NC0021156_Renewal (Application)_20230620

United States Office of Water EPA Form 3510-2A
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
r^EPA Application Form 2A
New and Existing Publicly
Owned Treatment Works
NPDES Permitting Program
9ED
4 2023
NGt)EQ/DWR/NPDES
Note: Complete this form if your facility is a new or existing publicly owned treatment works.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2A to average between 4.7 and 24.7 hours, depending on the number of sections the
applicant must complete. The estimate includes time for reviewing instructions, searching existing data
sources, gathering and maintaining the needed data, and completing and reviewing the collection of
information. Send comments about the burden estimate or any other aspect of this collection of
information to the Chief, Information Policy Branch (PM-223), U.S. Environmental Protection Agency,
1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, 725 171' Street, NW, Washington, DC 20503,
marked "Attention: Desk Officer for EPA."

FORM 2A—GENERAL INSTRUCTIONS
Who Must Complete Form 2A7
All new and existing publicly owned treatment works (POTWs) and
other dischargers designated by the National Pollutant Discharge
Elimination System (NPDES) permitting authority must complete
Form 2A. Note that you may wish to consult the "General
Instructions" of NPDES Application Form 1 to determine if your
treatment works is required to submit any additional NPDES
application forms.
At the state level, either the U.S. Environmental Protection Agency
(EPA) or an approved state agency administers the NPDES permit
program. If you are located in a jurisdiction in which an EPA
regional office administers the NPDES permit program, you should
use Form 2A and all other applicable forms described in these
instructions. If you are located in a jurisdiction where a state
administers the NPDES permit program, contact the state to
determine the forms you should complete. States often develop
their own application forms rather than use the federal forms. See
hftp://www.epa.gov/npdes/npdes-state-program-informafion for a
list of states that have approved NPDES permit programs and
those that do not.
Exhibit 2A-1 (see end of this section) provides contact information
for each of EPA's 10 regional offices. Since the exhibit's content is
subject to change, consult EPA's website for the latest information:
hfto://www.epa.gov/aboutepa#regional.
Where to File Your Completed Form
• If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the state
forms.
• If you are in a jurisdiction where EPA is the NPDES permitting
authority (i.e., the state is not an NPDES-authorized state),
mail the completed application forms to the EPA regional office
that covers the state in which your facility is located (see
Exhibit 2A-1).
When to File Your Completed Form
Form 2A must be submitted at least 180 days before your present
NPDES permit expires or, if you are a new discharger, at least
180 days before the date on which the discharge is to commence,
unless the NPDES permitting authority has granted permission for a
later date.
Fees
EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES permit
program may charge fees. Consult with state officials for further
information.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request. You
may not claim any information on Form 2A (or related attachments)
as confidential.
You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by
Form 2A. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you. EPA will handle claims of confidentiality in
accordance with the Agency's business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations (CFR).
Completion of Forms
Form 2A is divided into six major sections. It also contains five
effluent monitoring tables (Tables A through E) and an industrial
discharge information table (Table F), all located at the end of the
form. Note that not all applicants are required to complete each
section of the form or all of the tables. The questions on the form
will direct you to the items and tables you must complete.
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Provide your EPA Identification Number from the Facility Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2A and any attachments. If your facility is new
(i.e., not yet constructed), write or type "New Facility" in the space
provided for the EPA Identification Number and NPDES permit
number. If you do not know your EPA Identification Number,
contact your NPDES permitting authority. See Exhibit 2A-1 for
contact information. Additionally, for Tables A through E, provide
the applicable outfall number at the top of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter "NA" for "not applicable" to
show that you considered the item and determined a response was
not necessary for your facility.
If you have previously submitted information that answers a specific
question to EPA or an approved state NPDES agency, you may
either repeat the information in the space provided or attach a copy
of the previous submission.
Note for New Dischargers
Provide all information available to you at the time you
complete Form 2A. If you do not have information to respond
to an item because your facility has yet to discharge, write or
type "data are not available" next to the item on the form. Note
that you are required to submit actual data no later than
24 months after your facility commences to discharge.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority's satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Definitions
The legal definitions of all key terms used in the various NPDES
application forms are included in the "Glossary" at the end of these
nstructions.
2A-1

FORM 2A—GENERAL INSTRUCTIONS CONTINUED
Exhibit 2A-1. Addresses of EPA Regional Contacts and Covered States
REGION 1
REGION 6
U.S. Environmental Protection Agency, Region 1
U.S. Environmental Protection Agency, Region 6
5 Past Office Square, Suite 100, Boston, MA 02109-3912
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: [phone]; toll free:[phone]
Phone: [phone]; toll free: [phone]
Fax:[phone]
Fax: [phone]
Website: http,l/www eoa govlaboutepalepa-reoion-l-new�naland
Website: hto llwww eoa govlaboutew/eoa-region6-south-central
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
Island, and Vermont
REGION 2
REGION 7
U.S. Environmental Protection Agency, Region 2
U.S. Environmental Protection Agency, Region 7
290 Broadway, New York, NY 10007-1866
11201 Renner Boulevard, Lenexa, KS 66219
Phone: [phone]; toll free:[phone]
Phone: [phone]: toll free: [phone]
Fax: [phone]
Wabsile: http /iwvnv.epa.gov/aboutepa/epa-region-7-rnidwest
Website: http'/twww epa oovlaboutepa/eoa-region-2
Covered states: Iowa, Kansas, Missouri, and Nebraska
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rica
REGION 3
REGION 8
U.S. Environmental Protection Agency, Region 3
U,S. Environmental Protection Agency, Region 8
1650 Arch Street, Philadelphia, PA 19103.2029
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: [phone]; toll free: (800) 43B-2474
Phone: [phone]; toll free: [phone]
Fax: [phone]
Fax: [phone]
Website: hm, llwwwepaaovlaboutepa/epa-region-3-mid-atlantic
Website: hhp'llwwwepagovlaboutepa/epa-reglon3-mountains-and-plains
Covered states: Delaware, Disldct of Columbia, Maryland, Pennsylvania, Virginia,
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
and West Virginia
Wyoming
REGION 4
REGION 9
U.S. Environmental Protection Agency, Region 4
U.S. Environmental Protection Agency, Region 9
Sam Nunn Atlanta Federal Center
75 Hawthorne Street, San Francisco, CA 94105
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: [phone]; toll free: (866) EPA -WEST
Phone: [phone]; toll free: [phone]
Fax:[phone]
Fax: [phone]
Website: httoil/ v eva.gov/aboutepalepa-region-g-pacific-southwes
Website: him Ih w epa aovlaboutepa/about-epa-reoion4- utheast
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
Covered states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
and Trust Territories
South Carolina, and Tennessee
REGION 5
REGION 10
U.S. Environmental Protection Agency, Region 5
U.S. Environmental Protection Agency, Region 10
77 West Jackson Boulevard, Chicago, IL 606043507
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: [phone]; toll free: [phone]
Phone: [phone]; toll free: (800) 4244372
Fax: [phone]
Fax: [phone]
Website: hftp//www.epa.govlaboutepa/epa-mqion
Website: http'//www.ePa.gov/aboutepalepa-region-10-pacific-nodhwest
Covered slates: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
Covered states: Alaska, Idaho, Oregon, and Washington
2A-2

FORM 2A—LINE-BY-LINE INSTRUCTIONS
Section 1. Basic Application Information for All Applicants
Facility Information
Item 1.1. Enter the facility's official or legal name. Do not use a
colloquial name. Provide the mailing address of the facility. Next,
give the name (first and last), title, work telephone number, and
email address of the person who is thoroughly familiar with the
operation of the facility and with the facts reported in this
application.
Include a complete location address for the facility if different from
the mailing address. If the facility lacks a street name or route
number, give the most accurate, alternative geographic information
(e.g., section number or quarter section number from county
records or "at intersection of Routes 425 and 22').
Item 1.2. Indicate whether the application is for a facility that has
not yet commenced discharge. If yes, be advised that you are
required to submit actual data no later than 24 months after your
facility commences to discharge.
Applicant Information
Item 1.3. Indicate if the applicant is different from the entity listed
under Item 1.1. If so, specify the applicant name and address.
Provide the name (first and last) of a contact, including his/her title,
telephone number, and email address.
Item 1.4. Indicate if the applicant is the facility's owner, operator, or
both.
Item I.S. Specify whether the NPDES permitting authority should
send correspondence to the facility or the applicant.
Existing Environmental Permits
Item 1.6. Indicate all environmental permits or construction
approvals received or applied for (including dates) under the noted
programs. Print or type the corresponding permit number for each.
Collection System and Population Served
Item 1.7. Specify the municipalities served by the treatment works,
including unincorporated connector districts. For each municipality,
indicate the population served, the percentage of each collection
system type if known (e.g., separate sanitary or combined storm
and sanitary), and collection system ownership status. Finally,
indicate the total percentage of sewer line each type comprises.
Do not report privately owned collection systems discharging
industrial waste to the treatment works in Item 1.7. Those facilities
must be reported on Table F.
Indian Country
Item 1.8. Indicate if the POTW is located in Indian Country.
Item 1.9. Note whether the treatment works discharges to a
receiving stream that flows through Indian Country.
Design and Actual Flow Rates
Item 1.10. Provide the facility's design flow rate in million gallons
per day (mgd). Next, specify the facility's actual annual average
daily flow rate and maximum daily flow rate for each of the previous
three years (in mgd).
Discharge Points by Type
Item 1.11. Provide the facility's total number of effluent discharge
points to waters of the United States by type (e.g., treated effluent,
untreated effluent, combined sewer overflows, bypasses, and
constructed emergency overflows).
Outfalls and Other Discharge or Disposal Methods
Outfalls Other Than to Waters of the United States
Item 1.12. Indicate whether the POTW discharges wastewater to
basins, ponds, or other surface impoundments that do not have
outlets for discharge to waters of the United States. If yes, continue
to Item 1.13, If no, skip to Item 1.14.
Item 1.13. Specify the location of each surface impoundment, the
average daily volume discharged to each surface impoundment in
gallons per day (gpd), and whether the discharge is continuous or
intermittent.
Item 1.14. Indicate if the facility applies wastewater to land. If yes
continue to Item 1.15. If no, skip to Item 1.16.
Item 1.15. Provide the location of each land application site; the
size of each land application site (in acres); the average daily
volume applied to each land application site (in gpd), and whether
the land application is continuous or intermittent.
Item 1.16. Note whether the facility's effluent is transported to
another facility for treatment prior to discharge. If yes, continue to
Item 1.17. If no, skip to Item 1.21.
Item 1.17. Describe the means by which the effluent is transported,
such as by tank truck or pipe.
Item 1.18. Specify whether the facility's effluent is transported by a
party other than the applicant. If yes, continue to Item 1.19. If no,
skip to Item 1.20.
Item 1.19. Provide the name, mailing address, contact person,
phone number, and email address of the entity that transports the
discharge.
Item 1.20. Provide the name, mailing address, contact person,
phone number, email address, and NPDES permit number (if any)
of the receiving facility. Also specify the average daily flow rate from
the facility into the receiving facility in mgd.
Item 1.21. Indicate if wastewater is disposed of in a manner other
than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the United States, such as
underground percolation and underground injections. If yes,
continue to Item 1.22. If no, skip to Item 1.23.
Item 1.22, Provide a description of the disposal method, including
the location and size of each disposal site; the annual average daily
discharge volume (in gpd), and whether disposal through this
method is continuous or intermittent.
Variance Requests
Item 1.23. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note that
you are not being asked to submit any other information at this
time. Contact your NPDES permitting authority to determine the
P7.51

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and an
applicant may request a variance consistent with statutory and
regulatory requirements.
Contractor Information
Item 1.24. Indicate if any of the operational or maintenance
activities associated with wastewater treatment and effluent quality
of the POTW are the responsibility of a contractor. If yes, continue
to Item 1.25. If no, skip to Section 2.
Item 1.25. Provide a listing of all contractors (by company name).
For each, specify the mailing address, a contact name, telephone
number, and email address. Also summarize the operational and
maintenance responsibilities of each contractor.
Section 2. Additional Information
Outfalls to Waters of the United States
Design Flow
Item 2.1. Indicate whether the treatment works has a design flow
greater than or equal to 0.1 mgd. If yes, continue to Item 2.2. If no,
skip to Section 3.
Inflow and Infiltration
Item 2.2. Specify the POTW's current average daily volume of
inflow and infiltration (in gpd) and steps the facility is taking to
minimize inflow and infiltration.
Topographic Map
Item 2.3. Prepare a topographic map (or other map if a topographic
map is unavailable) extending at least one mile beyond property
boundaries of the treatment plant, including all unit processes and
showing the following: (1) treatment plant area and unit processes;
(2) major pipes or other structures through which wastewater enters
the treatment plant and the pipes or other structures through which
treated wastewater is discharged from the treatment plant (include
outalls from bypass piping, if applicable); (3) each well where fluids
from the treatment plant are injected underground; (4) wells,
springs, and other surface water bodies listed in public records or
otherwise known to the applicant within''% mile of the treatment
works' property boundaries; (5) sewage sludge management
facilities (including onsite treatment, storage, and disposal sites);
and (6) location at which waste classified as hazardous under the
Resource Conservation and Recovery Act (RCRA) enters the
treatment plant by truck, rail, or dedicated pipe.
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools (e.g.,
https l/mynasadata.larc.nasa.gov/latitudelongitude-finder/1,
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).
On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS's National Map
website at http://nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map area
(e.g., residential, commercial). An example of an acceptable
location map is shown as Exhibit 2A-2 at the end of these
instructions. Note: Exhibit 2A-2 is provided for illustration only; it
does not show an actual facility. Note that you have completed your
topographic map and attached it to the application.
Flow Diagram
Item 2.4. Provide a process flow diagram or schematic showing the
processes of the treatment plant, including all bypass piping and all
backup power sources or redundancy in the system. This includes
a water balance showing all treatment units, including disinfection
(e.g., chlorination and dechlorination), and showing daily average
flow rates at influent and discharge points, and approximate daily
flow rates between treatment units. Also provide a narrative
description of the diagram/schematic. Answer "Yes" to Item 2A
once you have completed and attached your diagram to the
application.
Scheduled Improvements and Schedules of Implementation
Item 2.5. Indicate whether any improvements to the facility are
scheduled. If yes, list and briefly describe each scheduled
improvement and continue to Item 2.6. If no, skip to Section 3.
Item 2.6. For each scheduled improvement, indicate the outfall
number of each outfall affected and the scheduled or actual dates
of completion for the following: (1) commencement of construction,
(2) completion of construction, (3) commencement of discharge,
and (4) attainment of operational level.
Item 2.7. Note whether the appropriate permits/clearances
concerning other federal/state requirements have been obtained
and briefly explain your response.
Section 3. Information on Effluent Discharges
Description of Outfalls
Item 3.1. Provide a description of each of the POTW's wastewater
discharge ouffalls. The application form provides reporting space
for three outalls. If your facility has more than this number, attach
additional sheets as necessary.
For each outfall, provide the outfall number. Indicate the state,
county, and city or town where each outfall is located. Note the
distance from shore in feet and the depth below the surface in feet.
Specify the average daily flow rate through the outfall in mgd. Also
specify the latitude and longitude of each ouffall to the nearest
second. Latitude and longitude coordinates may be obtained in a
variety of ways, including use of hand held devices (e.g., a GPS
enabled smartphone), internet mapping tools (e.g.,
httos://'mynasadata.larc.nasa.gov/latitudelongitude-finder((,
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS). The location of each outfall (i.e.,
where the coordinates are collected) shall be the point where the
discharge is released into a water of the United States. For further
guidance, refer to hUp://www.epa.ciov/qeospatial/latitudelongitude
data -standard.
2A-4

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
Seasonal or Periodic Discharge Data
Item 3.2. Indicate whether any of the outfalls described under
Item 3.1 have seasonal or periodic discharges. If yes, continue to
Item 3.3. If no, skip to Item 3.4.
Item 3.3. Specify the following for each applicable ouffall:
(1) number of times per year discharge occurs, (2) average duratior
of each discharge, (3) average flow of each discharge in mgd, and
(4) months in which discharge occurs.
Diffuser Type
Item 3.4. Note whether any of the outfalls listed under Item 3.1 are
equipped with a diffuser. If yes, continue to Item 3.5. If no, skip to
Item 3.6.
Item 3.5. Briefly describe the diffuser type at each applicable
ouffall.
Waters of the United States
Item 3.6. Note whether the POTW discharges or plans to discharge
wastewater to waters of the United States from one or more
discharge points. If yes, continue to Item 3.7. If no, skip to
Section 6.
Receiving Water Description
Item 3.7. Provide receiving water and related information in the
table provided on the form (if known): (1) name of receiving water,
(2) name of watershed/river/stream system and U.S. Soil
Conservation Service 14-digit watershed code, (3) name of state
management/river basin and U.S. Geological Survey (USGS) 8-digit
hydrologic unit code, (4) acute and chronic critical low flow in cubic
feet per second (cis) and total hardness of receiving stream at
critical low flow, in milligrams per liter (mg/L) of calcium carbonate,
if applicable.
Treatment Description
Item 3.8. Specify the highest level of treatment provided for
discharges from each outfall (e.g., primary, equivalent to
secondary, secondary, or advanced). Also indicate the following
design removals (in percent) for the following parameters for each
outfall: (1) biochemical oxygen demand (BODsor CBOD5), (2) total
suspended solids (TSS), (3) phosphorus (if applicable), (4) nitrogen
(if applicable), and (5) any other removals that an advanced
treatment system is designed to achieve.
Item 3.9. Provide a description of the type(s) of disinfection used for
wastewater discharged through each outfall. Indicate the seasons
the disinfection type is used. Note whether the POTW dechlorinates
if disinfection is accomplished through chlorination. Otherwise,
check "Not Applicable."
Effluent Testing Data and Tables A through E
Items 3.10 to 3.26. These items require you to collect and report
data for the parameters and pollutants listed in Tables A through E,
located at the end of Form 2A. The instructions for completing the
tables are table -specific, as are the criteria for determining who
should complete them.
Important note: Read the "General Instructions for Reporting,
Sampling, and Analysis" later in these instructions before
completing Items 3.10 to 3.26 and Tables A through E.
Item 3.10 and Table A. All applicants that discharge wastewater to
waters of the United States must provide effluent data for Table A
parameters. Respond "Yes" to Item 3.10 when you have completed
Table A and attached it to your application.
Item 3.11. Answer whether the POTW has conducted any whole
effluent toxicity (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. If yes, continue to Item
3.12. If no, skip to Item 3.13.
Item 3./2. For each applicable ouffall, note the number of acute
and chronic WET tests conducted since the last permit reissuance
of the facility's discharges or of the receiving water near the
discharge points.
Item 3.13. Note whether the POTW has a design flow greater than
or equal to 0.1 mgd. If yes, continue to Item 3.14. If no, skip to Item
3.16.
Item 3.14 and Table B. Answer whether the treatment works uses
chlorine for disinfection, uses it elsewhere in the treatment process,
or otherwise has reasonable potential to discharge chlorine in its
effluent. If yes, complete Table B including chlorine. If no, complete
Table B, omitting chlorine.
Item 3.15. Answer "Yes" when you have completed monitoring for
all applicable Table B parameters and attached the results to your
application.
Item 3.16 and Screen for Tables C through E. Indicate whether
one or more of the conditions apply to your POTW. If yes, continue
to Item 3.17. If no, skip to Section 4.
Item 3.17 and Table C. Answer "Yes" to indicate you have
completed monitoring for all applicable Table C pollutants and
attached the results to your application package.
Item 3.18 and Table D. Answer "Yes" to indicate you have
completed monitoring for applicable Table D pollutants required by
your NPDES permitting authority and attached the results to your
application package, or "No" if the NPDES permitting authority has
not required additional sampling for the pollutants in Table D.
Item 3.19 and Additional Screen for Table E. Answer whether the
POTW conducted either (1) a minimum of four quartedy WET tests
for one year preceding this permit application or (2) at least four
annual WET tests in the past 4.5 years. If yes, continue to Item
3.20. If no, complete tests and Table E and then skip to Item 3.26.
Item 3.20 and Additional Screen for Table E. Report whether you
have previously submitted the results of the WET tests indicated in
Item 3.19 to your NPDES permitting authority. If yes, continue to
Item 3.21. If no, provide the results in Table E and skip to Item 3.26.
Item 3.21. Report the dates the testing data were submitted to your
NPDES permitting authodty and provide a summary of the results.
Item 3.22. Regardless of how you may have provided the results of
previously conducted WET analyses to your NPDES permitting
authority, indicate if any of the tests resulted in toxicity. If yes,
2A-5

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
3.23. If no, skip to Item
Item 3.23. Describe the cause(s) of toxicity.
Item 3.24. Indicate if the POTW has conducted a toxicity reduction
evaluation. If yes, continue to Item 3.25. If no, skip to Item 3.26.
Item 3.25. Provide details of any toxicity reduction evaluations
performed.
Item 3.26. Answer "Yes" when you have completed Table E for all
applicable outfalls and attached the results to the application
package, or answer "No" if the item is not applicable because you
previously submitted WET data to your NPDES permitting authority.
Section 4. Industrial Discharges, Table F, and Hazardous
Wastes
Item 4.1. Indicate if the POTW receives discharges from significant
industrial users (SIUs) or non -significant categorical industrial users
(NSCIUs), including SIUs and NSCIUs that truck or haul waste. If
yes, continue to Item 4.2. If no, skip to Item 4.7.
1. SIUs are defined as:
a. All industrial users subject to categorical pretreatment
standards under 40 CFR 403.6 and 40 CFR Chapter I,
Subchapter N (CIUs); and
b. Any other industrial user per 40 CFR 403.3 that:
1. Discharges an average of 25,000 gpd or more of
process wastewater to the treatment works (with
certain exclusions); or
ii. Contributes a process wastestream that makes up
5 percent or more of the average dry weather
hydraulic or organic capacity of the treatment plant;
or
iii. Is designated as an SIU by the control authority.
2. The control authority may determine that an Industrial User
subject to categorical Pretreatment Standards under 40 CFR
403.6 and 40 CFR Chapter 1, Subchapter N is a NSCIU rather
than a SIU on a finding that the Industrial User never
discharges more than 100 gpd of total categorical wastewater
(excluding sanitary, non -contact cooling and boiler blowdown
wastewater, unless specifically included in the Pretreatment
Standard) and the following conditions are met:
a. The Industrial User, prior to the control authority's finding,
has consistently complied with all applicable categorical
Pretreatment Standards and Requirements;
b. The Industrial User annually submits the certification
statement required in 40 CFR 403.12(q) together with any
additional information necessary to support the
certification statement; and
c. The Industrial User never discharges any untreated
concentrated wastewater.
Item 4.2. Indicate the number of SIUs and NSCIUs that discharge
to the POTW.
Item 4.3. Answer whether the POTW has an approved
pretreatment program, which is defined at 40 CFR 403.3 as a
program administered by a POTW that meets the criteria
established in 40 CFR 403.8 and 403.9 and that has been
approved by the NPDES permitting authority.
Item 4.4. Answer whether you have submitted either of the
following to the NPDES permitting authority that contains
information substantially identical to that required in Table F: (1) a
pretreatment program annual report submitted within one year of
the application or (2) a pretreatment program. If yes, continue to
Item 4.5. If no, skip to Item 4.6.
Item 4.5. Identify the title and date of the pretreatment program
annual report or pretreatment program referenced in Item 4.4 and
skip to Item 4.7.
Item 4.6 and Table F. Complete Table F by providing the following
information for each SIU that discharges to the POTW: (1) name
and mailing address; (2) description of all industrial processes that
affect or contribute to each SIU's discharge; (3) a list of the principal
products and raw materials that affect or contribute to the SIU's
discharge; (4) average daily volume of wastewater discharged by
each SIU, indicating the amount attributable to process flow and
non -process flow; (5) whether the SIU is subject to local limits;
(6) whether the SIU is subject to categorical standards and the
categories/subcategodes under which the SIU is subject; and
(7) whether any problems (e.g., upsets, pass -through interference)
have occurred at the POTW that can be attributed to the SIU in the
past 4.5 years. Answer "Yes" to Item 4.6 when you have completed
and attached Table F to the application package.
Note: SIUs include users that truck or haul industrial waste to the
POTW. Information for these users must be provided in Table F.
Item 4.7. Indicate if the POTW receives or has been notified that it
will receive by truck, rail, or dedicated pipe any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261. If
yes, continue to Item 4.8. If no, skip to Item 4.9.
Item 4.8. For each hazardous waste received, provide the
hazardous waste number, the method by which the waste is
received (e.g., by truck, dedicated pipe, rail, etc.), and the amount
of waste received annually (specify units).
Item 4.9. Answer whether the POTW receives, or has been notified
that it will receive, wastewaters that originate from remedial
activities, including those undertaken pursuant to Comprehensive
Environmental Response, Compensation, and Liability Act
(CERCLA) and Sections 3004(u) or 3008(h) of RCRA. If yes,
continue to Item 4.10. If no, skip to Section 5.
Item 4.10. Answer whether the POTW receives (or expects to
receive) less than 15 kilograms per month of non -acute hazardous
wastes as specified at 40 CFR 261.30(d) and 261.33(e). If yes, skip
to Section 5. If no, continue to Item 4.11.
Item 4.11. In an attachment to the application, provide an
identification and description of the site(s) or facilily(ies) at which
the wastewater originates; the identities of the wastewater's
hazardous constituents, as listed in Appendix VII of 40 CFR 261, K
known; and the extent of treatment, if any, the wastewater receives
pl-1QB

General Instructions for Reporting, Sampling, and Analysis
Important note: Read these instructions before completing
Tables A through E and Section 3 of Form 2A.
General Items
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit
number, facility name, and applicable outfall number at the top of
each page of the tables and any associated attachments.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through
E for each of your outfalls, so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your analysis of metals
completed under Table C.
Note for new dischargers. Provide all information available to
you at the time you complete Form 2A. If you do not have
information to respond to an item because your facility has yet to
discharge, write or type "data are not available" next to the item
on the form. Note that you are required to submit actual data no
later than 24 months after your facility commences discharge.
Reporting of Effluent Data
Where effluent data are requested, do not provide information on
CSOs. The latter information is requested instead under Section 5
of Form 2A.
Provide data for each outfall through which effluent is discharged.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report that quantitative data
as applying to the substantially identical ouffall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why
the other outfall(s) are substantially identical.
At a minimum, effluent testing data must be based on at least
three samples taken within 4.5 years prior to the date of the
permit application. Samples must be representative of the
seasonal variation in the discharge from each outfall. Existing
data may be used, if available, in lieu of sampling done solely for
the purpose of this application.
All existing data for pollutants specified in Tables A through D that
is collected within 4.5 years of the application must be included in
the pollutant data summary that you submit. If, however, you
sampled for a specific pollutant on a monthly or more frequent
basis, it is only necessary, for such pollutant, to summarize all
data collected within 1 year of the application.
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical
methods approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or 0. A method is "sufficiently sensitive"
when:
• The method minimum level (ML) is at or below the level of
the applicable water quality criterion for the measured
pollutant or pollutant parameter.
• The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility's
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in
the discharge.
• The method has the lowest ML of the analytical methods
approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or 0, for the measured pollutant or
pollutant parameter.
Consistent with 40 CFR 136, you may provide matrix- or sample -
specific MLs rather than the published levels. Further, where you
can demonstrate that, despite a good faith effort to use a method
that would otherwise meet the definition of "sufficiently sensitive,"
the analytical results are not consistent with the quality assurance
(QA)/quality control (QC) specifications for that method, then the
NPDES permitting authority may determine that the method is not
performing adequately and the NPDES permitting authority should
select a different method from the remaining EPA -approved
methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i). Where no other EPA -approved methods exist, you
must select a method consistent with 40 CFR 122.21(e)(3)(11).
When there is no analytical method that has been approved under
40 CFR 136; required under 40 CFR chapter I, subchapter N or 0,
and is not otherwise required by the NPDES permitting authority,
you may use any suitable method but shall provide a description
of the method. When selecting a suitable method, other factors
such as a method's precision, accuracy, or resolution, may be
considered when assessing the performance of the method.
Effluent monitoring data must comply with the QAIQC
requirements of 40 CFR 136 (and other appropriate QAIQC
requirements for standard methods for analytes not addressed by
40 CFR 136).
Clearly specify the units of measure on Tables A through E for
each parameter/pollutant analyzed. Values should be reported as
concentration or mass, except for flow, temperature, pH, color,
and fecal coliform organisms, unless otherwise requested or
required by the NPDES permitting authority. Flow, temperature,
pH, color, and fecal coliform organisms must be reported as mgd,
degrees Celsius ("C), standard units, color units, and most
probable number per 100 milliliters (MPN/100 mL), respectively.
Use the following abbreviations in the columns requiring "units" in
Tables A through D.
Concentration
Mass
ppm = parts per million
Ibs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
ppb = parts per billion
mg = milligrams
pg/L = micrograms per liter
g = grams
MPN = most probable number
kg = kilograms
per 100 milliliters
T = tonnes (metric tons)
2A-7

General Instructions for Reporting, Sampling, and Analysis Continued
Grab samples must be used for pH, temperature, cyanide, total
times, and the collection of duplicate samples —must be followed.
phenols, residual chlorine, oil and grease, fecal coliform (including
The time when you sample should be representative of your normal
E. co6), and volatile organic compounds. For all other pollutants,
operation, to the extent feasible, with your treatment system
24-hour composite samples must be used. For a composite
operating properly with no system upsets. Collect samples from the
sample, only one analysis of the composite of aliquots is required.
center of the flow channel, where turbulence is at a maximum, at a
The effluent monitoring data provided must include at least the
site specified in your present NPDES permit, or at any site
adequate for the collection of a representative sample.
following for each parameter. (1) the maximum daily discharge
based upon actual sample values, (2) average daily discharge for
Further Requirements for Table E, Whole Effluent Toxicity
all samples, expressed as concentration or mass, and the number
Testing
of samples used to obtain this value, (3) the analytical method
used, and (4) the threshold level (i.e., method detection limit,
Each applicant required to perform WET testing must provide
minimum level, or other designated method endpoints) for the
results of a minimum of four quarterly tests for a year, from the year
preceding the permit application, or the results from four tests
analytical method used.
performed at least annually in the 4.5-year period prior to the
Metals must be reported as "total recoverable metal," unless all
application, provided the results show no appreciable toxicity using
approved analytical methods for the metal inherently measure only
a safety factor determined by the NPDES permitting authority.
its dissolved form (e.g., hexavalent chromium) or otherwise directed
Applicants must conduct tests with multiple species (no less than
by the NPDES permitting authority.
two species; e.g., fish, invertebrate, plant) and test for acute or
Sampling
chronic toxicity, depending on the range of receiving water dilution.
The collection of samples for the reported analyses should be
See 40 CFR 122.21@(5)(v) for further details.
supervised by a person experienced in performing sampling of
WET testing must be conducted using methods approved under
domestic wastewater. You may contact your NPDES permitting
40 CFR 136. West coast facilities in Washington, Oregon,
authority for detailed guidance on sampling techniques and for
California, Alaska, Hawaii, and the Pacific Territories are exempted
answers to speck questions. See Exhibit 2A-1 for contact
from 40 CFR 136 chronic methods and must use alternative
information. Any specific requirements in the analytical methods—
guidance as directed by the NPDES permitting authority.
for example, for sample containers, sample preservation, holding
2A-8

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED
or will receive before entering the POTW. Answer "Yes" to Item
4.11 when you have completed and attached the information to the
application package.
Section 5. Combined Sewer Overflows
CSO Map and Diagram
Item 5.1. Indicate if the treatment works has a combined sewer
system. If yes, continue to Item 5.2. If no, skip to Section 6.
Item 5.2. Attach a CSO system map to the application. The map
should indicate: (1) all CSO discharge points, (2) sensitive use
areas potentially affected by CSOs (e.g., beaches, drinking water
supplies, shellfish beds, sensitive aquatic ecosystems, and
outstanding national resource waters), and (3) waters supporting
threatened and endangered species potentially affected by CSOs.
Answer "Yes" to Item 5.2 when you have completed the map and
attached it to the application package.
Item 5.3. Prepare a diagram of the CSO collection system. The
diagram should show the following: (1) the location of major sewer
trunk lines, both combined and separate sanitary; (2) the locations
of points where separate sanitary sewers feed into the combined
sewer system; (3) in -line and off-line storage structures; (4) the
locations of flow -regulating devices; and (5) the locations of pump
stations. Answer "Yes" to Item 5.3 when you have completed the
diagram and attached it to the application package.
CSO Outfall Description
Item 5.4. Provide the following information for each CSO outfall:
(1) outfall number; (2) state, county, city or town and ZIP code in
which the outfall is located; (3) latitude and longitude of the outfall,
to the nearest second, (4) distance of the outfall from shore and
depth of the outfall below water surface. Latitude and longitude
coordinates may be obtained in a variety of ways, including use of
hand held devices (e.g., a GPS enabled smartphone), Internet
mapping tools (e.g..
htti)s:llmvnasadata.larc.nasa.gov/lafitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., USGS). The location of each CSO
outfall (i.e., where the coordinates are collected) shall be the point
where the discharge is released into a water of the United States.
CSO Monitoring
Item 5.5. Indicate whether the POTW has monitored any of the
following items in the past year for each of its CSO outfalls:
(1) rainfall, (2) CSO flow volume, (3) CSO pollutant concentrations;
(4) receiving water quality, (5) CSO frequency, and (6) number of
storm events.
CSO Events in Past Year
Item 5.6. For each CSO outfall, record (1) the number of CSO
events in the past year, (2) the average duration in hours per event,
(3) the average volume per CSO event in million gallons, and
(4) the minimum rainfall that caused a CSO event in inches of
rainfall in the past year. Note whether your responses for sub -items
(2) through (4) above are based on actual or estimated data.
CSO Receiving Waters
Item 5.7. For each CSO outfall, record the following receiving water
information: (1) name of receiving water; (2) name of
watershed/stream system and the U.S. Soil Conservation Service
watershed (14-digit) code, if known; (3) name of the state
managemenUriver basin and the USGS 8-digit hydrologic
cataloging unit code, if known; and (4) a description of any known
water quality impacts on the receiving water caused by the CSO
(e.g., permanent or intermittent beach closings, permanent or
intermittent shellfish bed closings, fish kills, fish advisories, other
recreational loss, or exceedance of any applicable state water
quality standard).
Section 6. Checklist and Certification Statement
Item 6.1. Review the checklist provided. In Column 1, mark the
sections of Form 2A that you have completed and are submitting
with your application. In Column 2, indicate for each section
whether you are submitting attachments.
Item 6.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA Section
309(c)(2) provides that "Any person who knowingly makes any false
statement, representation, or certification in any application, ...shall
upon conviction, be punished by a fine of no more than $10,000 or
by imprisonment for not more than six months, or both."
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For the
purpose of this section, a responsible corporate officer means:
(1) a president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any
other person who performs similar policy- or decision -making
functions for the corporation, or (2) the manager of one or
more manufacturing, production, or operating facilities,
provided the manager is authorized to make management
decisions which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long term
environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete
and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
delegated to the manager in accordance with corporate
procedures.
B. For a partnership or sole proprietorship, by a general partner
or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected official.
For purposes of this section, a principal executive officer of a
federal agency includes: (1) The chief executive officer of the
agency, or (2) a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the
agency (e.g., Regional Administrators of EPA).
END
Submit your completed Form 2A and
alf associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
2A-9

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2A-10

FORM 2A—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 2A. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
• Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period; and
• Crops, vegetation, forage growth, or post -harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit, including any additions, revisions, or modifications to the
forms; or forms approved by EPA for use in approved states, including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants, and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single -pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFO) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows, whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
6. 500 horses;
7. 10,000 sheep or lambs;
2A-11

FORM 2A—GLOSSARY CONTINUED
8. 55,000 turkeys;
9. 30,000laying hens or broilers, if the AFO uses a liquid manure handling system;
10. 125,000 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
11. 82,000 laying hens, if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks (if the AFO uses other than a liquid manure handling system); or
13. 5,000 ducks (if the AFO uses a liquid manure handling system).
B. MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999laying hens, if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); ore
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar man-
made device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) means a hatchery, fish farm, or other facility which
contains, grows, or holds aquatic animals in either of the following categories, or which the Director designates as such on a case -by -case
basis:
A. Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms (approximately 20,000 pounds) of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms (approximately 5,000 pounds) of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including, but not limited to, the Ameiuridae, Cetrarchiciae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1. Closed ponds which discharge only during periods of excess runoff; or
2. Facilities which produce less than 45.454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92-500, as amended by Public Law 95-217, Public Law 95-576, Public Law 96-483 and Public Law
97-117, 33 U.S.C.1251 at seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
2A-12

FORM 2A—GLOSSARY CONTINUED
DAILY DISCHARGE means the "discharge of a pollutant" measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the "daily discharge" is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement, the "daily discharge" is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the "discharge of a pollutant"
DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no "approved State program," and there is an EPA administered program, "Director' means the Regional Administrator. When there is
an approved State program, "Director" normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
"Director" means the Regional Administrator and not the State Director.
DISCHARGE (OF A POLLUTANT) means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any "indirect discharger'.
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self -monitoring results by permittees. DMRs must be used by "approved States" as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
DRAFT PERMIT means a document prepared under § 124.6 indicating the Directors tentative decision to issue or deny, modify, revoke
and reissue, terminate, or reissue a "permit." A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of "draft permits." A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a "draft permit." A "proposed permit" is not a "draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantifies, discharge rates, and concentrations of "pollutants"
which are "discharged" from "point sources" into "waters of the United States," the waters of the "contiguous zone," or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of the CWA to adopt or
revise "effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES "point source" or any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES "permit" issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights -of -way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
• All Indian allotments, the Indian titles to which have not been exfinguished, including rights -of -way running through the same.
INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomeslic discharger introducing "pollutants" to a "publicly owned treatment works"
2A-13

FORM 2A—GLOSSARY CONTINUED
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (1) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; and
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held in self-contained bodies of water (mill ponds or
log ponds) or stored on land where water is applied intentionally on the logs (wet decking). (See 40 CFR 429, subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES "facility or activity" classified as such by the Regional Administrator, or, in the case of "approved
State programs," the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable "daily discharge."
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
(1) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix I of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (1), (ii), (iii) of this section.
2A-14

FORM 2A—GLOSSARY CONTINUED
MUNICIPALITY means a city, town, borough, county, parish, district, association, or other public body created by or under State law and
having jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
• Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, Flood control district or drainage, district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
• Designed or used for collecting or conveying stormwater.
• Which is not a combined sewer; and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE (see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) means the national program for issuing, modifying, revoking
and reissuing, terminating, monitoring and enforcing permits, and imposing and enforcing pretreatment requirements, under sections 307,
402, 318, and 405 of the CWA. The term includes an "approved program."
NEW DISCHARGER means any building, structure, facility, or installation:
• From which there is or may be a "discharge of pollutants;"
• That did not commence the "discharge of pollutants" at a particular "site" prior to August 13, 1979;
• Which is not a "new source;' and
• Which has never received a finally effective NPDES permit for discharges at that "site."
This definition includes an "indirect discharger" which commences discharging into "waters of the United States" after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
"site" for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a "site" under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a "new discharger" only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a "discharge of pollutants," the
construction of which commenced:
• After promulgation of standards of performance under section 306 of the CWA which are applicable to such source, or
• After proposal of standards of performance in accordance with section 306 of the CWA which are applicable to such source, but only
if the standards are promulgated in accordance with section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any "facility or activity" subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an "approved State" to implement the
requirements of this part and parts 123 and 124. "Permit" includes an NPDES "general permit" (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a "draft permit" or a "proposed permit"
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(I); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
P11.15 7

FORM 2A—GLOSSARY CONTINUED
POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 et seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
• Sewage from vessels; or
• Water, gas, or other material which is injected into a well to facilitate production of oil or gas, or water derived in association with oil
and gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located, and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator -produced isotopes. See Train v. Colorado Public Interest Research Group, Inc., 426 U.S.1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C.1976), modified 12 E.R.C.1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a "POTW."
PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the
production or use of any raw material, intermediate product, finished product, byproduct, or waste product.
PROPOSED PERMIT means a state NPDES "permit' prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A "proposed permit"is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and Nprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a "permit", including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the CWA, except that with respect to commercial
vessels on the Great Lakes this term includes graywater. For the purposes of this definition, "graywater" means galley, bath, and shower
water.
SEWAGE SLUDGE means any solid, semi -solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
SILVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non -point source silviculture[ activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and fire control,
harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some of these
activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
2A-16

FORM 2A—GLOSSARY CONTINUED
SITE means the land or water area where any "facility or activity" is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE -ONLY FACILITY means any "treatment works treating domestic sewage" whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an "approved program," or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, "State Director"
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in "industrial activity" for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)-(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non -coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17,1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator; inactive mining sites do not include sites
where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
2A-17

FORM 2A-GLOSSARY CONTINUED
7. Steam electric power generating facilities, including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221-25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design Flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) or, in the case of "sludge use or disposal practices," any
pollutant identified in regulations implementing section 405(d) of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, "domestic sewage" includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a "treatment works treating domestic sewage," where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET (defined at § 122.41(n)) means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does not include
noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of
preventive maintenance, or careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable "effluent
limitations guidelines" which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.
P7.115G1

Form �"`•
�EH0.8
?A U.S. Environmental P on Agency
NPDES 4 APPNcation for NPDES Permit to Discharge Wastewater
NEW AND EXISTING PUBLICLY OWNED TREATMENT WOR
1.1 Fatillty name r
Kil
ury or town
state ZIP cede
Contactnan (fin"and las Title
Phone number Email ad
VA AA, £, ORC -1-765
Locatipon address (street, route number, or otherspecific identifier) Same as mailing address
, ❑
l3 um appucauon for a facility that has yet to commence discharge?
❑ Yes + See instructions on data submission 50 No
requirements for new dischargers.
Is appGpnt different from entity listed under Item 1.1 above?
�f Yes
❑ No + SKIP to Item 1.4,
Appikant name
nppncantad
rt
City or town
rnm�
Contact nam,
1.4 Is the applica
M Owner
1.5 To which entit
❑ Facility
1.6 Indicate below
E
number for ea
d
or
owner, operatbr, or both
❑ Operator
PDES permitting authority ser
11 Applicant
14 NPDES (discharges to surface
water)
E
❑ PSD (air emissions)
W
A
_ ❑ Ocean dumping (MPRSA)
404)
EPA Form 3510-2A (Revised 3-19)
one
Program
Form Approved 03/05/19
OMB No. 204"004
❑ Both
�k only one response.)
❑ Facility and applicant
(they are one and the
type the corresponding pen
UIC (underground inje
control)
Page 1
rU—S

erv, iaenbncauon Number NPDES Permit Number
Facility Name
Form Approved 03105119
OMB No. 2040-0004
1.7
Provide the collection s stem information re nested below for the treatment works.
Municipality
Population
Collection System Type
Served
Served
indicate ercen a
Ownership Status
v
&Xt OF
1 W %separate sanitary sewer
8 Own CR' Maintain
Z
At- (ftf
jb'f auu
% combined storm and sanitary sewer
❑ Own ❑ Maintain
�,
❑ Unknown
❑ Own ❑ Maintain
o
% separate sanitary sewer
❑ Own ❑ Maintain
_ % combined storm and sanitary sewer
❑ Own ❑ Maintain
c❑
Unknown
❑ Own ❑ Maintain
n
%separate sanitary sewer
❑ Own ❑ Maintain
%combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer ❑Own ❑ Maintain
rn
_ % combined storm and sanitary sewer ❑ Own ❑ Maintain
o
❑ Unknown ❑ Own ❑ Maintain
Z
Total
o
Population lik
ca
Served
Separate Sanitary Sewer System Combined Storm and
Total percentage of each type of
SanitarySewer
Araloo K 13 0 ; �cs °
sewer line in miles
too /°
Z
c
1.8
Is the treatment works located in Indian Country?
❑ Yes No
�e
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
5
❑ Yes Q- No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
q mgd
Annual Average Flow Rates Actual
v
Two Years Ago
Last Year
This Year
c
A ;
w o
2, y5`j mgd
2.3o? mgd
2 I fj% mgd
r
c
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
7 iqf mgd
6, Zo y mgd
3173 f mgd
1.11
Provide the total number of effluent dischar a points to waters of the United States by type.
m
Total Number of Effluerd Discha a Paints b T
zm
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Constructed
Emergency
Overflows
a
Overflows
c
�
EPA Form 3510-2A (Revised 3.19) Page 2

EPA Identification Number
NPDES Permit Number Facility Name
Form Approved 03/05/19
U0211 j�o (r dr Mf (fp(( wwv
OMB No. 2040-0004
Outfails Other Than to Waters of the United States
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 United States?
❑ Yes ❑✓' No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface im oundment and associated discharge information in the table below.
Surface Im oundment Location and Discharge Data
Average Deli
Continuousorintermittent
Location Discharged to Surface
Im oundment (check one)
gpd
❑ Continuous
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
gpd
❑ Continuous
❑ Intermittent
s°
1.14
Is wastewater applied to land?
❑ Yes Rr No 4 SKIP to Item 1.16.
c
1.15
Provide the land a lication site and discharge data requested below.
m
Land lication Site
and Discharge Data
a
S
Location
Size
Average Daily Volume
Continuous or
m
°'
Applied
Intermittent
r
check one
a
acres
gpd
❑ Continuous
12
❑ Intermittent
r
acres
d
gpd
❑ Continuous
o
❑ Intermittent
A
acres ❑ Continuous
gpd
1.16
❑ Intermittent
Is effluent transported to another facility for treatment prior to discharge?
o'
❑ Yes [9' No + SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes M No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter 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
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily Flow rate of the
receiving facility.
Recelvina F cilltv Data
o
Facility name
Mailing address (street or P.O. box)
•
0
c
V
City or town
State
ZIP code
0
Contact name (first and last)
Title
Phone number
Email address
g
cNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
e,
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 not
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
m
IT
s
❑ Yes Q� No 4 SKIP to Item 1.23.
c1.22
Provide information in the table below on these other disposal methods.
m
information on Other
Dis osal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
v
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
❑ Continuous
w
=
acres
gp d
❑ Intermittent
0
❑ Continuous
acres
gpd
❑ Intermittent
acres
gp d
❑ 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.)
w
ElDischarges into marine waters (CWA Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes Ef 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
A
(company name
oMailing
address
c
street or P.O. box
$
City, state, and ZIP
code
c
Contact name (first and
0
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A (Revised 3-19) Page 4

EPA IdenOfication Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION 2. ADDITIONAL e•i
o Outfalls to waters of the United States
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
c
[�] Yes ❑ No 4 SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
V
and infiltration.
2 UjJc� gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
9
m
�r
`cmo"? I"'Lej Sm oEe Fel! cf� l,� e �Cff ie9/ /.ire C/eurvar9 r / �c , ey�a.'.1
t�-cw ryra•ifv.^.'n� Xf .dy :.t Cam!/e cl an sYrhsn,
c
a2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
1
specific requirements.)
o
e
t—
[] Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
e w
(See instructions for specific requirements.)
c
Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes Er 4 SKIP to Section 3.
F.2
Briefly list and describe the scheduled improvements.
E
w
2.
0
3.
v
m
4.
v
07Provide
or actual dates of com letion for im rovements.
�3Scheduled
or Actual Dates of Com letion for Im rovementsE
>Outfalls
AffectedBe
g in
End
Be in
go
Attainment of
list outfall
Construction
Construction
Discharge
Operational
Level
number
(MMIDDIYI'YY)
(MM/DD/Y1'YY)
(MM/DD/YYYY)
MM/DD
d
r
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:
EPA Form 3510-2A (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved UMbf19
OMB No. 2040-0004
SECTION• • ON • 1
3.1 Provide the following information for each outfall. (Attach additional sheets If you have more than three oulfalls.)
Outfall Number
Outfall Number_
Outfall Number_
State
/J
x
County
6C(sfo
`o
City or town
AAf- Gfoflh
4
Distance from shore
Depth below surface
3 ft.
ft.
ft.
0
Average daily flow rate
Z• 2, mgd
mgd
mgd
Latitude
3s° /40 ' iZ9" h/
Longitude
a1 ou " 35',7 W
°1 ,"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c
❑ Yes [ No + SKIP to Item 3.4.
a,
W
3.3
If so, provide the following information for each applicable outfall.
r
$
Outfall Number
Outfall Number
Outfall Number
e
Number of times per year
0
=
discharge occurs
a
Average duraflon of each
`o
discharge (specify units
Average flow of each
mgd
mgd
mgd
$
discharge
N
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
Eff' No 4 SKIP to Item 3.6.
❑ Yes
3.5
Briefly describe the diffuser type at each applicable outfall.
Outfall Number_
Outfall Number_
Outfall Number_
m
0
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
ai
d
3.6
discharge points?
m
Yes ❑ No SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
3.7
Provide the receivin water
and related information if known for each outfall.
Outfall Number I
Outfall Number _
Outfall Number
Receiving water name
SQiiIW� (&Lxy-
Name of watershed, river,
Co;{ jboL Q rive✓
g
0rstreamsystem
Rasrvt
U.S. Soil Conservation
m
Service 14-digit watershed
c
code
1a
Name of state
o ^/arts` er"
�+
managementfriver basin
„h„aba le; 'K" &4ia
rn
U.S. Geological Survey
U
8-digit hydrologic
0305-oIot
cataloging unit code
Critical low flow (acute)
0IS
cis
cfs
Critical low flow (chronic)
cfs
cis
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.
Provide the following information describing the treatment provided for discharcles from each outfall.
Outfall Number i
Outfall Number_
Outfall Number_
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
a Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
la' Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
Design Removal Rates by
y
Outfall
d
BOD5 or CB005
/o
/°
E
E
TSS
�',)� %
%
%
Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
°
/°
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Idenfificafion Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
OMB No. 2040-0004
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below. j (
CLlIJ1ru ✓lGlLl 0^
v
m
C
C
O
c
Outfall Numbers
Outfall Number_
Outfall Number_
0
n
Disinfection type
H
0, eine
m
Seasons used
€
kil �( ea✓
F
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
a Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
a 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?
[9-' Yes ❑ No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by oulfall number or of the receivinq water near the dischar a points.
Outfall Number I
Outfall Number_
Outfall Number_
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
L4
16
water
Number of tests of receiving
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
[v]' Yes ❑ No 4 SKIP to Item 3.16.
0
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
;
Yes 4 Complete Table B, including chlorine. ❑ No + Complete Table B, omitting chlorine.
M
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
w
ET Yes ❑ No
3.16
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
Yes 4 Complete Tables C, D, and E as ❑ No + SKIP to Section 4.
applicable.
3.17
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
[f Yes ❑ No
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
additional sampling required by NPDES
Yes El
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
[� Yes ❑ No + Complete tests and Table E and SKIP to
Item 3.26.
3.20
Haveyoupreviously submitted the results of the above tests to your NPDES permitting authority?
[ eyYes ❑ No + Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
IDD
Summaryof Results
9-P-ti G-3-2o 2-o
Au 14sw(4s twat rrTad
(,..r.t-zt g-2o-Zp i2--4-l6^Z-f
Y-yt-�, 0"-t4
=howyou
L_Z2-zrN-'i'21 9"t"-i2-f-2o
12v-2•.ss
of how ou rovided our WET testin data to the NPDES ermittin authorit did an of the tests result in
Y P Y 9 permitting Y, Y
c
toxicity?
c
❑ Yes No 4 SKIP to Item 3.26.
rm
3.23
Describe the cause(s) of the toxicity:
c
m
0
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes Not applicable because previously submitted
information to the NPDES ermittin authori .
SECTIONDISCHARGES
AND HAZARDOUS WASTES (40
4.1
Does the POTW receive discharges from SIUs or NSCIUs?
[r Yes ❑ No 4 SKIP to Item 4.7.
.am
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
3
Number of SIUs
Number of NSCIUs
s
3
0
E
4.3
Does the POTW have an approved pretreatment program?
x�
[' Yes ❑ No
v
W
4.4
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
0
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
•,
application or (2) a pretreatment program?
u
ER' Yes El No SKIP to Item 4.6.
o
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
4.6
Have you completed and attached Table F to this application package?
[]— Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 9

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
OMB No. 2040-0004
4.7
Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ❑r No 4 SKIP to Item 4.9.
4.8
If yes, provide the follo ing information:
Annual
Hazardous Waste
Waste Transport Method
Amount of
Units
Number
(check all that apply)
Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
c
c
0
U
❑ Truck ❑ Rail
3
❑ Dedicated pipe ❑ Other (specify)
H
0
0
a
❑ Truck ❑ Rail
_
❑ Dedicated pipe ❑ Other (specify)
9
C
N
N
d
A
4.9
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
c
Er Yes ❑ No 4 SKIP to Section 5.
R
4.10
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
❑ Yes 4 SKIP to Section 5. No
4.11
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater's hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
a Yes ❑ No
SECTION•
• SEWER OVERFLOWS (40
Does the treatment works have a combined sewer system?
B
5.1
o,
❑ Yes E3' No 4SKIP to Section 6.
m
v
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
w
❑ Yes ElNo
o.
w
c5.3
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
CID
cQ 1
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 10

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
5.4
For each CSO outran, rovide th!T011owjn nformation. Attach additional sheets as necessa .CSumber_
CSO OutNumber_
CSO Outfall Number
City or town
0
a
`u
State and ZIP code
N
d
o
County
0
Latitude
"
0
Longitude
"
Distance from shore
g,
ft.
tt
Depth below surface
(t.
5.5
Did the POTIN monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number_
CSO Outfall Number_
CSO Outfall Number
Rainfall
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
rn
c
o
CSO flow volume
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0
g
p
CSO pollutant
concentrations
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El No
w
Receiving water quality
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO frequency
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Number of storm events
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5.6
Provide the fallowing information for each of your CSO outfalls.
CSO Outfall Number_
CSO Outfall Number_
CSO Outfall Number_
}
Number of CSO events in
w
the past year
events
events
events
A
d
Average duration per
hours
hours
hours
m
event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
W
y
Average volume per event
million gallons
million gallons
million gallons
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
Minimum rainfall causing
inches of rainfall
inches of rainfall
inches of rainfall
a CSO event in last year
❑ Actual or ❑ Estimated 1
❑ Actual or ❑ Estimated 1
❑ Actual or ❑ Estimated
EPA Form 3510-2A (Revised 3-19) Page 11

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03105/19
OMB No. 204NO04
5.7
Provide the information in the table below for each of vour CSO outfalls.
CSO Outfall Number _
CSO Outfall Number _
CSO Outfall Number_
Receiving water name
Name of watershed/
streams stem
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
3
Service 14-digit
watershed code
z
if known
m
Name of state
management/river basin
U.S. Geological Survey
❑ Unknown
❑ Unknown
❑ Unknown
co
8-Digit Hydrologic Unit
Code if known
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam les
SECTION•
CERTIFICATION STATEMENT (40 .
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
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 9
Column 2
❑ ^ Section 1: Basic Application
0 wl variance request(s) ❑ w/ additional attachments
Information for All Applicants
Section 2: Additional
0 w/ topographic map [ w/ process flow diagram
Information
❑ w/ additional attachments
[� wl Table A [a wl Table D
Section 3: Information on
0 wl Table B w/ Table E
m
Effluent Discharges
[� wl Table C ❑ w/ additional attachments
Section 4: Industrial
w/ SIU and NSCIU attachments w/ Table F
in
c
[ Discharges and Hazardous
ElWastes w/ additional attachments
❑ Section 5: Combined Sewer
❑ w/ CSO map ❑ wl additional attachments
m
Overflows
❑ w/ CSO system diagram
v
Section 6: Checklist and
[]'
ET" wl attachments
R
Certification Statement
x
6.2
Certification Statement
u
certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
ci E' A* ����p�
Signature
Date signed
EPA Form 3510-2A (Revised 3-19) Page 12

" Y R° Fan Approved 03Wl9
tic coo a 1 t 5 w.: �� 0. OMB No. 2040-0004
5.7 Provide the Information in the table below for each of our CSO outfalls.
CSO 0utfall Number_ CSO OuftH Number CSO Outfall Number_
Receiving water name
Name of watershed/
stream s stem
U.S. Soil Conservation ❑ Unknown ❑ Unknown ❑Unknown
Service 14ttigit
watershed code
Survey ❑ Unknown ❑ Unknown ❑
is Unit
water quality impacts on
receiving stream by CSO
(see instructions for
6.1 1In Column 1 below, mark the sections of Form 2A that you have completed and are
each section, ape* in Column 2 any attachments that you are enclosing to alert It
all applicants are required to nmvlrla aat,*me +e
with your application. For
B authority. Note that not
L°
Information forAll A licents
w/variance request(s)
❑
w/ add tional attachments
Section 2: Additional
wt topographic map
wl process flow diagram
Information
❑
wt additional attachments
d
Section 3: Information on
[�
w/ Table A
w/ Table D
Effluent Discharges
w/ Table B
w/Table E
Section 4: Industrial
Q'
w/ Table C
❑
w/ additional attachments
d
Discharges and Hazardous
wl SIU and NSCIU attachments
w/Table F
Wastes
❑
w/additional attachments
❑ Section 5: Combined Sewer ❑ w/ CSO map ❑ w/ additional attachments
Overfl0N5 ❑ w/ CSO system diagram
Section 6: Checklist and
Certification Statement wf attachments
6.2 Certification Statement
I certify under penally 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 propedy gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belle(, true, accurate, and
complete. I am aware that there are significant penalties for submittingfalse information, including the
and im dsonmentfor knowin violations,
9 possbltyofhne
Name (print or type first and last name) Official title
M.t 3 L,
Signature Date sig ad
`{-21-2-K
EPA Fan 3510-2A (ReWssd 3.19)
Page 12

dl +
C
O
o ,5
y
I

--7Z
C0
C
W
L
T�
V
c
R
O
C.
L
a

Wastewater Treatment Facility
Annual Flow Monthly Averages
All Flows in Million Gallons
2017
Influent
Effluent
Rain Total
January
2.018
2.223
5.06
February
1.998
1.867
1.33
March
1.953
1.9
2.15
April
2.122
2.005
5.85
May
2.051
2.052
6.95
June
0.997
1.975
5.1
July
2.034
1.871
3.55
August
2.89
0.232
6.9
September
2.231
2.053
3.65
October
2.195
2.047
3.6
November
1.988
1.873
1.06
December
1.998
1.907
1.5
2019
Influent
Effluent
Rain Total
January
2.482
2.388
4.41
February
2.642
2.774
6.71
March
2.433
2.442
3.19
April
2.367
2.332
6.84
May
2.138
2.136
4.27
June
2.153
2.193
6.13
July
2.032
2.153
2.64
August
2.214
2.109
4.2
September
2.051
2.484
1.7
October
2.146
2.276
6.2
November
2.257
2.404
3.78
December 1
2.349
2.535
4.93
YR Total YR Total
Yr. Avg. 2.040 1.834 11 Yr. Avg. 2.272 2.352 55
2018
Influent
Effluent
Rain Total
January
2.152
2.105
2.5
February
2.366
2.337
3.5
March
2.059
2.08
3.75
April
2.059
2.04
3.65
May
2.056
1.766
5.96
June
1.938
1.753
1.58
July
1.849
1.678
3.82
August
2.064
1.933
3.46
September
2.158
2.06
5.88
October
2.157
2.049
5.76
November
2.317
2.289
6.65
December
2.486
2.407
7.76
2020
Influent
Effluent
Rain Total
January
2.419
2.650
5.3
February
2.633
3.003
6.78
March
2.040
2.369
3.2
April
1.969
2.160
6.62
May
2.168
2.497
7.11
June
1.852
2.045
3.36
July
1.769
1.906
1.71
August
1.912
2.064
4.28
September
2.19
3.73
6.48
October
2.178
2.328
3.66
November
2.171
2.453
5
December
2.135
2.297
4.43
YR Total YR Total
Yr. Avg. 2.138 2.041 54.271 1 Yr. Avg. 2.120 2.459 57.93

Wastewater Treatment Facility
Annual Flow Monthly Averages
All Flows in Million Gallons
2021
Influent
Effluent
Rain Total
January
2.297
2.498
4.45
February
2.644
2.89
5.76
March
2.539
2.762
5.15
April
2.196
2.291
1.32
May
2.133
2.019
2.19
June
2.178
2.064
3.79
July
2.272
2.186
6.39
August
2.196
2.115
2.76
September
2.21
2.158
1.71
October
2.099
2.184
1.41
November
2.047
2.268
0.99
December 1
1.942
2.251
1.83
2022
Influent
Effluent
Rain Total
January
2.035
2.385
2.93
February
2.065
2.444
4.26
March
2.190
2.674
5.5
April
2.18
2.668
4.34
May
2.024
2.298
2.71
June
2.052
2.1
2.61
July
2.11
1.971
6.31
August
2.178
2.052
2.98
September
2.11
1.926
3.79
October
1.931
1.732
0.99
November
2.069
1.928
5.1
December
3.31
2.064
4.97
YR Total YR Total
Yr. Avg. 2.229 2.307 1 37.75 [777Avg. 2.188 2.187 1 46.49
2023
Influent
Effluent
Rain Total
January
February
March
April
May
June
July
August
September
October
November
December
2024
Influent
Effluent
Rain Total
January
Februa ry
March
April
May
June
July
August
September
October
November
December
YR Tota I YR Tota I
Yr. Avg. #DIV/01 #DIV/0! 1 01 1 Yr. Avg. #DIV/01 #DIV/0! 1 0

Wastewater Treatment Facility
Annual Flow Monthly Total
All Flows in Million Gallons
2017
Influent
Effluent
Rain Total
January
62.573
68.928
5.06
February
55.942
52.279
1.33
March
60.55
58.886
2.15
April
63.666
60.148
5.85
May
63.571
63.618
6.95
June
59.901
59.249
5.1
July
63.065
57.988
3.55
August
67.865
69.196
6.9
September
66.942
61.598
3.65
October
68.047
63.467
3.6
November 1
59.632
56.197
1.06
December 1
61.923
59.120
1.5
YR Total
Annual Total 753.677 730.674 1 46.7
2018
Influent
Effluent
Rain Total
January
66.718
65.251
2.5
February
66.241
65.433
3.5
March
63.819
62.879
3.75
April
61.767
61.185
3.65
May
63.733
54.759
5.96
June
58.129
52.595
1.58
July
57.334
52.297
3.82
August
63.97
59.909
3.46
September
64.734
51.814
5.88
October
65.608
63.520
5.76
November
69.503
68.680
6.65
December
77.062 1
74.632
7.76
YR Total
Annual Total 778.618 732.954 54.27
2019
Influent
Effluent
Rain Total
January
76.95
74.020
4.41
February
73.985
77.668
6.71
March
75.425
75.698
3.19
April
71.000
69.969
6.84
May
66.288
66.213
4.27
June
64.591
65.778
6.13
July
62.977
57.469
2.64
August
68.627
65.383
4.2
September
61.543
64.748
1.7
October
66.517
70.544
6.2
November
67.702
72.113
3.78
December
72.818
78.600
4.93
YR Total
Annual Total 828.423 838.203 55.0
2020
Influent
Effluent
Rain Total
January
74.980
82.150
5.3
February
76.345
87.100
6.78
March
63.251
73.445
3.2
April
59.056
64.805
6.62
May
67.197
77.405
7.11
June
55.554
61.351
3.36
July
54.842
59.089
1.71
August
59.274
63.997
4.28
September
65.702
69.928
6.48
October
67.518
72.155
3.66
November
65.135
73.578
5
December
66.175
71.21
4.43
YR Total
Annual Total 775.029 856.213 57.93

Wastewater Treatment Facility
Annual Flow Monthly Total
All Flows in Million Gallons
2021
Influent
Effluent
Rain Total
January
71.203
77.442
4.45
February
74.045
81.028
5.76
March
78.724
85.632
5.15
April
65.886
68.717
1.32
May
66.12
62.603
2.19
June
65.325
61.927
3.79
July
70.423
67.761
6.39
August
68.087
65.58
2.76
September
66.291
64.729
1.71
October
65.056
67.703
1.41
November
61.404
68.037
0.99
December
60.202
69.779
1.83
YR Total
Annual Total 812.766 840.938 37.75
2023
Influent
Effluent
Rain Total
January
February
March
April
May
June
July
August
September
October
November
December
YR Total
Annual Total 0 0 0
2022
Influent
Effluent
Rain Total
January
63.099
73.936
2.93
February
57.848
68.427
4.26
March
67.893
82.896
5.5
April
65.385
80.045
4.34
May
62.748
71.23
2.71
June
61.572
63.012
2.61
July
65.405
61.113
6.31
August
67.53
63.608
2.98
September
63.289
57.769
3.79
October
59.697
53.697
0.99
November
62.071
57.827
5.1
December
64.203
63.99
4.97
YR Total
Annual Total 760.74 797.55 46.49
2024
Influent
Effluent
Rain Total
January
February
March
April
May
June
July
August
September
October
November
December
YR Total
Annual Total 0 0 0

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aceAnalytical
WW..pacalal a.cam
Doug Shoutd
City of Mt Holly WWTP
201 Broome Street
Mount Holly, NC 28120
Project: Muldooncentration NC211056
Pace Project No.: 92488921
Reviewed by:
Sarah Graham
[phone]
[e-mail]
Laboratory Report
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date: 08/24/2020
Date Received: 08/03/2020
Page 1 of 16

Document Name:
Document Revised: February 7, 2018
aceAnalytical"
Sample Condition Upon Recel t(SCUR)
Page 1 of 2
Document No.:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receiving samples:
A hewn F-1 Ederl rrppnl nd 1:1 u r 'II n Ins j1f:1 Mpelhanorquallopm
Client Name: project I wog : 924II 88921
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uatndv Seal PrcAnt? 1-1Yac Nn Seals Intact7 nYes mgo
Oete/Initlats Person lxamining Contents:�s+
Packing Material: ❑Bubble Wrap []Bubble Bags lonne�� ❑ Other Biological Tissue Frozen?
Thermometer: 92T061 Type of Ice: tdwet ❑Blue ❑None ❑[]NoR GuYes No [/A
n I0:
Cooler Temp ('C): r,,0 Correction Factor: Add/Subtract (°C) 0.0
Temp should he above freezing to 6°C
Cooler Temp Corrected(°C): ❑Samples out of temp criteria. Samples on ice, cooling process
has begun
USDA Regulated Soil ( N/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)7 Did samples originate from a foreign source llnternationally,
"—, M... Ind,dlneNawallandPunrcnWcnVnYes 71Nn
Commesns/Obcre ancy:
Chain of Custody Present?
es No
❑N/A
1.
Samples Arrived within Hold Time?
yes
[]NO
❑N/A
2.
Short Hold Time Analysis 102 hr.)?
13yes
o
N/A
3.
Rush Turn Around Time Requested?
0Y.
-Ka'
LJNJA
4.
Sufficient Volume?
PC
[IN.
❑N/A
S.
Correct Containers Used?
-Pace Containers Used?
Y
es
❑No
❑No
❑N/A
N/A
6.
Containers Intact?
Er es
❑No
N A
7.
Dissolved analysis: Samples Field Filtered?
❑Yes
Latdo
❑N/A
g.
Sample Labels Match COC?
yes
❑No
❑N/A
9.
-includes Date/Time/lO/Analysis Matrix:
L✓
Headspace in VOAVials(>S-6mm)7
[]Yes
No
/A
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑Yes
yes
[]NO/A
(]NO
R<A
11.
COMM£NTSJSAMPLE DISCREPANCY
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Project Manager SCURF Review: -SPY
JA
Project Manager SRF Review:
Date/Time:
Field Date Required? ❑Yes ❑Na
Page 2 of 16

Document Name:
Document Revised: February 7, 2018
m
aceAnalytM
Sample Condition Upon RecelptiSCUR)
Page 1 of 2
Document No,:
Issuing Authority:
F•:AR-CS-033-Rev.06
Pace Carolinas Quality Office
"heillk Ma.0 top quill of box it PH mAdAr dachlarination l6 pro)act _ I O * 924 892
w
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DR018015 (water) DOC, LLHg
**Bottom half of box Is to list number of bottle
PM: SMG Due Date: 08/26/20
CLIENT: 92-Mt. Holly
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adjusted
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Lot
Note: Whenever there is a discrepancy affecting North Carol! na compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers.
Page 3 of 16

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Page 4 of 16

Document Name:
Document Revised: February 7, 2018
aceAnalyticalm
Sample Condition U on Recel t(SCUR)
Pagee 1 of i
Document No.:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville ❑ El
Greenwood J
Huntersville
Raleigh[] Mechanicsville❑
Client Name: Project # WO# : 92488921
ery of lY1+. F{GI� pM: SMG Due Date: 08/26/20
Courier. ❑P Is Ex UPS ❑LISPS ❑Client
❑Commercial Pace ❑other:_ CLIENT: 92-Mt. Holly
Packing Material: Bubble Wrap [pi'U'bble Bags ❑None ❑ Other
Thermometer
QIR Gun I D: 92T061 Type oFlce: et ❑ewe
Cooler Temp ('Cl: U<r ,a Correction Factor: Add/Subtract('[) 0.0
Cooler Temp Corrected ('Q: 0.1
USDA Regulated Sail ( N/A, water sample)
Did samples originate in a quarantine zone withln the United States: CA, NY, or SC (check maps)?
rlvps rlN.
Biological Tissue frozen?
[-]None
❑Yes '❑C
NO Py/A
Temp should be above freezing to VC
Dimples out of temp criteria. Samples on ice, cooling process
has begun
Did samples originate from a foreign source pnternatlona IIy,
Including Hawaii and Puerto Ricci?rives I—INn
Comments/Olscrepancy:
Chain of Custody Present?
Ely.
[]NO
❑N/A
1,
Samples Arrived within Hold Time?
es
N/A
2.
Short Hold rime Amtvsis(<72 hr.)?
Yes
� �No
KN-.
❑N/A
3.
Rush Turn Around Time Requested?
❑Yes
C No
❑N/A
4.
Sufficient Volume?
yes
ONO
N/A
S.
Correct Containers Used?
-Pace Containers Used?
,.,.�/ yes
Mfefes
❑No
EJNQ
❑N/A
Q N/A
6.
Containers Intact?
Lgies
❑Nn
❑ N!A
7.
Dissolved analysis: Samples Field Filtered?
❑Y
o
N/A
a.
Sample Labels Match COC?
jnYes
[]NO
❑N/A
9.
-Includes Date/Time/ID/Analysis Matrix:
A4
Headspace in VOA VWs (>S-6mm)7
Qyes
❑No
N/A
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑ves
Yes
❑No
ONO
/A
OMA
11.
COMMENTS/SAMPLE DISCREPANCY
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person contacted:
Date/Time:
Fleld Oeta Required? ❑Yes []NO
Project Manager SCURF Review: Date: D /(� X
Project Manager SRF Review: .Z9 Date: � (�)- WOL(
Page 5 of 16

Document Name: Document Revised: February 1, 2018
Sample Condition Upon Recelpt(SCUR) Page 3 of 2
ceAaalyticalm Document issuing Authority:
f-CAR-CS-033-Rev.06 Pace Carolinas Qualit Office
'Check mark top half of box If pH and/or dechlorination Is
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Colifonn, TOC, Oil and Grease, DRO/8015 (water) DOC, LLH6
"Bottom half of box is to list number of bottle
Project II won
PM: SMG Due Date: 08/26/20
CLIENT: 92—Mt. Holly
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pN upon rerelpt
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adjusted
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added
Lot
m.,nhr—n�a nFNm rnrtipratian
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Note: Whenever there b a n6crepan cy anecung nmm 1uI v:.— I—,
out of hold, Incorrect preservative, out of temp, incorrect containers.
Page 6 of 16

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Page 7 of 1

aceAnalAcal
Document Name:
Sample Condition Upon Recel t(SCUR)
Document Revised: February 7, 2018
Page 1 of 2
Document No,:
Issuing Authority:
F-CAR-CS-033-Rev.06
Pace Carolinas Quality Office
Laboratory receivingrIIaakasamples:
lea n�6reentuead1 Hanterglost RgiplgQ MarhanirerdlEnl
Client Name: project#:I WO# a 92488921
Courier: d Ex UPS ❑LISPS
�� PM: SMIS Due Date: 08/26/20
❑FeClient
❑Commercial UKace ❑Other._ CLIENT: 92—Mt. Nally
Seats Intact? myes Fhqo—
--
Dale/Initials Person Examining Contents: - 07
Packing Material: ❑Bubble Wrap ❑Bubble Bags 21 one ❑ Other Blalogri-sa-,l��Tissue Frozen?
[]Yes -Pfio []N/A
Thermometer:
92TO61 Type of Ice: 2<et Qelue [:]None
J�WGun ID: �7
Cooler Temp (°C): a.1 Correction Factor: Add/Subtract ('Cj 0.0
Temp should be shave freezing to 6°C
Cooler Temp Corrected (°C): 0 ❑Sarrplesout of temp criterla. Samples on ice, cooling process
has begun
USDA Regulated Soil (Z N/A, water sample)
Did samples origins a in a quaran#ne zone within the United States: CA, NY, or SC (check mapsl? Did samples originate from a foreign source llnzernationally,
rn,.__ IncludineNawall and Punta Rica)?eyes (1No
Comments/Dlscrepancy:
Chain of Custody Present?
es
❑No
[]N/A
1.
Samples Arrived within Hold Time?
es
No
❑N/A
2.
Short Hold Time Analysis 02 hr.)?
2res
❑No
N/A
3.
Rush Turn Around Time Requested?
0yzs
Na
❑N/A
4.
Sufficient Volume?
es
[]NO
❑N/A
5.
Correct Containers Used?
-Pace Containers Used?
Des
es
[]NO
[]No
❑N/A
EINIA
6.
Containers Intact?
0<1
[IN.
ONJA
7.
Dissolved analysis: Samples Field Filtered?
❑Yes
[ No
N/A
a.
Sample Labels Match COC?
Yes
[]NO
❑N/A
9.
-Includes Date/Fime/ID/AnaWls Matrix:
Headspace in VOAVIaIS(z5-6mm7
Yes
[IN.
N/A
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
❑yes
QYes
-.2plo—
No
❑N/A
/A
11.
COMMENTS/SAMPLE DISCREPANCY
Lot ID of split containers:
CLIENT NOTIFICATIONfRESOLUTION
Person contacted:
Date/Time:
Fled Date Required? ❑Yes []No
Project Manager SCURF Review: /7 _ Date: Q(��� rr�/(�_y���*�
Project Manager SRF Review: 7J Date: (.� CytrlC� o
Page 8 of 16

Document Name:
Document Revised: February 7, 2018
c
ceAnalytical
Sample Cpndltion Upon Recel t(SCUR)
Page 1 of 2
Ohcument No.:
Issuing Authority:
F-CAR-
I Pace Carolinas Qualls Office
verified and within the acceptance range for preservation
samples.
Exceptions: VOA, Coliform, TOC, Oil and Grease, DRO/9015 (water) DOC, LLHg
"Bottom half of box Is to list number of bottle
PM: SMG
CLIENT: 92—Mt. Due Dmte: 08/26/20
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PH Adjustment Log for Preserved Samples
Sample to
Type of Preservative
pH upon receipt
Date preservation adjusted
Time preservation
adjusted
Amount of Preservative
added
Lot
Note: Whenever there is a discrepancy affectl nit North Carolina compliance samples, a copy of this Corm will ne sent to the North Carolina DEHNR Certification Office (Le.
Out of hold, Incorrect preservative, out of temp, incorrect containers.
Page 9 of 16

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Page 10 of

Envent�.
P.O. Box 16414. Green 1i6, SC 29608
(664) MAW. FAJi [phone]
4 CraRsrnan Court, Greer, SC 29650
Fathead Minnow Survival and Growth Test
EPA-821-R-02-013 Method 1000
Client: CITY OF MOUNT HOLLY
Facility: WWTP
NPDES #: NCO021156
Test Date: 04-Aug-20
Laboratory Sample ID #: T57101 P promelas
Test Reviewed and Approved By:
4-1
Robert W. Kelley, Ph.D.
QA/QC Officer
ertifrcation #E87819
Test results presented in this report conform to all requirements of
NELAC, conducted under NELAC Certification Number E87819
Farhad Rostampour
Laboratory Director
SCDHEC Certification #23104
Florida Dept. of Health. Included results pertain only to provided samples.
Page 1 of 6
NCDENR Certification # 022
Page 11 of 16

Effluent Toxicity Report Form -Chronic Fathead Minnow Multi -Concentration Test
Facility: Mount Holly WWTP NPDES # NC0021156 Pipe #: 001 County: Gaston
Laboratory: Comments
x
Signature of Operator in Responsible Charge
x .Ea
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Environmental Sciences Branch
Division of Water Quality
NC DENR
1621 Mail Service Center
Raleigh, NC 27699-1621
Test Initiation Daternme
08/04/20
/ 03:30 PM
% Eff. Repl.
1
2
4
Control Surviving #
Original #
WUoriginal (mg)
2.0 Surviving #
Original #
WUoriginal (mg)
4.0 Surviving #
Original #
WUoriginal (mg)
6.0 Surviving #
Original #
Wt/original (mg)
12.0 Surviving #
Original #
Wt/original (mg)
24.0 Surviving #
Original #
WUoriginal (mg)
Avg WUSurv. Control 0.6016 Test Organisms
4 Cultured In -House
10
9
10
10
10
9
10
10
0.5550
0.5822
0.6460
0.6230
10
10
1 10
10
if
10
10
1 10
10
0.6740
0.6450
1 0.6660
1 0.6650
10
10
10
10
10
10
10
10
0.7450
0.6560
0.6240
1 0.7040
10
10
9
110
10
10
10
1 10
0.6450
0.6250
0.6440
1 0.6830
10
1 10
1 10
110
10
1 10
1 10
1 10
0.6670
1 0.6590
1 0.7270
1 0.8040
10
10
10
i 10
10
10
ji10
10
0.7210
1 0.5540
1 0.6500
1 0.6260
% Survival 100.0°/ Xe Outside Supplier
Avg Wt (mg) 0.6016 Hatch Date: Ofi/03/20
% Survival 1 0 0_./_._1 Hatch Time:
Avg Wt (mg) 0.6625
% Survival 100.0%
Avg Wt (mg) 0.6823
% Survival
Avg Wt (mg) 0.6493
% Survival 100.0%
Avg Wt (mg) 0.7143
% Survival 100.0%
Avg Wt (mg) 0.6378
Water Quality Data
Day
Control
0
1
2
3
4
5
6 7
pH (SU) Init/Fin
DO (mg/I.) Init/Fin
ji
Temp (C) IniUFin
High Concentration
0
1
2
3
4
5
6 7
PH (SU) Init/Fin
DO (mg/L) IniUFin
li
7.6
/ -
7.7
/ 7.9
8.2
/ 7.9
7.7 I
8.1
7.8
/ 7.7
7.6
/ 7.7
7.7
/ 7.8
-/
7.8
7.5
/ -
8.1
/ 7.7
6.9
/ 6.3
8.0 /
7.6
7.7
/ 6.8
7.4
/ 6.5
8.0
/ 7.2
--/
7.8
24.7
/ -
24.6
/ 25.3
24.6
/ 25.5
24.5 /
25.1
24.6
/ 25.6
24.6
/ 25.3
24.6
/ 25.2
-- /
24.7
7.6
/ -
7.9 /
7.6
7.9
/ 7.7
8.2 /
7.7
7.6
/ 7.5
8.0
/ 7.6
8.0
/ 7.7
--/
7.9
7.7
/ -
8.2 /
7.2
7.1
/ 6.2
8.0 /
7.0
7.8
/ 6.0
7.3
/ 6.2
8.0
/ 7.2
--!
8
Sample
Collection Start Date
Grab
Composite (Duration)
Hardness (mg/L)
Alkalinity (mg/L)
Conductivity (umhos/cm)
Chlorine(mg/L)
Temp at Receipt (C)
Dilution H2O
Hardness (mg/L)
Alkalinity (mg/L)
Conductivity (umhos/cm)
1
2
06/02/20
O8/04120
08/06I20
24 hr
24 hr
24 hr
46.0
53.1
46.9
35.0
72.1
83.0
760
853
739
<0.05
c0.05
<0.05
0.2
0.3
2.3
83.7
51.9
306
Survival
Growth
Normal
no
as
Hom. Var,
es
es
NOEC
24.0%
24.0%
LOEC
>24.00 %
>24.00%
ChV
>24.00°k
>24.00%
Method
Steel's Test
T-Test
Overall Result
ChV
Slats
Survival
Growth
Conc.
Critical
Calculated
Critical
Calculated
2%
10.00
18.00
2.41
-1.75
4°h
10.00
18.00
2.41
-2.32
6%
10.00
16.00
2.41
-1.37
12%
10.00
18.00
2.41
-3.24
24 %
10.00
18.00
2.41
-1.04
Page 2 of 6

Lab#
T57101 P promelas
Cllunt
Mount Holly
Srune.10
WWTP
NPDES#
NCO021156
County
Gaston
Month
a
Stan S led Date
04-Aug-20
Steel S led Time
03:30 PM
Started 6 Ntl By
AM
Teat OrSanlem
PIMEPHALES PRO
Neea bom date
03-Au-20
Nee.bern time
0900-113OMT
Test Type
NCCD
Dilution waisr
MHSF 7-31-2OD
Units for Cone.
%
%9rtl BROOD
Test .seats
400 nil
Teat volume
250 m1
Imubntor#
1
Llpht 1161UBdk
Initial Toms-C 125
Aelsmis 1.1
2%DAY
Teel method 1,,VP.....
0301]'.�000
Page 3 of 6
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aceAnalytical a
www.0acelabs.cam
I
I
Doug Shoutd
City of Mt Holly WWTP
201 Broome Street
Mount Holly, NC 28120
Project: Toxicity - NCO021156 - Multico
Pace Project No.: 92580598
Reviewed by:
Sarah Graham
[phone]
[e-mail]
Laboratory Report
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date: 01/03/2022
Date Received:01/03/2022
Page 1 of

ET.T..-
P.O. Box 16414, Greenvlle, SC 29606
(E64) 877-6942 . FAX [phone]
4 Craftsman Courl. Graer, SC 29560
Fathead Minnow Survival and Growth Test
EPA-821-R-02-013 Method 1000
Client: CITY OF MOUNT HOLLY
Facility: WWTP
NPDES #: NCO021156
Test Date: 14-Dec-21
Laboratory Sample ID #: T60847
Test Reviewed and Approved By:
4!
Robert W. Kelley. Ph.D.
President
e
Certification #E87819
Test results presented in this report conform to all requiremems of
NEAC, conducted under NELAC Certification Number E87819
Patrick D. Timms
QA/QC Officer
SCDHEC Certification #23104
Florida Dept. of Health. Included results pertain only to provided samples.
Page 1 of 6
NCDENR Certification # 022
Page 2 of 7

Facility: Mount Holly W WTP NPDES # NC0021156 Pipe #: 001 County: Gaston
Laboratory: Comments
x
Signature of Operator in Responsible Charge
x 44t 4/4
of
MAIL ORIGINAL TO: Environmental Sciences Branch
Division of Water Quality
NC DENR
1621 Mail Service Center
Raleigh, NC 27699-1621
Test Initiation DateMme 12/14/21 / 04:10 PM
% Eff. Repl.
Control Surviving #
Original #
WUoriginal (mg)
F__3_.0j Surviving #
Original #
Wt/original (mg)
4.5 Surviving #
Original #
Wt/original (mg)
60Surviving #
Original #
WUoriginal (mg)
9.0 Surviving #
Original #
Wt/original (mg)
12.0 Surviving #
Original #
Wtoriginal (mg)
1 2 4 d
Avg Wt/Surv. Control F 0.9595
10
1 10
10
10
10
1 10
ji10
10
1.0410
1 0.8740
1 0.9850
1 0.9380
10
1 9
10
1 10
101
10
10
10
0.9900
1 0.9170
1.0730
1 0.9560
10
10
10
10
10
10
10
10
0.9920
1 0.7650
1 1.0420
11.0290
10
10
10
10
10
10
10
10
1.0390
1 0.9960
1 0.9590
11.0880
10
10
10
10
10
10
10
10
1.1500
1 0.8550
1 0.9630
1 0.9110
10
10
if
1 10
1 9
10
10
10
10
0.7830
1 0.9230
1 0.9130
1 0.8440
% Survival 100.0%
Avg Wt (mg) 0.9595
% Survival
Avg Wt (mg) 0.9840
% Survival 100.0%
Avg Wt (mg) 0.9570
% Survival 100.0%
Avg Wt (mg) 1.0205
% Survival 100.0%
Avg Wt (mg) 0.9696
% Survival
Avg Wt (mg) 0.8656
Test Organisms
eCultured In -House
X Outside Supplier
Hatch Date: 12/13/21
Hatch Time: 12:00 AM
Quality Data
Day
Control
0
1
2
3
4
5
6 7
pH (SU) Init/Fin
DO (mg/1.) Init/Fin
ji
Temp (C) Init/Fin
High Concentration
pH (SU) Init/Fin
DO (mg"-) Init/Fin
Temp (C) Init/Fin
Sample
Collection Start Date
Grab
Composite (Duration)
Hardness (mg/L)
Alkalinity (mg/L)
Conductivity (umhos/cm)
Chlorine(mg1L)
Temp at Receipt ( C)
7.8
/ -
7.7 /
7.7
7.7
/ 8.2
7.8 /
7.7
7.7 !
7.7
7.8 /
7.7
7.7
/ 7.5
--/
7.5
7.9
/ -
8.4 /
7.4
8.2
/ 7.4
7.9 /
7.0
7.7 /
6.1
7.6 /
5.1
7.8
/ 5.5
--!
6.2
24.7
/ -
24.4 /
24.9
24.4
/ 25.0
24.5 /
25.3
24.5 /
25.2
24.5 /
25.8
24.fi
/ 24.7
--- /
25.2
0 1 2 3 4 5 6 7
8.0
/ -
8.0
/ 8.0
7.8 /
7.9
8.0 /
7.7
7.8 /
7.8
7.7 !
7.5
7.8 /
7.6
--/
7.7
7.4
/ -
8.8
/ 7.9
8.4 1
7.1
7.8 /
7.2
7.5 /
6.0
7.2 /
5.4
7.6 /
5.5
--/
6.4
25.0
/ -
24.7
/ 24.9
24.6 /
25.0
24.6 /
25.3
24.7 /
25.2
25.0 /
25.8
24.6 !
24.7
-- /
25.2
Dilution H2O
Hardness (mg/L)
62.0
Alkalinity (mg/L)
61.7
Conductivity (umhos/cm)
301
Survival
Growth
Overall Result
Nonnal
no
as
ChV
Hom. Var.
es
es
NOEC
12.0%
12.0%
LOEC
>12.00%
>12.00%
ChV
>12.00%
>12.00%
Method
Steeps Test
T-Test
State
Survival
Growth
Conn.
Critical
Calculated
Critical
Calculated
3%
10.00
16.00
2.41
-0.38
5%
10.00
18.00
2.41
0.04
6%
10.00
18.00
2.41
-0.94
9%
10.00
18.00
2.41
-0.16
12%
10.00
16.00
2.41
1.45
NW(3 Fnrm AT-.'; H/ndl
rage 4 of

Labs
T60847
Clint
Mount Holly
Semple to
WWTP
NPDESe
NC0021156
County
Gaston
Month
12
Stan S fed pate
14-Deo&21
Stan & fee Time
04:10 PM
Started & fee 9y
JG
Test organism
Pimphales promelas
Ned. born date
13-Dec-21
Nao. bitter It..
1500-16300
Test TYpe
NCCD
DneBon wain,
MHSF
Unite rot Cede.
%
%prd BROOD
Teat vessels
400 ml
Test volume
250 m1
Inc. betore
i
light
i61Vad'
11IIal Temp•C
25
Anem la 1.15%2
PER DAY
Test methotl It—
B]f.R
Page 4 of 7
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Page 7 of 7

!d
�aceA ,nalytical
wwa pacelabsxom
Doug Should
City of Mt Holly WWTP
201 Broome Street
Mount Holly, NC 28120
Project: Toxicity - NCO021156
Pace Project No.: 92590533
Reviewed by:
Sarah Graham
[phone]
[e-mail]
Laboratory Report
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Page 1 of 1
Report Date: 02/28/2022
Date Received: 02/28/2022
Page 1 of 7

JEcnTV'.nMJt.ln..
CO. Box 16414, Greenville, 6C 29606
(164) B77-6942. fN4(864) B-7-6930
4 Craftsman Cwrl, Greer, SC 29050
Ceriodaphnia dubia Survival and Reproduction Test
EPA-821-R-02-013 Method 1002
Client: City of Mount Holly WWTP
Facility: WWTP
NPDES #: NCOO21156
Test Date: 09-Feb-22
Laboratory 1D #: T61222 C dubia
Test Reviewed and Approved By:
AW P✓,
Robert W. Kelley, Pb.D.
President
qW
Certification #E87819
Test results presented in this report conform to all requirements of
Patrick D. Timms
QA/QC Officer
SCDHEC Certification #23104
NELAC, conducted under NELAC Certification Number E87819
Flonda Dept. of Health. Included results pertain only to provided sat age
ge 1 of 6
NCDENR Certification # 022 Page 2 of 7

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50
Facility: Mount Holly WWTP NPDES#NCO021156 Pipe# 001 County: Gaston
Laboratory Performing Test: Comments
X
Signature of Operator in Responsible Charge
X i✓
Signature of L boratory Supervisor
Date 22-Feb-22
MAIL ORIGINAL TO Environmental Sciences Branch
Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaohnia Chronic Pass/Fail Reoroduction Toxicity Test
CONTROL ORGANISMS
i 2
3
4
5 6
]
6
9
10
11
12
=#Young
Produce!
22
22
23
22
24
22
22
23
23
22
22
22
LHanksum=e=
Avg. Reprod.
Adult (give (D)ead
L
L
L
L
L
L
L
L
L
L
L
L
22.4
Canso
Effluent % 6.0%
0%
21.3
Treatment
Treabaw
Compel CV
TREATMENT 2 ORGANISMS
1 2
3
4
5 6
]
6
9
10
11
12
3.0%
# Young Produced
21
20
22
24
21
20
22
21
21
1 21
22
20
% and Brood
PASS Ft
Adult 1(D)ead
L
L
L
L
L
L
L
L
L
L
L
L
100%
X
Complete This for Either Test Test Start Date
Data 09-Feb-22
pH lstsanni tat sample 2nd sample Sample 07-Feb-22 Sample 09-Fii
Control 7.8 8.3 7.7 8.2 7.7 8.3
Treatment 2 7.9 8.5 7.8 8.6 7.8 8.3 Grab Cony Duration lst 2nd
Tax Tex
Dilution Sample Sample
D.O. start end start end Start end
1st Same isl Saul le 2nd soul ie
Control
Treatment 2
LC50/Acute Toxicity Test
(Mortality expressed as %, combining replicates)
Sample 1 X 2
Sample 1 X 2
Hardness (ani
Spec. Cond.(pmhos)
Chlorine (mg)L)
101
Mortality stan/end staNend
LC50 = % Method of Determination conaei
15% Confidence Limits Moving Average Probit O High Conc
% % Spearman Kerber ROther pH D.O.
594
DEM Form AT-1 Page 3 of 7
Page 2 of 6

STATISTICAL ANALYSIS RESULTS
Facility: Mount Holly
NPnESN NCO021156
Sample ID: WWTP
Etta Te1222ca.bi,
Date: 09-Feb-22
Laboratory: �,
Certification k: NCO22
I Esp. Date: 111112122
Survival Data
7 Day Survival Test Used: FISHERS TEST
Control 100% Test Statistic: P= 1.000
Effluent 100% Critical Value: P= 0.01
PASS: The effluent does not reduce survival of the test organisms.
Reproduction Data
Rua, Pot.
Test for Normality
Mean young/female
Std. Dev.
Test Used: Shapiro-Wilks Test:
Control 22.4
0.67
Effluent 21.3
L14
W:
0.874
Critical Value:
0.884
Analysisfor Differences in Reproduction
Test for Homogeneity of Variance
Test Used: Wilcoxon Test
Test Used: F Test
Rank sum=
101.50
F=
2.90
Critical Value-
109.00
Critical Value=
5.32
The data are homogeneous in variance
PASS: The effluent is not chronically toxic.
Page 4 of 7
Page 3 of 6

Contra[ Mortality and Reproduction by Test Day
i 2 3 4 5 6 7 8
Total
source
I rep
G61.27
1
4
+7+11
22
C2 1.28
2
4
+8+10
22
F4 1-28
3
4
s8+11
23
J10 2-2
4
+5+6
11
22
HH82.2
5
+3+8
13
24
9 1-28
6
+4+7
11
22
N 1-27
7
4
+7+11
22
071-27
8
+5+7
11
23
06 1-27
9
4
+7+12
23
S7 1.28
10
1
1
+4+7
1
1 11
22
52 1-28
11
+4+8
10
22
6 11.27
12
+3+8
11
22
13
N/A
0
14
N/A
0
15
N/A
0
16
N/A
0
17
NIA
0
18
WA
0
19
N1A
a
can
20
N/A
0
22 4
6 % Effluent Mortality and Reproduction by Test Day
1 2 3 4 5 6 7 8
Total
G6 1-2
1
4
+7+10
21
G21-28
2
3
+6+11
20
F4 1-28
3
+4+7
11
22
JJ 10 2-
4
+5+7
12
24
HH824
5
+4+6
11
21
W9 1-2
6
+3+7
10
20
N 1-27
7
+4+7
11
22
07 1-2
8
+3+7
11
21
06 1-2
9
4
+6+11
21
S7 1-28
10
1
+5+6
1
101
21
S2 1-28
11
+4+7
11
22
J6 11-2
12
+3+6
11
20
0
13
N/A
0
0
14
N/A
0
0
15
NIA
0
0
16
N/A
0
0
17
N/A
0
0
8
N/A
0
01
19
NrA
Wean
0 20
N/A
p
21.3
etlN� - AM
C
JC
JC
AM
C
JC
JC
n ate
16-Feb-22
ume fed &renew- .1 n.
o2:es e.
a
aa:2on.
Io 1]
m.ra.
JZ
ew cane .'
24.7
24.6
Din temp. °c
25
24.8
25.1
Coorol Newmm9.-C
24.71
24.6
Labfi
T61222 C dubia
Cllertt
Mount Holly
Sam le 1p
WWTP
NPDES1t
NCO021156
County
Gaston
Month
2
Start &fed Date
09-Feb-22
Start &fed Time
11'30 AM
Started &fed By
AM
Vast Orgahlsm
Cerioda hnla dubia
so, born tlate
OB-Feb-22
ao. bone time
1645-2200
ast Typs
NCCPF
".clan Water
MHSF
Unite for Con..
%b
IWC
6
%0rd BROOD
Test vessels
30 ml
teat volume
15 ml
incubator4
1
LI ht
1SIUSdk
Initial Temp+C
248
Selenastrum
005.1
YAT
0 05.1
Teel meMotl
e2iaaz-oi]uooz
Page 5 of 7
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Mourn
HOLar-
I Y
February 17, 2023
CITY of MouNT HOLLY
NCEQ/DWR/Municipal Permitting Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
RE: City of Mount Holly
NPDES Permit No. NCO021156
Gaston County
400 Last Central Avenuc
Post Office Box 406
Mount Holly, NC 28120
704-8274261
704-827-6306 Fax
Websitc: www.mthollv.us
To Whom It May Concern:
The City of Mount Holly is submitting the Pretreatment Annual Report (PAR) for the
period January 1, 2022 through December 31, 2022.
If you have any questions concerning this material, please contact me at (704) 827-
4261 or Nadine Blackwell at [phone].
Sincerely,
City 3
oun
Dououtd
WWTP ORC
cc: Nadine Blackwell, SUEZ
ENCLOSURES
Sent via email

PRETREATMENT ANNUAL REPORT (PAR)
POTW NAME: City of Mount Holly
REPORT DATE: February 17, 2022
PERIOD COVERED BY THIS REPORT: from 1/01/22 to 12/31/22
NAME OF WASTEWATER TREATMENT PLANT(s) City of Mount Holly WWTP
NPDES Permit No: NC0021156
Person to contact concerning information contained in this report:
Name:
Title:
Mailing Address:
Telephone #:
Nadine Blackwell
Pretreatment Coordinator
P. 0. Box 1279
Clemmons, NC 27012
[phone]
I have personally examined and am familiar with the information submitted in this
document and attachments. Based upon my inquiry of those individuals immediately
responsible for obtaining the information reported herein, 1 believe that the submitted
information is true, accurate and complete. I am aware that there are significant
penalties for submitting false information.
2 I' A,CZ-5 /
DATE Signature of Official
Soot& -kc.-^ WASOK
Printed Name
Uk'A'AAes �lrtc�ot
Title

NARRATIVE SUMMARY
GENERAL INFORMATION:
GENERAL PROGRAM INFORMATION:
During this reporting period, the City did modify the Enforcement Response Plan.
The POTW did not modify any of the other Pretreatment Program Elements. The
POTW reviewed the "Pretreatment Program Info Database" sheet. A copy of the
"Pretreatment Program Info Database" is attached with noted corrections.
GENERAL PERMIT INFORMATION:
Effective June 27, 2022, the City of Mount Holly and American & Efird (A&E) entered
into a Consent Agreement with relaxed limits for BOD, COD, Total Nitrogen, and
Total Phosphorus. The Agreement allowed A&E time to determine the appropriate
pretreatment system to install and met the IUP limits. A copy of the Constant
Agreement was sent to the State in July 2022.
The POTW reissued industrial user permits to all SIUs with an effective date of
January 1, 2023. The City received a written letter in December 2022 from both
Daimler and A&E requesting an adjudicatory hearing. Both SIUs are adjudicating
various permit limitations. The limitations were developed based on the City of
Mount Holly discharging to Charolette Water sometime in 2024. The SIU Permits
were sent to the State on December 1, 2022. The State was informed of the SIU
Permit adjudications in January, 2023. As of date of this report, the City attorneys
and SIU attorneys are working through the adjudicatory process.
SIU INFORMATION:
American & Efird (A&E), IUP#1157
SIGNIFICANT NONCOMPLIANCE (SNC) INFORMATION:
None.
OTHER INFORMATION:
The City of Mount Holly and American & Efird (A&E) entered into a Consent
Agreement with increased limits for BOD, COD, Total Nitrogen, and Total
Phosphorus. The Agreement became effective on June 27, 2022. The
Agreement allowed A&E time to determine the appropriate pretreatment
system to install and meet the ]UP limits. As of date of this report, A & E did
meet the milestone dates in the Agreement. On October 15, 2022, A & E
submitted a Preliminary Engineering Report with recommendations of a
pretreatment system. The City extended the due date of final designs to
May 1, 2023 to allow time to resolve the Permit Adjudications and
determination of final permit limits.

During the reporting period, A & E exceeded the permit and Consent
Agreement limitations for BOD, CBOD, Total Nitrogen and Total
Phosphorus. A & E attributed the violations to the manufacturing process
chemicals they are using. A&E was sent a Notice of Violation in
accordance with the City's Enforcement Response Plan and Consent
Agreement. A & E violated the Consent Agreement limits Total Nitrogen
and Total Phosphorus which amounted to $1,750.00 in penalties. Also,
during the previous reporting period, A&E was assessed penalties in the
amount of $1,200.00 for the 2021 BOD SNC event. This penalty was paid
in February, 2022.
The POTW completed the sampling and monitoring as required by the
Permit. Also, an on -site inspection was completed by the POTW.
2. Clariant Corporation, IUP#1158
SIGNIFICANT NONCOMPLIANCE (SNC) INFORMATION:
No SNC Events.
OTHER INFORMATION:
During the first compliance period, Clariant exceeded the daily maximum
permit limitation for Total Nitrogen and Total Phosphorus. During the second
compliance period, the Total Nitrogen limit was exceed once. These
violations were caused by an upset of the activated sludge portion of their
pretreatment system which occurred from June 2022 to September 2022.
In an effort to restore a balanced nutrient load and promote bacterial growth,
Clariant introduced Urea (nitrogen) and Phosporic acid (Phosphorus) into
the activated sludge process. Clariant notified the POTW of the upset and
kept the POTW informed of the progess to return to compliance. Notices of
Violation and penalty assessments were sent in accordance with the City's
Enforcement Response Plan. A total of $1000.00 was collected in penalties.
The POTW completed the sampling and monitoring as required by the
Permit. Also, an on -site inspection was completed by the POTW.
3. Daimler Trucks North America, IUP#1163
SIGNIFICANT NONCOMPLIANCE (SNC) INFORMATION:
No SNC Events.
OTHER INFORMATION:
During the first compliance period, Daimler exceeded the monthly average
limit for Total Nitrogen. During the second compliance period, the Oil and
Grease limit was exceeded once. A Notice of Violation was sent for each
violation and a $500.00 penalty assessment for the Total Nitrogen.
The POTW completed the sampling and monitoring as required by the
Permit. Also, an on -site inspection was completed by the POTW.

Pretreatment Program Info Database printedon: 1/19/2023
for Program Name Mount Holly
WWTP Name City of Mount Holly
Program Approval Date 0812611983
Pretreatment Status Full
Region MRO
County Gaston
NPDES Number NC 02
0 1156
NPDEffective Date
Last PAR Rec 02/22/2022
PAR Due Date03/01/2023
mercury
12/01/2019
NPDES Expire Date 02/28/2024
Current Fiscal 05/27/2021
1631
required
Year PCI Done
es
POTW is Primary WWTP TRUE
Last Audit on 04/26/2019
Audit Year Nex123/24
Design Flow mgd 4.0000 % Design mgd is SIU permittetl F4325
Permitted SIU flow (mgd) [Pt SIU) 1.73
WWTP SIU's 3 Program SIUs 3
WWTPCIU's
-
HWA 1 LTMP
IWS ro su0
ProgramClUsp]
ERP
date Inactive Date Next Due
04/01/2024
08/10/2027
Date Received by DWR
03/28/2019 03/30/2016
12/07/2016 02/22/2022
02/22/2022
Date Approved
06/24/2019 05/04/2016
08/10/2022
Adopt Date Required
Date Adopted
11 /12/2012
Info in this Box from Pt Contacts
Date Date Date
PT_Pro Attended Attended Attended
Formal Name q Prime Phonel ext Fax HWA Wksn mp wk.. oep m&.,
Ms. Nadine Blackwell
jPrlm
336-766-0270
1
1
11 1/5/2005 1611612011 1/31/2013
[e-mail]
Pretreatment Coordinator JP.0. Box 1279 7012
Mr. Doug Shoutd
1 114111/2019
[e-mail]
Division Manager of Wastewater
-Deaid-�ehnsort-
not deliverable
Htility'DireLldr
-�Jor�.NTar� W,t�50n� u,t��iiy
r r S n> m o
jJir�e{1rr
DWR Central Office Contact Pretreatment Staff
DWR Regional Contact es 8e11

a§
i$
0
-
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Pretreatment Performance Summary (PPS)
1.
Pretreatment Town Name: City of Mount Holly
2.
"Primary" NPDES Number
NCO021156
Or Non -Discharge Permit # if Applicable
3.
PAR begin Date, please enter 01/01/yy or 07/01/yy
3.=>
01/01/22
4.
PAR end Date, please enter 06/30/yy or 12/31/77
4.�>
12/31/22
5.
Total number of SIUs, includes CIUs
5.==>
3
6.
Number of CIUs
6.z*
2
7.
Number SIUs with no IUP, or with an expired IUP
7.=*
0
8.
Number of SIUs not inspected by POTW
8.=>
0
9.
Number of SIUs not sampled by POTW
9.=>
0
10,
Number of SIUs in SNC due to IUP Limit violations
10.E
0
11.
Number of SIUs in SNC due to Reporting violations
11.E
0
12.
Number SIUs in SNC due to violation of a Compliance Schedule, CO
or similar
12.E
0
13.
Number CIUs in SNC
13.E
0
14.
Number SIUs included in public notice
14.a
0
15.
Total Number SIUs on a compliance schedule, CO or similar
15.E
1
16.
Number NOVs, NNCs, ADS, or similar assessed to SIUs
16.E
11
17.
Number of Civil Penalties asses to SIUs
17.E
7
18,
Number Criminal Penalties assessed to SIUs
18.E
0
19.
Total Amount of Civil Penalties Collected
19.E
$4,450.00
20.
Number of IUs from which penalties collected
20.E
3
Foot Notes: AO
Administrative Order
IUP
Industrial User Pretreatment Permit
POTW Public Operated Treatment Works
CIU
Categorical Industrial User
NNC
Notice of Nan -Compliance
SIU Significant Industrial User
CO
Consent Order
NOV
Notice of Violation
SNC Significant Non -Compliance
IU
Industrial User
PAR
Pretreatment Annual Report

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02/032023 CITY OF MOUNT HOLLY
11:29.•57 MISC RECEIPT INQUIRY REPORT ?age 1
Date Range: 01/0112022-12/31/2022 Receipt # Range: All
Batch # Range: 0000013084- 0000013222 Name: CLARIANT
BATCH NUMBER: 0000013084 RECEIPT NUMBER: 0000494990 ENTRY DATE: 08/12/2022
PAYOR: ebARTANT"CORPORATTKON--
ADDRESS: 625 E. CATAWBA AVE
MOUNT HOLLY, INC 28120-D000
--------------------------C H A R G E L I S T I N G --------------------------
CODE DESCRIPTION DUE DISCOUNT PAYMENT
-------------- - _
227 FINES 6 CITATIONS 500.00 0.00 500,00
------
NOTICE OF VIOLATION.
--- 4--_--
CHARGE TOTAL:500.00 D.00 500.00
-------------- P A Y M E N T I N F O R M A T I O N ---------------------
CHECKS: 500.00
-Y- ^TOTAL: 500.00
__________________________ C H E C K L I S T I N G ____-_____---_-___..____--__
LINE # CHECK # PAID BY AMOUNT
----.---_----__- -------------------------.._
01 9449 CLARTANT CORPORATIKON 500.00
---------------------------- ._----`-"
CHECK TOTAL: 500.DO
xx=amxx�rauuxxxax:asvxx-=xo=xnc=nmmyxaRenav-xsxcm... .vaxmovcxcxcm.......
BATCH NUMBER: 0000013220 RECEIPT NUMBER: 0000498457 ENTRY DATE: 09/28/2022
PAYOR: CLARIANT
ADDRESS: 500 E MOREHEAD ST
STE 400
CHARLOTTE, NC 28202-0000
--------------------------C H A R G E L I S T I N G --------------------------
CODE DESCRIPTION DUE DISCOUNT PAYMENT
________.__-.__-_._- _ _-_ _ -
21T FINES 6 CITATIONB 500.00 O.OD 500.00
CITATION
CHARGE TOTAL: 50D.00 0.00 500.00
---------------------- P A Y M E N T I N F O R M A T I O N ---------------------
CHECKS: 500.00
TOTAL: 500.00
-------------------------- C H E C K L I S T I N G-------'-----------•---__-.:___
LINE # CHECK # PAID BY AMOUNT
----------------- ---------------------------- ,.
01 109702 CLARIANT 500.00
----------- .----_.-.-----------------------------" -
CHECK TOTAL: 500.00
Ta�vn7RtaFs.P=v--- ---------- vv..a. mFfwW 4s.n'®Nv v,mTcic

02/03/2023 CITY OF MOUNT HOLLY
11:27:49 MISC RECEIPT INQUIRY REPORT Page 1
Date Range: 01/01/2022-12/31/2022 Receipt # Range: All
Batch#:0000013071 Name: DAIMLER
BATCH NUMBER: 0000013071 RECEIPT NUMBER: 0000494517 ENTRY DATE: 08/10/2022
PAYOR: DAIMLER TRUCK NA LLC
ADDRESS: 1800 N. MAIN ST.
MOUNT HOLLY, NC 28120-0000
--------------------------C H A R G E L I S T I N G ----------------_--_------
CODE DESCRIPTION DUE DISCOUNT PAYMENT
-------------------------------------------------------------------------
217 FINES k CITATIONS 500.00 0.00 500.00
NOTICE OF VIOOLATION PENALTY
-------------------------------------------------------------------------
CHARGE TOTAL: 500.00 0.00 500.00
-------------------- P A Y M E N T I N F O R M A T I O N
CHECKS: 500.00
TOTAL: 500.00
.------------------- C H E C K L I S '1' I N G -------_-----___----_-__---
LINE # CHECK # PAID BY AMOUNT
---------------------------------------------------------------------
01 1634 DAIMLER TRUCK NA LLC 500.00
CHECK TOTAL: 500.00

CITY OF MOUNT HOLLY
oz40023 MISC RECEIPT INQUIRY REPORT Page 1
09:T4:50
Date Range: All Dates Receipt # Range: All
Batch # Range: All Name: ELEVATE
BATCH NUMBER: 0000012541 - RECEIPT NUMBER: 0000479438 ENTRY DATE: 02/23/2022
PAYOR: ELEVATE TEXTILES
ADDRESS:
MOUNT HOLLY, NC 28120-0000
--------------------------C H A R G E L I S T I N G --------------------------
CODE DESCRIPTION DUE DISCOUNT PAYMENT
-------------------------------------------------------------------------
212 MISC REVENUE -SEWER 1,200.00 0.00 1,200.00
VIOLATION
-------------------'---_--------------------------------------------------
CHARGE TOTAL: 1,200.00 0.00 1,200.00
------------- P A Y M E N T I N F O R M A T I O N -------------------
CHECKS: 1,200.00
----------------------------------------------------------------------
TOTAL: 1,200.00
------------------- C H E C K L I S T I N G ------------------------
LINE # CHECK # PAID BY AMOUNT
------------------------------------------------------------------
01 104803 ELEVATE TEXTILES 1,200.00
------------------------------------------------------------------
CHECK TOTAL: 1,200.00
BATCH NUMBER: 0000012885 RECEIPT NUMBER: 0000488971 ENTRY DATE: 06/13/2022
PAYOR: A&E, ELEVATED TEXTILES
ADDRESS: 804 GREEN VALLEY RD
STE 300
GREENSBORO, NC 27408-0000
--------------------------C H A R G E L I S T I N,G --------------------------
CODE DESCRIPTION DUE DISCOUNT PAYMENT
212 MISC REVENUE -SEWER
VIOLATION- A&E
-----------------------------
CHARGE TOTAL:
---- ------ P A Y M E N T
CHECKS: 500.00
------------------------------------
TOTAL: 500.00
------------------------------
500.00 0.00 500.00
----------------------------
500.00 0.00 500.00
I N F O R M A T I O N
------------------- C H E C K L I S T I N G
LINE # CHECK # PAID BY
-----------------------------------------------
01 105412 A&E, ELEVATED TEXTILES
-----------------------------------------------
AMOUNT
500.00
CHECK TOTAL: 500.00
BATCH NUMBER: 0000013300 RECEIPT NUMBER: 0000501103 ENTRY DATE: 11/01/2022

CITY OF MOUNT HOLLY
02/03/2023
08:94:60 MISC RECEIPT INQUIRY REPORT
Page 2
Date Range: All Dates Receipt # Range: All
Batch # Range: All Name: ELEVATE
PAYOR: ELEVATE TEXTILES
ADDRESS: 804 GREEN VALLEY RED
STE 300
GREENSBORO, NO 27408-0000
------------`-------------C H A R G E L I S T I N G --------------------------
CODE DESCRIPTION DUE DISCOUNT
-------------------------------------------------------------------------
PAYMENT
217 FINES & CITATIONS 750.00 0.00
750.00
NOTICE OF VIOLATION
-------------------------------------------------------------------------
CHARGE TOTAL: 750.00 0.00
750.00
-------------------- P A Y M E N T I N F O R M A T I O N ---------------------
CHECKS: 750.00
--------------------------------------..-__--------------------------------------
TOTAL: 750.00
------------------------- C H E C K L I S T I N G ---------------------------
LINE # CHECK # PAID BY
------------------------------------------------------------------
AMOUNT
01 106379 ELEVATE TEXTILES
-----------------------------------------------------------------
750.00
CHECK TOTAL:
750.00
BATCH NUMBER: 0000013376 RECEIPT NUMBER: 0000503582 ENTRY
DATE: 11/29/2022
PAYOR: ELEVATE TEXTILES / AMERICAN & EFIRD LLC
ADDRESS: P 0 BOX 507
MOUNT HOLLY, NC 28120-0000
--------------------------C H A R G E L I S T I N G --------------------------•-
CODE DESCRIPTION DUE DISCOUNT
---------------------`--------------------------------------------------
PAYMENT
217 FINES & CITATIONS 250.00 0.00
250.00
CODE VIOLATION A&E
-------------------------------------------------------------------------
CHARGE TOTAL: 250.00 0.00
250.00
-------------------- P A Y M E N T I N F O R M A T I O N ---------------------
CHECKS: 250.00
--------------------------------------------------------------------------------
TOTAL: 250.00
-------------------------- C H E C K L I S T I N G ---------------------------
LINE # CHECK # PAID BY
------------------------------------------
AMOUNT
------------------------
01 106462 ELEVATE TEXTILES / AMERICAN &
------------------------------------------------------------------
250.00
CHECK TOTAL:
250.00
_
BATCH NUMBER: 0000013447 RECEIPT NUMBER: 0000505697 ENTRY
DATE: 12/16/2022
PAYOR: ELEVATE TEXTILES

CITY OF MOUNT HOLLY
0210312023
09:14:50 MISC RECEIPT INQUIRY REPORT Pages
Date Range: All Dates Receipt # Range: All
Batch # Range: All Name: ELEVATE
ADDRESS: 804 GREEN VALLEY ROAD SUITE 300
GREENSSORO, NC 27408-0000
--------------------------C H A R G E L I S T I N G ---
CODE DESCRIPTION DUE DISCOUNT PAYMENT
-------------------------------------------------------------------------
217 FINES 8 CITATIONS 250.00 0.00 250.00
VIOLATION PAYMENT
------------------- -
CHARGE TOTAL: 250.00 0.00 250.00
-------------------- P A Y M E N T I N F O R M A T I O N ---------------------
CHECKS: 250.00
------ ---------------
TOTAL: 250.00
-------------------------- C H E C K L I S T I N G----------------------------
LINE # CHECK # PAID BY AMOUNT
------------------------------------------------------------------
01 106572 ELEVATE TEXTILES 250.00
------------------------------------------------------------------
CHDCK TOTAL: 250.00