NC0033782_Fact Sheet_20230725

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C40610A1 F
DEQ / DWR / NPDES
EXPEDITED FACT SHEET
NPDES PERMIT NCO033782
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles Weaver / July 25, 2023
Permit Number - Class
NCO033782 — Class WW-1
Owner
Gates County Schools
Facility Name
Gatesville Elementary School WWTP
Type of Waste
100 % domestic
Basin Name/Sub-basin number
Chowan River Basin / 03-01-01
Receiving Stream
UT Bennetts Creek [segment 25-17]
Stream Classification in Permit
C-NSW
Does permit need Daily Max NH3 limits?
Ammonia limits are already at BAT (2 mg/L summer, 4 mg/L
winter
Does permit need TRC limits/language?
TRC limit & monitoring requirements in place in case UV system
fails
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Alternative disinfection
Does permit have instream monitoring?
No
Is the stream impaired on 303 d list)?
No
Any obvious compliance concerns?
One enforcement during the last permit cycle. Five NODs and
two NOVs during the last permit cycle.
Any permit modifications since last
permit?
No
New expiration date
A ri130, 2028
Changes in draft permit?
Updated eDMR language
Changes to final permit?
None
Fact Sheet
Renewal 2017 -- NPDES Permit NC0033782
Page 1

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
Publisher's Certificate of Publication
STATE OF NORTH CAROLINA
COUNTY OF HERTFORD
Ashley Vansant, being duly sworn, on oath says
he is and during all times herein stated has been
Publisher of Roanoke-Chowan Publications, Inc.
publisher and printer of the The Roanoke-Chowan
News -Herald (the "Newspaper"), has full knowledge
of the facts herein stated as follows:
1. The Newspaper printed the copy of the matter
attached hereto (the "Notice") was copied from the
columns of the Newspaper and was printed and
published in the English language on the following
days and dates:
06/10/23
2. The sum charged by the Newspaper for said
publication is the actual lowest classified rate paid
by commercial customer for an advertisement of
similar size and frequency in the same newspaper
in which the Notice was published.
3. There are no agreements between the News-
paper, publisher, manager or printer and the officer
or attorney charged with the duty of placing the at-
tached legal advertising notice whereby any advan-
tage, gain or profit accrued to said officer or attorney
Ashley Vansant, Publisher
Subscribed and sworn to before me
this
10th Day of June, 2023
RA jp ES ... ,%
iI
NOTARY Q`g
y. m=
PUBLIC
Mary Jo Eskridge, Notary Public
State of Alabama at Large
My commission expires 03-02-2026
Account # 228962
Ad # 1660631
NCDENR-DIVISION OF WATER RESOURCES
1617 MAIL SERVICE CENTER
RALEIGH NC 27699
PUBLIC NOTICE
North Carolina Environmental
Management Commission/NP-
DES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
NCO033782 Gatesville
Elementary School WWTP
The North Carolina
Environmental Management
Commission proposes to issue a
NPDES wastewater discharge
permit to the person(s) listed
below. Written comments
regarding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public
hearing should there be a
significant degree of public
interest. Please mail comments
and/or information requests to
DWR at the above address.
Interested persons may visit
the DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES permits
and this notice may be found
on our website: htto://deq.
nc.gov/about/divisions/water-
resources/water-resources-
permits/wastewater-branch/
nodes-wastewater/public-
notices,or by calling (919)
707-3601. The Public Schools
of Gates County requested
renewal of NPDES permit
NCO033782 for their Gatesville
Elementary School WWTP [709
N Main St, Gatesville, NC]. This
facility discharges to Bennetts
Creek/Chowan River Basin.
Currently Ammonia Nitrogen
and Fecal Coliform are water
quality limited. This discharge
may affect future wasteload
allocations in this portion of the
watershed.
Roanoke-Chowan:
Jun. 10, 2023
NCO033782

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C40610A1 F
Weaver, Charles
From: Bullock, Robert
Sent: Monday, May 15, 2023 10:59 AM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NCO033782
I am good with the Draft permit.
Thanks,
Robbie
Robbie Bullock
Environmental Program Consultant
Division of Water Resources
Water Quality Regional Operations
252-948-3843 Office
252-402-5832 Cell
Robert.e.bullock(a)ncdenr.gov Email
943 Washington Square Mall
Washington NC 27889
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Weaver, Charles <[e-mail]>
Sent: Monday, May 15, 2023 8:45 AM
To: Bullock, Robert <[e-mail]>; Kinney, Maureen <[e-mail]>
Subject: DRAFT permit renewal for NCO033782
This one will go to Notice in two weeks. Send me any comments as time permits.
Charles H. Weaver
Environmental Specialist II
Division of Water Resources
919-707-3616
charlesmeaver(c�ncdenr.gov
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617
�,}a EQ:>
oyrn.o. x eti.Yarr.`rr aY.a
Emeif correspondence to and hum Ibis address is subwd to the Nbilh
CaroUraa Public Records Law and may be drscbsed to ihrrd parties,

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Gates County Schools
Attn: Dr. Phillip Barry Williams, ED
PO Box 125
Gatesville, NC 27938-0125
Subject: Permit Renewal
Application No. NCO033782
Gatesville Elementary School WWTP
Gates County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
October 06, 2022
The Water Quality Permitting Section acknowledges the October 6, 2022, 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. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//deq nc gov/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.
Sincerely,
Wren The ford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E
;_Erolloa Department of Environmental Quality I Division of Water Resources
Q�� No th Ca
l Washington Regional Office 943 Washington Stryare Mall Washimgton, North Carolina 27889
TM ism\ 2S2946.6481

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
Of_fic.e of the Superintendent
P.O. Box 125
205 Main Street
Gatesville, NC 27938
[phone]
Dr. Phillip Barry Williams
Superintendent
To: Division of Water Resources
Water Quality Permitting Section-NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
gti
October 3, 2022
pR1G1NA�
Re: NPDES Permit Renewals for Buckland, TS Cooper, & Gatesville Elem Schools
Gates County, NC
Dear Permit Application Reviewer:
BOARD MEMBERS
Chairman
Ray Felton
Vice -Chairman
Sallie J. Ryan
Members
Glendale Boone
Leslie Byrum
Amanda Heimbecker
Please find attached the Permit Renewal Applications (EPA Modified Form 2A) for the above referenced
facilities. The forms have been prepared with the assistance of our Engineer Mr. John R. Harman, PE. Please
include him on any correspondence to us for any and all requests for additional information if needed @
[e-mail].
Regards,
Dr. Phillip Barry Wil I s, ED
Superintendent Gates Co Public Schools
Gates County Schools is an equal opportunity provider and employer

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
North Carolina
Department of Environmental Quality Modified Application Form 2A
Revised March 2021
Division of Water Resources
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
Modified March 2021
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 WX result in denial of the a ication.
SECTION•N
INFORMATION FOR r
1.1
Facility name
Gatesville Elementary School WWTP
Mailing address (street or P.O. box)
Gates Co Public Schools; P.O. Box 125
City or town
State
ZIP code
0
Gatesville
NC
27938-0125
E
Contact name (first and last)
Title
Phone number
Email address
w
c
Phillip Williams
Superintendent
[phone]
roundtreelj@gatescountyscho
w
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
w
709 North Main Street
City or town
State
ZIP code
Gatesville
NC
27938
1.2
is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
=
Applicant address (street or P.O. box)
0
City or town
State
ZIP code
cc
Contact name (first and last)
Title
Phone number
Email address
a
a
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 ❑ 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.
0
Existing Environmental Permits
n
NPDES discharges to surface
RCRA hazardous waste
UIC (underground injection
water)
control)
E
NCO033782
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
w
rn
H
❑ Ocean dumping (MPRSA)
E:]Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
Modified March 2021
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percenta e
100 % separate sanitary sewer
❑ Own ❑ Maintain
430
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
%separate sanitary sewer
❑ Own ❑ Maintain
%combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
m
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
_
❑ Unknown
❑ Own ❑ Maintain
Total
Population 430
0
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
sewer line in miles)100
?_'
1.8
Is the treatment works located in Indian Country?
c
❑ Yes ❑ No
v
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
r
❑ Yes ❑ No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.005 mgd
76
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c
a
2019 0.002420 mgd
2020 0,001274 mgd
2021 0.001440 mg
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.00491 mgd
0.004029 mgd
0.003086 mgd
H
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
n.
Combined Sewer
Constructed
Treated Effluent
Untreated Effluent
Bypasses
Emergency
.0Overflows
Overflows
_N
1
0
0
0
0
Page 2

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
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 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and 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
s
1.14
Is wastewater applied to land?
❑ Yes ❑ No 4 SKIP to Item 1.16.
c
1.15
Provide the land application site and discharge data requested below.
y
Land Application Site and Discharge Data
o
Continuous or
0
Location
Size
Average Daily Volume
Intermittent
Applied
check one
acres
d
gpd
❑ Continuous
o
❑ Intermittent
El Continuous
s
g
acres
d
gpd
❑ Intermittent
a
acres
gpd
❑ Continuous
cc
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
El Yes El 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

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
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.
Receivin IF cility Data
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
0
Contact name (first and last)
Title
0
d
Phone number
Email address
aNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
N
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
0
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
R
❑ Yes ❑ No 4 SKIP to Item 1.23,
L
C1
0
1.22
Provide information in the table below on these other disposal methods.
d
Information on Other Disposal Methods
L
Disposal
Location of
Size of
I Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
volume
❑ Continuous
3
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
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.)
H
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
c
Contractor name
(company name
Mailing address
street or P.O. box
S
City, state, and ZIP
code
oContact
name (first and
0
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number Facility Name i Modified Application Form 2A
NCO033782 Gatesville Elementary School Modified March 2021
SECTION11I I IUNAL INFORMATION1
c Outfalls to Waters of the State of North Carolina
C
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
rn
o
❑ Yes El 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
R
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
a
R
0
_o
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
o
specific requirements.)
rn�
0
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
c 1
(See instructions for specific requirements.)
LL �
a
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
R
1. Removal of Greenhouse structure covering Sand Filter and Replace with Roofed Structure
c
m
E
a
2.
E
0
H
3.
Z
m
co
4.
'a
R
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
E
0
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
CL
Improvement
Outfalls
(list outfa
Construction
Construction
Discharge
Operational
Level
E
(from above)
number)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
-c
d
s
in
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

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C40610A1 F
NPDES Permit Number Facility Name Modified Application Form 2A
NC0033782 Gatesville Elementary School Modified March 2021
SECTION•' • ON 1
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
R
County
Gates
0
City or town
Gatesville
0
.n
Distance from shore
ft,
y
Depth below surface
d
0
Average daily flow rate
0.0038 mgd
mgd
mgd
Latitude
36' 24' 44"
Longitude
-76° 45' 12"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
o
❑ Yes ❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable ouff all.
L
N
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
C
discharge occurs
a
Average duration of each
`o
discharge (specify units
Average flow of each
mgd
m d
g
discharge
(D,
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 e at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
d
N
3
I 0
c
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
2 =
one or more discharge points?
3
❑ Yes ❑ No 4SKIP to Section 6.
Page 6

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C40610A1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0033782
Gatesville Elementary School
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number oo,
Outfall Number
Outfall Number
Receiving water name
UT to Bennetts Creek
Name of watershed, river,
or stream system
Chowan River Basin
0
fl-
•L
U.S. Soil Conservation
y
Service 14-digit watershed
o
code
L
Name of state
management/river basin
rn
U.S. Geological Survey
8-digit hydrologic
Of
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 pr vided for discharges from each outfall.
Outfall Number oo,
Outfall Number
Outfall Number
Highest Level of
© Primary
❑ Primary
❑ Primary
Treatment (check all that
Fel Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
21 Secondary
❑ Secondary
❑ Secondary
Fel Advanced
❑ Advanced
❑ Advanced
21 Other (specify)
❑ Other (specify)
❑ Other (specify)
c
UV Disinfection
a
Design Removal Rates by
Outfall
d
BOD5 or CBOD5
%
%
%
d
E
w
L
TSS
%
%
%
F—
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
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.
d
c
a
0
U
-
Outfall Number 001
Outfall Number
Outfall Number
0
Disinfection type
uv
d
0
Seasons used
m
All year
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ 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
is
Number of tests of discharge
rn
water
Number of tests of receiving
water
d
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. ❑ No 4 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

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO033782
Gatesville Elementary School
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 our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DD/YYYY
c
0
U
�
3.22
Regardless of how you provided our WET testin data to the NPDES permitting authori did an of the tests result in
9 Y P Y 9 P 9 ty, Y
o
toxicity?
❑ 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 + SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
Not applicable because previously submitted
El Yes ElNot
to the NPDES permitting authority.
Page e,

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
v NPDES Permit Number Facility Name Modified Application Form 2A
NCO033782 Gatesville Elementary School Modified March 2021
SECTION•
1
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 1: Basic Application
❑ w/ variance request(s) ❑ w/ additional attachments
Information for All Applicants
® 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
Effluent Discharges
E
❑ w/ Table C
w
is
Section 4: Not Applicable
0
Section 5: Not Applicable
U
Section 6: Checklist and
®
® w/ attachments
Certification Statement
N
Y
6.2
Certification Statement
d
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel 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
Phillip Williams
Superintendent
Signature
Date signed
s I
Page 10

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
f
-T
NPDES Permit Number
Facility Name
Outfall Number
NCG033782
Gatesville Elementary School
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical ML or MDL
Numbers
Value
Units
Value Units Method' include units
( )
Samples
iochemical oxygen demand
[Fecal
60Ds or ❑ CBODs
9.3
mg/I
0.76
mg/I
72 Per State Cert. Lab ❑ ML
❑ MDL
e ort one
coliform
69
colonies/100ml
8.25
colonies/100ml
72 Per State Cert. Lab ❑ ML
MDL
Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NCO033782 Gatesville Elementary School Modified March 2021
•' •• • •
• •' 1 I
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Number of
Pollutant Value Units
Method'
(include units)
Samples
Ammonia (as N)
0 ML
❑ MDL
Chlorine
❑ ML
total residual, TRC 2
❑ MDL
D11
issolved oxygen
ML
❑ MDL
Nitrate/nitrite
❑ ML
❑ MDL
Kjeldahl nitrogen
0 ML
❑ MDL
Oil and grease
OML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
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) Page 12

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO033782 Gatesville Elementary School
Modified March 2021
•• 1 '•
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of —]
Method' (include units)
Value Units Value Units
Sam les
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
❑ MDL
OML
Antimony, total recoverable
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
0 ML
❑ MDL
❑ ML
Cadmium, total recoverable
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
El ML
Copper, total recoverable
❑ MDL
❑ ML
Lead, total recoverable
❑ MDL
❑ ML
Mercury, total recoverable
❑ MDL
❑ ML
Nickel, total recoverable
❑ MDL
❑ ML
Selenium, total recoverable
❑ MDL
❑ ML
Silver, total recoverable
❑ MDL
❑ ML
Thallium, total recoverable
❑ MDL
❑ ML
Zinc, total recoverable
❑ MDL
❑ ML
Cyanide
❑ MDL
❑ ML
Total phenolic compounds
❑ MDL
Volatile Organic Compounds
❑ ML
Acroleln
❑ MDL
❑ ML
Acrylonitrile
❑ MDL
❑ ML
Benzene
❑ MDL
❑ ML
Bromoform
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 13

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
PA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO033782 Gatesville Elementary School
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
tE
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
❑ ML
arbon tetrachloride
❑ MDL
❑ ML
h1Orobenzene
❑ MDL
❑ ML
Chlorodibromomethane
❑ MDL
❑ ML
Chloroethane
❑ MDL
OML
2-chloroethylvinyl ether
❑ MDL
❑ ML
Chloroform
❑ MDL
❑ ML
Dichlorobromomethane
❑ MDL
❑ ML
1,1-dichloroethane
❑ MDL
❑ ML
1,2-dichloroethane
❑ MDL
11 ML
trans- 1, 2-dichloroethylene
❑ MDL
0 ML
1,1-dichloroethylene
❑ MDL
0 ML
1,2-dichloropropane
❑ MDL
13 ML
1,3-dichloropropylene
❑ MDL
❑ ML
Ethylbenzene
❑ MDL
OML
Methyl bromide
❑ MDL
❑ ML
Methyl chloride
❑ MDL
0 ML
Methylene chloride
❑ MDL
❑ ML
1,1,2,2-tetrachloroethane
❑ MDL
OML
Tetrachloroethylene
❑ MDL
❑ ML
Toluene
❑ MDL
❑ ML
1,1,1-trichloroethane
❑ MDL
❑ ML
1,1,2-trichloroethane
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
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DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
EPA Identification Number NPDES Permit Number Facility Name OutFall Number
Modified Application Form 2A
NCO033782 Gatesville Elementary School
Modified March 2021
•' 1 '• Ty
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units Samples
Benzo(ghi)perylene
0 ML
❑ MDL
Benzo(k)fluoranthene
0 ML
❑ MDL
Bis (2-chloroethoxy) methane
C3 ML
❑ MDL
Bis (2-chloroethyl) ether
El ML
❑ MDL
Bis (2-chloroisopropyl) ether
El ML
❑ MDL
Bis (2-ethylhexyl) phthalate
11 ML
❑ MDL
4-bromophenyl phenyl ether
OML
❑ MDL
Butyl benzyl phthalate
OML
❑ MDL
2-chloronaphthalene
OML
❑ MDL
4-chlorophenyl phenyl ether
0 ML
❑ MDL
Chrysene
OML
❑ MDL
di-n-butyl phthalate
OML
❑ MDL
0 ML
di-n-octyl phthalate
❑ MDL
OML
Dibenzo(a,h)anth racene
❑ MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
El ML
1,3-dichlorobenzene
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
OML
❑ MDL
Dimethyl phthalate
OML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
❑ ML
2,6-dinitrotoluene
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO033782 Gatesville Elementary School
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
1,2-diphenylhydrazine
❑ ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ Mt
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
El 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
❑ MDL
N-nitrosodimethylamine
0 ML
❑ MDL
N-nitrosodiphenylamine
0 ML
❑ MDL
Phenanthrene
El ML
❑ MDL
Pyrene
OML
❑ MDL
1,2,4-trichlorobenzene
❑ ML
❑ MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 17

DocuSign Envelope ID: OCE97003-6F42-41 D5-9210-079C4061 OA1 F
NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO033782 Gatesville Elementary School
Modified March 2021
Maximum Dail Discharge,
ischa a Average Dail Discharge
Pollutant
Analytical ML or MDL
Number
(list) Value Units Value Units
Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ 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
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18