NC0041866_Fact Sheet_20240118

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc.) that can be administratively renewed with minor changes but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles H. Weaver 1/18/2024
Permit Number
NCO041866
Facility Name
Mountain Park Elementary WWTP
Basin Name/Sub-basin number
03-07-02
Receiving Stream
UT to Flat Branch
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
No — already resent
Does permit need TRC limits/language?
No — already resent
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Yes — backup disinfection requirement
Does permit have instream monitoring?
Downstream only
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
None. No enforcements since 2008. No
effluent violations since 2015.
Any permit modifications since lastpermit?
None
New expiration date
12/31/2028
Changes in Draft Permit
➢ Updated eDMR requirements.
Changes to final permit
➢ None
Most Commonly Used Expedited Language:
303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream
is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with permitted effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".
This page has been printed on scrap paper to save money and reduce our program's environmental
impact. Disregard any content on the back of this page.

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NORTH CAROLINA
SURRY COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Sandra Hurley who being first duly
sworn, deposes and says: that he (she) is Regional Publisher
(Publisher or other officer or employee authorized to make affidavit) of
ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a
newspaper known as THE TRIBUNE, published, issued, and entered as
periodicals class mail in the city of Elkin in said County and State; that he
(she) is authorized to make this affidavit and sworn statement; that the
notice or other legal advertisement, a true copy of which is attached hereto,
was published in THE TRIBUNE on the following dates:
and that the said newspaper in which such notice, paper, document or
legal advertisement was published was, at the time of each and every such
publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
This �day of
Signature of person making affida
2023
Sworn to and subscribed before me, this 0 day of
k.1�cc_ 12023
Notary Public c
My Commission expires:`�f°`�
JENNAJOHNSON
E
tary Public - North CarolinaSurry Countymmission Expires aeptemMr 13, 2028
Public Notice
North Carolina
Environmental Management
Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue
NPDES Wastewater Permit
NCO041866 Mountain Park
Elementary School WWTP
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a
NPDES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public hear-
ing should there be a signifi-
cant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC 27604 to
review the information on file.
Additional information on
NPDES permits and this notice
may be found on our website:
hftps:Hdeq.nc.gov/public-no-
tices-hearings,or by calling
[phone]. Surry County
Schools has requested re-
newal of NPDES permit
NCO041866 for its Mountain
Park Elementary School
WWTP (505 Mountain Park
Rd, Mountain Park). This per
miffed facility discharges
treated wastewater to an un-
named tributary to Flat Branch
in the Yadkin-PeeDee River
Basin. Currently BOD, ammo-
nia nitrogen, total residual
chlorine, dissolved oxygen,
and fecal coliform are water
quality limited. This discharge
may affect future allocations to
this portion of the watershed.
Publish: 11-16-23 203761

rDocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
August 28, 2023
Surry County Schools
Attn: Robert K. Draughn, Director of Plant Operations
PO Box 364
Dobson, NC 27017-0364
Subject: Permit Renewal
Application No. NCO041866
Mountain Park Elementary
Surry County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 28, 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://deq nc gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sinc ely,
���Xow
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Emir onmental Quality Divislon of Water Resources
Winston Salem Regional Office 1 450 West Hanes Mill Road Suite 300 1 Winston-Salem. North Carolina 27105
336 7769800

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
SURRY COUNTY SCHOOLS
Pathwa�S to &lobal Sv&'( S
August 23, 2023
NC Department of Environmental Quality
Division of Water Resources
512 North Salisbury Street
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SUBJECT: Application for NPDES Permit to Discharge Wastewater
Mountain Park Elementary
NPDES WW Permit No. NCO041866
Surry County
RECEIVED
AUG 2 5 2023
NCDEQ/DWR/NPDES
Please find the enclosed Modified Application (Form 2) along with additional supporting documents for
the renewal of the wastewater permit for Mountain Park Elementary School.
• Modified Form 2A
• Topographical map
• Current permit
• Compliance Inspection Report (2-24-2021)
Please contact my office if you need further documentation or have any questions related to the
application.
4Resp ctfully,
Rob rt K. Draughn
Director of Plant Operations
Surry County Schools
336-386-8381

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
f.."__1 \AAAITD
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 the application.)
SECTION
1. BASIC
APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.210)(1) and (9))
Facility name
1.1
Mountain Park Elementary School WWTP
Mailing address (street or P.O. box)
209 N. Crutchfield Street PO Box 364
City or town
State
ZIP code
o
Dobson
NC
27017
EContact
name (first and last)
Title
Phone number
Email address
Larry Riggans
ORC
[phone]
[e-mail]
T
—
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
R
U_
505 Mountain Park Road
City or town
State
ZIP code
State Road
NC
29676
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?
0 Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Surry County Board of Education
=
Applicant address (street or P.O. box)
209 N. Crutchfield Street PO Box 364
o
City or town
State
ZIP code
w
Dobson
NC
27017
Contact name (first and last)
Title
Phone number
Email address
a
Dr. Travis L Reeves, Ed
Superintendent
[phone]
[e-mail]
a
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 0 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
number for each.
Existing Environmental Permits
0 NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO041866
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
w
CD
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
C -L.. 1 \AI\A=)
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percentage)
z3o
100 % separate sanitary sewer
El Own El Maintain
% 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
a
a
% separate sanitary sewer
❑ Own ❑ Maintain
_
% combined storm and sanitary sewer
❑ Own ❑ Maintain
°
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
Cn
a
❑ Unknown
El Own ❑ Maintain
0
Total 230
°'
Population
li
0
Served
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
oho
sewer line in miles
1.8
Is the treatment works located in Indian Country?
o
❑ Yes 0 No
U
0
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes ❑ No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.0035 mgd
Average Flow Rates Actual
toAnnual
Two Years Ago
Last Year
This Year
30
0.0007 mgd
0.0008 mgd
0.0009 mgd
nu
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
0.0002 mgd
0.0001 mgd
0.0003 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 by Type
a a
Constructed
rn F
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Emergency
fl
Overflows
Overflows
0
1
Page 2

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
c.,6.....1 %AI\A=
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 ❑r No -+ SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
ElContinuous
gpd
❑ 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 Application Site and Discharge Data
0
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
a,
check one
Discharges into a Dry Ditch
acres
gpd
❑ Continuous
o
❑ Intermittent
acres
gp d
❑ Continuous
o
❑ Intermittent
acres
d
gpd
El Continuous
❑ Intermittent
R
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes ❑✓ No 4 SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes❑ No -+ SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
f.,L.. l \AAAITD
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 IF cility Data
Facility name
Mailing address (street or P.O. box)
a
City or town
State
ZIP code
0
U
y
Contact name (first and last)
Title
0
L
d
Phone number
Email address
QNPDES
number of receiving facility (if any) 0 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)?
L
❑ Yes 0 No -+ SKIP to Item 1.23.
0
1.22
Provide information in the table below on these other disposal methods.
;,
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
R
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
El Continuous
w
acres
gp d
❑ Intermittent
ElContinuous
acres
gpd
❑ Intermittent
acres
gp d
ElContinuous
❑ 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.)
R
❑ Discharges into marine waters (CWA ElWater quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No 4SKIP 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
o
Contractor name
(company name
E
`0
Mailing address
street or P.O. box
0
City, state, and ZIP
0
A
code
L
a
Contact name (first and
U
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number Facility Name Modified Application Form 2A
NCO041866 Mountain Park Elementary Modified March 2021
C-1.....1 %A1%A/TD
o Outfalls to Waters of the State of North Carolina
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o
❑ Yes ❑ No 4 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
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
0
_
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
R
0
C
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?
3 R
o
(See instructions for specific requirements.)
m
LL ,La
o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑� No SKIP to Section 3.
Briefly list and describe the scheduled improvements.
=
0
R
1.
E
4)
Q.
2.
E
0
y
d
3.
(D
4.
Cn
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
E
a)
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
Improvement
Outfalls
Construction
Construction
Discharge
Operational
CL
—
(from above)
l
(list outfanumber)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
Level
MMIDD/YYYY
1.
0
0
co
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

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576F0
NPDES Permit Number
Facility Name Modified Application Form 2A
NC0041866
Mountain Park Elementary Modified March 2021
C.,L.. 1 %A[%A/TD
SECTION
3. INFORMATION
ON EFFLUENT DISCHARGES (40 CFR 122.21(j)(3) to (5))
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number 1
Outfall Number
Outfall Number
State
NC
County
Surry
0
0
0
City or town
State Road
s .Q
Distance from shore
n/a ft,
ft.
ft.
Depth below surface
n/a ft.
ft.
ft.
0
Average daily flow rate
n/a mgd
mgd
mgd
Latitude
36' 22r 24"
°
Longitude
80 51' 15"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
A
0
0 Yes ❑ No 4 SKIP to Item 3.4.
a�
3.3
If so, provide the following information for each applicable outfall.
y
Outfall Number 1
Outfall Number
Outfall Number
0
o
Number of times per year
2 times per week
discharge occurs
n
Average duration of each
2 hours
o
discharge (specify units
oAverage
flow of each
n/a mgd
mgd
mgd
y
discharge
W
Cn
Months in which discharge
August - May
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 t pe at each applicable outfall.
a.
'•
Outfall Number
Outfall Number
Outfall Number
a�
y
w
O
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
vi
d �
3 6
one or more discharge points?
3:: w
0 Yes ❑ No >SKIP to Section 6.
Page 6

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
C,L.....1 %A/\AITD
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 1
Outfall Number
Outfall Number
Receiving water name
Unnamed Tributary
Name of watershed, river,
0
or stream system
Flat Branch
Q
U.S. Soil Conservation
L
h
Service 14-digit watershed
a
code
L
a,
Name of state
management/river basin
Yadkin Pee Dee
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
n/a cfs
cfs
cfs
Critical low flow (chronic)
n/a cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
n/a CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number
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
El Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
=
UV disinfection
0
Q
Design Removal Rates by
See data submitted via DMR
Outfall
ch
W
BOD5 or CBOD5
%
%
%
d
E
w
ai
TSS
%
%
%
F=
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
C-L.. 1 %AAAMD
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.
as
Ultraviolet (chlorination as a backup)
System is operated during normal school calendar year (August - May) June/July - system is shutdown for routine
_
0
U
=
Outfall Number 1
Outfall Number
Outfall Number
0
w
Q-
Disinfection type
DuelUV
(clorination as backup)
0
Seasons used
During school operation
d
E
Aug - May
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ 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 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
R
Number of tests of discharge
a�
=
water
Number of tests of receiving
=
water
d
0
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 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ 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

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO041866
Mountain Park Elementary
Modified March 2021
f.,L,--1 %AAAITn
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DD/YYYY
m
c
w
0
w3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
d
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No -+ 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 ID Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name Modified Application Form 2A
NCO041866
Mountain Park Elementary Modified March 2021
CA-1 ,nnnirn
SECTION,
CHECKLIST
AND CERTIFICATION STATEMENT (40
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
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: Basic Application
❑ w/ variance request(s) ❑ w/ additional attachments
Information for All Applicants
❑ Section 2: Additional
0 w/ topographic map ❑ wl process flow diagram
Information
❑ w/ additional attachments
0 w/ Table A ❑ w/ Table D
❑ Section 3: Information on
❑ w/ Table B ❑ wl additional attachments
Effluent Discharges
E
❑ wl Table C
d
Section 4: Not Applicable
0
R
Section 5: Not Applicable
d
U
❑ Section 6: Checklist and
El w/ attachments
Certification Statement
Y
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
Dr. Travis L. Reeves
Superintendent
Signature
Date signed
/ 4"4-W-1 I
08/22/2023
Page 10

DocuSign Envelope ID: B2E32B10-8A49-4CFF-A58D-OA3C43A576FO
NPDES Permit Number
Facility Name
Outfall Number
NC0041866
Mountain Park Elementary School
A /\ A iTn
Modified Application Form 2A
Modified March 2021
1
Maximum Daily Discharge Average Daily Discharge
Analytical
ML or MDL
Pollutant Number of
Value Units Value Units
Methods
include units
( )
Samples
Biochemical oxygen demand
❑ ML
o BOD5 or ❑ CBODS
6.7
mg/I
❑ MDL
(report one
❑ ML
Fecal coliform
1600
Geometic Means
❑ MDL
Design flow rate
0.0035
pH (minimum)
7.7
pH (maximum)
Temperature (winter)
16.0
c
Temperature (summer)
26.0
C
Total suspended solids (TSS)
5.8
mg/I
El ML
❑ MDL
I 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