NC0070408_Renewal (Application)_20230721

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Charles Clement
Clevon Woods Association
756 W King St
Boone, NC 28607
Subject: Permit Renewal
Application No. NCO070408
Art Plaza WWTP
Watauga County
Dear Permittee:
NORTH CAROLINA
Environmental Quality
July 21, 2023
The Water Quality Permitting Section acknowledges the July 21, 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•//deg ncgov/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
Sincere
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
iiigAEQ-4;A
-FS'..eV
North Carolina Department of Environmental Quality I Division of Water Resources
Wfnston-Salem Regional Office 1 450 West Hanes Mill Roa4 Suite 300 1 Winston-Salem, North Carolina 27105
336.776.9800

CLEVON WOODS ASSOCIATES, LLC
P.O. Box 1686
CLEMMONS, NORTH CAROLINA 27103
ROBERT E. HODGES
[e-mail]
July 19, 2023
VIA U.S. MAIL
CERTIFIED, RETURN -RECEIPT
Mr. Charles Weaver
Division of Water Resources
Water Quality Permitting Section-NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: NPDES Modified Application- Form 2A
NPDES Permit# NCO070408
Art Plaza WWTP- Watauga County
Clevon Woods Associates, LLC- Applicant
Dear Mr. Weaver,
Laserfiche
RECEIVED
JUL 21 2023
NCDEO/DWR/NPDES
Attached find two copies of this original letter, along with original and two copies of NPDES
Application- Form 2A, together with a topographic site plan of our site.
I again would like to thank you for your assistance in guiding me through the process of getting this
application completed to renew our current permit.
Please let me know if you need additional information.
Best Regards,
Robert E. Hodges
Member- Manager

Laserfche
North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
JUL 21 2023
NCDEQ/DWR/NPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza WWTP
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this forth, please read the instructions. Failure to follow,
NPDES
the instructions may result in denial of the application)
SECTION•N
INFORMATION FOR r
1.1
Facility name
Art Plaza WWTP
Mailing address (street or P.O. box)
PO Box 1686
City or town
State
ZIP code
Clemmons
INC
27012
Contact name (first and last)
Title
Phone number
Email address
Bob Hodges
MEMBER -MANAGER
[phone]
[e-mail]
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
LLNC
Highway 105
City or town
State
ZIP code
Seven Devils
INC
28604
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes 0 No 4 SKIP to Item 1.4.
Applicant name
Clevon Woods Associates, LLC
C
Applicant address (street or P.O. box)
PO Box 1686
City or town
State
ZIP code
Clemmons
NC
27012
Contact name (first and last)
Title
Phone number
Email address
a
Bob Hodges
Member -Manager
[phone]
[e-mail]
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
0 Owner ❑ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑ Facility ❑r 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.
Existing Environmental Permits
a
❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
mwater)
control)
E
c
NCO070408
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
a"
y
Ocean dumping MPRSA
❑ P 9 ( )
Dredge or fill CWA Section
❑ 9 (
Other (specify)
❑ (p fy)
6
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza W WTP
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
.o
N/A No Facilty
% separate sanitary sewer
❑ Own ❑ Maintain
Z
Constructed
% combined storm and sanitary sewer
❑ Own El Maintain
d
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
o
a
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
tO
❑ Unknown
❑ Own ❑ Maintain
ro%
separate sanitary sewer
❑ Own ❑ Maintain
N%
combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
Total
°1
Population
L)
Served
Combined Stonn and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
N/A %
N/A
sewer line in miles
1.8
Is the treatment works located in Indian Country?
c
0
❑ Yes El No
U
R
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
e
❑ Yes No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
35,000 mgd
Annual Average Flow Rates Actua
a
Two Years Ago
Last Year
This Year
g
N/A No Facility mgd
N/A No Facility mgd
N/A No Facility mgd
O
w.2
"'
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
N/A mgd
N/A mgd
N/A mgd
y
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points by Type
d
Constructed
LM T
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Emergency
cc J2
Overflows
Overflows
M
A- No Facility Construct
A- No Facility Construct
A- No Facility Construct
N/A
N/A
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza WWTP
Modified March 2021
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 ❑✓ 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
❑ Intermittent
y
1.14
Is wastewater applied to land?
_3E
❑ Yes ❑ No 4 SKIP to Item 1.16.
1
1.15
Provide the land application site and discharge data requested below.
a
w
Land Application Site and Discharge Data
a
o
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
LM
check one
❑ Continuous
o
acres
d
god
❑ Intermittent
s
acres
gpd
El Continuous
v
❑ Intermittent
c
acres
d
gpd
❑ Continuous
W
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
El Yes ❑✓ 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 ❑ 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
Page 3

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza WWTP
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving F cility Data
Facility name
Mailing address (street or P.O. box)
N/ A Facility not yet identified.
City or town
State
ZIP code
O
C.�
v
Contact name (first and last)
Title
0
Phone
Email
number
address
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate mgd
C3
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)?
❑ Yes ❑ No 4 SKIP to Item 1.23.
c
1.22
Provide information in the table below on these other disposal methods.
Information on Other Dis osal Methods
m
=
Disposal
Annual Average
Continuous or Intermittent
V
C
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
N/A- Not yet
acres
gpd
❑ Continuous
irlPnrifiad
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
cc
❑✓ 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
O
Contractor name
North Carolina Water and Sewi
(company name
€
Mailing address
c
street or P.O. box
4700 Haywood Court Suite 108
o
City, state, and ZIP
Raleigh, NC 27609
code
Contact name (first and
last)
Kennith Raber
Phone number
[phone]
Email address
[e-mail]
Operational and
When Operational- Yes
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO070408 Art Plaza W WTP Modified March 2021
SECTION11 • •• • 1
c Outfalls to Waters of the State of North Cardin
U.
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
a�
o
❑ Yes ❑r No -+ SKIP to Section 3.
2.2
Provide the treatment works' current average daily volume of inflow
e Daily volume of Inflow and Infiltration
gpd
L7
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration.
�i
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
a
0
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
cE
o►
(See instructions for specific requirements.)
`L c
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
c
1.
9
m
a
2.
E
'S
3.
7j
4.
n
R
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
E
d
>
Scheduled
Affected
Outfalis
Begin
End
Begin
Attainment of
Operational
o
Improvement
(list l
Construction
Construction
Discharge
Level
E
(from above)
number)
)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYY
„
m
s
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 I Facility Name I Modified Application Form 2A
NC0070408 Art Plaza W WTP Modified March 2021
SECTION•'
• ON 1 I
3.1
Provide the following information for each outfall. (Attach additional
sheets if you have more than three outfalls.)
Outfall Number 001
Outfall Number
Outfall Number
State
North Carolina
w
County
Watauga
w
City or town
Seven Devils
0
c
T.
Distance from shore
N/A
c
Depth below surface
N/A ft.
Average daily flow rate
N/A mgd
mgd
mgd
Latitude
"
Longitude
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
❑ Yes 0 No -* SKIP to Item 3.4.
S'
3.3
If so, provide the following information for each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
discharge occurs
N/A No Facility Constructed
Average duration of each
discharge s eci units
Average flow of each
mgd
mgd
mgd
discharge
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 t rpe
at each applicable outfall.
n
Outfall Number
Outfall Number
Outfall Number
m
H
c
vi
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
�
one or more discharge points?
3 m
❑ Yes ❑ No -*SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
ArtPlaza WWTP
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number
Outfall Number
Outfall Number
Receiving water name
Name of watershed, river,
or stream system
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
3
as
management/river basin
=
U.S. Geological Survey
8-digit hydrologic
cc
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment provided for discharges from each outfall.
Outfall Number
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
Design Removal Rates by
Outfall
m
BOD5 or CBOD5
%
%
%
�
TSS
o
/°
0 /°
0
/°
f-
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
°
/o
❑ 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
NCO070408
Art Plaza WWTP
Modified March 2021
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.
N/A- No Facility Constructed
t�
c
Outfall Number
Outfall Number
Outfall Number
Disinfection type
Seasons used
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
F-
❑ 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?
❑ Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
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
Number of tests of discharge
water
N/A
Number of tests of receiving
r
water
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.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza W WTP
Modified March 2021
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
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No + Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DDNYYY
m
c
e
0
v
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
4
toxicity?
w
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
m
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 permitting authority.
Page 9

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO070408
Art Plaza WWTP
Modified March 2021
SECTION
6. CHECKLIST
AND CERTIFICATION STATEMENT I
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
I Column 2
Section 1: Basic Application ❑
Information for All Applicants
❑ w/ variance request(s) El w/ additional attachments
❑ Section 2: Additional
❑ w/ topographic map ❑ w/ process flow diagram
Information
❑ w/ additional attachments
❑ w/ Table A ❑ w/ Table D
❑ Section 3: Information on
❑ w/ Table B w/ additional attachments
EffluentDischargesDischarges
E
❑ w/ Table C
Section 4: Not Applicable
c
0
Y
R
Section 5: Not Applicable
r
(D
U
Section 6: Checklist and
ElCertification
❑ w/attachments
Statement
N
6,2
Certification Statement
U
U
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 o pe first and last name)
Official title
o T C s
A d• ll l'E
Signature
Date signed
1
Page 10

NPDES Permit Number Facility Name
NCO07O4O8 Art Plaza WWTP
Outfall Number
Modified Application Form 2A
Modified March 2021
Nils Iy uuau uv w11UUUMu aUwiuniy ru awuLAenlly be[I51LIVe lest proceaures (i.e., metnocis) approved under 4U CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

trH menuncauon Numoer NPDES Permit Number Facility Name
NCO070408 Art Plaza WWTP
Outfall Number
Modified Application Form 2A
Modified March 2021
• ' ' • • • •I A 117, 1 Cj I
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Method'
(include units)
Samples
Ammonia (as N)
k No Facility Construc
I ❑ ML
❑ MDL
Chlorine
-
- —
total residual, TRC 2
❑ ML
❑ MDL
Dissolved oxygen
❑ ML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
—911NIIIIy 01— UU �UlIUWA«U aUkujujjly w auimcienuy sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19)
Z
30
m
M
r--
TT
M
c� /
rn\ w
m
� ■ �
Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO070408 Art Plaza WWTP
Modified March 2021
Maximum Daily Discharge Avenge Daily Discharge
r-p7
ollutarrt
1
Analytical ML or MDL
Value Units Value Units Number of
Method' (include units)
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
k No Facility Construc
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑ MDL
Mercury, total recoverable
❑ ML
❑ MDL
Nickel, total recoverable
❑ ML
❑ MDL
Selenium, total recoverable
❑ ML
❑ MDL
Silver, total recoverable
❑ ML
❑ MDL
Thallium, total recoverable
❑ ML
❑ MDL
Zinc, total recoverable
❑ ML
❑ MDL
Cyanide
❑ ML
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile Organic Compounds
crolein
❑ ML
❑ MDL
crylonitrile
❑ ML
[Benzene
❑ MDL
❑ ML
❑ MDL
romoform
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
-7
Modified Application Form 2A
NCO070408 Art Plaza WWTP
Modified March 2021
Maximum
Maximum Daily Discharge Average Daily Discharge
Pollutant
ML or MDL
Value Units Value Units Number of
Method' (include units)
Samples
Carbon tetrachloride
k No Facility Construc
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
❑ MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2-dichloropropane
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
❑ ML
❑ MDL
❑ ML
❑ MDL
roethane
Ll,'l,'2-trichloroethane
❑ ML
❑ MDL
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number Facility Name Outfall Number
Modified Application Form 2A
]��NPDES�Permitmber
NArt Plaza WWTP
Modified March 2021
•• 1 ••
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Value Units Value Units Number of
Method' (include units)
Sampies
Trichloroethylene
k No Facility Construc
❑ ML
❑ MDL
Vinyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
No Facility Constru(
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethylphenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
❑ ML
❑ MDL
❑ML
❑ MDL
❑ML
❑ MDL
IM
❑ML
❑ MDL
❑ML
❑ MDL
❑ML
❑ MDL
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCOO70408 Art Plaza WWTP
Modified March 2021
•' 1'•
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Value Units Value Units Number of
Method' (include units)
Samples
Benzo(ghi)perylene
k No Facility Construc
❑ ML
Benzo(k)fluoranthene
— �—
— — ——
—
M
oDL
❑ MDL
Bis (2-chloroethoxy) methane
❑ ML
❑ MDL
Bis (2-chloroethyl) ether
❑ ML
ElMDL
Bis (2-chloroisopropyl) ether
❑ ML
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ ML
❑ MDL
4-bromophenyl phenyl ether
❑ ML
El MDL❑
Butyl benzyl phthalate
ML
❑ MDL
2-chloronaphthalene
❑ ML
❑ MDL
4-chlorophenyl phenyl ether
❑ ML
❑ MDL
Chrysene
❑ ML
❑ MDL
di-n-butyl phthalate
❑ ML
❑ MDL
di-n-octyl phthalate
❑ ML
❑ MDL
Dibenzo(a,h)anthrace ne
❑ ML
❑ MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
1,3-dichlorobenzene
❑ ML
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
❑ ML
❑ MDL
Dimethyl phthalate
❑ ML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCOO7O408 Art Plaza W WTP
Modified March 2021
•' • •
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Value Units Value Units Number of
Method' (include units)
Samples
1,2-diphenylhydrazine
k No Facility Construc
❑ ML
❑ MDL
Fluoranthene
❑ ML
~
-
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
❑ ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ ML
❑ MDL
Isophorone
❑ ML
❑MDL
Naphthalene
❑ ML
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi- n-propylamine
El ML
El MDL
N nitrosodimethylamine
❑ ML
❑ MDL
N-nitrosoiphenylamine
❑ML
❑ MDL
Phena
❑ML
❑ MDL
Pyree
❑ML
❑ MDL
-tr1,,2ichlorobenzene
El ML
c—r. �k utie
❑ MDL
---•••r••••a � ••��•••••••..� u....vU1 ij w auuwicnuy acnauivc icai NiuGcuuieS ti.e., meuious) approvea under 4u ct-K 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).
EPA Form 3510-2A (Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCOO7O408 Art Plaza W WTP
Modified March 2021
Pollutant _ Maximum Dail Dischar a Average Daily Dischar a Number
of (list) Value Units Value Units Samples
Analytical ML or MDL
Method' (include units)
❑ No additional sampling is required by NPDES permitting authority.
a No Faciity Construc
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
00-1Ip1iy 61ICI UC wi iuuLieu deem uuiy ru sumcienuy sensmve lest proceaures tl.e., memods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18

Clevon Woods Association, LLC
Clevon Woods - Art Plaza WWTP
NPDES Permit NCO070408
NC Highway 105, Seven Devils 28604
Receiving Stream: WATAUGA RIVER Stream Class: B;Tr,HQW
Stream Segment: 8-(1) Sub -Basin #: 04-02-01
River Basin: Watauga HUC: 060101030301
County: Watauga
N
SCALE
1:24,000
36.1464° N,-81.7917° W
NC Grid: CI INE
USGS Quad: Valle Crucis, NC
L