 1-99). Replaces EPA form 7550-8 d 7550-22. Page 4 of 21

FACILITY NAME AND PERMIT NUMBER:
Grassey, Gap Creek WWTP, NCO022730
Form App vmd 1/f4W
0016 NUMsr 204&4W
WASTEWATER DISCHARGED:
if you answered y"" to quastlon A.S.a, complete questions A.0 through A72 onca for each oufalf (Yldudln0 bypass points) trrough
which eAuent (e dbcharged. Do not Include Information on combined sewer overflows In this seclon. if you attmsired'no' to question
A.D.a, go to 11911 B,'AdditionalApplloeon Information for AppII®Ms with a Design Flow Greater than or Equal to 0.1 mgd'
A.9. Dascrlptipn of Outfell.
a. Outall number 002
b. Location Town of Beech Mtlunteln 28604
(Coy Watauga n dappicsw) code)
N
1S
38 degree; 12 minutes 49 seccmds N 81rel Braes 52 minutes 30 semmds W
(Le"e) (L.angnude)
c. Distance from Bhae (t epp9catile) ft.
d. Depth below surface OR applicable) ft.
e. Average daily flow rate mgd
I. Does this outell have elther an Intermittent or a
penodk dledwgo7
If yes, provide the following Information:
Number of lanes per year discharge oa W
Average duration of each dame arge.
Average flow per discharge:
Months In which discharge OW M:
g, Is oudall equipped with a diffuser?
A.10. Deacripdon of Receiving Waters.
e. Name of receiving waler
b. Name of waershed (if known)
Buckeye Creek
Yes No (go to AL9 g.)
26280
8 minutes
mild
A9
Yes No
United States Soll Conservation Service 14-fg0 watershed code (t known):
c. Name of Suft ManegemMUROver Basin Of known): Watauga River Basin
United Stales Geological Survey 8-0lgft hydrologic catabging unit code Of known)
0. Crtllcal low flow of recehdnp steam (H epp9ca01e):
Baits cfs chronic
e. Total hardness of receiving stream at at cal low now (t applicable): _
ds
mgA of CaCO3
EPA Form 3510.2A (Rev, 1.99). Repleats EPA forms 75W-6 D 7550-22. Page 5 of 21

FACILITY NAME AND PERMIT NUMBER:
Farm Approved 1/74W
GmsM Gap Creek VWVTP, NCO022730
Ose Number 2004M
_ _—
A.11. Daacrip8o t of Treatment.
a. What levels of treatment are provided? Check all that apply.
✓ Primary Secondary
Advanced Other. Describe:
b. Indicant the following removal mine (as applicable):
Design BOD6 removal g Design CBDDs removal %
Design SS removal %
Design P removal %
Design N removal %
Other %
c. What type of disinfection le used for the effluent from this ouUell7 If dlslnfeCbDn varka by season, please descMe.
Chlorine
If disinfection Is by chlorination, Is dechlonnatton used for UW outlall? ✓ Yes No
d. Does eM bealrtwnt plent twee post eersaon7 ✓ Yes No
A.12. Effluent Testing Information. All Applicants that discharge to watere of the US must Provide effluent testing data for the following
parameters. Provide the Indicated offluem testing required by the permaeng authority for each outfall throuah which effluent Is
ditchifrood. Do not Include Information on combined sower overflowa In this section. AB Irdormation reported must be based on data
collected through ana"Is conducted wing 40 CFR Part 136 methods. In addition, this dote most comply with DAIOC requirements
of 40 CFR Part 138 and other appropriate OAIOC requirements for standard methods for onstytes not addressed by 40 CFR Part 136.
At a minlmu n, effluent testing date most be based on at lent three samples and must be no mom than four and one-half years spent
Outfall number. 002
PARAMETER MAX6AUM DAILY VALUE AVERAGE DAILY VALUE
Value Untlt Value Units Samples
H Mfrnum
B.20
seas.
_
mum
7.40
seas.
HNumberall
-
Flow Rate
0.03
Temperature ester
14.00
degrees C
Tam ndure b
22.00 degrees C
a maximum dal value
' F d a minlmum
and
POLLUTANT
MAXIMUM DAILY
_
AVERAGE DAILY DISCHARGE
ANALYTICAL
MIL IMDL
DISCHARGE
METHOD
Conc
UMte
_
Cont.
Who
_
Number of
Samples
CONVENTIONAL AND NONCONVENTIONAL COMPOUNDS.
BIOCHEMICAL OXYGEN
60. 05
24.80
m071
8.10
mg/I
52.00
wn205210b
DI]AANO fta one
C806s
FECAL COLIFDRM
64.00
/100t1101
3.D0
/100m01
152.00
TOTAL SUSPENDED SOLIDS SS)
20.00
111ODmo
18.80
/100M91
52.00
END OF PART A.
REFER TO THE APPLICATION OVERVIEW TO DETERMINE WHICH OTHER PARTS OF FORM
2A YOU MUST COMPLETE
EPA Fortes 3510-2A (Rev. 1-99). Replaces EPA forme 7550-8 6 7550-22, Page 6 of 21

FACILITY NAME AND PERMIT NUMBER:
FO11n01ild fnwa
OMB Number 7010-0090
Gmasey Gap Creek Virl N00022730
BASIC APPLICATION INFORMATION
PARTS. ADDITIONAL APPLICATION INFORMATION FOR APPLICANTS WITH A DESIGN FLOW GREATER THAN OR
EQUAL TO 0.1 MOD (100,000 9611110" par day) -
AD applkznts with a design Bow rate > 0.1 mgd must answer questions 6.1 through B.B. NI others go ai Part C (CerUSratlon).
BA. Inflow and Inflttrrtlon. Estimates the average number of gallons per day that flow Into the ternment works from Inflow and/or Infiltration.
10 D00.00 opit
Briefly "plain any steps underway or planned to mfilla a Inflow and 1011"n ion.
2000 reel Of existing sewer pipes hl wearty _
.Replace
132. Topographic Map. Attach to Ilia application a topographic map of the area extending at Waal one milk beyond fariBy, property boundaries.
This map must show the outline of She fadlity and the following Information. (You may submit more San one map S one map time not show
the entire area.)
a. The area surrounding the treatment pkrd, Including as unit processes.
b. The major pipes or other atructumm through which wesavater enter& the treatment works and the pipes or polar structures through which
treated wastewater is discharged from the treatment plant Include outfals from bypass plpkq, If applicable,
c. Each well where wastewater from the bratment plant In Injected underground.
d. Wells, springs, other surface water bodies, eM drinking water wells that ere: 1) within 114 mile of the property boundaries of"treatment
works. and 2) gated In public record or otherwise known to the applicant.
e. Any areas where the sewage sludge produced by the treatment works Is trained, treated, or deposed.
f. If the treatment works recelves waste that Is classified as lazardous under Ile Resource Conservation and Recovery Act (RCRA) by
trucic, rail, or special pipe, show on the map where Sat hazardous waste enters the treatment works and where It is treated, stored, and/or
disposed.
8.3. Procau Flow Dlegrom or Schematic. Provide a diagram showing the processes of the treatment plant ktduding all bypass piping and all
backup power sources or redundancy In the system. Also provide a water balance ahwing as treatment units, Including dslnfecton (e.g,
chlorination and de0plinatun). The water balance must show daM average Bow rates at influent and discharge points and approxi nate dairy
now rates behveen treatment units. Include a brief normative description of the diagram.
BA. Operationfstalmertance Performed by Contractorls).
Ara any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a
contraCW7 _Yea V No
if yea. Est the name, address. telephone number, and status of each contractor and describe the cantractofs responsokkba (attach additional
pages If necessary).
Name:
Melling Address.
Telephone Number.
Responsibilities of Contractor,
B.6. Scheduled lmproverrrnte and Schedule of Implementation. Provide Information on any uncompleted Implementation schedule or
uncompleted plans or improvements mat will aged the wastewater treatment effluent quality, or design rapacity of the treatment works. If the
treatment works has several different Implementation schedules or Is planning several Improvements, submit separate responses to question
8.5 for asc h. (If rwroi, go to question B.B.)
a. List the outall number (assigned In question A.9) or each outks that is covered by this knpkrrontatbn acladula
b. Indicate whether the planned improvements or Implementation schedule era required by loml, State, or Federal agendas.
Yes No
EPA Form 3510.2A (Rev. 1-0). Replaces EPA forme 75506 S 7550-22. Page 7 of 21

FACILITY NAME AND PERMIT NUMBER:
Form Apprewd f/14W
Grassey Gap Creek WWTP, NCO022730
060 Neer 20404oae
c N the answer to 8.5.b N Yes' bnb5y describe, Inckldng new meskratm dairy beow rate (t applicable).
d. Provide dates Imposed by any compliance schedule or any actual dabs of completion for the Implementation steps isled below, as
applicable. For Improvements planned Independently of local. State, or Federal agencies, Indicate planned or acWal completion dales, as
applicable. Indicate dales as accurately as possible.
SUhedWe Aceral Completion
Implementation Slaps MM I DO I YYYY MIA r DO I YYYY
- Begin conslllcticn
-End mrntnrcton
-Begin discharge
- Attain operational level
a. have appropriate pem*Ltlearncee conceming other FWamUStato rquiMmera been obbWod? _Yes —No
Describe briefly:
B.S. EFFLUENT TESTING DATA (GREATER THAN 0.1 MGD ONLY).
Applicants that discharge to webs of the US must provide emsrerd testing date lor the fotlorAng parameter, Provide the indicated of luenl
bsfing required by the permitting authority for each outlay through which ef5uenl Is tlhcheroed. Do not include Information on combined sewer
overflows In this section AN Information reported must be based on data collected through analysis conducted using 40 CFR Part 13e
metlads. In addition, this date must comply with OAQC requirements of 40 CFR Part 135 and other appropriate OAfOC regttlreme lei for
standard methods for analyles not addressed by 40 CFR Pan 135. At a minimum, effluent bebng data must be based on at bast three
pollrbm scans and must be w more Scan tow and one-half years did.
Outial Number.
POLLUTANT
MAXIMUM DAILY
AVERAGE ONLY DISCHARGE
DISCHARGE
Conc. Units
Conn.
Unfb
Number of
ANALYTICAL
MLIMDL
Sami
METHOD
CONVENTIONAL AND NONCONVENTIONAL COMPOUNDS.
AMMONIA (as N)
CHLORINE (TOTAL
RESIDUAL,Ti
DISSOLVED OXYGEN
TOTAL XJELDAHL
NITROGEN
NITRATE PLUS NITRITE
NITROGEN
OIL and GREASE
PHOSPHORUS (rote[)
TOTAL DISSOLVED
SOLIDS (TDS)
OTHER
END OF PART B.
REFER TO THE APPLICATION OVERVIEW TO DETERMINE WHICH OTHER PARTS OF FORM
2A YOU MUST COMPLETE
EPA Form 3510-2A (Rev, 1-Bg) Replaces EPA forms 7550-8 S 7550-22 Pape 6 of 21

FACILRY NAME AND PERIW NUMBER:
Grsssey Gap Creek W WTP, NCO022730
N e
BASIC APPLICATION INFORMATION
PART C. CERTIFICATION
At applicants must complete the Certification Section. Refer lo Instructions to determine who Is an officer for the ptaposas of thb certification. All
eppllcants must complete el applabie aecftu o1 Fomn 2A, as explained h the Applfcabon Ovwvlew. Indicate below which pans of Form 2A you
hew compl and are submitting. By agrwlg it" cor"Witon stetemenL appoiams confirm OW dray have revtewad Form 2A and haw completed
all sections met apoN to the facility for which this application to submitled.
Indicate which parts of Form 2A you have completed and am submhting:
AL Bask: Application Information packet Supplamantal Application Information packet.
Part D (Expanded Effluent Testing Data)
Part E (Toxicity Testing: Blomonitoring Date)
Part F (Industrial User Discharges and RCRA/CERCLA Wastes)
Pen G (Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
I ce" under penalty of law that this documrnt and as attachments were prepared under my direction or supervision In accordance with a system
designed to assure that Qualified personnel property gamer and ewktate the Information submitted. Saud on my Inquiry of the pawn or persona
who menage the system or those pawns directly responsible for gathering tiro Inknmetlon, the Information Is, to the bast of my knowledge and
bet true, accurate, and complete. I am ewers that there am slpnlflanl peneabs for submlbkp tease Information, Incfud" the posslbUny, of fine
and imprisonment for knowing violstkns.
Nome and offldal title TIM H. nager
Signature ---.. —
Telephone number (B26) 3074
Date signed GlD
Upon request of the permitting authority, you must submit any other Information necessary to assess wastewater beatmroM prececes at the treatment
woks or Identify appropriate permitting requirements.
SEND COMPLETED FORMS TO:
EPA Forth 3510-2A (Rev. 1•99). Repla om EPA forms 7550-6 6 7550-22. Page 9 of 21