NC0038822_application_20230822

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North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
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.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO038822
Central Care WWTP
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 may result in denial of the application.)
SECTION•N
INFORMATION FOR i
1.1
Facility name
Central Care WWTP
Mailing address (street or P.O. box)
139 Apex Lane
City or town
State
ZIP code
o
Mt. Airy
NC
27030
r
EContact
name (first and last)
Title
Phone number
Email address
.�
c
David Payne
Owner
[phone]
[e-mail]
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
R
LL-
139 Apex Lane
City or town
State
ZIP code
Mt.Airy
INC
27030
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
M Yes ❑ No SKIP to Item 1.4.
Applicant name
Pace Analytical Services
Applicant address (street or P.O. box)
1377 South Park Dr.
E
City or town
State
ZIP code
w
Kernersville
NC
27284
r
Contact name (first and last)
Title
Phone number
Email address
Q
Clifford Cain
Operator
[phone]
[e-mail]
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 and applicant ✓ ElFacility
❑ Facility ❑ Applicant
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
R
water)
control)
E
c
NCO038822
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
w
a�
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO038822
Central Care WWTP
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 percentage)
100 % separate sanitary sewer
El Own 0 Maintain
Rest Home
20
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
c%
separate sanitary sewer
El Own ❑ Maintain
R
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a
% separate sanitary sewer
ElOwn ElMaintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
2
% separate sanitary sewer ❑ Own ❑ Maintain
N%
combined storm and sanitary sewer ❑ Own ❑ Maintain
c
❑ Unknown ❑ Own ❑ Maintain
Total
Population 20
�
Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
°
° /°
100 �°
1.8
Is the treatment works located in Indian Country?
'
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
0.010 mgd
= N
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
a 0
0.002 mgd
0.002 mgd
0.002 mgd
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.004 mgd
0.003 mgd
0.003 mgd
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
oTotal
Number of Effluent Discharge Points b T pe
a Q-
a'
Combined Sewer
Constructed
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
Overflows
M
G
1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO038822
Central Care 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 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 Discharge Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
ElContinuous
gpd
❑ Intermittent
gpd
ElContinuous
❑ Intermittent
Z
1.14
Is wastewater applied to land?
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
0
1.15
Provide the land application site and discharge data requested below.
C
Land Application Site and Discharge Data
o
0
Average Daily Volume
Continuous or
a,
Location
Size
Applied
Intermittent
check one
Hacres
d
gpd
❑ Continuous
o
❑ Intermittent
acres
d
gpd
El Continuous
o
ElIntermittent
acres
d
gpd
El Continuous
❑ Intermittent
R
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes ❑✓ No -* SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ✓❑ 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
NCO038822
Central Care 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
-a
Facility name
Mailing address (street or P.O. box)
Central Care WWTP
139 Apex Lane
City or town
State
ZIP code
0
Mt. Airy
NC
27030
Contact name (first and last)
Title
0
David Payne
Owner
d
Phone number
Email address
[phone]
[e-mail]
c
NPDES number of receiving facility (if any) 0 None
Average daily flow rate 0.002 mgd
0.
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)?
Er
❑ Yes ❑✓ No 4 SKIP to Item 1.23.
0
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
.�
acres
gpd
El
❑ Intermittent
acres
gpd
ElContinuous
❑ 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.
ti
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
@
El El into marine waters (CWA ElWater 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 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
R
(companyname
0
Mailing address
street or P.O. box
r
City, state, and ZIP
code
L
o
Contact name (first and
c�
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO038822 Central Care WWTP Modified March 2021
SECTION11 • •' • 1
o Outfalls to Waters of the State of North Carolina
a
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
T
c
❑ Yes ❑✓ No 4 SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
;�
w
and infiltration.
gpd
=
Indicate the steps the facility is taking to minimize inflow and infiltration.
3
0
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
g
specific requirements.)
a�
C
0
0
El Yes ❑ No
H
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
c M
(See instructions for specific requirements.)
o
❑ 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
w
d
E
d
CL
2.
E
0
0
y
3.
d
4.
Cn
R
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
E
a)
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
Improvement
Outfalls
Construction
Construction
Discharge
Operational
CL E
(from above)
(list o number)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
Level
MMIDDIYYYY
1.
14908 0 R
a�
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
Facility Name Modified Application Form 2A
NC0038822
Central Care WWTP Modified March 2021
SECTION•'
• ON DISCHARGES
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
NC
w
r
County
Surry,
0
w
City or town
Mt. Airy
0
c
r
Distance from shore
6 ft.
ft.
ft.
n
'i
Depth below surface
2 ft.
ft.
ft.
c
Average daily flow rate
0.002 mgd
mgd
mgd
Latitude
36° 27' 12" N
"
Longitude
80 38' 53" W
"
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.
a�
3.3
If so, provide the following information for each applicable outfall.
y
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
L
discharge occurs
a
Average duration of each
o
discharge (specify units
Average flow of each
mgd
mgd
mgd
0
discharge
R
in
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 pe at each applicable outfall.
CL
Outfall Number
Outfall Number
Outfall Number
d
w
0
vi
3 6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
12
one or more discharge points?
3::
❑ Yes ❑' No 4SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO038822
Central Care 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,
0
or stream system
•L
U.S. Soil Conservation
N
Service 14-digit watershed
o
code
L
Name of state
a�
management/river basin
U.S. Geological Survey
8-digit hydrologic
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
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)
0
Q
Design Removal Rates by
0
Outfall
d
BOD5 or CBOD5
%
%
%
c
d
E
d
L
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
NCO038822
Central Care 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.
d
0
U
Outfall Number
Outfall Number
Outfall Number
0CL
r
Disinfection type
tp
N
G
Seasons used
E
r
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
R
Number of tests of discharge
a,
water
Number of tests of receiving
water
d
w
LU
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 4 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

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO038822
Central Care WWTP
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 4 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
>3
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 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
d
w
L
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
NCO038822
Central Care WWTP Modified March 2021
SECTION•
6.1
In Column i 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
all applicants are required to provide attachments.
Column 1
Column 2
❑ Section 1: Basic Application
❑ wl variance request(s) ❑ wl additional attachments
Information for All Applicants
❑ Section 2: Additional
❑ wl topographic map ❑ wl process flow diagram
Information
❑ w/ additional attachments
© wl Table A ❑ wl Table D
❑ Section 3: Information on
❑ wl Table B ❑ wl additional attachments
Effluent Discharges
❑ wl Table C
Section 4: Not Applicable
c
0
Section 5: Not Applicable
d
U
✓❑ Section 6: Checklist and
❑ wl attachments
Certification Statement
2
6.2
Certification Statement
l 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 property 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.! am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment forknowin violations.
Name (print or type first and last name)
Official title
Clifford Cain
Operator
Sign
Date signed
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO038822
Central Care WWTP
001
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Pollutant
Value Units
Average Daily Discharge
Analytical
Methods
ML or MDL
Include units
( )
Value
Units
Number, of
Samples
Biochemical oxygen demand
❑ BOD5 or ❑ CBOD5
(report one
41
mg/L
9.0
mg/L
104
varies
El ML
NA ❑ MDL
Fecal coliform
2420
col/100ml
1.6
col/100ml
104
varies
NA ❑ MDL
Design flow rate
0.004
mgd
0.002
mgd
365
pH (minimum)
6.0 (minimum)
N/A
pH (maximum)
6.9
Std. Units
Temperature (winter)
20
°C
10.4
°C
22
Temperature (summer)
27
T
19.3
°C
30
Total suspended solids (TSS)
44.6
mg/L
2.9
mg/L
104
varies NA ❑ 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 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NCO038822 Central Care WWTP Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Methods
Include units
( )
Samples
Ammonia (as N)
❑ ML
❑ MDL
Chlorine
❑ ML
total residual, TRC 2
❑ 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
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).
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

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO038822 Central Care WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
P ollutant
Number of
Method' (include units)
Value Units Value Units
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
❑ MDL
Antimony, total recoverable
❑ MIL
❑ MDL
Arsenic, total recoverable
❑ MIL
❑ MDL
Beryllium, total recoverable
❑ MIL
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ MIL
❑ MDL
Mercury, total recoverable
❑ MIL
❑ MDL
Nickel, total recoverable
❑ MIL
❑ MDL
Selenium, total recoverable
El M
El MI
MDL
Silver, total recoverable
❑ MIL
❑ MDL
Thallium, total recoverable
❑ MIL
❑ MDL
Zinc, total recoverable
❑ MIL
❑ MDL
Cyanide
❑ MIL
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ MIL
❑ MDL
Acrylonitrile
❑ ML
❑ MDL
Benzene
❑ ML
❑ MDL
Bromoform
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0038822 Central Care WWTP
Modified March 2021
= ••
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Carbon tetrachloride
❑ MIL
❑ MDL
Chlorobenzene
❑ MIL
❑ MDL
Chlorodibromomethane
❑ MIL
❑ MDL
Chloroethane
❑ MIL
❑ MDL
2-chloroethylvinyl ether
❑ MIL
❑ MDL
Chloroform
❑ MIL
❑ MDL
Dichlorobromomethane
❑ MIL
❑ MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ MIL
❑ MDL
trans- 1,2-dichloroethylene
❑ MIL
❑ MDL
1,1-dichloroethylene
❑ MIL
❑ MDL
1,2-dichloropropane
❑ MIL
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethylbenzene
❑ MIL
❑ MDL
Methyl bromide
❑ MIL
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ MIL
❑ MDL
1,1,2,2-tetrachloroethane
❑ MIL
❑ MDL
Tetrachloroethylene
❑ MIL
❑ MDL
Toluene
❑ MIL
❑ MDL
1,1,1-trichloroethane
❑ MIL
❑ MDL
1,1,2-trichloroethane
❑ MIL
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0038822 Central Care WWTP
Modified March 2021
= ••
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Trichloroethylene
❑ MIL
❑ MDL
Vinyl chloride
❑ MIL
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ MIL
❑ MDL
2-chlorophenol
❑ MIL
❑ MDL
2,4-dichlorophenol
❑ MIL
❑ MDL
2,4-dimethyl phenol
❑ MIL
❑ MDL
4,6-dinitro-o-cresol
❑ MIL
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ MIL
❑ MDL
4-nitrophenol
❑ MIL
❑ MDL
Pentachlorophenol
❑ MIL
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ MIL
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ MIL
❑ MDL
Anthracene
❑ MIL
❑ MDL
Benzidine
❑ MIL
❑ MDL
Benzo(a)anthracene
❑ MIL
❑ MDL
Benzo(a)pyrene
❑ MIL
❑ MDL
3,4-benzofluoranthene
❑ 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
NC0038822 Central Care WWTP
Modified March 2021
= ••
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Benzo(ghi)perylene
❑ MIL
❑ MDL
Benzo(k)fluoranthene
❑ MIL
❑ MDL
Bis (2-chloroethoxy) methane
❑ MIL
❑ MDL
Bis (2-chloroethyl) ether
❑ MIL
❑ MDL
Bis (2-chloroisopropyl) ether
❑ MIL
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ MIL
❑ MDL
4-bromophenyl phenyl ether
❑ MIL
❑ MDL
Butyl benzyl phthalate
❑ MIL
❑ MDL
2-chloronaphthalene
❑ MIL
❑ MDL
4-chlorophenyl phenyl ether
❑ MIL
❑ MDL
Chrysene
❑ MIL
❑ MDL
di-n-butyl phthalate
❑ MIL
❑ MDL
di-n-octyl phthalate
❑ MIL
❑ MDL
Dibenzo(a,h)anthracene
❑ MIL
❑ MDL
1,2-dichlorobenzene
❑ MIL
❑ MDL
1,3-dichlorobenzene
❑ MIL
❑ MDL
1,4-dichlorobenzene
❑ MIL
❑ MDL
3,3-dichlorobenzidine
❑ MIL
❑ MDL
Diethyl phthalate
❑ MIL
❑ MDL
Dimethyl phthalate
❑ MIL
❑ MDL
2,4-dinitrotoluene
❑ MIL
❑ MDL
2,6-dinitrotoluene
❑ MIL
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0038822 Central Care WWTP
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
❑ MIL
❑ MDL
Fluoranthene
❑ MIL
❑ MDL
Fluorene
❑ MIL
❑ MDL
Hexachlorobenzene
❑ MIL
❑ MDL
Hexachlorobutadiene
❑ MIL
❑ MDL
Hexachlorocyclo-pentadiene
❑ MIL
❑ MDL
Hexachloroethane
❑ MIL
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ MIL
❑ MDL
Isophorone
❑ MIL
❑ MDL
Naphthalene
❑ MIL
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi-n-propylamine
❑ MIL
❑ MDL
N-nitrosodimethylamine
❑ MIL
❑ MDL
N-nitrosodiphenylamine
❑ MIL
❑ MDL
Phenanthrene
❑ MIL
❑ MDL
Pyrene
❑ MIL
❑ MDL
1,2,4-trichlorobenzene
❑ MIL
❑ 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 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0038822 Central Care WWTP
Modified March 2021
Maximum Dail Discharge Average Dail Discharge
Pollutant
Analytical ML or MDL
Number
ist) Value Units Value Units
(l�
d Metho(include units)
Samples
s
❑ 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
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

Sludge Management Plan
Central Care WWTP
NPDES Permit No. NC 0038822
Sludge from the Central Care wastewater treatment plant (WWTP) is disposed of in the
following way:
Central Care WWTP uses a sludge hauling subcontractor (P D Quik in Mt. Airy.) who
periodically removes digested sludge from septic tank and delivers waste sludge to City
of Mount Airy WWTP. Information found in documented log includes date, time,
volume of sludge removed and location, date and time sludge transported to final
destination. The designated ORC coordinates the frequency in which digested sludge is
removed.