The URL can be used to link to this page

Home My WebLink AboutNC0081426_Fact Sheet_20230208DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 DENR / DWR / NPDES EXPEDITED FACT SHEET - NPDES PERMIT DEVELOPMENT NPDES Permit NCO081426 Emily Richards, Compliance & Expedited Permitting Unit / 919-707-9125 Oct 2021 & Sept 2022 Facility Information Applicant/Facility Name City of Greensboro- N.L. Mitchell WTP Applicant Address P.O. Box 3136, Greensboro, NC 27402 Facility Address 1041 Battleground Avenue, Greensboro, NC 27408 Permitted Flow (MGD) Not limited Type of Waste Water Plants and Water Conditioning Discharge Facility Class PC-1 County Guilford Permit Status Renewal Regional Office WSRO Stream Characteristics I Receiving Stream North Buffalo Creek Stream Classification WS-V; NSW Stream Segment 16-11-14-1 Drainage basin Summer 7Q10 (cfs) 0.06 Subbasin 03-06-02 Winter 7Q10 (cfs) 0 303(d) Listed Yes- benthos 30Q2 (cfs) 1.9 Average Flow (cfs) 0 IWC (%) 100% Facility Summary This facility is a conventional water treatment plant with discharge of wastewaters backwashed from filters after the filter backwashing process and settling in sedimentation basins with a design potable flowrate of 24.0 MGD and a current maximum, monthly average wastewater discharge of 0 MGD based on data from this past permit cycle. Because the waste flow is >0.050 MGD, continuous flow monitoring is required. This process waste system is a binary discharge, sending effluent to either a Sanitary Sewer collection system or to the NPDES permitted outfall. During this permit cycle (2016-2021), all wastewater was sent to the sanitary sewer collection system This was due to hydraulic restraints inherent to the process as well as ongoing capital improvement construction projects on the site. NDPES discharge is expected again in the future. Construction of the new system is slated to begin June of 2022 with an expected duration of 18 months. Monthly average FLOW (MGD) — this treatment system has not discharged in the past 36 months at the date of this issuance Toxicity — no results Renewal Summary — • Added facility classification above effluent table Fact Sheet Renewal 2021 -- NPDES Permit NCO081426 Page 1 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 • Iron and Manganese monitoring requirements have been removed from the permit. There are no longer action level standards for these parameters. • Section A. (2) has been updated to include language for electronic submittal of toxicity results • The language of Section A.(4) Electronic Reporting of Monitoring Reports has been updated to be consistent with current federal requirements for electronic reporting. • Added 1,4-dioxane monitoring in A(1) per draft 1,4-dioxane permitting strategy with footnote for monitoring frequency reevaluation o REMOVED FOR 2nd NOTICE • COMMENT ON 1st DRAFT — Removed aluminum because no aluminum is used in process Stream — Discharge from WTP for Outfall 001 is into North Buffalo Creek [Stream ID: 16-11-14-11. This segment is currently listed as impaired for benthos in the 2020 North Carolina 303(d) List. North Bu io Cmek 16 1i-14-1a3 WS-V;NS1N 1 7,� FVi! Miles 3800 From source to Philadelphia Lake PARAMETER IR CATEGORY CRffERIASTATUiS REASON FOR RATING 33D YUK. Benthos (rear, Al, FW) _ � s Exceeding Criteria Fair, Pour Or Severe liioclaSSiFitatiun 20161 • 303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List. Addressing impaired waters is a high priority with the Division, and instream data will continue to be evaluated. If there is noncompliance with permitted effluent limits and stream impairment can be attributed to your facility, then mitigative measures may be required". RPA: No RPA could be conducted because this facility has sent all waste to a sanitary sewer collection system since 2015. 2"a Public notice (September 2022) This facility was public noticed previously (October 2021) along with four other Water Treatment Plants. The original notices included the proposed addition of monthly monitoring for 1,4 Dioxane. There was no limit associated with this requirement, just monitoring and reporting. After completion of the notice process the Division has reviewed and worked to update its strategy for addressing 1,4 Dioxane. The updated strategy will not require monitoring for Water Treatment Plants, it instead focuses on areas that are more likely potential sources of 1,4 Dioxane. Water Treatment Plants themselves do not appear to have sources of concern for 1,4 Dioxane. Raw water from surface waters used by Water Treatment Plants may possibly contain 1,4 Dioxane. Where this is shown to be a potential issue the Division can work with the appropriate sources to require monitoring at the water intake area for the Water Treatment Plants rather than as part of the plants' effluent monitoring, as previously proposed. The proposed permit in this notice maintains all changes previously proposed with the exception of removal of the monitoring requirement for 1,4 Dioxane. Fact Sheet Renewal 2021 -- NPDES NCO081426 Page 2 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 ROY COOPER Governor ELIZABETH S. BISER Secretary RICHARD E. ROGERS, JR. Director MEMORANDUM To: Eric Hudson NORTH CAROLINA Environmental Quality January 06, 2023 NC DEQ / DWR / Public Water Supply Winston-Salem Regional Office From: Emily Richards Compliance and Expedited Permitting Unit Subject: Review of Draft NPDES Permit NCO081426 N.L. Mitchell WTP Guilford County Please indicate below your agency's position or viewpoint on the draft permit and return this form by February 3, 2023. If you have any questions on the draft permit, please contact me at [Emily.richards@ncdenr. gov]. §§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§ RESPONSE: (Check one) Concurs with the issuance of this permit provided the facility is operated and maintained properly, the stated effluent limits are met prior to discharge, and the discharge does not contravene the designated water quality standards. Concurs with issuance of the above permit, provided the following conditions are met: ❑ Opposes the issuance of the above permit, based on reasons stated below, or attached: Signed: Date: %� l zl . North Carolina Department of Environmental Quality I Division of Water Resources 512 North Salisbury Street 1 1611 Mail Service Center I Raleigh, North Carolina 27699-1611 NORTH CAROLINA �' � 919.707.9000 OeDar ent of Environmental Qnlity DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 Greensboro News Record Advertising Affidavit 200 E. Market St Greensboro, NC. 27401 (336) 373-7287 NCDEQ-DIVISION OF WATER RESOURCES 1617 MAIL SERVICE CENTER RALEIGH, NC 27699-1617 PO Number Order Category Description Account Number 4019534 Date —71 September 09, 2022 00008GI B44 Legal Notices Public Notice North Carolina Environmental Management Commission/ NPOES Unit 161T Mail Publisher of the Greensboro News Record Before the undersigned, a Notary Public duly commissioned, qualified, and authorized by law to administer oaths, personally appeared the Publisher's Representative who by being duly sworn deposes and says: that he/she is authorized to make this affidavit and sworn statement; that the notice or other legal advertisement, a copy of which is attached hereto, was published in the Greensboro News Record on the following dates: 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 the requirements and qualifications of Section 1-597 of a General Statutes of North Carolina. Billing Representative Swam to and subscribed before me the 9th day tt. mber, 2. �& `��titrnrrrr�rl (Notary Public) State of Virginia ti�55�O�i' 3A 202 : County of Hanover � Q ;�o • S N, Z My commission expires ON t :y # 32951 .Op P t v �0 " Ohl' Pti�� THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 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 NCDO81426 N.L. Mitchell WTP, and NCODS1256 Frank L. Ward WTP The North Carolina En- vironmental Management Commis- sion proposes to issue a NPDE5 wastewater discharge 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 notice. The Director of the INC Division of Water Resources (DWR) may hold a public hearing should there be a sig- nificant degree of public interest. Please mail comments and/or infor- mation requests to DWR at the above ad d ress. I nte rested persons may visit the DWR at 512 N. Salis- bury Street, Raleigh, INC 27604 to re- view information on file. Additional Information on NPDES permits and this notice may be found on our website: http://deg.nc.gov/about/di visions/water- re sou rc es/ovate r- resou rces-permits/wastewater- branch/npdes-wastewater/pu hlie- notices,or by calling (919) 7D7-3601. NPDES Permit Number NCO081426: The City of Greensboro (P.O. Box 3136, Greensboro, NC 27402) has re- quested renewal of the NPDE5 per- mit for the N1. Mitchell WTP in Guil- ford County. This draft permit is be- ing re -noticed due to monitoring changes. This permitted facility dis- charges treated filter -backwash wastewater to North Buffalo Creek in the Cape Fear River Basin. Cur- rently total residual chlorine, TSS, and total copper are water quality limited. This discharge may affect future allocations in this portion of the Cape Fear River Basin. NPDES Permit Number NCOD81256: The City of High Point (121 N. Pendleton Street, High Point, NC 27260) has applied for renewal of the NPDES permit for the Frank L. ward WTP in Guilford County. This draft permit is being re -noticed due to monitoring changes. This permitted facility dis- charges treated filter backwash wastewater to an unnamed tributary to Richland Creek in the Cape Fear River Basin. Currently, Total Residu- al Chlorine and TSS are water quali- ty limited. This discharge may affect future allocations in this portion of the Cape Fear River Basin. DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 ROY COOPER Governor DIONNE DELLI-GATTI Secretory S. DANIEL SMITH Director City of Greensboro Attn: dell Harney, Water Supply Manager PO Box 3136 Greensboro, NC 27402-3136 Subject: Permit Renewal Application No. NC0081426 N.L. Mitchell WTP Guilford County Dear Applicant: •� �w"Vdp� NORTH CAROLINA Environmental Quality May 11, 2021 The Water Quality Permitting Section acknowledges the May 11, 2021 receipt of your permit renewal application and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made" Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a timely manner to requests for additional information necessary to allow a complete review of the application and renewal of the permit" Information regarding the status of your renewal application can be found online using the Department of Environmental Quality's Environmental Application Tracker at: https://deq.nc.gov/pgrmits-requlations/Permit-quidance/envir nmental-a pplication-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. Q r Administrative Assistant Water Quality Permitting Section ec: WQPS Laserfiche File w/application Nvnh Catalina Depar Imem of Errvconmenial Qual11y Division of water Re$Wr[es Winston Salem Regional Offere 1 450 West Hanes hRll Road, Suite 300 1 Wlnsmn-Salem North CaroVn 27105 ►'+ 336.776.9wo DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Perrni Number Facility Name Form Approved 03105/19 NCR000013078 NCO081426 NL Mitchell WTP OMB No. 2040-0004 Form U.S. Environmental Protection Agency 1 :0EPA Application for NPDES Permit to Discharge Wastewater NPDES GENERAL INFORMATION 1. ACTIVITIES NPDESSECTION REQUIRING AN 1.1 Applicants Not Required to Submit Form 1 1 1 1 Is the facility a new or existing publicly owned 1 1 2 Is the facility a new or existing treatment works treatment works? treating domestic sewage? If yes, STOP. Do NOT complete ❑� No If yes, STOP. Do NOT JZ] No Form I. 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 1s the facility an existing manufacturing, operation or a concentrated aquatic animal commercial, mining, or silvicultural facility that is production facility? currently discharging process wastewater? o❑ Yes 4 Complete Form 1 0 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, to M mining, or silvicultural facility that has not yet commercial, mining, or silvicultural facility that commenced to discharge? discharges only nonprocess wastewater? Cr Yes 4 Complete Form 1 0 No [] Yes 3 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 # a associated with industrial activity or whose Sez C..ae�w.�..�`� RECEIVED discharge is composed of both stormwater and non-starmwater? j Yes 4 Complete Form 1 0 No MAY 112021 and Form 2F unless exempted by WDEO DWR/WDES 40 CFR 122.26(b)(14)(x) or b 15). SECTIONDD-LOCATION Facility Name 2.1 N.L Mitchell Water Treatment Plant 0 2.2 EPA Identification Number U J NCR000013078 2.3 Facility Contact Name (first and last) Title Phone number Dell Harney Water Supply Manager (336) 373-7900 a Email address deil.harney@ greensboro-nc.gov 2A Facility Mailing Address m Street or P.O. box a PO Box 3136 City or town State ZIP code Greensboro NC 27402-3136 EPA Form 3510-1 (revised 3-19) Page 1 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03M/19 NCR000013078 NC0081426 NL Mitchell WTP OMB No.2040-0004 H 2.5 Facility Location Street, route number, or other specific identifier Q o 1041 Battleground Avenue rnv v County name County code (if known) Guilford R_j 13 City or town State ZIP code 2 @ Greensboro NC 27408 SECTIONt NAICS CODESI 3.1 SIC Code(s) _ Description (optional) water supply 4941 Vl d O (J 3.2 NAICS Code(s) Description (optional) -a c) m SECTION OPERATOR INFORMATION+ 4.1 Name of Operator City of Greensboro .R 4.2 Is the name you listed in Item 4.1 also the owner? E 0 ❑r Yes ❑ No 4.3 Operator Status El Public —federal El Public —state 0 other public (specify) municipal w a ❑ Private ❑ Other (specify) 0 4.4 Phone Number of Operator (336) 373-7660 4.5 D p erator Address Street or P.O. Box E CV 1041 Battleground Avenue • City or town State ZIP code 0 U Greensboro NC 27408 9. Email address of operator 0 Larry.Nance@greensboro-nc.gov SECTION 5. 1 •I 0 5.1 Is the facility located on Indian Land? R -� ❑ Yes 0 No EPA Form 3510.1 (revised 3-19) Page 2 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19 NCRO00013078 NCO081426 NL Mitchell WTP OMB No. 204"004 SECTION 6. EXISTING ENVIRONMENTAL PERMITS I 6.1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each) E m NPDES (discharges to surface ❑ RCRA (hazardous wastes) ElUIC (underground injection of o water) fluids) N .2 - NCO081426 Small Generator NCR000013078 w a ❑ PSD (air emissions) ❑ Nonattainment program (CAA) ❑ NESHAPs (CAA) X ❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify) w SECTION 7. MAP I Have you attached a topographic map containing all required information to this application? (See instructions for 7.1 C specific requirements.) ❑r Yes ❑ No ❑ CAFD—Not Applicable (See requirements in Farm 28.) SECTION S. NATURE OF BUS] NESS I Describe the nature of your business. 8.1 Water Supply -Conventional Water Treatment Facility that provides potable water for the City of Greensboro and some Guilford County residents. N tl] y 7 on I � I � R Z SECTIONOO I Does your facility use cooling water? 9.1 Ln ❑ Yes ❑� No 4 SKIP to Item 10.1. 5 w 9.2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at aV , y 40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your o NPDES permitting authority to determine what specific information needs to be submitted and when.) a R U = SECTION I 1 I Do you intend to request or renew one or more of the variances authorized at 40 C F R 122.21(m)? (Check all that 10.1 apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and when.) ❑ Fundamentally different factors (CWA ❑ Water quality related e#fluent limitations (CWA Section OF! Section 301(n)) 302(b)(2)) R ❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a)) Section 301(c) and (g)) []r Not applicable EPA Form 3510.1 (revised 3-19) Page 3 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105119 NCROOD013078 NCO081426 NL Mitchell WTP OMB No.2040-0004 SECTIONf i In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application. 11.1 For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not all appiicanIs are reg wired to p rovide attachments. Column 1 Column 2 0 Section 1: Activities Requiring an NPDES Permit wf attachments ❑� Section 2: Name, Mailing Address, and Location ❑ w! attachments ❑r Section 3: SiC Codes ❑ wl attachments ❑� Section 4: Operator Information ❑ wl attachments ❑ Section 5: Indian Land ❑ wl attachments ❑� Section 6: Existing Environmental Permits ❑ wl attachments m E r Section 7; Map ❑ wl topographic ❑� Elw! additional attachments map o ❑r Section 8: Nature of Business ❑ wl attachments w ❑ Section 9: Cooling Water Intake Structures ❑ wl attachments d ❑ Section 10: Variance Requests ❑ w! attachments a �, ❑ Section 11: Checklist and Certification Statement ❑ w! attachments Y d 11.2 Certification Statement c� 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, ar those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. f am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Name (print or type first and last name) Official title Dell Harney Water Supply Manager Signature Date signed MautJ� f EPA Form 3510-1 (revised 3.19) Page 4 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 3510-1, ATTACHMENT 1 (FOR SECTION 1.0) This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent to either a Sanitary Sewer collection system or the NPDES permitted outfall. All process waste system discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This has been due to hydraulic restraints inherent to the process waste system that can limit water treatment plant production and also to ongoing capital improvement construction projects on the site. Improvements to the process waste system are in the design phase which, when constructed, will make NPDES discharge possible again. Construction of the new system is planned to begin June of 2022 with an expected duration of 18 months. This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit without having discharged to the designated outfall for the previous permit cycle and thus having no discharge analysis data to provide. Instructions from our regional NCID EQ office for renewal of the Mitchell NPDES permit are to complete: • EPA form 1 • EPA form 2E ■ Tables A & C of EPA form 2C, as well as table B if applicable N.L. Mitchell INTP process waste system line drawing Ex. Waste Clarifier iFliiter Backwash >fox,,ackwash With Decanter & aste PSHydraulic Improvements-`M NPDES '0 E Fitter to waste FF C Settled r3o s Sanitary Sewer N RIP wow, In DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105/19 NCR000013078 NC0081426 NL Mitchell WTP OMB No.2O40-0004 Form U.S. Environmental Protection Agency 1 ■—. EPA Application for NPDES Permit to Discharge Wastewater NPDES GENERAL INFORMATION SECTION•r f Applicants Not Required to Submit Form 1 1.1 1.1.1 Is the facility a new or existing publicly owned 1'1'2 Is the facility a new or existing treatment works treatment works? treating domestic sewage. If yes, STOP. Do NOT complete ❑r No If yes. STOP. Do NOT 0 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 production facility? currently discharging process wastewater? a ❑ Yes 3 Complete Form 1 0 No ❑ Yes 4 Complete Form a❑ No a and Farm 2B. 1 and Form 2C. z C 1.2.3 Is the facility a new manufacturing, commercial, 1.2.4 Is the facility a new or existing manufacturing, mining, or silvicultural facility that has not yet commercial, mining. or silvicultural facility that — commenced to discharge? discharges only nonprocess wastewater? ❑ Yes 3 Complete Form 1 [2] No ❑ Yes 3 Complete Form [jr No and Form 2D. 1 and Form 2E. 0 ' 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? 0 Yes 4 Complete Form 1 No and For -in 2F unless exempted by 40 CFR 122.26(b)(14)(x) or b (15). SECTIONDD- i 2.1 Jacifity name N.L Mitchell Water Treatment Plant 0 .R 2.2 EPA Identification Number U NCRO00013078 0 2.3 Facility Contact N d Name (first and last) Title Phone number a hell Barney Water Supply Manager (336) 373-7900 a Email address - dell.harney@ greensboro-nc.gov 2A Facility Mailing Address Street or P.O. box PO Box 3136 City or town State ZIP code Greensboro NC 27402-3135 EPA Form 3510.1 (revised 3-19) Page 1 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPOES Permit Number Facility Name Form Approved 03105119 NCROOOD13078 NC0081426 NL Mitchell WTP OMB No.2040.0004 2.5 Facility Location wStreet, route number, or other specific identifier Q 1D41 Battleground Avenue rn o County name County code (if known) Guilford City or town State ZIP code Greensboro NC 27408 CODES ! Description (optional) 3.1 SIC Code(s) 4941 water supply N G] rlJ V a 3.2 NAICS Code(s) Description (optional) c3 SECTION 4. OPERATOR INFORMATION (40 I Al I Name of Operator I City of Greensboro 0 4.2 Is the name you listed in Item 4.1 also the owner? ❑r Yes ❑ No e 4.3 Operator Status ❑ Public —federal ❑ Public —state 0 Other public (specify) municipal d a- ❑ Private ❑ other (specify) v 4.4 Phone Number of Operator (336)373-7660 4.5 Q perator Address Street or P.O. Box E1041 CD Battleground Avenue w City or town State de 0 o Greensboro NC 7274 U a Email address of operator a Larry.Nance@greensboro-nc.gov 1 •1 Is the facility located on Indian Land? 5.1 Q _j ❑ Yes ❑ No EPA Form 3510.1 (revised 3.19) Page 2 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105/19 NCROD0013078 NCO081426 NL Mitchell WTP OMB No. 2040-0004 SECTION't I CFR 122.21(0(6)) R 6-1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each) ❑ NPDES {discharges to surface ❑ RCRA (hazardous wastes) ❑ t]iC (underground injection of o water) fluids) 2 NCO081426 Small Generator NCR000013078 0 LuEL ❑ PSD (air emissions) ❑ Nonattainment program (CAA) ❑ NESHAPs (CAA) CM ❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify) Lu SECTION 7. MAP 7.1 Have you attached a topographic map containing all required information to this application? (See instructions for R specific requirements.) 0 Yes ❑ No ❑ CAFO--Not Applicable (See requirements in Form 28.) SECTION 8. NATURE OF 8.1 Describe the nature of your business. Water Supply-Conventianal Water Treatment Facility that provides potable water for the City of Greensboro and m some Guilford County residents. m w c .N m I v m I Z I SECTION 9. COOLINGI 9.1 Does your facility use coaling water? U ❑ Yes ❑r No 3 SKIP to ltem 10.1. m w 9 22 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at �, y 40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your o U) NPDES permitting authority to determine what specific information needs to be submitted and when.) o � L] _ SECTIONI VARIANCE REQUESTSI I 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.) ❑ Fundamentally different factors (CWA [] Water quality related effluent limitations (CWA Section Section 301(n)) 302(b)(2)) CV ❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a)) Section 301(c) and (g)) ❑� Not applicable EPA Form 3510.1 (revised 3.19) Page 3 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number j Facility Narre Form Approved 005119 AICROD0013078 NCD081426 OMB No. 2040-0004 NL Mitchell WTP SECTION1 a ♦ . 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 Column 2 Section 1: Activities Requiring an NPDES Permit 0 wl attachments 0 Section 2: Name, Mailing Address, and Location ❑ wl attachments D Section 3: SIC Codes ❑ wl attachments 0 Section 4: Operator Information ❑ wl attachments ❑ Section 5: Indian Land ❑ wl attachments M Section 6: Existing Environmental Permits ❑ wl atfachments ❑� Section 7: Map ❑ wl topographic ❑ wl additional attachments z ma o •R ❑� Section 8: Nature of Business ❑ wl attachments w ❑ Section 9: Cooling Water intake Structures ❑ wl attachments `� ❑ Section 10: Variance Requests ❑ wl attachments ❑� Section 11: Checklist and Cerfification Statement ❑ wl attachments 11.2 Certification Statement ca i certify under penalty of law that this document and all attachments were prepared under my direction or supervision irj accui dance wish a systern designed to assure that qualified persom iel prop erly gather avid evaluate Me 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 Dell Harney Water Supply Manager Signature Date signed /��7 / V4 LIU G� I EPA Form 3510.1 (revised 3.19) Page 4 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 3510-1, ATTACHMENT 1 (FOR SECTION 1.0) This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent to either a Sanitary Sewer collection system or the NPDES permitted outfall. All process waste system discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This has been due to hydraulic restraints inherent to the process waste system that can limit water treatment plant production and also to ongoing capital improvement construction projects on the site. Improvements to the process waste system are in the design phase which, when constructed, will make NPDES discharge possible again. Construction of the new system is planned to begin June of 2022 with an expected duration of 18 months. This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit without having discharged to the designated outfall for the previous permit cycle and thus having no discharge analysis data to provide. Instructions from our regional NCDEgoff ice for renewal of the Mitchell NPDES permit are to complete: ■ EPA form 1 • EPA form 2E ■ Tables A & C of EPA form 2C, as well as table B if applicable N.L. Mitchell WTP process waste system line drawing Fx. Wsrte ClariCi�r Fitter SmIlkwash A Ex. sockwash With decanter & Waste PS Hydraulic irn rovcrncnts kMA HPOES iD lk E FiiTCT to hlascc C Settled Salida F Sanituy Sewer d!f •.Aq, 4► � 4:.r11! f�.'ifut '.�i3i�3� �. _�..'��3:�ua; � '�:'�L��;.e:t:y„t..i �93tt�rai►i'tin _ • _ DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03WA9 NCROOD013078 NCO081426 N.L. Mitchel WTP OMB No. 2040-0004 Form U.S. Environmental Protection Agency 2C '. EPA Application for NPIDES Permit to Discharge Wastewater NPDES EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS SECTIONIOUTFALL LOCATIONi 1-1 Provide information on each of the facility's outfalls in the table below. OutfReceiving Water Name Latitude Longitude Number I 001 North Buffalo Creek 36° 0813' 89" -79' 8033' 3 co 3 a SECTIOND-• i M 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water 3 balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.) o` ❑ Yes ❑ No SECTION■ t 3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if necessary- 1 e e tn "Outfall Number" 001 Operations Operation Average Flow FILTER BACKWASH o mgd E FILTER TO WASTE (REWASH) o mgd is mgd c mgd v Treatment U nits Description Code from Final Disposal of Solid or (D (include size, flow rate through each treatment unit, Table 2C 1 Liquid Wastes Other Than retention time, etc.) by Discharge DECHLORINATION 2E CLARIFICATION lU SANITARY SEWER DISCHARGE TO SURFACE WATER 4A DISCHARGE TO SANITARY SEWER EPA Form 3510-2C (Revised 3-19) Page : DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03ro5119 NCROCCO13078 NCO081426 N.L. Mitchell WTP OMB No.204HM 3-1 "Outfall Number** cant- Operations Operation Average Flow mgd mgd mgd mgd Description Code from Final Disposal of Solid or (include size, flow rate through each treatment unit, Table 2C•1 Liquid Wastes Other Than retention time. etc.) by Discharge -o d c 0 0 ca m E a� '"Outfall Number" N Operatilons Contributing to Flow c Operation Average Flow U- mgd L a' mgd mgd mgd Treatment Description Units Code from Final Disposal of Solid or (include size, flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than retention time, etc.) by Discharge 3.2 Are you applying for an NPDES permit to operate a privately owned treatment works? ❑ Yes 0 No 4 SKIP to Section 4. =D 3.3 Have you attached a list that identifies each user of the treatment works? ❑ Yes ❑ No EPA Form 3510-2C (Revised 3-19) Page 2 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Fad Iity Name Form Approved 03M119 NCROOD013078 NCO081426 N.L. Mitchell WTP OMB No. 2040-0004 SECTIONI r 4.1 Except for storm runoff. leaks, or spills, are any discharges described in Sections 1 and 3 intermittent or seasonal? ❑ Yes ❑r No 4 SKIP to Section 5. 4.2 Provide information on intermittent or seasonal flows for each applicable outf all. Attach additional pages, if necessa . Frequency Flow Rate Qutfall Operation Duration Average Average Long -Term Maximum Number (list) Da s/Week Months/Year Average Dail days/week montnsryear mgd mgd days N7 30 days/week months+year mgd mgd days days/week monthslyear mgd mgd days days/week monthslyear mgd mgd days c r dayshveek monthslyear mgd mgd days daystweek monthslyear mgd mgd days days/week monthslyear mgd mgd days daysMeek monthstyear mgd mgd days days/week montlWyear mgd mgd days SECTION 5. PRODUCTION 5.1 Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility? ❑ Yes [D No 4 SKIP to Section 6. 5.2 Provide the following information on applicable ELGs. i ELG Category ELG Subcategory Re ula oy Citation u1 ID n 5.3 Are any of the applicable ELGs expressed in terms of production (or other measure of operation)? ❑ Yes ❑ No 3 SKIP to Section 6. v :s 5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs. Qutfall unit of -a Number Operation, Product, or Material Quantity per Day Measure d m 0 ca a EPA Form 3510-2C (Revised 3-19) Page 3 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03M/19 NCR000013078 NCO081426 N.L. Mitchell WTP OMB No-2040-0004 IMPROVEMENTSSECTION 6. I 6,1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing, upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could affect the discharges described in this application? ❑ Yes ❑r No 4 SKIP to Item 6.3. 6,2 Briefly identify each applicable project in the table below. Affected Final Compliance Dates E Brief Identification and Description of Outfalls Source(s) of o Project (list outfall Discharge Required Projected ;2 number N i2 M CL 6.3 Have you attached sheets describing any additional water pollution control programs (or other environmental projects that may affect your discharges) that you now have underway or planned? [optional item] ❑r Yes ❑ No ❑ Not applicable SECTION 7. EFFLUENT AND INTAKE CHARACTERISTICS i See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must complete. Not all applicants need to complete each table. Table A. Conventional and Non -Conventional Pollutants 7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of your outfails? ❑ Yes ❑r No 4 SKIP to Item 7.3. 7.2 If yes, indicate the applicable outfails below. Attach waiver request and other required information to the application. Outfall Number Outfall Number Outfall Number 7.3 Have you completed monitoring for all Table A pollutants at each of your outfails for which a waiver has not been requested and attached the results to thisiapplication package? ❑ Yes �/� S�� C+. �+i��F� �� ,� ❑ No; a waiver has been requested from my NPDES permitting authority for all pollutants at all outfails. Table B. Toxic Metals, C yanide, Total Phenols, and 0 rg anic Toxic Pollutants Y 7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories listed in Exhibit 2C-39 (See end of instructions for exhibit.) m ❑ Yes El No 4 SKIP to Item 7.8. 7.5 Have you checked 'Testing Required" for all toxic metals, cyanide, and total phenols in Section 1 of Table B? zl w ❑ Yes ❑ No 7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified in Exhibit 2C-3. Primary Industry Category Required GCIMS Fraction(s) Check applicable boxes. ❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide ❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide ❑ Volatile ❑ Acid ❑ Base/Neutral ❑Pesticide EPA Form 3510-2C (Revised 3-19) Page4 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPOES Permit Number Facility Name Form Approved 03105119 NCR000013078 NC0081426 N.L. Mitchell WTP OMB No. 204"004 7.7 Have you checked "Testing Required" for all required pollutants in Sections 2 through 5 of Table B for each of the GCIMS fractions checked in Item 7.6? ❑ Yes ❑ No 7.8 Have you checked "Believed Pre sent° or "Believed Absent" for all pollutants listed in Sections 1 through 5 of Table B where testing is not required? ❑ Yes No 7.9 Have you provided (1) quantitative data for those Section 1, Table B, pollutants for which you have indicated testing is required or (2) quantitative data or other required information for those Section 1, Table B, pollutants that you have indicated are "Believed Present" in your discharge? ❑ Yes 0 No 7A0 Does the applicant qualify for a small business exemption under the criteria specified in the instructions? ❑ Yes 4 Note that you qualify at the top of Table B. 0 No then SKIP to Item 7.12. 7.11 Have you provided (1) quantitative data for those Sections 2 through 5, Table B, pollutants for which you have o determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B, 0 pollutants you have indicated are "Believed Present" in your discharge? H y ❑ Yes [ZI No Table C. Certain Conventional and Non -Conventional Pollutants 7.12 Have you indicated whether pollutants are "Believed Present" or "Believed Absent" for all pollutants listed on Table C for all outfalls? ca d 0 Yes ❑ Na Je 7.13 Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated 'Believed Present'? } Cl Yes ❑r No Lu Table D. Certain Hazardous Substances and Asbestos 7.14 Have you indicated whether pollutants are "Believed Present" or "Believed Absent" for all pollutants listed in Table 0 for all outfalls? �] ❑ Yes A/ No 7.15 Have you completed Table D by (1) describing the reasons the applicable pollutants are expected to be discharged and (2) by providing quantitative data, if available? ❑ Yes JV 4 ❑r No Table E. 2,3,7,8•Tetrachlorod ibenxo• •Dioxin 2,3,7,8-TCDQ 7.16 Does the facility use or manufacture one or more of the 2.3,7,8-TCDD congeners listed in the instructions, or do you know or have reason to believe that TCDD is or may be present in the effluent? ❑ Yes 4 Complete Table E. No 4 SKIP to Section 8. 7.17 Have you completed Table E by reporting qualitative data for TWO? 1 ❑ Yes ❑ No SECTION 8. USED OR MANUFACTURED TOXICSr Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as 8.1 an intermediate or final product or byproduct? ❑ Yes 0 No 4 SKIP to Section 9. H 8.2 List the pollutants below. c `a 1. 4. 7. d N 2. 5. 8, 3, 6, 9. EPA Form 3510.2C (Revised 3-19) Page 5 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA IdenlifraGon Number NPDES Permit Number Facility Name Form Approved 030119 NCR000013078 NCO081426 N.L. Mitchell WTP 0M8 No.204MOO4 SECTION■ ■ ■ i 9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made within the last three years on (1) any of your discharges or (2) on a receiving water in relation to your discharge? ❑ Yes 0 No 4 SKIP to Section 10. N w 9.2 Identify the tests and their ur oses below. Z. Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted x Permitting Authority? Q H ❑ Yes ❑ No v v "m ❑ Yes ❑ No ❑ Yes ❑ No SECTION i CONTRACT ANALYSES (40 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm? 10.1 ❑ Yes 0 No 4 SKIP to Section 11. 10.2 Provide information for each contract laboratory or consulting firm below. Laborato Number 1 Laboratory Number 2 Laboratory Number 3 Name of laboratory/firm y, Laboratory address Phone number Pollutant(s) analyzed SECTIONDD ■ INFORMATION - 11.1 Has the NPL]ES permitting authority requested additional information? ❑ Yes 0 No 4 SKIP to Section 12. 0 11.2 List the information requested and attach it to this application. a 1. 4, 0 2. 5. a 3. 6. EPA Form 3510-2C (Revised 3-19) Page 6 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03W/19 NCROD0013D78 NCO081426 N.L. Mitchell WTP OMB No.2040-0004 12. CHECKLIST CERTIFICATIONSECTION AND I 12.1 In Column 1 below, mark the sections of Form 2C 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 ail app Iicants are req uired to cam Dlete all sections or p rovide attachments. Column 1 Column 2 0 Section 1: Outfall Location ❑ wJ attachments 0 Section 2: Line Drawing [Z] wl line drawing ❑ wl additional attachments Section 3: Average Flows and 0 wl list of each user of 0 wl attachments ❑ privately owned treatment Treatment works ❑ Section 4: Intermittent Flows A(4 ❑ wl attachments ❑ Section 5: Production ❑ wl attachments wl optional additional ❑r Section fi: Improvements 0 wl attachments ❑ sheets describing any additional pollution control tans ❑ wJ request for a waiver and ❑ wl explanation for identical supporting information outfalls El wl small business exemption 0 wl other attachments request N ❑ Section 7: Effluent and Intake 0 wl Table A ❑ wl Table B Characteristics El wl Table C ❑ wl Table D d ❑ w! Table E wl analytical results as an ❑ attachment R ❑ Section 8: Used or Manufactured ❑ wl attachments Toxins NR El5ectian 9: Biota ical Toxicity ❑ wl attachmentsRECEIVE Tests N ❑ Section 10: Contract Analyses #4 ❑ wl attachments MAY 112021 ❑ Section 11: Additional Informatio ❑ wl attachments NGDEQJIDWPJNPDES Section 12: Checklist and [d El wI attachments Certification Statement 12.2 Certification Statement 1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly responsible for gathering the information, the information submitted is, to the hest 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 Dell Harney Water Supply Manager Signature Date signed EPA Form 3510-2C (Revised 3-19) Page 7 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 LFIA Iden!ificaGCn Nurnber NCR000013078 NCODS1426 Facility Name I Outfall Number N.L. Mitchell WTP 001 Form Approved OM5119 OMB No. 2040-0004 TABLE A. CONVENTIONAL AND NON CONVENTIONAL■ 1 Effluent Intake Waiver Units (7 tional Maximum Maximum Long -Term Pollutant Requested (specify) Daily Monthly Average Gaily Number of Long -Term Number of (if applicable) Discharge discharge Discharge Analyses Average Value Analyses (required)it available if available ❑ 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. 1 Biochemical oxygen demand ❑ Concentration mgll 0 0 Mass Ibs 0 0 (BOD5) 2. Chemical oxygen demand El Concentration Concentration mg1l 0 0 Ibs 0 0 (COD) Concentration mg/l 0 0 3. Total organic carbon (TUC) ❑ Mass Ibs 0 0 Concentration mg/l 0 ❑ 4. Total suspended solids JSS) ❑ Mass Ibs 0 a Concentration mgll 0 0 5. Ammonia (as N) ❑ Mass Ibs o 0 6. Flow ❑ Rate mgd o 0 Temperature (winter) ❑ °C °C NA 0 7. Temperature (summer) ❑ °C "C NA a pH (minimum) ❑ Standard units S.U. NA 0 8. pH (maximum) ❑ Standard units s.u. NA 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 parameters or required under 40 CFR chapter I, subchapter N or D. See instructions and 40 CFR 122.21(e)(3). Sec- a-fft. A P1P1 P l`+ -4� EPA Form 3510.2C (Revised 3-19) Page 9 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name NCROD0013078 NCO081426 N.L. Mitchell WTP Outfall Number Form Approved 0 310 5)19 OMB No. 2040-0004 Intake Presence or Absence check one Effluent (optional) PollutantlParameter (and CAS Number, if available) Testing Required Believed Believed Units (specify) Maximum Maximum Long -Tenn Average Number Long. Number Present Absent Daily Monthly gaily of Term of Discharge Discharge Discharge Analyses Average Analyses (required) (if available) ifavailable Value ❑ Check here if you quality as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections 2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge. Section 1. Toxic Metals, Cyanide, and Total Phenols 11 Antimony, total ❑ ❑ ❑ Concentration Mass (7440-36-0) 1.2 Arsenic, total ❑ ❑ ❑ Concentration Mass (7440-38-2) 1.3 Beryllium, total El El El Concentration Concentration (7440-41-7) 1.4 Cadmium, total El ❑ ❑ Concentration Mass (7440-43-9) 1.5 Chromium, total Concentration Mass (7440-47-3) 16 Copper, total ❑ ❑ ❑ Concentration Mass (7440-50-8) 1.7 Lead, total ❑ ❑ ❑ Concentration Mass (7439-92-1) 18 Mercury, total ❑ ❑ ❑ Concentration Mass (7439-97-6) 1.9 Nickel, total ❑ El ElConcentration Mass (7440-02-0) 1.10 Selenium, total ❑ ❑ ❑ Concentration Mass (7782-49-2) 1 11 Silver, total ❑ ❑ ❑ 1 Concentration 1 Mass (7440-22-4) EPA Form 3510.2C (Revised 3-19) Page 11 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 EPA Identification Number NPOES Permit Number Fadlity Name NCR000013078 I NCO081426 N.L. Mitchell WTP Form Approved 030119 OMB No. 2040.0004 TOXICTABLE B. a ORGANIC TOXIC POLLUTANTS Effluent Intake (optional) 11.12 Pollutant/Parameter (and CAS Number, it available) Testing Required Presence or Absence check one Knits (specfy) Believed Present Believed Absent Maximum Daily Discharge (required) Maximum Monthly Discharge (if available) Long -Term Average Daily Discharge if available Number of Analyses Long - Term veragAverage Number of Analyses Thallium, total (7440-28-0) EJ Concentration Mass 1.13 Zinc, total (7440-66-6) Concentration Mass 1.14 Cyanide, total (57-12-5) ❑ ❑ Concentration Mass 1.15 Phenols, total El El Concentration Mass Section 2. Organic Toxic Pollutants (GCIMS Fraction —Volatile Compounds) 21 Acrolein (107-02-8) El El El Concentration Mass 2.2 Acrylonitrile (107-13-1 ) El ❑ El Concentration Mass 2,3 Benzene (71-43-2) ❑ El 1 Concentration Mass 2.4 Bromoform (75-25-2) El El 11 Concentration Mass 2,5 Carbon tetrachloride (56-23-5) ❑ ❑ 0 Concentration Mass 2.6 Chlorobenzene (108-90-7) El Concentration Mass 2.7 Chlorodibromomethane (124A8-1) El ❑ Concentration Mass 2.8 Chloroethane (75-00-3) ❑ ❑ Concentration Mass EPA Form 3510.2C (Revised 3-19) Page 12 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 NA EPA Identification Number NPDES Permit Number Faciiily Name NCRD00013078 NCO081426 N.L. Mitchell WTP WWI Number Form Approved 03/05/19 OMB No. 204NO04 TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND ORGANIC TOXIC -OI Presence or Absence check one Units Believed Believed {specify} Present Absent Effluent Intake (optional) PollutantlParameter (and CAS Number, if available) Testing Required Maximum Daily Discharge [required] Maximum Monthly Discharge [if available} Long -Term Average Daily Discharge if available Number of Analyses Long - Term Average Value Number of Analyses 2.9 2-chloroethylvinyl ether (110-75-8) ❑ El El Concentration Concentration 2.10 Chloroform (67-66-3) ❑ ❑ Concentration Mass 211 Dichlorobromomethane (75-274) ❑ ❑ El Concentration Mass 212 1,1-dichloroethane (75-34-3) ❑ ❑ ❑ Concentration Mass 2.13 1,2-dichloroethane (107-06-2) ❑ ❑ El Concentration Concentration 214 1,1-dichloroethylene (75-354) ❑ ❑ ❑ Concentration Mass 2.15 1,2-dichloropropane (78-87-5) ❑ ❑ ❑ Concentration Mass 2.16 1,3-dich Ioropropylene (542 75 6) ❑ El ❑ Concentration Mass 217 Ethylbenzene (100-41-4) ❑ ❑ Concentration Mass 218 Methyl bromide (74-83-9) ❑ ❑ El Concentration Mass 219 Methyl chloride (74-87-3) ❑ ❑ Concentration Mass 2.20 Methylene chloride (75-09-2) ❑ ❑ Concentration Mass 2 21 1,1,2,2-tetrachIoroethane (79-34-5) ❑ El ❑ Concentration Mass EPA Form 3510-2C (Revised 3-19) Page 13 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 � 'A A Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03105/19 I NCR000013078 NCO081426 N.L. Mitchell WTP OMB No.2040-0004 a aa •a r Units (specify) Effluent Intake {optional} 12,22(127-18-4) Pollutant/Parameter (an d CAS Number, if available) Testing Required Presence or Absence (check onel Believed Present Believed Absent Maximum Daily Discharge {required} Maximum Monthly Discharge (if available) Long -Term Average gaily Discharge g if available Number of Analyses Long - Term Average Value Number of Analyses Tetrachloroethylene ❑El El Concentration Mass 2,23 Toluene (108-88-3) ❑ ❑ ❑ Concentration Mass 2,24 1 2-trans-dichloroethylene (156-60-5) ❑ ❑ ❑ Concentration Mass 2,25 1,1,1-trichloroethane (71-55-6) ❑ ❑ ❑ Concentration Mass 2.26 1 1,2-trichloroethane (79-00-5) ❑ ❑ Concentration Mass 2.27 Trichloroethylene (79-01-6) ❑ ❑ ❑ Concentration Mass 2.28 Vinyl chloride (75-014) ❑ ❑ Concentration Mass Section 3.Organic Toxic Pollutants (GC1MS Fraction —Acid Compounds 3.1 2-chlorophenol (95-57-8) El El El Concentration Concentration 3.2 2,4-dichlorophenal (120-83-2) ❑ ❑ ❑ Concentration Mass 3.3 2,4-dimethylphenol (105-67-9) ❑ ❑ ❑ Concentration Mass 3.4 4 6-dinitro-o-cresol (534-52-1) ❑ ❑ ❑ Concentration Mass 3.5 2,4-dinitrophenol (51-28-5) ❑ ❑ ❑ Concentration Mass EPA Form 3510.2C (Revised 3-19) Page 14 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 N! P NCR000013078 NCO081426 Facility Name N.L. Mitchell WTP Number Form Approved 03/05/19 OMB No. 2040-0004 Effluent Units Long -Term Maximum Maximum (speci`y) Average Number Daily Monthly Daily of Discharge Discharge Discharge Analyses (required) (if available) if available Intake (optional) Pollutant/Parameter [and CAS Number, if available] Testing Required Presence or Absence (check one) Believed Present Believed Absent Long - Term Average Value Number of Analyses 3.6 2-nitrophenol (88-75-5) ❑ ❑ ❑ Concentration Mass 3.7 4-nitrophenol (100-02-7) El El ❑ Concentration Mass 3.8 p-chlero-m-cresol (59-50-7) ❑ ❑ ❑ Concentration Mass 3.9 Pentachlorophenol (87-86-5) El ❑ ❑ Concentration Mass 3.10 Phenol (108-95-2) ❑ ❑ ❑ Concentration Mass 311 2,4,6-trichIorophenoI (88-05-2) ❑ ❑ ❑ Concentration Mass Section 4. Organic Toxic Pollutants (GCIMS Fraction —Base /Neutral Compounds) 4.1 Acen aphthene (83-32-9) El ❑ El Concentration Concentration 4.2 Acen aphthylene (208-96-8) ❑ ❑ El Concentration Concentration 4.3 Anth racene (120-12-7) ❑ ❑ El Concentration Concentration 4.4 Benzidine (92-87-5) ❑ ❑ ❑ Concentration Mass 4.5 Benzo (a) anthracene (56-55-3) ❑ ❑ ❑ Concentration Mass 4'6 Benzo (a) pyrene (50-32-8) ❑ El ❑ Concentration Mass EPA Form 3510.2C (Revised 3-19) Page 15 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 Nft EPA Identificalion Number NPDES Permit Number Facility Name NCR000013078 NCO081426 N.l. Mitchell WTP Outian Number Form Approved 0365119 OMB No. 204U O04 TABLE - TOXIC METALS, CYANIDE, TOTAL PHENOLS,ORGANIC TOXIC •Or CIFR Effluent Intake (optional) 1 Pollutant/Parameter (and CAS Number, if available) (and Testing Required Presence or Absence f.c.rieck o-iej Units (specify) Believed Present Believed Absent Maximum (faquiredge Maximum Monthly Discharge if available) j Long -Term Average Daily Discharge f available Number Analyses Long - Term e AValue Number of Analyses 431 7 3,4-benzofluoranthene (205-99-2) ❑ El El Concentration Mass 4.8 Benzo (ghi) perylene (191-24-2) ID ❑ El Concentration Concentration 4.9 Benzo (k) fluoranthene (207-08-9) El ❑ El Concentration Mass 4.10 Bis (2-chloroethoxy) methane (111-91-1) ❑ ❑ ❑ Concentration Mass 4.11 Bis (2-chloroethyl) ether (111-44-4) ❑ ❑ El Concentration Concentration 4.12 Bis (2-chioroisopropyl) ether (102-80-1) ❑ El El Concentration Concentration 4.13 Bis (2-ethylhexyl) phthalate (117-81-7) ❑ ❑ ❑ Concentration Mass 4.14 4-bromophenyl phenyl ether (101-55-3) ❑ El ❑ Concentration Mass 4.15 Butyl benzyl phthalate (85-68-7) ❑ ❑ ❑ Concentration Mass 416 2-chloronaphthalene (91-58-7) ❑ ❑ ❑ Concentration Mass 4.17 4-chlorophenyl phenyl ether (7005-72-3) ❑ El El Concentration Concentration 4.18 Chrysene (218-01-9) ❑ ❑ ❑ Concentration Mass 419 Dibenzo (a,h) anthracene (53-70-3) ❑ ❑ Concentration 1 Mass EPA Fort 3510.2C (Revised 3-19) Page 16 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 I 4 4ldentificabon Number NPDES Permit Number Facility Name NCR000013078 NCO081425 I N.L. Mitchell WTP Number Form Approved 03Mf19 OMB No. 2040-0004 Intake Presence or Absence check fine Effluent (optional) Pollutant/Parameter Testing Units Long -Term Maximum Maximum Long - 14.20(95-50-1) (and CAS Number, if available) Required g Believed Believed {speuf ;, Y i Daily Monthly Average Number Term Term Number Present Absent Discharge Discharge Discharge Daily chare Analyses Average Analyses (required) {if available) f available Value 1,2-dichlorobenzene ❑ ❑ ❑ Concentration Mass 4.21 1,3-dichlorobenzene El El El Concentration Concentration (541-73-1) 4.22 1,4-dichlorobenzene ❑ ❑ ❑ Concentration Mass (106-46-7) 4.23 3,3-dichlorobenzidine ❑ ❑ Concentration Mass (91-94-1) 4.24 Diethyl phthalate ❑ ❑ ❑ Concentration Mass (84-66-2) 4.25 Dimethyl phthalate ❑ ❑ ❑ Concentration Mass (131-11-3) 4.26 Di-n-butyl phthalate ❑ ❑ ❑ Concentration (84-74-2) Mass 4 27 2,4-dinitrotoluene ❑ ❑ Concentration Mass (121-14-2) 4 28 2,6-dinitrotoluene El ❑ 11 Concentration Mass (606-20-2) 4'2� Di-n-octyl phthalate ❑ El ❑ Concentration (117-84-0) Mass 4.3Q 1,2-Diphenylhydrazine ❑ El ❑ Concentration Mass (as azobenzene) (122-66-7) 4.31 Fluoranthene ❑ ❑ ❑ Concentration Mass (206-44-0) 4.32 Fluorene ❑ ❑ ❑ Concentration 1 Mass (86-73-7) EPA Form 3510.2C (Revised 3.19) Page 17 DocuSign Envelope ID: 2F30O212-2811-4487-A7A0-07AF46CC6259 NA EPA Idenhfrcation Number NVUL6 VOMI Nw NCROOOO13078 I NCOO81426 Facility Name Oulfall Number N.I . Mitcl)ell WTP Form Approved 03105119 OMB No. 204MOO4 � fi a ■ fi ■ ' ■ ' ■ I Presence or Absence � Intake (check one) Effluent (optional) PollutantlParameter Testing Units Maximum Maximum Long -Term Long - (and CAS Number, if available) Required Believed Believed (Specify) Daily Monthly Average Number Term Number Present Absent Discharge Discharge Daily of Average of (required) (if available) Discharge Analyses Value Analyses if available 4,33 Hexachlorobenzene Concentration Mass (118-74-1) 4,34 Hexachlorobutadiene ❑ El El Concentration Mass (87-68-3) 4.35 Hexachlorocyclopentadiene El ❑ 11 Concentration Mass (77-47-4) 4.36 Hexachloroethane Concentration Mass (67-72-1) 4.37 Indeno (1,2,3-cd) pyrene Concentration Mass (193-39-5) 4.38 Isophorone El 11 El Concentration Mass (78-59-1) 4,39 Naphthalene El lConcentration Mass (91-20-3) 4.40 Nitrobenzene El ❑ El Concentration Mass (98-95-3) 4.41 N-nitrosodimethylamine Concentration Mass (62-75-9) 4.42 N-nitrosodi-n-propylamine Concentration Mass (621-64-7) 4.43 N-nitrosodiphenylamine ❑ Concentration Mass (86-30-6) 4.44 Phenanthrene Concentration Mass (85-01-8) 4.45 pyrene Concentration Mass (129-00-0) EPA Form 3510.2C (Revised 3-19) Page 18 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 NA EPA IdenGTication Number NPDES Permit Number Facility Name NCR000013078 NCO081426 N.L. Mitchell WTP Number Form Approved 03105/19 OMB No. 2WH004 TABLE B. TOXIC METALS, CYANIDE. TOTAL PHENOLS, AND ORGANIC TOXIC POLLUTANTS (40 CIFIR Presence or Absence 122.21(g)(7)(y))' Intake check one Effluent (optional) Poll utant]Pa rameter [and CAS Number, if available] Testing Required Units Believed Believed (specify, Maximum Maximum Long -Term Average Number Long - Number Present Absent Daily Discharge Monthly Discharge Daily of Term Average of (required) (if available) Discharge Analyses Value Analyses if available 1,2,4-trichlorobenzene 4.46 1(120-82-1) El ❑ El Concentration Section 5. Organic Toxic Pollutants C1MS Fraction --Pesticides) 51 Aldrin ❑ ❑ ❑ Concentration (309-00-2) Mass 5'2 p-BHC El El ❑ Concentration Mass (319-84-6) 5'3 R-BHC El ❑ El Concentration Concentration (319-85-7) 5"4 y-BHC El ❑ El Concentration Concentration (58-89-9) 5.5 b-BHC ❑ El El Concentration Concentration (319-86-8) 5 6 Chlordane ❑ ❑ ❑ Concentration Mass (57-74-9) 5.7 4,4'-DDT ❑ ❑ El Concentration Concentration (50-29-3) 5.8 14,4'-DOE El El I]Mass Concentration (72-55-9) 5,9 4,4'-DDD ❑ ❑ ❑ Concentration (72-54-8) Mass 5.10 Dieldrin ❑ ❑ ❑ Concentration (60-57-1) Mass 5.11 a-endosulfan ❑ ❑ El Concentration (115-29-7) Mass EPA Form 3510.2C (Revised 3.19) Page 19 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 h�A EPA Identification Number NPOES Permit Number Facility Name NCR000013078 I NCO091426 N.k. Mitchell WTP Form Approved 0305119 OMB No. 2040-0004 TOXICTABLE B. ■ ORGANIC TOXIC •Oi Effluent intake (optional) Pollutant/Parameter (and CAS Number, if available) Testing Required Presence or Absence (check one) Units (specify) Believed Present Believed Absent Maximum Daily Discharge (required) 'Maximum Monthly Discharge (if available) Long -Term Average Daily Discharge if available Number of Analyses Long - Term Average Value Number of Analyses 5.12 R-endosulfan (115-29-7) ❑ ❑ ❑ Concentration Mass 5.13 Endosulfan sulfate (1031-07-8) ❑ ❑ ❑ Concentration Mass 5,14 Endrin (72-20-8) El ❑ ❑ Concentration Mass 515 Endrin aldehyde (7421-93-4) El ❑ ❑ Concentration Mass 516 Heptachlor (76-44-8) ❑ ❑ ❑ Concentration Mass 517 Heptachlor epoxide (1024-57-3) ❑ ❑ ❑ Concentration Mass 5.18 PCB-1242 (53469-21-9) ❑ ❑ El Concentration Mass 5.19 PCB-1254 (11097-69-1) ❑ ❑ ❑ Concentration Mass 5.20 PCB-1221 (11104-28-2) ❑ ❑ ❑ Concentration Mass 5.21 PCB-1232 (11141-16-5) ❑ ❑ Concentration Mass 5.22 PCB-1248 (12672-29-6) ❑ ❑ ❑ Concentration Mass 5.23 PCB-1260 (11096-82-5) ❑ ❑ ❑ Concentration Mass 5.24 PCB-1016 (12674-11-2) ❑ ❑ ❑ Concentration Mass EPA Form 3510-2C (Revised 3.19) Page 20 DocuSign Envelope ID: 2F30O212-2811-4487-A7A0-07AF46CC6259 NP 4 Identification Number NPDES Permit Number Facility Name NCRO00013O78 NCOO81426 N.L. Mitchell WTP Form Approved 03MI19 OMB No. 2040-0004 CYANIDE,TABLE B. TOXIC METALS, ■PHENOLS,ORGANIC TOXICr Intake Presence or Absence check one) Effluent (optional) PalEutantlParameter Testing Units Maximum Maximum Lang -Term 'Number Long- {and CAS Number, if available} Required Believed Believed {specfy} Daily Monthly Average Term Number Present Absent Discharge Discharge Daily Discharge of Analyses Average of Analyses (required) (if available) if available) Value Toxaphene Concentration 5.25 (8001-35-2) ❑ ❑ ❑ Mass ' 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 21 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 This page intentionally left blank. DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA identification Number NPI7E5 Permit Number Facility Name OutfaIt Number Form Approved 03lD5119 NCRIO00013078 NCO081426 N.L. Mitchell WTP OMB No.2D40-0004 Presence or Absence intake check one Effluent {Optional} Pollutant units Maximum Long -Term Believed believed (specify) Maximum Daily Long -Term Monthly Average Daily Number of Number of Present Absent Discharge Average Discharge Discharge Analyses Analyses {required] (if avaiiable ifavailable Value ❑ 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 outfal1, You need not complete the "Presence or Absence" column of Table C for each pollutant. Bromide ❑ ❑ Concentration 0 0 (24959-67-9) Mass 0 0 2 Chlorine, total ❑ ❑ Concentration a 0 Mass 0 0 residual 3, Color 0 ❑ Concentration 0 0 Mass ❑ 0 4. Fecal coliform 0 El Concentration 0 0 Mass ❑ ❑ 5. Fluoride ❑ ❑ Concentration 0 0 Mass 0 0 (16984.48-8) 6 Nitrate -nitrite ❑� ❑ Concentration 0 0 Mass D o 7 Nitrogen, total ❑ ❑ Concentration 0 0 organic (as N) Mass ❑ 0 8. Oil and grease ❑ Concentration ❑ 0 Mass 0 0 9 Phosphorus (as ❑ J ❑ Concentration 0 0 P), total (7723.14.0) Mass 0 0 10 Sulfate (as SO4) ❑ ❑ Concentration 0 0 (14808.7") Mass 0 0 11. Sulfide (as 5) ❑ 0 Concentration ❑ 0 Mass 0 o EPA Form 3510.2C (Revised 3.19) ece A 4&a uc v-,1 _*�� Page 23 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPOES Permit Number I Facility Name NCR000013078 NCO081425 N.L. Mitchell WTP WWI Number Form Approved 03105/19 OMB No. 204M004 Effluent Intake (Optional) Pollutant Presence or Absence check one Units [specify} Believed Present Believed Absent Maximum Daily Discharge (required) Maximum Monthly Discharge if available Long -Term Average Daily Discharge if available Number of Analyses Long -Term Average e Value Number of Analyses 12 Sulfite (as SD3) (14265.45-3) r7i Concentration ❑ 0 Mass 0 0 11 Surfactants ❑r Concentration 0 0 Mass 0 0 14 Aluminum, total (7429.90.5) J Concentration 0 0 Mass 0 0 15. Barium, total (7440.39.3) r Concentration o 0 Mass 0 0 16. Boron, total (744"2-8) J Concentration 0 a Mass 0 0 17 Cobalt. total 7440.48.4 ( } J Concentration o a Mass 0 0 18 Iran, total (743M9.6) ❑ Concentration 0 0 Mass 0 a 19 Magnesium, total (7439.95.4) ❑ Concentration 0 a Mass 0 0 20. Molybdenum, total T439.98-7 ❑J Concentration 0 0 Mass 0 0 21 Manganese, total (7439.96.5) ❑r Concentration 0 0 Mass 0 0 22 Tin total (7440-31-5) ❑ El Concentration 0 0 Mass 0 ❑ 23. Titanium, total (7440-32.6} El El Concentration 0 0 Mass o 0 Sew c , /CN J w �Ev� EPA Form 3510.2C (Revised 3-19) Page 24 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number HPDES Permit Humber Facility Name ❑ulall Number Form Approved 03ro5119 NCR000013078 NCO081426 N.L. Mitchell WTP OMB No.2040-0004 b 0 a, E. r Presence or Absence Intake check one Effluent (Optional) Pollutant Believed Believed Units (specify) Maximum Daily Maximum Long -Term Monthly Average Daily Number of Long -Term Number of Present Absent Discharge Discharge Discharge Analyses Average Analyses (required) Value (if available) if available 24. Radioactivity Alpha, total ❑ ❑r Concentration 0 Mass 0 0 Beta, total El 0 Concentration 0 0 Mass o a Radium, total ElMass Concentration 0 0 0 0 Radium 226, Total ❑ 0 Concentration 0 0 Mass 0 0 $ 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 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 A14 EPA Identification Number NPQES Permit Nui NCR000013078 NCO081426 Facility Name N.L. Mitchell WTP ❑uttall Number Form Approved 03/05119 OMB No. 2040-0004 Reason Pollutant Believed Present in Discharge Available Quantitative Data (specify units) Pollutant Presence or Absence cbeckone Believed Present Believed Absent 1. Asbestos ❑ El2. Acetaldehyde ❑ ❑ 3, Allyl alcohol ❑ ❑ 4. Allyl chloride ❑ ❑ 5. Amyl acetate ❑ ❑ 6. Aniline ❑ ❑ 7. Benzonitdie ❑ ❑ 8. Benzyl chloride ❑ ❑ 9. Butyl acetate ❑ ❑ 10. Butylamine ❑ ❑ 11. Caplan ❑ ❑ 12. Carbaryl ❑ ❑ 13. Carbofuran ❑ ❑ 14. Carbon disulfide ❑ ❑ 15. Chlorpyrifos ❑ ❑ 16. Coumaphos ❑ ❑ 17. Cresol ❑ ❑ 18. Cratonaldehyde ❑ ❑ 19. Cydohexane ❑ ❑ EPA Form 3510.2C (Revised 3.19) Page 27 DocuSign Envelope ID: 2F30O212-2811-4487-A7A0-07AF46CC6259 0 EPA Identification Number FPresence NPDES Permit (dumber I adlily Name Oulfall Number Form Approved 03105/19 NCR000013O78 NCO081426 N.-. Mitchell WTP OMB No.2040-0004 or Absence Pollutant check one Believed Believed Reason Pollutant Believed Present in Discharge Available Quantitative Data Present Absent {speeiiy units} 20. 2,4-D (2,4-dichlorophenoxyacetic acid) ❑ ❑ 21. Diazinon El ❑ 22. Dicamba ❑ [] 23. Dichlobenil ❑ ❑ 24. Dichlone ❑ ❑ 25. 2,2-dichioroproplonic acid ❑ ❑ 26. Dichlorvos ❑ ❑ 27. Diethyl amine ❑ [] 28. Dimethyl amine ❑ ❑ 29. Dintrobenzene ❑ ❑ 30. Diquat ❑ ❑ 31. Disulfoton ❑ ❑ 32. Diuron ❑ ❑ 33. Epichlorohydrin ❑ ❑ 34. Ethion ❑ ❑ 35. Ethylene diamine ❑ ❑ 36. Ethylene dibromide ❑ ❑ 3T. Formaldehyde ❑ ❑ 38. Furfural ❑ ❑ EPA Form 3510.2C (Revised 3-19) Page 28 DocuSign Envelope ID: 2F300212-2811-4487-A7AO-07AF46CC6259 �i A EPA Identification Number NPDES Permit Nc:rnber Facility Name Outfal, Number Form Approved 03l0M119 NCR000013078 NCO081426 NA.. Mitchell WTP OMB No.2040.0004 Presence or Absence Pollutant check one Believed Believed Reason Pollutant Believed Present in discharge Available [quantitative Data Present Absent (specify units) 39. Guthian11 40. Isoprene El 41, Isopropanolamine El 42. Mthane El 43, Kepone El 44. Marathion ❑ 45. Mercaptodimethur 46. Methoxychlor El 47. Methyl mercaptan 48. Methyl methacrylate ❑ El 49. Methyl parathion ❑ El 50. Mevinphos 0 51. Mexacarbate ❑ ❑ 52. Monoethyl amine El 53. Monomethyl amine El 54. Naled ❑ # 55. Naphthenic acid ED El 56. Nitrotoluene El El F7. ParathionEl EPA Form 3510-2C (Revised 3-19) Page 29 DocuSign Envelope ID: 2F30O212-2811-4487-A7A0-07AF46CC6259 10 DIA tlentificahon Number WIDE Permit Number Facility Name Outfall Number Form Approved 03105119 NCR000013O78 NC0O81426 N.L. Mitchell WTP OMB No. 2040 O04 Presence or Absence ro Pollutant check Believed one)Available Believed Reason Pollutant Believed Present in Discharge Quantitative Data Present Absent {specify units) 58. Phenolsulfonate ❑ ❑ 59. Phosgene ❑ ❑ 60. Propargite ❑ ❑ 61. Propylene oxide ❑ ❑ 62. Pyrethrins ❑ ❑ 63. Quinoline ❑ ❑ 64. Resorcinol ❑ ❑ 65. Strontium ❑ ❑ 66. Strychnine ❑ ElF67. Styrene ❑ ❑ 68 2,4,5-T (2,4,5-trichlorophenoxyacetic ❑ ❑ acid 69. TDE (tetrachlorodiphenyl ethane) ❑ ❑ 70 2,4,5-TP [2-(2,4,5-trichlorophenoxy) El ❑ ro anoic acid 71. Trichlorofon ❑ ❑ 72. Triethanolamine ❑ ❑ 73. Triethylamine ❑ ❑ 74. Trimethylamme ❑ ❑ 75, Uranium ❑ ❑ 76. Vanadium ❑ ❑ EPA Form 3510.2C (Revised 3-19) Page 30 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 41denfification Num NCR000013078 Pollutant NPDES Permit Number NC0081426 Presence or Absence Number N.L. Mitchell WTP Reason Pollutant Believed Present in Discharge Form Approved 03105119 OMB No, 2040-OON Available Quantitative Data {specify units} Present Absent 77. Vinyl acetate El 78. Xylene 79. Xylenol [Ell El 80. Zirconium ' 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 C F R chapter I, subchapter N or 0. See instructlons and 40 C F R 122.21(e)(3). EPA Form 3510.2C (Revised 3-19) Page 31 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 This page intentionally left blank. DocuSign Envelope ID: 2F30O212-2811-4487-A7A0-07AF46CC6259 EPA IdenFhogon Num NCR00OO13O78 Pollutant 2,3,7,8-TCDD NCOO81426 TCD❑ Presence or Congeners Absence Used or check one Believed Believed Manufactured Present Absent ❑ I ❑ I ❑ Facility Name N.L. Mitchell WTP Results of Screening Procedure Form Approved 03MI19 OM8 No, 2040-M EPA Form 3510-2C (Revised 3-19) Page 33 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 2C, ATTACHMENT 1 (LINE DRAWING FOR SECTION 2.0) N.L. Mitchell WTP process waste system line drawing r NJL Waste Cider Filter ■"kwa4sh 'A, With �e�amw & EX. iaCkM►aslr Hydroullc ltn rovewte Waste PS .� iS p E 1=MCV to tlrasse C Settled Solids Sanitary Sewer Mrl1ES This NPDES permit (NCo081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent to either a Sanitary Sewer collection system or the NPDES permitted outfaR. Alt process waste system discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit without having discharged to the designated ❑utfa[I far the previous permit cycle and thus having no discharge analysis data to provide. Instructions from our regional NCDEQ office for renewal of the Mitchell NPDES permit are to complete: ■ EPA form 1 • EPA form 2E • Tables A & C of EPA form 2C, as well as Table B if applicable DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 2C, ATTACHMENT 2 (EXPLANATION FOR SECTIONS 3.0, 7.3, 7.13, Table C) This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter backwash and filter rewash streams. The process waste system has a binary discharge, sending effluent to either a Sanitary Sewer collection system or the NPDFS permitted outfall. All process waste system discharge has gone to the Sanitary Sewer collection system during the current NPDES permit cycle. This puts the City of Greensboro in the unusual position of renewing the Mitchell site NPDES permit without having discharged to the designated outfall for the previous permit cycle and thus having no discharge flow or analysis data to provide on the application. (Section 7.3) The applicant cannot answer YES due to the fact that there has been no discharge at the outfall to sample and analyze. The applicant cannot answer NO due to the fact that a waiver has not been requested. Our current permit requires: a Continuous monitoring of discharge flow 0 2X monthly testing for • TSS • pH • Total Chlorine Residual • Turbidity o Quarterly testing for • Aluminum • Total Iron • Total Copper • Manganese • Fluoride • Hardness • Upstream Hardness • Total Nitrogen • Total Phosphorus • Whole Effluent Toxicity Monitoring DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 2C, ATTACHMENT 3 (DESCRIPTION OF PLANNED IMPROVEMENTS FOR SECTION 6,3) This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). The process waste system influent flow is composed of Filter backwash and filter rewash streams. There are hydraulic restraints within the process waste system at this water treatment plant that have led to discharging to Sanitary Sewer instead of the NPDES outfall for the entirety of the current permit cycle. Improvements to the process waste system are in the design phase which, when constructed, will make NPDES discharge possible again without limiting production. Construction of the new system is planned to begin June of 2022 with an expected duration of 18 months. The new system will include Equalization/Clarification of intermittent backwashes, Mixing, ❑echlorination, pH adjustment, Flocculation and Settling. ❑ihcharge options will include. Recycle back to the treatment plant, NPDES to permitted outfall and Sanitary Sewer. N.L. Mitchell WTP New Process Waste System Ff DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 030119 NCO081426 N-L. Mitchell WTP OMB No- 2040-0004 U.S. Environmental Protection Agency FORM Application for NPDES Permit to Discharge Wastewater 2E E PA SixMANUFACTURING, NPDES COMMERCIAL, MINING, AND SILVICULTURAL FACILITIES WHICH DISCHARGE ONLY NONPROCESS WASTEWATER LOCATIONt 1-1 Provide information on each of the facility's outfalls in the table below- o — Outfall Number Receiving Water Name Latitude Longitude J 001 North Buffalo Creek 36' 0813' 89" -79' 8033' 33" O SECTION 2. i I W 2-1 Are you a new or existing discharger? (Check only one response-) tM 2 ❑ New discharger 0 Existing discharger 4 SKIP to Section 3. N a 2.2 Specify your anticipated discharge date: a SECTION 3. WASTE TYPES t 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 0 Other nonprocess wastewater {desObefexplain ❑ Restaurant or cafeteria waste directly below) ElNan-contact cooling water WTP Filter Backwash Wastewaters n 3.2 Does the facility use cooling water additives? ❑ Yes ❑r No 4 SKIP to Section 4. 3.3 List the cooling water additives used and describe their cam osition. Cooling Water Additives Composition of Additives tilt if available toyou) 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? See ztf I No; a waiver has been requested from my NPDES permitting authority El Yes ��f ElNo; ", waiver request and additional information 4 SKIP to Section 5. 4.2 Provide data as requested in the table below. See instructions fors ecifics. N Number of Maximum Daily Average Daily Source N Parameter or Pollutant Analyses Discharge Discharge {use codes (i actual data s eci units (sped units per Mass Conc. !Hass Conc. reported) instructions) Biochemical oxygen demand (BOD5) o y Total suspended solids (TSS) o Oil and grease a LU Ammonia (as N) a Discharge flow 0 0 mgd NA pH (report as range) 0 NA NA Temperature (winter) 0 NA NA Temperature (summer) 0 NA NA 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 1 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03105119 NCO081426 N.L. !Mitchell WTP OMB No, 2040-0004 4.3 Is fecal col iform believed present, or is sanitary waste discharged (or will it be discharged)? ❑ Yes El No 3 SKIP to Item 4.5. 4.4 Provide data as re quested in the table below. See instructions fors ecifics. Number of Maximum Daily Average Daily Source Parameter or Pollutant Analyses Discharge Discharge {use codes {if actual data (spec' units) (speaty units)_per Mass Conc. Mass Conc. reported] Instructions.) Fecal coliform E. col+ >= Enterococci 0 4.5 Is chlorine used (or will it be used)? U ❑ Yes ❑ No 4 SKIP to Item 4.7, N 4-6 Provide data as requested in the table below.t See instructions forspecifics.) Number of Maximum Daily Average Daily Source m Parameter or Pollutant Analyses Discharge Discharge {use codes s (if actual data s units (specify units per Mass Conc. Mass Conc. reported) instructions} r Total Residual Chlorine LU 4.7 Is non -contact cooling water discharged (or will it be discharged)? ❑ Yes ❑r No 4 SKIP to Section 5. 4.8 Provide data as reg uested in the table beiow.t See instructions fors ecifics. Number of Maximum Daily Average Daily Source Parameter or Pollutant Analyses Discharge Discharge (use codes {if actual data (spedfy units) (sped units per Mass Conc. Mass Conc. reported) instructions] Chemical oxygen demand (COD) Total organic carbon JOC) SECTIONE 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 3 Complete this section. ❑ No 4 SKIP to Section 6- c 5.2 Briefly describe the frequency and duration of flow. Intermittent discharge flow from filter backwash waste. t 6.1 Briefly describe any treatment systems) used (or to be used). aEi Filter backwash waste stream is dechlorinated with sodium thiosulfate and sent to a decant clarifier prior to discharge into North Buffalo Creek. m E iv w r` ' Sampling shall be conducted according to sufficiently sensitive test procedures (Le., methods) approved under40 CFR 136 forthe 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 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA Identifca5on Number NPDES Permit Number Facility Name Form Approved 03105119 NC0081426 N.L. Mitchell WTP CMBNo- 2040-0004 SECTIONOTHER INFORMATION1 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. o Due to on -going construction at the Mitchell plant, all plant discharges were sent to the sanitary sewer. There has been ._ no discharge to North Buffalo Creels under the current permit. Improvements to the process waste system are in the design phase which, when constructed, will make NPDES discharge possible again. Construction of the new system is planned to begin June of 2022 with an expected duration of 18 months. m SECTION ■ I and r 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 ❑,r Section 1: Outfall Location ❑ wl attachments (e.g., responses for additional outfalls) ❑ Section 2: Discharge date IV14 ❑ wl attachments ❑r Section 3: Waste Types ❑ wl attachments 15 ❑� Section 4: Effluent Characteristics 0 wl attachments a) E m ❑� Section 5: Flow ❑ wl attachments U) o ❑ Section 6: Treatment System ❑ wl attachments to w ❑ Section 7: Other Information ❑ wl attachments ❑� Section 8: Checklist and Certification Statement ❑ wl attachments 8.2 Certification Statement N t certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible forgathering 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 Dell Harney Water Supply Manager Signature Date signed � � r �} EPA Form 3510-2E (revised 3-19) Page 3 DocuSign Envelope ID: 2F300212-2811-4487-A7A0-07AF46CC6259 EPA FORM 2E, ATTACHMENT 1 (FOR SECTION 4.0) Sections 4.1 and 4.2 of form 2E could not be completed because all process wastes have been discharged to a Sanitary Sewer connection during the current permit cycle. With no NPDES discharge to the permitted outfall, the facility has no data to complete section 4.2 and is not requesting a waiver. This NPDES permit (NC0081426) is for a conventional filtration water treatment plant operated by the City of Greensboro (PWSID 0241010). Instructions from our regional NCDEQ office for renewal of the Mitchell NPDES permit are to complete: • EPA form 1 • EPA form 2E ■ Tables A & C of EPA form 2C, as well as table B if applicable