NC0066958_fact sheet_20230307

FACT SHEET
EXPEDITED - PERMIT RENEWAL
NCO066958
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles Weaver/ March 7, 2023
Permit Number - Class
NC0066958 — Class WW-2
Owner
Jackson County Board of Education
Facility Name
Blue Ridge School WWTP
Type of Waste
100 % domestic
Basin Name/Sub-basin number
Little Tennessee River Basin / 04-04-02
Receiving Stream
Hurricane Creek [segment 2-79-23-2]
Stream Classification in Permit
WS-III Trout HQW
Does permit need Daily Max NH3 limits?
N/A due to massive dilution
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No enforcements since 1990. No limit violations during the last
permit cycle.
Any permit MODS since last permit?
No
New expiration date
October 31, 2027
• Updated eDMR language
• Added monitoring for turbidity to determine
compliance with 15A NCAC 0213.0211.
Changes to current permit?
• Added monitoring for dissolved oxygen to determine
compliance with 15A NCAC 0213.0211
• Added instream monitoring for temperature to
determine compliance with 15A NCAC 0213.0211
• NC0066958 was first issued in November 1986, before
the existence of the HQW rule (15A NCAC 02B.0224).
HQW Rule applicability
The HQW rule lists effluent requirements for new and
expanding discharges. This permit's discharge is not
"new" as defined by the rule. Any expansion to the
discharge would be governed by the HQW rule.
Changes to final permit?
• None

IWC Calculations
NC0066958
Prepared By: Charles Weaver
Enter Design Flow (MGD): 0.01
Enter s7Q10(cfs): 1.5
Enter w7Q10 (cfs): 1.2
Residual Chlorine
Ammonia (NH3 as N)
(summer)
7Q10 (cfs)
1.5
7Q10 (CFS)
1.5
DESIGN FLOW (MGD)
0.01
DESIGN FLOW (MGD)
0.01
DESIGN FLOW (cfs)
0.0155
DESIGN FLOW (cfs)
0.0155
STREAM STD (ug/L)
17.0
STREAM STD (mg/L)
1.0
UPS BACKGROUND LEVEL (l
0
UPS BACKGROUND LEVEL (mg/L)
0.22
IWC (%)
1.02
IWC (%)
1.02
Allowable Conc. (ug/1)
1662
Allowable Conc. (mg/1)
76.5
Ammonia (NH3 as N)
(winter)
7Q10 (CFS)
1.2
Fecal Limit
200/100ml
DESIGN FLOW (MGD)
0.01
(If DF >331; Monitor)
DESIGN FLOW (cfs)
0.0155
(If DF <331; Limit)
STREAM STD (mg/L)
1.8
Dilution Factor (DF)
97.77
UPS BACKGROUND LEVEL (mg/L)
0.22
IWC (%)
1.28
Allowable Conc. (mg/1)
124.1
3/7/2023

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
MEMORANDUM
S ATe
NORTH CAROLINA
Environmental Quality
December 6, 2022
To: Nicole Hairston
NC DEQ / DWR / Public
Asheville Regional Office
From: Charles H. Weaver, Jr.
NPDES Unit
Water Supply
Subject: Review of Draft NPDES Permit NCO066958
Blue Ridge School WWTP
Jackson County
Please indicate below your agency's position or viewpoint on the draft permit and return this
form by January 13, 2022. If you have any questions on the draft permit, please contact me
at 919-707-3616 or via e-mail [[e-mail]].
RESPONSE: (Check one)
51the
Concur with the issuance of this permit provided the facility is operated and maintained properly,
stated effluent limits are met prior to discharge, and the discharge does not contravene the
designated water quality standards.
1-1
Concurs with issuance of the above permit, provided the following conditions are met:
F-1
Opposes the issuance of the above permit, based on reasons stated below, or attached:
Signed N[6r,� f-l&frgftNv Date: 12/07/2022
North Carolina Department of Environmental Quality Division of Water Resources ^�
512 North Salisbury Street 1611 Mail Service Center Raleigh, North Carolina 27699-1611 D �./}j
919.707.9000 o�canouN�iQ�` ��J

PUBLIC NOTICE
North Carolina
Invoice / Affidavit
Environmental Management
Crossroads Chronicle
C
Commission/NPDES Unit
1617 Mail Service Center
P.O. Box 1040 Cashiers North Carolina 28717
Raleigh, NC 27699-1617
Notice of Intent to Issue a
Phone: [phone]
NPDES Wastewater Permit
Fax: [phone]
NCO066958 Blue Ridge School
WTTP The North Carolina
Environmental Management
STATE OF NORTH CAROLINA
Commission proposes to issue a
NPDES wastewater discharge
JACKSON COUNTY
permit to the person(s) listed
below. Written comments
regarding the proposed permit
will be accepted until 30 days
after the publish date of this
AFFIDAVIT OF PUBLICATION Personally appeared before the undersigned, Rachel
notice. The Director of the NC
Division of Water Resources
Hoskins, who having been duly sworn on oath that she is Regional Publisher of
(DWR) may hold a public hearing
The Crossroads Chronicle, and the following legal advertisement was published
should there be a significant
degree of public interest. Please
in The Crossroads Chronicle newspaper, and entered as second class mail in the
mail comments and/or
Town of Cashiers in said county and state; and that she is authorized to make
information requests to DWR at
the above address. Interested
this affidavit and sworn statement; that the notice or other legal
persons may visit the DWR at
advertisement, a true copy of which is attached hereto, was published in The
512 N. Salisbury Street, Raleigh,
NC 27604 to review the
Crossroads Chronicle newspaper on the following dates:
information on file. Additional
information on NPDES permits
and this notice may be found on
NPDES WASTEWATER PERMIT
our website:
hftp://deq. nc.gov/about/divisions/
NCO066958
water- resou rces/water-resou rces-
01 / 11 / 2 0 2 3
permits/wastewater-
b ranch/n pdes-wastewater/public-
document or legal
notices,or by calling (919) 707-
3601. The Jackson County Board
And that the said newspaper in which such notice, paper,
advertisement was published, was at the time of each and every such
Sf Education[39 has talapplied for
Y ]
publication, a newspaper meeting all the requirements and qualifications of
renewal of permit NCO066958 for
Section I-597 of the General Statues of North Carolina and was a qualified
its Blue Ridge School WWTP.
This permitted facility discharges
newspaper within the meaning of the Section I-597 of the General Statues of
treated domestic wastewater to
Hurricane Creek in the Little
North Carolina.
Tennessee River Basin.
Currently fecal coliform and total
residual chlorine are water quality
limited. This discharge may
(� &j
affect future allocations in this
portion of Hurricane Creek.
01-11-2023 #742255
Sworn to and subscribed before me this 12th day of January, 2023
My Commission Expires:
Notary Public
Filed with: NCDENR- DIV WATER RESOURCES
Address: 1617 MAIL SERVICE CENTER RALEIGH NC 27699 ``�����u���►�ly���,'
DTOTAL COST?/$54392 ���\�NNE/j jy ��'�
No .. 01
•m
O� : N/C

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

NPDES Permit Number Facility Name
n , 1 ' o � �`
'
Modified Application Form 2A
Modified March 2021
Form
NC Department of Environmental Quality - Application f NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the instructions My result in denial of the ication.
SECTI1•4
1. BASIC
APPLICATION•• • •• r
1.1
Facility name
`
� 1
Mailing address (street or P.O. box)
City or town
State
ZIP code
vca
NC
3 T�
Contact e (first and last)
Title
Phone number
Email address
c
'
Location addr ss (street, route nu er, or other specific identifier) ❑ Same as mailing address
L49
City or town
State
ZIP code
a� ��-
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
[� Yes ❑ No 4 SKIP to Item 1.4.
Appli ant name
Applicant address (street or P.O. box)
c
City or town
State
ZIP code
Contact name (first an last)
Title
Phone number
Email address
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
Owner ❑ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
acility and applicant
❑ Facility ❑ Applicant (they are one and the same)
1,6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
Existling EnvironmentalPermits
NPDES (discharges to surface
at r
❑ RCRA (hazardous waste)
❑ UIC (underground injection
control)
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
NESHAPs (CAA)
e'
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
404)
Page 1

NPDES Permit Number Facility Name
Modified Application Form 2A
t `C—
' Modified March 2021
1.7
Provide the collections stem information
requested below for the treat nt works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
[-j \cL.
%separate sanitary sewer
Own ❑ Maintain
m
r t C1
1',
% combined storm and sanitary sewer
❑ Own El Maintain
m
K��'1
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
16
% combined storm and sanitary sewer
El Own El Maintain
Q
ElUnknown
❑ Own ❑ Maintain
as
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer ❑ Own ❑ Maintain
N%
combined storm and sanitary sewer ❑ Own ❑ Maintain
c
❑ Unknown ❑ Own ❑ Maintain
Total ; {e
Population (�
�1
Q
Served rC iU
1
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
° 41 °
�J �0 N 1A �°
sewer line in miles
1.8
Is the treatment works located in Indian Country?
,.,�.'
c
e
❑ Yes No
U
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes VNo
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
D . U mgd
Annual Average Flow Rates Actual
a
Two Years Ago
Last Year
This Year
vo;:
0
V mgd
r �� mgd
mgd
"
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
. 10c) 1 mgd
��-% 1L mgd
`Thhiis-YYear
' 1 q mgd
W
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
H
c
Total Number of Effluent Discha a Points by Type
d
rn r—
Treated Effluent Untreated Effluent
Combined Sewer
Constructed
BypassesEmergency
t
Overflows
Overflows
M
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
(�(�
Ou#alls Other Than to Waters of the State of North Cantina
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes VNo 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Discharge Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one}
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
gpd
El Continuous
W
[IIntermittent
s
1.14
Is wastewater applied to land?
2
❑ Yes No + SKIP to Item 1.16.
(n
1.15
Provide the land application site and discharge data requested below.
C
Land Application Site and Discharge Data
Average Daily Volume
Continuous or
m
Location
Size
Applied
Intermittent
check one
acres
gpd
❑ Continuous
0
❑ Intermittent
acres
gp d
El Continuous
ElIntermittent
o
c
acres
d
gpd
❑ Continuous
eo
❑ Intermittent
1.16
Is effluent transported to another facility for treatment pri r to discharge?
El Yes No 4 SKIP to Item 1.21.
0
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page:

NPDES Permit Number Facility Name
Modified Application Form 2A
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receivinq facility.
Receivin IF cility Data
Facility name
Mailing address (street or P.O. box)
c
City or town
State
ZIP code
a
Contact name (first and last)
Title
ffi
Phone number
Email address
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate m d
9 Y 9
CL
!,
0
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
`o
not have outlets to waters of the State of North Carolina e.g., underground percolation, underground injection)?
s
❑ Yes No 4 SKIP to Item 1.23.
1.22
Provide information in the table below on these other disposal methods.
m
Information on Other Disposal Methods
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
a
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
a
acres
9P d
El Continuous
r
❑ Intermittent
0
acres
gp d
❑ Continuous
❑ Intermittent
acres
9p d
[I Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES'permitting authority to determine what information needs to be submitted and when.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Cr
Section 301(h)) 302(b)(2))
Not applicable
�1,24Are
any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the r sponsibility of a contractor?
P Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
o
Contractor name
R
(company name
Mailing
Vo
address
gc5A
street or P.O. box
City, state, and ZIP
r l v
code
Contact name (first and
U
last
Phone number
Email address
EnOlro1*a w
(�{1L� �l
Operational and
CW (Vf� —rc
`-1'
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
' Modified March 2021
SECTION 2. ADDITIONAL INFORMATION (40 CFR 122.210)(1) and (2))
c Outfalls to Waters of the State of North Carolina
c_
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
a�
❑ Yes �No 4 SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume
Daily Volume of Inflow and Infiltration
=erage
and infiltration.
gpd
s~
=
Indicate the steps the facility is taking to minimize inflow and infiltration.
v
0
3
0
c
a2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
0
0
❑ Yes ❑ No
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
o
(See instructions for specific requirements.)
o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
?a
1.
c
d
E
c
2.
E
3.
6
d
v
Cn
4.
v
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled
or Actual Dates of Completion for IMProvements
E
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
Improvement
p
(list outfall
Construction
Construction
Discharge
level
(from above)
number
(MM/DDiYYYY)
(MMIDD/YYYY)
{MM/DDlYYYY)
MMIDDNYYY
S
1.
a�
5
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NY-( T) a enrol -?A -� -k-�I d(,V) Soh I Modified March 2021
SECTION•'
• ON 1 1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number W
Outfall Number
Outfall Number
StateNC�4A
w
Count y
C�-SL+1
City or town
o,
o
Distance from shore
�
Depth below surface
ft.
ft.
ft.
I
{
Average daily flow rate
mgd
mgd
mgd
Latitude
© + LAC)
°
Longitude
33 o -.' Q3Q5
°
3.2
perio
Do any of the outfalls described under Item 3.1 have seasonal or c discharges?
1
n
❑ Yes No 4 SKIP to Item 3.4.
m
R
3.3
If so, provide the following information for each applicable outfall.
P 9 � PP
s
a
Outfall Number
Outfall Number
Outfall Number
Number of times per year
'a.
discharge occurs
a
Average duration of each
o
discharge (specify units
flow of each
mgd
mgd
mgd
cAverage
discharge
Months in which discharge
cn
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes [/No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type
at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
a"
N
G
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
0
Ca :::5
3.6
one or more discharge points?
d
1O �
'
Yes ❑ No -SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name
Modified Application Form 2A
(� p —5` C `
( Modified March 2021
of G
3.7
Provide the receiving water and
related information if known
for each ou all..
WWI Number �
Outfall Number
Outfall Number
Receiving water name
�Au' ' e
Name of watershed, river,
o`
or stream system
V
��-
U.S. Soil Conservation
Service 14-digit watershed
i
code
Name of state
10W-e 21111�55e�2
$
management/river basin
51
cam:
>i._
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment provided
for discharges from each
outfall.
Outfall NumberUA _
Outfall Number
Outfall Number
Highest Level of
VPrimary
❑ Primary
El Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
Design Removal Rates by
TI
Outfall
BOD5 or CBOD5
%
%
%
TSS
%
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
[INot applicable
ElNot applicable
[I Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number Facility Name
Modified Application Form 2A
n e I U
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in th44able below. If disinfection varies by
`-
season, describe below.
a
c
0
OutfaN Number ,
Outfall Number
WWI Number
Disinfection type
av \uxY )
a-
R C%lilSr'1 %f-
�-
Seasons used
AA n -1 CAC)
ec:ur r
Dechlorination used?
❑ Not applicable
❑ Not applicable
pp
❑ Not applicable
,�,/
I� Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have ou completed monitoring for all Table A parameters and attached the results to the application package?
Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
dischar es by outfall number or of the receiving water near the discharge points,
OutFall Number
Outfalf Number
Uu#fali"Nur
Acute
Chronic
Acute
Chronic
Acute `
Chronic
•`
Number of tests of discharge
water
"
Number of tests of receiving
water
3.14
Does thef6TVV'use chlorine for diiinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
t Yes + Complete Table B, including chlorine. No Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
❑ Yes No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests fo ne year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes Del', 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No + Provide results in Table E and SKIP to
Item 3.26,
3.21
Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Summary of Results
A,
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity.
s
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
Not applicable because previously submitted
❑ Yes information to the NPDES ermittin authority .
Page 9

([�\ NPOES Ram, t NU!71tSEf F&day Nampa Abate A€:pSc cation Form 2A
•*1
Is iffam m t t
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments 'hat you are enclosing to ales the permitting authorty Note that not
all ap ts are required to Rrovide attachments.
"MPA,
Column
a
F y.
Section 1: Basic Application
Information for All Applicants
❑ ` variance request(s) ❑ wi additional attachments
Section 2: Additional
❑ wt topographic map ❑ wt process flour diagram
Information
❑ wl additional attachments
3: Information on
wl Table A ❑ mt Table C
❑
Effluent
EenDischargesSe uen
l wl Table 8 ❑ wl additional attachments
❑ wl Table C
Section 4; Not Applicable
Section 5: Not Applicable
Section 6: Checklist and
El Certification Statemnte
❑ wf attachments
6.2
Certification Statement
l certify under penalty offaw that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualif€ed personnel property gather and evacuate 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, 1 am aware that there are significant penalties for submitting false information, including the possibility of fine
;i
and imprisonment for knowing violations,
Name (print or type first and last name)
Official title
Davia
f'
Sig ure
Hate signed
Page 10

NPDES Permit Number I Facility Name I Outfall Number Modified Application Form 2A
r . _ . . �+.C� `a.2i. Y) a C_.i �� r r I Modified March2021
Maximum Daily Discharge.
w
_ Average Daily Discharge Analytical
ML ar iNOL
Pollutant
Value Units
Value Units Number of Method'
�5a 171 rS i0 s�'
(include units)
n Ml
11 A14o
Bio hemical oxygen demand
l OD5 or ❑ CBODe
(report one)
Fecal coliform
r
�� l_
�-�
CF7U
(LZWIL.
OM
Design flow rate _--
•OD k to
r-1 A G
S(�
• Uv, a
pH (minimum)
•a
pH (maximum)
S�
Temperature (winter)
' �--
©G
D
Temperature (summer)
Total suspended solids (TSS)
MI (L
n iG L
'5r>1a5��DD-2t ( li
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved undel'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).
Page 11