NC0020591_Renewal (Application)_20240304

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
M Taylor
City of Statesville
227 S Ctr St
Statesville, NC 28687
Subject: Permit Renewal
Application No. NCO020591
Third Creek WWTP
Iredell County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
March 05, 2024
The Water Quality Permitting Section acknowledges the March 5, 2024 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. 150B-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
p�
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Dtvlslon of Water Resources
Mooresville Regional Office 1 610 East Center Avenue. Suite 301 1 Mooresville. North Carolina 28115
704.663.1699

tateg I&
CIof
NORTH CAROLINA
February 29, 2024
Division of Water Resources
Water Quality Permitting Section — NPDES
1617 Mail Service Center Raleigh, NC 27699-1617
To Whom it may concern:
RECEIVED
MAR 0 4 2024
KDEO/DWR/NPDES
Permit Renewal Application
Third Creek Wastewater Treatment Plant
NPDES Permit No. NCO020591
Enclosed you will find an original and two copies of the Permit Renewal Application EPA form
2A with Table A, Table B, Table C, Table E, Table F, Process Flow Schematic and Topographic vicinity
map. The City of Statesville is requesting the permit renewal for the Third Creek WWTP under permit
NC0020591. The continued operation of the Third Creek WWTP consists of the following:
Influent Pump Station
Perforated panel bar screens (2)
Y Oxidation Ditch (2) with Mechanical aerators.
RAS and WAS pumps (2 each) Secondary Clarifiers (3)
Hypochlorite disinfection
Sodium Bisulfite de -chlorination
Aerobic digester with Mechanical aerators (3)
2 meter/ 2 belt filter press (2)
Should you require more information, or further action is required, please contact me at 704-878-3438.
Sincere
ja
Andy Smith
Water Resources Operations Manager
www. st a to sv i I l e n c. net

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No.2040-0004
Form
U.S. Environmental Protection Agency
2A
V",EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION•N
INFORMATION FOR
Facility name
1.1
Third CreekWWTP
Mailing address (street or P.O. box)
P.O Box 1111
City or town
State
ZIP code
0
Statesville
NC
28697
EContact
name (first and last)
Title
Phone number
Email address
°
Andy Smith
Operations Director
[phone]
[e-mail]
c
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
y
U-
444 Third Creek Rd
City or town
State
ZIP code
Statesville
INC
28677
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -* 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 SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
E
L0
City or town
State
ZIP code
w
c
Contact name (first and last)
Title
Phone number
Email address
n
Q
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 21 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.
d
Existing Environmental Permits
a
❑✓ NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
c
water)
control)
d
E
NCO020591
0
L
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
C
w
y
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
404)
w
W Q0004040
EPA Form 3510-2A (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No. 2040-0004
1.7
Provide the collections
stem information
requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
100 % separate sanitary sewer
O Own ❑ Maintain
City of
21360
% combined storm and sanitary sewer
❑ Own ❑ Maintain
Statesville
❑ Unknown
❑ Own ❑ Maintain
r-
100 % separate sanitary sewer
❑ Own B Maintain
Town of
1413
% combined storm and sanitary sewer
❑ Own ❑ Maintain
Troutman
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer
❑ Own ❑ Maintain
N%
combined storm and sanitary sewer
❑ Own ❑ Maintain
r-
❑ Unknown
❑ Own ❑ Maintain
0
Total
2
Population
22773
0
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage
of each type of
°
�°
°
�°
sewer line in miles)ioo
1.8
Is the treatment works located in Indian Country?
o
❑ Yes 0 No
U
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
6.0 mgd
w
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
o
.74 mgd
.74 mgd
1.3 mgd
Maximum Daily Flow Rates Actual
d
Two Years Ago
Last Year
This Year
3.1 mgd
3.6 mgd
3.1 mgd
1.11
Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
CL
Constructed
Treated Effluent
Untreated Effluent
Combined Sewer
Bypasses
Emergency
T
Overflows
Overflows
U
N
0
1
0
0
0
0
R E 19 V, OFED,
Z 2224
EPA Form 3510-2A (Revised 3-19)
NCOEO/ ►WIRUN DES
Page 2

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
NCO020591
Third Creek WWTP
Outfalls Other Than to Waters of the United States
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 United States?
❑ 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 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
❑ Continuous
gpd
y
❑ Intermittent
1.14
Is wastewater applied to land?
❑ Yes 0 No 4 SKIP to Item 1.16.
y
1.15
Provide the land application site and discharge data requested below.
0
y
Land Application Site and Discharge Data
o
Continuous or
0
Location
Size
Average Daily Volume
Intermittent
M
Applied
check one
CZ
L
❑ Continuous
o
acres
d
gpd
❑ Intermittent
El Continuous
acres
d
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
El Yes 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 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter 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
EPA Form 3510-2A (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No. 2040-0004
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)
d
City or town
State
ZIP code
0
U
Contact name (first and last)
Title
0
t
d
Phone number
Email address
0
NPDES number of receiving facility (if any) El None
Average daily flow rate mgd
_N
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 not
0
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
s
❑ Yes 0 No -+ SKIP to Item 1.23.
U
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
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ 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.
N
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
❑ 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 0 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
Contractor name
0
(company name
E
Lo
Mailing address
c
street or P.O. box
o
City, state, and ZIP
code
L
c
Contact name (first and
0
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A (Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO020591 Third Creek WWTP OMB No.2040-0004
SECTION•NAL INFORMATION (41 and
o Outfalls to Waters of the United States
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.
=
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
0
and infiltration.
.015 d
9P
w
Indicate the steps the facility is taking to minimize inflow and infiltration.
-a
Water/ Sewer department is continuing to repair broken lines.
3
0
w
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
CM R
0
0 Yes ❑ No
Fo
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
3
(See instructions for specific requirements.)
o
0
0 Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No SKIP to Section 3.
Briefly list and describe the scheduled improvements.
=
0
w
1.
c
a�
E
m
n
2.
E
0
y
3,
d
v
4.
Cn
2.6
Provide scheduled or actual dates of completion for improvements,
Scheduled
or Actual Dates of Completion for Improvements
Scheduled
Affected
Begin
End
Begin
Attainment of
E
0
>
o
CL
Improvement
Outfalls
l
(list outfnumber)
Construction
Construction
Discharge
Operational
level
E
_
(from above)
)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
-o
v
d
L
2.
Cn
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:
EPA Form 3510-2A (Revised 3-19) Page 5

Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
rEPA
I NCO020591
Third Creek WWTP
OMB No. 2040-0004
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
N
County
Iredell
0
City or town
Statesville
w
0
rz
.Q
Distance from shore
n/a ft,
L
W
Depth below surface
n/a ft.
d
0
Average daily flow rate
.74 mgd
mgd
mgd
Latitude
35° 44' 17"
° '
°
Longitude
80° 50' 28"
"
12
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o
❑ Yes 0 No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
N
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
°
•L
discharge occurs
a
Average duration of each
L0
dischar e (specify units
flow of each
mgd
mgd
mgd
oAverage
discharge
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
a
0
0
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
° vi
3.6
discharge points?
w
❑ Yes ❑`' No 4SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO02OS91
Third Creek WWTP
OMB No.2040-0004
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number
Outfall Number
Outfall Number
Receiving water name
Third Creek
Name of watershed, river,
0
or stream system
South Yadkin River watershed
a
U.S. Soil Conservation
N
Service 14-digit watershed
03040102040040
o
code
Name of state
a�
management/river basin
Yadkin Pee Dee
U.S. Geological Survey
8-digit hydrologic
03040102
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
rtal hardness at critical
mg/L of
mg/L of
mg/L of
flow
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
O 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)
n
Design Removal Rates by
Outfall
Cn
d
BOD5 or CBOD5
85 %
%
%
d
E
m
TSS
8S %
%
%
0 Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
°
°
°
0 Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
EPA Form 3510-2A (Revised 3-19) Page 7

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO02OS91
Third Creek W WTP
OMB No. 2040-0004
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.
chlorination
a�
c
w
c
0
Outfall Number 1
Outfall Number
Outfall Number
c.�
0
Disinfection type
w
E-
liquid sodium hypochlorite
N
d
Seasons used
d
all
8
w
L
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?
0 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 1
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
Number of tests of discharge
water
23
Number of tests of receiving
water
3.13
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No + SKIP to Item 3.16.
0
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.
~
c
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
Y P 9 PP� P PP�
package?
w
B Yes ❑ No
3.16
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
❑ Yes 4 Complete Tables C, D, and E as ❑ No 4 SKIP to Section 4.
applicable.
3.17
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
H Yes ❑ No
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑✓ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page 8

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No. 2040-0004
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
PASS
10/30/2023
c
c
0
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
0 Yes ❑ No 4 SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
c
Unknown cause
m
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 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 authorit .
SECTI•N
4. INDUSTRIAL
DISCHARGESHAZARDOUS
4.1
Does the POTW receive discharges from SIUs or NSCIUs?
❑ Yes ❑ No -+ SKIP to Item 4.7.
d
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs
Number of NSCIUs
0
5
3
4.3
Does the POTW have an approved pretreatment program?
N
_
El Yes ❑ No
4.4
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
application or (2) a pretreatment program?
cc
❑ Yes ❑ No 4 SKIP to Item 4.6.
0
L
4.5
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
March 2023
c
—
4.6
Have you completed and attached Table F to this application package?
M Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 9

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No.2040-0004
4.7
Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes 0 No -+ SKIP to Item 4.9.
4.8
If yes, provide the follo ing information:
Annual
Hazardous Waste
Waste Transport Method
Amount of
Units
Number
(check all that apply)
Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
0
U
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other (specify)
y
O
❑ Truck ❑ Rail
N
❑ Dedicated pipe ❑ Other (specify)
Vl
Gl
4.9
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
N
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
0
❑ Yes ❑✓ No 4 SKIP to Section 5.
N
4.10
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non -acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
0 Yes 4 SKIP to Section 5. ❑ No
4.11
Have you reported the following information in an attachment to this application: identification and description of the
site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater's hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTI•N
5. COMBINED-
OVERFLOWS
E
5.1
Does the treatment works have a combined sewer system?
c,
❑ Yes S No 4,SKIP to Section 6.
5.2
Have you attached a CSO system map to this application? (See instructions for map requirements.)
a
❑ Yes ❑ No
cc
M
5.3
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
0
in
c�
❑ Yes ❑ No
EPA Form 3510-2A (Revised 3-19) Page 10

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek WWTP
OMB No. 2040-0004
5.4
For each CSO outfall, provide the following information. Attach
additional sheets as necessary.)
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
City or town
0
Q-
State and ZIP code
U
fn
o
�o
County
Latitude
°
0
0
N
U
Longitude
°
Distance from shore
ft.
ft.
ft.
FlDepth below surface
ft.
ft,
ft.
5.5
Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
Rainfall
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
o
.r
CSO flow volume
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO pollutant
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0
concentrations
Receiving water quality
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
CSO frequency
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Number of storm events
❑Yes El No
El Yes ❑ No
El Yes El No
5.6
Provide the following information for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number
CSO Outfall Number
}
Number of CSO events in
events
events
events
the past year
cAverage
duration per
hours
hours
hours
event
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
a
'L
million gallons
million gallons
million gallons
0
Average volume per event
Cn
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
Minimum rainfall causing
inches of rainfall
inches of rainfall
inches of rainfall
a CSO event in last year
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
❑ Actual or ❑ Estimated
EPA Form 3510-2A (Revised 3-19) Page 11

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO020591
Third Creek 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 Outfall Number
Receiving water name
Name of watershed/
y
streams stem
U.S. Soil Conservation
❑ Unknown
❑ Unknown
❑ Unknown
Service 14-digit
watershed code
'>
if known
d
d
Name of state
management/river 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•
i
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
121 Section 1: Basic Application
w/ variance request(s) wl additional attachments
ElInformation
for All A licants
a Section 2: Additional
0 w/ topographic map ❑✓ w/ process flow diagram
Information
❑ w/ additional attachments
0 w/ Table A ❑ w/ Table D
ID Section 3: Information on
❑ w/ Table B ❑✓ w/ Table E
Effluent Discharges
E
❑✓ wl Table C ❑ wl additional attachments
Section 4: Industrial
❑ w/ SIU and NSCIU attachments ❑ w/ Table F
❑✓ Discharges and Hazardous
Wastes
❑ w/ additional attachments
r.
Section 5: Combined Sewer
ri
Elw/ CSO map ❑ wl additional attachments
UOverflows
❑ w/ CSO system diagram
Section 6: Checklist and
❑
❑ w/ attachments
Certification Statement
Mh
Y
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. l am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name type first and last name)
Official title
xvtM t
(% eck-' )45 NK ate. o--
Signa re
Date signed
(
3 16
1- g ;
EPA Form 3510-2A (Revised 3-19) Page 12

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
NCO020591
Third Creek WWTP
1
Form Approved 03/05/19
OMB No. 2040-0004
Maximum Daily Discharge
Average Daily Discharge Analytical
ML or MDL
Pollutant
Value Units
Number of Method'
Value Units
Include units
( )
Samples
Biochemical oxygen demand
o BOD5 or ❑ CBOD5
9.29
mg/I
<2.0
mg/I
249 SM 5210 B
mg/I 0 ML
❑ MDL
(report one
Fecal coliform
>7100
N/100mi
7.8
N/100ml
249 SM 9222 D
N/100 ml [a ML
❑ MDL
Design flow rate
6.0
MGD
0.74
MGD
365
pH (minimum)
6.4
Std. units
degree
125
pH (maximum)
7.6
Std. units
Temperature (winter)
16
degree
13
Temperature (summer)
24
degree
22
degree
125
Total suspended solids (TSS)
14.6
mg/I
<2.0
mg/I
249 SM 2540C mg/I 121 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).
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number I NPDES Permit Number
NCO020591
Facility Name
Third Creek WWTP
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
Maximum Daily Discharge
Average Daily Discharge
Analytical
ML or MDL
Value
Units
Number of
Pollutant
Value Units
Method'
Include units
( )
Samples
Ammonia (as N)
4.79
mg/I
<2.0
mg/I
249
SM4500 NH3F
ID MIL
❑ MDL
Chlorine
total residual, TRC 2
<20
ug/I
<20
ug/I
249
SM4500 CI G
O MIL
❑ MDL
Dissolved oxygen
12.7
mg/1
8.4
mg/1
249
SM4500 OG
O MIL
❑ MDL
Nitrate/nitrite
20.28
mg/1
8.5
mg/I
52
SM4500 NO3-E
21 ML
❑ MDL
Kjeldahl nitrogen
2.94
mg/I
1.8
mg/I
52
SM4500 Norg-B
❑ MDL
Oil and grease
<5.0
mg/I
<5.0
mg/I
4
EPA 1664B
❑ MDL
Phosphorus
13.57
mg/I
5.1
mg/I
52
HACH 8190
❑ MDL
Total dissolved solids
N/A
ID MIL
❑ 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).
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.
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03105119
OMB No. 2040-0004
NCO020591 Third Creek WWTP 1
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
monitor and report
mg/I
EPA 200.7
4.0 0 MIL
0 MDL
Antimony, total recoverable
0.52
mg/I
EPA 200.7
.025 MIL
0 MDL
Arsenic, total recoverable
<0.010
mg/I
EPA 200.7
.010 El MIL
O MDL
Beryllium, total recoverable
<0.005
mg/I
EPA 200.7
.005 O MDL
Cadmium, total recoverable
<.002
mg/I
EPA 200.7
.002 ML
0 MDL
Chromium, total recoverable
<.005
mg/I
EPA 200.7
.005 0 ML
MDL
Copper, total recoverable
0.014
mg/I
EPA 200.7
.01 O MDL
Lead, total recoverable
<0.010
mg/I
EPA 200.7
.010 0 IVIL
MDL
Mercury, total recoverable
<0.0002
mg/I
EPA 1631
.0002 0 ML
MDL
Nickel, total recoverable
<0.010
mg/I
EPA 200.7
.010 0 MIL
MDL
Selenium, total recoverable
<0.010
mg/I
EPA 200.7
.010 O MDL
Silver, total recoverable
<.005
mg/I
EPA 200.7
.005 IVIL
0 MDL
Thallium, total recoverable
<.020
mg/I
EPA 200.7
.020 El ML
O MDL
Zinc, total recoverable
0.48
mg/I
EPA 200.7
.010 ML
O MDL
Cyanide
<.005
mg/I
EPA 335.4
.005 0 MIL
O MDL
Total phenolic compounds
0.13
mg/I
EPA 420.1
0.10 0 MIL
O MDL
Volatile Organic Compounds
Acrolein
<50.0
ug/I
EPA 624
El ML
50.0 171 MDL
Acrylonitrile
<10.0
ug/I
EPA 624
10.0 0 MIL
O MDL
Benzene
<1.00
ug/I
EPA 624
1.00 0 MIL
0 MDL
Bromoform
<1.00
ug/I
EPA 624
El IVIL
1.00 21 MDL
EPA Form 3510-2A (Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
NCO020591 Third Creek WWTP 1
OMB No. 2040-0004
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant
Number of
Method' (include units)
Value Units Value Units
Samples
Carbon tetrachloride
<1.00
ug/L
EPA 624
0 ML
1•00
p MDL
Chlorobenzene
<1.00
ug/L
EPA 624
1.00 El ML
El MDL
Chlorodibromomethane
<1.00
ug/L
EPA 624
1.00
❑ MDL
Chloroethane
<5.00
ug/L
EPA 624
5.00
E] MDL
2-chloroethylvinyl ether
<5.00
ug/L
EPA 624
5.00 0 ML
MDL
Chloroform
9.50
ug/L
EPA 624
5.00 0 IVIL
MDL
Dichlorobromomethane
1.08
ug/L
EPA 624
1.00 El ML
O MDL
1,1-dichloroethane
<1.00
ug/L
EPA 624
1.00 0 ML
O MDL
1,2-dichloroethane
<1.00
ug/L
EPA 624
1.00
0 MDL
trans-1,2-dichloroethylene
<1.00
ug/L
EPA 624
1.00 El IVIL
O MDL
1,1-dichloroethylene
<1.00
ug/L
EPA 624
1.00 El IVIL
El MDL
1,2-dichloropropane
<1.00
ug/L
EPA 624
1.00 11 ML
Z MDL
1,3-dichloropropylene
<1.00
ug/L
EPA 624
1.00 0 IVIL
MDL
Ethylbenzene
<1.00
ug/L
EPA 624
1.00 El ML
O MDL
Methyl bromide
9.24
ug/L
EPA 624
5.00 0 NIL
O MDL
Methyl chloride
<5.00
ug/L
EPA 624
5.00 El ML
O MDL
Methylene chloride
<l.00
ug/L
EPA 624
1.00
O MDL
111,2,2-tetrachloroethane
<1.00
ug/L
EPA 624
1.00
O MDL
Tetrachloroethylene
<1.00
ug/L
EPA 624
1.00
O MDL
Toluene
<1.00
ug/L
EPA 624
1.00 El IVIL
0 MDL
1,1,1-trichloroethane
<1.00
ug/L
EPA 624
1.00 ML
�
MDL
1,1,2-trichloroethane
<1.00
ug/L
EPA 624
1.00 0 IVIL
MDL
EPA Form 3510-2A (Revised 3-19) Page 18

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
NCO020591 Third Creek WWTP 1
OMB No. 2040-0004
Maximum Daily Discharge Average Daily Discharge
Analytical MIL or MDL
Pollutant
Method' (include units)
Number of
Value
Units
Value
Units
Samples
Trichloroethylene
<1.00
ug/L
EPA 624
1.00 El MIL
O MDL
Vinyl chloride
<5.00
ug/L
EPA 624
5.00 0 MIL
0 MDL
Acid -Extractable Compounds
p-chloro-m-cresol
<10.0
ug/L
EPA 625
10.0 El ML
I] MDL
2-chlorophenol
<10.0
ug/L
EPA 625
10.0 O MDL
2,4-dichlorophenol
<10.0
ug/L
EPA 625
10.0 0 MIL
O MDL
2,4-dimethylphenol
<10.0
ug/L
EPA 625
10.0 11 MIL
11 MDL
4,6-dinitro-o-cresol
<50.0
ug/L
EPA 625
50.0 0 MIL
MDL
2,4-dinitrophenol
<50.0
ug/L
EPA 625
50.0 0 MIL
O MDL
2-nitrophenol
<10.0
ug/L
EPA 625
10.0 11 MIL
I] MDL
4-nitrophenol
<50.0
ug/L
EPA 625
50.0 El ML
El MDL
Pentachlorophenol
<50.0
ug/L
EPA 625
50.0 El MIL
O MDL
Phenol
<10.0
ug/L
EPA 625
10.0 0 MIL
O MDL
2,4,6-trichlorophenol
<10.0
ug/L
EPA 625
10.0 0 MIL
0 MDL
Base -Neutral Compounds
Acenaphthene
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Acenaphthylene
<10.0
ug/L
EPA 625
10.0 1-1 MIL
O MDL
Anthracene
<10.0
ug/L
EPA 625
10.0 L1 MIL
O MDL
Benzidine
<50.0
ug/L
EPA 625
50.0 0 MIL
O MDL
Benzo(a)anthracene
<10.0
ug/L
EPA 625
10.0 0 MIL
MDL
Benzo(a)pyrene
<10.0
ug/L
EPA 625
10.0 0 MIL
O MDL
3,4-benzofluoranthene
<10.0
ug/L
EPA 625
10.0 0 MIL
MDL
EPA Form 3510-2A (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NCOO2O591 Third Creek WWTP 1
Maximum Daily Discharge Average Daily Discharge
Pollutant
Value Units Value Units Number of
Samples
Form Approved 03/05/19
OMB No. 2040-0004
Analytical ML or MDL
Method' (include units)
Benzo(ghi)perylene
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Benzo(k)fluoranthene
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Bis (2-chloroethoxy) methane
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Bis (2-chloroethyl) ether
<10.0
ug/L
EPA 625
El ML
10.0 0 MDL
Bis (2-chloroisopropyl) ether
<10.0
ug/L
EPA 625
0 ML
10.0 ❑ MDL
Bis (2-ethylhexyl) phthalate
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
4-bromophenyl phenyl ether
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Butyl benzyl phthalate
<10.0
ug/L
EPA 625
10.0 O MDL
2-chloronaphthalene
<10.0
ug/L
EPA 625
10.0 O MDL
4-chlorophenyl phenyl ether
<10.0
ug/L
EPA 625
10.0 0 VIL
MDL
Chrysene
<10.0
ug/L
EPA 625
10.0 0 ML
0 MDL
di-n-butyl phthalate
<10.0
ug/L
EPA 625
10.0 El ML
MDL
di-n-octyl phthalate
<10.0
ug/L
EPA 625
10.0 ML
El MDL
Dibenzo(a,h)anthracene
<10.0
ug/L
EPA 625
10.0 0 ML
0 MDL
1,2-dichlorobenzene
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
1,3-dichlorobenzene
<10.0
ug/L
EPA 625
10.0 0 ML
0 MDL
1,4-dichlorobenzene
<10.0
ug/L
EPA 625
10.0 ID MDL
3,3-dichlorobenzidine
<50.0
ug/L
EPA 625
50.0 MIL
11 MDL
Diethyl phthalate
<10.0
ug/L
EPA 625
10.0 0 ML
21 MDL
Dimethyl phthalate
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
2,4-dinitrotoluene
<10.0
ug/L
EPA 625
10.0 El IVIL
O MDL
2,6-dinitrotoluene
<10.0
ug/L
EPA 625
1:1 ML
10.0 ID MDL
EPA Form 3510-2A (Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
1
OMB No. 2040-0004
NCO02O591 Third Creek WWTP
7Maximum7Dailyscharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units
Samples
10.0 0 ML
1,2-diphenylhydrazine
<10.0
ug/L
EPA 625
MDL
Fluoranthene
<10.0
ug/L
EPA 625
10.0 El IVIL
O MDL
❑ ML
Fluorene
<10.0
ug/L
EPA 625
10.0 EIMDL
Hexachlorobenzene
<10.0
ug/L
EPA 625
10.0 0 MDL
Hexachlorobutadiene
<10.0
ug/L
EPA 625
El ML
10.0 O MDL
50.0 El IVIL
Hexachlorocyclo-pentadiene
<50.0
ug/L
EPA 625
O MDL
Hexachloroethane
<10.0
ug/L
EPA 625
10.0 El ML
O MDL
Indeno(1,2,3-cd)pyrene
<10.0
ug/L
EPA 625
10.0 El ML
MDL
Isophorone
<10.0
ug/L
EPA 625
10.0 El IVIL
O MDL
Naphthalene
<10.0
ug/L
EPA 625
10.0 O MDL
O ML
Nitrobenzene
<10.0
ug/L
EPA 625
10.0 O MDL
N-nitrosodi-n-propylamine
<10.0
ug/L
EPA 625
10.0 0 ML
O MDL
N-nitrosodimethylamine
<10.0
ug/L
EPA 625
10.0 0 MDL
10.0 El IVIL
N-nitrosodiphenylamine
<10.0
ug/L
EPA 625
O MDL
Phenanthrene
<10.0
ug/L
EPA 625
10.0 IVIL
El MDL
El ML
10.0
Pyrene
<10.0
ug/L
EPA 625
0 MDL
1,2,4-trichlorobenzene
<10.0
ug/L
EPA 625
El IVIL
10.0 El MDL
1 Qomnlinn Shan hp r•nnrtiirtPri acrnrrtinn to siifficiPntly sPnsitivP test nrncedures
(i_e_ methods) annrnvpd under 40 CFR 136 for the analvsis 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 3510-2A (Revised 3-19) Page 21

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
NCO02O591 Third Creek WWTP 1
OMB No.2040-0004
Maximum Dail Discharge Average Dail Discharge
Pollutant
Analytical ML or MDL
Number
(list) Value Units Value Units
Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ 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).
EPA Form 3510-2A (Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0020591 Third Creek WWTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Information
Test Number 22
Test Number 23
Test Number
Test species
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
Outfall number
1
1
Date sample collected
07/17/2023
10/09/2023
Date test started
07/18/2023
10/10/2023
Duration
7 days
7 days
Toxicity Test Methods
Test method number
1002.0
1002.0
Manual title
Short TermMethods for Estimating the Chronic
Short Term Methods for Estimating the Chronic
Edition number and year of publication
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
Sample Type
Check one:
❑ Grab
El 24-hour composite
❑ Grab
0 24-hour composite
❑ Grab
❑ 24-hour composite
Sample Location
Check one:
❑ Before Disinfection
❑ After Disinfection
21 After Dechlorination
❑ Before Disinfection
❑ After Disinfection
ID After Dechlorination
❑ Before disinfection
❑ After disinfection
❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
o r both. (Check one response.)
❑ Acute
� Chronic
❑ Both
❑ Acute
0 Chronic
El Both
❑ Acute
El Chronic
El Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO020591 Third Creek WWTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
e table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number 22
kii
Test Number 23
Test Number
Test Type
Indicate the type of test performed. (Check one
response.)
❑ Static
❑� Static -renewal
❑ Flow -through
❑ Static
0 Static -renewal
❑ Flow -through
❑ Static
❑ Static -renewal
❑ Flow -through
Source of Dilution Water
Indicate the source of dilution water. (Check
one response.)
❑ Laboratory water
Receiving water
❑ Laboratory water
0 Receiving water
❑ Laboratory water
❑ Receiving water
If laboratory water, specify type.
r
If receiving water, specify source.
take Brandt
Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt
water, specify "natural' or type of artificial
sea salts or brine used.
0 Fresh water
❑ Saltwater (specify)
0 Freshwater
❑ Salt water (specify)
El Fresh water
❑Salt water (specify)
Percentage Effluent Used
the percentage effluent used for alltrations in the test series. 41
41
i
Parameters Tested
Check the parameters tested.
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
ID Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑ Dissolved oxygen
Acute Test Results
Percent survival in 100% effluent
LC50
95% confidence interval
%
Control percent survival
EPA Form 3510-2A (Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0020591 Third Creek WWTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
e table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
iii 0 Test Number 22
Test Number 23
Test Number
Acute Test Results Continued
Other (describe)
Chronic Test Results
NOEC
%
%
%
IC25
%
%
%
Control percent survival
%
%
%
Other (describe)
PASS
PASS
PASS
Quality Control/Quality Assurance
Is reference toxicant data available?
D Yes
❑ No
0 Yes
❑ No
❑ Yes
❑ No
Was reference toxicant test within
acceptable bounds?
El Yes
❑ No
0 Yes
❑ No
❑Yes
ElNo
What date was reference toxicant test run
(MM/DD/YYYY)?
07/18/2023
10/10/2023
Other (describe)
EPA Form 3510-2A (Revised 3-19) Page 27

EPA Identification Number NPDES Permd Number Facility Name Form Approved 03/05/19
NCO020591 Third Creek WWTP OMB No. 2040-0004
TABLE F. INDUSTRIAL DISCHAKUt INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU 4
SIU 5
SIU 6
Name of SIU
Kewaunee Scientific Corp.
Gnta's Corp.
Mailing address (street or P.O. box)
P.O Box 1842
P.O Box 1458
City, state, and ZIP code
Statesville, NC 28677
Statesville, NC 28677
Statesville, NC 28677
Description of all industrial processes that affect
or Contribute to the discharge.
Manufacturing and installation of laboratory
Industrial uniform company. Cleaning
Manufacturer of composite materials
furniture
uniforms, mats, towels, and mops.
used in aerospace and industrial
applications
List the principal products and raw materials that
wood and metal cabinetry and epoxy resin
Rent or lease products and cleaning.
affect or contribute to the SIU's discharge.
counter tops. Plywood, solid wood,laminate,
Laundry detergent, softner, bleach,
liquid resin, steel, and water based paints,
neutralizer, sulfuric acid, flocculant and
stains and powder paints.
aniomic for waste water treatment.
Indicate the average daily volume of wastewater
discharged by the SIU.
27,450 gpd
45000 gpd
48000 gpd
How much of the average daily volume is
attributable to process flow?
2420o gpd
ao600 gpd
528o gpd
How much of the average daily volume is
attributable to non -process flow?
3250 gpd
4400 gpd
42720 gpd
Is the SIU subject to local limits?
0 Yes ❑ No
0 Yes ❑ No
Yes ❑ No
Is the SIU subject to categorical standards?
0 Yes ❑ No
❑ Yes 0 No
❑ Yes No
EPA Form 3510-2A (Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
NC0020591 Third Creek WWTP
TABLEIUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU 4
SIU 5
SIU
Under what categories and subcategories is the
SIU subject?
433
Has the POTW experienced problems (e.g.,
upsets, pass -through interferences) in the past 4.5
0 Yes ❑ No
❑ Yes 0 No
❑ Yes ❑ No
ears that are attributable to the SIU?
If yes, describe.
EPA Form 3510-2A (Revised 3-19) Page 30

EPA Iden0cation Number
NPDES Permit Number Faulity Name
NCO020591 Third Creek WW7P
OWall Number Form Approved 03105119
1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Informatiom,-
".i Test Number-'�
Test Number S'
TestNurrsber 6
Test species
Ceriodaphnia
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
<24
Outfall number
1
1
1
Date sample collected
08/03/2020
09/14/2020
10/12/2020
Date test started
08/04/2020
09/15/2020
10/13/2020
Duration
7 days
7 days
7 days
Toxicity Test Methods 41-1
Test method number
1002.0
1002.0
1002.0
Manual title
Short TermMethods for Estimating the Chronic
Short TermMethods for Estimating the Chrord
Short Term Methods for Estimating the Chrord
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
141-189
Sample Type
Check one:
TgGrab
24-hour composite
El Grab
24-hour composite❑
El Grab
24-hour composite
Sample Location ... ...
Check one:
0 Before Disinfection
0 After Disinfection
0 After DechlorinatiDn
❑ Before Disinfection
El After Disinfection
After DechlDrination❑
❑ Before disinfection
❑ After disinfection
After dechlo(hation
Point in Treatment Process..
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Effluent
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response.)
❑ Acute
0 Chronic
El Both
❑ Acute
Chronic
❑Both
❑ Acute
Chronic
❑Both
EPA Form 3510-2A (Revised 3-19) Page25

EPA Identification Number NPDES Permit Number Facility Name Oatfall Ntmber Form Approved03105119
NCO020591 Third Creek WWTP 1 OMB No. 2040-M
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
,e Test'Number. 4
Test Nurnber
tea tier^ s tNuni
TestJype
Indicate the type of test performed. (chew one
response.)
❑ Static
(21 Static -renewal
El
❑ Static
0 Static -renewal
ElFlow-through
❑ Static
✓❑ Static -renewal
❑ Flow -through
Source of Dilution Water- � ,...
Indicate the source of dilution water. (Cheat
one response.)
✓❑ Laboratory water
❑ Receiving water
❑ Laboratory water
❑ Receiving water
❑ Laboratory water
❑� Receiving water
If laboratory water, specify type.
Reconstituted synthetic fresh water
Reconstituted synthetic fresh water
If receiving water, specify source.
Lake Brandt
Type of Dilution -Water -
Indicate the type of dilution water. If salt
water, specify "natural" or type of artificial
sea salts or brine used.
✓❑ Fresh water
❑ Salt water (specify)
❑✓ Fresh water
❑ Salt water (specify)
0 Freshwater
❑ Saltwater (specify)
Percentage Effluent Used i_
Specify the percentage effluent used for all
concentrations in the test series.
20.5,37.75,41,51.25,82
20.5,37.8,41,51.3,82
41
Parameters Vested ,
Check the parameters tested.
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammons
Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
Dissolved oxygen
Acute Test Results
Percent survival in 100% effluent
%
%
%
LCso
95%confidence interval
%
oho
ova
Control percent survival
%
%
%
EPA Form 3510-2A (Revised 3-19) Page 26

EPA Identicaton Number NPDES Pent Number Fadlity Name Outfall Numbe
NCO020591 Third Creek WWTP 1
MONITORINGTABLE E. EFFLUENT •' WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Form Approved 03r05r19
OMB No. 2040-000a
Testifumt�er 4
Test'Number,
Teat Numhec 6
Acute Test-Resulb Continued F
Other (describe)
Chronic Test Results
NOEC
<20.5 %
82 %
IC25
%
>82.0 %
%
Control percent survival
100 %
100 %
%
Other (describe)
FAIL
PASS
PASS
QmWi ControUDua' :.Assurance _--.
,>
u
Is reference toxicant data available?
El Yes
❑ No
0 Yes
❑ No
❑
Yes--7
No
Was reference toxicant test within
acceptable bounds?
❑� Yes
❑ No
0Yes
❑ No
❑
Yes
❑ No
What date was reference toxicant test run
WDDIMM?
01/14/2020
oa/la/zozo
10/13/2020
Other(desaibe)
EPA Form 3510-2A (Revised 3-19) Page 27

EPA ldentitcation Number NPDES Permit Number Faality Name Outfall Number Form Approved 03A5r19
NCO020591 Third Creek WWTP 1 OMB No 2040-0M
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXJCITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Irtfomiation
Test:Number l • - '
Test Number 2 -
Test Number 1
Test species
Ceriodaphnia
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
<24
Outfall number
1
1
1
Date sample collected
01/13/2020
04/13/2020
07/13/2020
Date test started
01/14/2020
04/14/2020
07/14/2020
Duration
7 days
7 days
7 days
Toxicity Test Methods,
Testmethod number
1002.0
1002.0
Manual title
Short Term Methods for Estimating the Chronic
Short Term Methods for Estimating the Chrot
Short TermMethods for Estimating the Chrory
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
141-189
Sample Type
Check one:
❑ Grab
24-hour composite
❑ Grab
❑✓ 24-hour composite
❑ Grab
❑ 24-hour composite
Sam to Location
Check one:
❑ Before Disinfection
❑ After Disinfection
❑✓ After Dechlorination
❑ Before Disinfection
❑ After Disinfection
❑✓ After Dechlorination
❑ Before disinfection
❑ After disinfection
✓❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Effluent
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response.)
❑ Acute
❑✓ Chronic
❑ Both
❑ Acute
El Chronic
❑ Both
❑ Acute
0 Chronic
❑ Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Identfcation Number
NPDES Permit Number
NC0020591
Facility Name Outfall Number Form Approved 03/0519
Third Creek W WTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Tesf Number-�:
Test N' er z.
umb
Test Number 3 ".
TestTpe
Indicate the type of test performed. (check one
response)
❑ Static
Static -renewal
❑ Flow -through
❑ Static
0 Static -renewal
❑ Flow -through
❑ Static
0 Static -renewal
❑ Flow -through
Source of Dilution Water
Indicate the source of dilution water. (check
cre response)
❑ Laboratorywater
0 Receiving water
❑ Laboratory water
ry
Q Receiving water
El Laboratory water
❑✓ Receiving water
If laboratory water, specify type.
If receiving water, specify source.
Lake Brandt
Lake Brandt
Lake Brandt
Type of Dilution Water -
Indicate the type of dilution water. If salt
water, specify "natural" or type of artificial
sea salts or brine used.
0 Fresh water
❑salt water (specify)
❑✓ Fresh water
❑Salt water (spedfy)
Fresh water
❑Salt water (spedry)
PermEffluent Used
the percentage effluent used for alltrations in the test series. ai
ai
ai
i
Parameters Tested
Check the parameters tested.
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑✓ Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑� Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑✓ Dissolved oxygen
Acute Test Results
Percent survival in 100% effluent
%
%
%
LCso
95%confidence interval
%
%
%
Control percent survival
%
%
%
EPA Form 3510-2A (Revised 3-19) Page 2d

EPA identficat:on Number NPDES Penrnt Number Fadliry Name Outfall Number Form Approved 03MI9
NCD020591 Third Creek WWTP 1 OMB No.2040-0004
TABLE• •' FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additionai test results.
Test Number 1- �.. �' - - :Test Number 2 ;; . ,., � :' Test Number �
Acute Test Results Continued
Other (describe)
Chronic Test Resul
NOEC
%
%
%
IC25
Control percent survival
%
%
%
Other (describe)
PASS
PASS
FAIL
Quality ControllQual Assurance -
Is reference toxicant data available?
❑✓ Yes
❑ No
0 Yes
❑ No
Yes
❑ No
Was reference toxicant test within❑
acceptable bounds?
Yes
❑ No
0Yes
❑ No
❑✓ Yes
El No
What date was reference toxicant test run
MM/DD/YYl^f ?
01/14/2020
04/14/2020
07/14/2020
Other (describe)
EPA Form 3510�2A (Revised 3.19) Page 27

EPA IdenHcation NumberNPIDES Permit Number Fachty Name Outlafl Number Form Approved D3/C5ti 9
LL NCO020591 Third Creek W\NTP 1 OM 8 No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Infofmation
TestNunnber:
'T estNumbeir,
Test,,Niinb4ir
Test species
Ceriodaphnia
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
<24
Outfall number
Date sample collected
1
01/11/2021
1
04/12/2021
1
04/12/2021
Date test started
1 01/12/2021
04/13/2021
04/13/2021
Duration
7 days
7 days
7 days
TO)dcity Test Methods
Test method number
Manual title
1002.0
Short Term Methods for Estimating the Chronic
1002.0
Short TermMethods for Estimating the Chrord
1002.0
Short TermMethodsfor Estimating the Chro;d
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
141-189
Sample Type ­
Check one: El Grab El Grab ❑Grab
ID 24-hour composite 24-hour composite 0 24hour composite
Sam ple Loc;ftion
Check one:
0 Before Disinfection
El After Disinfection
El After Dechlorination
El Before Disinfection
❑ After Disinfection
0 After Dechlorination
El Before disinfection
11 After disinfection
After dechlorination
Point in Treatment Process
the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Effluent
Effluent
EDescribe
Effluent
Toxic' Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (check one response.)
El Acute
Chronic
❑ Both
❑ Acute
Chronic
El Both
El Acute
ID Chronic
El Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Identification Number NPJES Permit Number Fad'ity Name Ou!fall Number Form Approved 031W19
NC0020591 Third Creek WWTP 1 OMB No, 2040-0004
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number, 7"
Test Ncrmber 8
Test. Number g'
:,..Test Type,
Indicate the type of test performed. (Oriedk one
response.)
Static
❑ Static
❑ Static
❑✓ Static -renewal
Static -renewal
0 Static-renewai
ElFlow-through
❑ Flow -through
ElFlow-through
Source ofDilutiorf Water ,_
_
Indicate the source of dilution water. (check
❑ Laboratory water
Lb
Laboratory water
❑✓
one response.)
❑✓ Receiving water
Receiving water
Laboratory water
❑ Receiving water
If laboratory wafer, specify type -
If receiving water, Specify source.
Reconstituted synthetic fresh water
Lake Brandt
Lake Brandt
T of Dilution Water
Indicate the type of dilution water. If salt
water, specify "natural" or type of artificial
❑ Fresh water
0 Fresh water water
sea
sea salts or brine used.
❑ Salt water (specify)
❑ Salt water (specify) ❑ Salt water (specify)
PercentEffluent Used
Specify the percentage effluent used for all
concentrations in the test series. 41
41
20.5,37.8,41,51.3,82
ParametersTested
Check the parameters tested.
❑ pH
❑ Ammonia
❑ pH
❑ Ammonia ❑ pH
❑ Ammonia
❑ Salinity
❑✓ Dissolved oxygen
❑ Salinity
❑✓ Dissolved oxygen ❑ Salinity
Dissolved oxygen
❑ Temperature
❑ Temperature
❑ Temperature
Acute Test Results77
, : .
Percent survival in 100%effluent
LCso
95% confidence interval
Control percent survival
%
%
EPA Form 3510-2A (Revised 3-19) Page26

mit Number Fadli;y Name OutlaH Number Form Approved OaMl9
L::!!2���NCO02i
591 Third Creek WW P 1 OMB No 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXIC
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
oftTest Number 7 Test Number $ Test Number 9
Acute Testlkesults:Cdn inued
Other (describe)
Chronic Test Results -_ ,-
NOEC
%
%
82.0
iC2s
%
%
>82 %
Control percent survival
%
Other (describe)
%
100 %
PASS
PASS
PASS
,Quality ControliQuality Assurance,
Is reference toxicant data available?
❑ Yes
❑ No
0 Yes
❑ No
Yes
❑ No
Was reference toxicant test within
acceptable bounds?
❑✓ Yes
❑ No
Yes
❑ No
✓❑ Yes
❑ No
What date was reference toxicant test run
MWDD/YYYY)?
01/12/2021
04/13/2021
04/13/2021
Other (descr be)
EPA Farm 3510-2A (Revised 3-19) Page 27

EPA ldentifcaton Numder
NPDES Permt Number
NCO020591
Faality Name Outfall Number Form Approved 03>n509
Third Creek WWTP 1 OMB No. 204OaN
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Testanfarmation..:--
.TestNunber-?°
Fest,Number
TestNuinber
Test species
Ceriodaphnia
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
<24
Outfall number
1
1
1
Date sample Collected
07/12/2021
08/09/2021
10/11/2021
Date test started
07/13/2021
08/10/2021
10/12/2021
Duration
7 days
7 days
7 days
To)dcity Test Methods
Test method number
1002.0
1002.0
1002.0
Manual title
Short Term Methods for Estimating the Chronic
Short Term Methods for Estimating the Chroid
Short TermMethods for Estimating the Chrord
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
141-189
Sam Ie Type_.
Check one:
❑ Grab
❑✓ 24-hour composite
❑Grab
0 24-hour composite
❑Grab
❑ 24-hour composite
Sample Location
Check one:
❑ Before Disinfection
❑ After Disinfection
After Dechlonnation
❑ Before Disinfection
❑ After Disinfection
After Dechlorination
❑ Before disinfection
❑ After disinfection
After dechlorination
Point in Treatment Process --
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Effluent
Toxicity Type .
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Ched<one response.)
❑ Acute
0 Chronic
❑ Both
❑ Acute
ED Chronic
❑ Both
❑ Acute
❑✓ Chronic
❑ Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Idertification Number NPDES Perm t Number Facility Name Outran Number Form Approved 03105/19
NCO020591 Third Creek W WTP 1 OMB No 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Numb410
Test Number 19
Test:Number 12,
Test`
indicate the type of test performed. (Check one
response)
❑ Static
❑� Static -renewal
❑ Flow -through
❑ Static
❑� Static -renewal
❑ Flow -through
❑ Static
❑✓ Static -renewal
❑ Flow -through
Source of Dilution Water
Indicate the source of dilution water. (check
one response.)
❑ Laboratory water
0 Receiving water
❑ Laboratory water
0 Receiving water
❑ Laboratory water
Receiving water
If laboratory water, specify type.
If receiving water, specify source.
Lake Brandt
Lake Brandt
Lake Brandt
Type of Dilution Water -
Indicate the type of dilution water. If salt❑
water, specify `natural" or type of artificial
sea salts or brine used.
Freshwater
❑ Saltwater (specify)
❑✓ Fresh water
Salt water (specify)❑
❑ Fresh water
Salt d water (spety)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
41
41
41
.:Parameters Tested -
Check the parameters tested.
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑✓ Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
0 Dissolved oxygen
Acute Test Results
Percent survival in 100% effluent
%
%
%
LCso
95% confidence interval
%
%
%
Control percent survival
%
I %
%
EPA Form 3510-2A (Revised 3-15) Page26

EPA IdentfCation Number NPDES Permit Number Fadity Name OuVall Number Form Approved 03105/19
NC0020591 Third Creek W WTP 1 OMB No. 2040.0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number 10 Teat N 4er 11 Test Number 12
ACItte7est:Reisutts'C6nt1nued
Other (describe)
Chronic,Test Results _ >
NOEC
%
%
%
IC2s
%
%
o,
J
Control percent survival
%
%
%
Other (describe)
PASS
PASS
PASS
Qual. ,:C.orrtlol Assurar►Ce ,,
Is reference toxicant data available?
0 Yes
❑ No
❑ Yes
❑ No
Yes
❑ No
Was reference toxicant test within
-acceptable bounds?
0 Yes
❑ No
Yes
❑ No
Yes
❑ No
What date was reference toxicant test run
MM/DD/YYYY ?
07/13/2021
08/10/2021
10/12/2021
Other (describe)
EPA Form 3510-2A (Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name FOutfall Number Form Approved 03105119
NCO020591 Third Creek W WTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test resutts.
Test inforrnadon
Teat Number 13
Test Number-14
TestNtimber s
Test species
Ceriodaphnia
Ceriodaphnia
Ceriodaphnia
Age at initiation of test
<24
<24
<24
Outfall number
1
1
1
Date sample collected
01/24/2022
04/04/2022
07/11/2022
Date test started
01/25/2022
04/OS/2022
07/12/2022
Duration
7 days
7 days
7 days
Taxi Test Methods
Test method number
1002.0
1002.0
1002.0
Manual title
Short Term Methods for Estimating the Chronic
Short Term Methods for Estimating the Chroig
Short TermMethods for Estimating the Chro
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
141-189
141-189
San pie Type<_
Check one:
❑ Grab
❑✓ 24-hour composite
❑ Grab
❑✓ 24-hour composite
El Grab
24-hour composite
Sample location _
Check one:
❑ Before Disinfection
❑ After Disinfection
✓❑ After Dechlorination
❑ Before Disinfection
❑ After Disinfection
After Dechlorination
❑ Before disinfection
❑ After disinfection
✓❑ After dechlorination
Pant in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Effluent
Toxicity Type
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response)
❑ Acute
0 Chronic
❑ Both
❑ Acute
D Chronic
❑ Both
❑ Acute
Chronic
❑ Both
EPA Form 3510-2A (Revised 3-19) Page 25

C" iuenurcauon Number NPDES Permit Number Facility Name Outtall Number
Form Approved 03ro5119
NCO020591 Third Creek W WTP 1
OMB No. 2340-0004
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results,
Test 4W66ir 13
Teaf`Number 14
Teat Number -t
Test T
Indicate the type of test performed. (check one
response.)
❑ Static
❑ Static
Static -renewal
Static -renewal
-renewal
7EDIFlow-through
❑ Flow -through
❑ Flow -through
Source of Dilution Water
,.;_ . .
Indicate the source of dilution water. (cheat
one res onse
p J
❑Laboratory water
❑ Laboratory water
ry
El Laboratory water
If laboratory wafer, specify type.
✓❑ Receiving water
0 Receiving water
❑✓ Receiving water
If receiving water, specify source.
Lake Brandt
Lake Brandt
Type of Dilution Water -,
Lake Brandt
Indicate the type of dilution water. If salt
water, specify "natural" or type of artificial
❑✓ Fresh water
❑✓ Fresh water
_.
❑ Fresh water
sea salts or brine used.
❑ Salt water (specify)
❑ Salt water (specify)
❑ Salt water (specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
41
41
41
Paramefem.Testad -- ,
Check the parameters tested
❑ pH ❑ Ammonia
❑ pH ❑ Ammonia
❑ pH ❑ Ammonia
❑ Salinity Dissolved oxygen
❑ Salinity Dissolved oxygen
:E1 Salinity 0 Dissolved oxygen
❑ Temperature
❑ Temperature
❑ Temperature
Acute Test Results .
Percent survival in 100°/a effluent
LCso
95%confidence interval
Control percent survival
%
%
EPA Form 3510.2A (Revised 3-19)
Page 26

EPA Identification Number
mit NuI
NPOES Permit Number
Fadlity Name
L
Third Creek WWTP
�INberNC00
Form Approved 03JO5119
OMB No.20400004
• •• ••
• •
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number
Test Number"24
TeatN u umber
Acute Test .Results=Continued-`::;
Other (describe)
Chronic,Test Resutis
;..
NOEC
%
sr,.
ICzs
Control percent survival
%
a/o
%
% %
Other (describe)
PASS
PASS
PASS
Quality ControMuaii Assurance
�
Is reference toxicant data available?
yes
El No
✓❑ Yes ❑ No
❑✓ Yes ❑ No
Was reference toxicant test within
0 Yes ❑ No
acceptable bounds? ❑ Yes El No Yes El No
What date was reference toxicant test run
MlvvDDffm ?
01/25/2022
04/05/2022
o7/1z/2ozz
Other (describe)
EPA Form 3510-2A (Revised 3-19)
Page 27

Number NPDES Permit Number Faality Name Outfall Number
NCO020591 I Third Creek WWTP I 1
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results
Form Approved 03105119
OMB No. 2040-0004
Test lnfornation
Test Ntxnber;;16 ..
Test Nrmtber -17, ,
Test Number 2$'`
Test species
Ceriodaphnia
Ceriodaphnia
Pimephales Pomelas
Age at initiation of test
<24
<24
<48
Outfall number
1
1
1
Date sample collected
10/10/2022
01/23/2023
01/25/2023
Date test started
10/11/2022
01/25/2023
01/26/2022
Duration
7 days
7 days
7 days
Toxicfty Test Methods ;.
Test method number
1002.0
Manual fitle
Short TenmMethods for Estimating the Chronic
Sh
Edition number and year of publication
4th Edition 2002
Page number(s)
141-189
Sample Type_
Check one:
❑ Grab
24-hour composite
Sample Location
Check one:
❑ Before Disinfection
❑ After Disinfection
0 After Dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Eft
1002.0
❑
❑✓
❑
❑
✓❑
1000.0
ort TermMethods for Estimating the Chrot
Short Term Methods for Estimating the Chro
4th Edition 2002
4th Edition 2002
141-189
53-106
Grab
24-hour composite
❑ Grab
24-hour composite
Before Disinfection
After Disinfection
After Dechlorination
❑ Before disinfection
❑ After disinfection
El After dechlorination
luent I Effluent
TOXICItyType
Indicate for each test whether the test was ❑ Acute ❑ Acute ❑ Acute
performed to asses acute or chronic toxicity, ✓❑ Chronic ❑� Chronic ❑✓ Chronic
or both.(Chedconeresponse.)
❑ Both ❑ Both ❑ Both
EPA Form 35WA. (Revised 3-19) Page 25

EPA Identfication Number NPDES Permit Number Facility Name Outfall Nkrnber Form Approved 03IM19
NCO020591 Third Creek W WTP 1 OMB No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLETOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test.Number L6
TestiVumber-a7 =
TestNumber.-iS
Test T
Indicate the type of test performed. (Check one
❑ Static
❑ Static
❑Static
response.)
❑✓ Static -renewal
Static -renewal
El Static -renewal
❑ Flow -through
❑ F!ow-through
❑ Flow -through
Source of Dilution Water
-
Indicate the source of dilution water. (check
❑ Laboratory water
❑ Laboratory water
Laborato water
one response.)
Receiving water
Receiving water
El Receiving water
If laboratory water, specify type.
reconstituted synthetic fresh water
If receiving water, specify source.
Lake Brandt
Lake Brandt
T of Dilution Water
indicate the type of dilution water. If salt
water, specify "natural" or type of artificial
❑✓ Fresh water
✓❑ Fresh water
✓❑ Fresh water
sea salts or brine used.
❑ Salt water (specify)
❑ Salt water (specify)
❑ Salt water (specify)
Percentage Effluent Used
the percentage effluent used for allai
rations in the test series.
a1
1o.25,zo.5,a1,61.5,8z
i
Parameters Tested
Check the parameters tested.
❑ pH
❑ Ammonia
❑ pH
❑Ammonia
❑ pH
❑ Ammonia
❑ Salinity
0 Dissolved oxygen
❑ Salinity
Dissolved oxygen
❑ Salinity
❑ Dissolved oxygen
❑ Temperature
❑ Temperature
❑ Temperature
Acute Test Results -•':. -
Percent survival in 100%effluent
%
%
%
LCso
95%confidence interval
%
%
aka
Control percent survival
%
oho
%
EPA Form 3510-2A (Revised 3.19) Page 26

EPA ldentlrrc ation Number NPDES Permit Number Facility Name Oultall Number Form Approved 03 )5r19
14CO02OS91 Third Creek WWTP 1 OM8No. 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number 1S 7�,W Number'lz TestNumber .18
Acute Test ResultsContinued
Other (describe)
Chronic Test Results.
NOEC
%
%
82 %
1C25
%
%
o
/a
Control percent survival
%
%
100 %
Other (describe)
PASS
PASS
PASS
Quality ControllQuality Assurance..
Is reference toxicant data available?
❑✓ Yes
ElNo
0 Yes
ElNo
❑ Yes
❑ No
Was reference toxicant test within
acceptable bounds?
Yes
ElNo
❑✓ Yes
❑ No
Yes
❑ No
What date was reference toxicant test run
MM1DD1fYYY)?
10/11/2022
01 za 2023
/ /
01/26/2023
Other (describe)
EPA Form 3510-2A (Revised 3.19) Page 27

EPA Iderblicetion Number NPDES Perrot Nurnber Faality Name Outfall Number Form Approved 03,05It9
NCO020591 Third Creek W WTP 1 OMB No. 2040-0004
• •• •• •
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test -Information <, .. ., ;,
Teat Number ss
Test Number 20
. , Test.Nr nber 21 '
Test species
Pimephales Pomelas
Ceriodaphnia
Pimephales Pomelas
Age at initiation of test
<24
<48
Outfall number
1
<48
Date sample collected
04/19/2023
1
04/17/2023
1
07/17/2023
Date test started
04/20/2023
04/18/2023
07/18/2022
Duration
7 days
7 days
7 days
Toxicity Test Methods
Test method number
1002.0
1000.0
1000.0
Manual title
Short Term Methods for Estimating the Chronic
Short Term Methods for Estimating the Chrojo
Short TermMethods for Estimating the Chrorn
Edition number and year of publication
4th Edition 2002
4th Edition 2002
4th Edition 2002
Page number(s)
141-189
53-106
53-106
Sample Type
Check one: ❑ Grab ❑ Grab ❑ Grab
✓❑ 24-hour composite ❑✓ 24-hour composite 24-hour composite
Sample Lowflon -.
Check one:
❑ Before Disinfection
❑ Before Disinfection
❑ Before disinfection
❑ After Disinfection
❑ After Disinfection
❑ After disinfection
El After Dechlorination
After Dechlorination
After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
Effluent
Effluent
Effluent
test.
Toxic4 Type
Indicate for each test whether the test was
❑ Acute
❑ Acute
❑Acute
performed to asses acute or chronic toxicity,
El Chronic
or both. (Cheat one response.)
Chronic
Chronic
❑ Both
❑ Both
❑ Both
EPA Form 3510-2A (Revised 3-19) Page 25

EPA Identfication Number
NPDES Permit Number
NCO020591
Facility Name Outtall Number Form Approved 03/05/19
Third Creek WWTP 1 OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
TatNumber 19 Test_Number 20 TestNumber; 21
Test Type
Indicate the type of test performed. (Chem one
response.)
❑ Static
Static -renewal
❑ Flow -through
❑ Static
0 Static -renewal
❑ Flow -through
❑ Static
❑✓ Static -renewal
❑ Flow -through
Source of Dilution Water -
Indicate the source of dilution water. (Chen
one response.)
❑ Laboratory water
❑✓ Receiving water
Laboratory water
❑ Receiving water
❑ Laboratory water
❑ Receiving water
If laboratory water, specify type.
Reconstituted synthetic soft water
reconstituted synthetic fresh water
If receiving water, specify source.
Lake Brandt
Type of Dilution Water .. :.
Indicate the type of dilution water. If salt
water, specify "natural' or type of artificial
sea salts or brine used.
✓❑ Fresh water
❑ Salt water (soeafy)
0 Fresh water
❑ Salt water (speaty)
Fresh water
❑ Salt water (specify)
Percentage Effluent Used
ntage effluent usedfor all
the test series.
41
10.25,20.5,41,61.5,82
10.25,20.5,41,61.5,82
W
Parameters Tested;-
Check the parameters tested.
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
R1 Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
❑✓ Dissolved oxygen
❑ pH
❑ Salinity
❑ Temperature
❑ Ammonia
✓❑ Dissolved oxygen
Acute Test Results,
Percent survival in 100% effluent
%
%
%n
LCso
95%confidence interval
%
%
%
Control percent survival
%
%
EPA Form 3510-2A (Revised 3-19) Page26

EPA IdenVfication Number NPDES Permit Number
Fadgty Name
Outfall Number
Form Approved 03/05119
NCO020591
Third Creek W WTP
1
OMB No 2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE
EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
- test Number
Teod Number 20
Test Number 1
Acute Test Results:Contusued,:,;
—
Other (describe)
Chronic Test Results
NOEC
%
82 %
82 %
IC2s
%
%
Control percent survival
°
/°
97'S %
97.5
Other (describe)
PASS
PASS
PASS
Quality Control/Qualitv Assurance
Is reference toxicant data available?
❑ Yes
❑ No
0 Yes
❑ No
✓❑ Yes ❑ No
Was reference toxicant test within
acceptable bounds?
0 Yes
❑ No
0 Yes
❑ No
✓❑ Yes ❑ No
What date was reference toxicant test run
DNYYY ?
04/20/2023
04/21/2023
07/18/2023
(describe)
r
EPA Form 3510-2A (Revised 3-19) Page 27

EPA Identification Number
TABLE E. EFFLUENT MONITORING
NPDES Permt Number
NCO020591
FOR WHOLE EFFLUENT TOXICITY
Faclity Name CUYAl Number Form Appromed 0310519
Third Creek WWTP 1 OMB No. 2040-0004
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test reformation
Teat Number 22
Test species Cerioda hnia
Test Number,
-Test Ntnnt>er
Pimephales Pomelas
Age at initiation of test
<24
<48
Outfall number
1
1
Date sample Collected
07/17/2023
10/09/2023
Date test started
07/18/2023
10/10/2023
Duration
7 days
7 days
Toxicity Test Methods _
Test method number
1002.0
1002.0
Manual title
Short TermMethods for Estimating the Chronic
Short Term Methods for Estimating the Chrorp
Edition number and year of publication
4th Edition 2002
4th Edition 2002
Page number(s)
141.199
141-189
Sample Type
Check one: ❑ Grab ❑ Grab ❑ Grab
✓❑ 24-hour composite 24-hour composite ❑ 24-hour composite
Sam le Location.
_
Check one:
El Before Disinfection
❑ After Disinfection
0 After Dechlorination
❑ Before
ore Disinfection
❑After Disinfection
© After Dechlorination
❑ Before disinfection
El After disinfection
❑ After dechlorination
Point in Treatment Process r,: .. : - : _
Describe the point in the treatment process
at which the sample was collected for each
test.
Effluent
Effluent
Toxicity Type: _
Indicate for each test whether the lest was
performed to asses acute or chronic toxicity,
or both. (Check one response)
❑ Acute
0 Chronic
❑ Both
❑ Acute
0 Chronic
❑ Both
❑ Acute
❑ Chronic
❑ Both
EPA Form 3510-2A (Revised 3-19) page 25

I NCO02OS91 Third Creek VvVvTP
Emil
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number 22''
-Teit
Test T
Indicate the type of test performed. (Check one
El Static
response.)
Static -renewal
Swrce Of-Dflutiort Water
Indicate the source of dilution water. check
one response,)
EJ Laboratory water
-type
Receiving water
If laboratory water, specify
If receiving water, specify source.Lake
-of Dilution Water
Brandt
Indicate the type of dilution water. If salt
Fresh water
water, specify *natural" or type of artificial
sea salts or brine used.
❑ Salt water (speofy)
the percentage effluent used for al
rations in the test series. 7 41
El static
0 Static -renewal
❑ Flow -through
❑ Laboratory water
Receiving water
Lake Brandt
Freshwater
❑ Saltwater (specify)
41
Form Approved 03105119
OMB No. 2040-0004
7es'Mumbei
El static
El Static -renewal
El Flow -through
El Fresh water
11 Saltwater (specify)
Check
the parameters tested.
0 PH 0 Ammonia El pH El Ammonia PH
0 Salinity Dissolved oxygen 11 Salinity Dissolved oxygen 0 Salinity
❑ Acute Test Results Temperature- 0 Temperature El Tempen
Percent survival in 100% effluent
LC50 %%
95% confidence interval
Control percent survival %
%
EPA Form 3510-2A (Revised 3.19)
Page 26

ES Permit Number Facility Name Outfall Number
Form Approved 03ro5119
NC0020591 Third Creek WVVTP 1 OMB No. 2040-0004
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number 22 Test Number` J Test Number
Acute Test: Results:Continued
Other(descdbe)
un runic 1 em Kesurm
NOEC
IC2s
%
%
%
Control percent survival
%
Other (describe)
PASS
PASS
PASS
� ........ vv.nivu�uwn rwsurancg ,. :-.. -;.. -..• - -. _. - .-
_.
s reference toxicant data available?
I
✓❑ Yes ❑ No Yes ❑ No El Yes ❑ .No
Was reference toxicant test within
acceptable bounds? El Yes ❑ No Yes ❑ No ❑ Yes ❑ No
What date was reference toxicant test run
MWDDNYYY ? 07/18/2.023 10/10/2023
Other (oe^,aibe)
EPA Form 3510-2A (Revised 319)
Page 27

*� �a
ti
cP SCALE: 1'=60'`-
/
AERDBC
AERDW OIC61a 2
/ �J
L/
ABANDONED AERATION BASIN
r e
CLAM of
OMOM ORCH NO. 2
o x OmOp1 OIICN NO. 1 1 All /
0 �/
i i•'• %
is V —�—I �\ �•�
\/ THIRD CREEK WWTP SITE PLAN
CITY OF STATESVILLE, NORTH CAROLINA
SEPTEMBER 2015
OMcGifl
ASSOCIATES
ENGINEERING•PLANNING•FINANCE
13tl 19•SllFti.Ut�NT/ M[SQT.KIMY IRt01 AliM 1lNIJLtM[•Cdtll

HAUL SLUDGE LAKE ✓ ./ �.'
TO ATM CREEK YMIP Sri'✓/
OMcGill
A S S O C I A T F S
C N G I N G CR INGP L A NN IN G PIN AN CC
�Yu.w.YiY[T.I.�nEn�E x�tvw? MJWI Main?crw tCNSE.t'r
FIGURE - PROCESS FLOW DIAGRAM
THIRD CREEK WASTEWATER TREATMENT PLANT EXPANSION
CITY OF STATESVILLE
IREDELL COUNTY, NORTH CAROLINA

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