NC0021156_Renewal (Application)_20240214

EPA Identification Number
NPOES Permit Number
Facility Name
Form Approved 03/05/19
NCO021156
Mount Holly WWTP
OMB No.2040-0004
Form
U.S. Environmental Protection Agency
2A
480EPA Application for NPDES Permit to Discharge Wastewater
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION
1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21 U)(1) and (9))
1.1 Facility name
City of Mount Holly
Mailing address (street or P.O. box)
PO Bx 406
City or town
State
ZIP code
o
Mount Holly
NC
28120-0406
Contact name (first and last)
Title
Phone number
Email address
Keith E. Lynch
ORC
[phone]
keith.lynch@mtholly.u5
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
a
U-
201 Broome Street
City or town
State
ZIP code
Mount Holly
NC
28120-0406
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission 0 No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
✓❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Jonathan Blanton - City Manager
Applicant address (street or P.O. box)
0
d
PO Bx 406
w
City or town
State
ZIP code
5
w
Mount Holly
NC
28120-0406
Contact name (first and last)
Title
Phone number
Email address
QJonathan
Blanton
City Manager
[phone]
[e-mail]
1.4
is the applicant the facility's owner, operator, or both? (Check only one response.)
❑ Owner ❑ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
Facility and applicant
El Facility ✓❑ Applicant ElFacility
are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
19
number for each.
Exlsting Environmental Permits
✓❑ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
=
NCO021156
t'_
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
ur
en
c
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section
❑ Other (specify)
404)
EPA Form 3510-2A (Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO021156 Mount Holly WWTP OMB No. 2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number_ CSO Outfall Number CSO Ouifall Number
Receiving water name
Name of watershed/
I!
streams stem
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
I
3
Service 14-digit
C
watershed code
2:
if known
Name of state
mana ementiriver basin
U.S. Geological Survey
❑ Unknown
❑ Unknown
❑ Unknown
8-Digit Hydrologic Unit
Code if known
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam les
SECTION
6. CHECKLIST
1
r
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
Information for All A licants
0 wl variance request(s) ❑ wi additional attachments
❑ Section 2: Additional
✓❑ wl topographic map r❑ wl process flow diagram
Information
❑ wi additional attachments
✓❑ wl Table A wl Table D
d
Section 3: Information on
Effluent Discharges
R1 wl Table B 0 wl Table E
d❑
wl Table C ❑ wl additional attachments
Section 4: Industrial
✓❑ wl SIU and NSCIU attachments ✓❑ wl Table F
�'
❑✓ Discharges and Hazardous
Wastes
❑ wl additional attachments
❑ Section 5: Combined Sewer
❑ wl CSO map ❑ wl additional attachments
Overflows
❑ wl CSO system diagram
-a
R
Section 6: Checklist and
❑
wl attachments
Certification Statement❑
UP
6.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or nd last name)
Official title
Jonathan Blanton
City Manager (Mount Holly, NC)
Signature
Date signed
02- Ob
EPA Form 3510.2A (Revised 3-19) Page 12