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NC0040797_Renewal (Application)_20220131
HICKORY North Carolina � Life. Well Crafted. Public Utilities January 31, 2022 Attn: Charles Weaver North Carolina Department of Environmental Quality Division of Water Quality, NPDES Unit 512 N. Salisbury Street Archdale Building Room 925i Raleigh, NC 27699-1617 RE: NPDES Permit Renewal Application (NPDES NC0040797) City of Hickory —Henry Fork WWTP Hickory, NC Dear Sir or Madam, City of Hickory PO Box 398 Hickory, NC 28603 Phone: (828) 323-7427 Fax: (828) 322-1405 Email: cbvnum6@hickorvnc.gov C�k"j Laserf;che Enclosed for your review and processing you will find the application package for the renewal of the City of Hickory's — Henry Fork Wastewater Treatment Plant NPDES permit. Included in this cover letter is a brief narrative explaining the biosolids management plan for the Henry Fork Wastewater Treatment Plant, as well as a request for this plant to be designated as an Exceptionally Performing Facility. The application package includes the following: • NPDES Form 2A o Section 1: Basic Application Information for All Applicants o Section 2: Additional Information o Section 3: Information on Effluent Discharges o Section 4: Industrial Discharges and Hazardous Wastes o Section 6: Checklist and Certification Statement • Table A • Table B • Table C • Table F • Attachments for Section 2: Plant Flow Schematic / Area Maps • Exceptionally Performing Facility (EPF) Justification and Statistical Analyses The City of Hickory's Henry Fork Wastewater Treatment Plant processes all of its sludge by composting. Sludge is removed from the primary clarifiers and secondary clarifiers. The solids are stored in a sludge tank before being loaded into tankers and taken to the Hickory Regional Compost Facility (Permit # WQ0004563) in Newton, NC, for further processing into class "A" compost material. During the composting process, the sludge is stabilized sufficiently to meet all vector attraction and pathogen reduction requirements. Once dry, the cured compost is distributed to various entities for use as a soil amendment. The City of Hickory is requesting reduced monitoring for this facility per the Exceptionally Performing Facilities guidance. The Henry Fork WWTP facility meets all of the requirements for the reduced monitoring. There were no civil penalties assessed during the past three years; the permittee nor any of its employees have been convicted of criminal violations under the clean water act within the last five years; the facility is not under an SOC; and the facility is not on the EPA's Quarterly Noncompliance Report. Attached you will find the justification and statistical analysis to support the designation of this plant as an Exceptionally Performing Facility. Thank you in advance for your review. Should you have any questions regarding this submittal, please do not hesitate to contact me at (828) 323-7427 or via email at cbvnumnc hickorync.cov. Sincerely Caleb M. Bynum, PE Utilities Engineer Henry Fork WWTP Permn't 2022 Renewal 1. NPDES Form 2A 2. Table A 3. Table B 4. Table C 5. Table F 6. Attachments for Section 2: Plant Flow Schematic & Area Maps 7. Exceptionally Performing Facility (EPF) Justification and Statistical Analysis Henry IFoirk WWTP Pefrmu*t 2022 Renewal NPD ES Form 2A United States office of Water EPA Form 3510-2A Environmental Protection Agency Washington, D.C. Revised March 2019 Water Permits Division ." EPA f-L-\p � [ cafl � FOOD � �� N, aw arad] c�oSNong PJP Ulb�oC�Y/ Oobrsmed Treatment VAgorks Note: Complete this form if your facility is a new or existing publicly owned treatment works. EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/009 OMB No. 2040-0004 210064595175 NCO040797 City of Hickory - Henry Fork U.S. Environmental Protection Agency Form 2A 1ryEPA Application for NPDES Permit to Discharge Wastewater NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS • rolurme• • ••r Facility name 1.1 City of Hickory Henry Fork Wastewater Treatment Plant Mailing address (street or P.O. box) PO Box 398 City or town Stale ZIP code o Hickory NC 28603 € Contact name (first and last) Title Phone number Email address c Robert Shaver Plant Superintendent (828) 294-0861 rshaver@hickorync.gov 21 Location address (street, route number, or other specific identifier) ❑ Same as mailing address m 4014 River Road LL City or town Slate ZIP code Hickory NC 25602 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 A. Applicant name City of Hickory Applicant address (street or P.O. box) .9 PO Box 398 € Gty or town State ZIP code Hickory NC 28603 Contact name (first and last) Title Phone number Email address n n Warren Wood City Manager (828) 323-7427 spenneli@hickorync.gov 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❑ Facility and applicant ❑ Applicant ((hey are one and the same) 1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit ?e number for each. € Existing Environmental Permits °� ✓❑ NPDES (discharges to surface ❑ RCRA (hazardous waste) ❑ UIC (underground injection water) controq E NCO040797 Q ❑ PSD (air emissions) ❑ Nonaltainment program (CAA) ❑ NESHAPs (CAA) .0 w ❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section ❑✓ Other (specify) 404) W00004563 (Biosolids) EPA Form 35ID-2A (Revised 3-19) Page 1 EPA Identilicabon Number NPDES Permit Number Fachly Name Form Approved 03/05119 110064595175 NC0040797 City of Hickory- Henry Fork OMB No. 2040-0004 1.7 Provide the cooll ion systern information requested below for the treatment works. Municipality Population Collection System Type Ownership Status Served Served indicate percentage 100 % separate sanitary sewer ❑+ Own ❑ Maintain City of Hickory 17,476 %combined storm and sanitary sewer ❑ Own ❑ Maintain ,2 ❑ Unknown ❑ Own ❑ Maintain 100 % separate sanitary sewer O Own ❑ Maintain Town of 397 %combined storm and sanitary sewer ❑ Own ❑ Maintain Brookford ❑ Unknown ❑ Own ❑ Maintain 100 % separate sanitary sewer ❑ Own ❑ Maintain a .a Town of Long 5,066 % combined storm and sanitary sewer ❑ Own ❑ Maintain View 1 ❑ Unknown ❑ Own ❑ Maintain w_ % separate sanitary sewer ❑ Own ❑ Maintain y% combined storm and sanitary sewer ❑ Own ❑ Maintain c ❑ Unknown ❑ Own ❑ Maintain .16 Total 01 Population 22,939 rJ Served Combined Storm and Separate Sanitary Sewer System Sanitary Sewer Total percentage of each type of % % sewer line in miles too 1.8 Is the treatment works located in Indian Country? c o ❑ Yes ❑✓ No C1.9 Does the facility discharge to a receiving water that flows through Indian Country? ❑ Yes ❑✓ No 1.10 Provide design and actual flow rates in the designated spaces. Desi n Flow Rate 9.0 mgd Annual Average Flow Rates Actual ar Two Years Ago Last Year This Year a � m a 2.849 mgd 2.962 mgd 2.281 mgd Maximum Daily Flow Rates Actual d Two Years Ago Last Year This Year 11.732 mgd 13.559 mgd 8.79 mgd 1.11 Provide the total number of effluent discharge points to waters of the United States by type. 42 .5 Total Number of Effluent Discharge Points by Type a' a m a Combined Sewer Constructed a Treated Effluent Untreated Effluent Overflows Bypasses Emergency o Overflows u 0 1 N/A N/A N/A N/A EPA Form 3510-2A (Revised 3-19) Page 2 EPA Identification Number NPDES Permit Number Facllily Name - Form Approved 03/05/19 110064595175 NCO040797 City of Hickory- Henry Fork 0108 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 0 No 4 SKIP to Item 1 A4. 1.13 Provide the location of each surface impoundment and associated discharge information in the table below. Surface III m 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 gpd ❑ Continuous ❑ Intermittent 5 1.14 Is wastewater applied to land? ❑ Yes ❑✓ No 4 SKIP to Item 1.16. 1.15 Provide the land application site and discharge data requested below. Land Application Site and Discharge Data o `o Average Daily Volume Continuous or Location Size Applied Intermittent LM check one z acres 9Dd ❑ Continuous Ma ❑ Intermittent t acres gpd ❑ Continuous ❑ Intermittent A acres gPd ❑ Continuous ❑ Intermittent 1.16 Is effluent transported to another facility for treatment prior to discharge? ,}}m o © Yes ElNo 4 SKIP to Item 1.21. 1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe). Biosolids are transported to the Regional Compost Facility (Class A Composting) by 6,500 gallon tanker truck. 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 otter Data Entity name Mailing address (street or P.O. box) City of Hickory PO Box 398 City or town State ZIP code Hickory NC 28603 Contact name (first and last) Title Robert Shaver Plant Superintendent, ORC Phone number Em4ll address (828) 294-0861 rshaver@hickorync.gov EPA Farm 3510-2A (Redsed 3-19) Page 3 EPA IdenOfica9on Number NPDES Permit Number Facility Name Form Approved 03105119 110064595175 NCO040797 City of Hickory- Henry Fork 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. Recelvina F cliltv Data Facility name Mailing address (street or P.O. box) City of Hickory Regional Compost Facility 3200 20th Ave SE City or town Stale ZIP code o Newton NC 28658 Contact name (first and last) Title cDavid Bollinger Project Manager, ORC '15 Phone number Email address (828)465-1401 david.bollinger@veolia.com 0 'o NPDES number of receiving facility (if any) IZI None Average daily flow rate 0.0748 mgd a, 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)? N LM ❑ Yes 0 No + SKIP to Item 1.23. 0 1.22 Provide information in the table below on these other disposal methods. to Information on Other Dis osal Methods Disposal Location of Size of Annual Average Continuous or Intermittent a Method Disposal Site Disposal Site Daily Discharge (check one) Descri tion Volume A acres 9P d ❑ Continuous ❑ Intermittent O acres ❑ Continuous gpd ❑ 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.) Into Water related effluent limitation (CWA Section ❑ Discharges marine waters (CWA ❑ quality Section301(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) Contractor Contractor g Contractor name 7„ com an name Mailing address `c street or P.O. box City, state, and ZIP code Contact name (first and ci last Phone number Email address Operational and maintenance responsibilities of contractor EPA Form 3510-2A (Revised 3-19) Page 4 EPA Iden9Rcation Number NPDES Permit Number FeolityName rarmnpproveaaavariu OMB Na. 2040-0004 I 110064595175 NCO City of Hickory - Henry Fork ADDITIONAL INFORMATION c Outfalis to Waters of the United States 2.1 Does the lreabnent works have a design flow greater than or equal to 0.1 mgd? o, o ❑✓ Yes ❑ No 4 SKIP to Section 3. 0 2.2 Provide the treatment works' current average daily volume of inflow Average Dail Volume of Inflow and Infiltration 125,000 gpd and infiltration. c Indicate the steps the facility is taking to minimize inflow and infiltration. v m The City of Hickory currently utilizes video Inspection of the collection system, and manhole rehabilitation to manage u inflow and infiltration. The City of Hickory has also targeted a specific sewer basin for a flow study to pinpoint problem areas. 2.3 Have you attached a topographic map to this application that contains all the required information? (See instructions for m specific requirements.) o ❑✓ Yes ❑ No 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information? E o 12 (See instructions for specific requirements.) r 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 c E E n 2. E 0 m 3. 4. 5 2.6 Provide scheduled or actual dates of completion for improvements. Scheduled or Actual Dates of Com letion for Improvements a Scheduled Affected Outfalls Begun End Begin Attainment of Operational Improvement p (list l Construction Construction Discharge Level � (from above) number) (MMIDDIYYYY) (MMIDD/YYYY) (MMIDDlYYYY) MMIDD/YYYY v N 2. 3. 4. 2.7 Have appropriate permits/clearances concerning other federallstate requirements been obtained? Briefly explain your response. ❑ Yes ❑ No ❑ None required or applicable Explanation: EPA Form 3510-2A (Revised 3-19) Pape 5 EPA Idenfifica6on Number NPDES Permit Number Facility Nome Form Approved 03105119 110064595175 NC0040797 City of Hickory- Henry Fork OMB No. 2040-0004 SECTIONO • ON • r 3.1 Provide the following information for each oulfall. (Attach additional sheets if you have more than three outfalls.) Ouffall Number 001 Outfall Number_ Outfall Number_ State INC County Catawba O city or town Hickory 0 pDistance a from shore -10 ft. Depth below surface ft. 0 Average daily flow rate 2.281 mgd mgd mgd Latitude 35° 39' 49" N ° ° Longitude 81° 19, 30" W " 3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges? ❑ Yes ❑ No 4 SKIP to Item 3.4. a, Q, 3.3 If so, provide the following information for each applicable outfall. c a Outfall Number_ Ouffalf Number_ Outfall Number_ 0 o Number of times per year discharge occurs a Average duration of each `o discharge (specify units c Average flow of each mgd mgd mgd m 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 at each applicable oulfall. Outfall Number_ Outfall Number_ Outfall Number_ `w S c Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more 12 j 3.6 discharge points? w ❑✓ Yes ❑ No +SKIP to Section 6. EPA Farm 3510-2A (Revised 3-19) Page 6 EPA kIentiGcaaon Number NPDES Permit Number Facility Name Form Approved 03105119 OMB No. 2040-0004 110064595175 NC0040797 City of Hickory- Henry Fork 3.7 Provide the receiving water and related information if known for each outfall. Outfall Number 001 Outfall Number_ Outfall Number_ Receiving water name Henry Fork River Name of watershed, river, South Fork Santee 0 or stream system U.S. Soil Conservation Service 14-digit watershed code Name of stale 3 management/riverbasin >r r: U.S. Geological Survey W8-digit hydrologic 03050102 cataloging unit code Critical low flow (acute) cfs cis ds Critical low flow (chronic) cis cfs cfs Total hardness at critical mg/L of mg/L of ni of low now 1381303 CaCO3 CaCO3 3.8 Provide the following information describino the treatment provided for dischantes from each outfall. Outfall Number Outfall Number Outfall Number Highest Level of O Primary ❑ Primary ❑ Primary Treatment (check all that ❑ Equivalent to ❑ Equivalent to ❑ Equivalent to apply per outfall) secondary secondary secondary O Secondary ❑ Secondary ❑ Secondary ❑ Advanced ❑ Advanced ❑ Advanced ❑ Other (specify) ❑ Other (specify) ❑ Other (specify) c Design Removal Rates by 001 Outfall BODs or CBODs 94 % % % c d TSS as % % % r— ❑ Not applicable ❑ Not applicable ❑ Not applicable Phosphorus 86 % % % ❑ Not applicable ❑ Not applicable ❑ Not applicable Nitrogen 87 % % % 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 03105/19 110064595175 NCO040797 City of Hickory- Henry Fork OMB No. 2040MU 3.9 Describe the type of disinfection used for the effluent from each oulfall in the table below. If disinfection varies by season, describe below. d c a c 0 c Outfall Number 001 Outfall Number_ Outfall Number_ a Disinfection type Chlorine Gas U N d (] Seasons used All Seasons v Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable 0 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? 0 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? 0 Yes ❑ No 4 SKIP to Item 3.13. 3.12 Indicate the number of acute and chronic WET tests conducted since the last permit retssuance of the facility's discharges by outfall number or of the receiving water near the dischar a points. Outfall Number D01 Outfall Number_ I Outfall Number_ Acute Chronic Acute Chronic Acute Chronic Number of tests of discharge 26 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? ❑✓ 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? 0 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? w 0 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). 0 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? El Yes 0 No additional sampling required by NPDES permittingauthority. EPA Form 35104A (Revised 3-19) Page 8 EPA Identification Number NPDES Permit Number Facility Name Form Approved 031009 OMB No. 2040-0004 110064595175 NC0040797 City of Hickory- Henry Fork 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? 0 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 MM4)DIYYYY We conducted 26 Chronic toxicity tests from 2/17 through 11/21. Of those 26, 20 were P/F test with 19 Pass and 1 Fail; 2 were Multiple 78 02/06/2017 Concentration tests with 2 >100% and 4 were 2nd species tests with 3 E ChV>200%and 1 ChV 82.5%. c 0 � 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did an of the tests result in e9 Y P Yo 9 P 9 tY. Y c toxicity? $' ❑✓ Yes ❑ No + SKIP to Item 3.26, 3.23 Describe the cause(s) of the toxicity: A review of all plant data was conducted. All plant limits were met and no unusual events occurred so therefore the � w cause of the toxicity was undetermined. 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 ermittin authoril . SECTION0IAL DISCHARGES AND HAZARDOUS WASTES (40 and Does the POTW receive discharges from SIUs or NSCIUs? 4.1 ✓❑ Yes ❑ No -* SKIP to Item 4.7. ffi 4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW. m Number of SIUs Number of NSCIUS 3 s 0 2 4.3 Does the POTW have an approved pretreatment program? ❑✓ Yes ❑ No m 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the •v A' application or (2) a pretreatment program? ❑✓ Yes ❑ No 4 SKIP to Item 4.6. a 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7. 5 Pretreatment Program Annual Report 01/26/2021 a 4.6 Have you completed and attached Table F to this application package? ❑✓ Yes ❑ No EPA Form 3510-2A (Revised 3-19) Page 9 EPA Iden55wtion Number NPDES Permit Number Facility Name Form Approved 03/05/19 110064595175 NCO040797 City of Hickory- Henry Fork OMB No. 2040-0004 4.7 Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are regulated as RCRA hazardous wastes pursuant to 40 CFR 2617 ❑ Yes ❑ No 4 SKIP to Item 4.9. 4.8 If yes, provide the folill Ing information: Annual Hazardous Waste Waste Transport Method Amount of Units Number (check all that apply) Waste Received ❑ Truck ❑ Rail ❑ Dedicated pipe ❑ Other (specify) c a e ❑ Truck ❑ Rail ❑ Dedicated pipe ❑ Other (specify) N 0 O ❑ Truck ❑ Rail _ ❑ Dedicated pipe ❑ Other (specify) v c m ffi A 4.9 Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities, N including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA? ❑ Yes 0 No 4 SKIP to Section 5. m 9 4.10 Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as specified In 40 CFR 261.30(d) and 261.33(e)? ❑ Yes 4 SKIP to Section 5. ❑ No 4.11 Have you reported the following information in an attachment to this application: identification and description of the site(s) or facility(ies) at which the wastewater originates; the identities of the wastewaters hazardous constituents; and the extent of treatment, if any, the wastewater receives or will receive before entering the POTW? ❑ Yes ❑ No SECTION• a SEVVER OVERFLOWS (40 Does the treatment works have a combined sewer system? 5.1 E m ❑ Yes ❑✓ No 4 SKIP to Section 6. v 5.2 Have you attached a CSO system map to this application? (See instructions for map requirements.) m ❑ Yes ❑ No a g 5.3 Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.) 0 o 0 ❑ Yes ❑ No EPA Form 3510-2A (Revised 3-19) Page 10 EPA Identification Number NPDES Permit Number FacilityName Form Approved 03/05/19 110064595175 NCO040797 City of Hickory- Henry Fork OMB No. 2040-0004 5.4 For each CSO oulfall, provillde the followinq information. Altech additional sheets as necessa . CSOOulfallNumber_ CSOOutfallNumber_ CSO OutfatlNumber— City or town 0 a •� u Stale and ZIP code a o County ° Latitude 0 y U Longitude Distance from shore ft. ft. ft. Depth below surface ft. ft. ft. 5.5 Did the POTIN monitor any of the following items in the past year for its CSO outfalis7 CSO OutfallNumber— CSOOutfallNumber_ CSOOutfallNumber— Rainfall ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No rn o CSO flow volume ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No M C50 pollutant ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 0 concentrations U Receiving water quality ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No CSO frequency ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Number of storm events ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 5.6 Provide the following information for each of your CSO outfalls. CSO OutfallNumber _ CSO OutfallNumber _ CSO OutfallNumber _ Number of CSO events in events events events the past year a Average duration per hours hours hours event ❑ Actual or ❑ Estimated ❑ Actual or ❑ Estimated ❑ Actual or ❑ Estimated d w' million gallons million gallons million gallons 0 Average volume per event ❑ Actual or ❑ Estimated ❑ Actual or ❑ Estimated ❑ Actual or ❑ Estimated Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall a CSO event in last year p Actual or ❑ Estimated ❑ Actual or ❑Estimated ❑Actual or ❑Estimated EPA Form 3510-2A (Revised 3-19) Page 11 EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19 110064595175 NCO040797 City of Hickory - Henry Fork OMB No. 2040-0004 5.7 Provide the information in the table below for each of your CSO outfalls. CSO Outfall Number_ CSO Outfall Number_ CSO Outfall Number Receiving water name Name of watershed/ streams stem dU.S. Soil Conservation ❑ Unknown ❑ Unknown ❑ Unknown Service 14-digit watershed code '> (1known) Name of state management/river basin U.S. Geological Survey ❑ Unknown ❑ Unknown ❑ Unknown 8-Digit Hydrologic Unit Code if known Description of known water quality impacts on receiving stream by CSO (see instructions for examples SECTION• r 6.1 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 all applicants are required to provide attachments. Column 1 Column 2 Section 1: Basic Application Elw/variance request(s) ❑✓ w/ additional attachments Information for All A licants 0 Section 2: Additional ❑✓ w/ topographic map ❑✓ w/ process flow diagram Information ❑✓ w/ additional attachments 0 w/ Table A ❑ w/ Table D 0 Section 3: Information on ❑ w/ Table B ❑ w/ Table E Effluent Discharges E ❑✓ w/ Table C ❑ w/ additional attachments R Section 4: Industrial ❑ wl SIU and NSCIU attachments w/ Table F F1 Discharges and Hazardous ❑ Wastes w/ additional attachments ❑ Section 5: Combined Sewer El w/ CSO map El w/ additional attachments c Overflows ❑ wl CSO system diagram O Section 6: Checklist and ❑ w/ attachments Certification Statement N s 6.2 Certification Statement 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 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. 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 Warren Wood City Manager Date signed X-V��j (M•zF -z Z EPA Form 3510-2A (Revised 3-19) Page 12 Henry Fork WW'I P Permft RenewO N CO040797 2022 Renewal Table A ti O J a ❑® ❑El ❑� O fV u N 0 A d Q g O N N N v0 I N m of N N N N O N a E E � oy z rl .I O M V h M m m ti m uO1i m LM m t O N O o � g y E u « E a Q W m y N e L y c E • E E w m • pO O f a0 ry A eM1 O m a N � N � E y N N C E N E Oca t O u rn n N m E E E Henry Fork WWTP Permit RenewO NCO040797 2022 Renewal TalbRe B § { \ \ k 2§592■§■,�,)■§, wf ce0e090S06)13911e00 ) % / ) ) ) ) \ E ao § \ m ; § § K . !a m k a 7! ?2 { ) / ./ 2 ) i ) ) ) E | . .� 2 ) / ) ) ) ) ) \ Ae �E- �� Z e a k 6 R 2/ . 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