NC0088749_Renewal (Application)_20231019

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
C J Ramey
Lissara Partners LLC
PO Box 10
Bethania, NC 27010
Subject: Permit Renewal
Application No. NCO088749
Lissara WWTP
Forsyth County
Dear Permiee:
NORTH CAROLINA
Environmental Quality
October 19, 2023
The Water Quality Permitting Section acknowledges the October 19, 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/perm it-guidance/environmental-appl ication-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,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
DEQ��
V
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes MITI Road SuHe 300 1 Winston-Salem North Carolina 2n05
336.776.9800

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
OCT 19 2023
NDDEQ/DWR/NPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO088749
Lissara WWTP7:1
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the instructions may result in denial of theapplication.)
SECTION
1, BASIC
APPLICATION IN FORMATION FOR ALL APPLICANTS (40 CFR 122.21 j)(1) and (9))
1.1
Facility name
Lissara WWTP
Mailing address (street or P.O. box)
PO Box 281
City or town
State
ZIP code
c
Lewisville
NC
27023
EContact
name (first and last)
Title
Phone number
Email address
0
Lang Wilcox
Manager
[phone]
[e-mail]
c
_ _
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
A
U-
9689 Wildflower Woods Way
— —
City or town
--
State
ZIP code
Lewisville
NC
27023
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 1.4.
Applicant name
=
Applicant address (street or P.O. box)
0
c
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
.n
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 ❑ Applicant ❑ Facility and 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
w
number for each.)_
€
Existing Environmental Permits
a
✓❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
:?
�
water)
control)
E
nICOO
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

--L
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO088749
Lissara WW1"P
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served _
Served
(indicate percents a)Ownership
100_ % separate sanitary sewer
0 Own 121 Maintain
250 (est.)
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own _ ❑ Maintain
^❑
_
_
_ % separate sanitary sewer
❑ Own Maintain
°
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
CL
0
CL
_
_
% separate sanitary sewer
❑ Own ❑ Maintain
% combined stomr and sanitary sewer
❑ Own ❑ Maintain
1O
❑ Unknown
❑ Own _ ❑ Maintain
d%
_
separate sanitary sewer ❑ Own ❑ Maintain
% combined stomi and sanitary sewer ❑ Own ❑ Maintain
co
r
❑ Unknown ❑ Own ❑ Maintain
°
_
Total
Population 250 (est.)
0
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
° �0 °
/0
Total percentage of each type of
sewer line in miles'
100
z'
1.8
Is the treatment works located in Indian Country?
'o
❑ Yes ✓❑ No
—
U
r-
1.9
—
Does the facility discharge to a receiving water that flows through Indian Country?
20
❑ Yes ❑✓ No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.054 mgd
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c 0
0.0073 mgd
0.0078 mgd
0.0081 mgd
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.0132 mgd
0.0161 mgd
0.0153 mgd
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
o
Total Number of Effluent Discharge Points b y Type
0- c
___
Combined Sewer
Constructed
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
Overflows
N_
Ca
1
0
0
0
0
RECEIVED
OAT � ;L
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO088749
Lissara WW7P
Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12
_
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes © No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im Location and Dischar a Data
_oundment
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
_
— Impoundment _
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
y
❑ Intermittent
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. -_
y
_^ Land A) lication Site and Discharge Data
u
o
c
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
a,
check one
y
—
acres
gpd
❑ Continuous
❑ Intermittent
acres
d
gpd
❑ Continuous
os
❑ Intermittent
-o
-_
acres
_
❑ Continuous
M
gpd
0 Intermittent
0
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes Q) No + SKIP to Item 1.21.
1.17
_
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant? —
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below._
Transport r 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
NC0088749
Lissara WUt/TP 7
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.—
Receiving F cilitv Data
a
_
Facility name
Mailing address (street or P.O. box)
d
0
City or town
State ZIP code
CnContact
name (first and last)
Title
0
Phone number
Email address
nNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
0
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
`0
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
a�
M
❑ Yes ❑✓ No 4 SKIP to Item 1.23,
0
1.22
Provide information in the table below on these other disposal methods.
d
Information on Other Disposal Methods
o
_ _
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
M
Description _
Vo_lume
_
acres
gpd
❑ Continuous
❑ Intermittent
acres
gpd
❑ Continuous
❑ 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.)
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑✓ Net 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
Contractor name
L & N Wastewater Managemer
%
(company name
o
Mailing address
5646 Hampton Road
c
street or P.O. box)
City, state, and ZIP
Clemmons, NC 27012
code
15
Contact name (first and
Crystal Messick
last)
Phone number
[phone]
Email address
[e-mail]
Operational and
Contractor is Operator in
maintenance
Responsible Charge of WWTP
responsibilities of
operations
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO088749 Lissara WN/TP Modified March 2021
SECTIONADDI I [UNAL INFORMATION1
o Outfalls to Waters of the State of North Carolina
C
2.1
Does the treatment works have a design flow greater than or equal to 0.1 rngd?
0
o
❑ Yes ❑ No -+ SKIP to Section 3.
0
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
and infiltration,
gpd
e
Indicate the steps the facility is taking to minimize inflow and infiltration.
c
cc
3
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
M CL
specific requirements.)
6 M
0
0
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
0 -
0
(See instructions for specific requirements.)
a�
ir .1°
o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
w
1.
c
E
—
2
c.
2.
E--
—
0
N
— --
3.
d
4.
2.6
Provide scheduled or actual dates of completion for improvements. _
Scheduled
or Actual Dates of Completion for Im rovements
d
>
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
CL
Improvement
(list outfal
Construction
Construction
Discharge
level
E
(from above)
number)
(MNI/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DDIYYYY
a
ar
m
—
t
v
Cn
2,
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response,
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NCO088749 Lissara WWTP Modified March 2021
SECTION•' • ON 1
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
North Carolina
County
Forsyth
City or town
Lewisville
0
c
Distance from shore
NA ft.
a
Depth below surface
NA ft.
c
Average daily flow rate
0.0081 mgd
mgd
mgd
Latitude
36° 06' 58.8" N
"
Longitude
80° 27' 30.4" W
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c
❑ Yes No + SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
t
Outfall Number
Outfall Number
Outfall Number
c
Number of times per year
o
discharge occurs
a
Average duration of each
o
discharge (specify units
c
Average flow of each
mgd
mgd
mgd
g
discharge
Months in which discharge
occurs
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 type at each applicable outfall.
CL
Outfall Number
Outfall Number
Outfall Number
d
0
c
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
3
❑✓ Yes ❑ No +SKIP to Section 6.
Page 6

— NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0088749
Lissara WWTP
Modified March 2021
3.7
Provide the receivinc, water and related information if known for each outfall.
Outfall Number
Outfall Number
Outfall Number
Receiving water name
Yadkin River
Name of Watershed, river,
Yadkin Pee -Dee Basin
0
or stream system
U.S. Soil Conservation
—
Service 14-digit watershed
HUC 12-030401011203
o
code
'6
Name of state
Yadkin Pee -Dee Watershed
management/river basin
U.S. Geological Suney
8-digit hydrologic
03040101
°'
catalo in 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 followinn information
describing the treatment pr vided for discharges from each outfall.
Outfall Number 1
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
0 Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ ,Advanced
❑ Advanced
❑ Other (specify)
❑ other (specify)
❑ Other (specify)
c
Q
Design Removal Rates by
Outfall
d
BOD5 or CBODs
90 %
%
%
c
d
—
E
—
m
TSS
90 %
%
%
© Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
ova
® Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
o
�o
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Fecal Coiiform
99 %
%
%
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO088749
Lissara WWTP
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
o
Ultra -violet light disinfection with chlorination/dechlorination back-up system
m
c
c
0
o
Outfall Number 1
Outfall Number
Outfall Number
�-
Disinfection type
Tablet chlorination
m
0
Seasons used
All
d
E
w
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
[Z] Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
✓❑ Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes © No + SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
R
Number of tests of discharge
o>
5
water
Number of tests of receiving
water
d
LU
w
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
© Yes + 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 ❑ 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 ZA
NCO088749
Lissara WWTP
Modified March 2021
3.19
Has the PQTW 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 + Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DDN-m
c
c
0
�
3.22
Regardless of how you provided our WET testing data to the NPDES permitting authority, did an of the tests result in
9 Y P Y 9 P 9 tY� Y
c
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
c
m
3
W
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes [ 1 No i SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes © Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NCO088749 Lissara WWTP Modified March 2021
SECTION• 1
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
w/ variance request(s) ❑ wl additional attachments
Informationforfor All A licants
❑ Section 2: Additional
❑ w/ topographic map ❑ w/ process flow diagram
Information
❑ w/ additional attachments
© w/ Table A © w/ Table D
❑ Section 3: Information on
© w/ Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ w/ Table C
-S
rn
Section 4: Not Applicable
c
0
Section 5: Not Applicable
d
c.�
M
R
Section 6: Checklist and
❑ w/ attachments
w
Certification Statement
LA
s
6.2
Certification Statement
1 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
Lang Wilcox
Manager
Signature
Date signed
J/
RECEIVED
OCT 19 2023
NCDEQ/DWR/NPDES
Page 10

NPDES Permit Number Fa&q Name Outlal Number Modified Application Fom 2A
NC0088749 Lissara W WTPT 1 Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytica)
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Method'
(include units)
Samples
Biochemical oxygen demand
m BODs or ❑ CBODs
46.6
8.77
31
2.0 me 0 ML
0 MDL
(report one
me
me
SM5210 B-2011
Fecal coifoun
2419.E
/100 ml
2.72
/100 ml
31
❑ r,C
O rIDL
Design flow rate
0.108
MGD
0.0077
MGD
31
�^
pH (minimum)
6.6
pH (maximum)
8.8
Temperature (winter)
6
deg C
9.3
deg C
31
Temperature (summer)
28.2
deg. C
20.6
deg. C
31
Total suspended Solids (TSS)
66.28
m g/I
10.63
mg/I
31
SM2540 D-2011
O ML
❑ MDL
r 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

-T-
EPA Identi6caton Number NPUES PertnR Number Facility Name Outfall Number Modified Application Form 2A
N00088749 Ussara WWTP 1 Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Value
Units
Number of
Pollutant
Method'
(include units)
Samples
Ammonia (as N)
44.0
mg/I
25.8
mg/I
31
❑ ML
❑ MDL
Chlorto10
tal (ne rCl
esidual TRC
26
ug/I
11.7
ug/1
31
t7 ML
MDL
Dissolved oxygen
10.6
mg/I
7.2
mg/I
31
❑ ML
❑ MDL
Nitratetnitrite
t7 ML
❑ MDL
KjeldahI nitrogen
❑ ML
❑ MDL
Oil and grease
13 ML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
❑ ML
0 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 1, 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.
EPp Form 3510-2A (Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Oudall Number Modified Application Form 2A
NC0088749 Lissara WWTP
Modified March 2021
Maximum Daily Discharge Average Dully Discharge
Analytical ML or MOL
Pollutant
Method' (include units)
Number of
Value
Units Value
Units
Samples
Metals, Cyanide, and Total Phenols
Hardness (as, CaCO3)
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑MDL
Arsenic, total recoverable
❑ ML
❑ MD
Beryllium, total recoverable
❑ ML
❑MDL
Cadmium, total recoverable
❑ ML
❑M L
Chromium, total recoverable
❑ ML
❑MDL
Copper, total recoverable
❑ ML
❑MDL
Lead, total recoverable
❑ ML
❑MDL
Mercury, total recoverable
p 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
OML
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ ML
❑ MDL
Arxylonitrile
O ML
❑MDL
Benzene
❑ ML
❑ MDL
Bromoform
❑ ML
❑MDL
EPA Form 351D•2A (Revised 3-19)
RECEIVED
OCT 19 2323
NCDEQ/DWR/NPDES
Page 13

EPA Identification Number NPDES Permd Number Facility Name OLttall Number Modified Application Form 2A
FNC0088749 Lissara WWTP
Modified March 2021
•• ••
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
Value
Units
Value
UnitsSamples
Number of
Carbon tetrachloride
❑ ML
❑MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑MDL
Chlorcethane
❑ ML
❑M L
2-chloroethylvinyl ether
° ML
_ ❑MDL
Chloroform
❑ ML
❑MDL
Dichlorobromomethane
❑ ML
❑MDL
1,1-dichloroethane
_
❑ ML
❑ Iu1Dl
1,2-dichloroethane
❑ ML
❑MDL
trans-1,2•dichloroettlylene
❑ ML
❑MDL
1,1-dichloroethylene
13 ML
❑MDL
1,2-dichloropropane
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑M L
Ethylbenzene
❑ ML
❑ MD1.
Methyl bromide
El ML
❑MDL
Methyl chloride
13 ML
❑ MDL
Methylene chloride
❑ ML
❑MDL
1,1,2,2-tetrachloroethane
❑ ML
❑MDL
Tetrachloroethylene
❑ ML
❑MDL
Toluene13
ML
❑ MDL
1, 1, 1 -trichloroethane
❑ ML
❑MDL
1,1,2-triehloroethane
❑ ML
❑ MD
EPA Form 3510.2A (Revised 3.19) Page 14

EPA (dent fication Number NPDES Permit Number Facility Name Outfail Nunter Modified Application Firm 2A
T-NCAO88749 Lissara WWTP
Modified March 2021
Maxima n Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
value
Unite
Value
Units
Numberof
Samples
Trichloroethylene
q ML
q MDL
Vinyl chloride
❑ ML
❑ MDL
Acid•Extractable Compounds
p-chloro-m-,cresol
q ML
q MDL
2-chlorophenol
q ML
q MDL
2,4-dichlorophenol
q ML
❑ MDL
2,4-dimethylphenol
q ML
❑MDL
4,6-dinitro-o-cresol
q ML
❑MDL
2,4-dinitrophenol
q ML
aM L
2-nitrophenol
_
❑ ML
❑MDL
4-nitrophenol
❑ ML
q MDL
Pentachlorophenol
El ML
q MDL
Phenol
q ML
❑ MDL
2,4,6-tdchlorophenol
q ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
q ML
❑ MDL
Acenaphthylene
q ML
❑MDL
Anthracene
❑ ML
❑ MDL
Benzidine
q ML
❑ MDL
Benzo(a)anthracene
q ML
❑ MDL
Benzo(a)pyrene
q ML
O MDL
3,4-benzofluoranthene
q ML
aM
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Idenlificatlon Number NPDES Permit Number Facility Name Qutfall Number Modified Application Form ZA
N00088749 U.I. WWTP
Modified March 2021
•• a ••
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
Value
Units
Vglue
Units
Number of
Samples
Benzo(ghi)perylene
❑ ML
❑MDL
Benzo(k)tluoranthene
❑ ML
❑MDL
Bis (2-chloroethoxy) methane
❑ ML
❑MDL
Bis (2-chloroethyl) ether
ML
❑ MDL
Bis (2-chkxoisopropyl) 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
ID ML
❑MDL
di-n-butyl phthalate
❑ ML
❑MDL
di-n-octyl phthalate
❑ML
MDL
Dibenzo(a,h)anthracene
❑ ML
O MDL
1,2-dichlorobenzene
❑ ML
p 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
o ML
❑ MDL
2,6-dinitrototuene
EI ❑MDL ML
EPA Form 3510-2A (Revised 3-19) Page 16

EP,; Identification Number NPDES Permit Number Facility Name Ougall Number Modified Application Form 2A
NCO088749 Lissara WWrP Modified March 2021
�LUENT PARAMETERS
FOR
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Method'
(include units)
Value
Units
Value
Units
Number of
Sampies
1,2-diphenylhydrazine
O ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML_
0 MDL
Hexachlorobutadiene
O ML
❑ MDL
Hexachlorocyclo-pentadiene
O ML
❑ MDL
Hexachloroethane
O ML
O MD
_
Indeno(1,2,3-cd)pyrene
O ML
❑ MOL
isophorone
O ML
❑ MDL
Naphthalene
O ML
❑ MDL
Nitrobenzene
O ML
O MDL
N-nitrosodi-n-propylamine
O ML
❑ MDL
N-nhrosodimethylamine
O ML
O MDL
N-nhrosodiphenylamine
O ML
O MD
Phenanfhrene
❑ MLO
MDL
Pyrene
O ML
❑MDL
1,2,4-tdchlorobenzene
O ML
❑ MDL
1 Sampling shail 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], Subchapter Nor 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19) Page 17

NPDES Permit Number Facility Name Outiall Number Modified Application Form 2A
N00088749 Lissara WWTP 1 Modified March2021
�•• • •• • • •• 1 ••
7Maximum DailyDischa a Average DailyMachuIla
Pollutant
Analytical ML or MDL
Number of
At) Value Units Value Unita
Method' (include units)
Sam les
❑ No additional sampling is required by NPDES permitting authority.
Chlorine(TRC)
26
ug/I
11.7
ug/i
31
❑ML
❑ MDL
NH3-N
44.0
mg/I
25.8
mg/I
31
❑ML
❑ MDL
Dissolved Oxygen
20.6
mg/I
7.2
mg/I
31
❑ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
El MDL
❑ ML
❑ MDL
❑ML
0MDL
❑ 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