NC0029611_Renewal (Application)_20230829

Ns-STATE,
ROY COOPER �,��
Governor
••
ELIZABETH_S.BISER ^'"
Secretary""
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director - Environmental Quality. - - -
August 29, 2023
Yadkin County Board of Education
Attn: Mithcell Long, ORC
121 Washington St
Yadkinville, NC 27055-7725
Subject: Permit Renewal
Application No. NC0029611
East Bend Elementary School WWTP
Yadkin County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 29, 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. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit.The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of f the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
v74:1
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
;Vp North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road,State 300(Winston-Salem,North Carolina 27105
336.776.9800

Yadkin County Board of Education RECEIVED
AUG 2 9 2023
NCDEQ/DWR/NPDES
Renewal request for discharge wastewater
treatment facility:
East Bend Elementary School WWTP
205 School Street,
East
as Bend, NC 27018
Permit # NC0029611

a
•
NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions may result in denial of the application.
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and (9))
1.1 Facility name
East Bend Elementary School
Mailing address(street or P.O.box)
121 Washington St
City or town State ZIP code
Yadkinville NC 27055
Contact name(first and last) Title Phone number Email address
Mitchell T Long ORC [phone] [e-mail].i
Location address(street, route number,or other specific identifier) ❑ Same as mailing address
205 School Street
w
City or town State ZIP code
East Bend NC 27018
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
0 City or town State ZIP code
cc Contact name(first and last) Title Phone number Email address
0
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 0 Applicant ❑ (they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
NC0029611
❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
LLI
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate,percentage)
1 250 loci %separate sanitary sewer El Own El Maintain
combined storm and sanitary sewer 0 Own ❑ Maintain
CD Unknown ❑ Own ❑ Maintain
c %separate sanitary sewer ❑ Own ❑ Maintain
o
combined storm and sanitary sewer 0 Own ❑ Maintain
CO
0 Unknown ❑ Own ❑ Maintain
o %separate sanitary sewer ❑ Own ❑ Maintain
-a %combined storm and sanitary sewer ❑ Own 0 Maintain
co 0 Unknown ❑ Own 0 Maintain
d %separate sanitary sewer ❑ Own ❑ Maintain
›. %combined storm and sanitary sewer 0 Own 0 Maintain
_ ❑ Unknown ❑ Own 0 Maintain
o
Total 250
0 Population
o Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of 100 % °/°
sewer line(in miles)
Z' 1.8 Is the treatment works located in Indian Country?
c
o ❑ Yes 0 No
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
co
a ❑ Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.007 mgd
Annual Average Flow Rates(Actual)
aTwo Years Ago Last Year This Year
co 0.003 mgd 0.003 mgd 0.003 mgd
"' Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
0.003 mgd 0.003 mgd 0.003 mgd
01.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
c Total Number of Effluent Discharge Points by Type
0 a Constructed
Combined Sewer
Treated Effluent Untreated Effluent Overflows Bypasses overflows
v
N_
G 1
Page 2

r
NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins, ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes ❑ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
O Continuous
gpd 0 Intermittent
O Continuous
tn gpd ❑ Intermittent
2 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.
Land Application Site and Discharge Data
o ! Continuous or
Location Size Average Daily Volume Intermittent
Applied Icheck one)
acres gpd El
0 Intermittent
acres d 0 Continuous
9p Cl Intermittent
-0 ❑ Continuous
acres gpd ❑ Intermittent
7, 1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ Yes ❑✓ 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 El 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
NC0029611 East Bend 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.
Receiving Facility Data
-0 Facility name Mailing address(street or P.O.box)
City or town State ZIP code
0
Contact name(first and last) Title
0
m Phone number Email address
NPDES number of receiving facility(if any) ❑ None Average daily flow rate mgd
U,
in 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)?
❑ Yes El 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
-0 Method Daily Discharge
Description Disposal Site Disposal Site Volume (check one)
acres gpd ❑ Continuous
❑ Intermittent
❑ Continuous
acres gpd 0 Intermittent
acres gpd ❑ Continuous
0 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.)
C 0 ❑ Discharges into marine waters(CWA El Water quality related effluent limitation(CWA Section
K Section 301(h)) 302(b)(2))
❑r 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?
El 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
(company name)
Mailing address 418 Lentz Road,
(street or P.O. box)
4 City,state,and ZIP Statesville,NC 28625
code
Contact name(first and
0 last) Jason Lentz
Phone number [phone]
Email address [e-mail]
Operational and Clean Sludge Storage Tanks at
maintenance the end of School Year.
responsibilities of Usually in June.
contractor
Page 4

•
NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o 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.
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.
c
0
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
R specific requirements.)
o
0 ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
c os (See instructions for specific requirements.)
" o ❑ Yes El No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
.1° 1.
C
E
2.
0
3.
0
d
4.
cn
-0
( 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
Improvement Construction Construction Discharge Level
(from above) number(list outf)fl (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)
(MM/DD/YYYY)
1.
0
0
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
I —

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
SECTION 3. INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number 1 Outfall Number Outfall Number
State NC
co
County Yadkin
o City or town
East Bend
li
o
c Distance from shore 10560 ft. ft. ft.
a
N Depth below surface 3 ft. ft. ft.
0
Average daily flow rate .003 mgd mgd mgd
Latitude 360 1d 52" "" ° „
Longitude 80 32' 15" ° "' ""
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
iv
a ❑✓ Yes ❑ No 4 SKIP to Item 3.4.
&
3.3 If so, provide the following information for each applicable outfall.
n Outfall Number 001 Outfall Number Outfall Number
0
:D Number of times per year 170
o discharge occurs
a Average duration of each
`o discharge(specify units) 10 hours
oAverage flow of each 003 mgd mgd mgd
cn discharge
co
n Months in which discharge
OCCUfS Jan.-May Aug.-Dec.
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes 0 No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser t pe at each applicable outfall.
1- Outfall Number Outfall Number Outfall Number
0
46 ui 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
d = one or more discharge points?
z El Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Logan Creek
Name of watershed,river,
c or stream system Sub Basin 03 07 02
0. U.S.Soil Conservation
y Service 14-digit watershed
o code
a) Name of state
's management/river basin Yadkin-Pee Deer River
c
U.S.Geological Survey
0 8-digit hydrologic
cc 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 0 Primary 0 Primary 0 Primary
Treatment(check all that El Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0
a Design Removal Rates by
.� Outfall
y
Q>
CI
BOD5 or CBOD5 70
m
al l TSS 70 % %
t-
0 Not applicable ❑ Not applicable ❑ Not applicable
Phosphorus
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
% % ok
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend 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
0
a '
0
Outfall Number 1 Outfall Number Outfall Number
0
a. Disinfection type Ultraviolet Light
V
Gt
Seasons used all
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
❑ Yes ❑ Yes El Yes
El No ❑ No El No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
El 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
ra Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
water
-
m
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. r❑ 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?
El 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
NC0029611 East Bend 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?
CI 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 your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MMIDDNYYY)
0
w 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?
cn
❑ Yes ❑ No SKIP to Item 3.26.
d 3.23 Describe the cause(s)of the toxicity:
d
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?
ID Yes a Not applicable because previously submitted
information to the NPDES .ermittin. authori .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
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 I Column 2
❑ Section 1: Basic Application ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
❑ Section 2:Additional ❑ wl topographic map ❑ w/process flow diagram
Information ❑ w/additional attachments
El w/Table A 0 w/Table D
❑ Section 3: Information on © w/Table B ❑ wl additional attachments
Effluent Discharges
E g ❑� w/Table C
d
Section 4: Not Applicable
a
0
Section 5: Not Applicable
d
c.�
Section 6:Checklist and
❑ ❑ w/attachments
Certification Statement
6.2 Certification Statement
/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
/7,tL�/2 � >C��l -+ 08/22/2023
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A ,
NC0029611 East Bend Elementary School 1 Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical ML or MDL
Value Units Value Units Method (include units)
Samples
Biochemical oxygen demand
i BODB or❑CBOD5 45.0 mg/L 3.85 mg/I 36 SM5210B-2016 O ML
❑MDL
(report one)
Fecal coliform 400/100 #/100m1 <1 #/100m1 36 Colilert-18 El ML
❑MDL
Design flow rate 0.007 MGD 0.003 MGD 35
'
pH(minimum) >6.0 standard ,
pH(maximum) <9.0 standard i 1
Temperature(winter) No limit C
Temperature(summer) No limit C
Total suspended solids(TSS) 45.0 mg/I <3 mg/I 36 SM 2540D-2015 ❑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
NC0029611 East Bend Elementary School 1 Modified March 2021
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical IV%or MDL
Value Units Value Units Method1 (include units)
Samples
Ammonia(as N) No Limit .635 mg/I 36 D ML
❑MDL
Chlorine ❑ML
(total residual,TRC)2 ❑MDL
Dissolved oxygen No Limit 8.87 mg/I 36 ML
0 MDL
Nitrate/nitrite ❑ML
❑MDL
0 ML
Kjeldahl nitrogen ❑MDL
0 ML
Oil and grease ❑MDL
0 ML
Phosphorus 0 MDL
Total dissolved solids ❑ML
❑MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
I Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number of Methods (include units)
Samples
Metals,Cyanide,and Total Phenols
0 ML
Hardness(as CaCO3) ❑MDL
0 ML
Antimony,total recoverable ❑MDL
Arsenic,total recoverable ❑ML
❑MDL
0 ML
Beryllium,total recoverable 0 MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable ❑ML
❑MDL
0 ML
Copper,total recoverable ❑MDL
Lead,total recoverable ❑ML
❑MDL
0 ML
Mercury,total recoverable ❑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
0 ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
Acrolein `1 ML
❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
0 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
NC0029611 East Bend Elementary School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant — Number of Methods (include units)
Value Units Value Units Samples
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
0 ML
trans-1,2-dichloroethylene ❑MDL
0 ML
1,1-dichloroethylene ❑MDL
0 ML
1,2-dichloropropane ❑MDL
ML
1,3-dichloropropylene o MDL
ML
Ethylbenzene ❑MDL
0 ML
Methyl bromide ❑MDL
0 ML
Methyl chloride o MDL
0 ML
Methylene chloride ❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
ML
Tetrachloroethylene ❑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
NC0029611 East Bend Elementary School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant — -- Number of Method1 • (include units)
Value Units Value Units Samples
Trichloroethylene ML
❑MDL
Vinyl chloride o ML
❑MDL
Acid-Extractable Compounds
0 ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol 0 MDL
0 ML
2,4-dichlorophenol 0 MDL
0 ML
2,4-dimethylphenol 0 MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
0 ML
2,4-dinitrophenol ❑MDL
0 ML
2-nitrophenol ❑MDL
0 ML
4-nitrophenol ❑MDL
0 ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
0 ML
2,4,6-trichlorophenol ❑MDL
Base-Neutral Compounds
ML
Acenaphthene ❑MDL
0 ML
Acenaphthylene ❑MDL
Anthracene ❑ML
❑MDL
Benzidine ❑ML
❑MDL
Benzo(a)anthracene ❑ML
❑MDL
0 ML
Benzo(a)pyrene ❑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
NC0029611 East Bend Elementary School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Methods (include units)
Samples
D ML
Benzo(ghi)perylene ❑MDL0 ML
_
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane ❑MDL
0 ML
Bis(2-chloroethyl)ether ❑MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
ML
Bis(2-ethylhexyl)phthalate _ ❑MDL
ML
4-bromophenyl phenyl ether ❑MDL
0 ML
Butyl benzyl phthalate ❑MDL
ML
2-chloronaphthalene ❑MDL
0 ML
4-chlorophenyl phenyl ether ❑MDL
0 ML
Chrysene 0 MDL
0 ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
0 ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene 0 ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
0 ML
Dimethyl phthalate ❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number I NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0029611 East Bend Elementary School Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Methods (include units)
Samples
ML
1,2-diphenylhydrazine o MDL
Fluoranthene ❑ML
❑MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene 0 ML
❑MDL
Hexachlorobutadiene 0 ML
❑MDL
ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane 0 ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene 0 MDL
❑ML
Isophorone ❑MDL
❑ML
Naphthalene ❑MDL
Nitrobenzene ❑ML
❑MDL
0 ML
N-nitrosodi-n-propylamine 0 MDL
0 ML
N-nitrosodimethylamine 0 MDL
0 ML
N-nitrosodiphenylamine 0 MDL
Phenanthrene 0 ML
0 MDL
0 ML
Pyrene 0 MDL
1,2,4-trichlorobenzene 0 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 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A •
NC0029611 East Bend Elementary School Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of y
sti Value Units Value Units Samples Method' (include units)
❑ 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
0 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
J

DocuSign Envelope ID:368E1CB1-C7F5-45AC-A615-F279AF25A23E
r
s
1 •
j 4,. Treatment Plant Location
. a
s ..
i _
1
fy/{ jj1 i , t 9 sib df
b 3 .... J _
r
f
t " nodR.
t Y
/
/
...-` �... V
� tag. -f �.,—•,._ �_. _
r f _
f "
f
^S444:
d
Toirill
� I.
4-
r- t`r f
,t
Discharge Location b� -
i y �,_- �'
NC0029611 - East Bend Elementary School WWTP
Outfall & Treatment Plant Locations
County: Yadkin N
Sub-Basin: 03 07 02 Facility
Stream Class: C
Receiving Stream: Logan Creek Location