NC0029599_Renewal (Application)_20230828

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Donald Hawks
Yadkin County Board of Education
121 Washington St
Yadkinville, NC 27055-7725
Subject: Permit Renewal
Application No. NCO029599
Courtney Elementary School WWTP
Yadkin County
Dear Permittee:
NORTH CAROLINA
Environmental Quality
August 28, 2023
The Water Quality Permitting Section acknowledges the August 28, 2023 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//dgq 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.
ec: WQPS Laserfiche File w/application
Sincerely, /
u"Y
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
D Q
North Carolina Department of Emlronmental Quality I DNlsion of Water Resources
Winston-Salem RegionalOffice 1 450 West Hanes MITI Road State 300 1 Winston-Salem North Carolina 27105
336.776.9800

Yadkin County Board of Education
Renewal request for discharge wastewater
treatment facility:
Courtney Elementary School WWTP
2529 Courtney -Huntsville Road,
Yadkinville, NC 27055
Permit # NCO029599
WIN
AUG
NCDEQ/DWR/NPDES

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO029599
Courtney 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 instrudons mly result in denial of the plication.
SECTION
1. BASIC
APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and
(9))
1.1
Facility name
Courtney Elementary School
Mailing address (street or P.O. box)
121 Washington St
City or town
State
ZIP code
o w
Yadkinville
NC
270SS
Contact name (first and last)
Title
Phone number
Email address
Mitchell T Long
ORC
[phone]
Mi1:[e-mail].i
i
—
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
LL
2529 Courtney -Huntsville Road
City or town
State
ZIP code
yadkinville
NC
27055
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes See instructions on data submission r❑ 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)
•a '
oi
City or town
State
ZIP code
r
C
T �
Contact name (first and last)
Title
Phone number
Email address
CL
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
❑ Facility ✓❑ 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
y
number for each.
_Y =-
❑ RCRA (hazardous waste)
❑ UIC (underground injection
a
A
❑ NPDES (discharges to surface
water)
control)
c
NCO029599
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
f�
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
404)
Ui
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO029599
Courtney Elementary School
Modified March 2021
i
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
PoP6-
— Collection System Type
Ownership Status
Served
Served
indicate percents
1
280
100 % separate sanitary sewer
i]
Own
0 Maintain
i
% combined storm and sanitary sewer
❑
Own
❑ Maintain
m ° "
❑ Unknown
❑
Own
❑ Maintain
j
% separate sanitary sewer
❑
Own
❑ Maintain
r
% combined storm and sanitary sewer
❑
Own
❑ Maintain
CL `
❑ Unknown
❑
Own
❑ Maintain
a
% separate sanitary sewer
❑
Own
❑ Maintain
c
!
% combined storm and sanitary sewer
❑
Own
❑ Maintain
❑ Unknown
❑
Own
❑ Maintain
C m
{
% separate sanitary sewer
❑
Own
❑ Maintain
a
% combined storm and sanitary sewer
❑
Own
❑ Maintain
❑ Unknown
❑
Own
❑ Maintain
Total zso
m
Population
I,
Served
Separate Sanitary Sewer System
Combined Storm and
J
Sanitary
Sewer
Total percentage of each type of
sewer line in miles
100
I ' `,
1.8
Is the treatment works located in Indian Country?
i=3❑
a
Yes ❑ No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes 0 No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.005 mgd
f
Annual Average Ftow Rates (Actual)
Two Years Ago
Last Year
This Year
i
—
6
0.003 mgd
0.003 mgd
0.003 mgd
m
_ Maximum Daily Flow Rates (Actual)
--
Two Years Ago^ Last Year
This Year
O 003 mad 0.003 mgd
0.003 mgd
Provide the total number of effluent discharge points to wafers of the State of North Carolina by
type.
1.11
Total Number of Effluent Discharge Points by Type_
I
7--
Combined Sewer
Constructed
Treated Effluent untreated Effluent
Overflows Bypasses
F Emergency
,
Overflows
I a`-
I
I
1
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029599 Courtney 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 im oundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average gaily Volume Continuous or Intermittent
Discharged to Surface I.
(check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
1.14 Is wastewater applied to land?
❑ Yes
❑ Continuous
gpd
❑
Intermittent
ElContinuous
gpd
❑
Intermittent
❑ 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
Average Daily Volume Continuous or
Location Size Intermittent
Applied (check one)
acres gpd El
❑ Intermittent
acres gpd ❑ Continuous
❑ Intermittent
acres gpd ❑ Continuous
❑ Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
{ ❑ Yes ❑✓ No 4 SKIP to Item 1.21.
1.17 1 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 0 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
NCO029599 Courtney 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.
_
Receiv' Facilit
a
Facility name
Mailing address (street or P.O. box)
m
City or town
State
ZIP code
,I 0
U
Contact name (first and last)
Title
a
f m
Phone number
Email address
'
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate mgd
CL
v,
n
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
c
❑ Yes ❑ No 4 SKIP to Item 1.23.
H !
o
1.22
Provide information in the table below on these other disposal methods.
d
Information on Other Disposal Methods
o
Disposal i
Location of
Size of
Annual Average
Continuous or Intermittent
o
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
N
_
_Volume
ElContinuous
acres
gP d
❑ Intermittent
❑ Continuous
acres
9Pd
❑ Intermittent
❑ Continuous
acres
gp d
❑ 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.
d
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
Q
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
0 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
_
0
Contractor name
Lentz Septic Tank Service
M
(company name
`0
Mailing address
street or P.O. box
418 Lentz Road,
City, state, and ZIP
I o
Statesville, NC 28625
code
-
Contact name (first and
"� i
c0�
last)
Jason Lentz -
Phone number
I
I
[phone]
Email address
off [e-mail]
Operational and
Clean Sludge Storage Tanks at
maintenance
the end of School Year.
responsibilities of
contractor
Usually in June.
Page 4

iES Permit Number Facility Name
I
NCO029599 Courtney Elementary School
Modified Application Form 2A
Modified March 2021
0
c
ai
0
c
0
w
-o
c
3
0
c
v
C
m n.
4M `°
02
M
t°
E
o
c
0
m
E
43
a.
E
.0
0
W
m
>3
s
U
-a
c
co
y
C
0
a
E
m
a
m
s
cn
Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑ Yes ❑ No 4 SKIP to Section 3.
2.2 Provide the treatment works' current average daily volume of inflow Avera(
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration
Volume of Inflow anc
gpd
2.3 Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
❑ Yes ❑ No
2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements
1.
fj
3
4
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
Scheduled Affected i Begin End Begin Attainment of
Outfalls Operational
I Improvement (list OUtfalt Construction Construction Discharge Level
I
(from above) (MM/DDiYYYY) (MM/DDIYYYY) (MMIDDNYYY)
number_ MM/DDIYYYY
1.
_1
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

j NPDES Permit Number Facility Name Modified Application Form 2A
NCO029599 Courtney Elementary School Modified March 2021
SECTION•' • ON 1 I to
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfails.)
Outfall Number 001
Outfall Number Outfall Number
State
INC
`—"
County
Yadkin
a
City or town
East Bend
o
c
Distance from shore
10560 ft.
_
a.
jW
Depth below surface
3 ft.
ft.
ft.
a
Average daily flow rate
.003 mgd
mgd
mgd
Latitude
36° 003"
"
Longitude
80 3d 37"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o
❑ Yes ❑ No 4 SKIP to Item 3.4.
a'
3.3
If so. provide the following information for each applicable outfall.
9 P p
H
Outfall Number 001 {{ 0 tfall Number Outfall Number
❑'
-- - — L - --- — - -----
Number of times per year
discharge occurs
170
a
-
Average duration of each
o
discharge (specify units
10 hours
oAverage
flow of each
003 mgd
mgd
mgd
discharge
n
Months in which discharge
Jan. - May Aug. -Dec.
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.
a
Outfall Number
Outfall Number
Outfall Number
I
vi
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
m �
3 6
one or more discharge points?
Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NCO029599 Courtney Elementary School Modified March 2021
3.7 1 Provide the receiving water and related information if known for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Harmon Creek
i
Name of watershed, river,
or stream system
Sub Basin 03-07 02
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
Yadkin -Pee Deer River
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
i
i
Critical low flow (acute)
cfs
cfs
Critical low flow (chronic)
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
low flow
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number oa,
Outfall Number
Outfall Number -
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
0 Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify
Design Removal Rates by
Outfall
BOD5 or CBOD5
TSS
Phosphorus
Nitrogen
Other (specify)
70 %
70 %
0 Not applicable
0 Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Not applicable
cfs
cfs
mg/L of
CaCO3
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

r
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO029599
Courtney 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.
Ultra Violet disinfection is used through all seasons.
a
c
c
O
-
1
Outfall Number
Outfall Number
Outfall Number
i
i 1
Disinfection type
.?
Ultraviolet Light
H
W
0
Seasons used
all
d
E
M
d
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
~
❑ Yes
❑ Yes
❑ Yes
0 No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
21 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 -* 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 receivinlc water near the discharge points.
Outfall Number _
Outfall Number
Outfall Number
Acute Chronic
) Acute
Chronic
Acute
Chronic
0
Number of tests of discharge
as
5
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 4 Complete Table B, including chlorine. ❑ No -* Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes 0 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 0 No additional sampling required by NPDES
ermittin authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO029599
Courtney 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 4 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.
Dates) Submitted
Summary of Results
MM#DDNM
c
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
toxicity?
_
❑ Yes ❑ No 4 SKIP to Item 3.26.
42
3.23
Describe the cause(s) of the toxicity:
m
3
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 0 Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO029599
Courtney Elementary School
Modified March 2021
SECTION,
CHECKLIST
AND CERTIFICATION1
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
❑ wl variance request(s) ❑ wl additional attachments
Information for All A licants
❑ Section 2: Additional
r
❑ wl topographic map ❑ wl process flow diagram
Information
❑ wl additional attachments
wl Table A ❑ wl Table D
❑ Section 3: Information on
© wl Table B ❑ wl additional attachments
Effluent Discharges
E
❑ w/ Table C
m
r
Section 4: Not Applicable
0
Section 5: Not Applicable
d
❑ Section 6: Checklist and
❑ w/ attachments
Certification Statement
N
y
6.2
Certification Statement
m
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. 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
Mitchell Thomas Long
ORC
Signature
Date signed
08/22/2023
G I
Page 10

NI`UtJ Hermit Number
NCO029599
Facility Name
Courtney Elementary School
Number
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Number of
Pollutant
Value Units
Method'
(include units)
Samples
Biochemical oxygen demand �
o BODs or ❑ CBODS
45.0
mg/L
<7.6
mg/I
36 SM521OB-2016
O ML
❑ MDL
(report one
#/100ml
1
Fecal coliform
400/100
#/looml
36 Colilert-18
O ML
❑ MDL
Design flow rate
0.005
MGD
MGD
36
pH (minimum)
>6.o
standard
E10.003
0
pH (maximum)
<9.0
standard
Temperature (winter)
No limit
C
Temperature (summer)
No limit
C
Total suspended solids (TSS)
45.0
mg/I
<23
mg/I
36 SM
2540D-2015
O ML
L
❑ MDL
t 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 Cutfall Number Modified Application Form 2A
NCO029591 Courtney Elementary School 1 Modified March 2021
Maximum Daily Discharge Average Daily Discharge
-------_ _- ------ r— — — . -- Analytical ML or MDL
Pollutant Number of
Value Units Value Units Method' (include units)
- Samples
Ammonia (as N)
No Limit
.73
mg/I
36
❑ MI
❑ MDL
Chlorine
❑ ML
total residual, TRC z
❑ MDL
Dissolved oxygen
❑ ML
❑ MDL
Nitrate/nitrite
No Limit
42.3
mg/I
12
O ML
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
No Limit
9.3
mg/I
12
O ML
❑ MDL
Total dissolved solids
❑ ML
❑ MDL
I 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
NCO029599 Courtney Elementary School
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
j
Analytical ML or MDL
Pollutant
Method' (include units)
--- ----�a
_
Number of
Value
Units Value
Units
Samples
i
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
----------
Li ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
Antimony, total recoverable
Arsenic, total recoverable
— —
-
Beryllium, total recoverable
0 ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑ MDL
Mercury, total recoverable
0 ML
❑ MDL
Nickel, total recoverable
❑ ML
❑ MDL
Selenium, total recoverable
❑ ML
❑ MDL
Silver, total recoverable
❑ ML
❑ MDL
Thallium, total recoverable
❑ ML
❑ MDL
Zinc, total recoverable
❑ ML
❑ MDL
Cyanide
❑ ML❑
MDL
Total phenolic compounds ❑ ML
❑ MDL
Volatile Organic Compounds
Acrolein
u ML
_ ❑ MDL
OML
Acrylonitrile
❑ MDL
❑ ML
❑ MDL
Benzene
romoforBm
❑ 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
NCO029599 Courtney Elementary School Modified March 2021
Maximum Daily Discharge Average Daily Discharge
_.�_ Analytical ML or MRL
- _.. __ ___..._.. _ .W.. --
Pollutant Number of Method' (include units)
Value Units Value Units
Samples
Carbon tetrachloride
U ML
❑MDL
Chlorobenzene
-- -----
- -
_
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
_
❑ ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
❑ MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2-dichloropropane
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML
❑ MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
❑ ML
❑ MDL
Toluene
❑ ML
❑ MDL
1, 1, 1 -trichloroethane
❑ ML
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number
Facility Name Outfall Number Modified Application Form 2A
NCO029599 Courtney
Elementary School Modified March 2021
Maximum Daily Discharge
Average DailyDischarge
Pollutant _
Value _ Units
_ Analytical ML or MDL
_ Number of Method (include units)
Value Units Samples
Trichloroethylene
11 MDL
-- — --- —
Vinyl chloride
-
t i r1-
_ . _ _ . ..! Dt.
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethyl phenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
----- --- —.._
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
-
T ---
-
Acenaphthylene
❑ ML
--- -
-
-
❑ MDL
Anthracene
_
_
❑ ML
_
❑ MDL
Benzidine
—
❑ ML
❑ MDL
Benzo(a)anthracene
- ❑ ML
❑ MDL
Benzo(a)pyrene
❑ ML
❑ MDL
3,4-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name I Outfall Number
NCO029599 Courtney Elementary School
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical ML or MDL
r _._ - _-��
Value
Units
Value
Units
Number of
Method' (include units)
Samples_
Benzo(ghi)perylene
❑ ML
❑ MDL
❑ ML
Benzo(k)fluoranthene
❑ MDL
Bis (2-chloroethoxy) methane
❑ ML
❑ MDL
Bis (2-chloroethyi) ether
❑ ML
❑ MDL
Bis (2-chioroisopropyl) ether
❑ ML
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ ML
❑ MDL
4-bromophenyl phenyl ether
❑ ML
❑ MDL
Butyl benzyl phthalate
❑ ML
❑ MDL
2-chloronaphthalene
❑ ML
❑ MDL
4-chlorophenyl phenyl ether
❑ ML
❑ MDL
Chrysene
❑ ML
❑ MDL
di-n-butyl phthalate
❑ ML
❑ MDL
di-n-octyl phthalate
❑ ML
❑ MDL
Dibenzo(a,h)anthracene
❑ ML
❑ MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
1,3-dichlorobenzene
❑ ML
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
❑ ML
❑ MDL
Dimethyl phthalate
❑ ML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO029599 Courtney Elementary School
Modified March 2021
• &Ig1 glu, To
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
.._� ._
Pollutant
Value Units Value Units Number of
— ---
Method' (include units)
—_
-
,J ML
1,2-diphenylhydrazine
❑ MDL
❑ ML
Fluoranthene
❑ MDL
❑ ML
Fluorene
❑ MDL
❑ ML
Hexachlorobenzene
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
❑ ML
Hexachlorocyclo-pentadiene
❑ MDL
❑ ML
Hexachloroethane
❑ MDL
❑ ML
Indeno(1,2,3-cd)pyrene
❑ MDL
❑ ML
Isophorone
❑ MDL
❑ ML
Naphthalene
❑ MDL
❑ ML
Nitrobenzene
❑ MDL
N-nitrosodi-n-propylamine
OML
❑ MDL
N-nitrosodimethylamine
0 ML
❑ MDL
N-nitrosodiphenylamine
OML
❑ MDL
Phenanthrene
❑ ML
❑ MDL
❑ ML
Pyrene
❑ 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

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO029599 Courtney Elementary School
Modified March 2021
I11 � •• � 1• I �'
'
Maximum Dail Discharge Average Daily Discharge
-- _ __.__ __ _ ._- ___4_ _-------.-.-----.--.
Analytical ML or MDL
Pollutant ;--
Number of
(I stj Value Units I Value Units Samples
Method' (include units)
❑ No additional sampling is required by NPDES permitting authority.
- --
❑ ML
❑ MDL
i
❑ 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

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NCO029599 - Courtney Elementary School Facility •
USGS Quad: Farmington Latitude: Location
Receiving Stream: Harmon Creek 36G05103"
Stream Class: WS-I`% Longitude: f Yadkin County
Basin / Subbasin: Yadkin / 03-0 7-02 8003637" y NIap not to scale