NC0071005_application_20230807

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
N CO071005
LYNNBROOK ESTATES
OMB No. 2040-0004
Form
U.S. Environmental Protection Agency
2A
�=/EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
1. BASIC
APPLICATION •- i
INFORMATIONSECTION
Facility name
1.1
LYNNBROOK ESTATES
Mailing address (street or P.O. box)
43 LYNNBROOK WAY
City or town
State
ZIP code
c
w
COLUMBUS
INC
28722
E
L
Contact name (first and last)
Title
Phone number
Email address
c
JOAN BECK
HOME OWNER
[phone]
[e-mail]
w
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
cvv
w
NCSR 1135
City or town
State
ZIP code
COLUMBUS
INC
28722
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission 0 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
E
City or town
State
ZIP code
0
c
Contact name (first and last)
Title
Phone number
Email address
Q
a
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
D 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
H
number for each.)
E
as
Existing Environmental Permits
a
NPDES (discharges to surface
0 ( g
❑ RCRA (hazardous waste)
UIC (underground injection
❑ ( g 1
15
water)
control)
CD
E
NCO071005
c
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
w
a�
Ocean dumping (MPRSA)
❑ D04) ge or fill (CWA Section
❑ Other (specify)
w❑
EPA Form 3510-2A (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
NCO071005
LYNNBROOK ESTATES
OMB No. 2040-0004
1.7
Provide the collection system information
requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
(indicate percentage)
13
100 % separate sanitary sewer
❑' Own ❑I Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
3
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
ElOwn 1-1Maintain
IL
% combined storm and sanitary sewer
❑ Own ❑ Maintain
R
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
cn
❑ Unknown
❑ Own ❑ Maintain
Total 13
Population
i�
Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
100 % o
1.8
Is the treatment works located in Indian Country?
3
0
U
ElYes No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
009 mgd
w y
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
c
.001 mgd
.0005 mgd
.001 mgd
_o
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
.001 mgd
.001 mgd
.0014 mgd
W
1.11
Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
T
Combined Sewer
Constructed
T
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
s
Overflows
Ln
0
1
0
0
0
0
EPA Form 3510-2A (Revised 3-19) Page 2

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO071005
LYNNBROOK ESTATES
OMB No. 2040-0004
Outfalls 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 a 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 Impoundment Location and Discharge Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
gpd
❑ Continuous
�
-a
❑ Intermittent
w
1.14
Is wastewater applied to land?
CD
❑ Yes 0 No SKIP to Item 1.16.
c
1.15
Provide the land application site and discharge data requested below.
Q-
Land Application Site and Discharge Data
Continuous or
°
Location
Size
Average Daily Volume
Intermittent
a,
Applied
(check one)
N
acres
gpd❑
❑ Continuous
o
Intermittent
acres
gpdElIntermittent
El Continuous
o
N
acres
gpd❑
El Continuous
Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes 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.
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
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
N CO071005
LYN N B R00 K ESTATES
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.
Receiving Facility Data
Facility name
Mailing address (street or P.O. box)
d
City or town
State
ZIP code
_
0
Contact name (first and last)
Title
0
t
d
Phone number
Email address
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate mgd
CL
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
0
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
s
❑ Yes D No 4 SKIP to Item 1.23.
c
1.22
Provide information in the table below on these other disposal methods.
4)
Information on Other Disposal
Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
0
Method
Description
Disposal Site
Disposal Site
Daily Discharge
Volume
(check one)
R
acres
9pd
❑ Continuous
3
❑ Intermittent
ElContinuous
acres
gpd
❑ Intermittent
acres
gp d
ElContinuous
❑ 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))
[� 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 D No 4SKIP 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
Mailing address
(street or P.O. box)
0
City, state, and ZIP
R
L
code
c
Contact name (first and
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A (Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Fo m Approved 03/05119
NCO071005 LYNNBROOK ESTATES OMB No.2040-0004
ADDITIONALSECTION 2. ORI
c 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?
a0
c
❑ Yes No -+ SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
=
Indicate the steps the facility is taking to minimize inflow and infiltration.
R
3
0
c
s
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
M Q
specific requirements.)
o
Q-
0
ElYes ElNo
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
R
o
(See instructions for specific requirements.)
LL R
3
❑ 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
0
.R
1.
W
d
E
°'
2.
E
w
0
3.
d
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
Improvement
Outfalls
Construction
Construction
Discharge
Operational
CL E
(from above)
(list l
numberber)y
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
Level
(MMIDDIYYYY)
1.
d
co
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 03/05/19
N CO071005
LY N N B ROO K ESTATES OMB No. 2040-0004
INFORMATIONSECTION 3.
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
County
POLK
0
City or town
COLUMBUS
0
w
Distance from shore
D ft.
ft.
ft.
n
L
Depth below surface
2 ft.
ft.
ft.
c
Average daily flow rate
.0005 mgd
mgd
mgd
Latitude
35° 14' 28" N ]
°
° ' "
Longitude
82° 13' 56" W]
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
c
❑ Yes No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
'c
Outfall Number
Outfall Number
Outfall Number
Number of times per year
.L
discharge occurs
a
Average duration of each
0
discharge (specify units)
Average flow of each
mgd
mgd
mgd
R
discharge
co
in which discharge
occurs
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes D No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
d
CL
Outfall Number
Outfall Number
Outfall Number
d
0
ui
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
d =i
discharge points?
3::
Yes ❑ No 4SKIP 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
NCO071005
LYNNBROOK ESTATES
OMB No. 2040-0004
3.7
Provide the receiving water and related information (if known) for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
SKYUKA CREEK
Name of watershed, river,
0
or stream system
BROAD RIVER BRP
U.S. Soil Conservation
y
Service 14-digit watershed
03050105150010
o
code
L
Name of state
management/river basin
BROAD
U.S. Geological Survey
8-digit hydrologic
03050105
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 001
Outfall Number
Outfall Number
Highest Level of
D 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)
QDesign
Removal Rates by
Outfall
4)
d
BOD5 or CBOD5
85 %
%
%
d
E
m
TSS
85 %
%
%
F--
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
° /o
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
°
/o
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05119
NCO071005
LYNNBROOK ESTATES
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.
d
3
C
O
c
Outfall Number 001
Outfall Number
Outfall Number
O
L
Disinfection type
CHLORINE
d
=
Seasons used
ALL
d
E
w
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 D 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
Number of tests of receiving
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
R
❑ 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 -* Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
F-
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
w
❑ 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 4 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?
❑ 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?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

817/23, 6:00 PM
5can_20230729.png
EPA Identification Number NPDES Permit Number
Facility Name
Form Approved 03105119
N00071005
LYNNBROOK ESTATES
OMB No. 2040-00M
5.7
Provide the Information in the table below for each of your CSO outfalis.
r—
050 0utia1l Number
C50 0utfaft Nuna6®s
C50 0utfall Nurnber
_
—
Receiving water name���
f
Name of watershed!
streams stem
U.S. Soil Conservation
© Unknown
© Unknown
© Unknown
Service 14-digit
watershed code
}
if known
Name of state
mana ementtriver basin
U.S, Geological Survey
❑ Unknown
Ci Unknown
© unknown.
8-Digit Hydrologic Unit
Code if known
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
I
exam les
SECTION
6. CHECKLIST
i CERTIFICATION O B
6.1
I in Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
i all applicants are required to provide attachments. -
Column 1
Column 2 -
�
I
jmm Section 1: Sasic Application
a
❑ wl variance request(s) ® w/ additional attachments
j Information for Ail W(icants
Section 2: Additional
❑
❑ w! topographic map ❑ wi process flow diagram
i Information
❑ wl additional attachments
j
w/ Table A ® w! Table D
!
Section 3: Information on
®
I. ❑ w1 Table B ® w/ Table E
I
Effluent Discharges
I
w1 Table C ❑ w1 additional attachments
Section 4: Industrial
❑ w1 SiU and NSM attachments ❑ w! Table F
i
❑ Discharges and Hazardous
n
Wastes
❑ wl additional attachments
i
_
❑ Section 5: Combined Sewer
❑ w! CSO map © wl additional attachments
Overflows
❑ w1 CSO system diagram
i
i
Section 6: Checklist and
❑`�
® wl attachments
Certification Statement
_
6.2
Certification Statement
t certify underpenaity of law that this document and ah attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel property gather and evaluate the information
submitted. Based or, my inquiry of the person or persons who manage the system, or those persons directly responsible
forgathering the intonnation, the information submitted is, io 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 im fisontnent for knowing violations.
Name (print or type first and last name)
C)icial title
9OAN BECK
HOME OWNER
Signature
Date signed
I
EPA Roan 3510.2A (Revised 3-14)
Page 72
https:/Imail.google.com/maillu/0/#search/jkbeckl I°/a40gmail.com/FMfcgzGtwMgllchxdkmpTXrLrXcHrKTr?projector=l &messagePartic =0.1 111

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
NCO071005
LYNNBROOK ESTATES
Form Approved 03/05/19
OMB No. 2040-0004
�' •�
Maximum Daily Discharge
Pollutant
Value Units
Average Daily Discharge
Analytical ML or MDL
Include units
Methods ( )
Value
Units
Number of
Samples
Biochemical oxygen demand
❑ BOD5 or ❑ CBOD5
(report one)
27.26
MG/L
9.84
MG/L
26
Q,ML
5210B MG/L
❑MDL
Fecal coliform
6
CFU/100 MILS
3
CFU/100MLS
26
9222D U/100MLS 13,ML
❑ MDL
Design flow rate
.009
MGD
.001
MGD
52
pH (minimum)
6.0
Su
pH (maximum)
7.4
SU
Temperature (winter)
15.32
C
14.45
C
26
Temperature (summer)
21.7
C
18.05
C
26
Total suspended solids (TSS)
13.84
MG/L
10.87
MG/L
26
Ld ML
2540D MG/L ❑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).
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO071005 LYNNBROOK ESTATES OMB No.2040-0004
TABLE D. ADDITIONAL POLLUTANTS
AS REQUIRED•DAUTHORITY
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
(list)
Value
Units Value
Units
Method' (include units)
Samples
E' 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).
EPA Form 3510-2A (Revised 3-19) Page 23