NC0087840_Fact Sheet_20230830

DEQ / DWR / NPDES
EXPIDITED FACT SHEET FOR PERMIT RENEWEL
PERMIT NCO087840
Facility Information
Applicant/Facility
Name:
Town of Middlesex - Middlesex Well No.4 WTP
Applicant Address:
Town of Middlesex; P.O. Box 69; Middlesex, NC 27557
Facility Address:
10921 East Finch Street; Middlesex, NC 27557
Permitted Flow:
Maximum monthly average 0.0034 MGD not limited
Tvve of Waste:
Treated backwash wastewater from greensand filters
Facility/Permit Status:
WPCS Class I /Active; Renewal
Count
Nash Count
Miscellaneous
Receiving Stream:
UT to Turkey Creek
Stream Class:
C, NSW
Subbasin:
03-04-07
Stream Index No:
27-86-3- 1
Drainage Area mil :
HUC:
030202030104
Summer 7Q10 cfs
303 d Listed?
No
Winter 7Q10 cfs :
Regional Office:
Raleigh
30Q2 cfs :
USGS Quad:
Middlesex, NC
Average Flow cfs :
Permit Writer:
Joe R. Corporon, P.G.
IWC % :
1 100%
Date:
30Au 2023
BACKGROUND
The Town of Middlesex operates a designed -rate 0.133 MGD potable -water treatment plant
(WTP) to serve its surrounding community. Currently operated by Envirolink, Inc., the WTP
applies greensand filtration technology generating a filer -backwash averaging 0.005 MGD [for
—15 minutes, one day per week]. Backwash wastes discharge to an unnamed tributary (UT) to
Turkey Creek, a waterbody currently classified C; NSW within the Neuse River Basin.
It is however noteworthy that the effluent travels via culverts, and a system of unlined ditches
(providing subsurface infiltration) such that the effluent seldom, if ever, reaches the unnamed
tributary (RRO Inspection Staff Report, 2013).
CURRENT TREATMENT PROCESSES
1. Well water is chlorinated then introduced to two greensand filter units.
2. filtered water continues through air stripper treatment then
3. pumped into the potable water distribution system
4. operator manually backwashes/rinses each sand filter as needed [typ. once (1) per week],
5. process backwash/rinsate passes through a meter, sand filter beds,
6. tablet dechlorinator
7. discharged into a UT to Turkey Creek.
Permittee determines when to remove solids based on their accumulation in drying beds; solids
removed and disposed by licensed contractor, per state regulations.
Fact Sheet Renewal — September 2023
NPDES NCO087840
Page 1 of 7

PERMITTING HISTORY
2008 — Renewal permit issued with no changes to the previous permit [Greenland Filter 2004
WTP Strategy limiting Flow, TSS, TRC, and pH].
2013 — Applied 2009 WTP Strategy for Greensand filter technology and BPJ:
• flow limit removed; monitoring changed to 2/month; footnote added;
• corrected outfall location; IWC corrected to 100%;
• fluoride and zinc monitoring removed (neither used by the [Permittee);
• iron and manganese - reduced monitoring to Quarterly
• added Turbidity monitoring, 2/month (EPA requirement);
• per Neuse River 2013 Nutrient Guidelines, semi-annual monitoring required
for nutrients as Total Nitrogen (TN) and Total Phosphorus (TP)
• TN requires Total Kjeldahl Nitrogen (TKN) plus Nitrate and Nitrite Nitrogen.
2018 — Renewal continued 2009 WTP Strategy for Greensand filter technology
1. Updated site map and narrative for Supplement to Permit Cover Sheet.
2. Discontinued monitoring for Total Iron [no standard/no longer a
parameter of concern (POC)].
3. Continued quarterly monitoring for Total Manganese as required for
greensand, but not limited, per WTP strategy [not discharging to WS waters];
4. Total Hardness [for calculating dissolved fraction limits] — Because manganese cannot
be limited (limit applies only to WS), and because manganese is the only remaining
metal POC, Total Hardness monitoring (U&E) is not required;
5. Current Neuse River Guidelines classify this facility as non -nitrogen
producing; however, TN/TP semi-annually monitoring remains in the
permit per strategy; no changes recommended.
6. Because TN/TP monitoring is required [class NSW], this facility is not
elijzible for WTP General Permit NCG590000.
COMPLIANCE
Since 2020 BIMS records no violations / no penalty assessments issued by the DWR.
PERMITTING STRATEGY -- RATIONALE FOR 2023 RENEWAL
The following will be incorporated into the permit.
1. Updated site map and narrative for Supplement to Permit Cover Sheet.
2. Discontinued monitoring for Total Iron [no standard/no longer a
parameter of concern (POC)].
3. Continued quarterly monitoring for Total Manganese as required for
greensand, but not limited, per WTP strategy [no discharge to WS waters].
4. Total Hardness [to evaluate dissolved fraction limits] — Because manganese
cannot be limited (applies only in WS waters), and because manganese is the only
remaining metal POC, Total Hardness monitoring (U&E) is not required.
Fact Sheet Renewal — September 2023
NPDES NC0087840
Page 2 of 7

5. Current Neuse River Guidelines classify this facility as non -nitrogen
producing; however, TN/TP semi-annually monitoring remains in the
permit per Neuse River strategy; no changes recommended.
6. Because TN/TP monitoring is required [class NSW], this facility is not
eligible for WTP General Permit NCG590000.
PROPOSED SCHEDULE FOR PERMIT ISSUANCE
Draft to Public Notice:
Scheduled to Issue (Est):
Effective Date (Est):
NPDES DIVISION CONTACT
September 12, 2023
October 13, 2023
November 1, 2023
If you have questions about any of the above information, or on the attached permit, please email
Joe R. Corporon, P.G. [e-mail]].
NAME: I /y `VV DATE: 29AUG2023
ES Mnnlementakion of Instream Dissolved Metals Standards —
The NC 2007-2015 Water Quality Standard (WQS) Triennial Review was approved by the NC
Environmental Management Commission (EMC) on November 13, 2014. The US EPA subsequently
approved the WQS revisions on April 6, 2016, with some exceptions. Therefore, metal limits in draft
permits out to public notice after April 6, 2016 must be calculated to protect the new standards - as
approved.
Table 2. NC Dissolved Metals Water Quality Standards/Aquatic Life Protection
Parameter
Acute FW, µg/1
(Dissolved)
Chronic FW, µg/1
(Dissolved)
Acute SW, µg/1
(Dissolved)
Chronic SW, µg/l
(Dissolved)
Arsenic
340
150
69
36
Beryllium
65
6.5
---
---
Cadmium
Calculation
Calculation
40
8.8
Chromium III
Calculation
Calculation
---
---
Chromium VI
16
11
1100
50
Copper
Calculation
Calculation
4.8
3.1
Lead
Calculation
Calculation
210
8.1
Nickel
Calculation
Calculation
74
8.2
Silver
Calculation
0.06
1.9
0.1
Zinc
Calculation
Calculation
90
81
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NPDES NCO087840
Page 3 of 7

Table 2 Notes:
1. FW= Freshwater, SW= Saltwater
2. e7arc7a_74 = Hardness dependent standard
3. Only the aquatic life standards listed above are expressed in dissolved form. Aquatic life
standards for Mercury and selenium are still expressed as Total Recoverable Metals due to
bioaccumulative concerns (as are all human health standards for all metals). It is still necessary
to evaluate total recoverable aquatic life and human health standards listed in 15A NCAC
213.0200 (e.g., arsenic at 10 µg/l for human health protection; cyanide at 5 µg/L and fluoride at
1.8 mg/L for aquatic life protection).
Table 3. Dissolved Freshwater Standards for Hardness -Dependent Metals
The Water Effects Ratio (WER) is equal to one unless determined otherwise under 15A NCAC
02B .0211 Subparagraph (11)(d)
Metal
NC Dissolved Standard, 1
Cadmium, Acute
WER*{1.136672-[In hardness] (0.041838){ e^{0.9151 [ln hardness]-
3.1485{
Cadmium, Acute Trout
waters
WER* { 1.136672-[ln hardness] (0.041838){
3.62361
e^{0.9151 [ln hardness] -
Cadmium, Chronic
WER*{1.141672-[In hardness] (0.041838){
4.4451 }
e^{0.7998[ln hardness]-
Chromium III, Acute
WER*0.316 e^{0.8190[ln hardness]+3.7256}
Chromium III, Chronic
WER*0.860 e^{0.8190[ln hardness]+0.6848}
Copper, Acute
WER*0.960 e^{0.9422[ln hardness]-1.7001
Copper, Chronic
WER*0.960 e^{0.8545[ln hardness]-1.7021
Lead, Acute
WER* { 1.46203-[ln hardness] (0.145712)}
1.460}
e^{ 1.273[ln hardness]-
Lead, Chronic
WER*{1.46203-[In hardness] (0.145712)}
4.705 }
e^{l.273[ln hardness]-
Nickel, Acute
WER*0.998 e^{0.8460[ln hardness]+2.255}
Nickel, Chronic
WER*0.997 e^{0.8460[ln hardness]+0.0584}
Silver, Acute
WER*0.85 • e^{l.72[ln hardness]-6.59{
Silver, Chronic
Not applicable
Zinc, Acute
WER*0.978 e^{0.8473[ln hardness]+0.884}
Zinc, Chronic
WER*0.986 e^{0.8473[ln hardness]+0.884}
General Information on the Reasonable Potential Analysis (RPA)
The RPA process itself did not change as the result of the new metals standards. However, application of
the dissolved and hardness -dependent standards requires additional consideration in order to establish the
numeric standard for each metal of concern of each individual discharge.
Fact Sheet Renewal - September 2023
NPDES NC0087840
Page 4 of 7

The hardness -based standards require some knowledge of the effluent and instream (upstream) hardness
and so must be calculated case -by -case for each discharge.
Metals limits must be expressed as `total recoverable' metals in accordance with 40 CFR 122.45(c). The
discharge -specific standards must be converted to the equivalent total values for use in the RPA
calculations. We will generally rely on default translator values developed for each metal (more on that
below), but it is also possible to consider case -specific translators developed in accordance with
established methodology.
R.PA Permitting Guidance/WQBELs for Hardness -Dependent Metals - Freshwater
The RPA is designed to predict the maximum likely effluent concentrations for each metal of concern,
based on recent effluent data, and calculate the allowable effluent concentrations, based on applicable
standards and the critical low -flow values for the receiving stream.
If the maximum predicted value is greater than the maximum allowed value (chronic or acute), the
discharge has reasonable potential to exceed the standard, which warrants a permit limit in most cases. If
monitoring for a particular pollutant indicates that the pollutant is not present (i.e. consistently below
detection level), then the Division may remove the monitoring requirement in the reissued permit.
1. To perform a RPA on the Freshwater hardness -dependent metals the Permit Writer compiles the
following information:
• Critical low flow of the receiving stream, 7Q10 (the spreadsheet automatically calculates
the 1 Q 10 using the formula 1 Q 10 = 0.843 (s7Q 10, cfs) 0.993
• Effluent hardness and upstream hardness, site -specific data is preferred
• Permitted flow
• Receiving stream classification
2. In order to establish the numeric standard for each hardness -dependent metal of concern and for
each individual discharge, the Permit Writer must first determine what effluent and instream
(upstream) hardness values to use in the equations.
The permit writer reviews DMR's, Effluent Pollutant Scans, and Toxicity Test results for any
hardness data and contacts the Permittee to see if any additional data is available for instream
hardness values, upstream of the discharge.
If no hardness data is available, the permit writer may choose to do an initial evaluation using a
default hardness of 25 mg/L (CaCO3 or (Ca + Mg)). Minimum and maximum limits on the
hardness value used for water quality calculations are 25 mg/L and 400 mg/L, respectively.
If the use of a default hardness value results in a hardness -dependent metal showing reasonable
potential, the permit writer contacts the Permittee and requests 5 site -specific effluent and
upstream hardness samples over a period of one week. The RPA is rerun using the new data.
The overall hardness value used in the water quality calculations is calculated as follows:
Combined Hardness (chronic)
_ (Permitted Flow, cfs *Avg. Effluent Hardness, mg/L)xs7Q10, cfs *Avg. Upstream Hardness, mg/L)
(Permitted Flow, cfs + s7Q10, cfs)
The Combined Hardness for acute is the same but the calculation uses the 1 Q 10 flow.
Fact Sheet Renewal — September 2023
NPDES NCO087840
Page 5 of 7

3. The permit writer converts the numeric standard for each metal of concern to a total recoverable
metal, using the EPA Default Partition Coefficients (DPCs) or site -specific translators, if any
have been developed using federally approved methodology.
4. The numeric standard for each metal of concern is divided by the default partition coefficient (or
site -specific translator) to obtain a Total Recoverable Metal at ambient conditions.
In some cases, where an EPA default partition coefficient translator does not exist (ie. silver), the
dissolved numeric standard for each metal of concern is divided by the EPA conversion factor to
obtain a Total Recoverable Metal at ambient conditions. This method presumes that the metal is
dissolved to the same extent as it was during EPA's criteria development for metals. For more
information on conversion factors see the June, 1996 EPA Translator Guidance Document.
5. The RPA spreadsheet uses a mass balance equation to determine the total allowable concentration
(permit limits) for each pollutant using the following equation:
Ca = (s7Q 10 + Qw) (Cwgs) — (s7Q 10) (Cb)
Qom'
Where: Ca = allowable effluent concentration (µg/L or mg/L)
Cwqs = NC Water Quality Standard or federal criteria (µg/L or mg/L)
Cb = background concentration: assume zero for all toxicants except NH3* (µg/L or mg/L)
Qw = permitted effluent flow (cfs, match s7Q 10)
s7Q 10 = summer low flow used to protect aquatic life from chronic toxicity and human
health through the consumption of water, fish, and shellfish from noncarcinogens (cfs)
* Discussions are on -going with EPA on how best to address background concentrations
Flows other than s7Q 10 may be incorporated as applicable:
IQ 10 = used in the equation to protect aquatic life from acute toxicity
QA = used in the equation to protect human health through the consumption of water,
fish, and shellfish from carcinogens
30Q2 = used in the equation to protect aesthetic quality
6. The permit writer enters the most recent 2-3 years of effluent data for each pollutant of concern.
Data entered must have been taken within four and one-half years prior to the date of the permit
application (40 CFR 122.21). The RPA spreadsheet estimates the 95th percentile upper
concentration of each pollutant. The Predicted Max concentrations are compared to the Total
allowable concentrations to determine if a permit limit is necessary. If the predicted max exceeds
the acute or chronic Total allowable concentrations, the discharge is considered to show
reasonable potential to violate the water quality standard, and a permit limit (Total allowable
concentration) is included in the permit in accordance with the U.S. EPA Technical Support
Document for Water Quality -Based Toxics Control published in 1991.
7. When appropriate, permit writers develop facility specific compliance schedules in accordance
with the EPA Headquarters Memo dated May 10, 2007 from James Hanlon to Alexis Strauss on
40 CFR 122.47 Compliance Schedule Requirements.
8. The Total Chromium NC WQS was removed and replaced with trivalent chromium and
hexavalent chromium Water Quality Standards. As a cost savings measure, total chromium data
results may be used as a conservative surrogate in cases where there are no analytical results
based on chromium III or VI. In these cases, the projected maximum concentration (95th %) for
total chromium will be compared against water quality standards for chromium III and chromium
VI.
Fact Sheet Renewal — September 2023
NPDES NCO087840
Page 6 of 7

9. Effluent hardness sampling and instream hardness sampling, upstream of the discharge, are
inserted into all permits with facilities monitoring for hardness -dependent metals to ensure the
accuracy of the permit limits and to build a more robust hardness dataset.
10. Hardness and flow values used in the Reasonable Potential Analysis for this permit included:
Table 4
Parameter
Value
Comments Data Source
Average Effluent Hardness (mg/L)
N/A
No metals monitored
[Total as, CaCO3 or (Ca+Mg)]
Average Upstream Hardness (mg/L)
N/A
[Total as, CaCO3 or (Ca+Mg)]
7Q 10 summer (cfs)
N/A
1 Q 10 (cfs)
N/A
Permitted Flow (MGD)
N/A
Fact Sheet Renewal — September 2023
NPDES NC0087840
Page 7 of 7

NPDES Permit NCO087840
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended, the
Town of Middlesex
is hereby authorized to discharge treated wastewater from a facility known as
Middlesex Well No. 4 Water Treatment Plant (WTP)
10921 East Finch Street, Middlesex
Nash County
to receiving waters designated as unnamed tributary (UT) to Turkey Creek within the Neuse River
Basin, in accordance with effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, and IV hereof.
The permit shall become effective, September 1, 2018.
This permit and the authorization to discharge shall expire at midnight on April 30, 2023.
Signed this day August 3, 2018.
Linda Culpepper, Interim Director
Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

NPDES Permit NCO087840
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under
the permit conditions, requirements, terms, and provisions described herein.
Town of Middlesex
is hereby authorized to:
1. continue to operate a filter -backwash treatment system employing greensand filter technology to
treat groundwater in support of potable -water production (design flow 0.133 MGD), generating a
backwash discharge averaging 0.0034 MGD [once per week] utilizing
• raw water [pumped from a single well — 185 gpm]
• disinfection system (chlorination using sodium hypochlorite)
• two (2) each, circular 6 ft-diameter greensand filter tanks
• potable water air -stripper system
• one (1) flow meter for filter -backwash discharge
• two (2) each, 8 ft x 36 ft wastewater drying beds
• tablet dechlorination
these facilities located at the Middlesex Well No. 4 Water Treatment Plant (WTP), 10921 East
Finch Street, Middlesex, Nash County, and
2. discharge from said treatment works via Outfall 001, at a location specified on the attached
map, to an unnamed tributary (UT) to Turkey Creek [Stream Segment 27-86-3-(1)], a
waterbody currently classified C; NSW within Subbasin 03-04-07 [HUC: 03020203] of the
Neuse River Basin.
Page 2 of 6

NPDES Permit NCO087840
PART I
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[NCAC 0213.0400 et seq., 0213.0500 et seq.] WTP Class PC-1
During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is
authorized to discharge filter backwash via Outfall 001. Such discharges shall be limited, monitored and
reportedl by the Permittee as specified below:
EFFLUENT
CHARACTERISTIC
[PARAMETER CODES]
LIMITS
MONITORING REQUIREMENTS
MonthlyDail
Average
3'
Maximum
Measurement
Frequency
Sample
p
Type
am p
Sample
Location
Flow 2
50050
2/Month
Instantaneous
Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
Total Residual Chlorine
50060
17 µg/L 3
2/Month
Grab
Effluent
pH [standard units]
00400
Not < 6.0 or > 9.0
2/Month
Grab
Effluent
Turbidity (mg/L)
00070
2/Month
Grab
Effluent
Total Manganese (µg/L)
01055
Quarterly
Grab
Effluent
Total Nitrogen (TN) 4 (mg/L)
C0610
Semi-annually
Grab
Effluent
Total Phosphorus (TP) (mg/L)
I C0665
Semi-annually
Grab
Effluent
Footnote,.-
1. Beginning from the permit effective date, the Permittee shall report monthly discharge monitoring
data electronically using the NCDWR's Electronic Discharge Monitoring Report (eDMR) internet
application [See Section A. (2.) for eDMR submittal requirements].
2. Flow: Permittee shall record both flow rate and flow duration in log books; logs to be kept onsite
available for DWR inspection; Permittee shall report Total Daily Discharge in all monthly
DMRs/eDMRs.
3. The Division shall consider compliant all TRC effluent values reported below 50 µg/L. However,
the Permittee shall continue to record and submit all values reported by North Carolina -certified
test methods (including field certified), even if these values fall below 50 µg/L.
4. TN = TKN + NO3-N + NO2-N, where TN is Total Nitrogen, TKN is Total Kjeldahl Nitrogen, and
NO3-N + NO2-N are Nitrate and Nitrite Nitrogen, respectively.
Conditions:
All effluent samples shall accurately represent the physical and/or chemical character of the discharge.
The Permittee shall discharge no floating solids or foam visible in other than trace amounts.
There shall be no discharge of wastes or chemicals unrelated to responsible treatment of raw water.
A. (2.) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Page 3 of 6

NPDES Permit NC0087840
[G. S. 143-215.1(b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and
program reports. The final NPDES Electronic Reporting Rule was adopted and became effective on
December 21, 2015.
NOTE: This special condition supplements or supersedes the following sections within Part II of
this permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting Requirements [Supersedes Section D. (2.) and Section E. (5.) (a)1
The permittee shall report discharge monitoring data electronically using the NC DWR's
Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month
and submitted electronically using eDMR. The eDMR system allows permitted facilities to enter
monitoring data and submit DMRs electronically using the internet. Until such time that the
state's eDMR application is compliant with EPA's Cross -Media Electronic Reporting Regulation
(CROMERR), permittees will be required to submit all discharge monitoring data to the state
electronically using eDMR and will be required to complete the eDMR submission by printing,
signing, and submitting one signed original and a copy of the computer printed eDMR to the
following address:
NC DEQ / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the
facility being physically located in an area where less than 10 percent of the households have
broadband access, then a temporary waiver from the NPDES electronic reporting requirements
may be granted and discharge monitoring data may be submitted on paper DMR forms (MR 1,
1. 1, 2, 3) or alternative forms approved by the Director. Duplicate signed copies shall be
submitted to the mailing address above. See "How to Request a Waiver from Electronic
Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the month
following the issuance of the permit or in the case of a new facility, on the last day of the month
following the commencement of discharge.
Page 4 of 6

NPDES Permit NC0087840
Starting on December 21, 2020, the permittee must electronically report the following
compliance monitoring data and reports, when applicable:
Sewer Overflow/Bypass Event Reports;
Pretreatment Program Annual Reports; and
Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to Request a
Waiver from Electronic Reporting" section below).
2. Electronic Submissions
In accordance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at the
time of each electronic submission. The permittee should use the EPA's website resources to
identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated facilities means the
entity (EPA or the state authorized by EPA to implement the NPDES program) that is the
designated entity for receiving electronic NPDES data [see 40 CFR 127.2(b)].
EPA plans to establish a website that will also link to the appropriate electronic reporting tool for
each type of electronic submission and for each state. Instructions on how to access and use the
appropriate electronic reporting tool will be available as well. Information on EPA's NPDES
Electronic Reporting Rule is found at:
https://www.federalre.ig ster.gov/documents/2015/10/22/2015-24954/national-pollutant-
discharge-elimination-system-npdes-electronic-reporting-rule
Electronic submissions must start by the dates listed in the "Reporting Requirements" section
above.
3. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an
electronic reporting waiver, a permittee must first submit an electronic reporting waiver request
to the Division. Requests for temporary electronic reporting waivers must be submitted in
writing to the Division for written approval at least sixty (60) days prior to the date the facility
would be required under this permit to begin submitting monitoring data and reports. The
duration of a temporary waiver shall not exceed 5 years and shall thereupon expire. At such
time, monitoring data and reports shall be submitted electronically to the Division unless the
permittee re -applies for and is granted a new temporary electronic reporting waiver by the
Division. Approved electronic reporting waivers are not transferrable. Only permittees with an
approved reporting waiver request may submit monitoring data and reports on paper to the
Division for the period that the approved reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are found
on the following web page:
http://deq.nc. gov/about/divisions/water-resources/edmr
Page 5 of 6

NPDES Permit NC0087840
4. Signatory Requirements [Supplements Section B. (11.) (b) and Supersedes Section B. (11.)
All eDMRs submitted to the permit issuing authority shall be signed by a person described in
Part II, Section B. (11.)(a) or by a duly authorized representative of that person as described in
Part II, Section B. (11.)(b). A person, and not a position, must be delegated signatory authority
for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user
account and login credentials to access the eDMR system. For more information on North
Carolina's eDMR system, registering for eDMR and obtaining an eDMR user account, please
visit the following web page:
hllp://deq.ne.gov/about/divisions/water-resources/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall
make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF
CERTIFICATION WILL BE ACCEPTED:
V 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 fines and imprisonment for knowing violations. "
5. Records Retention [Supplements Section D. (6.)]
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR
submissions. These records or copies shall be maintained for a period of at least 3 years from the
date of the report. This period may be extended by request of the Director at any time [40 CFR
122.41].
Page 6 of 6

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO087840
Well No.4 WTP
OMB No. 2040-0004
U.S. Environmental Protection Agency
Form
1 SOMA
Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
SECTION
1. ACTIVITIES
REQUIRING AN r t
Applicants Not Required to Submit Form 7
Is the facility a new or existing publicly owned
1.1.2
Is the facility a new or existing treatment works
treatment works?
treating domestic sewage?
71.1.1
If yes, STOP. Dc NOT complete 0 No
If yes, STOP. Do NOT �r No
Form 1. Complete Form 2A.
complete Form 1. Complete
Form 2S.
Applicants Required to Submit Form 1
1.2.1
Is the facility a concentrated animal feeding
1.2.2
Is the facility an existing manufacturing,
E
operation or a concentrated aquatic animal
commercial, mining, or silvicultural facility that is
d
production facility?
currently discharging process wastewater?
cYes
4 Complete Form 1 No
Yes -* Complete Form ❑ No
a
and Form 28.
1 and Form 2C.
1.2.3
Is the facility a new manufacturing, commercial,
1.2.4
Is the facility a new or existing manufacturing,
mining, or silvicultural facility that has not yet
commercial, mining, or silvicultural facility that
—
commenced to discharge?
discharges only nonprocess wastewater?
6
Yes 4 Complete Form 1 No
Yes 4 Complete Form 0 No
and Form 2D.
1 and Form 2E.
1.2.5
Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stonnwater and
non-stormwater?
Yes 4 Complete Form 1 �✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b111M
SECTION
2. NAME,
MAILING ADDRESS, AND LOCATION (40
2.1
FacilityName
Middlesex Well No. 4 Water Treatment Plant (WTP)
0
2 22
EPA Identification Number
U
O
J
V
m
2.3
Facility Contact NIMPOIDWRNP
Name (first and last)
Title hone number
v
Luther lewis
[phone]
Q
o>
Email address
c
QT
d
2.4
Facility Mailing Address
E
R
Street or P.O. box
Z
P.O. Box 69
City or town
State
ZIP code
Middlesex
NC
27557
DES
EPA Form 3510-1 (revised 3-19) Page 1

EPA Identiff on Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO087840
Well No. 4 WTP
OMB No. 2040-0004
„ d
2.5
Facility Location
a `
Street, route number, or other specific identifier
10921 East Finch Street
ro
rn
g
County name
County code (if known)
Nash
- o
E
City or town
State ZIP code
z m
Middlesex
NC 27557
SECTION•r
1
31
SIC Code(s)
Description (optional)
N
N
a
0
U
u)
U
z
3.2
NAICS Code(s)
Description (optional)
v
A
U
fN
4.1
Name of 0 erator
William Lamm
`0
4.2
Is the name you listed in Item 4.1 also the owner?
E
0
❑ Yes ❑� No
=
4.3
Operator Status
❑ Public —federal ❑ Public —state ❑ Other public (specify)-
0
El Private ❑ Other (specify)
4.4
Phone Number of Operator
[phone]
4.5
Operator Address
Street or P.O. Box
M
E a
0
4700 Homewood Court Suite 108
3
City or town
State
ZIP code
o
Raleigh
NC
27609
ro
m
o
Email address of operator
O
[e-mail]
SECTIONr
' r l40
a �
5.1
Is the facility located on Indian Land?
�7
❑ Yes ❑° No
EPA Form 3510-1 (revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
NCO087840 Well No. 4 WTP OMB No. 2040-0004
SECTION• 1
6.1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each)
d
✓❑ NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
a
water)
Fluids)
02
5 E
w a
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify)
w
SECTION1
Have you attached a topographic map containing all required information to this application? (See instructions for
7.1
specific requirements.)
B Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 2B.)
SECTIONOF
I
8.1
Describe the nature of your business.
The Municipal treated water passes through presure sand filtration to remove oxidizes iron and manganese
pecipitant. The water then passes by an air stripper to remove VOC's before distribution to the customers. Water is
m
treated with sodium Hypoclorite wich is added for desinfection.
�
.y
During a filter backwash, the backwash water passes through a sand filter bed and the effluent is treated with
m
dechlorination tablets before being discharged to the outfall.
0
d
m
Z
SECTION••
I
Does your facility use cooling water?
9A
LD
❑ Yes ❑� No + SKIP to Item 10.1.
R
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
o
rn 2
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
O Y
O q
V C
SECTION
1 VARIANCE
10.1
REQUESTSI I
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
m
when.)
m
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Section 301(n)) 302(b)(2))
A
❑ Non -conventional pollutants (CWA j] Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
❑r Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

)ES Peak Number Facft Name I Form Approved 03105119
NC0097840 Well No.4 WTP OMB No. 20400004
11.1 In Column 1 below, made the sections of Form 1 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: Activities Requiring an NPDES Permit ❑ wl attachments
0 Section 2: Name, Mailing Address, and Location ❑ wl attachments
❑ Section 3: SIC Codes ❑ wi attachments
❑✓ Section 4: Operator Information ❑ wl attachments
Section 5: Indian Land ❑ wl attachments
❑✓ Section 6: Existing Environmental Permits ❑ wl attachments
g ❑✓ Section 7: Map ❑ wmal tepograp*❑ w/additional attachments
B
$ ❑✓ Section 8: Nature of Business ❑ wl attachments
❑✓ Section 9: Coding Water Intake Structures ❑ wl attachments
❑ Section 10: Variance Requests ❑ wl attachments
0 Section 11: Checklist and Certification Statement ❑ wl attachments
11.2 Certification Statement
ca
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 forgathering 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 for knowing viols lions.
Name (print or We first and last name) Official title
Lef.�c (hr��oti I,
Date signed
EPA Fria 3510.1 (revised 3-19) Page 4

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