NC0040908_Renewal (Application)_20230719

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Frederick Thomen
Randolph County Board Of Education
2234-B Enterprise St
Asheboro, NC 27203
Subject: Permit Renewal
Application No. NCO040908
Tabernacle Elementary School
Randolph County
Dear Permittee:
NORTH CAROLINA
Environmental Quality
July 19, 2023
The Water Quality Permitting Section acknowledges the July 19, 2023, receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//de9 nc gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I DMsion of Water Resources
Winston-Salem Regional Office 1 450 West Hanes MITI Road Suite 300 1 Winston-Salem. North Carolina 27105
336.776.9800

NPDES Permit Number I Facility Name
Modified Application Form 2A
Modified March 2021
c v o r�48e
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the instructions may result in denial of the application.
SECTION
1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.210)(1) and
1.1 Facility name
'!T EiZNA a Y -S
Mailing address (street or P.O. box)
r pri,5F-
I
City or town
State N C
E07D W R/N P E
Z>
z
E
Contact name (first and last)To
itle
Phone number
Email address
EaED N
2C
-267- 9 rr#6
—
Location address (street, route number, or other specific identifier) 0 Same as mailing address
Z v l
City or town State ZIP code
5 KFI34R a Al C- Z 7Zos--
Is this applicatidn for a facility that has yet to commence discharge?
1.2
❑ Yes 4 See instructions on data submission No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes No 4 SKIP to Item 1.4.
i
1
Applicant name
Applicant address (street or P.O. box)
o
City or town
State
ZIP code
_o
5
Contact name (first and last)
Title
Phone number
Email address
a
n
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
❑ Owner ® Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑, Facility IR11" Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
E
m
Existing Environmental Permits
°
> NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
$� —
❑ PSD (air emissions) ,
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
E] Other (specify)
w
404)
=S
f 7, In c .V�s
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
1.7 Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
wnership Status
Served
Served
indicate percentage
s 10 % separate sanitary sewer
Own ❑ Maintain
2-1%
combined storm and sanitary sewer
❑ Own ElMaintain
❑ Unknown
❑ Own ❑ Maintain
c
% separate sanitary sewer
❑ Own ❑ Maintain
R
% combined storm and sanitary sewer
❑ Own ❑ Maintain
n
❑ Unknown
❑ Own ❑ Maintain
a
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer ❑ Own ❑ Maintain
% combined storm and sanitary sewer ❑ Own ❑ Maintain
o
❑ Unknown ❑ Own ❑ Maintain
0
Total
d
Population $�
Served '
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
%
Z'
1.8
Is the treatment works located in Indian Country?
0
U
❑ Yes E4 No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes ® No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
D. 0 mgd
�v
H
Annual Average Flow Rates Actual
ao �t Two Years Ago
Last Year
A 0 23 This Year
c
c,
d 6 mgd
mgd
Do oil mgd
—�°
4
Maximum Daily Flow Rates Actual
c
a c A 9 Two Years A o
9
A p t Last Year
d o'to S This Year
0, 0 mgd
mgd
00mgd
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
c
Total Number of Effluent Discharge Points by Type
a a �0%
Combined Sewer
Constructed
rn
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
Overflows
y_
y
RECEIVED
JUL i y �J23
NC®EQ/DWR/NPDES
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
_ / _, Modified March 2021
i�t C?�� ®8 LF/411t
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes R No -* SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
y
❑ Intermittent
1.14
Is wastewater applied to land?
❑ Yes ( No 4 SKIP to Item 1.16.
W
1.15
Provide the land application site and discharge data requested below.
y
Land Application Site and Discharge Data
o
Average Daily Volume
Continuous or
0
Location
Size
Applied
Intermittent
E m
check one
ElContinuous
N
0
acres
gpd
❑ Intermittent
I
❑ Continuous
acres
gpd
❑ Intermittent
0
Continuous
R
acres
gpd
❑ Intermittent
1 1.16
Is effluent transported to another facility for treatment prior to discharge?
❑ Yes Ek No 4 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 K No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
-�-
N c 00�go� I
1.20 In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receivinq F cilitv Data
Facility name A /
Mailing address (street or P.O. box)
A
City or town
State
ZIP code
0
U
Contact name (first and last)
Title
0
d
Phone number
Email address
cNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
A
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 State of North Carolina (e.g., underground percolation, underground injection)?
a
L
❑ Yes No + SKIP to Item 1.23.
c
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
@
Description
Volume
[IContinuous
acres
gpd
❑ Intermittent
ElContinuous
acres
gpd
❑ Intermittent
acres
d
El Continuous
gpd
❑ 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.)
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 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
0
Contractor name
(company name
E
Mailing address
c
street or P.O. box
c
City, state, and ZIP
A
code
c
Contact name (first and
U
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
Modified March 2021
ADDITIONALhie-
.-
c Outfalls to Waters of the State of North Carolina
=
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
rn
o
❑ Yes (K No 4 SKIP to Section 3.
0
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
9pd
and infiltration,
Indicate the steps the facility is taking to dnimize inflow and infiltration,
3
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
M Q
specific requirements.)
0
0
Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
otb
(See instructions for specific requirements.)
as
" o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes 'Q No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
i
c
m
E
m
n
2.
E
O
y
d
3.
NCDEQ/DWR/NPDE
rN
4.
.0
om
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled
or Actual Dates of Completion for Im rovements
E
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
Improvement
(list outfall
Construction
Construction
Discharge
Level
(from above)
number
(MM/DDIYYYY)
(MMIDDIYYYY)
(MMIDDIYYYY)
MMIDDIYYYY
a,
U
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
Facility Name Modified Application Form 2A
Modified March 2021
INFORMATIONSECTION 3.
I
sheets if you have more than three outfalls.)
3.1
Provide the following information
for each outfall. (Attach additional
Outfall Number I
Outfall Number
Outfall Number
State
L G
County
0
City or town
a
Distance from shore
p ft.
ft.
ft.
Depth below surface
ft.
ft.
ft.
0
Average daily flow rate - t mgd mgd mgd
o
Latitude 3-T- ,43 4 Z
Longitude Oq
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
3.2
o
❑ Yes ( No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
y
Outfall Number
Outfall Number
Outfall Number
0
2
Number of times per year
2
discharge occurs
a
Average duration of each
o
discharge (specify units
oAverage
flow of each
mgd
mgd
mgd
N
discharge
n
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
a
Outfall Number
Outfall Number
Outfall Number
d
N
O
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
6 3.6
one or more discharge points?
Yes ❑ No 4 SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
I Modified Ma ch 2021
Wa 08 r
3.7 Provide the receiving water and related information if known for each outfall.
Outfall Number
Outfall Number
Outfall Number
Receiving water name
f.�4QAv 1A'/ C
Name of watershed, river,
0
or stream system
CAPS FF,42
a
U.S. Soil Conservation
N
Service 14-digit watershed
o
code
w
Name of state
management/riverbasin
Y,DKN_ W DfE
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
03 03 ODO
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number
Outfall Number
Outfall Number
Highest Level of
V Primary
❑ Primary
❑ Primary
Treatment (check all that
1 ❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
�
aDesign
I
Removal Rates by
Outfall
CD
BODs or CBODs %
%
%
c
a
E
TSS
%
%
Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
Modified Miarch 20 1
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.
0
Outfall Number
Outfall Number
Outfall Number
0
Disinfection type
U
Nvnl>=
0
Seasons used
E
Dechlodnation used? Not applicable
❑ Not applicable
❑ Not applicable
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have ou completed monitoring for all Table A parameters and attached the results to the application package?
Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water nuearAhe discharge points?
❑ Yes Alliq ❑ No + 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 outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number Outfall Number
Acute
Chronic
Acute Chronic Acute Chronic
is
i
Number of tests of discharge
�
rn
=
water
Number of tests of receiving
`—
water
3
w
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 + Complete Table B, including chlorine. 2111*' No + Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
No additional sampling required by NPDES
❑
❑ Yes permitting authority.
Page 8

NPDES Permit Number Facility Name I Modified Application Form ZA
Modifi d March 2021
C p Aele g/J+tbR
3.19 Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding t is permit application
or (2) at least four annual WET tests in the past 4.5 years?
No + Complete tests and Table E and SKIP to
❑
❑ Yes Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
No + Provide results in Table E and SKIP to
❑
❑ Yes Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permittingauthorityand provide a summaryof the results.
Date(s) Submitted
Summary of Results
MMIDO YYYY
m
c
0
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
�'
❑ Yes ❑ No + SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
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 toreduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
Not applicable because previously submitted
❑ Yes information to the NPDES permitting authority.
Page 9

NPDES Permit Number
Facility Name I Modified Application Form 2A
Modified Mach 2021
v09D` o
)26 4V-
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 1
Column 2
Section I Basic Application
❑ wl variance request(s) ❑ wl additional attachments
Information for All Applicants
Section 2: Additional
2 wl topographic map ❑ wl process flow diagram
❑ Information
❑ wl additional attachments
wl Table A ❑ wl Table D
❑ Section 3: Information on
wl Table B ❑ wl additional attachments
Effluent Discharges
❑
wl Table C
R
N
Section 4: Not Applicable
c
0
w.
Section 5: Not Applicable
d
Section 6: Checklist and
®'
❑ wl attachments
Certification Statement
.r
Y
6.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. 1 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
GEC
Signature
Date signed
7-/ 0-Z3
Page 10

_
NPDES P�e�rmpit Number
Facility Name
Qutfall Number
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
Methods
ML or MDL
Include units
( )
Pollutant
Value
Units
Value
Units
Number of
Samples
Biochemical oxygen demand
BOD5 or ❑ CBOD5
(report one
� L
�N1 `�
z
�
is Z
❑ ML
❑ MDL
Fecal coliform
iv�
lOC� .ti
Z
�„s
Z
❑ ML
❑MDL
Design flow rate
z t
d Oo7-5-0
pH (minimum)
pH (maximum)
���
S
Temperature (winter)
Temperature (summer)
Total suspended solids (TSS)
—7,s
07 1/L
OML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 LFK 13b for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number
NPDIrmit Number
Facility Name
Outfall Number Moomea mppncauvn rvnn —
Modified March 2021
Ne ogo&Vrm
Moo
..
Average
Daily Discharge
Analytical
ML or MDL
Maximum Daily
Discharge
Pollutant
Value
Units
Value
Units
Number of
Samples
Method'
(include units)
❑ ML
Ammonia (as N)
Q �t(P
c [_�3�
1 `
❑MDL
❑ ML
❑ MDL
�
Chlorine
2
A'
total residual, TRC
, •
—
❑ ML
Dissolved oxygen
L%
r 4 l
v
yn ---
3-3
❑MDL
f (%
❑ ML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
❑ ML
Total dissolved solids
❑MDL
.r.,.+I—A�% --jael i inriar An r.FR 136
for the analvsis of pollutants
or pollutant parameters
or
Sampling shall be conducted according to sutnclenuy sensitive test Nluu-160 ��•�•, „�• ����
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122,41(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment
required to report data for chlorine.
process, and have no reasonable potential to discharge chlorine in their effluent are not
Page 12
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N00040908 Tabernacle Elementary School Facility
Latitude: 35' 43' 42" N Longitude: 79' 57' 08" W Location
Sub -Basin: 03-07-09 Stream Class: C
Receiving Stream: Caraway Creek Randolph County
North Map not to scale