NC0081281_Renewal (Application)_20231220

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Steven King
Richmond County
118 Vance St
Hamlet, NC 28345
Subject: Permit Renewal
Application No. NCO081281
Richmond County WTP
Richmond County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
December 20, 2023
The Water Quality Permitting Section acknowledges the December 20, 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://deg. 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,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
E North Carolina Department of Environmental Quality I Division of Water Resources
Fayetteville Regional Office 1 225 Green Street. Suite 714 1 Fayetteville, North Carolina 28301
"'�� 91OA33.3300

Richmond County Water Treatment
Facility
"; � 326 Old Charlotte Hwy.
Rockingham, North Carolina 28379
�P
"Protecting Our Water Resources"
December 12, 2023
Lee P. Butler
Facility ORC
Phone: [phone]
Fax:[phone]
Carolina Robinson, Environmental Specialist II
Division of Water Resources
North Carolina Department of Environmental Quality
Reference Subject: Permit NCO081281 Renewal
RECEIVED
DEC 2 0 2023
NCDEO/DWR/NPDES
I'm sending the completed material specified to complete the review of my application for the
renewal of our existing NPDES permit NC0081281. I have received the Waiver of Monthly
Reporting Requirement and appreciate all the assistance with getting that in place. As per our
discussion regarding this, because of the reclaim ability of our system we have had no discharge
for several years and as such have not been able to collect samples for lad analysis. So much of
the data necessary to complete sections of the renewal forms are not available. All other
sections were completed and will hopefully be adequate for the permit renewal process.
Again, I appreciate all the assistance you gave with this and have included with the permit
renewal package, 2 copies of the package as requested. I also apologize the delay in getting this
permit renewal application completed and to you by the original timeline and your leniency
with this matter.
Please let us know if there is any other information or questions you may have.
Sincerely,
Lee P. Butler, Richmond CountyORC
Rockingham, NC

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No. 2040-0004
Form
U.S. Environmental Protection Agency
1
�-0EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
SECTION•NPDES
1.1
Applicants Not Required to Submit Form 1
1.1.1
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?
If yes, STOP. Do NOT complete No
If yes, STOP. Do NOT No
Form 1. Complete Form 2A.
complete Form 1. Complete
Form 2S.
1.2
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,
operation or a concentrated aquatic animal
commercial, mining, or silvicultural facility that is
a
production facility?
currently discharging process wastewater?
o❑
Yes 4 Complete Form 1 No
Yes -+ Complete Form No
a
and Form 26.
1 and Form 2C.
z
C
1.2.3
Is the facility a new manufacturing, commercial,
1.2.4
Is the facility a new or existing manufacturing,
cM
mining, or silvicultural facility that has not yet
commercial, mining, or silvicultural facility that
commenced to discharge?
discharges only nonprocess wastewater?
Yes 4 Complete Form 1 No
Yes Complete Form 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
Q
associated with industrial activity or whose
discharge is composed of both stormwater and
non stormwater?
Yes •+ Complete Form 1 ❑✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b 15).
SECTIONADDRESS,
• •
2.1
Facility Name
Richmond County Water Treatment Facility
`0
2.2
EPA Identification Number
O
J
2.3
Facility Contact
Name (first and last)
Title
Phone number
Q
Lee P. Butler
Facility Superintendent
[phone]
C
Email address
-
[e-mail]
d
2.4
Facility Mailing Address
ZStreet
or P.O. box
326 Old Charlotte Highway
City or town
State
ZIP code
Rockingham
North Carolina
28379
EPA Form 3510-1 (revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No. 2040-0004
u 'S
2.5
Facility Location
Street, route number, or other specific identifier
Q 0
326 Old Charlotte Highway
rn
c
County name
County code (if known)
Richmond
£
City or town
State ZIP code
z
Rockingham
NC 28379
SECTION••
t
3.1
SIC Code(s)
Description (optional)
4941
Water Supply
N
N
O
0
U
N
U
Z
3.2
NAICS Code(s)
Description (optional)
U
NA
NA
U)
4.1
Name of Operator
Bryan R. Land
`0_
4.2
Is the name you listed in Item 4.1 also the owner?
❑✓ Yes ❑ No
z
4.3
Operator Status
0
❑ Public —federal ✓❑ Public —state ❑ Other public (specify)
❑ Private ❑ Other
(specify)
4.4
Phone Number of Operator
[phone]
4.5
Operator Address
Street or P.O. Box
R
E
PO Box 504
A
City or town
State
ZIP code
0 0
is
Rockingham
NC
28380
o
Email address of operator
O
[e-mail]
SECTION
5.1
Is the facility located on Indian Land?
❑ Yes El No
EPA Form 3510-1 (revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name
Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water
OMB No.2040-M
SECTION-•
1
6.1 Existing Environmental Permits (check
all that apply and print or type the corresponding permit number for each)
d
m NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
c
w
water)
fluids)
20
NCO081281
1+ a
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
r
0
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ElOther (specify)
SECTION1
7.1
Have you attached a topographic map containing all required information to this application? (See instructions for
W
specific requirements.)
❑✓ Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 2B.)
SECTIONOF
1
8.1
Describe the nature of your business.
Water is pulled from a reservoir on the Pee Dee river, is treated in a conventional gravity treatment plant with
filtration and disinfection for distribution to customers throughout the county as potable water.
d
m
0
Z
/� GlU 6 W M J ;�
COOLING1
9.1
Does your facility use cooling water?
d
❑ Yes ✓❑ No 4 SKIP to Item 10.1.
o
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
2
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
cY
NPDES permitting authority to determine what specific information needs to be submitted and when.)
U c
SECTION1
VARIANCE
REQUESTS1 1
10.1
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
n
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Section 301(n)) 302(b)(2))
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
❑✓ Not applicable
EPA Form 3510-1 (revised 3.19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NC0081281
Richmond County Water
OMB No. 2040-0004
SECTION•
11.1
In Column 1 below, mark 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
0 Section 1: Activities Requiring an NPDES Permit
❑ w/ attachments
0 Section 2: Name, Mailing Address, and Location
❑ w/ attachments
0 Section 3: SIC Codes
❑ wl attachments
0 Section 4: Operator Information
❑ w/ attachments
❑ Section 5: Indian Land
❑ w/ attachments
❑✓ Section 6: Existing Environmental Permits
❑ wl attachments
ro
❑✓ Section 7: Map
❑ ❑ w/ additional attachments
matopographic
c
✓❑ Section 8: Nature of Business
❑ w/ attachments
❑ Section 9: Cooling Water Intake Structures
❑ w/ attachments
❑ Section 10: Variance Requests
❑ w/ attachments
c
0 Section 11: Checklist and Certification Statement
❑ wl attachments
e
11.2
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. 1 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
Lee Butler
Facility Superintendent
Signature
Date signed
M „ IdodJ
EPA Form 3510-1 (revised 3-19) Page 4

RICHMOND COUNTY WATER TREATMENT PLANT
OPERATIONS AND MAINTENANCE
WATER TREATMENT PLANT
SURFACE WATER SUPPLY
Prchminan-Irc.nmr�H
1 lntalc¢
I. kt... 2 J
J
`
11"vdivc Travelling
Chrm.cnl ' 11
" Par 1V4W
Screen Semen
4 Low la/t Pump 11c1 l
Coa ulrnts
Anthtacitc
r-t
_ i. _..
Sand - f.
- `"- -"--
•
7FWc bhon
6C—gulation
• .�Gravc6,
8 W. inw,xatien Basin
1'od- 9Sand rmtration
Inrinttion
F•le,oled 1\'aler
•lunridalion
Storage kmvr
13 Hi .h hfi I'um i Well 1
14b Ground Le-wl
10
(
'
Rcxrv,ar
Clear
To ni.lriLmlion Sy�lrm
• 1 Intake Crib
Raw water from a surface water lake or reservoir is drawn into the plant through
intake structures. Large debris like logs are prevented from entering the intake.
• 2 & 3 Screens
Smaller debris like fish, vegetation and garbage are removed from the raw water
by protective screen before the water enters the low lift pumps and are cleaned
with forced air blowback.
• 4 Raw Water Pump Station
4 raw pumps are used to lift the water to the treatment plant which then flows
through the treatment processes by gravity.
• 5 Ph and Alkalinity Adjustment
Calcium Hydroxide is added to raise the pH and alkalinity to aid in coagulation.
The specific processes used have been determined by the chemical and biological
raw water characteristics.
• 6 Coagulation
Coagulants, rapidly add electrochemical charges that attract the small particles in
water to clump together as a "floc". This initial charge neutralization process
allows the formed floc to agglomerate but remain suspended. Polyelectrolyte is
also added for better floc formation.
• 7 Flocculation
By slower mixing, turbulence causes the flocculated water to form larger floc
particles that become cohesive and increase in mass. This visible floc is kept in
suspension until large enough to settle under the influence of gravity.
3

RICHMOND COUNTY WATER TREATMENT PLANT
OPERATIONS AND MAINTENANCE
• 8 Sedimentation
Flocculated water is applied to large volume tanks where the flow speed slows
down and the dense floc settles. Settled floc is removed and treated as a waste
product that is discharged to the sewer system.
• 9 Media Gravity Filtration
Relatively floc free, settled water flows through a media filter by gravity. Filter
media are made from layers of anthracite or granular activated carbon and sand.
Gravel or synthetic materials support the media. Physical straining removes the
remaining floc. Filters are periodically backwashed to clean off accumulated floc
and other trapped impurities.
• 10 Clear Well
Filtered water in the clear well is used to backwash filters and kept in storage to
ensure that disinfectants are in contact with the water long enough to inactivate
disease causing organisms.
• 11 Secondary Disinfection
Supplemental chlorine is added to maintain disinfection concentrations while the
water is pumped through the distribution system. The purpose is to ensure
minimum residual disinfectant levels at the farthest points of the system.
• 12 Fluoridation
A process where fluoride compounds are added to treated drinking water to
artificially raise the fluoride concentration to within a specified range; for
example between 0.5 to 0.7 mg/L (ppm). Fluoridation is an optional public health
dental policy.
• 13 High Lift Pump Well
Treat drinking water is pumped through large pressure pumps to other pumping
stations, reservoirs or points of supply within the local distribution system.
• 14a & 14b Elevated Water Storage Towers and Ground Level Reservoirs
Water distributed to water towers and storage reservoirs ensures stable water
pressure. An adequate supply of water is maintained to meet peak water demands
or emergencies such as fires, water main breaks, power outages and pump
failures.
• Distribution System
Distribution systems are comprised of large pipes known as trunk mains to deliver
drinking water. Smaller diameter branch mains feed individual streets. Service
connections to branch mains deliver water into residences. Pumping stations are
used to increase pressure and to maintain adequate supply flows.
4

"— j`�-'�' j �,� Blewitt Falls Road
0
Approximate Property Perimeter
4000
0000 Outfall 001
�•l.�f' ,, �..` .� L; i1� (Flows south) f
Old Charlotte 1-1 WY � �( �r� „ c N.
I
UT to Pee Dee River )• ='� '�
f
llyyl 1i� �ti��l Tel ,11; �� , i, • • -� `S ' /+
,
' it `• '� %'r �"-�_/� �_�/ram �'-� �`_ �,'/� ' � 1 4 t
US Hwy 74
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7�' - r
30 ;s� �� t� - Zion Church Road
C
Richmond County
Richmond County WTP
Facilit y
Location
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::
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S1rmm (.limm:
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not to scale
ladrindr,:
34, SIN 10, , 1.r�neund 79' 5W 20" w
`+na13min;
4)3-077..Ih 111 (: 03040201
Sink Grirl,'Dwid:
llis)ih Rockingham Sirr.am:S awns: 13-(34)
?North
NPDES Permit NCO081281
Rmeinina5lrrnm 1 T to PL%� llec Rner Dminaer I•la.sin: Yadkin -Pee Ike
Richmond County

IV
4A
moo
1w
T

Clearwell Finished
Water Storage
Average 4.5 MGD
4.]
�lchmand Cgunt/ W]Tfp
4 Pump Raw
Pump Station
12 MGD
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U
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v �
Rapid Sand Filters
4-1
m kx/Coagule"tion ✓�
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V) =
Sedimentation basins
@450 Rpm x 8 basins
v Filter Backwash 10,000 gpd
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Q) oo Supernatant reclaim water
Y -
3 Sludge Thickeners
Outfsli oo_
MA
O
N
4-
N

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009842466 NC0081281 Richmond County Water OMB No. 2040-M
Form U.S. Environmental Protection Agency
2C \"% EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTIONOUTFALL LOCATION
1.1 Provide information on each of the facility's outfalls in the table below.
`all
o Number Receiving Water Name Latitude Longitude
0
001 Pee Dee River 34° 58' 20" N 79° 50' 20" W
is
O
SECTION1- t
o, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
3 balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J `
o
T❑ Yes ❑ No
SECTION• 1 1
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
"Outfall Number" 001
Operations
Operation Average Flow
Conventional water treatment facility .200 mgd
C
e
E Non -potable Claricone water production .050 mgd
a,
mgd
v
c
mgd
Treatment Units
U.
o, Description Code from Final Disposal of Solid or
m (include size, flow rate through each treatment unit, Liquid Wastes Other Than
a
retention time, etc. Table 2C-1 by Discharge
Flocculation 1-G Landfill, Land Application
Coagulation 2-D Landfill, Land Application
Multimedia Filtration 1-Q Landfill, Land Application
Sedimentation 1-U Landfill, Land Application
EPA Form 3510-2C (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No 2040-0004
3.1
**Outfall Number** 001
cont.
Operations Contributing
to Flow
Operation
Average Flow
Residuals Management
.001 mgd
mgd
mgd
mgd
Treatment
Description
Units
Code from
Final Disposal of Solid or
(include size, flow rate through each treatment unit,
Table 2C-1
Liquid Wastes Other Than
retention time, etc.)
by Discharge
Gravity Thickener
5-1-
Landfill, Land Application
c
Belt Filtration
5-C
Landfill, Land Application
0
U
c
m
E
m
m
H
**Outfall Number** 001
R
y
Operations Contributing to Flow
0
Operation Average Flow
LL-
Effluent Reuse/Recycle
0 mgd
m
<
mgd
mgd
mgd
Treatment
Description
Units
Code from
Final Disposal of Solid or
(include size, flow rate through each treatment unit,
Table 2C-1
Liquid Wastes Other Than
retention time, etc.)
by Discharge
Reuse/Recycle of Treated Effluent
4-C
Reclaim to Claricone System
3.2
Are you applying for an NPDES permit to operate a privately owned treatment works?
d
❑ Yes ✓❑ No 4 SKIP to Section 4.
Cn M
3.3
Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C (Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-0004
SECTION• r
4.1 Except for storm runoff, leaks, or spills, are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.2
Provide information
on intermittent
or seasonal flows for
each applicable outfall.
Attach additional paqes, if n
cessary.
Outfall
Operation
Freq
uency
Flow
Rate
Average
Average
Long -Term
Maximum
Number
(list)
Duration
Da sMeek
MonthsNear
Avera a
Dail
daystweek
monthstyear
mgd
mgd
days
�+
3�
clays/week
monthstyear
mgd
mgd
days
daystweek
months/year
mgd
mgd
days
daystweek
monthstyear
mgd
mgd
days
c
daystweek
monthstyear
mgd
mgd
days
days/week
monthstyear
mgd
mgd
days
days/week
monthstyear
mgd
mgd
days
daystweek
monthstyear
mgd
mgd
days
daystweek months/year mgd mgd days
SECTION•••D
• r
5.1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ✓❑ No 4 SKIP to Section 6.
to
5.2
Provide the following information on applicable ELGs.
w
ELG Category
ELG Subcategory
Regulatory Citation
d
u
.n
0.
a
5.3
Are any of the applicable ELGs expressed in terms of production (or other measure of operation)?
❑ Yes ❑ No 4 SKIP to Section 6.
0
w
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J
Outfa
Operation, Product, or Material
Quantity per Da y
Unit of
Number
Measure
h
W
m
C
O
V
7
O
a
EPA Form 3510-2C (Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009842466 NC0081281 Richmond County Water OMB No. 204DMN
SECTION-• r
6.1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑✓ No 4 SKIP to Item 6.3.
6.2
Briefly identify each applicable project in the table below.
Affected
Final Compliance Dates
E
Brief Identification and Description of
Outfalls
Source(s) of
'o
Project
(list outfall
Discharge
Required
Projected
o.
number
E
o
A
d
CL
n
6.3
Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (optional item)
❑ Yes ❑ No ✓❑ Not applicable
SECTIONr
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
complete. Not all applicants need to complete each table.
Table A. Conventional and Non -Conventional Pollutants
7.1
Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ❑✓ No 4 SKIP to Item 7.3.
7.2
If yes, indicate the applicable outfalls below. Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3
Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
requested and attached the results to this application package?
No; a waiver has been requested from my NPDES
❑ Yes ❑permitting
E
authority for all pollutants at all outfalls.
Table B.
Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
c
listed in Exhibit 2C-3? (See end of instructions for exhibit.)
C
❑ Yes ❑ No 4 SKIP to Item 7.8.
7.5
Have you checked "Testing Required" for all toxic metals, cyanide, and total phenols in Section 1 of Table B?
w
❑ Yes ❑ No
7.6
List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified
in Exhibit 2C-3.
Primary Industry Category
Required GCIMS Fraction(s)
Check applicable boxes.
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
EPA Forth 3510-2C (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No. 2040-0004
7.7
Have you checked 'Testing Required" for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8
Have you checked 'Believed Present" or "Believed Absent' for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑ Yes ❑ No
7.9
Have you provided (1) quantitative data for those Section 1, Table B, pollutants for which you have indicated testing is
required or (2) quantitative data or other required information for those Section 1, Table B, pollutants that you have
indicated are "Believed Present' in your discharge?
❑ Yes ❑ No
7.10
Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑ No
then SKIP to Item 7.12.
7.11
Have you provided (1) quantitative data for those Sections 2 through 5, Table B, pollutants for which you have
c
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
pollutants you have indicated are "Believed Present' in your discharge?
❑ Yes ❑ No
0
Table C. Certain Conventional and Non -Conventional Pollutants
ff
7.12
Have you indicated whether pollutants are 'Believed Present' or "Believed Absent" for all pollutants listed on Table C
49
for all outfalls?
❑ Yes ❑ No
7.13
Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
`Believed Present'?
c
❑ Yes ❑ No
w
Table D. Certain Hazardous Substances and Asbestos
7.14
Have you indicated whether pollutants are "Believed Present" or "Believed Absent" for all pollutants listed in Table D for
all outfalls?
❑ Yes ❑ No
7.15
Have you completed Table D by (1) describing the reasons the applicable pollutants are expected to be discharged
and (2) by providing quantitative data, if available?
❑ Yes ❑ No
Table E. 2,3,7,8-Tetrachlorodibenzo- -Dioxin 2,3,7,8-TCDD
7.16
Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions, or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑ No 4SKIP to Section 8.
7.17
Have you completed Table E by reporting qualitative data for TCDD?
1
❑ Yes ❑ No
SECTIONOR
MANUFACTURED TOXICSi
8.1
Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
d
an intermediate or final product or byproduct?
❑ Yes ❑ No 4 SKIP to Section 9.
,n
8.2
List the pollutants below.
c
1. 4. 7.
Fc
0
d
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-M
SECTION• • • 1 ,
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on (1) any of your discharges or (2) on a receiving water in relation to your discharge?
•, ❑ Yes ❑ No 4 SKIP to Section 10.
w
9.2
Identify the tests and their
Durposes below.
Test(s)
Purpose of Test(s)
Submitted to NPDES
Date Submitted
o
Permitting Authority?
0
M
❑ Yes ❑ No
co
0
m0
❑ Yes ❑ No
❑ Yes ❑ No
SECTION•
•, i
10.1
Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑ Yes ❑ No 4 SKIP to Section 11.
10.2
Provide information for each contract laboratory or consulting
firm below.
Laboratory Number 1
Laboratory Number 2
Laboratory Number 3
Name of laboratory/firm
Laboratory address
a
Phone number
Pollutant(s) analyzed
SECTION••
• •- •
11.1
Has the NPDES permitting authority requested additional information?
o
❑ Yes ❑ No 4 SKIP to Section 12.
E
11.2
List the information requested and attach it to this application.
0
1. 4.
0
0
2. 5.
a
3. 6.
EPA Form 3510-2C (Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-0004
SECTION
12. CHECKLIST
AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
12.1
In Column 1 below, mark the sections of Form 2C 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 com fete all sections or provide attachments.
Column 1
Column 2
❑✓ Section 1: Outfall Location
✓❑ w/ attachments
❑✓ Section 2: Line Drawing
✓❑ w/ line drawing ❑ w/ additional attachments
Section 3: Average Flows and
w/ list of each user of
❑ w/ attachments ❑ privately owned treatment
Treatment
works
❑ Section 4: Intermittent Flows
❑ w/ attachments
❑ Section 5: Production
❑ w/ attachments
w/ optional additional
❑ Section 6: Improvements
❑ w/ attachments ❑ sheets describing any
additional pollution control
tans
❑ w/ request for a waiver and ❑ wl explanation for identical
supporting information outfalls
m
w/ small business exemption
❑ ❑ w/ other attachments
request
I
❑ Section 7: Effluent and Intake
❑ wl Table A ❑ w/ Table B
Characteristics
0
❑ w/ Table C ❑ wl Table D
❑ wl Table E ❑ w/ analytical results as an
attachment
Section 8: Used or Manufactured ❑
❑ w/ attachments
h
Toxics
32
Section 9: Biological Toxicity
❑ w/ attachments
•
r
Tests
c.�
❑ Section 10: Contract Analyses
❑ w/ attachments
❑ Section 11: Additional Information
❑ wl attachments
Section 12: Checklist and
❑ w/ attachments
Certification Statement
12.2
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
Lee Butler
Facility Superintendent
Signature
Date signed
4
'—�40
1211112023
EPA Form 3510-2C (Revised 3-19) Page 7

A Iaennncanon NUmoer Nruto rermii Numoer raahty Name Outfall Number Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water 1 001 1
OMB No. 2040-0004
TABLE
A. CONVENTIONAL AND NON
CONVENTIONAL
POLLUTANTS (40 CFR
122.21 (g)(7)(iii))
Effluent
Intake
Pollutant
Waiver
Requested
Units
o tional
Maximum
Maximum
Long -Term
(if applicable)
(spy)
Daily
Monthly
Average Daily
Number of
Long -Term
Number of
Discharge
Discharge
Discharge
Analyses
Average Value
Analyses
(required)
if available
if available
❑
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1'
Biochemical oxygen demand
❑
Concentration
Mass
(BOD5)
2'
Chemical oxygen demand
El
Concentration
Mass
(COD)
Concentration
3.
Total organic carbon (TOC)
❑
Mass
Concentration
4.
Total suspended solids (TSS)
❑
Mass
Concentration
5.
Ammonia (as N)
❑
Mass
6.
Flow
❑
Rate
Temperature (winter)
❑
°C
°C
7.
Temperature (summer)
❑
°C
°C
pH (minimum)
❑
Standard units
S.U.
8.
pH (maximum)
❑
Standard units
S.U.
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 3510-2C (Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Outfall Number form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-0004
Presence or Absence
Intake
check one Effluent
(optional)
Pollutant/Parameter Testing Units Long -Term
Maximum Maximum Long-
(and CAS Number, if available) Required Believed Believed (specify) Average Number Number
Daily Monthly Term
Present Absent
Discharge Discharge Daily of Average of
(required) (if available) Discharge Analyses Value Analyses
f available
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.1
Antimony, total
El
❑
El
Concentration
Mass
(7440-36-0)
1.2
Arsenic, total
❑
❑
Concentration
Mass
(7440-38-2)
1.3
Beryllium, total
El
❑
Concentration
Mass
(7440-41-7)
1.4
Cadmium, total
❑
❑
❑
Concentration
Mass
(7440-43-9)
1.5
Chromium, total
❑
Concentration
Mass
(7440-47-3)
1.6
Copper, total
❑
❑
Concentration
Mass
(7440-50-8)
1 7
Lead, total
El
1:1
El
Concentration
Mass
(7439-92-1)
1.8
Mercury, total
❑
❑
Concentration
Mass
(7439-97-6)
1.9
Nickel, total
El
❑
❑
Concentration
Mass
(7440-02-0)
1.10
Selenium, total
❑
❑
Concentration
Mass
(7782-49-2)
1.11
Silver, total
El
El
Concentration
Mass
(7440-22-4)
EPA Form 3510-2C (Revised 3-19) Page 11

EPA Identification Number
110009842466
NPDES Permit Number
NCO081281
Facility Name Outfall Number Form Approved 03/05/19
Richmond County Water OMB No. 2040-0004
Presence or Absence
check one
On
Units
(Specify)
Effluent
Intake
(optional)
Poll utant/Parameter
(and CAS Number, if available)
Testing
Required
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
112
Thallium, total
(7440-28-0)
❑
Concentration
Mass
1.13
Zinc, total
(7440-66-6)
El
El
1:1
Concentration
Mass
1.14
Cyanide, total
(57-12-5)
El
El
Concentration
Mass
1.15
Phenols, total
El
❑
El
ConcentrationMass
Section 2.Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
21
Acrolein
(107-02-8)
❑
El
❑
Concentration
Mass
2.2
Acrylonitrile
(107-13-1)
❑
Concentration
Mass
2.3
Benzene
(71-43-2)
Concentration
Mass
2.4
Bromoform
(75-25-2)
Concentration
Mass
2.5
Carbon tetrachloride
(56-23-5)
El
❑
1:1Concentration
Mass
2.6
Chlorobenzene
(108-90-7)
Concentration
Mass
27
Chlorodibromomethane
(124-48-1)
❑
❑
❑
Concentration
Mass
2.8
Chloroethane
(75-00-3)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 12

EPA Identification Number
110009842466
NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
NC0081281 Richmond County Water
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
2.9
2-chloroethylvinyl ether
(110-75-8)
Concentration
Mass
2.10
Chloroform (67-66-3)
Concentration
Mass
211
Dichlorobromomethane
(75-27-4)
❑
❑
❑
Concentration
Mass
212
11-dichloroethane
(75-34-3)
Concentration
Mass
2.13
12-dichloroethane
(107-06-2)
❑
❑
Concentration
Mass
2.14
11-dichloroethylene
(75-35-4)
Concentration
Mass
2.15
1,2-dichloropropane
(78-87-5)
❑
El
11
Concentration
Mass
2.16
1,3-dichloropropylene
(542-75-6)
Concentration
Mass
217
Ethylbenzene
(100-41-4)
Concentration
Mass
2.18
Methyl bromide
(74-83-9)
Concentration
Mass
2.19
Methyl chloride
(74-87-3)
Concentration
Mass
2.20
Methylene chloride
(75-09-2)
Concentration
Mass
2.21
1 1,2,2- tetrachloroethane
(79-34-5)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
110009842466 NC0081281 Richmond County Water
Presence or Absence
Intake
check one Effluent
(optional)
Pollutant/Parameter Testing Units Long -Term
Maximum Maximum Long-
and CAS Number, if available Required Believed Believed
( ) q (specify) Average Number Term Number
Present Absent Daily Monthly
Daily of
Discharge
DischaAverage
Discharge Analyses Analyses
(required) if available)
e) Value
if available
2 22
Tetrachloroethylene
El
El
1:1
Concentration
Mass
(127-18-4)
2.23
Toluene
Concentration
Mass
(108-88-3)
2.24
1,2-trans-dichloroethylene
Concentration
Mass
(156-60-5)
2.25
1, 1, 1 -trichloroethane
Concentration
Mass
(71-55-6)
2.26
1,1,2-trichloroethane
El
El
1:1
Concentration
Mass
(79-00-5)
2.27
Trichloroethylene
El
El
11
Concentration
Mass
(79-01-6)
2.28
Vinyl chloride
Concentration
Mass
(75-01-4)
Section 3. Organic Toxic Pollutants (GC/MS Fraction
—Acid Compounds)
3.1
2-chlorophenol
Concentration
Mass
(95-57-8)
32
2.4-dichlorophenol
Concentration
Mass
(120-83-2)
3.3
2,4-dimethylphenol
1:1
El
Concentration
Mass
(105-67-9)
3.4
4,6-dinitro-o-cresol
El
1:1
Concentration
Mass
(534-52-1)
3.5
2,4-dinitrophenol
El
Concentration
1 Mass
(51-28-5)
EPA Form 3510-2C (Revised 3-19) Page 14

EPA Identification Number
110009842466
NPDES Permit Number
NCO081281
Facility Name Outfall Number Form Approved 03/05/19
Richmond County Water OMB No. 2040-0004
�:
• I
Pollutant/Parameter
(and CAS Number, if available)
(and
•rj•
Testing
Required
•'
Presence or Absence
check one
• '• 1
Units
Effluent
Intake
(optional)
Believed
Present
Believed(specify)Maximum
Absent
Dail y
D
(eq edge
i
Maximum
Monthly
y
Discharge
available)
Long -Term
Average
Discharge
f available
Number
of
Analyses
Long -
Term
Average
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
❑
❑
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
Concentration
Mass
3.8
p-chloro-m-cresol
(59-50-7)
❑
El
Concentration
Mass
3.9
Pentachlorophenol
(87-86-5)
❑
❑
❑
Concentration
Mass
3.10
Phenol
(108-95-2)
❑
❑
Concentration
Mass
3.11
2,4,6-trichlorophenol
(88-05-2)
❑
❑
❑
Concentration
Mass
Section 4.Organic Toxic Pollutants (GCIMS Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
(83-32-9)
Concentration
Mass
4.2
Acenaphthylene
(208-96-8)
Concentration
Mass
4.3
Anthracene
(120-12-7)
El
❑
Concentration
Mass
4.4
Benzidine
(92-87-5)
El
❑
El
Concentration
Mass
4.5
Benzo (a) anthracene
(56-55-3)
El
❑
❑
Concentration
Mass
4.6
Benzo (a) pyrene
(50-32-8)
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 15

EPA Identification Number
110009842466
NPDES Permit Number
NCO081281
Facility Name Outfall Number Form Approved 03/05/19
Richmond County Water OMB No. 2040-0004
• 11:WeIrTill
Pollutant/Parameter
(and )
and CAS Number, if available
Testing
Required
q
06111l• e]
Presence or Absence
check one
MCI1
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
ischarge
(if
Long -Term
Average
aily
Discharge
f available
Number
of
Analyses
Long -
Term
Average
Number
of
Analyses
4.7
3,4-benzofluoranthene
(205-99-2)
Concentration
Mass
4.8
Benzo (ghi) perylene
(191-24-2)
❑
❑
Concentration
Mass
4 9
Benzo (k) fluoranthene
(207-08-9)
❑
Concentration
Mass
4.10
Bis (2-chloroethoxy) methane
(111-91-1)
❑
❑
❑
Concentration
Mass
4.11
Bis (2-chloroethyl) ether
(111-44-4)
❑
❑
Concentration
Mass
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
El
El
Concentration
Mass
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
❑
❑
❑
Concentration
Mass
4.14
4-bromophenyl phenyl ether
(101-55-3)
❑
Concentration
Mass
4.15
Butyl benzyl phthalate
(85-68-7)
❑
ElConcentration
Mass
4.16
2-chloronaphthalene
(91-58-7)
❑
El
❑
Concentration
Mass
4.17
4-chlorophenyl phenyl ether
(7005-72-3)
❑
❑
❑
Concentration
Mass
4.18
Chrysene
(218-01-9)
❑
El
El
Concentration
Mass
4.19
Dibenzo (a,h) anthracene
(53-70-3)
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 16

EPA Identification Number
110009842466
NPDES Permit Number
NCO081281
Facility Name Outfall Number Form Approved 03/05/19
Richmond County Water OMB No. 2040-0004
• I
Pollutant/Parameter
(and CAS Number, if available)
•
Testing
Required
• + �
Presence or Absence
check one
• •• 1
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
f available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
4.20
1,2-dichlorobenzene
(95-50-1)
Concentration
Mass
4.21
1,3-dichlorobenzene
(541-73-1)
El
El
1:1
Concentration
Mass
4.22
1,4-dichlorobenzene
(106-46-7)
Concentration
Mass
4.23
3,3-dichlorobenzidine
(91-94-1)
Concentration
Mass
4.24
Diethyl phthalate
(84-66-2)
El
Concentration
Mass
4.25
Dimethyl phthalate
(131-11-3)
Concentration
Mass
4.26
Di-n-butyl phthalate
(84-74-2)
El
El
1:1
Concentration
Mass
4.27
2,4-dinitrotoluene
(121-14-2)
Concentration
Mass
4.28
2,6-dinitrotoluene
(606-20-2)
El
11
Concentration
Mass
4.29
Di-n-octyl phthalate
(117-84-0)
Concentration
Mass
4.30
1,2-Diphenylhydrazine
(as azobenzene) (122-66-7)
Concentration
Mass
4.31
Fluoranthene
(206-44-0)
El
1:1
Concentration
Mass
4.32
Fluorene
(86-73-7)
El
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 17

EPA Identification Number
110009842466
NPDES Permit Number
NC0081281
Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
Richmond County Water
Poll utant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)Maximum
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Dail y
Discharge
(required)
Maximum
Monthly
yof
Discharge
(if available)
Long -Term
Average
aily
DisDcharge
if available)Value
Number
of
Analyses
Long -
Term
Average
Number
Analyses
4.33
Hexachlorobenzene
(118-74-1)
El
1:1Mass
Concentration
4.34
Hexachlorobutadiene
(87-68-3)
Concentration
Mass
4.35
Hexachlorocyclopentadiene
(77-47-4)
❑
Concentration
Mass
4.36
Hexachloroethane
(67-72-1)
El
❑
11
Concentration
Mass
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
El
❑
11
Concentration
Mass
4.38
Isophorone
(78-59-1)
Concentration
Mass
4.39
Naphthalene
(91-20-3)
El
❑
Concentration
Mass
4.40
Nitrobenzene
(98-95-3)
Concentration
Mass
4.41
N-nitrosodimethylamine
(62-75-9)
El
Concentration
Mass
4.42
N-nitrosodi-n-propylamine
(621-64-7)
El
El
1:1
Concentration
Mass
4.43
N-nitrosodiphenylamine
(86-30-6)
El
11
El
Concentration
Mass
4.44
Phenanthrene
(85-01-8)
El
El
❑
Concentration
Mass
4.45
Pyrene
(129-00-0)
1Mass
Concentration
EPA Form 3510-2C (Revised 3-19) page 18

EPA Identification Number
NPDES Permit Number
Facility Name Outfall Number
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No. 2040-0004
Presence or Absence
check one
Effluent
Intake
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long-
(and CAS Number, if available)
Required
Believed
Believed
(Specify)
Average
Number
Number
Present
Absent
Daily
Monthly
Daily
Term
of
D
Discharge
Analyses
Average
Analyses
re
e
(required)
f available)
f available
Value
4.46
1,2,4-trichlorobenzene
El
El
Concentration
Mass
(120-82-1)
Section 5. Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
Concentration
Mass
(309-00-2)
5.2
a-BHC
1:1
ElConcentration
Mass
(319-84-6)
5.3
R-BHC
El
ElConcentration
Mass
(319-85-7)
5.4
y-BHC
El
E]Concentration
Mass
(58-89-9)1:1
5.5
b-BHC
El
Concentration
Mass
(319-86-8)
5.6
Chlordane
El
1:1Concentration
Mass
(57-74-9)
5.7
4,4'-DDT
El
1:1Concentration
Mass
(50-29-3)
5.8
4,4'-DDE
El
1:1Concentration
Mass
(72-55-9)
5.9
4,4'-DDD
El
Concentration
Mass
(72-54-8)
5.10
Dieldrin
El
1:1Concentration
Mass
(60-57-1)
5.11
a-endosulfanEl
Concentration
Mass
(115 29 7)
EPA Form 3510-2C (Revised 3-19) Page 19

EPA Identitication Number NPDES Permit Number
110009842466 NC0081281
Facility Name Outfall Number Form Approved 03/05/19
Richmond County Water OMB No. 2040-0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(Specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
required
Maximum
Monthly
DfaCailablge)
Long -Term
Average
a I
aily
DisDcharge
if available
Number
of
Analyses
Long-
Term
Average
Number
of
Analyses
5.12
a-endosulfan
(115-29-7)
❑
❑
❑
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
❑
❑
❑
Concentration
Mass
5.14
Endrin
(72-20-8)
❑
❑
❑
Concentration
Mass
5.15
Endrin aldehyde
(7421-93-4)
❑
❑
❑
Concentration
Mass
5.16
Heptachlor
(7644-8)
❑
❑
❑
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
❑
❑
❑
Concentration
Mass
5.18
PCB-1242
(53469-21-9)
❑
❑
❑
Concentration
Mass
5.19
PCB-1254
(11097-69-1)
❑
❑
❑
Concentration
Mass
5.20
PCB-1221
(11104-28-2)
❑
❑
❑
Concentration
Mass
5.21
PCB-1232
(11141-16-5)
❑
❑
❑
Concentration
Mass
5.22
PCB-1248
(12672-29-6)
❑
❑
❑
Concentration
Mass
5.23
PCB-1260
(11096-82-5)
❑
❑
❑
Concentration
Mass
5.24
PCB-1016
(12674-11-2)
❑
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 20

tt'A Identification Number wut�) rermrt Number Facility Name I Outfall Number
110009842466 NCO081281 Richmond County Water
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
check one
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Believed
Present
Believed
Absent
Units
(spe*)
Maximum
Daily
Discharge
(requiredd)
Maximum
Monthly
lee)
(if available)
Long -Term
Average
aily
Discharge
f available
Number
of
Analyses
Long-
Term
Average
Number
of
Analyses
Toxaphene
5.25 (8001-35-2)
❑
❑
El
Concentration
Mass
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 3510-2C (Revised 3-19) Page 21

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NC0081281 Richmond County Water OMB No. 2040-0004
Presence or Absence
check one Effluent Intake
i
(Optional)
Units
Pollutant Maximum Long -Term
Believed Believed (specify) Maximum Daily Long -Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Dischar a Dischar a Anal ses Anal ses
r uired g y y
(� ) Value
I I I if available if availabll e
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the `Presence or Absence" column of Table C for
each pollutant.
1
Bromide
❑
❑
Concentration
Mass
(24959-67-9)
2
Chlorine, total
❑
❑
Concentration
Mass
residual
3.
Color
❑
❑
Concentration
Mass
4.
Fecal coliform
❑
❑
Concentration
Mass
5
Fluoride
❑
❑
Concentration
Mass
(16984-48-8)
6
Nitrate -nitrite
❑
❑
Concentration
Mass
7.
Nitrogen, total
❑
❑
Concentration
Mass
organic (as N)
8.
Oil and grease
❑
❑
Concentration
Mass
9
Phosphorus (as
❑
❑
Concentration
Mass
P), total (7723-14-0)
10.
Sulfate (as SO4)
El❑
Concentration
Mass
(14808-79-8)
11.
Sulfide (as S)
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NC0081281 Richmond County Water OMB No. 2040-0004
Presence or Absence
check one Effluent Intake
(Optional)
Units
Pollutant Maximum Long -Term
Believed Believed (specify) Maximum Daily Long -Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
i __ - I (required) g 9 y Value y
if available if available
12.
Sulfite (as S03)
(14265-45-3)
❑
❑
Concentration
Mass
13.
Surfactants
❑
❑
Concentration
Mass
14.
Aluminum, total
(7429-90-5)
❑
❑
Concentration
Mass
15.
Barium, total
(7440-39-3)
❑
❑
Concentration
Mass
16.
Boron total
(7440-42-8)
❑
❑
Concentration
Mass
17.
Cobalt, total
(7440.48.4)
❑
❑
Concentration
Mass
18
Iron total
(7439-89-0)
❑
❑
Concentration
Mass
19.
Magnesium, total
(74 9-95.4)
El
El
Concentration
Mass
20.
Molybdenum,
total
7439-98-7
❑
❑
Concentration
Mass
21'
Manganese, total
(743 96-5)
❑
❑
Concentration
Mass
22
Tin total
(7440-31-5)
❑
❑
Concentration
Mass
23.
Titanium, total
(7440-32-0)
El❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 24

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
110009842466
NCO081281
Richmond County Water
OMB No. 2040-0004
Presence or Absence
check
one
Effluent
Intake
(Optional)
Pollutant
Believed
Believed
Units
(specify)
Maximum Daily
Maximum Long -Term
Long -Term
Present
Absent
Discharge
Monthly Average Daily Number of
Average Number of
(required)
Discharge Discharge Analyses
Value Analyses
f available if available
24. Radioactivity
Alpha. total
❑
❑
Concentration
Mass
Beta, total
❑
El
Mass
Mass
Radium, total
❑
❑
Concentration
Mass
Radium 226, total
❑
❑
Concentration
Mass
' 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 3510-2C (Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-0004
Presence or Absence
Pollutant check one Available Quantitative Data
Believed Believed7ReasonPollutant Believed Present in Discharge (specify units)
Present Absent
1.
Asbestos
❑
❑
2.
Acetaldehyde
❑
❑
3.
Allyl alcohol
❑
❑
4.
Allyl chloride
❑
❑
5.
Amyl acetate
❑
❑
6.
Aniline
❑
❑
7.
Benzonitrile
❑
❑
8.
Benzyl chloride
❑
❑
9.
Butyl acetate
❑
❑
10.
Butylamine
❑
❑
11.
Captan
❑
❑
12.
Carbaryl
❑
❑
13.
Carbofuran
❑
❑
14.
Carbon disulfide
❑
❑
15.
Chlorpyrifos
❑
❑
16.
Coumaphos
❑
❑
17.
Cresol
❑
❑
18.
Crotonaldehyde
❑
❑
19.
Cyclohexane
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NCO081281 Richmond County Water OMB No. 2040-0004
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
❑
21.
Diazinon
❑
❑
22.
Dicamba
❑
❑
23.
Dichlobenil
❑
❑
24.
Dichlone
❑
❑
25.
2,2-dichloropropionic acid
❑
❑
26.
Dichlorvos
❑
❑
27.
Diethyl amine
❑
❑
28.
Dimethyl amine
❑
❑
29.
Dintrobenzene
❑
❑
30.
Diquat
❑
❑
31.
Disulfoton
❑
❑
32.
Diuron
❑
❑
33.
Epichlorohydrin
❑
❑
34.
Ethion
❑
❑
35.
Ethylene diamine
❑
❑
36.
Ethylene dibromide
❑
❑
37.
Formaldehyde
❑
❑
38.
Furfural
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NC0081281 Richmond County Water OMB No. 2040-0004
• 1
Presence or Absence
Pollutant check one Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
F39Guthion
❑
❑
40.
Isoprene
❑
❑
41.
Isopropanolamine
❑
❑
42.
Kelthane
❑
❑
43.
Kepone
❑
❑
44.
Marathion
❑
❑
45.
Mercaptodimethur
❑
❑
46.
Methoxychlor
❑
❑
47.
Methyl mercaptan
❑
❑
48.
Methyl methacrylate
❑
❑
49.
Methyl parathion
❑
❑
50.
Mevinphos
❑
❑
51.
Mexacarbate
❑
❑
52.
Monoethyl amine
❑
❑
53.
Monomethyl amine
❑
❑
54.
Naled
❑
❑
55.
Naphthenic acid
❑
❑
56.
Nitrotoluene
❑
❑
57.
Parathion
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 29

EPA IdentN DES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110NC0081281 Richmond County Water OMB No. 2040-0004
1 • 1Presence or Absence
ntcheck °me Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
58.
Phenols
❑
❑
59.
Phosgene
❑
❑
60.
Propargite
❑
❑
61.
Propylene oxide
❑
❑
62.
Pyrethrins
❑
❑
63.
Quinoline
❑
❑
64.
Resorcinol
❑
❑
65.
Strontium
❑
❑
66.
Strychnine
❑
❑
67.
Styrene
❑
❑
68
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid
❑
❑
69.
TDE (tetrachlorodiphenyl ethane)
❑
❑
70
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
ro anoic acid
❑
❑
71.
Trichlorofon
❑
❑
72.
Triethanolamine
❑
❑
73.
Triethylamine
❑
❑
74.
Trimethylamine
❑
❑
75.
Uranium
❑
❑
76.
Vanadium
❑
❑
EPA Forth 3510-2C (Revised 3-19) Page 30

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
110009842466
NCO081281 Richmond County Water
OMB No. 2040-0004
Presence or Absence
Pollutant
`heck °ne
Believed Believed Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Present Absent
77.
Vinyl acetate
❑
❑
78.
Xylene
❑
❑
79.
Xylenol
❑
❑
80.
Zirconium
❑
❑
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 3510-2C (Revised 3-19) Page 31

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110009842466 NCOO81281 Richmond County Water
OMB No. 2040-0004
TCDD Presence or
Congeners Absence
Pollutant Used or check one Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD 11❑
EPA Form 3510-2C (Revised 3-19) Page 33